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Westminster Hall

Volume 705: debated on Tuesday 7 December 2021

Westminster Hall

Tuesday 7 December 2021

[Steve McCabe in the Chair]

Asthma Outcomes

Before we begin, I remind Members that they are expected to wear face coverings when not speaking in the debate. This is in line with current Government and House of Commons Commission guidance. Members are also 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 asthma outcomes.

Thank you very much for calling me to speak, Mr McCabe. This is an issue that is close to my heart and close to the hearts of others here. There are few families in the whole of the United Kingdom for whom asthma has not been a key issue; it has been an issue for my own, and I want to speak about that as well. I am grateful to the Backbench Business Committee for agreeing to have the debate. I am chair of the all-party parliamentary group for respiratory health, which recently completed an inquiry into this issue, so I am delighted to be able to raise the issue of improving asthma outcomes in the UK. I very much look forward to the response from the Minister. I am also very pleased to see the shadow Minister, the hon. Member for Enfield North (Feryal Clark), in her place, and I wish her well in her new role.

What does asthma mean to me? My second son, Ian, had asthma. He was born with very severe psoriasis, which meant that we had to apply cream to him three times a day when he was a wee boy. The doctor told us that the psoriasis would eventually go away, but that it would be replaced by asthma. I am not sure of the medical connection—I am not medically qualified to understand it—and I know only what the doctor told me and my wife. Ian has had asthma all his life now—he is 30 years old—and has used salbutamol, the wee blue inhaler, which is always there. It is very clear, from our family’s experience, that those salbutamol inhalers are really important. They are important for Ian. Asthma did not stop him participating in sports, but it meant that he always had to have that inhaler close by, should he at any time feel shortness of breath or need a wee helper.

In Ian’s class at school, there were many others who had asthma issues. As an elected representative, whenever I help constituents with benefit forms, whether for attendance allowance, personal independence payments or whatever, I always ask them about their medical circumstances. More often than not, asthma features among the ailments that they confirm they have—even for those of a different generation. They have often had it for many years. Asthma is an incredibly important issue.

I am pleased to see the Minister in his place. I always like dealing with him, because I always find his answers helpful. He has a passion for the health issues that we bring to his attention, and he always tries to give, and indeed succeeds in giving, the answers that one wishes to receive. Today, we are going to ask a number of questions, and we very much look forward to his responses. I am pleased to see hon. Members in their places. I had hoped that more Members would be able to attend, but I understand that last night was a late night for Members and that there are other pressing matters today.

I have always had a particular interest in respiratory health. This debate has arisen as a consequence of the APPG’s report, which we published last year: “Improving asthma outcomes in the UK”. We looked at the UK mainland, but we also had contributions from Scotland, Wales and Northern Ireland. Obviously, I bring the Northern Ireland perspective to any debate, wherever it may be about, and bring in Strangford too. I am my party’s health spokesperson in this place, and I work closely with my colleagues back home in the Northern Ireland Assembly, particularly with Pam Cameron, my party colleague. She and I work on many things together, including this topic.

Last year, the APPG produced a report investigating the reasons behind the UK’s poor asthma outcomes. We were pleased, honoured and humbled that recognised experts in fields relating to asthma responded to our invitation to take part. The experts ranged from clinical experts from primary, secondary and tertiary care to patient advocacy groups, national asthma champions and patients.

The inquiry was incredibly helpful and detailed. I thank Hugh McKinney of the APPG secretariat and his team for bringing together all the people who wanted to contribute. As a result of the inquiry and the report, many countries in the world now look towards us to learn about how we deal with asthma. They want to learn something from us here in the United Kingdom, and perhaps do things that wee bit better.

I congratulate the hon. Member on securing today’s debate. As with most conditions, research and development is key to improving outcomes. Does he agree that funding into asthma research must be provided from a clearly defined central source and that there must be increased capacity for trials in hospitals?

I absolutely agree with the hon. Lady. No matter what the sphere of health, early diagnosis and attention is key. Indeed, my son is an example of that, as a child born with the ailment. There was early participation in his treatment by the doctors, including our own GP and those in the hospital. It is clear to me that that helped him on the pathway to better health. The hon. Lady is absolutely right and I thank her.

We received a large number of written submissions, including evidence from across the numerous asthma disciplines. We were encouraged that there was such a high level of interest. The APPG tries to do a catch-up once a month with stakeholders and those with medical expertise. Each month, we aim to hear from between 16 and 20 people who have an interest in the subject. They bring all their information to us, which we are pleased to have. We were incredibly encouraged that there was such a high level of interest, and I thank every one of them for their help and expert advice.

Let us consider the impact of asthma on people in the UK. The number of people affected by asthma in the UK is among the highest in the world, with some 5.4 million people sufferers. I had never done an interview with GB News until yesterday morning, but they were interested in this debate and a former colleague in this House was the interviewer. It was nice to catch up with Gloria de Piero again in her new job, and it was a platform and an opportunity to raise awareness and the questions were clear. That figure of 5.4 million people suffering from asthma came up early on in that interview.

I congratulate my hon. Friend on securing the debate. On raising awareness, will he join me in congratulating and commending so many of the voluntary groups, particularly those working with issues around chronic obstructive pulmonary disease? I can think of one such group in my constituency, in the Causeway area, that highlights these matters and draws attention to them in the wider community, in order that there is greater awareness across society to try and help people cope with that debilitating condition.

I thank my hon. Friend and colleague for that point. He is right that there many charities and volunteers, as well as many people who have the disease. A great number of people have expertise, interest and keenness to help and assist them. COPD is one of the most debilitating diseases that I have ever seen. I never realised just how many people in my constituency suffer from COPD, but there seem to be a large number, some of whom are in the advanced stages of a deterioration in health. I have a very good friend who is an artist; we have been friends for many years. He is interested in rural and country sports, as I am, which is where our friendship came from. Today, he is completely dependent on oxygen 24/7 and rarely leaves the house. For a man who was active and fit, COPD has changed his life dramatically.

Some 65% of people with asthma do not receive a yearly review—I am keen for the Minister to respond to that—despite recommendations by the National Institute for Health and Care Excellence that they should. I respectfully ask the Minister, if they are not getting a review, why not? Asthma has an impact on every patient’s quality of life. A recent pilot study for Asthma UK showed that the impact can be considerable: 68% said asthma attacks hold them back from work in school; 71% said severe asthma affects their social life; 54% said it holds them back from going on holiday; and 66% said severe asthma has made them or their child anxious. When the child is anxious, the parent is anxious—we all worry about what happens. The study also found 55% said having severe asthma has made them or their child depressed. The issue of depression and mental health has come up during the difficulties we have had with covid over the past year and a half.

Asthma deaths in the UK have increased by one third over the last decade. Three people in the UK die from asthma every day, which is among the highest in Europe, yet studies show that more than two out of three asthma deaths could be prevented. Three people die every day and if we had the right things in place, we could save two of those three lives every day in the UK. I put that challenge to the Minister, who I hope will give us the confident and positive reply that we would like to see.

Air pollution can trigger asthma attacks, and it is believed that it is linked to the rise in childhood asthma. Does the hon. Member agree that tackling air pollution could also bring public health benefits?

I absolutely agree. The hon. Member is making points that we all agree with. I am glad she has brought that to my attention. I come to London to work and am aware of the air pollution and the steps that the Mayor of London and others that are taking to try to address that, by restricting the number and type of cars coming in. As the hon. Lady rightly said, people have died in London from air pollution and we must address that. In large metropolises and population clusters, where vehicles and the economy are concentrated, air pollution is important.

I am fortunate to have lived in the countryside all my life. It means that when I go out of my back door there are green fields and the neighbours are about half a mile away, so there is a distance between us as well. However, some 14,000 vehicles a day pass by us on the road—the A20 from Ards to Portaferry—which, by its very nature, shows where the problem is.

Asthma exacerbations lead to over 77,000 hospital admissions each year. It is estimated that asthma leads to a direct cost to the NHS of £1 billion and an indirect cost to society of £1.2 billion due to time off work and loss of productivity. This goes back to the intervention by the hon. Member for Rutherglen and Hamilton West (Margaret Ferrier) when she referred to early diagnosis which can stop people losing work days and reduce the cost to the NHS. These factors cannot ignored be when it comes to addressing the health issues and helping to balance the books.

This year, the APPG’s intention was to produce a one-year-on report to highlight and emphasise the tremendous work that has been carried out by all those working in asthma. We intended to highlight the progress that has taken place in the past year, the actions of the Government, and any further areas that needed to be reconsidered. Our job will be to continue to note the progress—it may not be the progress we would like to see—and speak to the Minister to see how we can change that. However, covid changed everything. It changed our thinking dramatically. It has had a devastating effect on many lives and has impacted on asthma care. It affected the scope of our latest report, as well as concentrating on asthma outcomes one year on. We have also looked carefully at the impact of covid on respiratory health and asthma in particular.

I have the greatest admiration and respect for all those working in the NHS during these difficult times, especially those in respiratory health, which has been the hardest hit. They are all heroes—that word is used often, but it is true here—and a credit to the profession and the NHS. We are grateful and thankful to them all.

In the past year, covid has had an impact on those with asthma, COPD and the complex health needs that can sometimes be exacerbated by covid, leading to further difficulties. The past year has been difficult for every one of us. We have probably all lost loved ones to covid. In October last year, we lost my mother-in-law, who had complex needs. Covid took her, and we still miss her.

Today, I want to concentrate on the three critical issues identified by the clinical advisers who addressed our inquiry and shared their expertise and evidence. The first issue is the overuse of salbutamol reliever inhalers. We are not saying that people should not have them. That is not what the inquiry said or what the APPG is saying. We are looking at the potential overuse of those inhalers. The second issue is the new unified asthma guidelines. Thirdly, we need better use of biologics.

Prior to the covid pandemic, responders to our inquiry last year identified the overuse of salbutamol inhalers—the blue, not brown, inhalers—and oral corticosteroids as the biggest area of concern and the most important cause of exacerbation and unnecessary asthma deaths. In our report, the APPG also cited numerous studies that have shown that over-reliance on salbutamol may lead to the reduced use of preventer inhalers and to a greater risk of preventable attacks. Regular overuse has also been shown to increase the risk of asthma attacks, hospitalisations and deaths. The Department of Health and Social Care needs to look at the overuse of medications and whether that may do more harm. The evidence in this case seems to show that this is one of those situations.

A recent study by the SABA use in asthma global programme—the SABINA programme—found that high use of such inhalers was frequent among UK patients and

“was associated with a significant increase in exacerbations”

and in reliance on asthma-related healthcare. It stated the need to align SABA inhaler prescription practices with current treatment recommendations.

Some 22.5 million of these inhalers are dispensed to asthma patients each year, an average of five per diagnosed patient. Way back in 2019, before covid, and during one of the few times in my life I have had health issues, there was a week when I could not even come to Westminster, because the doctor told me it would not be safe to travel. My chest and breathing were at a level where he advised me not to travel. At that time, I was on the blue inhalers. I think I had three over that 11 or 12-week period. I may have had a wee bit too much, although I did not realise that at the time. That is one of the issues highlighted by the inquiry.

Patients using excessive numbers of inhalers should be flagged, identified and immediately seen by an asthma-trained clinician. I bring it to the Minister’s attention that we think it is time to rethink asthma treatment and get this right for patients and constituents across the United Kingdom of Great Britain and Northern Ireland. There are innovative approaches that demonstrate SABA-reduction.

A 2018 study in The Lancet suggested a maintenance and reliever treatment, with a combination steroid and long-acting beta-agonist, which would allow SABA-free treatment. That could be an effective way to reduce SABA overuse among patients, where clinically appropriate. As ever, it must always be done in consultation with and under the guidance of your doctor and those with health expertise.

The Sentinel project undertaken in Hull and East Yorkshire improved outcomes for adult asthma patients by identifying SABA over-reliance and appropriate implementation of a MART strategy. There is a pilot scheme, which could be the marker, the guide, the standard, the level for the rest of the United Kingdom. Data from that pilot Sentinel study demonstrated that MART can substantially reduce the SABA prescribing.

To ensure that that happens, it is important to restore the asthma reviews, which were hit badly by covid. It is time, ever mindful that covid is our priority, to look at the other issues in the United Kingdom, and asthma is one of them. Asthma UK’s latest annual survey showed that 66% of people with asthma are not receiving basic care for their condition, and that that level has fallen, for the first time in eight years. Minister, what has been done to address that fall? How can we do it better?

An annual asthma review is an important component of addressing that. I should be grateful if the Minister would update us on the progress that has been made on restoring the annual reviews. When we are responding to health issues in the United Kingdom we often need data, so it is important to have that in place.

We also suggested in our APPG report that primary care incentives might be necessary to drive the reduction of SABA use. We stated that the QOF—quality and outcomes framework—or the investment and impact fund have the potential to help with that. The patient pathway is also an important method to reduce SABA use, which brings me to my second point—the new unified guidelines.

Last year, in our inquiry, we analysed the challenges faced by clinicians in treating severe asthma. We found that almost all the experts identified the existence of multiple asthma guidelines as confusing, unnecessary and a cause for concern. If they are confusing to experts, and therefore for our constituents and patients too, we need to have a singular approach. Again, I look to the Minister for a response.

The Royal College of Physicians told us in its submission that

“national audit data collected from England, Scotland and Wales indicates that the standard of care against national guidelines (NICE and BTS) and recommendations from NRAD are variable and on the whole substandard.”

There is a need to get things right and singular. As a consequence, the APPG strongly welcomed the commitment to and the ongoing work to produce unified guidelines as a necessary step forward to improve asthma outcomes. We felt that it was especially important for our time-stretched clinicians that all guidelines on asthma should be in one place.

The unified guidelines were delayed due to covid, but are due in 2023. Our main concern, however, is that we understand that the draft scope for the new unified guidelines does not include severe asthma. I bring that to the Minister’s attention, because we feel it should. Perhaps the Minister will give us some indication of what will be done to address that, because that appears to me to be a serious omission, and others will agree.

It is unclear how any guidelines could be described as “unified” when the most serious type of asthma is not included. I have a concern, a question mark in mind, about that. It is especially puzzling when we consider that the existing NICE, British Thoracic Society/Scottish Intercollegiate Guidelines Network, Global Initiative for Asthma and NRAD—national review of asthma deaths—guidelines all give similar criteria for referring a patient for severe asthma.

If severe asthma is excluded from the scope of the unified guidelines, the concern is that newer treatment options will not be addressed properly, which takes us back to the intervention by the hon. Member for Rutherglen and Hamilton West. This is about early diagnosis and treatment at an early stage. If we do not get that right, we will have complications and problems later.

Those newer treatment options include the use of biologic treatments and the latest best practice in phenotyping, which were strongly recommended by both clinicians and severe asthma patients in our inquiry. The long-term plan states:

“We will do more to support those with respiratory disease to receive and use the right medication”,

but without severe asthma included in the unified guidelines, that is unlikely to happen. How can we make that happen, rather than being unlikely? Will the Minister therefore give me, the House and those in and outside this Chamber the thinking behind that omission? What is the possibility of adding severe asthma back into the discussion? If we can retrieve that and bring it back in, I will be pleased. I also wonder what can be done while we wait for the new guidelines. Four sets of guidelines are confusing for clinicians. Surely it would be preferable not to wait until 2023 for clarity. We need to act today—for the three people who die every day due to asthma. That is the imperative. Is there any way that the Minister can reflect on that and give consideration to updated living guidelines to reflect current best practice and treatment?

Unified or updated guidelines can materially affect my third point on biologic therapies. They are life-saving treatments for people with certain types of severe asthma and asthma that is difficult to control. They can reduce asthma attacks in severe asthma, reduce the need for steroids and improve symptoms. At present, they are only offered to patients through the specialist asthma clinics. There was strong support in our report last year for the appropriate use of biologic treatments and we supported the extension of prescribing to secondary care clinicians for severe asthma patients. Many clinicians viewed the use of biologics as a better alternative to traditional oral corticosteroid treatment for severe asthma and we received evidence that a large majority of patients who are eligible still do not have access to them.

Asthma UK suggests that

“82% of difficult and severe asthma patients are often not being referred at the right time, or sometimes, not at all.”

That is hard to believe. Asthma UK and BLF also told us that the current NHS asthma care pathway does not take full account of the availability of the new treatments. So most people with severe asthma are still reliant on OCS. According to Asthma UK, three in four people eligible for biologic treatment are still not accessing it and thousands of patients are having to endure treatments that are considered inadequate and suffer unnecessary side effects.

That is linked to the Government’s five highest health gains programme, which introduced a commitment by the UK to match or surpass comparative nations in the access to new and innovative medicines in five clinical areas, one of which is severe asthma biologics. The scheme committed to the objective of

“reaching the upper quartile of uptake for 5 highest health gain categories”

during the course of the first half of the scheme, by mid-2021. We applaud the Government’s initiative and action on that to date, but the deadline has clearly been missed. New data commissioned by NHS England has shown that the UK is far from the upper quartile and confirms that we are currently ninth out of 10 with regard to comparator countries. We must improve that. We must get better and do that for our patients. We also recommended extending the Accelerated Access Collaborative’s severe asthma programme, and increasing resources to increase capacity for prescribing biologics will be important for achieving that. Will the Minister give a renewed commitment to achieving upper quartile access and set a new, clearly defined target for when and how that will be achieved?

In October 2021 the Government announced 40 new community diagnostic centres, which are set to open across England in a range of settings, from local shopping centres to football stadiums, to offer new and earlier diagnostic tests closer to patients’ homes. I want to put on record my thanks to the Government and the Minister for that commitment. It is clearly there and we thank him for that. However, we cannot make it a postcode lottery. If it can happen here in London, it should happen in Cardiff, Newcastle, Liverpool and everywhere else. Nowhere should be any different, so I would like to see that happening.

The Government have stated that the new centres will be backed by a substantial amount of money—a £350 million investment—and will provide around 2.8 million scans in the first full year of operation. They are designed to assist with earlier diagnosis through faster and easier access to diagnostic tests for symptoms in areas including breathlessness, cancer and ophthalmology. In the Budget, the Chancellor announced an additional £5.9 billion to tackle the backlog of general diagnostic tests to deliver more checks, more scans and more treatment. The intention is to increase the number of diagnostic centres to at least 100 and I understand that each one will include a multidisciplinary team of staff, including nurses and radiographers, and will be open seven days a week. The Government and the Minister are to be commended for that, and I warmly welcome it and the funding that will be allocated. I hope they can help address the covid-imposed inequalities that we have seen across the country in asthma care and treatment. Will the centres be fully staffed, will they have trained staff and will they be in place?

I also welcome the breathlessness diagnostics, which will be included in the centres. It is essential that they should be equipped to diagnose any cause of breathlessness, whether cardiovascular, lung cancer, asthma or chronic obstructive pulmonary disease, which my hon. Friend the Member for East Londonderry (Mr Campbell) mentioned. It is also important to establish an appropriate referral system from the centres, should further investigation be warranted. Will the Minister confirm that the FeNO and spirometry tests will be included in all centres, to allow for fuller asthma assessments?

I look forward to the contributions from other Members, and I thank those who intervened on my speech. I very much look forward to the Front-Bench contributions, particularly from the Minister.

It is a pleasure to serve under your chairmanship, Mr McCabe. I am delighted to follow the hon. Member for Strangford (Jim Shannon), and I congratulate him on securing this excellent debate. I thank him very much for what he has said. My speech will be less wide-ranging than his, but I want to deal with two particular aspects. First, I should declare an interest, in that my brother works in this industry. Having said that, we never talk about work, so that is literally as much as I can say about what he does. However, I have had several meetings with representatives of Kindeva, a company that deals in the asthma industry, and visited its site. It is based in my constituency, so I will refer to the company in some detail. I will first discuss the change in drug delivery that is proposed by DHSC, before talking about prescription charges.

Asthma can be an incredibly dangerous condition. As Asthma UK data show, there are around 75,000 asthma-related emergency admissions to hospital every year in the UK and, sadly, asthma causes the death of around 1,200 people every year. Thankfully, however, although there is no cure, there are simple and, importantly, accessible treatments that can help keep the symptoms under control, including inhalers. That being said, the fact that people are still dying from this condition shows that more work needs to be done, and I was encouraged by the response from the Minister for Care and Mental Health to the debate on access to salbutamol inhalers last week, during which she set out the steps that the Government and NHS are taking to improve asthma outcomes. I was particularly encouraged to learn that the NHS long-term plan includes respiratory disease as a national clinical priority and sets out a number of respiratory interventions, including plans for early and accurate diagnosis of respiratory conditions. I would welcome reassurance from the Minister that the Government will work with the NHS to achieve the aims set out in the long-term plan.

I want to take the opportunity to mention an issue that has been raised with me by Kindeva, a pharmaceutical contract development and manufacturing organisation, when I visited its state-of-the-art research, development and manufacturing facilities at Charnwood Campus in my constituency, which is the very first life sciences opportunity zone that is based in the UK. During my visit, I saw the production of pressurised metred-dose inhalers, or PMDIs, and I heard about Kindeva’s work to transition to green propellants. I am delighted that as part of this, Kindeva and Loughborough University formed a knowledge transfer partnership to proactively address the inhalation drug delivery industry’s move to develop PMDI propellants with lower global warming potential, or GWP, than exists currently in marketed propellants. That is a fantastic example of universities and businesses working together to turn a cutting-edge idea into a marketable product, and it reflects the success of Charnwood Campus.

That being said, I understand that the NHS’s current target to reduce the carbon impact of inhalers by 50% by 2028—by switching patients from PMDIs to dry powder inhalers—coupled with the Government’s review on the use of fluorinated gases, is creating uncertainty for the industry. Specifically, I have been informed that the NHS switchover policy is shrinking the size of the UK PMDI market, and that Department for Environment, Food and Rural Affairs’ proposals to remove the essential medical use exemption of F gases in PMDIs would put considerable pressure on the market before green propellant alternatives are widely available.

Although I fully support the Government’s net zero strategy and their commitment to build back greener from the pandemic and level up all areas of the country in the process, if we are to achieve these aims, we must work with industry to ensure that we do not unintentionally drive innovation out of the country, along with opportunities for inward investment and long-term, highly skilled jobs, particularly in the east midlands and, from my point of view, most particularly in Loughborough. We have a fantastic opportunity to be a world leader on green propellants, and we have the willingness of industry to make the necessary changes. I therefore ask the Minister and the NHS to work with the industry and, most importantly, afford it the time needed to transition to greener propellants, by delivering the current NHS emissions reduction targets over a longer timeframe, and maintaining the current medical use exemption for F-gases until 2030.

Consider the situation, imagine the scene, of struggling for breath. Constituents have that problem across the country every day. They need consistency of treatment to enable them to trust the medication and have it delivered quickly and accurately. When they need the medication, it is very often an emergency. They need the drug delivery to be accurate and timely. Let us take that into consideration when looking for net zero outcomes in medications and treatment.

Asthma UK called for a suspension of prescription charges for asthma medications and for them to be added to the medical exemptions list. I think we would all agree, particularly in the case of the son of the hon. Member for Strangford, who was born with the condition, that this is not something that can be avoided. Therefore, why should patients pay for those prescriptions?

It is a pleasure to serve under your chairmanship, Mr McCabe. I congratulate the hon. Member for Strangford (Jim Shannon) on securing this important debate. It is incredible that the subject of asthma has not been discussed more often in the House, given that it affects to so many people.

I would like to start with some key statistics on severe asthma: 5.4 million people in the UK currently receive treatment for asthma, including 5,282 people in my constituency of Blaydon, where we have a sad history of respiratory conditions, including asthma, affecting the lives of too many people.

Around 200,000 people in the UK have severe asthma, which is the most debilitating and life-threatening form of the condition, and which does not respond to conventional treatments. Four out of five people with suspected severe asthma, who should be referred to a specialist, are not getting the care that they need; 46,000 people are missing out on life-changing biologic treatments.

The north-east region has the highest oral steroid prescribing rate at 20%, prescribing two or more courses of oral corticosteroids in the previous 12 months compared with the 14% average. As we have heard, oral steroids can have very nasty side effects, including osteoporosis, weight gain and diabetes.

Severe asthma has a devastating impact on every part of someone’s life. Living with severe asthma is so much more than asthma attacks and occasional hospital admissions. People may feel isolated, lonely and scared, left without hope or the right support. The covid pandemic has clearly shown that for many people that is a very real concern, leaving many of them in isolation.

One person with severe asthma reflected on how it impacts on them:

“It’s really restricted me. I have suffered because there was a point when I refused to leave the house… So, it really affected my work, my lifestyle. Meet your friends, just even speaking to them, I would get really out of breath. I was trying to avoid all of that.”

Without specialist treatment and support, people with severe asthma end up in a never-ending cycle of emergency trips to hospital, relying on toxic oral steroids, which can have very nasty side effects. It has now been shown that as few as four courses of oral steroids over a lifetime can be associated with adverse effects. Another person with asthma, speaking to the British Lung Foundation and Asthma UK, said:

“Steroids made me able to breathe but they ruined my life. The insomnia, the racing thoughts, the weight gain. I have lost all confidence and self-esteem.”

Asthma UK’s recent survey of more than 2,000 people who used oral steroids in the last year revealed the devastating consequences on their quality of life, with 73% experiencing at least one side effect, and one third experiencing side effects relating to their mental health. Another person in the survey, a woman in her thirties, said:

“They affect my mental health really badly and the effects last for weeks or months after I finish the course. I dread taking them but do it to make my asthma better.”

That is not the kind of life that we want people to have.

However, there are some potential treatments. Life-changing biologic treatments offer hope, but only if people have access to them. Treatment in care for severe asthma has transformed over recent years. There are now five life-changing biologic treatments available that reduce, or even stop, the need for oral steroids. A person in another Asthma UK survey said:

“I just wish I had been put on this biologic a lot sooner. Because the period I was suffering, you can’t explain it in words. It was really, really hard for me. It was just so depressing that sometimes you think your life is just not worth living anymore.”

Access to those biologic treatments is poor. Asthma UK’s report, “Do No Harm: Safer and Better Treatment Options for People with Asthma” showed that an estimated 46,000 potentially eligible people are still missing out. Recent analysis by Logex showed that England is second from the bottom on biologic uptake in a comparison with similar European countries. Work is being done to improve the uptake of biologic therapies through the accelerated access collaborative, and Asthma UK has also developed a patient-facing tool, but much more needs to change to bring us in line with other European countries.

Nicki, from Oxford, has been able to access a biologic treatment early, in special circumstances, because she was not responding to other treatments for severe asthma. She says:

“My asthma was so bad that I spent my late twenties and early thirties being blue-lighted to hospital regularly with life-threatening asthma attacks, rigged up to machines to help me breathe and not knowing if I was going to see my 35th birthday. I couldn't walk anywhere due to breathlessness and had severe asthma attacks without warning. My plans for starting a family were put on hold because I was too ill and the only thing that offered any kind of relief was long-term steroid tablets, but these caused me to rapidly put on weight and I was still in and out of hospital continuously. My partner had begun to feel like my carer and I was losing my independence.

Since I have been on dupilumab, I feel like a new woman. I’ve taken part in cycling challenges, love walking my dogs, have a fantastic new job in health research and am able to finally contemplate starting a family.

It was a difficult process for me to get access to dupilumab but I know I’m one of the lucky ones—some people wait years for referrals and this can have a huge impact on their lives. It’s vital people get referred if they’re ever going to reap the benefits of this potentially life-changing treatment.”

That is a vivid illustration of the dramatic impact of new biologic treatments on those for whom they are suitable and available.

A lack of comprehensive guidelines can result in delays and missed opportunities for referral. Dedicated specialist services now offer a comprehensive systematic assessment, multidisciplinary team input and phenotyping. However, 82% of people who would benefit from seeing a specialist, according to British Thoracic Society guidelines, are not getting referred. Covid-19 will have compounded that; there was an 86% drop in referrals for respiratory disease during lockdown, and that has not fully recovered. People are unable to access these specialist services because there is a lack of awareness that severe asthma is a distinct condition that needs dedicated services and biologic therapies to treat it effectively. Furthermore, many health professionals do not know when to refer someone or understand the benefits that referral to a specialist could bring.

Other research from Asthma UK has shown that there is a variation in when clinicians think they should refer someone. This is because the current guidelines are confusing and conflicting, as we have heard. It is incomprehensible that a condition affecting over 200,000 people in the UK did not have a National Institute for Health and Care Excellence management guideline until the covid-19 pandemic, when rapid guidance was produced. That was a positive step, but a fully evidenced guideline with clear referral criteria is still urgently needed to address the huge unmet need and show the benefits of referring someone to specialist care. It is disappointing to see that severe asthma has been excluded from the upcoming NICE, British Thoracic Society and Scottish Intercollegiate Guidelines Network joint guideline draft scope on asthma. Including severe asthma, with clear referral criteria, within the NICE guidelines has the potential to transform care for people with asthma.

There are some clear policy recommendations regarding severe asthma. Repeated use of oral steroids must be seen as a failure of asthma management, and prompt urgent action and appropriate referral should be taken. Primary and secondary care clinicians need to be proactive in order to recognise and refer those with suspected severe asthma. NICE should develop a single, comprehensive severe asthma guideline on identifying, referring and treating people who may have difficult or severe asthma. We need to see the brilliant work by the accelerated access collaborative implemented, and the appropriate funding put in place, to allow severe asthma specialists to provide the right care and biologics to all who need them.

Before concluding, rather than concentrating only on severe asthma, I will touch on some broader issues about asthma. These are key points that need to be addressed. The SENTINEL study, which we heard about from the hon. Member for Strangford, is looking at the use of the blue short-acting beta agonist inhalers, and proper management for people with asthma that ensures they are properly reviewed. This is with the aim of reducing the use of SABA inhalers, and of using other anti-inflammatory inhalers properly to decrease the number of exacerbations. That has the potential to bring improvements for all asthma sufferers, not just those with severe asthma.

As we also heard from the hon. Member for Strangford, annual reviews are really important for all those with asthma. It is important that there are properly trained asthma nurses who can conduct those reviews, and that they feature in the new community diagnostic hubs that have been announced, so people can get access to these reviews. Not everyone gets access to reviews—too few people do at present.

We have talked about how the new asthma guidelines need to include severe asthma. Having that unified guideline would be very helpful. We need better access to biologic treatments for those who would benefit from them. Finally, I want to mention the impact of covid-19 and the recovery plan. I hope that the Minister will say something about what is being done to support people with asthma, and with severe asthma, and to make positive improvements in the wake of covid-19.

It is a pleasure to serve under your chairmanship, Mr McCabe, in what is an extremely important and timely debate. I thank the hon. Member for Strangford (Jim Shannon) for securing it, and I know that the issue is very close to his heart. He exerts such energy, enthusiasm and dedication through his work with the all-party parliamentary group on respiratory health, and the issue also has a very personal resonance for him, as we heard, given that his son has been diagnosed with asthma. The hon. Gentleman has first-hand experience of asthma’s impact on a young person and a family, of the concerns that it brings to the whole family and of the need for improved, ongoing care for everybody affected.

The hon. Gentleman set the scene extremely well, and in a detailed manner. He raised with the Minister the issues that clearly need to be addressed, and ensured that we are all aware that we should be speaking more about asthma and its implications, given its impact on so many people across the United Kingdom. He gave some startling figures, including that three people a day die as a result of this treatable disease. We should be doing far more to ensure that those deaths do not happen and that the interventions required are delivered in a timely manner. Those who need additional support must get access to the trained nurse clinicians and the annual reviews that they so desperately need.

I also thank the hon. Member for Loughborough (Jane Hunt). I do not believe I have had the pleasure of speaking to her personally in this place yet, because of our absence during the covid pandemic. I look forward to speaking with her about her particular interest in health. I say that as a clinician, as the chair of the all-party parliamentary health group and as someone with an interest in taking these issues forward. She raised such important matters, including the move towards climate change-friendly, net-zero alternatives. She said that the move must be staged so as not to be too quick for the people who desperately need the medication to catch up, and that it must be done in a very pragmatic way so that it does not impact on those UK organisations that she spoke about, including in her own constituency. Those organisations are working so hard to ensure that science is at the forefront and that, while we achieve net zero, we put patient health at the forefront of all of the decisions that are made in this context. She spoke extremely well on that matter.

The hon. Member for Blaydon (Liz Twist) always speaks eloquently on health-related matters, and I very much welcomed her person-centred approach to the debate. She detailed the impact of asthma on people’s lives, and contributed that first-hand information to the debate. Asthma has a devastating impact on individuals, and people must have access to the biologic treatments that she described. Where there is innovation and excellence in our NHS, it must be available to everybody who needs treatment. That is why, importantly, she told the Minister that individuals must have access to community hubs for diagnosis, linked with early prevention and prescribing. There should be no postcode lottery; no matter where people live in the United Kingdom, they should have access to the treatment that they so desperately need.

While I think about hon. Members’ contributions, I will also briefly mention prescription charges, which the hon. Member for Loughborough also discussed and are extremely important. The Scottish Government abolished prescription charges in 2011, but in England the current charge is £9.35 per item. Since 2011, those suffering from asthma in Scotland have had access to free inhalers, meaning that no person is ever left without an inhaler because of cost. A recent survey conducted by Asthma UK found that three quarters of people living with asthma in England had struggled to pay for their prescriptions and that individuals had often turned to skipping doses of their inhaler to cut costs—again, the impact of poverty and deprivation causing detriment to those who have asthma.

I thank the hon. Lady for letting me intervene. I understand her point about Scotland, but there is available an annual prescription charge, which is far less. However, my point was really about the fact that asthma sufferers cannot help it, essentially. Is there something we could do there?

Absolutely, and the hon. Lady makes an excellent point. While the choice in Scotland has been to abolish prescription charges, I note that she did not suggest that to the Minister. However, she did suggest—perhaps because we know that asthma often starts in childhood and is not something that people have much control over—that an exemption could be applied. Following that recommendation from the hon. Lady, I would be interested to hear the Minister’s thoughts on the matter.

Cost itself should not mean that someone cannot access healthcare, and in a developed country such as the United Kingdom, there should be no prohibition owing to charges and costs, particularly for something for which people often need daily medication. We have heard from Asthma UK that that is happening—people are skipping doses and many are struggling to pay for their prescriptions in England.

In 2021, the Scottish Government published their respiratory care plan, which is a care plan covering 2021 to 2026. It includes a workstream specifically on asthma, and I am pleased that that is being taken forward at that level. We know that asthma attacks across the UK, including Scotland, have increased by a third over the last decade, and the number of people affected in the UK is among the highest in the world, with about 5.4 million receiving treatment for asthma. That is equivalent to one adult in every 12, and one child in every 11, so we know that asthma is widespread and that it needs to be a priority for Government action.

Asthma affects people of all ages, as we have heard, and often starts in childhood. I must declare that I have been diagnosed with asthma and have had asthma since childhood. I say to the Minister that there is absolutely nothing worse than the feeling of struggling for breath. I have found wearing a mask difficult at times, but I have continued to do so, and there are exemptions for people with severe health conditions. However, asthma comes upon people suddenly and can leave them with a feeling of such a lack of control, so it is important to have specialist advice from the nursing staff, which the hon. Member for Strangford spoke of.

I do not believe that I received such advice when I was younger; I think I was given an inhaler, told to go off home to practice and learn to use it myself. I wonder whether the issue that the hon. Gentleman raised—people overusing their inhaler medication—is down to there not being enough early intervention and education on how to use an inhaler properly.

I say to the Minister that although the recommendations have been raised on the Floor of this debating Chamber, we need meaningful data. We need to know about overuse, and the rationales and reasons for that overuse. Do people need more education and intervention from clinical nursing staff in the community hubs? Does the cost mean that people in poverty struggle to access treatment, and is that contributing to the death toll? That data is crucial.

As has also been widely mentioned, Asthma UK has indicated that NICE should develop comprehensive guidance on severe asthma. Can we also make sure that the newer treatment options—the biologic treatments—are widely available to everyone who needs them?

I thank everyone who has taken part in this debate, which has been an extremely positive one. I particularly thank the hon. Member for Strangford, because this issue is so important to so many people in the United Kingdom, and I look forward to hearing the Minister’s response.

It is a pleasure to serve under your chairmanship, Mr McCabe.

I thank the hon. Member for Strangford (Jim Shannon) for securing this Backbench Business debate on improving asthma outcomes and for setting out so comprehensively the issues and challenges faced by the UK’s asthma sufferers. He said there are not many families in the UK who are not affected by asthma—his own son is an asthma sufferer—and I absolutely agree with him. I have a cousin currently in hospital who is a severe asthma sufferer; his covid was made worse by his severe asthma. It is a condition that affects many of us.

The hon. Member also set out some sobering statistics about asthma, which should shame us all. He made three asks and set out the areas where he believes the Government need to do more, which was echoed by many other speakers. They relate mainly to the overuse of blue inhalers, the conflicting guidelines and the need to improve them, and biologic therapy, which I will touch on.

We also heard from the hon. Member for Rutherglen and Hamilton West (Margaret Ferrier), who raised the issue of air quality and air pollution. We know that air pollution exacerbates asthma. Most Members will know the case of Ella Kissi-Debrah, the nine-year-old asthma sufferer who died, and the coroner said air pollution was a factor in her death. We know that air pollution affects asthma sufferers really badly and more needs to be done about it.

The hon. Member for Loughborough (Jane Hunt) set out very well the great work being done by businesses and the university in her constituency, and also raised the important issue of prescription charges and the need to have a medical exemption from them. Others raised that issue, too, and I absolutely agree.

Finally, my hon. Friend the Member for Blaydon (Liz Twist) set out the facts and statistics—the really terrible statistics—that the UK has on asthma and the challenges around gaining access to biological medicines. She also told the stories of some asthma sufferers.

We have heard today that severe asthma is the most debilitating, even life-threatening, condition that does not respond to conventional treatment. As has been said, it is estimated that about 200,000 people in the UK have severe asthma, and without specialist treatment and support people with severe asthma end up in a never-ending cycle of emergency trips to hospitals, relying on toxic oral steroids that have nasty side effects; we heard real-life stories about those from my hon. Friend the Member for Blaydon. She also said that four out of five people with suspected severe asthma who should be referred to a specialist do not receive the care they need, and that 46,000 people are missing out on life-changing biological treatment, an issue that was raised by almost all hon. Members who spoke today.

Today’s debate is important because currently there is no cure for asthma; it is only possible to manage the condition so that symptoms are kept under control. We must ensure that asthma treatments and outcomes are of the highest quality. The UK has one of the worst mortality rates for asthma in Europe, with a death rate almost 50% higher than the average death rate for the EU. That should embarrass us all. Despite initiatives such as the 2014 national review of asthma, asthma deaths rose by more than 33% in England and Wales between 2008 and 2018. Some 5.4 million people in the UK are receiving treatment for asthma, leading to 41,000 hospital admissions last year for asthma-related concerns, and 1,300 deaths.

If those figures are not enough to show that we must improve asthma outcomes, we should note that two thirds of asthma deaths are preventable. Three people die from asthma attacks every day. That number must be lowered.

The disruption caused by the pandemic has had a huge impact on asthma care and outcomes. Basic asthma care is an annual review, an inhaler technique check and a written asthma action plan. Members have discussed how that care is not enough. Last year, the number of people receiving even that basic level of care dropped for the first time in eight years, with more than 3.5 million people missing out on potentially life-saving treatment—that is 3.5 million people with asthma who were put at risk. However, even before the pandemic, respiratory care was lagging behind care for other conditions. Basic care levels for asthma were stalling. Recent research by Asthma UK shows that 75% of people with chronic obstructive pulmonary disease were also missing out on fundamental care.

We must understand the challenges of asthma treatment in our country and look at what we might do differently to save lives and improve patient outcomes. There are several areas for the Government to improve. Many excellent suggestions have been made today. I want to focus on the restoration of the normal delivery of care, prescription charges and air pollution. The Government’s work should not be limited to these areas and I urge the Minister to explore other avenues, such as early diagnosis and promoting the take-up of covid booster vaccinations for asthma patients.

In England, the NHS long-term plan included respiratory diseases as a national clinical priority, with the objective of improving outcomes for people with respiratory diseases including asthma. I urge the Government to therefore commit to restoring the normal delivery of care for people with respiratory diseases, so that everyone with asthma receives at the very least the most basic level of care and that 3.5 million people are not denied the basic care they deserve.

Many Members have referred to the Asthma UK survey that found that 76% of people with asthma struggle to afford their prescriptions, 57% skip their medication because of the cost, and 82% say their symptoms worsen as a result. People on lower incomes are already nearly twice as likely to have had an asthma attack than those on higher incomes. The inability to afford prescription charges is highly likely to be a contributing factor. It is putting lives at risk. People should not be forced to choose between paying for a prescription or risking their lives.

Health inequality is one of the major drivers of poor health outcomes that we see today, and asthma is no exception. We know that asthma symptoms are exacerbated by breathing polluted air, as well as from smoking. Air pollution can worsen existing health inequalities and the people living in the poorest areas are often the most exposed to polluted air, reinforcing unequal health outcomes for deprived communities. We need to make sure that air pollution is reduced across the country and must adopt into law enforceable targets set out by the World Health Organisation to bring air pollution down to below harmful levels.

In November 2020, the APPG on respiratory health produced its report on improving asthma outcomes in the UK, which we have heard about today, and I look forward to its forthcoming one-year-on report. I urge the Minister to consider those reports and reflect closely on the recommendations and issues raised by the hon. Member for Strangford.

It is a pleasure to serve under your chairmanship once again, Mr McCabe, after our many hours in Committee. I thank my hon. Friend the Member for Strangford (Jim Shannon) and congratulate him on securing this debate and for his work on the APPG. As ever, in speaking of his and his family’s experiences, he was typically open for the benefit of the House and those watching our proceedings, and I pay tribute to him for that.

I also welcome the hon. Member for Enfield North (Feryal Clark) to her role on the Opposition Front Bench. She has big shoes to fill, but on the basis of today and what I know of her from her time in this House, I have no doubt that she will do so with skill and dedication and with her typical courtesy while holding us to account as a Government. I wish her all the best in the role.

The Government are dedicated to improving asthma outcomes. In the past 10 years, we have rolled out guidance and initiatives to improve in this area. In 2011, the Department for Health, as it then was, published an outcome strategy for COPD and asthma. It set out a proactive approach to early identification, diagnosis, intervention, proactive care and management. All stages of the disease, as we have heard from hon. Members on both sides of the House, can affect anyone. When it does, it has a huge impact on their lives.

I pay tribute to the hon. Member for Blaydon (Liz Twist) for bringing to life this issue and what it means for individuals with the examples she used, and for talking about her own experience, which is incredibly powerful. I pay tribute with her, as ever, for being willing to share that with this House.

A wrong diagnosis will result in patients not getting the care they need. That is why in 2013 “A Guide to Performing Quality Assured Diagnostic Spirometry” was produced by the NHS with several charities and stakeholders. It was published to support the accurate diagnosis of respiratory conditions to tackle the effects of misdiagnosis.

In 2014, the national review of asthma deaths—the first UK-wide investigation—was published. It aimed to identify avoidable factors, and make recommendations to improve care and patient self-management. NHS England and NHS Improvement commissioned the national asthma audit programme in 2018. It provides data on a range of indicators to show improvements and opportunities in asthma outcomes. The audit’s data are used by providers to assess their quality and support improvement.

More recently, as a number of hon. Members have alluded to, the NHS long-term plan, published in 2019, includes respiratory disease as a national clinical priority with the objective to improve outcomes for people with respiratory diseases including asthma. The respiratory interventions proposed in the NHS long-term plan include early and accurate diagnosis of respiratory conditions. Diagnosing conditions earlier may help to prevent avoidable emergency admissions for asthma.

As part of the long-term planning commitment, pharmacists in primary care networks will undertake a range of medicine reviews, including teaching patients the correct use of inhalers and contributing to multidisciplinary work. I can give my hon. Friend the Member for Loughborough (Jane Hunt) and constituency neighbour the reassurance she sought that we continue to work closely with the NHS in the delivery of that long-term plan, specifically on these objectives set out in it.

To deliver on that objective, NHS England has established 13 respiratory networks across the country. They will provide clinical leadership for respiratory services and are focused on improving clinical pathways for asthma. Since the long-term plan was published, a number of initiatives and publications have been announced.

Before making further progress, I will turn briefly to some of the comments made by hon. Members—I suspect this is a timely way of responding to them. My hon. Friend the Member for Loughborough talked about Kindeva, based on the Charnwood campus in Loughborough in her constituency. I know it well, as the neighbouring Member, and know that it is something she and Jonathan Morgan, the leader of Charnwood Borough Council have championed as a huge asset to our national economy and national effort in this space. She talked about the pMDI market, F-gases and the transition. We commit to our net zero ambitions, but she is right to highlight the need for the transition to be done in a sensible and measured way, and we continue to work closely with industry partners and industry-representative bodies in order to manage that process. I hope that gives her at least a degree of reassurance on this important issue.

NHS England’s national patient safety team has prioritised its work on asthma. This work is part of the adoption and spread safety improvement programme, which aims to identify and support effective and safe evidence-based interventions and practice across England. The asthma ambition is to increase the proportion of patients in acute hospitals receiving every element of the British Thoracic Society’s asthma discharge care bundle to 80% by March 2023.

The quality outcomes framework—QOF—ensures that all GP practices establish and maintain a register of patients with an asthma diagnosis. The QOF for 2021-22 includes improved respiratory indicators. The content of the QOF asthma review was amended to incorporate key elements of basic asthma care for better patient outcomes, including an assessment of asthma control, a recording of the number of exacerbations, an assessment of inhaler technique, and a written, personalised asthma action plan.

Since April 2021, the academic health science networks and patient safety collaboratives have been working with provider organisations to increase take-up of the British Thoracic Society’s asthma care bundle for patients admitted to hospital in England. Centres’ compliance with the elements of good care outlined in the bundle is measured in the national asthma audit.

I thank the Minister for his responses. He mentioned the 2023 target, to which I referred. Is it possible to shorten that timescale?

As ever, the hon. Gentleman tempts me to be more ambitious. We have set 2023 as a realistic and achievable target. If it were possible to achieve it sooner, that would of course be a positive. Both in my Department and beyond, everyone will have been encouraged by the hon. Gentleman’s ambition and encouragement to go further and faster on that target, if they can. He makes his point well. I will make a little progress and then come back to several of the hon. Gentleman’s questions.

We recognise the particular effect of asthma on children and young people, which is why NHSEI’s children and young people’s transformation programme is promoting a systemic approach to asthma management. The first phase of the national bundle of care for children and young people with asthma has been developed with clinical and patient experts. A complete version of the bundle of care will be published in spring next year. The children and young people asthma dashboard, developed alongside the bundle, will be able to identify asthma care by race, geography, age and social deprivation, which goes to a number of points highlighted by the shadow Minister, among others. That will help ensure that children and young people with asthma who face the starkest health inequalities are prioritised.

The national care bundle has an environmental impact section that sets out three key standards around air pollution, which is an issue raised by Members on both sides of the House, including the hon. Member for Rutherglen and Hamilton West (Margaret Ferrier), who is no longer in her place. We set out the Government’s clean air strategy in 2019, recognising the impact of air pollution on health and a range of other factors that affect people’s lives. In this space specifically, we recognise three key standards. First, all healthcare professionals working with children and young people with expected or diagnosed asthma should understand the sources and dangers of air pollution. Secondly, patients and their parents or carers should always receive information on how they can manage asthma with regards to air pollution. Thirdly, integrated care systems should ensure that they are linked with schools, where education around asthma should also be provided.

The NICE guidance, entitled “Air pollution: outdoor air quality and health”, provides advice for people with chronic respiratory or cardiovascular conditions on the impacts of air pollution. It is important that we recognise that there are ways that, in a health context, we can care for people who face those impacts. Going back to the 2019 clean air strategy, however, we as a society have a much broader obligation to tackle the root causes of those problems and to improve the quality of our air, particularly in our cities but across our whole country.

Given the pivotal role of respiratory medicine in treating patients with covid-19, some centres’ ability to commence patients on biologics may have been impacted at the peak of the surge. I think all Members will recognise that.

The pandemic obviously revolves around a respiratory illness. Those who treat respiratory illnesses, including asthma, have been on the frontline, along with all our health and care staff. I join the shadow Minister and others in paying tribute to the amazing work they have done. As we seek to recover elective services and get more routine services back to normal, we are ambitious but also recognise, in the face of uncertainties over winter and the new variant, that respiratory services can be some of the hardest to recover and bring back to normal operation, because those are the services affected by the disease and the nature of its transmission.

Will the Minister be a little more specific about the opportunity for those with severe asthma to access biologic services? That is a very specific ask. Without wanting to minimise the impact of covid-19 and the size of the need for a recovery plan, that is a specific issue for a group of people.

I always give way to the hon. Lady, occasionally with a little trepidation, because I know she will ask a measured and difficult question. That is a very important question. During the pandemic, specialist respiratory services for severe asthma have continued to run, but she asked a specific question about biologics, a subject raised by several colleagues. Prescription and access to biologics is co-ordinated through severe asthma centre multidisciplinary teams. They should ensure all treatments, conditions and options are considered when prescribing. I am perhaps less clear about that than she might want, because I would caveat that by saying it would be a clinical judgment.

We do recognise the value of biologics. That goes to what the hon. Member for Strangford said: all treatments and options should be considered by clinicians on an individual, case-by-case basis, rather than what may have happened in the past, which was a presumption in favour of inhalers as a way of managing the condition rather than treating it or getting to the root causes. Although not eliminating the condition, that could deliver the improvements that make a difference based on an individual’s condition.

As the Minister has said he is unable to be specific, will he write to us with a little more information on that issue, and how we could attempt to put it right? We have heard about the huge impact for the better on people’s lives.

That is one of the easier things to do, given that this policy area belongs to the Minister for Care and Mental Health, my hon. Friend the Member for Chichester (Gillian Keegan), so I can commit to her writing to the hon. Lady. I am happy to do that, though I suspect that response will come back to the point about clinical judgment and decision making. I will also commit my hon. Friend to writing to the hon. Member for Strangford on the detailed and specific point he made about the annual review.

The use of remote consultations and biologic medication that can be taken at home mean we have been able to support most people with severe asthma during the pandemic. At the start of the pandemic, NICE published “COVID-19 rapid guideline: severe asthma”, which provided guidance on starting or continuing biological treatment. In writing that guidance, particular attention was paid to streamlining the process of moving patients on to biologic therapies, to compensate for any barriers that may have occurred because of changes to the NHS in response to covid-19.

The hon. Member for Strangford raised the subject of unified guidelines. NICE’s updated guidance is produced jointly with the British Thoracic Society and SIGN, so it will update all three key areas. They are working with other UK expert bodies to develop a joint guidance for the diagnosis, monitoring and management of chronic asthma, which will update and replace existing guidance.

Community diagnostic centres or CDCs—another theme raised by several hon. Members—which diagnose a number of conditions, are to be launched in place of asthma diagnostic hubs. Diagnostics for respiratory conditions are part of the proposed core services to be provided by CDCs. I hope that gives reassurance.

A review of diagnostics in the NHS long-term plan highlighted that patients with respiratory symptoms would benefit from that facility due to the number of diagnostic tests involved. At the spending review, we announced an extra £5.9 billion of capital support for elective recovery, diagnostics and technology over the next three years, with £2.3 billion of that to increase the volume of diagnostic activity and to roll out CDCs. The planned increase will allow the NHS to carry out 4.5 million additional scans by 2024-25, enhancing capacity, enabling earlier diagnosis and benefiting asthma patients.

I am conscious that I need to leave the hon. Member for Strangford at least three or four minutes for his winding-up speech. One point that has come up among hon. Members this morning has been about prescription charges: a challenging area. Currently, we have no plans to review or extend the NHS prescription charge medical exemption list to include asthma. I heard the points made by hon. Members, but a number of conditions are analogous to asthma, in terms not of their effects, but of their chronic or lifelong impact.

Equally, a balance has to be struck with proportionate charges and the contribution that makes to the NHS drugs budget to facilitate the provision of new treatment. Approximately 89% of prescriptions are dispensed free of charge already, and arrangements are in place to help those most in need. My hon. Friend the Member for Loughborough alluded to the fact that to support those who do not qualify for an exemption, the cost of prescriptions can be capped by purchasing a prescription pre-payment certificate, and that can be paid for by instalments. A holder of a 12-month certificate can get all the prescriptions they need for just over £2 a week.

When we started the debate, I wondered whether we would use the full hour and a half. It is testament to the hon. Member for Strangford, and the contributions of all hon. Members, that we have, and I should stop here to give him a few minutes to come back. To conclude, it is right for him to bring this debate to the House. I am grateful, as other hon. Members are, because asthma affects many of our constituents, day in, day out, and while we have made huge progress, it is right for him and other hon. Members to continue to press for even more ambition and even more progress. I pay tribute to him for that.

I thank all hon. Members for their immense contributions and incredibly helpful comments. I think we all spoke with a united voice, from all parties and all parts of the Chamber. I believe we got an excellent response from the Minister and a commitment—even though asthma is not in his direct portfolio.

My hon. Friend the Member for East Londonderry (Mr Campbell) referred to volunteers and charity groups. The hon. Member for Rutherglen and Hamilton West (Margaret Ferrier) referred to air pollution, as others did. The hon. Member for Loughborough (Jane Hunt)—also a Leicester City supporter, though we lost on Saturday, but that is by the way—referred to prescription charges. The firm that she mentioned contacted me as well, and I am pleased that the Minister was able to respond to her questions. The hon. Member for Blaydon (Liz Twist) brings a vast amount of knowledge of and interest in this subject. She referred to quality of life, mental health issues and how biologic therapy is needed.

The hon. Member for East Kilbride, Strathaven and Lesmahagow (Dr Cameron), a friend and the SNP spokesperson, spoke about her personal experience of asthma. It is also pleasing to have so many Members present to support the shadow Minister taking her place for the Labour party, the hon. Member for Enfield North (Feryal Clark). Certainly; she has had an exceptional debut as the shadow Minister in Westminster Hall. I was pleased with her contribution, which encompassed all our thoughts and ideas, notably the effect of air pollution and how treatment for severe asthmatics is not in place.

I thank the Minister so much for his response. He gave us the details and told us about the 2023 target, but we will try to do better. He referred, too, to consideration of the annual review and to the unified or joint guidelines to be agreed. There is much to be encouraged by in his response. With that in mind, I thank all hon. Members for their contributions. Here is a battle to be fought; we are about to fight it.

Question put and agreed to.


That this House has considered asthma outcomes.

Mavisbank House

Before we begin, I remind Members that they are expected to wear face coverings when not speaking in the debate. This is in line with current Government guidance and that of the House of Commons Commission. Members are asked by the House to take a covid lateral flow test twice a week if coming on to the estate, which can be done either at the testing centre in the House or at home. Please give one another and members of staff space when seated, and when entering and leaving the room.

I beg to move,

That this House has considered the restoration of Mavisbank House.

I hope everyone is sitting comfortably, because the next 15 minutes or so have something for everyone: Romans, the Enlightenment, social justice and more. That is what Mavisbank House is—something for everyone. At least, it could be, with the right proposals and the right funding.

Mavisbank House, near Loanhead, in my constituency of Midlothian, is a category A listed building, proudly perched in a landscape of registered ancient woodland and high biodiversity. It is considered the most important example of early 18th century Scottish architecture. Words can do Mavisbank House only so much justice. To really appreciate it in all its splendour, people would have had to see it in person a century ago. That is because this architectural marvel now stands as a gutted, neglected, dilapidated shell. It is literally crumbling by the day.

I hope that, at the end of today’s debate, the Minister will agree that this situation can and should be reversed, and I look forward to setting out the ambitious proposals to save Mavisbank House that would turn this ruin into a real asset for the community. I am sure the Minister would be welcome at any time to come and see its current condition.

This is how the Landmark Trust has referred to Mavisbank House:

“Arguably the most important building at risk case in the UK”.

That is a bold claim, but it is absolutely true. To understand why Mavisbank is more important than hundreds of similar Palladian villas in Scotland and in Britain, we need to start with its history.

Mavisbank House was first planned in 1698 and the foundations were laid in 1723, under the supervision of Scotland’s pre-eminent architect, William Adam. Adam has been credited with being the first to bring Palladian and baroque architecture to Scotland, and he was prolific in transforming fusty old castles into grand country retreats. He totally revolutionised his field. In many ways, Mavisbank House was where this revolution began. It was Scotland’s first Palladian villa, a style that soon became ubiquitous among the landed classes. That brings to mind something that stills rings true today: where Midlothian leads, Scotland follows.

Owing to its pioneering style, Mavisbank House was also a bit of an experiment. It was a prototype for the Roman ideal of cultured retreat and classical design that set the pattern for Scottish and British architecture for the next century. It was a bold experiment, and it succeeded. It totally changed the way the landed classes lived and created a new kind of country economy. Its style embodied the Enlightenment ideals of improvement and logic, making it one of the world’s first physical embodiments of this intellectual revolution.

As for who this ground-breaking architectural experiment was being made for, Sir John Clerk of Penicuik was Mavisbank’s first resident. He might not be one of the towering names of Scottish history, but he certainly knew many of the big names and played a part in many of the key historical events that took place during his lifetime. Through him, Mavisbank was placed at the centre of Scotland and Midlothian’s story.

We could take, for instance, Sir John’s contribution to the Scottish Enlightenment. Sir John served as vice-president of the Philosophical Society of Edinburgh at a time when the philosophical foundations of a new world of reason were being laid in the closes and wynds of Edinburgh’s old town. In the midst of that distinctly Scottish movement, which, in the words of historian Arthur Herman, “invented the modern world”, Sir John penned essays on everything from the effect of lightning on trees to the size of deer horns, while remaining true to his Scottish roots by penning humorous songs in the Scots language, his ain mither tongue.

Sir John’s love of writing extended to his friendships. On numerous occasions, Mavisbank hosted the great Enlightenment poet, Allan Ramsay, whose Scots poetry influenced giants such as Robert Ferguson and Robert Burns, and whose son, of the same name, became a renowned portrait artist for everyone from George III to Bonnie Prince Charlie. Into that world of Enlightenment and Scottish cultural renaissance, Mavisbank was born. I hope it can soon be reborn in a new, but similar, context. I look forward to the day when intellectual havering and bonnie music can again be heard in Mavisbank.

Aside from Sir John’s philosophical and musical leanings, he was also a Member of not one, but two, national Parliaments—first, the pre-Union Scottish Parliament, and then this place. I could not possibly comment on which of the two Christmas parties he might have preferred, but when he voted for the Union in 1706, who is to say whether it was a case of being

“bought and sold for English gold”?

Surely not.

Whatever the case, that is another example of Mavisbank’s deep connection to some of the most significant moments in Scottish history and it underlines Mavisbank’s status as a building of utmost historical importance. It sat at the heart of conflicts over intellectualism and Scottish independence, as well as the blossoming of distinctly Scottish arts and culture and a renaissance of the Scots language. Those issues are as relevant today as they were back then.

Perhaps the most salient aspect of Mavisbank’s history is that which touches on one of the darker and most shameful practices carried out by our predecessors—the trading of human beings as slaves. If the Minister happens to be a connoisseur of Caribbean coffee, he will no doubt be aware of Blue Mountain Coffee, a Jamaican coffee company whose main plantation is a place called—you’ve guessed it—Mavis Bank. Mavis Bank, Jamaica, was named after Midlothian’s Mavisbank because of the owner’s Scottish roots. It was recorded as a coffee plantation as early as 1808. There are records of the estate selling slaves in the 1820s. On their labour those fortunes were made.

Mavis Bank, Jamaica, was home to the atrocity of treating human beings as property, for the profit of wealthy Scots, all under the name of a couthy manor house back in the old country—back in Midlothian. That is not an image of ourselves that many of us want to confront, but confront it we must, because it is the truth. By exploring the history of Mavisbank House, we are forced to come face to face with those injustices of the past. We are forced to recognise the horrors of Scotland’s role in the slave trade and learn the lessons needed to build a more just future.

I consider it a great honour to have as one of my constituents Professor Sir Geoff Palmer, who not only discovered the game-changing barley abrasion process in brewing, but has been a prominent campaigner for social justice and human rights for many years. He grew up in Jamaica and became Scotland’s first black professor in 1989. Sir Geoff has used his wealth of life experience and incredible strength of character to campaign for many years against racism and the legacy of slavery, most recently as part of the Black Lives Matter movement.

Last year, Sir Geoff was a prominent voice calling for the Melville monument in Edinburgh to be reinterpreted through new signage, to reflect Dundas’s support for “gradual abolition”, which delayed the abolition of the slave trade by some 15 years. In the past, Midlothian was instrumental in the racist horrors of the slave trade, but Midlothian residents such as Sir Geoff give me hope that we can contribute to the dismantling of the racism of today.

In the light of Mavisbank House’s huge significance to architecture, the Enlightenment, art and the pursuit of social justice, it is an absolute scunner to see the state of it today. This building of national and European significance is in a state of extreme dilapidation. In the 1950s, the forecourt was used as a scrapyard. In 1973, the house was gutted by fire. It has never recovered and sits as an empty shell, slowly crumbling. Things got so bad that it was scheduled for demolition in 1987; it was saved only by a public outcry and a High Court interdict. Decades of neglectful ownership have left us at a point where we now do not even know who owns it.

It does not have to be this way. There is nothing inevitable about Mavisbank falling into disrepair, and plenty of buildings in a similar state have been given a new lease of life. In the case of Mavisbank House, the Save Mavisbank project has set out a new vision for how this incredible piece of history can be brought back into the present to benefit Midlothian. The Save Mavisbank project is led by Historic Environment Scotland and supported by the Landmark Trust. The project seeks to unlock Mavisbank’s huge potential for environmental, health, economic and cultural benefits, and aims to give this amazing asset back to the community. The project wants not only to recreate the house as it was in yesteryear, but to bring it to life again, with real value for the surrounding communities. The Save Mavisbank project aims to

“return glass to its windows, urns to its rooftops, heat and light to its rooms, laughter to its terraces, living and learning to its stairwells and courtyards”.

The project’s vision is for the remains of Mavisbank House to be compulsory purchased and reunited with the surrounding landscape, in the care of Historic Environment Scotland. The estate would become a natural and historical landscape where people could come to enjoy its beauty, learn its history and take home some of its knowledge. This pioneering plan includes a skill centre, a community wing, visitor accommodation, a community green space, walkways and a participatory rewilding project.

Let me take some time to consider key aspects of the proposals, and the benefits they could bring to Midlothian and to Scotland. I am deeply grateful to Rhona Brankin, chair of the Mavisbank Trust, for her deep knowledge of the site and her passion for the proposals, as well as everyone else involved, including those who showed me round when I have visited. Restoring Mavisbank is much more than preserving a piece of heritage; it is a chance tangibly to improve the lives of people in a former mining area that needs investment. The process of restoring it, maintaining it, and then hosting programmes at Mavisbank it would create jobs, skills and training opportunities—this is a massive investment opportunity. Creating skills and jobs is a core component of the project, whether in landscape management, horticulture, stone masonry or heritage science. On top of that, Historic Environment Scotland’s Engine Shed skills centre could provide a crucial link to wider training activities across the country.

Let me come to the fantastic tourism value of the site. Midlothian is blessed with world-renowned heritage sites such as Rosslyn Chapel, Penicuik House and Dalkeith Country Park, to name but a few. The addition of Mavisbank House would create what Save Mavisbank has called a “string of pearls” along the Esk Valley, cementing Midlothian as a visitor destination right on the doorstep of Scotland’s capital. An invigorated tourism economy, and all the accommodation and catering businesses that that would bring, is much needed post-pandemic.

There are even proposals for on-site accommodation at Mavisbank itself. That would also offer a chance to pioneer how the heritage sector should approach challenging sites such as this in the future. Mavisbank is undoubtedly one of the most ambitious heritage restoration projects ever planned in Scotland, so just think of the lessons that could be learnt from it if we took it on.

The health and wellbeing benefits of this project are numerous too. NHS Lothian’s support for the project points to the fact that the proposals include “green health prescribing”—using exposure to nature to tackle mental and physical health problems. Save Mavisbank’s community surveying found that one of Mavisbank’s qualities most valued by visitors is the sense of tranquillity and green space. Why not harness that for health benefits? It is an approach that started gathering steam only in recent years, and, with NHS Lothian on board, Mavisbank could be at the centre of this movement—just as it has been with so many movements in the past. Gardening is a big part of this, and with its ample grounds there is even the potential for allotments, which are something in very high demand in Midlothian.

I have not even mentioned the potential for digital reconstruction projects, live theatre, and arts spaces. It is a vast and varied space; it is almost a case of, “Name something the community needs, and Mavisbank has the potential for it.” I am sure the Minister needs no telling just how rare that kind of opportunity is. Incredibly, there might even be the remains of a Roman fort in the grounds of the house—a rare thing in unconquered Caledonia. The Romans might not have made it very far in Scotland, but they did make it to Midlothian, and I am sure they found it well worth the journey from Rome, just as with our EU friends nowadays who find their way there. Imagine how that potential site could benefit local schools and nearby universities studying archaeology—yet another string to the bow.

Importantly, collaboration and community engagement run deep in the Save Mavisbank proposal. It is the product of collaboration between the Landmark Trust and Historic Environment Scotland and comes after four years of close working through a joint project board meeting monthly in Scotland and England to draw up the scheme.

On a local level, Midlothian Council has confirmed its support and its willingness to take forward the compulsory purchase of the house, and the people of Midlothian themselves have had a voice throughout, as a community representative has sat on the project board since its inception. Consultation with community stakeholders has been key.

Beyond that, both NHS Lothian and NatureScot formally support the proposal. NHS Lothian would be brought on board for the social prescribing programmes planned for the house’s grounds, and NatureScot would be a key partner in the environmental programmes. There is huge local enthusiasm for saving Mavisbank, demonstrated by the project’s audience research. Current efforts are indebted to the community-led Mavisbank Trust; its efforts to rescue the building were by the community and for the community.

However, saving Mavisbank is completely contingent on funding from the National Lottery Heritage Fund. Put plainly by Save Mavisbank,

“if the National Lottery Heritage Fund cannot support this project it will not proceed”.

Following an initial failed lottery bid in 2013, Save Mavisbank was advised to reapply, which makes it particularly disappointing that the latest proposal was again rejected in July.

Potential challenges, which could have impacted the application, included issues with parking and general access, but those are easily surmountable. Save Mavisbank has considered having multiple different entrances spread throughout the ground, and the improvement of paths and signage are in the proposal. More steps could be taken to move that forward.

In the 2021 bid, the project’s partners had committed to finding £10 million, on top of the £8 million it sought from the lottery. Funding for the project is there; the lottery is just the missing element in it. In spite of their bitter disappointment, everyone previously on board remains committed to the project, which is coming together. So many different bodies with a shared motivation and passion is really quite something to behold. We cannot allow that momentum and energy to fade into nothing.

That brings me to the reason for this debate: to bring Mavisbank to the Minister’s attention. Obviously, I recognise that a big hurdle here is the question of funding, specifically from the lottery, but there are some key ways in which the Government could do their bit to help save Mavisbank. Will the Minister meet with me and representatives from Save Mavisbank to discuss how we can take this forward? That would be the best way to get into the detail of the issues.

To draw my contribution to a close, us Scots pride ourselves on our history and our ability to keep it alive and vivid in our own culture. However, the track record in giving due respect to architectural heritage has been quite shocking in the past; ancient tenements have been demolished for car parks and castles have been allowed to crumble into the sea. Mavisbank cannot be allowed to join the list of important buildings that used to exist. Let us not repeat yesterday’s mistakes and allow a piece of history to disappear, then mourn its loss after it is too late. Let us act while we still can. I will share some words directly from the building itself, translated from the Latin carved into the stone:

“And may what the numerous ages erode be restored intact, and may it be granted that the older you are, the more beautiful you may shine.”

It is a pleasure to serve under your chairmanship, Mr McCabe. I thank the hon. Member for Midlothian (Owen Thompson) for securing this debate on the important topic of Mavisbank House.

As the hon. Member said, there was indeed something for everyone in his speech, which highlighted a good smattering of famous names from our history and acknowledged, quite rightly, that not all of our history is glamorous or uncontroversial. We have some challenging facts in our history, which we also need to face head-on, as he quite rightly articulated. As he clearly laid out, Mavisbank House is testament to a unique aspect of Scottish and British history and is one of the most important at-risk heritage sites in the country. The Government share the hon. Member’s concern that this unique piece of Scottish and British history has fallen into such disrepair.

The hon. Member rightly mentioned the importance as Scotland’s most pre-eminent small country house and first palladium villa. It was built by two towering figures of the Scottish Enlightenment, Sir John Clerk and William Adam. Sir John Clerk was a poet, politician, musician, classicist, mathematician and philosopher, which puts us all to shame, and he played a vital role, as he mentioned, in the Act of Union. The house Sir John built at Mavisbank was a testament to the man and his time. Mavisbank would go on to become an iconic landmark, not just in Scotland but across the United Kingdom.

I have not yet had the opportunity to visit Mavisbank, but I appreciate the hon. Member’s offer and would like to take him up on it at some point. I have seen pictures of the site, which are quite alarming, and I share his concern at the potential loss of this important historic monument. I also share his sentiment that it is a vitally important heritage asset for the local community. Mavisbank House is a fine example of the power of heritage and culture to create a sense of place. Heritage sites such as Mavisbank House are also vital for the local economy, attracting visitors and providing high-skilled jobs, and I was pleased to hear the hon. Member mention the importance of those important skilled jobs in the heritage sector.

The hon. Member mentioned his understandable disappointment and frustration at the National Lottery Heritage Fund’s decision not to fund the scheme through the heritage horizon award. The National Lottery Heritage Fund is an arm’s length body of the Government, as I am sure he will know. It is for the fund rather than me or Government to decide or dictate which of the many worthy bids receive funding. Since its formation in 1994, it has awarded more than £3 billion to almost 10,000 areas, historic buildings and monument projects across the UK. In Scotland alone, the National Lottery Heritage Fund has distributed more than £890 million to 4,727 projects since 1994. In the hon. Member’s constituency of Midlothian, the National Lottery Heritage Fund has invested £17 million in that time, of which more than £12 million has funded built heritage projects such as the Penicuik heritage regeneration project and many more important historic places and assets across Midlothian. The hon. Member mentioned Penicuik in his speech, so we see the importance of that name in his local area.

Since the onset of the pandemic, the National Lottery Heritage Fund has worked tirelessly to support the heritage sector through several alternative funds. However, I share the hon. Member’s disappointment that Mavisbank House was not able to secure heritage horizon funding. I have been assured that all due processes were followed—I do not think he was questioning the process—but the harsh reality was that the heritage horizon award was a highly competitive fund designed to revolutionise the UK’s heritage through investment in “ambitious, innovative and transformational projects.”

I am told that, fortunately—or unfortunately, depending on perspective—other schemes matched those objectives even more clearly than Mavisbank, leading to the difficult decision to reject its bid for funding. Although Mavisbank also met those criteria, limited funding can only go so far. An example of a successful bid in Scotland was the Cairngorms national park authority, which was awarded £12.5 million. That award will fund an ambitious seven-year programme to achieve transformational change for people and nature in north-east Scotland. It will bring together 45 different partner organisations to look at cultural heritage, environmental protection, climate change and biodiversity, and deliver meaningful improvements to people’s health and wellbeing. Though that is a great example of a project, it does not distract from the hon. Member’s compelling arguments about Mavisbank, covering many of those areas as well.

I understand that the National Lottery Heritage Fund has been in contact with the hon. Member, as well as with Historic Environment Scotland and the Landmark Trust, which I acknowledge play a pivotal role in securing our national heritage. I understand that the National Lottery Heritage Fund has provided feedback and is looking at alternative options for Mavisbank House. I urge him to explore all available options—he is clearly doing that—to save Mavisbank House, including the National Heritage Memorial Fund, a funder of last resort for assets of national importance in the UK. I am sure that, as one of the most important at-risk heritage sites in Scotland, Mavisbank House would have a strong case. Of course, any decisions are at the discretion of the National Heritage Memorial Fund board, but I am sure that, given the case that I have heard articulated today, he would get a strong and sympathetic hearing. As hon. Members will be aware, heritage is a devolved matter for the Scottish Government, and I also therefore urge the hon. Member to continue conversations with the Scottish Government and Historic Environment Scotland.

In conclusion, I thank the hon. Member for bringing the house and this fascinating piece of history, which his speech articulated so well, to our attention. I am happy to continue conversations with him, the Scottish Government and any other stakeholders. It sounds as though he is already engaging with a very large number of stakeholders, and Mavisbank House is fortunate to have him bringing so many people together and supporting this bid with such passion. I am happy to help in any way I can—with the caveat that I cannot promise funding that is not directly under my control—with this really important project. I wish him and everyone involved the best of luck in securing funding for this unique heritage site.

Question put and agreed to.

Sitting suspended.

Affordable Housing: Planning Reform

[Dr Rupa Huq in the Chair]

Before we begin, I remind Members that they are expected to wear a face covering when not speaking in the debate, 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 onto the Estate; those can be obtained from Portcullis House or taken at home, as preferred. Please also use your judgment—everyone here is very intelligent—and give each other and members of staff space when seated and when entering and leaving the Chamber.

I beg to move,

That this House has considered access to affordable housing and planning reform.

It is a pleasure to serve under your chairmanship, Dr Huq, and I am delighted to have the opportunity to take the lead in today’s debate. I would like to declare a registered financial interest in that I have a part-share in a property used for long-term rent. I am glad to have secured this debate, as the severity of the housing situation in Cornwall and the Isles of Scilly, which I represent, requires urgent intervention. It is not a new situation; I recall having a meeting with the current Health Secretary when he was the Housing Secretary, some years ago now, asking him to intervene in the housing situation on Scilly by allowing the council to have powers to address the rate of second home ownership on the islands.

Likewise, in relation to housing in Cornwall, my Cornish colleagues and I have regularly raised the difficulty faced by residents to acquire affordable housing since we were elected. More recently, we have raised this directly with the Prime Minister in meeting of Cornish MPs. I secured a debate in 2018 asking the Government to address the difficulties that second home ownership and the holiday let industry place on families who need affordable homes so that they can both work and raise their families locally.

Various measures have been introduced, predominantly in support of first-time buyers, which is welcome, as having a home of one’s own brings security and a commitment to the local community that is rarely matched by any other intervention. However, recent developments in relation to the pandemic and a clumsy approach to housing by some council officers, until recently, have starved ordinary working families of appropriate and affordable secure housing. Therefore, while access to affordable housing for working families is not a new difficulty, it has become a whole lot more difficult over the past two years.

In the first quarter of 2021, searches for homes to buy in Cornwall topped 15 million, and 1.1 million people searched for homes to rent. Our total population is just half a million, and many of them are finding that the house that they rent and believed was secure is being taken back by the landlord to capitalise on the boom in Cornwall as a holiday destination. I feel slightly guilty because I have promoted Cornwall and the Isles of Scilly as holiday destinations for many years; I might need to tone that down a bit, because although it has had the desired effect, it has also put enormous pressure on our housing supply.

If my hon. Friend is going to stop promoting people coming to Cornwall, he is very welcome to promote them coming to Devon. However, he makes a serious point about the fact that the impact of visitors and tourists is driving up prices. Does my hon. Friend think that there are ways in which we can act by closing the business rate loophole, for instance?

I would not want a tabloid paper to misinterpret what I said about coming to Cornwall; please do still come. I am going to Devon as well, so let us not argue about jam and cream. Absolutely, the topic of the debate I had in 2018 was that very thing: how to ensure that properties that should pay council tax do so, because that helps to deliver services that we all need, including for those who own a second home.

If a person is lucky enough to get anywhere near a rental property, then they will pay approximately £100 a week for one bedroom in a shared house; £200 a week for a two-bedroom house with no garden; and £400-plus a week for a three-bedroom house. That may not surprise people living in London, but it marks an enormous inflation in rent in Cornwall, particularly given that the average wage in my constituency is £25,000 a year. It can quickly be seen that such rent is not an affordable housing solution.

As it happens, there is almost no chance of securing a property. A search for houses to rent in my constituency last night returned a total of three three-bedroom houses across the whole constituency. A letting agent has advised me that 100 families compete for each three-bedroom property that is advertised. Those families include key public sector workers who have accepted jobs as teachers, police officers, NHS workers and, ironically, according to our own planning department, planning officers themselves. On the Isles of Scilly, people with jobs that are critical to the islands’ day-to-day existence face the prospect of leaving Scilly in the spring if they cannot find a home to rent. Properties for sale are equally few, and are out of reach for the majority of those needing homes in Cornwall and on Scilly. House prices have risen by 15% in the last year.

I do not want to dwell on the severity of the situation much more, other than to thank a number of town and parish councils in my constituency. They share my concern and have taken time to discuss the issue and write to me, pressing and calling for action. They include Penzance Council, Ludgvan Parish Council, St Just Town Council, St Erth Parish Council, Sancreed Parish Council and a representative of Madron Parish Council, to name just a few.

I am pleased to say that there has been a dramatic gear change at Cornwall Council since May this year. A new Conservative administration, council leaders and MPs are tackling the housing shortage. The council’s strategy, now under consultation, includes commitments to improve availability and access to homes for local residents by working with public and private sector partners to bring forward sites, and to provide modular private rented homes for key workers and local people in towns. After years of pressure from me, there is a renewed emphasis on bringing more long-term empty homes back into use. It is unbelievable that there are thousands of empty homes in Cornwall. They are not second homes or holiday lets; they are just empty—not used at all—despite the pressure on housing that we have had for such a long time.

The council plans to increase the rate of affordable housing provision on exception sites—increasing the minimum number of affordable housing units, I hope to 100%—through the use of grants. It will work with housing associations to develop a pipeline of sites to increase affordable housing, including by releasing council sites, which is a new and novel idea. Critically, the council wants to re-engage with small and medium-sized developers to find and develop land, and to step up work with local councils, parishes, towns and communities to identify suitable and stalled sites.

In my constituency of Twickenham, housing is extremely expensive. For anyone who grows up in the area and for key workers, as the hon. Gentleman said, it is almost impossible to get on the housing ladder. The social housing waiting list is enormous, and I see people every week who are struggling to get rehoused. He spoke about finding sites. We have very few sites in south-west London. Does he agree that, where there are public sector-owned sites, for instance police stations—Teddington police station, to be exact, in my constituency—there is national legislation that forces the owner to get the best value, so they have to sell to the highest bidder? I know that there are local housing associations—and, indeed, a GP surgery—that would be keen to redevelop that police station for affordable and social housing, but they are going to be outbid by luxury developers, who will build more luxury housing that we do not need.

I thank the hon. Lady for that intervention. That is a theme with which we are familiar in Cornwall. In fact, in 2015 we signed a devolution deal that talked about one public estate. The idea was that all publicly owned land would be used for the benefit of the local community, including for housing. It would be fair to say that that has not materialised, for various reasons. When we talked to the NHS, it said what the hon. Lady said: that it must get the maximum return. The police station in St Ives, where the housing shortage is most critical, has been sold, even though there was a local attempt to try to secure it for housing. There is a real challenge, and maybe the Minister will look at that. Network Rail owns land, and all sorts of land that could be built on seems to be locked up. That would be a great thing to address, and I am sure that it will be addressed in the White Paper.

Another bugbear of mine has been the sheer number of planning proposals that have approval but are yet to be built. I understand that, in Cornwall alone, there are 19 units that are approved and not yet built. The council intends to work with Homes England to develop a partnership to unlock developments that have planning permission, so that they can become homes for local people. Other ideas include a pilot to explore the conversion of vacant buildings in town centres, which the towns fund is seeking to do in Penzance and St Ives.

I am also hopeful that the council recognises that it is not solely responsible for bringing family homes into existence. For example, despite several attempts by me and other colleagues in Cornwall, the council has repeatedly blocked opportunities to build family homes using models such as rent to buy, because it has an apparent dislike of local people freely owning their own homes. This is a missed opportunity, as I know that rent-to-buy companies have had ambitions to build thousands of homes on sites without using any public money, which would have helped to address many of the pressures that we see. I am hopeful that we will see a change of heart at the council.

The timing of this debate is not an accident. I have been trying to secure it for some time but was particularly keen to get it now, because I am aware that the Secretary of State for Levelling Up, Housing and Communities plans to bring forward revised proposals to address the problems faced by hundreds of thousands of people who need housing across the country. The hon. Member for Twickenham (Munira Wilson) referred to the waiting list for social housing in her constituency. In Cornwall, there are 14,000 homes needed by people on the list. There is no better way to level up than to ensure that people have a secure home of their own.

Secure homes mean secure communities which, in turn, mean secure rural schools, secure services such as post offices, GP practices and bus routes, and the survival of pubs and churches. The Government’s plan must speed up the delivery of homes that are genuinely secure and affordable. Cash that goes to councils for housing must be spent on housing, not on endless meetings and draft proposals. A recent council-owned scheme that I visited took seven years to deliver 55 houses for shared ownership and affordable rent.

Support must be given to small builders, which are best placed to build quality homes in rural areas, and there needs to be a massive effort to attract people into the trade with high-quality training opportunities. The building trade can be seen—I know this from my experience in school, because I went on to become a Cornish mason, which involves slate, stone and different types of plastering—as a negative career, but I can testify that some of our most skilled people work in the construction trade, and we need an awful lot more of them.

As I have just discussed, land belonging to the public sector must be secured in order to build homes that are affordable, and this must be done quickly. I am fully in favour of building homes, but we must ensure that they are built in the right place for the right people, and at the right price. If we do not, which is the greatest fear of people in Cornwall, house building in areas such as Cornwall will never match the demand of an open market, prices will always be out of reach, and green fields will continue to be lost. In the current climate, we cannot leave the situation to the mercy of market forces. Although I would ordinarily support that, intervention is needed in Cornwall, on Scilly and in many parts of the United Kingdom.

Novel ideas must be considered to ensure that people can access the homes they need. With your permission, Dr Huq, I will suggest a few novel ideas to the Minister that would help to address the situation in Cornwall and elsewhere where it is a real issue for local people. First, we could speed up and increase the supply of housing by using Homes England money to pay on results, such as rewarding social landlords and developers big and small on the completion of homes that people can afford. At the moment, it takes an age to even get anywhere near the site by using Homes England money. It would be far better to create the incentive that the money follows the completion of homes.

Secondly, the Government should consider offering local authorities the opportunity to introduce a blanket requirement for all new building to be restricted to primary residence only. This policy idea is reassuring to communities who find that they are quickly becoming ghost towns in the winter months. When I go and talk to my parish and town councils about the housing that is needed, they have no confidence that the houses will meet a local need. To have a blanket restriction—as a tool and opportunity for local councils—that all new housing must be for primary residence only would really help to reassure communities who, at the moment, often oppose such developments.

I am sorry to interrupt and have two bites of the cherry, but my hon. Friend is making a really important point. I understand that somewhere else in Cornwall has introduced such primary residence restrictions, and I wonder whether he might add any weight to the implications of doing so and whether it has been deemed a success.

It is a great subject, because it actually happens to be in St Ives, which is part of my constituency, so I know a little bit about that. My hon. Friend is absolutely right. A neighbourhood plan introduced the policy of primary residence only, so all new housing has to be for primary residence. They did it—this is years ago now, so it is not a new problem—because purchased properties were often pulled down and others built in their place, which devastated the local community. We have seen villages such as Mousehole, Porthleven, Coverack and others where, in winter, the lights are pretty much switched off.

St Ives has done it and we have not seen a particular impact. In the summer I went to see quite a large site developed by bunnyhomes, where every single home for primary residence was sold without a problem. It definitely can be done and it would make it easier if it applied across the whole authority, rather than in one particular town area. I thank my hon. Friend for his intervention.

The Government should re-emphasise to councils our commitment to home ownership and make it more difficult for councils, such as Cornwall council, to restrict other housing delivery models, such as rent to buy. I fully understand the pressure on houses to urgently respond to the situation today, but I cannot stress enough how positive it is for a family to own a home and put roots down in that community, support the local school and feel that they have a stake in how that community goes forward. Home ownership is a significant part of the mix and must be protected.

The Government should consider an incentive to landlords to sell to their tenants by enabling capital gains tax to be used to give the tenant help with the deposit and purchase price. We remember that a previous Chancellor introduced rules that made the financial incentives for being a long-let landlord much more difficult. Many landlords in my constituency are looking to sell their properties to their tenants, but that is surprisingly difficult to do. One idea came to me from a landlord who is keen to do this. His alternative is to switch it—avoid the tax implications and switch the property to a holiday let, which he does not want to do. We are seeing other landlords do that, but he wants to have the opportunity to sell his property to the tenant, but the tenant needs help to get the deposit together. There may be a way to use capital gains to support that transfer. Otherwise, we will continue to see long lets lost to holiday lets or sold to the highest bidder. These homes are often snapped up by those who can afford a second home to retreat to in coastal areas and other attractive parts of the British Isles. That issue must be addressed.

The Government should consider introducing a licence scheme, so that properties currently lived in require a specific licence before they can become a holiday let or bolthole. This policy idea favours permanent residents. In the past couple of years, because of the need for staycation and inability and sometimes reluctance to fly abroad for holidays, we have seen people flooding into tourist attraction areas and driving up a holiday let market that has seen large numbers of families evicted from their homes, which they have sometimes rented for many years, and these homes transferred a holiday lets. We would therefore like the Government to intervene and require a licence to be given to allow that house to move from a permanent residence to a holiday let or some other use. That is novel, I know, but we are in such a time where families cannot hold down the jobs or get the jobs we need them to have because of the lack of housing.

Councils should consider applying council tax to all homes, irrespective of their use. At the moment, the police, the parish and town councils do not get their share of the council tax if that property is switched to a holiday let or business, as we discussed a few moments ago. Such a policy of council tax across all properties built for living in would also save the UK taxpayer, who at the moment pays the Treasury to refund councils which lose that council tax income. That is a fair idea that recognises and values houses built to be lived in.

The Government have encouraged the possibility of creating new locally led development corporations to encourage local areas to come forward with ideas for new towns to deliver jobs, homes and economic growth. There is an appetite in Cornwall to identify village garden sites. This seems entirely sensible, but the challenge facing this innovation is the immediate escalation of land value when an area is identified for development. That absorbs the very money that would otherwise be used to create the infrastructure to serve a new community.

The increase in land value, which the locally led corporation then has to find, undermines the viability of the scheme and the ability to deliver the infrastructure needed. The Secretary of State and the Minister here, my right hon. Friend the Member for Tamworth (Christopher Pincher), should consider allowing these locally led development corporations to be established much earlier in the process, to secure the sites before the value rockets. This policy idea enables the development of these garden villages, which reduces the incredible pressure placed on existing towns and villages to meet the entire housing demand.

I would like to quickly move on to the thorny issue of enforcement, because as we consider planning reform, enforcement should not be ignored. Currently, we have something of a gold rush in Cornwall, with people and businesses buying any land they can get hold of. Small farms are being sold because they are no longer commercially viable and are often snapped up by individuals who have no intention of farming but would quite like a piece of Cornwall’s real estate. They get hold of this land and carry out all sorts of development and destruction, knowing that the council’s enforcement team is overwhelmed, under-resourced and seemingly lacks power, or at least fears legal challenges at every turn. It is a huge problem across Cornwall, and I am sure it is a problem elsewhere in the country.

It is a complex issue, but I would like to take this opportunity to suggest a simple adjustment. The Government could, and should, introduce a fixed penalty system where councils can apply a significant and proportionate fine to both the owner and contractor. An owner or developer may feel that a breach of planning and possible enforcement is worth the risk, as the financial gain may outweigh any enforcement action. However, such people rely heavily on contractors who will be less inclined to breach planning law if the penalty applied to them. As a former tradesman, I know that I would check to ensure the task I am charged with has the necessary planning consent if there were a potential fine and a blot on my copybook. A fines system would fund enforcement and ensure councils have the capacity to do a good job.

When it comes to housing, this is the time to be bold. It is time to apply some clear, blue-sky thinking and demonstrate that the Government are on the side of those who, in the past, we have described as “just about managing.” Right now, in Cornwall and on Scilly, these families are not managing.

I aim to take the Front-Bench spokespeople from 3.38 pm, so please could the Back-Bench speakers stick to six minutes? We kept changing it, as we did not know how long the hon. Member for St Ives (Derek Thomas) was going to speak for, but if everyone sticks to six minutes, then everyone will get in.

It is a pleasure to speak in this debate, Dr Huq. I thank the hon. Member for St Ives (Derek Thomas) for opening the debate. I want to reinforce much of what he said, because the challenges that we have in York seem to replicate those in Cornwall and elsewhere across the country.

We have a housing market that is out of control and heating up at pace, year after year. When I bought my first house, the housing affordability ratio was 3. In 2019, in York, it was 8.3. Right now it is 11.7. So, just in the period of the pandemic, it has already risen significantly and is increasing even today. In York it is growing faster than anywhere else in the north, or indeed, I understand, in the country, at 14% in the last year. York is a very desirable place to live and, with new ways of working, people now realise they can live in York and still have a base in London.

People’s patterns are changing, but the housing crisis is just escalating for us. We cannot recruit skilled workers, the tourism and hospitality sectors are struggling to function and, while social care has not been able to recruit for some time, we are now seeing graduate professions, such as working in the NHS, coming under significant strain. People cannot afford to live in York, but we need their skills. Therefore, the impact of the housing crisis is showing itself in the economy.

As the luxury and investment markets increase, the housing market is heating up further. I understand that estate agents can, and do, now name their price and that investors see opportunity. Why are we in this situation? There are so many questions to be asked, including why we see housing as at asset at all, when we know it should be a human right. York’s social housing numbers have also been falling, but at the same time, the waiting lists have increased threefold since I have been an MP. Affordability is completely unaffordable in York. In post-industrial cities such as York, like in many areas of the north, there is an economic dependence on low-wage and insecure work. Housing poverty is a reality for vast swathes of my constituents. In the private rental sector, behind Bath, Brighton and Oxford, York is the fourth least-affordable place to rent outside of London—and the least affordable in the north. When 61% of renters have no savings, a future of home ownership is completely unrealistic. This traps more people in housing poverty.

Over the past decade, the City of York Council has only built an average of 36 affordable homes a year, and has seen a net loss of its social housing stock. Over 200 of these units lie empty, awaiting repairs, but the council is struggling to recruit the necessary skills to bring them back into use because traders cannot afford to live in York. That means that we have a skills shortage preventing us from bringing those properties into use. That is a problem right across the industry; it shows how investment is needed to get control of the housing market—to then get control of the economy.

Of those who are lucky enough to rent, many are living in box bedrooms—I am talking about whole families—or damp, mouldy homes. That is completely unacceptable. As in Cornwall, York is being absolutely overrun by Airbnb’s, holiday lets and second homes. Over a quarter of the housing stock is owned by private landlords, who can literally name their price. In addition to the measures laid out by the hon. Member for St Ives, we need to collect proper data, both on what domestic residential properties are being used for and on Airbnb’s and holiday lets. We also need to ensure that we have a mechanism or lever to secure homes for primary occupation, as opposed to other use.

York’s local plan is with the inspectors; this is an issue that runs sore in our city, so we want to see that come forward as fast as possible. However, the local plan process was designed for a different era; I put it to the Minister that we need to refresh and overhaul that process, so it is not just about numbers but about looking closely at tenure and what is needed to join up the housing and economic needs of an area. We need to look at longer-term development, and ensure that it is hardwired into what we are doing. As the Minister knows, we have a massive site in York Central that is owned by Homes England and Network Rail, which are public sector organisations, and yet the demand on Network Rail is to release that land as a capital receipt, in order to see investment over 60 or 70 years that will enable housing to be built to meet local needs in the right forms of tenure.

There are so many things that I could speak about today, but I will end by saying that the issue of land banking must be addressed. Developers’ ability to sit on land without having to pay the price, needs to be brought into focus. Today housing is a driver of inequality, and housing is too important to be used in such a way. We need to make sure that we build homes that people can afford to live in, and end this racket in the housing market.

It is a pleasure to serve under your chairmanship, Dr Huq. I congratulate my hon. Friend the Member for St Ives (Derek Thomas), because this is a long overdue debate on a subject that many of us across the south-west feel extraordinarily passionate about, and extremely concerned. Each week, issues relating to available housing affordability can be found in my inbox—by post or email. It is becoming distinctly more alarming over the course of covid.

I just want to add a bit more of a Devon perspective. First, in my constituency of Totnes and south Devon, there are 5,000 second homes in South Hams; 27% of all second homes are found in the south-west. To put that in context, 57% of the properties in Salcombe are second homes; in Hope Cove that goes up to 80%; and in Thurlestone Sands it is 95%. That has had the undeniable impact of pushing up rental and property purchase rates. Anybody who wants to work or live in the local area on a full-time basis simply cannot find a property to live in, so of course they look around to see where they can find appropriate housing—and it is often many miles away. I think about the lifeboat service in Salcombe. I think about the teachers in Salcombe. I think about the doctors and nurses who live in and around Kingsbridge and Totnes, who do not have adequate properties to live in to enable them to work and provide the very necessary public service that we expect in our rural community.

The second part of this is the way in which we calculate what is “affordable”. According to the Devon County Council website, “affordable” is not based on the reality of what people are actually earning on the ground, so I ask the Minister to be considerate and to look into how we might find a better formula. When we have a lot of people with second homes working outside the area, it pumps the number up so that it is not indicative of what local wages really are.

From my perspective, the purpose of this debate, and the purpose of the discussion that we are having around affordability and available housing, is to make sure that those that do have second homes pay their fair share, and that there is support for those who want to live and work in the area. I do not want to take up much time because I know that lots of people will make many of the same points, but since I arrived in Westminster I have made it a bit of a mission to work on closing the loophole around business rates for second home owners.

For those that do not know, lots of people got away with not paying council tax by claiming business rates, and therefore were eligible for business rates relief. When covid came along, they were then eligible for the covid grants, and there were two of those. So actually, out of the 13,593 properties in Devon alone, the vast majority claimed the covid grants. I have no doubt that some of them absolutely are legitimate businesses, and we should welcome their taking that money to support their businesses so that they can continue to thrive, but I personally know of many examples where lots of people were claiming for that money because they were just putting their second home on to the business rates so that they could escape paying council tax and then, in the circumstances of covid, benefited. That is totally unacceptable and morally, I have to say, completely dubious and unacceptable. I hope there will be a review to look into those who were claiming to be eligible to pay business rates but were not actually running businesses. That is important.

That brings me to what I think we can do. The Chancellor has been good by mentioning that he wants to close that loophole, but can we do it sooner rather than later, and not in the expectation that more grants will be paid out? We need to announce where we are going with this. I might add that there should be a minimum requirement of actual days let in order to be eligible for business rates, and the Minister should make it as high as possible because legitimate businesses would have nothing to fear—so 180 days, 200 days, 210 days, or whatever he thinks is proportionate. That would at least start us on the process to getting this right and closing that loophole.

I have been very privileged to work with Councillor Judy Pearce, the leader of South Hams District Council. The hon. Member for York Central (Rachael Maskell), in a fantastic speech, made a very important point about data. In South Hams we are running a review of all second home properties and Airbnb, and we are happy to share best practice with any other hon. Member. We need to be able to point to the data so that we can make the argument somewhat better. So my first ask is to push on with the business rates.

My second ask is around Airbnb. It is great that people want to come to south Devon and spend their holiday in the south-west, but I do not understand the taxation policy around Airbnb. I believe that all too often the money does not stay in the local area, unlike with local letting agencies. We need to consider what Edinburgh and London are doing, and now, as I think I saw in The Guardian—it might surprise people that I occasionally read The Guardian—the island of Tiree has just introduced an alternative to Airbnb. Those are models that we should definitely look at.

My third and fourth points are on local government. Where possible there should be, as my hon. Friend the Member for St Ives said, a new planning requirement to have one’s house as a second home. Local government and local authorities should have the power to raise council tax above and beyond the statutory level that they have now. Again, it is about the stresses and strains that are put on our resources and our communities, so we have to make sure that we get that right.

It is great that we now have the planning Bill. The Minister has been extremely diligent in listening and working with many of us. Two weeks ago, we debated the Planning (Enforcement) Bill. If we insert measures in that Bill into the planning Bill, we might use the fines put on all the developers that break their enforcement orders to build social and affordable housing. Frankly, we need to toughen up on developers and ensure that we are leading by example.

It is a pleasure to see the hon. Member for St Ives (Derek Thomas), who has called such an important debate, especially for the south-west. The holiday industry is important to us, but so is our housing market. Our housing market in the south-west is broken, and needs fixing.

The pandemic has turbocharged our housing crisis. We not only have a housing crisis; we have a homes crisis. In many cases, there are enough houses but not enough homes for people to live in. Too many tenants have been turfed out to make way for holiday lets and second homes, which can sit empty for much of the year.

The low-wage economy means that many people cannot afford to live in the communities where they work. The sell-off of council homes means that there is no longer that safety net for far too many local families, and that is not good enough. We need to see proper action, and nowhere is that more important than in the south-west, where more than a quarter of England’s second homes are, according to 2019 data. Our rural and coastal villages are being hollowed out, and local people are priced out of moving or buying within the community where they grew up. In cities such as Plymouth, homes are being flipped to become Airbnb properties, damaging our local hotel trade and robbing local people of a home of their own.

I want to see more people come to the south-west—it is a great place to be—but housing policy should put local people first. We need a focus on first homes, not second homes. That is why I have worked with Councillor Jayne Kirkham, leader of the Labour group on Cornwall County Council, and Councillor Tudor Evans, leader of the opposition on Plymouth City Council, to develop our “First Homes not Second Homes” approach. That is a very simple, five-point radical plan, designed to tackle the housing crisis that is facing so many rural and coastal communities because of the surging number of second homes and holiday and Airbnb lets in the south-west, especially since the pandemic hit. The region most affected by second homes is rightly where the solution to fix the problem should be first applied. Our “First Homes not Second Homes” approach is a simple one, which I hope that the Minister and my hon. Friend the Member for Greenwich and Woolwich (Matthew Pennycook) will be able to support.

First, let us give councils the power to quadruple council tax on holiday lets and empty second homes. We need an economic disincentive against keeping houses empty, denying local people homes.

Secondly, let us introduce a licensing scheme for second homes, holiday homes and Airbnb lets, to understand the full extent and to set a minimum floor on the number of homes in any community that must be for local people and not for second homes, holiday homes or Airbnb lets. The minimum floor should be 51%, meaning that no community can be dominated by folks who do not live there. Then let us give councils the power to adjust that threshold upwards, to suit local circumstances—60%, 75% or 90%—because it is time that we called time on the takeover of the south-west by absent landlords.

Thirdly, let us create a “last shop in the village” fund, so that councils gain the power to introduce an affordable community infrastructure levy on empty and underused second homes, to support the last shop in the village, the last pharmacy, the last post office, the last pub and the last bus. Hollowed-out communities do not sustain essential community infrastructure and services. We need to find a new way to keep them in business.

Because people should not need to move away from where they grew up to get a decent job and a home they can afford, I want us to focus, fourthly, on an effort to build first homes, not second homes. That means building more genuinely affordable zero-carbon homes to buy or rent and for social rent, with a preference and priority for local people. In particular, that should focus on the key workers who keep our communities alive—the nurses, the shop workers, the teachers, the care workers, the farm workers who are now being priced out of our communities.

Finally, we need to introduce a discount lock for future renters and purchasers of those properties, to ensure that affordable first homes are not lost in the market blizzard of second home and holiday let purchases after that first family moves on, staircasing the benefits, not losing them. That is why we need a focus on first homes, not second homes.

We need to be bold, because our communities are being dominated by a second-homes approach. If we do not act soon, the south-west’s amazing attractiveness will be lost. Shops will not have anyone to work in them. Care homes will not have anyone to support the people inside. We will lose the essential spirit of the west country. That is why we need a focus on first homes, not second homes. I hope the Minister will respond to those points. We need to put first homes first and second homes second.

It is a pleasure to serve under your chairmanship, Dr Huq. I congratulate my hon. Friend the Member for St Ives (Derek Thomas) on securing, as he called it, a timely debate that is at the heart of the Government’s levelling-up agenda. I question the Cornwall and Devon bias to my right; Derbyshire is where people should be going for their holidays.

Like many former coal communities, the Bolsover constituency is fairly rural. Small pit villages, such as Glapwell and Shuttlewood, and small towns are its backbone. Anyone who has driven through the constituency recently will have seen the number of new dwellings popping up—439 since 2019. I have had the pleasure of visiting many of them, and many are affordable. It is a step in the right direction. It is great to hear how welcome those new residents are, many of whom are moving from outside the constituency and, indeed, from the south-east because they realise the benefits of living in Derbyshire.

In my relatively short time as the Member for Bolsover, my mission has always been focused on four things: infrastructure, skilled jobs, education and housing, which are all tied together. An area needs those things to thrive. They cannot be looked at in isolation. There is no point having housing without jobs and infrastructure, and there is no point building it all without equipping people with the skills they need to take advantage of those opportunities. Places in my constituency such as Shirebrook have suffered cycles of stagnation and deprivation that are difficult to disrupt. Nothing has ever really replaced the jobs and pride that the mines brought to many of my local communities. Honest people can work hard their entire lives, but because of the social and economic facts of the area, it is hard to grow the standard of living.

It is crucial that the Government continue to make bold decisions to promote the sustainable building of new homes in parts of the world like Shirebrook, which the Minister visited recently. On top of the tremendous benefits to the construction sector, new affordable housing is an important part of our offer to young people in our community. For too long, it has been accepted that, to find a good job and start a good life, people have to move away from places like Bolsover, where there are limited services and opportunities. Building affordable homes gives young people an incentive to stay local and invest their energy and creativity in the place they grew up. It can keep families together; staying local allows young people to maintain their most powerful support networks during a mental health crisis, takes pressure off the social care system and breaks down the worrying trend of loneliness in old age.

That is why I particularly welcome the Government’s decision to launch the First Homes scheme in Shirebrook. It allows local people and key workers the opportunity to buy their first home at a 30% discount. I was grateful to host the then Secretary of State for Housing, my right hon. Friend the Member for Newark (Robert Jenrick), who I think appreciated the unique challenges associated with regeneration in my constituency. Actively building new homes allows us to plan and grow our public services sustainably. Why do we build a few more houses in a village, with a salami-slice approach, rather than building a proper new estate with a school and GP practice, which can benefit the whole community? Building sustainably means a stronger local market for public services, which means better services for residents. When residents are against developments, it is almost certainly because they are unsustainable.

That is also why I am supporting and working with a number of local stakeholders on a project that has been known by many names, but which we will refer to as the Shirebrook growth corridor. We are looking to bring together infrastructure, housing, education and employment opportunities, which can help to break the cycle of stagnation that places such as Shirebrook have seen and unleash our potential.

I am sure the Minister will agree that now is the best time to embrace developing sustainably. We need to look at how we can use green technologies, such as mine water heating, electric vehicle charging points and heat pumps to reduce energy bills, reduce emissions and make the journey to net zero much more achievable. That is precisely what we are doing with the Shirebrook growth corridor.

All of that is not without its challenges, however. During the summer, I did a series of village hall meetings across my constituency and was slightly amazed that the most raised topic was not anything on the national agenda; it was parking in rural villages. Many of those areas were built at a time when most families did not have a car and if they did, they had one. Now, it is perfectly common for families to have two or three. That puts a huge burden on the villages in question and people do not like the traffic that builds up. I therefore encourage the Minister to get his officials to give some serious thought as to how we can solve the great parking issue in rural areas, particularly in areas such as Pinxton.

I would also raise section 106 moneys, because unfortunately, we hear time and again that although section 106 moneys have been agreed, they do not appear. Serious efforts are needed to ensure that residents are not being undersold by developers.

In closing, Dr Huq, as I can see that you are giving me that look, affordable housing is a vital cog in the system, but we need to see it in line with all the other elements that make sustainable communities. I am grateful for the way the Department has engaged with me so far, but I look forward to further conversations on the Shirebrook growth corridor, among many other things.

I congratulate the hon. Member for St Ives (Derek Thomas) on bringing this matter to Westminster Hall today. It will be no surprise to right hon. and hon. Members that I am here to give a Northern Ireland perspective. It is not the Minister’s responsibility, but I want to replicate the viewpoints put forward by others.

I am reminded that the former Prime Minister Margaret Thatcher had a policy and a strategy to ensure that people who wanted to buy their homes could do so. That introduced many people to the opportunity of having their own home. I have supported that over the years. I bought my own home and my mother and father’s farm. The opportunity was there to do so and the opportunity to reduce the price was also helpful for me.

While I am aware of the differences between the planning system in Northern Ireland and that in mainland UK, the similarities in need are outstanding. In my constituency of Strangford, families are in need of suitable homes, as are young people, and our elderly and disabled are in need of affordable homes. We have currently not found the right way to provide that. Co-ownership is one option I suggest to the Minister and we have schemes of that kind in Northern Ireland. My second son Ian and his wife Ashley bought a co-ownership home, where they bought half and the other half was controlled by the firm that built the homes. That meant people were able to have access to homes at an early stage in life. Is that a policy that the Government, and the Minister in particular, are looking at for the mainland? People can access half the price of co-ownership homes, thereby providing the possibility of home ownership. It has to be set up by the firms, but it can happen.

To give a snapshot of the needs at home, the population of Ards and North Down is projected to rise by some 1.5% from 2019 to 2029, along with the percentage of older people who are 65-plus. As other hon. Members have said, we have areas where people want to go and live—it is good that that is the case—thereby the demand for houses has risen dramatically. I know that those from the 65-plus vintage buy a lot of the houses down on the Ards peninsula, where I live. However, it also means that the social stock is under pressure. Some 25% of buildings in the years 2019 to 2029 will need to be specifically for people who are elderly or disabled, or will need to be age-friendly. The housing growth indicator shows that there will be a new dwelling requirement of 5,500 in Ards and North Down for the 14-year period starting in 2016. In that year, there were more than 70,000 households in Ards and North Down, of which 72% were owner-occupied, 16% were privately rented, and 12% were socially rented.

The reason I list those stats is that they show a rising demand for social housing. Even if we built 5,500 houses over that 14-year period, the demand for social housing in Ards and North Down at this moment is over 3,000, so that tells us what the need is. The public and private sectors are simply not meeting the need that is there. My constituency has much to offer—others have said this as well, so I will say the same thing—including a quick commute to Belfast just up the road. There is the joy of great high street shopping, salons and solicitors. Everything is there to make homes much more attractive if appropriate housing were available.

I have outlined the housing sector report that was presented to Ards and North Down council in an attempt to explain why there must be changes in planning zones and policy, in order to allow affordable, economic, environmentally friendly housing to meet the need that it perceives. The right housing in the right place at the right price can empower people to put roots down and to feel that where they live is where they want to be. The upshot is that weighted consideration must be given to new building applications, taking in the need in the area. I need to impress on Members that when I talk about housing stress, it is not a matter of numbers on a page: it is a matter of people’s lives. It is about the pensioners who are unable to heat their old four-bedroom draughty houses; the young families who are unable to pay £850 per month for a two-bed terraced house in the private sector housing market; the young person who is unable to leave their parents’ home and live their own life; or the abused partner who is unable to leave their home, as there is nowhere they can afford to go. Those are the realities in my constituency, and they are realities in everybody else’s constituency.

I fully support what the hon. Member for St Ives has said. I very much look forward to the Minister’s response: I know it will not be about what he can do to help us in Strangford, but he will be able to help us look at the bigger picture. We need changes in the system that lead to changes on the ground, and that work needs to begin now, so I urge the Minister to work co-operatively with the devolved Administrations—that is where there is contact between the Minister and my representation of the constituency of Strangford—to swap and enlarge ideas and strategies to allow UK-wide changes that will enable affordable housing to be built, thereby enabling our need to be met.

It is a pleasure to serve under your chairmanship, Dr Huq. I thank the hon. Member for St Ives (Derek Thomas) for securing this important debate on planning reform and affordable housing, and also for his work as the chair of the all-party parliamentary group on brain tumours, of which I happen to be a member.

The two issues we are debating today are of great importance to people across the whole country, including in my constituency of Bolton South East. Access to affordable, good-quality housing is the single biggest issue that fills my mailbox every week, and I am sure it fills other Members’ mailboxes as well. The importance of housing has been highlighted by the covid pandemic, and specifically by the effect it had on those parts of the country where there is a lot of overcrowding due to multi-generational households or because many people cannot afford a home of their own and are living in rented accommodation—perhaps renting a room in a house. The pandemic threw up this big problem that we have in our country and, to be fair, it is not a party political issue. Over the past 40 or 50 years, there seems to have been a failure to build more affordable, decent homes in our country across the piece.

Obviously, most Members are not able to help when our constituents write to us about such issues, irrespective of how much effort we make, because the housing stock is just not there. In Bolton alone, there are 9,000 people on the waiting list for a council property. I pay tribute to the work of Bolton at Home, whose representative I met this summer at one of its new developments. Jon Lord, the chief executive officer, told me that a single three-bedroom home for social rent, which had just been finished, had received 400 applications from families—400 people applying for one home. How is Bolton at Home meant to choose which of those 400 families, who are all equally needy, is deemed worthy of that property?

When it comes to owning a home, an affordable home is classed as costing no more than 30% of the average monthly household income. Although the median income in Bolton is around £26,000, which equates to a house price of around £80,000, the average house price in my area is £125,000. How does that add up? That builds on the point made by my hon. Friend the Member for York Central (Rachael Maskell) about the cost of housing in relation to salaries.

Some 14,000 of my constituents are on universal credit, the majority of whom are working people on low incomes. We are living through a massive housing crisis, and that is compounded by the fact that mine is the 37th most deprived constituency in the United Kingdom, with almost 9% unemployment and 40% of children living in poverty. The route out of the crisis is clear: we need to build more homes.

On planning reform, I want to briefly discuss an issue that is important to my constituents. I am concerned that the Government will implicitly force local councils like mine to turn greenfield sites into housing developments, rather than existing brownfield sites. In Bolton, historically an industry-based town, we are blessed with more than 100 existing brownfield sites, predominantly in the form of ex-factories. However, the lack of available funding and the costs of converting those premises means councils are often forced to give planning permission to build on green spaces. Often, if planning permission is denied, companies appeal to the Secretary of State and, because of the rules, most of the time they are successful, so our green space is taken.

I would like to see a legislative and financial framework to assist housing developers, private developers, local authorities and social housing companies to convert existing brownfield sites into affordable housing, which could alleviate much of our housing crisis. That is a possible solution that could lead to affordable housing. We do not have to have this crisis. It is not just in Bolton—across the country, there are brownfield sites that are eyesores, blotting the landscapes of our towns and cities.

We should do something practical to see how we can use brownfield sites rather than greenfield sites. We know that because of the particular buildings that are there, the preparation needed to make it possible to build on that land will cost money. I ask the Government to work nationally, through a special body, with local authorities or even with private developers to give out grants to make the land usable, and then it can be built on. The houses could then be sold with a 5% or 10% profit on each property, or it could also be done through a housing association. There are ways that we can deal with the issue.

Again, it is not a party political issue. Brownfield sites have not been utilised by any Government for so long, and they are pieces of land that could be used for building good homes. I really hope that the Minister will go back and talk to the relevant people. I am sure that they can work out a suitable, fair formula that helps everyone to convert brownfield sites and thereby provide homes. I know that if the brownfield sites in my area were converted, my constituency would not have a housing problem.

It is always a pleasure to serve under your chairmanship, Dr Huq, and I pay tribute to the hon. Member for St Ives (Derek Thomas) for securing this really important debate. I associate myself with the remarks that many Members have made about planning reform, but I want to focus on why we desperately need a clear solution to affordable housing.

My constituency of Vauxhall lies in the centre of London, just over the river from this House. As such, it faces the brunt of the affordable housing crisis in this country. As an MP, I get constituents contacting my office every day with problems that are exacerbated by the lack of affordable housing in Vauxhall. Many of those who contact me have horror stories of poor housing, urgent maintenance issues and severe overcrowding, which are making their lives a misery.

One of my constituents lives with four other family members in a one-bedroom flat, and they are forced to share bunk beds because there just is not enough room for individual beds. Would this be tolerable to any of us? My constituent also told me that right above the bed, there is a massive crack on the ceiling that lets in cold air, and that the flat is damp and has rodent problems. My constituent’s grandmother has dementia and has to adhere to strict guidance, meaning that the rest of the family are confined to the bedroom.

Another constituent explained to me that she lives with her three children, two of whom have been diagnosed with autism. They, too, share a one-bedroom flat, with no room for the children to develop. They also highlighted safety concerns; one child nearly fell from the third floor before a neighbour intervened. I defy anyone in this House to say that we should not expect such cases in Britain today. We are the fifth-richest economy in the world, but the truth is that unacceptable housing standards, poor housing and overcrowding are far too often the norm—not just in Vauxhall and London, but across the country.

The pandemic highlighted the devastating impact of overcrowded housing on households and families. In the past one and a half years, those in overcrowded housing have been at more risk of contracting covid, and such households also suffered the most from measures to combat covid. Our local councils play a vital role in housing supply and council reform, and research by the Local Government Association highlights that investment in new social housing could generate £330 billion for the country over 50 years. In turn, that would generate work in the construction sector, with over 89,000 jobs. More importantly, however, it would offer a clear route out of unaffordable housing and insecure private rental.

A survey commissioned by the National Housing Federation found that nearly 20% of respondents had experienced mental or physical health problems because of the lack of space in their homes during lockdown. We cannot fail to see the link between inequality and the social injustices that plague our society, so I ask the Minister to look at how we can increase the supply of genuinely affordable housing and social housing—like the home I grew up in, in Vauxhall—at the heart of housing policy. Only a publicly funded programme of council house building, supported by Government grants, will help the Government to meet their target of 300,000 new homes.

It is a pleasure, as always, to serve under your chairmanship, Dr Huq, just as it is to respond to what has been an extremely thoughtful and well-informed discussion. I congratulate the hon. Member for St Ives (Derek Thomas) on securing this important debate, and on the considered way in which he opened it. He spoke with great clarity and persuasiveness about the severe housing pressures in his corner of England—pressures that, as he made clear, have been exacerbated by the pandemic—and he set out a number of interesting proposals to address them, many of which warrant further consideration.

When it comes to second and holiday home ownership in particular, we very much agree that more needs to be done to ensure that local first-time buyers get priority access to new homes for market sale, and that local people who are not in a position to buy or to secure social housing can access affordable private rentals, rather than those homes being used by landlords exclusively as short or holiday lets.

As an aside, I very much welcome the fact that there is an energetic all-party group on the short lets sector, because the regulatory balance in this area is delicate and needs to be approached sensibly, without party political controversy. If the Minister has time, I hope that he might outline whether the Government have any plans to better regulate the short-term platforms spoken about by many in this debate.

I strongly commend the detailed “First Homes not Second Homes” proposals set out today by my hon. Friend the Member for Plymouth, Sutton and Devonport (Luke Pollard). I know the painstaking work he has been doing, as have Councillor Jayne Kirkham, Councillor Kate Ewert and others, to ensure that local people in Devon and Cornwall are not priced out of their local communities. I hope that the Minister will give those proposals serious consideration.

More generally, the hon. Member for St Ives was absolutely right to have used this debate to make the case, on behalf of his constituents, for focusing on delivering the right quantity of new housing in the right places at prices that local people can afford. It was implicit in his remarks that that should be done in a way that secures buy-in from existing local communities. I think those sentiments were shared widely by Members on both sides of the Chamber. Where he and I differ is in the belief that the means of achieving that vision are the flawed proposals outlined in the Government’s August 2020 White Paper for reform of the planning system—assuming that those proposals eventually emerge in some recognisable form from the review initiated by the Secretary of State following his appointment in September.

I will use what remains of my time to pick up on the two main themes of the debate—availability and affordability of housing—but also to draw out the third element, which is what the public’s role in the planning process should be. When it comes to the availability of housing, all Members who have spoken today have made it clear that there is widespread agreement on the need to accelerate the delivery of new housing across the country.

While the Opposition do not deny that the existing planning framework has its problems and there is an obvious case for reform, there is scant evidence that it is the primary cause of supply constraints. Even with all the caveats that must be considered, the statistics make it clear that the total number of units granted planning consent each year has consistently outstripped the rate of construction over the past decade, and the number of un-built permissions is highest in the regions with highest demand. Amazingly, London, of all places, where housing pressures are acute—I know this from my constituency caseload, which mirrors the situation set out by my hon. Friend the Member for Vauxhall (Florence Eshalomi)—has the largest volume of unused consents. A report by the consultancy BuiltPlace suggests that our capital has as much as 8.1 years of supply approved, and yet unused.

Instead of obsessing about supply side reform, the Government would do well to focus, in the first instance, on cracking down on land banking and speculative planning, and consider what might be done to incentivise or compel developers—a point made by my hon. Friend the Member for York Central (Rachael Maskell)—to build out the permissions they have acquired.

When it comes to housing affordability, we really must get away from the over-simplistic notion that ramping up the supply of new housing will fully resolve the affordability crisis affecting many parts of the country. That is a theme that has re-emerged time and time again. Even if the Government’s target of 300,000 new houses a year were to be met—that is a very big if, given that completions in 2020-21 stood at just over 216,000—the impact on prices would be relatively small, and it would be felt only in the medium term.

Prior to the pandemic, there were a million more houses in England than there were households; that surplus has increased over recent decades and continues to grow, at the same time as prices continue to rise. Put simply, increasing home ownership—and boosting home ownership rates among the young, in particular—is as much about the affordability criteria and who can buy any new housing that becomes available as it is about overall deficiencies in supply. Instead of obsessing about supply side reform, the Government should look at how lending can be better targeted towards first-time buyers, so that they, and not just those who already have large amounts of equity, can purchase new homes to live in. As my hon. Friends the Members for York Central, for Vauxhall, for Plymouth, Sutton and Devonport, and for Bolton South East (Yasmin Qureshi) have said, we need better support for those who simply cannot buy, such as greater protection for private renters and action to reverse the sharp decline in social housing provision over recent years.

A key point, which has been implicit in today’s contributions but not brought expressly to the surface, is the role of local people and their priorities in the planning process. It is not disputed that there is an issue that needs to be confronted in terms of England’s discretionary planning system, but the solution to the problems of housing availability and affordability is not to silence communities and hand control of planning to development boards appointed by Ministers in Whitehall. As much as some rather offensively like to brand them in this way, most people in England are not die-hard nimbys, and that is why nine in 10 planning applications are approved.

What local people want, and what they should retain, is a say over how their areas are developed and a right to challenge inappropriate or harmful proposals that they do not believe will help to sustain balanced communities or, as the hon. Member for Bolsover (Mark Fletcher) remarked, provide the necessary infrastructure and amenity to thrive. Instead of attempting to reduce the public’s involvement or remove them from the planning process entirely, the Government should concentrate on how the system can be reformed to ensure that more developers bring forward proposals that significantly enhance local areas for existing communities, as well as for newcomers. That will incentivise local people to say yes with greater frequency.

As things stand, we have no idea whether proposals to reform the planning system will re-emerge from the review that the Secretary of State commissioned and, if they do, what form they will take. If a Bill is introduced next year, we hope that it will be the product of genuine reflection on the criticisms levelled at the White Paper by Members from all parts of the House. We hope that rather than approaching the planning system as so much red tape that needs to be swept aside, the Government will seek to make the current system more reflective, rational, transparent and democratic, and better resourced, putting communities at the heart of good place making that delivers high-quality, zero-carbon affordable new homes in the places where they are so desperately needed. As the hon. Member for Strangford (Jim Shannon) said powerfully, the housing crisis is, at the end of the day, not about numbers or units; it is about how we build the homes that people and families need so that they can flourish.

It is a great pleasure to serve under your chairship, Dr Huq, and to wind up this Westminster Hall debate. It has been thoughtful and considered, with detailed and useful contributions from Members from across the House. I hope that I will be able to pick up on the points made by Members, and occasionally I may refer to the excellent speech that has been provided to me by my officials.

I congratulate the hon. Member for Greenwich and Woolwich (Matthew Pennycook) on his appointment to the shadow housing portfolio—a very important role indeed. I look forward to working with him as he attempts to keep us true, and to helping to persuade him of the righteousness of our approach, and I wish him well. I congratulate my hon. Friend the Member for St Ives (Derek Thomas) on securing this important debate and making such a thoughtful contribution. I am sure that he will not stop promoting Cornwall or, for that matter, Devon. We want him to promote them, but we also want to ensure that his constituents have good quality, decent and affordable homes to live in.

I remind everybody of the importance of building more homes. The hon. Member for Greenwich and Woolwich spoke about other reasons and methods to ensure that we provide affordable homes, but fundamentally we have to build more homes if we are going to supply good quality homes in the places that people want. That is why over the last 10 years we have had programmes such as the affordable homes programme, under which hundreds of thousands of new properties have been built across our country. That is why we are using programmes such as Help to Buy, which has only recently provided its 300,000th instance of help to buy for Sam Legg and his partner, Megan, who bought a home in Asfordby in Leicestershire. Sam said that without the Help to Buy programme, he would not have been able to afford to get on to the property ladder. That is a dream that more than 80% of people, particularly those in the social and private rented sectors, say they want to achieve—the right to own, the right to buy and the right to acquire. They want to get themselves on to the property ladder.

My hon. Friend the Member for St Ives and several other colleagues—including my hon. Friend the Member for Totnes (Anthony Mangnall) and the hon. Member for Plymouth, Sutton and Devonport (Luke Pollard)—mentioned the importance of primary residences. I recognise the challenge that has been put to us, and it is one of the reasons why we have reformed stamp duty and increased the costs to foreign and international purchasers of British property. To the point made by my hon. Friend the Member for Totnes, it is why we will introduce a threshold for the business rate loophole tie-up, to ensure that only proper letters are letting their properties and making use of the business rate regime.

I am conscious that other Members have made points about council tax and the importance of local authorities having discretion over it. We have allowed local authorities to increase the council tax to 100% for second homes, but I will consider carefully the points that Members have made about local authorities having further discretion over their council tax regime.

The hon. Member for Bolsover (Mark Fletcher) spoke about First Homes, which the hon. Member for Plymouth, Sutton and Devonport mentioned in a slightly different context. I was pleased to visit Bolsover a couple of weeks ago to give Nicky Bembridge, an NHS worker, the keys to his first home. As my hon. Friend pointed out, the First Homes regime is provided by developer contributions and it does not cost the taxpayer a penny. It means that local homes are available to local people at a discount of at least 30% off the market rate. Local authorities have the discretion to determine which residents will be eligible—it could be people who live locally, or people with skills that are missing from the area and are needed.

The First Homes product allows people to get on the property ladder, while covenanting the discount into the future so that future generations of local people or skilled workers, defined by the local authority, will be able to get on to the property ladder. I rather hope that if some First Homes are built in Plymouth, they can be built on the site of the former registry office, which I think is being demolished—thanks partly to £250,000 of brownfield funding that the Government are providing to Plymouth City Council to ensure that that work is done.

The hon. Member for Bolton South East (Yasmin Qureshi) mentioned brownfield sites. We are absolutely committed to further development on brownfield land, and that is one of the reasons why we have introduced further funding for that purpose. In the recent Budget, £1.8 billion was made available for brownfield remediation, £300 million of which will be given to mayoral combined authorities. Greater Manchester has already benefited to the tune of more than £90 million of public money for brownfield remediation, and we look forward to going further in the future.

The hon. Member for York Central (Rachael Maskell) raised an important point about the time it takes to make local plans. She is perhaps more aware of that than most, because York has not had a local plan since 1956, when the present planning regime was barely eight years old.

We are very conscious of that challenge. If we are to get more developers, particularly small and medium-sized enterprises, to build different types of property on different land packets to different tenures, we need a planning system that is far more transparent, predictable and speedy. I take on board the points made about the planning system by the shadow Minister, the hon. Member for Greenwich and Woolwich, but I think we all recognise that it is far too slow. It can take seven years for a local plan to be produced, and a further five years for planning permissions to be granted and spades to go into the ground. That is far too long for SME developers that are living, quite literally, hand to mouth. We need a system that is far more predictable and speedy, and that will be the effect of our planning reforms, which I can assure the hon. Gentleman and the House we will introduce.

We also want to make the planning system far more engaging. It is very important that more people get involved in our planning system. It really is not very democratic that literally 1% of local people on average get involved in local plan making—that is more or less local planning officers and their blood relations. The percentage rises to a massive 2% or 3% of people getting involved in individual planning applications—still not enough. We need a system that is far more engaging, three-dimensional and digitised. That is what our planning reforms will provide.

By providing a digital planning system, we will free up local planning officers, giving them much more bandwidth to do the sort of strategic planning that they trained to do, that we want them to do and that communities need them to do, rather than focusing on the administration of agreeing that a dormer window can be put in a particular building. We will ensure that we have a faster and more accessible planning system. We have also committed ourselves to a review of the resourcing of local planning authorities to make sure that—quite apart from digitisation, which should increase their bandwidth—they have the wherewithal to do the work that we want them to do.

My hon. Friend the Member for St Ives raised the importance of skills and apprenticeships in our construction supply chain, a point also made by my hon. Friend the Member for Bolsover. The Department for Education has made available some £2.7 billion for the purposes of apprenticeships, and innovative partnerships between the National House Building Council and developers such as Redrow have allowed for the development of bricklayer academies. One has opened in my constituency —I am sure it is just coincidence that they chose Tamworth.

The academies mean that the time it takes to train a bricklayer is cut in half. They also allow young people to see that there is a career in construction beyond bricklaying. They may be 19 and learning how to lay bricks, but they also learn that, by the time they are 30 or 35, they can do other things in the construction sector and they do not have to lay bricks for the rest of their working life. That encourages more people, and also more women, into the construction sector—a very important thing.

My hon. Friend the Member for Bolsover raised the importance of infrastructure. That point was also made by the hon. Member for Plymouth, Sutton and Devonport. We recognise that, if we are to get more people to support our planning regime, they must have the infrastructure to support the homes that are built around or near them—the GP clinic, school, roundabout or kids’ play area. We know that the present system of section 106 agreements is loaded in favour of the developers, and that the bigger developers tend to have the bigger lawyers, with the bigger guns, who can drive down the will of local authorities to resist.

That system means that proposed infrastructure is often negotiated away, or does not arrive on time. We are going to introduce an infrastructure levy, and I hear the point made by many contributors that that ought to be as localised as possible. That levy will allow infrastructure to be built up front, when people want it and in a way that they expect. As my hon. Friend the Member for Bolsover rightly said, if the infrastructure can be put in place, that will carry with it the hearts and minds of local communities, who will see that they will get some bang for their buck.

Members raised the issue of empty homes. There are sometimes good reasons that homes are empty—for example, if they cannot be repaired, if they are in the wrong place to meet demand or if they are not the right size for the people who most need them. However, I hear what colleagues have said. As I have already pointed out in my remarks about council tax and the consideration of further discretions, I will go away and ponder the points that have been raised by a significant number of Members.

I will make one final point, Dr Huq, before I make some concluding remarks.

I want to pick up the point I made in my intervention, about the statutory duty placed on police forces to sell to the highest bidder police stations that are being closed, which therefore considers financial rather than social value. This is a problem not just for Teddington police station, but across London, where we have a real dearth of sites. Will the Minister look at changing national legislation so police forces can consider affordable housing bids?

The hon. Lady makes an important point. I remind her that developer contributions can contribute to affordable homes being built in her locality, and that it is a Government obligation carefully to consider how public money is spent so as to ensure we get best value for it. I will certainly go away and consider the point she has raised.

I will say one quick thing about net zero, which a number of Members raised. The future homes standard, which we are to introduce in 2025, will mean that homes are built with materials and heating systems that make them at least 75% more carbon efficient than homes built to present standards. As a down payment on the 2025 date that we have set the sector, next year we will introduce an uplift in building regulations to ensure that homes are at least 31% more carbon efficient than homes built at present.

This has been an important debate, and I have been pleased to hear the contributions made by colleagues from across the Chamber. I hope I have given reassurances to Members as to the importance that the Government place on building good-quality, affordable homes around our country, where they are needed. Be they for ownership, shared ownership, affordable rent or social rent, we need more good-quality homes. That is one of the building blocks of levelling up. It is a mission that the Government have set me and the Department for Levelling Up, Housing and Communities, and one that we shall deliver.

I am grateful to the Minister for his response and to all the Members who took part in the debate. What was really clear from the debate, and something I hope will follow through to the White Paper, is that at the centre of the issue are families and people across the country who need housing. They need houses they can afford and that give them security in their local communities. If we can get that message across and if it is in the White Paper, I feel that we have done our job.

Question put and agreed to.


That this House has considered access to affordable housing and planning reform.

Great British Railways HQ: Darlington Bid

[Sir Gary Streeter in the Chair]

Before we begin, I remind Members that they are expected to wear face coverings when not speaking in the debate. 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. This 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. There will not be an opportunity for the Member in charge to wind up the debate, as is the convention for a 30-minute debate. I see that other colleagues are here as well. It is a pleasure and a delight to call Peter Gibson to move the motion.

I beg to move,

That this House has considered Darlington’s bid to become the home of Great British Rail.

Thank you, Sir Gary, and it is a pleasure to serve under your chairmanship. I thank my Tees valley colleagues for attending to show their support, and Darlington Borough Council for its ongoing work to help to bring the headquarters of Great British Railways to Darlington.

Perhaps it was inevitable that our railways should feature heavily in my work as the Member for the great railway town of Darlington. Over the last 24 months during which I have had the privilege to serve in this place, railways have featured extensively, both here in Parliament and at home in Darlington. To quote the father of the railways, Edward Pease,

“thou must think of Darlington; remember it was Darlington sent for thee.”

Those words are as relevant today as when they were spoken two centuries ago, and they led to the route of the railway line from Shildon to Stockton incorporating Darlington. Edward was a visionary who used infrastructure as the basis for levelling up. However, for too long, those words and Darlington’s position as the birthplace of the railways have been overlooked and ignored.

I always enjoyed my little spats with the hon. Gentleman’s predecessor, Jenny Chapman, when we both claimed our respective towns were the real home of the railways. The first passenger line went from Stockton to Darlington. We agreed that it started in Stockton, but, she said, with Darlington money. Surely Stockton is the real birthplace of the railways. The hon. Gentleman should set aside his ambition to bring these headquarters to Darlington and work with me and the hon. Member for Stockton South (Matt Vickers) to bring them to Stockton, the real home of the railways. After all, Darlington is getting all those civil service jobs. We need to be levelled up.

The hon. Gentleman grew up and spent a long time in Darlington. I am sure he will back my campaign, rather than a personal campaign.

In the 1970s, the National Railway Museum was tipped to be located in Darlington, but was instead opened in York. In 2004, a new museum was opened at Shildon. Both decisions robbed Darlington of hundreds of thousands of visitors. I am told that, at the time, a councillor is reported to have said, “We want nowt more to do with trains.” However, I am pleased that that attitude has changed, with firm backing from Conservative-led Darlington Borough Council and with cross-party interest in protecting and restoring our railway heritage. Despite those oversights, Darlington’s ingenuity and expertise have not waned, and many of my constituents are already working in the railway industry or in skilled engineering and administrative jobs. Indeed, Darlington is home to Railpen, which administers railway pensions and occupies the stunning baroque revival-style Stooperdale Offices, built as a HQ for the North Eastern Railway Company.

I am delighted to make the case on the record for why Great British Railways should come to Darlington. As we are in the festive season, I want to inform the Minister of the carol of Darlington’s railway past, present and future yet to come, in the hope that by the end of the debate he will embody the spirit of Christmas and be mindful to bestow this gift on Darlington. Fundamentally, Darlington has a unique and unmatched connection to our railways. It all began in 1819, when the novel idea of using a steam-powered locomotive to pull passenger carts was first mulled over. Indeed, although the House legislated in 1821 to allow the creation of the Stockton and Darlington railway, it was in our town that the idea of a modern passenger railway was conceived between Edward Pease, Jonathan Backhouse and the famous George Stephenson. Stephenson’s ingenious Locomotion No.1, built in the north-east thanks to the financial backing of the Pease family, would pull the first passenger carts over Darlington’s Skerne bridge in 1825.

I congratulate my hon. Friend on securing the debate. I am the Member for the rest of Darlington borough, where the railway line heads to the west. Does my hon. Friend agree that the original railway line started to the west of Darlington and finished to the east of Darlington, at Stockton, and that Darlington is obviously the central part of that historic railway line?

I am grateful for that intervention from my hon. Friend, who makes an excellent point. With its position on the Stockton-to-Darlington railway line, Darlington is actually central to the Stockton and Darlington railway.

Skerne bridge commemorated the birth of the railway in 1825 and is immortalised on the former £5 note—a bridge that still carries passenger trains, is a world heritage site and is the world’s oldest continuously used railway bridge. In my maiden speech, I challenged the decision of the National Railway Museum to remove Locomotion No. 1 from our town, where it had been on display for over 160 years and stood as a monument to the father of the railways, Edward Pease, who embodied Darlington’s entrepreneurial spirit. First, it stood on a plinth at Darlington’s North Road station, before being moved to Bank Top station. It then once again returned to North Road to sit in the Head of Steam Museum. The only times it had left our town was to be showcased around the world, and to be protected from harm during the second world war. Thankfully, our battle to protect the engine resulted in some success. Under the agreement, Darlington and Shildon will share the display of the engine, and there will be a guaranteed plinth for a new replica of Locomotion No. 1 at Bank Top station.

I am sure that the hon. Member for Stockton North (Alex Cunningham) and I would be happy for my hon. Friend to play around with Locomotion No. 1 for some time, but everybody would agree that Stockton is the real home of the railway. The first discussions about putting the railway together were had in Stockton, the first railway track for that railway line was laid in Stockton, and the first ticket was sold in Stockton. My hon. Friend can keep Locomotion No. 1, but we want Great British Railways.

I am grateful to my hon. Friend, who is a great champion of Stockton. I challenge and question some of his historical perspective, but I know that he is campaigning vigorously, just as I am, to bring Great British Railways to the Tees valley.

The permission to describe Darlington town as the historical home of Locomotion No. 1 was agreed with the National Railway Museum, and we have agreed to the purchase of a working replica for the Head of Steam Museum in Darlington. Through a kind gift from Network Rail and the efforts of Sir Peter Hendy, we also have Darlington’s D6898—the very last diesel railway engine, which was built at Faverdale in 1964.

While my hon. Friend is on the subject, he will be aware that Locomotion No. 1 was the first train to pull into Redcar train station. Does he share my passion to see Redcar train station redeveloped, as I have shared with the Minister previously?

I am grateful for that intervention from my hon. Friend, who is a doughty champion of Redcar. Redcar station is very familiar to me, having travelled through it as a schoolchild, and having previously served on the coastal communities board in Redcar, I know that it is a pivotal piece of infrastructure for the levelling up of Redcar. I would be happy to support him in his endeavours to do just that.

To enhance the discussion around Redcar railway, I am sure my hon. Friend the Member for Redcar (Jacob Young) is aware of the need to put a station at Ferryhill and allow the people of Redcar to come to Sedgefield and the people of Sedgefield to go to Redcar.

My hon. Friend is continuing his campaign for Ferryhill station. I thank Paul Gilbert, Rob Davis, and Rob Morton who did the restoration work as part of Network Rail’s gift of D6898 to Darlington. The culmination of this campaign, and its outcome, will ensure that Darlington’s railway past continues to be the bedrock of our town’s story, while establishing Great British Railway’s headquarters in Darlington will secure its present and future.

In choosing a new home for Great British Railways, the Government have the chance to recognise the essential and pivotal place that Darlington has in the national, and international, story of the railways, and to restore our place in history as the home of the organisation. This is an exciting time in Darlington’s railway present, as our Bank Top station is redeveloped and our railway heritage is protected and restored, ahead of the bicentenary celebrations of the Stockton and Darlington railway in 2025. There has been a massive investment of £20 million from Tees Valley Combined Authority to help establish our rail heritage quarter. I pay tribute to the efforts of Ben Houchen and all he has done for our area.

Darlington is firmly on the up, thanks in large part to the Government’s levelling-up agenda. Earlier this year, the Chancellor—a firm friend of our town—announced that the Treasury would create a new northern economic campus in the centre of our town, in close proximity to Darlington’s Bank Top station. Already, civil servants from the Treasury, the Department for International Trade, the Department for Business, Energy and Industrial Strategy, the Department for Levelling Up, Housing and Communities, the Competition and Markets Authority and the Office for National Statistics are benefitting from our excellent transport links.

I am sure that my hon. Friend will agree with me that levelling up is about spreading opportunity the length and breadth of the country. Darlington has its Treasury jobs, and York has its Cabinet Office jobs. Is it not about time that Great British Railways came home to Stockton?

I am once again grateful to my hon. Friend for his intervention. However, my job is to champion all that is great about Darlington, and push for continued investment and new jobs. I will not dissuade him from continuing his campaign, but my job here is to champion Darlington’s cause.

I am grateful to the hon. Gentleman for giving way. We are all Tees valley MPs in this Chamber this afternoon. I would like to send a message to the Minister. I am old enough to have been there in Darlington as a schoolboy when we celebrated the 150th anniversary of the Stockton to Darlington railway. I hope to still be around when we celebrate the 200th anniversary. Our message from Tees valley is that we want it in the Tees valley. We might fight among ourselves over it, but we want the headquarters of Great British Railways in the Tees valley.

The hon. Gentleman should know that we can work together, just as he has worked with my hon. Friend the Member for Cleethorpes (Martin Vickers) on the campaign for a hospital in his constituency, and just as all the Tees valley MPs have worked hard to secure the Darlington economic campus. However, at this stage in the discussions about the home for Great British Railways, there is nothing wrong with a little bit of friendly competition between me, the hon. Gentleman and my hon. Friend.

My right hon. Friend the Chancellor has already been working in Darlington and was recently spotted in its redeveloped market hall. That redevelopment complements the rejuvenation of the town centre, with £23.5 million secured from the towns fund, allowing our town to reverse the disastrous changes of the past and making Darlington a thriving market town once again.

Only a few weeks ago, the Chancellor announced millions more in his autumn Budget to revolutionise transport in the Tees valley—vastly improving regional connectivity. At its centre will be the redeveloped, modern Bank Top station, which will help the thousands of civil servants, along with Ministers, to move freely up to the town from London and make journeys locally, connecting the northern economic campus with the new freeport along the Tees. This £105 million transformation will revolutionise rail capacity north of York, increasing the frequency and reliability of services. The redevelopment of Bank Top will increase capacity with three new platforms, a new station building, car park and improved public access, adding to and enhancing the splendour of our grade II* listed station. This will turn Bank Top into a regional hub that is fit to serve not only Darlington and the Tees valley but large parts of south Durham and North Yorkshire. I also warmly welcome the recent award of £50,000 for a feasibility study on the reopening of the Darlington to Weardale railway, which will further enhance connectivity and opportunity.

In addition, we are restoring our rail heritage. I pay tribute to Network Rail, Darlington Borough Council and the A1 Steam Locomotive Trust, which have worked hard locally to maintain Darlington’s Skerne bridge and to brighten up three other historic railway bridges in Darlington. With reeds and weeds already cleared from Skerne bridge and the continuation of the £60,000 project to restore three of the bridges, two having already been repainted, our town centre is already looking like the natural place to find the headquarters of a national railway, with green livery aplenty and the restoration of the town’s proud crest, replete with Locomotion No. 1 at its heart.

There is, of course, more to be done, and I will continue to push Network Rail to ensure that the restoration of North Road bridge is completed and, most importantly, that our Bank Top station has tactile paving installed, something that has been called for by the excellent Darlington Action on Disability group.

We may have lost our huge carriage works many years ago, but sleek new Azuma trains roll off the production line just a few miles up the road at Hitachi Newton Aycliffe, where many of my constituents work. The Minister will also be aware of the wonderful work of the A1 Steam Locomotive Trust, which hand-built Tornado, the new steam train licensed to operate on the mainline, and I look forward to the Prince of Wales engine, again hand-built in Darlington, joining its sister on the network very soon. With thousands of civil servants moving north, the redevelopment of Bank Top and the restoring of our railway heritage at this pivotal moment in our town’s railway story, bringing the HQ of Great British Railways to Darlington just makes sense.

As I have already set out, we have secured Darlington’s future prosperity and growth through the movement of civil servants north, the creation of a new freeport on the River Tees and the investment in our town centre. However, as my hon. Friend the Minister will know, Darlington’s railway connections are under threat once again from London North Eastern Railway. Our greatest worry is that, even though we recently saw off the proposed changes to next year’s timetable on the east coast main line, the proposals are back, and I am worried that they will lead to a further act of betrayal of Darlington, robbing us of vital connectivity.

We know that there will be a growth in the number of journeys made from Darlington’s Bank Top station. Indeed, estimates show that within a decade an additional 340,000 passengers will be using the station every year, yet proposals for May 2022 risk leaving the town poorly connected, with regular services to London and Edinburgh slashed. Locating the Great British Railways HQ in Darlington would undoubtedly soothe the worries of my constituents as we bounce back from the damage done in the past, and it would further restore our town’s pride in its historical connections with the railways.

I need not repeat the myriad Government Departments coming to our proud town. The reasons are manifold: our proud history, local talent, connectivity, levelling-up opportunities and reversing the brain drain from the north-east. There are, of course, many other notable towns bidding for the HQ—Crewe, York, Derby and, as we have already heard, Stockton—but ours is the only bid backed by the people of Darlington, whose forebears created and built the railways, and I am proud to work closely with Darlington Borough Council to unite the town behind the bid. I trust I have conveyed to the Minister the desire and the need to put the HQ of Great British Railways in Darlington. We have the heritage, the history, the connectivity, the ingenuity and the people. I will conclude by imploring the Minister to choose Darlington as we build on a legacy of the past, secure our present railway and deliver for the future.

It is a pleasure to serve under your chairmanship, Sir Gary. I am not sure I have served under your chairmanship before. You might recall that I am a football referee in my spare time, and it feels as though we have had a bit of a derby between Stockton and Darlington this afternoon. Before I respond to the various points made by hon. Members, I want to thank my hon. Friend the Member for Darlington (Peter Gibson) for securing this debate and putting across his points so forcefully and politely, and also for allowing his colleagues from across the Chamber to contribute. He is a very good parliamentarian and conducted this debate excellently.

Only a couple of weeks ago I was in this Chamber debating the merits of York as a potential headquarters. It is genuinely heartening to see right hon. and hon. Members doing outstanding work up and down the country, preparing bids for their cities and celebrating the rich railway heritage of this country, no matter where it may be. It is equally heartening to see all the Tees valley MPs working together—and a bit apart, but mainly together—to put forward the case for the Tees valley, and I thank the hon. Member for Stockton North (Alex Cunningham) for his contributions. He has announced that he might be leaving this place at the next election, which would be a tremendous loss, but the way he has conducted himself in this debate shows that he is doing the best for Tees valley, and should be commended for it.

We are all aware of the important role that Darlington and County Durham played in the formation of the railways, with that county deserving the name of “the cradle of the railways”. It was the home of the world’s first public railway to run steam locomotives, as we have heard: the famous Stockton and Darlington Railway—I am quite sure that is the right way around, but I am very careful about what I am saying now—which opened in 1825. As my hon. Friend the Member for Darlington said, when designing the route for that railway George Stephenson at one point suggested that it bypass Darlington altogether. That was when Edward Pease, a local Darlington manufacturer and main promoter of the railway, replied,

“George, thou must think of Darlington; remember it was Darlington that sent for thee”,

securing its position in the rich railway heritage of this country.

Today, Darlington houses the Head of Steam railway museum in the historic North Road station building, which opened in 1842. That museum is home to several locomotives, including the replica of Locomotion No. 1, which appropriately was the train that connected the two great towns that have been the subject of a minor debate here today. I am sure it went from both Stockton to Darlington and Darlington to Stockton with equal gusto.

A place as steeped in the history of this country’s railways and, indeed, the world’s railways as Darlington and County Durham will always have an important role to play. As evidenced by my mailbox, there are a few other places across the country that have played an important part in our proud railway heritage, and which right hon. and hon. Members are proud to represent. I look forward to the next debate in this Chamber in which I get to learn about the railway history of another place, but it has been a delight to hear celebrated all that is good about Darlington’s rail past, rail present and, as my hon. Friend said, rail future.

I do not want to bore Members with a repeat of the speech I gave in the York debate—although I am very good at doing choruses and am available for karaoke at Christmas parties if they are allowed. However, I think it is important that we remind ourselves of the Government’s aim, which is a world-class railway that works seamlessly as part of a wider transport network, delivering opportunities across the nations and regions of Great Britain. In the Williams-Shapps plan for rail, published in May this year, we set out the path towards a truly passenger-focused railway underpinned by new contracts that prioritise punctual and reliable services, the rapid delivery of a ticketing revolution with new flexible and convenient tickets, and long-term proposals to build a modern, greener, and accessible network.

There is a bypass around Darlington at the moment, all the way to Stockton, which the Minister may like to bear in mind. He might have enjoyed the small spat between the Tees valley MPs as we bid for the headquarters, but I wanted to tease him a little and ask him how he is going to ensure that Great British Railways is in fact British, particularly given that much of our railway sector is run by foreign companies, the latest example being that Chiltern Railways is now run by a company owned by German state railways.

I say to the hon. Gentleman that those private operators are great innovators in our rail market. Rail privatisation has doubled the number of passengers being carried on our railways over the course of the past decade or so. That is something to be celebrated, because it took place at a time when the view that we need to decarbonise our transport network—which all parties now share—was not quite so widely held. Innovation that has been brought in by private operators should be celebrated, no matter where in the world they come from.

Just to pick up on a point made by the hon. Member for Stockton North (Alex Cunningham), the bypass at Darlington needs a bit on the top as well. Perhaps we could make that point to the Roads Minister. In terms of rail, where better to put the home of Great British Railways—[Interruption.] I shall ignore the barracking from Members in a sedentary position. Where better to put it than right next to Hitachi, one of the foremost railway manufacturing companies in the UK and which is based just along the road in Newton Aycliffe?

I thank my hon. Friend for that point. Hitachi is a Japanese company, but the intellectual property, huge number of jobs and innovation that it brings to our rail market are fantastic. Those are British jobs, in Britain, and we should welcome that. We should not be afraid of what international investment can bring to our rail market, or indeed any other market, and to the supply chain, as my hon. Friend quite rightly says.

Central to the Williams-Shapps plan for rail is the establishment of a new rail body, Great British Railways, which will provide a single, familiar brand and strong, unified leadership across the rail sector—something for which the rail sector has been calling for a decent time now. GBR will be responsible for delivering better value, flexible fares and the punctual and reliable services that passengers deserve, but it will also bring the ownership of the infrastructure, fares, timetables and planning of the network all under one roof. It will bring today’s very fragmented railways under a single point of operational accountability, ensuring that the focus is on delivering for passengers and freight customers.

GBR will be a new organisation with a commercial mindset and strong customer focus, and it will have a different culture from the current infrastructure owner, Network Rail, and very different incentives from the beginning. This new body obviously needs a new headquarters. GBR will have responsibility for the whole rail system, and needs a national headquarters as well as regional divisions. I am very happy to confirm that the national headquarters will be based outside of London, bringing the railway closer to the people and places that it serves and ensuring that skilled jobs and economic benefits are focused beyond the capital, in line with the Government’s commitment to levelling up.

My hon. Friend the Minister has confirmed that he is aware of Stockton’s amazing historic links to the railway—it is the home of the railway—and of the incredible and improving transport links from Stockton. However, is he aware of the incredible, committed, hard-working, high-skilled, dedicated, dynamic workforce that the Department for Transport could be lucky enough to employ should it bring Great British Railways to Stockton?

The honest answer to that is yes. The competition to find the national headquarters will recognise that. Indeed, it will recognise the towns and cities with rich railways histories that are strongly linked to the network, ensuring that the headquarters will take pride of place at the heart of a new era for British railways.

Sir Gary, thank you very much for the reminder about time. I shall wind up by saying that the reforms proposed under the Williams-Shapps plan for rail will transform our railways for the better, strengthening and securing them for the next generation. The reforms will make the sector more accountable to taxpayers and to Government, and will provide a bold new offer to passengers: punctual and reliable services, simpler tickets and a modern, green and innovative railway that meets the needs of our nation. Although transformation on this scale cannot happen overnight, the Government and the sector are committed to ensuring that benefits for passengers and customers are brought forward as quickly as possible. We have done this with flexible season tickets, and the transition from emergency recovery measures agreements to the new national rail contracts is under way, with the first tranche delivered in July 2020. GBR will be in a place to continue to move fast in delivering reform.

The Government and the GBR transition team welcome everybody’s interest in the competition and their advocacy for their respective cities and towns, and we invite participation in the forthcoming competition, which I have yet even to announce but which has engendered great initiatives of debate in this place. I look forward to seeing the visions put forward by Stockton and especially Darlington, which I am sure will be heard by those who will make a judgment on this competition.

Question put and agreed to.

Antimicrobial Resistance

Before we begin our next debate, I remind Members that they are expected to wear face coverings when they are not speaking in the debate. That 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 the health impacts of increasing levels of antimicrobial resistance.

It is a pleasure to serve under your chairmanship again, Sir Gary. Mark Twain once said:

“I am an old man and have known a great many troubles, but most of them never happened.”

This is not a trouble that will not happen. This trouble is happening now; this trouble will get much worse. The UK Health Security Agency chief medical adviser, Dr Susan Hopkins, said that antimicrobial resistance, or AMR, was “a hidden pandemic” and that it was important that

“we do not come out of COVID-19 and enter into another crisis.”

What I fear most is that, as Warren Buffet once said:

“What we learn from history is that people don’t learn from history.”

There can be no excuse this time if we do not prepare well for a future pandemic of AMR.

This is not the first time I have raised the issue in the House, and it will not be the last, because AMR is simply too important to ignore. Antibiotics are one of the most powerful tools in healthcare, underpinning every aspect of modern medicine. We need them not just when we are poorly at home with an infection but when we are going through significant life-changing procedures such as chemotherapy and hip replacements. Antibiotics work by killing bacteria but, in the same way that the covid-19 virus can mutate and evolve, so can bacteria, developing resistance to antibiotics.

Right now, this year, about 700,000 people will die from antibiotic resistance infections across the world. It is estimated that by 2050, AMR could claim as many as 10 million lives a year. It is not a hypothetical or vague threat that is happening elsewhere; it is happening in the UK, is getting worse and will get much more so. Professor Jennifer Rohn of University College London has said:

“AMR has very much not gone away, and in the long term the consequences of AMR will be far more destructive.”

The latest report from the English surveillance programme for antimicrobial utilisation and resistance found that antibiotic resistance increased by 4.9% between 2016 and 2020. That means that one in five people with a bloodstream infection in 2020 had one that was antibiotic resistant—a serious, potentially life-threatening situation.

I want to tell you about a mother named Helen. Helen experienced resistant infections in 2013 and 2018, which caused her a great deal of anxiety and pain. She was to experience a third resistant infection shortly after giving birth. When her baby was just six weeks old, Helen developed mastitis, an infection of the breast tissue. She soon developed flu-like symptoms, and a GP prescribed her an oral antibiotic. The infection was resistant and two days later it was getting worse, and she could barely hold her baby. She started vomiting and was sent to A&E, where she was kept on heavy-duty intravenous antibiotics for two nights. Luckily, the sepsis was caught early and she recovered, but it could have been a very different story. Sepsis causes 48,000 deaths in the UK every year, many of them due to resistant infections.

AMR is the next pandemic. It is a hidden pandemic, but that does not mean that we can treat it any less seriously than covid-19. We must have the right plan in place. First, we need a strong system for monitoring the impact of rising AMR here in the UK. I welcome the fact that the Government have been looking into recording AMR or antibiotic resistance as a cause of death on death certificates and I had a welcome update from the Minister on where we are with those proposals. However, it is surprising that not many parliamentarians are focused on the problem, given its context and scale. It is good to see my fellow parliamentarians here today who are taking an interest, but until we have a proper register and until more parliamentarians are made aware of the issue through their constituents, I do not think the levels will be sufficiently high to raise awareness as often as we need in Parliament to make sure we take the matter forward and take action against it. Secondly, we need to support only the appropriate use and prescription of existing antibiotics. Thirdly, we need to ensure that we incentivise the development and research of new antimicrobials and antibiotics.

We need to take a one-health approach across all three issues that recognises the link between resistance and use in humans, animals, agriculture and the environment. The Government’s five-year national action plan on AMR set out the steps we need to take, but we are now just about halfway through and have yet to see any clear update on progress. The UK has been a trailblazer on AMR, but that lack of reporting is not where we need to be. We must be at the forefront of taking domestic action, not least because we are trying to maintain our leadership position as an example for other countries.

It was pleasing to see that the UK made AMR a centrepiece of our G7 presidency. We are long-standing global leaders in AMR and this is hugely important work, but we cannot afford to let our attention drop from what we can also do here and at home. The Minister and I shared many conversations on this matter as Back Benchers and I know she is very focused on and aware of the context, particularly in diagnostics, which I will talk about shortly. Will she consider introducing annual reports for all the partners on the actions in both this plan and in the next five-year action plan?

As has already been mentioned, one of the biggest issues facing us is the fact that there is not enough research and development of new antimicrobials. I would be interested to see what metrics of success we can use to judge the outcomes of the National Institute for Health and Care Excellence’s AMR project, formerly called the pilot, which is trialling a new model for valuing and paying for antibiotics. This is a world-leading, first-of-its-kind subscription-style payment model that will help incentivise companies to develop new drugs needed to tackle resistant infections and is supported by NICE.

The reasons we need a new model are complex. Bacteria naturally evolve to become resistant to certain drugs, but that evolution is happening faster than new medicines are reaching healthcare systems. That is partly because developing antibiotics is a long, complex and risky process, with many products failing along the way. At the end of that process, we do not have a viable commercial market for the new products. That is the key problem and that is because antibiotics are not like other medicines. Often, we want to reserve the new antibiotics for the patients who really need them, meaning the new products could just sit unused on the shelf. In that scenario, the cost of development could way exceed the return, undermining future research. The commercial model for developing antibiotics is broken.

I pay tribute to the UK’s leadership in introducing the AMR project in the first place. I know it is the result of many years of work by the Government, NHS, NICE and the industry sector, but we cannot afford that leadership and drive to slacken off now, because the price is simply too high if we do not succeed. As the Minister knows, the pilot looks at only two antibiotics and, as yet, there are no concrete plans to evolve into a new permanent model for all new antibiotics that come after them. Even though we are world leaders, we must urgently start thinking about the next steps and that must be built into the next action plan. The next steps must consider how we evolve the pilot and implement its learnings at scale and pace. Will the Minister comment on what conversations she has had with NHS England and NICE about how best to do this and what the timeframe might be?

We must also remember that the world is watching the world-leading AMR pilot. NICE has always been regarded as the gold standard and its actions have always carried weight, but now it is running one of only two pilots in the world considering this issue. It is therefore important not only that we get the project right, but that we also get right how we talk about what happened, the results and, indeed, what went wrong. Given that the goal is to incentivise private research and development, I urge the Minister to work with industry on that communication to ensure we are all aligned on the successes and learnings.

In 2019, in their five-year national action plan, the Government committed to reducing hospital-acquired infections by 2024 and halving gram-negative bloodstream infections in the NHS long-term plan. However, there is increasing concern that the covid-19 pandemic will have pushed those targets into the background. I would welcome the Minister’s comment on that issue, too.

As a final action point, in his landmark report, Lord O’Neill describes diagnostics as the most important of his 10 commandments to tackle AMR. The launch of the community diagnostic hubs represents an important opportunity to combat an increased incidence of AMR through accurate and targeted prescription. However, we need to tackle the false economy of simply prescribing antibiotics because they are cheaper than a diagnostic test.

I know other Members want to come in, so I will close by recognising those who do tireless work on this issue and with whom I work closely. First, Antibiotic Research UK or ANTRUK, which is in my constituency, is the world’s first charity specialising in antimicrobial research and education. It provides vital research and support services for patients impacted by resistant infection. Secondly, the British Society of Antimicrobial Chemotherapy provides the secretariat to the all-party parliamentary group on antibiotics, of which I am a member. Without its efforts, the efforts of the Minister and her team and the work of many others, we would not have achieved so much in our fight to stop the next pandemic, but that must be our challenge, to make sure that this time we prepare properly for a pandemic that absolutely will happen if we do not put the right steps in place.

Before I call Theresa Villiers, we are expecting three Divisions in the House in a moment. When we get to that point, Members should perhaps think about adjusting their diaries, because it will be 25 to 35 minutes before we come back.

It is a pleasure to serve under your chairmanship, Sir Gary, and to follow my hon. Friend the Member for Thirsk and Malton (Kevin Hollinrake), whose track record on this important issue is second to none. I warmly congratulate him on securing more time in this Chamber on this important issue.

“Before Alexander Fleming discovered penicillin in 1928, an infection from a simple cut could mean the end of life. Nearly 100 years later, the antibiotic safety blanket we live our lives with is being pulled from us.”

That is a quote from the former chief medical officer, Dame Sally Davies, on the threat posed by antimicrobial resistance. She and many others have spoken out in apocalyptic terms about the catastrophe ahead of us if we do not stem the tide of infections resistant to treatment with antibiotics, as my hon. Friend has so articulately put it.

Sitting suspended for Divisions in the House.

On resuming—

We will get under way. I know Karin Smyth is not here, but I am sure she will pick up the pace of the debate when she returns. The debate may now continue until 5.55 pm.

I started my speech by referring to the remarks of the former chief medical officer, and I was about to say that she is entirely right to have spoken out on this issue. It is not just some millennium-bug anxiety about something that might or might not happen in the future, because people are already dying. Every year, an estimated 50,000 people die from drug-resistant infections, and that number will grow massively unless we deal with the problem.

During lockdown, many of us will have viewed the video of Bill Gates’s warning about a global virus pandemic, which was made years before it actually happened. If action is not taken now on a global scale to deal with AMR, people will look back on Dame Sally’s predictions in the same way. They will say that leading scientists highlighted the potential return to the days when routine surgery, childbirth, a cut in the arm or even an insect bite could give rise to a serious risk of death, and they will ask why we did not act. The good news is that a great deal of action is under way. The O’Neill report, commissioned by David Cameron, was groundbreaking. It was highly influential around the world, and 135 countries have finalised action plans on tackling AMR.

This year, it is very welcome that the UK Government have been using their G7 presidency to try to deliver more tangible progress, as they did last time they held the presidency, in 2013. However, the fact is that developing new antibiotics is massively expensive. The attempt to do so has already forced a number of smaller firms into insolvency and caused some bigger companies to exit their research and development programmes in this area. The fact is that many hundreds of millions of pounds can be pumped into R&D, with no return on that investment whatever if a project turns out to be unsuccessful.

The high failure rates of antibiotic development apparently leave just 40 antibiotics in clinical trials globally. The problem is compounded by the fact that if a new antibiotic is successfully discovered, we want to use it as sparingly as possible, keeping it for serious conditions and to head off potentially worsening AMR problems in the future. That creates even more problems with the risk-return ratio. There is therefore an urgent need for policy reforms to create market conditions that enable sustainable investment in antibiotic innovation, including properly valuing and paying for new antibiotics.

It is very encouraging that the industry has set up a £1 billion investment fund to try to bridge the funding gaps, particularly for smaller biotech companies, that will have a strong focus on drugs that could have the maximum impact in securing and safeguarding public health. Also welcome is the AMR project, which we have already heard about from my hon. Friend the Member for Thirsk and Malton. The project, launched by the UK Government, NICE and NHS, is trialling a new subscription-style model for antibiotics. Under the model, payment is based on the product’s overall value to the NHS, rather than on just counting the pills dished out to patients. Two medicines have been selected, and contracts are expected to commence in April 2022.

It is very welcome that the project has continued despite the pandemic, but we now need to press ahead with wider implementation in order to cover more research and bring in the devolved nations, so that we have a whole-country approach. We need the project to get beyond the pilot stage, and we need to learn from it to ensure that a sustainable solution is put in place for new antibiotics that reflects their long term value to society as a whole.

In conclusion, I very much welcome the leading role that the UK Government have taken on this issue on the world stage. However, if we are to succeed in addressing this great challenge of our time, there is still a lot of work to be done. For example, we need to increase public understanding of the dangers of over-prescribing or misusing antibiotics. We must also tackle the overuse of antibiotics in farming. I do not see that as a domestic problem with our sector—we have strict rules to prevent that from happening in UK farming—but we need to use our trade and foreign policy to raise standards on antibiotics use in agriculture all around the world.

Above all, the Government need to be bold and ambitious in putting in place a long-term market solution that changes how we pay for antibiotics, so that we can reward and incentivise the scientific research that can save us from the nightmare we face: a return to Victorian medical outcomes, where 40% of our population have their lives cruelly cut short by infections we cannot treat. I look forward to hearing from the Minister what action the Government are going to take to drive this crucial issue forward.

It is a pleasure not only to serve under your chairmanship, Sir Gary, but to speak in this important debate. I warmly thank my hon. Friend the Member for Thirsk and Malton (Kevin Hollinrake) for having secured it. I share his view on the priority of keeping the Government’s focus on this very important subject: as a co-chair with my hon. Friend of the all-party parliamentary group on antibiotics, I urge the Minister to reflect very carefully on the suggestions my hon. Friend has made and that continue to be made in this debate. I also want to highlight a few other important points that we need to consider.

First, the Government need to carefully assess how covid has impacted on the global and national antibiotic resistance challenge. Unsurprisingly, the once-in-a-century scale of the pandemic has generated concerns that the increased prescribing of antibiotics worldwide on the back of covid will amplify the problems of growing resistance. The scale of the virus disaster and the variety of global health systems has led to a huge, unco-ordinated and large-scale use of different antibiotics, and we need to know how the nature of the AMR threat has evolved as a result.

The covid experience and the size of the Government’s response also offer lessons for the AMR debate by indicating that, when necessary, we can rise to the challenge and assign huge resources to protect the public. The costs involved in developing the new drugs needed to beat the resistance are enormous, as has already been touched on in this debate, but arguably our perspective on that has shifted somewhat when we consider the scale of the fiscal firepower deployed against the covid virus—some £378 billion in this country alone, as of October’s Budget.

Given the potential of AMR to equal or surpass what covid has done, as my hon. Friend the Member for Thirsk and Malton mentioned, with the very plausible prediction of 10 million dead annually across the world by 2050, it seems reasonable to increase our national financial commitment now. With a much more significant—but still relatively small—investment, we can really make a difference. As has already been mentioned during this debate, and as the Association of the British Pharmaceutical Industry has called for, raising the £10 million cap for the Government’s AMR project subscription trial could be one such investment.

The Government should also explore whether they can build more laboratory capacity in middle income countries and the developing world, as part of our public health and wider aid strategies. The lack of significant medical microbiological facilities in such nations is a significant factor in the mistaken prescribing of antibiotics that fuels the growth of AMR around the world. These labs are necessary to generate the guidance on which antibiotics best fit which disease.

The source of the deficiency is an absence of quality, accredited training and the lack of medical microbiological biomedical scientists, producing a situation in which under-informed prescribing practices simply spread resistance. Building that capacity would be a helpful addition to the UK public health and aid policy, because, as the pandemic has shown, disease mutations that develop abroad do not stay there for long.

Growing antibiotic resistance in lower income countries is both a disaster for them and a serious threat to lives in this country. I urge the Department of Health and Social Care to engage closely on this aspect of the problem and listen to calls, such as those from the British Society for Antimicrobial Chemotherapy, for the creation of a global antimicrobial stewardship accreditation scheme to ensure co-operation across health and research systems and to generalise global good practice. Ministers should constantly remember the need to address the challenge of resistance across Government—I mean making sure that other Government Departments know the impact that AMR has.

I want to touch on one example of that. At the APPG on antibiotics, we recently connected scientific researchers at the University of Exeter with Ministers at the Department for Environment, Food and Rural Affairs, so they could share the case for amending the Environment Bill so that it took account of the issue of antimicrobial residues in water and sewage. I understand DEFRA’s decision that although it should not adopt the specific University of Exeter recommendations, it will continue to listen to this research work, including through the new shared outcomes fund pilot project on AMR surveillance, which is in the Environment Act 2021, but we need to see a level of engagement across the board, from all Departments. A Government assessment of whether a further statutory basis is needed to step up action on AMR should be welcomed.

I finish on this brief point, Sir Gary. Many of us in the Chamber now have sat here before, talking about AMR. We are constantly raising the same arguments and the same points, but we really need to spread that message wider. The biggest disappointment is that it is the same few Members raising the same points: the subject does not seem to be getting the political traction it needs. Given where we have been with covid, that might be slightly understandable, but we have to remember, as my hon. Friend the Member for Thirsk and Malton said: if we take our eye off the ball, AMR has the potential to be a much larger pandemic than we have ever seen before.

The winding-up speeches will begin at 5.32 pm. We are now going to have seven and half minutes of pure gold from Jim Shannon.

You are most kind, Sir Gary; thank you very much. I am not sure about the pure gold, but I will certainly do my best to make my contribution to the debate. I congratulate and thank the hon. Member for Thirsk and Malton (Kevin Hollinrake). He is not only an hon. Member but my friend, and has been for all the time we have been together in the House. We have spoken on many issues together, so I am pleased that he has brought this subject forward.

I have an interest in this issue, probably because of my constituency. I will start with a comment from back home. This is not only a UK-wide issue but a global issue. As Northern Ireland’s chief medical officer, Dr Michael McBride, said:

“As certain antibiotics lose their ability to kill particular strains of microbe, and if we cannot develop new drugs that can beat those bugs, then by the year 2050 we can expect about 10 million deaths per year, worldwide, from drug-resistant infections.”

If that does not shock hon. Members or sound horrific, it should. If hon. Members thought the covid-19 pandemic was their worst nightmare, with all its repercussions and problems and horribleness, I suggest that this debate has the potential to be their even worse nightmare. Will I be here in 2050? It is highly unlikely, but many others will be, so we should ensure that what we do today will be sufficient to protect those of tomorrow—my children, my grandchildren and, whenever they come, my great-grandchildren.

The rise in antibiotic-resistant infections is of real concern: England saw 90,000 hospital admissions because of such infections in 2019-20 alone. There is a real problem, and we need to act now, as right hon. and hon. Members have said. There is a rising tide of antibiotic-resistant infections. We have to do something.

I declare an interest as a member of the Ulster Farmers’ Union. I have acknowledged on the record the need for investment in agriculture in the effort to tackle antimicrobial resistance from every angle. The Ulster Famers’ Union said:

“As a farming industry, we are committed to playing our part in reducing antibiotic usage and resistance. Significant progress has already been made in the pig and poultry sectors, which have seen their usage fall by over 50% and 80% respectively. Historically, those working with cattle are smaller users of antibiotics but there are improvements that can be made.”

I welcome that commitment from not only the Ulster Farmers’ Union but the National Farmers Union here on the mainland; it is a joint operation. We should support the clear commitment by the farmers unions to do these things and take this action.

The hon. Gentleman is making a very good speech, and he makes a good point about the pig sector. I am sure he will be aware that the reduction in antibiotic use in the pig sector has not affected yields at all, which demonstrates that things can be done more sustainably, and can be better for the environment, without affecting the economics of farming.

The hon. Gentleman is absolutely right. The farmers unions welcome these things because, first, they are the right things to do, and secondly, because they do not affect the profitability of the sector or the industry. We need to try to reinforce that.

My constituency has only two or three pig units—one is fairly big, by the way—but a big poultry sector, which has made significant moves towards those things. I live right in the middle of a farm. All my neighbours are dairymen or have beef cattle or some sheep, and they told me that they are careful about what antibiotics they give their animals because that is the right thing to do. Who led the way on net zero targets from the farming sector? The National Farmers Union. It did not have to be coaxed to do that; it was happy to do it. Those are some good things.

It is clear that the farming community is stepping up to the mark and that we in this House need to do more. We need to get the message out that antibiotics are a last line of defence. We must allow our bodies to do their work against viral infections, which antibiotics cannot hope to address. I do not take antibiotics often, but I had to in 2019 because I got a bad infection, and those worked well to clear up my chest infection. Researchers at the University of Limerick found that GPs often felt pressurised into prescribing antibiotics, particularly for fee-paying patients in both in and out-of-hours situations, despite being aware that antibiotics were inappropriate for treating non-bacterial infections. Can the Minister provide an idea of what GPs and consultants do in relation to that and why it is important to get that right and not to be pressurised into giving those out?

GPs need our support and a clear message needs to be sent. We need to ensure that the message is simple: that it is a matter of life and death. Antibiotics are the last of our steps to take and only if we hold them as sacred will we ensure they can still work effectively and save lives. At the end of the day, that is all we want.

It is a pleasure to serve under your chairmanship, Sir Gary. I thank the hon. Member for Thirsk and Malton (Kevin Hollinrake) for securing this important debate. He spoke passionately about this important issue and I thank him for all his work to highlight it. I also thank him for telling us Helen’s story. Very often, when we stand in this Chamber, we forget that we are speaking about real people, so I thank him for sharing that with us.

The right hon. Member for Chipping Barnet (Theresa Villiers) made a reasoned contribution and I completely agree with her that action needs to be taken on a global scale. We cannot just look at isolated countries, one by one. The hon. Member for York Outer (Julian Sturdy) made a thought-provoking contribution when he spoke about the awareness required and that we need more political traction, not just by having debates but ensuring that more Members of Parliament are aware of the matter. I also thank the hon. Member for Strangford (Jim Shannon), who, as we say, is everyone’s friend. His contribution was pure gold and he made important points about the support that GPs should be getting, and that taking antibiotics is the last step.

Antimicrobial treatments are among the most powerful tools in healthcare and have helped save millions of lives, as has been said. They are one of the most important medical discoveries in history, adding an average of 20 years to a person’s life expectancy. Yet the growing resistance to antimicrobial treatments poses a threat to our collective health. In Scotland, for example, an estimated 1,312 bloodstream infections were caused by antibiotic-resistant bacteria last year. That number is likely to grow, with drugs becoming less effective over time, and research into new antibiotics is simply not keeping up with the speed at which microbes are developing resistance. In the long term, that poses a threat to our health services. As the World Health Organisation noted, antimicrobial resistance is a serious threat that is no longer a prediction for the future. It is happening now in every region and has the potential to affect anyone, of any age and in any country.

Much of that antimicrobial resistance is caused by the overuse of antibiotics and more emphasis must be placed on ensuring that antibiotics are not overused in treatments. In the UK, for example, only 10% of those suffering from a sore throat actually require antibiotics, yet they are prescribed in 60% of cases when patients seek treatment. Part of the problem is a lack of awareness of antimicrobial resistance. We can help raise awareness through initiatives such as World Antimicrobial Awareness Week in November and the APPG’s work, as mentioned by the hon. Member for York Outer. In Scotland, the antimicrobial resistance and healthcare associated infection strategy group leads the domestic approach to tackling the misuse of antimicrobials, with a plan published every five years. We are gradually seeing a reduction in the use of antibiotics in Scotland, but as has been said, this is a global problem that requires global action.

Greater global action is also required on the use of antibiotics in animal feed. Currently, many farmers feed their livestock antibiotics to prevent potential infections. That practice may pose a problem because it allows bacteria to build up immunity to antibiotics, potentially reducing their overall effectiveness, and that then may pose a risk to humans in cases where those antibiotic-resistant bacteria jump from an animal to a person. To prevent that from happening, the European Union prohibits the import of animal products where antibiotics have been used to promote growth; currently, the UK Government have taken no such action. When negotiating trade deals, the Scottish Trade Minister, Ivan McKee MSP, noted that the UK failed to include measures to prevent antimicrobial resistance in its trade deal with Japan.

In conclusion, antimicrobial agents are a miracle of modern medicine. However, their effectiveness is under threat. Although the UK has made progress in combating microbial resistance, I have spoken to relevant organisations working in the field, and the feedback that they gave me was that more action will be needed in the long term. I ask the Minister, and the UK Government, if they will consider increasing the level of funding to help reduce the threat of antimicrobial resistance. I look forward to hearing how she plans to ensure that the general public are more aware of this situation. Without drastic action being taken, it threatens to be the next pandemic-in-waiting.

It is a pleasure to serve under your chairmanship, Sir Gary. I congratulate the hon. Member for Thirsk and Malton (Kevin Hollinrake) on bringing this very timely debate to Westminster Hall. It is timely because if we do not learn from the situation that we are in, we will end up in a very bad place; it is with that in mind that I give my remarks.

This is a really unusual subject; I have not been involved in a debate on it before, but it is one on which there is so much agreement. We have a problem, we have evidence of a problem, we agree that we have a problem, we have solutions that we generally agree on and we are genuinely world leaders. I think the Government sometimes bandy around the fact that we are world leaders when we are not; but we are genuinely world leaders in this area, and that is something to be proud of. We have some fantastic people in this country. However, why is the situation not improving? What more needs to be done, and, crucially, has enough been done in recent years? How do we know what has been done? As the hon. Member for York Outer (Julian Sturdy) said, why is there not greater interest and political pressure on this subject?

It was 2013 when Professor Dame Sally Davies described this as a

“catastrophic threat”.

She said:

“If we don’t act now, any one of us could go into hospital in 20 years for minor surgery and die because of an ordinary infection that can’t be treated by antibiotics. And routine operations like hip replacements or organ transplants could be deadly because of the risk of infection.”

It was in 2014 that the estimated figure of 10 million people dying as a result of AMR by 2050 was mooted. I was working in the health service when that discussion was being had, back in 2013-14. I vividly remember the concern of specialists, particularly colleagues in pharmaceuticals, about that, and the actions that were being taken to support clinical practice to make sure that did not happen. However, I do not think that most people walking the streets are aware of the catastrophic prediction made then.

We have a problem—we agree on the problem—and we know the causes of the problem: inappropriate use of antimicrobial drugs in healthcare; poor infection prevention and control practices; use of antimicrobial drugs in agriculture, and accelerated spreads of AMR infections through global trade and travel. Additionally, as the right hon. Member for Chipping Barnet (Theresa Villiers) and other hon. Members have said, there are limited numbers of new drugs available to replace those that become ineffective. The former Prime Minister, David Cameron, launched a review in 2014, and the list of 10 recommendations was published in 2016. In 2017, the cost of global action was estimated at $40 billion. That is an eyewatering sum, but when compared with what is being described as the incalculable cost of covid, which reaches trillions of dollars, that $40 billion estimate starts to look quite small. Others have indicated that in reality the cost of this could be unimaginable to most of us.

There was an excellent debate in Westminster Hall on 26 April 2016, in which my hon. Friend the Member for Ellesmere Port and Neston (Justin Madders) addressed the hon. Member for Mid Norfolk (George Freeman), who is also an expert in this area. My hon. Friend said:

“Although I welcome the renewed focus that today’s debate brings, I fear we are no closer to a solution than we were two and a half years ago.”—[Official Report, 26 April 2016; Vol. 608, c. 540WH.]

I think there is concern in the Chamber that that remains the case today.

The Government have targets, although they are not terribly specific. Many are for the period 2021 to 2025—for example, being able to

“report on the percentage of prescriptions supported by a diagnostic test…by 2024.”

On the eve of 2022, I expect the Minister to be able to outline how meeting those commitments is going. The hon. Member for Thirsk and Malton made some helpful suggestions for what we should be measuring, how we should be measuring it and how that should be reported, which I am sure the Minister will address.

On animal use, which the hon. Member for Strangford (Jim Shannon) highlighted, the investment required by farmers was yet to be formally evaluated in 2019, so it would be useful to know whether the Minister has evaluated that cost. It would also be helpful to have an understanding of how we are collaborating with our European neighbours, now that we have left the European Union, because we know that collaboration is really important, particularly in the agricultural industry.

We should be prepared, and we should certainly be on track, but I fear we are not, so the crucial issue is: what do we need to do? I pay tribute to Dame Sally Davies, our special envoy on AMR, and her work to highlight this issue, which, as she has said in the last year, is a silent pandemic. As she has told us, covid needs to be a wake-up call to the warnings that she has issued over the years. I have listened to her speak on this issue, as has another all-party group, and she has recently used quite a vivid image to describe the situation: covid is like putting a lobster into boiling water, but AMR is like a lobster in cold water. It is a silent pandemic.

One of the issues is that fewer adults know about this. I absolutely agree, and I think that is also true of Members of Parliament. We need to learn from covid, including about things such as altering behaviour, washing our hands and access to water. We also need to support those on the frontline much better, including through clinical direction, to help them in the way that they need in order to treat patients.

It is a pleasure to serve under your chairmanship, Sir Gary. I thank my hon. Friend the Member for Thirsk and Malton (Kevin Hollinrake) for bringing forward today’s debate, and all hon. Members for their thoughtful contributions. As has been made clear in this debate, antimicrobial resistance is undoubtedly one of the most significant global health challenges that we face today. The covid-19 pandemic has illustrated the substantial impact that major outbreaks of disease can have on society, endangering lives and disrupting public services and the economy. The threat of AMR is no different.

Last year, in England alone, there were over 55,000 cases of resistant infections and more than 2,000 estimated deaths. Across Europe, hospital infections caused by resistant bacteria add £1 billion to hospital treatment and societal costs. In addition, the emergence of multi and extremely drug-resistant strains of infectious diseases threatens to undo years of global effort to tackle them. For example, there are now strains of tuberculosis that are resistant to almost all lines of treatment. TB deaths have increased for the first time in a decade and global targets are no longer on track. As other hon. Members have said, without working antibiotics, routine surgery such as caesarean sections or hip replacements could become too dangerous to perform, and cancer chemotherapy could become prohibitively high risk. As my hon. Friend highlighted, the threat of AMR also extends beyond human health. The implications of AMR for animals and crops threaten food security and trade. It is predicted that the global cost of AMR could amount to $100 trillion without action.

So what are the UK Government doing to tackle this risk? As Members have referenced, in January 2019 the Government set out the UK’s vision to contain and control AMR by 2040. That vision is supported by a five-year national action plan across the spectrum of human and animal health, agriculture, the environment and food. We are halfway through implementing our five-year action plan and have made considerable progress. We are committed to reducing the need for antimicrobials by lowering the burden of infection in our communities, in the NHS, on farms and in the environment—if you don’t get the bug, you don’t get the drug.

We have also taken a series of steps to ensure the appropriate use of antimicrobials, where they are needed, in both humans and animals. Antibiotic use in farmed animals has decreased by 52% since 2014, with a decrease of 79% in sales of veterinary antibiotics that are most critical for human health. Among European nations with a significant livestock farming industry, the UK has the lowest use of antibiotics, and antibiotic consumption by humans reduced by 6.6% between 2016 and 2019.

No new class of antibiotic has been developed since 1987, and the market for antimicrobials is broken, as my hon. Friend the Member for Thirsk and Malton said. To address that, we are testing a new Netflix-style subscription model for antibiotics—a world first. The economic model and evaluation reports for the two antimicrobials in the project have been completed, and the reports are currently undergoing consultation with registered stakeholders, including drug manufacturers. We hope that the first payments under the new model will be made in 2022, and I can reassure my hon. Friend the Member for Thirsk and Malton that we will incorporate the learnings from the pilot project in any new framework for the purchase of antimicrobials in the future.

We maintain a formal dialogue with industry through the joint Government and industry working group on AMR. The group, which has members from the Association of the British Pharmaceutical Industry, the National Institute for Health and Care Excellence and NHS England and Improvement, last met in October 2021, and the next meeting will take place in spring 2022.

I wholeheartedly agree with the point raised by my hon. Friend the Member for Thirsk and Malton on the importance of reporting. That is why a range of annual reports are already published by our partners across Government and their agencies, highlighting progress against the ambitions of the national action plan. The most recent of these, the “English surveillance programme for antimicrobial utilisation and resistance report 2020 to 2021”, was published on 17 November 2021. The report includes national data on human antibiotic prescribing, resistance, antimicrobial stewardship implementation, and awareness activities. The UK Health Security Agency also publishes data on antibiotic prescribing at practice level, and quarterly on the web platform Fingertips.

My hon. Friend the Member for Thirsk and Malton asked for an update on the national action plan ambitions. I will start by exercising caution on the figures in the light of covid-19. In England, however, we have seen an 11.2% decrease since 2019 in healthcare-associated gram-negative engagement. In response to my hon. Friend’s question about death certificate recording, it is important to acknowledge the difficulty faced by medical practitioners in distinguishing whether the cause of death of a patient with a resistant infection was due to the resistance itself, the infection or another cause. However, we will work with professional bodies to enhance the likelihood of AMR being accurately recorded where it can be determined that a resistant organism is responsible for an infection that caused or contributed to death.

Additionally, the Office for National Statistics upgraded its death recording software in January 2020 in order to support codes for AMR and allow analysis of mentions of AMR in death certificate data. We are not only taking action at home but continue to take a global lead in the world’s collective fight against AMR. The UK is committed to pushing the AMR agenda forward through multilateral forums, including as a signatory to the United Nations’ Call to Action. I am delighted that the UK’s special envoy, Professor Dame Sally Davies, represents the UK on the UN Global Leaders Group on Antimicrobial Resistance in order to advocate and advise on AMR globally.

Under the UK’s G7 presidency this year, we have secured ambitious commitments on AMR to balance innovation, access and stewardship for antimicrobials. G7 Health Ministers have agreed to strengthen the resilience of antibiotic supply chains and, with the G7 Climate and Environment Ministers, they will develop sustainable, clean and green solutions for antibiotic manufacturing. The G7 Health and Finance Ministers are working together to strengthen antibiotic development to ensure that there is a sustainable pipeline of new and equitably accessible antimicrobials in the making and building of the UK’s subscription model.

Finally, in recognition of the global effort required to tackle AMR, the UK invests significantly to improve global knowledge, surveillance and understanding of AMR—an issue raised by my hon. Friend the Member for York Outer (Julian Sturdy). The Department of Health and Social Care invests significantly in tackling AMR where the burden is highest, including through the Fleming fund, which improves laboratory capacity for surveillance of AMR, and the global AMR innovation fund, which funds innovative science in neglected areas of AMR R&D. Both of these projects are UK aid funded and are primarily for the benefit of people living in low and middle-income countries.

We also invest UK aid on research into new drugs, vaccines and diagnostics, as well as capacity building, technical expertise and support to relevant programmes, such as strengthening healthcare systems and improving infection prevention and control. Again, I want to thank my hon. Friend for bringing this incredibly important matter to the Chamber and for providing the opportunity to emphasise the necessity of collective domestic and international action if we are to effectively solve the very serious threat that AMR poses to us all.

I thank my hon. Friend the Minister. As I said earlier, she has always been a passionate champion of this subject, long before she was an excellent Health Minister. AMR is quite an esoteric issue. Most hon. Members, as we can tell from the attendance, are not particularly concerned about or aware of the problem. I was only made aware of the issue because a charity in my constituency, Antibiotic Research UK, or ANTRUK, drew my attention to it. It acted as an adviser to a Radio 4 programme called “Resistance”, which is well worth listening to. There are about four or five series, and it is a dramatisation where an antibiotic-resistant bug wipes out over 99% of the planet’s population.

That is the potential for how devastating AMR could be, so it is absolutely critical that we get this right. For me, it is down to the three D’s—drugs, diagnostics and data. I wonder how concerned we all would have been about covid, particularly early on in the crisis, had we not seen the data behind it. For most of us, it did not really directly affect us, so the data is crucial. I know that it can be challenging to determine exactly what somebody has died from in the case of a resistant infection, but it is critical that we establish a framework so that there is more concern among parliamentarians, the media and constituents, which leads to parliamentary concern, and constituents can come to our surgeries and say, “We are very concerned about this, because we have had a catastrophic personal incident ourselves.”

I thank hon. Members for their contributions. There were few of them, but this is a hugely important issue, and I really am grateful to hon. Members for coming here and speaking about it today.

Question put and agreed to.


That this House has considered health impacts of increasing antimicrobial resistance.

Sitting adjourned.