Tuesday 31 January 2023
[Geraint Davies in the Chair]
Levelling-up Missions: East of England
I beg to move,
That this House has considered progress on the Government’s levelling up missions in the East of England.
It is a pleasure to serve with you in the Chair, Mr Davies. I thank the Backbench Business Committee for granting this debate, which comes a year after a similar debate, when the opportunities and challenges facing the east of England were also considered through the prism of levelling up.
Last February the Government published their White Paper, “Levelling Up the United Kingdom”, in which they set out 12 levelling-up missions, with targets to be achieved by 2030. Last month, in December, the all-party parliamentary group for the east of England, which I co-chair with the hon. Member for Cambridge (Daniel Zeichner), published a report in conjunction with the East of England Local Government Association and various private sector partners that analysed confidence in the region in achieving those targets.
In summary, the report found that there was high confidence in achieving three of the levelling-up missions: employment and pay, research and development, and wellbeing. There was medium confidence in achieving four of the missions: improving digital connectivity, delivering pride in place, reducing crime and widening devolution. However, there is low confidence in five policy areas, many of which are the most important to the people of, and the prospects for, the east of England: improved educational attainment, more skills, better transport, longer, healthier living, and more affordable housing to buy and rent.
The hon. Member is doing an excellent job of making the case for the east of England. One of the five areas of concern he referenced was transport. Does he agree that it is essential to keep up the pressure for important rail improvements at Ely and Haughley junctions, to restore four trains per hour to London Stansted, to secure East West Rail and to ensure that affordable, reliable bus services become the norm rather than the exception across the region?
I thank the hon. Member for that intervention, and I greatly enjoy working with him on the APPG. He is correct to raise those issues. I will comment on the rail issues in passing a little later, but they are vital to the east of England and to the whole UK.
I will comment in a little more detail on the five issues where there is low confidence and on what needs to be done so that we can get on course to deliver the 2030 targets. I anticipate that colleagues will home in on areas and issues that are important to them and their constituents. I should add that each of the issues warrants a debate of its own, and I am conscious that I will only scratch the surface of each mission.
Earlier this month the Government published the results of round 2 of the levelling-up fund. In the two rounds that have taken place so far, there have been 12 awards in the east of England, with a total value of £252.5 million. In both rounds we secured the fourth lowest amount of funding in the UK. Although, on an allocation per head basis, the situation has improved significantly, from £14 per head in the first round to £26 per head in the second, the east of England remains the region with the third lowest funding over both rounds.
It would be wrong to judge levelling up solely on the basis of those grants, but there is a worry that there is a lack of understanding in Whitehall of the challenges faced by many people in the east of England and of the exciting opportunities available in the region. With the right policies and support, the Government can help unlock these opportunities, which will benefit not just our region but the whole United Kingdom.
Down here in London, there may be a view that East Anglia is a comfortably-off region where levelling up does not apply. That is wrong, as we have relatively low levels of pay and there are deep pockets of deprivation in coastal communities such as Lowestoft, which I represent, in rural areas and in our larger cities and towns, such as Norwich and Ipswich.
My hon. Friend raises a good point. I am mindful of the fact that Jaywick, which is in his constituency, is statistically the most deprived area in the east of England. As he rightly says, pockets of deprivation can be hidden, because there are often areas of wealth within a few miles of them that camouflage that deprivation.
The east of England is an economic success story, and it is one of only three regions that are net contributors to the Exchequer. With the right policies and the necessary initiatives, we can significantly reduce poverty and create what, in effect, would be a global powerhouse, with specialist skills and expertise in such sectors as low-carbon energy, agritech, life sciences and sustainable fishing. Despite the drawbacks, a good start has been made locally in Waveney, and much of Lowestoft resembles a building site at present, with work well under way on the Gull Wing bridge—the long-awaited and much-needed third crossing of the port, which divides the town—as well as on the construction of permanent flood defences.
At this stage it is appropriate to pause and to recall that this evening is the 70th anniversary of the 1953 storm surge that hit our coast so cruelly, causing death, destruction and, ultimately, the demise of the beach village in Lowestoft. Today the region remains extremely vulnerable to rising sea levels and the threat of climate change, but the drive towards net zero presents our economy with significant opportunities, which we must grasp. In Lowestoft, work is also getting under way on the various towns fund projects designed to regenerate the town centre and the surrounds. These projects, together with the flood defence scheme and the new bridge, currently represent a public investment in the town of in excess of £220 million.
Due to inflation, the shortage of raw materials and supply chain challenges, delivering such construction projects is not easy at present, and I commend the project managers at Suffolk County Council, Coastal Partnership East and East Suffolk Council for their hard work. Our task locally is to ensure that the developments act as a catalyst for private sector investment and that they fit in with and complement the overall economic strategy for the region.
I will now briefly touch on the five missions where there is low confidence of meeting the 2030 targets.
The hon. Gentleman’s constituency and mine are very alike from a fishing point of view. He mentioned 1953, which is also an anniversary for us back home: the MV Princess Victoria went down that year, and I was at the service on Sunday, so 1953 also resonates with us.
Does the hon. Gentleman agree that it sometimes appears that the regions that shout the loudest get the lion’s share of the funding? Does he agree that the Government should consider introducing a scoring matrix, which would ensure that each constituency sees projects delivered? That would mean that my constituency could level up with the rest of the United Kingdom.
The hon. Gentleman is quite right that there are significant similarities between the east of England—East Anglia—and Northern Ireland. As far as a matrix is concerned, I am not 100% sure about that, but there needs to be much better feedback from Government on why particular bids are not successful. We probably need to look at the criteria that bids must satisfy before we come on to the next round.
I will comment on the five missions where there is low confidence in achieving the 2030 targets, and I will start with transport. It should be highlighted at the outset that the east of England, with 17 ports and airports—including two freeports and Stansted—is very much a strategic gateway to the whole UK. If the east of England has a fit-for-purpose, 21st-century transport system, the whole UK benefits; unfortunately, we are some way from achieving that. There is concern that the transport needs of the region are being overlooked in Whitehall, notwithstanding the good, co-ordinated work of our two strategic transport bodies, Transport East and England’s Economic Heartland.
On the railways, it is vital that funding is provided for the upgrading of the Ely and Haughley junctions. That will improve connectivity from the Felixstowe-Harwich freeport to the midlands and the north, thereby facilitating levelling up in those regions. It will get freight off the busy A14 and help to provide additional capacity for passenger services into London Liverpool Street. Reinstating the four trains per hour from Liverpool Street to Stansted would help to attract investment from airlines and to secure new routes to destinations such as San Francisco and Boston—that is the one in Massachusetts, not our near neighbour in Lincolnshire, although that road also needs improvement.
It is estimated that, if such routes are opened up, they will deliver £95 million in new investment to the east of England. However, if we are to deliver such investment, there is a need for good transport links to and from the airport. Locally, the Waveney constituency is served by two railway lines—the East Suffolk and the Wherry—which must be upgraded to improve accessibility and connectivity. That is vital to deliver meaningful levelling up to coastal communities such as Lowestoft and Yarmouth.
I will turn now to education. Achieving good grades not only benefits the individuals themselves, improving their life chances and sense of wellbeing, but enhances the prospects of economic growth. Unfortunately, the overall level of attainment across the region is behind that in England as a whole. That is predominantly because the funding for east of England schools is way below the national average. The f40 is a group of the lowest-funded education authorities in England; it is a club to which one does not aspire to belong but, unfortunately, Suffolk, Cambridgeshire and Central Bedfordshire are all members. To ensure that young people in the east of England have a fair opportunity to realise their full potential, attention should be given to revising the funding formula that applies to rural schools, and a significant part of the increased funding of £4.6 billion over the next few years should be allocated to councils to support children and young people with educational needs and disabilities.
On skills, exciting opportunities are emerging in the east of England, such as in the energy sector and in further education colleges such as East Coast College, with its campuses in Lowestoft and Great Yarmouth. Such colleges are doing great work, but they are hamstrung by a lack of revenue funding and a shortage of teachers and trainers. The key recommendations in the APPG’s report when it comes to meeting the region’s future needs are that there should be much greater in-work education provision and participation in further education and skills training for adults; improvements in the overall quality of training; better access to training, taking into account rurality and transport challenges; and better alignment with employers’ needs.
Local skills improvement plans, which are being worked up by chambers of commerce, councils and local enterprise partnerships, are the vehicle for bringing about that sea change. However, when we look at energy—with the construction of Sizewell C, with 50% of the UK’s offshore wind fleet anchored off our coast and with the potential for hydrogen production distribution starting from the gas terminal at Bacton—there is concern that the scale of the opportunity has not been fully recognised and acknowledged. The fact that we do not have a bespoke institute of technology is a disappointment.
With regard to the health mission, insufficient regard is had to the fact that population of the east of England is increasing and that a higher percentage of elderly people are resident in the area than in other areas. Those factors apply added pressure to our health and care sector, which is grappling with unprecedented demand and a workforce crisis. There are also significant health inequalities, including an increasing number of children living in poverty and an alarming gap in healthy life expectancy between areas that are often only a few miles apart. To meet those challenges, Government policy should recognise the significant population growth and pressures in the east of England to ensure that the region gets a fair share of funding overall for its demography and that the most deprived areas are recognised within that.
While home ownership in the east of England is the highest of any English region, at 67.4% in 2021, those homes are less affordable than in the rest of the UK. In 42 out of 48 areas in the region, average house prices are more than eight times the median wage. The bottom rungs of the housing ladder have, in effect, been sawn off. In my own constituency casework, the No. 1 issue is the challenges faced by many people seeking a comfortable, warm and dry place to live that they can truly call home. To meet that challenge, we need to build more houses, with the necessary supporting infrastructure, across all tenures, including social housing. We need to meet the needs of all people, whether those setting up home for the first time, those starting families or those looking to downsize or rightsize as their children leave home.
Moreover, the Government need to follow up on their recently announced and welcome ambition to reduce energy demand by driving forward a national retrofit programme. We have successful individual schemes, such as the energy company obligation, but we are yet to embark on the journey to upgrade the bulk of the UK’s existing building stock. Policies should be set in Whitehall—hopefully, the Chancellor will have more to say on that next month—and then delivered locally, carried out by local craftsmen who are trained in local colleges and overseen by local councils.
In conclusion, I will make three observations about levelling up in the east of England. First, those living in the east of England will clearly benefit if we achieve the 2030 targets for the 12 missions, but so will the rest of the UK. For example, as I mentioned, improved connectivity and transport links across the region will lead to benefits flowing to all corners of Great Britain.
Secondly, there is the opportunity not just to level up but to create global exemplars in sectors such as low-carbon energy, life sciences and agritech. Low-carbon energy is particularly important in my constituency on the East Anglian coast—the all-energy coast. Nowhere else in the UK, quite likely nowhere else in Europe and possibly nowhere else in the world, do we find offshore wind, nuclear, carbon capture and hydrogen clustered so closely together. We must realise the full potential of this once-in-a-lifetime opportunity. It is an open goal staring us in the face, and it is vital that we do not kick the ball over the bar.
Thirdly, in these uncertain times, we need to have in mind our national security, which the east of England played a crucial role in providing during world war two, when the RAF and the US air force flew from our network of airfields across the region. I hope that security in that form will not be necessary again, but in a geopolitical context, we are in worrying and uncertain times. As the breadbasket of Britain, and as the aforementioned all-energy coast, we have a vital role to play in providing food and energy security.
Delivering on the levelling-up missions, not just in the east of England but across the country, requires collaboration. There is a need for Departments to be properly co-ordinated—I am conscious that I have commented on many issues that do not fall within the Minister’s remit, and I apologise for that. There is also a need for collaboration between national Government and local government, and with the region’s businesses. We need a delivery vehicle to achieve that. I look forward to the Minister’s summing up, and I hope she can pledge that the Government will commit to this important partnership approach.
It is a pleasure to serve under your chairmanship, Mr Davies. I congratulate the hon. Member for Waveney (Peter Aldous) on securing this important debate, and for the work that he and others here do with the APPG to promote and improve the eastern region. I read the APPG’s report into levelling up with great interest. It is obvious that the potential in the region is not being unleashed. In essence, we are underfunded; our funding per head of population is near the bottom of the table, despite the fact that the region is one of only three that are net contributors to the Exchequer.
I will not be the only MP in the room to feel profound disappointment at the Government’s latest levelling-up fund allocation. My constituents in Bedford and Kempston got a raw deal yet again, when a second attempt to access levelling-up funding was rejected. The funding would have regenerated the area around the Saxon Centre in Kempston by encouraging new businesses and public services, including a desperately needed new health centre, and improving the town’s walking and cycling infrastructure. It is a real blow to everyone at Bedford Borough Council who worked so hard on a great bid that ticked a lot of boxes in the Government’s stated levelling-up aims—in particular, delivering pride in place and crime reduction. My constituents pay their taxes too, so it is not right that they miss out. They can see where the money has gone, and they know the area has not been levelled up, which has become a meaningless slogan.
Instead of pitting towns, communities and regions against each other, we need the Government to improve areas through long-term, sustained support that is based on need—not these random, piecemeal hand-out schemes. The public continually have to pay more for less, and that is most obvious in health services. There is an overall failure to invest in critical infrastructure, such as modernising in-patient mental health services and GP hubs. Government bureaucracy is holding up Whitehall capital funding allocations. As a result, the Borough of Bedford is unable to attract desperately needed GPs and community-based health professionals to the area because the primary care estate is not fit for purpose. I hope that the Minister will say when the Government will finally release the funding to build the facilities to relieve the pressure on our hospitals and get patients in Bedford, Kempston and across the eastern region the appropriate community care.
On transport infrastructure, the Government’s handling of the East West Rail project has been shambolic. Bedford residents are sick and tired of waiting for a detailed decision on the project. Reasonable requests for information from residents, such as to see a business case, have not yet materialised. A lack of transparency has created significant and understandable distrust in the project. It also came as a big blow for rail users when train services on the Bedford to Bletchley line were suspended when Vivarail entered administration in December.
So far, the Government’s levelling-up agenda has delivered the worst living standards in the past 70 years. I think my constituents would prefer the Government concentrate on getting the basics right and delivering public services that work again. Only thoughtful, long-term investment in our region will unlock the vast potential and deliver the prosperity my constituents richly deserve.
It is an honour to serve under your chairmanship, Mr Davies. I am incredibly grateful to my hon. Friend the Member for Waveney (Peter Aldous) for securing this great debate. He is a great champion of levelling up the east and I thank him very much.
As was mentioned, it is just a year since our last debate on levelling up the east of England. I am happy to say that my local authority has been successful in its bid to receive £20 million for the much-needed rejuvenation of Clacton town centre. It was a fantastic result and I want to thank the Minister. One does not always anticipate a great phone call, but it was a great one to receive. I also want to thank the leader of Tendring District Council, Neil Stock, the chief executive officer, Ian Davidson, and all the other officers who backed them to achieve that result.
We mentioned Jaywick earlier. Seventy years ago today, 37 people lost their lives in that very small village, of the 307 across the east of England. Although the local council is making great efforts to improve that particular area with flood-proof homes and building a brand new market area, it is still served by one very poor road. It is one of the areas in my constituency that needs investment.
We are not an urban city down in Clacton, like Chelmsford or Colchester. We are multiple communities spread across a rural landscape. We have two railway lines that come into Walton and Clacton, with an hourly service that takes 90 minutes to cover the 69 miles to reach London. I have always said that is not acceptable in this day and age. It is certainly not appealing to commuters and is a great barrier to levelling up my patch. There is the unfair and flippant view, about which we heard earlier from my hon. Friend the Member for Waveney, that the east of England is just universally wealthy. We know that it is not. Try telling that to pockets of my constituency, which have deprivation issues that outstrip anywhere in Scotland or Wales. That is just a fact.
The roads are a core part of that and some are in a very poor state. They are the only way to get from one end of my constituency to the other. If we throw in some roadworks, which we recently had in Kirby Cross, it is somehow quicker to get to London than it is to cross the 14 miles of my constituency. That is ridiculous. We must invest in my constituency’s roads, which means affordable homes and sustainable jobs, if they can be built in the right places. We currently lag behind urban neighbours. We talk about how future rail such as High Speed 2 will change the world. What about the old-fashioned, crumbling roads that are holding back areas such as Clacton?
The east of England has been granted a fantastic and brilliant opportunity with Freeport East. That will help enormously with the global powerhouse that my hon. Friend the Member for Waveney mentioned earlier. It will create jobs and provide long-term income for the area. We need to utilise it, and I can think of no better way than by investing in transport infrastructure, so jobs in the freeport can be accessed from areas such as Jaywick, which is the most deprived ward in the country. This is our opportunity not to gloss over the situation. It is a better chance than any for the Government to show their long-term ambitions for levelling up and really improve the lives of my constituents. My plea to the Minister is that she should not think the job is done following the latest round of investment. Instead, I urge her to work with colleagues in the Department for Transport and the Department for Work and Pensions, to maximise the benefits of levelling up in tucked-away coastal communities such as mine in Clacton.
It is a pleasure to serve under your chairmanship, Mr Davies. I begin by congratulating my hon. Friend the Member for Waveney (Peter Aldous) on securing the debate. I pay tribute to him and to the hon. Member for Cambridge (Daniel Zeichner) for their leadership of the important all-party parliamentary group. It is a pleasure to follow my hon. Friend the Member for Clacton (Giles Watling). I am very fond of Clacton. I have been a resident of the east of England for nearly 17 years, and I know my hon. Friend’s constituency well. We campaigned on a by-election together, with good long-term results.
It is important to say that the contributions so far have included some serious issues that need to be addressed, which I say as the Member of Parliament for Witham for just over 12 years. My hon. Friend the Member for Clacton is the chairman of GEML, which for the benefit of Hansard is the Great Eastern Main Line taskforce. I co-set that up nearly 10 years ago: GEML was all about getting infrastructure investment into that main line. We have been successful, though I will touch on some elements that have not materialised. There are important areas, highlighted by my hon. Friend the Member for Waveney, that speak to lamentable actions across Government and the low confidence that my hon. Friend touched on. I want to speak specifically about those.
First and foremost, infrastructure clearly covers road and rail. That has frankly become a joke in the overall way that Whitehall has failed to integrate. That is not to do with the Minister’s Department; it is a failure of the Whitehall system to work across Departments and integrate funding. Basically, securing investment in our infrastructure is one example of how we can support levelling up. It is a statement of the obvious.
We have new rolling stock on our line—part of the GEML taskforce—for a very good reason. A decade ago, I and colleagues across that network went to the Treasury and the then Chancellor of the Exchequer, the former Member for Tatton, and put forward a business case. Some of us are capable of putting together presentations and business cases. We put that forward in conjunction with Network Rail and it secured £600 million, linked to a nine-year franchise that was very much about delivering rolling stock, improvements on productivity, performance and so on. We achieved that, but it is only one example.
The failure to secure funding for Ely junction and Haughley junction was not the fault of the taskforce but of Whitehall, and its lack of integration. Those sites are not in my constituency, but they are east of England infrastructure projects that would unlock the economic potential not just of the east, but of the nation. It is interesting that, at a time when HS2 is again being vilified for a range or reasons, such as being over budget and not on time, we have to stick the course with infrastructure projects.
The problem is that the Armitt process has not been published. That is the funding mechanism, which sits in the Department for Transport, for securing these major infrastructure projects. The other problem, as we have already heard, is that the east of England is a net contributor. Our main line has been subsidising the rail network for the rest of the country for decades. That money goes to the Treasury. The revenue base sits with Treasury, and the Department for Transport is deprived of the funding stream to help with the financial pipeline of rail investment.
My hon. Friend, the chair of the GEML rail taskforce, has hit the nail on the head: this speaks to a fundamental failure in Whitehall, and my hon. Friend the Member for Waveney repeatedly highlighted that. This is the core message that has to be taken away, and that is just on rail. Of course, rail supports economic growth. The west Anglia line is another classic case. With four trains an hour to Stansted airport, it feels like “Mission Impossible” right now. Some proper work needs to be undertaken, and the Government need to support that. We have been successful in getting Emirates into Stansted. We want to get other international airlines, as my hon. Friend said, including from India.
On roads, I have again secured funding, as a Member of Parliament, for feasibility studies on the A12 and A120, but yet again we are going round the merry-go-round of not getting the commitment from central Government to proceed with those schemes. Quite frankly, that is down to inadequacies with National Highways, which fails to operate in a transparent way, to engage with local community or the county council, which has responsibility for the strategic road network, or to engage with the Department for Transport, so we are not getting the road upgrades we need in the county. Those road networks are the economic arteries of the east of England.
Integration in the planning of infrastructure goes beyond just roads and rail; there is the integration of offshore wind into the national transmission network. Only in East Anglia are there radial connections from offshore wind to the national transmission network. The rest of the country benefits from the holistic network design. Does my right hon. Friend agree that East Anglia should be included in that design and that we should move away from these radial connections?
My hon. Friend is absolutely right. I will come on to energy shortly for another reason, and I will pick up on that point after I conclude on the issue of roads.
Essex is a net contributor, and the A12 and A120 are literally roads from the dark ages. They are deeply unsafe roads. If we care about road safety and the people who get up every day at the crack of dawn, such as lorry drivers and commuters, to service our public services or to come to London to provide services for major hotels and the UK’s service sector, we must upgrade these roads. It is becoming a joke right now—it really is. It is an insult to commuters and the people who use the roads who have to navigate the potholes and poor quality of the roads every single day. They feel, by the way, that they are getting an unfair deal when they fill up their cars because of the cost of fuel at the pump. This is not a criticism of the Minister’s Department, but it shows the breadth of issues that need to be grasped across Government on integration to provide those levelling-up outcomes. Otherwise, levelling up will just become a slogan.
I would like to touch on a couple of other areas, which are both linked. One is skills and education. I am proud not just to be the Member of Parliament for Witham, but to represent Essex and the east region. When I became the MP for Witham, the majority of my schools locally were in special measures or required improvement. I am pleased to say right now that we have great schools—good schools and outstanding schools—and, as a result, Witham is now a commuter town. People want to live and work there, and some schools are outstanding—that is a great thing. We need not just to give our youngsters great educational opportunities through our schools, but to ensure that they can get jobs and that they inherit skills for life. That could be skills within the region for the great energy coastline that we have developed over the past decade, which has been remarkable, and previous Ministers in Government should be thanked for their hard work on that matter.
Essex is a county of entrepreneurs, and I never tire of saying that. We are the home of small businesses and innovators, and R&D is big in Essex. However, our prosperity masks challenges when it comes to deprivation, as we have heard, but also skills, opportunity and aspiration. We need businesses to work with our schools and get their foot in the door to talk to pupils at an earlier age. I have a careers fair taking place on 24 March on Witham. I never tire of being a champion of those skills fairs, and we are bringing in businesses from former industries I have worked in to those schools. I want to see Government embrace that, because the apprenticeship levy is, quite frankly, not delivering the outcomes it was originally set up to deliver. I maintain that it needs reform. Of course, by getting those skills locally, we can create jobs with skills that focus on areas that Members have touched on already. I feel very strongly about that.
I want to touch on health, which has been raised. My hon. Friend the Member for Waveney said that we do not have a technology campus in the east of England—I agree, and we should work to achieve that—but we do have a university medical school. I was involved in the original bid to do the business case for that, and I am proud that we achieved it. However, I am afraid that our health infrastructure across the east of England is inadequate. Our patient-GP ratio is one of the highest in the country, and we are not training enough students in our medical schools. We need to do much more. When he was Health Secretary, my right hon. Friend the Member for South West Surrey (Jeremy Hunt) worked well with us to deliver some good health outcomes, but there is much more that needs to be done. We are an ageing part of the country, but we must work with our young people to grow skills in health and social care. I pay tribute to Essex County Council for the work it is doing in that area.
This is a message to central Government: we cannot have people working in silos in Government anymore. When I was Home Secretary, the Health Department said to me, “Please do much more on health and social care visas,” which I am pleased that we have done—I did that as Home Secretary. However, there is more that we need to do in that area, and we also need more home-grown talent.
Finally, planning is the biggest issue in my constituency casework. Witham has become a building site over the past decade. We are building homes, and it is right that we do that. The question is, are they affordable homes? We have already heard of the high income ratio that is required to live in our fantastic part of the country. This point is specific to the Minister’s Department. Planning is contentious, and we are not getting it right in this country; there is no doubt about that.
In Essex, and in my constituency in particular, we stopped the West Tey development, a proposal for a garden community of 45,000 new homes—which, by the way, was without any infrastructure at all. The entire concept was an absolute scandal and a disgrace. I pay tribute to campaigners such as Rosie Pearson and others in my constituency who worked together to bring that to the Planning Inspectorate and get that proposal overturned. Five-year land supply has also been a problem, along with local councils that have no neighbourhood plans. I want to put on the record the fact that I think it is deeply disappointing that the Department, in its former guise as the Ministry of Housing, Communities and Local Government, used taxpayers’ funds to boost and beef up that concept without working in a considered way with the local community on the kind of housing that was required.
I am afraid that this is not specific to the Minister’s Department. We are going through this all over again with another project: pylons. It is less about housing, but it will become a planning issue. The development of pylons across the east of England will, frankly, have a detrimental impact. We are pioneers in offshore grid wind farm development and renewables, and we must absolutely look to invest in that capability, rather than putting up more infrastructure that will bring great blight to our local communities and, I am afraid, agitate them even more.
I know I have taken up a great deal of time, Mr Davies. In conclusion, there are great things about the east of England. We are net contributors to His Majesty’s Treasury, and we cross-subsidise much of the United Kingdom through the hard graft of the great men and women of the east of England, but we are lagging behind on these key assets that are of national significance. My hon. Friend the Minister can only do so much with her remit in her Department. My wider message is about devolution and local government reorganisation, as well as about the size of the state in Whitehall; how bloated and unaccountable that has become, and how detached it is from the good men and women of the east of England who, as taxpayers, contribute to the bureaucracy of Whitehall and get very little back. That is where reform has to start. The devolution train is well under way now—certainly in our part of the country. In Essex, I back it. Quite frankly, we need reform of the core of Whitehall to start delivering for the good people of the east of England.
I congratulate my hon. Friend the Member for Waveney (Peter Aldous) on securing this debate and on the great work that he does with the hon. Member for Cambridge (Daniel Zeichner) in chairing the APPG. I will begin by marking the 70th anniversary of the terrible floods that look lives in Hunstanton, Heacham, Snettisham, King’s Lynn and along the east coast in my constituency.
As we have heard, the east of England is a driver of growth and one of only three regions that are net contributors to the Exchequer. However, the full potential of our region is being held back by barriers including skills, connectivity and housing. I am fortunate to represent one of the most attractive constituencies in the country, but it is also a priority 1 levelling-up area due to the deprivation that exists in certain parts, as it does in other areas of Norfolk and across the east. Levelling up is therefore as relevant in North West Norfolk as it is anywhere in the country.
For me, levelling up is about spreading opportunity, which starts with education. The paper from the APPG highlights the challenge of meeting the 2030 reading, writing and maths targets. That mission is essential to giving young people the best opportunity to realise their potential. Much will depend on the White Paper’s parent pledge and on supporting teachers to deliver the improvements.
Giving children the best environment in which to learn is also important. I welcome the inclusion of Smithdon High School, and King Edward VII Academy, where I am a governor, in the school rebuilding programme to give young people the best facilities. From my weekly visits to schools across the constituency, I know that they continue to face significant issues, despite the additional £4.6 billion to which the Government have committed. As my hon. Friend the Member for Waveney highlighted, the current funding formula does not work effectively for rural schools. That is particularly the case with special educational needs and disabilities, which the head of St Martha’s Catholic Primary School raised with me only a week ago. There is much anticipation for the forthcoming Government response to the consultation on special educational needs and disabilities to ensure that provision can meet growing demand.
This is a timely debate, coming a week after the latest round of the levelling-up fund. I am grateful to the Minister that the £24 million bid submitted by Norfolk County Council to transform the 15th-century South Gate entrance to King’s Lynn has been successful. That will do a lot to promote growth, improve transport links, protect heritage and improve air quality. That comes after the success of the £25 million town deal for King’s Lynn, which will deliver projects to boost skills, jobs and regeneration.
My hon. Friend the Member for Clacton (Giles Watling) will be interested to know about the project to restore St George’s Guildhall, which is the oldest continually working theatre in the country and the only one that can credibly claim Shakespeare performed there. That is £49 million of investment in a priority 1 levelling-up area, underlining the Government’s commitment to North West Norfolk and to working with Conservative council leaders Stuart Dark and Andrew Proctor to spread opportunity in our area.
Many of the issues facing my constituents and local businesses come down to connectivity, and digital connectivity is crucial. Due to the geography of the rural area, Norfolk lags behind other areas in mobile and broadband, which is why I pressed for it to be included in the early phase of Project Gigabit. Contracts worth over £100 million to connect 86,000 premises are due to be awarded in May. That could cover up to 8,000 premises in my constituency, making a real difference to growth and productivity.
Turning to rail, I will highlight the importance of upgrading Ely junction, as others have. The project is backed by MPs across the east of England precisely because it will deliver a major boost in capacity—up to 30%. That will create more passenger services for my constituency and support freight and Freeport East, delivering a major boost to growth for our area and the country. That is the case regardless of the damage that the unions are currently doing with their strike action. The business case by Network Rail demonstrates a benefit-cost ratio of nearly £5 for every £1 invested. That compares favourably with any other rail project. I hope that the project will proceed in the next rail network enhancements pipeline update.
A number of colleagues have commented on roads. My constituents want to see the A47 dualled, and the next investment round should include the Tilney to East Winch scheme that has been prioritised by Transport East. That comes on top of six schemes that are currently under way in the road investment strategy 2 process. The A10 West Winch housing access road is desperately needed to unlock—as the name suggests—housing in a growth area. Work is continuing on the next phase of the business case for that. We need to have the infrastructure alongside the affordable homes that people desperately need.
Finally, the APPG report highlights low confidence regarding the mission on health and life expectancy, which is a vital issue. North West Norfolk has many of the coastal areas that the chief medical officer has highlighted as having some of the worst health outcomes. People living in those areas are served by the Queen Elizabeth Hospital in King’s Lynn. The hospital has nearly 3,400 steel and timber supports holding up its cracking concrete roof, which desperately needs to be replaced. The new hospital programme offers a once-in-a-generation opportunity to transform the QEH, to deliver modern, fit-for-purpose facilities, and to support people to live healthier lives. The Health and Social Care Secretary has stated that dealing with hospitals made of reinforced autoclaved aerated concrete is his priority, and I welcome the focus that he has brought to solving this problem. I call on the Government to give certainty to my constituents, patients and staff that the QEH will be rebuilt by 2030.
In conclusion, the APPG report and the debate show that progress is good in some areas, but greater focus is needed elsewhere to realise the huge potential of the east of England and to meet the cost-cutting missions and our shared ambition to level up.
It is a pleasure to serve with you in the Chair, Mr Davies, and to speak in this debate on behalf of the Opposition.
As has been mentioned, it is a little over a year since we had a similar iteration of this debate. I was relatively new in my role as shadow Minister and rather expected a blizzard of similar, regional-type levelling-up debates in this Chamber, but that has not been the case. That is testimony to the commitment of the hon. Member for Waveney (Peter Aldous), but also to his ingenuity in the use of the Backbench Business Committee process and to the wisdom of the Committee’s members. I associate myself with comments that he and others have made about the 70th anniversary of the 1953 storms. We will all hold those communities in our thoughts as they mark the anniversary today and tomorrow.
I was struck by the way in which the hon. Gentleman’s all-party parliamentary group is monitoring levelling up on a thematic basis, which probably provides a good model for the rest of the country. There are likely to be some similarities, particularly the more input-type targets, such as on research and development, which are easier to do. Progress is good, but there are knottier, longer-term questions around skills, transport and housing. As he said, we could debate each of them at great length. They pose common challenges across the regions, and they show how much further we have to go.
The region was well represented in the debate, and I agree with everything that the hon. Gentleman and my hon. Friend the Member for Bedford (Mohammad Yasin) said about long-term funding moving away from the “Hunger Games”-style stuff that we have seen with the levelling-up fund, and all the disappointment that it has clearly generated in Bedford and other parts of the country.
In response to a comment made by the hon. Member for Clacton (Giles Watling), levelling up can be a funny fish. All our communities are different in some way, and we could create many different carve-outs for towns, cities, rural, coastal, north, south or whatever, to the point that the scheme would stop meaning anything. There has to be some degree of commonality so that there is a consistent and effective approach, but coastal might just be different in this case. There are many issues relating to housing and mental health services that mean that we have to have a bit of an enhanced approach to coastal communities if we are going to deal with some of the knotty, long-term challenges. I think the right hon. Member for Witham (Priti Patel) said that the hinterland may mask a lot of those social challenges, which is a very important point.
One of the things I will take away from the debate is the cross-departmental focus. We have many different and well-meant interventions from all over Government, but how do we get true value? For me, the answer is devolution—certainly of the leadership, if not of all the funding and the power—to those communities, because place is the best way to hold all those different streams together.
I knew the hon. Member for North West Norfolk (James Wild) would not miss an opportunity to raise QEH, as he does with admirable consistency. He made an important point about the funding formula for rural schools, which can have a profound impact on resources for children with special educational needs and disabilities.
Members do not see levelling up as either a “north versus south” thing or a “London versus the rest of the UK” thing. We recognise that there is deprivation in every local authority, and all right hon. and hon. Members made that case very well. For the east of England, that is certainly a real challenge. If we look at the top lines—it is one of the net contributing regions and it has high home ownership—we could kid ourselves about some of the underlying challenges. That point has been well made in the debate.
Of course, the region has huge potential. The hon. Member for Waveney spoke about energy, which made me think of a visit I undertook with the Industry and Parliament Trust last week to the east midlands. We went to see Donaldson Timber in Ilkeston, which has 10 similar sites around the country, including one in Cambridge that serves the east of England. It specialises in off-site timber making and provides hundreds of jobs and tens of thousands of homes each year. If we get the right mix of increased house building and skills, sites like that in Cambridge have the potential to create many more skilled jobs in careers that will last. That is the sort of potential we need to tap into through levelling up-type interventions.
We have to deal with the problem that the brand of levelling up has become highly discredited. YouGov polling this year showed that in only four local authority areas residents feel that their community has improved in recent years, whereas in 215 areas they think it is the same, and in 142 they think it has got worse. Of course, that is understandable and right: people cannot see a GP, they cannot get a train, the available jobs are insecure and on low pay, and there is the sense that nothing in this country works any more.
The levelling-up model has not delivered by tackling that. Devolution deals are great, unless the Government have decided an area is not good enough to have one or that it deserves more limited powers than others. Similarly, the “Hunger Games”-style funding by bidding for pots has not delivered. Those who succeeded in round 1 are now trying to work out how to salvage bids that have been eaten up by the inflation crisis. Round 2 threw up some eccentric and disappointing outcomes for many, including confusion about whether some areas could ever have been successful. If not, why were they encouraged to bid?
Indeed, even the winners are losers. For example, it is great news that Norfolk County Council has secured £24 million to improve transport in King’s Lynn; it is less good news that, even taking that money into account, in the last four years alone, that local authority is £146 million worse off in real terms due to cuts to its budget. With levelling up, even the winners are losers.
It does not have to be this way. There is a better model that would deliver for the nations and regions of this country. We can end the deals and the beauty parades, provided we get the powers and resources to all our nations and regions—to the experts in place—to shape their economies and invest in the things they know their areas will be good at in the future and that their young people will work in. We want every community, as part of a combined authority—or on its own if it is big enough—to access top-level powers. We want to go further than what is on offer on skills, devolution, the Department for Work and Pensions and jobcentres, net zero and much more. We want to move funding away from having hundreds of different pots and instead, as my hon. Friend the Member for Bedford said, have proper funding based on need, with consolidated settlements, so that local communities can plan and spend in a way that reflects their priorities.
There are significant political conversations to have about levelling up in this country, as there are in the east of England, but we must be hopeful as we have those. The hon. Member for Waveney and many other colleagues have shown the clear potential in the east of England. We want the power and resources to be given to those communities to make that potential a reality.
It is a pleasure to serve under your chairmanship, Mr Davies, I think for the first time.
Huge congratulations to my hon. Friend the Member for Waveney (Peter Aldous) on securing this vital debate. I echo the sentiments that have been expressed across the Chamber to mark 70 years since the terrible storm that took far too many lives.
Huge congratulations to the APPG for the east of England, that incredible cross-party body, on producing an incredibly insightful report, which my officials and I have been pleased to read and look into. It shone the brightest possible light on the region’s towering strengths: energy and clean growth, with the east of England producing more than half of the UK’s offshore wind and power; exports and global trade, with Felixstowe alone accounting for more than 40% of national container traffic; and the life sciences sector, which my hon. Friend the Member for Waveney mentioned. AstraZeneca’s R&D facility is rightly cited in the APPG’s report as an exemplar of the region’s booming sector, not least for its leading role in producing the life-saving covid-19 vaccine, for which we are all incredibly grateful.
For all those brilliant strengths, the report also highlights how the east of England faces its own challenges, too. As my hon. Friend the Member for Waveney highlighted, last year the Government published their levelling-up White Paper, where we outlined 12 key levelling-up missions between now and 2030. I fear, as my hon. Friend did, that I might scratch only the surface of the issues, but I will endeavour to cover as much ground as I can.
I will start with devolution—something very close to my heart and within my brief, so hopefully I have an advantage on my first point. As I read the report, I was a little troubled to find only medium confidence in delivering devolution. I clearly want that to be high confidence, so I will address a few of the points raised today.
We are pleased with our progress on devolution, particularly in the east of England with the historic deals we recently signed with both Norfolk and Suffolk. We all know that local areas know best what they need; they know better than Whitehall and we Ministers in Westminster ever will, and that is what devolution is all about. Transferring money and powers on housing, regeneration and skills will empower new directly elected leaders to drive local growth and focus on their priorities to level up their own areas.
That comes on top of substantial devolution and local growth commitments that we have already made through investments such as the £500 million city deal with Greater Cambridge and the £600 million Cambridgeshire and Peterborough devolution deal, and wider investment across the region through the getting building fund and £1.5 billion from the local growth fund. To reassure my hon. Friend the Member for Waveney and others, devolution deals are only one of the areas where my Department works in co-ordination across Government to deliver on levelling up. That is what the White Paper with its 12 missions was all about: recognising that levelling up has to be a whole Government effort.
An inter-ministerial group was recently established to pull together Ministers from across Government to focus on core levelling-up outcomes and missions to make sure there is a co-ordinated effort. Without such effort, we never will achieve the levelling up that this country deserves.
For years the east of England has been a region that punches above its weight, but arguably below its potential. If we want to realise the full potential of the region, we need to level up skills provision—the region currently falls below the national average. I was concerned to read in the report that participation and academic achievements in the east of England were among the lowest of all regions in England. As we would expect, where there is a lack of skills and too few decent jobs to go around, there is inevitably deprivation as well. That remains a real challenge for the region, which has pockets of significant poverty, including in coastal towns, as highlighted by my hon. Friend the Member for Clacton (Giles Watling), such as Jaywick, Lowestoft and Great Yarmouth.
I was pleased to see the recommendation in the report that the Government should promote skills devolution—something on which we are very much focused. In the current academic year, the Government have devolved approximately 60% of the adult education budget to nine mayoral combined authorities and the Greater London Authority, and Cambridgeshire and Peterborough received £11.9 million in the most recent financial year. As set out in the levelling-up White Paper, devolution of adult education funding has been a core part of all MCA devolution deals to date.
The Department for Education has committed to devolving adult education functions and the associated core adult education budget to new areas from 2025-26 as part of new devolution deals. We have worked across the country with new areas on devolution, including Norfolk and Suffolk, as I have already referenced. We will fully devolve the adult education budget in Norfolk from the academic year 2025-26, subject to readiness conditions and parliamentary approval of the required legislation.
We are also ensuring that everyone, irrespective of their age or background, has access to high-quality education or training, while prioritising the needs of employers. We are investing £3.8 billion more in further education and skills—
Before my hon. Friend moves on to further education, let me ask about skills devolution; we in Essex have wanted this for a long time, so we must have it. What work is taking place to bring businesses into skills devolution? Local authorities, like Whitehall, can only do so much. This is all about ensuring that businesses are connected with a potential pool of labour and a talent base, so that this can come together.
My right hon. Friend will recognise that that does not fit within my brief, but I can reference the Skills and Post-16 Education Act 2022, local skills improvement plans and work that is being done on our trailblazing devolution deals to further devolve skills powers, which would take into account local skills needs as outlined by local businesses. More on that will be coming soon, when we announce further details on those deals. We are investing in further education skills over this Parliament to ensure that people can get on the ladder of really good, high-quality training and education that leads to good jobs, addresses skills gaps, boosts productivity and, ultimately, supports levelling up.
Having skills really is not the end of it. Without stable and reliable jobs to go along with those skills, areas such as the east of England could lose their newly skilled and experienced workforce, which we of course want to avoid. The region already boasts incredible companies, particularly in life sciences. The Cambridge Biomedical Campus is the largest centre of life sciences and medical research in Europe, employing over 20,000 researchers, industry scientists and clinicians. I have referenced internationally significant companies such as AstraZeneca, with their £1 billion state-of-the-art global research and development facility, and GlaxoSmithKline.
There is always more to do to make sure that people have the necessary skills and adequate jobs. That is why, in the autumn statement last November, the Government reaffirmed their commitment to Sizewell C, which, once operational, will generate 7% of the UK’s energy needs. This investment is vital to the Government’s net zero strategy, which is connected to the east of England’s 13th mission, which we are working across Government to ensure we deliver. The Government’s £700 million investment in the project marks a further step towards energy independence for the UK, while providing a boost to the local economy in Suffolk, with over 10,000 highly skilled jobs set to be created during the plant’s lifetime. The skills investment and devolution is on top of other education investment—for example, the £294.9 million extra being provided for mainstream schools in the east of England this year, as well as the three priority education investment areas in the east of England.
As hon. Members from across the Chamber have highlighted, the issues go beyond skills shortages. Poor connectivity is holding the region back. A lack of decent rail and public transport connections between towns and cities means that a lot of people are forced to drive, not just for their commute but for hospital appointments, to go shopping, and to visit friends and loved ones. Transport East estimates that well over 40% of the region’s carbon emissions are down to private car use. There is a long way to go to bring that figure down over the medium to long term. That throws into sharp relief the need for the Government to redouble our efforts on levelling up when it comes to transport.
I have heard much, loud and clear, about the Ely and Haughley junctions, and will elbow colleagues in the Department for Transport to meet you guys who raised the matter to discuss it further. It is vital that we continue to improve roads across the region, as has been mentioned by a number of hon. Members, including my hon. Friend the Member for Clacton and my right hon. Friend the Member for Witham (Priti Patel). We have invested £462 million in local roads maintenance between 2022-3 and 2024-5, and £88 million in transport improvements across the east of England. We are going further to ensure that we improve capacity on the railways and bus services, because that rail capacity is crucial, as we all know.
East West Rail plays a vital role in boosting connectivity and unlocking productivity in the Oxford to Cambridge area, supporting access to jobs, education and other opportunities. It plans to create a direct rail link between Oxford and Cambridge, significantly improving journey times, and delivering benefits for passengers and businesses regionally and nationally. The Government have provided £1.3 billion towards the delivery of connection stage 1 of the project, which will provide services between Oxford, Bletchley and Milton Keynes. In the autumn statement the Government affirmed their commitment to plans for transformative growth for our railways, including East West Rail, and I am told that an update on that project will be provided in due course.
On buses, DFT is providing over £100 million of bus service improvement plan funding in the east of England, with £49.6 million going to Norfolk County Council. That will make a significant contribution to local public transport connectivity in the region. The Cambridgeshire and Peterborough Combined Authority received £4.3 million funding from the zero emission bus regional areas scheme, for 30 double-deck electric buses to be introduced on park and ride bus routes in Cambridge.
Let me turn to the APPG’s recommendation that simpler, long-term funding mechanisms are required to support the priorities set out in the strategies of the region’s two sub-national transport bodies. DFT seeks to ensure that all local transport authorities have stronger plans and capabilities to deliver enhanced local public transport. DFT is currently developing guidance and options to incentivise the refresh of local transport plans, so that places have an up-to-date plan for improving connectivity.
As previously mentioned—this is a bit of a pet project of mine—devolution of powers and funding is an intrinsic part of that work. The recently signed devolution deals in the east of England mark a new relationship between Government and Norfolk and Suffolk. A directly elected leader for each county will be responsible for a devolved and consolidated integrated local transport budget for their area, consisting initially of the local highways maintenance funding, both the pothole fund and highways maintenance block, and the integrated transport block, helping to provide strong local leadership and better transport outcomes for local people.
I was pleased to read in the report that the APPG agrees that living standards, especially when it comes to pay, employment, research and development, and wellbeing within the region, are all trending in the right direction. In the same breath, I was disappointed by the report’s assessment of digital connectivity and pride in place, as I know that my Department, and Departments across Government, are working incredibly hard to ensure we make progress on those areas.
My hon. Friend the Member for North West Norfolk (James Wild) raised the issue of gigabit broadband coverage. In the east of England alone, that has increased from 5% in November 2019 to 61% in January 2022, and since then that coverage has been expanding rapidly, with forecasts predicting it should reach 70% to 80% by 2025. Ensuring that areas in the east of England with the poorest fixed and mobile connectivity are improved is a big priority for my Department and for the Department for Digital, Culture, Media and Sport. In terms of mobile connectivity alone, the majority of 4G coverage uplifts from a shared rural network will come from the industry-led element of the network, which will target partial notspots in areas where there is coverage from at least one but not all mobile network operators.
As all hon. Members will know, growing people’s pride in the places where they live and work is at the heart of the investment we are making through the levelling-up fund. On that basis, I congratulate my hon. Friends the Members for Clacton and for North West Norfolk on their successful bids, on which I know they and their local authority teams worked incredibly hard. I reassure my hon. Friend the Member for Waveney that full written feedback will be provided to local authorities and the MPs who supported the bids, with the option of follow-up verbal meetings to go through the bids and see how they can be strengthened to secure potential future funding.
Our flagship levelling-up funding investment is helping people in a huge number of overlooked and under-appreciated communities in the east of England. Some £253 million has already been allocated; of that, £87 million was awarded in round 1 and £166 million was awarded in round 2. Almost £48 million was awarded to redevelop the station quarter in Peterborough and nearly £60 million-worth of bids were successful in Tendring, Harlow and Colchester. On top of that, the east of England has been allocated a total of £97 million from the UK shared prosperity fund.
I should highlight that the UK shared prosperity fund is one measure that the Government have taken to simplify funding streams and give more autonomy to local areas to deliver, without having to go through competitive funding processes. I hope that will reassure the hon. Member for Bedford (Mohammad Yasin). That is just one of the measures we are taking, and a funding simplification plan is coming incredibly soon.
We all recognise that significant population growth in any area will have an impact on vital and speedy access to healthcare for all residents, as highlighted by my right hon. Friend the Member for Witham, my hon. Friends the Members for Waveney and for North West Norfolk, and the hon. Member for Bedford. That is why, in the autumn statement, the Government made up to £8 billion available to the NHS and adult social care in England in 2024-25, including an additional £3.3 billion in both 2023-24 and 2024-25.
The Department of Health and Social Care works closely with NHS England and regional teams to distribute that funding settlement as needed, in order to reflect and address the needs of local populations, including through the agreement of annual plans for each NHS trust. Healthcare funding allocations are weighted heavily towards deprivation, which in turn correlates strongly with need. Per capita, funding for the most deprived local authorities is on average about 130% more than for the least deprived.
Finally, to ensure that we are improving capacity and capability in the healthcare system in the east of England, we are continuing to build five new hospitals as part of the Government’s commitment to build 40 new hospitals by 2030. That includes the rebuilding of James Paget University Hospital and the West Suffolk Hospital, a new cancer hospital at Addenbrooke’s, a new high-tech healthcare campus to replace the ageing Princess Alexandra Hospital in Harlow, new hospital buildings at Watford General Hospital and the refurbishment of Hemel Hempstead and St Albans City Hospitals.
I hope that has given a rough flavour of just some of the work that is going on right across Government to ensure that we are focusing on levelling up, obviously with specifics for the east of England. I know how hard the APPG and all Members present have worked on preparing this incredibly insightful report, which my Department and others have valued a great deal. As well as the challenges, some of which we have touched on, it reinforces that the region really is a true economic success story. As has been highlighted, it is a net contributor to the Treasury; few regions can boast of that, and it is something that the region should rightly be proud of. It is an international gateway for global Britain, and it boasts some of the highest levels of employment, pay and productivity anywhere in the UK.
Our shared challenge now is ensuring that the huge benefits of these tremendous assets and opportunities are shared more evenly across the region and that it ultimately achieves its true potential. As my hon. Friend the Member for Waveney and others have rightly highlighted, ensuring that the east of England reaches its potential really is core to the prospects of the UK as a whole. I believe that there is every chance we can ensure the east of England reaches its potential.
The report illuminates the significant progress we have made on our levelling-up mission so far, but it also shows that there is clearly room for improvement. To reassure my hon. Friend the Member for Clacton, we know that the job is not done; we set out those missions to aim towards by 2030 to ensure that we are levelling up in the east of England and right across the UK. The only way we can achieve that is by ensuring that we are working cross-Government, cross-Whitehall and, of course, cross-party to ensure that we are achieving what we need to achieve to truly level up the UK.
On that basis, I look forward to continuing to work cross-party with Members across the House, and with Ministers across Government, to unlock the east of England and the UK’s true potential.
We have had a very full debate. I will go through the contributions made by hon. Members and hon. Friends, and I will try to pull one or two things together out of those.
The hon. Member for Bedford (Mohammad Yasin) highlighted the importance of investment in health infrastructure and services. He is right to do so, because it is something that particularly concerns a great many of our constituents, and we must get that right. We have had a lot of discussion about the importance of rail, which I will come to in a minute. Being at the west of the region, he has highlighted the importance of East West Rail and, generally, in the east of England that can be a challenge.
We look so much north-south and at the roads to London; in fact, very often our road network is focused on the roads down to London. The A12 used to be a toll road from Yarmouth, and it was the main road serving that part of the area, and there was also the A10. Actually, those cross-country routes—whether they are the railways or the roads—are so important. In Suffolk or Norfolk, there is the A143, which links to Lowestoft but actually runs from Yarmouth right down on the county border through to Bury St Edmunds and down to Haverhill. That is a tortuous way to go down, so those cross-country routes are absolutely vital.
My hon. Friend the Member for Clacton (Giles Watling) emphasised the challenges faced by Jaywick and also highlighted the railways. Like me, his constituency is served by two railway lines, and he highlighted the slow, tortuous journey to Liverpool Street. From my perspective, on the East Suffolk line from Lowestoft to Ipswich the journey time has not improved since 1859. That is another particular challenge that we need to address.
A lot of our strategic investment in the coming years will be in the railways, but the road network is there and we must not forget it. There are pinch points and particular challenges. The A12 through Essex is heavily overused. Quite frankly, its activity justifies M status, but I do not think that will ever come, and we have to address that. Because of a lack of maintenance, a lot of our main roads are turning into little more than country tracks in some respects, which reminds me that there were most regrettable accidents on the B1062, which links Beccles to Bungay, over the new year period. I talked that through with the local community and the county council. The county council engineer is doing great work. He said, “We have analysed what happened and think there is a need for improvement, and you are now in the top 20% of our priority schemes.” I thought, “Great.” I said to him, “How many priority schemes do you have?” And he said, “Oh, 10,000”. That illustrates that investment in the existing network—
That is fine. My right hon. Friend the Member for Witham (Priti Patel) gave an impassioned speech, which emphasised the railways. She raised reform of the apprenticeship levy, which is vital, and investment in skills.
My hon. Friend the Member for North West Norfolk (James Wild) raised digital connectivity, which, although a medium risk in the report, is a challenge in the east of England because of our dispersed population, which covers a relatively large geographical area. I also have an interest in the A47, which runs from the A1 and, one might say, begins or finishes in my constituency—in Lowestoft. It is good that work has been done on that. He is an impassioned campaigner for the Queen Elizabeth Hospital. The James Paget University Hospital, which serves my constituency, is going to be rebuilt. Investment in NHS buildings is important, as is addressing demand and the workforce.
The hon. Member for Nottingham North (Alex Norris), speaking for the Opposition, raised some interesting points, including the common challenges across the country and how the approach that we have adopted might be an exemplar elsewhere. He also highlighted the particular challenges of coastal communities.
I thought the Minister gave a tremendous speech. It is unfortunate that, as I understand it, we will be losing her. She gets it; there was no camouflaging, and she came straight to the point, for which I thank her.
To sum up—my right hon. Friend the Member for Witham got this right—we have to break out of departmental silos. Levelling up is not just for my hon. Friend the Minister’s Department but for all Departments. There were so many issues that were not necessarily for her to address in her remit; they cover the whole of Government. It is about thinking in a joined-up way down here in Whitehall and Westminster, and devolution to local authorities, which will be very important. My right hon. Friend also raised the fact that we have to bring business with us. I think the LEPs have been a success, because they have put business at the forefront. I am not sure about the future of LEPs, but whatever happens, business has to be there, working in partnership and in collaboration with local and national Government. [Interruption.] I see that you are getting impatient, Mr Davies, so on that point I will sum up. I thank all colleagues for their contributions to the debate and thank you for chairing it.
Essex Mental Health Independent Inquiry
I beg to move,
That this House has considered the Essex Mental Health Independent Inquiry.
It is a pleasure to serve under your chairmanship, Mr Davies. Today’s debate is important for the future of mental health services across the country and ensuring that the tragic stories that I and many of my Essex colleagues have heard from the families affected by the failings in mental health services in Essex are not repeated. This is not the first time that mental health in Essex has been debated, and I pay tribute to my hon. Friend the Member for South Suffolk (James Cartlidge) for his previous Adjournment debate. Before I start, I ask everyone to take a moment to think about all those who have died, those who have suffered, those who love them and those who care for them.
As well as other in-patient facilities, many concerns have been raised about the Linden Centre in Chelmsford, where there have been a significant number of in-patient deaths, both on the wards and while vulnerable patients were on section 17 leave or had absconded. The Linden Centre lies just outside the boundary of my constituency, but the patients treated there come from across Chelmsford and, indeed, Essex. For example, Jayden Booroff was suffering from acute psychosis and known to be at high risk of absconding. In October 2020, he was killed by a train just a few hours after he had been able to tailgate a staff member out of the Linden Centre. The inquest concluded that Jayden died following inconsistencies in care at the Linden Centre run by Essex Partnership University NHS Foundation Trust, or EPUT. Jayden’s mother, Michelle, is one of my constituents. She has told me of her wish to achieve accountability, for responsibility to be accepted and for long-term lasting improvements to services.
I and many of my Essex colleagues represent family members of mental health in-patients who have died under the care of EPUT, which is responsible for the provision of adult NHS mental health services in Essex. Many inquests and investigations have taken place, but it has been very clear for a long time that a fuller inquiry was necessary to understand why so many deaths have occurred and to try to prevent future tragedies.
In January 2021, the Government set up an independent inquiry, to be chaired by Dr Geraldine Strathdee, to investigate matters surrounding the deaths of mental health in-patients in Essex between 2000 and 2020. At the time, when local MPs were briefed on the issues, Ministers believed that a non-statutory inquiry was more appropriate, more likely to get to the truth and more likely to make recommendations for improvement in a timely manner, whereas a statutory inquiry was likely to take much longer to set up and report. It was made clear that, while the inquiry did not have statutory powers, witnesses were expected and would be encouraged to come forward and give evidence.
On 12 January 2023, I and many other Essex MPs were deeply concerned to receive the open letter published by the inquiry chair, Dr Strathdee, stating that she felt that the non-statutory inquiry into EPUT was unable to fulfil the terms of reference due to the extremely low engagement of EPUT staff. We also heard that rather than the 1,500 deaths we had been informed of, close to 2,000 fall within the scope of the inquiry. It is incredibly disappointing that, of the 14,000 members of EPUT staff whom the inquiry had written to, only 11 had agreed to give evidence. In the specific cases that the inquiry is investigating, only one in four responded. That is a shockingly low figure. It is abundantly clear that, with this extremely small pool of staff witnesses, it is highly unlikely that the full truth would be heard.
Upon receipt of Dr Strathdee’s letter, my right hon. Friends the Members for Maldon (Sir John Whittingdale) and for Witham (Priti Patel) immediately wrote to the Health Secretary to raise their serious concerns that the powers available to the inquiry did not go far enough. I have also written to the Health Secretary to underline my agreement with all the points they raised. Dr Strathdee’s unequivocal view, as stated in her open letter, is that the inquiry will not be able to meet its terms of reference with a non-statutory status. I want to put it on the parliamentary record that I join those calls for this to be converted into a statutory inquiry, which will compel witnesses to give evidence, to ensure full transparency and greater public scrutiny of its progress.
My hon. Friend knows that I did not support a public inquiry—I thought it would take a long time and be an expensive distraction from spending money on the service—but the approach we have taken simply has not worked. Unless the Department and EPUT transform miraculously over the next four weeks, the only real option is a statutory inquiry, for which she has our full support.
I thank my hon. Friend for his words, which are absolutely spot on, and for emphasising the support among Essex colleagues on this matter.
Having said that, I also recognise the points made to MPs in a letter from the chief executive of EPUT on 19 January. He points out that a public inquiry could bring consequent delays and costs, and the trust needs to be focused on continued improvement to services at a time of rising demand, both in numbers and complexity of cases.
He made a number of recommendations, including an increase in resources and expertise available to the inquiry chair, and ensuring appropriate information-sharing protocols. He also suggested a number of practical steps to drive better staff engagement with the inquiry. He has informed me that, since 2019, absconsions have decreased by more than 60%, the use of prone restraint has reduced by 88% and fixed ligature incidents have reduced by 32%. He has told me that many staff are scared to come forward, and that all board members will come forward now, as an example to others.
Given that, I can understand that Ministers might be tempted to give those suggestions a short period of time, to see if they bring improvements. However, I make two points. First, it is two years since the independent inquiry was announced. EPUT has already had a long time to take action and to support staff to engage. Secondly, given how incredibly low the engagement has been to date, I have serious doubts about whether the process would be effective. Therefore, I suggest that, if Ministers decide to take this option, they should set a deadline of no more than one month, making it clear that if there is not a massive material change in staff engagement, the statutory route will be actioned. They should also make it clear that the statutory route is likely to include some staff being named, and being compelled to give evidence in public.
I thank my hon. Friend for securing this debate and for her contribution. I also want to pay tribute to the families who are here today. We support the point she makes about a statutory inquiry. I want to thank the Minister for his engagement on that. Alongside that, does my hon. Friend have any thoughts on the role of an independent public advocate for family members? Perhaps the Minister could also comment on that. Their voices are simply not being heard. At the end of the day, we are here to represent them against institutional state failure. Duty of candour for stuff to come forward is important, but the time has now come for an independent public advocate for family members.
I thank my right hon. Friend for making that point. It is important that the voices of the families are heard. I am about to come on to the point that it is also important that the voices of the survivors are heard. Anything we can do to help to ensure that those voices are heard is vital. In calling for a statutory inquiry, I am not just supporting the calls of the bereaved families, but those of the group that I strongly feel has not, until now, been mentioned often enough. That is the group who, although they did not lose their lives, have been victims of appalling care: they are the survivors. That group also falls within the scope of the inquiry, which is investigating issues beyond in-patient deaths, including the management of self-harm and suicide attempts, sexual safety on the wards, the use of restraint and restrictive practices with in-patient units, medication practices and management, and various other issues, as outlined in the inquiry terms of reference, which were published in May 2021.
One of my constituents shared with me the testimony that she has given to the inquiry. She describes how during her time at the Linden Centre in the mid-2000s, she was raped by another patient, and when she asked for support, she was laughed at by staff members. She describes being able to make suicide attempts, including absconding from the ward and overdosing, as well as being able to ligature on the ward. She has told me of times when staff refused to treat her self-harm injuries and how she herself treated her own serious injuries and the injuries of others. She has also described to me how she was repeatedly restrained, often held on the floor by a number of staff, and forcibly injected.
This survivor reflected to me that she had hoped things might have changed in the years since she was an in-patient, but the recent “Dispatches” documentary suggests to her and many others that that is not the case. This is just one of the appalling stories shared by survivors of the horrific treatment they suffered while in the care of mental health services in Essex. This survivor is absolutely clear about the need to establish answers and uncover the truth of the situation to ensure that nobody else has to suffer the trauma she faced, which will live with her for the rest of her life. This survivor and others who have worked with the inquiry simply want to ensure that this never happens again.
Before Christmas, I spoke in the Chamber of the House of Commons about my own lived experience. I explained that it is very hard to talk about one’s own experiences of mental illness. It brings back all the horrors. The survivors who have shared their testimony are extraordinarily brave. I have asked what support is available for them, and I understand a contract is in place with Hertfordshire Partnership University NHS Foundation Trust, while psychological support is available to anyone involved in the inquiry. I understand also that some survivors might not be aware of that. EPUT has promised to publicise it, and I will ask the inquiry to ensure that it publicises it too.
Based on all that I have said, the words of the chair of the inquiry herself, and the devastating testimony of bereaved families and survivors, I believe that there is an urgent need to revisit the powers available to the inquiry and reconvene it on a statutory footing to ensure accountability and learning, and, most importantly, to embed long-lasting changes to safeguard lives in the future.
I start by thanking my right hon. Friend the Member for Chelmsford (Vicky Ford) for securing the debate and for allowing me to make a brief contribution.
I, too, represent several family members of those who lost their lives while in the care of EPUT. The matter has been continuing for a long time, and the inquiry is considering 20 years of NHS provision for people suffering from mental illness in Essex. We have had a number of inquests for those who died, and we have had Care Quality Commission investigations and police investigations, but there are still unanswered questions. For that reason, I agreed with and supported the establishment of the mental health inquiry by my right hon. Friend the Member for Mid Bedfordshire (Ms Dorries), who was then a Health Minister.
As my right hon. Friend the Member for Chelmsford has said, real concerns were expressed to us about the fact that the inquiry would not be statutory, but we were assured by the Minister that a non-statutory inquiry could reach conclusions faster than a statutory one and that there were other advantages to such an inquiry, which might lead to people being more willing to come forward than if the inquiry were under statutory control. I listened to the concerns expressed by my constituents who felt strongly that the inquiry should be statutory, but I accepted the assurances of the Minister. I want to say to the families that they were right and we were wrong, and I am sorry that that was the case. I was therefore greatly concerned when I saw the letter from the chair, who says that she has now concluded that statutory powers are needed owing to the lack of co-operation from staff and former staff, although initially she, too, had thought that a non-statutory inquiry was correct.
I have had a long conversation with the chair of the inquiry. I am impressed by her absolute determination to get to the truth and her independence. As my right hon. Friend has said, the chair still hopes very much that not only staff members, but all family members who have evidence to give will come forward, particularly as there will be support available. I understand that the family members still believe the inquiry should be statutory. Therefore, I agree with my right hon. Friend that we have reached the point at which, unless we receive co-operation in a very short time, statutory powers are needed.
We need to get to the bottom of this. A figure of 2,000 deaths has mysteriously and suddenly appeared from the trust, and we need to find out what happened to those people. I say to the Minister that I understand the wish of the Government and the inquiry to obtain testimony from all those concerned, but if it cannot be achieved by the present arrangement, we will move to statutory powers.
It is a pleasure to serve under your chairmanship, Mr Davies. I thank my right hon. Friend the Member for Chelmsford (Vicky Ford) for securing this important debate, and I thank her and all the local MPs—my right hon. Friend the Member for Witham (Priti Patel), my hon. Friend the Member for Rochford and Southend East (Sir James Duddridge) and my right hon. Friend the Member for Maldon (Sir John Whittingdale)—for their dogged work over a long period in trying to get justice both for those in the Public Gallery and for all the others who are unable to be present this morning.
I know that Members have raised a lot of concerns about the progress of the inquiry, and I want to take this opportunity to make clear our strong commitment to this absolutely vital work. The speech made by my right hon. Friend the Member for Chelmsford was stark, and I know that some of the victims, survivors, and friends and families of people who have been affected are in the Public Gallery. It is a powerful reminder of why the inquiry is so important: it has to get to the truth.
The Government are committed to improving mental health services across the country, which is why we launched the independent inquiry in January 2021, covering a 20-year period from 2000 to 2020. Obviously, it is a complex inquiry. Like Members present, I am pleased with the hard work of Dr Geraldine Strathdee, the inquiry chair, since the inquiry started its work. However, I am concerned about the level of co-operation that the inquiry has received, which was set out clearly by my right hon. Friend the Member for Chelmsford. It is not good enough, and Dr Strathdee has recently raised concerns about this. She met the Secretary of State and has since published an open letter in which she stated that
“in the event that staff engagement remains very poor, it is my view that the inquiry will not be able to meets its terms of reference with a non-statutory status.”
We take those concerns very seriously.
Dr Strathdee has raised two particular concerns. The first is about the participation of current and former staff, and the second is about the availability of documents for the inquiry. As a result of Dr Strathdee’s concerns, the Secretary of State met Paul Scott, the chief executive of Essex Partnership University NHS Foundation Trust, to better understand how the trust will support the inquiry. The Secretary of State sought assurance on two key issues. The first is what actions the trust will take to encourage more staff engagement with the inquiry, and the second is assurance that the trust will provide all the evidence and information requested by the inquiry, to enable it to fulfil its terms of reference. I know that Mr Scott has also written to local MPs setting out the steps that he thinks necessary to improve engagement, and he feels confident that progress can be made.
On staff participation, I remind the House that it is incumbent on all holders of public office and all health professionals to demonstrate their fitness for office by voluntarily co-operating with independent inquiries. In their guidance on the duty of candour, professional regulators advise that health and care professionals must be open and honest with their colleagues, employers and relevant organisations, and take part in reviews and investigations when requested. Similarly, they must support and encourage each other to be open and honest. I therefore hope that anybody who is asked to contribute evidence will co-operate fully with the inquiry in the public interest and in fulfilment of their professional obligations. The Department is also working closely with the inquiry and NHS England to look at what more can be done.
Dr Strathdee has expressed her concern that an additional 600 cases were recently sent to the inquiry. The trust has advised that they were identified during a validation process. I appreciate that this is not ideal, but I understand that the trust has allocated appropriate staffing and resource to ensure the thoroughness of the searches requested by the inquiry.
As Members have mentioned, the participation of families is equally important to the work of the inquiry, and I am grateful to all who have provided evidence to date. I am disappointed that a number of families who have tragically lost loved ones have chosen not to participate and get their voices heard. I urge them to reconsider, so that the inquiry can be as thorough as possible.
Our view is that a non-statutory inquiry, if it is possible, remains the most effective way to get to the truth of what happens. It is quicker, and potentially involves not having to drag clinicians through the public processes of a statutory inquiry. When my right hon. Friend the Member for Witham was Home Secretary, she used the non-statutory process to protect those who did not want to be named and dragged through a statutory process. It is faster and more flexible, which is why it was chosen in the first place. Although statutory inquiries can compel witnesses to give evidence under oath, that does not necessarily mean that it will be easier to obtain the evidence we want. However, all that turns on people co-operating with a non-statutory inquiry, and we now need to see a quantum leap in the level of co-operation. We will not hesitate to move to a statutory inquiry if we do not see a dramatic increase in the level of co-operation. Given how long this has gone on, we cannot wait for a long period for a transformation in the level of engagement. While the approach remains non-statutory for now, we will not hesitate to change that approach if we do not see the change we need rapidly.
I have visited Essex Partnership University NHS Foundation Trust in Rochford a number of times and have been incredibly impressed with its work, notwithstanding its very real problems. What I cannot get over is why people have not come forward to give evidence in a non-statutory environment, because these are caring individuals who want to improve the service. I do not understand why only 11 people have come forward.
That is a vital question. There is an excellent chair, and many publicly spirited individuals are already co-operating to get to the truth and improve services for the long-term. We are currently in this environment of the non-statutory inquiry, which allows an informal approach. People do not have to give evidence in the way they would if we went to a statutory approach. There is an opportunity for people to co-operate more with the inquiry, exactly as my hon. Friend says.
It is not for me to put a date on that in this setting. I have had conversations with a number of the hon. Members here, but my hon. Friend can rest assured from the tone of what I am saying that this will not be a long period of time. We are not kicking this into the long grass; we urgently need this change because, as numerous Members have pointed out, this has been going on for a long time and families who have been through the mill are waiting for justice.
One of the problems with a non-statutory inquiry is people’s reluctance to come forward. If it becomes statutory, certain consequences obviously follow, including the publication of the names of those who are summoned to appear. Will my hon. Friend the Minister think about making his requirement that the co-operation be achieved in a short space of time more public, so that people understand exactly what will follow if they continue to fail to co-operate?
This debate goes some way to achieving exactly that. My right hon. Friend is exactly right that the current non-statutory approach has the benefit that those who give evidence do not have to be named. That is why it would clearly be more desirable if we could make the non-statutory approach work, but that has not been the case to date and, unless that changes, something else will have to change too.
To continue making progress in how we address issues with mental health services, Members will be aware that we have recently announced a rapid review into patient safety in mental health settings across England. The review will focus on what data and evidence is available to healthcare services. I am pleased that Dr Strathdee will be leading the rapid review over the next couple of weeks, given her knowledge and experience. However, I assure hon. Members that the work of the inquiry in Essex will continue at the same time.
I firmly believe in the importance of transparency and accountability to improve patient safety, and I wish to take all action necessary to assist the inquiry in its work. This is absolutely the last chance to make progress. If staff engagement and access to documents remain unsatisfactory despite these actions, we will consider whether the inquiry should remain on a non-statutory footing. We simply cannot go on as we have, with inadequate co-ordination and documents not being forthcoming. Everyone in the inquiry knows the situation and that there is not a long period of time for things to change.
I thank hon. Members for bringing forward the debate, because it allows us to set out the situation clearly for the public. I thank all who are here today, all who have co-operated with the inquiry, and all who have lost loved ones or been personally affected by this matter and have had the bravery and grit to come forward and talk about their experiences. We are extremely grateful to them.
Question put and agreed to.
NHS Hysteroscopy Treatment
[Sir Mark Hendrick in the Chair]
I beg to move,
That this House has considered the matter of NHS hysteroscopy treatment.
It is an absolute pleasure to serve under your chairship, Sir Mark. I am particularly glad to be joined in this debate by hon. Friends and by the hon. Member for Thurrock (Jackie Doyle-Price). When she was responsible for women’s health, she took this issue seriously. We had a number of highly productive meetings about it, so it is welcome that we have the benefit of her ministerial experience in the debate.
This is the 10th time that I have spoken in this House about the completely unnecessary pain and trauma that women are subject to when they undergo hysteroscopies. Women who need pain relief are simply not being given it. They are being patronised, belittled and, frankly, betrayed. Effectively, they are bullied into accepting treatment so painful and damaging that they would never have agreed to it had they known what was coming.
I first spoke about how this issue needed to be resolved 10 years ago, at the behest of a constituent who came to my surgery to talk to me about her experience. Frankly, I am horrified that precious little seems to have changed since then. I will share a few of the recent stories that women have sent me since the last time I spoke about hysteroscopies in this place. I have had to choose very carefully: the number of women who have written to me is large, but my time this afternoon is short.
Julie had a hysteroscopy in July last year. She is 71 years old and wears hearing aids. Julie thought she was going in to see a gynaecologist and perhaps to have an ultrasound to investigate unexpected bleeding. She had been given no additional information, despite having waited for that emergency appointment for six long months. I can imagine how frightened she was. As expected, Julie’s appointment started with an ultrasound; unfortunately, the scan showed some thickening in the lining of her womb. Julie had removed her hearing aids to avoid losing them, which had happened before, so she could not clearly hear what was being suggested, but she was told that another procedure was necessary. A different nurse came in, and that was the very first time that Julie heard the word “hysteroscopy.”
Julie was, of course, a little confused about what was happening, because she could not hear properly, but she managed to make out that she might feel some mild cramping as the fluid and the scope were inserted. However, she describes the pain as utterly excruciating. The nurse tried to talk her through it and take her through breathing exercises, but they did no good—how could they? Julie was in a clammy sweat; she was worried that she would pass out. She was asked whether they could continue, and she was so worried about the ultrasound findings, and the last six months’ wait, that she said they could. A second attempt was made. Julie simply could not hold back her tears, or even breathe, through the terrible pain. Thankfully, the nurse asked again whether the procedure could stop, and Julie could say nothing but yes.
Afterwards, Julie was terribly woozy. She was wobbly, and scared that she would faint and fall. She was well cared for at that point—given pads for the bleeding and hot packs to help with the severe abdominal cramping. She lay in the recovery suite for about an hour, crying. Even after that, she was disassociated, trembling and struggling to walk. I remind hon. Members that she is 71 years old. She is truly lucky that she did not fall and break something.
Another woman who wrote to me was so overwhelmed by the pain of her hysteroscopy without pain relief that she fainted and fell from the full height of the operating bench to the floor. After that, she was left with not just serious bruises but lasting dizziness that has led to repeated falls and broken bones. It has physically affected her so badly that she has found it hard to stay in work for the very first time in her life.
In some ways, Julie was lucky, but the lasting impact on her was still significant. She vomited, and when she got home she continued to bleed for more than a week afterwards. She describes herself as stoic. She has had several surgeries before, and she lives with serious arthritis, so she is no stranger to pain. In her words, what she went through was “a brutal, torturous experience”.
The shameful truth is that at no point was Julie offered any form of pain relief at all. She only heard that a hysteroscopy was even a possibility while lying on the examination table with her legs up in stirrups. It is frankly a miracle that she was not so traumatised as to lose trust completely in the NHS, but she has since been back. She has had another hysteroscopy under general anaesthetic and found it an utterly different experience. All the procedures and risks were explained beforehand, and she had outstanding care throughout.
While Julie was in the waiting room for the second, successful hysteroscopy—this points to how commonplace this experience is—she met another woman whose experience was just like hers. The other patient was just as upset, but said she would not make a complaint because she felt she would just be ignored, and that would make her even more stressed. Sadly and understandably, most people who have had similar terrible experiences with the procedure are like the woman Julie met. We never hear their stories.
Let me offer some more testimonies to give voice to those whose pain and distress were completely ignored. Martha was seriously injured during her hysteroscopy last August. She went in for a check-up after she had bleeding for several days after starting hormone replacement therapy. Her GP referred her for the hysteroscopy, but although he explained some of what the procedure would involve, he was, in Martha’s words, “blasé”. He showed absolutely no understanding that Martha’s medical history and conditions made extreme pain and damage much more likely. When the procedure began, Martha described the pain as “excruciating”—exactly the same word that Julie used.
Martha screamed out, “No, no, stop,” repeatedly, yet when the doctor looked at her, he looked very unimpressed. He asked her whether she would rather he stopped so she could come back and have it under general anaesthetic. She said yes, but instead of listening, he insisted that he have more time—just 30 seconds. He went in again with a smaller scope, but again it caused searing pain.
After the procedure, Martha understandably felt violated, but sadly that was far from the end of her ordeal. She had burning pain for weeks, mixed with a loss of feeling in her groin. She developed repeated bladder infections and double incontinence, and her muscles started wasting. She had difficulty standing and walking. Eventually, Martha was told that she had post-operative nerve damage. To put the cherry on the cake, I understand that the doctor who did this to Martha recorded her pain score as just one out of 10. To me, this sounds very much like fraud—on top of sheer callousness, absolute incompetence and indifference.
Martha describes herself as a fiercely independent woman who does not suffer fools, but she told me she had the overwhelming feeling she had been duped and made a fool of. She says she has always trusted professionals, but never, ever again. She is reeling because the NHS that she supported for decades
“managed to injure me and cripple my life, take my self-respect and my confidence in under 15 minutes.”
Martha tells me—I think she might be right—that the next great women’s health scandal after mesh implants will be this.
I am really appalled, and I want to raise a point with my hon. Friend. The situation Martha found herself in is happening up and down the country. A constituent who was due to have a hysteroscopy examination at our local hospital in Salford was told the same thing as in the stories my hon. Friend is telling: “Local anaesthesia can be given if necessary” and “Take paracetamol one hour before.” However, this constituent had a family member who had had a hysteroscopy in a private hospital and was offered a general anaesthetic because the procedure was “too painful” to be performed in any other way. So the NHS patient in a private hospital is offered a general anaesthetic, but the one in an NHS hospital is not. When I wrote to the hospital on my constituent’s behalf, I was told:
“a general anaesthetic can be requested, though the medical team advise against it.”
There is a key question that I want to put to my hon. Friend. It is all right to say that the procedure can be stopped or carried out later, but does she believe that the information given to patients is wrong and that that is not acceptable care?
I agree with my hon. Friend that there is a massive lack of information. I am sure there is a difference between private and public health in this area, but a friend of mine went to a London hospital and asked whether she could be given a general anaesthetic. The answer she got was, “Of course. Do you think we’re barbarians?” There is different practice in different NHS hospitals, and a different understanding of the kinds of issues we face.
I think we all know the upshot of these kinds of experiences: women will end up too afraid to get procedures that they need to have. It will impact on their long-term health prognosis. It will cost the NHS more in the future, as it has to play catch-up on diagnosis. As we know, hysteroscopies are really important. They can be used to rule in or out cancer and a host of other important conditions, so women have to be confident about having them. They need to have them, and they need to know that they will not experience what Julie, Martha and so many more women have experienced.
The survey being run by the Campaign Against Painful Hysteroscopy has had over 3,000 responses and counting. Despite that, and despite all the individual stories I receive and raise in Parliament, we simply do not know how widespread the problem is. I am afraid that the reason might be that the NHS really does not want to know, because knowing would strengthen our calls for change and for all women to be treated with respect, to have their pain taken seriously and to be given accurate information and genuine choice. For that to happen, I believe that the Minister has to engage with this issue personally and dig a bit deeper to ensure that accurate and appropriate data is being collected and analysed. We also need independent oversight. I beg the Minister not to be content when, inevitably, the medical profession says, “It’s fine” and “Action is being taken,” because, frankly, it has been 10 years, and we have heard it all before.
I am sure the Minister will remind us about some of the campaign successes, such as scrapping the best practice tariff, which until very recently financially rewarded NHS trusts for doing hysteroscopies in out-patient environments, where proper anaesthetic is not possible. Sadly, that drive for more cheap, quick hysteroscopies, regardless of the risk to women’s health and wellbeing, is still going strong. The target of 90% of hysteroscopies to happen within out-patient rooms has emerged again in a new NHS programme, which, ironically, is entitled “Getting It Right First Time”. I can tell the Minister that if women continue to be pushed into hysteroscopies without proper care, the NHS will not be getting it right first time at all. Instead, more women will endure pain for no reason at all during unsuccessful procedures, and they will then have to repeat those procedures under general anaesthetic.
It appears that the target of 90% is the brainchild and objective of the British Association of Day Surgery—well, I am sure there is no vested interest there. It is frankly alarming that we have a clinical lobby group advocating, effectively, against women having a genuine choice over the pain relief they need when they have a hysteroscopy. What is worse is that I understand that some private companies are promoting their no-anaesthetic out-patient procedures within the NHS by bragging that hospitals can save up to £1,000 per patient. You could not make it up. Clearly, there are some very influential people who do not want this campaign to succeed and who prioritise saving money—or making money—over women’s safety from pain and trauma.
I know how busy the Minister is, but we ain’t going to be successful in our campaign for pain-free hysteroscopies without Government leadership. I was pleased to hear last night that the Minister’s office has contacted the campaign group offering times for a meeting. That is good news. I strongly agree with some of the Minister’s words in response to one of the anonymous women whose cases I have raised today. Let me quote the Minister:
“It is clearly important that women are offered, from the outset and as part of the consent process, the choice of having the procedure performed…under general…anaesthetic.”
I ask the Minister to emphasise that point today, because women cannot give truly informed consent unless they have had a full discussion—including a discussion of their individual risk factors and a choice of anaesthetic—from the very start. In my view, that means that Julie, Martha and so many others have had a surgical procedure performed on them without consent. I am sure we would all agree that that is very serious indeed. When the Minister responds, I hope she will commit to treating this issue as a high priority for women’s health. We do not want women to be bullied when they go into the NHS for treatment.
We are eagerly awaiting the publication of the good practice paper from the Royal College of Obstetricians and Gynaecologists, and other new guidance—I had hoped to have it yesterday in order to inform this debate. I understand that the draft paper recognises that fully one third of women report pain scores of between seven and 10 out of 10. That clearly shows that we need a massive change. The need for real choice cannot just be in guidance; it also needs to be enforced.
Based on the recent stories of women that I have told today, in many cases we are seeing brutality instead of best practice. Women are being violated and betrayed. Their trust in the NHS and medical professions is completely undermined. Surely that cannot be a legacy that the Minister, or the Government, want to leave behind.
It is a pleasure to serve under your chairmanship, Sir Mark. I wish I could say it was a pleasure to follow the hon. Member for West Ham (Ms Brown). I have genuinely enjoyed working with her on this subject for quite some years. But it is not a joy to follow her in this debate, because it is frustrating that we are still having the same discussion. It feels like groundhog day; it has been four years since I ceased to be the Minister responsible for this issue.
The hon. Member for West Ham reminds me that I started the moves towards the women’s health strategy, and established the women’s health taskforce, exactly because of the stories that she tells. It was very clear to me, when I started to look at this subject, that ultimately all the female Members of Parliament who are present have had terrible experiences at the hands of the NHS. We are very good at looking out for ourselves. If that has happened to us, then it is something that is being repeated for women up and down the land. It is something that we must address properly.
At the heart of what the hon. Member for West Ham is talking about is the principle of informed consent. Informed consent is the underpinning principle of our NHS. The stories that the hon. Member has outlined this afternoon show negligence around consent. They show women being referred for what is an investigatory procedure, not a treatment, without any proper consideration as to what they need to understand before consenting to such a procedure. The truth of the matter is that women find themselves undergoing a procedure in terrible pain before they even know what is happening to them. In 21st-century Britain, that is not acceptable.
We have made a lot of progress on centring women when we look at health, and ceasing to treat them as walking incubators for babies. We are human beings and we need to have our needs properly considered when we consent to treatment. We now have a women’s health strategy, which shows we have made some progress.
However, the hysteroscopy procedure has not received the attention that it deserves. Although two thirds of women who have the procedure go through it with less pain than in the cases we have heard today, a third of women experience terrible pain. That this is not properly explained to them is appalling. I have heard cases where women are just told to take some paracetamol before they go in and there will be no problem. For those women who do experience pain, as the hon. Member for West Ham has outlined, it is very severe. We must ensure that we have proper, well-understood protocols that govern how this procedure is managed, and how women are engaged in it.
The hon. Member for West Ham draws a parallel with mesh implants, and I think that is absolutely right. Again, the issue of informed consent was missing in many of those cases. We found that the mesh treatment was being routinely recommended to women after childbirth, women were not having any risks explained to them, and then, low and behold, they were suffering debilitating problems for the rest of their lives. As we roll forward with the women’s health strategy, we must stress-test exactly how much information we are giving to women, so that we can make informed consent an absolute reality.
The truth is, our wombs are not just here to incubate babies; they are part of us. The women here will have all had to go through invasive examinations internally. They are not very nice experiences. I do not know about anyone else, but when I have to do that I have an out-of-body experience where I zone out of what is happening to me. These women cannot do that, because they are suddenly visited with terrible pain. They cannot zone out of the fact that somebody is fishing around between their legs; they are living that, and that is an absolute trauma—a trauma that will stay with them for the rest of their life, notwithstanding the other side effects that they experience.
The women’s health strategy has alluded to some of those aspects, but I do not think it has taken up the issue with sufficient seriousness. It talks about the need for conversations about pain relief before a hysteroscopy procedure, but it needs to be a lot more than that: people need to be given sufficient information to enable them to decide whether or not they even want that examination. As many as 10% of women suffer with problem periods, fibroids and the kinds of conditions that would lend to them having such an investigation, but we need to be able to make that informed choice—“Is it really going to make a difference?” Frankly, if you are 71 years old, what difference is it going to make? All it is going to do is establish the cause of the bleeding. You might be better off managing that condition, because if there is going to be no end of treatment following the hysteroscopy, the whole thing is absolutely pointless, with a substantial degree of risk.
I am pleased to hear that the Royal College of Obstetricians and Gynaecologists is updating its best practice guidelines. I ask the Minister to consider inviting the women’s health ambassador, Lesley Regan, to carry out a proper stress test of everything around this issue. I had the pleasure of working with Lesley when I invited her to co-chair the National Women’s Health Task Force: she brings considerable expertise, including as a gynaecologist who is a woman. The truth is that far too many gynaecologists are male, and with the best will in the world, I do not think they are ever going to understand, let alone care about, the degree of pain that is being administered to their patients. I am really pleased with that appointment: Lesley is a fantastic advocate for women’s health, but I would like her to look at this issue properly so that we have a good set of ideas, advice and principles to help women make informed choices, and to make the medical profession understand exactly what difficulty this procedure involves for some women.
I invite the Minister to put that advice alongside some advice about healthy periods generally. Women need to be encouraged to take ownership of their gynaecological and menstrual health, but again, they can only do that with sufficient information. We will not avoid situations where women rock up to hospital for an appointment and, the next thing they know, find themselves on the trolley in stirrups without properly understanding what is happening to them unless everyone understands what good menstrual health looks like; what the alert factors are for some of the conditions that might invite a hysteroscopy examination; and what potential treatment might follow.
The hon. Member for West Ham has outlined the painful experiences that some people have had, but we all need to understand exactly what is involved in a hysteroscopy. It is an internal examination of the womb, which is undertaken by the insertion of a camera through the cervix. We know from the evidence that the hon. Lady and I have examined that women who have not had children are particularly affected by pain. If we think about what that procedure involves, it seems like a no-brainer that women who have not had children would suffer more pain, so again, I cannot get my head round the negligence with which women are referred for this procedure without proper consideration of the pain involved.
I want to emphasise this aspect of the issue, based on what I was told by my constituent: the leaflet did not mention that the procedure can be stopped if the patient is unable to tolerate it. Can the hon. Lady think of another medical procedure that is run without anaesthetic on that basis—that it can be stopped if the patient cannot tolerate the pain? There are not many other examples.
No, and the interesting thing is that, in theory, a patient should be able to stop anything. That is what informed consent should be about. Again, it illustrates the relationship that we have with our health service. We naturally defer to medical professionals. We assume that they know better than us, and perhaps that is where we need to alter our relationship. These are human beings; they are not gods.
We need to be empowered to take more agency and ownership of how we approach these things. Listen to the description by the hon. Member for West Ham of Julie removing her hearing aids: there is no way that she was in control of that situation. How can a patient make informed consent and have the ability to stop something that is causing them significant distress and trauma in those circumstances? As I mentioned, it is extremely painful, especially for those women who have not had children.
We know that some women are just told to take paracetamol before they arrive, and there is a massive discrepancy from organisation to organisation when women try to exercise their ability to choose whether they have a general anaesthetic. In some cases, women are told that that is not really the best thing for them; in others, as we have heard, that elective choice was made quite easily. To me, that brings a real worry that too many in our medical establishment are not giving their patients the respect that they deserve. That is something that we really need to change in the culture of our NHS. It is all about behaviours, ultimately; we need to look at how we can encourage better behaviours towards patients throughout the system.
In the short time that I have left, I will make some specific asks of the Minister. I have mentioned that I would like her to invite Lesley Regan to properly stress-test this, but we need a proper risk assessment tool for each woman undertaking the procedure, so that both they and the medical professionals they are dealing with can make an informed choice on whether they are more or less likely to suffer the substantial pain that has been outlined in the debate. I also invite the Minister to consider the work of Baroness Cumberlege in “First Do No Harm”. One of the themes running through that work—and again, I mentioned mesh earlier—was the absence of informed consent. One of the conclusions we drew was that we need a proper patient’s voice to be able to stress-test those incidents where there is widespread poor practice in the NHS.
Ultimately, the NHS is a producer-driven system. We have care pathways that are very much process driven and not practitioner or patient driven, frankly. We must help practitioners to help themselves by empowering patients, because they need to have that mutual understanding on the same level. I invite the Minister to consider properly the establishment of a patient commissioner so that we have somewhere to refer these incidents of widespread poor practice.
We have outlined today the serious harm being done to women put through the procedure without appropriate care. That is doing real harm, and if we are going to have an NHS that works for all patients, we need to address incidents such as this extremely quickly.
I am grateful, Sir Mark, for the opportunity to speak in the debate. I thank the hon. Member for West Ham (Ms Brown) for raising the issue and, as she so often does, setting the scene so well. She has had a number of debates on this—some of them were Adjournment debates in the Chamber—and on every occasion I have been there to support her. I will come on to explain why I support her and what she is trying to achieve. I thank the hon. Lady for her contribution, and I look forward to the contribution of the hon. Member for York Central (Rachael Maskell); I thought I was going to follow her, but today it is the other way round. I very much look forward to the contributions.
Over the years, the hon. Member for West Ham has done her bit to secure debates on raising awareness of issues surrounding hysteroscopy treatment. As my party’s spokesperson on health, it is always a pleasure to be here to support her and her requests. The hon. Lady pushes these requests with perseverance and dedication, and I recognise that in supporting her. We look to the Minister for a positive response to what she is asking for. She has always made her requests in a way that is direct but never nasty, and with determination, which I support.
Many women have contacted my office about issues relating to this procedure that have been going on for years. It is great to be here to add my support to the requests of the hon. Lady and others. I have spoken in these debates before, and I am always shocked at how common these issues are. There have been countless reports on issues such as anaesthesia and pain relief, to the extent that all Health Departments across the devolved Assemblies have taken formal action.
I always try to give a Northern Ireland perspective to these debates. Back home, the then Minister of Health Robin Swann provided an overview of guidance currently followed in Northern Ireland for hysteroscopy procedures, referring to information provided by the National Institute for Health and Care Excellence and the professional guidance produced by the Royal College of Obstetricians and Gynaecologists. He stated that there was a need to
“write to the HSC trusts in Northern Ireland to highlight this guidance and remind the service about the importance of the consistent application of the guidance.”
The Cumberlege report plays a role in this area too, and the hon. Member for Thurrock (Jackie Doyle-Price) referred to it. The purpose of the report was to make recommendations for improving the healthcare system’s ability to respond to the issues that women have been having with hysteroscopies. The hon. Member for West Ham set the scene well and with thoughtful consideration with regard to the guidance. According to the Campaign Against Painful Hysteroscopy, at least 70—or 35%—of women who have had hysteroscopies this year in English NHS hospitals said they were left in extreme pain following their procedures, with many suffering trauma for several days.
The reason I am here is simple. My wife went through one, and the hon. Member for West Ham knows that. I am here to support my wife, first of all, but also to highlight from a male point of view why I think this is so important and why the hon. Lady is right in what she asks for. Before my wife and I got married, my wife had had some problems, and the doctor—who was lovely, by the way—said to my wife, “You know, Sandra, when you get married and have children, things will be okay.” Well, they were not okay. The years went by and after three children things became worse. I believe it is important that I stand here in support of my wife and other women across the United Kingdom of Great Britain and Northern Ireland.
In a world of many technological advances, we can do more to ensure that pain relief is available and pain is kept to a minimum. The hon. Member for West Ham illustrated that well in the example that she gave. No one could have any doubt whatsoever as to exactly what was happening and why that 71-year-old lady had to endure what she endured. The Royal College of Obstetricians and Gynaecologists has been in touch with my office ahead of this debate. I am always thankful for its input, as I believe it gives a real insight into the problems that are occurring and backs up evidentially what others have said. It has raised a valid point that is often left out of the argument—that the fear of pain puts women off these procedures completely. I believe it probably does. From looking at the evidence and hearing the stories, my goodness me, would someone not be scared? That is it.
Hysteroscopies are used to detect and diagnose a range of conditions and symptoms, such as pelvic pain, repeated miscarriages—which are a reality as well—excessive bleeding, fibroids and polyps or cancerous growths in the womb. It has to be underlined that hysteroscopies are a possible life-saving tool. Unfortunately, the risk of pain puts many women and girls off, which increases the likelihood of problems in later life. The best thing we can do is get the conversation going. The hon. Lady has done that consistently over the years. I want to continue that conversation, so we can ensure that sustainable pain relief is readily available. I hope today we get a positive response from the Minister.
I want to conclude by thanking the hon. Member for West Ham—I mean this genuinely—for her valiant efforts in raising this issue. She has raised awareness of consent, choice and effective communication in this matter, and it is clear that existing provision falls down on all three. It has to get better, as the backbone of many procedures and especially those more intimate procedures where younger women may feel scared and even unsupported. For the mainland and the devolved Administrations, there is more to be done in safeguarding and implementing efficient practice for hysteroscopies and other intimate treatments for women.
I look forward to what the Minister will say in response to the debate. I know that she understands these matters very well and I think the response will be helpful. Again, we look forward to improvement, which is what we ask for. We need to see that process starting today in Westminster Hall.
It is a pleasure to serve under your chairmanship, Sir Mark. I thank all hon. Members for their powerful contributions.
Jan was not one to make a fuss and had never written to her MP before. The fact that she felt impelled to do so is testament to how awful her hysteroscopy was; it motivated her to do everything in her power to prevent other women from suffering the same trauma, despite facing the prospect of terminal cancer herself. Jan sadly died two years ago this week. Her husband came to my surgery last autumn and asked me to take up this work, informing me of the work my hon. Friend the Member for West Ham (Ms Brown) was pursuing. Knowing her as I do, I know that she will do everything possible to speak up for women and ensure they are heard.
It was 16 November 2020. My constituent was terrified. She had discussed the process with her medical friend, who advised her to tell clinicians on arrival. She did, but was met with derision and disdain. The official guidance says:
“If you feel anxious about the procedure, you should talk to your healthcare professional before your appointment.”
She wished she had not. My constituent was there for an examination of a possible cancer of the uterus. She was naturally very concerned. She did not want to have to delay a diagnosis for the sake of waiting for a general anaesthetic. She was not informed that she could have a general anaesthetic; it was just her own research that took her to that place. She was told that it could be another two to four-week wait. As we later found out, that would have been a significant period of the rest of her life.
Jan went ahead but nothing prepared her for the pain she was about to experience. She had had no pain like it. Even having given birth vaginally three times with little or no pain relief, she could not comprehend the pain that she was about to experience. The clinician did not stop and did not seek to know her pain level until she was in so much pain that she could not speak. She was trying not to pass out; she was trying to stay conscious. When she was asked, she could not respond. I must say that when I heard the story from her husband, I sat there thinking, “This is assault.” There was no informed consent.
As we know, a third of women experience significant pain in this procedure, although research is poor. Options are not clearly communicated to women and women’s voices are simply not heard. If a third of women are experiencing significant pain, that means the majority are experiencing some level of pain. It is beyond my comprehension why women have to experience pain at all. As we have seen in the “First Do No Harm” report, which many have raised today, the voices of women in healthcare are simply not being heard. We can all reflect on our own experiences of being dismissed—that it is nothing and there are clearly other more important things to deal with. It is simply not good enough. A woman’s voice is disappearing in our health service; it needs to come to the fore and today’s debate will do that.
That was not the end of the story. We sought a review of the case and the department lead carried one out. The review said that there was consultation and listening, but that was a very different story from Jan’s experience. Ultimately, the outcome did not change the situation, but women will be going through that process every day, and we therefore have to change the situation all together.
We have a women’s health strategy. We need to ensure that the woman’s voice is heard in our NHS, because Jan’s was not. Constant verbal feedback is so important when going through any procedure. A clinician should be constantly looking, watching, seeing and understanding their patient. That clearly did not occur. Of course, the clinician should have stopped, but they never should have started. It never should have got to that point.
The way in which patients are counselled for this process needs to be completely re-examined. Having a general anaesthetic should not just be posed as an option, but perhaps be suggested as the most pain-free way of having the procedure. There are other things available, for instance a local or regional anaesthetic, or—if a woman dares or is ill-advised—just an analgesic, but we should focus on ensuring that this is a pain-free procedure for women. But that is not what is advised; that is not the target. It is a target that is driving this experience as well, and it must be removed all together.
Like many areas of women’s health, this is a massively under-researched area of medicine. Can the Minister commission research into hysteroscopies, particularly in post-menopausal women? A doctor came to see me to talk about how the cervix changes as people get older. It can cause tightening, meaning the procedure is even more difficult for older women. Therefore, carrying out proper research to understand the changes within the body would seem completely appropriate before the procedure continues, particularly for older women.
In conclusion, we have talked about the need for women to be heard in the health service, but we need to gather that. I hear about the work that is being undertaken, but as we were saying in response to the “First Do No Harm” report, there should be proper logging of who has been through this procedure. We should seek out that voice, because we may see a different reflection of what has happened. In Jan’s words, the experience left her “deceived, patronised and betrayed”. That is simply not good enough for our NHS.
It is a pleasure to serve under your chairmanship, Sir Mark. I thank my hon. Friend the Member for West Ham (Ms Brown) for securing this debate, and for her tireless campaign on the matter. It has been 10 years with almost 10 debates, and she is still going. Numerous Ministers have committed to making this a priority. As we have heard, there have been some improvements, but nowhere near enough to make a difference to the lives of women. I praise the incredible contributions from the hon. Members for Thurrock (Jackie Doyle-Price) and for Strangford (Jim Shannon), and my hon. Friend the Member for York Central (Rachael Maskell).
As we have heard, a hysteroscopy is a procedure used to examine the inside of the uterus. It involves dilation of the cervix, sending fluid into the uterus to expand it so clinicians can examine the uterus and the fallopian tubes, and the use of surgical instruments to examine the inside of a woman. It is an essential tool for diagnosis and treatment of many conditions affecting women, including unusual bleeding, pelvic pain, recurrent miscarriages, difficulty getting pregnant and many more. When I had my hysteroscopy, I had had several miscarriages and I was desperate for a baby. When I was offered this procedure for further investigation, I read every side of the leaflet and looked into it. Not only did I take paracetamol; I took ibuprofen, to ensure that I did not have the “little discomfort”.
I turned up and there was a lovely nurse, who was very softly spoken. A nurse stands next to the patient to talk them through it, and holds the patient’s hand. If it is a “slight discomfort”, the whole process of having someone standing there trying to be a guide through it, is worrying. It is the most excruciating thing anyone can go through. It may have been a 10 on the scale. I do not understand how even slightly lower than that could be acceptable for any human being.
I was asked things and the nurse kept talking to me, but I could not respond. I was in so much pain. Because I was so desperate for that baby, I would have walked over broken glass with bare feet. I did think about continuing through the pain, but luckily I passed out and the procedure ended. It is not acceptable in this day and age that women have to go through that level of pain for healthcare.
I thank the hon. Member for sharing a very personal story. She lands an important point. When women are desperate to fulfil the urge to give birth to a child—a deeply biological impulse—they will go through anything, as she rightly says. Does that not tell us that the degree of pain we are aware of could just be the surface?
I wholeheartedly agree with the hon. Member. It develops a level of acceptance, which is not right or acceptable. Hysteroscopies are paramount to women’s health, but we have heard horrific accounts from my hon. Friend the Member for West Ham of women’s experiences of having the procedure. That should never have happened to women, and those women affected are right in their fight for justice. There is a lack of information or no information about the choice of pain relief available before, during or after the procedure. Paracetamol is not enough. There is an assumption that the patient will experience only discomfort—in my case, it was slightly more than that—despite some women experiencing intolerable pain. If they do experience that so-called discomfort, the assumption is that it does not matter because it is only short lived.
It is astonishing that the NHS still does not collect data on the number of women who experience severe pain during hysteroscopy. However, the Campaign Against Painful Hysteroscopy, which does undertake surveys of women, has found that more than 90% of women surveyed were traumatised for a day or longer by the pain. Three quarters said they were not aware of pain management options before the procedure was carried out. In 2020, half of NHS hospital trusts in England failed to warn patients that they could suffer pain. Women are simply not given the information they need to make informed decisions, which must include information on potential pain, options for pain management and alternative procedures. Let us be clear: a woman should not have to experience excruciating levels of pain to access essential healthcare.
As we have heard, the national tariff creates an incentive for hysteroscopies to be carried out as an out-patient. We cannot deny the obvious advantages of out-patient care. For example, it allowed women to access hysteroscopies more easily during covid, and can reduce the time women have to wait for diagnosis and treatment, but it does not allow for patient choice and patient voice. Some 61 out of 131 NHS trusts admitted to the Campaign Against Painful Hysteroscopy that they did not warn patients about the risk of severe pain, and this could lead to unnecessary pain for women. Informed consent, choice and effective communication is not the norm when it comes to women’s health; it is barely there. That cannot and must not continue.
While some women are left in excruciating pain, some women hear those stories and decide not to have the procedure—I am not sure which is worse. No woman should feel discouraged from attended a hysteroscopy appointment for fear that they could experience pain, because, as mentioned earlier, hysteroscopies are an essential tool in diagnosis and treatment of women’s health.
The Royal College of Obstetricians and Gynaecologists’ guidance states that all pain relief options should be discussed with women. I welcome that those guidelines are being updated, but the clinical guidance currently in use is over 10 years old. Today is not the first time Ministers have been made aware of the seriousness of the issue for women, so why did the Government not ask for the guidance to be updated sooner? Will the Minister tell us what she is doing to ensure that the new clinical guidance will be in place as soon as possible, for all clinicians to use? We must ensure all women have access to the pain management they are entitled to. How is that being monitored, because it does not seem to be happening currently?
Improvements in hysteroscopy care are included in the women’s health strategy, which was published late last year, as the hon. Member for Thurrock mentioned. The Minister is responsible for the women’s health strategy, and it is her ambition that women and girls report better experiences of procedures, such as this one. However, the Minister’s letter, setting out her year 1 priorities, which she sent around last week, did not mention hysteroscopies. How many women will continue to have the procedure in pain, or not at all, as a result of it not being considered a priority? Will the Minister explain to us, and to all those women who face having the treatment, why it is not considered a priority?
Finally, painful hysteroscopies are just another iteration of no care being given to women and their health. Yet again, women have been given empty promises of improved care. How many more stories must we hear about women in unnecessary pain? How many more times must we hear that women are not listened to in healthcare settings? And how much longer must women wait for the healthcare they so desperately need?
It is a pleasure to serve under your chairmanship, Sir Mark. I congratulate the hon. Member for West Ham (Ms Brown) on securing this important debate. As Minister, I also responded to her debate on the subject last year and I recognise her campaigning on the issue.
First and foremost, I recognise the pain suffered by women during the hysteroscopy procedure. Many women have contacted me to share their stories and distress. The testimony of the shadow Minister, the hon. Member for Enfield North (Feryal Clark), was powerful in explaining the distress the procedure can cause.
We have seen some progress around the tariff issue, which I will touch on later in my remarks. Last year, the tariff system financially rewarded out-patient settings that undertook hysteroscopies, but that has changed. However, I take the point made by the hon. Member for West Ham about getting it right first time. I may be doing the same with a new initiative, so I will certainly commit to looking at that.
We heard about patients such as Julie, and about how, right from the very start, an appointment letter is sent out that does not provide information about what to expect or the choices that are available. We heard about the procedure itself, including what pain relief is given, and the need to give women informed consent—they can have a general anaesthetic or ask for the procedure to stop. Another 30 seconds is not the answer to “stop”, and that would be my first concern.
My hon. Friend the Member for Thurrock (Jackie Doyle-Price) made a valid point about why the procedures are being done in the first place, and the testimony of Martha lends itself to that. Bleeding after HRT is very common for the first three to six months, and it is usually only after six months, or if there has been bleeding after long periods of non-bleeding, that perhaps an investigation could be considered. My hon. Friend pointed out that sometimes we carry out the procedure where there is not necessarily a clinical case for it. Both the procedure itself and the reason for it need to be justified in those cases.
As the shadow Minister said, hysteroscopy is an essential investigative tool. We do not want to put women off coming forward for diagnosis of their conditions or for investigations into distressing problems—whether it be heavy periods, miscarriages or difficulty getting pregnant—but it is true that women’s experiences of pain, and sharing those experiences with friends and family, can put women off or prevent someone from coming back for treatment or further investigation. Many women experience little or no pain, but the percentage that do experience pain is of significant concern.
The hon. Member for York Central (Rachael Maskell) highlighted the experience of Jan and the sheer scale of her pain. That was very powerful, and I reiterate to Jan’s husband, Steve, that her voice has been heard very powerfully in the debate. I am keen that we make progress on the issue, because we, like the hon. Member for West Ham, who comes on an annual basis, have been talking about it for far too long. I am keen to meet with the Campaign Against Painful Hysteroscopy group, and hope to do so fairly soon, to discuss how we can take the issues forward. A general anaesthetic can be used in some circumstances, but there are also a range of other anaesthetics—it does not have to be general anaesthetic—to make the procedure less painful.
For most women, the first issue is choice, having information about what to expect up front and being able to make a decision based on that. That needs to be done in advance of the procedure and not, as my hon. Friend the Member for Thurrock described, when your legs are in the stirrups. That is why the guidance is so important. The Royal College of Obstetricians and Gynaecologists provides evidence-based guidance. It is old, and it is being updated. My understanding is that RCOG is producing a good-practice paper on pain relief and informed decision making for out-patient hysteroscopy that will be published imminently— I understand in days rather than weeks or months. I committed in the debate last year to wait for that, and I hope that it will be through fairly soon. If we can get those good-practice guidelines, it is essential that they are rolled out in practice.
I do not really know how to phrase this, but part of the problem is that, as we have heard, gynaecologists are basically being utterly insensitive to the needs of the women they are treating. My anxiety is that we will be told, yet again, that it is all okay, and that they have changed this or tweaked that. But the stories that we have heard today are from this year, so there has not been change. I am not sure whether we will be able to manage change unless the Minister is quite firm about the actions that she wants to see.
I very much take the hon. Lady’s point. The change to RCOG guidance is not the only way we will change this. The hon. Member for Strangford (Jim Shannon) highlighted his wife’s experience, which also shows why this is so important. The royal college is important because it can bring clinical change on the ground, but it is not enough just to assume that its updated guidance will be enough to change what happens in practice. Its current guidance already sets out that a leaflet should be provided with information about what a hysteroscopy is, what happens, and what the possible risks and alternatives are, but that does not always happen. Women can choose whether to have their hysteroscopy in an outpatient setting or have a general anaesthetic and come in as a day case. They do not always get that leaflet now, so just changing the guidance does not necessarily mean that we change the practice, and that is the key.
It is important that women are in control when it comes to hysteroscopies, which we are talking about today, and many other issues that we have debated. That is the fundamental principle behind the women’s health strategy, which we introduced because women are very often not listened to in all aspects of their healthcare.
The hon. Member for Enfield North touched on the top priorities for the first year of the women’s health strategy. The reason that hysteroscopy did not make that list is that we want to wait for the guidance before we act, but it will be a high priority, and work is starting this year.
One of the key priorities is to provide better information to women and girls about their health. We are setting up a space on the NHS website for women’s health so that women who are going for a procedure have go-to information. If they are thinking, “I don’t know what a hysteroscopy is. I don’t know what sort of tests I need. I am going for an ultrasound, but what else might they suggest to me while I am there?” they can go to that site and get reliable information that will help them make that decision. If they are not sent a leaflet and the procedure is not discussed in the clinic, they will be able to know in advance what to expect. We want that to happen this year so that women have more power when making decisions about their healthcare needs.
Waiting times for gynae procedures have not come up much today, but we know that the covid pandemic has had an impact on them. Gynae procedures are part of the elective recovery plan, which is why we are investing in community diagnostic centres to get those waiting lists down as quickly as possible. It is hoped that by having specialist centres such as community diagnostic centres, which are specialists in doing diagnostic tests, we may be able to improve women’s experience.
One of the things that will make the greatest difference is the appointment of Professor Dame Lesley Regan as the first women’s health ambassador—my hon. Friend the Member for Thurrock mentioned her. She is a female gynaecologist, and she completely gets the issues facing women. We also now have the patient safety commissioner, Dr Henrietta Hughes, who was appointed last year. She is a female GP. Dame Lesley has been passionate about this issue for many years and has been working with women’s groups on it. I have asked her and Dr Hughes to discuss hysteroscopies. They are planning a roundtable on the issue to get stakeholders round the table to discuss how we can make things happen in practice. If guidance is issued, how do we make sure that is what is happening on the ground? The roundtable will be chaired by Dame Lesley, and the patient safety commissioner will be attending. I will update Members on their recommendations, which I will take extremely seriously, and I will want to implement them as quickly as possible.
Absolutely. Dame Lesley has been very keen in some of her first work to ensure that we go out to women, rather than expecting women to come to us with their experiences. Often, if we wait for them to come to us, it is the usual voices that get heard. The people who have the greatest difficulties accessing healthcare are often the ones who get missed, so I can absolutely reassure the hon. Lady about that.
That is why we are setting up women’s health hubs, which are a particular priority of the women’s health ambassador. They are go-to one-stop shops that have experienced women’s healthcare professionals. If someone is going for a smear test, contraceptive advice or perhaps a hysteroscopy, there are experienced practitioners there who can support women’s health needs and perhaps give a better experience than many women have now. We hope to improve women’s experience in those areas.
I say to the hon. Member for West Ham that I absolutely recognise the significance of this issue. It is unacceptable that a test that is so important for women’s health is currently such a painful experience. We changed the tariff in the hope that it would encourage the use of general anaesthetics if that is what women want, because we felt that the previous tariff system worked against that. However, I am really keen that we deliver changes on the ground once we get the royal college guidelines and the roundtable with Professor Dame Lesley Regan and the Patient Safety Commissioner, who are there to advocate for women and patients. I hope that will be within the next few months, and I am happy to meet the hon. Member for West Ham, as I will be meeting the patient campaign groups too.
We can change this behaviour. A woman who is having a hysteroscopy should know in advance what is involved and what her choices are. She should feel confident that if she turns up for her appointment and finds it uncomfortable, which she was not expecting, the procedure can be halted and a separate appointment can be made swiftly to make sure that the procedure is as comfortable as possible. I hope that gives some reassurances that I absolutely take the seriousness of this issue on board, and that we want to make a change and a difference for women.
We have had a really good debate this afternoon about the serious harms to women, the lack of respect and the lack of regard in this area of healthcare. I am really grateful to all the contributors, including the hon. Member for Thurrock (Jackie Doyle-Price)—we will march on with this one, I am sure. The hon. Member for Strangford (Jim Shannon), who has been at many of these debates, offered his support. My hon. Friend the Member for York Central (Rachael Maskell) shared a story that I recognise, which was tragic and sad. My hon. Friend the Member for Enfield North (Feryal Clark) did not tell me about her personal experiences before the debate—how brave and amazing that she stood up and told us all. I am genuinely grateful for that.
I think we all agree that we need informed consent, individual risk assessments and compassionate care in our health service. We need proper and independent research into the actions that are being taken, and we need action. We do not need to be back here in a year’s time, with me reading out people’s stories again, and we certainly do not need to be led in this debate by those who seek to profit from women’s pain.
I say to the Minister that the gynaecologist who saw my hon. Friend the Member for Enfield North was a woman. A few years ago, the gynaecologist who tried to talk me—a childless woman with a frozen cervix—into a hysteroscopy without an anaesthetic was a woman, and I worry that the idea that this is a pain-free procedure is somehow baked into the gynaecological community. However, I express my gratitude to the Minister for offering to stay in touch on this issue. Hopefully, we can get some resolution to the betterment of women’s health generally in the country.
Question put and agreed to.
That this House has considered the matter of NHS hysteroscopy treatment.
Smaller Musical Genres: Scotland
I will call Pete Wishart to move the motion, and then the Minister to respond. As is the convention for 30-minute debates, there will not be an opportunity for the Member in charge to wind up because the debate is too short. I will not call any Members to make speeches other than Mr Wishart and the Minister, so other Members can make interventions only.
I beg to move,
That this House has considered Government support for smaller musical genres in Scotland.
I look forward to serving under you in the Chair, Sir Mark, in this afternoon’s short but hopefully important debate. I refer to my entry in the Register of Members’ Financial Interests.
When I was thinking about how to open this debate, I thought I would start with something profound and interesting—perhaps that music is the sustenance and nourishment of the soul. It is the one thing we turn to when we feel happy, and when we are trying to escape or evade any feelings of melancholy. It is what we turn to when we have that special occasion or anniversary, during time with friends, and when going out in the evening. Music is absolutely everywhere, and it has a multiplicity of genres. Music is a great chronicler. It takes you back to that time in your life, that special experience, that moment. It is almost instant recall: a song comes on, and we remember exactly where we were and what we were feeling in that moment. Everybody has a favourite song, or several favourite songs.
Then I thought that as the debate is about musical genres, I could perhaps look at the sheer infinity of music available, and the multiplicity of genres everywhere around the world—at how those 12 available notes have fired human imagination, and how we have managed to sequence and organise them in so many different and profound ways to create a huge catalogue of wonderful works of artistry—songs, compositions and beautiful sounds.
After all that, I thought I would open this debate with what is probably the most profound thing that anyone has ever said about music—what Eric Morecambe said to André Previn as he grabbed his lapels: “I’m playing all the right notes, but not necessarily in the right order.” That sums it up for me: not necessarily in the right order. Music takes us where the imagination dictates and determines. Music is only semi-constructed sonorous chaos, and that is the way it should be.
I have probably bored you before, Sir Mark, by telling you about my life in music. I had 16 wonderful years in the music industry, playing keyboards with Runrig. We were lucky and had great success, but I come from what is probably the smallest of the small genres: I played in a Gaelic folk-rock band. When I started out, we were probably the only Gaelic folk-rock band in existence. We were never going to get played on commercial radio, or on Radio 1—there was not great demand for Gaelic songs about medieval clan battles on Skye, or cuddy fishing in the Minch—so it was to the specialist radio stations and programmes that we turned for some sort of support.
The support was there on Radio Scotland, in the guise of the people who championed us and backed us—people such as Iain Anderson, Tom Ferrie and Robbie Shepherd, all providing a fantastic service. That gave us a break, and an audience to build. It helped to develop and shape our career. More than anything else, it gave us hope; here were our songs being performed on Radio Scotland. The songs of this Gaelic folk-rock band—it was never going to be the trendiest band in the world—were being played, and that was so important to us. We went on to become one of the top rock bands in Scotland, selling millions of albums worldwide and sustaining a great touring career. That is what it is all about. That is what small, specialist radio programmes and stations can provide. They give opportunity, but more than anything else, they give hope.
Why this debate, and why today? Because of the simply appalling decision by the BBC and BBC Scotland to cancel “Jazz Nights”, “Pipeline” and “Classics Unwrapped”. These are indispensable specialist programmes that serve a distinct and particular audience—programmes that do not really exist anywhere else, and that the audience turn to for the services that they want, and aspire to be on.
I do not think I have ever seen anything like the overwhelmingly negative response to the decision to axe these three important programmes. It has united the whole of Scotland’s musical community in condemnation. Already, three distinct petitions exist to have the programmes restored and put in the right places, so that they continue to be a feature of BBC Scotland’s scheduling. In the last few minutes I have heard that they have collected a combined 20,997 signatures, such is the interest, and the desire to save these programmes.
The head of jazz at the Royal Conservatoire of Scotland, Tommy Smith, has co-ordinated an open letter, which I think he has sent to the Minister, as well as Ministers in the Scottish Government. The letter is signed by the cream of Scotland’s cultural voice—people such as Nicola Benedetti, who is responsible for the delivery of the Edinburgh festival; Sir James MacMillan, one of Scotland’s prime composers; our national Makar; Scottish Opera; and of course various luminaries from the jazz world. All have voiced their concern about what will happen if these programmes are taken off air.
The letter rightly notes that this decision comes at an extremely difficult time for all parts of the cultural and creative industries. I do not think I need say that to the Minister, because she is more than aware of the distinct challenges that everybody in the cultural sector is experiencing. The pressure on the music industry is acute. I think what that letter said is that we must do everything we can to protect the infrastructure that supports our fragile but world-leading Scottish cultural ecosystem. More than that, what comes across in the letter is passion—passion for the music that these programmes support; passion from those who assemble the programmes and put them together; and passion from the broadcasters who present them, and from the audiences who lap them up and love every minute. Nicola Benedetti from the Edinburgh festival, one of the signatories, said:
“Axing these programmes is to perform a heartbreaking disservice to the irreplaceable role they have played in the lives of musicians and music lovers across the country and all parts of society.”
She is spot on.
This chorus of disapproval underlines just how much support there is in our small nation. It is a nation that excels way beyond what might be expected, given the number of people in it, in every sphere of cultural activity—a nation that is internationally renowned, and a brand that is known. We feel this is important. There is a real sense that we in Scotland will do everything we can to defend and protect our cultural output, and ensure that we recognise the distinctive flavour of all its different parts.
I congratulate my hon. Friend on securing this incredibly important debate. A fantastic example of how Scotland’s cultural and music scene can be shared with the entire world is the Celtic Connections festival, which we are right in the middle of, and which is celebrating its 30th year. That forum has nurtured the kinds of bands and different genres that he has talked about, and has brought them to a wider audience, helping people not just in Scotland but around the world to understand and explore the whole range of music that can be connected to through such a festival.
Absolutely; my hon. Friend is quite right to mention Celtic Connections, because they do not come any better than that. I remember when it all kicked off, back in 1993. It was a few concerts in the concert hall in Glasgow. It is now at practically every venue in central Glasgow, and I think it goes on for 10 days. Of course, like my hon. Friend, I will have the great pleasure of attending a performance on Friday evening. We are all looking forward to that, although I think he will probably have better luck than me at cadging tickets for the club activities in the evening, but we will see how that all ends up. I am looking forward to it. It is a great example of how smaller, niche music is supported, although the festival not small anymore because of the support it has been given over the years.
I want to come to jazz in particular, because it is important. The cutting of “Jazz Nights” comes at a time when Scottish jazz is really doing well. Jazz has flourished in Scotland in recent years, and our emerging artists have started to gain national and international recognition. One of those, of course, is the wonderful Fergus McCreadie, who won the Scottish album of the year and was nominated for last year’s Mercury prize. I do not know if the Minister has had an opportunity to listen to his album, “Forest Floor”; I know that she will rush to stream it this evening, because it is a wonderful example of virtuosity, and it combines a number of genres and disciplines. It is a wonderful piece of work, and he is only in his 20s. I mention him because he is a great example of what “Jazz Nights” did: he got his first break from it. It supported and sustained him; it played his music, and now he is on the point of embarking on an international career. That is the type of thing it should be doing.
We should recognise that Edinburgh is the home of international festivals, particularly the jazz festival. Edinburgh is becoming increasingly renowned as a European, if not world, centre for classical music. No wonder, with facilities such as the redeveloped Usher Hall. It is a great place to watch classical music. Again, if the Minister is looking for recommendations, she should go there some day to see some of the wonderful concerts that it puts on.
My hon. Friend has strayed too far into Glasgow for my liking. Would he agree that the Royal Conservatoire of Scotland, based in my Glasgow Central constituency, is a huge part of that flourishing scene, in which there is classical, jazz and pipe music, and that there is now collaboration between those three? It is key that young people hear that music on the radio, and that it reaches a wider audience, because it will not be picked up by the commercial stations. The BBC has a key role in identifying and promoting young talent, which can then go on to great success.
My hon. Friend is absolutely correct in her assessment and description of the wonderful work that goes on in the Royal Conservatoire of Scotland. It has fantastic staff. I have not had an opportunity to visit for a while, so I will put that on my list now; I will definitely go and see it. John Wallace, a distinguished former leader of the conservatoire, asked what the point of cutting all these programmes is. He is right to ask. We must ensure that young artists get to hear themselves on the radio.
When we want to hear these genres of music, we naturally turn to the BBC. The BBC remains the dominant force in UK broadcasting because of its distinctive funding arrangement, and because the licence fee allows it to do things that no other operator can. We turn to it when trying to find the things that we want. Even with all the increased competition over the years, the BBC still accounts for 47% of radio consumption. That privileged position makes it especially important that BBC radio provides programmes that are distinctive and of public value. The BBC has statutory responsibilities and obligations to do so, and Ofcom is there to ensure that the BBC fulfils them. The BBC has a clear commitment to ensure that all genres of music are played, and to serve an audience beyond the mainstream. That is what the BBC is supposed to do. Instead, there has been a reduction in important public value obligations, and a loss of distinctiveness.
Ofcom is consulting, and is expected to produce its final proposals in a few months’ time, and a new operating licence comes into effect from April. The Department for Digital, Culture, Media and Sport is also having its mid-term review of the BBC, and of course we are all expecting the White Paper with great anticipation. The Minister and I discussed that at length when she appeared before the Scottish Affairs Committee. There are lots of things going on. With all this activity and all these reviews, I plead with her not to lose sight of the prime objective of serving all audiences and ensuring that everyone has something that they can listen to. It is so tempting to play to the mainstream only—to appeal to the mass audience. We should ensure that everyone is served.
Let us look at the BBC’s obligations and responsibilities as outlined by Ofcom. It says that the BBC should ensure a
“range of programming is provided”
across all its services. Specifically on radio services, Ofcom says:
“the BBC should ensure its portfolio of stations offer the broadest variety of output and that the range of musical output on its popular radio services is broader than that of comparable providers”.
The BBC’s decision to cut jazz, classical and piping programming will vastly reduce its fulfilment of that commitment, and the way that it represents and platforms some of Scotland’s most dynamic and emerging music scenes. It is clearly a breach of what is set out in the charter and in regulation. I hope that the Minister will remind BBC Scotland of its obligations and responsibilities.
In response to the chorus of disapproval, the BBC has got in touch with all of us about the subject. My hon. Friend the Member for Glasgow Central (Alison Thewliss) met the BBC last Friday, I believe, and heard some of its alternative proposals. None of what has been suggested comes close to beating it on satisfaction grounds or to making up for the loss of these programmes. The BBC seems to be proposing a series of amalgamations where it takes these programmes off-spectrum, puts them online and diverts people to other services. That is simply not good enough. It does not even start to address what is being lost.
My appeal to the BBC is to listen to people on the frontline, such as those at the meeting with my hon. Friend. They are the ones who know the genres, how they work and operate and what they require in order to survive, sustain and develop. Is there anything the Minister could do to encourage the BBC to engage positively with them? The BBC has engaged positively in the past, and I know that the people at BBC Scotland are good guys. I believe they have the best interests of our nation at heart. They want to serve these audiences, but they just need encouragement to do the right thing and make sure the services are safe.
This is a hard time to be a musician. I would have hated to be a musician during this period. I was one in the ’80s and ’90s, which were days of bounty. It is an entirely different regime now. Streaming accounts mean that musicians earn very little from their recorded work. Then there are the effects of the pandemic and a cost of living crisis. I think I saw a survey showing that over 90% of musicians are now concerned about the impact of the cost of living crisis on their ability to perform. There was a report yesterday about the loss of venues and clubs, which is restricting live performance.
We have had the impact of Brexit. Europe is practically closed to new artists with all the different paperwork that is required. This is not a good time. We do not need these difficulties to be compounded with the loss of an opportunity to be played on the radio. We may not get all the right notes in the right order, as specified by our good friend the great late Eric Morecambe, but I hope we can bring some support to the sector and encourage people to think again and look at the damage this might bring to the sector. I hope the Minister will do all she can to ensure that people are aware of the responsibilities and obligations and think again about the damage.
It is a pleasure to serve under your chairmanship, Sir Mark, and I hope we are not interrupted by votes. I thank the hon. Member for Perth and North Perthshire (Pete Wishart) for calling the debate and for our exchanges last week as part of his Committee’s examination of broadcasting in Scotland. I look forward to receiving his recommendations about the best approach. He talks of sonorous chaos in his beautiful speech, and it makes me think about the behaviour of the SNP at Prime Minister’s questions every Wednesday.
I absolutely agree about the importance of music, and the hon. Gentleman spoke beautifully about that. Scotland has such a rich and vibrant cultural heritage, and it is a pleasure to speak to that. I know that that music is at the core of Scottish identity, but it is also at the core of British identity. As he was speaking, I was thinking back to Her Majesty Queen Elizabeth II’s state funeral. It was opened by a band of pipers, which was extremely moving, and then closed by a lone piper in Windsor. That sound and image was a thing of beauty that has stuck in many of our minds, and that music will be noted internationally as something that both makes up a very strong cultural identity and can move the human soul.
The Minister talks about the importance of piping both here and internationally. Is she aware that there is no back-cataloguing of piping, because it is live, meaning that the “Pipeline” programme is, in effect, the back catalogue of the nation’s piping, and that is why it is so important?
I thank the hon. Lady for her intervention. I was not aware of that. I know how strongly people feel about “Pipeline”. I suspect the BBC has been surprised by the strength of feeling expressed about not just these particular programmes but the local radio changes proposed by the organisation.
Music is an absolutely essential part of our arts and cultural sector, but it is also big business. Pre pandemic, the music sector was worth about £5.8 billion and exported music and services were worth £2.9 billion—I think we are all familiar with how many UK artists make waves internationally. As well as fuelling tens of thousands of jobs, it is a huge source of soft power on the world stage. Scotland’s music ecosystem forms a valuable component of that, having produced a wealth of internationally renowned artists, including Lewis Capaldi, Annie Lennox and Calvin Harris. It would be wrong of me not to mention the hon. Member for Perth and North Perthshire, who I believe was the first representative of the House of Commons to have appeared on “Top of the Pops”. I am also told that he has sold something in the region of a million records—I do not know whether he can verify that. I confess that I had no idea that Gaelic folk rock, while seemingly niche, has such a broad and dedicated audience. Of course, his crowning glory is being a member of MP4.
Traditional Scottish music is internationally recognised as the sound of Scotland, but it is also recognised for its richness and diversity, which spans and often blends an array of musical genres and styles. The hon. Member for Perth and North Perthshire mentioned the burgeoning jazz scene, particularly around Edinburgh, and I agree that it is crucial that that music is preserved and remains as culturally relevant today as it has been in the past.
Radio and television are fantastic ways to celebrate culture, and the BBC has played an important role in producing audio and visual content across the UK. The Government believe it is essential that the BBC continues to reflect, represent and serve the diverse communities across the entire country, including in Scotland, and I recognise that audiences value BBC Scotland’s showcasing all genres of musical talent that that nation has to offer.
The hon. Member for Perth and North Perthshire raised some profound concerns about changes to “Pipeline”, “Classics Unwrapped” and “Jazz Nights”. I am glad that the BBC is aware of the strength of feeling, and I recommend that hon. Members continue to make that strength of feeling known, because the BBC is independent of the Government and therefore makes its own decisions. Although it is influenced by the funding envelope it receives, my understanding is that a lot of the radio changes are funding neutral. They are part of the drive towards a “digital first” model for the BBC, so it is important that we in this House continue to express what we are hearing from our constituents about the services that are valued the most. They might not have the largest audiences, but they have a profound meaning in a lot of people’s lives. They serve particular pockets of culture that are important to our national identity, and I advise the hon. Member to continue to liaise with the BBC and make clear the level of feeling.
We believe it is important that the BBC continues to cultivate the partnerships that have made it such an important mechanism for making sure that local musicians can get an audience. Last year, the BBC extended its partnership with Creative Scotland to December 2024. It is also renewing its collaboration agreement with MG Alba, which I spoke to very recently, and it has been working with the Scottish Government and others to deliver “SpeakGaelic”, which is a suite of resources—including a website, podcast, and radio and TV programmes —to support learners.
However, talent must start somewhere and has to be nurtured. Musicians, particularly those practising in lesser-known genres, have to be afforded a platform so that they can excel in the music industry and reach their potential. In response to the concerns that have been expressed by hon. Members, the BBC has set out some of things it is doing to support emerging musical talents, such as “BBC Introducing in Scotland” and the BBC Radio Scotland Young Traditional Musician of the Year award. I urge the BBC to consider how its changes will impact on its ability to deliver for audiences across our country. As the hon. Member for Perth and North Perthshire mentioned, it is a requirement of the charter, and it is important that Ofcom holds the BBC to account for its delivery in that regard.
The hon. Member raised a number of other issues in relation to the music industry, which I am very alive to. We are drawing up a strategy in our creative sector vision, which will touch on some of those issues. He raised the issue of streaming, which I know the Digital, Culture, Media and Sport Committee has been looking at in great detail. The Competition and Markets Authority has looked at this issue extensively, and it is also being looked at by the Intellectual Property Office. We will be coming forward with further workstreams in the coming weeks and months.
We also do a lot of work on music export. There is always more we can do in this regard, but we work closely with the Department for International Trade on the music export growth scheme, which is helping to break new artists into other markets, including the Scottish singer-songwriter Nina Nesbitt. I will continue to work closely with DIT on these kinds of initiatives.
As the hon. Member for Perth and North Perthshire knows, many aspects of culture are devolved, so spending on arts and culture in Scotland is mainly carried out by the Scottish Government. I know that he has taken up some of his concerns with Angus Robertson, and it is for him to decide how to allocate some of the cultural spend. It may be that he wishes to look at some of the programmes in relation to the musical genres that the hon. Member talks about. We are always keen to work collaboratively with the Scottish Government.
The creative industries are one of the fastest growing sectors in the UK. As I mentioned, we are drawing up a creative sector vision, which will look at a range of ways in which we can ensure that that sector continues to thrive. That includes looking at creative clusters across the UK. Dundee is a great cluster for video gaming, when looking at the some of the skills required for the workforce and some of the issues that the hon. Member for Perth and North Perthshire highlighted in his very good speech.
We support culture in a range of ways, including through the cultural recovery fund, which is devolved in the Scottish context. The hon. Member mentioned music venues and it has been a time of profound challenge, with the pandemic closing a number of venues, and a reluctance of audiences to go back to them. The cost of living pressures on households might make going to such venues an item of expenditure that many people feel they can cut out. We are trying to support venues, mainly through the energy support scheme, which will continue in a slightly different form from April this year.
I conclude by thanking the hon. Gentleman for raising his concerns with such passion and beauty. Music is profoundly important for us all. It serves us in many purposes and guides us as a companion through life’s journeys. It has an important heritage in Scotland that people value very much. I hope the BBC is listening to the hon. Gentleman’s concerns, and is alive to what hon. Members are talking about on the subject of radio cuts. I will continue to raise those matters in the regular meetings I have with the director-general.
Question put and agreed to.
Council Tax and Revenue Support Grant
I beg to move,
That this House has considered council tax and the distribution of the revenue support grant.
It is a pleasure to serve under your chairmanship today, Sir Mark. I thank other Members, and indeed the Minister and my hon. Friend the Member for Loughborough (Jane Hunt), for attending.
People who live in Dorset currently pay over two and a half times more council tax on an average band D property than people who live in London. People of school age living in Dorset, or their parents, will need to pay for their ravel to school or college; meanwhile, in London and other urban areas, that travel is paid for. A third of our community in Dorset is over 65, compared with around 10% of the community in London. In Dorset, 85% of services are provided diligently by the council, and will be funded through council tax, compared with a national average of 50%. Why, then, given the rurality of West Dorset, the demographics of its residents and the challenges we face, do we receive a fraction of the Government support that urban boroughs receive?
The Government have a powerful lever of influence on local government finance and its impact on the tax burden of local residents, and that lever is the revenue support grant, which allows the Government to choose and target which areas of the country to help most. Year after year, the residents of rural West Dorset are continually frustrated that preference is given to urban areas, such as those in the capital, over places such as my constituency. The formula for the revenue support grant is in need of a great deal of scrutiny and reform as part of a wide-scale review of local authority funding.
In West Dorset, we are custodians of picturesque rolling green hills, with livestock grazing and productive arable land, and magnificent landmarks and heritage sites, such as the Cerne Abbas giant and the Jurassic coastline. Yet the people of West Dorset and the wider county face one of the highest rates of council tax in the country. My constituents and those living in neighbouring rural Dorset constituencies pay £2,225 for an average band D property, compared with just £866 in the London Borough of Wandsworth—an enormous difference of £1,359. In short, that means that West Dorset’s council tax is 150% more than Wandsworth’s.
Through diligent financial management, Dorset Council has continued to cut its costs, but many still face high council tax bills. A key reason for that is that the local government funding formula requires urgent reform. In 2019-20, local authorities on average received 50% of their revenue through council tax, alongside 23% from Government grants and 27% from retained business rates. Dorset Council is forced to derive 84% of its revenue from council tax, which itself has increased 12% since 2010-11 and, in 2022-23, totals almost £300 million. In contrast, Wandsworth Borough Council needs only to raise around £70 million in council tax. In previous years, we in Dorset have received zero revenue support grant, compared with a £24 million revenue support grant last year for Wandsworth. We have to ask: is that really fair? [Interruption.]
Sitting suspended for Divisions in the House.
I would like to remind Members present that, just before the Division, I was talking about the fairness of the specifics of the Dorset Council revenue support grant. For the past three years, Dorset has received exactly zero revenue support grant. This is the first year since my election that we have received any form of revenue support grant. At a slim £654,000, that equates to roughly 0.2% of total council income. Although welcomed, that has come only after others and I spent a long time banging the drum for the situation to change. I am afraid that it is still overshadowed by the £24 million that, for example, Wandsworth Borough Council and other boroughs receive.
I thank the hon. Gentleman for being such an assiduous MP for his constituency, which he clearly is. He is outlining the pressure caused by the rising cost of living. Councils are finding it increasingly difficult to balance their books, and I believe that Government must consider increasing the grants to ensure that the basic service-level provision is in place—that basic services are maintained, and that the parity of grant that the hon. Gentleman has referred to applies across the whole of the United Kingdom. There is deep privation in the hon. Gentleman’s area: the same is true in other parts of the country.
I agree that deprivation affects all parts of the United Kingdom—not just urban areas, but rural areas as well, and indeed all four nations of the UK.
Despite Dorset benefiting from £654,000 from the revenue support grant, local councillors have made me aware that while we have finally received a positive revenue support grant contribution, other Government grants have been reduced by a broadly similar amount, meaning that the council is little better off in real terms. It is therefore clear that the way in which local government finances and the revenue support grant are calculated and delivered is in need of urgent review. Unlike others, I am not looking for favour or preference for Dorset, or indeed West Dorset, but I am looking for fairness.
The average age in rural Dorset is much higher than almost anywhere else in the UK, with one third of the community aged over 65, compared with an average of 19% in England and just 10% in some London boroughs. That, alongside rising special educational needs and disabilities among young children, means that 69% of Dorset Council’s revenue is spent on social care. Since 2010-11, there has been a 25% rise in the number of those aged between 65 and 84 in Dorset, and a 20% increase in those aged over 85—with, of course, the associated social care needs. Those changing demographics have caused the council’s spending to change dramatically, with net spending on adult social care in Dorset increasing by 15% to £139 million, and children’s social care spending increasing by almost 25% between 2010-11 and 2019-20, reaching over £60 million. However, the fundamental funding structure has still not changed.
Care of adults and children is an obvious council priority, and with internal migration having increased the average age in Dorset, that service has taken up more and more of the council’s budget in recent years. That has resulted in cuts elsewhere: planning, development, culture, environment and regulatory services, and highways and transport have all seen reductions in net spending over the same period to facilitate the priority of adult and child social care. Highways and transport spending has been reduced by more than half over the past 10 years —a fact that is only too evident, as Dorset is also home to the worst frequency rail line in the country, between Yeovil, the county town of Dorchester and Weymouth. At best, there is a train every three hours, if you are lucky.
Buses have also been impacted, with Dorset Council having to spend its already tightening pool of transport resources on taking over vital community service routes from commercial operators that have pulled out. While concessionary bus passes appear good, they result in operators receiving 92p from a £6.50 single fare. That makes many routes commercially unviable and, paradoxically, reduces bus services in rural Dorset, which cuts off elderly communities from essential health and community services—the very groups of people who are meant to benefit from those concessionary passes. The young in West Dorset are also impacted by the inequalities in funding for transport. While I recognise that transport provision is often the responsibility of the Department for Transport, I am bringing up this issue today because of the situation we are in with the allocation of local government funding. Children throughout London enjoy the perks of free bus and tram travel to go to school or see their friends, but the parents of children in West Dorset are faced with financial obstacles. Some school bus passes cost over £600—and that is just for their child’s daily travel to and from their place of learning at sixth form or college.
A 17-year-old living in Dorset will have to find a way to pay to get to their sixth form college or apprenticeship. A 17-year-old living in a London borough will not, thanks to the 16-18 bus pass, which is included in the funding for London. It is also worth noting that per passenger journey in London, TfL receives 10 times the amount of public funding than we do in Dorset. This refusal to give Dorset its fair share, according to its population and characteristics, is pushing the elderly into increasing isolation. That is an increasing concern for me as their MP.
It also places obstacles in the way of our bright, young minds, all while residents and small businesses continue to buckle under the ever-high rates of council tax. It is time that Dorset received its fair share of Government investment and funding and that my hon. Friend the Minister and his colleagues show that the south-west is just as important to the levelling-up agenda as the north-east or indeed other parts of the United Kingdom. The need for funding is especially pronounced following the impacts of the covid-19 pandemic, during which, I am afraid to say, we lost some 20% of our businesses.
A very topical subject being debated around the country is funding for emergency services. Here, too, we see the detrimental impact that the Government’s failure to treat Dorset fairly is still having. My constituency and those surrounding it continue to face the difficult blight of county lines drugs gangs. Dorset Police’s resources are pushed to breaking point during the summer months, especially when the county’s population trebles with holidaymakers and day trippers. Dorset is the sixth-most popular region in the country for visitor trips during the summer, but these can sometimes stretch police resources. I understand that the Minister cannot answer for the Home Office, but I would like him to note this difficulty that we face.
I recognise that these policing matters sit with the Home Office, but I wonder whether my hon. Friend would consider the points I raised at the beginning of the debate. I will refresh everyone’s memory on what those are. Why is levelling up not focused on rural areas in the same way as urban areas? Why does rural hardship not seem to matter in the same way that urban poverty does? Why does Dorset Council have to raise 85% of its funds through council tax, when the national average is 50% and even less in some urban locations? Why is it deemed acceptable to put financial obstacles in the way of access to rural education but to remove them for urban education?
Why does Transport for London get £1.7 billion of Government money when needed, yet Dorset Council gets hardly anything? Why, despite known patterns of domestic migration, is the cost burden of rural social care placed on the local community, whereas other communities can get help? Why does Dorset receive such low levels of the revenue support grant, whereas in inner London there are boroughs that charge very low rates of council tax comparatively and are furnished with tens of millions of pounds in Government grants?
In short, it is my intention with this debate for the House to consider two central points. The first is that rural Britain, and specifically rural Dorset and my constituency of West Dorset, should finally receive its fair share of Government local authority support. For too long, Dorset has been overlooked in the allocation of RSG payments, and for too long council tax has had to cover the deficit. It is time that services in Dorset had adequate funding, so that they can continue to support rural and coastal communities in the way they need to. Finally, as I continue to champion relentlessly the needs of West Dorset and advocate for fairness across the board, I believe that the Government need to examine the whole system of revenue support grants, and that there is a need for reform so that local authorities such as Dorset Council receive their fair share of Government funding and support to enable us to thrive.
It is a pleasure to see you in the Chair, Sir Mark. I think I might have caught my daughter’s cold, so forgive me if I am a little hoarse—I wish that the Minister had bought two Lucozades. I congratulate the hon. Member for West Dorset (Chris Loder) on securing the debate and highlighting the regional inequality that his constituents face. That is a reality for many areas across the country.
Council tax is a fraught issue in every part of our country, from Dorset to Durham. Sadly, local communities in rural, urban and suburban areas will have seen their neighbourhoods decline over the last decade while also seeing costs go up. Every household paying their council tax will increasingly feel the strain as we deal with the fallout of the mini-Budget and a looming depression. With the revenue support grant being withdrawn in many areas and rising running costs not being met with adequate funds, council tax seems to be all there is left for local authorities. That is all that they can rely on. As we heard from the hon. Member for West Dorset, more than 80% of local funds are raised through council tax. That is reflected nationally: since 2010, core funding for councils has been reduced by £16 billion, and yet council tax has increased—it has been forced to go up—by over £15 billion. What we see locally is happening nationally.
Following 13 years of relentless, debilitating cuts, councils desperately hoped for respite from the autumn statement, but no such support was provided. Instead, the Government laid more burdens on local authorities by forcing them to take the tough decision on whether to raise council tax further. That was a cop-out—a refusal to own and fix the holes that they have created in our communities. The Chancellor talks—all Chancellors talk—about taking tough decisions, but, to be blunt, they are not taking the tough decisions when it comes to local government. They are instead forcing difficult decisions back on local authorities and local people. After taking 60p from every £1 given to local authorities since 2010, this Government are now pushing councils to charge residents even more money—often for worsening services. That is not sustainable. The Chancellor’s plans to raise council tax in the way he has outlined will bring in an extra £80 per person in Surrey but just £39 per person in Hull.
Some have misunderstood levelling up or seen it as a bit of an empty slogan. Has it now come to mean that we are just creating greater economic divides than those that existed before? The hon. Member for West Dorset talked about rural areas perhaps not faring as well as everywhere else in levelling-up fund bids. I have asked before about the transparency over how levelling-up funding bids are allocated. Local authorities have not been told why they have been unsuccessful. As Ministers will know, MP after MP stands up in the Chamber or Westminster Hall to ask for their bids to be looked upon favourably, or to talk about how successful the bids are or where they are in the process. If we had a transparent process, we would know more, and local authorities and local areas could put in stronger bids. We need to end the cycle of beauty pageant crossed with Hunger Games-style bidding wars, which pits area against area, community against community and project against project, with no guaranteed outcome and without even tackling regional inequality. Instead, Labour would trust local areas and move towards longer-term funding settlements for councils and communities to use according to their priorities and make genuine long-term efficiency savings as they can better plan for the future.
After service after service has been cut, it is clear that local funds do not meet those needs. The hon. Member for Strangford (Jim Shannon), who is not in his place now, talked about demand outstripping supply and resources in local areas. We have seen councils’ desperate need to revive their youth provision or deal with increased levels of antisocial behaviour. Yet the funding does not make a dent in the amount needed to restore our crumbling high streets, prevent library closures or save local nurseries, and we all know it does not come anywhere close to plugging the gaps in the ailing, failing adult social care sector.
As has been stated, the hon. Member for West Dorset represents a rural constituency with a higher than average number of older residents, and that necessarily means higher demands on adult social care. I am sure he will appreciate that pouring more local taxpayers’ money into a broken care system is just not sustainable. Private companies are making huge profits off children in care and through contracts with local authorities that have been stretched so thin that they can no longer directly provide the services that are needed. There has to be another way.
I worked as a care worker. I know the hard graft, the long hours and the low pay, and I know the conflicting demands. Those who had funding support and those who paid privately were pitted against each other—often for minutes—regardless of need. The Government cannot continue to ignore the dereliction of this sector forever. Even the current Chancellor acknowledged when he was Chair of the Health and Social Care Committee that that was not sustainable. When the funding comes, it will be just another sticking plaster and will come nowhere close to healing the wounds of more than a decade of neglect of social care, as well as rising demand. Constituencies such as mine and that of the hon. Member for West Dorset are varied in their demographics and geography but alike in their need for stable, adequate funding. I sincerely hope the Minister can answer some of the questions that have been put to him today.
It is a pleasure to serve under your chairmanship, Sir Mark. I am grateful for the opportunity to respond to the debate. My hon. Friend the Member for West Dorset (Chris Loder) is an extremely vocal and proud champion of his local area in West Dorset. We have already spoken about this issue on a number of occasions in the short time I have been in post. He strongly advocates for his constituency’s position and the importance of rural Britain being heard in debates such as this one. I congratulate him on securing the debate and highlighting important points, even though there was a gap in the middle for other reasons.
This is an important issue, and I accept that. My hon. Friend has outlined some of the points that affect his constituency and the supporting unitary authority. It is important we discuss these issues fairly regularly. There will never be a perfect methodology, and there will never be a single answer for everything. There will always be these necessary discussions, but it is important—I say this as someone who represents a semi-rural area as well—that the voice of rural Britain is heard. He has made that voice heard loud and clear today.
In response to my hon. Friend, I want to talk briefly about the broader situation and then answer a number of the points he raised to the best of my ability in the time we have. His point is both broad and narrow. It is broad in that people should have confidence that the system works for all parts of Britain, broad in that we want a local government settlement that reflects need, and broad in ensuring that all parts of our country get the resources we are able to offer. In the usual way, there is a challenge around the allocation of resources in a system that has infinite and worthy demands on it, but very finite resources to support it.
My hon. Friend also makes a more specific and narrow point about the RSG. He has highlighted how that has changed for a number of areas across the country over a number of years. He has highlighted that Dorset has had, for a number of years, a zero or negligible grant. It has gone up slightly this year.
I will do that, Sir Mark. The RSG has been in place since the late 1980s. It has been a feature of the financial and settlement landscapes for a number of years. But, as my hon. Friend the Member for West Dorset has indicated, the utility of the RSG and the way in which it is applied to individual areas, such as Dorset and elsewhere, has changed over recent years. That is to be expected as the local government funding landscape changes over a 20 or 30-year period.
That plays out within the context of a broader settlement, and in order to have these kinds of conversations we have to acknowledge what is within that broader settlement—not just the RSG but all the other grants, and the overall envelope within which it is offered. While I absolutely accept that there are a significant set of challenges at the moment, I hope the sector has recognised—in my experience from speaking with the sector, from unitary councils and districts to county and metropolitan boroughs, it has done—that a significant amount of money has gone into it. While there is still a challenge with inflation, it looks like £60 billion-worth of taxpayer subsidy, in one shape or form, in England will be allocated in the provisional local government finance settlement that was announced for consultation before Christmas. We will make decisions and finalise that for the sector shortly.
That figure represents a significant increase across all councils. We have also provided additional clarity about what is likely to come in the financial year 2024-25, which has been a long-standing request of the sector, irrespective of the way in which it funds its individual services. That has been welcomed by the sector, and I hope we can build on it in future years, once we are through the current spending review period.
Although it has tended to be more relevant for non-unitary councils than unitary councils, we have also given a one-off funding guarantee that meant the provisional settlement contained a floor that ensured that individual councils were able to obtain some uplift prior to deciding what they wished to do or not do about council tax. The hon. Member for Strangford (Jim Shannon) is no longer in his place, but he raised an important point about his concerns regarding local government finance. I hope that with the provisional settlement and the clarity that we will provide shortly with the financial settlement, we have demonstrated our willingness to respond where we are able.
That is all within an extremely challenging global financial context, which we all know about, even if those on either side of the House disagree in part on the reasons for it. That is all down to challenges that were discussed at the Budget and that have been visible for a number of years—both within the immediate post-covid era and stretching back longer—across many western democracies as debt has risen, as the recovery from the global financial crisis has been attempted and as we seek to accommodate spending decisions that were made a number of years or decades ago, which still have overhang even now. We have to contextualise decisions about the financial settlement as a whole, which will hopefully be finalised soon, and how it is distributed within the very challenging financial context.
My hon. Friend the Member for West Dorset talked powerfully about the particular pressures on children’s services and adult social care, and he is absolutely right to highlight that there have been significantly increasing challenges around both those areas in the last decade or so. That is not unique to Dorset, but is absolutely the case in all other councils, as the hon. Member for Luton North (Sarah Owen) highlighted from the Opposition Front Bench when she spoke of her own experiences of adult social care.
That has been recognised in the last number of years of the financial settlement with the creation of, and then increased funding for, grants earmarked for adult social care and children’s care, including the social care grant. Over recent weeks, we have seen an additional amount made available for adult social care through the discharge fund, of which at least a portion will go through local authorities to support additional social care provision within individual localities, to help the NHS get through the winter challenges. My hon. Friend will probably also be aware of the market sustainability and improvement fund, which is due to come in in the next financial year. So there has been a response to the increasing pressures, and one that reflects greater linearity between grants that are provided by the centre and the challenges and pressures that individual authorities are facing. I hope that that further additional context is helpful.
My hon. Friend talked powerfully and at length about the specific aspects of rural funding. He made a strong point, and I will absolutely consider it more. As he will be aware, councils that have a significant proportion of rurality have already received additional funds through the rural services grant over the last few years. As part of the provisional settlement, we confirmed that that will continue in the coming years. I know that there is a debate about the quantum of that grant, but we have sought to do that. Within the funding formulas for other grants, there is a recognition of need, irrespective of rurality. As my hon. Friend rightly indicated, need is not necessarily related only to urban areas, but is also present in rural areas. I hope that, at least in part, the overall funding settlement is able to reflect that.
I want to talk about three points that my hon. Friend raised—I am not sure he will fully agree with me, but I want to touch on each of them. He made a number of points about the difference, both perceived and actual, between how different parts of the country and different authorities allocate their resources, and about the different funding that comes to different parts of the country, both in terms of what is provided centrally and what is raised. He highlighted a differential between London and other parts of the country, and that is returned to regularly. As somebody who was a councillor in London for eight years and who is now happily back home in Derbyshire as a Member of Parliament, I have seen both sides of the equation. As I say, nothing in life is perfect—no methodology is perfect, and no funding formulas are perfect. However, if there were an equivalent number of Members of Parliament here from urban areas—I know this because I used to be part of this conversation—they too would make a strong case that there are challenges, issues and problems in their areas that need attention. That is not to take anything away from my hon. Friend’s point about comparison, but it offers some context.
There are different pressures in urban and rural areas, in different geographical areas and in areas with different demographics. Ultimately, different choices are made. I have served in councils where there are significant choices around how social care is approached and where different choices are made around how leisure services and library services are approached. If we accept the principle of devolution—I know that my hon. Friend was not making this point per se—we also have to accept that there will be differences in the choices that are made, while recognising that some of those choices are down to the ability to determine things locally and some are more influenced by the overall process and decisions made elsewhere.
I appreciate that, between the Minister’s constituency and mine, there is an £800 difference in council tax at a band D level, so the issues that my constituents face are very much as he is kindly outlining. However, even if we take away the urban areas, which I used as a comparator, there is a level of disparity—his constituency and mine are not totally dissimilar, but there is a clear disparity. We welcome many people to retire in West Dorset, and indeed across the whole county and the whole south-west. That means that local councils often have to bear much greater financial responsibility for social care, but that is not reflected in the financial machinery we have today. From what the Minister said, and from my understanding of the process, there is not really a way to take that into account. Are the Government doing anything to give us some hope that we will have a better machinery in due course to take it into account?
I am grateful to my hon. Friend for his question. I accept that the existing settlement is a complex landscape with multiple different grants, interventions and interactions. At the core of those grants, there is a set of need assessments, need calculations and funding formulas. Some of those funding formulas are a number of years old, some are more than a number of years old, some are more recent and some approach things in different ways from others, so I accept that there is a complex landscape. Local government finance has always been a complicated and challenging landscape, but there is, at the core, a set of needs assessments. There is always a question about whether they could be updated and changed and whether they could better reflect how things are working and what is happening in individual localities, but needs assessment is at the heart of local government finance. As I indicated, there has also been a move over the last few years to a greater set of earmarked grants, specifically around adult social care, and they are intended to reflect need to the extent that is possible.
To respond to the second of the points from my hon. Friend’s speech, there is then a set of different circumstances in each individual area, in terms of both spend—lots of demand on adult social care in one place, but slightly less in others, and lots of demand on children’s services in some places, but less in others, depending on the geography—and the funding available. That is because of a complicated web of where councils started from; decisions that have often been made over many decades; the corporate approach that successive councils and their leadership have made; and reflections of need—however perfect or imperfect they may be. Can I say that that process is perfect? Absolutely not. Can I say that there will not be anomalies or challenges in it? No, because there absolutely will be.
My hon. Friend mentioned his concerns about areas with older demographics and the pressures that that puts on them. He makes a cogent case that rural areas, parts of which are more affluent, although they still contain areas of deprivation, are highly dependent on council tax. However, if there were urban MPs here—he compared his area to at least one such location—they would argue that their areas receive significant revenue from business rates, and Government are removing an element of that and distributing it elsewhere, including to places that are not urban. It is a very difficult, complex set of interactions. I absolutely accept that it is not perfect and that we need to continually look at it, but it seeks to reflect need, notwithstanding the complicated process by which it has got there.
On my hon. Friend’s point about whether there are opportunities to review the situation, there is always a need to look at these kinds of landscapes, particularly given the complexity and the fact that some elements of them have been around for a number of years. He will be aware—we have spoken about this previously—of some of the things that were started in recent years, such as the fair funding review.
On the financial settlement this year—I am not taking anything away from my hon. Friend’s point about the need to review these areas—having come through three years of significant difficulty in everybody’s lives, but particularly in the local government sector, we had to choose whether to make significant changes or offer stability. Through the provisional settlement, we have tried to offer a platform for stability, with significant additional funding, so that local authorities in the coming financial year—2023-34—have some breathing space after the tremendous work they have done post covid and during the inflationary period, which we hope has now peaked or will shortly peak. That will give them the opportunity to plan, think and look at how they can reform and do things differently to get ready for the years ahead.
We will always look at opportunities for review and change. Before Christmas, the Secretary of State indicated to the Levelling Up, Housing and Communities Committee that he wanted to do that, and I am doing it as a new Minister. We are looking at what can and cannot be done in individual areas. I welcome the comments and thoughts of my hon. Friend and the hon. Member for Luton North about those kinds of changes, and we will look that in the coming months and years.
I want to make a small plea to my hon. Friend to see things in the round. Although I accept that it is important to zero in on areas of contention and problematic areas, councils should have a significant absolute-terms increase in revenue in the coming financial settlement, and there have also been significant grants, particularly on the capital side. I do not want to tell my hon. Friend things he already knows, but I want to read this into the record: there has been significant funding on both the revenue and the capital sides to Dorset in recent months through the community renewal fund and the UK shared prosperity fund, and I believe that an area near his constituency was successful in a levelling-up bid just a few weeks ago. None of that takes away from his points, but it is important to see the context in which this discussion is taking place.
I absolutely accept that these are challenging times, that no methodology is perfect and that there is a legitimate debate to be had about how local government finance supports all parts of our country, all demographics and all facets and characteristics, including rurality and other things that my hon. Friend outlined. I hope that, in acknowledging all that, we can also collectively recognise that there has been a significant increase in funding this year, which is likely to go to all areas, as outlined in the provisional settlement. I hope my hon. Friend accepts that the prioritisation of stability in this coming year is important, given the challenges we have gone through in recent years. I look forward to working with all Members, including my hon. Friend, to see what changes and improvements are possible in the coming months and years.
I thank my hon. Friend the Minister, the hon. Member for Luton North (Sarah Owen) and the hon. Member for Strangford (Jim Shannon), who is no longer in his place, for contributing. I appreciate the extent to which the Minister was able to answer some of my questions.
There is clearly still a lot of work to do to address fair funding throughout the country, particularly for rural areas. I appreciate all the work that the Government have done. The Government intervention, funding and support that we have seen in the last three years is unparalleled by pretty much anything we have ever seen, certainly in my lifetime and, although I hate to hazard a guess at the Minister’s age, probably in his as well—he might be younger than me, so I do not know.
The point is that we in West Dorset are below where we started. I mentioned the situation with our businesses; we lost 20% of them over covid. Our economy has already shrunk. As I said, our children who want to go to sixth form are having to pay £600 or £700 to get a bus to the nearest school, which can be 10 or 15 miles away, in order to study. We should not be in a situation where one part of the country is having to do that and another is not.
I appreciate the Minister’s points on stability. I know how important that is, especially when we are going through a turbulent period with inflation and other things. I know that the Minister—and I hope that his colleagues in the Department—will take away from this debate the fact that, although stability is important, we have a lot to address in our mechanisms for local government and local funding. The fact that there are immense differences between how much the constituents of the four of us in this room contribute towards council tax indicates the extent of the variation. I am advocating that we review those processes and work for fairness. I hope the Minister will take that back to the Department, and I look forward to seeing a much better case for Dorset in the next settlement.
Question put and agreed to.
That this House has considered council tax and the distribution of the revenue support grant.