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Westminster Hall

Volume 736: debated on Tuesday 18 July 2023

Westminster Hall

Tuesday 18 July 2023

[Dame Maria Miller in the Chair]

Radiotherapy: Accessibility

Before we start, may I point out that there will be some videoing by the education department? Please do not be distracted. The Doorkeepers are aware and the video will simply be used to illustrate how a Westminster Hall sitting works, so just ignore it.

I beg to move,

That this House has considered the accessibility of radiotherapy.

It is a privilege to serve under your chairmanship, Dame Maria. I thank the Backbench Business Committee for granting this important debate, all colleagues who supported the application, and Professor Pat Price for her tireless work in supporting the all-party parliamentary group for radiotherapy and championing this vital treatment.

We all know that the cancer backlog was affected by the pressures of covid-19, but in May this year there were 7.47 million people waiting for cancer treatments and 3 million of those have been waiting for over 18 weeks. Only 61.7% of patients receive their first treatment within two months, far below the operational standard of 85%. Radiotherapy is a key part of cancer care. It is the second most effective treatment for cancer and is needed in four out of every 10 cancer cures.

Radiotherapy targets the cancer with radiation. The cancerous cells are more affected than the healthy cells, which are better at repairing themselves. Modern radiotherapy has come on leaps and bounds, and within the last 10 years breakthroughs have increased the accuracy and focus of the treatment to within millimetres, significantly reducing collateral damage to healthy cells.

Surgical treatments require intensive care, with all of the hospital resources and emotional trauma that that entails, and chemotherapy has a significant impact on the immune system. In contrast, radiotherapy is an out-patient treatment that requires fewer patient visits to care centres. It only costs between £3,000 and £7,000 per patient, despite being incredibly high tech.

The international recommendation is that 53% to 60% of cancer patients receive radiotherapy treatments. However, in the UK only 27% of cancer patients received radiotherapy treatment in 2019. In my North Devon constituency, only 4.7% of my constituents live within the recommended 45-minute travel time for radiotherapy treatment. The other 95.3% are among the 3.4 million people in England for whom distance from a radiotherapy service effectively limits the availability of treatment.

As the hon. Member said, radiotherapy is the second most effective cancer treatment and is required by half of all cancer patients. However, the ability to access treatment has been described as a postcode lottery, with 3.4 million people unable to access radiotherapy without travelling more than 45 minutes. Does the hon. Member agree that it is unacceptable that there should be such significant disparities in access to radiotherapy?

I do indeed agree with the hon. Member. In my case, North Devon is the fourth worst constituency in the country for access to radiotherapy services. North Devon is home to the smallest and most remote hospital on the UK mainland—and possibly the most loved. An exceptional team works tirelessly to deliver the best care, despite the challenges of rurality and the availability of staff, mostly linked to the availability of affordable housing, which is currently at its most extreme.

Radiotherapy is usually a series of daily treatments over a number of weeks. Far too many of my constituents choose not to have radiotherapy because the 120-mile round trip each day is too much to consider on top of the understandable pressures that patients with a cancer diagnosis already experience.

Radiotherapy is a far less invasive treatment than many others. With such an elderly population in North Devon it is often the best treatment for patients. A further complication that has been brought to my attention by the wonderful volunteer drivers we have in North Devon who help patients to their appointments across the expansive county, often to Exeter—a 120-mile round trip—for many different treatments, including radiotherapy. I do not want to discourage anyone from reaching out for those services, it will be clear to everyone that a daily radiotherapy session involving a journey of that length is a significant undertaking for patients and volunteer drivers alike. We have a declining number of volunteer drivers, which restricts driver availability for other patients.

It is hard to explain to those who have not visited North Devon the remoteness and the distances involved in undertaking all sorts of treatments. We benefit hugely from the merger of our hospital trust with Exeter’s, but that does not bring Exeter any closer. While it is positive that the backlog of patients waiting longer than 62 days for a GP referral is improving, the 62-day wait to start treatment is not. We know that every four weeks of delay in starting cancer treatment can increase the risk of death by 10%. To ensure everyone receives timely cancer care, radiotherapy needs to be an accessible treatment for every patient.

I commend the hon. Lady for bringing forward a matter that is so important, which I think all of us here recognise. She has set the scene very well.

Another issue, which the hon. Lady is perhaps coming to shortly, is the shortage of radiotherapists across the United Kingdom. I understand that England is some 1,500 shy, and we have vacancies in Northern Ireland as well. The training takes five years, which means that it will be five years before the workforce, who are under pressure now, make gains, and that is if all the vacancies are filled. Furthermore, the age of current radiotherapists is an issue. Does the hon. Lady think that the Government need to take the initiative and put in place a visionary recruitment plan for the five-year period?

I thank the hon. Gentleman for his intervention. We do not talk enough about the lack of specialist staff in this area, and I am indeed going to talk about the need for a proper plan for radiotherapy. Obviously, that involves resources of all types moving forward.

I think we all ask why a treatment as effective as radiotherapy is not used more often. Funding for radiotherapy falls between the cracks, and radiotherapy receives only 5% of the cancer budget. While there has been specific investment in radiotherapy, such as the £162 million in 2016 to replace 64 out-of-date machines, and the additional £32 million in 2019, there will be approximately 74 machines in need of replacement by the end of 2024.

We all know the NHS budget is under strain, but radiotherapy is the closest thing we have to a silver bullet for improving cancer care. An investment of £200 million would update all the machines due to be out of date by the end of next year, benefiting an estimated 50,000 people a year. An investment of £45 million in an innovative British technology—surface guided radiotherapy—could reduce waiting times by 1.8 weeks nationwide, and the use of artificial intelligence tools in radiotherapy could save clinicians two hours per patient.

If radiotherapy received between 10% and 12% of the cancer budget, instead of 5%, we could invest in more machines to bring ourselves up to international standards. In England, we have 4.8 treatment machines per 1 million people, while France has 8.5. and Italy 6.9. New machines and techniques would treat patients more quickly and help to clear the backlog. We need to reap the benefits of successful investment in early diagnosis and increased screening programmes so that early diagnosis leads to timely treatment and improved patients outcomes, rather than long and stressful waits for treatment.

We also need to focus investment in the right areas. Treatments such as proton therapy do not help patients outside Manchester and London. Proton therapy assists only 1% of patients, and my constituents in North Devon do not benefit from more investment in urban centres.

Does my hon. Friend agree that satellite radiotherapy centres have an important role to play? People from my area have to travel down to Hillingdon from north Hertfordshire. The journey is supposed to take 40 minutes, but it is actually an hour and a half each way. If we had a satellite radiotherapy centre in north Hertfordshire it would make all the difference.

I thank my right hon. and learned Friend for his intervention, and I agree entirely. Indeed, I believe the Government should look at bringing radiotherapy treatments closer to patients such as those in my constituency of North Devon. I ask the Minister to consider bringing radiotherapy to satellite centres or community cancer treatment centres to complement diagnostic tools such as radiology in community diagnostic hubs.

Furthermore, may I recommend a trial in North Devon? We have a proud history of raising funds locally for cancer care provision, and I would dearly love to work with the Minister to deliver a new radiotherapy machine—on a partnership basis, if necessary—to begin to tackle some of our challenges head on. Indeed, that sounds significantly more achievable than tackling some of the other health inequalities from which my constituents suffer. Not a single NHS dentist across Devon is taking patients, and the last orthodontist has just left Barnstaple. I recognise that dentists are hard to come by but, for anyone listening, the surf is fantastic and you will be the most welcome blow-in we have ever seen in Devon.

Sorting out radiotherapy could be easier with a community-driven fundraising scheme and some assistance from the Minister to facilitate such as trial. I have former community hospitals waiting, and space on the main hospital site that could accommodate the machine and bunker. As we look to 2040, when an estimated 500,000 people will be diagnosed with cancer each year, we need to invest in cost-effective and efficient treatment.

Half of us will get cancer in our lifetime, so one in four of us will require radiotherapy treatment. Access to such treatment should not be limited by someone’s postcode. I ask the Minister not just to look at modernising and supporting radiotherapy, but to ensure that planning for cancer care accounts for rurality and that everyone has access to all available treatments.

It is a pleasure to serve under your chairmanship, Dame Maria, and I congratulate the hon. Member for North Devon (Selaine Saxby) on securing this important debate. Unusually, I agree with absolutely everything that a Conservative MP said, and I hope the Minister is making copious notes.

I hope you will forgive me if there is a bit of repetition, Dame Maria, because we have been trying hard to address this issue. In effect, this is the radiotherapy lobby. Although we do not have the big guns and finances of the pharmaceutical industry, we are the Members of Parliament who argue for the very small, dedicated and highly skilled radiotherapy workforce to be given the tools and facilities to deliver what they want, which is an improvement in cancer outcomes.

I would like to declare an interest: I am a cancer survivor and have had it twice. I have undergone various treatments, including cancer drugs, chemotherapy, surgery, and radiotherapy on three occasions. I am also privileged to be a long-standing vice-chair of the all-party parliamentary groups for radiotherapy and on cancer. Given the current economic climate, characterised by fiscal conservatism and a reluctance to commit to new spending—that is not a criticism of just the governing party, because it is an issue that my own party is addressing—it is crucial that we optimise the opportunities that present themselves to improve cancer outcomes, and the hon. Member for North Devon raised the issue of IT networks and the use of AI software.

AI technology is proving to be an asset in improving cancer treatment outcomes, and Radiotherapy UK has outlined the fact that a £4 million investment in AI technologies, which equates to £15 to £40 per patient, would immediately enhance NHS workforce capacity and reduce wait times. Does the hon. Member agree that further investment in AI could be vital in increasing access to radiotherapy?

That is a really important point, and I hope the Minister is taking note. I do not know whether the term is “low-hanging fruit”, but here is an opportunity to get some synergies from the new technologies that are available now but perhaps were not available even a couple of years ago. I will return to that theme, but AI is potentially a force multiplier, if that is the appropriate term: it can improve the productivity of the small radiotherapy workforce. As the hon. Member for North Devon mentioned, AI can save a consultant oncologist two hours in planning a patient’s treatment. As a couple of hon. Members have said, it is wonderful to have centres of excellence—some of the best hospitals not only in the United Kingdom, but in the world—such as the Royal Marsden in London and the Christie Hospital in Manchester. Now we have the opportunity, through IT networks and AI, for doctors and clinicians, even in remote locations, to access highly qualified oncology specialists, who can plan the treatment to be delivered in satellite centres. There is a huge opportunity here.

As we have heard, almost half of individuals experience cancer at some point in their lives, and about a quarter require radiotherapy. It is quite a disturbing statistic that only 27% of cancer patients in the UK access radiotherapy. The international recommendation is that between 50% and 53% should. Only half the people who would benefit from radiotherapy are accessing it at the moment.

One thing of great concern in my constituency is that people start radiotherapy by travelling to Mount Vernon, which is an excellent hospital, but they cannot keep going, because it is such a terrible journey, so they give up.

That is a valid point that needs to be addressed. Perhaps part of the solution is the development of more satellite centres. If I have two words for the Minister, if he will forgive me, they are “treatment capacity”; or make that three words: “radiotherapy treatment capacity”. That is what we need—to increase radiotherapy treatment capacity.

Radiotherapy has immense potential for treating various types of cancer. It has been found that a greater number of cancers can be treated effectively using radiotherapy, either exclusively or in combination with other treatments. It has a critical role in four out of 10 cancer cures. As the hon. Member for North Devon said, it is highly accurate, and there is limited damage to healthy cells surrounding the cancerous tumours, particularly with the latest forms and most modern types of radiotherapy, such as stereotactic ablative radiotherapy and so on.

Radiotherapy is particularly useful for treating cancers in vulnerable areas, and requires fewer patient visits compared with other treatments. It does not occupy intensive care capacity, in the way surgery does, nor does it impact the patient’s immune system like chemotherapy. Dame Maria, I am still suffering from the impact of a depressed immune system from the chemotherapy that I had some years ago. That does not happen with radiotherapy. We are not fully utilising the life-saving potential of radiotherapy.

In 2019, Cancer Research UK published a report highlighting inadequate early cancer detection and limited access to the best treatments, resulting in the UK having some of the worst cancer survival rates among western countries. Radiotherapy has been chronically underfunded and under-resourced for a number of years. That is not a political criticism of only this Government, but of previous Governments too, and it needs to be addressed if we are to approach the outcomes and improved survival rates that we all want to see.

As the hon. Member for North Devon said, the UK currently allocates only 5% of its cancer budget to radiotherapy. That is not the whole NHS budget of more than £100 billion; that is just the cancer budget. Most other European countries allocate 10%. That disparity is very telling. It affects patient outcomes, waiting times and the overall NHS budget. Radiotherapy is the most cost-effective of the three main cancer treatments, with a typical cost per cure of £3,000 to £7,000.

However, the lack of investment has left us lagging behind other countries. Our technology is characterised as outdated. As we have heard, within the next year approximately 55 existing radiotherapy machines, which are 10 years old or more, will need replacement. That is about a fifth of the total number of linear accelerators in our NHS. Although the Government talk about record NHS investment, our radiotherapy access falls behind international comparators. As the hon. Member for North Devon said, England has 4.8 radiotherapy treatment machines per million people, while Italy has 6.9 and France has 8.5. The NHS would require another 125 linear accelerators to meet international standards.

It is true that covid-19 had a devastating impact on the NHS and on cancer services, but it is important to note that this problem—the cancer care crisis—predates the pandemic. We had a statement on 3 July from the Health Secretary about the NHS workforce plan. I was rather disappointed, because I raised the issue of the cancer workforce and the 62-day treatment target and he completely avoided giving an answer. The target is that 85% of people should start their first treatment within two months—62 days. However, the latest figures, which have just been published, show that we are hitting that for only 59% of patients. If the Secretary of State does not know that stat, I will be very disappointed. I know a little about Sunderland football club. I know that Jimmy Montgomery, our best ever goalkeeper, made 638 appearances and that we won the FA cup in 1973 and 1937. I would not expect the Health Secretary to know those things, but I would expect him to know the latest key performance indicators in relation to cancer waits, so I hope that the Minister responding today will emphasise the importance of that.

Delays in cancer treatment are not academic. It is not just a question of statistics for our constituents. For every four-week delay—for every month that a treatment is delayed—the chances of survival reduce by 10%, so this is significant. The hon. Member for North Devon mentioned Professor Pat Price. She is a leading authority on cancer, based at the Royal Marsden, and she has warned that up to 45,000 cancer patients could face deadly delays in their treatment by the end of the year. She is consistently reported in the national press, most recently in the Express, and emphasises the need for a cancer-specific plan supported by the requisite investment in improving radiotherapy treatment capacity.

It is great to invest in diagnostics, but this is a hand-in-glove situation: we need to ensure that as the investments in new diagnostic hubs are taking place, we are also making, in parallel, investments in treatment capacity. The Government have access to world-leading cancer specialists such as Professor Price, but we need a greater sense of urgency from Ministers to lift the UK from the bottom of the global cancer outcomes league table to the top. I say to this Minister: that is within our grasp; we have given you the route map for how it can be done.

The NHS has undergone two major reforms in the past 13 years and, although reforming public services is essential, the root causes of the issues sometimes come down to a lack of investment. Investment in cost-effective cancer treatments such as radiotherapy can result in quick gains. Expanding and modernising radiotherapy equipment with a modest—by NHS standards—£200 million investment could update the estimated 76 machines about to become outdated. That would benefit 50,000 patients annually. Then, allocating £45 million for the new surface guided radiotherapy—a fast and accurate British innovative technology—could reduce national waiting times for radiotherapy by almost two weeks. We had a meeting quite recently just along the corridor from this Chamber, and these machines can be installed over a single weekend in a specialist radiotherapy centre. We must utilise new technologies to address the workforce crisis and make access to radiotherapy treatment available across the entire country. Technology is available to the NHS today that was not available 25 years ago, and it is unwise that we are not currently using that technology to its utmost potential. If the NHS made better use of AI software, cancer specialists could plan for radiotherapy treatment two-and-a-half times faster than at present, ensuring that many more patients could be treated sooner. I urge the Minister to reconsider accelerating the roll-out of AI technologies in radiotherapy. There is no shortage of excellent science, technology and innovation in this country, and it is worth noting that most of the advanced radiotherapy machines currently operating all across Europe and in North America are made here in the UK—in Crawley, actually—so we are not making the best use of this British technology.

The Government should be laser-focused on retaining current staff and harnessing the opportunities of AI, up-to-date treatment machines, software and innovation to treat more patients and improve productivity. Some of these technologies could save clinicians up to two hours per patient, which is vital in a health service where we have a workforce crisis and a shortage of specialist oncologists. To bring treatment closer to home, investment is necessary in satellite centres or community cancer treatment centres to complement community diagnostic hubs.

Radiotherapy is a quick and highly effective treatment, and cost-effective radiotherapy services are at the forefront of cancer treatment across the world. It is the first duty of the Government to protect their people. The Minister can demonstrate his commitment to that duty by outlining a workable plan to meet the 62-day cancer treatment target after almost a decade of failure, and ensuring that all patients who will benefit from radiotherapy have access to this lifesaving treatment within 45 minutes of their home.

It is a pleasure to serve under your guidance this morning, Dame Maria. I pay tribute to the hon. Member for North Devon (Selaine Saxby) for leading the debate and doing so extremely well; I agree with every word she said. I also pay tribute to the hon. Member for Easington (Grahame Morris) for not just his speech, but his ongoing work in this area. He speaks with great authority and obviously with great personal experience. I also thank Professor Pat Price, who has been mentioned by both of my colleagues and leads the cancer charity Radiotherapy UK. She is a specialist who adds enormous value to our campaigns to help those in positions of influence to make wise decisions about this vital technology.

Let me start with another positive, and say a massive thank you to that small but incredibly talented workforce of maybe only 5,000 people who deliver radiotherapy in all the centres around the country, literally saving lives every single day. We are massively, massively grateful to all of them.

I apologise that there will be some repetition, but all good campaigns involve repeating one’s messages. We know that one of the most dark and terrible facts of life is that around half of us at some point in our lives will contract cancer, which means that pretty much all of us have experienced it in our families—some with remarkable and wonderful outcomes, some with tragic and incredibly sad ones. I have experienced both within mine. We know that radiotherapy is a really important tool in tackling cancer in terms of both palliative and curative treatment. As has been said, the international standard for the number of people with cancer who should receive radiotherapy is 53%; in the United Kingdom, it is only 27%. That should ring enormous alarm bells in all parts of the House and in every corner of the national health service, but I am afraid that it does not feel like that is happening. There are many reasons behind that, but one that we have already heard is that we spend only 5% of our cancer budget on radiotherapy, and the average of countries similar to ours in the western world is nearer to 10%.

Again, we have already heard—but I will restate—that in the United Kingdom we have 4.9 linear accelerators per 1 million of population. In France, there are 8.5 linear accelerators per million people. For the UK to become just average, we would need 125 additional linear accelerator machines this year, as has already been said. Put bluntly, the fact that this is quite a balkanised commissioning process is one reason why we are where we are. The lack of central commissioning means that different centres will, or will not, have sinking funds, so there is absolutely a postcode lottery. It also means that, as our survey—through the all-party parliamentary group for radiotherapy, which I am privileged to chair—discovered, 75 machines that are basically past their sell-by dates will be in use in our hospitals next year, many without a plan to replace them.

We are behind not just on the volume of technology but, as has been suggested, on the deployment of new technology, much of which was developed in this country. That makes it all the more inexcusable. For example, AI software could allow clinicians to accurately plan patient care in a few minutes rather than a few hours. Imagine the impact that would have on our workforce.

We absolutely need to invest in our workforce. We need to support them, to ensure that we boost the morale of people who are already in the service to keep them working in the service, and to bring in the perhaps 1,500 additional net posts needed to ensure that we have a properly functioning radiotherapy workforce. Alongside that, the fact that we could allow clinicians to do their planning even more accurately, in a fraction of the time, obviously makes sense because we would get even better use out of the workforce than we currently do, in terms of the hours that they put in.

We could also invest, as has already been mentioned, in surface-guided radiation therapy to reduce waiting times. Again, that was developed in the UK, but has not been deployed much here. When we have 40% of people in north Cumbria and about 30% of people in south Cumbria waiting more than two months for their first treatment—we have already heard that every four weeks of delay means that someone is 10% less likely to survive—then, surely, investing in that capacity in radiotherapy, as well as in new technology, is just a no brainer.

All of that costs peanuts—that is a Treasury term, I think—in comparison with equally worthy but vastly more expensive drug treatments. We are talking just £200 million for those 125 new linear accelerators. I am not knocking those treatments, by the way; chemotherapy and immunotherapy are vital weapons in our fight against cancer. Herceptin has saved so many lives, for example, but I have picked that drug for a reason, because the cost of Herceptin, in one year, is equivalent to two thirds of the entire radiotherapy budget.

That is understandable, because drugs do cost more than kit, but it is a reminder of how relatively straightforward this problem is to solve. For a Government that wanted to shift the dial quickly and do something of long-term value, but that would have an impact in a short period of time and would cost, relatively speaking, very little, it should be an obvious no-brainer, and it frustrates me that we are where we are.

Let us be cross-party in our self-criticism, because I can blame this Government for their inaction, and I can blame the coalition Government, and I can blame the previous Labour Government. It is 30 years of us being behind the curve here. Let all accept that we are all responsible and we will all do something about it, starting right now.

Why are we in this situation? I suspect that it is because decisions are often made when the right people are in the room. I am not knocking the pharmaceutical companies, but they have the resource to be in the room. However, when we have our radiotherapy APPG meetings, and we have clinicians from right across the country—the best people in their profession—huddled into little rooms off Westminster Hall, I realise that that is the radiotherapy industry. That is the radiotherapy “lobby”. That is it. We do not have paid specialists; the lobby is in that room. That is perhaps why radiotherapy has slipped off the radar. This is the moment in which it must go right back on to it.

The situation is even worse in rural communities. Some 3.5 million of us live in what we would refer to as radiotherapy deserts, where we are more than a 45-minute journey away from the nearest radiotherapy treatment centre. The national radiotherapy advisory group says that any trust that allows that to happen is guilty of bad practice. In my constituency, pretty much everybody lives outside that 45-minute guideline distance, and when we are looking at the travel times, they are always those from the best-case scenario—travelling at 2 o’clock in the morning, or not in the middle of the tourist season. Twenty million people visit the lakes every year; the roads get a bit clogged up from time to time. If someone is from Dent, the round trip to Preston to get their treatment will take them about two and a half hours. From Kirkby Stephen, it is two hours to Carlisle, two and a half hours to Preston. From Grasmere and Coniston, the round trips are nearer three hours.

Over my time as an MP it has been a privilege to often take my constituents to their treatment in the Rosemere cancer treatment centre in Preston. By the way, it is absolutely excellent, but just blinking miles away; it is far too far away. I remember taking a young mum—a teaching assistant—and her two young children, for her breast cancer treatment. I remember the impact it had on her, how wearying it was; and she was an otherwise fit and healthy young person. I remember taking an older woman from Kendal, some years later, also for daily treatment, and the impact that had on her and her family. It is not just that travelling those long distances is inconvenient; it is actually dangerous. Sometimes, as has already been said by the right hon. and learned Member for North East Hertfordshire (Sir Oliver Heald), it means that people will choose not to complete their treatment. It is also true—clinicians will sometimes baulk at this, but I am not criticising them—that people will not be recommended or referred for radiotherapy because it is recognised that that person will not cope with the travelling.

Not long ago there was a bus driver in my neck of the woods who gave up work for two months and moved to Preston for his treatment, because he could afford to do so. The economic impact on people, in terms of worsening their poverty because of the distances that people have to travel, is huge. The simple fact is that because of the distance they have to travel to treatment, people do not live as long in rural areas. That is outrageous.

In 2008 we launched a campaign to bring a cancer treatment centre to Westmorland General Hospital in Kendal. We have largely succeeded. We brought chemotherapy there in 2011, there is more and more surgery, and diagnostics is arriving in the coming months. The one thing we wanted that we have not got is that radiotherapy satellite unit. I want to be clear that the Rosemere unit in Preston is fantastic. We do not want to replicate it; we want to be associated with it. That is, we want a satellite unit that is attached to the Rosemere one and operating at the hospital in Kendal—just as Rosemere itself was once a satellite to the Christie. Today, there are centres that are satellites of the Christie at Oldham, Macclesfield and Bolton, all of them doing a fantastic job and allowing people who live in those communities closer access to that important treatment.

The simple reality is that over these last few years the proposal that has been made for a radiotherapy satellite unit at the Westmorland General Hospital in Kendal has been written and proposed, and the trust has been behind it. It was eventually signed off in 2014 and then cancelled in 2016. I often point the finger at Ministers and the NHS for that failure to deliver, but I also encourage the trusts and commissioners locally not to let it drop off their agenda. It has vital importance. I often hear commissioners, local trusts in Morecambe Bay and the Lancashire hospitals teaching trusts say the right things, but it feels not sufficiently urgent—tell you what, it is urgent to my constituents. It is urgent every time that somebody gets that awful diagnosis and then realises that they have weeks and weeks of travelling and might not make it. They might not complete the journeys; that might mean that they do not survive.

Yet if we look at the demographics, our need in Cumbria is increasing. It is recognised that at the moment there is demand for 1.3 linear accelerators, just in the area that is closer to Kendal than to Preston. Sadly, cancer is a disease of ageing, at least in part; as our population ages, we know that that demand will get greater.

Here is a crucial point that I really want the Minister to take on board. The evidence is that when a satellite unit is opened, there is a greater level of demand than was predicted. Why is that? There are reasons why only 27% of people are having radiotherapy treatment when it should be 53%, and access is one of them. The APPG for radiotherapy had a forum for the satellite units a little while ago. What we gained from that was the staggering news that when a new satellite centre opens, rather than just getting the demand from the parent centre that was predicted, there is at least 20% more demand than was expected, in every single one. In some cases, the increase in demand is 50%. That is because those patients were not being referred or were choosing not to complete. If you build them, Minister, they will come, and lives will be saved. That all means that people in Kendal, Grange, Windermere, Kirkby Stephen, Appleby, Sedbergh, Ambleside, Coniston, Grasmere and the rest of our communities in rural Cumbria are facing not just longer journeys, but shorter lives. That is not acceptable.

The United Kingdom needs a radiotherapy boost across the board. It would be relatively inexpensive, and if the Government committed right now, we would see dividends and lives being saved within a matter of months. Rural communities, from Westmorland to the west country and from Northumberland to Norfolk, need it even more. For the 3 million people who live in a radiotherapy desert, as I do, investing in satellite units will make an immense difference.

We are desperate for action in Westmorland. We are desperate to see our satellite radiotherapy unit delivered at the Westmorland General Hospital in Kendal. I ask the Minister to act personally now and look at our bid for a satellite unit. If he acts and instructs commissioners to get on with the business of commissioning, I promise that our community will raise at least £2 million to help him to make that case in a partnership bid. If he commits to helping people in Westmorland to have better treatment, shorter journeys and longer lives, I will be permanently, eternally grateful.

As ever, it is a pleasure to serve under your chairmanship, Dame Maria. I thank the hon. Member for North Devon (Selaine Saxby) for securing this important debate and for all her work on this issue, which is not a party political one. As we have found today, there is great consensus across the House on this cause, because it is the right thing to do to use our voices as Members of Parliament to champion it. I commend her and other hon. Members present for their work.

We have had a good debate. There has been a lot of repetition, because these issues need reinforcing, and I fear that I will be reinforcing some of the arguments that we have already heard. I commend my hon. Friend the Member for Easington (Grahame Morris) for all his work over a long time. He is always championing the cause of radiotherapy and bending the ear of shadow Ministers, and no doubt of Ministers, about its importance. I also commend the hon. Member for Westmorland and Lonsdale (Tim Farron) for his work as chair of the APPG for radiotherapy. He brings great knowledge to these debates.

This issue is close to my heart, too. As the hon. Member for Westmorland and Lonsdale said, all families are touched by cancer. Some have good experiences, where loved ones survive; others have less good experiences. I lost both my parents to cancer: my mum died from ovarian cancer when I was 19, and my dad died last year. In fact, last week was the first anniversary of his death. He lived to the age of 77. He had a very rare and aggressive form of rectal cancer; sadly, it could not be treated, because by the time even the earliest symptoms had been discovered, the cancer had already spread in various places throughout his body.

I will be forever grateful for the loving care that my dad received, principally from The Christie in Manchester, but also from the satellite at Oldham. He received palliative care, chemotherapy, immunotherapy and, indeed, radiotherapy. It gave him at least a year longer than he should have survived. My dad was a sporting man and a bit of a gambler, so he was willing to take those odds. Anyway, it gave him an extra year with his great-grandson, as well as with the rest of his family. That is precisely why radiotherapy is key. It was a game changer. The chemotherapy and the immunotherapy did not work; it was the radiotherapy that probably prolonged his life for those extra months.

As we know, radiotherapy is a key treatment for many people affected by cancer. It can be used to try to cure cancer completely, it can make other treatments more effective; it can reduce the risk of cancer coming back post surgery, and it can relieve symptoms in palliative care. Unfortunately, as we have heard today, radiotherapy services are under significant pressure, which is all too evident in the treatment statistics that have been cited. For example, the proportion of people in England having their first cancer treatment within two months of an urgent GP referral has fallen to 58.7%, which is down from 61% in April. As we heard from my hon. Friend the Member for Easington, the target is 85%, but that target has not been met on an annual basis since 2013-14. That really needs the Government’s urgent attention. We cannot just blame the pandemic for these statistics, because way before the pandemic the targets were not being met, although I am sure it exacerbated the issue and made the challenge even harder.

My first question to the Minister is what action he is taking to reverse this concerning decline in treatment within two months. We all know that the key to treating cancer is catching it early, but it seems that a significant number of patients are waiting far too long even to begin care, which potentially harms their chances of receiving successful treatment.

There are also serious concerns about technology and infrastructure within radiology services, as we have heard from hon. Members today. In a response to the Government’s long-overdue NHS workforce plan, the Royal College of Radiologists stated that

“we all know how frustrating it is to try and do our jobs with systems and infrastructure that simply aren’t fit for purpose.”

The RCR also cited an interview in which

“Tom Roques, Vice President for Clinical Oncology, talked…about needing to use seven passwords for seven separate systems in order to provide information to one patient”.

When the Opposition talk about embracing new technology and giving NHS staff the tools they need to do their job, that is precisely what we mean. We must embrace new technology. For example, there are tools that can map radiation therapy to cancer cells, avoiding organs more precisely and more quickly than a human can. That is standard technology in the United States of America, but is used by just one in three radiotherapy planning centres in England. Alongside the workforce plan, what is the Minister planning to do to address this problem? Staff already face an uphill battle. The last thing they need is inadequate equipment or overly complex systems.

Regarding the workforce plan, Cancer Research UK has highlighted what it calls

“a lack of detail on cancer-specific professions”.

What assessment has the Minister made of that? Can he set out what engagement his Department is having with organisations such as Cancer Research UK on ensuring that services such as oncology are adequately staffed into the future?

The final point on which I wish to press the Minister relates to the inequality in access that all hon. Members have spoken about. Approximately 30,000 extra cases of cancer in the UK each year are attributable to socioeconomic deprivation. Studies have consistently shown that there is unwarranted variation in radiotherapy access rates. We have heard about poor access in rural parts of England, which is an issue that specific hubs linked to the main centres of excellence would start to tackle. I certainly welcome the calls from the hon. Members for North Devon and for Westmorland and Lonsdale. It is crazy that their constituents are missing out on key treatments because access requires them to travel too far, and some who do access such treatments give up their treatment early. We should be doing everything we can to encourage people to access those treatments and keep on them until they are completed.

There are issues with monitoring the inequalities. Cancer Research UK has called for improvements to be made to radiotherapy data collection so that policymakers can understand the scale of the problem and set about addressing it. Does the Minister agree? What action is he taking to ensure that we eliminate the inequalities in radiotherapy access that we have heard about today, and certainly to try to get England to the average level of kit needed, if not to exceed the average? I do not just want England to be average at these things; I want us to be an exemplar.

The next Labour Government will work tirelessly to improve access to radiotherapy, alongside providing the NHS with the staff it needs. We will reform our health system and embrace new technology that has the potential to transform the way we deliver care. We will build an NHS that is fit for the future, and we aim to achieve all relevant cancer waiting time standards within our first term. That is a pledge that we have made: we have done it before, and there is no reason we cannot do it again, with the political will.

Until then, however, we need to see this Government engaging with clinicians and experts, and doing everything in their power to ensure that the treatment is there for patients when they need it most. As I said, this is not a party political point. We are a responsible Opposition. We encourage the Government to do more. We want them to meet those targets and to expand services—particularly in rural areas, so that access is equal across the country. We encourage Ministers to do that, and to do it at pace. If they do, we will support them.

It is a pleasure to serve under your chairmanship, Dame Maria. I thank my hon. Friend the Member for North Devon (Selaine Saxby) for securing this important debate on the accessibility of radiotherapy. I agree wholly with the hon. Member for Denton and Reddish (Andrew Gwynne) that there are issues in this place that are not by nature party political. The debate has demonstrated that there is huge consensus on all sides of the House on the need for change, and I thank all right hon. and hon. Members for their contributions today.

Let me turn back to my hon. Friend the Member for North Devon for one moment. Whether it is in the meetings—dare I say it, the many meetings—that I have had with my hon. Friend, or through her public contributions in the House and outside, she has been consistent and powerful in her advocacy on health issues. Her constituents, and patients around the country, are very lucky to have her in their corner.

It is rare for the Front Benchers in a Westminster Hall debate to be allowed so much time to respond. I do not intend to take the entire time available, but I would like to try to answer as many of the questions, points and themes raised as possible. Although Members will know that I am not a new Minister, I am relatively new to this brief, having taken on the cancer portfolio in the last few days. I very much look forward to working with parliamentary colleagues from across the House, including those present today and others who I know have specific interests in cancer, to bring about the changes that we all want to see. I echo the words of the hon. Member for Easington (Grahame Morris) and thank him for sharing his personal experience; I certainly agree with him that we all want to see cancer outcomes improve across the country.

My hon. Friend the Member for North Devon raised the matter of performance levels, which I will touch on briefly before turning to specific points raised in the debate. I echo the hon. Member for Westmorland and Lonsdale (Tim Farron) in paying tribute to the brilliant work of NHS staff in this field. Thanks to them, levels of first treatment following an urgent cancer referral have been consistently above pre-pandemic levels, with activity in May standing at 111% of pre-pandemic levels on a per working day basis. Over 52,000 people had their first or subsequent treatment for cancer in May. In total, over 332,000 people received their first cancer treatment in the 12 months up to May, which is up by more than 18,000 on the same period before the pandemic.

As hon. Members have eloquently pointed out, waiting time performance for radiotherapy is influenced by a range of factors, including workforce and equipment—two subjects that I will come on to address in greater detail. My hon. Friend the Member for North Devon referred to the impact of covid and the recovery of cancer services following the pandemic. In February last year, the Government published the delivery plan for tackling the covid-19 backlog of elective care. We will spend more than £8 billion between now and 2024-25 to drive up elective activity, including cancer diagnosis and treatment. My hon. Friend referred to the community diagnostic centres, which make a huge difference, and the building of surgical hubs.

I am grateful to the Minister for taking the time to answer the points that have been made. Over the years, we have seen every single cancer Minister and probably every Secretary of State, but it seems that just when the penny is about to drop for the responsible Minister, they get shuffled off and nothing actually happens. I hope the Minister will stay in post long enough to deliver the improvements that we want to see.

The community diagnostic hubs are, of course, a wonderful thing, and we have been calling for them, but they must go hand in glove with increased treatment capacity. Otherwise, all that will happen is that the waiting lists will get longer as we diagnose more patients who require early treatment, but without having the treatment capacity to make the inroads that we all want.

I will come on to the hon. Gentleman’s specific point, but he is absolutely right. On remaining in post and Government reshuffles, the Prime Minister giveth and the Prime Minister taketh away, but I thank the hon. Gentleman for his best wishes ahead of any future reshuffle. Having been in the Departments of Health and Social Care, for Education and for Work and Pensions, I know that any Minister understandably ends up taking a considerable interest in their work. I assure the hon. Gentleman that whether or not I maintain my position in the Government, I will maintain my interest in all the areas I have worked on as a Minister. I certainly commit to continuing that work from the Back Benches when one day the Prime Minister chooses to dispense with my services.

I thank the Minister for all his time and commitment and for meeting me so regularly. When he takes things away and reflects on them, will he bear in mind that although community diagnostic hubs are fantastic, it is still a 120 mile round trip from my constituency to get to one, so there are issues in respect of rurality. In Ilfracombe in my constituency, the healthy life expectancy is 59. Remote coastal communities need to be able to access services, and we are underdiagnosing because it is so hard to access even a diagnosis, let alone the treatment.

I will come on to this point in greater depth, but many of the conversations that my hon. Friend and I have had on health issues, and previously on education issues as well, were about rurality and the challenges of rural and coastal communities. Her points are well made—I certainly understand them—and she makes a compelling case. I will address them in greater detail later in my speech.

Not only are we building the community diagnostic centres and surgical hubs—and notwithstanding my hon. Friend’s point about the distance that some have to travel to get to them—but we are creating them deliberately closer to communities; they are not just based in district and general hospitals. In each of the next two years they will be supported by an additional £3.3 billion of funding, which was announced in the autumn statement, and that will enable rapid action to improve emergency, elective and primary care performance towards the pre-pandemic levels.

On cancer specifically, NHS England recently set out the progress made on reducing the number of patients with urgent suspected cancer who wait for longer than 62 days, and announced that the faster diagnosis standard was met for the first time in February this year. It also confirmed the ongoing priorities to improve performance and long waits, prioritise diagnostic capacity for cancer and, of course, focus on the cancer pathway redesign.

The Government and NHS England have pushed to improve the early diagnosis of cancer, which is so important to give patients the best chance of receiving successful treatment and in turn see more people living longer following a cancer diagnosis. However, as my hon. Friend the Member for North Devon eloquently and articulately pointed out—the hon. Member for Easington also made this point—we know that early diagnosis needs to be backed up by high-quality treatment options such as radiotherapy, with its remarkable ability to shrink tumours, as has been set out, and often with minimal side effects.

The hon. Members for Easington and for Denton and Reddish referred to the 62-day cancer target and the changes required to improve cancer outcomes. I hear the strong and compelling arguments that have been made, and I am happy, as I set out at the beginning of my speech, to meet hon. Members to discuss the steps that we are already taking and the further steps that can be taken, alongside NHS England, to improve cancer outcomes.

The hon. Member for Denton and Reddish asked specifically about steps to meet the 62-day target. To target support towards the most challenged trusts in the country, NHS England has developed an intervention model that is designed both to maximise and expand capacity. Challenged trusts have been placed into tiers 1 and 2, and all tiered trusts have weekly or fortnightly oversight calls, and they also have visits with the regional and national teams from NHS England. They receive support on things like the development of a co-ordinated support plan, which is monitored by fortnightly progress meetings. The plans have focused on areas such as pathway improvements, workforce support and targeted capacity increases. That supports the trusts that do not have the resource or bandwidth internally to turn around services.

When my hon. Friend the Member for North Devon made the case for a satellite centre in her constituency, she raised specific challenges in relation to North Devon that are translatable to other parts of the country that have rural and coastal characteristics. I will outline the basis on which provision is reviewed, but before I do let me acknowledge the local efforts that she mentioned. She is rightly proud of her constituents’ initiative in terms of support with travel and other things.

The network oversight group, in conjunction with the relevant specialised commissioning team and cancer alliances, is required to review service provision on a regular basis to ensure that optimal access arrangements are in place. That applies to proposals that relate to the expansion or re-provision of existing services, or to the development of any satellite facilities. The development of any new service location requires the development of a business case, as my hon. Friend pointed out, and business cases must demonstrate, among other criteria, the consideration of the effect on the provision of existing cancer pathways, both within and outside the network geography.

As I have mentioned, that responsibility sits not with the Government but with the integrated care boards, cancer alliances and local specialised commissioning teams. I am happy to meet my hon. Friend, alongside the ICB, to understand the challenges and what can be done in this space. I understand from NHS England that around 450 patients a year travel from my hon. Friend’s constituency to Exeter for treatment, but I am cognisant of the point made by the hon. Member for Westmorland and Lonsdale that many more patients might want to access those services but do not because of the travelling and distances involved. That is why a meeting between me, my hon. Friend and the ICB might be a good starting point.

The Minister is being generous in giving way. The debate is instructive, and I am glad he has mentioned integrated care boards. As the hon. Member for Westmorland and Lonsdale (Tim Farron) mentioned—sorry, the right hon. Gentleman.

Well, I am sure it is only a matter of time.

One of the issues has been commissioning. NHS England is responsible for commissioning without having a sensible plan to replace old machines, and there are bizarre disincentives to using the most modern machines, which require fewer visits. Furthermore, the fractionations are smaller, and the radiotherapy could be delivered in a shorter time. Bizarre commissioning arrangements and tariffs apply. Is the advent of the ICBs, with the responsibilities they hold, an important element in deciding where the new treatment centres are going to be? Will the Minister outline their role in the context of access to radiotherapy services?

I thank the hon. Gentleman for his question and will jump to the part of my speech that covers equipment, because the issue has been raised by all hon. Members during the debate.

We are absolutely focused on improving cancer treatment and supporting advances in radiotherapy using cutting-edge imagery and technology. As my hon. Friend the Member for North Devon pointed out, since 2016 we have invested £162 million in the most cutting-edge radiotherapy equipment, which is designed to replace or upgrade more than 100 radiotherapy treatment machines so that we can deliver the best possible outcomes for patients. As the hon. Member for Westmorland and Lonsdale said, NHS England is carrying out a stocktake of linear accelerator age, which will be completed in the summer. It is also working with partners to undertake a demand and capacity review, which will complete by the end of the year.

On AI specifically, we want to ensure that we have the best possible cutting-edge, innovative equipment and technologies in the NHS, so we have announced an additional £21 million of funding that will speed up the roll out of AI across the NHS. That will enable us to help to improve diagnosis and to reduce waiting times—one of our top priorities—and clinicians will be freed up to spend more time delivering frontline patient care. The point made by the hon. Member for Easington about AI and the benefits thereof is well made.

The hon. Member for Westmorland and Lonsdale has been campaigning on the issue for around a decade, or perhaps longer, and he has met several Ministers. I am yet to meet with the hon. Gentleman, and I know he was due to meet my hon. Friend the Minister for Social Care, but I am happy to honour that meeting. He recently met his local hospital trust to discuss radiotherapy being part of the new hospital programme. Ultimately, that is a matter for commissioners, but we can certainly have that conversation when we meet and try to find a way forward.

A number of hon. Members raised the issue of the workforce. The hon. Member for Strangford (Jim Shannon) is no longer in his place, but he laboured this point, and rightly so. We have made good progress in growing the cancer workforce. The annual growth rate of the workforce remains steady at between 3% and 4%, but we need to go further. As of February, there were 33,174 full-time equivalent staff in the cancer workforce. In trusts, that is an increase of more than 11,300 since February 2010. Specifically, the number of therapeutic radiography staff grew by 17.4% between 2016 and 2021. As has been referenced, we published our long-term workforce plan, which sets out actions that are backed by £2.4 billion of Government funding up to 2028-29, a couple of weeks ago.

On travel, the travel that a patient needs to undertake is dependent on the type of treatment they need. Decisions about treatment locations are made on a case-by-case basis. As hon. Members have pointed out, specialised services are not available in every local hospital, in part because they have to be delivered by specialist teams of health professionals with the necessary skills and experience and access to the necessary equipment and medicines. Patient-specific requirements are based on what each individual can cope with and are discussed between the patient and clinician.

The Government are, of course, striving wherever possible to reduce any necessity to travel unreasonable distances, which is why our priority continues to be to bolster the specialist workforce and ensure ever-expanding coverage of equipment. That includes by investing in new radiotherapy machines, but the responsibility for investing in that equipment sits with local systems—the ICBs, which I suspect we will discuss in greater detail when we meet. I hear the case that has been made about equality and rurality. We can address some of those issues and work with integrated care boards so that they see the benefits to patients and to outcomes, as well as the cost savings, if we get it right.

We are supporting providers to accelerate the delivery of stereotactic ablative body radiotherapy for targeted cancers, thereby lowering the risk of damage to normal cells. Specialised commissioners have allocated £12 million to support providers to deliver SABR.

The Minister has given a comprehensive response to us all. On the issue of SABR, would he look in particular at the point made by the hon. Member for Easington (Grahame Morris) about commissioning arrangements and the perverse incentives that lead to some cancer treatment centres effectively being paid more for using lesser treatment than they would be for more efficient, less invasive, less frequent but more powerful SABR technology and other similar advanced forms of treatment? It would save an awful lot of money and still do a better job.

In short, the answer is yes. There are perverse incentives that exist across Government, and the NHS is no exception. Wherever we identify them, we have to work to drive them out of the system. We have a tendency, unfortunately, to focus on processes and procedures. I want all trusts—I would like us to do this across Government—to focus more on outcomes than on processes. Perhaps when we meet the hon. Gentleman could set out that exact challenge in more detail, because I would be glad to look at it in detail.

Dame Maria, I am conscious that I have gone on for longer than I should have; you have been very generous. I again thank my hon. Friend the Member for North Devon for bringing this matter to the attention of the House, and I thank all hon. Members for their contributions on this hugely important subject. I hope I can assure my hon. Friend and Members from all parties that with the investments we have made and the innovations the NHS has adopted, and the innovations to come, we will continue to improve access to radiotherapy throughout the country. I look forward to meeting the hon. Members present, alongside NHS England, to see what is within the art of the possible in this space. I look forward to working with parliamentary colleagues throughout the House to bring about the improved cancer outcomes that we all want to see.

It has been a pleasure to participate in a debate with you in the Chair, Dame Maria. I thank the Minister for such a comprehensive response, and I thank all right hon. and hon. Members for participating in the debate. I very much hope that the next time we come together we will be celebrating some successes and improved access for our rural constituents to radiotherapy and other cancer treatments. I thank the Minister once again for his time.

Question put and agreed to.


That this House has considered the accessibility of radiotherapy.

Sitting suspended.

Electronic Travel Authorisation: Northern Ireland

I will call Stephen Farry to move the motion, and then I will call the Minister to respond. As is the convention for 30-minute debates, there will not be an opportunity for the Member in charge to wind up.

I beg to move,

That this House has considered Electronic Travel Authorisation and Northern Ireland.

It is a pleasure to serve under your chairmanship, Dame Maria. I thank the Minister for his attendance.

This debate is not about the concept or the introduction of the electronic travel authorisation itself, though I have my concerns in that regard. Rather, the debate covers the implications for the movement of residents and tourists on the island of Ireland, and especially the implications for Northern Ireland. Significant concerns have been expressed by the Northern Ireland Tourism Alliance, Tourism NI, Tourism Ireland, the Committee on the Administration of Justice and other stakeholders in Northern Ireland. The issue has also been raised with the Government by the Irish Government and in the Oireachtas, the Irish Parliament. The key, overarching point is that a one-size-fits-all approach to the world does not work when it comes to the island of Ireland.

Of course, we have the common travel area, which has been in place since the 1920s. By convention, it allows free movement and residency for British and Irish citizens, with associated rights and privileges. Although the UK and Ireland have always had their own immigration rules and systems for other nationalities, until recently there has been a relatively free flow of other residents and tourists from non-visa jurisdictions across the island. I welcome the exemption to the ETA requirements for non-visa third-country permanent residents in the Republic of Ireland, which I and others had been calling for, but there is a lack of clarity on the evidence requirements for legal residents of Ireland. The UK Government had committed to publish guidance on which documents would be accepted as proof of legal residence, but I do not think that has been published yet. Given the nature of land crossings, it is essential that a pragmatic approach is taken, as many people will drive over the border without ID documents.

I commend the hon. Gentleman on bringing forward this important and pragmatic debate on the practicalities of the issue. Does he agree that, for the hospitality industry, the ability of residents of Northern Ireland to travel freely to the Republic for a night away, and the ability of the residents of the Republic to avail themselves of the world-class facilities in Northern Ireland—especially in Strangford, where the beauty and the attractions are very obvious—must be as seamless as someone coming over on a boat from Scotland or hopping on a flight from Liverpool for a boys’ weekend away?

I thank my colleague from Northern Ireland, who represents the constituency neighbouring mine. I agree with everything the hon. Member said, with a minor exception: I would put North Down marginally ahead of Strangford, obviously. Yes, the ETA has to work in both directions.

It is essential that immigration enforcement throughout the UK is familiar with the exemption and the documents that can be accepted, as it applies to travel within the entire common travel area. We need to know what happens if someone who is exempt from an ETA is encountered and has no documents proving their legal residence in Ireland, as this will happen from time to time. Will they be given an opportunity to return to Ireland or to provide the documents subsequently, or will they face criminal prosecution and immigration detention?

Overall, the exemption illustrates that it is possible for the Government to be pragmatic in recognising the particular circumstances in Ireland and the reality of the thousands of daily journeys by non-UK or non-Irish citizens: to shop, for leisure, for medical appointments, for education, and in some cases to work. The focal point for flexibility is now largely centred around tourism, although there is considerable disappointment in the tourism sector that similar flexibilities were not announced at the same time as they were for residents in Ireland.

It is important to note two key, overarching factors. First, under the Good Friday agreement, Ireland is marketed internationally as a single destination. The success of tourism on the island is one of the standard examples of successful north-south co-operation. Secondly, most visitors to the island of Ireland, including those who travel onwards to Northern Ireland, enter through airports and seaports in the south. The overwhelming majority of international flights to the island come via Dublin, especially from the lucrative North American market. Overall, 70% of international visitors to Northern Ireland start in the Republic of Ireland.

I congratulate the hon. Member on securing this debate. He will recall the engagement that we had collectively, as Members of Parliament from Northern Ireland, with the Minister at the turn of the year. One point that we made to him was about the practical outworkings of a lack of enforcement against the legal requirement that tour operators and insurance companies would have for their visitors to comply with the law. We had a discussion about an exemption for such individuals, so that they could visit Northern Ireland and avail themselves of all of our beauty and our offering without this legal impediment, which would render them without insurance cover or put tour operators in an invidious position. Does he share my disappointment that we thought we had reached a positive conclusion with the Home Office, but that has not been borne out?

The hon. Member is right to highlight the situation whereby enforcement and practice may be very light or non-existent but none the less the legal jeopardy continues. That is the nub of the problem that will complicate matters for the tourism sector, particularly when it comes to things such as insurance cover. Again, he reflects on our general disappointment, because there was a time when we felt that a pragmatic outcome for tourism was very close to getting over the line—and, indeed, the Minister kindly facilitated some discussions between his officials and representatives of the Northern Ireland Tourism Alliance.

Overall, there are three types of negative impacts of the ETA on tourism. The first is the bureaucracy, which could serve as a deterrent to visitors coming to Northern Ireland; they may perceive it to be too much hassle and not worth the bother of coming north, and instead choose to do other things in the Republic of Ireland. The Government may well argue that the relative cost is low, highlight the two-year duration of the ETA and stress that it will be relatively easy to apply, but it is worth highlighting a few features of Northern Ireland entry in contrast to other potential entry points. Unlike with the rest of the UK, visitors will be entering via a land border rather than an air or seaport, so there is not the failsafe of drawing attention to the ETA requirement as visitors enter the UK at those other locations. Visitors to Ireland may have the need for an ETA highlighted to them within wider marketing of the island, but that may not necessarily always filter through.

There will also be practical difficulties in highlighting the need for an ETA at the time of booking flights because many tourists will be arriving formally into Irish airports, where there is no need for an ETA, so it would be a case of trying to second guess whether people were going to make further journeys into Northern Ireland. Indeed, there is a clear pattern of tourists making spontaneous decisions to come to Northern Ireland, including for day trips—after all, Northern Ireland is barely an hour’s travel time from Dublin—and feedback from coach operators confirms that much of their business reflects last-minute bookings. Any marketing campaign at Dublin airport will obviously require the co-operation of Irish authorities, which would be difficult at the best of times, never mind in the politically charged context of today. The biometric aspect may also become a barrier to some with limited ICT literacy—for example, some older people, especially whenever they are seeking to make spontaneous journeys.

The second area of impact is the legal jeopardy for tourists who travel to or through Northern Ireland without an ETA. Although there will be no routine immigration control on the Irish land border, those who enter Northern Ireland will nevertheless still legally be required to possess a valid ETA. Problems may arise if someone has an accident or needs medical assistance or otherwise has to interact with the UK state, and they do not have an ETA and the associated legal right to be in the UK. That could lead to insurance policies becoming invalid. Failure to possess an ETA could open someone to a criminal offence and potentially—under the Illegal Migration Bill—to deportation.

At the same time, the absence of routine immigration controls undermines the Government’s main justification for the ETA—knowing or monitoring who is entering the UK—so we could end up placing legitimate visitors in legal uncertainty without any real benefit to the state from the ETA. There is a potential headache and deterrent to those running coach tours and other forms of transport, especially if there is a danger that operators become liable for any passengers they carry who do not have an ETA.

Confusion and uncertainty may also exist for those seeking to travel from two different points in the Republic of Ireland, but who travel through Northern Ireland to get to the second point. For example, the quickest route for most of County Donegal to and from Dublin means travelling through County Tyrone on the A5, even without stopping. A short journey from Clones to Cavan town entails a short road journey that weaves in and out of Northern Ireland in the south-east of County Fermanagh. There is now an enhanced consequence of the Illegal Migration Bill for those who knowingly come into the UK, including Northern Ireland, without permission, including having an ETA.

The interpretation of “knowingly” will be crucial, including in what circumstances it is deemed reasonable or otherwise for someone to be expected to know that requirement. In the event that the term “knowingly” is interpreted in due course in a very narrow way, it may render the application of the ETA to movements within the common travel area to be relatively meaningless in certain respects. None the less, it will still leave that degree of jeopardy and uncertainty for tourists. Someone could potentially be deported to their own country or a third country, even banned from ever returning, under the provisions of clause 2 of the Illegal Migration Bill. That risk is most acute with inadvertent movements over the land border, because elsewhere, at air and sea ports, there would be safeguards.

Any such outcomes for tourists moving into Northern Ireland would send a terrible message regarding the UK being open or otherwise to international tourism. I understand that the Government are looking at that particular point in relation to the Illegal Migration Bill, and I would welcome any clarification from the Minister in that regard, not least given that the Bill has now concluded its formal proceedings.

It is worth stressing the potential legal jeopardy will also apply to visa nationals who are ordinarily resident in the Republic of Ireland and who cross into Northern Ireland without proper permission. I shall give a couple of examples. A woman from Kenya, living legally in County Donegal, could cross the border, which is a simple bridge, into Strabane to do some weekly shopping, and end up interacting with the state and attracting the attention of immigration control. She could be detained and deported back to Kenya. A Nigerian man, travelling between two points in the Republic of Ireland, could unfortunately have a traffic accident and come to the attention of the state. Again, under clause 2 of the Bill, he could be deported, not just back to his home in Ireland, but all the way back to Nigeria.

There will be a resultant impact on the tourism sector in Northern Ireland from the ETA. Tourism professionals tell us that additional bureaucracy and costs are decisive in what are otherwise marginal tourism decisions. That could be an American choosing between going from Dublin to Cork and going from Dublin to Belfast. Despite having some amazing scenery—already alluded to—and wonderful attractions, the tourism sector in Northern Ireland is still below its full potential. Profit margins are very narrow in that sector, so this additional burden and deterrence could be critical, and make or break for a number of operators and attractions. Overseas tourism represents 25% of the annual tourism spend in Northern Ireland, so it is very significant.

A potential pragmatic solution lies in granting a short exemption for tourists to come to Northern Ireland for around five to seven days, without the need for an ETA. There is no routine immigration control planned anyway, so the actual threat to the integrity of the UK borders is overstated as a contrary argument. Legal jeopardy would kick in after that period of exemption had expired, if the person had not left the UK or otherwise applied for an ETA. The Northern Ireland tourism sector believes that that exemption is not only vital but workable. Another angle could be to decriminalise the penalties for someone who crosses inadvertently. That is another potential angle that we would like to put on the table.

I shall move on to a wider issue. Despite Home Office assurances that no immigration checks will take place along the land border, individuals travelling between Northern Ireland and Britain, or directly from Ireland to GB, may still encounter some immigration inspections. An inconsistency between residents and tourists on the island of Ireland raises concerns about how one could possibly differentiate between the two, as determining who fits into each category is highly subjective. Such subjectivity could create fertile ground for perpetuating biases and heightening the risk of racial profiling.

The instance of racial discrimination and profiling within the common travel area has generated significant alarm, with direct negative consequences on our racialised and migrant communities. We would welcome clarity on how the Government intend to safeguard the rights of people of colour departing the island of Ireland, ensuring that racial profiling does not increase on such journeys.

It is worth stressing that until recently, there has been a degree of harmony in how the UK and Ireland have managed movements around these islands. Notably, both the UK and Ireland stayed outside the Schengen arrangements when they were first put in place. However, we are now seeing the implications of growing divergence. The Government may well reference the US electronic system for travel authorisation, and the fact that the European Union is developing its own system specifically for the Schengen zone. However, Ireland is not joining the EU system. Any notion of reinventing an all-islands framework to manage such an arrangement, even if politically doable, would flounder on the basis that Ireland cannot restrict or impinge the free movement of EU citizens beyond passport control, while the post-Brexit UK can.

In conclusion, this is a significant issue for the tourism sector in Northern Ireland specifically. We are joined today by some of its representatives in the Public Gallery. I appreciate that there has been considerable communication between stakeholders and the Minister and his officials, but we do not yet have a solution to this extremely thorny problem. We believe that a pragmatic solution is warranted on the island of Ireland, given our very particular circumstances, and I look forward to a constructive response from the Minister.

It is a pleasure to serve under your chairmanship, Dame Maria. I congratulate the hon. Member for North Down (Stephen Farry) on securing the debate, and I thank his colleagues from Northern Ireland—the hon. Members for Belfast South (Claire Hanna), for Strangford (Jim Shannon) and for Belfast East (Gavin Robinson)—for attending. I thank him for the opportunity to further discuss what is, as he said, an important issue for Northern Ireland.

I intend to cover as many of the specific points that have been made as possible, although the purpose of the debate is not to relitigate the UK Government’s decision to introduce an electronic travel authorisation, or ETA, scheme. It is worth explaining that decision. The ETA scheme will enhance the Government’s ability to screen visitors and prevent the travel of those who pose a risk to the UK.

The introduction of an ETA scheme is in line with the approach that many of our international partners already take to border security. The United States, Canada, Australia and New Zealand have similar schemes, and the European Union is preparing to introduce the comparable European travel information authorisation scheme, or ETIAS. That scheme is due to be implemented later this year, although we hear from the Commission that it may be somewhat delayed. In that sense, the UK is not an outlier; it is moving in lockstep with international partners. However, I appreciate that the Republic of Ireland has not chosen thus far to create its own scheme, and there may be reasons why it is particularly difficult for it to do so.

Overall, we believe that the UK will be a safer place as a result of the ETA scheme, but that is not to deny the fact that the unique circumstances of Northern Ireland pose a series of challenges, which is the purpose of this debate. The Government have tried to take a pragmatic approach, which is seen most vividly in the exemption for non-visa national residents of Ireland. In response to concerns raised by Members of this House and the Government of the Republic of Ireland, as well as other stakeholders, about the possible impact of ETAs on residents of Ireland who frequently cross the Northern Ireland-Ireland border, the Government have agreed to exempt non-visa nationals who are legally resident in Ireland from the requirement to obtain an ETA when travelling to the UK on a journey within the common travel area. In order to benefit from that exemption if required by a UK immigration official, those who are legally resident in Ireland may instead present physical evidence to demonstrate that they are legally resident in Ireland. That seems to be a satisfactory solution to most parties involved.

The next issue is whether the Government could agree some form of exemption for tourists. As the hon. Member for North Down said, I am grateful for opportunities to engage with him and others, including some of the tourism organisations who are in the Public Gallery. My officials have also done extensive engagement work behind the scenes.

We have carefully considered the request to exempt those tourists visiting Northern Ireland from Ireland from the ETA requirement due to concerns that the requirement to obtain an ETA will be considered a bureaucratic barrier for international visitors visiting Northern Ireland from Ireland. We appreciate that the Northern Irish economy depends to an extent on those visitors and that a number of businesses and sectors benefit significantly from tourists who primarily come to, or at least fly into, the Republic, but want to take advantage of the many great attributes of Northern Ireland, whether that is golfing or visiting the coastline or historic cities and towns. We appreciate the concern that those people may view this modest barrier as sufficient to deter them from making day trips to or overnight stays in Northern Ireland.

In the Government’s view, ETAs will for the first time allow us to have a comprehensive understanding of those seeking to come to the UK via the common travel area and to refuse them permission in the very judicious circumstances where that would be appropriate. Exempting tourists visiting Northern Ireland from Ireland from the requirement to obtain an ETA would, to our mind, result in an unacceptable gap in UK border security, which would allow persons of interest or risk who would be refused an ETA to enter the UK legally, undermining the very purpose of the ETA scheme, which is to prevent those who pose a risk to the UK from entering it.

Will the Minister respond directly to the point that the hon. Member for Belfast East (Gavin Robinson) and I made? While the Government’s justification for the ETA is to collect that data and have an understanding of who is coming in, the Government do not have the means to collect that data from people crossing the land border, because there is no routine immigration control on the border. As such, those tourists entering Northern Ireland will not be in the system, but none the less they still carry the legal jeopardy of having that legal requirement. That is the nub of the issue: they do not go through immigration control, but they still bear all the risks associated with it. That is the essence of the plea for pragmatism.

I understand the point the hon. Gentleman makes. This is not a perfect solution. A perfect solution is unavailable as long as we want to respect the unique circumstances of the island of Ireland and the common travel area, but we consider that it would be even more complex, or suboptimal, to have a situation where Northern Ireland was hived off from the scheme altogether. That would be a greater loophole in the ETA scheme and one that, having given this considerable thought, we are not willing to countenance.

I will come back to the hon. Lady in a few moments time. I would like to answer the questions posed by the hon. Member for North Down around non-compliance and the legal jeopardy of individuals, because those are important points. As now, the UK will not operate routine immigration controls on journeys from within the common travel area, with no immigration controls whatsoever on the Ireland-Northern Ireland land border. However, as is currently the case, individuals arriving in the EU, including those crossing the land border will need to continue to enter in line with the UK’s immigration framework, including the requirement now to obtain an ETA. For example, visa nationals are required to obtain a visa for the UK when travelling via Ireland to lawfully enter the United Kingdom. That is a well-established requirement, and we are simply extending the same principle to individuals requiring an ETA.

The Government will launch a clear communications strategy to tackle any misunderstandings about the requirement on travel to Northern Ireland. That is something we are preparing, and we will work extensively with Northern Irish, Irish and island of Ireland tourism organisations to ensure that we get this right. For individuals who accidentally travel to Northern Ireland without an ETA under the illegal entry offence, we want to take a sensible and pragmatic approach. We have made it clear that prosecutions under illegal entry will focus on the most egregious cases and not on accidental errors.

We will take a very careful approach when examining the individual circumstances of each case before deciding whether or not it should be pursued for prosecution, and the Crown Prosecution Service in England and Wales and the Public Prosecution Service in Northern Ireland will ultimately determine whether a prosecution is proportionate and in the public interest. We hope and expect that they will take that responsibility very seriously, so those individuals who are simply going about their daily lives or who are tourists who inadvertently forget to obtain an ETA will not be put in an unnecessarily difficult situation.

As the Minister can see from the debate, this is an issue that has a very broad consensus—he will know that that is no mean feat—due to the very serious impact on tourism businesses. He will be aware of that impact and the fact that many decisions to come north are ad hoc ones to visit, for example, the Ulster Museum, the Lyric Theatre or the Let’s Go Hydro water park, or for destination shopping on the Lisburn Road. Has his Department conducted any economic analysis of the loss to Northern Irish businesses of those ad hoc decisions to come north for just one day in a trip to the island?

The hon. Lady is absolutely right to note all of the many reasons why it is great to visit Northern Ireland; I have visited Northern Ireland myself on several occasions and always enjoyed it. The Department has conducted an impact analysis, which shows that there is an impact on tourism in Northern Ireland. However, we still consider that the overall value to the security of the United Kingdom outweighs concerns about that impact.

That does not mean that we do not take mitigating steps, one of which is to work with the Northern Irish tourism bodies on communications. I have mentioned that and my officials met representatives from the Northern Ireland Tourism Alliance, Tourism Ireland and Tourism Northern Ireland last month to begin discussions about how we can collectively work together on communications, both within the UK and abroad. Clearly, there is more work to be done in that regard with travel agents and some of the ancillary services to which the hon. Member for North Down referred, such as insurance companies and car rental companies, to ensure that this message is properly communicated to all involved.

We have deliberately chosen to keep the cost of the ETA as low as possible. We have now announced that it will have a maximum fee of £10, which compares favourably with the fees for the versions of the ETA in the EU and the United States, so we do not think that that level of fee is likely to deter visitors, particularly some of the higher-income and higher-spend tourists whom Members present are particularly concerned about.

We have also said that we will work very closely to keep this matter under review and of course we want to ensure that we learn from the initial experience once the system is created. If there are things that we need to do to change the system over time, we will do so. We want to work pragmatically with Northern Ireland and its MPs, because we care about the success of the Northern Irish economy.

In closing, I thank the hon. Member for North Down for securing this debate and for raising this issue today. I commit that we will continue to discuss this issue and will continue to work well with the organisations that I know he is in contact with, and we will try to find sensible, pragmatic solutions to make this system as successful as possible, while understanding that this is not the solution that he wanted. Nevertheless, we all share a common desire both to protect security for the people of Northern Ireland and of the wider United Kingdom and, of course, to ensure growth and prosperity in the years ahead, particularly for the critical sector of tourism.

Question put and agreed to.

Sitting suspended.

Cost of Living: Private rented sector

[Dr Rupa Huq in the Chair]

I beg to move,

That this House has considered the cost of living and the private rented sector.

It is a pleasure to serve under your chairmanship, Dr Huq.

I am pleased to have secured this debate on an aspect of the cost of living crisis that does not get the attention it deserves: the huge financial challenges facing private renters. Much focus is rightly placed on the Tory mortgage bombshell that is causing misery for millions of homeowners, but we should not forget that this crisis also affects renters, who are seeing increased mortgage costs passed down to them as a result, or landlords selling up and leaving them at the mercy of a market in which rents are soaring. It is the latest blow to renters, whose home lives are already characterised by insecurity and extortionate costs. For many of the approximately 11.6 million people privately renting in this country, the situation is becoming increasingly untenable. Average rents in the UK are almost 10% higher than they were in 2020, and rents on new tenancies recorded by Zoopla have increased by 22% since March 2021.

National statistics do not tell the whole story, as they mask staggering increases in certain areas. For example, average monthly rents for lets in my home borough of Trafford were £1,093 per month in January 2023—a 12% increase on the year before. Rent as a share of income is at its highest level in over a decade, at 28% of average earnings, rising to 40% in London. That is among the highest in the OECD, and around three times higher than in Germany and France. Evidence from Shelter shows that a third of private tenants are now spending over half of their monthly income on rent.

The steep increases are a result of local housing allowance rates being frozen since 2020. In the past year, the number of private rented homes that are affordable on LHA dropped by some 55%. When less than one in five private rents in England is viable for those on LHA, and virtually everyone accepts that there is not enough social housing, what do we expect low-income renters to do? Grim figures released by the Office for National Statistics last week revealed that one in seven renters have reported running out of food and being unable to afford more. According to Shelter, almost 2.4 million renters are behind on their rent or consistently struggle to pay it. It is clear that renters have been experiencing the cost of living crisis for some time and are reaching breaking point.

Let me illustrate the situation by sharing some stories from my constituency of Stretford and Urmston. A single mum recently contacted my office in desperate need of help. She has two children, one of whom is disabled, with multiple health issues that mean she is now awaiting the fourth surgery of her young life. My constituent told me:

“The cost of living crisis makes it impossible to stay where I am.”

The family, unable to afford their rent, are now homeless and living in temporary accommodation under a level of stress that I cannot begin to imagine.

Another mum from my constituency suffers from a tumour on her spine, as well as anxiety and depression. She is currently living with her baby in a third-floor flat with no lift. There is mould in the flat, which is making her baby and her ill. She is in arrears, as the flat is so mouldy that she has been spending £100 a week trying to heat it. She has recently been issued with a section 8 eviction notice by a landlord who will not even return her messages.

I thank both constituents for allowing me to share their stories today, but the sad reality is that their experience is not uncommon. I could provide dozens of examples from my constituency alone, and many hundreds more, as a result of the engagement work that the parliamentary engagement team did in advance of the debate. On behalf of my constituents, and every other renter living under this intolerable pressure, I ask the Minister why support is so slow to arrive. Why is the plight of renters so often ignored? What will the Government do to help? The Renters (Reform) Bill, first promised in 2019, yet introduced only in May 2023, is moving at a snail’s pace—still no Second Reading, two months on from First Reading. During that time, the House has risen early on 10 occasions, which tells us the simple truth that this is not an issue of parliamentary scheduling; it is an issue of priorities.

We are going into a summer where, according to Generation Rent, a section 21 eviction claim—something the Government promised to end—is being made once every 15 minutes. That means that 96 tenants a day will be forced to find new homes over the summer, in this incredibly difficult market. Inevitably, that means that renters will be forced into cheaper substandard parts of the market, where approximately 600,000 homes pose a serious risk to health, with issues such as damp and mould.

Some renters will fare even worse, and be made homeless, adding to the shameful record of this Government, under which the number of people living in temporary accommodation has increased by 97% since 2010. The Government are sitting on the sidelines as our housing market, from rents to mortgages, is in crisis. Because of that, the situation is set to get even worse, with rents now expected to rise by 6.5% by the end of 2023, and the number of homeless people potentially reaching 300,000.

As the chief executive of the charity, Crisis, has said, low-income renters are facing a “catastrophe”. The Labour party grasps the urgency of the situation. Our renters’ charter will deliver substantial new rights and protections for tenants, including longer notice periods and, finally, a ban on no-fault evictions. Ultimately, the cost of living crisis for private renters is, at its core, another symptom of our broken housing market. The increased demand for private rentals, driven by years of Government failure to invest in genuinely affordable social homes, is the major reason why rents are so high. The only solution to this, and to the wider housing crisis, is to build, build, build. That is not just my view. The Levelling Up, Housing and Communities Committee says in its report on the private rented sector:

“The affordability crisis in the private rented sector, the source of many of the other problems in the sector, can only be properly solved by a significant increase in house building, particularly affordable housing.”

My hon. Friend is making an excellent speech. Does he acknowledge that we have more houses now per head than we did in the 1950s? It is not just a crisis of the number of units but, as he has just said, it is the tenure of those units that is vitally important. If we do not get that mix right, the crisis will not be solved.

My hon. Friend is right and, like him, I look forward to a Labour Government ensuring that social rent is returned to the second highest form of tenure. We retain a significant shortage of homes overall. We are nowhere near where we should be, compared with the European average. He is correct, and I agree, that we are in desperate need of a significant increase in social homes, up and down this country.

Conservatives seem to have given up on building, as demonstrated by their capitulation on housing targets, which will leave house building at its lowest since the second world war. Only last week, we learned that, under this Government, we are in a situation where, despite the UK being short of approximately 4 million homes, the Department that is meant to build those homes is handing back £1.9 billion to the Treasury after failing to find housing projects to spend it on. I am pretty sure that, had the Minister sought advice or support from Members in this room and beyond, that money could have been well spent.

Thankfully, Labour has not given up on house building. Reforming planning rules, reintroducing house building targets, building on parts of the green belt that are in fact far from green, and, as I have just discussed with my hon. Friend the Member for Brighton, Kemptown (Lloyd Russell-Moyle), restoring social housing to the second largest form of tenure will be key drivers in our mission to achieve the fastest growth in the G7.

I congratulate the shadow Minister, my hon. Friend the Member for Greenwich and Woolwich (Matthew Pennycook), on all his work to raise this issue and to promote house building but, as he knows, I would go further still. Our 76-year-old planning system needs to be scrapped so that we can shift away from a discretionary system at the mercy of nimbyism towards one that is rules-based, underpinned by a flexible zoning code and determined nationally for local implementation. Only then will we be sure that we can build the number of homes, and the types and tenures of property, that we require.

Does my hon. Friend welcome the Labour party’s proposal to empower local councils to set up development bodies, which would not only be reactive in the planning policy debate, but would be proactive, in the sense that they could buy up land at the current land-value cost rather than inflated future costs, and develop it themselves or with partners?

My hon. Friend makes an important point. I welcome the Labour party’s commitment not only to end the hope value that exists in the sale of land at present but, as he says, to introduce the vehicles that empower local authorities to build. As a formal local authority leader, I know how challenging it is, particularly without a housing revenue account, to build those homes, and therefore to influence the place-shaping of communities. It is imperative that local authorities can do that to ensure that we get the homes that our local neighbourhoods require.

I congratulate the hon. Gentleman on securing this important debate. I am a London MP, representing a constituency in south-west London. On average, renters in London are spending almost 50% of their pre-tax income on rent, and the housing supply in the private rental sector has dropped dramatically. The impact is that our key workers—our nurses and teachers—cannot afford to live in the capital, and young families are being driven out, which is demonstrated in falling school rolls. However, London Councils says that local authorities could be building 143,000 new social homes; they are ready to do that, but they just need the funding. Does the hon. Gentleman agree that the Government need urgently to come forward with that cash so we can boost the supply of social housing in our capital?

I agree with the points made by the hon. Lady. I commend the work of the local authorities that are leading the way in building social and affordable homes in an incredibly difficult climate. It is not an easy thing to do with the way the grant regime is set up, but I know how fixated council leaders are on tackling the housing crisis, particularly in places such as London and my constituency in Greater Manchester, where prices are driving key workers and low-income workers out of the local area, which causes all sorts of issues with labour shortages and the provision of skills that we desperately need.

I support planning reform, but it will not be easy. Difficult choices must be made to end the gross inequities of our housing market. In the current system, we are set to spend more on housing benefit than on building affordable homes, and renting is no longer a step in the journey towards owning a home, but an expensive, insecure quagmire, dragging down a generation of younger people. The cost of living crisis is affecting us all, but especially private renters. They are generally, younger, poorer, more vulnerable people, trapped in the vicious circle of a broken rental market. It is no wonder that Sky News found last week that low-income private renters are suffering the most in the current financial climate, and the need for action to tackle this social catastrophe is now acute. Labour has shown that it gets this. I hope that when the Minister responds to the debate, she will show that she understands it too.

It is a pleasure to speak under your chairmanship, Dr Huq.

I had not intended to participate in this debate, but having listened to what the hon. Member for Stretford and Urmston (Andrew Western) said in introducing his debate, I wondered where the issue of supply comes into this equation. The crisis in the rented housing sector is largely one of a lack of supply. When I had the privilege of being a junior housing Minister in the 1980s, we transformed the supply of rented housing by introducing the Housing Act 1988, which freed up tenancies and introduced shorthold tenancies. It enabled those with surplus accommodation to let it out through agreements under which they realised that, if they wanted to recover possession, they could do so at a time of their choosing and by agreement with the tenants. As a result of the 1988 Act, the supply of private rented housing in this country soared, and the sector was completely transformed for the better.

Does the hon. Member recognise that 50% of former council houses that have been sold off are now just rented out, rather than providing stable homes? The reforms that he talks about have led to an increase in private rents above and beyond the inflation in the housing market, less home ownership, less stability in the housing market and more insecurity. They have partly caused the crisis that we are in now.

Obviously, I do not accept that analysis, and I certainly do not accept the hon. Gentleman’s proposition that, just because somebody lets out a property that used to be a council property, that somehow means it is a meaningless value to the person renting it. If a former council tenant buys a house and ultimately chooses to let it out, that property is available in the private rented sector. On supply, a lot of people in that sort of situation are now withdrawing their properties from the rental market, thereby reducing the supply and forcing up pressure on costs and rents.

Does the hon. Gentleman agree with the chief executive of the National Residential Landlords Association that it is a myth that landlords are leaving the market, that in fact the private rented sector is growing, despite further regulation, and that there is no evidence that the private rented sector is being vacated? Some people are leaving, but more people are joining.

I do not accept that, because I have looked in vain at the impact assessment that accompanies the Renters (Reform) Bill—I looked at the latest iteration a couple of weeks back—and the Regulatory Policy Committee condemned that impact assessment as totally inadequate in dealing with the consequences of the reforms for the supply of housing from the private rented sector. The Government’s own impact assessment does not answer the question as to the quantity and quality of private rented accommodation that would be available were those reforms to be implemented. One can only assume that the Government either do not know the answer to that question or do not wish to disclose it.

As somebody who believes in the market, my instinct is that, if we put pressure on potential suppliers of a product through regulation, the likely consequence is that the potential suppliers will withdraw some of that product from the marketplace. That is exactly what is happening at the moment. One of the figures used by the hon. Member for Stretford and Urmston in introducing the debate was the large increase in section 21 evictions. My understanding—admittedly, it is only anecdotal—is that that is because private landlords now feel that they are going to be squeezed by both a nominally Conservative Government and the prospect of a real socialist Government, both of whom are basically anti-private landlord and are determined to reduce the supply of rented accomodation available in the private sector.

The Renters (Reform) Bill has only been printed and had its First Reading—it has yet to receive a Second Reading, which is a complaint from the Opposition—but I hope the Government withdraw that legislation, because the mere fact that it has been printed in the form of a Bill is driving a large number of people away from renting out their private homes and causing them to bring property back under their control, with a view to selling it. A lot of the property that is available for sale at the moment is property that was formerly rented.

May I take the hon. Gentleman back to his analysis—I will be polite and say “analysis”—of section 21 evictions? If there is fear of a Labour Government, can he explain why so many Members of Parliament are having to move out of their London accommodation? Landlords are putting up prices by so much, and when an MP says to the landlord, “Let’s negotiate,” they are immediately served with a section 21 eviction notice. If landlords are doing that to Members of Parliament, surely they can do it to anybody else. That why the legislation needs to be scrapped.

Surely a landlord should have the right to decide whether they wish to rent out a property. If they decide that they cannot rent it at a price that they think is reasonable, they can withdraw it from the marketplace.

The hon. Gentleman raises an interesting point about Members of Parliament and the rented sector. When I was first a Member of the House, we had a system whereby the taxpayer subsidised the cost of Members of Parliament renting a second home. Then the rules were changed, because it was decided that it was very poor value for taxpayers to keep on paying rent for Members of Parliament. The rules were changed to allow Members of Parliament to take out a mortgage on their constituency home or second home, and the interest on that mortgage, rather than rent, was paid by the authorities in Parliament. That was because prices in the rental market could only increase, and it is why, traditionally in this country, most people choose to be owner-occupiers, rather than renters, if they can afford it.

The point was made earlier about the reduction in the number of people who own their home, particularly among the younger generation. It is really sad and a chronic problem. Between 1 million and 2 million more people would probably own their home if we had the same policies in place for home ownership as we had in the late 1980s. The advantages of home ownership include flexibility, and the fact that when someone retires, they will probably have paid off their mortgage and not have any ongoing housing payments. It also means that people can be mobile; if their job takes them to another part of the country, they can move. All the rigidities in the private rented sector were reduced, to an extent, by the 1988 legislation, but it seems that there is pressure, from both my Government and the Opposition, to reintroduce a lot of the controls. That would make it very difficult for somebody to move from one private rented home to another in another part of the country for a job.

The supply of private rented housing is key, and nothing suggested by the hon. Member for Stretford and Urmston would do anything other than reduce the supply of private rented accommodation.

The hon. Gentleman is arguing very strongly on behalf of landlords in the private rented sector, but the overwhelming evidence shows that the majority of tenants are on a low income. Their tenure is often insecure, and the properties are often low quality, with damp and mould. Did you consult tenants? Can you speak on behalf of the tenants who are suffering?

I shall try to address the hon. Lady’s remarks by saying that in my constituency, there is a lot of social rented accommodation, and to suggest that poor-quality accommodation with damp and mould is the exclusive purview of the private landlord is a complete travesty of the facts. In much of the social rented sector, the stock is very poor quality, insulation standards are very low, repair standards leave much to be desired, and rents are increasing. This year, the Government have allowed social rents to go up by 7%. The point was made just now that there may be a 6.5% increase in private sector rents by the end of 2023.

There is a problem right across the rental market—it is not confined to private landlords—but one thing is absolutely certain: if we restrict the supply of private rented accommodation, rents will go up, and the Government’s response will be to control the rents, which will produce an even worse result. Landlords will not even have the resources to maintain their properties in good repair. Those of us who were privileged to be around in the late 1970s and to see the state of the accommodation across much of our urban areas, particularly London, know that that resulted from years and years of neglect by the public sector, and of penalising the private sector and driving it out of business. My concern is that we should not get back into that scenario. I hope that when my hon. Friend the Minister winds up the debate, she will confirm that the Government will not go ahead with the renters’ reform legislation, because that will have the perverse consequence of reducing supply and increasing rent.

My final point is about population. The population of this country is expanding exponentially and unsustainably. Since 1990, which is also the base date for measuring CO2 omissions, the population of this country has gone up by between 10 million and 11 million, or about 20%. Last year and the year before, net migration was more than 600,000. The number of people who wish to live in this country is increasing far faster than our ability to provide rental accommodation for them.

Order. I am told by the Clerk that we are straying from the terms of the debate. There are others who want to get in.

I have given way a lot, and hope that I have been able to give some more balance to the debate. My hon. Friend the Minister should not forget the undoubted success of the 1988 reforms, and should remember that she is a Minister in a Conservative Government.

As ever, it is an honour to serve with you in the Chair, Dr Huq, and an honour to take part in this debate, brought forward by my hon. Friend the Member for Stretford and Urmston (Andrew Western). It is really important and timely, because the cost of living crisis rages on. Inflation is at its highest for 41 years, and thousands of our constituents up and down the country are falling into poverty. I have no doubt but that since the emergence of the crisis, every colleague in this Chamber will have heard, in their advice surgery, harrowing stories—perhaps more of them than ever before—of suffering and difficulty. Indeed, when I hosted a dedicated cost of living support event in Rhydyfelin just a few weeks ago, I heard story after story from terrified residents who felt that they just could not make ends meet any more. They told me that it felt as though the walls were closing in. That is the reality of Tory Britain today.

It is the same story across the country. One in seven people in the UK goes hungry because they cannot afford to eat. According to recent research from the Trussell Trust, an estimated 11.3 million people have faced hunger in the past year. That is double Scotland’s population. This Tory Government have presided over the largest slide in living standards in a generation, in the sixth-largest economy in the world. That is a shameful indictment of the Government’s record. As colleagues will no doubt be aware, a staggering fifth of our population lives in poverty—13.4 million people. The Prime Minister has hedged his bets on delivering on those laughable five priorities, but so far he has failed to get a grip on inflation, or do anything of substance to help the thousands of families and households who are suffering.

We have nothing but inaction from this zombie Tory Government, who are asleep at the wheel while our constituents face the impossible decision of whether to pay the rent or feed themselves. In recent months, we have heard much about the impact of the Tory mortgage penalty on homeowners, and the mortage market has capsized, thanks to the Tories’ incompetence, but it is absolutely right that today’s debate should highlight the incredibly difficult conditions that our constituents in the private rental sector face. Thousands of people are already struggling with rent arrears from the pandemic, but now, on average, renters are having to spend a third of their income—or, more often than not, half—on rent. We desperately need reform in the private rental sector. One of the most urgent changes for which Labour and housing campaigners have been calling for years is reform of the cruel practice of no-fault evictions. Tenants already suffering under impossible conditions thanks to inflation and the cost of living crisis frequently face eviction by their landlord, just for reporting disrepair or mould.

Colleagues will be aware that the Tory Government promised to ban no-fault evictions in England way back in 2019, three whole Prime Ministers ago. The disgraced former Prime Minister Boris Johnson also promised to ban them, but we are all familiar with his reputation for breaking promises. Of course, the disastrous short-lived tenure of the right hon. Member for South West Norfolk (Elizabeth Truss) as Prime Minister hardly left her time to act on no-fault evictions. It is shameful that it has taken the Tory Government four years to act on their manifesto commitment to introduce a Bill banning the vile practice.

The Renters (Reform) Bill looks set to be delayed once again. As we have heard, First Reading took place in May, but colleagues will not be able to debate the Bill until September at the earliest. With every day of delay that passes, the Government are letting down thousands of renters in desperate circumstances. This is more dither and delay from a hapless Tory Government who seem to have given up the ghost. There is zero progress on debating the Bill, let alone passing it into law.

A staggering 65,000 households have faced homelessness through no-fault evictions since the Government first pledged to act, but I am pleased to say that the Welsh Labour Government are leading the way. The Renting Homes (Wales) Act 2016 is the biggest change to housing law in Wales for decades. The Welsh Government have taken the bold step of extending the notice of eviction that landlords must serve to their tenants to six months. That is a vital period of respite. The measure will go a long way towards reassuring renters in difficult situations. England is the only nation in the UK without a mandatory landlord register; the devolved nations, including the Welsh Labour Government, have had such a register for years. That is yet more evidence that this Tory Government are just not interested in helping vulnerable tenants in the private rental sector.

Before I finish, I would like to give one anecdote. We all have hundreds from our constituency surgeries, but the one that hit me hardest was from a resident of Tonyrefail. She has rented her house for 14 years, and is the single mum of a young daughter. Recently, she got in touch with me because she is being evicted by her landlord of 14 years. The landlord is putting up her rent from £425 to £650 per calendar month—a 50% increase in the rent. How is that reasonable? Where is the compassion? Where is she meant to find that extra money every month?

We urgently need action to help those in private tenancies who are already exhausted from the cost of living crisis, but with zero leadership from the Tory Government, it is clear that only a general election, and a Labour Government, will deliver the change that we desperately need. I urge the Minister to bring forward legislation as soon as is possible. We desperately need it on the statute book. Renters can no longer wait.

It is a pleasure to serve under your chairship, Dr Huq. I congratulate my hon. Friend the Member for Stretford and Urmston (Andrew Western) on securing this vital debate. We are living through a housing crisis in the United Kingdom, and there is a desperate lack of affordable, accessible, suitable and settled accommodation for millions of people across the United Kingdom. At the same time, we are suffering the greatest cost of living crisis in living memory, with rising rents, extortionate energy costs, food bills rising, below-inflation pay rises and inadequate social security benefits. This is a perfect storm, and nowhere more so than in the private rented sector, as others have commented.

Data from last week shows that private renters are five times more likely to struggle financially than homeowners. The private rented sector is now bigger than the social rented sector, and the demography of the people using the private rented sector has changed quite significantly. They tend to be older people, families and those on low incomes. Private renting tends to be insecure, and the accommodation tends to be in poor condition. If Government Members cared to look at research by Shelter, Crisis and many others—the Chartered Institute of Housing has written a lot about this—they would see that hundreds of thousands of people have been forced to accept properties that are either unsuitable or in poor condition. They are living in damp, mouldy and overcrowded accommodation, because that is all that they can afford. That is a major issue in the private rented sector.

The increasing competition for private rented properties means that there are increases in rents. Private rent prices increased by about 5% last year. Low pay is the cause of housing issues for millions of people, but many of those on low incomes are unable to afford private rent because of the complete inadequacy of the local housing allowance, which has been frozen since 2020. More than half of those receiving LHA have a shortfall. In Wales, during the first two weeks of February, just 1.2% of properties advertised on the formal rental market were available at or below LHA rates. That is absolutely shocking. That is putting unbearable pressure on families. There was an almost 70% increase in repossessions across the UK between January and March last year. Local authorities are doing what they can to help, through the discretionary housing payment scheme, but that is insufficient to meet the shortfall. Wales spent 155% of its discretionary housing payment allocation on support for housing costs. That is much more than any region in England.

The evidence is clear: the Government must restore local housing allowance rates and re-link them to rents, so that they cover at least the cheapest 30% of local rents. As others have commented, we have been inundated by constituents with an array of housing problems, including problems with affordability in the private rented sector. One lady has taken on a kinship caring responsibility, but she is being penalised by the system. She was unable to afford rent; she had assistance via the discretionary housing payment, but it was insufficient, and she is now in arrears with her utilities. That is not acceptable in the fifth-richest nation in the world. The quickest and most effective way to keep people in their home is for the Government urgently to invest in local housing allowance, so that it covers the true cost of rents.

The Renters (Reform) Bill does not address cost issues, so, as my hon. Friend the Member for Pontypridd (Alex Davies-Jones) mentioned, the Welsh Government are leading the way. They have just opened a consultation on fair rents and affordability. They are seeking evidence on defining “local income” and “fair rent”, as well as setting out proposals for fair rent and affordability. ACORN in Wales commented that rent controls are “the bare minimum response”, but it is pleased to see the Welsh Government considering rent controls. Rent controls must be considered. I completely agree with the comments of the Bevan Foundation: it endorses rent controls, but says that we must also increase the provision of social housing, reform the social security system, and take action to improve security of tenure.

To conclude, if we are to address the UK’s horrendous housing crisis, we need a holistic approach that also looks outside housing. We need to challenge the capitalist neoliberal system, which allows the few to benefit at the expense of the many. Housing is more than bricks and mortar; it is a home. We need to look at housing in a different way. Diolch yn fawr.

It is a pleasure to serve under your chairship, Dr Huq, and to follow my hon. Friend the Member for Cynon Valley (Beth Winter). I congratulate my hon. Friend the Member for Stretford and Urmston (Andrew Western) on securing this important debate.

The cost of living crisis has hit people across the country hard. The price of food, fuel and household bills have soared at the same time as wages have fallen in real terms, and 13 years of consecutive Conservative Governments has seen family budgets squeezed at the longest and deepest levels since records began in the 1950s. One of the biggest household expenditures, of course, is a place to live, whether that is a rented or mortgaged property, and that means monthly rent or payments. Almost one in five households in England live in the private rented sector, and that number is rising as the cost of home ownership rises, too.

As we have heard today, people who live in the private rented sector face a number of challenges. The charity Crisis found that private rents rose by an average of 11% across the country in 2022, but household allowances and people’s wages have not kept pace with the rise. Between January and March 2023, landlord repossessions increased by 69%. More people are struggling to support themselves and their families, and, of course, if they live in the private rented sector, they often live in fear that they will be evicted through a no-fault eviction notice. As we have heard, this Government promised to abolish no-fault evictions in their 2019 manifesto, but they have not done so to date.

Privately renting in this country is far too insecure. Renters not only face the prospect of no-fault eviction, but can have their rent raised considerably at short notice. Landlords are piling the rising costs on to tenants, or in some cases simply putting prices up to the highest level they can get away with. One distressed constituent contacted me after they, along with their partner and four-year-old, were forced to move back in with their parents because their private rented property was repossessed. Their sibling and nephew are also living with their parents—all sharing one bathroom and toilet. Family members are suffering health issues because of the stress of the situation, and relationships are fraying.

Having somewhere to live should not be a luxury. A number of people living in private rented properties in Barnsley have contacted me about the quality of their housing. They have described having to put up with conditions that make it unfit to live in: plaster falling off the walls, areas of rising damp, windows that will not shut and unresolved structural issues. That needs to change. A Labour Government would pay the private sector the urgent attention it needs by introducing the private renters’ charter, which would ban no-fault evictions, lengthen repossession notices and introduce a code of practice for letting agents.

Too many people are being forced to make difficult choices just to keep a roof over their head, and the poorest in society are suffering the most from the cost of living crisis. I have spoken today about those living in the private rented sector, but of course people across Barnsley, whether they rent or own, are struggling. The Tory mortgage bombshell has cost mortgage owners £1,500 extra a year, and in Barnsley that is in the context of poverty rates that are higher than the national average. Over 40,000 residents in the borough are in fuel poverty, 11 children in every class of 30 are living in poverty and workers are on average £100 a month worse off than in previous years.

I have spoken to many constituents at the various cost of living advice surgeries that I have hosted across Barnsley East, and they have told me about the real impact of the cost of living crisis on their health and wellbeing. As we saw from the ONS report a few weeks ago, levels of anxiety and depression are at their highest in over 15 years, and life expectancy in areas such as Barnsley is significantly lower than the national average. The cost of living crisis has a real impact not just on people’s day-to-day existence but on their future. I hope that the Government are listening to the debate, and I look forward to hearing from the Minister.

It is a pleasure to serve under your chairmanship, Dr Huq. I thank my hon. Friend the Member for Stretford and Urmston (Andrew Western) for securing this incredibly important debate.

The cost of living is one of the most difficult challenges facing people across the UK. It comes up on the doorstep and in my constituency surgeries in Erdington, Kingstanding and Castle Vale time after time. My constituents, just like many people across the UK, are really struggling to manage the rising costs of energy and food. A constituent told me that they cannot even pay their bills, let alone start paying off their debts. This is all while residents have been hit by the Tory mortgage bombshell—either as homeowners or as renters absorbing costs through higher rents. One of my constituents said:

“Our rent was increased twice within the space of a few months”.

That feeling of helplessness is sadly not unique to communities such as mine. Shelter estimated that on a single night in 2022, there were more than 20,000 homeless people across the west midlands and more than 14,000 in Birmingham. That is equivalent to one in 80 people in the region. We know that the cost of living crisis is pushing more people than ever out of secure housing, with no-fault evictions increasing by 116% this year.

One of my constituents was issued with a section 21 notice. She lives with her son and is a foster carer for her three grandchildren. She has been renting her home for the last six years, but her landlord has decided to sell the property and now she does not even know where they will be living this time next month.

I am sorry to interrupt the flow of the hon. Lady’s speech, but she gave startling statistics on homelessness in the west midlands. I wonder whether she is aware that in London, where the homelessness crisis is probably at its most acute, a shocking one in 23 children is homeless. That is, on average, one in every classroom. In constituencies such as mine—Twickenham, in the London Borough of Richmond—very little emergency accommodation is available to the council. Families who come to my surgery are having to come in from as far afield as Croydon, Slough and the upper reaches of north London to get to school. That is particularly difficult if their child is on an education, health and care plan. Does the hon. Lady agree with me that as well as urgently building more social housing, a short-term fix for some of these problems is to increase the local housing allowance urgently?

I thank the hon. Lady for that question. I absolutely agree with her that the allowance needs to be increased. The situation is just going from bad to worse. At the moment, to say that we must tighten our belt, as the Prime Minister has said, is just not good enough. Sometimes we have to spend so that we can ensure that our citizens are being taken care of.

There are real, human implications from the Conservatives’ failure to end no-fault evictions. Since they promised to do so three years ago, more than 50,000 households—like my constituent’s—have been threatened with homelessness under section 21. Where people can find housing, it is not always suitable or even safe.

In Erdington, we have real problems with houses in multiple occupation and exempt accommodation. In April 2023, the ward of Stockland Green in my constituency was assessed as having 271 HMOs. That places the ward sixth highest in Birmingham, with an increase of 39 properties this year; it is reducing family homes in that area. I hear regularly from constituents living in so-called supported housing complaints about anything and everything from bedbugs and disrepair to serious concerns about fire safety, fly-tipping and antisocial behaviour.

In the last month alone, two new planning applications have been made for HMOs in my constituency. One is to turn a three-bedroom property into a seven-bed HMO, and one is to turn a former pub into a 10-bed HMO. I led a campaign calling on local people to object, and our petition collected the support of 398 concerned residents in a week. That is an issue that my constituents and I feel strongly about, and it is not going away. The only way to fix the housing crisis is to build far more social housing. Under the Conservatives, the number of new social rented homes has fallen by over 80%. Labour will build more social homes, ban no-fault evictions and prioritise boosting our economy so we can fix the broken housing market. The bottom line is that everyone deserves a secure and safe home, but sadly right now my constituents and people across the UK cannot have one because they are paying the price of a Tory Government. It is time for change.

It is a pleasure to serve under your chairship, Dr Huq. I congratulate my hon. Friend the Member for Stretford and Urmston (Andrew Western) for bringing forward this extremely important debate. The UK is a country shamed by the poverty of its people and especially of its children. The Government’s failure to act to curb the corporate profiteering that is driving inflation is just one of many ways in which the Government are fanning the flames of the cost of living emergency. In this country, 14.5 million people live in poverty and 4.3 million of them are children. In the last full calendar year, real-terms wages fell by 3.1% while, according to the latest ONS figures, private rents rose by 5% in the year to May.

Figures from Generation Rent tell us that private rents have increased by 22% since March 2021 and have been pushed up further in response to even higher interest rates and as landlords take advantage of the crisis to improve profits. As a result, private renters in England pay up to 40% of their median household income on rent. Rent as a share of income is at its highest level in over a decade. While the Scottish Government took action last year to at least temporarily cap rent increases at 0% through the Cost of Living (Tenant Protection) (Scotland) Act 2022, the Westminster Government have allowed rents to be driven by the market and by greed, with little thought for the additional burden it places on the backs of those already going under.

The Government’s Renters (Reform) Bill, which was introduced in May almost a year after the planned reforms were announced, has seen its Second Reading delayed until at least the autumn, with no date yet announced despite the imminent recess. Meanwhile, more than 4 million households that rent privately—a number that has doubled in the two decades of failure to build council and social housing—continue to face unsecure tenancies, arbitrary and back-door section 21 no-fault evictions and often appalling living conditions. In the middle of a cost of living crisis, they are also paying over £570 a year more than they need to in energy costs, according to E3G, because of landlords’ refusal to upgrade heating systems and insulation. As a result, fuel poverty charity National Energy Action has noted that private renters are more likely to be fuel poor than people in all other types of tenure and more likely to live in the leakiest properties, often needing to spend thousands of pounds more than the average household just to keep a healthy temperature at home.

We have seen, in the case of the odious Illegal Migration Bill, just how quickly this Government can force legislation through Parliament when they have a mind to do so. Against the backdrop of a perfect storm of misery for millions living in privately rented accommodation, the Government must—yes, must—urgently publish an accelerated timetable for the Renters (Reform) Bill and combat the affordability crisis in private renting, which is absent from the proposed measures, but will at least go some way toward reducing the injustice and inequality of private rent.

I am delighted to see you in the Chair, Dr Huq. I congratulate the hon. Member for Stretford and Urmston (Andrew Western) on leading the debate. I always like and enjoy listening to his contributions. He follows a fantastic former Member of Parliament, Kate Green, who represented his constituency very well. He used his local authority experience, which is very important when discussing such issues.

The related issues of the cost of living and the private rented sector should be of great concern to members of all political parties as they affect the wellbeing of people in each of the nations of these islands. Much of what we are discussing today is centred on the experiences of people in England and Wales, so I will contribute a Scottish perspective. There have been some criticisms, from some sources, of the SNP-led Scottish Government and how they have handled the private rented sector. What Members will hear from me are the views of other interested organisations that contradict those misgivings and are supportive of the stance the Government have taken in Scotland.

We are familiar with the factors that have contributed to the current cost of living crisis, although some might question how much those factors have contributed, or even whether they have contributed at all—for example, Brexit—but no one will dispute that the war in Ukraine has driven up the price of oil, with a consequent massive increase in domestic energy costs. Russia’s de facto blockade of the Black sea has also resulted in Ukraine’s exports dropping to one sixth of the pre-war level, causing grain prices to rise dramatically. We have all seen the effects on the price levels on supermarket shelves. Covid has also played an obvious part in taking us to where we are.

We know that the biggest factors in determining the cost of living are wage rates and housing costs. The limits of devolution mean that the Scottish Government have no real say in private sector incomes, but for many in the public sector—nurses, midwives, teachers, junior doctors—pay awards have been sufficient to avoid protracted industrial and strike action. It is not as much as we would wish to pay, but better than elsewhere and certainly appreciated, which brings us to the major factor in the cost of living crisis: rent prices.

Different legislatures in the UK have taken different approaches to dealing with rent prices. In Scotland there were recent changes to the Cost of Living (Tenant Protection) (Scotland) Act 2022, which took effect from 1 April. With the exception of some defined limited circumstances, those changes have included a cap on most private landlords’ mid-tenancy rent increases at 3%. The enforcement of evictions continues to be paused across all sectors for up to six months and increased damages for unlawful evictions of up to 36 months of rent will continue to apply. Those measures will be in force until 30 September, provided they remain necessary, but there is also the option to extend for another six-month period if required. As previously announced, a social sector rent freeze has been replaced with agreements from landlords to keep any rent increase for 2023-24 well below inflation. That voluntary approach to rent setting agreed with the social sector will equate to an approximate average rental increase of £5 per week. That is still a strain for many, but more manageable than is the case elsewhere.

The legislative approach has had its detractors who suggest that SNP policies have harmed or unfairly targeted the private rented sector. There is, however, no credible evidence for that, leaving the detractors’ motives open to question. For example, concerns are expressed by some private landlord representatives about the different approach between social and private landlords. The Scottish Government contend that a collective approach like that in the social sector is simply not possible in the private rented sector. As a consequence of the policy, the 3% increase in the average rent of a two-bedroom private rented property, which is the most common size, is broadly comparable in monetary value with the average planned increase in the social sector.

The Scottish Government continue to monitor the data and to listen to landlords and tenants, in order to consider whether the measures that are in place remain proportionate and necessary. The recent legislation is time-limited and can only be extended with the approval of the Scottish Parliament, and in any event it cannot extend beyond March 2024 at the latest.

Some have suggested that investors will exit when certain rent-controlled regimes are introduced, and some political parties claim that this has already happened. But, again, there is no evidence to support those claims or suggestions. On the contrary, the chief executive of the Scottish Association of Landlords has stated publicly that

“We do need to have rent control in Scotland. I think that’s where we’re going to be going.”

Let me add a few other views about Scotland and its recent decisions. Crisis Scotland told Parliament:

“We all know that the cost of living crisis is an emergency at the moment, and for those in poverty that’s an emergency as acute as the pandemic. And it calls for emergency measures that at other times wouldn’t be considered. We absolutely support the need to do something to support tenants through that crisis.”

Living Rent said that a rent freeze would have a

“massive impact, as skyrocketing rents continue to pile on top of out of control energy bills.”

Shelter Scotland stated that short-term emergency measures in the Programme for Government

“are great news for tenants and will stop people from losing their homes.”

The Scottish Trades Union Congress said that

“the Scottish Government is to be commended for freezing rents…when used, the powers of our Parliament can bring positive change.”

It is on the use of the powers of the Scottish Parliament that I will now dwell, because Scotland has delivered 10.8 social rented homes per 10,000 population compared with just 1.2 per 10,000 population in England—nine times as many. Spend on affordable housing in Scotland remains the highest in the UK. Since the Scottish National party came into office in 2007, that has produced 14 homes per 10,000 population compared with 9.7 per 10,000 population in England. The Scottish Government’s per capita spending on affordable housing is more than three times higher than that of the UK Government. And in their published 2022-23 Programme for Government, the Scottish Government pledged to deliver 110,000 homes ahead of 2032, of which at least 70% will be available for social rent and 10% will be in our remote rural and island communities.

The Scottish Government have also committed a five-year investment of £3.5 billion to Scotland’s internationally recognised Affordable Housing Supply Programme, which this year’s £752 million affordable housing budget feeds into, despite a 3.4% real-terms cut in capital funding from the UK Government.

The first-time buyer relief, which raises the nil rate band to £175,000, means that the majority of Scotland’s first-time buyers pay no land and building transaction tax, which replaced stamp duty, and all other buyers benefit from a tax reduction of £600.

All that activity can be compared with the work of the Department for Levelling Up, Housing and Communities, which recently handed back £2 billion in funding, including £1.2 billion that was unused from the Help to Buy scheme.

I ask everyone here to ponder on the past achievements and future plans for Scottish housing, and consider whether some of them might also be applicable in some other parts of the UK. There have been several well-documented attempts in recent times to dilute the dissolution settlement and reduce the decision-making powers of the Scottish Government.

The hon. Gentleman is making a very powerful contribution to the debate and the comments with regard to Wales and Scotland show the progressive, more radical policies there. Does he agree that if the devolved nations received fair, needs-based funding settlements from the UK Government, we could go much with those radical socialist policies?

I absolutely agree with the hon. Member.

In closing, on the cost of living in the private rented sector, the UK Government might do well to follow the policy lead of Scotland and Wales, and I urge the Minister to respond positively to the suggestions that have been made today.

As ever, Dr Huq, it is a pleasure to serve with you in the Chair.

I start by congratulating my hon. Friend the Member for Stretford and Urmston (Andrew Western) on securing this incredibly important debate and on his powerful opening remarks. He has served in this place only for a relatively short time, but he has already made a considerable impact. His commitment to advocating for all those at the sharp end of the acute housing crisis has helped and will continue to help to ensure that it remains a prominent consideration for the House.

I also thank all those other hon. Members who have participated in this afternoon’s debate. I particularly commend the compelling contributions of my hon. Friends the Members for Barnsley East (Stephanie Peacock), for Pontypridd (Alex Davies-Jones), for Birmingham, Erdington (Mrs Hamilton), and for Cynon Valley (Beth Winter)—I hope that I pronounced that last constituency correctly.

I also want to take the opportunity at the outset to express the Opposition’s thanks to all those organisations that have done so much to keep the issue of renters’ reform on the political agenda, particularly the 20 organisations that form the Renters’ Reform Coalition.

The cost of living crisis remains the most pressing issue facing households across the country. Against the backdrop of static inflation and rising core inflation, prices in some areas are easing, but remain high by historical standards. Pay is now rising, despite a cooling labour market, but continues to fall in real terms. Direct cost of living support for households is being scaled back, and the Government have overseen one of the biggest tax rises in a generation. As a result, families are continuing to feel the squeeze, and many are cutting back on essentials, withdrawing savings and racking up debts.

All the evidence suggests that private renters are particularly hard hit. Data released by the Office for National Statistics only on Friday, made clear that renters are nearly five times as likely to be financially vulnerable compared with mortgage holders or outright homeowners. According to that analysis, as many as four in 10 renters are finding it difficult to pay their rent. Renters are more likely than mortgage holders to cut spending on groceries and other essentials, to run out of food, and to be behind on energy payments.

The pressure on private renters reflects, at least in part, the sharp increase in rents over the recent period, owing to the mortgage crisis this Conservative Government presided over, as well as the general shortage of lettings, an issue rightly highlighted by my hon. Friend the Member for Stretford and Urmston in his comments relating to overall supply. According to the ONS, private property rental prices across the country rose 5% in the 12 months to May 2023, the biggest increase since the national data series began in 2016, with rent rises most acute in London.

We have heard several statistics in the debate, and other analysis suggests that the situation could be even more dire, with property website Rightmove suggesting that rents have risen nationwide by 9.4% in the past year, and by an eye-watering 14% in Greater London. The combination of all those pressures means that the situation for many renters is nothing short of dire. According to Shelter, almost 2.5 million are either behind or constantly struggling to pay their rent, an increase of 45% since April 2022. An analysis produced by the debt advice charity, StepChange, suggests that private renters are twice as likely as the general population to be in problem debt.

With renters across the country at breaking point, and many falling into arrears and at risk of eviction, they urgently need the long-term security and better rights and conditions they have been promised by this Government. After so many years of waiting, the Government finally published the Renters (Reform) Bill on 17 May. Yet, two months on, the Bill has not had its Second Reading and will not have it before the summer recess. That means, as my hon. Friend the Member for Pontypridd mentioned, we will not get a chance to consider it before September.

The Government’s justification for the delay, as suggested by the Secretary of State at departmental questions last week, is that a “fit-for-purpose impact assessment” was required to be available before progressing the legislation. No one disputes the need for a fit-for-purpose impact assessment to accompany the Bill, as we subject it to detailed scrutiny. We welcome the fact that the regulatory policy committee declared it green rated as of 3 July. However, it is frankly laughable for a Government that published the impact assessment for the Levelling-up and Regeneration Bill the day before Third Reading to suggest the absence of a fit-for-purpose one is the sole reason that Second Reading of the Renters (Reform) Bill was delayed.

Whatever the reason for the delay, with a green-rated impact assessment now available, there is no reason whatsoever that we cannot begin to progress this long overdue and desperately needed piece of legislation. Will the Minister confirm to the House, and all those renters following our proceedings today, that the Renters (Reform) Bill will finally have Second Reading in the weeks immediately following the House’s return after the summer recess? Can she also reaffirm the commitment she made in response to a question from journalist Vicky Spratt at the Renters’ Reform rally on 21 March, to the effect that the Government will ensure that the abolition of section 21, and presumably therefore the passage of the Bill in its entirety, will be completed this autumn?

As the Minister will know, the Opposition were supportive of the proposals published in the “A fairer private rented sector” White Paper last year, on the basis that they provide a solid foundation for overhauling the private rental market, and we welcome much of what is in the Bill. However, we do have some concerns. We were troubled, for example, that the proposed legally binding decent homes standard for the private rented sector, and the ban on landlords refusing to rent to those in receipt of benefits or with children, commonly known as “no DSS” practices, are not in the Bill.

The explanatory notes accompanying the Bill state:

“The Government is carefully considering how to implement these policies and intends to bring forward legislation at the earliest opportunity within this Parliament.”

The Minister confirmed to the Levelling Up, Housing and Communities Committee last Monday that separate legislation was not required, but that the Government intended to introduce both measures, along with stronger enforcement powers for councils, through the Renters (Reform) Bill. Can she confirm today that that is indeed the case? Will she provide the House with an assurance that the changes will be considered and scrutinised in Committee, rather than tabled as detailed amendments just prior to Report, thereby allowing for only limited scrutiny, as her Department has done with other pieces of recent legislation?

Lastly, the Minister will know that the Opposition regret the fact that important elements of the White Paper are missing from the Bill as published, including powers to limit the amount of advance rent that landlords can ask for and measures to expand rent repayment orders to cover repayment for non-decent homes. Can she tell us whether the Government are open in principle to amending the Bill to include those measures and to address its other well-known and well-understood deficiencies and loopholes, not least the inadequate means of redress provided for challenging extortionate within-tenancy rent hikes, or is it the Government’s intention to resist such attempts to strengthen this important piece of legislation?

Private renters have waited long enough to secure a fair deal. The case for transforming how the rental sector is regulated, and for finally levelling the playing field between tenant and landlord, is indisputable. The case for reform existed before the cost of living crisis, which has now made it an urgent imperative. The Government must act, and must act boldly. I look forward to listening carefully to the Minister’s response.

It is a great pleasure to serve under your chairmanship, Dr Huq, and to respond to the debate on behalf of the Government. As is traditional, I thank the hon. Member for Stretford and Urmston (Andrew Western) for securing the debate on this important issue, which matters to all of us, including those of us who serve in the Government. He spoke passionately on behalf of his constituents, as did the other Members who have spoken, and I will come on to their contributions before I conclude my remarks.

The hon. Gentleman’s concerns reflect my determination to make sure that the Government deliver a strong, functioning private rented sector. As has been reflected during the course of the debate, private rented accommodation is the second largest housing sector in England, providing homes for 4.6 million households and an estimated 11 million tenants. It plays a vital role in supporting people to study away from home, explore new locations or move to find work, which is why we are ensuring that tenants have the security they need and enjoy a positive experience of renting a home.

As has been alluded to, the Government recently introduced the Renters (Reform) Bill to Parliament. The Bill will help change the landscape of the private rented sector. It is the most significant reform to the private rented sector for a generation, and it will deliver on the Government’s commitment to a better deal for renters. The Bill will make a fairer, more secure and higher quality private rented sector, fit for the 21st century. It will end section 21 “no fault” evictions and move to periodic tenancies, allowing landlords and tenants to end tenancies when they need to. This means that tenants can rent decent, secure homes and put down roots in their communities, while being empowered to challenge poor practice without worrying about retaliatory eviction, or they can leave if the landlord fails to meet their basic responsibilities.

However, we know that the overwhelming majority of landlords provide a good service, and we recognise that good landlords play a vital role in providing decent homes for millions of people across the country. That is why we will introduce comprehensive, fair and efficient grounds to ensure that landlords have confidence that they can regain possession of their property when it is reasonable to do so. We also want to simplify the system for both tenants and landlords, which is why all rent increases will take place via one mechanism. We will allow rent increases once per year in periodic tenancies and increase the notice that landlords must give to two months, giving tenants more time to plan and to seek advice. That will create a fairer system that allows both parties to negotiate rents effectively, while protecting security of tenure. I want to be clear: this Government do not support rent controls. Some Members asked me to set out our position on that. We recognise, however, that most people want to buy their own home one day. We are therefore firmly committed to helping generation rent to become generation buy.

We are working towards delivering on our commitment of 300,000 homes a year. Despite all the doom and gloom that may be reported, we are making strong progress. There is always more to do, but it is important to recognise that annual housing supply is up 10% compared with the previous year, with more than 232,000 net additional homes delivered in 2021-22. That is the third highest yearly rate for the past 30 years. We have also announced £10 billion of investment in housing supply since the start of the Parliament, and the Government are on track to deliver thousands of affordable homes to rent and buy across the country through our £11.5 billion affordable homes programme. A large number of those are for social rent.

I want to address the—if I may put it this way—nonsense stated by a couple of contributors to this debate, who said that money has been handed back to the Treasury. That is simply not the case. The money referred to was re-profiled, which is a normal part of Government accounting —[Interruption.] Opposition Members might want to listen and find out how Government funding and finance work. That money will be recycled and refocused into the 2016 to 2023 affordable homes programme. I hope that we will hear no more of that kind of comment.

A healthy housing market thrives on having a range of tenures. That is why we have launched the £1.5 billion levelling-up home building fund, which provides loans and takes out equity in house builders that would otherwise struggle to access finance. The Government have made a range of interventions to support the sector over the past decade. The construction of new Build to Rent homes will play an important part in helping to ease demand pressures in the private rented sector and is already providing thousands of much-needed new quality homes.

We know that right now meeting immediate housing costs is a huge struggle for some people, and that a higher proportion of income is being spent on rent by those on lower incomes in particular. In April 2020, therefore, we raised local housing allowance rates—a significant investment of almost £1 billion—and that increase has been maintained since then. Where tenants are unable to meet their housing costs and need further support, discretionary housing payments are available from local councils. Since 2011, the Government have provided almost £1.6 billion in discretionary housing payment funding to local authorities. For those who need additional support, the Government are providing another £1 billion of funding—including any Barnett impact, as colleagues from the devolved nations have spoken today—to extend the household support fund in England into the next financial year, bringing total funding to £2.5 billion.

I will not give way, if the hon. Lady does not mind, because I have a lot to get on the record.

Cost of living pressures go beyond housing costs, and that is why we have taken decisive action to support households, totalling £94 billion or £3,300 per household on average, across 2022-23 and 2023-24. We uprated benefits and state pension by 10.1% in April. For 2023-24, the Government are providing additional means-tested cost of living payments of up to £900. We also provided significant support for households with their energy bills, covering about half of a typical household energy bill this past winter. I utterly reject comments to suggest that the Government are not interested in helping people on low incomes. I have set out how we are doing just that with billions of pounds of taxpayers’ money.

I will touch on the Members who have spoken. I thank the hon. Members for Pontypridd (Alex Davies-Jones), for Cynon Valley (Beth Winter), for Barnsley East (Stephanie Peacock), for Birmingham, Erdington (Mrs Hamilton) and for Leicester East (Claudia Webbe), the Front Benchers of the SNP and the official Opposition, the hon. Members for Glasgow South West (Chris Stephens) and for Greenwich and Woolwich (Matthew Pennycook), and my hon. Friend the Member for Christchurch (Sir Christopher Chope).

I am about to refer to my hon. Friend’s comments, if he will allow me, so he can come back to me after that. He asked about the RPC and the impact assessment. I agree with him that this is about supply, and I assure him that the number of PRS properties increased by 11,000 in 2022 compared with the previous year. The data from UK Finance shows that the number of buy-to-let landlords reached a record high at the end of last year. There is no evidence that private rented landlords are leaving the market. Our Bill is fair to decent landlords, and the RPC has estimated the net cost to landlords to be just £10 per property. The committee has given the Bill a green rating, and I do not think £10 per property is a significant sum that is going to force landlords to leave the market.

I want to ask the Minister about her aspiration to move from generation rent to generation buy. When does she expect the Government to deliver the voluntary right to buy for housing association tenants, which was first promised in 2015?

I refer my hon. Friend to my earlier remarks, which set out that we are building record numbers of houses both to buy and for rent. We will make further announcements on that point in due course.

I gently remind the other Members who have spoken that all of them, I think, represent areas that have Labour-run councils, or else represent areas in the devolved nations. Their own councils have considerable powers, funding and tools, especially in enforcement, to tackle a lot of the issues that have been raised in their casework.

I was struck by the complaint made by the hon. Member for Birmingham, Erdington about the way her own city council, which is run by the Labour party, is allowing HMOs to be delivered. I suggest that she takes that up with her own Labour-run council—likewise for the hon. Member for Stretford and Urmston, whose constituency is of course part of the Greater Manchester Combined Authority, which is run by Labour Mayor Andy Burnham, who has considerable powers, influence and devolved funding from the central Government.

Is the Minister aware that the devolved nations have been underfunded by billions of pounds? Going back to the point that the Minister made earlier, the local housing allowance is a reserved matter, and it has been frozen since 2020, since which time we have had a cost of living crisis. People are struggling. My question, though, relates to the report by the Levelling Up, Housing and Communities Committee, which stated:

“If the Government believes the PRS is the right place for those on the lowest incomes, it should…make sure housing benefit…covers benefit recipients’ housing costs.”

The Committee is still awaiting a response from the Government. When will the Government respond?

I am afraid that I do not agree with the premise of the hon. Lady’s question, which is that the devolved nations have been underfunded. Her Government in Wales is led by the Labour party, and it is up to them to deliver housing for people who live in Wales. I suggest that she address her comments to their door.

We recognise the struggles that renters have faced in recent months, which is why we have taken decisive action to offer vital support where it is desperately needed. More importantly, we are making the most significant change to the private rented sector in over 30 years to provide the stability and security that renters need, as well as continuing to build new affordable homes so that many more people can own their own home. I therefore look forward to working with Members from across the House to achieve that goal, which we all share. I thank all Members who have contributed.

I thank all colleagues who have taken the time to contribute to what has been an important and insightful debate into an issue that affects all our constituents very acutely. I will not speak to all the contributions from Opposition colleagues, but they have all accurately reflected the plight of private renters, both in terms of the impact of the cost of living crisis on their living standards and ability to pay for basics such as food, energy and rent, and in terms of the condition of the properties that many constituents have to live in. Many constituents are unable to afford to move and terrified to challenge their landlords on the need for repair.

I want to spend rather longer, though, on the comments of the hon. Member for Christchurch (Sir Christopher Chope). He is absolutely right to state that we need additional supply in the housing market. He seemed to suggest that I had not referenced that when I set out the need to scrap the Town and Country Planning Act 1990 to build, build, build, to utilise the green belt, and to drive up housing supply in a way that delivers significantly more affordable and social homes. None the less, we agree on that point. I stress that because it was probably the only part of his contribution I agree with. He will appreciate that I am not in a position to comment on many of the changes made 40 years ago in the 1980s; sadly, I was not born until 1985. However, it is certainly the case that the interventions made back then have done nothing to ease the terrible situation for those at the sharp end of private rent, who are experiencing this cost of living crisis, often on very low incomes.

I also object to the suggestion that immigration, or indeed any form of demand issue, is driving the housing crisis. It is simply a fact that the biggest driver of demand for private rent is the 307,000 young people looking to move out of their parents’ homes in 2022, which was caused by many of them staying at home for longer during covid, as well as the impacts on their employment during that time and so on. Although that is the biggest aspect of demand, it is important to remember that the housing crisis is always fundamentally about supply.

I am sure the hon. Member for Christchurch will be aware of this, given that he has already subjected us to one history lesson. If I point to the history of house building in this country, we have not been building enough homes for the past near 70 years. In some of those years we had net migration out of the country, so to suggest that immigration is a driver of the housing crisis does not bear any alignment with the evidence before us. It was wholly unsurprising to hear that the hon. Gentleman stands against the Renters (Reform) Bill—not only from his contribution today, but from the significant delay in bringing the Bill forward for both First and Second Reading. We know now that it is the Tory Back Benchers who have caused significant delay to this important legislation.

I thank the hon. Member for Glasgow South West (Chris Stephens) for his comments. I am not going to speak to the merits of the system that has been brought forward in Scotland, other than to note the significant difference between the interventionist approach there and the inertia from the Government here in bringing forward their proposals.

Again, I thank the Opposition spokesperson, my hon. Friend the Member for Greenwich and Woolwich (Matthew Pennycook), who was absolutely correct to highlight the ONS data showing that private renters are five times more likely to be struggling, and that 2.5 million of them are struggling to pay their rent. I know he understands that, which is why he is pressing so hard for the Renters (Reform) Bill to come forward, as he did today.

In many ways, the Minister echoed that desire to see the legislation come forward, which leaves one wondering why there has been such a delay. I appreciate that we have had a number of Housing Ministers over the past few years; I can only hope that she is still in the job on Monday. The issue with that many changes, and with the number of Prime Ministers over the past few years, is that this legislation has been kicked down the road time and again. When people are in desperate need and struggling to pay their rent, that is simply not good enough.

I was interested by what the Minister said about the £1.9 billion not actually being clawed back, but reprofiled. I am sure that will be of great reassurance to the many people struggling to get on the housing ladder and to access social and affordable property, not least because the Minister promised that the money will be available from 2026. How wonderful!

What I said was that the programme is from 2016 to 2023. It is already delivering affordable housing. I will send the hon. Gentleman a copy of my speech, and he will find it in Hansard.

I am grateful for that and I apologise if I misheard the Minister. However, the fundamental point is that there is still much work to do. Yes, we need to see the Renters (Reform) Bill come through urgently. We also desperately need to see the support package that is being brought forward to stop mortgage holders being evicted extended to renters. Of course, we also need to build, build, build social and affordable homes in a way that gets them back to the second largest form of tenure in this country, giving the housing security that people desperately need.

Question put and agreed to.


That this House has considered the cost of living and the private rented sector.

Credit Unions and the Cost of Living

I call Hannah Bardell to move the motion. I shall then call the Minister to respond. As this is a 30-minute debate, there is no opportunity for a winding-up speech.

I beg to move,

That this House has considered credit unions and the cost of living.

It is a pleasure to move the motion, Dr Huq. I am grateful to the Backbench Business Committee for granting this short debate and to the Minister for responding. I am sure that other colleagues will want to make an intervention along the way in this debate on the importance of credit unions during a cost of living crisis.

First off, I declare an interest as someone who saves and borrows with credit unions, including my own in West Lothian—the great West Lothian Credit Union. I start by paying a passionate tribute to West Lothian Credit Union, its chair, Nancy MacGillivray, and her team, who work and fight tirelessly to develop their services and support our local community through that local credit union. I also thank my own team for the work they have done to prepare for today and the work they do every day for our Livingston constituents throughout this cost of living crisis. I am sure all of us here in the House are very conscious of the pressures on our constituents and the work that our teams are doing for us—in particular Marcus, Yvonne and Adam, who have had a close hand in today’s preparations.

Similarly, I pay tribute to my constituency colleague Angela Constance, the Member of the Scottish Parliament for Almond Valley, and her team, who have worked closely and fought for our local credit union over many years. My hon. Friend the Member for Glasgow South West (Chris Stephens) was not able to stay for this debate, but he wanted me to mention the work that Pollok Credit Union does in his constituency and the fact that so much great work is being done by credit unions with affordable food larders and community supermarkets—particularly a programme in his Glasgow South West constituency.

The role that credit unions play in supporting hard-working families across Scotland and the rest of the United Kingdom during this unprecedented cost of living crisis is indisputable. Unlike the high street banks, credit unions are run and owned by their members and distinctly operate under a co-operative principle. While credit unions are a relatively new form of banking in historic terms—they were first established in the UK in the 1960s—their founding principles of mutual co-operation and collective benefit were born of the friendly society movement of the 18th century.

Credit unions even predate the creation of the welfare state. My own grandparents were active members in the co-operative movement in West Lothian and beyond, and its importance in our communities is a long-held tradition. As we become increasingly globalised and vested interests creep further and further into our lives, the role of credit unions and co-operatives is increasingly important and potentially under threat.

The formation of the first credit unions in the UK was inspired by those in Ireland. The first recorded credit union in the UK was formed in 1960, in Derry, Northern Ireland; that union now has over 30,000 members. In Scotland and in other parts of the UK, several credit unions were established by immigrants who came to the UK with very little, but simply wished to tackle the inequalities and the financial hardship of others—what a worthy cause. Over the last 50 years, credit unions have grown to provide loans and savings to more than 1.2 million people across England, Scotland, and Wales. I am incredibly proud of West Lothian Credit Union and in awe of the work that it does in supporting my community. I have seen that first hand, and once again pay tribute. It offers a range of services, from banking to funeral plans. Its services are available to all those who live or work across West Lothian.

As colleagues will know, credit unions are regulated by both the Financial Conduct Authority and the Prudential Regulation Authority. The objectives of all credit unions are simply this: to promote thrift among their members by the accumulation of their savings; to create sources of credit for the benefit of their members at a fair and reasonable rate of interest; the use and control of members’ savings for their mutual benefit; and the training and education of members in the wise use of money and the management of financial affairs.

Those objectives may sound simple, but many of the high street lenders and other financial service providers would do very well if they simply applied the same ethical standards. Not only would they be better viewed by the public, but they would be able to act in the public interest—rather than for private profit, as we so often see. Credit unions work with many employers to set up payroll saving schemes for their employees. Many credit unions operate school credit unions, encouraging a savings habit among young students, as well as giving them life skills in operating a cash collection. My own credit union has done fantastic work in my constituency.

These are fantastic initiatives that help foster better relationships between individuals and their employers. They also help create greater educational awareness about the importance of money for young people. Despite those successes, more employers could be encouraged to participate in payroll schemes for their employees. Similarly, operating school credit unions can be a costly process for which limited funding is available, and I hope the Minister can give some thoughts on that. There is a clear need to provide better support to our children and for financial education to be done not just by banks. It is one of many ways we should be doing more to ensure that every child has the best opportunity in life.

We are already seeing change for credit unions. For instance, the community banking platform Engage has partnered with 10 credit unions to deliver its faster payment service to nearly 100,000 customers. That is a great example of how technology can help, and I note with interest the article shared by Electronic Payments International. Sofia Dogan, CEO of Kingdom Community Bank, based in Glenrothes, highlighted that the cost for its service was less than 50% of the cost that its bank was preparing to charge and that payments could now be sent to members’ accounts in minutes. The Bank of England’s latest report in April shows that the number of adult members of credit unions in the UK has risen to an all-time high of 1.98 million. The starkest increase was in loans to borrowers, which has jumped by a staggering 18.9% to £785 million last year in England alone.

It is worth reflecting on the point my hon. Friend just made. The number of people borrowing with credit unions has increased, and one part of that is that we are seeing such high interest rates from high-street banks and those more typical lenders. Credit unions certainly play a far more vital role during this Tory-induced cost of living crisis.

My hon. Friend makes an excellent point—perhaps she has foreseen what I am about to say. It is an important point to highlight because although it is welcome that more people are using credit unions, the root cause is increasingly concerning. The cost of living crisis has placed a huge economic squeeze on hard-working families.

A report from Responsible Finance found that 41% of people borrowed to pay for essential bills and expenses, while 20% borrowed to pay for appliances and white goods. Analysis from Freedom Finance found that credit unions are lending record sums to UK borrowers following the surge in borrowing costs. Again, it is great news that people are getting their money through responsible borrowing from credit unions, but it is concerning that they are having to borrow such high levels just to get by.

Total loans exceeded £2 billion for the first time by the end of 2022—an annual increase of £251 million, or 15% over the course of 2022. Time and again, evidence shows that increases in the cost of living disproportionately impact the poorest in our society. Those individuals are often helped by credit unions, but some fall victim to unscrupulous lending practices, such as high-interest payday loans, simply to meet basic needs. The Freedom Finance credit monitor has revealed that the average household quoted on credit cards rose to its highest level last year since 1998, reaching 22.8% at the end of December. We can all reflect that if things worsen and interest rates go higher, more and more people will be tipped over the edge.

I congratulate the hon. Member on securing the debate and making such a powerful speech. On that point, the Barnsley Chronicle stated that a report from the local council last week showed that one in five residents in Barnsley have debts that overtake their incomes. Obviously, people are really struggling with the cost of living. Food has gone up by 19%, and we have seen similar increases in gas and electric.

Given that situation—not just the rising cost of living, but the sheer rising level of debt—credit unions obviously play a huge role, but they are not always known about. I pay tribute to a fantastic credit union in my constituency in Wombwell, but residents do not always know they can access that affordable credit. Would the hon. Member join me in encouraging people to raise awareness of the issue?

I agree with everything that the hon. Member says. Part of the reason for today’s debate is to raise awareness of credit unions, as well as to recognise the challenges that we and many of our constituents face. An estimated 20 million consumers in the UK are underserved and unable to access credit from high street banks. That is compounded by the number of bank branches that are closing. Everybody across the House has been outraged by the behaviour of some banks, the closing of local branches and the cutting off of so many of our vulnerable and rural communities.

The Scottish Government are committed to ensuring that credit unions continue to be able to carry out their vital role in supporting communities across Scotland. In 2020, the Scottish Government established the credit union resilience loan fund and the third sector resilience fund, which provided grants and loans totalling more than £20 million, made available to be shared with over 100 credit unions across the country. The Scottish Government also actively ran a “People, Not Profit” campaign in 2018, encouraging people to consider joining a credit union—those are examples of what we can do with the limited powers we currently have in Scotland.

In stark contrast, the UK Government have been slow to respond to the cost of living crisis, and many households are desperately struggling. Many low-income households still do not meet the affordability criteria for many lenders. I was struck by the comments of one of my colleagues in Prime Minister’s Questions the other day, when she spoke powerfully about her experience, when her income dropped, of not being able to access funding. That shows the scale of what people face. Respectfully, credit unions will never be able to plug the gap, and the UK Government need to take urgent action to address the cost of living crisis. There is an increasing need for these services, and the Government must recognise that the increased demand for credit unions has also been driven by the closure of banks and post offices, especially in rural areas.

The UK Government urgently need to support credit unions further and look at ways in which they can better support them. In particular, the UK Government should consider funding specific outcomes—for example, promoting financial education classes for schoolchildren more compared with what is already available and supporting individual credit union projects where they have a clear community focus. The Government should continue to fund and expand initiatives that increase access to affordable credit, such as the no-interest loan scheme being led by Fair4All Finance—not an easy one to say—empowering local communities to develop and deliver affordable and responsible finance.

My constituency team and I have seen the tragedy of financial ruin time and again, from our casework to the constituency advice surgeries we hold. I know that much work has been done by many people in this place and, indeed, the Government on irresponsible lending, but it is incumbent on us to ensure that credit unions can not only survive, but thrive. I hope that the Minister will say a few words about how his Government will do that.

Earlier this year, when he was responding in the Chamber about his position, the Minister said:

“There are exactly 650 constituencies; would it not be wonderful if every one of them had a thriving credit union?”—[Official Report, 24 February 2023; Vol. 728, c. 426.]

I completely agree. I hope that Members present and all across this place continue to work towards achieving that goal by providing credit unions with the support they need to better empower our local communities and to help address the many inequalities that our constituents face.

Once again, I pay tribute to Nancy MacGillivray and her team at West Lothian Credit Union for all they do to support our Livingston and West Lothian communities, and I look forward to continuing to support them and the work that they do.

It is a pleasure to serve under your chairmanship, Dr Huq. I congratulate the hon. Member for Livingston (Hannah Bardell) on a thorough and thoughtful contribution to this subject. She said that one of her objectives was to raise awareness, and she should feel that she has fully achieved that. I also congratulate the West Lothian Credit Union, which I understand will be celebrating a quarter of a century since its establishment this year. All my colleagues in the Treasury and I send our congratulations to that very important institution, which does great work.

As the Economic Secretary, I am committed to supporting the credit union sector. From helping people to set aside savings—the hon. Member talked about the work done with employers as well as in schools to help to promote the savings habit—to probably its most vital role of offering credit at affordable rates, the Government really value the unique role played by credit unions for all their members, and particularly the financial inclusion agenda. The reach of credit unions is significant. There are 385 of them—not quite enough for one for every constituency, but would that not be lovely? I share the hon. Lady’s goal of having more credit unions, seeing those we have being even more successful and wanting to grow the number of users. There are 83 in Scotland, which, in this respect, is punching above its weight. Together, credit unions represent more than 2 million members and have assets of more than £4.5 billion.

The hon. Lady is right that recent cost of living challenges have proven that the trust placed in the credit union sector by their members, the Government and regulators is well deserved. That trust will be vital as people across the country continue to face cost of living pressures and must stretch every pound as far as possible. People’s money needs to work hard for them.

We know that there are global challenges, and we are not alone in facing challenging levels of inflation: in May, core inflation was higher in more than half of the countries in the EU than in the UK. Inflation erodes living standards for households, and particularly for the most vulnerable in society. That is why it is right that the Government continue to make it one of our priorities—this is one of the Prime Minister’s priorities—to halve inflation by the end of the year, and we will not hesitate to do what it takes to achieve that. Access to affordable, inclusive credit, such as that provided by credit unions, can make a real difference.

Does the Minister agree that when the chips were down during the financial crisis of 2008, the Government had no choice but to step in and save the banks, but that it is now time for the banks to step up and help people who need to borrow and those who need help?

The hon. Lady is right that people need help. Across the House, we all support that. The Chancellor has made it very clear, with the mortgage compact and in the conversations that he and I have had with all of the banking sector, that now is the time to ensure that people have fair products and that, wherever the banks are able to do so, they pass on the benefits of that.

That is one reason why it is important that we have genuine diversity and competition in the sector. Credit unions play such an important role, alongside co-operatives, mutuals and other forms of financial institution, because they are often rooted in place, people or the community. The Government are firmly on the side of credit unions, and I will try to support them. We are taking action to help them wherever there are legislative levers, although they are not the only answer. We amended the Credit Unions Act 1979 through the Financial Services and Markets Act 2023 to allow credit unions across the United Kingdom to offer a wider range of products and services. That allows them to grow, diversify, build their resilience and offer more products to their customers.

We set out Vision 2025, in consultation with stakeholders, to deliver on the sector’s priorities. That includes such things as offering hire purchase agreements, conditional sale agreements and distributing insurance services. The hon. Member for Livingston said that the West Lothian Credit Union offers funeral plans. Many people want to access that sector to give them some peace of mind, so I was genuinely interested to hear that. I will ensure that we seek the right legislative framework for that.

The 2023 Act also makes amendments to support best practice in corporate governance, including a legal requirement for credit unions to submit annual accounts to the Financial Conduct Authority. It gives credit unions permission to temporarily lend to or borrow from each other. That is about designing more financial resilience for a sector that we are on the side of and want to see grow.

The hon. Lady mentioned a number of initiatives. We are providing Fair4All Finance—that little tongue twister—which is an independent not-for-profit organisation, with significant amounts of money from the dormant assets funds. We are piloting no-interest loan schemes—another product that will be delivered hand in hand with credit unions. Credit unions, with their roots in the community and communities of interest, are a very good way of delivering that, and I will continue to work with them. There is about £145 million, in aggregate, from the dormant assets scheme.

The hon. Lady also talked about financial literacy, and a key priority as we go forward is what we can do about the real challenges of that. Wherever possible, it makes sense to work upstream and try to tackle problem debt before people get into it, because it can be a terrible place to be trapped. We are doing a lot of work on that.

Finally, as well as providing credit, credit unions are obliged to focus on financial inclusion. They have a role of advocacy in helping their members to take steps to accumulate savings. Even a small amount of savings can provide the resilience for exactly what the hon. Lady talked about: unexpected bills, white goods that fail, or perhaps the cost of a child’s uniform and a school trip falling in the same month. Even a small amount of savings can help to build financial resilience, and the Government are very supportive of that. We have the Help to Save scheme to try to help those in work and on universal credit to build a savings habit, and obviously the ISA programme is a strong part of that. Again, credit unions distribute cash ISAs as a very simple product that does not get anybody into difficulties with their tax.

I thank and congratulate the hon. Lady and those who contributed to the debate, including the hon. Member for Barnsley East (Stephanie Peacock). Across the House, we can always challenge ourselves to do more on this issue.

The Community First Credit Union in my constituency raised some issues with me about the operation of the eligible loan deduction scheme by the Department for Work and Pensions and some of the work that the Government do with credit unions. I wonder whether I could write to the Minister, because he might be able to look into some of those issues for me.

I would be happy to do so. I support anything that removes a point of friction and allows credit unions to do their important work. Regardless of whether it is me or one of my colleagues in the DWP, we will certainly take that forward and do what we can to support the hon. Member.

We value the work of credit unions. In seeking this debate, the hon. Member for Livingston has built a good level of awareness, and there is consensus that we can and should do more. That is the Government’s policy, and we are very keen to engage with the sector. Maybe one day there will be an opportunity to meet or have a call with the wonderful West Lothian Credit Union, and I am certainly happy to do so. The hon. Lady has done a magnificent job of putting the credit union on the Treasury’s radar, and I will be interested in following its continued success over the years.

Question put and agreed to.

Sitting suspended.

HIV Action Plan Annual Update 2022-23

I beg to move,

That this House has considered the HIV Action Plan annual update 2022-23.

It is a pleasure to serve under your chairmanship, Dr Huq. I was pleased to be successful in my application for this debate, and I thank colleagues from across the House for attending. I start by thanking the Government for fulfilling their commitment to update Parliament on the progress they have made on the HIV action plan—which I fully support—as it is crucial that Members are given the opportunity to scrutinise the progress that we are making on tackling HIV.

We are the generation that has the golden chance to end new cases of HIV by 2030. It is vital that we do all we can to ensure that that becomes a reality. Positive progress has been made to that end, as highlighted in the report. However, there remain further opportunities to stop new HIV transmissions in this country. That would certainly be a lasting legacy the Government could be proud of.

Two measures, in particular, will help to ensure that the Government fulfil their mission to turn the tide on HIV once and for all. First, opt-out testing is the hidden tool in our armoury that is waiting to be unleashed. Last December, I spoke in the House during the World AIDS Day debate about how effective opt-out testing was in those places that had already introduced it.

My hon. Friend will be aware of how health practitioners in Blackpool have led the way on opt-out testing to achieve great results. The focus on that in high-prevalence areas is of course particularly important, but does she agree that, although the NHS is making solid progress in this regard, it needs to up its game if it is to achieve its own targets by 2025?

I thank my hon. Friend for his intervention. I know that opt-out testing is already making improvements and that that will benefit his constituents in Blackpool. We have the blueprint for how to do this; we just need to roll it out further.

The numbers do not lie. The annual update revealed that more than 2,000 people have been diagnosed with HIV, hepatitis B and hepatitis C in 12 months alone. It is very likely that without opt-out testing many of these people would not have been diagnosed until a much later stage. That includes diagnoses in parts of London classed as having a “high” rather than a “very high” prevalence of HIV. Let us imagine what can be achieved if we now extend the roll-out to areas of high HIV prevalence, such as in my constituency of West Bromwich East.

The west midlands have several high-prevalence areas outside Sandwell, including Wolverhampton, Coventry and Birmingham. That is why, for World AIDS Day last year, West Midlands Mayor Andy Street joined the calls to fund this scheme in the west midlands. The way to end this virus is to find exactly these people—those who are unaware that they are carrying the disease but who are in fact passing it on to others—so that they can get the care they need and do not increase transmission further.

Opt-out testing in London, Blackpool, Brighton and Manchester has also revealed a quiet but growing crisis by identifying people who have previously been diagnosed with HIV but are not receiving the treatment they need. The UK Health Security Agency estimates the number of people who have fallen out of the HIV care system since 2015 to be an alarming 22,670. The Terrence Higgins Trust, which I take this opportunity to thank for all its excellent work, estimates the number of those who are alive and remain living in the UK as somewhere between 10,650 and 13,006. They are all at risk of becoming seriously ill and further transmitting the virus. In fact, hospitals in London are reporting that this has overtaken undiagnosed HIV as the primary cause of HIV-related hospital admissions.

This is totally preventable. Once someone living with HIV is on effective treatment, they can live a long, healthy life and do not pass on the virus. The annual update shows that more than a third of those found with HIV by opt-out testing were previously lost to care. That is another 473 people who can access treatment, prevent further serious illness and help to stop the spread of HIV. This is an important step forward, but we should not only be finding people when they need emergency care; we should be supporting them to stay in care in the first place. Without finding and providing treatment to those people, we cannot realise our ambition of ending new cases by 2030.

Opt-out testing is helping not only to save lives, but to save money in our health system. The initial investment to set up opt-out testing is dwarfed by the amount saved by providing treatment earlier and preventing serious illness. There is a huge saving to be made, and it is truly making a difference to health outcomes in the places in the country that already have opt-out testing.

[Dame Caroline Dinenage in the Chair]

Furthermore, the Elton John AIDS Foundation has done fantastic work with hospitals in south London on a pilot scheme that can inform a national programme to re-engage people who have been diagnosed with HIV but who are lost to care. Clearly, finding and restarting treatment for those lost to care is an urgent consideration and, at a cost of £3,000 per person, it would be significantly cheaper than providing emergency care if their condition worsened.

The hon. Lady highlights an important study from the Elton John AIDS Foundation, which found that, with a low amount of money, people can be returned to care. The problem is that sexual health and HIV services are under strain. That money needs to be ringfenced and provided by the Government so that we can spend now to save later.

The hon. Gentleman does a lot of work in this area and is a voice to be listened to.

I have shown that the key benefits of extending opt-out testing and further lost-to-care work are threefold: saving lives, saving money and reducing the pressure on the NHS at a time when every effort must be made to reduce waiting lists.

At the time of the World AIDS Day debate last December, I was assured that the Minister would look closely at the outcomes of the trial once 12 months of data was available. I hope that he agrees that the trial has been a success, as the annual report states, and that we should extend the roll-out without delay.

We already have an excellent programme in place, ready to support the expansion of combined blood-borne virus testing. After the Government initially invested £20 million in opt-out A&E testing through the HIV action plan, funding from the hepatitis C programme made it possible to add hep B and hep C to the programme. The success of that has been remarkable, and the hepatitis C elimination programme is already funding opt-out hep C testing in further areas. However, without specific funding for HIV we are missing an opportunity to save even more lives by testing for HIV at the same time.

For example, a pilot programme that took place in the Leeds Teaching Hospitals NHS Trust, where opt-out HIV testing was rolled out alongside hepatitis testing, found 25 people with HIV in just 17 months, along with a combined 297 people with hep B and C. After the end of that pilot, the hospital has been able to secure funding from NHS England to reinstate hepatitis C testing in the emergency department whenever blood is taken. However, it is disappointing that no funding has been provided for HIV testing to go alongside that, especially when the area is one in which there is a high prevalence of HIV. These opportunities to test are currently being wasted.

If we are to expand HIV testing further, it has to be combined with blood-borne virus testing—there is no hierarchy when it comes to the elimination of viruses, and it is important that we make progress against both. We are showing that combining testing is not just better; it is cheaper, more effective and de-stigmatising. I would therefore appreciate it if the Minister could confirm that a national expansion of opt-out hepatitis C testing would include HIV and hep B, as should be the case.

Another way in which we can stop the spread of the virus is by better utilising PrEP, which has been proven to be very effective at preventing the transmission of HIV. As part of the HIV action plan, we committed to an innovation in PrEP delivery to improve access for key groups, including provision in settings outside sexual and reproductive health services. However, we continue to await a date for when that will start, and I strongly urge the Department to outline when that will be as soon as possible.

The Prime Minister recently committed to making other prescription medications, including contraception, available directly from pharmacies. Please can the Government consider doing the same for PrEP, which would make a massive difference to so many? By making it easier to access, we can prevent those most at risk from ever being infected with HIV. PrEP needs to be available to people in GP surgeries, pharmacies and online to truly harness its potential to stop HIV spreading and to end the inequalities in access to the drug. I hope that that is something the Minister can provide an update on when responding to this debate.

The hon. Lady is dreadfully kind for giving way. I hope she will acknowledge to the Minister that many people end up buying PrEP online, anyway, so there is already a market for it where people access it outside of clinics. The Government are taking a cautious approach, and the people have already marched two miles ahead. The Government should take a more reactive approach, follow where the people are and allow them to buy it over the counter, with advisory blood tests rather than compulsory ones.

I thank the hon. Member again for his intervention, and I totally agree.

I would also like to raise the plight of those who are living with HIV but who feel unable to access healthcare for a variety of reasons—mainly as a result of the stigma surrounding the virus and concerns over their mental health. Engagement with this group is an important part of the action plan. Can the Minister please use this opportunity today to reassure colleagues that people living with HIV have the opportunity to seek support, and that tailored measures will be introduced to combat the issues I have raised?

Finally, all parts of the health system are responsible for delivering on the action plan. Shortly this will change, with adult HIV services moving from NHS England to integrated care systems in April 2024. As may be evident, the lines of responsibility are somewhat blurred. For that reason, it is key that we clarify as soon as possible the exact lines of authority, so that work can be accelerated to deal with the disparity in HIV support across different areas of the country. Again, I strongly encourage the Minister to provide the House with information on what the Government are doing to deal with this issue.

It is vital that we deliver on the HIV action plan, which gives us a genuine opportunity to be the first nation in the world to end this epidemic, which has both taken and harmed so many lives. By working together and implementing the reforms the action plan sets out, some of which I have mentioned today, we can stop the spread of the virus and, instead of allowing transmission to go undetected, we can stop the virus in its tracks. Many of these measures are non-burdensome but highly effective, so it is vital that we act before it is too late. We have a social responsibility to do all we can now and not to delay the implementation of the plan. I look forward to hearing the Government’s response.

I plan to call the Front Benchers at 5.13 pm, to be precise. I do not think there is any need to impose a time limit at the moment, but we are looking at roughly six and a half minutes per Member, if everybody could self-edit.

It is a pleasure to serve under your chairship this afternoon, Dame Caroline, in this really important and timely debate. I thank the hon. Member for West Bromwich East (Nicola Richards) for opening it so well and for outlining the importance of the action plan and what more the Government should do.

This issue is really important for me, because my constituency has one of the highest rates of HIV prevalence not just in London but in the whole UK. Forty years ago, the situation seemed hopeless, but we have seen life-changing improvements in treatment since then. With today’s medical advancements, someone on effective medical treatment cannot pass the virus on. That is vital, and we need to reiterate it loudly and clearly. What we have achieved is incredible and testament to the hard work of so many people in our life sciences industry and the NHS, and of the many charity and community groups that work behind and across the sector.

The HIV action plan, which was launched by the Government in 2021, is a comprehensive strategy aimed at tackling the HIV epidemic across the country. It focuses on four key areas: prevention; testing and diagnosis; treatment and care; and reducing stigma. However, the progress made in the last year is not equal across all areas—we have to be honest about that.

As part of the action plan, hospital emergency departments in London, Brighton, Blackpool and Manchester are testing people for HIV. I had the opportunity to visit Lewisham hospital a year and a half ago to see that work, to listen to the doctors and to see the results. The doctors told me that the oldest person tested for HIV in the A&E was an 85-year-old woman.

This programme has identified people living with HIV from groups who are less likely to test routinely, including women, heterosexuals and those of black ethnicities. That is crucial, as many people in those groups are currently experiencing poorer health outcomes due to late diagnoses.

The opt-out testing figures show that hundreds of people are being identified with HIV but are not currently engaged in treatment. Minister, that is simply not good enough. The longer that people are living with HIV, but without medication and support, the sicker they become, and they are still able to transmit the virus to others.

People are not able to engage in medical care for their HIV for a whole variety of reasons, but in each case more must be done to empower and support vulnerable people to access life-saving treatment that—most importantly—meets their individual needs. People should not be dying of HIV in the UK in 2023; that is the reality.

I want to echo the points made by the hon. Member for West Bromwich East on opt-out testing: it works, and the results are there. It is time to expand that programme to more hospital emergency departments across the country. Any further delay from the Government on expanding opt-out testing will mean missing the chance to diagnose hundreds of people across England. Everyone should have an equal chance to be diagnosed and to access treatment.

Finally, I want to pay tribute to my colleagues on the all-party parliamentary group on HIV and AIDS. I am proud to be one of the co-chairs. The APPG has been at the forefront of work on this issue for 36 years, as one of the longest-standing APPGs, ensuring that this important subject is high on the parliamentary agenda for all of us, regardless of our political background. I am proud of the work done by the APPG in looking at how the UK will be one of the first countries to end the transmission of HIV, and on helping those 106,000 people currently living with HIV in the UK. The APPG’s hope is that positive news from the HIV action plan galvanises the Government to go further with their HIV interventions. Our 2030 goals are achievable but by no means guaranteed.

It is a pleasure to serve under your chairmanship, Dame Caroline. I, too, would like to congratulate my hon. Friend the Member for West Bromwich East (Nicola Richards) on securing the debate and on her comments. She has already said much of what I wanted to say, so that will spare us some time.

I apologise if anyone thinks I am about to drift out of order—I am not—but I want to focus on the women’s health strategy. We know that the HIV action plan has been incredibly effective in increasing the number of men diagnosed with HIV. We have seen a fantastic and sustained fall in HIV incidence for gay, bisexual and other men who have sex with men, but not for women. That is because there seems to be a lack of joined-up thinking when it comes to breaking down some of the stigmas and taboos that still exist for women, and we need to do more to ensure that they are tested.

This is where I drift off into the women’s health strategy, which is a comprehensive and excellent document, and I pay tribute to you, Dame Caroline, for ensuring we saw it get over the line. It clearly states:

“independent reports have shown, too often it is women whom the healthcare system fails to keep safe and fails to listen to.”

The document contains some important and crucial points around tackling taboos and stigma and addressing disparities in outcome that might be affected by age, ethnicity or where the woman is from. It says clearly that those factors should not impact a woman’s ability to access services, but they do.

We know that women are less likely to have access to PrEP and that they are the least likely group to have their need for it identified—only 33% in 2021 had had their need identified. They are also the least likely to continue taking PrEP. The HIV action plan told us about making PrEP available from GPs, and the hon. Member for Brighton, Kemptown (Lloyd Russell-Moyle) commented on making medication more readily available from pharmacies. We have already done that for a range of conditions. Some contraception is readily available from pharmacies. For women, some forms of hormone replacement therapy are available from pharmacies. The morning-after pill is available from pharmacies. What we need to do, to break down the stigma and taboo, is to ensure that PrEP is more accessible from pharmacies. It seems to be a complete no-brainer.

The right hon. Lady makes some very good points about PrEP. But is this not also about a problem with sexual health and reproductive testing in clinics? In Britain, only one in 10 clinics offers online testing. That means that many people who cannot take time off work, or who cannot get away at the right time, are never able to get tested.

The hon. Gentleman makes an important point, and one that I had completely forgotten about but that I wanted to highlight. Online testing and receiving test packets through the post is incredibly discreet, quick, easy and efficient. I know that because even I have availed myself of those services—that will send the Twittersphere into an absolute frenzy. It is a really important point: to be in control of their own health, a person needs to know. Annually, I have an HIV test provided to me—I believe it is Terrence Higgins Trust that does that, because it is a brilliant charity that does fantastic work, not least in providing us with up-to-date information. It also promotes relentlessly the need to make sure that testing kits are readily and easily available through the post and online. It is absolutely critical that we have that. We learned during the pandemic, did we not, the importance of test, test, test?

That moves me on to tests, tests, tests of the opt-out variety. My constituency in Southampton does not benefit from opt-out testing at present. It is classified as having a high prevalence of HIV, with 2.4 adults per every 1,000 living with HIV in the area. We know that opt-out testing finds people living with HIV and brings about an earlier diagnosis in many cases. We all know that earlier treatment is the most effective and that once somebody on treatment has got to the point where their viral load is undetectable, it is untransmissible. Of course, we have to do the maths backwards; we know that if people are not diagnosed and not receiving treatment, they are more likely to be transmitting HIV.

We know that opt-out testing works. We know that it works in Blackpool and London, but we know that in Southampton, more than a third of HIV diagnoses are late, which puts people at much greater risk of ill health and death and increases the problem of onward transmission. We also know that women, black Africans and older people are more likely to be diagnosed late. My plea to the Minister is to ensure that we have an expansion of opt-out testing so that we can identify those people from groups who are less likely to be identified. We know that opt-out testing means that a higher proportion of women and older women are also likely to be identified.

That takes me very neatly back to the women’s health strategy, which puts people into three stages of life. There is the early stage, from puberty up to about 24; the mid-stage of life; and older people, such as me, who have passed their 51st birthday. The important thing about the women’s health strategy is that it is absolutely explicit in saying that sexual health and wellbeing is relevant across all three of those age groups. I make a big plea that we do not forget older people; the hon. Member for Vauxhall (Florence Eshalomi) mentioned a woman of 85 going through opt-out testing. It is absolutely, crucially important. Representing Romsey and Southampton North, it would be remiss of me not to make a quick plea for those living in rural areas, who wait an average of 19 days to get an appointment with a sexual health service. That is far too long to wait.

Much of this comes down to education and information. We know from the women’s health strategy that there is a big emphasis on relationships, sex and health education and that the Department for Education is conducting a review into that at the moment. We must teach boys as well as girls about sexual and reproductive health. The best place to do that is via RSHE, yet a written answer from the Department of Health and Social Care tells me that there has not yet been any contribution to the RSHE review from the Department. That is remiss of the DHSC; it should feed into the review in the same way that every other Government Department that has even a passing interest in the wellbeing of our young people and their ability to respect themselves and each other should. Notwithstanding the fact that I had a very negative answer from the Department, dated earlier this week—it might have been the latter end of last week—will the Minister take back to the Department how crucial that is if we are to hit the target of living HIV-free? Government Departments must work together to ensure that that happens.

It really is a great pleasure to serve under your chairmanship, Dame Caroline. I am grateful to my hon. Friend the Member for West Bromwich East (Nicola Richards) for securing this timely debate and for her thoughtful contribution, which laid out the principal issues. I am also grateful to my right hon. Friend the Member for Romsey and Southampton North (Caroline Nokes) for making sure that the full gamut of issues was covered, because sometimes it is possible for the perception to be that this is just an issue about gay men, and it is not. The hon. Member for Vauxhall (Florence Eshalomi), who, along with me and others, is a co-chair of the all-party parliamentary group on HIV and AIDS, made it absolutely clear that this is a wider issue than for just that one group.

As the HIV action plan has put in print, we have already reached the UN’s 95-95-95 target and are hopefully within touching distance of ending new transmissions by 2030. If that can be achieved, we should be clear that it is a milestone, equivalent to the eradication of polio in past years. I believe it is also a tangible example of British leadership in health and a testament to consistent and concerted efforts, which have produced incremental gains, giant leaps and, ultimately, a pathway that others have followed. As we have heard, however, we are not there yet.

The HIV action plan makes it clear that the goal will not be reached without PrEP. We know that PrEP works, with new transmissions of HIV dropping by over a third from 2019, but a recent survey by Prepster, the National AIDS Trust, the Terrence Higgins Trust, Sophia Forum and One Voice Network found that many people end up being diagnosed with HIV while waiting for PrEP. We need to close the gap between awareness of risk, accessing services and receiving PrEP, and I absolutely agree with the hon. Member for Brighton, Kemptown (Lloyd Russell-Moyle) about the availability of PrEP. I could sit down after this speech, go on my phone and order PrEP to be delivered to me from India in the next few days, but I could not go to a pharmacy in the centre of London or, indeed, in my own constituency to receive that. Not only is that discriminatory, in the sense that people who can afford to buy it or access online services have an advantage; as the hon. Member suggested, it is putting the risk ahead of the reality that people are already accessing it. It is far better to get it from a pharmacy than from an Indian or other overseas supplier.

Our targets on new transmissions will not be reached if we have not identified those who are living with HIV, and we have heard Members speak about that. Many of these issues are devolved in relation to Scotland, but one thing that I would like to see there is a properly funded national testing week. To maximise its impact, it should work in tandem with that which already takes place in England, because having a UK-wide event—with a focus on national television, in the national media and on social media—is a much better way to draw attention to the issue. We have heard from my right hon. Friend the Member for Romsey and Southampton North; like her, I can confirm that even someone like me can use a test kit. I am grateful—this will interest the hon. Member for Vauxhall—that the funding is at least better now in Vauxhall, because people used to have to phone up at 3 am to get the kit. If someone tried to phone at about 9 am, all the kits for that day had been distributed, but now people seem to be able to get them 24 hours a day. Virtually anyone can use such a kit effectively.

As the action plan identifies, reaching those who do not know that they are living with HIV will mean targeting hard-to-reach parts of our society, and those who either do not see themselves at risk or ignore the risk because of stigma. Opt-out testing has proven to be a success in that regard, and it is also cost-effective. When I was in South Africa, I had the opportunity to hear directly from medical professionals that opt-out testing, where it applies, has had a remarkable effect on the identification of cases in women. There are issues with support and treatment, but in terms of identification of cases, South Africa demonstrates that opt-out testing has a proven record. We should not prevaricate before rolling out opt-out testing beyond the areas already identified. Agencies and charities are champing at the bit to partner the Government to do just that.

The position of no new transmissions is almost tangible, but, as with the progress we have already made, it will not come without consistent and concerted action. Like the hon. Member for Vauxhall, I commend the all-party parliamentary group on HIV and AIDS, and the Members across both Houses who are part of it, for the continued commitment to action. As the hon. Lady did, I vouch that the group will continue to work with any charity, trust, health board or Government to get our country to the position of no new transitions and to highlight the issue globally.

It is a privilege to serve under your chairmanship, Dame Caroline. I congratulate my hon. Friend the Member for West Bromwich East (Nicola Richards) on leading this important and timely debate. As I remarked in Prime Minister’s questions in February, that month marked the 22nd anniversary of the death of a good friend of mine from AIDS-related complications. I am absolutely certain that had he been tested earlier and more regularly, he would have been given the right treatment and would still be alive today. It is because of people like him that this issue is so important to me.

I am entirely supportive of the Government’s commitment made in 2019 to end all new HIV transmissions in England by 2030. Although we have made some progress, we cannot be complacent. We should rightly celebrate the successes in improving HIV treatment, prevention, management and care. However, without testing we cannot treat, and without PrEP we cannot prevent further infection. It is great that HIV-positive people now experience a similar life expectancy to people without HIV, but we still have a lot of work to do. Although new HIV diagnoses have continued to fall, late diagnoses remain stubbornly high in England, and progress across the UK is not equitable.

There are three key areas where we need to seek more action: access to PrEP, more HIV testing and care for people living with HIV. As we have heard, access to PrEP remains limited. The HIV action plan included a commitment to develop a plan for PrEP access beyond sexual health services. However, more than a year on from that commitment, it is still not possible to access PrEP at a pharmacy or a GP surgery. May I ask the Minister why that is, and whether he will look urgently at this point? This is an easy win in our fight against HIV.

The HIV action plan included a £20 million investment in opt-out testing in emergency departments in areas classed as very high prevalence. As a result of additional hepatitis C funding, the whole of London was included and the programme became a combined one to tackle bloodborne viruses. The annual report includes the first year of data, and the results have been quite remarkable across London, Manchester, Blackpool and Brighton, as other speakers have highlighted. The figures demonstrate the huge success that opt-out testing has had in rooting out cases of bloodborne viruses—not just HIV, but hepatitis C and B.

In February, as a result of campaigning from many colleagues here and stakeholders across the country, the Public Health Minister committed to consider the case for expanding opt-out testing to all areas with a high HIV prevalence. Will he tell us the outcome of that review? When will opt-out testing be rolled out to high prevalence areas? People do not live their whole lives in fixed locations. Simply because someone now lives in an area that is not high prevalence does not mean that they did not once do so or have not visited such areas in the past.

Opt-out is a win-win: it is good for public health and the public purse. It is essential that we meet our target of ending all new HIV transmissions in England by 2030. We have made progress, but I fear that without renewed impetus, greater access to PrEP and an expansion of opt-out testing, we will miss the mark. Our internationally significant position on HIV is in no small part due to the zeal of giants in the field, such as Lord Fowler, and the efforts of the Terrence Higgins Trust. I ask the Minister to rekindle that zeal and energy, and ensure we take up this mantle and race towards a day when we have no new infections. It can be done.

It is a pleasure to serve under your chairmanship, Dame Caroline. I am glad to have the opportunity to contribute to this debate on the Government’s annual update on their HIV action plan. I thank my hon. Friend the Member for West Bromwich East (Nicola Richards) for securing it.

The annual update makes it clear that progress has been made. The plan has set the stage for a transformative approach to prevention, testing, treatment and support but, as ever, there is still room for improvement, and the annual report highlights several key opportunities. First, there is scope for improving access to the HIV prevention drug PrEP, HIV testing and care for people living with HIV. As the Member of Parliament for Cities of London and Westminster, I know how important that is. Reports show that Westminster has among the highest HIV prevalence in the country: eight 15 to 59-year-olds per 1,000 are living with HIV. The action plan will change those statistics, and the Government’s investment in opt-out HIV testing and emergency departments in areas classed by the UK Health Security Agency as having a very high HIV prevalence should be highly commended.

As a result of additional funding, in St Mary’s Hospital in my constituency, three people were newly diagnosed with HIV, seven with hepatitis B and 14 with hepatitis C in the first 10 months of the Government’s programme. Those figures from the first year of the programme have been broken down by the Terrence Higgins Trust. There have been more than 2,000 positive diagnoses across London, Blackpool, Brighton and Manchester.

Now that we are in the second year of the programme, it is only right that we consider expanding opt-out testing. I understand that NHS England has costed and prepared a plan for expanding HIV testing to 41 additional A&E units in areas with a high prevalence of HIV, and I hope that will go ahead. Modelling by the Terrence Higgins Trust shows that such an expansion has serious merit in supporting the Government’s aims and ambitions.

Also important in supporting the aims of the action plan is increasing equal access to PrEP. That revolutionary drug has changed so many lives—including for many of my friends. I am proud that my constituency is home to the outstanding 56 Dean Street—the sexual health clinic that pioneered PrEP in England—which is recognised internationally for its innovation, particularly in regard to its engagement with London’s higher-risk communities. More than that, it has been a haven for so many of the LGBT+ community over the decades. I pay tribute to the outstanding staff who work there today and have worked there in the past. They have always operated without prejudice, even in the face of systemic discrimination.

Nearly 60% of people wait more than 12 weeks for their PrEP. I am glad that the annual report acknowledges the publication of the first national PrEP monitoring and evaluation framework, but there is more to do. The framework is clear in showing that there are inequalities in who is able to access PrEP; we really need to push against that. The HIV action plan includes a commitment to develop a plan to expand access to PrEP through sexual health services, but there is a case to be made to have access through GP surgeries in particular, as well as pharmacies. We need to ensure equal access to PrEP if we are to meet our 2030 commitments.

In the remaining time I have left, I would like to pay tribute to the work of the Terrence Higgins Trust. From its policy to its fundraising efforts, it is second to none in its field. In fact, I have been to visit its brilliant team in Boutique, the only Terrence Higgins Trust charity shop in the UK, which happens to be based in Pimlico in my constituency. The shop recently reached £1 million raised for charity, which is utterly amazing. I pay tribute to all the volunteers who work there. For nearly 15 years, the shop has helped the Terrence Higgins Trust to fund its hardship grant, services for people living with HIV and its campaign to end new cases by 2030. I pay huge tribute to both the shop and the Terrence Higgins Trust.

The Government’s HIV action plan is the first step in reinforcing the progress the UK has already achieved. Now Government, civil society organisations, healthcare providers, researchers and communities must continue to work together to address the global challenge. By combining our knowledge, resources and expertise, we can develop innovative solutions, advocate for policy change and create a sustainable impact that will shape the future of HIV prevention and treatment.

It is always a pleasure to see you in the Chair, Dame Caroline. I congratulate the hon. Member for West Bromwich East (Nicola Richards) on securing this important debate. It has been a good debate, and we have had consensual contributions from Members across the House. I pay tribute to my hon. Friend the Member for Vauxhall (Florence Eshalomi), the right hon. Members for Romsey and Southampton North (Caroline Nokes) and for Dumfriesshire, Clydesdale and Tweeddale (David Mundell), and the hon. Members for Cities of London and Westminster (Nickie Aiken) and for Darlington (Peter Gibson), for their thoughtful contributions. I thank them individually for the work they are doing here in the House of Commons on this important topic.

The publication of the first HIV action plan update in Parliament last month showed real positive progress in ending new HIV cases and HIV-related deaths in England by 2030. However, as the number of new HIV cases falls, it will become harder to find people living with undiagnosed HIV—something we have recognised in the debate. I therefore welcome the opportunity to press the Minister on some key points, particularly regarding the HIV action plan update. The first relates to opt-out HIV and hepatitis testing. The inclusion of opt-out testing in areas of high HIV prevalence—something for which Labour has called for some time—has been hugely successful. Across London, Manchester, Blackpool and Brighton, we have seen 343 people newly diagnosed with HIV, over 1,500 people newly diagnosed with hepatitis B and C, and 473 people previously lost to care found. Those are incredibly encouraging statistics, and they point to the effectiveness of opt-out testing. I would be grateful if the Minister set out what assessment the Government have made of opt-out testing being implemented in areas of high prevalence—and if not, does he have any plans to do so?

The second thing I want to focus on were those people lost to care. By “lost to care”, we mean those previously diagnosed with HIV who have not attended an HIV clinic in the past year. In general, those people are disproportionately likely to be black women, and most likely to be from the most deprived parts of the country, to have caring responsibilities, or to be subject to the misuse of drugs and alcohol.

I also commend the Terrence Higgins Trust, which does brilliant work and I thank those there for their support for me in my role. The trust estimates that the number of people lost to care, but alive and still in the UK, could be as high as 13,000. That is extremely concerning and means not only that individuals are at risk of developing serious HIV-associated illness, but that they risk passing the virus on to others. What action is the Department taking to re-engage those individuals? What further work is the Minister planning nationally to support people back into care?

The third and final point I want to ask the Minister about is access to PrEP and sexual health services more generally. As we have heard in the debate, there are serious inequalities in PrEP identification and initiation. Even when people access care, they face extraordinarily long waiting times, with 57% of people waiting more than 12 weeks to receive PrEP. The Terrence Higgins Trust is aware of people who have, tragically, acquired HIV while waiting to access PrEP. That is clearly unacceptable. Such cases were entirely preventable and should seriously alarm Ministers.

The HIV action plan included a commitment to develop a plan for PrEP access beyond sexual health services. However, more than a year on from that commitment, there is no pharmacy or GP surgery in the country where PrEP is accessible. I know from responses to written parliamentary questions that the Minister is still committed to that aspect of the HIV action plan, so when can we expect it to be set out in detail? The Government initially promised their PrEP plan in the autumn of 2022. We are now three days away from summer recess in 2023. Where is the plan?

In closing, I want to raise the issue of sexual health services and ask the Minister about Government proposals to change schedule 1 to the Health Protection Notification Regulations 2010, which lists notifiable diseases. What guarantees will the Minister give that that will not impact the important anonymity of those accessing sexual health services or increase stigma?

Labour stands ready and waiting to support the Government in driving down HIV prevalence. I am sure that the Minister will agree that, across the House, we have a responsibility to redouble our efforts so that we can eliminate all new transmissions of HIV by 2030. I hope that, with cross-party action, we can make that a reality.

I pay tribute to my hon. Friend the Member for West Bromwich East (Nicola Richards) and to all other hon. Members present. A number of them have played leading roles in campaigning on this issue.

This afternoon, we have had an excellent debate, hearing important contributions about particular aspects of the challenge: my right hon. Friend the Member for Romsey and Southampton North (Caroline Nokes) on the dimension for women; the hon. Member for Brighton, Kemptown (Lloyd Russell-Moyle) on the opportunities for home testing; and the hon. Member for Vauxhall (Florence Eshalomi) on the importance to her constituency. We heard about the inspirational work of centres such as 56 Dean Street from my hon. Friend the Member for Cities of London and Westminster (Nickie Aiken) and about the searing personal experience of friends and families of people suffering and dying of this terrible disease from my hon. Friend the Member for Darlington (Peter Gibson).

I apologise, as I have not been present for the whole debate. May I mention one other clinic, 10 Hammersmith Broadway? I visited it recently and was hugely impressed by the staff and their partners in the community, such as the Terrence Higgins Trust. It is clear, however, that they are under increasing stress. The problem is that it only takes an emergency like the outbreak of mpox, or STIs going up, and routine services such as providing PrEP go on to the back foot. Will the Minister look at that, particularly in high-prevalence areas, because the limited cost is not worth the great risk involved?

I am happy to look into that. We provided extra funding

in respect of mpox, but I will look into the issues the hon. Gentleman raised.

This debate is an opportunity to restate our joint commitment to tackling HIV and to reflect on the progress we have made since 2019, when the Government first announced our ambition to end new HIV transmissions, new AIDS diagnoses and new HIV-related deaths in England by 2030. As all Members know, 30 years ago AIDS was a fatal illness; today, when they are diagnosed early and have access to antiretrovirals, the majority of people with HIV in England can expect a near-normal life expectancy. People who are diagnosed with HIV can expect to receive HIV care that is world class, free and

open access.

We have come a long way. Despite the unprecedented and challenging backdrop of the covid pandemic, England has seen a 33% fall in new HIV diagnoses since 2019, and fewer than 4,500 people live with undiagnosed HIV. The vast majority of those diagnosed are on high-quality treatment and are now unable to pass on the virus—still not enough people know that. Our successes have been possible only through clear national leadership and strengthened partnership working.

I am incredibly grateful to Professor Kevin Fenton, the Government’s chief adviser on HIV, who chairs the HIV action plan implementation steering group, which has representation from the key partners involved in the delivery of the HIV action plan, including local government, the UK Health Security Agency, the NHS, professional bodies and our voluntary and community sector. The group has met quarterly throughout the year to monitor progress on our commitments and ensure that appropriate action is taken to help us to move forward on our objectives.

Within the steering group’s remit, we have established a community advisory group, comprising representatives from a wide range of community and voluntary groups, from which we have a lot to learn, and four task and finish groups to support PrEP access and equity, workforce, HIV control strategies in low-prevalence areas, and retention and engagement in HIV care. The groups provide vital, comprehensive and timely advice and help us to remain on track to meet our 2030 goal.

Many areas of the country have replicated the national action regionally by providing leadership and oversight of the work that is under way within local systems. For example, we have seen the development of regional HIV action plans in areas such as the south-west, multi-agency working groups in the midlands, and stocktakes of testing activity and action via sexual health networks in the south-east, the north-east and Yorkshire.

I am interested to hear the stories the Minister is telling about regional action plans; do they include opt-out testing?

I will come on to opt-out testing in a moment.

We are incredibly grateful for the work of the UK Health Security Agency, which is a world-class organisation that runs high-quality data-collection and surveillance systems to help us to better understand the scale of the challenge. In December 2022, the UKHSA published the first monitoring and evaluation report on the HIV action plan, which indicated that the achievement of our ambitious commitments, including the interim commitment to an 80% reduction in transmissions by 2025, is within our grasp, and we should be encouraged by the progress that has been made.

As various Members pointed out, progress in the UK is increasingly recognised internationally at different HIV global forums, such as the UNAIDS and WHO international boards. The proof of that is that the UK met the UNAIDS 95-95-95 targets for the second time in 2021: 95% of HIV-positive individuals were diagnosed; 99% of those diagnosed were receiving treatment; and 98% of those receiving treatment were being virally suppressed and unable to pass on the disease.

Transparency and accountability are a key cornerstone of our plan, which is why we also committed to update Parliament each year on the progress made towards our ambition to end new HIV transmissions. In particular, we are committed to ensure that underserved populations benefit equally from the improvements made in HIV outcomes, including by scaling up our prevention efforts and increasing access to PrEP. We have already invested £33 million to roll out PrEP across sexual health services over the past two years, and PrEP is now being commissioned as a routine service through the public health grant. However, we know that there is more to do to improve PrEP access and equity for key groups, and we are in the process of developing a road map based on the input of the PrEP task and finish group that I mentioned, to improve PrEP provision and help us to reach those who are under-represented in PrEP access.

The hon. Member for Brighton, Kemptown raised the issue of the blood test, which I will absolutely take away and look at. On the specific point about timing made by my hon. Friend the Member for Darlington (Peter Gibson) and by my right hon. Friend the Member for Dumfriesshire, Clydesdale and Tweeddale (David Mundell), the HIV plan implementation steering group is working to develop a road map based on the task and finish group’s recommendations, to help to guide our movement forward. Our work will be informed by the findings of research on the use of HIV PrEP commissioned by the English HIV and sexual health commissioners group. In particular, we want to understand the barriers for underserved groups that access PrEP and how they can be mitigated.

It is expected that the research will be published this month—of which there is, of course, not much left. Members will see that very shortly, because we know the urgency of this issue, and I have been struck by Members’ testimony today about what is happening in respect of private access and the need for people to access PrEP in a timely and smooth way.

A number of hon. and right hon. Members raised the issue of the opt-out testing programme. I have met some of the people who have already benefited from that incredible programme, which powerfully underlines its huge benefits. Preliminary results from the pilot are promising, and we are still considering the full evidence from the first year of the programme, alongside the data on progress towards our ambition of ending new transmissions. Through the HIV action plan, DHSE is investing £3.5 million in our national HIV prevention programme from 2021 to 2024, to raise awareness of ways to prevent the spread of HIV and other sexually transmitted infections among the most affected communities.

As part of that programme, we deliver National HIV Testing Week in partnership with the Terrence Higgins Trust. In 2023, it distributed almost 22,000 free HIV testing kits ordered by the public. The self-testing kits provide instant at-home results and are available for the very first time. A targeted summer campaign is currently being delivered through the brilliant work of our partners at the Terrence Higgins Trust. The campaign has been carefully developed and tailored through strong audience insight evaluation to help us reach those most at risk, and it aims to increase testing among key groups, particularly young people and people of African heritage. It also aims to promote awareness of good sexual health practices to prevent transmission of other sexually transmitted infections. To reassure my right hon. Friend the Member for Romsey and Southampton North, we are working with the Department for Education on its RHSE review, and have been doing so since March, so I absolutely recognise the importance of the point that she made.

Achieving our 2030 goal will require sustained commitment from many partners across the health system and beyond—in education, for example—and the HIV action plan describes the role that each partner will play in this vital endeavour. The success of recent years, and the scale of the task that remains, should give us the belief and the drive to go further in the years ahead. Let us continue working together to ensure that we are the generation that ends HIV once and for all.

I thank all hon. and right hon. Members for taking part in today’s debate. We all said very similar things, and I hear from the Minister that the first year’s data from the opt-out testing trial is still being analysed. I think he will agree with us that it looks very promising so far, and I want to reiterate that we have all the knowledge we need to end new transmissions of HIV in the UK by 2030. We have the tools and the knowledge to do it. We just need to get on and do it, so I urge the Minister to speed up the work on this issue, because it will be an incredible achievement if this Government can end new transmission by 2030 through the programmes we have set up. It is possible, we can do it and we have to get on with it.

Question put and agreed to.


That his House has considered the HIV Action Plan annual update 2022-23.

Sitting adjourned.