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Commons Chamber

Volume 738: debated on Tuesday 17 October 2023

House of Commons

Tuesday 17 October 2023

The House met at half-past Eleven o’clock


[Mr Speaker in the Chair]

Oral Answers to Questions

Health and Social Care

The Secretary of State was asked—

Training of NHS Staff

The NHS long-term workforce plan sets out a path to double the number of medical school training places, increase GP training by 50% and double the number of adult nursing training places.

What steps are the Government taking to increase the recruitment of midwives, given the closure of Stafford County Hospital’s freestanding midwifery birthing unit due to shortages, and how is the Secretary of State going to ensure that all midwives are trained to deal with birth injuries to reduce risk?

My hon. Friend raises an important point, and I know she has secured a debate in the House this week to further explore these issues. She will be aware that there has been a 13% increase in the number of midwifery programme place starters since two years ago. That is alongside the £165 million added to the maternity budget since 2021 and the key increase in midwifery places in the long-term workforce plan.[Official Report, 7 November 2023, Vol. 740, c. 2MC.]

It is obviously welcome to train and recruit as many staff as possible, but part of the problem is actually retaining the staff. We are increasingly seeing among the reasons given for leaving, particularly by nurses, their work-life balance. What is the Secretary of State doing to address that?

Just yesterday, I met leaders of the NHS Staff Council, who represent trade unions under Agenda for Change, as part of our ongoing discussions on the agreement we will reach with them, which includes working together on retention and how we address some of the challenges the workforce face.

May I congratulate the Secretary of State on being ahead of track to hire 50,000 more nurses this Parliament, as we committed to in the 2019 manifesto? However, can I push him by asking him where he is up to on ensuring that enough staff are trained to do clinical trials, as set out in the excellent O’Shaughnessy review, and can he give us an update of where implementation of that review is up to?

I very much welcome my right hon. Friend signalling that we are ahead of the manifesto commitment not just in nurses being recruited, but in key additional roles in primary care, where the target was 26,000 and actually 31,000 have now been recruited. He is right about the importance of clinical research. The O’Shaughnessy review speeds that up and reduces the cost. It better leverages the taxpayer pound in investment from the private sector, and standardises contracts across NHS trusts to bring the time down. We are also looking at innovation in areas such as the NHS app to better empower patients to take part in clinical research trials. That ensures they are at the front of the queue in getting the latest medicine, which is exactly where we want the NHS to be.

The Secretary of State did not mention the increase planned in the number of physician associates. The Norfolk and Waveney integrated care system has posted:

“Got abdominal pain that isn’t going away? A Physician Associate based in your GP practice can help…They are highly skilled at diagnosing conditions”.

After the tragic case of Emily Chesterton, who was misdiagnosed after seeing a physician associate twice at a GP practice and no GP at any point, when will the lesson be learned that the NHS workforce cannot be safely expanded by this route of associates with only two years’ medical training?

All clinical roles need to have the right regulation around them, and we need to ensure that patient safety is to the fore. The hon. Lady gives a very good illustration of how the Labour party talks about reform, but not when it comes to the reform of new roles, having new roles in the NHS and having a ladder of opportunity for people to come into the NHS. Physician associates are people with masters’ degrees: these people are highly skilled. Of course, we need to get the regulation right. However, the Labour party talks about reform, but when it comes to standing up to the trade unions, it is not willing to do so, which is why, when there is an innovation such as physician associates, it wants to block it.

Suicide Prevention

Last month, we published a cross-Government five-year suicide prevention strategy. It sets out our pledge to reduce England’s suicide rates within two and a half years, with over 100 measures aimed at saving lives and providing early intervention for those at highest risk of suicide, including new mums and middle-aged men.

Like many others, I dropped into the campaign event for “One Million Lives”, developed by Jacobs and supported by R;pple, and I was impressed by its efforts to interfere with the online risk of suicide-centric websites. The Minister may be aware that my wife is a long-term volunteer with Darlington and district Samaritans, which has raised with me the “Saving Lives Can’t Wait” campaign. It asks the Government to review local funding for suicide-safer communities, which is due to end. Could I ask the Minister to support the “One Million Lives” campaign, and to push for the renewal of local funding to support suicide-safer communities?

I thank my hon. Friend for his hard work in this area and for his mental health campaigning overall, and also his wife and all who selflessly give their time to volunteer with the invaluable mental health charities. We fully recognise that, and that is why when we launched the suicide prevention strategy we also launched our £10 million suicide prevention grant fund.

On my hon. Friend’s point about wider funding beyond 2024-25, that is subject to a future spending review, but our commitment and record in delivering record investment of £15.9 billion in mental health services just in this financial year, which is 28% more funding than in 2018, should give him confidence that this Conservative Government deliver on mental health services.

Is the Minister able to provide an update on the suicide prevention grant, and particularly on when the money is expected to reach the successful organisations?

We have had a huge response to the opening of the grant, with over 1,800 applications from voluntary groups and organisations. We are assessing those bids and hope to make an announcement before the end of the year.

Campaigns such as 3 Dads Walking and Just 3 Mums Walking have worked incredibly hard to raise awareness of suicide prevention. Has the Minister had time to meet with either of those campaigns yet?

I have met with 3 Dads Walking; I have not met the mums group but am very happy to do so. Because of their intervention and campaigning, we were able to successfully put their campaign about improving mental health awareness in the school curriculum into our suicide prevention strategy. It is a cross-Government strategy, and the Department for Education has very much taken their points on board.

Over 1.8 million people languishing on mental health waiting lists, black people five times more likely to be detained under the Mental Health Act 1983, and over 2,000 people with learning disabilities detained in hospital, all while the Government are dragging their feet on mental health and suicide prevention. You will be interested to know, Mr Speaker, that we had cross-party support to tackle these burning injustices through the draft Mental Health Bill, yet since the Joint Committee on the Draft Mental Health Bill published our report in January we have heard nothing from the Government, so will the Minister today commit to including reform of the Mental Health Act in the King’s Speech?

I was going to pay tribute to the hon. Lady for her work on mental health campaigning, and she will know we have done a huge amount. The suicide prevention strategy is a cross-Government piece of work, which makes sure suicide is everyone’s business, not just that of health and social care. Whether by supporting families bereaved by suicide or rolling out mental health support schemes in schools, it is this Government who are delivering on mental health services.

The House of Commons Library says there has been no statistically significant change in the rate of suicides in England since 2015. Suicide remains the biggest killer of men under 50 in the UK. Why has it taken so long for the Government to bring forward a strategy, and why do they continue to drag their feet over reform to the Mental Health Act? Can the Minister give the House a firm timetable today?

The hon. Lady is not quite right in her statistics. Just before covid we had seen a 20% reduction compared with two decades ago in suicide levels in England. She might be interested to know that in Labour-run Wales suicide rates are higher than in England, and its suicide prevention strategy expired last year. Mental health has been demoted on the shadow Front Bench, too, as we saw from the resignation of the hon. Member for Tooting (Dr Allin-Khan) when the role of shadow mental health Minister was removed from the Opposition Front Bench.

RAAC in Hospitals

4. What steps his Department is taking to remediate hospital buildings with reinforced autoclaved aerated concrete. (906547)

We are determined to address the safety issues caused by RAAC. We are prioritising the seven worst-affected hospitals and have a fund of just under £700 million covering the four-year programme of replacement.

Can the Secretary of State tell the House how many of the hospitals where RAAC is an issue also have issues with asbestos being present? What assessment has his Department made of the impact should asbestos spores be released in a RAAC collapse?

The hon. Member raises an interesting point about asbestos, because much of the NHS estate dates from a time when asbestos was widely used. Of course, asbestos is considered safe if it is undisturbed. It is a similar issue with RAAC.

On RAAC, we are following the guidance from the Institution of Structural Engineers and monitoring it. The advice is not that all RAAC needs to be replaced; the point is that it needs to be monitored. Where there is deterioration, we have a fund of just under £700 million to tackle that. The asbestos is being monitored, as is the RAAC. We have been monitoring this since 2019 and have a four-year national programme backed up with £700 million to address issues as and when they arise.

The residents of Stoke-on-Trent North, Kidsgrove and Talke would like me to place their thanks on the record to the Secretary of State for having ensured that the Haywood walk-in centre, which has RAAC present, has just received £26.5 million for a new build out-patient building, which will do a lot to improve the care of residents locally. As spades are already in the ground, will the Secretary of State commit to coming to visit so that we can show off this fantastic progress?

It is always a pleasure to visit my hon. Friend’s constituency. He highlights a good illustration of how the national programme is working, backed with that £700 million of funding. We are closely monitoring the estate and, where RAAC mitigation is required, that work is taking place. He brings a good example of that to the House’s attention.

Not only are the hospital buildings crumbling after 13 years of neglect, creating huge capacity challenges; it seems that those still standing do not have enough beds. As we heard from The Times this morning, the number of

“hospital beds…has fallen by almost 3,000 since ministers promised 5,000 before winter”.

It feels pretty much like winter to me. Is that just another broken promise?

First, we have got more than £1 billion of investment in an additional 5,000 permanent beds going into the NHS estate as part of our urgent and emergency care recovery programme. More widely, the Government are committed to the biggest ever investment in the NHS estate, backed with more than £20 billion—the biggest of any Government. Of course, we will not take lectures from Labour, which bequeathed the NHS the consequence of expensive private finance initiative deals that many trusts are still paying for to this day.

Health and Social Care Recruitment: EU Exit

5. What recent assessment he has made of the impact of the UK’s departure from the EU on trends in the level of recruitment in the health and social care sector. (906548)

6. What recent assessment he has made of the impact of the UK’s departure from the EU on trends in the level of recruitment in the health and social care sector. (906549)

It is fine; thank you, Mr Speaker.

Since Brexit, we have more than 13,000 more doctors and 48,000 more nurses working in the NHS in England, and 40,000 more full-time equivalent staff in adult social care. Our points-based immigration system means that we can recruit the talent we need from all over the world for our health and social care system, including from the European Union.

If everything is as rosy as the Minister says, why did a spokesperson for the Nuffield Trust say last year that

“greater costs, more paperwork and uncertainty over visas because of Brexit have been among the biggest barriers to recruiting and keeping EU and EFTA doctors”?

Cannot she admit that Brexit is exacerbating difficulties with recruiting appropriate staff for the NHS across the whole of the UK? Scotland did not vote for Brexit. Why are we having to pay the price?

I suggest it is really time that the hon. Gentleman stops blaming Brexit. He should in fact look to his SNP colleagues in Holyrood and ensure that they make Scotland’s NHS a better place to work. If he had listened to my answer, he would have heard me say that since Brexit we have recruited more than 13,000 more doctors to the NHS in England. In fact, we are doing so well that we recently recruited a doctor from the SNP Benches. [Laughter.]

Very droll. I congratulate the Minister on that one.

If not the Nuffield Trust, perhaps BMA Scotland’s Chair Dr Iain Kennedy will be good enough. He recently said that the recruitment and retention of senior medical staff across the NHS in Scotland remains a huge challenge, with the health immigration surcharge cost increases announced by this Government potentially further deterring foreign workers from joining the NHS. Given the recently announced NHS long-term workforce plan, what steps is the Minister taking to ensure that Scotland has the immigration we need for future recruitment and retention for our health service?

We have the health and social care visa, which supports our health and social care services to recruit doctors, nurses and other professionals, as well as social care staff, helping to boost those numbers. The hon. Gentleman referred to the important NHS workforce long-term plan, which will increase the home-grown staff in our health service. That will give us 60,000 more doctors, 170,000 more nurses and 70,000 more allied health professionals in our NHS over the next 15 years.

It has been reported that the Home Secretary plans to tighten the rules for those arriving on a health and care worker visa, to block most from bringing dependents with them—yet another in a long list of her vendettas against children coming to these isles. What recent assessments has the Secretary of State made of how that will impact international recruitment and capacity in our already struggling health and care services?

I work closely with colleagues in the Home Office to ensure that the health and care visa achieves the objectives set out. We are seeing real success in social care—the recent Skills for Care workforce report showed that we have 20,000 more care workers in England. We are doing well on recruitment to social care.

HIV: Emergency Department Opt-out Testing

7. What recent assessment he has made of the effectiveness of emergency department opt-out testing for HIV. (906550)

Provisional NHS data shows that opt-out testing has found around 700 cases of HIV during its first year. In total, it has found more than 2,000 cases of blood-borne diseases, including hepatitis B and C.

I welcome the Minister’s news on those figures. He will have seen the impact of opt-out testing—detecting more people, treating them earlier and saving the NHS money. However, if we are to meet our 2030 target on no new infections, we cannot delay a further roll-out of opt-out testing. Will he commit the resources needed to expand it in time for World AIDS Day on 1 December?

I pay tribute to my hon. Friend for all his work on this important issue. We will assess all the evidence and reply before the end of the year. Opt-out testing is not the only thing we are doing to drive down HIV transmission. We have had a 40% rise in the number of people getting pre-exposure prophylaxis, and we have increased the number of people testing, with 20,000 free testing kits handed out this year. We are doing everything we can to meet that visionary goal to stop HIV transmission in this country.

I thank the Minister for his answer to the question from the hon. Member for Darlington (Peter Gibson). It is clear that today, HIV is not the death sentence that it once was, because of the progress of medication and healthcare in prolonging life and improving quality of life. In Northern Ireland we are proactive, as the Minister will know, on PrEP and young people. We are doing progressive things through the Department of Health, Social Services and Public Safety in the Northern Ireland Assembly. Has the Minister had the opportunity to discuss with the Northern Ireland Assembly and the Health Department how we can work better together? I always say we are better together in every case.

The hon. Gentleman is completely correct. He has been a fantastic champion on this issue. The UK is leading the world on this issue, hitting the UN’s 95-95-95 goals, driving down transmission and reducing stigma. People increasingly realise that as well as suppressing the virus, the treatment makes it impossible to transmit, transforming the lives of people with HIV.

Access to GPs: Rural Communities

8. What recent assessment he has made of the adequacy of the level of access to GPs in rural communities. (906551)

We have increased funding for general practice by about a fifth in real terms since 2018. We have increased the workforce by about 30% since 2019 alone, with 2,000 extra doctors and 31,000 extra clinicians going into general practice. With the hard work of GPs, that has enabled about 15% more appointments than before the pandemic. In rural areas we are going further with things such as the targeted in-house recruitment scheme and the elements of the funding formula that favour rural areas.

I am grateful to my hon. Friend for that answer, but I have repeatedly raised with Ministers the specific case of an innovative model from Long Crendon Parish Council to use land secured through planning gain to replace Long Crendon Surgery, which closed during the pandemic. There is an agreement for Unity Health to provide primary care services there, but no money to physically build. My right hon. Friend the Secretary of State has advised consistently that the money be sought from the integrated care board, but after prolonged talks it has said that there is no money. Will the Minister look at this innovative model again? It is a great way of building rural GP provision in the future, with a mind to his Department making it happen.

I will absolutely look closely at that specific case. My hon. Friend has put a huge amount of work into Long Crendon. As he knows, we are already changing the national planning policy framework to enable more developer contributions to flow into such innovative projects. We have more GP practices than we did in 2010, but we continue to look at ways to go further.

Cardiovascular Disease Prevention

We are making the most significant public health intervention in a generation by creating a smoke-free generation. To put that in context, every five cigarettes a day increases the risk of stroke by 12%. We are also rolling out free blood pressure checks to people over 40 in community pharmacies, which will help to detect much earlier thousands more people living with high blood pressure.

I thank the Secretary of State for that answer. Many commercial infant and toddler foods are ultra-processed, which sets alarm bells ringing as ultra-processed food is strongly associated with cardiovascular diseases and 40% of 10 to 11-year-olds are overweight or obese. I strongly believe that parents are being misled by companies that put health claims on ultra-processed infant food, when in fact the food is anything but healthy—it is high in fat, salt and sugar. What steps are the Government taking to address the disingenuous and grossly misleading marketing and labelling of commercial infant and toddler food and drink?

As my hon. Friend knows, there is no agreed definition for ultra-high processed food. As a general principle, I do not think we should be taxing and banning things—smoking is an outlier. We have to empower the patient and recognise the pressures from the cost of living. We are also rolling out anti-obesity drugs to give patients access to the most innovative drugs as part of our wider response to the challenge of obesity.

What is the Secretary of State’s view of the worrying trend of increased cardiac-related deaths in the UK and around the world since 2021, which correlates closely with the roll-out of the experimental mRNA vaccines?

It is always important to follow the science. That is why, at the G20, Health Ministers agreed to look at the various research being done in multiple countries, particularly on long covid but also on the lessons from that period, to ensure that research from that period is shared internationally so we can learn best practice from other countries as well as within the NHS.

Radiotherapy Linear Accelerator Machines

10. How many and what proportion of NHS radiotherapy linear accelerator (LINAC) machines will reach the end of their recommended lifespan in 2024. (906553)

The Government and NHS England are committed to ensuring cancer patients can receive high quality radiotherapy treatment. Between 2016 and 2021, £162 million was invested which enabled the replacement or upgrade of around 100 radiotherapy machines. Responsibility for investment in radiotherapy machines has sat with local systems since April 2022. I look forward to meeting the hon. Gentleman and the all-party group for radiotherapy on this matter soon.

I am very grateful to the Minister for his reply and in particular for the offer of the meeting coming soon. Radiotherapy UK says that for us to even meet average international standards we must commission 125 additional new linear accelerators. Will he make the commitment to do that and, in doing so, ensure that rural and remote communities do not lose out by placing some of those machines in new satellite centres, such as the Westmorland General Hospital?

The hon. Gentleman is hugely passionate on this subject. As I said, integrated care boards are responsible for meeting the health needs of their individual populations, and that includes capital allocation. The 2021 spending review set aside £12 billion in capital funding, and since 2016 over £160 million has been invested in radiotherapy equipment, but of course I want to see more investment in this important technology and the necessary upgrades across England. I very much look forward to our meeting, where we can discuss that further.

Paediatric Cancer Strategy for London

11. What recent progress NHS England has made on implementing its paediatric cancer strategy for London. (906554)

Following Professor Sir Mike Richards’s review, it is now a national requirement for all paediatric cancer services to be co-located with a children’s intensive care unit. The current principal treatment centre for south London and the south-east does not meet those requirements. NHS England has launched a reconfiguration process to identify a new location, which includes a public consultation. The future centre will achieve world class outcomes for children with cancer. I would be very happy to meet Members whose constituents may be affected to discuss that further.

I am grateful to the Minister for that offer, because that would have been part of my question.

But in true style, Mr Speaker, I was hoping for two bites at the cherry. [Laughter.]

In my recent discussions with the management of St George’s Hospital, one concern about the consultation is that the specialist paediatric cancer surgical unit based at St George’s may be lost if the current proposal goes through. That would potentially affect real outcomes for a number of children. Will the Minister have a look at that and explain to me whether he is concerned about the current scoring by the NHS?

I thank my hon. Friend for his supplementary question. While I cannot pre-empt the outcome of the consultation, which closes on 18 December, I can assure him that there will be no sudden changes in the way patients receive their care. Any move will of course be carefully planned with the full involvement of current teams, and clear information will be provided for parents and families. NHS England will help as many experienced staff as possible to move to the future centre, and I can reassure my hon. Friend that that centre will build on all the strengths of the existing service and provide the best quality of care for patients.

Integrated Care Systems

Integrated care systems and the organisations within them are making real progress in understanding the health needs of their populations, setting out their plans, developing the infrastructure needed for collaboration, and bringing health and social care organisations together to serve the needs of their communities.

NHS Cheshire and Merseyside integrated care board has instructed all NHS providers to make cuts of 5% in their services. Its instruction is not being discussed with members of the public, Members of Parliament or indeed anyone, and it is clear there is no mandate for this action. Given that the Government have made great play of the NHS having more funds than ever before, I am at a loss to understand why the cuts are necessary, so will the Minister intervene to ensure that they do not happen on her watch?

NHS England determines the funding received by integrated care systems. That follows a formula which takes into account the needs of local populations, demographic deprivation and so on, and ICSs are then able to direct resources as they are best needed across those populations. Part of their value, and part of the intention in setting them up along with the organisations within them, lies in that ability to understand the health needs of local populations and direct resources accordingly.

Integrated care systems bring partner organisations together to improve health, tackle inequalities, and enhance value for money. Detailed data such as that produced by NHS Digital is critical to their work, but we learnt this week that A&E waiting times in Wales had been under-reported for the last 10 years. Does the Minister agree that without accurate data, the Labour Government in Cardiff are scuppering the attempts of NHS Wales to deliver better health outcomes throughout Wales?

My hon. Friend has made a good point about the importance of transparency and accurate data. As she said, just this week we learnt that Labour-run NHS Wales had been under-reporting its A&E waiting times. According to the Royal College of Emergency Medicine, about 45,000 patients are missing from the data. While we are working hard to improve services in the NHS in England, the Labour-run NHS in Wales is merely fudging the figures.

The whole purpose of integrated care systems is to join up social care and NHS services in a better way. We know, for example, that fracture liaison services keep 100,000 people out of hospital, but only 50% of English NHS trusts have them, and despite the commitment given by the Under-Secretary of State for Health and Social Care—the hon. Member for Lewes (Maria Caulfield—to providing more, nothing has happened, and Lord Evans has walked back from her commitment. I realise that I am pushing at an open door in directing this question to a Minister whose leg is strapped up, but when will the Government finally deliver for the “back better bones” campaign to help older people to survive and thrive?

As the hon. Member has mentioned, I have a broken ankle, and I am taking my responsibility as Minister with oversight of urgent and emergency care very seriously in making use of several of those services. As for my oversight of integrated care systems, what I am seeing is that they are making a very good job of enabling the integration of services. For instance, we are seeing real success in the growth of virtual wards—or “hospital at home”—which bring together acute and community services to look after people in their homes and help them to be discharged earlier. The NHS has achieved its target of having 10,000 “hospital at home” places ready for this winter.

Access to Primary Care

Our primary care recovery plan supports GP practices in addressing the 8 am rush for appointments, cutting bureaucracy for GPs and expanding community pharmacy services. We have recruited over 31,000 additional primary care staff and have over 2,000 more doctors working in general practice, compared with before the pandemic.

People are finding it nigh-on impossible to see their GP when they need to. Labour has pledged to guarantee face-to-face appointments when people want them by training more NHS GPs but, as my constituents point out to me, under the Tories, a two-tier healthcare system is emerging where some are forced to pay to be seen quicker while those that cannot afford it are left behind in agony. Why have the Conservatives broken their promise, made in 2019, to deliver 6,000 more GPs, and when will this GP crisis finally be resolved?

There is a two-tier approach within the UK, between what is going on with the NHS in Wales and what is going on in England. We have more appointments, more staff—over 2,000 more doctors and over 31,000 additional roles—and more tech, with £240 million invested in delivering the digital telephony and the online booking system so that we can get patients to the right level of care with an appointment as part of our commitment to 50 million more appointments in primary care.

In my constituency of Aylesbury we have some absolutely fantastic GPs and some brilliant services being delivered, thanks in part to many of the policies that have been introduced under this Government. I thank my right hon. Friend for continuing with that. However, there are still challenges for constituents to get through to their GP surgery to make an appointment in the first place. He has just mentioned digital telephony. Could he update the House on the progress that is being made on rolling out this technology to health centres to end the incredibly frustrating waits that people have, sometimes being on hold on the phone for hours at a time?

Through that £240 million, we have 100% adoption from GP practices that want to take part in receiving those funds and putting digital telephony in place if they have not already done so. This includes call-back, which allows people to know where they are in the queue, and links to online booking, which allows us to maximise the 31,000 additional roles that we have put into primary care so that people can see the specialist that they need. In my hon. Friend’s own integrated care board, appointments for July increased from 768,000 last July to 816,000 this July, so more patients are being seen, more appointments are taking place and more tech investment is going into the practices in his area.

To listen to the Secretary of State, you would think it was all going so well, so let me give him a reality check. In Tamworth last year, only a third of patients said it was easy to get through to their doctor on the phone, one in three GP appointments were not conducted face to face and fewer than half of patients were offered a choice of appointment. The Government are not listening to the people of Tamworth. Perhaps the Secretary of State would like to explain to the people of Tamworth why, after 13 years of Conservative Government, this is the case, and better still, adopt Labour’s plan to cut red tape, incentivise continuity of care and bring back the family doctor.

I am glad that the hon. Gentleman raised GPs in Tamworth. The GP lead for the Doctors Association said that his plans for general practice filled them with despair, and his proposal for GP nationalisation was mocked by the Nuffield Trust, one of the respected think-tanks. The reality is that this Government are investing in more tech in primary care, have recruited 31,000 additional roles into primary care and have over 2,000 more doctors working in primary care than before the pandemic. Those are the facts. His plans have been mocked by respected think-tanks because he talks a good game on reform but we know that he will never stand up to the trade unions.

New Health Centre: Thornbury

I am aware of the project to provide a new health centre in Thornbury and, of course, my hon. Friend’s tireless work to champion it. My officials are working closely with colleagues in NHS England and the integrated care board to help progress the scheme. I understand that he met Lord Markham earlier today to discuss imminent funding for the development of the business case, and we will be in touch in the coming days.

I am grateful to Ministers for taking the time to meet me this morning to discuss the £40 million bid for a new health centre in Thornbury, which is a growing town that desperately needs this new facility. The health centre will provide more GP appointments, more mental health support and, crucially, more out-patient services. Can the Minister update me on the timescales for the announcement on funding for Thornbury health centre so we can get this crucial facility open as quickly as possible?

My hon. Friend makes a powerful case, and I know how passionate and determined he is to deliver the new Thornbury health centre. I can assure him that my officials will continue to work closely with him, with the integrated care board and with the NHS to progress the scheme. We will be in contact in the coming days, following the meeting he had earlier today with Lord Markham.

NHS Dentistry

15. What recent steps his Department has taken to increase the availability of NHS dentistry services. (906558)

We are making NHS work more attractive to dentists. We have started to reform the contracts and create more UDA bands. We have introduced the minimum UDA value to help sustain practices where values are lower, and we are allowing dentists to deliver 110% of their UDAs. We are also reforming the rules to empower both clinicians and commissioners, for example by enabling therapists to start delivering medicines such as anaesthetics. We are rebasing contract values where they are underperforming, and we are growing the workforce with a record commitment to grow the number of dentists in training by 40%—a commitment never made by the Opposition.

UDA rates, the sum paid to NHS dentists for each unit of dental work undertaken, have long been deemed insufficient. Being based on figures from 2005, there are huge differences in rates between practices, with some receiving less than the NHS charges patients for the service. A recent 5% uplift was based on the Government estimate of a 3% rise in costs, a figure that local dentists tell me is more like 10% to 15%, compounding the losses that NHS dentists are already making. What steps is my hon. Friend taking to reform the UDA system and to stop the flow of dentists leaving the NHS?

That is exactly why we have started to reform the UDA system. As well as the introduction of the first ever minimum UDA rate, which will help constituencies such as my hon. Friend’s, we have changed the rules nationally so that commissioners can take UDAs away from dentists who are underperforming and give them to those who want to do more NHS work. As a result, nearly a quarter more NHS dentistry is being done than a year ago.

NHS Dentistry: South-west England

In addition to the steps we are taking to drive up NHS dentistry everywhere, we are going further in the south-west, with NHSE commissioning additional urgent appointments. There are several hundred extra appointments every week.

I thank my hon. Friend for his answer. It is not sustainable for the people of West Dorset who have needed dental care for some time when there is a £400 million national underspend in the dental care budget. The NHS and local dentists tell me that the incompatibility often relates to the national dental care contract, which is up for review. When does the Minister expect a solution to be found to this contract difficulty? Will he meet me and the NHS Dorset ICB to discuss the matter in detail to find a solution?

Absolutely. I am keen to continue the conversation with my hon. Friend. These issues are exactly why, this summer, we legislated to allow rebasing and to end the inflexibility he describes. We are also in the process of ringfencing local dental budgets, because we do not want to see underspends. We want to see that money going to NHS dentistry.

Cancer Treatment Waiting Times

Improving cancer treatment waiting times is a top priority for this Government, and it is a key focus of our elective recovery plan, backed by an additional £8 billion in revenue funding across the spending review period. In August 2023, cancer treatment activity for first treatments stood at 105% of pre-pandemic levels on a per working day basis, and the 62-day backlog has fallen 30% since its peak in the pandemic.

Pancreatic cancer is the deadliest type of common cancer, killing more than half of those diagnosed in England within three months. I know the pain of losing close friends and family to pancreatic cancer and how important it is that people are diagnosed and treated quickly. Under this Government we have seen NHS waiting lists go up, not down. What is the Minister doing to ensure that people with pancreatic cancer are seen, diagnosed and treated quickly?

I thank the hon. Lady for her question, and, of course, I recognise the importance of early diagnosis and treatment. Cancer checks are up by a quarter on pre-pandemic levels, and in August more than 91% of patients started their first cancer treatment within a month of a decision to treat. We have opened 123 additional community diagnostic centres and an additional 94 surgical hubs, but I accept, of course, that there is much more that we need to do.

The Minister has again been referring to “pre-pandemic levels”. Ministers have a tendency to blame covid for increased waiting times, including in respect of cancer. I presume they are aware that the number of cancer patients not getting care on time rose in every year since the Conservatives came to power before the pandemic. How can the Government defend that dreadful record?

We are continuing to support NHS England in increasing cancer treatment capacity. As I say, I recognise the importance of early diagnosis and treatment of cancer. NHS England has instructed integrated care boards to increase and prioritise the diagnostic and treatment capacity for cancer. As of the middle of this year, we have 93 additional surgical hubs that are currently operational and 123 additional community diagnostic centres, which have delivered more than 5 million additional tests since July 2021, but we know and recognise that we need to do more.

Members will know from my entry in the Register of Members’ Financial Interests that I am an NHS consultant and a member of the British Medical Association. I congratulate the Minister on the work he is doing to reduce waiting lists, but BMA strikes have led to the loss of more than 1 million appointments, have delayed the reporting of scans, including scans for cancer, and have disrupted people’s chronic long-term condition treatment. What is he doing to ensure that there are no further strikes? What talks is he having on minimum service levels to expand the provision if further strikes do take place?

I thank my hon. Friend for her question, which is better directed at the BMA. However, she is right to suggest that we are taking action on minimum service level legislation. We recognise that industrial action means that services are under increased pressure, with appointments and treatments being cancelled because of the strikes. The NHS is taking action, prioritising urgent and cancer care, and will of course continue to do so. It will do its best to maintain appointments and elective procedures, wherever possible, but she is right to say that these strikes and the actions of the BMA are having a devastating impact on patients.

My constituent Elaine Lynch was diagnosed with stage 4 lung cancer in September 2021. The drug she needs, Enhertu, is available free on the NHS to treat breast cancer, but not lung cancer, so it is costing my constituent £10,000 a month to get the treatment, without which she will die. The public petition on this matter has received more than 200,000 signatures, so it is very much in the public interest. As the company Daiichi Sankyo does not offer the drug on compassionate grounds, will the Minister meet me to see how we can make this drug available for Elaine as soon as possible, because this is literally a matter of life or death?

I have huge sympathy and empathy with the case that my hon. Friend raises. The National Institute for Health and Care Excellence is rightly independent, and strict and robust processes are in place on drug repurposing and clinical trials. Nevertheless, I would of course be happy to meet him to see what can be done.

Topical Questions

First, may I welcome Opposition Front-Bench Members to their new roles, as there have been changes since we last met? Since then, we have launched a new £30 million fund to speed up the adoption of tech across the NHS. Even when local pilots prove their effectiveness, it often takes too long for those innovations to be rolled out nationally. This fund can change that, giving integrated care systems across England the chance to invest in tech that is proven to improve care, for instance in detecting cancer sooner. These investments will be made this financial year, getting patients care faster. We are also making more than 200 more medical school places available for universities from next September, accelerating a commitment that we made in the NHS long-term workforce plan and delivering more doctors to areas that need them most.

This Government are listening to patient voices too, particularly on the importance of biological sex in healthcare. That is why, following a consultation later this year, we will amend the NHS constitution to make sure that we respect the privacy, dignity and safety of all patients. The Prime Minister has also unveiled plans to introduce a new law to prevent children who turn 14 this year from ever legally being sold cigarettes, creating the first smokefree generation. Last week, my Department launched an expedited consultation to crack down on youth vaping.

I thank the Secretary of State for his statement, particularly what he said about tech. On dental provision, I recently met with Dr Khan of Westbury Park dental practice in my constituency to discuss access to NHS dentistry, which is becoming more difficult for many of my constituents. I welcome the plans we have to increase the number of dentists and I reiterate my support for a dental school at Keele University, but those plans will take time. In the short term, there is a huge backlog of overseas clinicians waiting to take the registration exam so that they can practise here. What steps is the Secretary of State taking to expedite this?

He is right that we are taking both long-term and short-term actions. A key part of the long-term workforce plan is to boost the number of dentists being trained. In the more immediate term, earlier this year we made legislative changes that give the General Dental Council the flexibility to improve the way professionals are registered, giving more flexibility in terms of the skills mix and, for example, tripling the number of people sitting part 1 this year, so that more overseas professionals can be recognised and qualified to practise in the UK.

In Mid Bedfordshire last year, 165 children—[Interruption.] I do not know why Government Members are laughing; perhaps they should listen, as it is not our party that has let down the people of Mid Bedfordshire. Last year, 165 children in Mid Bedfordshire had teeth removed due to tooth decay. Some 800 patients were forced into A&E for the same reason and 100,000 people across the region cannot get access to an NHS dentist. Instead of laughing, the Government might like to adopt Labour’s plan to provide 700,000 extra dentistry appointments every year.

Since 2010, we have had 6.5% more dentists, a quarter more appointments and, as we have just touched on, increasing flexibility in regulation and boosting overseas recruitment. It is striking that one area of the country that the shadow Secretary of State does not want to talk about is Wales, which has a record of what a Labour Government will deliver. Indeed, the Leader of the Opposition says that he wants Wales to be the “blueprint” for what the NHS would be in England. There, this week, we have seen a fiddling of the figures on health. Even without that fiddling, we know people are twice as likely to be on a waiting list in Wales as in England—

Order. One of us has got to sit down and it is not going to be me. I let you have a good crack at the beginning, Secretary of State. Your opening statement took quite a long time, which I do not mind. I do not mind your having a go about Wales, but I am certainly not going to open up a debate between the Government and Opposition Front Benches. Topical questions are for Back Benchers and about short questions with short answers. I want it to be kept that way, so please understand that. There must be too many by-elections, because Members are getting carried away.

It is not just Mid Bedfordshire. Across the country, the No.1 reason children aged six to 10 are admitted to hospital is tooth decay. Given that, will the Secretary of State at least adopt the modest measure that Labour has proposed to introduce national supervised tooth brushing for small children—low cost, high impact—to keep their teeth clean and keep children out of hospital?

We are reforming the NHS workforce more fundamentally, looking at how we expand the roles that dental hygienists and dental therapists can perform. We are looking at how we can boost training, which is why we have made the commitment for more dentists in the long-term workforce plan, backed by £2.4 billion. How does that help? It increases the number of dentists being trained and we have a quarter more activity compared with last year.

T2.   Can the Minister confirm that the £312 million capital investment to transform the Shrewsbury and Telford Hospital NHS Trust acute hospitals is on track through the NHS approval process, with its outline business case, to enable a full business case to be concluded in the coming months so that construction can commence during this financial year? (906585)

My right hon. Friend has long championed this cause. I hope it is good news that I am able to confirm that enabling works have recently been approved for the Shrewsbury and Telford Hospital NHS Trust hospital transformation programme and are expected to commence this financial year. I can also confirm that funding has been provided for the development of the full business case and is expected to be submitted in the coming months.

New research by UNICEF UK has made clear how badly the cost of living crisis has hit the mental health of families with young children. Rising prices and services gutted by austerity have left 60% of parents feeling overwhelmed, anxious, unsupported and lonely all or most of the time. What representations has the Secretary of State made to his Cabinet colleagues ahead of the upcoming autumn statement to support families and to improve health outcomes?

That shows just how divorced the SNP line of questioning is from the reality of funding. The funding for mental health is £2.3 billion more this year than it was four years ago. We are funding 160 mental health crisis cafés and we have a programme of mental health support teams being rolled out in our schools, all of which is subject to Barnett consequentials on which the Scottish Government receive money. This Government are committed to investing in mental health. That is what we are doing. The question for the Scottish Government is why they are not getting the same results that we are.

T3. Most supermarkets practise place-based and price promotions mainly on ultra processed food—food that plays a key part in feeding the obesity crisis. How can the Government best ensure that supermarkets promote affordable, unprocessed and sustainable foods, not foods high in fat, sugar and salt, and, importantly how can we ensure that supermarkets comply with the regulations? (906586)

We have already brought in restrictions on the places that unhealthy food can be sold to stop pester power. That is on top of other measures that we are taking on obesity such as the sugar tax, calorie labelling, the extra money for school sport, and the extra facilities for young people. It is a serious issue and one on which we are taking urgent action.

I was going to ask a question about the shocking statistic of 85,000 people on the waiting list at Norfolk and Norwich University Hospital, but so poor was the Secretary of State’s response to the question of my hon. Friend the Member for Ilford North (Wes Streeting) about the dental desert that I will tell him a quick story. Ukrainian refugees who come to my constituency are travelling back to war-torn Ukraine to have their teeth seen to because there is a better dental service there than in Norfolk and Norwich. What does he have to say to that?

As I have said, we have 6.5% more dentists now than when we came to power. There is also a quarter more dental activity this year compared with last year. I understand why the hon. Gentleman does not want to talk about the investment that we are making on the elective programme in Norfolk, because it includes funding for two new hospitals in Norfolk through our new hospitals programme and significant funding into diagnostic capacity, with a number of diagnostic centres being opened in Norfolk, which he does not want to mention.

T4. My local hospital, North Tees, is tired, dated and well beyond its life expectancy, with operating theatres too small to meet modern requirements, so I was hugely disappointed that my NHS trust failed even to apply for Government funding that could have built a new state-of-the-art surgical hub on the site. Will my hon. Friend work with me to ensure that the people of Stockton get the healthcare facilities that they need? (906587)

We will always work with my hon. Friend and the trust on capital improvements where needed, but I am pleased to note that the trust has been allocated significant investment from national programmes in recent years, which my hon. Friend fought hard for, including £32.2 million from our community diagnostic centres programme, which will provide vital testing to local residents close to home, and £3 million from our A&E upgrade programme. We will of course continue to work closely with colleagues in the NHS and the local trust to continue delivering for the people of Stockton.

Ten years on from the Francis report, the National Guardian’s Office—for freedom to speak up—reports that last year there were 937 cases where whistleblowers were not listened to and experienced detriment. If we add that to 170,000 complaints, with 30,000 reaching the Parliamentary and Health Service Ombudsman, we can see that the complaints system across the NHS is defensive and dangerous. Will the Secretary of State review the NHS complaints system, and embed a listening and learning culture and early intervention?

I discussed this with Henrietta Hughes, the patient safety champion, just yesterday as part of the sprint that we have commissioned in the Department in response to Martha’s rule. We are doing considerable work with NHSE colleagues on how we better respond to the concerns of patients, whether it is through the work on Martha’s rule or the complaints process, and a significant amount of work is ongoing as part of that.

T5. The Secretary of State has seen for himself the dilapidated steam generators at Kettering General Hospital. The new £34 million net zero energy plant designed to replace them faces challenges from rising costs and new design requirements. Will he ensure that the final business case approval process for this new power plant is completed as soon as possible, so that spades can hit the ground on time in spring 2024? (906588)

Yes I will. I pay tribute to my hon. Friend for the way he has championed this issue. I have visited the hospital; I have seen it for myself. As he will be aware, the full business case was received by the Department this morning. While the cost has increased, it is still within the wider funding envelope for the scheme on that site and I will do everything I can to expedite the process as he asks.

In recent months, there was a concerted campaign from the public to prevent the closure of Park View Medical Centre in Liverpool, which was subsequently closed by the Merseyside and Cheshire integrated care board. Not long after the conclusion of the campaign, during which members of the public were turning up to board meetings, the ICB announced that 50% of its meetings would now be held exclusively in private. I for one do not believe that that is a coincidence. What would the Secretary of State’s advice be to Merseyside and Cheshire ICB on transparency and accountability, and is it not time we looked at strengthening the guidance?

The hon. Lady raises an important point. I was not aware of that decision by the local ICB. As a principle, I think we can agree across the House that greater transparency on such meetings is important, so I will follow up on that. The Government are making significant investment into Merseyside; both Alder Hey Children’s Hospital and the Royal Liverpool University Hospital have been rebuilt at significant cost as part of this Government’s commitment to investing in the NHS estate in that area.

T6. Will the Secretary of State join me in thanking the outgoing chief executive of the South Western Ambulance Service, Will Warrender? He came to join the service in the middle of covid, during very difficult times, and did a lot of work to help, and that comes after his 32 years of public service in the Royal Navy. (906589)

I am happy to join my hon. Friend; indeed, I am sure the whole House is happy to pay tribute to the exemplary public service Mr Warrender has provided, both in the Royal Navy and with the ambulance trust, and to wish him a very happy retirement.

Immunocompromised patients are facing their fourth winter without adequate protection from covid, despite a new study showing that they now comprise approximately 25% of all covid hospitalisations, intensive care unit admissions and deaths. In the last few days, some hospitals have been giving guidance to their staff that they should not even test for covid unless they are working on specific wards. After three and a half years, what are the Government going to do to put an end to this appalling situation, where some of the most clinically vulnerable patients are scared of accessing the healthcare they need for fear it could literally be a death sentence?

During the pandemic, as the hon. Lady knows, the Government prioritised the clinically extremely vulnerable and significant investment went in there. We follow the guidance from the UK Health Security Agency about the right level of infection control. More widely, we need to look at what medicine is effective. If it relates to immunosuppressants, there was a big debate in summer 2022 about that issue and we keep the science under active review.

T7. I thank Ministers for their earlier helpful replies about NHS dentistry, but I am afraid the situation in Weston-super-Mare remains extremely worrying. Local residents regularly say there is not a single local dentist accepting new adult NHS patients, and many practices have actively reduced NHS work since the pandemic. I have pushed both NHS England and the local integrated care board, but all we have so far are PowerPoint presentations rather than bookable appointments. What hope can the Secretary of State offer to Westonians who have paid their taxes, but are not getting any NHS dentistry in exchange? (906590)

My hon. Friend is right. The amount of NHS dentistry being delivered in his ICB has gone up in the last year, but we want to go further. The NHS has recently commissioned additional children’s orthodontic capacity within his ICB, but through the actions we are going to take, we will go further.

Having 100% fracture liaison services coverage in England would prevent an estimated 74,000 fractures, including 31,000 hip fractures, over five years. Will the Minister finally commit to 100% FLS coverage across England?

In the interests of brevity, I will actively look at that issue and write to the hon. Lady about it.

Core School Budget Allocations

(Urgent Question): To ask the Secretary of State for Education if she will make a statement on the 2023-2024 core school budget allocations.

As the Government confirmed in a written ministerial statement yesterday, the Department for Education has corrected an error in the notional allocations of the schools national funding formula for 2024-2025. Those allocations were originally published and notified to the House on 17 July 2023. However, the Department has subsequently uncovered an error made by officials during the initial calculations of the national funding formula. Specifically, there was an error processing forecast pupil numbers, which meant that the overall cost of the core schools budget for 2024-25 would be 0.62% greater than allocated. The Department therefore issued new national funding formula allocations on 6 October to rectify that error as quickly as possible.

The permanent secretary has apologised for the error in writing to both the Chair of the Education Committee and the Secretary of State. The Secretary of State has instructed the permanent secretary to conduct a formal review of the quality assurance process surrounding the calculation and quality assurance of the NFF, with external and independent scrutiny. Peter Wyman CBE, the chair of the Institute of Charted Accountants in England and Wales, will lead the review. Improvements have already been identified to ensure that similar mistakes are not made.

I would like to reassure the House that the error does not affect the overall level of school funding, which remains at £59.6 billion for 2024-25. The Government continue to deliver, in full, the core schools budget, which includes funding for mainstream schools and for high needs. As I said, it will remain at £59.6 billion in 2024-25—its highest ever level in real terms and, of course, in cash terms. That is a percentage increase of 3.2% compared with the current year of 2023-24. Through the schools national funding formula, average funding is £5,300 per primary school pupil and £6,830 per secondary school pupil in 2024-25, up from £5,200 and £6,720 respectively in 2023-24.

Schools have not yet received their 2024-25 funding, so the correction of this error does not mean adjusting any funding that schools have already received. Likewise, the error will not impact on the publication of a dedicated schools grant in December, or on when schools will receive their final allocations for 2024-25. The 2024-25 high needs national funding formula allocations, which fund provisions for children with complex special educational needs and disabilities, are also unaffected by the error, as are other funding streams outside the NFF, including the teachers’ pay additional grant announced in the summer.

I also clarify that the recalculation of the NFF for 2024-25 does not affect the affordability of the 2023 teachers’ pay award. There has been no change to the funding that was promised as part of the pay settlement in July and which the unions agreed meant that the pay award is properly funded. The Government recognise that the correction of the NFF error will be difficult for local authorities and frustrating for some school leaders, which is why the Department has rectified the error as quickly as possible.

Order. The Minister has taken three, nearly four, minutes. I hope that he is coming to the end of his remarks.

This is my final sentence, Mr Speaker.

The Department is working closely with school stakeholders, including unions, to communicate this change and support schools and local authorities.

Thank you for granting this urgent question, Mr Speaker. Since the House returned from the summer recess, Ministers have been forced to come here twice, first to explain how this Government left school buildings in such a parlous state that many are now at risk of collapse, and now to explain that the Conservatives are taking £370 million out of schools’ budget allocations for next year. It is shambolic, it is chaotic, and our children deserve a lot better. I am glad that Ministers have listened to Labour’s call for an independent investigation, but what is the timeline for this review? How will the review be reported to the House, and how will Members have a chance to scrutinise its findings?

We need to know much more, too. We need to know why, when the mistake was first identified in September, it was not until after the Conservative party conference in October that headteachers were finally notified. What support will schools now receive to ensure that children’s education does not suffer as a result of Conservative incompetence? Rather than blaming officials, will the Secretary of State—wherever she is today—finally take some responsibility?

We all know that mistakes happen, but this is not a one-off; this is part of a much bigger pattern of Conservative mismanagement right across the Department and right across Government for 13 long years, and it is our children who are paying the price. It is Conservative mismanagement that brought us the RAAC—reinforced autoclaved aerated concrete—crisis in our schools, that kept children at home as Ministers failed to resolve industrial action for months on end, and that is now seeing record numbers of teachers leaving the profession, attainment gaps widening and standards falling. It will fall to the next Labour Government to reset the relationship between Government, families and schools, to show once again that it is Labour that is the party of high and rising standards in our schools.

The hon. Lady refers to RAAC. We took the only decision that any responsible Government would take when the evidence changed on RAAC in school buildings that surveyors had previously assessed as not in a critical condition and we discovered it was not safe for pupils to stay in those schools. There are 174 schools so far confirmed with RAAC, which we have published details of, and we are taking urgent action to make sure that no child or member of staff in our school buildings will be at risk from this reinforced autoclaved aerated concrete—which, by the way, has been around through successive Administrations, both Labour and Conservative, since the 1950s and 1960s.

The hon. Lady refers to £370 million being taken out of the school budget. No money has been taken out of the school budget. It is £59.6 billion next year, and it will remain at £59.6 billion. What would be irresponsible would be to increase funding for schools by 0.62% solely as a result of an error by officials. That is not how Government spending systems work. It has to go through the proper value for money procedures, and that is how we always conduct our allocation of taxpayers’ money.

The hon. Lady talks about standards in schools. We are rising in the international tables. We are fourth in the world for the reading ability of nine-year-olds, according to the recent progress in international reading literacy study, or PIRLS, of pupils of that age. We are rising in TIMSS, the trends in mathematics and science study, and we are rising in PISA, the programme for international student assessment. That is in direct contrast with what happened under the last Labour Government, when we were falling in those PISA tables.

I am grateful for the apology and the letter that the Select Committee received on this issue, which we have published today. Clearly, it is deeply unfortunate that this error took place. It is a result of a complex and very difficult to understand funding system that provides schools with a lack of transparency as to how their funding works in the long run.

We were elected on a manifesto to deliver a fair national funding formula. There were plans in place to legislate for the direct funding of schools. While I welcome my right hon. Friend’s confirmation that this does not in any way affect the high needs block or take money out of the overall school budget, can he update the House on plans to deliver that direct funding formula, which, along with multi-year funding settlements, the Select Committee and the sector have been calling for over many years?

Yes, it is unfortunate, for which officials and Ministers have apologised. It is frustrating, particularly for local authorities that have to conduct their calculations—it was an error based on the coding of the pupil numbers.

My hon. Friend mentioned moving to the direct funding formula. That is the intention of the Government, and the latest edition of the national funding formula and high needs technical briefing does say that we want ultimately to get to direct funding. Many local authorities are moving their local funding formula ever closer to the approach taken in the national funding formula.

I saw a tweet to the Minister earlier this morning saying that one man’s error is another man’s total cock-up—I do not know whether that is technical language, Mr Speaker. The fact of the matter is that he is the longest-serving Minister in any Department in any Government for many years, and on his watch we have seen the demoralisation of the education sector in our country, with good people leaving. It is the Gibb factor. Why does he not resign and talk to people?

If I may say so, Mr Speaker, that was an extraordinary outburst. Today, we have the highest number of teachers in the profession—some 468,000—which is, by the way, 27,000 more than when we came to office in 2010. In Labour-run Wales, we are not seeing that rise in the number of teachers.

Naturally, this error is very disappointing, but I welcome that the Department has rectified it speedily. What steps is my right hon. Friend taking to work with school stakeholders to communicate the change and to support schools and local authorities?

My right hon. Friend is absolutely right: it was unfortunate. As a Minister, when officials gather outside my office to tell me great news about an error that has been made, my instinct is always to find out what the error is and rectify it as quickly as possible. That took about four weeks, compared with the normal six weeks to calculate the NFF, and we then published the figures as rapidly as possible. That is the approach that the Department and I have taken.

Earlier this year, the Sutton Trust reported that half of school leaders said that they had already been forced to cut back on trips and outings. That includes cultural trips to concerts and plays, which often have a profound effect on young people who would not otherwise be able to attend those events. The average secondary school is now being told that it will have around £58,000 less to spend than was announced in July—whatever the Minister says, those schools will have planned on the basis of that money. I am concerned that even fewer young people will now be able to access the benefits of cultural trips. What is the Minister doing to make sure that young people in state-funded schools still have access to cultural experiences that enrich their education?

The figures published in July were indicative figures. They are used by local authorities. Once the October census comes out with the pupil numbers, they then apply their local formula to those figures. That is the allocation that schools use for their budgeting, and that happens around December.

Over the period between 2021-22 and 2024-25, school funding has increased by 20%, so there has been a very significant increase. I agree with the hon. Member about the importance of cultural activities in schools, which is why we have a cultural education plan that is being worked on at the moment.

One reason why this Minister has been in his post so long is that successive Prime Ministers have judged him to be rather good at his job. For the benefit of the House, can he confirm that the civil servants who discovered the mistake made it known to Ministers at the first possible opportunity, and that Ministers made it known to the public at the first possible opportunity? Does that not reflect credit on our parliamentary democratic system?

I am grateful to my right hon. Friend for his kind comments. He is absolutely right: as soon as we knew about the error, I wanted to make sure that we were doing everything we could to rectify it and find a solution to the problem that officials and the Department had caused. That was my approach, and that is why we recalculated the whole of the national funding formula notional allocations as soon as we could and published that detail on 6 October.

For far too long, the Department for Education has been plagued by a litany of failures that have had a devastating impact on children, their parents and teachers. We have had the mutant algorithm and the RAAC roofs, we have a crisis in our SEND system, and now we have a bit of good old-fashioned incompetence. Does the Minister agree that it is high time that the Secretary of State offered an apology to the British public for all this, or does he think that—in her words—we should thank her for doing a flipping good job?

The last flippant comment was not necessary; these are all serious issues. Issues such as RAAC have been around in our school system since the 1950s and 1960s. When we discovered new facts and new evidence, we took swift action. There will always be almost no notice; when we have evidence, we cannot just sit on it until a more convenient time to announce it. We had to announce it straightaway. Every school with confirmed RAAC has a caseworker allocated to make sure that we are keeping children safe and keeping them in face-to-face education. So far, we have identified 174 schools with RAAC and in the vast majority of those—all but 23 schools—all the children are still in face-to-face education.

In terms of special educational needs, we published a Green Paper and an implementation plan to improve the experience of parents and children with special educational needs in our school system.

I thank my right hon. Friend for the update. Clearly, when formulas such as this are being used, it is important that they are tested first to see the results, before those are issued to the schools and other people are involved. Will he confirm that the position is that, even after this error has been corrected, all schools in this country will have enough money to fund the teachers’ pay award agreed by the Government?

My hon. Friend is right. I have to say that my experience of this particular team in the Department is that they are one of the best teams I have dealt with. This was an error made by officials. They have owned up to it and we have corrected it. It does not affect school funding at all, and it relates to the next financial year, 2024-25. It certainly does not affect this financial year, 2023-24, and the funding of the pay award. Incidentally, it is the highest pay award for 30 years. The 6.5% pay award for teachers is fully funded, with an extra teachers’ pay grant of £525 million this year and £900 million next year. It is totally unaffected by this error.

Cambridgeshire schools are some of the lowest funded in England, and they will now receive £4.4 million less than they expected. The Minister will know that local authority officials and schools will now have to spend time recalculating their budgets. What will he do to compensate them for the time they are spending on that?

The situation is unfortunate for local authorities, which will have been spending time calculating their school budgets on a local authority basis. That is why we wanted to get the recalculation of the figures done as soon as possible and out to local authorities. Cambridgeshire is funded in the way it is because we base funding on the level of deprivation in our communities. We have targeted a greater proportion of the schools national funding formula towards deprived pupils than ever before. In total, about £4.4 billion, or 10% of the formula, will be allocated according to deprivation factors in 2024-25. If an area has fewer children from disadvantaged backgrounds than other areas, that will of course be reflected in its overall ranking for local authority funding.

Last week I visited Meadgate Primary School, which is one of the many good and outstanding schools in my constituency. I am sure the Minister will recall precisely how many good and outstanding schools there are today, compared with 13 years ago. Meadgate Primary School is part of an academy trust of seven schools, and across the schools this situation could account for a £70,000 difference between what they had calculated they might expect and what they will receive.

That is obviously concerning, but also concerning is the number of children now coming in who would have had an education, health and care plan done when they were at pre-school, but did not get one because of the pandemic and now face delays. Given that high needs funding has doubled, will the Minister raise this backlog in assessments with the children’s Minister, my hon. Friend the Member for Wantage (David Johnston), to try to make sure that our primary schools are getting the support they need today for those children with SEND?

I pay tribute to my right hon. Friend for the great work that she did as children’s Minister in the Department for Education. She is right that the proportion of schools judged good or outstanding has increased. In 2010, it was 68%, and today that figure is 88%. We are not happy with that—our focus is on the remaining 12%. Every local school in our country should be a good or outstanding school.

My right hon. Friend makes an important point about education, health and care plans. She is right that the funding of the high needs budget has increased considerably over the past few years, and I will raise the issue of the backlog in EHCPs with my hon. Friend the children’s Minister. I should say that we are building significant numbers of new free special schools, so that there are more places available for children with severe special educational needs.

We know that a child growing up in an area of deprivation is on average likely to do less well through our school system. I take the point that the Minister made about extra funding for deprivation, but will he accept from me that we know that money makes a difference? When will this Government get a grip on the problem of deprivation?

Deprivation and disadvantaged children have been the core driving force of all our reforms since 2010. We are spending record amounts of money on school funding—£59.6 billion is the highest ever in cash terms, in real terms and in real terms per pupil. Before the pandemic, we had closed the attainment gap between disadvantaged children and other children by 13% in primary schools and by 9% in secondary schools. That has been undone by the pandemic, but we are determined to close that gap again. All the reforms that led to that closure are still in place, and we are confident, particularly with the £5 billion of recovery funding and the tutoring programme, that we will close that gap once again.

I welcome my right hon. Friend’s answers today, and I thank him for his leadership and his ownership of this issue, which is not his fault. He has approached it in exactly the right manner, as my right hon. Friend the Member for New Forest East (Sir Julian Lewis) said. I welcome that we are continuing to deliver the core schools budget in full, not just for mainstream schools, but for high needs. Will my right hon. Friend the Minister set out what the percentage increase for those areas will be in 2024-25, compared with this year?

On the increases in funding last year and this year, funding is increasing by £3.9 billion in 2022-23 and by £1.8 billion in 2024-25. When we combine that with the £4 billion increase we had between 2021-22 and 2022-23, that is a 20% increase in cash terms over that period.

I wrote to the Secretary of State at the beginning of August, asking for a meeting to discuss a series of special educational needs funding issues in Harrow. The Minister will be aware that special educational needs are one of the many pressures on school budgets across the country. They certainly are a significant issue in Harrow. Can he explain specifically how much schools in Harrow will now not receive, compared with what they had expected to receive? Will he encourage the Secretary of State to respond to my letter, and to do so with generosity?

I say first to the hon. Member that no funding is being reduced in Harrow. All areas will be receiving significant increases in school funding. The error is about the allocation figures—the notional figures—for 2024-25, and those have been corrected. On special educational needs, we have increased special educational needs funding significantly over the past several years, because of the pressures that local authorities are facing with increased numbers of EHCPs. We are taking a number of measures to help address that, and I will of course ensure that the hon. Member has his meeting in the Department as soon as possible.

This is yet another error and case of incompetence under this Government. The average primary school is expected to be more than £12,000 worse off next academic year and the average secondary school £57,000 worse off than under the July publication. How will the Government help headteachers in Slough and across the country deal with the extra stress and pressure on account of this error, especially when they have to make difficult decisions on staffing and additional support for those pupils who need it?

The actual allocations to schools happen in December each year in the normal way, so this situation will not affect the figures that local authorities have informed schools they will be receiving. Those are based on the October census of pupil numbers and the application of the local formula. We then fund the local authorities on the basis of the national funding. The record funding of £59.6 billion equates to an average of £5,300 per primary school pupil and £6,830 per secondary school pupil.[Official Report, 23 October 2023, Vol. 738, c. 3MC.]

The Minister’s argument in a nutshell is, “You didn’t have the money, so you’ve not lost it.” But the point is that local authorities received the notional funding allocation and were beginning to plan based on that figure given by the Government. In places such as Stockport, Tameside and Manchester, the figures that are going to be withdrawn from those areas are not insubstantial. I politely say to the Minister that his argument is incoherent—I will grade him D-minus. And his maths is appalling—I will grade him U. Can I suggest he goes into detention and fixes this matter, because schools in Tameside, Stockport and Manchester desperately need that cash?

The funding allocated for local authorities is ringfenced. This is an allocation and calculation issue—it is not that they have received the money—and we corrected it as soon as the error was made. Any Labour Members in the same position would have reacted in precisely the same way that I have.

This blunder is going to cost schools in York dear. We are already in the bottom 20 in the country for school funding and in the bottom third for high needs. I had a meeting with parents on Friday night, and 150 of them were in tears and on their knees about the SEN funding. The formulas are just not working in areas where there is low funding. Will the Minister bring forward the fair funding formula to ensure that children in my constituency with SEND have fair funding allocated to them?

I understand the hon. Lady’s points, and I share the concern of parents with children with special educational needs and disabilities. We do want to make sure that local authorities are properly funded for children with those special needs, which is why we have increased funding for high needs very significantly over the past few years. Over £10 billion is now allocated to local authorities for those children. If we look at the national funding formula, we see that 10.2% of the formula—£4.4 billion—is on the basis of deprivation factors, and 17.8% is allocated on the basis of additional needs. These are very significant sums both in the national funding formula for mainstream schools and the extra money we are giving to local authorities for high needs.

Devolution (Employment) (Scotland)

Motion for leave to bring in a Bill (Standing Order No. 23)

I beg to move,

That leave be given to bring in a Bill to amend the Scotland Act 1998 to grant legislative competence for employment matters to the Scottish Parliament.

At the outset, I draw the House’s attention to my entry in the Register of Members’ Financial Interests, as a member of the SNP trade union group and in relation to my own membership of Unite.

As this Parliament begins to draw to a close, many of us are left wondering why the much-vaunted Employment Bill never materialised. After all, we were promised that Brexit—now supported enthusiastically by the Tories and Labour—would not lead to a diminution of workers’ rights, but would instead be an opportunity to enhance employment protections. Despite countless fire and rehire incidences—many of which have been referenced by my hon. Friend the Member for Paisley and Renfrewshire North (Gavin Newlands)—ever more maternity discrimination and an assault on trade union rights by a Tory Government acting like Thatcher on steroids, the very opposite has happened.

The fact is that employment rights under this British Government are under attack. Far from dealing with workplace discrimination on issues such as the menopause, we have a Government actively and increasingly hindering the rights of workers with their Strikes (Minimum Service Levels) Act 2023. It is a piece of legislation that even the International Labour Organisation has expressed concern about. As the world of work continues to evolve and we seek to build back better from the pandemic, Brexit Britain is now on a steep decline when it comes to employment protections. However, this is an issue that extends far beyond the immediate rights available to workers, because it is fundamentally a matter of equality. The way in which we value workers in our legislative framework sets the expectation of what we should expect workplace cultures to emulate, and legislation must help build the foundations of a fair and equal labour market.

Let us take, for example, some evidence published in July by the charity Pregnant Then Screwed. Of 24,000 parents surveyed, it was found that 7% of women lost their job through redundancy, sacking or feeling forced to leave due to a flexible working request being denied. The charity estimates that, if scaled up, this would mean that over 41,000 pregnant women or mothers could be sacked or made redundant every year. Under-represented groups continue to face significant inequalities in the workplace, and I and many of my colleagues have stood here time and again calling for the enshrinement of flexible working as a day-one right, as well as mandatory gender and ethnicity pay gap reporting.

Given the powers, these are just some of the examples of workplace injustices that the Scottish Government would seek to remedy. However, it is an inescapable truth that Westminster’s crackdowns on workers’ rights—not to mention the assault on unions—have seen the UK’s global rating on workers’ rights fall. Indeed, the UK has dropped in the International Trade Union Confederation’s annual report on workers’ rights from a rating of three, which is for countries where ITUC considers there to be “regular violation of rights” to four, which is for those where it says there are “systemic violations”. Sadly, that puts the British Government on a par with the likes of Qatar and Oman. The latter is an absolute monarchy, where criticism of the Government is illegal. If that is the message the Government want to send out as Brexit Britain, it is certainly a bold move, but ITUC’s recent report is damning. It says:

“In the United Kingdom, union busting, attempts to introduce legislation curtailing the right to strike and protest, and violations of collective bargaining agreements have become systematic and led to the country’s rating dropping from three to four.”

Perhaps it is no wonder that the devolution of employment law is backed by some of the biggest trade unions in these islands, including the Scottish Trades Union Congress and the TUC itself. Only recently, the Trades Union Congress passed a motion calling for the repeal of current anti-union legislation and the devolution of employment law to Scotland. Roz Foyer, the outstanding STUC general secretary, is on record as saying:

“It’s clear, especially to any incoming UK Labour Government, that the voices of workers across the country now support the Scottish Parliament having full autonomy over labour and employment rights.”

That poses a question for our colleagues on the Labour Benches: why not Scotland? In his rush to out-Union Jack even the Secretary of State for Scotland, the hon. Member for Edinburgh South (Ian Murray) has said no, nay, never—no further devolution. Today’s vote is also a first test for the new hon. Member for Rutherglen and Hamilton West (Michael Shanks). It poses a question for him when the Division bells ring shortly: whose side is he on? Is he on the side of the Scottish Trades Union Congress, or the side of his Westminster boss in Camden?

On blocking the devolution of employment law, the right hon. Member for Ashton-under-Lyne (Angela Rayner) has come in for criticism from Michael Sharpe, a former general secretary of Scottish Labour, who has said that ruling out the devolution of employment law was a “huge blow” and

“a slap in the face to the trade unions who have campaigned for this for many years.”

Since taking over the reins as Labour leader, the Leader of the Opposition has moved ever more to the right, distancing himself from trade unions and, ironically, deciding to go on strike from attending picket lines himself. We have even had the spectre of shadow Ministers being sacked simply for having the temerity to support workers on a picket line.

The blunt reality is that Scotland is already missing out on Europe’s enhancement of workers’ rights, thanks to a Brexit we did not vote for and do not support. Post pandemic, we could have been taking opportunities to empower trade unions, increase statutory sick pay, ban fire and rehire, and do so much more for workers, but it appears once more that the Labour party and the Conservatives have landed in the exact same space.

It is clear to us that a Westminster Government of whatever colour do not have workers’ rights as a priority. It is only by giving Scotland powers over employment law that the Scottish Government can entrench workers’ rights in law and build a fair work society for all our citizens. We can and we must do so much better for our workers and our trade unions. If Westminster is not up to the job, Holyrood will take this on, and working people will be better off as a result. It is for that reason, and with the support of our trade union colleagues, that I commend this motion to the House.

Question put (Standing Order No. 23).

Levelling-up and Regeneration Bill (Programme) (No. 4)

Motion made, and Question put forthwith (Standing Order No. 83A(7)),

That the following provisions shall apply to the Levelling-up and Regeneration Bill for the purpose of supplementing the Order of 8 June 2022 (Levelling-up and Regeneration Bill: Programme), as varied by the Orders of 22 September 2022 (Levelling-up and Regeneration Bill: Programme (No. 2)) and 23 November 2022 (Levelling-up and Regeneration Bill: Programme (No.3)):

Consideration of Lords Amendments

(1) Proceedings on consideration of Lords Amendments shall (so far as not previously concluded) be brought to a conclusion at 5.00pm at today’s sitting.

(2) The Lords Amendments shall be considered in the following order: 117, 231, 237, 369, 1, 2, 4, 3, 6, 10, 13, 14, 18, 22, 30, 31, 44 to 46, 80 to 82, 90, 102, 103, 133, 134, 137, 139, 142, 156, 157, 172, 180, 199, 239 to 243, 288, 244, 249, 273, 280, 285, 327, 329, 5, 7 to 9, 11, 12, 15 to 17, 19 to 21, 23 to 29, 32 to 43, 47 to 79, 83 to 89, 91 to 101, 104 to 116, 118 to 132, 135, 136, 138, 140, 141, 143 to 155, 158 to 171, 173 to 179, 181 to 198, 200 to 230, 232 to 236, 238, 245 to 248, 250 to 272, 274 to 279, 281 to 284, 286, 287, 289 to 326, 328, 330 to 368, 370 to 418.

Subsequent stages

(3) Any further Message from the Lords may be considered forthwith without any Question being put.

(4) Proceedings on the first of any further Messages from the Lords shall (so far as not previously concluded) be brought to a conclusion two hours after their commencement.

(5) Proceedings on any subsequent Message from the Lords shall (so far as not previously concluded) be brought to a conclusion one hour after their commencement.—(Andrew Stephenson.)

Question agreed to.

Levelling-up and Regeneration Bill

Consideration of Lords amendments

I must draw the House’s attention to the fact that financial privilege is engaged by Lords amendments 46, 73 to 75, 78, 82, 231, 241, 249, 301 to 327 and 349 to 367. If any of these Lords amendments are agreed to, I will cause the customary entry waiving Commons financial privilege to be entered in the Journal.

Clause 148


With this it will be convenient to consider:

Government amendments (b) to (d) to Lords amendment 117.

Lords amendment 231, and Government amendment (a).

Lords amendment 237, and Government amendments (a) and (b).

Lords amendment 369, and Government amendments (a), (c), (b) and (d).

Lords amendment 1, and Government motion to disagree.

Lords amendments 2 and 4, Government motions to disagree, and Government amendments (a) and (b) in lieu.

Lords amendment 3, and Government motion to disagree.

Lords amendment 6, Government motion to disagree, and Government amendments (a) to (d) in lieu.

Lords amendment 10, Government motion to disagree, and Government amendments (a) and (b) in lieu.

Lords amendment 13, and Government motion to disagree.

Lords amendment 14, Government motion to disagree, and Government amendments (a) to (p) in lieu.

Lords amendment 18, Government motion to disagree, and Government amendments (a) and (b) in lieu.

Lords amendment 22, and Government motion to disagree.

Lords amendments 30 and 31, Government motions to disagree, and Government amendments (a) to (d) in lieu.

Lords amendment 44, Government motion to disagree, and Government amendments (a) and (b) in lieu.

Lords amendment 45, and Government motion to disagree.

Lords amendment 46, and Government motion to disagree.

Lords amendment 80, and Government motion to disagree.

Lords amendment 81, Government motion to disagree, and Government amendments (a) to (c) in lieu.

Lords amendment 82, and Government motion to disagree.

Lords amendment 90, Government motion to disagree, and Government amendment (a) in lieu.

Lords amendments 102 and 103, Government motions to disagree, and Government amendments (a) to (d) in lieu.

Lords amendment 133, and Government motion to disagree.

Lords amendment 134, and Government motion to disagree.

Lords amendment 137, and Government motion to disagree.

Lords amendment 139, and Government motion to disagree.

Lords amendment 142, and Government motion to disagree.

Lords amendment 156, and Government motion to disagree.

Lords amendment 157, and Government motion to disagree.

Lords amendment 172, and Government motion to disagree.

Lords amendment 180, and Government motion to disagree.

Lords amendment 199, and Government motion to disagree.

Lords amendment 239, Government motion to disagree, and Government amendments (a) to (c) in lieu.

Lords amendment 240, Government motion to disagree, and Government amendments (a) to (c) in lieu.

Lords amendment 241, and Government motion to disagree.

Lords amendments 242, 243 and 288, Government motions to disagree, and Government amendments (a) to (d) in lieu.

Lords amendment 244, and Government motion to disagree.

Lords amendment 249, and Government motion to disagree.

Lords amendment 273, Government motion to disagree, and Government amendment (a) in lieu.

Lords amendment 280, and Government motion to disagree.

Lords amendment 285, Government motion to disagree, and Government amendment (a) in lieu.

Lords amendment 327, and Government motion to disagree.

Lords amendment 329, Government motion to disagree, and Government amendments (a) and (b) in lieu.

Lords amendments 5, 7 to 9, 11, 12, 15 to 17, 19 to 21, 23 to 29, 32 to 43, 47 to 79, 83 to 89, 91 to 101, 104 to 116, 118 to 132, 135, 136, 138, 140, 141, 143 to 155, 158 to 171, 173 to 179, 181 to 198, 200 to 230, 232 to 236, 238, 245 to 248, 250 to 272, 274 to 279, 281 to 284, 286, 287, 289 to 326, 328, 330 to 368 and 370 to 418.

The Levelling-up and Regeneration Bill has had a lengthy passage. I take this opportunity to pay tribute to all my predecessors in my role and to colleagues across the Department who have shepherded the Bill to its position.

The Bill reflects the huge importance of levelling up for the future of the country. For decades, successive Governments have failed to address the inequality of opportunity in our country. Economic growth has for too long been concentrated in a select few areas. The Bill will ensure that this Government and future Governments set clear, long-term objectives for addressing entrenched geographic disparities.

The Bill will expand and deepen devolution across England. It will devolve powers to all areas in England where there is demand for it, allowing local leaders to regenerate their towns and cities and restore pride in places by creating a new institutional model more suitable for devolution to whole-county areas outside city regions that have more than one council: the combined county authority.

I do not know what the Minister is going to say about Lords amendment 14, but if she is agin it, will she reassure me that the voice of district councils will not be lost in combined county authorities, which would create a disparity of the type that she is out to remove in the Bill?

I thank my right hon. Friend for his view. I will come on to address that point substantially in my remarks.

We are modernising our planning system, putting local people at its heart so that it delivers more of what communities want. The reformed system will champion beautiful design in keeping with local style and preferences and ensure that development is sustainable and accompanied by the infrastructure that communities will benefit from.

The Bill further strengthens protections for the environment so that better outcomes are at the heart of planning decisions. I am pleased to be able to inform the House that we have reached agreement with both the Welsh and Scottish Governments on a UK-wide approach to environmental outcomes reports in part 6 of the Bill.

May I welcome the amendment that the Government tabled in the other place that will have the effect of addressing the issues I raised on Second Reading about the propensity of developers simply to clear a site in advance, with no regard for the wildlife on it at all? We had a controversial case of that happening only last week. I think the amendment will make a real difference and stop that terrible practice happening. It is a good example of the Government’s commitment to wildlife and the environment. I am grateful to the Minister.

I thank my right hon. Friend from the bottom of my heart for all the work he has done to protect wildlife both in his constituency and across the country. Hedgehogs will be a lot safer for his determined work—and not only hedgehogs but all other species of our beloved wildlife.

I will give way shortly.

We have committed to resolving a related anomaly by reinstating a devolved regulation-making function for the Scottish Government on Electricity Act 1989 consents. That was lost following the repeal of the European Communities Act 1972. Our Governments will work together to transfer functions so that powers lost in the repeal of that Act can be reinstated, using existing processes under the Scotland Act 1998.

Since the Bill left this House, the Government have made a number of amendments to improve it. For example, we have addressed the issue of the payment of compulsory purchase hope value compensation by removing hope value from certain types of schemes where there is justification in the public interest. Part 11 of the Bill has been refined in response to concerns raised by the House about the need to specify the purposes for which the new information-gathering powers may be used. To bolster the Bill’s benefits for the environment, we have reduced opportunities for incentives for site clearance before development, just as we heard from my right hon. Friend the Member for Epsom and Ewell (Chris Grayling), and included a clear requirement for plan makers to take into account the content of local nature recovery strategies.

I turn to the changes added by peers in the other place. Part 1 of the Bill provides the foundations to address entrenched geographic disparities across the UK. We have heard calls to be clearer on the third round of the levelling-up fund and tabled an amendment that adds a duty to lay a statement before each House of Parliament within three months of Royal Assent about the allocation of levelling-up fund round 3. Our views differ from those in the other place. We do not think that there is any connection between that further clarity on the levelling-up fund and the publication of the statement of levelling-up missions. Therefore, we do not think it is necessary to bring forward the laying date of the statement of levelling-up missions as proposed in Lords amendment 1.

We have been clear that the first statement of levelling-up missions will contain the missions from the levelling up White Paper. Missions may need to evolve over time and, if the detail of missions appears in the Bill, the process to adjust them in the future will become unhelpfully rigid and time-consuming. Therefore, in response to Lords amendments 2 and 4, seeking missions on child poverty and health disparities, the Government have tabled an amendment that requires the Government to consider both economic and social outcomes in deciding their levelling-up missions. That means that we retain that vital flexibility for future Governments to set missions according to the most important pressing issues of the day, while recognising that social outcomes such as child poverty and health inequalities are essential factors when deciding missions.

We are not able to accept Lords amendment 3, which would define criteria for assessing the success of levelling up, because those criteria will inevitably change as the data we have evolves. However, given the strength of feeling, I am pleased to announce that the Government can commit to publishing an analysis of geographical disparities alongside the first statement of missions. Linked to that, there have been calls for more specific reporting on levelling up and rural proofing in Lords amendment 6. We strongly agree that levelling up must work for all types of communities, not just those in urban centres.

I will just finish this remark, and I will certainly give way to my former ministerial colleague.

The Department for Environment, Food, and Rural Affairs already publishes an annual rural proofing report, which reflects the Government’s consideration of rural challenges across policymaking.

As someone proud to represent a predominantly rural community, does my hon. Friend agree that one of the best ways to level up in rural areas is by ensuring that those areas get strong devolution deals with strong local leadership?

Order. Just a little reminder that if Members intervene on a speaker, it is customary to stay until the end of their speech.

I want to reiterate my thanks to my former colleague, my hon. Friend the Member for Bishop Auckland (Dehenna Davison), who did so much to shepherd the Bill to its current position. I completely agree with her. The best way to ensure levelling up across the country is by voting Conservative, because we have done more than any other Government to spread opportunity around the country.

To avoid anything that would duplicate the work I just mentioned, we have tabled an amendment that will require the Government to have regard to the needs of rural communities in preparing the statement of levelling-up missions. That is consistent with the approach we have taken in other areas, including with respect to the devolved Administrations.

We have heard the concerns highlighted through Lords amendment 199 on access to banking facilities for communities, and we share those concerns. Branch closures are commercial decisions for banks, and we do not believe that a blanket requirement on local authorities to produce strategies to inhibit that would be effective or proportionate. Instead, the Treasury will continue to support the roll-out of alternative services, such as banking hubs, which will ensure that communities across the country have access to the facilities they need.

On Lords amendment 199, a lot of constituents have written to me with their concerns about bank closures. In West Kirby in my constituency, when the last bank closes next year there will be a banking hub, but it will not meet the needs of everyone across the constituency. Does the Minister agree that banks, post offices and so forth are incredibly important, particularly for those who are not able to or do not have the facility to access the internet and do their transactions online? Will she reconsider that position?

The hon. Lady makes some good points. As I said, we agree on the importance of those services, particularly for the rural communities that we represent. That is why we are pushing through with the other work being done by our colleagues in the Treasury, and with the banking services model.

Turning to combined county authorities, the Government have heard the strength of feeling in both Houses about combined county authority associate member voting rights, and the combined authority boundary changes. The Government are therefore content to remove the ability to vote from associate members of both combined authorities and combined county authorities, the latter of which is called for by Lords amendment 14. We are also content to accept the requirements that must be satisfied before local government areas are added to an existing combined authority for the first nine months after Royal Assent, as proposed in Lords Amendment 18. The Government have accordingly tabled amendments in lieu, which we hope the House will support.

The core feature of combined county authorities is that only upper tier local authorities can be constituent members. That principle is essential to ensuring devolution, and its benefits can be expanded to two-tier areas. The House will not need reminding of several previous devolution deal negotiations for combined authorities that have failed in these areas, despite majority support for the deal. Allowing non-constituent members of a combined county authority to become full members would undermine our efforts to address the problem in future and would reduce the effectiveness of devolution in those areas. We remain of the view that combined county authorities must engage all relevant stakeholders, and wish for district councils to have voting rights on issues pertaining to them, but they must be established at local level. Let me reassure the House that the Under-Secretary of State for Levelling Up, Housing and Communities, my hon. Friend the Member for Redcar (Jacob Young), who is next to me on the Front Bench, is having detailed discussions with districts on that point.

Given the Minister’s enthusiasm for devolution and the wish to spread investment more sensibly around the country, what extra powers will local communities have to decide what is a realistic number of new homes in any given area?

I will address that matter in due course, so I hope my right hon. Friend will allow a little patience.

I would like to reinforce what my right hon. Friend the Member for New Forest West (Sir Desmond Swayne) said about the concern at district council level that they may be sidelined in combined authorities. We have received a persuasive letter from New Forest District Council, and I would like the Minister to reassure the House that her pledge that they can vote on areas relevant to them will be honoured.

New Forest MPs are definitely speaking up for their residents today. My right hon. Friend will have seen the Levelling Up Minister next to me; he has heard that vital point. These matters must be decided locally, but I can reassure both my right hon. Friends the Members for New Forest West (Sir Desmond Swayne) and for New Forest East (Sir Julian Lewis) that their voices have been heard and those points will be considered in future arrangements.

It is our strong view that one of the core principles of local democracy is that citizens can attend council meetings to interact in person with their local representatives. There are no limits placed on authorities broadcasting their meetings online and we do not agree that councillors should be able to attend those meetings and cast their votes remotely. It is important that they are present, active participants in local democracy. Therefore, the Government are not able to support Lords amendment 22.

The Bill removes a key barrier to transferring police and crime commissioner functions to combined authority Mayors, a long-standing Government commitment. Those powers do not permit the removal of a police and crime commissioner in favour of a mayor mid-term, as some have suggested. The powers simply allow the May 2024 mayoral elections to elect the Mayor as the next police and crime commissioner for an area, where Mayors request that the election be conducted on that basis. It is to allow the proper preparation for, and administration of, those elections that the Government are seeking to commence the provision upon Royal Assent, and so we are unable to support Lords amendment 273.

Turning to planning, we have heard the strength of feeling across both Houses about the need for national development management policies to be produced transparently, with clear opportunities for scrutiny. We have therefore strengthened the consultation requirements in the Bill, to make it clear that consultation will take place in all but exceptional circumstances, or where a change has no material effect on the policies. Draft policies will also need to be subject to environmental assessment, which in itself will require consultation. That will give everyone with an interest in these important policies—the public and parliamentarians alike—the opportunity to scrutinise and influence what is proposed.

Housing provision has been raised by my right hon. Friend the Member for Wokingham (John Redwood).