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Westminster Hall

Volume 702: debated on Wednesday 3 November 2021

Westminster Hall

Wednesday 3 November 2021

[Mr Virendra Sharma in the Chair]

Hospital Building Programme

Before we begin, I remind Members that they are expected to wear face coverings. This is in line with current Government guidance and that of the House of Commons Commission. I also remind Members that they are asked by the House to have a covid lateral flow test twice a week if coming on to the parliamentary estate. That can be done either at the testing centre in the House, or at home. Please also give each other and members of staff space when seated, and when entering and leaving the room.

I beg to move,

That this House has considered the hospital building programme.

It is a pleasure to serve under your chairmanship, Mr Sharma. I welcome the chance to discuss the Government’s £3.7 billion hospital building programme, and particularly welcome the opportunity to make the case to the Minister for my local hospital, Leighton, to be included as one of the final eight sites chosen by the Government.

Leighton Hospital was built in the 1970s, and officially opened by the Queen in 1972. I have looked back at the pictures of her visit, and it made me think about just how long Her Majesty has been serving our nation in this way—visiting, before I was even born, the hospital that serves my constituents today. At that time, Leighton Hospital represented a huge change in how healthcare was provided in the area, going on to pick up the role of several smaller hospitals spread across the patch. Its importance and role have only grown since then, serving a population that has increased significantly and now stands at more than 300,000 people.

Whether it is the hip and knee replacements it carries out, the babies it helps deliver, the thousands of cancer screening tests and treatments it undertakes, the cataracts it repairs, or the urgent GP and accident and emergency care it provides, Leighton is at the heart of our local health services. In an ordinary year, Leighton provides around a quarter of a million out-patient appointments, carries out more than 30,000 operations and more than 200,000 diagnostic imaging tests, and has more than 90,000 visits to its emergency department. Of course, none of that would be possible without its fantastic staff: Leighton employs more than 4,500 staff, and that fantastic team of cleaners, porters, cooks, receptionists, healthcare assistants, physiotherapists, occupational therapists, nurses, doctors, volunteers and many others is what turns a building into a hospital.

Those staff can be proud of their achievements in the battle against covid. Not only have they cared for covid patients, but they have also vaccinated 47,000 people under the leadership of their director of pharmacy, Karen Thomas. I had the absolute pleasure of volunteering alongside the staff during the first lockdown. I was quite uncomfortable with the media attention on me for doing this for only a short period of time, when those staff do it day in, day out without any fuss or attention.

As I have seen again and again during my time working in the NHS, its staff have an enormous amount of dedication, often going above and beyond, and are perhaps too accustomed to working in departments and environments that make doing a really good job more difficult than it should be. That is why, although we are talking about buildings today, it is important to highlight that—as others have said—we will only be able to make the most of new facilities if we are able to carry on with the success we have had so far in recruiting more staff.

My hon. Friend is making a strong case for Leighton, and he will know that, as a former Member for his constituency, I was able to work with that hospital very closely. All four of my children were born at Leighton Hospital, which sits in my constituency, and I also spent a week working in that hospital and cannot praise its staff highly enough. I hope that this building programme will give those staff the environment they deserve in order to provide the healthcare we know they can deliver, which is world class.

My hon. Friend is absolutely right, and what he has said is typical of people who live in the area, who have also experienced their children being born at that hospital and receiving excellent care there.

Speaking as a neighbouring constituency MP whose family has also made great and beneficial use of Leighton over many years, I strongly support my hon. Friend’s campaign for additional resources and support for Leighton. I very much respect him for that effective campaign, which I know has strong support across our constituencies.

My hon. Friend has spoken about the number of people who seek services from Leighton at the present time. Does he agree that that number is not going to diminish: it is going to increase, due to the additional numbers of houses that are being built in our areas? I note, for example, Northwich, where there is a huge amount of house building on the former ICI site, Middlewich in my constituency and Sandbach. Altogether, in recent years, thousands of new houses have been built for people who will want to look for support from Leighton.

My hon. Friend is absolutely right. One of the great things about the plans for the new site is that they take into account those future projected increases in population. I do not know what we will do if the resources are not there to do that.

Going back to staffing, we have more nurses and doctors and more staff overall working in the NHS than ever before, but it remains a huge undertaking for the Government to continue to work on recruitment and retention to staff new facilities. I know a lot of the media and campaigning by Opposition parties has focused on pay. While it is important, my experience is that fixing staff shortages would be the priority for most staff. The obstacles for further recruitment will not simply be solved by higher pay; the challenges are more complicated than that.

Of course, buildings and facilities matter, but we have to remember that the material used to build Leighton was expected to last only 30 years. It might seem odd to us now to create a major public facility with that sort of life span, but that is the reality.

The hon. Gentleman is a neighbouring MP. A reference was made to Northwich in my constituency. This proposal certainly has cross-party support. I support the hon. Gentleman and all Cheshire MPs in arguing this case with the Minister in front of us for much-needed investment in a first-class hospital facility in our patch.

It is great to get cross-party support to demonstrate to the Minister how important it is to all our local communities. I thank the hon. Gentleman for his support.

As I was saying, the building was not designed to last this long or to serve the size of population that it serves. My view is clear that we can be more efficient and do more in the community, but an aging population will have an ever-increasing demand for healthcare. We can delay the need for the most specialist hospital care in a population, but we can almost never remove it and stop the demand increasing overall.

How has Leighton managed this challenge over recent years? Rightly, it has benefited from major investment, as mentioned by my hon. Friend the Member for Eddisbury (Edward Timpson) who is working closely with me on this campaign alongside my hon. Friend the Member for Congleton (Fiona Bruce). I remember his excellent work in helping to secure funding for brand new theatres and a brand new ITU.

My first campaign after becoming the candidate for Crewe and Nantwich was to reverse the decision to turn down a request for an emergency department extension, which was ultimately funded in 2019. More recently, Leighton received £15 million to build a brand-new emergency department. As the Government understand the necessity, Leighton has had funding to tackle the parts of the original building that are simply not fit for use in the short term. However, there comes a point where the costs of one-off investments, accumulated maintenance and the need to replace the original building structures become a cost that cannot be borne by the ordinary capital spending, and when a whole new building becomes the best option financially and for patient care. That is where Leighton is at.

The life span of the original building is coming to an end. I suggest to the Department of Health and Social Care and the Treasury that they view the funding committed to the hospital building programme as a unique opportunity to look at estates that are winding down towards the end of their life span and address that now.

Under the leadership of the chief executive officer, James Sumner, Leighton has done an enormous amount of work for many months to develop its plans for a new hospital. The team sought expert advice on the life span of the current estate and, importantly, the cost of maintaining it and to keep the existing original buildings in use. I know the Minister will scrutinise the figures and see for himself the financial sense in the case that has been made. Independent analysis demonstrates that the ongoing refurbishment of the present failing infrastructure over the next 15 years will cost substantially more than projected new build costs.

Importantly, the plans are ambitious in ensuring better healthcare is delivered in a better environment for patients and staff. As well as providing the mentioned much-needed bed capacity to meet the projected demand later in the decade, the new facilities will deliver single rooms to improve privacy, dignity and infection control. The new layout will incorporate the latest design advice for supporting patients with conditions such as dementia.

The site as a whole will be reorganised some of the long journeys from key locations, such as the emergency department, to other parts of the hospital that have grown as a result of sporadic development to date. They will future proof the hospital with the most up-to-date digital infrastructure which is becoming increasingly important for delivering the best possible care and doing so efficiently. A new site will enable Leighton to play its part in the race to net zero with more energy efficient buildings and solar power and even, potentially, a geothermal heat source, which is a technology I am campaigning for the Government to support to get off the ground across the country.

The team at Leighton have a track record of delivering improved and innovative care to back up their pledges. For example, the trust recently received an award for its same-day emergency care programme, led by surgeons David Corless and Ali Kazem. I am sure that, with improved facilities, they will continue to find new and better ways to care for their patients.

My hon. Friend has been extremely generous with his time. Will he also confirm that this project, if delivered, would save more than £400 million in backlog maintenance, as well as helping to free up a lot of the community care, which at the moment is under extreme pressure because of the lack of beds available at Leighton and in the surrounding area?

My hon. Friend makes an excellent point. This is actually about saving money in the long term given the unavoidable costs at the existing site.

Of course, building the hospital will provide jobs and opportunities for local people, with apprentices at South Cheshire College and others well placed to take advantage in the parts of Crewe where employment and salaries are still not where we would want them to be. I know that the plans have the full support of my hon. Friends for Congleton and for Eddisbury. Leighton’s bid is also supported by both Cheshire West and Cheshire East, as our local authorities, and the Cheshire clinical commissioning group. There is also cross-party support with the hon. Member for Weaver Vale (Mike Amesbury).

The chair of our newly formed Crewe Town Board, Doug Kinsman, has been keen that the whole board support the proposal, and the rest of the board have seen how important Leighton is to Crewe, both economically and in improving the health and wellbeing of Crewe residents. Importantly, we have the support of those residents. So far, more than 1,000 people have signed our petition supporting the hospital in its efforts to make it into the final eight. The residents include Betty Church, whose daughter was born in the hospital the year it opened, 1972, and Steve Burnham, who explained that not only were three members of his family born there, but his mum worked there for 40 years.

I asked residents to tell me about their experiences and share why they were supporting the campaign. Janice Butler wrote:

“My husband, elderly mother-in-law and father-in-law have all received fantastic help and treatment here. The hospital serves a huge population now and help to improve and upgrade its facilities is desperately needed and has been for many years. Despite the huge pressures, we have experienced excellent help here.”

Susan Marsh wrote:

“I started work at Leighton in 1972 and worked there for 35 years. Since retiring I have been a patient there numerous times. It has changed in the care it delivers since my day, both numbers and treatments. With a new build it will be able to continue to grow along with the population in the area, which will be badly needed.”

I will finish with what a current staff member said about Leighton, both as somewhere to work and as somewhere their family received treatment. Sophie Morris has shared her perspective from what must have been a difficult time in her life, which makes her words even more powerful. She wrote:

“I have worked at Leighton A&E for 6 years now and over that time the demand on the hospital has increased massively. Our last few summers have been busier than most winters. Shortly after starting as a nurse in A&E, my husband became ill. We found out he had terminal throat cancer when I was 7 months pregnant. From beginning to end we had fantastic support and care from all over the hospital.

I think it says a lot about the place and the fabric that is the staff who work there, that I could carry on working in a place that holds so many raw memories. As a body of staff we work so hard to look after the people who come to us for help, now we need some help so that we can provide the care that is demanded of us. Now we need some help so that we can provide the care that is demanded of us.”

I could not have put it better myself.

I know that the Minister will hear the case for investment in many other sites. He will need to consider all the applications carefully. I will work with residents to campaign for this much-needed investment, whatever the outcome of this opportunity, but I hope that I have left him in no doubt today that the case for Leighton to be included is a strong one and there is a whole community of people who want to see it succeed.

It is a pleasure to serve under your chairmanship, Mr Sharma, as was alluded to by my hon. Friend the Member for Crewe and Nantwich (Dr Mullan). This debate is enormously important. Hospitals are often the heart of our communities. The staff in our hospitals, whatever job they do, do a fantastic job, and it is right and proper that we pay tribute to them. But the environment that they work in is also vital to them.

To give a little history lesson from Hemel Hempstead and South West Hertfordshire, which is my part of the world, we had three hospitals—three acute hospitals—until just over 20 years ago when St Albans was closed as an acute hospital. The promise was made at the time that the emergency facility would be picked up by Hemel Hempstead and partly by Watford. That promise was made and then, sadly, Hemel Hempstead was closed—I am not going to get into party politics, but it was by the previous Administration—and we fought tooth and nail, as most constituency MPs would, to save it. Now we have partly elective surgery for non-emergency care at St Albans and I have a clinic—there is no other way I can describe it—at Hemel hospital. Three quarters, if not more, of my hospital is boarded up or vandalised on a site worth hundreds of thousands or millions of pounds.

I was thrilled—absolutely thrilled—when the Prime Minister announced at the general hospital in Watford, which is the only acute hospital we have left in our part of the world, that we were in the top six to get a brand-new hospital. That thrilled us not because we wanted suddenly to bring back our hospital—we understand the restrictions on doing so and what a modern hospital needs to provide for a community—but within hours of the Prime Minister announcing that we were in the top six and that there was the funding, unlike what it sounds as though the management did in my hon. Friend’s constituency, the management ruled out a new hospital on a greenfield site.

As for many of my colleagues, the population in my part of the world on the edge of London is booming. We have a thriving economy, and we have more jobs than we actually have people to fill them, even after the pandemic. The population is growing massively, and I have 20,000 homes coming to my own constituency in the next 15 years. The logic of not building a new hospital on an available greenfield site is confusing to everybody, especially to those who know that Watford hospital is a Victorian hospital next to the Watford Football Club ground in the middle of a Victorian town. All we have been offered is a refurbishment of Watford and a running down even more of the Hemel site.

What fascinates me is that the West Hertfordshire Hospitals NHS Trust seems to be completely unaccountable to the politicians who are giving them the money to look after care in our constituencies. I know that the Health and Care Bill going through Parliament at the moment is going to address that going forwards, but it does not address the historical problem going backwards. The trust spent millions of pounds proving that we cannot have a new hospital on a greenfield site, rather than actually spending some of its consultancy money proving that we could have it on a greenfield site.

My constituents had been campaigning to save the Hemel hospital long before I was around, and there is cross-party support in our part of the world for saying, “Watford is not the right place, and it is not a new hospital. It is a refurbished hospital in completely the wrong place. Please see sense.” I fully understand that Watford constituents are worried they might lose their hospital, but they will not lose it because nothing is going to close until the new one opens. However, we have already lost ours, and the largest town in Hertfordshire has a clinic, with proposals for no intermediate care beds whatsoever and with pathology being taken away as we speak.

The point I want to make to the Minister is that, when we look at the bids that come in, we have to be careful that trusts have done what they were supposed to do, which is to look at the best possible options for the community they are supposed to serve, in the same way that we are serving them, rather than be blindfolded by the situation. In my case, the trust seems fixated with one site in the middle of a town and next to a football stadium, which by anybody’s logic would seem to be ludicrous.

I wish Watford every success—they may well stay up again this season. I am not a Watford fan, although most of my constituents are. I am sad to say I am a Spurs supporter, and that comes with a lot of problems, as we know. However, when Watford play at home, there is a massive knock-on effect on the hospital next door. Believe it or not, but the trust gives up some of its parking spaces to the football club, which is an historical agreement.

I can give an instance of when an ambulance was turned away from the route it would normally take into the hospital because Watford were playing at home. I am not blaming Watford and I am not blaming the police for this; it is just a logistical problem. The ambulance was turned away and sent on a different route as the road was closed because of the home game. I said to the police officer in charge, “If one of your officers had been injured, what would you have done? Would you have allowed that ambulance through?” He said, “Of course, we would have done.” The guy in the back of the ambulance that was trying to get to hospital had had a heart attack; fortunately he survived.

That is the sort of illogical thinking that is going on in some of the trusts, though clearly not in that of my hon. Friend the Member for Crewe and Nantwich. In my trust, its unaccountability to do what is right for the people it serves seems to be blindfolded. I politely ask the Minister, as he knows I have been pushing on this for more years than I can remember, please do not trust the management of my trust to give the full information. We want a new hospital on a greenfield site. I have letters showing that there is £590 million available for that, but not for refurbishment.

It is a pleasure to serve under your chairmanship, Mr Sharma. I congratulate my hon. Friend the Member for Crewe and Nantwich (Dr Mullan) on securing this important debate on the new hospitals building programme. I warmly welcome the Government’s commitment to 48 new hospitals and the funding that was included in the spending review.

My local hospital, the Queen Elizabeth Hospital in King’s Lynn, serves 300,000 people across Norfolk, Cambridgeshire and Lincolnshire, and is in dire need of modernisation. QEH is one of the best-buy hospitals that have proved to be anything but. It is more than a decade beyond its planned life span and has real issues with planks of reinforced autoclaved aerated concrete—RAAC—that are structurally deficient.

The Standing Committee on Structural Safety issued an alert regarding RAAC planks two years ago, having first warned in 1999 of problems with them. That warning came after the collapse of a school roof. As much as 80% of QEH’s decaying and ageing estate is RAAC-planked; it is the most propped hospital in the country, which is nothing to boast about, with more than 200 props supporting the cracking roof in more than 50 areas across the hospital. The trust’s risk register has a red rating, with a direct risk to life and safety of patients, visitors and staff, due to the potential catastrophic failure of the roof structure. The critical care unit had to close for two weeks earlier this year as a result, while mitigation measures were put in place.

Although the trust is managing that risk, and the £20 million provided by the Department of Health and Social Care and the Minister for some of the most immediate issues is very welcome, the funding is but a sticking-plaster for the problem. The Minister knows he has an invitation to come and look at the modular endoscopy unit that is being constructed to allow the decant and fixing of fail-safes. As well as the very real structural issues, the layout of the hospital does not meet modern care pathways. There are too few consulting rooms, there is poor co-location of services and there are wards less than half the size of national guidance. That impacts on both patient experience and infection control.

In short, the hospital needs to be replaced. There is a once in a generation opportunity to fix this and a compelling case for QEH to be one of the new eight schemes for which the Government are currently holding a competition. The Queen Elizabeth Trust has submitted an expression of interest for a single-phase new build that will meet current and future demand, with many thousands of homes planned in the area. The need is strong; QEH covers areas of deprivation, with poor health outcomes, and is in the Government’s priority areas for levelling up.

The plans put forward by the trust will eliminate RAAC from the hospital, but it is not just about replacing defective buildings. It is also an opportunity to transform and modernise local health care, integrating primary, community, mental health, acute, social care and third sectors in a health and wellbeing village. It will also promote sustainability, using modern methods of construction and net-zero principles, incorporating the digital-first approach.

The project is well advanced and highly deliverable, with a strategic outline case well developed. It is backed by 4,000 staff at the hospital, and more than 15,000 people have signed a petition in support. The borough and county councils are on board, the regional NHS and at least seven right hon. and hon. Members whose constituents are served by the Queen Elizabeth. An acute hospital is essential in the area and the plans would deliver major improvements in care, patient outcomes and staff experience. An alternative multi-phased plan has also been submitted, although that would not deliver the same benefits or value for money.

Now is the opportunity to deliver a new hospital and support the trust’s strategy to be rated “good”, then “outstanding”, and to be the best rural district general hospital in the country. The Department of Health and Social Care has already committed to the removal of RAAC from the estate, and its risk will only continue to worsen. By including QEH in the new hospital programme, the inevitable need for replacement will become a funded programme, rather than an unplanned demand repeatedly requiring emergency capital funding. The people of North West Norfolk and beyond deserve nothing less.

It is a pleasure to serve under your chairmanship, Mr Sharma. I congratulate my hon. Friend the Member for Crewe and Nantwich (Dr Mullan) on securing this important debate. I am glad to speak once again in this place about my campaign for a new Airedale hospital in my constituency. I have raised the subject in Westminster and met the Minister on several occasions.

To set the scene about why we need a new, rebuilt Airedale hospital, similarly to the case that has just been made, my hospital suffers immensely from aerated concrete. The hospital opened in the 1970s, construction having started in the 1960s. Although the hospital’s original life expectancy was 30 years, we are now in its 51st year. The 1960s design sadly leaves a huge legacy of structural failings. Some 83% of the hospital is constructed from aerated concrete, which is in the roof, floors and ceilings. In total there are 50,000 aerated concrete panels in the hospital—five times more than any other hospital affected by that issue.

Aerated concrete is not the only unfortunate hangover from 1960s hospital design. The Airedale is also the largest flat-roofed hospital of any NHS asset in the country and, given that my constituency has some of the wettest weather in the UK, that leads to severe leakage. Unfortunately, the Airedale has more recorded leaks than any other hospital in the UK. Since being elected I have made several visits to the hospital, including up to the roof, where I have seen these issues for myself. I have also been shown parts of the hospital that are closed to the public to mitigate the risks from the aerated concrete and the flat roof.

Aerated concrete panels, such as those found in Airedale hospital, are prone to fail when deflections are recorded between 50 mm and 90 mm. More and more panels are constantly getting to this risk deflection. To put it bluntly, if swift action is not taken then the possibility of a collapse within the structure of the Airedale will constantly rise. We only need look back to 2019, when a school roof unfortunately collapsed because it had been constructed from aerated concrete. Such a collapse would be unthinkable, which is why we need to take swift action.

The Airedale trust has informed me that if it were to experience a closure, even a temporary one, then 45,000 referrals to treatment, 60,000 diagnostic tests, including MRI scans and ultrasound therapy treatments, and 2,000 maternity deliveries would be affected. That cannot arise and I cannot stress how important it is that it is avoided. I firmly believe that that can only be done by delivering a new Airedale hospital.

The catchment area for Airedale hospital covers a huge rural area. I have the full support of my right hon. Friend the Member for Skipton and Ripon (Julian Smith) and my hon. Friends the Members for Pendle (Andrew Stephenson) and for Shipley (Philip Davies), all of whose constituents use the Airedale hospital alongside mine. We also have to look at the wider area. The local authority has proposed plans for 3,000 new houses to be built in my area alone, which will add pressure on existing hospital services.

It is fantastic that the Government have announced that there will be a further eight new hospitals, on top of the 40 already announced. I was proud to see that in September the Airedale trust submitted its bid for one of those final places. It is an ambitious bid, detailed and affordable. The plans are convenient, in that they will not disrupt the current workings of the Airedale and are following a fully strategic outlined case.

A full appraisal recommended that the most cost-effective and future-proofed solution would be a new Airedale hospital on the grounds already owned by the trust. Indeed, the trust owns 43 acres of land and can build a new hospital while keeping existing operations until a transfer to the new build. The plans have a strong environmental case and outline the Airedale trust’s vision to be Europe’s first carbon-neutral and fully digitally enabled hospital, with the capability to generate renewable energy on site.

May I once again request a visit to Airedale hospital by my hon. Friend the Minister? I want to raise again the urgency of the case, as I did last week in the main Chamber to the Prime Minister. The Airedale needs and deserves a rebuild, and I will continue to do everything that I can to stand up for my constituents and press the case.

It is a pleasure to serve under your chairmanship, Mr Sharma. I thank my hon. Friend the Member for Crewe and Nantwich (Dr Mullan) for securing the debate.

The coronavirus pandemic has thrown health inequalities in this country into stark relief. Those living in the poorest constituencies of England and Wales have been twice as likely to die from the virus as those in more prosperous constituencies. Figures from the Office for National Statistics covering March to May 2020 show that those living in the poorest 10% of England, which includes my constituency of Hartlepool, died at a rate of 128.3 per 100,000, whereas in the wealthiest 10% the rate was 58.8 per 100,000.

Any death in any part of the country is a tragedy, but such grotesque levels of health inequality cannot be allowed to continue in the world’s fifth-richest country. That is why I fully support the bid by the North Tees and Hartlepool NHS Foundation Trust for a new hospital by 2030 to replace the current North Tees hospital in Stockton—another hospital crumbling with concrete cancer that has outlived its life span, and facing huge remedial costs.

The replacement hospital must be built in an equitable location for all residents north of the Tees, and I have a site available in my constituency—one of the most deprived areas of the UK, where health inequalities have been most apparent. The number of people suffering from a range of health problems is consistently higher in Hartlepool than the England average. Those include cancer, depression, asthma, obesity, heart disease and high blood pressure. As a result, life expectancy in Hartlepool is significantly and regrettably below the national average. If the Government are serious about tackling health inequality in the UK, they must start in Hartlepool.

Despite the sheer scale of deprivation and health inequality in my constituency, healthcare services in Hartlepool have not been expanding over the past decade, but shrinking. My constituents are often required to travel to the currently crumbling North Tees hospital in Stockton for urgent or specialist treatment. For example, owing to the lack of a doctor-led maternity ward in Hartlepool, mothers-to-be in my constituency must travel 20 miles in labour to the nearest hospital if there are potential complications, which, sadly, commonly occur with the prevailing underlying health conditions in my community. During the birth of their baby, mothers have to undertake that terrible journey to a hospital that is crumbling. A child’s first experience of this world should not be health inequality.

I appreciate that the coronavirus pandemic has placed unprecedented pressures on healthcare services in this country and I welcome the record levels of investment that the Government are injecting into the NHS to tackle waiting lists and treatment backlogs, but I fear that will not be enough to reverse decades of neglect and indifference on the part of my predecessors. Only a new hospital can do that. Levelling up must mean more than simple investment in transport and general infrastructure. Levelling up life expectancy across the country should be a priority. Plans must be put in place now to abolish health inequality in the UK and to ensure that our ability to live a good and decent life is not determined by an arbitrary postcode lottery.

It is a pleasure to see you in the Chair today, Mr Sharma. I congratulate my hon. Friend the Member for Crewe and Nantwich (Dr Mullan) on securing the debate. He is absolutely right to say that our hospitals are the centre of our communities. That is absolutely the case in my constituency of Basingstoke. Of course, care is provided by our doctors, our nurses and all the staff involved in running the hospital, but it is also one of my largest local employers. I congratulate the Minister, who I am pleased to see still in his place, on all the work he is doing to ensure that the Government’s commitments to build 40 new hospitals by 2030, the other eight previously committed to and upgrades to more than 70 hospitals, are being progressed as fast as they can be.

My hospital is a similar age to that of my hon. Friend the Member for Crewe and Nantwich. Like his, Basingstoke and North Hampshire Hospital was built to last 30 years, back in the 1970s. The backlog of maintenance reflects the fact that it should have been replaced many years ago. Hampshire Hospitals NHS Foundation Trust, an excellent trust that serves my community, was already well advanced with plans for a new hospital when the Government also identified that the current hospital needed replacing and included it in the renewal programme.

Basingstoke hospital has served our community extremely well since the 1970s, but the buildings are reaching the end of their useful life, for many of the reasons that Members have gone through. Those buildings were not built to last any longer. Furthermore, estimates show that the population that is served by the Hampshire Hospitals NHS Foundation Trust will increase by around 23% between 2018 and 2050. Unlike many areas of the country, Basingstoke has continued to build houses not just for the last two decades but for the last four decades. We have grown extraordinarily as a town over that time, served by the same hospital. Our population is therefore rapidly ageing, with all the implications that brings for our health services. Our over-75s population in Hampshire will have increased by a shocking 35% between 2017 and 2024. I should not be surprised about that, given the level of house building.

So many of the people who moved to Basingstoke when it rapidly expanded in the 1960s and 1970s are reaching an age where they are much more reliant on the health services available. The Government need to make sure that they follow through not only on more recent commitments to building houses, particularly in the south-east, but on the commitments that date back many decades, when people were encouraged from London out to places such as Basingstoke. That is an ageing population, and the Government need to ensure that the right facilities are in place for that much bigger population.

I am fortunate in Basingstoke that all the organisations involved in planning for the new hospital are working together in exemplary fashion, through an organisation that has been formed called Hampshire Together, which is all about modernising our hospitals and health services. That organisation firmly welcomed the Prime Minister’s announcements in October that all NHS trusts that receive seed funding to develop a business case for a new hospital project as part of phase 2 of the health infrastructure plan 2 programme, including Hampshire Hospitals NHS Foundation Trust, will be fully funded to deliver those by 2030.

The trust was especially pleased to note that Hampshire Together had been earmarked for inclusion in first group of HIP2 projects due for completion. The trust’s plans are well-developed with a preferred site, which the Minister already knows a little about, at junction 7 on the M3, which has been identified by the ambulance services as the best location to save more lives, providing acute care for hundreds of thousands of people living in the rapidly expanding communities in north and mid Hampshire. The planning authorities of Basingstoke and Deane Borough Council and Hampshire County Council are working actively and positively together, and Hampshire hospitals have been working to put together their business case and have forwarded their cases to the Department. They are very much looking forward to putting those cases out to public consultation as soon as possible.

Because our house building has been so rapid in Basingstoke throughout the 50 years that our hospital has been in existence, there is a need for a new hospital now. We would value a commitment from the Minister on the timelines and the next round of seed funding, so that we can continue to develop the business case and will be able to start building from 2025. I also renew my offer for the Minister to visit Basingstoke to see the site that we have already earmarked for the construction of the hospital. It is a greenfield site, so that residents’ enjoyment of the hospital facilities will not be disrupted during the building process.

It is a pleasure to see you in the Chair, Mr Sharma. I congratulate the hon. Member for Crewe and Nantwich (Dr Mullan) on securing the debate. As a fellow Cheshire Member, our paths will no doubt cross as we get involved in the megalithic integrated care system that covers our area, and it is good to see healthy representation from Cheshire Members, which shows the interest and passion that we have for improved health services in our area. He mentioned that he volunteered to use his medical skills on the frontline during the pandemic, and we thank him for his efforts, just as we thank everyone who contributed to the fight against covid, be it in the NHS, in social care or in any of the other many sectors that played their part. We recognise and value the commitment that was made by so many people over such a long period of time.

As the hon. Member for Crewe and Nantwich set out, hospitals are more than the buildings themselves. It is the staff who make hospitals, and he brought that to the fore in his comments. He said that the site of Leighton Hospital has exceeded its original lifespan—I think it is as old as I am, which is a concern. Hopefully, I will not be up for a rebuild any time soon. It was a common theme of contributions to the debate that a lot of the buildings in Members’ constituencies have reached the end of their natural lifespans. It would be useful to hear from the Minister whether any assessment has been made of how many hospital buildings, and buildings across the wider NHS, have already exceeded their original lifespans. The hon. Gentleman made a compelling case for why a new hospital needs to be built in Crewe, and he mentioned that the local population has grown considerably.

I thank my hon. Friend and constituency neighbour for giving way. Of course, Leighton Hospital is part of the Mid Cheshire Hospitals NHS Foundation Trust, which also includes Victoria Infirmary in Northwich. This would be a real opportunity to capture investment across the campuses, which serve a number of our constituents, and I would certainly welcome my hon. Friend’s support on that. As a Cheshire MP, it would certainly be very welcome indeed.

My hon. Friend probably needs to direct his pleas to the Minister more than me—at this stage, of course—but I would be delighted to visit the facility with him. I am sure that he will make a strong case for investment, as other Members have done. There is an issue with how the interplay works between some of the competing bids for what is obviously a very competitive process, which I will return to later. Like the hon. Member for Eddisbury (Edward Timpson), my hon. Friend the Member for Weaver Vale (Mike Amesbury) has shown that there is cross-party support for the case for a new hospital that was made by the hon. Member for Crewe and Nantwich, who also set out why this is good for patients. He talked about some of the issues around privacy, dignity and infection control, and he said that a new build gives us an opportunity to invest in modern digital infrastructure. Of course, he also mentioned important stuff to do with COP26 and the energy efficiency of a new build. Those were all well-made points.

We also heard from the right hon. Member for Hemel Hempstead (Sir Mike Penning), who made a persuasive and passionate case as to why the current plans need to be reconsidered. He made a very interesting point about the accountability of trusts. He is probably not aware that the Minister and I have been debating this issue in Committee for a number of weeks, and it is fair to say that we have differing views as to how accountable the current system is and whether it will actually change at all when the Health and Care Bill receives Royal Assent. There is an issue with how large trusts have their own priorities, which are not necessarily in tune with the rest of the wider population and healthcare system.

The hon. Member for North West Norfolk (James Wild) made a very strong case for the Queen Elizabeth Hospital in King’s Lynn; he highlighted the critical nature of the maintenance issues there, which are clearly having an effect on patient care now. The Minister will not be surprised to know that I will be referring to the maintenance backlog during my comments today. The hon. Member also set out very well how new builds can not only improve infection control, but enhance the patient experience. We should always remember that the patient journey is central to these things. A new hospital always has to have the interests of patients, and their perspective, at the heart of its plans.

The hon. Member for Keighley (Robbie Moore) made a strong case for why a new hospital is needed in Airedale. Again, it is a building that is past its original lifespan; it has critical infrastructure issues. Describing it as the “leakiest hospital is the UK” is not something the hon. Member will want to repeat for much longer. It shows again that many of these issues have been building up for some time.

I was very interested in what the hon. Member for Hartlepool (Jill Mortimer) said about health inequalities; it was an important point, and perhaps a broader one than some of the others that have been made. She is absolutely right that the pandemic has shone a light on the existing health inequalities in this country. I agree that if we are serious about levelling up, reducing health inequalities has to be central to any policy.

The right hon. Member for Basingstoke (Mrs Miller) made a compelling case about how investment is needed for her new hospital, and how the change and growth in local population has created additional demand. It is an important point that, because of the way that her town has built up, there is more demand from an increasingly ageing population.

All the Members have made very good cases today; if it was based on the commitment and passion of individual Members, the Minister’s job would be quite straightforward. However, I know there will be many other demands on the departmental budget. There is a serious point here. We need to have transparency on the criteria that will be applied when the decisions are made. It would be fair to say, if we look at levelling-up bids, there has been some consternation that the decisions are not always made on the merits of the case. It is important that the Department is crystal clear on why particular projects are getting the go-ahead, and why others may have to wait a little longer.

I am sure that the Minister would be disappointed if I did not make a reference to whether the Prime Minister’s claim to be building 48 new hospitals is in fact an accurate one. We take with a large pinch of salt the definitions from the Department’s playbook that the following count as a new hospital: they say this includes

“a new wing of an existing hospital (provided it contains a whole clinical service, such as maternity or children’s services).”

They also say this includes

“A major refurbishment and alteration of all but the building frame or main structure, delivering a significant extension to useful life which includes major or visible changes to the external structure.”

That may well be investment in buildings—which is of course welcome—but it stretches credibility to say that those are new hospitals. I will not repeat the whole debate again on whether those descriptions can be classed as new hospitals, except to say that the Minister will no doubt rely on his VAT notices to reach that figure of 48: we will rely on the good sense of the British public to judge whether a new hospital is indeed a new hospital. When we get to 2030, we will see how many new hospitals we actually have—although it is possible that both the Minister and I will have moved on by that point.

Let us return to the present day, move away from the headlines and the spin, and ask some specific questions about the programme. I will start with the cost issue. It is my understanding that the projects identified in phase 1 have been promised a total of £2.7 billion, although some reports suggest that a £400 million price cap is being applied to each scheme, even though some of the published plans for those schemes have exceeded that limit already. Could the Minister comment on whether there is in fact an upper cash limit on particular projects, and whether it is indeed £400 million?

Almost exactly a month ago, the Prime Minister made an announcement on round 2 of the health infrastructure plan, in which, incidentally, only three out of the 25 hospitals are in the whole of the north of England. I think that says something about the Government’s commitment to levelling up and bolsters the case made by the hon. Member for Crewe and Nantwich to push forward for a new building in Crewe. Could the Minister advise what period and how much of the total programme the £3.7 billion mentioned in that announcement covers? Could the Minister also advise if the £4.2 billion, announced in the spending review last week in relation to new hospitals, is the same money as the Prime Minister announced on 2 October or is in addition to that? If it is additional, what period does that £4.2 billion cover? We want a little clarity on how much has actually been allocated and the period that it covers. I am sure the Minister realises that, even if we add up all those figures, it would not be the total cost of all those projects moving forward to 2030.

We have had three separate announcements over the last year. I make that point because the foreword to the health infrastructure plan talks about ending the “piecemeal and uncoordinated approach”. We have an investment plan spanning a decade, but the necessary investment has been announced for only the first half of that decade, at best, to come out in dribs and drabs. I suggest that the Minister might need to read the foreword to the plan again to see whether the ambitions set out there are being met.

NHS Providers has said that the actual cost of the planned building projects would be around £20 billion, most of which will need to be found in the next few years. Even building an average-sized new hospital costs around £500 million, which rather puts the spotlight on the supposed £400 million cost limit I referred to earlier. I wonder if the Minister could put a total cost—

I think we have to be slightly careful when referring to costs such as that £500 million. Built into that is inflation, because of the way the Green Book works, because of the risk. I had to deal with this on the roads programme as roads Minister: what happens is that a figure is set out, but it is not the same as the actual cost of the build project. That is probably where some of that cost anomaly comes from. The Treasury Green Book insists on inflation of that price when the build price is much lower; in my case, £500 million was £420 million in the Birmingham build. We have to be careful of trusts that do not want to do that; for example, my trust—the West Hertfordshire Hospitals trust—inflates the cost into £600 million because it does not want to do it.

I will reflect on the right hon. Gentleman’s comments. That leads on to another point I wanted to raise with the Minister: we are aware that the economy is currently in something of a flux in a whole range of sectors, in terms of finding the right people and the right skills, and construction is not immune to that. Do the plans include any wiggle room to take account of the fact that the cost of labour and materials is unfortunately going up quite rapidly at the moment?

NHS Providers said that

“there are still significant questions on whether the NHS will be able to meet the government's manifesto pledge to upgrade 70 hospitals and build 40 new ones given the lack of clear, long term, funding commitments beyond 2024/25.”

It also said that it awaits

“confirmation of the money that will be available to providers to tackle the £9.2bn maintenance backlog that has built up.”

The Minister will know that that has shot up in recent years, leading to cancelled operations and a 23% increase in treatments being delayed or cancelled in the last year because of infrastructure failures, and yet we are hearing very little on what is being done about that. I think the hon. Member for Eddisbury mentioned something in the region of £400 million being identified as the maintenance backlog costs at Leighton Hospital alone. We have also heard from other Members on infrastructure issues causing difficulties in their own trusts.

These problems are not new; they are the result of a decade of underfunding on both capital and revenue, with the Health Foundation reporting that

“the UK is investing significantly less in health care capital as a share of GDP compared with most other similar European countries.”

Of course, we have also seen frequent revenue raids on capital in the last few years. If these plans are to be successful, those raids must stop. I hope the Minister will be able to guarantee that there will be no revenue raids on capital for this programme in the next decade. I would also be grateful if he could set out the Department’s plan to tackle the maintenance backlog.

A few moments ago, I mentioned the interplay between large infrastructure projects and other capital requirements at a system level, particularly around how we get capital investment into primary and community care. Taking my own patch, Ellesmere Port, which I know best, we have several GP premises in the town centre that are past their best—past their useful life, perhaps—they are not really suitable in these covid-conscious times. We are not short of more modern, available premises in the town centre, where there might even be greater potential for integration with other services

However, these projects take time and money, and some decision must be taken at a system level to prioritise them. I think that would be an important step forward for improving access in my community and dealing with some of the health inequalities we have talked about. I recognise that sometimes it is a fact of life that the bigger players—the acute trusts—will always be higher profile than individual practices for attracting funds and investment. In many ways, this is an echo of the debate that the Minister and I have had in recent weeks on the Health and Care Bill Committee. I mention it again because, particularly with capital investment, there is a danger that primary and community services will struggle to have their voices heard against some of the bigger players in an extremely large integrated care system.

I will end with a few comments from stakeholders regarding the Chancellor’s statement last week. The King’s Fund said that

“the real game changer would have been clear funding for a workforce plan. Chronic workforce shortages across the health and care system heap further pressure on overstretched staff who are exhausted from the pandemic. Yet despite pledges, promises and manifesto commitments, the government has failed to use this Spending Review to answer the question of how it will chart a path out of the staffing crisis by setting out the funding for a multi-year workforce strategy.”

The Health Foundation said that

“new money for technology and buildings, although vital, is of limited value without additional staff. A workforce plan backed by investment in training are critical and we await details of both so that the NHS’s recovery can be secured.”

The Nuffield Trust said:

“It is striking that there is a lack of strategic workforce investment alongside this boost in funding for facilities. Staffing is recognised as the number one issue for the sustainability of the health service. Recovery from the pandemic not only rests on investment but on hard-working staff as well.”

Finally, the NHS Confederation said that

“to ensure the extra money delivers for the public, a strong and supported NHS workforce is needed. This is why training and increasing the supply of doctors, nurses and other health and care professionals is so important at a time when public polling recognizes that staffing is the biggest problem facing the NHS.”

While we welcome the investment in new buildings, we hope that none end up being a white elephant, because the elephant in the room is that we could find ourselves in the remarkable position by 2030 that brand new hospitals, extensions, or refurbishments are delivered, but are not fully operational because of a failure over the preceding decade to tackle the workforce crisis. That is here and now, and it needs to be tackled in the short, medium and long term. That is the final plea I make to the Minister: these investments are welcome, but we must ensure that we have a plan so that these buildings are fully staffed when they are up and running.

Before I ask the Minister to contribute, I will just say that I will be joining that long queue very soon to lobby for Ealing Hospital’s future, but not this morning.

I am very grateful to you, Mr Sharma; that was a deft and adept use of the Chair. It is a genuine pleasure to serve under your chairmanship.

I pay particular attention and pay tribute to my hon. Friend the Member for Crewe and Nantwich (Dr Mullan) for securing this debate. The case that he makes for Leighton Hospital has cross-party support, as we have seen, including from the hon. Member for Weaver Vale (Mike Amesbury) and, indeed, from the shadow Minister, the hon. Member for Ellesmere Port and Neston (Justin Madders). This has been a cross-party and very well-tempered debate, and as ever I am grateful to the shadow Minister for the tenor and tone of his comments. We have spent the past couple of months sitting opposite each other in a Bill Committee, which reported yesterday. Clearly, so shocked were we at the prospect of not continuing to sit opposite each other, here we are in Westminster Hall this morning.

I am also grateful to my right hon. Friend the Member for Basingstoke (Mrs Miller) for her kind words in highlighting the fact that I am still in this role. In the same vein, I should say that the hon. Member for Ellesmere Port and Neston is still in his role, having served as shadow Minister even longer than I have served in my role. There is some value in that, because too often in this place we see a very rapid churn of Ministers and shadow Ministers. Issues such as those we are grappling with today need, by their very nature, a long-term view and a long-term understanding.

I join the shadow Minister in paying tribute to my hon. Friend the Member for Crewe and Nantwich, not only for introducing this debate but for his work on the frontline. He was typically humble about that work, but his contribution was significant and he should be proud of it. He quite rightly paid tribute to all of those in our health and care system, as we all should—and should continue to do—for the work that they have done; not only the work they have done throughout the pandemic, which has been incredibly challenging, but the work they do every day, year in and year out, on the frontline to help to keep our constituents safe.

My hon. Friend is absolutely right about the importance of the topic that we are debating today. Buildings are hugely important. They give our clinicians, our frontline staff and our ancillary staff the context or the environment in which they can do their best. Therapeutics, research, new diagnostic kit, technology: all these things are hugely important because, as the shadow Minister alluded to, they allow the beating heart of our NHS—the workforce; the people—to do their job, and who, for want of a better way of putting it, make the magic happen in those environments. It is incumbent on us to give them that environment and these tools, so that they can do their best.

Various right hon. and hon. Members have highlighted the context in which we approach this debate. Many areas are undergoing significant development, growth in housing and increases in demand. There are demographic changes, with ageing populations in some areas needing increased hospital facilities.

Coupled with that, the context was set out again by many right hon. and hon. Members, particularly my hon. Friend the Member for Keighley (Robbie Moore), who spoke about the state of the estate, for want of a better way of putting it. There are hospitals that have, in a sense, served for far longer than they were designed to serve. They have been kept going, but that poses challenges, not just with reinforced autoclaved aerated concrete, or RAAC, planks, which I will turn to in a moment, but operationally with the task of running them, given the day-to-day choices that clinicians and managers have to make to put fixes in place, so that they can continue to provide services.

The shadow Minister asked several questions. I will address one or two of them now, then come on to the others later. He talked about the workforce, whom I have just mentioned. I say to him that the number of doctors is up, the number of nurses is up, and the number of radiographers and radiologists is up since 2010. We have continued to grow our NHS workforce. Do we need to continue to do more to do that? Of course we do. That is why the Government are committed to, for example, the 50,000 more nurses that was a manifesto commitment, and we are on course to deliver that by the end of this Parliament.

We need to be conscious, and I know that the shadow Minister is, that as we talk, for example, about elective recovery and getting waiting lists and waiting times down, we need to be honest with our electors and the British public that that is a huge job that will take time. That is because the workforce who will deliver those things are the same workforce who have been through the pandemic, and they need time to recover, emotionally and physically, from what they have had to do over the past year and a half. Often, we hear some commentators saying, “Ah, yes, but some were in the ICU wards, or in A&E, and a lot of others wouldn’t have been on the frontline.” Well, the reality is that, for example, surgeons who may not have been operating on their usual lists will have gone back to the wards to assist their colleagues, and we know that a team is needed to perform surgery. The anaesthetists will certainly have been working flat out during the pandemic, as will the theatre nurses, so we need to ensure, as we deliver our recovery plan for the NHS, that we give the workforce the support they need to recover.

Let me turn to the specifics of the programme. My hon. Friends the Members for Crewe and Nantwich, for Congleton (Fiona Bruce) and for Eddisbury (Edward Timpson), and the hon. Member for Weaver Vale all made, as one would expect, a passionate, well-informed and cogent case for investment in a new hospital at Leighton. My hon. Friend the Member for Crewe and Nantwich will not be surprised when I say that the expressions of interest period has closed. The expressions of interest are all being considered carefully and a decision will be made next spring on the long list to whittle them down, with further work to determine the final eight. I therefore hope that he will allow me not to be drawn on the specifics of the merits or otherwise of his case while that process is under way, but as ever he makes a strong and powerful case on behalf of his constituents.

In the context of the next eight, the shadow Minister asked about criteria and how the process would take place. That is set out and published on the programme website, but the key considerations are these. Does a scheme or proposal have the potential significantly to transform and improve the quality and quantity of care available to a community? Is there a safety or other pressing need that has to be addressed in the system? Equally, we will be looking to achieve a degree of geographical spread to ensure equity and fairness—levelling up. With any of these schemes, as hon. Members would expect, we will look at whether the proposals are clear and can be delivered on budget, and whether there is the capacity and capability to deliver on them.

One such scheme, for which I and my hon. Friends the Members for Warrington North (Charlotte Nichols) and for Halton (Derek Twigg) and the hon. Member for Warrington South (Andy Carter) have been campaigning, is two campuses for Warrington and Halton trust. They seem to meet those criteria, so I look forward to an assessment and conclusion in the not too distant future.

I am grateful to the hon. Gentleman, who quite rightly never misses an opportunity to champion his constituents’ interests.

Hon. Members will be aware that the interest around the country is significant. A significant number of expressions of interest have been submitted, so whittling them down will be a competitive and challenging process, but we undertake to be as clear and transparent about that as we can be. I suspect that, when the final list is announced, if I do not come to the House with a statement, the shadow Minister may well UQ me, to give colleagues an opportunity to say they are very pleased or to ask why their hospital is not on the list.

Let me turn to points made by other hon. and right hon. Members. My right hon. Friend the Member for Hemel Hempstead (Sir Mike Penning) will not be surprised that I will not be drawn on the specifics of the internal politics and the plans for his trust at this point. However, he quite rightly made the extremely important point that when trusts develop their plans and bring them forward, they need to carry the communities they serve with them and genuinely reflect on stakeholder input from elected Members and others, rather than—I am not saying that this is or is not the case with this trust—automatically having a preconceived idea of what the right answer is.

The Minister might not be willing to say that my trust has preconceived the decisions it was going to make; I will, because it made its mind up long before the latest announcement. However, we are in a slightly different position from other colleagues here. We are in HIP 1—part 1 of the health infrastructure plan—and we do not want that money to be wasted. We do not want a sticking plaster; we do not want a refurbishment in the middle of Watford. The community in my part of the world is absolutely solid on that, and if that meant that we slipped out of HIP 1 into HIP 2—I will put my neck on the block—I would be happy with that, as long as we get the right facility on a greenfield site, rather than the wrong facility as a refurbishment in the middle of Watford next to a football ground.

I did not regret giving way to my right hon. Friend quite as much as I feared I might, although he may yet come back to me. As ever, he makes his point powerfully and clearly, and I suspect that, as well as my having heard it, his trust will also have heard it.

As the shadow Minister said, my hon. Friend the Member for Hartlepool (Jill Mortimer) made broader points, in addition to points about her local hospital and trust, about health inequalities and the role that the right infrastructure and staff—the right people in the right place—can play in tackling that. I have to pay tribute to her. Within a day of her arriving in this place following her fantastic by-election victory, she had pinned me down so she could come and see me and talk about Hartlepool and health services there. Her constituents are extremely lucky to have her. She hit the ground running and has not stopped working since on behalf of her constituents.

My right hon. Friend the Member for Basingstoke and I, as she alluded to, have spoken a number of times about her trust. How can I not accept her kind offer of going to the site and seeing her in her constituency? I have known her for a long time, so it is a pleasure to say yes. I would like to go there and do that, then perhaps we can discuss the plans further. She and I have met on several occasions. She is a great champion for the new hospital in her area, so I am grateful for the invitation.

My hon. Friend the Member for Keighley—I almost said “my hon. Friend the Member for Airedale”, given the frequency with which, he raises and champions in the House at every opportunity the need for a new hospital at Airedale—is right to highlight the challenges that his trust faces, as he has done on many occasions, particularly in the context not only of the needs of his population, the challenges of an old building that has long exceeded its intended lifetime, but also the RAAC plank issue. I know that his trust is keen to be one of the eight. I will only say to him, I am afraid, what I said to my hon. Friend the Member for Crewe and Nantwich, which is that the bids will be considered very carefully. I know that he will continue making the case, as he has done in the past.

I will give way briefly to my hon. Friend, then I will turn to the contribution of my hon. Friend the Member for North West Norfolk (James Wild).

Can the Minister clarify how the final eight will be decided and will structural risk profile be a key consideration?

My hon. Friend, quite wisely, presses his advantage. I can give him some reassurance on that, as I did to the shadow Minister when talking about the criteria, that safety and risk will not be the only criterion, but that will be a key factor in the consideration.

I turn now to the contribution of my hon. Friend the Member for North West Norfolk. The other day in the Chamber, I inadvertently paid tribute to my hon. Friend the Member for North Norfolk (Duncan Baker) for the work being done by my hon. Friend the Member for North West Norfolk in one of my responses. I pay tribute to my hon. Friend for North West Norfolk, who has quite rightly raised with me on several occasions the Queen Elizabeth Hospital King’s Lynn and the challenges posed by RAAC planks there. I know he is campaigning both in Parliament and locally on that issue. Courtesy of him, I have met his trust in the past and we have provided more than £20 million in this financial year for critical risk remediation. I know that, quite understandably, my hon. Friend is saying very clearly that that is welcome and will help, but it will not solve the problem. He will continue to press the case for a new hospital. He, too, has kindly invited me to his constituency, so I think I am due to go on tour around the country at some point, visiting various hospitals and colleagues.

Turning to some of the broader underlying themes that have emerged in the debate, I will seek to answer some of the questions posed by the shadow Minister. He gently tempted me on definitions. I am clear that the definitions we have—the three key elements he alluded to—not only pass the common-sense test and the understanding of what the reasonable person in the street would consider a new hospital. Equally, he teased me gently about VAT notice 708. I mentioned that at the Dispatch Box because—he says that we should be transparent and have a logical reason for how we define, do and choose things—our starting point was that there can be a VAT exemption for new builds, but not necessarily for refurbishment. I took that as a starting point for developing the common-sense definition. A lot of what he sees in the definitions is reflected in the same one used there, so there is consistency.

The shadow Minister talked about skills and inflation and whether we will have the people to build the hospitals. He is right to do that, because, as we have seen following the bounce back after the pandemic, builders and construction firms are very much in demand. There is pressure on materials as well, not just inflationary pressure, but on quantities. That is one of the reasons why, even before the impact of the pandemic, this is a phased programme. These hospitals will be built over a period of years up to 2030, allowing for market capacity.

Equally, one of the reasons why we have set out this long-term plan is so that we can make the market aware of what our plans are. If there is certainty in the market that the hospitals will be coming through, we will see firms investing, because they know there is potential for long-term business and work for them. That is one of the ways in which we have helped to handle that.

The shadow Minister asked about funding, and what would be available for what period. He will be aware of the initial £3.7 billion that has been allocated to this project, which takes us to 2024. Future funding will be subject to future spending reviews for that period. Between the 2024 period and 2030 there will be a general election at some point, and I suspect that may play a part in the spending review as well. We have the funding up front to get going with this programme, and off the top of my head, I think we already have eight hospitals in construction. The Cumberland Cancer Hospital has already been opened by my right hon. Friend the Health Secretary. Over this period, we will continue to start further construction of new hospitals.

The shadow Minister also alluded to geography and the distribution of the hospitals. Off the top of my head, 30 of the 40 are outside London and the south east, so we have sought to achieve geographical spread for the new hospitals and, equally, will seek to do that with the new eight. He also asked about the quantum needed for a new hospital, and he had a particular figure in mind. If he looks at the list of 40, many of them are very different hospitals, from the major acute district general hospital to a community hospital with in-patient beds; it is clearly a new hospital. The costs vary in the nature of what is built, its scale and size.

The shadow Minister also asked whether there would be a cap and whether trusts have complete freedom. No—as he would expect, there is a balance is to be struck between delivering what a trust wants for its plans and the need for financial prudence and recognition of the need to safeguard taxpayers’ money; it is not a limitless amount. Conversations are going on between the national team and local projects to ensure that their schemes are affordable and not hugely over budget. That is a pragmatic, ongoing process.

The shadow Minister also touched on some of the criteria for the scheme and how we are making the national scheme work. We include in this modular build modern methods of construction. We have a national set of standards for what we would expect from a new hospital, but a degree of local flexibility for the delivery of that. We recognise that each trust is slightly different, but we want to standardise where we can, because that keeps costs down and provides certainty in the market and speeds up construction. We have also built into our plans, since they were originally announced, even more ambitious green targets and energy efficiency targets for those trusts.

I am grateful to the Minister for giving way. He has made a valiant attempt to answer all my questions.

No, but there is one that the Minister has overlooked, on the sum announced in the spending review last week. Was that additional money on top of what had been previously announced?

I omitted to mention two things to the shadow Minister: the spending review and backlog maintenance—he always avails himself of the opportunity to gently raise that issue. We have seen a confirmation of the money already in place for the new hospital programme, but we have also seen further moneys announced for capital in the spending review—new money—for example, just over £5 billion for community diagnostic centres, surgical hubs and the IT infrastructure around that. We have therefore seen a reconfirmation of money, plus new money in the capital space.

I turn now to maintenance, which the shadow Minister rightly always highlights. He will know—he occasionally quotes it at me at the Dispatch Box—that backlog maintenance across the entire estate is around £9 billion-worth. That is pretty constant from the previous financial year; it has not particularly increased. It may have gone up by a tiny fraction, but it has remained broadly constant.

Let me just finish this point before I take interventions from my right hon. Friend the Member for Basingstoke and then the hon. Member for Weaver Vale.

Our investment in new hospitals will also significantly reduce the backlog maintenance, because it will take out of the total a number of hospitals, some of which have been mentioned, that are being propped up day after day, with money being spent just to patch up and mend.

I thank the Minister for agreeing to come to our new preferred site in Basingstoke—we will be grateful for that—and for his comment about backlog maintenance. I think Basingstoke is in the top three in the country for backlog maintenance.

May I press the Minister on the timelines of the next round of seed funding to develop business cases and to be able to start building our new hospital in 2025? Clarity on some of these timelines is essential not only for our communities but for the people developing the plans, because they need to know what will happen next and have clarity on that.

I am grateful to my right hon. Friend, and I entirely understand her call for clarity. Each case is being looked at on an individual basis, in the allocation of the £3.7 billion. The senior responsible officer of the new hospitals programme, Natalie Forrest, is in regular discussion with each trust, but business cases, more funding to develop business cases, and movement from outline business cases to final business cases are done on a case-by-case basis by trusts. It is not the case that every one must submit them by a fixed time.

Let me take the hon. Member for Weaver Vale first, because I promised him that I would give way. I also want to leave a few minutes at the end for my hon. Friend the Member for Crewe and Nantwich to wind up.

On the point about maintenance, several hospital buildings built in the 1970s have used Grenfell-style aluminium composite material cladding and high pressure laminate, so I assume that is part of the assessment criteria. Some have roof systems that are in a critical state.

I am grateful to the hon. Gentleman, who raises a couple of points. Yes, roofs are a factor. In some cases—my hon. Friend the Member for Keighley talked about Airedale—there is a flat roof, which is vulnerable to heat and water, and aerated concrete planks, which is extremely challenging.

The hon. Gentleman mentioned cladding. I might be slightly out, but from memory I think that there are no hospitals with cladding in need of remediation. We put a programme in place following the Grenfell findings. Off the top of my head, I think every hospital trust has either had it removed or been assessed by the fire brigade as not having a risk. If I am wrong about that, I will of course write to him to correct the record.

On the point the Minister has just made, Natalie Forrest has taken on her new role. I notice that the Minister said she has been in communication with the trusts, but she has not been in communication with the MPs who have emailed her and asked her to respond to them, including me. My hospital action group and I met her predecessor and had very fruitful discussions, and Natalie Forrest would be very welcome to have a discussion with me.

I am grateful to my right hon. Friend. Understandably, the approach we take with right hon. and hon. Members is that correspondence is replied to by Ministers. Occasionally it is a little belated, but that is the conduit for responses.

On meetings with senior officials, I am always happy to facilitate that. Normally, the approach is that I would attend as the Minister in order to reflect the respect that I have for right hon. and hon. Members—and I suspect that he may be about to ask me whether I will therefore do that.

The Minister is being very generous in giving way again. Yes, that would be great. However, I did meet Natalie Forrest’s predecessor without a Minister present, and I just want an email back to say, “I acknowledge you.” That might be quite nice.

Very briefly, because I want to leave some time for my hon. Friend the Member for Crewe and Nantwich.

This is really important. What the Minister has just said is that no part of the process should be held up because certain projects might be ahead of others. Therefore, the public consultation that stands ready to go live in Basingstoke should not be delayed for any reason other than hopefully getting ministerial approval.

I take the point, and I think I understand where my right hon. Friend is coming from on this. I said that business cases will be considered on their own merits, but of course there has to be phasing of different trusts at different times and different phases of this programme, because of the profiling of that funding. Only £3.7 billion has been committed so far, with more to come in further spending reviews, so if every trust came forward and said, “We are ready”—as my right hon. Friend knows, many will do so, although I suspect she would say that her trust is genuinely ready compared with some others—we could not commit to every one of those, because we have to look at the financial profiling that the Treasury has given us about when that money becomes available. That is the point. I hope she will forgive me if I did not understand what she was getting at in the first instance, but I hope that is of some help.

I will conclude, in order to leave my hon. Friend the Member for Crewe and Nantwich a little time to wind up. As a Government, we are proud that we have committed to arguably the largest and most ambitious new hospital building programme in decades, with initial moneys of £3.7 billion put in place to get that programme going. Eight of those new hospitals are in construction and one is completed, and we look forward to delivering on that commitment in full by 2030.

I thank the Minister and the Opposition spokesperson, the hon. Member for Ellesmere Port and Neston (Justin Madders), for the time they have taken to listen to us all in Westminster Hall today. I particularly thank the Minister for his openness and frankness in discussing this issue. I am sure that, as Members, we all understand why he cannot commit today to the various programmes we have put forward.

I particularly thank my hon. Friends the Members for Eddisbury (Edward Timpson) and for Congleton (Fiona Bruce), who have worked very closely with me on pushing forward this campaign for Leighton Hospital. I also thank the hon. Member for Weaver Vale (Mike Amesbury) for showing cross-party support for Leighton. The contribution from my right hon. Friend the Member for Hemel Hempstead (Sir Mike Penning) reminded us all of what a unique role an MP plays in their constituency, having that individual voice on behalf of their constituents. My hon. Friends the Members for North West Norfolk (James Wild), for Hartlepool (Jill Mortimer) and for Keighley (Robbie Moore) and my right hon. Friend the Member for Basingstoke (Mrs Miller) all spoke powerfully and passionately about their commitment to their local hospital and the investment they are seeking.

There were a couple of common themes that I want to pick out, the first of which was about house building and population growth, which touches on work I have been doing in my constituency to address the postcode lottery when it comes to the voice of the NHS in the planning system. Very often, schools’ education provision is supported by housing development, but it is not very often that our local hospitals are supported financially by developers. Those developers have a role to play, and I encourage the Minister to look at what more he could do centrally to spread best practice. I have been doing that locally, but we need that central drive to make sure that hospital developments, mental health and primary care get the money they deserve where there is new housing.

We are all facing a similar challenge when it comes to the shelf life, so to speak, of our hospital buildings. There is no shame in that—when things are built, they have a timeline—but it is very important that the Minister makes sure that for those of us who may end up disappointed, particularly in relation to the RAAC plank issue, the Government have a clear and strong story about how they are going to tackle that issue and what investment will be put in place, regardless of which hospitals make it into the final round of the hospital building programme. I will finish by inviting the Minister to Leighton Hospital, if he does not mind,

I look forward to seeing him there with my hon. Friends the Members for Eddisbury and for Congleton. I thank the Minister for his time, and thank you, Mr Sharma, for chairing proceedings today.

Question put and agreed to.


That this House has considered the hospital building programme.

Trophy Hunting Imports Ban: Endangered Species

Before we begin, I remind Members that they are expected to wear face coverings. This is in line with current Government guidance and that of the House of Commons Commission. I remind Members that they are asked by the House to have a covid lateral flow test twice a week if coming on to the parliamentary estate. That can be done either at the testing centre in the House or at home. Please also give each other and members of staff space when seated and when entering and leaving the room.

I beg to move,

That this House has considered banning trophy hunting imports and the protection of endangered species.

It is a pleasure to speak under your chairmanship, Mr Sharma, as I do not believe I have had the pleasure before. I also welcome the Minister to her place. Before I properly begin this important debate, I would like to take the opportunity to pay tribute to a dear friend and colleague, Sir David Amess. Sir David was incredibly passionate about the problem of trophy hunting imports, and inspired colleagues across the House with his enthusiasm and leadership on the issue.

This debate takes place in the context of COP26, a conference on protecting the future of our planet and showing British leadership on global issues. Unfortunately, the Government’s lack of action on their commitment to ban trophy hunting demonstrates a failure to show global leadership in protecting our planet, which is not just about carbon emissions but about protecting and preserving biodiversity and endangered species.

I would like to make three key points. First, trophy hunting damages conservation efforts around the world; therefore, the Government’s commitment to ban trophy hunting is extremely important and welcome. Secondly, it is a policy with overwhelming public and parliamentary support; there is no reason to delay its implementation. Thirdly, this is not just a domestic issue. It is about Britain showing leadership in conservation on a global stage.

Action is needed urgently to show that, as well as convening world leaders in Glasgow this week to talk about protecting the planet for future generations to come, we are also giving those generations the chance to live alongside magnificent animals such as African lions, polar bears and many others that are being hunted to extinction. I will conclude by asking the Minister to assure the House that legislation is imminent and that this practice, which nobody doubts is wrong, will be banned immediately, demonstrating global leadership and significantly impacting on the practice of trophy hunting by UK citizens.

Taking each of those points in turn, the impact of trophy hunting is enormous. It threatens the already tiny populations of endangered species such African lions. Even putting aside the morality of killing animals for fun, it is not a sustainable industry. Zimbabwe was forced to impose a moratorium on hunting lions in 2013 because numbers were so low. During that moratorium, the survival rate of lions in the Hwange national park, the home of Cecil the lion, almost doubled. A similar moratorium in Zambia saw lion numbers double, showing the damaging effects of hunting on endangered populations.

It is not just about extinction. Trophy hunting is damaging evolution and rendering these magnificent animals less fit for their environments. Hunters seek to kill the biggest and most magnificent animals, which in turn means that only the smaller and weaker animals breed and reproduce. Humans are interfering with Darwin’s principle of the survival of the fittest because the fittest are not surviving. This puts these animals at serious risk of changes, such as climate change, or of predators. The gene pool of the African lion has shrunk by 15% in the last century. Heads and bodies of lions today are significantly smaller than they were just 30 years ago.

In the Addo elephant national park in South Africa, 98% of adult female elephants have been reported as tuskless—without the tusks they use to find food and water as well as to defend themselves. In the nearby Kruger national park, where hunting is prohibited, just 3% of elephants are tuskless. Many of those elephants will now have died, and as climate change accelerates, the same fate may befall many others.

It is a long-held argument of hunters and hunting lobby groups that shooting animals actually preserves animal populations through the fees that the hunters pay to kill these majestic animals. This is far from the truth. A report co-authored by the UN Food and Agriculture Organisation and international hunting group CIC—the International Council for Game and Wildlife Conservation—has found that hunting companies contribute only 3% of their revenue to local communities.

The fees paid by hunters for killing an animal do not even cover the cost of keeping that single animal alive up to that point. To take the example of Cecil the lion, about which we have all heard—he was killed in 2015 in the Hwange reserve in Zimbabwe—the cost to the park authorities of protection to keep Cecil alive until he was 12 years old was about $1.5 million, but the dentist who killed him paid just $50,000.

Furthermore, it is not true that allowing trophy hunting deters poaching. A US congressional study has found that rhino poaching in the last decade has soared even as the South African Government have encouraged trophy hunting. Nature tourism is much more effective as a tool to support conservation. It not only generates much greater revenues than trophy hunting, but creates more and better-paid jobs for local people. Since Kenya stopped trophy hunting and prioritised nature tourism, tourism in Kenya is generating nearly $1 billion per year. Kenya has benefited financially from stopping hunting.

Trophy hunting is a reprehensible practice that goes against nature. By killing the biggest and best of the race, it is leaving entire species doomed to suffer the evolutionary consequences. It does not bring economic benefit to the area or support conservation in anything like the way that nature tourism does. Does the Minister agree with me that trophy hunting is abhorrent and that we should do everything we can to stop it?

Turning to my second point, I know this is only a 30-minute debate, but I hope the Minister will appreciate that a great many colleagues would have wished to participate if we had had longer. This is an issue of great cross-party significance. Polls consistently show that over 80% of the British public wish to ban trophy hunting imports, and a March 2021 poll noted that 85% were in favour of this happening as soon as possible.

It was heartening to see the commitment to bring forward a ban on trophy hunting imports in the Queen’s Speech earlier this year under the animals abroad Bill, but I and other parliamentarians are dismayed at the progress—or lack of progress—it is making. Every month that passes is another month during which British hunters are killing majestic animals such as lions, leopards and polar bears, and bringing their gruesome trophies back to the UK. Over 170 Members, on a cross-party basis, have signed the early-day motion in the name of my hon. Friend the Member for Chatham and Aylesford (Tracey Crouch) calling for action on trophy hunting imports as soon as possible. Many people such as me do not sign EDMs, and there would be many more signatures if we did.

Will the Minister explain why we are yet to see the animals abroad Bill, despite the fact that the consultation on trophy hunting imports closed in February 2020, nearly two years ago? Covid is no excuse: people do not need to be together to consider the consultation document. It is rumoured that the animals abroad Bill has been indefinitely. Will the Minister please explain exactly what the reservations are? After all, the Bill commands overwhelming public and parliamentary support, which leads to my third point.

As mentioned previously, this week our Government are hosting the COP26 conference in Glasgow, where world leaders and others have gathered to discuss how we can protect the planet for generations to come. That is not just about protecting the planet for humans; we have a responsibility not to eliminate magnificent and powerful species and to conserve the work with nature. We cannot make the laws of other countries, but we can in this Parliament reduce the number of British people taking part in trophy hunting. If we ban the import of trophies, we will have a significant impact on the number of British trophy hunters killing endangered species around the world.

Furthermore, our Government talk about the importance of being a global leader in the conservation and protection of endangered species, yet it remains legal in this country to import the body parts of animals killed for entertainment. Sadly, we are not a world leader in this sphere. France and Australia have already implemented bans on trophy hunting imports of endangered species and have seen no negative consequences on their conservation efforts as a result. The Netherlands has gone further, as we would like the UK to, and has banned virtually all imports of trophies from hunting abroad. Making a commitment such as the Netherlands has will enable us to push other countries for stronger commitments on animal welfare and conservation.

I want to see Ministers pushing other Governments to end trophy hunting imports too. It is a global problem. Will the Minister confirm whether the Prime Minister or any other Government Members at COP26 this week have raised the issue of banning trophy hunting imports with the United States Government? The US is by far the largest importer of hunting trophies in the world, but we will not be able to put pressure on it to stop until we ban the practice ourselves.

I urge the Government to act now to ban in full the import of trophies from the hunting of all animals abroad. That is necessary because it is a barbaric practice. I recognise and welcome the Government’s intention to ban it, but that needs to happen now. There is no reason not to legislate. Legislation has broad and widespread support, and the Government have had plenty of time to consider the consultation.

Finally, we are at a crucial juncture and we must show global leadership on conservation and biodiversity. We cannot convince other countries to end the hunting of endangered animals if it is legal here in the UK. If at the end of this debate the Minister has only one thing to say on this matter, I would like her to tell me when the legislation will come into force. If she cannot say when, why not?

I congratulate my hon. Friend the Member for Mid Derbyshire (Mrs Latham) on securing this timely debate. I also associate myself with her comments about our colleague, Sir David. She is right: he was passionate about animal welfare, and he would have taken part in this debate.

My hon. Friend is also right to say how timely this debate is, because nature and land use is a core theme of the COP26 presidency. It is essential in adapting to and mitigating the effects of climate change and in supporting lives and livelihoods. We seek to lead a global transition towards the sustainable use of land, ocean and natural resources to tackle biodiversity and climate issues together, which as she so eloquently put it affect both humans and animals. I commend her on her success over the past few years in bringing this issue to the fore and in maintaining the spotlight on this important agenda, which has rightly attracted considerable interest and attention.

I agree with my hon. Friend’s remarks at the start of her speech and I hope to talk to one or two of them directly in my response. She knows as well as I do that there are strong views on both sides of the debate. On one side, there are those who consider that well-managed trophy hunting can benefit conservation and support livelihoods. On the other, there are those who find the hunting of endangered species for trophies completely unacceptable.

We received 44,000 responses to our consultation and call for evidence. My hon. Friend is right that the consultation closed in February 2020 and I do not dispute that. As she mentioned, she and the British public want us to get on with delivering the Government’s manifesto commitment to ban the import of hunting trophies from endangered species. The outcry that often accompanies the reports and photos of trophy hunting of threatened animals is clear. To see that, we need only think back to the huge response to the cruel killing of Cecil the lion in 2015 or to last weekend’s reports of trophy hunting of threatened species—this time the polar bear.

That strength of feeling came through loud and clear in our consultation and I look forward to hearing the comments of the Environment, Food and Rural Affairs Committee in due course. The Committee is running an inquiry into the animals abroad Bill and is in the middle of its evidence gathering, before the Bill goes through the usual parliamentary process. I appreciate my hon. Friend’s push for urgency around this matter.

As I say, the strength of feeling came through loud and clear, so we will get on and deliver the change we promised in our manifesto. We will introduce a ban that is comprehensive, robust and effective and that protects many thousands of animals. We will set out our detailed plans and our rationale for action. On timeliness, the only comment I can give my hon. Friend is that we will set those things out soon, including our response to the consultation.

Arguably, this is just the tip of the iceberg because biodiversity is declining at an unprecedented rate. Around 1 million animal and plant species are now threatened with extinction—many within decades—which is more than ever before in our history. Across Government, we are committed to playing our role in protecting the environment, including animals, both at home and abroad.

Internationally, we are investing over £46 million to counter the illegal wildlife trade over the timespan of 2014 to 2022. That includes our well-respected illegal wildlife trade challenge fund, which is a competitive grant scheme established to tackle the illegal trade in wildlife and, in doing so, to contribute to poverty reduction in developing countries. My hon. Friend has a wealth of experience in overseas development and poverty, and her speech intertwined the arguments about the importance of us playing our part internationally to sustain communities. In Malawi, for example, our support from the challenge fund in developing law enforcement capabilities has helped increase protection for endangered species such as elephants and rhinos. The £100 million biodiverse landscapes fund will also tackle the direct drivers of species loss, protecting habitats and supporting local communities as well.

At home, in the Environment Bill, we will set a new and ambitious domestic framework for environmental governance. This Bill will ensure that we leave the environment in a better state than we found it in. It requires a new and historic legally binding target to be set to halt the decline in species abundance by 2030. We are driving forward our ambitious agenda of animal welfare and conservation reforms during the current parliamentary Session and beyond. Further legislation will be introduced as soon as parliamentary time allows—my hon. Friend knows as well as I do that it is not always in her gift or mine to say when that will be, and I am afraid I cannot give her more information than that—to strengthen and secure our position as a global leader in championing the welfare and protection of animals abroad.

I thank my hon. Friend for bringing attention to this topic. I know that she also regularly talks to Lord Goldsmith in the other place. I am sure she will be resolute in continuing to focus on making sure we adhere to that commitment.

Question put and agreed to.

Sitting suspended.

Ethiopia, Sudan and Tigray: Humanitarian Situation

[Hannah Bardell in the Chair]

Before we begin, I remind Members that they are expected to wear face coverings. Given the recent outbreak in Parliament, I expect to see everybody wearing a face covering if they are not speaking, in line with current Government guidance and that of the House of Commons Commission. I also remind Members that they are asked by the House to have a covid lateral flow test twice a week if coming on to the parliamentary estate. That can be done either at the testing centre in the House or at home. Please give each other and members of staff space when seated, and when entering and leaving the room.

I beg to move,

That this House has considered the humanitarian situation in Ethiopia, Sudan and Tigray.

I am delighted to serve with you in the Chair, Ms Bardell. I am very pleased that Members have come to debate the humanitarian situation facing Sudan, Ethiopia and Tigray. The debate could not be better timed for the news that we have had today and in the last few days. I will open with a few reminders of the size of the humanitarian crisis facing people in that area.

In Sudan at this very moment there are 60,000 Tigrayan refugees, who have crossed the border from the fighting in Tigray, and there are still in Sudan, which is not a wealthy country, 1.1 million refugees from historical conflicts in Darfur and other places. As all Members will know, Sudan suffered a coup recently. Huge protests are going on in Khartoum and other cities, the elected Prime Minister is under house arrest and the military are patrolling the streets and trying to restore the previous regime’s methods. I wish the people of Sudan well in their demands for democracy, and I send a message of support to the demonstration that was held outside Downing Street last Saturday.

Ethiopia can now be described only as a country in a state of war. The Prime Minister has gone on national television to ask people to be mobilised to defend the capital, and the society as a whole, and is busy enlisting large numbers of often very young people—he is complaining that they are ill-trained—into the armed forces in order to continue the conflict. That was preceded by—indeed, it continues—many people from Tigray or other parts of Ethiopia who have made their homes in Addis Ababa being attacked, arrested and persecuted by the authorities. There is a whole popular mood against the people of Tigray, who are seen as separatists within the country of Ethiopia. I say that as somebody who is a friend and an admirer of the amazing history of Ethiopia—the one country in Africa that never became part of the European colonisation system.

In Tigray, 2.1 million people are displaced, 5 million are food-insecure, which is about 80% of the population, and at least 400,000 are literally starving, but because of the conflict, aid trucks, relief trucks and support simply cannot get through. Only 15 minutes ago, before I came to the debate, I was watching Michelle Bachelet of the United Nations. She is a wonderful woman and an old friend of mine; I have known her ever since the dark days of Pinochet’s dictatorship in Chile, before she became the President of Chile. A report that I have just received states:

“Michelle Bachelet, the UN high commissioner for human rights, said there were ‘reasonable grounds to believe’ that ‘all parties to the Tigray conflict have committed violations of international human rights, humanitarian and refugee law. Some of these may amount to war crimes and crimes against humanity.’”

She is a very intelligent and normally very cautious person. She does not throw those kinds of allegations out willy-nilly. They are very serious indeed.

My right hon. Friend is making a powerful opening speech. He is talking about the Tigrayan situation, which I think we would all agree amounts to war crimes and crimes against humanity. He mentioned starvation and so forth, and I just want to highlight the issues facing young women and girls. There have been reports that many have been subject to rape, gang rape and other forms of sexual mutilation and torture. Does he agree that, while there is a potential breach of international law, our Government must also show some leadership in bringing an end to what is happening?

I thank my hon. Friend for that intervention—I was actually going to come on to that point next—and she is absolutely right. The abuse of women and girls by the forces in Tigray has been abominable and appalling. The crime of rape has been used as an act of war, and multiple rapes, sexual slavery and the abuse of women have been the order of the day. It is utterly disgraceful, and I hope that when the conflict is over, and all conflicts have to be over eventually, there will be the most thorough investigation of every one of those cases. We have seen rape as a weapon of war in so many places—in Congo and many other parts of Africa, as well as in many other wars around the world—and I hope there is the most thorough investigation and that prosecutions will follow as a result.

To return to the account I was quoting, Michelle Bachelet has said:

“The investigation recounts a report of a massacre of ‘more than 100 civilians’ in Axum, Tigray by Eritrean forces”—

note: the Eritrean forces—

“on 28 November 2020. The victims were ‘mostly young men’ but one witness told the joint investigation team that others were targeted too. ‘EDF soldiers took a 70-year-old man and his two sons out of their homes. They took them to the nearby water tanker, ordered them to lay on the ground and shot all three of them in the head,’”

and so it goes on about a series of other occasions. Again, note that the Eritrean defence forces have become involved in the conflict as well, which is more than unfortunate in the sense that it indicates the danger that the war is about to spread.

Yes, I will in a second. I do think that we have to recognise the seriousness of the situation we are in at the present time—that is why Michelle Bachelet has said what she has said—and I want to put that into historical context, once I have given way.

Is the right hon. Gentleman as confused as I am about the reports of the involvement of Eritrean forces? There are very strong reports that they are indeed involved and committing some of the worst atrocities, but at the same time there is also a denial that they are in that country.

I thank the hon. Member for his intervention, and he is absolutely right. The reports of Eritrean forces being involved are very disturbing because that clearly internationalises the conflict. Verification is obviously difficult when the Ethiopian occupying forces and the conflict itself make it impossible for independent investigators to get there to understand exactly what is going on. One plea I am going to make at the end of my contribution is that international observers be allowed in, so that they can assess what is on.

If I may, I think we should put this in the context of the tragic history of Ethiopia. It has been through all kinds of things, right back to the Italian fascists’ invasion in the 1930s and their removal by British and other forces during the second world war. It has been a party to the cold war, and there has been a massive flow of armaments into Ethiopia from the Soviet Union, the United States, Europe and arms dealers all around the world. It is a country that has seen the most appalling conflict and the most appalling humanitarian disasters, such as the famine of the 1980s.

I pay tribute to the International Development Committee for its report on the humanitarian situation in Tigray. I am delighted that its Chair, my hon. Friend the Member for Rotherham (Sarah Champion), is here, and I hope she is going to speak in this debate. If I may say so, I think the Select Committee puts the history of Ethiopia in summary form very well, and of course the enormous conflict that took place before Eritrea gained its independence and the further conflict that went on during the border dispute.

For goodness’ sake, there has been enough death, wars, conflict and loss of development opportunities without there now being a descent into a massive civil war across Ethiopia. It is always the most vulnerable and the young people who die as a result. The points in the Select Committee report about gender-based violence, on which my hon. Friend the Member for Battersea (Marsha De Cordova) intervened earlier, are so apt and well put. I hope they become centre stage in any UN human rights investigation into the causes and continuation of this conflict.

The most immediate response to this conflict is the two events of 2019, when the Government of Ethiopia were pursuing a more democratic and participatory course and getting a lot of international support for it. There was then, effectively, the break-up of the Government by a change in the ruling party and by the Tigray People’s Liberation Front—removing itself from the Government. The Government in Addis then delayed the election that was to be held in Tigray. The TPLF in Tigray then decided to hold its own election, which it did.

It was claimed that this was illegal under the terms of the Ethiopian constitution and the whole thing descended very rapidly into armed conflict. We then get the deaths, rape and occupation, and huge refugee flows as a result. That is the immediate tragic history that Ethiopia and Tigray have descended into. I hope that in our debate today we can, at least, find out what the British Government think about this and what action they are prepared to take.

The issues we face are four-fold. First, we need to somehow or other get an immediate ceasefire in this conflict so that the food aid, medicine, water and all the other things can get in and so that the thousands who have gone mainly to the Sudan—and some who apparently have also gone to South Sudan, although I am not sure of the numbers—can return home.

Secondly, we need to recognise the consequences for those countries of the massive refugee flows. At the start of my contribution, I gave figures for the numbers of people who are refugees in Sudan—60,000 in Tigray and 1.1 million from Darfur. The media in this country complain about a few hundred refugees coming in across the channel. I am talking about a poor country hosting more than 1 million refugees without the infrastructure or wherewithal to cope with them. That, sadly, is the story of so many poor countries around the world.

Thirdly, who is going to be the interlocutor to bring about a ceasefire? The UN obviously must and should have a role in this. The African Union must and should have a role in this, but it appears that the degree of mistrust, particularly by Tigrayan forces towards the African Union, which is housed in Addis anyway, is one of the problems in bringing about a meaningful ceasefire. I do think there has to be involvement with the African Union, perhaps brought about by the UN itself. It is extremely important that we send that message today.

Fourthly, the arms sales to Ethiopia, Eritrea and Tigray are not huge on the global scale of things—I am not pretending there are massive arms sales—but nevertheless, in a conflict of this nature, rapid-fire machine guns and all those kind of armaments are the instruments of war. We are not necessarily talking about planes and drones and things, but more about those things. The UK sells quite little to Ethiopia. According to the figures I have from Campaign Against Arms Trade, UK arms exports approved to Ethiopia in the last three years amount to only £58,000, and most of that was related to armoured vehicles. Those questions were put. The three known military export applications are from Safariland Group, Harrington Generators and Boeing. I look forward to the Minister saying that there will be no further exports there. EU arms exports to Ethiopia over the last three years are more considerable, amounting to £36 million. I hope we put pressure on the European Union not to allow those arms sales to continue.

The urgent need, as I said, is for food aid to get through. Hundreds of thousands—nay, millions—are suffering from malnutrition or lack of food. There is a huge lack of medicines all across the country, as well as the war crimes investigations and all the rest going on. The situation is that well-armed and presumably well-fed and watered soldiers are able to kill each other in Tigray. Forces of the TPLF are active in Ethiopia and Ethiopian forces are active in the conflict against them. Arms are available for soldiers to kill civilians in a conflict that has to be resolved by a ceasefire and a coming together, so that people may decide their future in peace. All those soldiers are passing starving people—babies who are dying because of malnutrition; women who have suffered the most abominable abuse by those very same soldiers—and the war carries on with the arms that come from God-knows-where, from all around the world. It is the poorest people who suffer, in the worst possible situation.

I hope that we can send a message: we will give all the necessary aid and support that we can to get through this and, above all, we will take the political initiative and support Michelle Bachelet in her determination to bring about a ceasefire and some hope for the future. I am pleased that the Joint Committee on Human Rights, the all-party parliamentary human rights group and the all-party group on prevention of genocide and crimes against humanity are meeting tomorrow afternoon at 2 o’clock to go through all the issues. I urge Members to attend that meeting, which I understand will be online. It will be helpful for us to be better informed.

My purpose in calling the debate was not necessarily to blame the British Government for the whole situation there, but to thank the International Development Committee for what it has done and to ask our Government to give what aid is necessary and, above all—I repeat this—to use our political clout, whatever we have and wherever we have it, to get a ceasefire, to stop the killing, to stop the refugee flows and to let the people of Tigray, the rest of Ethiopia, Eritrea and Sudan decide their own future in peace. That is the best message that we can give.

Before I call Members, I have requested that the temperature be turned up, because I am conscious that it is very cold in here. I intend to call the Opposition spokespeople, including the shadow Minister, and the Minister from 3.28 pm, depending on the votes that we are expecting.

It is a pleasure to serve under your chairship again today, Ms Bardell.

I congratulate my right hon. Friend the Member for Islington North (Jeremy Corbyn) not only on securing the debate and his kind words to the Select Committee, but on the fact that he will not let this go. We need to keep raising the atrocities happening in the region, particularly in Tigray, again and again, because too often the news just moves on while the people stay and the desperation gets worse. I thank him personally for calling the debate.

A peaceful resolution of the conflict seems far off, with fighting intensifying and a state of emergency declared overnight. As my right hon. Friend said, the Select Committee has been monitoring with increasing concern the deteriorating situation in the region and the escalation of humanitarian needs as a direct consequence. Earlier this year the International Development Committee published a report on the situation in Tigray, which included moving evidence from agencies working in the region to address the increasingly complex humanitarian situation. We heard shocking reports of the impact of the conflict, including killings, the systematic use of sexual violence and the use of hunger as a weapon of war. In our report, my Committee urged the Government to use the combination of the UK’s diplomatic clout and development funding to seek a peaceful political resolution to the conflict, and to ensure that aid reaches communities in the region that are in such desperate need for it.

I was pleased to receive the Government’s constructive response to the report, which set out the FCDO’s commitment to working with regional partners in seeking an end to the conflict and focusing on getting humanitarian supplies to Tigray. It is with great sadness that I note that the scale of the challenge in Tigray seems greater than ever. Alongside a deteriorating military situation, the humanitarian crisis is becoming acute and the consequences of inaction increasingly catastrophic.

A constituent of mine has been unable to contact her family since the beginning of the conflict. Their stories are terrifying and upsetting. Does the hon. Lady agree that the Government should outline not only how they will provide aid to the people there, but how to communicate with relatives living in the country?

I completely agree. Many of us, if not all, have constituents with family members over there, and hearing their stories makes it so real and such a live issue for us all; one cannot fail to be moved. Trying to get reliable information is one of the big problems we have had all the way through this conflict.

The UN estimates that at least 5.2 million people need emergency food assistance, with almost half a million people in Tigray living in famine-like conditions. The UN reports indicate that just 1% of those in need of food are being reached, with only half of those receiving more than two food items a week. The UN says that an alarming number of children are suffering with severe acute malnutrition, with numbers increasing by the day, because just a fraction of the humanitarian aid needed in Tigray is reaching that region. Fuel shortages and limits on access to cash have forced a reduction of what remains of humanitarian assistance, with barely $800,000 of the $6.5 million needed per week getting through. Ongoing restrictions on entering the region and an escalation of fighting means that trucks simply cannot get in. Each day, Tigray alone needs around 100 trucks of fuel, food and other supplies, but since 18 October not a single truck has entered. The UN Humanitarian Air Service has been suspended. The situation in Amhara grows more alarming by the day due to the large-scale displacement of people, with reports that electricity and communication lines have been cut.

The international community and Ministers must press the Ethiopian Government and regional partners to ensure that humanitarian agencies have unimpeded access to Tigray despite the current state of emergency. The longer the delivery of aid is obstructed, the deeper and more complex this humanitarian emergency will be to solve. Communities will continue to be decimated by war and hunger will spread. This shows why the Foreign Office must have a robust approach to atrocity prevention. Embassy staff must be empowered to raise concerns about the likelihood of a situation deteriorating and trained appropriately so that they can recognise red flags and escalate concerns before a situation falls into complete disarray. That is why my Committee called on the FCDO to embed an atrocity prevention strategy in its updated country strategy for Ethiopia and neighbouring states.

Our report found:

“A failure to adequately resource the response to this crisis increases the risk of a ripple effect of instability throughout the region.”

The Government identified the east of Africa as a priority region for UK aid spending but cut aid to the region by almost 50%. Aid to Ethiopia has been slashed from £240 million to £107 million, and aid to Sudan and South Sudan is set to be halved. That is having a real impact. Failure to support communities in the region, combined with the lack of an inclusive political settlement, is compromising hard-won gains in security, stability and prosperity in Ethiopia. We are seeing the impact of that failure, with refugees fleeing to Sudan, itself in the grip of a military coup. The Government are right that the east of Africa should be a priority, but it is time they backed their words with action and engagement. We must step up, mobilise and work with partners in the region to meet the humanitarian needs of communities and prevent the further spread of instability. If we fail to act now, we will count the costs for years to come.

It is a pleasure to serve with you in the Chair, Ms Bardell, although it is very depressing to be addressing this subject again. I asked an urgent question on the issue awhile ago and took part in the debate led by the hon. Member for Rotherham (Sarah Champion). As chair of the all-party parliamentary group on Ethiopia, I thank the right hon. Member for Islington North (Jeremy Corbyn) for introducing this debate and for his continued interest. I have spoken with him and have attended debates with him. I know he approaches the debate as a friend of Ethiopia, as does the hon. Member for Rotherham.

The situation is very depressing. I am very pleased that the new Minister for Africa is with us today to reply to the debate. All too often we see the media and the world focus on other conflicts, understandably perhaps—in Syria, or the Balkans or other areas of the world. Conflicts in Africa tend not to be focused on. They tend not to be reported as much as those in other areas.

I remember feeling ashamed in 1994 of the fact that the world stood back and watched 800,000 people killed in Rwanda. I visited Rwanda shortly after. I do not want to be too graphic, but I walked through the bones of some of the people who had been slaughtered in that terrible conflict. The world stood and watched. We cannot do that again—we cannot just watch, as we see the crisis growing and the tragedies increasing. We have heard reports of forces moving through Ethiopia towards the capital, Addis Ababa, just recently. The report produced by the Joint Investigation Team highlights the most horrific crimes that are taking place. We have to focus on what is happening—we have to concentrate—so I am glad that this debate is being held today, with the Minister present, but it is not easy to know what to do.

As I said in my intervention, reports are conflicting. For the reasons that the right hon. Member for Islington North gave, it is very difficult to know exactly what is going on, who is to blame or how we stop it happening. There is, however, a growing humanitarian crisis, and it is also heading towards an economic crisis. The right hon. Gentleman touched on the problems that Ethiopia had in the mid-’80s. Since then, the country has made great strides and is far more resilient, but millions of people are still dependent on food aid every year. That situation is likely to get so much worse, the more the conflict grows.

I have the privilege of being the Prime Minister’s trade envoy to Zambia and Angola. On my recent travels, I have spoken to companies who want to invest in Ethiopia. They have told me they will not and cannot do that when the conflict is raging—indeed, getting worse. That situation will make people in Ethiopia even poorer than they are now. We cannot simply stand by and watch that happen.

It is difficult to know what to do. The right hon. Gentleman mentioned Ethiopia’s past. It has a troubled past, but also a very proud past, as I said in the debate led by the hon. Member for Rotherham. Sizeable Christian and Muslim populations have lived peacefully together for many years. There are more than 80 tribes and 80 languages in the country, which have not in themselves led to problems. The country has enjoyed a great deal of peace, and economic growth that is the envy of the western world. It has so much going for it; it is seen as a country with huge potential. There is an awful lot in favour of Ethiopia and the way it can develop as a country. However, as we have so often seen—the right hon. Member for Islington North expressed great exasperation and frustration at this—we see the descent into war, which cannot benefit anybody. Even the victors, if there are any victors in this conflict, will not win overall; they will lose, too. That message must get through to all the players in this conflict in Ethiopia.

I do not have any solutions, but I repeat the questions I have asked before. Could the United Nations be doing more? I am not an expert on this, but is it time for a peacekeeping force to be sent by the United Nations? I really do not know the answer to that question, but I put it to the Minister: is that what we should be looking at now, before the situation becomes unmanageable? Could the African Union be doing more to bring about peace and a ceasefire in this conflict? Could more pressure be put on the Eritrean Government to withdraw any forces they have in Tigray? As we have heard in previous debates, many of the worst atrocities are being laid at the feet of people coming in from Eritrea.

Can we somehow find a way to get aid to the people who so desperately need help? We often hear people say that we should not be giving aid to countries that are dictatorships—actually, we do not, but it is important to note that the people in greatest need in the world are those in war-torn countries. The secret is to get under the radar and try to help those people as best we can.

The right hon. Member for Islington North also mentioned the arms that are getting through to the sides in Ethiopia. There was a very brief BBC report last night, showing what I think were rebel groups, who seemed so well armed. Who on earth is providing arms at such a level to those people? That needs to be addressed.

This is a deeply worrying situation. I do not expect the Minister to have any easy answers or to come up with any solutions today. All I ask of her—I know she will do it—is to speak to our Prime Minister and the Cabinet to see whether there is more that we can do to try to bring about the ceasefire that the right hon. Member for Islington North correctly called for, before this situation becomes an absolute catastrophe.

Ethiopia is a great country and one I am very proud to be a friend of. I have visited it many times and I want to visit again as soon as possible. I do not want to see Ethiopia disintegrate into an absolute shambles. We do not need that. There are more than 100 million people in that country, and they need some help. They need us to do everything we can to help them. That is not easy, as I say, but I know the Minister will do everything in her power to raise this matter at the highest levels of Government in this country, and hopefully we can try to find a way through.

It is a genuine pleasure to serve under your chairmanship, Ms Bardell, albeit on a very sobering topic, as has been outlined by the speakers we have heard so far. I congratulate the right hon. Member for Islington North (Jeremy Corbyn) on securing this opportunity to consider the issue again.

We considered the conflict back in September, and one of the messages of that debate was the risk of deterioration of the situation. In fact, one of the questions I asked was:

“What if the worst has yet to come?”—[Official Report, 8 September 2021; Vol. 700, c. 95WH.]

The speeches we have heard and the evidence that has been presented, particularly the findings today from the UN High Commissioner for Human Rights, show that the situation has got considerably worse, and that must be of real concern to us. Bringing the issue back to the Floor of Westminster Hall keeps it alive and gives a new Minister an opportunity to respond and to think again, as the hon. Member for Tewkesbury (Mr Robertson) has just said, about what opportunities there might be for the UK to exercise some influence.

I spoke in the last debate about the particular challenges in Oromia. They have become more acute as a result of the developments in recent weeks and months. I have a constituent who is from that area and who is passionate about the right of the people there to have democratic self-determination and the kind of political autonomy that regions, countries and nations in our part of the world enjoy. However, we enjoy that peacefully and democratically. We resolve our differences in forums like this, not by taking up arms or through the horrific war crimes being reported. Even people who hold those genuine aspirations ought to live up to the standards that they are seeking.

That also speaks to the deep-seated and historical regional and tribal tensions across the whole of Ethiopia and the wider regional context. As the right hon. Member for Islington North said, Ethiopia was never a colony in the way that many African countries have been, but that does not mean that it has not been affected by the colonisation and map-drawing that went on in the continent all those years ago. That is why the issue of Eritrea keeps raising its head.

Not long ago, I was in the right hon. Member’s constituency for the photo exhibition by Eritrea Focus, commemorating the 40th anniversary of the political imprisonment of journalists and politicians in that country, the deterioration and ending of democracy in any meaningful form, the militarisation of the country, the influence that it still apparently seeks, and the destabilising effect that appears to be having in the conflict in Ethiopia. I should say that my hon. Friend the Member for Argyll and Bute (Brendan O’Hara), who we will hear from, was also at that important event.

I would draw the Minister’s attention—I think I sent it to her predecessor, and I will certainly send it to her—to the report produced by the Oromia Support Group detailing the atrocities and extra-judicial killings of the people of that region, mostly by the national Government, by their assessment. However, it is very clear, from other reports and today’s debate, that all sides must take responsibility for the violence that has been experienced.

The hon. Member for Tewkesbury said that he saw the BBC report; I heard it on Radio 4, because the BBC these days multitasks in that way. It was incredibly sobering, and very worrying to hear of the spiralling effect that now appears to be happening. Violence is begetting violence. There was a woman who had to flee because her son had been brutally murdered.

Is it not the case, time and again, that women are often the worst victims of violence in that form? Sexual violence against women is also something that we should point out when we talk about this terrible conflict.

The hon. Lady is absolutely right. Hearing any story from mothers, like that one, is heartbreaking. She is right; women are affected—they are victims, if she wants to use that word. Women could also be a big part of the solution. If women’s voices were heard more frequently in these debates, in the peace forums and in the democratic institutions—such as exist—in those countries, perhaps we would not be seeing this level of violence. I think that is an incredibly important point.

As I said, violence is begetting violence; the attempts by the Ethiopian Government to root out the Oromo Liberation Army lead to further resentment of the central Government and less willingness to engage with processes. That leads to displacement across the region and into neighbouring countries, including Sudan, which is also a topic for this debate. It is increasingly clear, as others have said, that there needs to be an external brokering of peace. Whether that is the United Nations, the African Union, the European Union or some other body, the UK is a key player—either directly, as a member of some of those institutions, or through important relationships to them—and it must play its role.

I want to echo some of what the Select Committee Chair said about aid. The Library briefing shows—even before the aid cut from 0.7% to 0.5% of GDP—the decrease in overall bilateral aid since 2015 to Ethiopia, but within that, the increasing amount of money being spent on humanitarian response. That is a very stark lesson in basic development theory: if we stop spending money on long-term development projects—on long-term peacebuilding, infrastructure, education and so on—then all of a sudden we find ourselves spending money on humanitarian relief, on trying to resolve the problems of conflict and war, and at the end of the day, the problem is not being resolved; it is spiralling.

The Government must look again at their budget. It is all good and well for the Chancellor to say in the Budget that we will get back to 0.7% before the end of this Parliament; but that will not undo the damage that is already being done. Every time the Government say that they will increase support to Ethiopia, that is great, welcome and necessary but it means that, by definition, somewhere else is suffering; somewhere else is experiencing a cut because the overall budget has declined. It was going to decline anyway because GDP had gone down as a result of the pandemic—we all understand that—but this is adding to that unnecessarily.

At a time when the Government are supposed to be showing global leadership, which we are all calling for in this debate, the stark facts are there for anyone to see who has picked up the Library report or reports by the International Development Committee. Sadly, I will not be able to make tomorrow’s APPG being organised by the hon. Member for Putney (Fleur Anderson), which the right hon. Member for Islington North mentioned, but I am looking forward to reports from it. I strongly encourage the Minister to pay attention to that. When we had a briefing before the last Westminster Hall debate, some very useful points, with strong and clear recommendations, were made, and I suspect some of those will be heard.

This has been an important opportunity to consider these issues, especially given how rapidly the situation is changing. We appreciate that the opportunity for the UK Government is limited, but that does not mean that it does not exist. I very much hope that the new Minister will be willing to look at this afresh and I look forward to hearing what she has to say in response.

It is a pleasure to serve under your chairship, Ms Bardell, and to follow the hon. Member for Glasgow North (Patrick Grady). I am very grateful to my right hon. Friend the Member for Islington North (Jeremy Corbyn) for securing this debate. It was only a couple of months ago that we last talked about this region and it is timely to talk about it again. Every day the news is getting worse, and the situation is extremely worrying. We need to give as much airtime as possible to what is happening in the region, because it is truly shocking.

I agree with the hon. Member for Glasgow North that Ethiopia is a beautiful country. I have been to Addis Ababa and enjoyed great hospitality there. While it is already a beautiful country, it also has potential. We want it to have a better future—that is our hope for the people of Ethiopia, Tigray and Sudan.

I speak as a member of the all-party parliamentary groups on Ethiopia and Djibouti and on Sudan and South Sudan, and I am also chair of the APPG on the prevention of genocide and crimes against humanity. I am delighted that there have been two advertisements for our meeting tomorrow, at which Alice Wairimu Nderitu, the UN special adviser on the prevention of genocide, will speak. What she will have to say will be very pertinent to the current situation.

The eyes of the world are not on Ethiopia, Tigray and Sudan, but they should be. It is an important time to put on the record what is happening right now, and to hear from the Minister what the Government are doing about it. I welcome her to her new role and look forward to hearing about the meetings she has been holding and what has resulted from them; what visits she has planned to the region and what she hopes to get out of them; and her plans for aid. We have been talking about aid cuts and the false economy they create. There are different decisions to be made about aid to the region.

As a country, we were so proud at the time of Live Aid to stand up together to support the people of Ethiopia in their time of crisis. We want to do the same again. We want to know what is happening in the region, with which we have a great bond. Like other Members, I have constituents with family members in the region. On Monday I spoke to a Tigrayan constituent who is very concerned about her family. She has not been able to hear any news for so long because of the blackout, which must be very worrying. As we stand here today, we know that many people in this country are concerned about their relatives in the region.

The UN Secretary-General has said of Tigray:

“A humanitarian catastrophe is unfolding before our eyes.”

It could be argued that the previous Foreign Secretary took his eye off Afghanistan, but I hope to hear from the Minister today that that is not the case with Tigray. More than 5 million people in Tigray require immediate humanitarian assistance. At least 54 organisations are providing aid and services. I join other Members in paying tribute to the brave humanitarian workers on the ground right now, in very difficult circumstances, at great risk to themselves.

However, there are significant gaps in assistance, which disproportionately affect Ethiopian women and girls. I echo what we have heard in today’s debate: it is women and girls who are disproportionately the victims of war. Rape is being used as a weapon of war and we need to know more about that. They have virtually no access to livelihoods, often living in insecure environments.

We are also witnessing a refugee crisis because of the violence. In December 2020, the United Nations High Commissioner for Refugees reported that 46,000 Ethiopian refugees had arrived in Sudan since the start of November and they were continuing to arrive in their hundreds. It is hard to imagine what that is like. If we could see it more clearly, if we knew more about the situation, I am sure there would be more demand for more action to be taken.

The numbers are now estimated to be more than 60,000, including Eritrean refugees. More worrying still, a famine is looming. According to the Tigray external affairs office, 150 people died of hunger in August. The UN believes that around 400,000 people are facing famine-like conditions. Millions are also on the brink of hunger in the Afar and Amhara regions, which share a border with Tigray. UNICEF recently alerted that more than 100,000 children in Tigray could suffer from life-threatening severe acute malnutrition in the next 12 months, which will affect them for the rest of their lives. That constitutes a tenfold increase to the annual average.

Deaths are also occurring due to sickness that could previously have been treated or prevented. Prior to retreating, Eritrean forces had looted Tigrayan infrastructure extensively and destroyed clinics, equipment, medicines and medical records, putting years of development back instead of forward. In March, Médecins Sans Frontières reported that 70% of the 106 medical facilities that its teams had been allowed to visit had been looted and only 13% of them were functioning fully, undermining medical treatment for those in need. That is truly frightening and it is happening on our watch.

As mentioned earlier, Michelle Bachelet, the UN High Commissioner for Human Rights, reported that

“all parties to the conflict in Tigray have…committed violations of international human rights…and refugee law, some of which may amount to war crimes and crimes against humanity.”

Those crimes need to be investigated. We need to know we have the strong evidence to bring to justice those who are committing these crimes. We cannot let this go untried. The justice we need means that we need to get the evidence, so independent investigators need to be there on the ground.

Turning to Sudan, I am distressed at the graphic reports of the use of excessive and lethal force against protestors, the arbitrary detentions, their enforced disappearance and torture, and other forms of ill treatment. Those patterns of violations are consistent with Sudan’s long and extensively documented history of abuses against protestors, human rights defenders and perceived political opponents. Sudanese forces have regularly used excessive force, including beatings, tear gas, rubber bullets and live ammunition against protestors, including during the transitional period.

When the new country of South Sudan was formed, the world cheered. It was exciting to have a new country with a proud future looking forward to peace. That long conflict had been put to one side; the peace process had won out. I want to put on the record that it had been led by a lot of local women, who were successful in winning that peace. The joy at which South Sudan was welcomed was amazing to see, but it is so disheartening and worrying that the instability in the region is now threatening that peace.

I want to hear from the Minister that the UK is stepping up and leading on Sudan. The Government need unequivocally to call on the Sudanese military to immediately end the arbitrary detention of all detained political leaders, journalists and human rights activists, and refrain from torture and other forms of violence against protestors; to impose targeted sanctions on those responsible for the coup and for ongoing human rights violations; and to demonstrate global leadership at a special session of the UN Human Rights Council by calling for an independent UN fact-finding mission on Sudan.

As I have made clear time and again in this House, the Foreign Secretary and the Minister need to have their eyes firmly fixed on what is unfolding in Ethiopia and Tigray. In particular, I call on the Minister urgently to consider the imposition of sanctions on the leaders of Ethiopia and Eritrea, who bear ultimate responsibility for human rights violations committed with impunity by their respective armed forces. No one come out well form this conflict. Atrocities are definitely being committed by both sides—I want to be clear about that—and we need to make sure that their leaders are investigated and stand trial.

We need to lead international efforts, including at the UN Security Council, to ensure an immediate cessation of hostilities, the complete departure of Eritrean forces, and unimpeded access to Tigray for local and international aid agencies—those lorries must get through.

As was said earlier, we need an atrocity prevention strategy at the heart of our funding for those countries. We need to stop the aid cuts. What meetings has the Minister had with civil society groups working in the region, the African Union and leaders in Sudan, Tigray and Ethiopia? Finally, I urge the UN Human Rights Council to mandate a truly independent inquiry into alleged human rights violations in Tigray and to secure justice.

I thank my right hon. Friend the Member for Islington North again for securing this debate. I pledge to do all I can to keep what is happening in Ethiopia, Sudan and Tigray on the global agenda. Millions are suffering. We cannot forget them. We must act now.

I thank Members for being so succinct. I am conscious that the temperature has dropped further, so if Members or staff need to don further layers, they have my support. I call the first of our Front-Bench speakers, the Scottish National party spokesperson Brendan O’Hara.

It is a genuine pleasure to see you in the Chair for today’s extremely important and particularly timely debate, Ms Bardell. I also thank the right hon. Member for Islington North (Jeremy Corbyn) for securing this debate and for the manner in which he opened the proceedings this afternoon, on the day that the joint report of the United Nations Human Rights Office and the Ethiopian Human Rights Commission joint report has been published. And as we have already heard from several Members, the debate falls on the first day of the anniversary of the start of the armed conflict in Tigray.

As we heard from the hon. Member for Putney (Fleur Anderson), this debate also gives us the opportunity to discuss last week’s military coup in Sudan and the consequences it will have not just for the unfortunate Sudanese victims but for the region as a whole, which seems to be descending further into conflict and violence.

As the right hon. Member for Islington North said, the joint report of the UN Human Rights Office and the Ethiopian Human Rights Commission was published this morning. It points the finger of blame at all sides, saying unequivocally that all parties to the Tigray conflict have committed violations of international human rights, and of humanitarian and refugee law. Some of these may amount to war crimes and crimes against humanity. It also says that most violations in the period covered by the report were committed by Ethiopian and Eritrean forces, but recently there have been increased reports of violations by Tigrayan forces as well. No one emerges with clean hands. As always, it is innocent civilians who suffer at such times.

Over the past 12 months, the people of Tigray have had to endure unimaginable horrors as war has raged through their country. Tens of thousands of people have died, millions have been displaced, and reports of crops being destroyed, property looted, massacres and summary executions of civilians are all too common. Almost inevitably, as the hon. Member for Putney said, there have been reports of widespread humanitarian abuses, including the use of rape and sexual violence against women and girls as a weapon of war. In the words of Sir Mark Lowcock, the former UN under-secretary-general for humanitarian affairs, it is being used

“as a means to humiliate, terrorize, and traumatize an entire population today and into the next generation.”

Six months ago, the UN reckoned that around 22,500 women would require support as a consequence of conflict-related sexual violence. Therefore, we have to assume that today, sadly, many more Tigrayan women and girls are going to have to seek help. They join that depressingly long list of women and girls from just about every part of the world who have been raped and abused by men carrying guns.

What is worse, those men carrying guns act in the almost certain knowledge that they will never be held to account for their actions. At the very least, the women and girls who have suffered those awful crimes deserve justice and those perpetrators not being allowed to believe that they act with impunity. I urge the Government to work with the UN, the non-governmental organisations and other international partners to ensure that all countries have legislation to ensure effective prosecution of sexual violence as a stand-alone international crime.

Despite the Ethiopian Government’s attempted communications blackout, reports continue to filter through of appalling crimes being perpetrated against the civilian population. We have heard that about all sides—let us be clear that all sides are responsible—but in particular about Ethiopian and Eritrean forces. In May this year, the US-based Catholic News Service ran a piece on the testimony given by an Ethiopian Catholic priest, who said that killings, abduction and rape by Ethiopian soldiers and their Eritrean allies were commonplace. The priest, who for obvious reasons did not want to be identified, accused the Ethiopian troops and their allies of ethnic cleansing:

“They want to annihilate Tigray. By killing the men and boys, they are trying to destroy any future resistance. They want to make sure that nobody can question their actions in future…They are raping and destroying women to ensure that they cannot raise a community in future. They are using rape and food as weapons of war.”

His observations echo those of the Patriarch Mathias, head of the Ethiopian Orthodox Church, who accused the Ethiopian army and its allies of the highest form of cruelty and brutality in Tigray.

War and conflict, however, do not exist in a vacuum. As the hon. Member for Rotherham (Sarah Champion) said, on top of everything else people have suffered, they now face the prospect of famine. Ninety per cent. of the Tigrayan population are in urgent need of humanitarian assistance, including 400,000 people who face famine-like conditions already. Millions are on the brink of hunger, food stocks that ran out at the end of August are not being replaced, fewer than one in 10 of the trucks required to carry food and fuel to the people of Tigray has made it through, and 100,000 children in Tigray are suffering from life-threatening acute severe malnutrition and could die in the next 12 months.

The hon. Member for Tewkesbury (Mr Robertson) was absolutely right to draw a parallel between what is happening in Tigray and what happened in Rwanda in the ’90s. We cannot allow history to repeat itself. By any measure, this is a deep humanitarian crisis. As the head of the UN Office for the Co-ordination of Humanitarian Affairs said in September, it is a “stain on our conscience”.

Similar to the Chair of the Select Committee, the hon. Member for Rotherham, and my hon. Friend the Member for Glasgow North (Patrick Grady), I ask the Minister in her response to the debate to tell us what assessment has been made of the impact of the Government’s cut to the overseas aid budget on the situation in Tigray. Also, what initiatives have been taken by her Department to support the United Nations and other agencies to prevent the humanitarian crisis from deepening? What have been the most recent discussions between the FCDO and the Governments of Ethiopia and Eritrea to bring the conflict to an end? What is her Department doing to ensure that those who use or encourage rape and sexual violence as a weapon of war are brought to justice?

At the start, I said that the crisis took a turn for the worse last week when there was a coup in Sudan. The military dissolved the transitional Government and seized control, arresting and imprisoning Government members and putting Prime Minister Hamdok under house arrest, in chilling echoes of the oppressive regime of Omar al-Bashir. It is extremely worrying that members of the former Government have now found themselves in hospital. We have all seen or heard reports of excessive illegal force being used against civilian protestors, with at least three people killed last week. Exact numbers remain unknown, as a result of an internet blackout. Sudanese doctors have reported a series of other injuries from beatings, suffocation on tear gas and being run over. [Interruption.]

Order. The sitting is suspended for 15 minutes if there is one Division in the House, or 25 minutes if two Divisions happen, as expected.

Sitting suspended for Divisions in the House.

On resuming

Thank you, Ms Bardell. It is a pleasure to be back. Picking up where I left off, as we have heard from the right hon. Member for Islington North, the types of human rights violations that we are currently seeing in Sudan are entirely consistent with that country’s long and documented history of abuses against protesters, human rights defenders and those perceived as political opponents of the regime. In addition to the questions I asked regarding Tigray, I would appreciate if, in replying to the debate, the Minister would tell me what contact, if any, has been made with the leaders of the military coup regarding the detention of the Prime Minister and members of his Cabinet. What assessment has her Department made of the impact of the coup on the stability of the region as a whole? Has she or her Department had any contact with Sudan’s nearest neighbours about the potential impact they think this coup will have on them? Would she clarify the current position on UK arms exports to Sudan and if and how, in light of the coup, that will be reviewed? Likewise, on the levels of military support currently being provided by the UK to the Sudanese army, how does she see the coup affecting that?

To follow up the point from the hon. Member for Putney, what use is the Government planning to make of Magnitsky sanctions against military leaders in Sudan? If I could add to that Ethiopia and Eritrea as well, which are complicit in these appalling violations of human rights, both in Sudan and Tigray. Finally, I want to thank once again the right hon. Member for Islington North for securing this debate and the hon. Members for Rotherham, for Tewkesbury and for Putney for their contributions. It is vital that this debate is not allowed to slide off the agenda and lose public attention. People are depending on us to keep it in the spotlight. I am glad to be part of that this afternoon.

It is a pleasure to serve under your chairship, Ms Bardell. I thank my right hon. Friend the Member for Islington North (Jeremy Corbyn) for securing this debate. I thank my hon. Friend the Member for Rotherham (Sarah Champion), the hon. Members for Tewkesbury (Mr Robertson) and for Glasgow North (Patrick Grady), and my hon. Friend the Member for Putney (Fleur Anderson), who have contributed to an excellent and timely debate on recent events in both Ethiopia and Sudan, and the first anniversary of hostilities in the Tigray region of Ethiopia.

These issues have, sadly, received far too little attention globally. I want to thank my hon. Friend the Member for Cardiff South and Penarth (Stephen Doughty), who could not be here today, and other Members for all that they have done to raise awareness of these issues, challenging the UK Government on their response over many months. I cannot emphasise enough the moment of peril we face in the region, or the ordinary civilians who, as ever, bear the brunt of instability and conflict and, indeed, of the wider risk to peace, prosperity and stability in a crucial region of Africa.

We have a long and complex history and responsibility with both Sudan and Ethiopia and a strong interest from the British people in both countries. The human-made famine in Ethiopia in the 1980s is seared in the hearts of the British people, as stated by my right hon. Friend the Member for Islington North. Sudanese and Ethiopian communities across the UK are right to be deeply frightened and concerned by recent events and what they may mean for their loved ones, as stated by my hon. Friend the Member for Rotherham, who is Chair of the International Development Committee. The Labour party stands in solidarity with them for peace, democracy, human rights and the humanitarian principle, and urges the UK Government to do all they can to ensure that that is upheld, rather than cutting our aid, our influence and our international leadership at such a crucial time.

I begin with the situation in Ethiopia, in Tigray and beyond. I am deeply concerned about events in recent days that appear to suggest a further descent into conflict and instability, which can only harm the people of Ethiopia, regardless of their politics, ethnicity or regional origins. Reports of the conflict widening, a state of emergency and the risk of conflict reaching the capital, Addis Ababa—the home of the African Union—should be a wake-up call to the world.

I want to state, as I am sure the Minister will, our desire to see, first, a return to peaceful dialogue; secondly, full humanitarian access and an end to attacks and restrictions on humanitarian personnel and operations; thirdly, urgent, full and independent investigations into the atrocities that have been committed, and the full force of international justice brought to bear on the perpetrators, whoever they may be, including the use of targeted UK sanctions under the Magnitsky regime.

It is nothing short of a tragedy, and we need an immediate ceasefire. Ethiopia had been a global success story, moving towards a democratic society, lifting millions out of poverty and acting as a bastion of stability. Ethiopia had been one of the largest recipients of UK aid, which has grown steadily along with our partnership in trade and other areas.

It is approaching a year since the clashes broke out in Tigray between the Tigray People’s Liberation Front and the federal Government. Ethiopia now risks falling into a lethal civil war, undoing decades of peace and prosperity, especially for those in the regions of Tigray, Afar and Amhara. Tens of thousands of refugees have already spilled over the border into Sudan, whose own Government have now been hijacked by a military coup, or have been coerced back into Eritrea, the very country so many were running from, given the history of conflict between the two countries. I am also deeply alarmed by reports of disappearances and targeted attacks on Tigrayans outside of Tigray.

This comes on top of existing economic and health crises and a growing food crisis, with tens of thousands facing the risk of famine. Thousands of Tigray’s children face life-endangering acute malnutrition, a condition that will likely affect their development if they survive. 100,000 could die from the condition in the next year alone. The UN Office for the Coordination of Humanitarian Affairs recently stated that in one week in early October, only 52,000 people were reached with food, or 1% of the 5.2 million

“targeted population in Tigray, in which half of them received only one or two food items.”

Some 400,000 people in northern Ethiopia are now facing famine-like conditions, as mentioned by my hon. Friend the Member for Putney. In addition, thousands face the prospect of no banking services: no cash, and complete disruption to commercial activities. Little fuel has gone into Tigray since August; organisations cannot work without fuel as they cannot travel to more remote areas. Medicines have not been going into the region either.

I therefore welcome the Government’s announcement that they have increased aid to Ethiopia by another £29 million, but the United Nations Office for the Co-ordination of Humanitarian Affairs has reported that it still faces a funding gap of some £270 million. Staggeringly, UK aid to Ethiopia has in fact decreased by 64.3% between 2018 and 2021 estimates, as stated in the FCDO budget reports.

Would the Minister say what financial assistance the UK has provided to Ethiopia since the onset of the crisis? Has that support been part of the regular official development assistance budget? Will the Government further increase their support, given the worsening situation? As my hon. Friend the Member for Cardiff South and Penarth has repeatedly asked Ministers, has total support for Ethiopia gone up or down?

We have also heard shocking reports of 10,000 rapes—an estimate that does not take into account the past several months—in a region where only around 9% of health facilities are functional; of those, only a third have the capacity for clinical management of rape. Amnesty International’s recent report on sexual violence in Tigray is damning. It highlights the sadistic brutality that is being inflicted on women by parties to the conflict, including members of the Ethiopian national defence force, the Eritrean defence force, the Amhara regional police special force, and Fano, an Amhara militia group. In the report, Agnès Callamard, Amnesty International’s secretary general, says:

“It’s clear that rape and sexual violence have been used as a weapon of war to inflict lasting physical and psychological damage on women and girls in Tigray. Hundreds have been subjected to brutal treatment aimed at degrading and dehumanizing them,”

Yet this is only the start of the crisis facing Tigray and other affected regions.

Ethiopia is also facing the fifth largest covid-19 outbreak in Africa. OCHA reports that only 3% of Tigrayans have been reached with essential sanitation and hygiene messages. Since Members last met to discuss this disaster, little has changed in terms of the human suffering other than that its extent has worsened. The UN recently stated that, from 18 to 28 October, no trucks with humanitarian supplies were able to reach Tigray, and from 1 July to 28 October, only 15% of the trucks needed were able to enter the region. Senior UN staff have been denied access, including the country heads of UNICEF and the head of OCHA. The UN recently announced that it has cancelled flights to the capital, Mekelle, and suspended aid delivery activities as a result of Government-led airstrikes in the area. UN aid chief Samantha Power has said:

“This shortage is not because food is unavailable, but because the Ethiopian Government is obstructing humanitarian aid and personnel, including land convoys and air access.”

I ask the Minister what assessment she has made of humanitarian access for civilians caught up in this conflict, and what consideration is being made of the growing evidence of serious human rights abuses and crimes against humanity? How is evidence such as that brought to public attention by the BBC World Service and human rights organisations being used to ensure that those responsible do not escape justice? She will know that the Office of the UN High Commissioner for Human Rights has now released a joint report with the Ethiopian Human Rights Commission that investigated abuses between November 2020 and late June 2021. Given the continued gravity of this situation, we call on the UK urgently to support the establishment of an independent investigation by the UN Human Rights Council.

As we all know—and my right hon. Friend the Member for Islington North raised this—the Sudanese transitional Government have been hijacked by a military coup, and I welcome the common view across the House and the international community condemning these events. For Labour, I repeat our complete condemnation of this coup, joining the Government, the UN and other international partners. This is nothing short of a betrayal of the hopes of the Sudanese people after decades of repression and the denial of human rights.

This comes at a critical time for the people for Sudan, after reports that heavy rainfall has led to hundreds of thousands of people being affected and that relief stocks, especially of WASH—water, sanitation and hygiene—products, are depleting. The country currently has 9.8 million severely food-insecure people and 1.1 million refugees. In addition, we know of at least 60,000 refugees from Ethiopia who have fled a war zone to those famine-like conditions. Can the Minister comment on the condition of those refugees, and what humanitarian support and assistance is being provided?

Last Monday, General Abdel Fattah al-Burhan took power from the Sudanese transitional Government and declared a state of emergency. Thousands have taken to the streets to protest against this attack on democracy, and reports suggest that several people have been killed and hundreds injured in clashes with armed forces in the capital. Live ammunition has reportedly been used on civilian protesters. Can the Minister confirm whether contact has been made with the general since the urgent question last week, and what action is being taken?

While UK overseas development aid depends on the recipient country upholding its people’s rights—and this military Government have not done so—millions are in need. It is shocking that the UK Government have in effect cut Sudan’s aid by £580 million for 2022, based on estimates, so will the Minister now reconsider those cuts to vital humanitarian assistance for both Sudan and Ethiopia? What assessment has the Minister made of the risk to international judicial processes against former President Bashir for crimes committed in Darfur and elsewhere, as well as against those responsible for more recent massacres?

While the Government pivot to the Indo-Pacific, cut our development budget and weaken our alliances and influence, the situation in east Africa and the horn of Africa goes from bad to worse, with consequences reaching far beyond the regional environment. If we are to avoid catastrophe for the ordinary women, men and children of Ethiopia and Sudan and avoid a descent into even worse consequences across the region, the Government must end their retreat from the world stage, step up, and show some desperately needed moral and political leadership.

It is a pleasure to serve under your chairmanship, Ms Bardell. I congratulate the right hon. Member for Islington North (Jeremy Corbyn) on securing this important debate, and I thank all hon. Members for their contributions.

The situation in Ethiopia is truly dire. It is worsening and very fast moving. In recent days, we have seen a further expansion of the conflict to the town of Dessie and beyond, and states of emergency have been called, first, in the Amhara region and, yesterday, nationwide. The provisions of those measures are deeply concerning; increased military powers place restrictions on gatherings and call for civilians to bear arms. We updated our travel advice last week, and again last night. We are reviewing this continually; British nationals in Ethiopia should check the website to make sure that they have the most current advice.

We should remember that this has been going on for a very long time. We are at the first anniversary of the start of this conflict. Right now, 7 million people in Tigray and the neighbouring regions need humanitarian assistance—the highest number of people in catastrophic food conditions since the 2011 famine in Somalia. The risk of widespread loss of life is high. Furthermore, humanitarian operations in Tigray are effectively suspended; no food or cash has been able to enter Tigray since 18 October. There have been no fuel deliveries since the beginning of August. There are currently 369 trucks trying to get aid, including medicines, into Tigray. On top of this, Government of Ethiopia airstrikes over the last three weeks are reported to have killed more than 20 civilians, including six children, and injured more than 70. This appalling ongoing situation is causing acute human suffering.

Before the violence had even started, Ethiopia was already suffering from the impacts of climate change and ecological issues—the issues we are discussing in Glasgow this week, and I just got back overnight. We should be focusing our attention right now on combatting these long-term climate impacts and on how we can use our £2.7 billion adaptation budget—about half of which will go into Africa—to help countries such as Ethiopia. Instead, we are seeing increased conflict, which is simply compounding human suffering. Today, children in Tigray are dying from malnourishment.

The response to the humanitarian crisis continues to be hampered, not only by the intolerable blockade, which in itself is intolerable. At the end of September seven key UN officials were expelled, and in October an airstrike took place while a UN humanitarian air service flight was in the air, putting humanitarian workers in grave risk. That should never have happened. Shockingly, 23 humanitarian workers have been killed in Tigray this year, including staff working on UK-funded programmes. The UN and NGOs are now withdrawing their staff from the region.

In seeking this debate, hon. Members are right also to consider the impact of what is happening in Sudan, which is facing significant internal challenges. I visited Sudan two weeks ago and I met representatives from many different parts of the Government, but also from civil society, including women activists, entrepreneurs and community leaders. I saw at first hand how the UK school feeding programme is enabling children, and especially girls, to attend school. That was before the coup. As I made it clear to the House on the day of the coup d’état in Sudan, the UK strongly condemns the arrest of civilian members of Sudan’s transitional Government by the military.

The hon. Member for Argyll and Bute (Brendan O'Hara) asked what we were doing with international partners. With them we are absolutely continuing to maintain public, international pressure on the military to restore the democratic transition. I personally commended the African Union’s leadership in its decision at a joint AU-UN Security Council meeting on 28 October to suspend Sudan from all activities. Together with partners we are also seeking a special session of the UN Human Rights Council as soon as possible to discuss the situation and maintain pressure to return Sudan to the democratic transition. Its people demand it. Furthermore, as part of our engagement with Gulf countries we are looking to release a statement with partners shortly. Our position is very clear; we continue to call for the military to release all unlawfully detained civilians and fully restore the civilian-led Government. Violence against civilian protestors must stop.

The right hon. Member for Islington North suggested that 60,000 Ethiopians have fled from conflict in Ethiopia to Sudan. It is actually more than 80,000. Refugee camps are struggling to absorb so many people. I also want to make it clear that the crisis in Ethiopia is man-made. It has been caused by human actions and decisions. There is no military solution. We have consistently called on all the warring parties to end hostilities and seek a political dialogue and a peaceful solution. We have made these points repeatedly to the Ethiopian Government and the Tigrayan authorities. We have also called for Eritrean troops to withdraw. When I became the Minister for Africa, I prioritised meeting the Ethiopian ambassador as my first meeting with a London-based ambassador. During the meeting, I pressed the need for urgent humanitarian access and an end to hostilities. The British ambassador in Ethiopia saw the Prime Minister and the Deputy Prime Minister last week and reiterated that call.

The UK has been very active on the world stage. We led the call for the first Security Council discussion on the conflict in November last year, and we have kept a spotlight on this at the UN. There have been six closed meetings and two open meetings of the Council to date. The Government have also called for consistent action at the Human Rights Council. In October, the UK led a joint statement signed by 43 partners, calling on the Ethiopian Government to reverse their decision to expel seven senior UN officials.

My hon. Friend the Member for Tewkesbury (Mr Robertson) pressed the need for the Ethiopian situation to have focus at the highest levels, and I reassure him that that is happening. The Foreign Secretary joined her international counterparts, including Secretary of State Blinken, in conversation with AU special envoy Obasanjo on 12 October. I also discussed the situation with Kenyan counterparts, including President Kenyatta, yesterday at COP and with a number of African leaders during my two days in Glasgow. It is a principle of the African Union, which is based in Addis Ababa in Ethiopia, that African solutions should be found to African problems. It is, of course, right that African partners are taking the lead on trying to find an end to the conflict, but I want to be utterly clear that the UK is working to fully support them in their efforts.

The right hon. Member for Islington North mentioned arms sales. I reassure him that there are no exports of arms from the UK on available records. The UK Government will not grant an export licence if to do so would be inconsistent with the consolidated EU and national export licensing criteria, which have respect for human rights and international humanitarian law. Arms for the conflict are sadly likely to come through formal arms sales and some smuggling routes. We are concerned about reports of arms arriving in Ethiopia and continue to push all international partners to call for an end to the conflict and support the peace effort.

The Chair of the Select Committee, the hon. Member for Rotherham (Sarah Champion), asked about atrocity prevention. The FCDO is committed to atrocity prevention in all contexts. FCDO staff can draw on the expertise of a new FCDO conflict centre, which was announced in the integrated review in March. We are in the process of fully establishing that centre. It will draw on expertise from across Government and beyond to develop and lead the strategic conflict agenda, harnessing the breadth of conflict and stability capabilities and working with partners to increase our impact. It will work on thematic issues, including preventing sexual violence in conflict, sanctions, women, peace and security, girls’ education, children in armed conflict, and freedom of religion or belief.

I will not take interventions until I clear a few more important lines.

The hon. Member for Glasgow North (Patrick Grady) mentioned our commitment to long-term projects in Africa. This week, right at the outset of COP26, the UK demonstrated our long-term commitment to the continent. We have mobilised international support and finance from donor countries to protect the Congo basin. I remind the hon. Member that many parts of the Congo basin have long suffered from conflict. We are committing new funding to support African countries in rolling out critical projects to adapt to climate change, and in partnership with South Africa, the USA, the EU, Germany and France we announced the ambitious Just Energy Transaction, which is mobilising $8.5 billion to support decarbonisation efforts in South Africa—a big project for South Africa’s stability and the future of our planet.

The hon. Member for Birmingham, Edgbaston (Preet Kaur Gill) mentioned prioritising humanitarian aid. As a result of last week’s Budget, we were pleased to announce that we will be increasing our funding for our highest priorities, including using more bilateral investment. That means spending aid money directly on our priorities, including lifesaving humanitarian aid, and especially prioritising the UK’s world-class organisations and our own frontline work. That is absolutely a focus for the Foreign Secretary.

On 16 October, the Foreign Secretary and I announced a further £29 million of humanitarian aid for northern Ethiopia, taking our commitment to more than £76 million. The UK is the second-largest donor there, and our finances provided water, healthcare and nutrition to hundreds of thousands of people facing famine. It is truly heartbreaking to see the continuation of this terrible conflict, which is also pulling resources away from the long-term development areas that Ethiopia had started to make such impressive progress in.

I really want to get my important statements out. I will come back to the hon. Lady at the end.

As many hon. Members have mentioned, the conflict has been marked by intolerable levels of sexual violence. They are appalling, and we are appalled and outraged at them. The UK is delivering essential services to survivors of sexual violence and to those at risk of sexual violence in northern Ethiopia. Our programmes provide individuals with critical support and care, including support for emergency mental health services. However, without sustained humanitarian access, these vital programmes for those horrifically abused women and for women at risk of abuse cannot be delivered.

We have strongly supported the joint investigation by the United Nations High Commissioner for Human Rights and the Ethiopian Human Rights Commission. Their report was published just a couple of hours ago; we are studying it carefully and will push for justice and accountability as the situation demands.

All sides must protect civilians and put humanitarian needs first. That means prioritising negotiations over military activities. I call again on all parties to allow humanitarian supplies to flow. Without that, we fear that many thousands of people will die. When the UK ambassador spoke to Deputy Prime Minister Demeke and Prime Minister Abiy in recent days, he made it clear that we must see an immediate improvement in humanitarian access and meaningful engagement in peace efforts. The expansion of hostilities by the TPLF and now the Oromo Liberation Army are displacing hundreds of thousands more people and further destabilising the country.

I call on all parties, in particular the TPLF, the Government of Ethiopia and the Oromo Liberation Army to stop fighting. The continued advance of TPLF and OLA forces must stop. They should not enter Addis Ababa.

I want to ask the Minister about the Sudanese aid funding. The Department for International Development was a long-term investor in the Sudanese peacebuilding process. That funding was entirely cut. Will she look into that cut and commit to returning to funding peacebuilding in Sudan, given what has happened recently?

Briefly, Minister, so that the right hon. Member for Islington North (Jeremy Corbyn) has an opportunity to sum up.

The UK has not only been a significant funder in Sudan, but has provided the bridging loan to help Sudan clear its arrears with the African Development Bank as part of that restructuring. We are a leading donor to Sudan. In addition to humanitarian assistance, our support had been focusing on the Sudanese Government’s twin priorities of the economy and peace. Importantly, we were putting support into the family programme, which helped to support those on the lowest incomes.

We really need to stabilise the situation in Sudan. Right now we need to see a return to civilian Government and the stabilisation of the situation, and we need to see aid coming through. We have spoken to the UN food programme today to see whether it is getting food aid, because of the blockade in Port Sudan. That is the key priority.

To sum up, we are under no illusions about the gravity of the humanitarian situation in Ethiopia. We will continue to provide aid to those who need it, and we call for that aid to be able to be delivered. We keep pushing the Government in Ethiopia, the TPLF and all—

Motion lapsed (Standing Order No. 10(6)).

Adult Dependent Relative Visas

Before I begin, I remind Members that they are expected to wear face coverings. Given the recent outbreak in Parliament, I expect to see everybody wearing one if they are not speaking. For those who do not have face coverings, I will ask the Doorkeepers whether they can source some spare masks. I remind Members that they are asked by the House to have a covid lateral flow test twice a week if coming on to the parliamentary estate. That can be done either at the testing centre in the House or at home. Please also give each other and members of staff space when seated and when entering and leaving the room. I assure the right hon. Member moving the motion that he will have his full 30 minutes. For those watching outside, we are somewhat delayed because of two votes in the House.

I beg to move,

That this House has considered adult dependent relative visas.

It is a pleasure to serve under your chairmanship, Ms Bardell. I want to talk about an important topic that deserves more attention than it has had, and I want to urge the Minister to change the current hostile environment policy on adult dependent relative visas, which is undermining the national health service. The immigration system should treat overseas nationals working in the UK and their families abroad more fairly than it does at the moment. I want to focus particularly on the impact on people working in the NHS.

Nine years ago, in 2012, the Government changed the immigration rules to establish their hostile environment policy. Under one of the changes, elderly parents or grandparents of British citizens are permitted to join them in the UK only if they can demonstrate that they require a level of long-term personal care that their home country cannot provide. Before 2012, a dependent relative needed to show only that they were living alone

“in the most exceptional compassionate circumstances”.

Now, the rules state that doctors are prohibited from bringing their elderly relatives to the UK from overseas unless they meet a very strict set of conditions. The problematic rules are set out in paragraphs E-ECDR.2.4 and 2.5, and I will read them. Paragraph E-ECDR.2.4 states:

“The applicant or, if the applicant and their partner are the sponsor’s parents or grandparents, the applicant’s partner, must as a result of age, illness or disability require long-term personal care to perform everyday tasks.”

Paragraph E-ECDR.2.5 states:

“The applicant or, if the applicant and their partner are the sponsor’s parents or grandparents, the applicant’s partner, must be unable, even with the practical and financial help of the sponsor, to obtain the required level of care in the country where they are living, because (a) it is not available and there is no person in that country who can reasonably provide it; or (b) it is not affordable.”

In practice, those conditions are extremely hard to meet. Home Office data shows that in the four years from 2017 to 2020 inclusive, 908 visa applications were made under the adult dependant rule. Only 35 were approved at the first attempt. Over 96% of them were refused. Some were subsequently granted after the difficulty and expense of an appeal. In 2017, I understand the Home Office did not issue a single adult dependent relative visa. Before the rule changes, thousands were approved.

What is the justification for the change? Ministers have argued that the rules are to stop adult dependent relatives from entering the UK and burdening taxpayers. Other ways to avoid any burden on the NHS and local authorities do not appear to have been considered. The existing immigration health surcharge could be incorporated into adult dependent relative applications—Canada, Australia and New Zealand have that sort of model in their schemes for elderly migration—or applicants could be required to have private medical insurance. Instead, we have made it virtually impossible for elderly relatives to come.

Over the past two years, we have all been reminded just how important the national health service is. I know I speak for all of us when I say how grateful we are for the extraordinary efforts of doctors, nurses and other NHS staff to protect and care for all of us throughout the pandemic. They should be rewarded for their hard work and dedication. Instead, many are being punished with these hostile immigration policies.

One doctor, a British national based in Birmingham, told me about the impact on him. He came from India to train as a GP in 2004. The UK is now his home. He studied here, he is working here, he is bringing up his children here. Sadly, he lost his father to covid in India earlier this year. Now, his 70-year-old mother wants to join her son and his family in the UK, but she is not allowed to do so, because of these rules. He tells me that

“no matter how much I earn and pay in taxes, my inability to look after my mother makes me feel incomplete and unfulfilled.”

He also feels his children are being denied a proper relationship with their grandmother. He says that

“my children should not be penalised for a decision I took 17 years back to move to the UK.”

I thank the right hon. Gentleman for raising such an important issue. His account from the doctor echoes that of a constituent of mine, a British national of Indian birth. She faces the same very difficult personal dilemma of having to consider, on the one hand, her patients and her service to the local NHS and, on the other hand, her parents in India. Does the right hon. Gentleman agree that when we discuss this difficult issue, we should bear in mind not only the potential impact on the NHS, but also the tragic personal stories and the trauma that it inflicts?

The hon. Gentleman is absolutely right. We are putting these dedicated public servants in an impossible position. I received an email yesterday referring to

“yet another consultant who has left the NHS (to live in Oman so that his mother could be with the family again).”

Six thousand doctors left the NHS to go overseas in the five years from 2015 to 2020. We do not know the reasons why they all went, but a significant number went for this reason.

The Chair of the Health and Social Care Committee, the right hon. Member for South West Surrey (Jeremy Hunt)—a former Secretary of State, of course—pointed out to the Prime Minister at Prime Minister’s questions today that

“there are now severe shortages in nearly every specialty.”

The policy we are debating this afternoon is part of the problem. We should be bending over backwards to keep doctors here. Instead, we are forcing them to leave the country. Many doctors feel very strongly, as the hon. Member for Ceredigion (Ben Lake) has just reminded the House, that they are being denied a family life. The emotional toll increases the risk of burnout.

In August this year, the British Association of Physicians of Indian Origin and the Association of Pakistani Physicians of Northern Europe carried out a survey of nearly 1,000 doctors in the UK, and 90% reported feelings of anxiety, stress and helplessness because of this issue. Is that really how the UK should treat doctors who have risked their lives to care for us throughout the pandemic?

The rules also have a severe impact on children in the families affected, not least through making it very difficult for them to have a relationship with grandparents. Equally, the Joint Council for the Welfare of Immigrants sampled a group of professionals in the UK. Of the 121 children affected, 20% came from families living in lower-income households, more likely single-earner households. It points out that having a grandparent who can help with childcare will enable parents to work in cases where childcare costs would rule that out.

The Government have said that the rules on adult dependent relatives are in place to protect the NHS. They are actually undermining it. Medical professionals have busy, stressful lives, even more so in the pandemic. Those with vulnerable relatives abroad often have to take leave, sometimes extended leave, and travel overseas often to arrange care for their elderly parents, at a time when the NHS needs them here, and we need them here more than ever. Some doctors have been forced to leave the UK altogether. In the survey I referenced a moment ago, eight in 10 respondents were looking at leaving due to these rules.

I thank my right hon. Friend, who has done terrifically well to secure this very urgent debate. Coming from Birmingham, I know both the associations he referred to. To train a junior doctor costs about £230,000 and to train a GP or consultant costs about £500,000. Every time we lose one of those consultants or GPs, or even a junior doctor, it is a huge cost to us. Should the Government not understand when they are looking at value for money that these people are well paid and able to support the parents they bring over, and will contribute towards the health insurance that they have already agreed? This would give them peace of mind. They are hugely stressed at the moment and most are still thinking of leaving at a time when we need their expertise.

My hon. Friend is absolutely right. Having invested so much in their training, we need to keep those experts here, not force them to leave the country. There are more than 96,000 non-UK graduates on the General Medical Council register. The evidence of the potential loss to the NHS if these restrictions stay in place is enormous. We simply cannot afford that loss. The investment made in their training is a very important point; I am grateful to my hon. Friend for raising it.

This is a real threat, not a theoretical worry. The Association of Pakistani Physicians of Northern Europe said that

“in many cases, highly trained and competent”

members of staff are leaving the UK to return to their home country or go somewhere else where the rules are more accommodating in order to care for their elderly family members.

Of course, these rules will apply to EU citizens arriving to live in the UK post Brexit. They will deter skilled doctors from European countries from working here, as they are forced to opt instead for countries with a less hostile and more accommodating policy. I remind the House that adult dependent relative entry clearance applications to the UK are among the most expensive type of visas that there are. The cost of a visa application for an adult who requires care from their relative here is £3,250. The Government say these rules are to avoid burdening the NHS; I wonder whether the Minister can put a figure on the cost of a more accommodating policy. What is the estimate that we are talking about? What will be the cost of losing all these highly trained staff who are forced to leave to fulfil their family responsibilities?

The British Medical Association represents and negotiates on behalf of all doctors and medical students in the UK. In January, together with other leading medical bodies, it wrote to the Home Secretary asking her to remove this restrictive adult dependant rule for doctors. Soon after its letter, I wrote to the then Immigration Minister asking him to meet to discuss the issue. He declined my request to meet and simply told me,

“those most in need of care remain the most likely to qualify.”

The problem is that enormous numbers are not able to come. According to the Home Office, just 70 adult dependent relative visas were issued in 2020. The Government need, at least, to review their application process to determine just why so few applicants succeed. I am certain the Minister will have received representations from the Health Secretary about this issue, and I hope they will undertake a review.

The BMA has consistently raised concerns about the potential impact on patient care and on the wider NHS if doctors have to move because of these rules. Ministers do not seem to take much notice of the urgent concerns of those working on the frontline of our health service, but it is time to start taking notice before serious harm is inflicted on the NHS. Doctors must not be kept waiting any longer. There is no justification for forcing committed, dedicated NHS doctors to choose between their work and their home in the UK, and their deeply felt duty to their elderly parents to support and care for them in difficulty and old age.

Will the Minister commit today to review this unfair policy? Why have so few applicants been successful in the past nine years? Why are Ministers weakening the NHS in order to prevent elderly relatives from joining their key worker families here in the UK?

It is a pleasure to serve under your chairmanship, Ms Bardell. I thank the right hon. Member for East Ham (Stephen Timms) for securing this debate. I also thank the other Members who contributed. I recognise the strength of feeling on the topic, as the right hon. Gentleman so eloquently articulated. I will respond to his points as best I can in the time I have, but it will be helpful if I set out some background on adult dependent relative visas.

The family immigration rules were reformed in July 2012 to ease the burden on the taxpayer, promote integration and tackle abuse, thereby ensuring family migration to the UK is fair to migrants and the wider community. Costs associated with cases under the route for adult dependent relatives can be significant. The Department of Health and Social Care has estimated that a person living until the age of 85 costs the NHS on average about £150,000 in their lifetime, with more than 50% of that cost arising from the age of 65 onwards. It is important to note that this figure does not take account of any social care costs met by local authorities.

Under the rules, adult dependants must demonstrate that they require, as a result of age, illness or disability, a level of long-term personal care that could be provided only in the UK by their sponsor here, and without recourse to public funds. They must apply from overseas and not while in the UK as a visitor. The rules in place before July 2012 in essence provided an expectation of settlement in the UK for a parent or grandparent aged 65 or over where they were financially dependent on their UK sponsor, subject to the provision by the sponsor of a five-year undertaking that they could maintain and accommodate the adult dependent relative without access to public funds. They also enabled a parent or grandparent under the age of 65 and other adult dependent relatives of any age to apply to settle permanently in the UK in the most exceptional compassionate circumstances, as the right hon. Gentleman said. The old rules allowed an application to be made in the UK, including while here as a visitor, as well as overseas.

The current rules for adult dependent relatives seek to ensure that only those who need to be physically close to and cared for by a close relative in the UK are able to settle here. Those who do not have such care needs can be supported financially in the country in which they live by their relative in the UK. Those in most need of care remain those most likely to qualify, compared with those who have a preference to come to live in the UK with a relative here. The lawfulness of the rules was upheld by the Court of Appeal in May 2017.

Does the Minister understand that this is not just a question of finances and money? This is an issue of relationships, of parents, children and grandchildren, and of building and understanding a family. We can support someone on their own abroad, but we cannot have that family linkage growing.

Yes, I fully understand the hon. Gentleman’s point, but the Government’s duty is to formulate rules that are fair to the British taxpayer and the NHS, and that ensure a fair system. I will come on to the specific issues about the health service to which the right hon. Member for East Ham alluded, but it is vital that our immigration policies do not place an unfair burden on the taxpayer.

We want to ensure that people here legally are welcomed and celebrated—which we do in this country—as part of a fair and sustainable immigration system. All family migration to the UK, including that of adult dependent relatives, must be on a properly sustainable basis that is fair to both migrants and the wider community.

Our position on adult dependent relatives remains that we have rules in place to support those who are most in need, but we are clear that the rules cannot provide a route for every parent to join their adult child in the UK and to settle here. It is simply not sustainable for the economy or the health service for there to be a routine expectation of settlement in the UK for parents and grandparents aged 65 or over. Therefore, only those who require long-term care that cannot be delivered in the country in which they live should be eligible to settle here.

We fully understand that such cases provoke strong feelings, as Members have articulated, and they can result in difficult choices for individuals, but it is essential that the rules are fair and balanced for the taxpayer, given the significant NHS and social care cost that can arise when those adult dependent relatives settle in the UK. Failure to maintain that balance puts the legitimacy of the entire system at risk.

I now turn to the issue of the NHS. Of course, we are hugely grateful for the vital contributions of all NHS staff, in particular during the pandemic. The Government have no intention whatever of punishing that group. By contrast, we have introduced a range of unprecedented measures to ensure that the health and care sector is supported fully. However, it is only fair that I address the points that have been made.

The impact of medical professionals potentially leaving the NHS was an issue that was raised five years ago and considered as part of the Home Office review of the adult dependent relative rules published in December 2016. That report considered the number of NHS staff who support adult dependent relatives overseas. It is likely to be a small proportion of the total population of professionally qualified clinical staff.

Furthermore, there is no evidence to show that significant numbers of medical professionals have left or been deterred from applying to work in the UK since the revised rules were implemented. It was concluded that, while some who might sponsor someone to come to the UK might choose to leave as a result of the revised rules, including some in skilled employment, the impact remains proportionate to the policy aim.

The latest figures show a 19% increase in skilled worker visas in the year ending June 2021, and that the majority of that increase was due to the new health and care worker visa, which saw 45,722 grants, accounting for 44% of the total skilled worker visas granted. In fact, such was the demand of overseas doctors and nurses wanting to work in the UK, in 2018 the Government lifted the cap on doctors and nurses. The Health Secretary at the time said:

“Overseas staff have been a vital part of our NHS since its creation 70 years ago. Today’s news sends a clear message to nurses and doctors from around the world that the NHS welcomes and values their skills and dedication.”

As I said, there is no evidence that significant numbers of professionals have been deterred from applying to work in the UK since the new adult dependent relative rules were implemented, and nor is there evidence to show that professionals have left the UK.

The NHS has made significant savings since the rules were introduced. The 2016 report notes that once assumptions were taken into account, the figures suggested potential NHS savings of around £249 million over 10 years. This policy will be kept under review. We are of course sympathetic about the impacts on individuals and families, but the policy must apply fairly across our society. It would not be right to provide a more generous approach for healthcare professionals than for other groups.

Just to elaborate and perhaps add to the considerations, there is of course an impact on the family, but there is also an impact on the community. In many rural areas, such as mine, if we lose a solitary GP, who has to go back, we will not have a GP practice for a very large area, so there is that wider impact too. We should bear in mind that even though it may be an individual example, it has quite a widespread impact.

Of course, I recognise the impacts of the issues highlighted by the hon. Gentleman. On the point made by the right hon. Member for East Ham, that we have not considered other ways to avoid the burden on the NHS and local authorities, making comparisons with other countries and their systems, I advise him that we did consider other ways. The Home Office published a review of the adult dependent relatives rules in December 2016. As I said, we continue to keep that under review. The report is published on, so I encourage him to look at that.

As part of the review, specific considerations were given to alternative methods of achieving the main aim, which is reducing the burden on the taxpayer and NHS costs. Those alternatives were mandatory medical and care insurance, amendments to the immigration health surcharge and a bond scheme, requiring up-front payment, which would be offset against the cost of any later NHS care. Particular consideration was given to how far each of those would achieve the policy intention, be feasible to administer, and continue to allow an adult dependent relative, with significant long-term personal care needs that could not be met in their home country, to join their relative.

Those options were considered to place a potentially unreasonable administrative burden on the NHS, while also raising significant concerns over affordability and discrimination. For example, mandatory private healthcare insurance was considered likely to be prohibitively expensive, especially if it was to cover NHS emergency treatment and/or social care and residential care. It would also benefit only those applicants whose sponsor had substantial means. Those without a close relative with such means would be excluded from the UK, even if they required long-term personal care that could only be provided by their relative here. There is also no guarantee that insurance taken at the date of application would not be later cancelled or not renewed, including in circumstances outside that person’s control, such as a significant deterioration in their health or a change in the financial circumstances of their sponsor making the insurance unavailable or the premiums unaffordable.

Any alternative scheme requiring an up-front payment of many thousands of pounds would, by definition, exclude those cases unable to pay it, regardless of the level of their personal care needs. Similarly, in the light of the estimates I mentioned earlier—that a person aged 65 to 74 costs the NHS £2,287 per year—such a scheme for adult dependents would likely need to be set at significantly more than its current level. That is why it was concluded that the revised rules were set at the right level to provide immediate settled status in the UK and free access to the NHS to those relatives whose care needs could not be met in their home country, while protecting the NHS and the tax burden.

The Minister makes the point that there is no evidence of doctors leaving the UK for this reason. We do know that 6,000 doctors left to go overseas in the five years between 2015 to 2020. She is right that we do not know the reason why they all left, but it is clear that at least hundreds went for this reason, and possibly more of those 6,000. Is she not concerned about that loss of skilled, committed doctors from the health service, at a time when—as the Chair of the Health and Social Care Committee, the right hon. Member for South West Surrey (Jeremy Hunt), pointed out at lunchtime today—there is a shortage in nearly every speciality?

I thank the right hon. Gentleman for his point. He is right to ask the question. As I said earlier, we do not have verified evidence of those numbers, and nor do we have specific evidence pointing to this specific reason. There may be a number of reasons why people choose to leave and work in another country. Moreover, I point to the evidence in front of us about the people who are choosing to take up those skilled visas to come to this country, so these rules are clearly not a deterrent. I refer to my earlier remarks about the policy intention behind introducing these changes to the rules, which is to make sure that only those people who genuinely need to come here are covered by these rules, and therefore would be able to come here under the system that we have.

In conclusion, I recognise that this is an emotive subject, and I pay tribute to the right hon. Member for East Ham for the way in which he has articulated it. Of course, I and the Government want to support the NHS. We keep our policies under review, as I have said, and we have given considerable care and consideration to the factors that he has mentioned.

The Minister is being very generous with her time. She has made much of the cost issue; I think she indicated that for somebody elderly arriving in the UK, we would expect health and care costs of something like £175,000, but a GP has had £500,000 invested in them. I wonder whether an assessment has been made somewhere of the value for taxpayers—the straightforward financial cost—of forcing somebody who is highly trained out of the country, versus the cost of care for their elderly relative.

I can reassure the right hon. Gentleman that the costs have been considered in the round, including the costs he refers to and others. In fact, those figures I quoted at the beginning of the remarks did not include care costs, which I am sure he will agree are significantly higher than the other figures I have referred to, which are purely for treatment and costs.

Motion lapsed (Standing Order No. 10(6)).

Medical Cannabis under Prescription: Children with Epilepsy

Before we begin, I remind Members that they are expected to wear face coverings, given the recent outbreak of covid-19 in Parliament. I expect all Members to be wearing masks if they are not speaking; if there are Members without a mask, masks can be found to my right, on top of the cupboard. This is in line with current Government guidance and that of the House of Commons Commission. I also remind Members that they are asked by the House to have a covid lateral flow test twice a week if coming on to the parliamentary estate. This can be done either at the testing centre in the House or at home. Please also give Members adequate space when seated, and when entering and leaving the room.

Members will be aware that we have been delayed as a result of two votes, so this debate is due to end at 5.56 pm.

I beg to move,

That this House has considered medical cannabis under prescription for children with epilepsy.

It is a pleasure to serve under your chairmanship, Ms Bardell, and I am very grateful to open this debate on an issue that affects many of our constituents. I do not propose to speak for long, because I can see that quite a large number of colleagues are in the Chamber and would like to speak as well. If they have not already done so, I invite them to inform the Chair that they wish to speak.

I wish to mention my constituents Maya, who is nine years old, and Evelina, who is just four. Maya and Evelina suffer from rare forms of epilepsy and rely on medical cannabis to improve their quality of life. Their families are currently having to pay up to £2,000 a month for private prescriptions of medical cannabis, as they are unable to access that medicine on the NHS. Their families are also having to go to unbelievable lengths to raise money, something that has been made more difficult during the pandemic as there has been less opportunity to fundraise. Maya’s family have set up a Facebook page called “Mercy for Maya”, where her mum Samantha runs monthly fundraisers and raffles to help with the enormous monthly costs. My constituents should not have to do this for something that is legal on the NHS.

The picture that the hon. Member paints is one that I and many other hon. Members are familiar with, because we also have constituents going through the same ridiculous hoops to get a legally available medicine. Is he aware of any other medication in this country for which that has ever been the case—it has been legal and available, but people have had to raise the money for it themselves in this way?

I am not sure, but I doubt that our constituents would have to put their hands in their pockets to the tune of £2,000 a month to pay for any other medication that was extremely important for their severely ill children. My constituents, and indeed all Members’ constituents who have children in this situation, should not have to pay for this medication themselves.

Medical cannabis has had lots of benefits for Maya, including preventing her from having prolonged seizures, which has meant less time in hospital. Medical cannabis has also improved her alertness and engagement. She used to spend a lot of time asleep during the day, but she is now able to attend school, which she very much enjoys.

Both I and colleagues have lobbied the Government tirelessly to widen access to this life-changing and life-saving treatment. I am sure that I speak for many Members here today in expressing delight that medical cannabis was made legal in specialist cases in November 2018. This week marks three years since that law change.

I welcome the new Minister to her place and the good progress that the Government have made on widening access to medical cannabis. I am also grateful to her for agreeing to meet me, as co-chair of the all-party parliamentary group for access to medical cannabis under prescription, along with my colleague the hon. Member for Gower (Tonia Antoniazzi), later this month. I look forward to discussing the issues in greater detail with her.

You may be interested to learn, Ms Bardell, that since the very welcome law change three years ago, which should have improved the lives of children who suffer with rare and intractable forms of epilepsy, only three prescriptions have been issued on the NHS—only three prescriptions. At this point, I would like to clarify that we are talking about whole-plant extract. This type of medical cannabis, containing CBD and THC—cannabidiol and tetrahydrocannabinol—together with many other active ingredients, has been life transforming for a small cohort of families and their children. It is vital that that point is understood, as there have been several hundred prescriptions for a fully licensed paediatric drug known as Epidiolex, but that is primarily CBD-only. There is an acknowledgement that that drug has a role to play, but it was not the subject of the appeals that were so eloquently and passionately made by the families concerned when they visited Parliament at the start of this week.

Access to medical cannabis was legalised after high-profile campaigning by me and other Members across the House, who are here today, and the hard work of the group End Our Pain. It and other campaigners, along with some of my colleagues, worked with the then six-year-old Alfie Dingley, who also suffers from rare, intractable epilepsy, to help him secure access to medical cannabis. In 2018, after intensive campaigning, Alfie was granted the first ever long-term licence for the type of medical cannabis that is life transforming. Medical cannabis subsequently became legalised in specialist cases on 1 November 2018. Since Alfie secured the prescription, his transformation has been significant. He has gone from suffering up to 150 life-threatening seizures a day to recently celebrating being 500 days seizure free. The change in health and quality of life for Alfie is nothing short of transformative, and that transformation has been evident in many others, too.

I am very grateful to the Secretary of State for Health and Social Care, who in 2018 was the Home Secretary who granted the licence for medical cannabis to Alfie Dingley. I know that my right hon. Friend cares deeply about this issue. Now that he is Secretary of State for Health, I urge him to consider the recommendations that I am mentioning today on what further action could be taken to help children like my constituents to access medical cannabis on the NHS. The law change has been a change in legislation, but not in practice. That has been reflected in the number of NHS prescriptions that have been issued. My constituents and many others were greatly reassured by the steps that this Government took to legalise these treatments in 2018, but they are understandably dismayed that actions have not followed words in this case.

There are a few reasons for this blockage on NHS prescriptions. At the same time that the law changed, a number of bodies issued guidance on how and when medical cannabis should be prescribed. Those bodies included the British Paediatric Neurology Association, the General Medical Council, the National Institute for Health and Care Excellence and the Royal College of Physicians, but let us be clear: nothing—absolutely nothing—in any of the guidance states that it is wrong or not allowed to prescribe this medicine, either privately or on the NHS.

However, I am advised by the families and advocates on this issue that the guidance paints a somewhat confusing picture. In my capacity as co-chair of the APPG, I have attended a number of meetings with senior NHS leaders. In those meetings, they tell me that if an NHS consultant wishes to prescribe medical cannabis, they are able to do so. The British Paediatric Neurology Association does not currently support the use of whole-plant medicinal cannabis, which includes the THC ingredient, and has published guidance stating that only neurologists should be allowed to prescribe cannabinoids containing CBD. That guidance has been criticised for being overly restrictive.

The high level of caution in the guidance issued is likely to have played its part in preventing the prescribing of those products and making NHS trusts unwilling to provide funding. Currently, there are only three paediatricians in Britain who prescribe the whole-plant oil to children with drug-resistant epilepsy, and one of them is to retire imminently, meaning that families are at risk of losing their prescriptions.

A few months ago we had a breakthrough, as NICE issued clarification of its guidance relating to the use of medical cannabis for drug-resistant paediatric epilepsy. It has now made it clear that clinicians can prescribe medicinal cannabis in appropriate cases. However, even since the clarification of the guidance, the hesitancy among the medical profession remains.

I am aware that this issue continues to receive a high degree of media, public and political attention, and I am concerned that some of those involved—perhaps some of the medical professional bodies such as the BPNA—may be experiencing a temptation to entrench and dig in. If that is the case, I make a plea to them and their medical professional colleagues to reject that temptation and instead to reach out to work with the Department of Health and Social Care, the Minister and her colleagues, the families and interested politicians to find a way forward to help these vulnerable families and their children.

I also strongly encourage the Government to ensure better education for paediatric neurologists on whole-plant extract medical cannabis and its benefits for children with drug-resistant epilepsy. I am aware that the previous Secretary of State for Health and Social Care tasked the NHS with undertaking a review of the blockage on NHS prescriptions. The review reported in August 2019 and made two main recommendations: first, that an expert panel be set up to advise on the prescription of medical cannabis in cases of paediatric epilepsy; and secondly, that a trial should be set up to inform the evidence base on safety and efficacy, and to act as a way of getting these families access to the medicine for free.

The families and campaigners have told me that those recommendations offered them great hope and a way forward. However, things have not worked out as the families hoped. Yes, the expert panel was set up; it is called RESCAS—the refractory epilepsy specialist clinical advisory service—and its members are indeed experts in paediatric epilepsy, but as far as the families can see they are not experts in the way that whole-plant extract has worked both here in the UK and overseas.

Imagine, then, the enormous disappointment when one of the very first cases considered was turned down for medical cannabis. The young boy in question is experiencing a life transformation similar in positive impact to that which Alfie is experiencing. The panel is not working. I know the Minister cares deeply about this matter. I hope she will agree that the make-up and terms of the panel are in need of urgent review so that it includes expertise not just in the condition itself, but in the medicine too.

The other main recommendation of the August 2019 review was the establishment of trials. I understand that the Government’s position is that there needs to be more research in the area before prescriptions can be available more freely. The proposed trial was to be observational, which meant the children could continue on the medicine and their condition be evaluated by medical professionals. It soon became clear last year that plans for the observational trial had been dropped and replaced with a randomised control trial. RCTs are not appropriate in this case, as I am sure hon. Members agree, as they require some of the cohort to be taken off the medicine and given a placebo.

That is simply not possible, and we have to ask ourselves why anyone would take their children off a medicine that was already working for them and improving their quality of life. RCTs can also be incredibly costly and take years to complete. That is time that my constituents and others do not have. I therefore suggest that the Government consider conducting an observational trial or an alternative study as a means of enabling the children to have continued access to medical cannabis at no cost. That would be possible for the Secretary of State, and the Under-Secretary of State for Health and Social Care, my hon. Friend the Member for Lewes (Maria Caulfield), here today, to commission under the National Health Service Act 2006.

The cost of having medicinal cannabis for children is astronomical, at between £800 and £2,000, and that is for those who can afford it. The very children who need the medicine to improve the quality of their lives where it has been proven to be effective and who cannot afford it cannot be put on the scrapheap to further delay. Does the hon. Gentleman agree?

I think it is imperative that we work cross party and we encourage, cajole and push the Government to do the right thing. The right thing is what? While acknowledging that the Ministers have these powers, I understand that there are concerns about whether such action might lead to unintended consequences in the form of legal challenge relating to other drugs. I am a lawyer; I understand that. I used to work in government and defend the Government from judicial review. I understand.

However, I believe that any such concerns and risks could be mitigated. I also suggest in the meantime that the Government use the discretionary fund that they have at their disposal to cover the cost of the private prescriptions. There are a small number of children and families across the country in this desperate financial situation. The Government can intervene financially to reduce the burden every month, so that families such as my constituents Maya and Evelina do not have to rely on the uncertainty of fundraising. That is my favoured option, and I urge my hon. Friend the Minister to access that fund.

During the pandemic, Maya had to be rushed to A&E a few times due to her condition. Surely these children needing to go to hospital to have urgent medical treatment is more costly to the NHS than providing them with the prescription they need. Therefore, I suggest, only as an interim measure—I plead—that the Government consider covering the costs of the private prescriptions for the most vulnerable children in our country suffering from severe epilepsy who need this medication, until the Government find a solution with the bodies and particularly the medical profession.

In conclusion, I urge my colleagues in Government to consider the recommendations that I and other colleagues across the House have made and are making here today, as well as listening to the families affected. While I appreciate the good work that the Government have done on this issue, they can and should go further. I and many colleagues across the House will continue to champion this matter: better access to medicinal cannabis on the NHS for my constituents, all the constituents affected across our country and all the children suffering from this awful illness, so that they get the drugs necessary, free at the point of need on the NHS.

Before I call speakers, I want to acknowledge those who are with us in the Chamber today and those who are watching. I also acknowledge the importance of this subject. Because it is such an important subject and I want to call the Front Bench by 5.34 pm, with the Labour and Scottish National party spokespersons having five minutes each, I will impose an initial time limit of four minutes to ensure that every Member has the opportunity to represent this very important issue.

It is a pleasure to see you in the Chair this afternoon, Ms Bardell. I pay tribute to the hon. Member for South Leicestershire (Alberto Costa) for securing this debate, for his articulate and forensic analysis, and for the coherent account we have heard from him.

It is three years since we were able to celebrate the change in the law that should have helped the children and families we have been hearing from this week. Sadly, after three long years, they are no further forward. As we have heard, since 2018, only three NHS prescriptions have been issued for the type of medical cannabis that was shown to be so life-transforming for the likes of the then six-year-old Alfie Dingley, whom the hon. Member spoke of earlier. It was Alfie and his mum who were at the forefront of this campaign. They and many others achieved the change in the law that they had all worked so hard for.

Heartbreakingly, while the law has changed, it has not been properly implemented and utilised for those crying out for help. Families have been left at breaking point emotionally and financially, having to find up to £2,000 a month to pay privately for this medicine. I cannot begin to imagine how on earth these loving parents cope with such massive monthly costs— £2,000 a month is the equivalent of an additional and very substantial mortgage. In fact, it would dwarf many people’s mortgage payments. Not even we MPs on over £80,000 a year could cope with that. How on earth can we expect those families to withstand such huge costs, simply trying to keep their children alive and free from the ravages of seizures by accessing a known and proven prescriptive solution?

That these families cannot secure NHS prescriptions for their children, when it has been proved beyond any doubt that cannabis is efficacious, is a monumental shame. The campaign group that the hon. Member mentioned, End Our Pain, rightly said that this saga has dragged on for far too long. Those families have petitioned, marched and campaigned with such dignity. They should not and must not be ignored.

The new Secretary of State for Health and Social Care was pivotal in the change in law when he was Home Secretary. I urge him and his Department to give effect to that change and remove all barriers to getting medical cannabis to those patients. The campaigning families will do whatever it takes to help Government remove any barriers to doing the right thing and give them and their loved ones access to medical cannabis as they would any other therapeutic drug.

We lost our 16-year-old son to epilepsy over 15 years ago. I do not know whether medical cannabis would have helped him, had we even known about it then, but I will do everything I can to assist these families in their determination to get the medication that their children need. The memory of seeing our beloved Rory locked in status; to hear my wife scream for me to get an ambulance; to see the paramedics come upstairs to his bedroom; to hear the consultant in the hospital tell us that we better call a priest; and to hold my child as he died is something that I never want any of these families to suffer. I beg the Government to do the right thing and remove whatever barriers there may be and guarantee them access to this life-changing, life-saving treatment.

May I say what a moving speech that was by the hon. Member for Middlesbrough (Andy McDonald)? That sort of personal experience is exactly what this issue is all about.

I came into politics to help. To my knowledge, I do not have a single constituent who benefits from a prescription for medical cannabis, but that does not make it any less important that I campaign on behalf of the all-party parliamentary group. I could not disagree with a single word in the speech by my hon. Friend the Member for South Leicestershire (Alberto Costa), who succeeded me as co-chair when I stepped down. It was the most coherent speech on the subject I have heard in a long time.

In 2015, as the Home Office Minister responsible for drug policy in Government, and sat where the Minister is sitting now, I made a speech saying that the Government were minded to allow the prescribed medical use of cannabis. I did not say that for the sake of it; I said it because the then Home Secretary, my right hon. Friend the Member for Maidenhead (Mrs May), gave me permission to do so. She went on to be Prime Minister, and one of the reasons why Alfie got his medication, and why the Caldwell family’s campaign was so successful in the Province, was that she picked the issue up and said, “We are going to do something about this.” In 2018, the then Home Secretary was able to change the law for that reason.

I say to all colleagues, and to anybody listening to the debate, that this issue is not about rolling a cannabis joint. It is not about reforming drug law in this country. It is about a group of children, some of whom have clicked over into adulthood now, who may well not have been here today were it not for some very brave consultants turning their backs on what the profession was telling them to do, and doing instead what was right for those children. Those consultants have come under enormous pressure not to sign the prescriptions.

When we drafted the legislation, we were very careful to ensure that it was not up to GPs alone to issue the prescriptions. We did not want to get into another opioid situation—I will not say that opioids are prescribed willy-nilly, because that would be unfair, but we know there is an opioid epidemic. We specifically said that the GP had to refer the child to a specialist, and that it would be for the specialist to decide. A few have been brave enough to do so.

Sadly, as my hon. Friend the Member for South Leicestershire mentioned, and as the parents were telling us only yesterday when they were here lobbying colleagues, some of those consultants are retiring, and of those who want to prescribe medical cannabis, some are too frightened that they will be referred to the professional body. If they do prescribe it, their employers are refusing to honour the prescription. I thought we had an NHS that was free at the point of delivery when an NHS prescription is issued.

I have no notes—I have no need for them. I have discussed this issue so many times in this Chamber, as well as in the main Chamber, where I will be tomorrow. Politicians get it; Secretaries of State get it; the Minister gets it. But parts of the medical profession do not get that they are responsible for keeping these young children alive, and that they need to get off their butts and do so.

It is an honour to serve under your chairship, Ms Bardell. I thank the hon. Member for South Leicestershire (Alberto Costa) for securing this incredibly important debate and for his extremely powerful contribution. I am also grateful for the other contributions that we have heard, especially that of my great friend, the hon. Member for Middlesbrough (Andy McDonald).

I pay tribute to those of my Liverpool, West Derby constituents who are living through the devastating consequences caused by the lack of access to medicinal cannabis. I pay tribute to the families, their friends and all those in our community who have campaigned relentless for those people. They should not have to fight that hard and they should not have to endure so much. It was a real privilege to meet some of the campaigners at the End Our Pain event. One of my constituents wanted to be there, but it is extremely difficult for her to be away from her child at the moment—their time together is so precious.

I was proud to sign End Our Pain’s letter to the Prime Minister and Secretary of State yesterday, which asked for immediate action to find a way to help the families with children with severe epilepsy, who continue to be denied NHS access to medical cannabis, as we have heard so powerfully so far. I know that the Minister was listening intently, and I can see the empathy in her eyes. I urge her, on behalf of my constituents, to take immediate steps and do whatever it takes to help these families. I ask that the Minister intervene to help adults who require access to medical cannabis under NHS prescriptions. I spoke to some families yesterday. There are siblings going through the same unimaginable pain. I am happy to discuss this at any time with the Minister.

The law was changed on 1 November 2018 to allow access to medical cannabis under prescription. This brought hope to many families. In my first meeting after becoming an MP in 2019, I spoke to families and they had an air of optimism. They thought there was change coming, but the reality three years on, as so eloquently put by the hon. Member for South Leicestershire, is that only three NHS prescriptions have been written for whole-extract cannabis oil. Families are having to raise £2,000 a month to buy this medicine privately.

We need to remember that we are in the middle of a pandemic, so funds that those families had raised previously had gone. The people I spoke to yesterday were talking about mortgaging or selling their house, doing whatever they can to raise the money. Tragically and heartbreakingly, there are families who believe that this medicine will help their child, but they will not put the child on it because of the limitations to starting the process and having to take the child off, as well as the financial issues. I cannot imagine what is going through their minds.

My constituent Lauren wrote to me last night. Although I cannot do full justice to everything she put in the email, I would like to impress on the Minister just some of what she is going through and what she is asking from the Government. She says:

“My time together with my son is precious, and I shouldn’t have to keep fighting. I want to make memories for whatever time we have left. In March NICE reiterated their guidelines about prescribing medical cannabis and these guidelines are certainly not being enacted. The Health Secretary must help now before it’s too late. Allow GPs to prescribe, and if that can’t be done instantly, then establish an emergency fund for the children already benefiting from private prescriptions.”

Lauren is a truly awe-inspiring mum and campaigner, like many I met yesterday. Her asks are simple and need to be listened to. Families are being pushed from pillar to post, and this injustice cannot continue. The interests of patients should be put first, and the system must start delivering the enormous benefits that this medicine can offer.

It is a pleasure, once again, to serve under your chairmanship this afternoon, Ms Bardell. I would not often say that I agree with every word said by a Conservative Member, but in the case of the hon. Member for South Leicestershire (Alberto Costa), it is accurate. He gave an incredibly considered speech. It is great to hear the consensus that exists in this room.

We have today’s debate, my hon. Friend the Member for Inverclyde (Ronnie Cowan) has a more general debate tomorrow on the medical use of cannabis, rather than in cases of epilepsy, and the hon. Member for Manchester, Withington (Jeff Smith) has introduced a private Member’s Bill on the issue. That shows the cross-party consensus, the momentum and the urgency of the issue. Everyone today is speaking about their constituents’ experiences. I pay tribute to all the families and campaigners who have come forward and are prepared to speak out. I met with some yesterday at the End Our Pain lobby. Plenty of my own constituents have lobbied on the issue, because they have been moved by the stories they have heard, and I have a particular case.

The name of the campaign, End Our Pain, says so much. It is the pain that the individual children, and the adults, are experiencing with their medical conditions. It is the psychological pain the families are going through as well, having to watch the physical pain that their children are suffering. All that pain can be, at the very least, mitigated, if some of the steps that we have heard about are properly taken.

I have spoken previously about my constituents John and Laura and their beautiful daughter Bláthnaid, who is affected by Aicadri syndrome, which is a very severe and rare form of epilepsy. There are only several thousand cases worldwide. It is very difficult for clinicians to know what might or might not work. It is incredibly distressing for both the parents and the children, who do not understand what is happening when they go through these seizures. Many of the conventional medicines that are tried have their own side effects that cause particular difficulties, or resistance builds up, which increases a different kind of suffering.

Is the hon. Gentleman aware that doctors are prescribing off-label drugs that work for adults, particularly steroids, to these children, but they are not willing to look at medical cannabis?

Yes, and a few years ago we had the Off-patent Drugs Bill, which sadly did not make as much progress as it could have done. That had the potential to give doctors more freedom, which is clearly one of the messages coming out of the debate. Of course there will be an element of risk, but there has to be a way of managing and mitigating it so that doctors can feel more confident about prescribing cannabis-derived treatments.

When my constituents see the positive effects that CBD can have, they wonder what effects a drug with THC might have. When they see the benefits to other children, even though every case and condition is unique, the potential must exist there, and when the alternative is to go private and pay incredible amounts of money, which is not without its own risk, the frustration becomes very real, so the Government have to speed up the trials and the opportunity for people to take part in them. They have to look at how the licensing can improve and how we can increase the confidence of doctors. Above all, they have to listen to the voices of parents and patients, and their carers and advocates in Parliament.

It is a pleasure to serve under your chairmanship, Ms Bardell. The debate is a bit like groundhog day for many of us—Members will forgive the expression. We have made the arguments about the children in our constituencies, and about the pain that their families are going through, knowing that there is a drug that not only can but does help them. In my constituency, Murray Gray has been transformed from a wee boy who was constantly ill, in and out of hospital and missing school, and whose parents feared for his life almost daily, to a happy wee boy who pays football with his dad, and has been to my office and explained to me exactly what dinosaurs are—not that I am one of them.

Seeing that transformation makes me only more determined to give what support I can. For me, and I am sure for many others, the question remains: why did the Government make medicinal cannabis legal if they did not intend it to be for the benefit of these children? I am sure that they did. When the then Home Secretary made that move, I am sure that the motivation was to improve the lives of these children, so why are the Government not taking the last step to encourage the medical profession to make that happen?

I met the father of Jorja Emerson the other day. He was literally in tears because his lovely daughter has multiple fits daily. The frustration is that the last remaining consultant who could make the prescriptions has retired. There is a real danger that some of these children will no longer have access to a drug that the Government intend them to have access to. I hope that the Minister has heard my intervention.

The hon. Member makes a pertinent point. This is the nub of the issue: we need consultants to be encouraged and enabled to write national health service prescriptions for these children. We have pestered the Government and will go on pestering the Government. There will be no resting place for them on this issue until we have the assurance that these children will get the help that I am sure that the Government originally intended them to have, and that is still just outwith their reach.

I congratulate the hon. Member for South Leicestershire (Alberto Costa) on securing the debate. It is great to see a Minister from the Department of Health and Social Care responding today, because for far too long we have been talking to the Home Office about these issues. I believe that the Minister is an ex-nurse, if there is such a thing; perhaps it is “Once a nurse, always a nurse.”

Yesterday in Portcullis House, family members came to tell us their heart-rending stories, yet again. As we politicians listened, the feeling of, “What can we do?” sank into us. We went over to No.10 Downing Street and delivered a letter—another letter—explaining the situation to the Prime Minister. During the course of the day I talked to a number of parents, and one of them asked me a question that I have been asked many times, but every single time it hits home: “What would you do if it was your child? What would you do if your child was suffering 30 seizures and more a day? Would you reach for the rulebook, or reach for the medicine— if you could afford it, because right now, in this country, if you cannot afford it, you are not getting it?”.

There have been only three NHS prescriptions, as was mentioned, despite the now Health Secretary promising to do everything he could to help. I am fascinated by that; three means that there is precedent. We have broken the dam. If there were none, it would be a different argument—but there have been three. Why not 30? Why not 300? Why are we still scrambling around for these things? Hannah Deacon, who has been mentioned often in this debate, and whose son Alfie is in receipt of one of those NHS prescriptions, has written to the Health Secretary three times asking him to help, as he promised to do when, as Home Secretary, he wrote to her. All three letters have gone unanswered. Some politicians are hiding behind medical professionals, and some in the medical profession are hiding behind politicians. The parents of these children have no place to hide. They have to manage the reality of the situation day in, day out. We need progress. We need to accept the validity of real world evidence. Asking kids to take part in trials with a placebo is abhorrent.

Many barriers would be broken if GPs were allowed to prescribe medical cannabis. At the moment, they cannot initiate prescriptions but can follow up. Cannabis is largely a GP medicine, given its efficacy in GP conditions such as pain and anxiety. It would be of enormous help to allow GPs to initiate prescriptions. A recent survey showed that about a quarter of GPs would be happy to prescribe it. This would require a simple change to the relevant misuse of drugs statutory instrument; it would not require parliamentary time.

I look forward to tackling this issue in much more detail tomorrow in the Chamber. I hope that we can investigate all the problems, and ultimately come up with solutions. We have talked round and round this subject for a long time. Three years and three months on from a promise by the UK Government to make medical cannabis available, we are still no further on. It is a crying shame that these people are still living in hope—living, I have to say, in desperation at the situation they find themselves in. They are looking to us politicians to do something about this. In my privileged position, I am sick to death of having to say to those people that we are no further forward.

Please, Minister, take on board what we have heard today. Politicians are asking the Minister, cross-party—a very rare thing—to look at the situation and do what she can, now and in the longer term. On what could be done now, if there was a fund that we could reach into to pay for these prescriptions, that would be a massive step forward, including for the parents and guardians of these children, who, day in and day out, are asking us to do something for them.

It is a pleasure to serve under your chairmanship, Ms Bardell. I congratulate the hon. Member for South Leicestershire (Alberto Costa) on securing this important debate. We have worked together over many years on health issues, and he has done very important work alongside my hon. Friend the Member for Gower (Tonia Antoniazzi) through the all-party parliamentary group on medical cannabis under prescription.

I start by saying to those who have spoken in the debate and those watching elsewhere that I cannot begin to imagine how difficult it must be to be the parent of a child with serious epilepsy. The fear that they go through every day, and the difficulties that they experience, must be beyond terrifying. I also recognise the huge financial burdens that many parents face, and the anxiety of parents who want access to these prescriptions, but are still denied it.

As the hon. Member for South Leicestershire said, it has been three years since the then Home Secretary, now Health Secretary, changed the law on this very important issue. As we all know, that change came about after a number of very high-profile campaigns in utterly heartbreaking cases of children suffering from epilepsy, including Billy Caldwell and Alfie Dingley. I pay tribute to the families who campaigned relentlessly on these issues. It gave hope to people that things would change. Yet three years later, we do not seem to be very much further forward. As the hon. Member for South Leicestershire said, the law has changed, but the practice has not.

I will focus on three things that need to happen to put this right. The first, which many hon. Members have spoken about, is the desperate need for more research and evidence. One of the barriers to clinicians prescribing is that they feel they lack knowledge, or are not really sure about the evidence on both the benefits and the risks. That point has been made time and again over the last three years. It was made during the original review, back in 2018, particularly by the Advisory Council on the Misuse of Drugs. It was repeated by the Health and Social Care Committee in its review of why things had not changed, back in 2019. Six of its 11 recommendations were about providing more research and evidence. Indeed, that was called for by the then chief scientific adviser, now chief medical officer, Professor Chris Whitty, and in the NHS England review commissioned by the last Health Secretary, the right hon. Member for West Suffolk (Matt Hancock).

I hope that the Minister will say where we have got to on that issue, and particularly on the point about more research and evidence from clinical trials being needed. However, that last point absolutely cannot mean taking children off these products if they are on them; that would be completely wrong. How will she make progress on all those issues?

Secondly, what other steps are being taken to improve access? I will focus briefly on three of the 10 recommendations made by NHS England. One was that the national medical director and chief pharmaceutical officer for England should write to doctors and pharmacists, reminding them of the guidance on prescribing, how they can access a cannabis education package produced by Health Education England, and how to get the message out about what can happen at present. NHS England also recommended much clearer information for patients, and that a specialist clinical network be established, so that everybody is aware of the real evidence. Could the Minister comment on what further action the Government have taken on that?

Finally, a really difficult but important point: as we move forward with the research and evidence, and as we try to improve understanding among all professionals—GPs as well as specialists, because we can have a partnership approach—what will we do to support those parents who are paying such huge amounts of money? Have the Government considered what support might be made available to them?

Changing the law is essential, but getting that to work in practice—changing hearts and minds, as well as the law—is the only way we will make progress. I thank all right hon. and hon. Members who have spoken. I hope that the parents out there listening know that they have champions in this place, and that we will carry on doing our best to make sure we get the best results for their children.

Before I call the Minister, I say gently and kindly to her that I would expect her to finish by 5.44 pm, so that I may call the hon. Member for South Leicestershire (Alberto Costa) to sum up for two minutes.

I would like to start by congratulating my hon. Friend the Member for South Leicestershire (Alberto Costa) on securing the debate. He lobbies on this issue almost daily, representing constituents such as Maya and Evelina so well. I fully appreciate the strength of feeling and the impact that this issue has on some of the most vulnerable children in their daily struggle with drug-resistant epilepsy. That is why, three years ago, my right hon. Friend the Secretary of State for Health and Social Care, who was then Home Secretary, changed the law to recognise the need to allow unlicensed cannabis-based products to be prescribed by specialist doctors. The Government are supportive and have used many levers, which has been quite challenging at times.

My right hon. Friend the Member for Hemel Hempstead (Sir Mike Penning) hit the nail on the head when he said that this is now more a clinical issue than a political one. In many cases, doctors are unwilling to prescribe medicinal cannabis; we heard from a number of Members that we may be down to just one clinician left who is willing to do that. The main reason is that these products are still unlicensed. The way that medicine works in this country is that the Medicines and Healthcare Products Regulatory Agency will license a product after significant research, not just into the efficacy—we have heard from many Members that there is a strong feeling that these medicines work—but into the adverse events and potential side effects. In prescribing these medications, the clinicians will take responsibility both for the drugs working and for any impact of those drugs.

This is the argument that always comes up in the briefings for Ministers. If it is not safe, how are prescriptions being given for free on the NHS? If it is safe, give it to the rest of them. It cannot be right that time and again Ministers use the argument about safety, when prescriptions are given free on the NHS.

These are clinical decisions. No one is saying that these products are not safe, but there is not the evidence base to get the licence. The MHRA does this for every single medicine, not just medicinal cannabis.

I want to set out how we can get to a place where we can get these drugs licensed and clinicians will feel confident in prescribing them. We recognise that, for many children, these drugs improve their quality of life—individuals have reported improvements—but without that research evidence base, the MHRA will not give a licence. The MHRA is an independent body—it is not controlled by the Government—and the clinicians will take advice and guidance from it. We may agree or disagree with how the MHRA licenses a medicine, but that is the process for all drugs. It is not just the MHRA—no country in the world has licensed this product. The Food and Drug Administration has not; the European Medicines Agency has not; the MHRA has not. The solution is in pushing the clinical research needed for a licence to be granted, which would open up prescribing for clinicians around the country.

Do the Minister and the MHRA not recognise that there is an abundance of practical evidence from the families who have scrimped and saved and raised money through charitable activities to fund the administration of the drug, and that it works? Surely that is persuasive. These families have not got time to wait for the research that the Minister is talking about, and I am yet to hear anybody tell me what harm would be done if that drug were to be given to those who need it and want it.

There are concerns, particularly around the THC element, that there could be some effect on the developing brain and on heart conditions. Research is needed not just on the effect of the drugs, but on their safety.

I want to point out that the Government have made funds available for good-quality research. That does not have to be done by the manufacturers; it can be done by charities, clinicians or researchers. A range of people can come forward to carry out clinical research. The MHRA—

I will not; I have only a couple of minutes left.

The MHRA is well equipped to provide advice to any applicants wishing to conduct clinical trials.

I have literally got two minutes left.

Currently, 13 trials are ongoing across the United Kingdom. In the previous 12 months, six of the other trials of cannabis-based products were completed, so some research is coming through the pipeline to help with that evidence base. I want to touch on one—the randomised clinical control trial mentioned by my hon. Friend the Member for South Leicestershire.

It is true that one study has three arms, one of which is a placebo. Having worked in clinical research myself, I reassure my hon. Friend that there are strict ethical guidelines for any clinical research. If someone is allocated to the placebo arm but it is clear when monitoring the research that one arm is doing significantly better than another, the trial has to be unblinded. Anyone on a placebo arm is automatically put on the arm that is doing best. I worked on clinical research for breast cancer, when we were trying to get Herceptin licensed, and for some patients that was the quickest way to get the drug. If there is clear evidence that one arm is working far better than others, patients can be moved on to that arm. It is a way of fast-tracking the drug for licensing.

I reassure Members that I absolutely understand the issue. The Government have changed the law to allow use of medical cannabis, but unless we give clinicians the confidence that the drugs, first, work—a feeling that they do seems to be the consensus in the Chamber—and, secondly, have a safety profile, they will not prescribe them. We can debate it forever in the House, but the clinicians have to be convinced. The way to do that is to get the product licensed, and the way to do that is to get good-quality research that the MHRA can look at to feel confident in licensing that drug.

The Government’s view is that there is funding for such research. My commitment to Members present today is that I will work with other colleagues to see whether we can speed up applications for research, encouraging them to come forward. For many Members, that is not the answer that they wanted to hear; they want me to stand up and say, “The drugs will be available tomorrow and we have people to prescribe them.”

We have to re-categorise cannabis from schedule 2 to schedule 4. That will open the gateway to medical research. Right now, it is hard for a lot of medical researchers to gain access to the product in the first place.

The licensing process is independent of Government, but we have levers to speed that up to ensure that the research coming through the pipeline—I have outlined some studies already in progress—will help the evidence base. We have been here before with other drugs in other sectors and we have manged to get there. We have another debate on Thursday, at which I am sure Members will press me further, but my commitment is that we will use every lever possible to get the research and the licensing process through, so that doctors across the country feel confident to prescribe this medicine, which makes such a difference to young people’s lives.

I thank all Members for contributing this evening. I thank the Minister for her response. Clearly, it is not the response that I was hoping for, but I know that she genuinely wants to find a solution.

I have offered a temporary solution. Doctors are prescribing this medication, but they are prescribing it privately. Many private prescriptions are being given by the medical profession to kids such as Evelina and Maya. My request once again to the Minister in my summing up is about her having a discretionary fund. Why do I know that? Because her predecessor told me so in answer to one of the debates that we had. The Minister has that discretionary fund and the executive authority to permit private prescriptions—which the parents of Evelina and Maya, and all the other parents across the country, have to pay for—to come from that pot, as a temporary solution until the Government, the regulatory bodies, the medicinal bodies and the medical profession sort out the issue.

I will be coming back to the Minister, I am afraid, once again requesting access to that fund.

Question put and agreed to.


That this House has considered medical cannabis under prescription for children with epilepsy.

Sitting adjourned.