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Westminster Hall

Volume 734: debated on Tuesday 13 June 2023

Westminster Hall

Tuesday 13 June 2023

[Carolyn Harris in the Chair]

Cancer Medicines: Appraisals

I beg to move,

That this House has considered the matter of appraisals for cancer medicines.

It is a real pleasure to serve under your chairship, Mrs Harris, and I am always pleased to see you in the Chair, as you know. I am always greatly impressed by your commitment to these issues, and I have been pleased to support you in a small way, although always fully. I thank you for being here.

I thank Members for coming along to participate in this important debate. I am pleased to see the shadow Minister, the hon. Member for Denton and Reddish (Andrew Gwynne), in his place, and the SNP spokesperson, the hon. Member for Midlothian (Owen Thompson). I do not think there is a debate when the Labour spokesperson and I are not together, and we are, more often than not, saying the same thing. I am also incredibly pleased to see the Minister in his place, and it is no secret that he listens and responds to the questions we ask. I think he will find today that there is a united front pushing for the same things. Hopefully, we are pushing at an open door and he can respond in a positive fashion.

It is great that Members have the time to be here to support this matter. The UK’s health technology appraisal process must evolve if it is to keep pace with innovations in cancer treatment and improve outcomes. That is important because, across this great United Kingdom of Great Britain and Northern Ireland, one in every two people—half the people we meet out on the street—will be struck by cancer. My father had cancer on three occasions. He was a Christian and he survived all three times due to the prayers of God’s people, the skill of the surgeon and, ultimately, the care and love of the nurses and the family who supported him.

There are many global healthcare challenges, and the UK must emerge as a leading force. That is why this debate, which is specifically about appraisals for cancer medicines, is so important. It is essential that the Government, the NHS and the National Institute for Health and Care Excellence evolve their processes to address emerging access challenges—and there are challenges. We must have a process that moves quicker, focuses attention and delivers in the necessary timescale.

In July 2022, cancer waiting lists stood at over 320,000 across the UK, which is breathtaking. In addition, there are wider challenges with patients getting treatment in Northern Ireland. As you and others will know, Mrs Harris, I always try to give a Northern Ireland perspective. I am ever mindful that this is not the Minister’s responsibility, but what is happening in Northern Ireland encapsulates what is happening in the UK, Scotland and Wales. Waiting times for cancer treatment in Northern Ireland are the worst on record. Just a third of urgent suspected cancer referrals from GPs—only 35.6%—began receiving treatment within the 62-day target in the final quarter of last year. We have a big challenge, there is a lot to do and there is clearly a lot more for Northern Ireland to do. It is incredibly concerning that we have deteriorated further since those figures from 2021-22. Back home we have a crisis; a catastrophe is perhaps waiting to happen. It is unacceptable that almost 64% are waiting too long to start cancer treatment.

We in Northern Ireland have a cancer strategy that echoes the asks of many cancer charities across NI, including Cancer Focus Northern Ireland and Cancer Research Northern Ireland. I want to put on record my thanks to those cancer charities, which do fantastic work and are very good at contacting us—I do not think there is an MP here who does not have regular correspondence with them. The information they formulated and sent to myself and others before the debate was really helpful.

The cancer strategy was agreed in March 2022 but, over a year later, given stringent funding cuts from central Government, we simply have not had the finances to fully implement it. It still has the potential to play a crucial role in the transformation agenda of the health and social care service, and I believe that it will prove to be an exemplar of true healthcare for cancer sufferers, but we look to our Ministers back home and here in Westminster to ensure that we have the funds to make that happen.

Throughout the United Kingdom of Great Britain and Northern Ireland, cancer survival rates have risen thanks to improvements in planning, but levels of diagnosis and treatment lag significantly behind those in other countries for some cancer types, especially our five-year net survival rates.

I congratulate the hon. Member on securing the debate. He mentioned the significance of diagnosis. Medical radioisotopes are highly significant for the diagnosis and treatment of dangerous cancer cells, and it is important to secure a domestic supply of them, in terms of both security of supply and cost. I am told there is a shortage of supply in the offing in the United Kingdom, but there is a chance to secure a generating reactor at Trawsfynydd in north Wales, known as Project ARTHUR. I am sure the hon. Member agrees that it would be a positive step for cancer care in the UK if the UK and the Welsh Government were able to make progress together on delivering that project.

As so often in Westminster Hall and in the main Chamber, the right hon. Lady makes a positive suggestion, and it is one I know you would also support, Mrs Harris. We think it should be the Government’s intention to make every effort to deliver that project in Wales alongside the Welsh Assembly, because it will help us all in the United Kingdom. I always enjoy these debates because they bring us all together, focused on the issue and not the politics of it. If we can make life better for all of us in the United Kingdom through that project in Wales, let us do it. I do not know whether the Minister has had time to prepare, but hopefully his civil servants will give him some indication on that, and then we can look forward with a positive suggestion out of this debate. I thank the right hon. Lady for her intervention; it was very helpful.

Our poor international standing and lack of supportive frameworks mean that, in some cases, certain innovative cancer medicines are not submitted for UK regulatory approval or to NICE, further impacting access for UK patients. Resolving challenges in the appraisal process for licensed medicines will provide important benefits. First and foremost, there will be benefits to our constituents and patients, including, importantly, access to a wider range of treatment options and the potential for improved outcomes for those needing treatment.

Secondly, there will be benefits to the NHS, which will be able to deliver more efficient care and have permission to access a full range of licensed medicines. Thirdly, there will be benefits to the UK—this great nation—because resolving these challenges will improve its attractiveness as a destination for clinical research by incentivising research and development to focus on new and more challenging patient populations. How the Government respond to what the right hon. Member for Dwyfor Meirionnydd (Liz Saville Roberts) asked for is an indication of how we will move forward and lead the way.

One issue is that NICE guidance is not automatically applicable in Northern Ireland, although the Department of Health there does tend to adopt NICE guidelines and approaches. As such, the patient access challenges outlined will likely have the same impact on Northern Irish cancer patients as they will on cancer patients in England and Wales. To be a successful, leading force in cancer medicines and treatments, we must be united, not divided, in how we tackle these issues. I have always been an avid believer in the idea that no nation in this United Kingdom should be left behind, and I know the Minister has always been committed to that; whatever the subject of a debate, he encapsulates my thoughts on how important it is to work together.

There will be challenges for medicines in the cancer drugs fund. Following the update of NICE’s methods and processes, medicines currently in the cancer drugs fund will be measured against different criteria to those used when those medicines entered it. That could mean that, for some medicines, the likelihood of recommending routine NHS access is significantly reduced, so we need some reassurance on that.

The cancer drugs fund is a source of interim funding for cancer drugs in England. It provides access to promising cancer medicines via managed access arrangements. The Northern Ireland Department of Health confirmed in 2018 that medicines approved by NICE for use through the cancer drugs fund will be equally accessible in Northern Ireland through a separate budget pot, which I urge the Minister to defend against any future budget cuts. I know that is not the Government’s intention, but it would be nice to have that reassurance today so that we can report it to everyone involved back home.

Given that medicines are to be reappraised under the NICE guidelines, they will not be appraised against the same criteria. I have ascertained that NICE is not presently considering any flexibility for medicines in that situation. For certain medicines, that will mean that the likelihood of recommending routine NHS access will be further reduced, and probably one of the major asks in this debate is to ensure that that does not happen.

The Government confirmed that 43% of medicines currently in a period of managed access through the CDF include the end-of-life modifier. Issues remain around who can access what medicines. New patients will not be given access to cancer drugs fund-approved drugs if they are not originally taking the drug at the first NICE regulation. Sometimes there needs to be flexibility in how drugs are allocated. It is not just a black and white tick-box exercise—it never is. We need to focus on the circumstances of the individual, the patient and our constituents—I know from his responses to questions that the Minister understands that, and we seek reassurance that that would be the case. The issues I have outlined mean that new cancer patients have no access to old drugs, so future eligible patients will lose out on options in their treatment plan. We seek reassurance that, when it comes to their treatment plan, eligible patients are given options to ensure that they are not debarred by some paper exercise—if I can use that phrase, with great respect.

NICE must act to address the impact that updates to its methods and processes will have on medicines currently in the CDF, especially in Northern Ireland, where these methods are usually followed to the rule. Ensuring that medicines in the CDF can be assessed against the same criteria under which they were initially recommended for use in the NHS will increase confidence for cancer sufferers that the medicines to which they so desperately need access are available. If the Minister has one positive reply for us today, that is the one we would ask for, because we know that it would bring relief to many people right away.

There will always be issues surrounding cost and the cost-effectiveness of financing a drug. The 2019 voluntary scheme for branded medicines pricing and access is an agreement between industry and Government that aims to meet the need to keep the NHS medicines bill affordable. I know there is a need to do that, but there is also a need to make the medication and drugs available, with the ambition to grow the life sciences sector as well, which we must do and have done before. The partnership between Government, pharmaceutical companies and universities is one that I recognise from Queen’s University Belfast and Ulster University in Northern Ireland. Those two universities have great relationships and partnerships with pharmaceutical companies that are to the fore of finding new cures for disease.

The scheme operates through rebate mechanisms, where companies pay a percentage of their net sales back to the Government. Historically, the rates in the voluntary scheme have averaged well below 10% of revenues, but as of 2023 they are 26.5%—wow! That rapid rise was driven by several factors, including the post-pandemic demands on the NHS and the fact that the UK is now widely out of line with comparator countries. Not only does the current level of repayment risk costing the UK economy far more than it saves, but it has an incredible impact on patients’ access to medicines. Again, we need some reassurance from the Minister on that.

For the UK to continue to be an attractive destination for clinical development, which brings benefits to all areas of the United Kingdom of Great Britain and Northern Ireland, a solution to the cost challenge must be found. In presenting the facts of the case and the evidential base, all of us present are very much solution-based, and our questions to the Minister will be about finding solutions.

Further combination therapies have been instrumental in combining medicines to attack different types of cancer and cancerous cells. There are still multiple unresolved issues around the value assessment, which I will briefly list, and I thank Sanofi for making me aware of this information before the debate—indeed, some organisations have been incredibly helpful in giving us a train of thought and a focus for requests, and hopefully we can be solution-driven.

Combination therapies undergoing appraisal can be found not to demonstrate cost-effectiveness or value for money. Furthermore, pricing barriers have proven problematic for manufacturers when two therapies are involved. The manufacturer of the new medicine has no influence over the price of the new therapy, meaning the total cost may go over the cost-effectiveness threshold. We all regularly meet lobby groups and pharmaceutical companies, which tell us that the NICE process is making it difficult for them to advance their medicines to provide relief and find a cure. I know that Governments have to be responsible and do not have the power to spend money willy-nilly, but it is important that we grasp what the manufacturers and pharmaceutical companies are trying to achieve.

Combination therapies can offer people suffering with cancer a better quality of life, a better response to treatment and—this is really what it is all about—a better chance of survival, which is so important. The UK must learn from countries such as Spain and the US in creating a more cohesive and agile path from pre-trial to treatment. Those are just two countries that have an excellent methodology for trying to advance. Hopefully, the Minister will reassure us that we in the United Kingdom are doing the same as other countries. The US dominates certain research, such as in immunotherapy, followed by China. The UK is in third place, with a global share of approximately 5%. Third place is not bad—it is a bronze medal—but we would like to move a wee bit further beyond that, and I think it is possible. The ideas are here, the technology is here and the will is here. We just need to drive it.

We must learn to strengthen links between UK academia, clinical medicine and industry, at a time when it is being reported that the number of industry-backed clinical trials has decreased by 41% since 2017. I know there has been a focus on covid, with everybody trying to find the cure, but let us get back to where we were before and lead the way again. I do not see how we can say that we are doing more to expand the variety of medicines that we offer patients, when the number of trials has declined by almost half.

I cannot emphasise enough how important it is that we ensure that the United Kingdom remains an environment where companies want to bring medicines forward for NICE appraisal in the first place. Being able to approve access to innovative cancer medicines is critical if we are to improve patient outcomes. The UK currently ranks 16th out of 18 comparable countries for five types of cancer, and it is important that we address the challenges with appraising cancer medicines to ensure that patients continue to access the new, innovative treatments in the pipeline. It is so important to get that pipeline concluded and the product line out the other end.

What is the solution? First, it is about exploring and adapting to the challenges and issues that must be overcome in terms of costing, combination therapies and fairer price negotiations for manufacturers and the NHS. The UK Government—our Government—must, in collaboration with NICE and the NHS, work with industry and patient organisations to develop and trial a sustainable solution.

Cancer has killed too many in recent years. Advances in medication and medicine have increased the likelihood of survival—not when my dad had cancer 40-odd years ago, but today. Cancer affects too many loved ones; there are too many horror stories, which we, as Members of Parliament, hear regularly. We do not always get the good stories; it is usually the bad stories about what has gone wrong. As MPs, our duty is to bring them forward on behalf of our constituents and highlight them, as we have done today.

The NHS can work closely with the cancer drugs fund to improve patient access to the good and decent drugs that will help them, and ensure that nobody is left behind. I sincerely thank all the organisations that have been in touch with me and others ahead of the debate on an issue that is so important and affects so many. I say a special thank you to Sanofi for its efforts and support and for answering my questions and queries.

We in this United Kingdom of Great Britain and Northern Ireland have real potential to ensure the best outcomes for constituents and patients. I look to the Minister for reassurance, which I am sure is coming, that we will continue to do all we can to work with the devolved nations—Scotland, Wales and Northern Ireland—and NICE to improve people’s lives. Our job is to do just that. If we can improve people’s lives and help them to live longer, what a joy it will be to have those answers.

It is a pleasure to serve under your chairmanship, Mrs Harris. I thank the hon. Member for Strangford (Jim Shannon), who is the closest thing this House has to a national treasure, for securing a debate that is so important to me.

This debate is about appraisals for cancer medicines. As with any debate about cancer in the House of Commons, there will be Members who have a personal connection to the issue. I will not spend a lot of time explaining my family’s situation, but for me this debate is different. It is not like the other debates that we take part in as parliamentarians. For some, we are experts in the field; for others, we are explaining the experiences of our constituents; and for others, we are speaking about what we have heard from stakeholders. My contribution is grounded in the year and seven months I spent caring for my sister, experiencing what the NHS treatment is like at first hand, and suffering as it became clear that over the past 40 years there has been no improvement in the treatment of glioblastoma—a brain tumour. The drug used to treat glioblastoma today, temozolomide, is the same drug that has been used for the past 20 years. That is not a national policy challenge; it is a frustration that I have lived.

When a person is diagnosed with a glioblastoma, they get six weeks’ radiotherapy, followed by six months’ chemotherapy with temozolomide if they can manage it. The drug was introduced in 2005, and it is called the gold-standard treatment in our NHS. That is a bastardisation of the English language. It is not a gold standard. It is not even a plastic standard. Although there are other treatments and drugs on the market for other cancers, the 3,200 people who are diagnosed with glioblastoma each year have had almost no improvement at all. The average life expectancy for someone diagnosed with a glioblastoma is nine months—do not believe the figures that suggest it is 18 months. The five-year survival rate is only 12.9%—just 1% better than the five-year survival rate in 2010.

For other cancers, the story is very different. For someone diagnosed with lung cancer in 2010, the five-year survival rate was 10.3%—not dissimilar to the survival rate for glioblastoma. The difference is that by 2020, the five-year survival rate for lung cancer had doubled to 21%. For some undiagnosed with breast cancer in 2010, the survival rate was 83.2%. By 2020, the five-year survival rate was all the way up to 85.9%. The five-year survival rate for bowel cancer has gone from 58% in 2010 to 60% in 2020.

I do not in any way mean to take attention away from those cancers. I am absolutely delighted that survival rates have increased, that there is innovation and that there are trials across the board. However, when I meet constituents who have had a cancer diagnosis for something other than a brain tumour, I regularly hear that they have had access to experimental trials. I appreciate that that is because I have a south London constituency and we are close to the brilliant Royal Marsden. When it comes to brain tumours, it is not that there are only a few trials; there are zero, with not many on the horizon. There are many reasons why survival rates have not changed for brain tumours in 20 years, but one is in the title of this debate: there are nowhere near enough appraisals for new brain tumour drugs and nowhere near enough clinical trials.

I will give an insight into how difficult it is to get a new drug on the market for glioblastoma. When my sister’s brilliant oncologist, Dr Paul Mulholland, set up a new clinical trial, he could not get the pharmaceutical companies to give him the drugs he needed. As a result, he had to rely on me, a Member of Parliament with no medical training, to write to the pharmaceutical chief executives asking them to donate to his trial. We were successful. We met senior members in four drug companies, and Roche was absolutely brilliant in its response. But why did it take a letter from somebody like me to get the drugs for a new clinical trial, instead of the other pharmaceutical companies responding to Europe’s expert on brain tumours? It completely baffles me, but I suppose that is the world we live in.

This experience tells me that the market is not working. It tells me that because only 3,200 people are diagnosed with a glioblastoma every year, it is not profitable for the pharmaceutical companies to invest in glioblastoma treatments. The market is very small, so it is not worth their while. As policymakers, it is our job to see where the market is working and where it is not. As legislators, it is our job to change, cajole and, ultimately, legislate to make sure that it does work. That has simply not been happening with glioblastoma, for which there has been no improvement in 40 years.

The drug companies will not change on their own. Unless we demand that they invest in those drugs, nothing will ever change; it will go on and on. Believe me, I do not want my worst enemy to go through what we have over the last 18 months. After speaking to some of the experts in the field and having conversations with all the main brain tumour charities, we have been able to develop a four-point manifesto that will make a real difference. As it happens, it will not cost very much either. I would be very grateful if the Minister could respond to that point.

On a personal level, I understand that the Minister is standing down at the next election. He has a year to 18 months to leave a real mark on this area of work. I ask him personally to be up to that challenge, to stand up to the status quo and the establishment in the medical profession and pharmaceutical companies, and to consider our glioblastoma manifesto.

First, we need a target of getting 200 glioblastoma patients into clinical trials each year on a drug that has the potential to change the course of the disease. That would be 1,000 patients over the lifetime of a Parliament. With those trials, we can begin to understand what works and what does not.

Secondly, the NHS should trial on brain tumours every drug that gets licensed to deal with other tumours, as long as there are not indications that it would be dangerous. Repurposing those drugs would be a cheap way to make a huge difference. It is sometimes the only way that makes a difference. The reason for melanoma survival rates of 90% at five years is precisely that: the use of a drug licensed for another cancer purpose.

Thirdly, the NHS should ensure that every neuro-oncology multidisciplinary team has a medical oncologist who is a core member and is required to attend meetings to discuss patients, so that brain tumour patients are not left in a corner of the ward because there is no specialist arguing for them. Unless a neuro-oncologist is in the room, we will not benefit from their ideas or expertise.

Fourthly, the NHS should require that every young—or not so young—doctor, training to be a medical oncologist should go through a mandatory course on brain tumours. At the moment, there is no compulsory training. Doctors have to take two courses on bowel cancer as part of their training, but nothing on brain tumours. Believe me, they do not take that option. The reason that there is nobody on those wards and the research infrastructure is not there is because nobody is required to do the course.

Fantastic work is being done in the world of cancer. There are improvements in some areas with some fantastic successes, which we should celebrate. However, we should have our eyes wide open when we are not making any progress. We should be able to take stock and say, “This is not working; we need to try something new.” In 2018, after Tessa Jowell sadly passed away from a glioblastoma, £40 million of Government funding was promised to fund research into brain tumours, but the infrastructure of treating glioblastoma is so poor that there have not been enough bids to allocate that funding. As of January, just £15 million of the promised £40 million had been awarded; the field is in such a dire situation that we cannot even spend the money that has been specifically allocated to brain tumours.

This is about trying something different. I do not care whether it is Labour, the Conservatives, the Lib Dems, the DUP or the SNP—I will get behind anyone with the political will to make a change. Einstein famously said:

“The definition of insanity is doing the same thing over and over again and expecting different results.”

I think we are getting to that point with the treatment of glioblastoma. It is time to break the mould, take a risk and try something different.

I think this is my first time speaking under your chairmanship, Mrs Harris; I am sure it will be a great pleasure. I congratulate the hon. Member for Strangford (Jim Shannon) on securing this important debate, and on his excellent speech setting out the issues with the new NICE methods and processes for cancer drugs. The hon. Member for Mitcham and Morden (Siobhain McDonagh) described him as a national treasure. As a Minister, I was once in charge of national treasures; I feel I lost the opportunity to enshrine his legacy in a Bill before Parliament, during whose passage I am sure he would have intervened.

The hon. Member for Strangford set out an interesting problem, and, like him, I am grateful for the briefing I have received on the matter. I am humbled to follow the hon. Member for Mitcham and Morden. I have been on the cancer treadmill, and I think that, as patients, people become incredibly compliant; they do as they are told. It is often much harder for those who love someone who has cancer. They fight for better treatment and care on behalf of their loved one because it is all that they feel they can do, as the hon. Lady set out.

We need to do so much more on rarer cancers, particularly brain cancers. I quickly googled global survival rates for glioblastoma; the survival rate in the US is 26%, compared with 10% in the UK as the hon. Member for Mitcham and Morden set out. That shows that factors such as access to drugs can make a significant difference to outcomes. I am sure that the Minister heard very much what she said, and many people who are suffering from brain tumours will be grateful for her contribution.

I have no intention of becoming the poster girl for all things cancer. In some cases, I still find talking about my experience of the disease quite hard, but I wanted to speak in this debate because I also find it infuriating that we lag behind so many countries on many cancer-related areas, including access to medicine. However, I want to give some good news on cancer targets from my area. It is extremely worrying for anyone to read front-page news of missed targets, backlogs, delays and so on at the start of their cancer journey, but in Kent and Medway we are fortunate to have one of the top performing alliances in the country for meeting the 62-day standard, with both Maidstone and Tunbridge Wells NHS Trust and Medway NHS Foundation Trust reaching 85%. In fact, MTW, which is where I was treated, has consistently met its targets for the last three years, having kept all its cancer services open during the pandemic. The improvements are generally down to achieving more rapid diagnoses by triaging referrals and sending as many patients as possible straight to their diagnostic test.

A lot of evidence links early diagnosis with better outcomes. Despite having top-notch treatments available on the NHS, the UK still lags behind Europe and the US. There may be many reasons, but my view and that of many others is that the main push should be for diagnosing patients as early as possible to improve outcomes. However, we really cannot afford to get into a situation where we do not have access to the latest treatments; otherwise, outcomes may worsen. There is a conundrum, which can be summarised as: methods and processes versus cost versus data—and it is really hard to squish that triangle into a circle. I met two pharmaceutical companies to learn about this issue. Although I am not naive to its aims, I was struck by the disadvantage that the changes to NICE’s methods and processes could leave UK cancer patients with.

The hon. Member for Strangford outlined the background to the changes so I will not repeat them in great detail, but in summary, in 2022 NICE changed the way it reviews disease severity as part of its assessment process. It introduced the severity modifier and removed the end-of-life criteria, which gave a higher value weighting to medicines for terminal illnesses. That change is likely to negatively impact cancer medicines in particular. Capacity issues, cost containment measures and other commercial environment factors are steadily combining to create a life sciences sector that is disincentivised to focus on cancer innovations or invest in the UK. That in turn will pose challenges to achieving the Government’s ambitions to accelerate access to oncology medicines and meet the policy targets set out in the “Life Sciences Vision” and the NHS long-term plan.

What worries me is that big, global oncology conferences take place—like the recent American Society of Clinical Oncology conference in Chicago—which are brilliantly reported in our newspapers, with references to breakthrough drugs for x cancer sending shivers of hope down the spines of people like me and many others, when the truth is that very few of those drugs will reach our NHS due to NICE methods.

That is when I see the other side of the argument, at least to some extent. We should really be congratulating whoever does the procurement negotiations with pharma to drive down the cost to the NHS so that investment can be made in other areas of cancer, such as diagnostics, although that can be stretched only so far before companies pull their drugs from the market. It is about finding a sweet spot that works well for both.

Data is another challenge. There is a lack of outcome data available to NICE in the full assessment of some medicines. The problem for pharmaceutical companies is that this data is hard to come by. Outside of a clinical trial, they have little or no access to outcome data from the use of the drug in the real world, and if it is expensive, it is hard to prescribe it without a NICE recommendation in the first place—thus we have come full circle due to a lack of evidence and, of course, the increasing cost.

Does the hon. Lady agree that it seems crazy that in a system as universal as the NHS there should not be access to outcome data? To give just one example, South West London Elective Orthopaedic Centre at Epsom Hospital is the largest hip and knee replacement centre outside of America. It is the lowest for blood risks, and has the lowest infection rates and quickest turnaround. It has its own small charity and keeps the data, making £1 million a year from it. That could go some way towards paying for the latest cancer drugs.

I entirely agree. Data sharing will help cancer outcomes full stop, not just in the example she gives. If my GP sent me for a breast screening, for example, the person doing the screening could not currently see whether I have had a cervical screening. Having the conversation about screening for other cancers while having some form of cancer screening is an important aspect of long-term survival rates, so I completely agree with the hon. Lady.

It appears that NICE, through changes to its methods and processes, has probably got stricter on the level of evidence it requires before it will make a recommendation, so that it ensures that there is a survival benefit to the things it recommends, all of which is a potential reason that we should collect and share data better across the NHS. We could allow pharma better access to anonymised NHS data, and some trusts already do so with strict governance in place. Working together in this way would allow us to access the actual impact of a drug when it is used outside of a trial and allow NICE to make a real-world evidence-based recommendation, which would be particularly helpful for rarer cancers such as glioblastoma.

We have to get over the clinical reticence of not using a drug before it has a NICE recommendation, otherwise we will never get the real-world data. Some 80% of cancer drugs recommended by NICE were only recommended if the price to the NHS was reduced, so, given that in the UK clinicians tend not to prescribe without a positive NICE recommendation, the pharmaceutical companies essentially have to drop the price to get the recommendation for the drug to be on the market. In all those points, it is forgotten that at the centre of this is a cancer patient just wanting to get the best possible treatment to live for as long as possible.

We all want positive outcomes for cancer. NICE has committed to keeping its new methods under review. During this time, it is essential that flexibility is maintained when considering disease severity so as to ensure timely and ongoing patient access. Pharmaceutical companies want to be at the forefront of developing life-enhancing, cancer-beating drugs for the market. There has to be a sensible way forward, but at the moment it feels like the changes may have made things worse for current and future cancer patients hoping for breakthrough life-enhancing treatments.

I know the Minister to be a sensible and reasonable person. I hope he will take renewed vigour from what he has heard so far in the debate and will sit down with all the interested parties to see how we can go forward, because without doing so, I fear that on this issue—coupled with others around screening, diagnosis and access on to pathways—we will continue to lag behind other countries in beating cancer.

It is a pleasure to see you in the Chair, Mrs Harris. I commend the hon. Member for Strangford (Jim Shannon) on securing this important debate. I will do my best to follow the two previous contributions from the hon. Members for Mitcham and Morden (Siobhain McDonagh) and for Chatham and Aylesford (Tracey Crouch) about their personal experience. I cannot contribute to the debate in that way, but I will do what I can.

All our lives have been touched by cancer in one way or another. We all know someone whose life has been changed in some way by the disease. Therefore the appraisal of cancer medicines is of the utmost importance to us all. These medicines give hope and, indeed, life to so many. Yet even something as vital as the evaluation and distribution of cancer medicines did not escape the upheaval of Brexit. The UK ended its membership of the EU three years ago, and that catastrophe, which Scotland did not want, meant that the Medicines and Healthcare products Regulatory Agency withdrew from the European Medicines Agency. While immediate disruption to patient care was avoided, there have been shortages across the board since Brexit.

In Scotland, the Scottish Medicines Consortium—if I mention it again, it will be easier to say SMC—must review and recommend a new medicine before it can be prescribed on the NHS for routine use. This would take place after a medicine has received a marketing authorisation from the MHRA. The SMC advises and provides recommendations to NHS Scotland. This due diligence must be carried out by medical professionals to ensure everyone’s safety. The Scottish Government remain concerned about the effect of Brexit on the authorisation of medicines, as medicines obviously play a crucial role in the NHS. The authorisation and appraisal of medicines also have a key role in the Scottish Government’s commitment to supporting people to live longer, healthier lives. Diagnosing and treating cancer are a priority for the Scottish Government, which is why they are investing £40 million over five years to support cancer services.

However, the NHS in Scotland has finite resources, and medicines are the second largest item of expenditure for NHS Scotland, so difficult choices have to be made. A number of factors need to be looked at. For example, what benefits does the medicine offer compared with other available treatments? Other factors include the quality of life and amount of extra life that may be gained by patients using the new medicine, how the medicine is administered and whether it will save money later on. Those are all examples of the considerations that have to be included when coming to decisions.

Despite UK Government vows to make the MHRA faster and nimbler, we remain concerned about budget and staff cuts to the organisation. There is also a question about the so-called light-touch approach to authorising generic medicines and relying heavily on approvals from larger regulators in the EU and US. The Financial Times reported that the need for cuts at the MHRA has been driven partly by Brexit and the loss of millions of pounds of annual income from its role in authorising medicines in the EU. There has also been a contraction in UK Government funding after the MHRA was subsumed into the budget of the Department of Health and Social Care, as far as I can see.

The hon. Member for Strangford referred to the payback rate of 26%. That is another thing we must not lose sight of. Two very large pharmaceutical companies have already withdrawn from the voluntary scheme as a result of the increase to the rate, which they claim is now punitive. Any further withdrawals from the scheme will surely only have impacts on patients—the people we all want to be doing everything we can to support.

According to recent research by the Nuffield Trust, although the UK Government and pharmaceutical industry averted immediate disruption to patient care from difficulties in the supply of medicines after leaving the single market, there has been a great level of shortages. A review by Imperial College Business School revealed that fewer novel drugs were authorised by the MHRA in 2021—its first year of independence—than by the European Medicines Agency; the UK saw the approval of 35 drugs, compared with 40 in Europe and 52 in the US. That goes back to the points about the availability of medicines and the options that that then makes available to doctors and their patients. Any reform of the regulatory framework must ensure that patients have a voice; their lived experience must inform regulatory decisions. That is where we can all play our part—by relating the experiences that are brought to us.

A cancer diagnosis can be a heartrending and life-changing event, but it can bring positives, and we can all learn from the experiences of those who have gone through it. We need to do everything we can not to add to that heartache by allowing standards to drop or by creating more red tape that stops people getting the medicines they so urgently need.

Brexit casts a long shadow and it has impacted on this area, so we must ensure that there is no withdrawal from the current EU standards or safety controls on medication. It is in all our interests to ensure that we support the development and appraisal of new medicines. We owe that to all our constituents and none more so than those affected by cancer.

It is a pleasure, as ever, to serve under your chairmanship, Mrs Harris, and to respond to this debate on behalf of the shadow Health and Social Care team.

I begin by congratulating the hon. Member for Strangford (Jim Shannon), who I call my hon. Friend, on securing this important debate, and I thank him for his tireless work campaigning on such issues.

Also, I pay tribute to my hon. Friend the Member for Mitcham and Morden (Siobhain McDonagh) for the powerful case that she put to the Minister in respect of brain tumours generally and specifically the glioblastoma manifesto. I very much hope that the Minister is able to take up her challenge, because the inequalities in outcomes that she laid out are unacceptable. In the year 2023, we should not be looking at a situation in which there have been zero improvements in life expectancy from cancers such as glioblastoma since 2005-06 when we have seen dramatic improvements in the other areas that she mentioned. We owe it to Baroness McDonagh—Margaret McDonagh—and to others such as Tessa Jowell to ensure that we see improvements in this area, too.

As for the hon. Member for Chatham and Aylesford (Tracey Crouch), she said herself that she has been on the cancer treadmill, and it is lovely to see her back in her place and up to her old usual tricks. We welcome her.

I just want to say that I was never not in my place; I was fortunate enough to go through cancer treatment during covid, when we were all working under a hybrid procedure. Actually, that experience has helped to form some of the contributions that I have made to the Procedure Committee about how we in this place support people who are going through significant illnesses.

Absolutely—the virtual Parliament hid a multitude of sins. I know that as somebody who struggled with long covid through that period. Many people would not have known just how ill I was, because I just appeared on a screen. However, it is nice to see the hon. Lady in person; I should put it like that. And she was entirely right to say that cancer touches us all, which is why we can all cite personal experiences of it. I lost my mum to ovarian cancer when I was 19; she was just 50. I lost my dad last year to rectal cancer. I am not alone; we all have people, including close family members and friends, who we have lost to cancer.

I also pay tribute to the hon. Member for Midlothian (Owen Thompson), who responded on behalf of the SNP, for his contribution to the debate and to the right hon. Member for Dwyfor Meirionnydd (Liz Saville Roberts), for her intervention.

I am sure that I speak for everybody from all parties in the House when I say that ensuring that patients have quick access to the most innovative and effective treatments is an absolute priority. This country has a proud history of medical innovation, a reputation that we should try not only to protect but to enhance, as we have already heard today.

We are talking today about the appraisal process for cancer patients, which, as we have also heard, has changed markedly over recent years in several areas. We have seen increased focus on targeted treatments and immunotherapies, as well as reform of the cancer drugs fund in 2016, a move that was taken to improve people’s access to cancer drugs while allowing NICE to collate more information on potential areas of clinical uncertainty.

In a recent report, the Association of the British Pharmaceutical Industry highlighted that 78% of medicines have been able to exit the cancer drugs fund with a positive recommendation, with most of them spending about two and a half years in the CDF process. It also recognised improvements as a result of the relaunched CDF, but raised concerns that the CDF has

“perhaps been overly relied upon”

in order to

“delay making routine recommendations.”

It states that

“a new balance may need to be struck between NICE and manufacturers in considering which treatments should enter the CDF to resolve genuine uncertainty surrounding long-term clinical outcomes and for how long.”

Given that NICE recently set out specific circumstances when committees may be able to accept a higher degree of uncertainty in routine commissioning decisions, can the Minister set out whether his Department has assessed the ABPI’s findings and whether more can be done to improve access to innovative treatments for patients via routine commissioning? That links to a wider point that I wish to raise on clinical research and trials.

Clinical trials provide an opportunity for the NHS, businesses and brilliant researchers to work together for the benefit of everyone. Unfortunately, however, in recent years the UK trials industry has collapsed. The number of commercial trials in the United Kingdom decreased by 41% between 2017 and 2021. Worryingly, the UK has dropped from fourth to 10th in the global rankings, behind Spain, France and Italy. Of most concern is that in 2020-21, the NHS lost £447 million in revenue due to a drop-off in clinical commercial trial activity. Those figures should seriously worry the Minister. They risk putting patients at a disadvantage for all kinds of innovative treatments, including cancer medicines.

In Labour’s recent health mission, we committed to putting Britain right at the front of the queue for new medicines and vaccines. Alongside our pledge to spend 3% of GDP on research and development across the public and private sectors, we want our clinical trials to be more competitive, efficient and accessible. Making those ambitions a reality means tackling unnecessary bureaucracy in how trials are set up and reducing the administrative burden on everyone involved in the clinical trial, including the NHS. Will the Minister set out how his Government plan to reverse the drop-off in clinical research and trials—a drop-off that is costing our NHS financially and clinically?

Finally, I want to touch on the issue of patient access to innovative medicines, including for cancer patients. In 2021, in its “Life Sciences Vision”, the Government committed to identifying and addressing “unwarranted variation” in the uptake of innovative medicines. But in February this year, in the innovation scorecard commissioned on behalf of the Department of Health and Social Care, it was found that a number of areas were still falling short of the NICE recommended levels of new medicine uptake.

Will the Minister provide an update on what work he is doing to improve regional variation in uptake of innovative medicines so that no matter where someone lives, they can access the treatment they need when they need it. Will he also commit to improving the data collected as part of the innovation scorecard to include information on cancer medicines so that we can meaningfully assess uptake and isolate areas for improvement where necessary? That is something that the life sciences sector has called for, so I would welcome more information on that from the Minister.

In conclusion, Labour is wholly committed to ensuring that cancer patients in this country receive access to the very best medicine and care. That means ensuring that appraisals for cancer medicines remain fit for purpose and adapt in line with evolving technologies and scientific advancements. It also means turbocharging clinical trials and tackling the unacceptable gaps in access to cutting-edge treatment. In his response, I hope that the Minister will meet the ambition set out by the Labour party and that we can work together towards making Britain a world leader in cancer care and treatment, because we owe it to all those people on the treadmill right now.

It is a pleasure to serve under your chairmanship, Mrs Harris. I thank the hon. Member for Strangford (Jim Shannon) for securing this important debate on appraisals for cancer medicines and thank all Members who have contributed to a hugely valuable discussion.

The hon. Member said that he thought the debate would be a presentation of a united front, and that has been demonstrated today. He also said that he hoped he was pushing at an open door. On many of the points he made, he certainly is doing that. He spoke with great passion and empathy for those who suffer from this terrible disease, and I commend him for bringing this issue to my attention and the attention of the Government. Unusually, for a Westminster Hall debate, I have some time to respond to the points, so as ever, I will offer all Members who would like it a meeting to discuss any of the issues that have been raised in greater depth, but I will try to cover them in as much detail as I can in my response.

According to Cancer Research UK, one in two people will develop cancer at some point in their lives. There are around 290,000 new cancer diagnoses a year, equating to around 780 every single day. I am acutely aware as a Health Minister that when we use statistics such as these, we must remember, as the hon. Member for Mitcham and Morden (Siobhain McDonagh) eloquently and articulately pointed out, that these are people; these are human beings who we all know and love—a dear friend, a loved one, a member of our family. It is important when we talk about statistics that we do not lose sight of that.

Let me turn to the hon. Lady’s contribution. She made a powerful speech, and it is not the first that I have heard from her and had the good fortune to respond to. She rightly made a powerful and emotive case on behalf of her sister Margaret and all those who suffer and have suffered with brain tumours. I think she knows my commitment to doing all I can to improve the situation in relation to brain tumours. In truth, I think I have spent more time on this particular issue in my time as a Minister than I have on any other condition under the umbrella of the major conditions strategy. I will continue to do so, not just because of the powerful case that she makes, along with others across this House and campaigners, but because I know there is an injustice in that this area does not get the attention it deserves, and I want to address that. I have raised it with the chief scientific adviser, who heads up the NIHR, and it is important to also raise it with NICE.

I have met the hon. Lady, and I would be happy to do so again. She makes a powerful case that we need the pharmaceutical industry to step up in this space, and I am keen to work with her to see what more we can and should do to make sure that happens. Finally, let me thank her for her kind words about my leaving Parliament at the next election. I assure her that I will do all I can for as long as I am in this role to help her achieve the objectives she seeks.

I join the hon. Member for Strangford in paying tribute to all the cancer charities—some very large and some very small—that work to support patients up and down this country. He is right to draw the House’s attention to that.

The NHS has seen enormously high demand for cancer checks. More than 2.8 million people were seen in the 12 months to April this year, up by 26% compared with the same period pre-pandemic. That returning demand is positive after the falls we saw during the pandemic. We are working closely with NHS England to reduce the amount of time people are waiting to receive a diagnosis, and we are making progress; it is not as fast as I would like, but we are working very hard to make progress. The latest published figures show that the 62-day cancer backlog for the week ending 30 April stood at 22,533. It has fallen by 34% since its peak in the pandemic, but I am acutely aware—this preys on my mind every single day—that it amounts to more than 22,000 people, too many of whom have had to wait 62 days and are struggling with the anxiety of waiting for either a diagnosis or the all-clear.

The hon. Member for Strangford set out the scale of the challenge we face, which I touched on there, but I will move on to what we are doing to address this. The Government are spending more than £8 billion on the elective recovery fund, £700 million on the targeted investment fund and, importantly, as has been referenced in a number of contributions, £2.3 billion of capital funding has been made available to increase our diagnostic capacity—those 160 additional community diagnostic centres. I was able to give the hon. Member for Denton and Reddish (Andrew Gwynne) some good news on that for his constituency recently.

We have 108 community diagnostic centres operational at the moment. I announced a further number only last week, and we have another eight coming on stream. We want to get to 160 centres by 2025, but I want to do it as quickly as we possibly can. There will also be additional surgical hubs. Those CDCs have already since July 2021 delivered over 4 million checks, so we have to get those open and operational as quickly as possible.

The Minister is of course aware of the proposal for a medical radioisotopes facility in north Wales, which is crucial for diagnosis in the future. I wonder whether he is also aware that this would complement Bangor University’s Nuclear Futures Institute and its planned new medical school. We are all aware of the shortage of clinicians. I am concerned that the centre for doctoral training in nuclear energy futures at Bangor, which plays a vital role for PhD projects and their funding, has had its application for renewal rejected by the Engineering and Physical Sciences Research Council.

I would be grateful if the Minister clarified whether he is aware of this issue. I appreciate that it is local, but when we are looking at the future, these local solutions will be absolutely critical. If he is not aware of this, could he commit to raising it with the Department for Science, Innovation and Technology and his counterparts in the Welsh Government? Most importantly, could I plead with the Minister for a meeting with him to discuss the wider issue of radioisotopes availability, their cost and the security of supply in the future?

The answer to both is yes, and yes. If the right hon. Lady would write to me with the details, I will certainly raise the issue and meet to discuss radioisotopes specifically.

NHS England is working very closely with the independent sector to ensure that we are using all the available capacity to us to deliver both diagnoses and treatment as quickly as possible. The Government announced the major conditions strategy on 24 January, which is important for cancer as it draws on previous work on cancer. Over 5,000 submissions were provided as part of our call for evidence last year, and we will continue to work closely with stakeholders, the public and patients—whose voice should never be forgotten, as the hon. Member for Strangford rightly points out—and the NHS in the coming weeks to identify the actions we need to take as part of the strategy that will have the most impact.

Specifically on NICE appraisals, the hon. Member raised several concerns about the way in which cancer medicines are appraised. Members will know that NICE is rightly independent of Government. It is an expert body that makes evidence-based recommendations to the NHS on whether new medicines should be routinely funded by the NHS on the basis of on assessment of clinical and cost effectiveness. Those recommendations then develop, mainly for the NHS in England, but as was mentioned, they are usually adopted by the NHS in Wales and in Northern Ireland. Scotland has its own system. This is a difficult matter to raise, but it is important to point out that every pound that we spend on a new medicine is money that is not available for other services, and the NICE appraisal process ensures that NHS funds are spent in a way that provides the greatest health benefit to society. That is a hugely difficult job, which NICE does with great professionalism.

Again, it is important to point out that NICE appraises all new medicines and that its approval rate for cancer medicines has consistently been around 90%–I think that the latest figure is 92%. It is absolutely right that when NICE recommends a medicine for the NHS, it is available for patients and NHS England is required to fund that drug or treatment. I know that the NHS in Northern Ireland and in Wales has adopted a similar model.

NICE’s methods and processes for assessing new medicines are internationally respected, and they have evolved over time to ensure that they reflect best practice and keep pace with advances in medical science. As my hon. Friend the Member for Chatham and Aylesford (Tracey Crouch) pointed out—I will come on to this in some detail— NICE concluded a comprehensive review of its appraisal methods and processes last year, which it carried out with a high level of ambition and transparency. As she pointed out, changes include the introduction of a new severity modifier, which will give NICE more flexibility to recommend medicines for more severe diseases at higher prices. The severity modifier replaces the previous flexibility for end-of-life treatments.

My hon. Friend raised some concerns about that, and I always listen very carefully to what she says on this and many other issues, especially given her personal experience and campaigning. She is right to say that the situation is hugely complex, and her point about data is a really good one, because decisions need to be informed by good-quality data. I would be happy to meet her to discuss how we can ensure that we are collecting data not just on a regional basis, but nationally, so that we can make sure that NICE is making informed decisions. As she rightly points out, we need to ensure that patients and their voices are always at the heart of all the decisions made by not just the Government, but NICE. I would be happy to meet her to discuss that in greater detail.

On the broader point about whether the introduction of a severity modifier in place of an end-of-life modifier will affect cancer drugs specifically, analysis was carried out by NICE in developing the modifier. It indicated that the vast majority of cancer medicines that would have been eligible for the end-of-life modifier would also be eligible for a weighting under the severity modifier. I am happy to meet my hon. Friend and any other Members who would like to meet NICE to discuss this issue further.

I think it is very important that the Minister also meets the pharmaceutical companies, because there is a counterclaim to the statistic from NICE that he has just given. The pharmaceuticals say that, actually, a significant percentage—I cannot remember off the top of my head what it is—of drugs would not pass the test. My plea to him is to sit down with all interested parties and not just listen to NICE’s statistics on this issue.

My hon. Friend is absolutely right, and I regularly meet the pharmaceutical industry, not least because of VPAS, which I will come on to discuss because it has been raised by a number of Members. While I understand the concern, it is absolutely right that assessment of clinical and cost effectiveness reflect up-to-date clinical pathways, evidence and evaluative methods and processes. However, my hon. Friend is absolutely right to say that we should also hear and understand the views and concerns of the pharmaceutical industry so that we have a rounded, balanced view and the full picture, to make sure that there are no unintended consequences because of the action that is being taken.

The hon. Member for Strangford mentioned non-uniform pricing and VPAS, so let me come on to that specifically. The tricky thing is that the negotiations for the next VPAS are currently under way. Given that there are ongoing discussions, it would not be appropriate for me to go into too much detail, because of the commercial sensitivity. It would also be inappropriate to set up a working group to review NHS England’s policy on non-uniform pricing. What I would say is that if changes were made to the wording in the next VPAS on commercial flexibilities, they would be reflected in an updated commercial framework for new medicines.

The hon. Members for Strangford and for Denton and Reddish raised clinical trials. We are doing a huge amount of work in that space because I recognise some of the issues and challenges that the hon. Member for Denton and Reddish set out. That is why we commissioned the O’Shaughnessy review into clinical trials, and why we accepted Lord O’Shaughnessy’s recommendations in full. We should take a step back for one moment and look at the work that we did as a country and an industry on clinical trials, particularly relating to covid. We basically shut down huge numbers of clinical trials to focus on a vaccine. To be fair, this country absolutely led the way in that, and we should be very proud of what we did, but we have not been fast enough in switching clinical trials back on and we have lost some of our competitive edge in relation to other countries, as the hon. Gentleman pointed out. The reality is that it is a race; clinical trials are globally competitive, and other countries, including Spain, have seized the advantage and are fighting hard for market share. We have to make sure we are a competitive place. That is about clinical trials but also our regulatory environment.

The hon. Member for Midlothian (Owen Thompson) made good points about the MHRA. We are absolutely looking at its processes and procedures, and we are putting an extra £10 million into it over the next two years to ensure it is a world-class regulator that is one of the fastest and most effective and efficient. It is already highly respected, but we must ensure that it does things at the right speed. That is very much on my radar, and as I said we are accepting the recommendations.

The hon. Member for Denton and Reddish also raised the cancer drugs fund. Since 2016, NICE has been able to recommend medicines for use through the Government’s £340 million cancer drugs fund, which enables patients to receive promising new treatments for a time-limited, managed access period while further evidence is being collected. That is then considered by NICE when determining whether a medicine should be routinely funded by the NHS. Since that fund was created in 2016, it has helped more than 91,000 patients in England, and more in other places, to access innovative medicines.

Those 91,000 did not include people suffering from a glioblastoma. We are not anywhere near NICE. We have not got that far. The drugs are not there. There is nothing. None of this works for people with glioblastoma. I do not want to mislead the Minister into thinking that I care only about my sister, Margaret. I draw hon. Members’ attention to early-day motion 1233, in my name, to commend the life of Laura Nuttall, a young woman diagnosed with a glioblastoma aged 18. She died on 22 May. I want to pass on all our condolences to her mum, Nicola, her sister, Gracie, and her father. Laura was a shining light and an ambassador for the Brain Tumour Charity. Although she was told that had only a year to live, she managed to live for four and a half years and secured a 2:1 in her degree. Laura highlighted that brain tumours are the greatest killer of people under the age of 40, who are being let down.

I totally take the hon. Lady’s point when she says that it is not all about her sister, Margaret— I know that from her contributions. Often in this place, we draw on our personal experiences, which enable us to bring to life powerfully and emotively what others are experiencing. I thank her for sharing Laura’s experience, and I send my condolences to Laura’s friends and family.

The hon. Lady is absolutely right that the cancer drugs fund can bring forward only innovative medicines that have gone through the clinical trials process. I will be very happy to work with her and meet her again to discuss how we get more research in this space. That is the key to so much, in relation to tacking brain tumours.

The hon. Member for Strangford spoke about the challenges presented by combination therapies. The commercial framework also recognises that realising the full potential health benefits from combination drug therapies can be challenging, given the requirement for commercial confidentiality and the need to maintain competition. Having said all that, NHS England has a proven ability to negotiate commercial agreements that secure combination treatments for patients. Just last month, deals were struck to enable NICE to recommend Keytruda and Lenvima for hundreds of women with advanced endometrial cancer. Progress is being made, but again, I would be happy to discuss the issue further.

Again, I thank the hon. Member for Strangford for securing this important debate and for his continued interest in the appraisal of cancer medicines and access to cancer treatments for NHS patients. I also thank other Members who have made such powerful contributions.

If one message comes across, Mrs Harris, I hope that Members are assured that the Government and I remain firm in our commitment to making the most promising and effective new cancer treatments available to NHS patients. The hon. Member for Denton and Reddish said that this is not a political issue, and I agree. It would be impossible to find anyone in the House who does not want to ensure that patients across the United Kingdom get access to the most innovative and cutting-edge medicines for cancer and other diseases, as quickly as possible. We all have a common endeavour there.

It is important to acknowledge the huge role that NICE has played, with its world-leading health technology assessment. It has enabled NHS patients to be at the forefront of access to new cancer treatments, in a way that also represents value for the taxpayer. I recognise the point that has been well made today, that we must always seek to improve and to go further and faster. I look forward to working with all Members present and others across the House to achieve that.

I thank all hon. Members for their contributions, which I will quickly go through. I thank the hon. Member for Mitcham and Morden (Siobhain McDonagh) for sharing her personal experience, which greatly affected us. She referred to brain tumours—glioblastoma—and the drugs available on the NHS, the survival rate and her heartfelt request for betterment, and the cajoling of legislators that needs to happen.

Drug companies need to change to help cancer patients. Trials need to be encouraged in the NHS and an oncology person needs to be available in meetings. That is a really good idea, because it gives focus. The hon. Lady also said the NHS needs more awareness and training for brain tumours. I wrote down, “Try something new now.” She also referred to the political will for change. The Minister clearly summed up for us all that this is not about politics; it is about patients. The hon. Lady put forward that point very well.

I thank the right hon. Member for Dwyfor Meirionnydd (Liz Saville Roberts)—I hope that is close to the right pronunciation—for coming along. She put forward a simple request; the Minister responded, and there will be a meeting. If we come up with solutions, we should push for them, and the right hon. Lady has a solution that will benefit us all.

The hon. Member for Chatham and Aylesford (Tracey Crouch) was a guest speaker at one of my DUP association meetings a few years ago; we had her down at the women’s football team in Comber. She knows I have always had a soft spot for her, and I am pleased to see her here making a heartfelt, personal contribution. She referred to the global survival rate for brain tumours, with the USA at 26% while the UK is at just 10%. Other points related to early diagnosis, pharmaceutical companies, better outcomes, the NICE change to the severity modifier, and the difficulties with drugs.

The hon. Lady summed the debate up so very well, and she centred it on the patient. Central to all this—the drug companies, the NHS, the political aspirations of the parties represented here—is the patient. That is critical, and that is what this debate is about. You know that, Mrs Harris, I know that, and the Minister has clearly accepted it. I thank the hon. Member for Chatham and Aylesford for providing that focus that we all needed.

My friend the hon. Member for Midlothian (Owen Thompson) referred to the contraction in funding and its impact on the pharmaceutical companies, on the availability of medicines to GPs and, ultimately, on patients. It keeps coming back to the patients; they are central. I thank the hon. Gentleman very much for his contribution.

I love having debates with the hon. Member for Denton and Reddish (Andrew Gwynne), because we are always on the same page, as we clearly were today. He grasped the issue and summed it up so well. He talked about priority access to innovative medicines, and referred to brain tumours and cancers too. However, he mentioned, as I did, that clinical trials, with businesses and researchers working together, are down by 41%. We really need to address that. The UK has dropped from fourth to 10th in the global rankings. We need to regain that higher position; the hon. Gentleman underlined that. It is not about moving up the rankings for the sake of it; it is about moving up the rankings to regain the position that we had. We understand the reasons for our drop in the rankings, which include covid; the Minister responded well in that regard. It is not about blame; it is about regaining that higher position. The hon. Member for Denton and Reddish also referred to the unacceptable gap in medicines, which must be addressed to make the UK a world leader once again.

It is a pleasure to attend any debate with the Minister, and I thank him for his answers today. He referred to something that should make us focus: there are 780 new cancer cases each day—wow! I had never heard that figure until today. We hear the bigger figure—the 200,000 or 300,000—but I had never heard that daily statistic. As we have been sitting here, there have been diagnoses across this great United Kingdom.

Again, the Minister summed the situation up: brain tumours do not get the attention that they deserve. He referred to a 26% increase in cancer diagnoses in the last year. I loved his positive answer—160 diagnostic centres approved by 2025, with 4 million extra checks. We heard about a 92% approval rate for new drugs, and about clinical trials. Covid changed things, and we must regain our place in the rankings. There is a need to improve and to go faster—how well that was summed up. I thank everyone for their contributions, and I especially thank the Minister for the positivity of his response.

Question put and agreed to.


That this House has considered the matter of appraisals for cancer medicines.

Cryptocurrency Regulation

I beg to move,

That this House has considered the regulation of cryptocurrency.

It is a pleasure to serve under your chairmanship for the first time, Mrs Harris, and to see you in your rightful place.

As chair of the crypto and digital assets all-party parliamentary group, I am delighted to be able to talk about the potential of the UK cryptocurrency and digital asset sector, and the need for clear regulation to protect consumers, which should be at the core of everything we do, and to support investment.

Just over a year ago, in April 2022, the UK Government set out their landmark vision to make the United Kingdom the global hub for cryptocurrency investment, committing to creating the right conditions for cryptocurrency and digital asset businesses to set up and scale up in the UK. Shortly afterwards, in August 2022, the APPG launched an inquiry to better understand the opportunities that a regulated industry could bring to the UK, as well as the challenges and potential barriers for Government in making their vision for the UK a reality.

Just last week, we published our report “Realising Government’s vision for the UK to become a global hub for cryptocurrency & fintech innovation”. Our inquiry looked at a number of key areas, including the potential for the UK to be a global hub for investment; the UK’s approach to regulation and the role of UK regulators in consumer protection; the potential offered by central bank digital currencies; and the risks of economic crime. We heard views from operators, regulators, industry experts and the general public—the Advertising Standards Authority, Innovate Finance, the City of London Corporation, the Payment Systems Regulator, the Royal United Services Institute, the Law Commission and many others—on the need for regulation of this ever-growing sector. I put on the record my thanks for their input and help in formulating our recommendations.

The APPG’s report is the first on cryptocurrency and the digital assets industry compiled jointly by MPs and Members of the House of Lords, and I thank colleagues in both Houses for their invaluable contributions. We set out more than 50 recommendations, which we hope will establish a foundation for further discussion. The Minister will be pleased to hear that I will not go through them all today, but I will focus on some of the report’s key findings.

It is clear from our work so far that the growth of cryptocurrency and digital assets presents a number of potential opportunities and that the UK is well placed to realise them, but that will require cross-Government strategic planning.

I commend the hon. Lady for securing the debate—we have become good friends in the House—and I thank her for all she does on this topic. Reports in 2019 indicated that Colu, a tech firm based in Israel, had developed a potential new cryptocurrency for Belfast City Council. There has been much discussion in this place of how cryptocurrency will be regulated across the UK. Does she agree that for the United Kingdom to become a leading force in crypto, regulation must be UK-wide, led centrally from Westminster, and that UK-wide discussion is the only way to achieve safe regulation?

I thank the hon. Member for his contribution. Yes, much of this will be led by the Treasury, and I imagine that regulation will be streamlined right across the United Kingdom. I am pleased to hear about developments in Northern Ireland; there have been many in Scotland, too. I spoke to Scotcoin not that long ago. This area has enthused and motivated people right across the United Kingdom, and it is important that we collaborate in order to realise its potential.

It is a privilege to serve under your chairmanship for the first time, Mrs Harris. I congratulate the hon. Lady on her work with the crypto and digital assets all-party parliamentary group and on its excellent report; it is a privilege to work with her. Some years ago, the UK became the world’s leading fintech centre because the regulatory environment was established with a clear direction from Government, which allowed businesses to invest and regulators to lean positively towards the sector’s development. Does she agree that if the positive record of the Government of that time is replicated with cryptocurrency, the UK will have a similar opportunity to be a leading nation in this sector, as well as in other financial technologies?

I thank the right hon. Member for his valuable contribution. I totally agree. I saw some research from PitchBook last month that suggested that since the EU produced its regulatory framework on markets in cryptoassets—MiCA—investment in the EU has increased substantially. With a regulatory pathway over the next 12 to 18 months at the maximum, the UK could harness a leadership position in this sector. That will be essential because of the digital revolution that is happening. The next generation is a digital generation already. This is the way that things are moving in the world, and the UK must be at the forefront. I am pleased that the Minister is harnessing his skills and endeavours to ensure that happens.

We heard that without comprehensive regulation there are considerable risks in the industry, particularly regarding consumer protection, economic crime and financial stability, which I will speak about later. While there are clearly legitimate concerns about the potential risk posed by cryptocurrency and digital assets, it is important to acknowledge a number of positive use cases that show the potential benefits of the new technology.

One such example is the use of cryptocurrency at the frontline of the conflict in Ukraine. Many may not know this, but following the Russian invasion, the Ukrainian Government appealed for cryptocurrency donations and received millions of dollars in cryptocurrency to support military and humanitarian efforts on the frontline. Ukraine’s Deputy Minister of Digital Transformation, Alex Bornyakov, has said that cryptocurrency has been “essential” to Ukraine’s response to the Russian invasion. I am delighted to welcome Minister Bornyakov and his team, who are in the Public Gallery. We are delighted to have them here today.

Our inquiry heard that the growth of the sector suggests that cryptocurrency is here to stay. The latest research by the Financial Conduct Authority shows that cryptocurrency ownership has almost doubled in the last year, with almost one in 10 people surveyed owning cryptocurrency in 2022. That highlights the need for proper, clear regulation to protect consumers and support the industry’s growth in a reasonable way. As countries around the world move quickly to develop regulatory frameworks, we feel that the UK must move within the next 12 to 18 months to harness the industry’s potential in order not to lose out to other jurisdictions.

Throughout our inquiry, we heard that there are potential barriers to the UK’s realising its vision, which we set out in the report. We heard that the process for cryptoasset businesses to enter the UK is very lengthy, with limited engagement at times, and that many businesses ultimately choose to invest outside the UK. While the Government have said that they are open for business and for companies in the sector to set up and scale up, we heard that that has not been the experience of many companies seeking to obtain licences to operate in the UK. They have seen very lengthy delays and, in many cases, had their applications rejected. That is fine, because we do not want a race to the bottom, but it often happens without a clear explanation and with limited communication throughout the process.

To date, only 41 firms have been approved to operate in the UK. Will the Minister say what more the Government can do to ensure that legitimate and responsible firms that want to set up and scale up here are able to do so? What steps are the Government taking to ensure that regulators have the resources they need to deliver on their responsibility to process applications?

It is good to see you in the Chair, Mrs Harris, and I congratulate my hon. Friend on securing the debate. On regulation, my hon. Friend mentioned risks, and does she agree that the Government need first to admit that when it comes to crypto there is a lot of risk? We know there is a lot of risk—it is called fraud, so fraud regulation should be used in the first instance before they introduce other regulation. There needs to be a recognition that fraud is fraud, whether it is related to crypto or anything else.

I thank my hon. Friend for raising those important issues. There is a section in my report on fraud and scam risks to consumers, so he has pre-empted the latter part of my speech, but I will cover his points in full.

Another area of concern is access to basic financial services. To be a hub of cryptocurrency—of innovation, scale-ups and start-ups—companies need to be able to open a bank account and pay their employees. The inquiry heard that firms were struggling to secure access to UK banking services. A high proportion of banks have refused to provide bank accounts to digital assets firms, even when those firms are regulated and licensed to operate in the UK. In addition, just in recent months, a number of major banks have also announced limits on transactions, making it more difficult rather than less.

Such services are absolutely necessary for companies to operate regulatorily compliant businesses. The inquiry heard that that could be one of the single biggest barriers to growth and innovation for the UK. There are concerns that this could fundamentally undermine the Government’s ambition for the UK to become a global cryptocurrency hub and could be a barrier to growth and innovation in the digital sector.

I recently chaired a roundtable with the industry to hear more about their concerns. What more can the Government do to help find a way forward and to ensure clear pathways for firms to access fundamental banking facilities when they are operating legitimately and robustly within the guidelines? Will the Government consider using their powers to help facilitate meaningful dialogue between the banking and digital assets sectors to find a way forward that works for both?

We also heard strong support for the Government’s current approach of regulating cryptocurrency in line with financial services regulations; when we look at the research and the details, we can see that that offers the best and most robust protections for consumers. In that sense, my report supports the Government’s position on financial services regulation.

There is another issue. I worked in the health service and I am keen that people who make gains in the UK should pay their taxes. A regulatory framework in financial services enables the Exchequer to collect taxes, as opposed to using the gambling regulations, which would not allow for that. It is also important that the UK sets regulations within financial services to position itself in collaboration with other jurisdictions internationally and rather than appear an outlier by using other regulatory frameworks.

Our inquiry heard serious concerns about the risks to consumers from fraud and scams associated with the sector. As with all new and emerging technologies, the sector has the potential to be exploited by criminals. We heard that given the rapid pace of growth and consumer adoption, the risks in this area cannot be ignored, particularly if the UK wants to position itself as the global home of investment. Consumer protection measures must be at the core of everything that the Government do. We must mitigate the risks associated with new developments in the sector.

Research from the FCA in 2021 showed that overall public awareness and ownership of cryptocurrency had increased, but it also showed that

“the level of understanding of cryptocurrencies is declining, suggesting that some users may not fully understand what they are buying”.

Consumer research by the Financial Services Compensation Scheme highlighted the low levels of understanding and the need for much greater financial education. Industry and the Government must partner to help raise awareness. We want a joined-up and co-ordinated approach, including industry, regulators, law enforcement and the Government, to clamp down on scams.

Before I conclude, let me briefly mention that the Government are making great strides with the consultation on a central bank digital currency, and we support the progress being made. I have also heard about improvements throughout industry on the sustainability of bitcoin mining and so on. That is very important because we must realise that we are in a climate crisis, and all innovations and new technological developments should contribute to net zero.

For our report, we heard about the need for a joined-up, co-ordinated approach across all Departments, and we have said that Government might consider the appointment of a crypto tsar, who could help to co-ordinate across Departments and support the Minister to ensure a consistent approach. Will the Minister update the House on the Government’s vision for the UK to become a global hub? I realise that yesterday the Prime Minister made a very important speech that contributes to the debate and I would be delighted to hear what more we can do, as the all-party parliamentary group, to support the Minister in his endeavours. We feel that things have been extremely positive, but there is a need to move at pace within the next 12 to 18 months.

It is a pleasure for me to serve under your chairmanship, Mrs Harris; congratulations on your first time chairing our proceedings in Westminster Hall. I congratulate the hon. Member for East Kilbride, Strathaven and Lesmahagow (Dr Cameron) on once again securing a debate in Parliament on crypto regulation. It is particularly apposite to do so during London Tech Week. I would also like to extend a welcome to Minister Bornyakov and his team, who are watching this debate from the Public Gallery.

I know that the hon. Member for East Kilbride, Strathaven and Lesmahagow shares with me and this Government a desire for the UK to be a leader in this space; that is our vision. I thank her and the crypto and digital assets all-party parliamentary group, which she chairs, for its excellent recent report, which is timely and adds to the growing canon of work. It is a good read, and I commend it to all parliamentarians and policymakers. One of the valuable functions that that group performs is to raise the level of understanding of this exciting but sometimes challenging new domain.

Let me be clear. The Government’s goal is simple: it is for the UK to be an open, well-regulated and technologically advanced society. The extraordinary technology under- pinning distributed ledger technology, or DLT, could have profound and positive impacts across multiple sectors in the UK, including more efficient trading, cheaper payments across borders, more choice for consumers and, as the hon. Member for East Kilbride, Strathaven and Lesmahagow said, the benefit for financial inclusion. Beyond that, it is part of the wider Web3 decentralised movement that is leading to a radical rethink about what the future of the internet might look like and who—which sort of organisations—determines that. McKinsey research suggests that this could be

“a paradigm shift in the business model…by making disintermediation a core element”,

while a research analytics firm estimates that the global market size of Web3 could reach $81.5 billion by 2030.

I congratulate my hon. Friend the Minister on pressing ahead with the digital pound that is under consideration in order to ensure that the UK is at the forefront of digital currencies. But is he confident that all the regulators—within the Bank of England for the digital pound, but also the Financial Conduct Authority and others—have the capacity and expertise necessary to deliver the vision that the all-party group and the Government are seeking to set out? Does he agree that it is worrying that many crypto companies find it challenging to open bank accounts simply to conduct their business?

I pay tribute to my right hon. Friend for the points that he made about how important it is that we lean into this space. He used the excellent and apposite example of fintech—a flourishing industry, for which the UK is genuinely one of the leading centres in the world. I share his concern about the availability of bank accounts. As he understands—I am sure he would not wish it otherwise—that is a commercial decision for organisations, but to the extent that the regulatory framework, or indeed the regulatory culture, is a contributing factor, Parliament will bring cryptocurrency into the regulated domain and decide that it is a lawful activity that could reap many benefits for the United Kingdom. It would, of course, be a concern if those who take part in this lawful and well-regulated activity were unable to procure bank accounts, so I can undertake to keep a close eye on that. I do not plan to make an immediate intervention, but he and other colleagues have raised the issue, as has the APPG. I will undertake to keep a close eye on it, and I am open to hearing examples of where people cannot open bank accounts.

The hon. Member for Strangford (Jim Shannon) has left the room, but I can give him the assurances he seeks. As a proud Unionist, it is a delight to have such a diverse set of representatives from across all parts of the Union. It is wonderful to have contributions from all parts of the Union today, but financial services is a reserved matter, and the Treasury and Parliament will bring forward the right regulations. The regulators have hitherto been clear about some of the risks in this domain, and we seek to strike the appropriate balance between not regulating and introducing appropriate regulations while recognising the potential consumer harms and making sure that we have effective, clear, proportionate and timely regulation. Those seem to be entirely desirable attributes.

I am afraid I am going to have to challenge the Minister on his point about regulation. We already have regulation, which he and I have talked about, especially in Committee on the Finance (No. 2) Bill. Pretending that we did not have levers for a technology that has, in its tech section, been around for 30 years is, quite frankly, pie in the sky. When will the Government implement the existing regulation around fraud to deal with some of the crypto bros we have all been talking about for years?

Fraud sits separately as part of criminal law. Fraud is fraud, which is a long-standing offence. I am sure the hon. Member has studied in detail the Government’s most recent fraud strategy, which is excellent, and I would be happy to introduce him to the Government’s recently appointed fraud tsar, my hon. Friend the Member for South Cambridgeshire (Anthony Browne), who will redouble the Government’s focus on tackling fraud.

On regulation, the hon. Member for West Dunbartonshire (Martin Docherty-Hughes) will recall that we recently passed secondary legislation covering cryptoasset financial promotions, which has now been passed by both Houses of Parliament. The regulators are working on its implementation, which will happen later this year. Importantly, it will once again bring the domain within the realm of the regulators we seek. I should say that the Government have no plans for a crypto tsar, but I undertake to champion the sector, quite rightly, in my role as the Economic Secretary, because I am responsible for financial regulation in the UK.

Given the potentially vast benefits of cryptocurrency, it is right that the Government are leaning forward and taking proactive action to harness the opportunities. I recognise the balance struck in the all-party parliamentary group’s report. I also agree that the UK must show early leadership within this internationally competitive sector, which is why we are working flat out to give clarity and to implement the framework as quickly as possible. I welcome the offer of support from the hon. Member for East Kilbride, Strathaven and Lesmahagow—it is a dialogue that we should continue—and I welcome the work of the all-party parliamentary group. I have regularly engaged with the cryptoasset sector. Rather than set up a single taskforce, I am regularly having multiple engagements to try to move things forward.

Fellow parliamentarians have suggested that cryptoassets are akin to gambling. I refute that. That is not the Government’s position; the right bodies to regulate them are the financial regulators, with their deep expertise and understanding of the issues such as how to ensure that markets are fair and how to protect consumers. They have much greater resource. That is no reflection on anyone, it is simply an important fact.

Importantly, industry can see that the UK has clear and ambitious plans for cryptoassets. I was thrilled to welcome one of the world’s leading tech investors, Andreessen Horowitz, which has decided to open its very first international office—its first outside silicon valley—in the United Kingdom. I hope that it blazes a trail that many others follow, and that reaches into all parts of this wonderful United Kingdom because it is about much more than simply London and the south-east.

I hope that I have made it sufficiently clear that the Government want to be a leader in this space and on the opportunities for growth that it can bring to the UK economy. In my view and that of the Government’s view, the best way to do that is to continue to develop a comprehensive regulatory regime that will create a safe environment to encourage innovation while managing the risks. I look forward to continuing discussions with parliamentary colleagues on this important agenda.

Question put and agreed to.

Sitting suspended.

East West Rail: Bedford to Cambridge

[Sir Mark Hendrick in the Chair]

I beg to move,

That this House has considered the Bedford to Cambridge section of East West Rail.

It is a pleasure to serve under your chairmanship, Sir Mark, and to discuss the recent announcements on the Bedford to Cambridge link for East West Rail. I am grateful to Mr Speaker for permitting this debate, and for the attendance of colleagues from other areas affected by the decision in my area. The areas directly affected include the parishes of Brickhill, which I share with the hon. Member for Bedford (Mohammad Yasin); Clapham; Ravensden; Wilden; Wyboston, Chawston and Colesden; Roxton; and Tempsford. Neighbouring parishes will also be affected, including Great Barford, Little Barford and Everton.

Many people think that a railway from Oxford to Cambridge is a nice idea. I used to think that too, but as I have got into the details of the railway, and as the performance of East West Rail has rolled out, my confidence and support have been completely eroded. Parliamentary colleagues present today will have their own questions for the Minister, and I am grateful to him for being here and for his helpful interactions with me. I will share with him after the debate specific questions that constituents have asked me to raise with him, and perhaps he can respond to them in due course, but I want to highlight six key asks today.

First, will the Minister agree to visit my constituency to walk the proposed route? Secondly, will the Minister ask the National Audit Office to conduct an inquiry into the East West Railway Company to provide the independent scrutiny that has been lacking to date? Thirdly, will the Minister release the full business case and cost-benefit analysis after the “theory of change” assessment, including all details of anticipated passenger and freight traffic, a discounted cash flow and a net present value? Fourthly, will the Minister today instruct East West Rail to release more detailed maps online, so that people can see what the impact is on their parish, their street or their home? Fifthly, will the Minister instruct East West Rail to write to all property owners whose homes or land are within the current corridor, explaining what the specific impact will be on their homes or properties? Finally, will the Minister conduct a full evaluation of the current status of primary care supply and demand in my constituency, and of East West Rail’s impact on that?

Last month’s announcement by East West Rail was supposed to clarify, to be deterministic, to eliminate doubts, to sideline the nimbys and to propose a great national project of economic growth. It has failed on all those fronts. Instead of a final route, we now have a completely new twist to the story between Roxton and Tempsford, and there is more doubt about the form of traction, although perhaps that is just deflection by East West Rail. Far from sidelining opposition from nimbys, the announcement has galvanised a much wider political alliance of those who have lost faith in the project and the company and who believe there is a greener, better alternative to support growth where we live.

On the question of growth, East West Rail should be a real opportunity for growth, but real problems will arise if the surrounding infrastructure is not there, which will put pressure on people. Does the hon. Gentleman agree that, together with East West Rail, the Government really need to work with local communities to create additional infrastructure, such as bus services and GP services, so that people see the benefits of that growth?

The hon. Lady is absolutely right, and that is why I circulated a letter, which all parties have signed, calling for exactly that: a greener alternative that focuses on sustainable growth and the work-life patterns that people want, not a 19th-century solution that is supposed to unlock growth on an unproven model.

One could sense the political support ebbing away from East West Rail as the announcement was made. The truth is that it has brought no relief to those most affected. I understand that, in a rearguard action today, Beth West, the chief executive of East West Rail, has said that she will approach Government to enable the purchase of houses that are currently planned to be demolished. That would help people who are already two or three years into uncertainty. As an additional ask, will the Minister instruct East West Rail to send an advice note to people whose homes or properties are within the proposed corridor and, included in that, the expected distance from the rail route itself? That will provide clarity to more people, particularly in the villages affected.

The Minister will know that we had elections recently, and that they have brought political change. I am not sure that the election results around the country were good for the Conservative party, but in Bedford borough, the Conservatives won the directly elected mayoralty for the first time ever. That was a repudiation of the Liberal Democrat Mayor, who had strongly supported East West Rail and such an environmentally destructive route across north Bedfordshire, with its phoney economic benefits for the town. Now with Tom Wootton as the Mayor, we have someone who is clear and determined in his opposition to the proposals presented by East West Rail. Conversely, in central Bedfordshire we also have a new leader—an independent, whose ward encompasses Tempsford, the site of a station that may herald substantial housing development, measured in the tens of thousands. Does the Minister appreciate the current scale of interest in alternatives to the project, given these political changes?

I have been contacted, without solicitation, by many sources and experts decrying the performance of the East West Rail Company. One constituent with expertise wrote to me to say:

“From my experience and observations the insincerity of the process pursued by EWR has been its most glaring weakness. In equal measure, however, any such criticism must also lie at the door of the Department for Transport who appear to be an acquiescing partner in the woefully inadequate activities of EWR. Unfortunately, the Government as a whole cannot escape association with the feeling of disillusionment generated through continuous stonewalling, lack of logical business planning, flouting of the law (freedom of information) and insincerity of approach.”

The route chosen by East West Rail is so full of twists and turns, and ups and downs, that it surely competes with what is probably our country’s bendiest road, the B3081 at Cann Common in Dorset—I am not sure whether the Minister knew that—which

“twists and turns more than many an Alpine climb.”

Those words could be applied to the route chosen by East West Rail. Back in the Victorian age, when Governments and others knew how to build railways, they chose a straighter, less hilly route. I encourage the Minister to watch the video from Alison, a constituent of the hon. Member for Bedford, who clearly outlines East West Rail’s irrationality in choosing a route with such topography.

One of the principals behind the campaign, BFARe, Bedford For a Re Consultation, wrote to tell me:

“The crux of the issue stems from the fact that the NSIP process contains a ratchet mechanism whereby the narrowing down of options precludes a fundamental review/rethink of alternatives when better evidence comes to light about previously discarded options. The starting premise for growth in the Arc was flawed and the initial public consultation into the scheme in 2019 was so badly handled that it shut out a lot of people and communities who stood to be most impacted by the scheme”.

Another constituent wrote to me expressing the view of many in my constituency:

“To get to Cambridge I personally would drive to the park and ride and get on a bus to the centre of the city; not drive to Bedford station, pay to park, buy an expensive train ticket to get a train which would not take me to the centre.”

I will spend some time on the cost-benefit analysis, because I think it is an open secret that nobody thinks that East West Rail is financially viable. Less than a year ago, the former Secretary of State for Transport, my right hon. Friend the Member for Welwyn Hatfield (Grant Shapps), when on the LBC radio show of Mr Iain Dale, had the following interaction. Mr Dale: “What would you cut from your Transport budget?” The former Secretary of State: “I would take East West Rail and I would remove.” Iain Dale: “Why haven’t you done it already?” The former Secretary of State: “Well, I haven’t had the opportunity.” Iain Dale: “You are the Transport Secretary. You could easily have done it already. You could have gone to the Chancellor and said, ‘I know you want to cut spending; here is one way you could do that.’” The former Secretary of State: “I have done that in other ways, but you have just asked what I would do as Prime Minister, and I am telling you I would cut East West Rail on what is called two and three, so there’s the second and third tranches of it, and save £3 billion to £5 billion straight away.” I therefore ask the Minister what he would do if he was Prime Minister?

A constituent wrote to me on the cost-benefit analysis and said:

“As someone who has had the ‘we intend to drive a railway line through your property’ notice recently I'd really like to get two questions answered, as this document failed entirely to do so. Where is an up to date business case? No-one has seen one, no-one affected believes a valid business case now exists…When will EWR engage directly with home owners on the route to purchase land?”

I have mentioned that second point already. East West Rail states in its documents:

“While the Business Case is still in development and won’t be completed until we’ve obtained the required consent for the Project...In the final weeks before publication, the proposals are subject to a cross-Government approval process.”

So it will get consent and then tell us what the business case is.

Appendix 5 to the economic and technical report discusses the “economic appraisal”. The report states that it will:

“compare benefits against costs over the life of a project or for a defined period of time. As is typical for infrastructure projects, the monetised impacts of EWR are projected to a point 60 years from entry into service. Both the benefits and costs are discounted and presented in 2010 prices and values in line with TAG guidance”—

transport analysis guidance. The report continues:

“The 60-year value is known as the Present Value (PV).”

It concludes:

“Standard approach to modelling and forecasting results showed us that, in conventional appraisal terms, the BCRs were ‘poor’ across all options”.

What does “poor” mean? It means benefit-cost ratios of 0.26 to 0.42—and that is based on the high-growth option. The high-growth option means that the best benefit-to-cost ratio is less than half the amount taxpayers will be asked to put into the railway. What does that mean in terms of cost to the taxpayer? It means £1.5 billion to £2.4 billion thrown away on a railway.

East West Rail seeks an escape route from such a common-sense economic appraisal. It states:

“These early estimates of costs were a key driver of the BCRs, which did not account for the transformational and strategic benefits considered later as part of the application of our Theory of Change.”

Over two chapters, East West Rail attempts to draw in every possible justification for its project. It talks about east-west connectivity, but it does not mention the cancellation of the expressway. It talks about housing costs, but it does not notice that the highest costs are where railways exist. Thus its proposals are as likely to increase house prices in areas where they are lower than in Cambridge than they are to lower house prices in Cambridge itself. It ignores the power of the market, with private companies already making decisions about where to locate if Cambridgeshire is too expensive. For example, Marshall Aerospace is very sensibly relocating to Cranfield Airport.

Before I entered Parliament, I was a partner in a strategy consulting firm, advising large businesses and utilities on investment decisions. I was also a partner in a venture capital fund, investing in the high-growth businesses of tomorrow. I am also a graduate of Havard Business School, and I can use all that life experience and those qualifications to assess the theory of change exercise by East West Rail as complete nonsense. What is the Department for Transport metaphorically smoking if it continues to go along with this economic illiteracy? I may have missed the financial conclusion of the theory of change exercise, but perhaps the Minister can advise us whether he will release the full financial case, together with all the assumptions and sources. Today, I issue a challenge to the chief executive of East West Rail to attend a public debate with me to argue the economic case for and against this project—openly, transparently and honestly.

We all know the real reason behind all of this: it is about housing. A constituent wrote to me saying:

“From the economic and technical report, it is clear that Bedford is viewed as simply a cheaper housing estate separate from where all the jobs are expected to be—in and around Cambridge. So what’s in this for Bedford?”

The real reason for East West Rail is the concreting over of north Bedfordshire. We have the issue of the Tempsford interchange section, with reports of up to 40,000 new homes in a village that currently has 400 residents. There is also Stewartby, in the Mid Bedfordshire constituency, where pages 92 and 93 of the economic and technical report suggest the railway will open up 70,000 jobs to households. In my estimation, that amounts to about 35,000 houses.

I am not a nimby on housing—we should all do our fair share—but as the MP for North East Bedfordshire I have to point out that there is considerable pressure on GPs, dentists and school places. Without investment in that soft infrastructure, it is very unwise to support additional housing growth.

Does the hon. Member agree that it is unfair to call people such as those in Mid Bedfordshire who are raising these absolutely real concerns nimbys? People need those services to go with the growth and the increased railway line.

I do, but I would not do what I understand the Liberal Democrats are doing in Mid Bedfordshire, which is to ask people which housing estate they do not like so that they can oppose it—that is not the right way to do it. However, as regards very large-scale developments, the hon. Lady is absolutely right, and we should have that consideration. In 2019 I stood on a manifesto calling for infrastructure first on these large-scale developments. I do not know whether the Minister can give me an update on that—it is not his remit, so I do not expect him to, but it is important, and he stood on the same manifesto as I did.

We should all do our fair share. I looked at the census data on the growth in households between the 2011 and 2021 censuses. The national average increase in households over that period was 6%, and I think we all feel that rapid growth in our constituencies. Perhaps unwisely, I then decided to look at specific constituencies. I looked at the Chancellor’s constituency, and he is doing his bit, with 6% growth. I looked at the Secretary of State for Transport’s constituency, and there was a 9% increase in households over that period, which is a substantial amount above the national average. The Minister, who is responsible for rail, had only 5% growth, but we will forgive him that 1%. In North East Bedfordshire from 2011 to 2021, there was 21% growth, which is already three and a half times the national average of growth in households. That is already putting pressure on GP services, dentists and school places. How on earth can I, as the MP for North East Bedfordshire, allow further pressure through an increase in housing growth until those problems are dealt with?

I want to turn to the environmental impact. I had an interaction today with Councillor Tracey Wye, who represents the ward that includes Potton. She wrote to me to say she would like to see a commitment that this project would be in harmony with the environment—something so future-proof, leading-edge and creative that we would be at the leading edge of sustainability and climate resilience. I could not agree more; she is absolutely right.

We have been a bit misled, I would say—perhaps that is unfair—about the electrification of this line. Originally, in the Railways Act 2005, it was going to be electrified as part of the electric spine. In the high-level output specification of July 2012, the line was listed as a new electric railway line. It was then dropped by East West Rail Company, but the company’s latest document now says that it may come back. Minister, which is it? Are we electrified or are we not? Is it battery powered or not? The announcement was supposed to clarify the form of traction, but it has done nothing of the sort.

I believe that Ministers know that the original plans by Lord Adonis in the 2017 “Partnership for Prosperity” report were bogus, and they have not kept pace with changes in working patterns and our greater focus on environmental issues. A previous Secretary of State cancelled the Oxford-to-Cambridge expressway in 2021, stating that

“analysis shows that the benefits the road would deliver are outweighed by the costs”.

Precisely that charge can be laid today against East West Rail, so why is the current Secretary of State not taking the same action?

A constituent wrote to tell me:

“From a net-zero perspective, how could they possibly introduce a new transport link, with the intention of running diesel trains on it until 2040 at the earliest? Hardly what you’d describe as inspirational or forward thinking.”

Another constituent wrote:

“As someone with long standing involvement in the biotech industry and academic community, I would question the whole rationale for the railway in the first place. Of course we all want to consolidate Cambridge’s position as a technology hub, but if science and industry in Oxford and Cambridge want to collaborate they’d do it remotely. East West Rail is a 19th century response to a problem for which we in the 21st century have solutions that are cheaper, better and less environmentally destructive.”

I call on the Minister to consider those solutions.

It is a pleasure to serve with you in the Chair, Sir Mark, and I congratulate the hon. Member for North East Bedfordshire (Richard Fuller) on securing the debate. We have had many animated discussions about this subject in the past, and it will probably not surprise him to know that I take a slightly different view, but I commend him for the powerful way in which he has represented his constituents. I suspect others will do the same, because infrastructure projects of this type always cause problems for local constituents, and I have every sympathy with them.

This debate about East West Rail, the Cambridge to Milton Keynes to Oxford link or the arc—call it what you will—has been going on for a long, long time. I have been involved in discussions and debates about it for many years, and frankly I want to move beyond the debates and get the railway done.

I pay tribute to the many people who have campaigned tirelessly on these issues, including those noble councillors who set it all in motion many years ago and the East West Main Line Partnership. I am grateful for the work of the National Infrastructure Commission, which the hon. Gentleman mentioned, and the all-party group for the east of England, which I co-chair with the hon. Member for Waveney (Peter Aldous). I wish to make three main points relating to the history and the purpose of the project, and the economic and environmental value of getting it delivered.

It has been a long-running goal of rail enthusiasts to restore the lost line between Cambridge and Oxford, which has been made harder by the loss of some of the old Varsity line route. I remember conversations some 20 years ago at least, when some foresighted people were talking about it, and over time the issue came to be picked up by local authorities, which could see the broader benefits. By the time I came into this place in 2015, that campaign was picking up pace. In the subsequent eight years, I can barely recall all the conferences, party groups, business tsars and leaders who have come and gone, some of whom were never appointed in the first place —“announcements and then steps back”, as it has been described. I fear that is all part of the rather hopeless way we go about building infrastructure in this country.

I remember that, at one Budget, the then Chancellor invited Members to show up at a surgery-style session with the Minister in one of those gloomy ministerial offices down the corridor. The then Minister, who shall remain nameless, looked absolutely astonished that anyone had actually shown up. We then had a rather civilised conversation—I think that is when the business tsar came and went—and I put to him the questions that I have been putting for a number of years: what is this line for, and will it be electrified? Predictably, answer came there none.

I put exactly the same question—what is the line for?—to one of the senior civil servants who had been working on the project at one of the many annual conferences about the arc. I was absolutely flabbergasted to get the reply that they were planning to consult on exactly that issue, which seems to be rather the wrong way around.

Back in 2017, at another one of those conferences, I challenged the then chair of the East West Rail Company over electrification, and he publicly promised that not a litre of diesel would be bought. As we have heard, that issue remains unresolved—although given that we are still quite a long way off seeing any trains, I suppose that pledge has been honoured so far.

At that time, the Government were planning to build not only a new rail line but, as we also heard, a major new road. Considerable time and effort were spent on that. I must say that I always opposed the road on the same line that has been mentioned: it is a 19th-century solution to a 21st-century problem. It was absolutely the wrong thing to do when we were trying to encourage a modal shift, and I am glad that it was finally abandoned.

I might be testing the Minister slightly, but can he tell us how much was spent on that abortive project, how many civil servants are still working on the arc project—including beyond the Department for Transport, in other Departments—and how long that project team has been going? I seem to have been aware of it for a number of years, and we really need to see some output from all that work.

That brings me to my main point. As I have said, I understand the concerns about the route. First, I am glad that the southern route has been settled on near Cambridge, because overall that seems to be the most sensible. However, the reason for my unswerving support for the project is that I believe that the environmental and economic benefits will be significant. Environmentally, we know that we have to move people off roads. It may be that the world is changing, but I think—and the evidence is rising on this—that people will want to get back to face-to-face contact.

We are in a climate emergency. If people want to really see the benefits of a new infrastructure, they need to see the benefits to both the environment and their health. The Government are not making electrification the main priority. Is that not really what this line should be about—electrification?

I served on the Transport Committee with the Minister for a number of years, and I appreciate that these issues are not straightforward or simple, but the hon. Lady is absolutely right. In the end, electrification is obviously the way we should be going.

Let us also look at the time savings for people. In the early-morning rush, it can take almost an hour to get the nine miles from Cambourne into the centre of Cambridge by car. By rail, that would be reduced to 15 minutes. Bedford to Cambridge by car is 75 minutes—as I discovered to my cost a few weeks ago—and 90 by bus; but, I am told, it takes 35 minutes by train. That is transformational.

I fully accept that this is partly about the future success of Cambridge, because we are struggling hugely to find housing for the people we need to maintain Cambridge’s position driving the UK economy. It is not an unimportant point, although I accept that the location of that housing will not always necessarily appeal to everyone. Cambridge housing is hugely expensive; we all know the figures. Development pressures on my city are intense, and we have an acute shortage of people. Ironically, those are not necessarily the world-leading people but all the people we need to run the basic services. Even the best scientists in the world require their lunches, and offices that are cleaned and maintained, and we are struggling to find those people for lower-paid jobs. We therefore need affordable housing.

I accept the point that house prices do not necessarily always conform to the economic models that some people would like to propose, but we need housing that is available via quick, reliable and environmentally sustainable transport links. Those points have long been made by the leaders of Cambridge City Council, Lewis Herbert and Anna Smith.

In addition, the project would begin to open up prospects for more jobs in high-quality, environmentally sustainable communities along the arc. That is an important point. If we are building these new communities, it must not be about just a developer’s charter; they have to be the kind of communities that will attract the people who will be part of our future—a success in both Cambridge and Oxford.

I accept that there will always be debates about the economic theories of how development works and what the drivers are, but I am pretty convinced that this must be the way forward, and not just along the arc. As others, including Eastern Powerhouse, have outlined, it potentially unlocks further opportunities to the east as well.

I will conclude by making some points about the economic significance of and for Cambridge. The region already adds more than £110 billion to the UK economy every year, and the Cambridge sub-region is a major contributor to the Treasury. Frankly, reinvesting some of that to improve the local quality of life is hardly a unreasonable demand. Cambridge and Oxford are world leaders in venture capital investment, with hugely important research and development sites.

I believe that East West Rail can help to unlock the physical constraints that are currently a real challenge, and help us to get the people we need to remain in our world leadership position. There is strong support for the line from the local authorities and the business community; indeed, I was struck by a recent briefing from the business-led organisation Cambridge Ahead, because this was one of its top priorities. I know that when Government support seemed to be wobbling a while ago—I think we heard a characterisation of that earlier—the University of Cambridge was among the organisations that were particularly concerned about the prospect of the line not going ahead. I am glad that the wobbling seems to have settled, that we have a Minister who is firm in his intentions, and that the current version of this Government seem to understand the significance of the project.

I end where I began: there will always be arguments over routes and local impact, but I urge people to step back, look at the bigger picture and get this electrified railway in place.

It is a pleasure to speak under your chairmanship in this important debate, Sir Mark, and I congratulate my hon. Friend the Member for North East Bedfordshire (Richard Fuller) on securing it. We have had many discussions about this issue over the years, including with my constituency neighbour, the hon. Member for Cambridge (Daniel Zeichner). My constituency is literally in between the constituencies of Cambridge and North East Bedfordshire —they border mine on either side—and both Members’ excellent speeches raised both the pros and the cons of East West Rail, which affects my constituency.

My job is to represent the views of my constituents, which are very split. There are those who are massively in favour. Cambourne, which the hon. Member for Cambridge mentioned, is the only town in my constituency that will be affected by East West Rail, and the people there are very frustrated at how long it takes to get into Cambridge city. A lot of them work there, and it can them an hour to get there on the train. A station is being built at Cambridge South, which the Rail Minister, my hon. Friend the Member for Bexhill and Battle (Huw Merriman), visited recently. It will take the people of Cambourne 11 minutes to get there, and 14 minutes to get to Cambridge Central, which will be transformative for their lives. The business groups and the university are in favour of the new line, and they regularly write to me about their support for it.

On the other hand, there are villages along the line where it is all downside and no upside, such as Haslingfield, Harston, the Eversdens, Hauxton and so on. They will suffer a railway line going right through them, and probably the worst affected will be Highfields Caldecote, where the rail line will clip the corner of the village. The housing being built there now will presumably have to be knocked down. I had a very impassioned email from Jason Western, who runs the Fortitude Fitness Centre, which is an outdoor assault course. He has built it up over 20 years, and the railway line will go right the way through it, affecting a lot of jobs. I can completely understand the distress that it will cause to people like that.

I want to address whether the East West Rail line is needed at all. My hon. Friend the Member for North East Bedfordshire made so many good points that there is not a huge amount I can add, but I also want to raise some of the main issues. Since being elected as an MP, I have been in discussion with the Government about whether the line is needed, and there have been various wobbles. I was told at one point that it had been cancelled and that we were just awaiting the announcement. I was awaiting the announcement, which did not come, and now it has been re-announced. That was because the calculation at the time was done under the Green Book methodology—the standard transport methodology, which my hon. Friend referred to—which produces benefit-cost ratios of just 0.27. That is astonishingly poor—so poor that we would never build a transport project like that. However, East West Rail has come up with a new methodology—the “theory of change”, which he referred to. It is not from the Green Book but from the Magenta Book, and it talks about the impact of the line on overall growth in the area. The project has certainly mutated from helping people to travel more quickly from Cambourne to Cambridge, to helping to supercharge growth in the area.

I do not know quite where it fits in my hon. Friend’s ranking, but I know that the growth of housing in South Cambs over the last 20 years has been about three times the national average, or maybe even higher. In the district of South Cambs, there are three new towns. I laugh when my colleagues complain about a new town or 500 houses, because I have tens of thousands of new houses in my constituency. There are already plans to build 57,000 new houses over the next 20 years, which is as many as in Cambridge city at the moment. We will be doubling the number over the next 20 years—that is what is planned at the moment.

East West Rail’s business case is clearly predicated on massive housing growth. That growth—this is all hidden in the small print, which is so small that I cannot read it but have to interpret it—is based on 23,500 new houses in Cambourne and 19,000 in Tempsford, just south of St Neots. I do not know whether that is in addition to the housing that has already been planned or whether it is included in the previous figures, which makes a huge difference. Such growth has a huge impact on neighbouring villages, such as the gorgeous little village of Knapwell, with only 45 houses. Knapwell is very remote, and its residents are quite understandably worried about being completely swallowed up. As various Members have mentioned, we also have to worry about all the soft infrastructure when building on that extraordinary scale.

One binding constraint is not mentioned at all in the 2,000 pages of East West Rail documentation. Although we have not read it all, we have done word searches. I entered the word “water” to find that it only appears in the name Waterbeach, which is one of the new towns. This is not some sort of made-up environmental issue, whereby we are worried about things in 20 or 50 years’ time; we do not have enough water in South Cambridge to serve the current housing and agriculture. We have an aquifer, so all the water comes in locally and is not piped in from the rest of the country, but we use more each year than is replenished naturally by rainfall, so the water level drops. The ponds, rivers and streams get completely dried out in the summer, which is terrible for wildlife. We are already building all these houses, and the Environment Agency is very concerned that we just do not have enough water, even for the houses on existing projections. I hate to think what those toilets and showers will be like without water.

East West Rail and the Department for Environment, Food and Rural Affairs really need to be joined up on water supply. There is a plan at some point to build a reservoir in the Fens and pipe the water down, but the existing planning structure means that it will probably not be for 20 years or more. Will that provide enough water for all this housing? Will we need two new reservoirs? How will it fit in? It really needs to be joined up, because we simply cannot build the housing envisaged in this document without the water supply. We need to think about that.

I would love to see the proper business case. We keep being told that it will come at some point, but who is responsible for its delivery? Is it the Department for Transport, the Department for Science, Innovation and Technology, the Department for Levelling Up, Housing and Communities, or DEFRA? Who will oversee it? Who will be responsible for the spatial plan? Will it be the local authority? There has previously been discussion of development corporations, about which I made my views incredibly clear. I am not opposed to development corporations in all situations, but if they are not about press releases, they are about solving a problem that we cannot solve in any other way. In this case, development corporations should only be used as a solution to an existing problem. I cannot see that that would be the case, so I see no case for development corporations.

As my hon. Friend the Member for North East Bedfordshire mentioned, one of the main concerns locally is the exact design. The 2,000 pages contain no detail about what the railway line will look like: no schematics, no visions, and no drawings or visualisations. It is difficult for the villagers impacted by the line to appreciate how it will affect them. For people living right by this thing, that is incredibly important to know, and makes all the difference. I will come to some of the issues for the individual villages in a minute.

My final main point is about the property blight. I mentioned my constituent who has a fitness centre, but there are lots of people whose properties have been quite severely blighted by the plan, including those who had just moved in when they found that the railway would be built next to them and they could not move away again.

My hon. Friend mentioned that East West Rail had been quite proactive. I have been strongly pushing it to address the blight issue way ahead of the statutory requirement, because the law operates far too much in favour of the infrastructure and not householders. It has introduced a scheme to help people buy properties beforehand if they want to move, but they have to prove they have a reason to move and go through a whole load of hurdles. It should at least be geographically defined, so that if people live within a certain distance of the railway, they can automatically sell their house.

The other issue is the need for additional compensation. Our compensation for compulsory purchase in the UK is not generous enough. The value of a house is not just its market value. My constituent has built up his business over 20 years—who knows the value of that piece of land? I do not know whether he has planning permission, but he will have to end up moving his business, and that is a huge disruption. I know of many homeowners who have built up their houses over 20 years and made it a forever home but will suddenly have to sell it. I urge the Department for Transport to look at giving people 10% or 20% above the value of those houses, because it is not fair on them to say, “You’ve got to move. We’re just going to give you the market rate.”

I want to put on record some of the impacts along the route, because these are questions that my constituents and their various campaign groups are asking. There are lots of campaign groups in my constituency, such as Cambridge Approaches, that are doing valuable and important work on this. I mentioned Highfields Caldecote, where the railway line is literally going through the top end of the village. Is it going under the A428 at that point, which is what East West Rail says? I cannot see how it can do that, because the A428 is pretty sunken underground already. At one point, there was going to be a huge embankment 30 feet in the air. Will it be at that level, or will there be a cutting? If it is under the A428, which is right next to it, there would have to be a cutting. This makes a huge difference to people, but there is no information about it.

In the villages of Great and Little Eversden, will there be an embankment at ground level or a cutting? Again, there is no information about that. The line goes through Chapel Hill, which is an iconic local hill where we get fantastic views across South Cambridgeshire, and it is called Chapel Hill because of its historic significance. Will that be fully cut into, which was the original plan, or will it be tunnelled? I hear lots of suggestions that it will be tunnelled, but without any concrete commitment. If it is tunnelled, would it be cut and covered or bored?

There is a possible road closure between Harlton and Haslingfield. Would that be cut and severed? Would the villages be separated? In Harston, will it go over the A10—the main road into the south of Cambridge—or under it? We have no information about that. Would the junction with the King’s Cross line at Harston be a grade separated junction? Would the railway be taken right up into the air and back down again, or could it be done at grade level, which would have far less impact?

What about the road between Harston and Newton? That is not just a road between the villages; they share shops and a school. The people of the village of Newton—which is next to the village I grew up in and has a fantastic pub, the Queen’s Head—would not be able to go directly to Harston. It would be incredibly disruptive to their lives, and the last plans published said that the road would be severed.

The railway line goes between the villages of Hauxton and Little Shelford, and there is currently a level crossing. Department for Transport guidance now is that there should not be any new level crossings, so how will it be done? There is housing right by it. Will it be tunnelled? Will it be bridged? The people there are really worried that the road will be cut in two.

In Great Shelford, as we get into Cambridge, will four-tracking be required? Will the Long Road bridge have to be taken apart? Will Shepreth branch junction at Great Shelford be grade separated? Again, if it is, that will have a dramatic impact on the village, because the railway line will have to be taken right up into the air and back down. If it is grade separated, how would that be done?

There are so many questions about this, and I wanted to put them on the record. I have been trying to get answers out of East West Rail. It needs to do a lot more work on mitigation; I know that it has done quite a bit already, and I commend it on that, but clearly it has not got there yet. Where full mitigation is not possible, I urge the Government to look at how properly to compensate people for the loss of their homes and businesses, not just at the market rate before the railway was proposed but for the damage, loss of amenity and so on.

Finally, the Government need to review the whole issue of housing. Whatever the arguments for East West Rail in terms of making it easier for people to travel from Cambourne to Cambridge, it cannot be used as an excuse to increase the amount of house building, which is already one of the highest rates in the country, and there is absolutely no water. I urge the Government to address all these topics.

It is a pleasure to serve under your chairmanship, Sir Mark. I thank my constituency neighbour, the hon. Member for North East Bedfordshire (Richard Fuller), for securing this debate, which is of great importance to our constituents.

I do not believe that any people along the proposed East West Rail route are impacted as negatively as my constituents. It is for them that I stand in opposition to the route alignment that was confirmed at the end of May. The proposed six-track route will impact at least 66 properties in Bedford, including the demolition of 37 residential properties based on reasonable worst-case railway corridor width and potentially more demolitions as part of the station redevelopment. I am a big supporter of green public transport, so I supported the East West Rail route in principle to bring much needed connectivity and growth opportunities to Bedford, but I have always opposed a route that requires the demolition of homes.

East West Rail has said that it reviewed both a four and a six-track alignment, but preferred the option that, in its view, better serves the wider rail line, although that comes at the expense of homes in Bedford. For years, many of my constituents have been living under the spectre of house demolition. People’s lives have been put on hold. They have been held ransom by a Government who did not care about them and were too incompetent to make a decision. Selling their homes has been an arduous process so far, and I sincerely hope that they are not further distressed by it. We also need to see far more detailed proposals about what is happening to the land around Bedford Hospital for the new Bedford St John’s station.

I hope Ministers will vastly improve their decision-making processes, ensure that East West Rail treats people whose homes are being stolen from them with the respect and compassion they deserve, and ensure they get the necessary support, and fair and timely compensation, for their losses. The base rate for this should be at least in line with that of HS2, plus inflation.

I have always maintained that East West Rail should be electrified or carbon free from day one, and I am disappointed that the Government have not committed to low or zero-emissions rail. It is outrageous that they are even thinking about a new rail project that is not powered by green technology. I hope the Minister will commit today to a green East West Rail, which will be vital if the Government have any chance of meeting their net zero targets.

I am disappointed that East West Rail has still not published a formal business case. The strategic case and the technical report amount to no more than a glossy corporate dream. There is no detail. We all know that the eastern region is one of the most under-invested places, so of course the growth potential is significant, but citing The Economist as recognising that growth potential as a strategic case is not good enough. We need a proper business case. I question why it has not materialised so far and why we are expected to wait another year to see it. It should be done before the fact, not after. We do not want another HS2 on our hands, with chaos and spiralling costs because we forged ahead with unsound plans before due diligence was complete.

I hope the Rail Minister will do more today to prove the business case for East West Rail, and I hope that business case includes the concerns of Bedford businesses about the potential for disruption and loss of trade that building works would cause. These proposals will rip the heart out of strong and vibrant communities in my constituency. These are people’s homes. Families have been living in turmoil for years, and now their worst fears have been realised. To many who responded to the last consultation, including myself, it feels like we have not been heard. There are lots of words in the consultation response to say, “We listen to people’s concerns,” but nothing has changed. I hope that the Minister will give a commitment today that if the majority of the residents respond in opposition to the plans in the statutory consultation, the Government will listen and not approve the proposal.

It is a pleasure to serve under your chairmanship, Sir Mark. I extend my gratitude to the hon. Member for North East Bedfordshire (Richard Fuller) for securing this important debate. It is clear that the debate has allowed Members from both sides to diligently voice their concerns on behalf of their constituents, and I commend their passion in ensuring that the voices of local people are heard. I hope the Minister has been listening intently and will address the questions posed to him clearly and transparently.

Despite being the Member for Slough, I am not stranger to Cambridge or Oxford, having studied at both universities, and I appreciate the importance of joining these two great cities by rail. More recently, I have had the pleasure of visiting Winslow station. I have also spoken to East West Rail in Milton Keynes, and visited some excellent companies in Milton Keynes that are local to this project, including on the Aylesbury spur, which would no doubt enhance the Bedford to Cambridge connection. Indeed, the line runs through some of the most productive and fastest growing towns and cities. The area supports over 2 million jobs and adds over £110 billion to the economy every year.

As shadow Rail Minister, my support for better rail connections should come as no surprise. As my hon. Friend the Member for Cambridge (Daniel Zeichner) eloquently explained, connecting our great towns and cities through rail links has been proven time and again to provide more opportunities, bolster local economies, unite communities and address the pressing climate crisis. I will always be an advocate for investing in our rail network to make it work for passengers, local communities and the rail industry. That is why it is so important to address the concerns laid out today in order to progress with the project in a way that benefits local people, businesses and passengers.

Putting it plainly, we should not have such limited public transport along this route. Currently, travel from Bedford to Cambridge is restricted to an hour and a half bus service. With the new connection, that is cut to a mere 35 minutes. Quicker journey times, emissions slashed by up to 76% and pressure taken off local roads: the benefits of rail are clear. Those within commuting distance will be increased, with a wider pool of talent for businesses and universities, increasing jobs and opportunities. No wonder, as my hon. Friend the Member for Cambridge again explained to us eloquently, that the top 50 employers in Cambridge have written to the Government in support of the scheme. The aim of the project—to deliver people a better and more convenient way to travel locally—must be maintained alongside local input, consultation and co-operation, not without it.

As hon. Members have outlined, the line covers an area that is going through a great deal of change and growth. This period of flux will undoubtedly mean that significant decisions will be made on infrastructure. Increasing the number of services to meet the existing and growing demand in the region is vital. Failure to provide Government funding to ensure that these needs are met is simply unacceptable. Across our country we have seen people struggle to get GP appointments, a place at their local school or on to the property ladder, and that is exacerbated in areas of high growth and development, as has been highlighted by hon. Members today. That is why progress on the project should be completed alongside public consultation, with local authorities and local people ensuring that decisions are made to benefit the communities who live in those areas.

I feel like a broken record when I say that progress on the project has been characteristically slow, as with countless other rail projects on this Government’s watch that we have debated in the main Chamber and in Westminster Hall. Just last year, the project was rated as “red” by the Infrastructure and Projects Authority’s delivery confidence assessment, which noted that the later stages of the project “appear unachievable”.

The National Infrastructure Commission, no less, recently commented:

“The region presents a significant growth opportunity for the UK but this will be missed if long term certainty is not provided.”

It seems that the Government are lagging behind in all areas. We must build a network for the future, but just 2.2 km of electrified track was added to our rail network last year, while other European nations and others around the world have been full steam ahead—no pun intended—on full electrification. Why has the Minister not insisted on full electrification for the new route, as has been highlighted by my hon. Friends the Members for Bedford (Mohammad Yasin) and for Cambridge, and others? What considerations has he made of the use of trains that are not diesel-only?

As with much of our railway, the Government’s lack of leadership and dithering has impacted progress. The impact of sky-high inflation on building costs, and ongoing Government uncertainty, have not been unique factors in the scheme. Although I am grateful for the Department’s latest update, I am sure the Minister can see that concerns remain. Most notably, perhaps, is the proposed demolition of homes in the constituency of my hon. Friend the Member for Bedford, who is a persistently strong champion and voice for his constituents. The Minister should directly address those concerns and meet my hon. Friend to discuss next steps. This is clearly devastating for the affected communities, as in the constituencies of the hon. Members for South Cambridgeshire (Anthony Browne) and for North East Bedfordshire.

An updated formal business case should also be published. It is simply unacceptable that we are progressing without that update. Clear and effective consultation is clearly the best way forward. The intentions of the project have always been to serve the local community better, so we must ensure that the final project achieves that. I assure hon. Members on both sides of the House that I will personally raise these matters directly with the chief executive of EWR in my planned meeting with her.

EWR must have direct engagement with affected residents to provide all the support that will be needed through the process, particularly regarding compensation and the sale of nearby homes. Will the Minister confirm what action has been taken and what co-ordination there will be with local representatives—Members of Parliament or councillors and authorities—following the recent announcement? Delivering rail projects with local communities’ needs at the very heart should be second nature to a Government in power for 13 years, but sadly they are more chaotic than ever.

We in the region will now have inflicted on us another by-election in which constituents will no doubt deliver a resounding message as to why they will not reward failure. Those that lose out most from Government incompetence are ordinary working people, so I hope the Rail Minister will use this opportunity to address the concerns laid out today. With our railways readying to go full steam ahead, we can ill afford to renege on further infrastructure promises. The people of the north have been betrayed. We cannot allow the people of Bedfordshire and Cambridgeshire to be betrayed. We cannot allow passengers to be let down once again.

It is a pleasure, Sir Mark, to serve under your chairmanship this afternoon. I thank my hon. Friend the Member for North East Bedfordshire (Richard Fuller) for securing this important debate on East West Rail from Bedford to Cambridge. I have listened carefully to his representations. As everyone in the debate has said, he makes excellent points and sets us a challenge. I am keen to work with him to address those points.

I have noted the six or seven points he raised. I will go through some this afternoon, but I will write to him on all of them. I want to work with him to ensure the project is delivered in a way that maximises benefits for members of his constituency and the country as a whole. I am well aware that, when it comes to building new railways, some are very much in favour because they benefit directly or indirectly from the delivery of that new railway. We will always call for infrastructure to be delivered before housing. This is an opportunity where that can be delivered.

Of course, there are those whose lives are directly impacted and blighted by railways, who suffer as a result of the build. I have every sympathy with them, and I am keen to work with my hon. Friend and other hon. Members to minimise that and to give as much information, clarity and frankness in the process as we can. I say that as someone whose family lives in Buckingham and is well aware of the impact of HS2. “I get it,” is what I want to say this afternoon.

Let me speak a little about the project and then go into detail as I go along. The East West Rail project will improve the UK economy, supporting ambitions for the Oxford to Cambridge region, to add £103 billion extra gross value added by 2050, securing the UK’s future as a world leader in science and technology. East West Rail will improve connectivity and ensure growth is spread across the region as a whole. The route update announcement, which was mentioned, was laid before us on 26 May, and set out the preferred route alignment between Bedford and Cambridge. That would serve new stations at Tempsford and Cambourne, and approach Cambridge from the south, enabling services to call at the new Cambridge South station and to serve the world-leading biomedical campus. As my hon. Friend the Member for South Cambridgeshire (Anthony Browne) mentioned, I was at the site a couple of weeks ago. It is absolutely fantastic; people are incredibly excited about what this railway will deliver through not just better connectivity but allowing more jobs to flow to the campus, enabling it to succeed and to take on the world’s finest. I am very excited to have been able to announce the funding.

The route update announcement is a milestone that reaffirms the Government’s commitment to the project, along with funding of £1.3 billion to deliver the first connection stage of East West Rail between Bicester and Bletchley. It is part of our national commitment to unlock transformative growth within the globally renowned Oxford-Cambridge hub of science, research and technology. It will transform connectivity for residents and businesses in addition to supporting economic growth and local housing plans. Again, I acknowledge the challenge that housing can deliver in that particular part of the country. The support from Cambridge University, biopharmaceutical companies such as AstraZeneca, Oxford University science park and local enterprise partnerships across the route demonstrates the confidence that key stakeholders and businesses have in the benefits of East West Rail.

With every project at this scale, important decisions must be made to optimise and maximise the benefits it can provide. The proposal to build new stations at Tempsford and Cambourne will enable communities to grow, provide opportunities to improve biodiversity and give people increasing access to green spaces, significantly outweighing the benefits that a St Neots station could provide. As I have stated, I recognise that the proposals will have an impact on some homes and businesses. In particular, I understand the concerns of residents immediately to the north of Bedford station.

The hon. Member for Bedford (Mohammad Yasin) mentioned a six-track rather than a four-track proposal. That is being put in place to regulate the disruptive performance on the existing Midland main line, as well as to mitigate congestion and provide options for future growth. It is an example of where we are building for the future, not just through East West Rail, but to deal with a spot of disruption that already exists. By going to the six-track proposal, we will deliver better infrastructure and a better service on both of those lines, though I do recognise that it has more of an impact on residents.

For local residents who are affected, East West Rail Company has launched a need to sell scheme, designed to support residents who have a compelling need to sell their property but are unable to do so other than at a substantially lower value because of the railway. On the point made by the hon. Member for Slough (Mr Dhesi) that I should meet the hon. Member for Bedford, I did that very recently. We discussed the case of one of his constituents and were able to talk about a solution. I continue to make myself available to all hon. Members on behalf of their constituents who are impacted.

East West Rail Company has also proposed to provide a new relocated station building at Bedford Midland, which will offer opportunities for local authorities to partner with East West Rail to deliver a destination station, if supported by third-party funding. Alongside that, the existing Bedford St Johns station will be relocated so that it is closer to Bedford Hospital, providing better connectivity for patients, hospital staff and visitors. Proposals for East West Rail will also mean a significant investment in the Marston Vale line between Bletchley and Bedford to provide a step change in the frequency of services.

As the House and my hon. Friend the Member for North East Bedfordshire will know, East West Rail Company is holding public information events to answer the questions that have been raised by Members on behalf of their constituents. It is also meeting with stakeholders along the line of route. I will take some of the questions that have been posed, particularly by my hon. Friend the Member for South Cambridgeshire about the design stage, and get responses to them.

A statutory consultation is planned for the first half of next year, in which the next stage of technical and operational design proposals will be presented alongside plans to mitigate any associated environmental impacts. East West Rail Company has committed to delivering a 10% biodiversity net gain across the entire project, and traction options such as full electrification along the whole line of route are currently being reviewed.

Phase 1, which goes from Oxford over to Bletchley, is a mix of an existing line and one that once was a railway line. Phase 2, from Bletchley to Bedford, is an existing line. In that sense, electrification is a more difficult challenge, because bridges and other infrastructure are already in place and would have to be significantly changed. Where we have built new bridges and infrastructure, we have done so with electrification for the future in mind, so there is that pathway available to it. Of course, we are looking toward hybrid options in future as far as trains are concerned, which would enable a better, decarbonised line of route. I know all hon. Members have mentioned that point.

The business case was also referenced. As is standard for a project of this size, a final business case will be put forward once planning consent is secured. Before then, a development consent order application will be prepared in accordance with the Planning Act 2008. East West Rail demonstrates the Government’s commitment to supporting growth and improving connectivity for people and business across the Oxford and Cambridge region.

Let me come to some of the points that were raised—my hon. Friends worked hard to raise as many as they could. The first question was, will I walk the line of route? I am not sure whether that is an invitation to walk the entire line of route or selected parts of it, but I am certainly able to say yes to the former—sorry, I should say the latter. I should get that right for Hansard. Yes, I will walk parts of the line of route so that my hon. Friend the Member for North East Bedfordshire can show me the areas that are impacted. Indeed, we did something similar when we looked at the options of coming into Cambridge from the north or going from Cambridge to the south, and I will of course do that in my hon. Friend’s constituency.

My hon. Friend mentioned the new Mayor, Tom Wootton. I met him and he laid out his arguments as to why he believes the line of route should come through the south rather than the north of Bedford. I have said I will write back to him to explain our thinking behind that and I am very happy to continue to liaise with him. We need to ensure that our case is the strongest case and cannot be rebutted, and that it is not only open and transparent but subject to challenges that will make it more robust. I am very keen to do that.

My hon. Friend also asked whether the National Audit Office will conduct an inquiry. We can consider that option. I always enjoyed working with the NAO when I was Chair of the Transport Committee; it has a lot of value to add when it comes to ensuring projects are built to time and cost. External assurance is provided by the Infrastructure and Projects Authority, whose next review is expected before the statutory consultation. It works as an external review body for the project.

My hon. Friend asked whether I will instruct East West Rail to release the maps. We can check what further information and detail can be provided. East West Rail does not yet have a detailed design for every single area, but where it has the details, it will publish them. It has done so in the Poets area of Bedford. I am very keen that we do that at the earliest opportunity to give residents and businesses impacted by the line as much clarity and detail as possible, so I will look at that point for my hon. Friend.

My hon. Friend’s fifth point was about writing to property owners about the current corridor. East West Rail has written to property owners about the route update announcement and will engage with them further in the lead-up to the statutory consultation. Again, I am committed to ensuring that more detail is provided. I will come back to my hon. Friend on all those points and the one or two that I have not addressed because I have not had the time.

The hon. Member for Cambridge (Daniel Zeichner) asked how much money has been spent on the Oxford-to-Cambridge road that was proposed and then stopped, and how many officials are still working on it. I can tell him that £28 million was spent on the development project, and there are no officials working on it right now. I hope he is impressed with that transparency and immediacy.

My hon. Friend the Member for South Cambridgeshire asked who will be responsible for producing the business case. It is East West Rail in partnership with the DFT. We will work closely with the Treasury to make sure that is properly done in the manner that one would expect. There was talk of the theory of change exercise. That methodology is validated by the Government. We have previously discussed the fact that the Green Book is not particularly good at taking into account regeneration and decarbonisation. Changes have now been made; I welcome them because they mean that transport, and certainly rail projects, score much higher. We will of course ensure that that is rigorous, and that the preparation is transparent. I note my hon. Friend’s expertise in this area from his academic background and his business work. I am keen to work with him to ensure the business case works and is in the right form. He can take that assurance.

The hon. Member for Slough visited Winslow. I did so too, and I was actually brought up a few miles away. I am a supporter of this project because when I went to the further education college in Aylesbury, I used to go over that bridge every day, and there was nothing going on underneath it. Now, as the hon. Gentleman is aware, there is a station that will be ready to be opened shortly, and off the back of that we have the housing and the school. The secondary school in Winslow closed down. I was at secondary school in Buckingham, and all the pupils had to be bussed over. That no longer has to happen, and it is the railway that has allowed that to be built. Winslow is a good example of the fact that, if we build the infrastructure, the rest follows.

I am keen to work with the hon. Member for Slough, because it is clear that he supports East West Rail and wants it delivered. I support his support, as it were. He talked about the electrification miles that have been built, but I have to correct the record. In the past 13 years, while we have been in government, 1,200 miles of railway has been electrified. In the previous 13 years, when the Labour party was in power, the figure was a paltry 63 miles. I am sure the hon. Gentleman will not wish to give me any lessons about how to electrify lines, because we are doing that.

I know the hon. Gentleman is going to tell me that he will do a lot more in the future, but the trouble is that we only have Labour’s record to judge him on, not his future deeds. Go on, have a go.

I would like to rebut what the Minister just said. I referred to what has been electrified in the past year, which is a mere 2.2 km of rail line. The Minister is right to point to the Conservative-led Governments’ record in the past 13 years, but having been Chair of the Transport Committee, he will also be aware that the previous Labour Government’s main priority was to invest tens of billions of pounds in our rolling stock to get rid of the old, inefficient trains that we inherited from the previous Conservative Government after 18 years of grinding public transport to a halt. Having got the rolling stock back up to full speed, the last decade has been a lost decade for electrification, which is what other European Governments have done. That is why I said that the Minister and the Conservative Government have been failing on electrification.

I am impressed with that argument, actually, that rather than electrifying lines—I am a big supporter of that, and we want to and will do more, as we have done 1,200 miles whereas, as I pointed out, in the previous 13 years Labour had done 63—there was a priority focus on rolling stock. That really is pulling the other one. We have been doing both during that whole process. If the hon. Member has been on an Azuma train, he will know full well that they have been delivered under our—

Of course, Sir Mark. I am happy to do so, but the invention was so long that I thought you might give me the grace of replying to it fully. I think the point has been made.

Overall, we are committed to the project of East West Rail. The hon. Member for Cambridge set out the case that was recognised—

I will make a little more progress, then I will perhaps give way one final time.

My hon. Friend the Member for North East Bedfordshire mentioned the housing challenges in the area. I recognise that, because, having family and being brought up between Oxford and Cambridge, I see that every single time I go back. He is right to prod me on the figures. In my own constituency, we have an 85% area of outstanding natural beauty. I would like to see more development, so that we have the housing, infrastructure and resources where I am, and spread that load more equally.

I recognise the points raised by most hon. Members that the housing will potentially impact their constituencies. I appreciate that, but I will come back to the point made by the hon. Member for Cambridge. We must ensure that cities such as Oxford and Cambridge can compete not just in this country, but internationally. It is absolutely vital that the scientists, entrepreneurs and innovators there who are coming up with extraordinary cures, which will help people not just in this country but around the world, have the support to do that. At the moment, they do not have a workforce. The idea of this line is to deliver a workforce to Oxford and Cambridge, to use Milton Keynes and allow towns such as Winslow to grow further and get schools in place. In my view, it is a good example of rail delivering for the regional economy. I truly believe that it will do that but, as I say, I know the impacts and I understand them. I want to work with hon. Members across the piece on behalf of their constituents so that they feel more reassured, understand what is going on, get the detail and reassurance and, where needed, get compensation, and so that we make the project work for them as well. I will take one final intervention, then I will conclude.

The Minister mentioned a statutory consultation earlier that will take place from January next year. My constituents think that it is a tick-box exercise; they think that the decision has already been made. If the Minister wants to prove my constituents wrong, will he commit today—I made this point in my speech as well—that if the majority of people taking part in the statutory consultation go against these plans, he will ensure that he puts the proposals on hold? Let him prove my constituents wrong, if he can.

That is not a commitment I can give. As we know, those who tend to write back on consultations tend to be the most affected and are therefore the most troubled by the issue. That is not the way that we would run a consultation. We have of course set out a preferred line of route and the ambition that this railway can deliver, but I can give the hon. Member the assurance—I say this as a former Chair of a Select Committee—that consultations run in my Department under my name will be run properly. We will look at all the responses that come back and at where we can make improvements because residents have come up with really good ideas that will be a win for everyone. I expect to look at those closely and work with those suggestions. It will not be a tick-box exercise for as long as I am responsible for the project; I can give the hon. Member that assurance.

I will wrap up. As I stated, I encourage my hon. Friend the Member for North East Bedfordshire and his constituents to continue to use the opportunities provided through the East West Rail company’s community events and its forthcoming consultation to provide feedback on the plans. I will conclude by thanking you, Sir Mark, and all those who have spoken with passion and expertise. I give my commitment that the Department for Transport will work closely with all the MPs who are represented and have concerns. I hope to assure those who have the most striking concerns and deliver for those who believe, like me, that East West Rail can be a power for good in the region.

I call Richard Fuller to wind up, cognisant of the fact that there is likely to be a vote at around 4 o’clock.

I will try not to detain you for 10 minutes, Sir Mark, but we will see. I thank the Minister, the shadow Minister—the hon. Member for Slough (Mr Dhesi) —and all hon. Members who have spoken, plus the hon. Member for Bath (Wera Hobhouse), who is no longer in her place but who made useful interventions. We certainly had a diversity of views, but one thing that united all those speaking from the Back Benches was that diesel is a non-starter on this railway. Until the Minister and the Government resolve that issue, they are pushing a plan that will further erode public support.

The hon. Member for Cambridge (Daniel Zeichner) made the crucial point that the goal of this investment is to try to build on the strength of Cambridge. We are lucky to have academic, technical and innovative skills in and around Cambridge, in the science parks and the university. That hub of activity has a national benefit for all of us. I completely agree with him, including about the importance of being able to provide accommodation for people and support for that potential to be fulfilled. East West Rail is not the smartest way to do that. There are greener, better alternatives that use public money better to achieve that. If we could engage on that rather than blindly going down this route of “We had already thought of it 10 years ago so we have to keep thinking about it”, we would get a better answer for Cambridge.

My hon. Friend the Member for South Cambridgeshire (Anthony Browne) made the crucial point that inadequate attention has been paid to the water supply in the East Anglia region. This is not a marginal concern, but a substantial one. Like my hon. Friend, I have spoken to the experts in this area about their plans going out 20 or 30 years. Even with all the effort they can make with a new reservoir and with desalination plants, we will run out of water in the eastern region unless there are other additional plans. We have to bear that in mind before the potential for more housing can be taken any further.

The hon. Member for Bedford (Mohammad Yasin) spoke with great passion about members in his constituency, which I know well, who have been given a notification, and about the need for compensation and support. My hon. Friend the Member for South Cambridgeshire emphasised how in this country we are not very good at managing these issues for people when it comes to quantity, the process of reassessing the value of properties or timeliness. It was kind of the CEO of East West Rail to say today that she will see whether things can be done. If the Minister took her up on that, that might help those people. As the hon. Member for Bedford said, there is new additional uncertainty about the new station at the hospital and what that will mean for his constituents and the town of Bedford.

The shadow Minister made some strong points. I shall not pick up on all of them. I always love it when I hear someone say they really like something. The shadow Minister said 50 businesses had written to the Government to say that they supported East West Rail. It is always easy for people to support something when they do not have to pay for it. Would those 50 businesses write the same letter if we said we were going to tax their profits until we made up the shortfall for the taxpayer of £1.5 billion to £3 billion? I wonder whether their support would be quite so evocative if they had to pay for it. In the good old days, people used to say, “I’m going to stand on my own two feet. I’m going to pay for things myself.” Perhaps the Minister should look at ways in which the shortfall could be reduced for the taxpayer by charging the businesses that say they are going to benefit. I would be interested in his thoughts about that one.

On the updated business case, again, the shadow Minister talked eloquently about the support he had for rail projects. Well, at the moment this rail project has a benefit-cost ratio of, basically, 26p in the pound to 52p in the pound. I wonder whether that is Labour’s assumption of good value for money to the taxpayer. Is that the benchmark? If we can anticipate Labour spending that £28 billion a year, that would mean a £20 billion to £50 billion a year loss to the taxpayer. I really think that Labour needs to sharpen its pencils on what is a beneficial return and not give such an easy pass if the benefit-cost ratio of East West Rail is as low as that.

I am grateful to the Minister for his responses, and for his willingness to walk the entire route. I am happy to say that we need him only for part of it, and we will find a date. He said that the announcement is a milestone; I fear it is a millstone. I do not think that this is the right way to unlock growth, but I understand that my view differs from that of the Government. It was disappointing that there was no more pressure from the Minister on East West Rail to be open on the business case. As many Members have said, there is no clarity about the business case, and people having the opportunity to discuss it openly would help with greater transparency, which is why I issued my challenge to the chief executive: I am happy to debate the matter with her in my constituency.

The Minister also talked kindly about the impact of housing growth, and I am grateful for that. He talked about his own constituency, which has a large number of areas of outstanding natural beauty. I know that the constituency of the hon. Member for Cambridge and Cambridgeshire have a significant number of areas with greenbelt protection, but we in Bedfordshire love our countryside too. It may not be classified as an area of outstanding natural beauty, and it may not be protected by the greenbelt, but we love it and want to protect it. We do not want a railway and more housing driven through it. The East West Rail announcement has sadly taken us backwards. It has left too many unresolved issues, and too much controversy and uncertainty. Much more work needs to be done before it gets any support from me.

Question put and agreed to.


That this House has considered the Bedford to Cambridge section of East West Rail.

Tackling Rogue Builders

I will call Mark Garnier to move the motion, and then call the Minister to respond. There will not be an opportunity for the Member in charge to wind up, as is the convention for 30-minute debates, although there will obviously be opportunities for interventions. I am sure that the Minister will accommodate those.

I beg to move,

That this House has considered Government policy on tackling rogue builders.

Thank you very much, Sir Mark. I am conscious that we may have to break off to vote, so I will try to keep my words to the point. I thank my hon. Friend the Member for Mid Worcestershire (Nigel Huddleston), who is my constituency neighbour, for stepping into the breach this afternoon. He and I are very good friends. He is an outstanding Minister for International Trade and is replying on behalf of the Minister for Enterprise, Markets and Small Business, my hon. Friend the Member for Thirsk and Malton (Kevin Hollinrake), who is held up in a Bill Committee. I appreciate that this Minister may not be able to answer every single issue that I intend to raise.

It was nearly 18 months ago that I first brought my presentation Bill to the House, seeking to require the Government to look into the possibility of a licensing regime for builders operating at the smaller end of the market—servicing those people, for example, seeking domestic repairs or small business repairs. That area is known as the repair, maintenance and improvement sector, and it is the RM&I sector that I will concentrate on today. The Minister—when I refer to the Minister, I am in fact referring to his colleague, the Minister for Enterprise, Markets and Small Business—will be aware that at the time the Government were not minded even to look at the possibility of the sector being regulated.

Since then, of course, we have had several new Prime Ministers and a reorganisation of Government Departments, but the Government appear to be, dare I say it, increasingly less interested in talking about this consumer minefield, not more. The Minister, who I have an immense amount of respect for, and I have chatted informally about that and we agreed to meet, accompanied by the Federation of Master Builders, which is championing the cause of improved experience for consumers. It has been difficult to get a meeting set up, but I am delighted to say that we now have a meeting in the diary for the beginning of July.

The issue of rogue builders in the RM&I sector is not widespread, but it is appalling when it occurs. It is important to set out that the majority of builders in the sector are good and decent people. Last week, I had the pleasure of being a judge for the Federation of Master Builders awards, which will happen later this year. It is refreshing to see just how innovating building companies are when it comes to training staff, ensuring health and safety, in some cases offering medical insurance and training for emergencies. Indeed, some of the building firms up for awards demonstrated to me that their reputation is second to none and that they work tirelessly to ensure the longevity of their business through word of mouth and positive endorsements from customers and clients.

I commend the hon. Member for introducing the debate. He is right: most builders are good workmen and do a grand job. That is the case in my constituency, but we also have cases of shoddy workmanship that go unchallenged as people cannot afford costly litigation on small claims, and feel unable to represent themselves. Does he agree that perhaps there should be a role for local authorities—I know that it is different in Northern Ireland than on the UK mainland—to take on the cases of people who have had shoddy workmanship and do not have the wherewithal to chase the case themselves?

I am grateful for the intervention. To a certain extent, local authorities can step in where builders fail to meet building standards, but the problem is that that does not work. That is what I am worried about. As I unwind my speech, the hon. Member will be able to understand a little of what I am proposing, which may be a solution to the problems in his constituency.

Of course, highly qualified and professional firms are not the target of any control that we may want to bring in, but a lot of those very good quality firms would benefit from a simple regime that demonstrates beyond any doubt that a builder firm is legitimate and that the workers within it are both honest and qualified. Repeated surveys from organisations within the sector reinforce that consumers are put off by stories of rogue builders. The FMB estimated a few years ago that up to £3 billion a year is wiped off building activity by consumers fearful of falling victims to rogues.

More recently, the HomeOwners Alliance conducted a survey of consumer worries: 79% of those surveyed reported obstacles in the way of their project, including 42% reporting that it was difficult to find a reliable builder, 29% a lack of available builders, and 15% a lack of confidence in the system. The problem that I am trying to address, working with the FMB, is that of rogue builders who prey on clients who are wholly inexperienced in this area. The vast majority of people who employ a builder have no idea how to manage them. Most of us will only infrequently need the work of a builder or tradesman.

I have a constituent, Michelle Thomas, who paid £70,000 for some restoration work to her house, and the house was left untenable. Building regulators said it should be destroyed. She has paid a further £70,000 and had a very honourable builder come and put it all right.

I am amazed that the Government are not minded to regulate the issue, because, as my hon. Friend says, it would be to the benefit of legitimate good builders who work hard and do good work. One of the issues is that we get repeat offenders, who offend time and again. In the case of my constituent, the rogue builder had been involved in six liquidations. That must be addressed in legislation.

My hon. Friend raises the most important point. We have had six phoenix companies wind up; what we do not want is another six—another six victims who have to have their homes pulled down. That is why we are trying to come up with a system of regulation that can prevent that.

Most of us will only infrequently need the work of a builder or tradesman. When we do, most of us get lucky—it is important to say that. We hear stories of people who endorse workers and pass on their names, as their work is of good quality. However, when someone gets caught by a rogue builder, their life descends into a nightmare. I know what that is like. In the interests of full transparency, I declare my interest, having found myself in such a position a few years back. It is because of that experience that I am keen to help other victims find a way out of the problem and draw the issue to a close once and for all.

When a problem starts—from poor and potentially dangerous work, as we have heard, through to the other end of the scale, which is fictitious bills—ultimately the only recourse is expensive legal fees. My experience opened my eyes to just how many people are victims of those types of rogue traders in so many different ways.

Rogue builders do not just prey on their clients. Others who lose out are the subcontractors and suppliers who do not get paid, as well as the plant hirers who do not get paid and find their machinery is often stolen. Other building firms do not see business because rogue builders will undercut their prices only to hike them later. All of us lose out through tax fraud, as rogue builders take cash in hand to dodge VAT and corporation tax. Tax fraud distorts the market, with rogues undercutting legitimate builders, creating a false impression of costs. The wider economy also loses out; the Federation of Master Builders has estimated that billions of pounds of building work is not undertaken because consumers fear being ripped off.

After my presentation Bill had its Second Reading, I was contacted by a number of victims of rogue builders. I also appeared on an ITV programme talking about the issue, leading to more victims making contact with me. The Petitions Committee contacted me to let me know that there is not one but four petitions seeking a resolution to the problem. Between them, they have gathered over 4,000 signatures, and I urge anyone who hears this debate who has been a victim, or is interested in resolving the problem, to sign one of those petitions.

It is the stories of victims that crystalises the problem, as we heard earlier. I was contacted by a police officer married to a nurse—two fine public servants. They bought their dream home and engaged a builder to renovate it. The work turned out to be massively substandard: it failed building standards and was deemed so dangerous that they could not move back into their home without remedial work. They contacted trading standards, but the builder is refusing to engage and is hiding behind his solicitor.

Similarly, someone else who contacted me had wanted to improve her home so that her disabled sister could get access. She was so let down by the system that she was motived to get in touch with the FMB, and has now launched one of the petitions I referred to in order to seek a licensing regime. Again, I urge people to go on to the Parliament petitions page and add their name.

The problem is that there is actually little redress for victims of rogue builders. Trading standards will probably have a good go at trying to sort it out, but if the builder holds fast, it can do little more than give the builder a telling off and flag their name for future people. The reality is that the only recourse for everybody is the courts, but the legal process is hopeless. Those are not my words; they are the words of a number of solicitors and barristers who advised that, irrespective of the merits of the case, the risk of prosecuting was way too high, so people should cut their losses. “Cut your losses”—do we really think that is a way for 21st-century Britain to tackle a known problem that keeps repeating itself?

The reality is that rogue builders hold all the cards: they can do whatever they like, and there is no recourse. Anyone can pick up a brick and call themselves a bricklayer, anyone can pick up a plank of wood and call themselves a carpenter, and anyone can pick up a pipe and call themselves a plumber. Ironically, they cannot pick up a gas hob and call themselves a gas fitter; that job requires compulsory certification, so there is an acceptance that regulation can be necessary. When a problem arises, however, the only redress is in the courts.

A consumer can be completely rolled over by a rogue trader, but in order to get redress, they need to put aside up to £150,000 to prosecute a legal case, securing barristers, surveyors, solicitors, court fees and all the rest of it. They may win—in fact, they probably will win—but they then need to recover their costs and damages from the builder, who closes their business and moves on to the next scam, having taken all the money out of the business so that there is no way to recover anything. The next victim is engaged and the circus goes on, but our successful litigant is left facing appalling, unrecoverable costs. Meanwhile, more suppliers, subcontractors, plant hirers and the wider building trade lose a little bit more.

However, the solution is simple. The problem lies in the imbalance of jeopardy between the victim and the perpetrator. The reason why there is so much rogue building going on is because it is an easy way to rip people off. In some ways, it is a basic level of fraud, although proving fraud is incredibly difficult. With no loss to the perpetrator, they can go on and on while the victim bears all the costs. How do we balance the jeopardy between the victim and the rogue builder? The answer must lie in regulation, with something such as a compulsory licence that the builder will lose if he or she falls foul of the rules—rules, by the way, that can and will save lives.

I congratulate my hon. Friend on securing the debate. Rogue builders will often go into liquidation to avoid potential litigation or paying out when they have been taken to court and successfully sued, so should we also look at potentially holding the individual responsible in a fiduciary manner, not just the company? That may be a much more effective mechanism for people to be able to chase potential assets that they can then charge against successful litigation.

My hon. Friend gets to the nub of the point. At the end of the day, individuals have to find some sort of personal liability if rogue builders perpetrate these endless infringements. The point is that they have nothing to lose at the moment. If they run the risk of losing their livelihood, they will think again before acting in such a way. It may be that they go on to another type of criminal activity, but we would at least get them out of the building market.

The Minister and I have had informal conversations about this issue, and I know that he and the Minister who replied to my Bill’s Second Reading in 2021—my hon. Friend the Member for North East Derbyshire (Lee Rowley)—are instinctively against licensing and overregulation. To a certain extent, I can see their point. Why burden an industry that gives opportunities to people who choose to work with their hands and avoid a life of form filling? Indeed, I can see from the Wikipedia page for the Under-Secretary of State for Business and Trade, my hon. Friend for Thirsk and Malton—for whom this Minister is standing in—that he was a very successful estate agent. There is limited regulation around estate agents beyond the Estate Agents Act 1979 and the Consumer Protection from Unfair Trading Regulations 2008.

Conversely, I was an investment banker and investment manager, and I know what it is like to be regulated up to the eyeballs. Having been on the Treasury Committee during the passage of the Financial Services Act 2012, and on the banking commission for the Financial Services (Banking Reform) Act 2013, I can see why people might accuse me of being an instinctive regulator. However, even residential estate agents have to be members of a redress scheme. The estate agency of the Under-Secretary of State for Business and Trade would have been required to be signed up to either the property ombudsman or the property redress scheme. Without membership, I understand that it would not have been allowed to trade under the Consumers, Estate Agents and Redress Act 2007.

When I, the two victims I referred to earlier or any of the millions of people who want to improve their home undertake this momentous challenge—as I have said, they might do that only once or twice in their lives—they start by approaching an architect. They may speak to surveyors, and they may go to their bank or mortgage broker to secure a loan to pay for the improvements. They will apply for planning permission from the local planning authority. They may even seek legal advice, and then they will engage a builder.

The architect is regulated by the Architects Registration Board, established by the Architects Act 1987. The surveyor is required to be a member of the Royal Institute of Chartered Surveyors, set up by royal charter and independent of the Government. The mortgage broker is required to be regulated by the Financial Conduct Authority, which was set up by this Government, and cannot trade without that membership. The local planning authority is subject to the oversight of the local government and social care ombudsman. When our home improver starts to pay the builder, it is done from a bank regulated by both the FCA and the Prudential Regulation Authority, the latter of which is run by the Bank of England. Both were set up by the Financial Services Act 2012. Legal advice is regulated by the Solicitors Regulation Authority.

Our home improver then pays the money—their hard-earned cash—having had to go through umpteen regulatory hoops, to someone with no meaningful regulation. That is ridiculous. Not only is the builder not subject to any meaningful regulation, but they could do something that results in someone being severely injured or even losing their life. It is all very well saying that the builder may then be subject to criminal proceedings, but that is small consolation to the relatives of a dead father or a mother with life-changing injuries.

The only outcome that would be satisfactory would be a scheme that honest and decent builders—the majority—would be both happy to sign up to and of which they would enjoy the benefit through being part of a system of excellence. Meanwhile, rogue builders who either game the system or care not one iota about their customers will have something to lose. Without membership of whatever scheme we come up with, they would never be able to trade again, either as individuals or as businesses.

My appeal to the Minister was originally going to be for a meeting, but I am delighted that he, or someone from his office, has got in touch with me. I have every confidence that nothing will get in the way in the diary to stop that meeting happening. I very much look forward to meeting the Minister in early July. However, this is the really important point: will his Department—I know that it has been working to a certain extent on this—work with us to find a solution to this problem and stop the scourge of rogue builders once and for all? Every one of us who comes to Parliament baulks at unnecessary regulation, but just how long are we prepared to knowingly allow people to be ripped off without any usable form of redress?

I congratulate my constituency neighbour, my hon. Friend the Member for Wyre Forest (Mark Garnier), on securing the debate. He is a great champion for his constituents and for many causes that impact right across the country, this being one of them. I am well aware that he has proposed a private Member’s Bill to improve consumer protection from rogue builders. I am also grateful to him for giving other hon. Members the opportunity to discuss this important subject today. I thank the hon. Member for Strangford (Jim Shannon) and my hon. Friends the Members for Clacton (Giles Watling) and for Central Suffolk and North Ipswich (Dr Poulter) for their contributions, because I suspect that every Member has had correspondence and interaction with constituents on this issue. It impacts right across the country.

I assure my hon. Friend the Member for Wyre Forest that the Government are committed to ensuring that there are high standards in the construction industry and that consumers can have confidence that the work they commission will be undertaken competently and will comply with building regulations to ensure safety. We are also committed to ensuring that there are high standards of consumer protection and redress for those who pay for work that falls short of acceptable standards of quality and safety.

The construction industry makes a great contribution to the UK economy. In 2021, it had a turnover of £439 billion, accounting for nearly 9% of the economy, and employed 2.2 million people in about 430,000 firms, with an additional 700,000 self-employed workers. That speaks to some of the challenges that my hon. Friend mentioned in terms of the fragmented nature of the industry. He is also right to point out that the vast majority of those engaged in this sector are hard-working, honourable and decent people, but there are rogues—there is no doubt about it.

The domestic repair, maintenance and improvement sector is a vital part of the industry, employing about 60% of all those who work in it. The small firms and tradespeople who make up this sector deliver essential work to people right across the country. They play an important role now, which will become only more important as we seek to improve the environmental and carbon performance of homes. They are critical to our approach to reducing the 40% of carbon emissions generated by the built environment, and to achieving our net zero targets. However, it is also a part of the industry where genuine concerns about consumer protection exist.

As I have said, while the majority of tradespeople are honest and competent and provide excellent service, there are some incompetent or dishonest firms and individuals who exploit consumers, undertake defective work or overcharge for the services that they deliver. That must be stopped. The Government are committed to working with the industry and local authority trading standards to improve standards of competence and consumer protection, and to take action against rogue builders. While we are not convinced that the introduction of a licensing scheme in such a large and varied sector would be practical or cost-effective, I hope that I will be able to reassure my hon. Friend and other hon. Members that the Government take the issue of consumer protection from rogue builders seriously, and that we are taking meaningful action.

The Government have taken action to strengthen consumer rights. The Consumer Rights Act 2015 sets out the standards that consumers can expect when a trader supplies goods and services, including building work, and remedies if those rights are breached. Under the Act, traders are required to carry out a service with reasonable care and skill, and, where the timeframe is not specified in the contract, within a reasonable timeframe. Where a trader fails to meet the standards required by the CRA for the supply of a service, or if the service does not conform to the contract, there is likely to be breach of contract and the consumer is entitled to ask for a repeat performance of the service or for a price reduction. If a trader and a consumer cannot agree to a remedy, the consumer can pursue a claim against the trader in the courts. The small claims procedure provides the means to pursue a claim for up to £10,000, at a modest cost and without the need for a solicitor. Consumers have up to six years to bring a claim against a trader for breach of contract.

The Government have also signalled their intention to go further in order to protect consumers with provisions in the Digital Markets, Competition and Consumers Bill, which will give enforcement bodies the power to levy tougher fines. However, we know that many individuals and businesses are reluctant to have recourse to the courts to resolve a dispute, with the costs and time that that entails.

My hon. Friend will be aware that the cost of even relatively modest building works is likely to exceed £10,000, but that is the small claims court limit, so that form of redress is not open to many of the victims of rogue builders.

Yes, we are aware of the challenges with the small claims court. Of course, many building works go above £10,000. The Ministry of Justice is also looking at other forms of redress and procedures, and I understand that those are live considerations within Government. I am happy to forward my hon. Friend’s comments to the relevant Ministers, but we do understand the challenges with the small claims court. It works in many circumstances but it is not right for everybody.

We know that consumers would prefer swift, cost-effective and less time-consuming measures to settle their differences with business. That is why, following the recommendations of the independent “Each Home Counts” review in 2016, the Government have worked with the industry to establish the TrustMark scheme. This created the first Government-endorsed quality scheme for homeowners across a range of trades and types of work. TrustMark provides consumers with a single brand to identify schemes run within the industry that require participating firms and tradespeople to demonstrate competence, and which provide for consumer redress.

We are also working with the industry to ensure that high standards of consumer protection are embedded in relation to domestic households.

The TrustMark scheme is great and is a very good start, but it is not compulsory, which means that a lot of consumers do not necessarily know about it. If they do not know about it, they do not know whether they should be asking for it in the first place. The key point is that we can run on TrustMark, but if that becomes the standard it needs to be made compulsory.

I completely understand the arguments that my hon. Friend makes. He is right: it is not compulsory, but it is an important signal, and a good signal to the industry. It is Government-endorsed, which is also important. We certainly encourage people, when they are seeking such works, to look for that TrustMark, because it is an important indicator.

In this area, and on all the things that my hon. Friend has raised today, the important principle is getting the right balance, as he acknowledged in his speech. That means not overburdening industry and small traders, most of whom operate very effectively and professionally, but we have to make sure that we have systems and processes in place so that when things go wrong, there is appropriate redress.

My hon. Friend mentioned that the temptation, certainly for most of us, is not to overburden businesses with regulation. There will always be an ongoing debate. I appreciate that he has had consistent engagement with the Department and multiple Ministers and that he has brought many other representations from industry to the attention of the Department. We appreciate that, because these are live debates.

Just before the Minister takes an intervention, I remind Members that this is supposed to be a short debate. I understand that we are possibly going to have as many as five votes, when the votes are called. In the short time we have available, I would be grateful if we could minimise interventions.

I am very grateful to the Minister for giving way. Is it not the case that historically we have relied on the cry of caveat emptor so much that we have not regulated, but that the time has come to regulate now?

I am sure the appropriate Minister has heard my hon. Friend’s appeals, and I promise to pass on those comments. The key thing is to get the right balance. If things work, we have got the balance right, but if they do not work properly, we need to reassess the balance. I assure him that on an ongoing basis, officials and Ministers pay close attention to what is going on in the sector. Many of the things that my hon. Friend and colleagues have appealed for today have been asked for by many people, but there is also some quite strong opposition, for good reason, so it is a matter of balance.

I will bring my comments to a close shortly, Sir Mark. On decarbonisation, the Government are working with the industry to ensure that high standards of consumer protection are embedded in our domestic household decarbonisation retrofit programmes. Government-funded schemes require installers to hold appropriate certifications. The Government are also seeking to increase the number of qualified and competent tradespeople and to ensure that they have the skills to deliver the quality of work required. We have already provided nearly £7 million to fund 8,000 training opportunities for the energy efficiency and low-carbon heating supply chains. We are considering options to work with the industry to support further training in key skills shortage areas and new routes of entry to increase capacity. My Department is also working closely with the Department for Levelling Up, Housing and Communities to strengthen the consumer protections available through competent person schemes.

In conclusion, I would like to thank my neighbour, my hon. Friend the Member for Wyre Forest, for securing a debate on this important issue. I hope that I have been able to reassure hon. Members that the Government are not only committed to, but taking action to ensure that high standards of consumer protection exist and to tackle the problem of rogue builders and tradespeople.

Question put and agreed to.

New Hospital Programme and Imperial College Healthcare NHS Trust

I beg to move,

That this House has considered the New Hospital Programme and Imperial College Healthcare NHS Trust.

It is a pleasure to see you in the Chair this afternoon, Sir Mark. I understand that our proceedings may be interrupted for some time, but let us make a start. I am delighted to see my west London colleagues here—my hon. Friends the Members for Westminster North (Ms Buck), for Ealing Central and Acton (Dr Huq) and for Brentford and Isleworth (Ruth Cadbury)—and indeed the hon. Member for Cities of London and Westminster (Nickie Aiken), my hon. Friend the Member for Reading East (Matt Rodda), and, of course, the hon. Member for Strangford (Jim Shannon), without whom no debate would be complete, perhaps to remind us that although this is to some extent a local or regional issue, it has much wider implications.

To be clear, this debate is about one thing specifically: the defunding and removal from the 2030 new hospital programme of three major hospitals—Charing Cross, Hammersmith, and St Mary’s—all of which form part of the Imperial College Healthcare NHS Trust. They are teaching hospitals, major emergency and trauma hospitals, research hospitals, academic hospitals, tertiary hospitals—hospitals with a huge national and international reputation—but they are also local hospitals for my constituents and those of many other Members.

In the Secretary of State’s statement on the new hospital programme on 25 May, seven of the schemes that had previously been in the 40 hospitals scheme were removed from that programme with respect to completion by 2030—we must be careful in our words here. I need to deconstruct what has happened since that time, because there has been some misleading presentation of the facts. In order to clarify this, I sent some rather key questions to the Minister in advance of this debate.

Essentially, looking at the statement that was made, the Secretary of State said, in respect of those seven schemes:

“The work will start on those schemes over the next two years, but they will be part of a rolling programme where not all work will be completed by 2030.”—[Official Report, 25 May 2023; Vol. 733, c. 479.]

That is the key change, as far as we are concerned, in relation to that statement.

The questions that still sadly remain unanswered are these: what works will be done at each of the three hospitals before 2030? How much will the budget be for that, and will it come out of the £20 billion new hospitals by 2030 programme? What is the total budget for the rebuild schemes at each of the three hospitals? Is this secured funding, and when will it be allocated? By what date or dates will the works for each hospital be completed?

I have put together what I think are the answers—I have done my sleuthing—but I really need to hear it from the Minister’s own mouth, this afternoon if possible, or in a follow up if he needs to use that. I might also add a sort of meta-question to that: when will I receive a response to the email that I and my hon. Friend the Member for Westminster North sent to the Secretary of State on 28 May, which raised those same issues?

I understand that there is confusion associated with the new hospital programme—as would be true of any scheme that came in under the aegis of the former Member for Uxbridge and South Ruislip—about whether those were new hospitals or not. Almost a year ago, I asked the then Prime Minister about the new hospitals—the “new” hospital at Hammersmith that opened in 1902, and the “new” hospital at Charing Cross that opened in 1818—but I will not focus on that point today. This is about the funding and the timetabling of the scheme; frankly, the Minister can call them whatever he likes.

There have been a number of schemes moving in and out. At one stage there were going to be 48 new hospitals. I think 128 bids came in for the extra eight places and five were successful. We are told there is £20 billion, which sounds like a lot of money—it is a lot of money—but it is not the £32 billion to £35 billion that the Health Service Journal says would be needed to complete all the schemes that have at one time been put forward for the new hospital programme. Those are legitimate grievances, but I do not have time to deal with them all today. I have time only to deal with the one matter that I have already raised.

I need to give a little bit of background. As I have indicated, the hospitals have a long and illustrious history, going back more than two centuries in the case of Charing Cross. In 2012, an Orwellian programme called Shaping a Healthier Future, which had been the product of two years’ secret work by the consultants McKinsey, said that several A&Es should close, including the one at Hammersmith, and that Charing Cross should be demolished and replaced by primary care and treatment services on the site. It was the biggest closure programme in the history of the NHS.

Sadly, we did lose the A&E at Hammersmith in 2014, but after a herculean battle fought over seven years by community groups, such as Save Our Hospitals, and by Labour local authorities, particularly that in Hammersmith, that battle was won and Charing Cross had a reprieve and would go on being a major hospital. That happened in 2019.

It was rumoured that the money that would have been gained by selling most of the land at Charing Cross might have gone into the St Mary’s scheme, which, by common consent, is the hospital that most needs emergency work. But although the bill for essential repairs on the three hospitals is about £350 million—far and away the biggest repair bill of any hospitals in the country—if we want to make those hospitals fit for the 21st century, the actual cost, which I believe is accepted by Department of Health and Social Care officials, will be about 10 times that, between £3 billion and £4 billion. If that seems an unspecific figure—my hon. Friend the Member for Westminster North will say more about this—it is because it depends to some extent on what receipts can be received from land value and moneys at Charing Cross. It is a significant sum of money, but it is to make those essential and world-class hospitals fit for purpose for decades going forward, not just to patch them up.

It was always going to be difficult, and it was disappointing that the hospitals were in cohort 4 and would just squeak in by 2030—that is when the work would be completed. We would have a newly built hospital at St Mary’s and refurbished hospitals at Charing Cross and Hammersmith over that time. That is why it was so disappointing when they were moved out of that without any further future date being given.

What is at stake here? Because there has been so much information, I do not want to use my own words, but the words of the trust itself. In preparation for this debate today, it said:

“the main funding for our schemes has been pushed back beyond the original commitment of 2030 as other schemes have been added to the programme and prioritised. We had two schemes in the original list of 40 hospitals to be built by 2030: a complete rebuild of St Mary’s Hospital in Paddington; and extensive refurbishment and some new build at both Charing Cross Hospital and Hammersmith Hospital”—

confusingly, the Department of Health classifies the two hospitals of Hammersmith and Charing Cross as one scheme, but it certainly affects the two hospitals. The trust goes on:

“It is clearly very disappointing that we will not now be funded to complete these schemes before 2030.”

It also states that

“some funding to progress to final business case approval and to support enabling work”

should be provided, and

“we are awaiting a response in terms of a decision and a funding allocation.”

It then talks about the business plans that it is going to put forward. In rather more emotive but absolutely accurate language, it says:

“If we waited until 2030 to start building works at St Mary’s it would become impossible to patch up our oldest facilities, many of which house key clinical services. As the provider of London’s busiest major trauma centre and host of the NHS’s largest biomedical research centre, that would be hugely damaging for the health and healthcare of hundreds of thousands of people”.

That is the statement from the chief executive officer at Imperial, Professor Tim Orchard, and those words should resonate with the Minister.

I am aware that the Division bell will probably start ringing as soon as I stand up, but I am familiar with that quote from Tim Orchard. My hon. Friend is making a really powerful speech. I am familiar with all these hospitals, as are all my constituents. I was born at Queen Charlotte’s, my little sister was born at Hammersmith, and both my parents were under Charing Cross. I went to the Western Eye Hospital last year when I had shingles, and I have an auntie who has retired but was a consultant professor at St Mary’s.

Does my hon. Friend agree that it is really sad that, in the 75th year of the NHS, we are talking about crumbling estates and all these issues? The backlogs at these hospitals existed long before covid. The Government like to throw up that smokescreen and say, “It’s covid’s fault.” I have just written to Tim Orchard because a constituent told me that there is only one temporary scanner at Hammersmith at the moment. Is that not scandalous? Does my hon. Friend agree that, to paraphrase the Sex Pistols, who were formed on the Wormholt estate, which borders both our constituencies, this is the great NHS scandal?

I thank my hon. Friend for that contribution, and I entirely endorse what she said.

I want to deal briefly with the misinformation—I accept that it was wholly unintentional—in the Secretary of State’s statement, or rather in his responses to questions following his statement, because it is important. A ministerial correction was made following a point of order that I made arising out of that. In response to my hon. Friend the Member for Westminster North, the Health Secretary said:

“We recognise the importance of the Imperial bid; that is why we are starting to build the temporary ward capacity at Charing Cross and the first phase of work is under way on the cardiac elective recovery hub, to bring cardiac work on to the Hammersmith site.”—[Official Report, 25 May 2023; Vol. 733, c. 485.]

There are 47 words in that statement, and four errors had to be corrected in the ministerial correction. That may be an all-time record; I do not know. Some are more important than others. There are bids, not one bid. We are not starting to build; we will start to build at some time in the unspecified future. There is no cardiac elective recovery hub; there is a cardiac catheter lab. The idea that we are just moving cardiac services to the Hammersmith Hospital site would be a surprise, given that St Mary’s is a world-leading cardiac hospital at the moment.

I accept that mistakes happen, but there were other errors in that statement. It implied that works are under way, whereas it is common consent now that they have not yet started. The cardiac work is nothing to do with the new hospital programme; it is part of the ordinary work, as is the refurbishment of wards. The temporary ward at Charing Cross will be necessary, but not until the main funding for the floor-by-floor hospital renewal refurbishment is ready to go. Some greater clarity would be helpful on those very contentious matters.

My first question is: what are the enabling works? What does that mean? We have heard several definitions. The trust says:

“We do not yet know when we will be able to start work.”

There has been mention of surveys. Of course there will have to be surveys before the works, which are estimated to cost several billion pounds, start. We are hoping to get a significant sum of money for the business case—perhaps as much as £200 million. This is about rebuilding the three main hospitals.

An energy centre is mentioned. There will need to be a new energy centre, partly because we have major supply issues in west London, and the existing energy supply would not supply modern, state-of-the-art hospitals. All that is true, but what is not true is that this is somehow the beginnings of the major works of the scheme. That is a fig leaf to cover the fact that the major works have been postponed beyond 2030. The fact is that they are not in the 2030 programme or the current spending review. I ask the Minister again: when will the work be done and what funds have been assigned? Yes, there has been preparatory enabling work, but does that come out of the £20 billion? What is the Government’s commitment to the major work of rebuilding those hospitals? There has been some work, with £20 million spent on preparing plans so far, but we are in limbo at the moment. We are suffering repeatedly from misinformation.

I understand that this is a highly contentious political area. The chairman of the Conservative party will, if the Boundary Commission proposals go through, be the MP who covers Charing Cross Hospital. That is no excuse for putting forward matters that are simply misleading to my constituents and many other people. That does us a great disservice. We all want to see these hospitals thrive, in the interests of patients, staff, management, the trust and the hospitals themselves.

Therefore, I will end my comments, because I want to give others an opportunity to contribute. What I need from the Minister today is clarity and honesty about what is happening. We will live with the consequences of that, and we will continue to campaign as we have done for our wonderful hospitals and local NHS. The Government do a disservice if they are not straightforward and clear in the message they send out.

Thank you, Sir Mark, it is a pleasure to serve under your chairmanship. I thank the hon. Member for Hammersmith (Andy Slaughter) for bringing forward the debate and for the points he has raised. As the Member of Parliament for the Cities of London and Westminster, I would like to focus my remarks specifically on St Mary’s Hospital in my constituency.

In September 2021, Imperial College Healthcare NHS Trust set out the need for a complete redevelopment of St Mary’s: a new 840-bed, research-led major trauma and acute teaching hospital, which would release around five acres of surplus land for wider site regeneration. As I know the Minister appreciates, that development is of huge—

Order. The sitting is to be suspended for multiple Divisions in the Chamber. We require approximately 15 minutes for each vote. There is an issue in that there may be more than four votes. I would imagine it could possibly be an hour before we come back. Those who have put in to speak should not worry, because there will be injury time.

Sitting suspended for Divisions in the House.

On resuming

Being the Member of Parliament for Cities of London and Westminster, I would like to focus my remarks specifically on St Mary’s Hospital, which is based in my constituency. Back in September 2021, Imperial College Healthcare NHS Trust set out the need for a complete redevelopment of St Mary’s Hospital, a new 840-bed research-led major trauma and acute teaching hospital, which would release around five acres of surplus land for wider site regeneration.

I know the Minister appreciates that the development is of huge importance to the wider London area and not just my constituency. After all, St Mary’s is the major acute hospital for north-west London, providing care across a range of specialities in London, in addition to its world-leading maternity centre and 24/7 A&E department. It played a significant role in the 7/7 bombings and other major incidents over the years. It is host to the NHS’s largest biomedical research centre and through its partnership with Imperial College London, the trust continues its long legacy of translating academic discovery into better care and treatment, including making a major contribution to the management of covid-19.

I welcome the Secretary of State for Health and Social Care’s recent confirmation of Government funding for the redevelopment of St Mary’s. Though the timescales have been altered, I appreciate that the full picture is more complex and I know that work continues to complete the majority of the redevelopment as near to the original timescales as possible. I also appreciate the complexities of the programme’s schedule for building works, so I am glad to hear from discussions with Ministers that they are committed to getting the enabling works started as soon as possible. To that end, I look forward to visiting St Mary’s with the Minister responsible, Lord Markham, and the Under-Secretary of State for Levelling Up, Housing and Communities, my hon. Friend the Member for Kensington (Felicity Buchan) to discuss the case for change and the redevelopment more widely.

I pay tribute to Lord Markham and to officials at the Department of Health and Social Care, as well as to the Minister and the Secretary of State, for their communication with the trust and me throughout the process. I am currently concerned about running key clinical services while we wait for building works to commence and specifically about services being patched up to keep patient care running. As it stands, key parts of the estate date back to 1845 and most of the facilities—even the most modern bits—are at least 70 years old. That is because St Mary’s has been developed piecemeal over the decades. I am sure anyone who has visited there will agree that, when walking through the site, it is clear that the hospital is a patchwork of buildings with complex patient pathways.

As a patient of St Mary’s, having recently gone there for one of my regular mammograms, I saw that parts of the hospital are very outdated and very much in need of redevelopment. That is a product of the hospital’s history. However, the space and configuration of the buildings are making it significantly harder to respond to increasing and changing healthcare demands and opportunities. Let us not forget that the hospital was first built in the 19th century, and is now dealing with 21st-century healthcare and medical advancements.

I have heard significant concerns about the fact that the acceleration of the estate decline is impacting patient care and experience and staff working conditions. In short, the St Mary’s buildings are in a poor and declining condition, despite investment in maintenance and repairs. Taken together, the size, age and condition of the buildings make it hard to deliver the high-quality care that people expect and deserve from such a major hospital.

From speaking to Professor Tim Orchard, the chief executive of Imperial College Healthcare NHS Trust, I am confident that we will find a way to mitigate decline and enable work as soon as possible. I am assured that the trust is doing all it can to find innovative solutions to the ongoing problems. I hope the Minister can update us on the outcomes of the Department’s conversations with the trust, focusing on the progress of the enabling works.

I know the trust is accelerating its exploration of alternative funding, design and phasing approaches that will make the most of the huge potential of the land surrounding the hospital once we have a new hospital on a less sprawling footprint. That hugely expensive real estate can then be used for better redevelopment. The development of St Mary’s has the potential to do so much more for our local community and the whole of the UK science, technology, engineering and mathematics sector.

St Mary’s Hospital has been a leading provider of clinical care, education and research for 175 years. We now have an opportunity to take advantage of and invest in new technologies and other opportunities for it so that it better serves its communities and the wider health system.

I am grateful for the opportunity to contribute to this debate, and I congratulate my hon. Friend the Member for Hammersmith (Andy Slaughter) on securing it. It is a pleasure to follow the hon. Member for Cities of London and Westminster (Nickie Aiken). St Mary’s Hospital, which I will mainly concentrate my remarks on, is located in her constituency but is the main hospital serving my constituents in north Westminster.

There is a feeling that this is déjà vu all over again. In April 2019, my hon. Friend the Member for Hammersmith and I spoke in a very similarly titled debate on the Imperial hospitals programme. I said:

“In January 2018, Imperial College Healthcare NHS Trust gained full planning permission for the first phase of the redevelopment of St. Mary’s”

as part of the overall redevelopment of the trust. I said that the

“failure to gain funding and approval from key stakeholders…is a key risk on the trust’s corporate risk register, because the conditions of St Mary’s Hospital have deteriorated so much…the structural issues in the hospital have become absolutely and imminently challenging.”—[Official Report, 24 April 2019; Vol. 658, c. 354WH.]

That case has intensified in the intervening years, as I will come to in a moment.

That was four years ago. A couple of weeks ago, we had the announcement that the main funding for the Imperial hospitals scheme has been pushed back beyond the start date of 2030. Other hospitals have been prioritised. Many of the 40 hospitals have received their commitment to proceed on the original timescale, but not St Mary’s or the Imperial hospitals. As the chief executive of the trust board said, that is very disappointing news.

The 40-hospital building programme was a key feature of the 2019 general election. Conservative candidates took advantage of the opportunity to pose outside St Mary’s Hospital and put the pictures on social media and in their campaign literature. One enthusiastically announced:

“We are helping rebuild St Mary’s hospital…Great to talk to Matt Hancock”

—the then Secretary of State for Health—

“about what it means for local residents”.

The Conservative Assembly Member for West Central, even more enthusiastically, talked about how she looked forward to talking to the BBC about the plans to completely refurbish Charing Cross and Hammersmith Hospitals and rebuild St Mary’s. Four years on, St Mary’s is still the hospital with the largest maintenance backlog in the country, and it has been left behind in the programme. That goes far beyond being yet another example of a broken promise.

There are two key issues. The first, which my hon. Friends and the hon. Member for Cities of London and Westminster have alluded to, is the centrality of the St Mary’s and Imperial trust life sciences campus as a leading centre for biomedical research. This is an incredibly exciting project that is part of this country’s scientific renewal—it could not be more important for the locality or the country—but to be honest, it is hard to sustain the necessary investment or the recruitment and retention of staff in a project of that kind in a crumbling hospital building.

But even more important is the central question of the condition of the hospital—all three of them, as my hon. Friend the Member for Hammersmith said, but particularly, from my point of view, St Mary’s—and its implications for patient care and public money. Put simply, this is about wasting money on routine maintenance and repairs to patch up a building that has for many years been recognised as being in need of a transformative rebuild; indeed, the plans have been proceeding on that basis.

I spoke four years ago about the litany of floods, fires and ceiling collapses that we have had to deal with in our hospital estate. However, some recent examples include the closure of the gynaecology day services unit due to the failure of the air handling unit, and the flooding of the Paterson surgical centre—both of which led to two weeks-worth of clinical activities being suspended—as well as flooding in the main out-patient building caused by a sewage blockage, a partial ceiling collapse in an in-patient ward, and sewage leaks into the bottom of the Queen Elizabeth building and into the pharmacy. These problems not only inconvenience patients and delay treatment; they demand ever more ad hoc spending, which is running at an estimated £6 million to £7 million every year, and there is a long list of repair work that needs to be done.

We know that the new hospital cannot be rebuilt overnight, but it is essential that the hospital redevelopment stays within the framework of the timescale that we have been working to over the last few years, since the programme of 40 hospitals became such a key element of the Government’s planning. St Mary’s and the Imperial NHS trust need Government support, and they need it fast.

I have two questions that I would like the Minister to answer today. Will any slippage in the hospital building programme, from other hospitals in the scheme, enable any assistance to be carried over to help Imperial and St Mary? Will the Government also commit to adopting an alternative funding approach to help that scheme—which is being led by a highly skilled, highly experienced team of clinicians and advisers—as a matter of urgency? A scheme is ready to move, but it needs Government support, and the people of Westminster need that hospital to be delivered fast.

It is a real pleasure to speak in this debate, and I congratulate the hon. Member for Hammersmith (Andy Slaughter) on securing it on this issue. He is indeed a hardy, dedicated and assiduous MP. I say that in all honesty, because I think the good people of Hammersmith have an excellent MP, and they should be very proud of the efforts he makes on behalf of his people in the Chamber and Westminster Hall.

This debate is about the new hospital programme, which applies to the UK mainland. I have come along to add my support to the hon. Gentleman, as I do for many right hon. and hon. Members, here and in the main Chamber. That is my purpose for being here. I am also here to discuss the new hospital programme, which was announced at the 2019 Conservative manifesto launch and would have delivered 40 new hospitals in the UK by 2030. I understand the reasons for the delays—the covid pandemic has focused attention elsewhere and taken away much of the funding—but there is a real need, and hon. Members have made that case today on behalf of their constituents.

I also understand the position of the hon. Member for Hammersmith on the refurbishment works at Charing Cross and Hammersmith Hospitals. As MPs, we want the best of care, access and opportunities for our constituents, and delays to any work are often frustrating, so I understand the request very well, and support his position and his ongoing commitment to his constituents.

I am pleased to see the Minister in his place. He responded to the first debate in Westminster Hall this morning on cancer very well. If he answers hon. Members in the same way in this debate as he did in that one, they will be more than satisfied. With the support of the new hospital programme, Imperial College Healthcare NHS Trust is beginning the next phase of redevelopment planning work for its three main hospital sites, all of which are included in the 40 new hospitals that the Government have committed to building by 2030.

I will quickly give a Northern Ireland perspective: what is happening here is also happening back home. It is important that we all remember that the demands for hospital care and better hospitals are not just in London; they are across the whole of this great United Kingdom of Great Britain and Northern Ireland. Northern Ireland has around 3% of all hospitals, with 40 across the Province.

In a constituency neighbouring mine, Belfast East, we have Ulster Hospital, which is the main hospital for us and is currently undergoing a £261 million revamp being done in stages. I believe that we are now going into section C of this refurbishment. So far there have been developments to a 30,000-square-metre in-patient block that is six storeys high, with a day surgery unit, an endoscopy unit, an angiography unit, and a cardiac investigation unit, with 12 in-patient wards. It is very much a modern hospital and very much of the modern programme that we have in Northern Ireland. The Minister is not responsible for that, but I just wanted to put it on record.

In order to clear our waiting lists, it is crucial that we do all we can to update outdated and old facilities. For a modern society and a fully functioning working hospital, things need to be modern and up to date. That is what the hon. Gentleman has asked for, and that is important. Hospital waiting lists in Northern Ireland are supposed to be banished by 2026—that is pie in the sky, in all honesty—according to a roadmap set out by the former health Minister, Robin Swann. More than 330,000 people are on some sort of waiting list in Northern Ireland and the new elective care framework proposes a £700 million investment over five years. It is important that the Government are committed to the requests of the hon. Member for Hammersmith and the hon. Member for Westminster North (Ms Buck), and to other requests that will follow.

That is what I have done in my comments, Sir Mark. I just want to give you the example of Northern Ireland—

I have every hope that the Department of Health and Social Care will be able to give us timely updates on hospitals in England. This is a discussion I always have with those in the devolved Assemblies. We must—I conclude with this—do our best for our constituents and ensure that the collective facilities are in place to serve their needs. I hope the work in the constituency of the hon. Member for Hammersmith will commence soon as some reassurance for his constituents. He put his case forward—the Minister, I am sure, will respond—and I support him in what he has requested.

It is a pleasure to serve under your chairmanship, Sir Mark. I thank the hon. Member for Hammersmith (Andy Slaughter) for his work in securing this debate, and I thank Members from across the House for their contributions. I support the points my hon. Friend made. He set out clearly in his speech a great deal of local need and hope for a solution to be found in his area, as have other Members. I would like to add my support to them and to highlight a similar issue at the Royal Berkshire Hospital in Reading, which serves both Reading and a very large part of the Royal County of Berkshire.

I start by paying tribute to NHS staff in our county and across the country. They are extremely hard working. They have been through the pandemic and many other great difficulties in recent years and they deserve our respect and support. This rebuilding programme is part of that. It is investing in the future of the country and in the health of our population.

The Royal Berkshire Hospital is one of 40 hospitals that were originally identified by the Government for rebuilding but, sadly, when the announcement was made by the Department of Health and Social Care recently, it was not mentioned. The public and hon. Members present can only imagine the stress that puts staff under, as well as the patients who are waiting for a resolution to many serious building problems in our area. I hope that the Minister will address that point.

Sadly, as my hon. Friend mentioned earlier, the hospital now risks potentially missing out, because if the Government’s plans and assumptions are correct, the pot of money available could run out in 2030 and, as of yet, there is no date for work to start at the Royal Berkshire Hospital.

The issues at the hospital are quite clear and are very similar to the ones in London and across the country. The old part of the hospital, the North Block, is 173 years old. The site is a patchwork of buildings from different dates since then, the A&E department is not suitable, and there is a £200 million backlog of repairs—all very similar to the situation my hon. Friend described for west London, which is obviously nearby. There are many other issues, and all of this affects the productivity of the hospital, the experience of patients and, to some extent, the morale of staff. A number of staff, many of whom I know, have contacted me over some months and years to express concerns about this issue, so I hope that today the Minister will be able to clarify the position for the 40 hospitals in London, Reading and many other areas around the country. I hope he will be able to reassure both patients and staff, and give the country the certainty it needs.

It is a pleasure to serve under your chairship, Sir Mark. I draw your attention to my revised entry in the Members’ Registry of Financial Interests: my spouse is chair of audit at the Imperial College Healthcare NHS Trust. I thank my hon. Friend the Member for Hammersmith (Andy Slaughter) for securing this important debate on the hammer blow that has been inflicted on west London—just one part of the funding and investment crisis being inflicted on the NHS by the Government.

Many of my constituents rely on services from the Imperial College Healthcare NHS Trust, and particularly the St Mary’s, Hammersmith and Charing Cross Hospitals. For constituents in the eastern third of my constituency, Charing Cross Hospital is their local general hospital, whereas for those across my constituency, some or all treatments could be at Charing Cross, Hammersmith or St Mary’s.

My hon. Friend powerfully laid out the case against the Government and the complete neglect they have shown over the past 10 years to those across west London who need NHS care and those who work in the NHS. The sad thing is that I am not even surprised, because this is what we have come to expect from a Conservative Government—things such as the promises made by the now former Member for Uxbridge and South Ruislip. He said there would be 40 new hospitals—that is a promise he drove into the ditch.

I expect that the Minister will make a valiant effort to shake the Etch A Sketch and pretend that the last four years did not actually happen, but patients and staff cannot pretend. Every delayed or inadequate repair or rebuild of any NHS buildings impacts on staff and patients. Leaking roofs, failing electrics, flooding sewage systems and structural faults put whole wards out of action. Operations have been cancelled, diagnostic units and pharmacies have suddenly closed, and much more. This all leads to delayed diagnostics, delayed treatment and delayed discharge.

The NHS backlog currently stands at over 7.3 million, and over 48,000 people in my constituency and the borough of Hounslow were waiting for treatment last year, including 50 who had been waiting over a year for an operation. Behind every single one of those cold numbers is a person whose life is put on hold or, worse, put at risk because of the delays to well-overdue investment. Examples of delay include people who are forced to go private, stroke victims waiting months for a physio, and a young man waiting over a year for an assessment for a broken hip. Behind every one of those stories is not just frustration, but a deeper anger—a righteous anger about just how bad the state of things is. How many of the delays that people are experiencing are made worse because of the failure to invest in the core infrastructure of NHS buildings? We should be clear that it is not the fault of NHS staff and boards. The Imperial trust has needed work to happen for years, and has been preparing and getting plans ready in the expectation that the Government’s promised support will arrive.

I will touch on another aspect that is not necessarily specific to the Imperial trust, but it has been raised with me recently and it is an example of the impact of cutting back on NHS capital investment. There has been a failure to invest in technology, equipment and buildings in testing labs. Without that investment, the NHS is becoming increasingly dependent on the private sector. Businesses are using their leverage position to demand unnecessarily high unit costs per diagnostic test from the already overstretched NHS revenue budgets. Of course, as my hon. Friend the Member for Westminster North (Ms Buck) has described, the annual additional maintenance cost is coming out of revenue budgets because of the lack of capital expenditure.

The failure to invest has left NHS staff, patients and their families down. I know from recently visiting West Middlesex University Hospital is Isleworth in my constituency how hard NHS staff are working, and the groundbreaking work they are doing, but staff say they get little to no support from Government. West Middlesex is not in the same position as the three hospitals mentioned in this debate; it had a complete rebuild on the core part of the hospital under the last Labour Government.

NHS staff and patients are fed up, and they feel ignored. Surely the failure to invest in our NHS estate and provide what was promised will be yet another kick in the teeth for them. The broken promises will have a huge impact on not just my constituents but all Londoners. As has been said, St Mary’s Hospital provides key clinical services and is one of London’s major trauma centres—I think there are only four across London.

In conclusion, my constituents, who already face record waiting lists, will face a longer wait and greater difficulty because of the Government’s decision to pause investment. The Government over-promise and under-deliver. The whole farce shows why, after 13 years in power, it is time for a change.

It is a pleasure to serve under your chairmanship, Sir Mark. It is good to see the Minister; the day after we were last opposite one another, he decided he would not continue after the next general election. I hope we have a good exchange today, and I wish him well.

I am pleased to be in the debate. I declare an interest in that I was born in the Chiswick branch of the old Hammersmith Hospital. The groundworks at Ealing were dug by my father and thousands of Irish labourers from across west London, and I used to visit that hospital as a child. My brother was born in Hillingdon. These places matter to local people.

We are here to discuss something called the new hospital programme, but what we quickly learned was that it was not new, they were not hospitals and there certainly were not 40 of them. It is an absolutely sorry saga, and as we have heard it is a hammer blow for people in west London. It is also a saga that is recognised across the country. Members should not just take my word for it; according to the National Audit Office, the NHS estate does not meet the demands of a modern health service. The growth in backlog maintenance risks harm to patients, and the need for capital is being consistently underestimated. Billions of pounds in capital have been diverted to cover inadequate revenue funding, and yet some capital cannot be used for technical reasons, so there are underspends. Assets are sold to fund day-to-day activities.

In July 2020, the Public Accounts Committee recommended a capital strategy and guidance, including expectations on how backlog maintenance costs will be addressed alongside other priorities. In October 2021, the NHS Confederation stated that NHS leaders had concerns about safety standards because they cannot sufficiently maintain their estate, enable positive digital innovations and reduce the elective backlog without further worsening health inequalities. It described a disjointed and opaque allocation system and unresolved issues about how integrated care systems will allocate and prioritise capital spend.

There is more. In September 2022, the King’s Fund reported that levels of capital investment had changed dramatically over the past 15 years—and don’t we know it! The transfer of NHS funds from capital budgets to support day-to-day spending and relieve the pressures in the NHS has come at a huge cost. NHS buildings and equipment have fallen into increasing disrepair and patients have experienced safety incidents.

The Government’s own review, chaired by Patricia Hewitt, recommended that there should be a cross-Government review of the entire NHS capital regime, with a view to implementing recommendations from 2024. Section 5.43 of the report makes suggestions that a review should consider. My first question to the Minister is, will the Government conduct a review in the light of the Hewitt recommendations? The Opposition would like that update.

NHS estates and capital are a subject that has always interested me in my time as a Member of Parliament. My first involvement as an NHS administrator working on NHS estates was in the late 1980s, when I was a junior planner in Enfield working on the final stages of Chase Farm Hospital, liaising with architects and clinicians and producing updates for the planning director. Later, in the noughties, I was part of the Bristol health service plan to reconfigure acute services and develop the primary and community estate as a non-executive. Yet, my real interest in capital, and part of my motivation in becoming an MP, was the disaster of the Tories’ Health and Social Care Act 2012. Nowhere is the destruction caused by that legislation more apparent than in the management of estates and capital planning, which was not even an afterthought. We cannot provide quality healthcare in leaky, dangerous and collapsing buildings.

Local taxpayers deserve to know how their money is being spent, and another key point made by Patricia Hewitt was about accountability. The MPs here today can get no clarity from their local NHS, and that is frankly outrageous. They have come here today from west London, and from across parties, to try to get some answers as to why the promises made to them have been reneged on. They also want some clarity and, as my hon. Friend the Member for Reading East (Matt Rodda) said, some certainty about the capital programme. It is entirely opaque why some schemes go ahead while others languish somewhere in a possible queue—I am not even sure there is a queue. Indeed, my second question is, can we see that queue? Can we understand the criteria for assessing what is in and what is out, and the timings?

There have been questions about enabling works. We need much more detail on what is in the system now, the original bids and the assessment of the capability to deliver. Who is designing? Who is project-managing? Who is freeing up the clinical time and paying for it to lead and advise on what is needed? Who is tackling safety and the sustainability of these future public buildings so they can meet the challenge of climate change? Because of the damage of the last decade, such skills are in short supply across the public and private sectors.

In case the Minister is not across this and does not have the detail from his civil servants, I will end with a little advice. From my 30 years in and around NHS capital schemes, I know they are complex and require a huge range of knowledge and skill throughout a long process that sometimes lasts for decades. We cannot land modular buildings in major towns and cities, with buildings surrounding them that are hundreds of years old. These are complex facilities that need to augment local services; they are not Amazon warehouses. Decanting clinical facilities and patients is not a matter of unplugging a few computers and moving desks into a portakabin.

Crucially, as the people of Hammersmith and Paddington, Hillingdon, and Uxbridge and South Ruislip certainly know, this is a Government of vague but still broken promises. They could not run a bath; they could not deliver a pizza. They are totally incapable of running this hospital programme. I hope the NHS is not waiting for them to deliver a 75th birthday card, because it will never arrive. They need to go.

It is a pleasure to serve under your chairmanship, Sir Mark. How do I follow that speech by the hon. Member for Bristol South (Karin Smyth)? Well, first, I would like to congratulate the hon. Member for Hammersmith (Andy Slaughter) for bringing forward the debate. I also thank my hon. Friend the Member for Cities of London and Westminster (Nickie Aiken) and the hon. Members for Westminster North (Ms Buck), for Strangford (Jim Shannon), for Reading East (Matt Rodda) and for Brentford and Isleworth (Ruth Cadbury). Time is short, but I will try to answer as many points as possible.

The new hospital programme is the biggest hospital building programme in a generation, which will help us deliver on our manifesto commitment to build 40 new hospitals by 2030. The hon. Member for Hammersmith raised a number of specific questions. I am not responsible for the new hospital programme, because that matter sits with Lord Markham. Nevertheless, I will endeavour to answer as many of the hon. Gentleman’s questions as possible. Furthermore, I know that Lord Markham would be pleased to meet him and colleagues, and I will ensure the hon. Gentleman gets a response to his letter.

On 25 May, we announced that the Government remain committed to building 40 new hospitals by 2030, and the new hospital programme is expected to be backed by more than £20 billion in funding for hospital infrastructure. It is the biggest hospital building programme in a generation. Going forward, new schemes will be considered through a rolling programme of capital investment in hospital infrastructure.

Time is very short, and I ask that the hon. Gentleman to let me answer as many of the questions as I can. If there is time, I will give way.

The programme is part of a more sustainable and consistent approach to delivering state-of-the-art new hospitals and will mean further investment to upgrade NHS facilities across the country. Our announcement is hugely significant to all hospitals in the programme and it gives funding certainty for trusts to progress their schemes in line with revised indicative allocations, most of which are a significant uplift on previous allocations.

I now turn to the specific questions. The hon. Member for Hammersmith said that the debate is about the defunding of the trust. I want to be clear that the trust has been informed of a significantly larger indicative allocation for both schemes than was previously given in 2019. Far from being defunded, the funding envelope has increased significantly.

Furthermore, no schemes have been removed from the programme, as the hon. Gentleman suggested. It is one programme, with a small number of schemes that will now complete beyond 2030. If I might correct the hon. Gentleman, he said that the pot is £20 billion; to be clear, it is over £20 billion.

On Charing Cross, I believe that the hon. Gentleman said that the temporary ward or decant facility will not be necessary until the main construction starts on the tower. That is part of the enabling works that have been raised, which can and should be completed well in advance of the main construction, and therefore can be used as extra capacity should there be a gap between the works. It is the first phase of that floor-by-floor work.

I understand that the main construction itself has not been postponed to start after 2030. We have been clear that, as part of the rolling programme, we may move schemes forward and backward—that question was raised by the hon. Member for Westminster North—based on their readiness to progress. The reason the two Imperial schemes were already in cohort 4 and are now in the rolling programme is that their plans are at such an early stage of development. If they are ready to progress sooner—or indeed other schemes, as the hon. Lady suggested, encounter problems along the way—some schemes may move forward and others may move back. Having the enabling works and business case ready is vital, and I know that hon. Members will have those conversations with the trust.

I will answer some of the other questions in a moment, but specifically on funding, I can confirm that Imperial and all other trusts will now have received confirmation of the individual indicative funding envelopes that give them the basis on which they can submit their proposals through the business case stages. Those individual scheme figures will not be released into the public domain, because they are commercially sensitive. I know that the hon. Member for Hammersmith would like to know the figures, but I hope he will understand why we will not release them: it could prejudice the future ability of contractors for tenders.

We announced that the programme is expected to be backed by over £20 billion, which gives trusts the funding certainty to deliver. We remain committed to delivering all the hospitals in the programme as soon as possible. Specifically on Imperial College, we are working closely with the trust on its two new hospital schemes within the programme. As the hon. Gentleman rightly said, that includes the rebuild of Hammersmith Hospital, the refurbishment of Charing Cross and the redevelopment of St Mary’s in Paddington, as well as any opportunities to commence supportive work ahead of the main construction starting.

Briefly taking each hospital in turn, Charing Cross is a large district general hospital with specialised services. It is a primary undergraduate training centre, and work is under way to explore practical options for a mix of new builds and refurbishment that will be phased across the site. We recognise that the 14-floor tower will need to be refurbished rather than rebuilt, as I mentioned. Other preparatory work that will be necessary, which the hon. Gentleman asked about, includes site-wide surveys and a new energy centre. As with all schemes in the programme, the funding is available for early enabling works such as those as soon as the trusts have their plans ready.

Hammersmith Hospital is a specialist hospital, as the hon. Gentleman said, whose specialisms include renal, haematology, cancer and cardiology care and, of course, its specialist heart attack centre and its research function. Plans for that scheme are also at an early stage of development and will require a phased approach due to space constraints.

Finally, St Mary’s is a large general district hospital, as my hon. Friend the Member for Cities of London and Westminster rightly pointed out, providing highly specialised services. The hospital will require a complete rebuild, and there are a range of options for a new site. We have been clear that we are establishing a new, centrally led programme to deliver those hospitals, which includes a new approach that enables standardisation.

The hon. Member for Hammersmith asked about the completion date for each hospital. The timelines are at an early stage. As a result, they are fluid, but I know that Lord Markham, the Minister in the Lords, will keep him updated on progress as work is undertaken with the trust to develop its proposals.

With a minute to go, I thank the hon. Gentleman for rightly raising this important issue and for his interest and engagement in the new hospital programme. I absolutely assure him that we are committed to the delivery of the two schemes at Imperial College Healthcare NHS Trust, and I thank all Members who have taken part in the debate.

I thank everybody who has contributed to the debate, and the Front Benchers for their contributions. I have a huge amount of respect for the Minister and genuinely wish him great success in his future career, wherever that may be, but he will not be surprised to hear that my constituents will not hear “early stage” and “fluidity” as comforting words. They had schemes for the completion of these major rebuilds of their hospitals by 2030 and assured funding. That is what we do not have, and however we dress it up, we are waiting in hospitals that are not fit for purpose. It is an insult not just to my constituents and patients but to the incredibly dedicated staff. Some of the best clinical staff in the world work in those hospitals, in frankly terrible conditions. That is why we need concrete answers. I will take up the offer of meeting the Lords Minister, but today’s Minister will not be surprised to hear that my hon. Friends and I will pursue this day by day and line by line until we have those assurances.

Question put and agreed to.


That this House has considered the New Hospital Programme and Imperial College Healthcare NHS Trust.

Sitting adjourned.