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Westminster Hall

Volume 738: debated on Tuesday 24 October 2023

Westminster Hall

Tuesday 24 October 2023

[Mr Laurence Robertson in the Chair]

IVF Provision

I beg to move,

That this House has considered the matter of IVF provision.

It is a pleasure to serve under your chairmanship this morning, Mr Robertson. I start by thanking everyone who came along to the briefing on this matter yesterday, and in particular, Megan and Whitney, Laura-Rose Thorogood from LGBT Mummies, and Michael Johnson-Ellis from TwoDads UK for sharing their deeply personal stories and for the time they spent talking to MPs about this important issue.

As a mum of two wonderful boys, one of whom was conceived through IVF—in vitro fertilisation—this subject is close to my heart. Everyone deserves a chance to start a family, no matter their sexuality or gender identity. It was around 14 or 15 years ago that I started the IVF process as part of a same-sex couple. At the time, we went through unnecessary procedures, a long waiting list and significant costs, but despite the hurdles, it was achievable and my wonderful youngest son is now 13.

In the 13 years that my son has been alive, life for LGBTQ+ people in the UK has got progressively worse, and not just in terms of IVF. In many ways, life for LGBTQ+ people has gone backwards over the past decade. Homophobic and transphobic bullying is on the rise, trans hate crime has risen, waiting lists for LGBTQ+ physical and mental healthcare are through the roof, and virtually every day we see an attack on our community from this Government. From attacks on LGBTQ+ refugees to attacks on inclusive education in schools, to language outright denying trans rights, the Government have ramped up their war on woke using divisive and inflammatory rhetoric that is designed to stoke hate and distract from the mess they have made of this country, ahead of the next general election.

Ministers have failed to keep their promise to ban so-called conversion therapy in full, allowing the barbaric practice to continue. As for IVF for same-sex couples, we are still waiting for the Government to keep their promise to remove the discriminatory practical and financial barriers that LQBTQ+ couples face.

Since the IVF journey that I was part of, NHS waiting lists have become longer and the hurdles that LQBTQ+ couples have to jump through have increased. A fragmented NHS means that there is a postcode lottery for provision, and the financial cost is significantly higher. If I were starting my journey to become a parent now, even on an MP’s salary, I doubt I would be able to afford to complete the process. It is a disgrace that 14 or 15 years later, couples like Megan and Whitney still have to go through the same unnecessary fertility tests that we had to go through.

When speaking to people ahead of this debate, it has been depressing to repeatedly hear from women who have given up on their dream to become a parent because they have run out of money. LGBTQ+ people are being priced out of having a family. Lesbian, bisexual, non-binary and trans women couples are expected to demonstrate their infertility before the NHS will fund IVF. To do so, they must pay privately for up to 12 rounds of artificial insemination.

Yesterday, MPs heard at first hand from people this is having a huge impact on, including Megan and Whitney, who are here again today to listen to this debate. Megan and Whitney spoke about their integrated care board requiring them to pay for 12 rounds of artificial insemination before they would be eligible for any treatment on the NHS, which led to their decision to take their ICB to a judicial review. I have spoken to many couples who have spent £30,000, £50,000, or £60,000 on treatment, and many more have given up because they cannot afford to start the process. They have been priced out of having children. Last week, the BBC referred to the situation as a

“‘gay tax’ facing same-sex couples starting a family”.

Megan and Whitney’s legal case more than a year ago helped to prove that NHS England’s IVF policy discriminated against same-sex couples. The National Institute for Health and Care Excellence recommends that couples who have been unsuccessful in conceiving after two years should be offered three full cycles of in vitro fertilisation for women under 40 and one cycle for women aged between 40 and 42. The current requirement is that same-sex couples are expected to self-fund up to 12 intrauterine insemination cycles before they are eligible for NHS IVF treatment.

One thing that is becoming more dangerous as a result of same-sex couples having to pay for artificial insemination is the rise in people on Facebook offering their services at a low-cost price. This means that unofficial sperm donors are selling their sperm on social media sites, and that is not covered by the Online Safety Bill. It is really dangerous and exploits same-sex couples, and there are all the health ramifications to which this could lead.

My hon. Friend is absolutely right, and I will touch on that later. The guidelines are due to be updated next year. The Government have accepted that the situation is unfair and discriminatory. Last year’s women’s health strategy promised to remove the additional financial barriers to IVF for female same-sex couples in England, including removing the requirement to privately fund artificial insemination to prove fertility status before accessing NHS IVF services.

I am pleased that the Minister with responsibility for mental health and women’s health strategy is responding to this debate. In May she said:

“We expect the removal of the additional financial burden faced by female same-sex couples when accessing IVF treatment to take effect during 2023.”

On 11 September 2023, in response to a parliamentary question, she told the House:

“We remain committed to remove the requirement for female same-sex couples to self-fund six rounds of artificial insemination before being able to access National Health Service-funded treatment. NHS England are intending to issue commissioning guidance to integrated care boards to support implementation, which is expected shortly.”

We are still waiting for that guidance. The response also failed to acknowledge that, even now, some ICBs are still requiring self-funding for up to 12 rounds. With just 10 weeks left of 2023, the promise to remove the additional financial burden in 2023 will obviously not be met.

Of the 42 integrated care boards in England, only four offer fertility treatment to same-sex couples without the requirement to pay privately for artificial insemination. Ten more have said that they are reviewing their policies, but without the guidance from the Government or NHS England, there is not even a timeline for ICBs to make the changes needed. The Minister must ensure the full implementation of the recommendation from the women’s health strategy and work with NHS England to set out a clear timeline to bring an end to the inequalities experienced by LGBTQ+ couples when accessing fertility services.

In England, the NHS will fund in vitro fertilisation for heterosexual couples who have been trying for a baby unsuccessfully for at least two years and who also meet certain other criteria such as age and weight, yet even here, there is a postcode lottery for IVF. Some ICBs use the outdated tool of body mass index as a way of measuring health and refuse women IVF on the basis of their or their partner’s BMI. Some ICBs set their own criteria—that happened to one of my constituents—and refuse to offer IVF if either person in the couple already has a child with a previous partner. I hope that the Minister’s guidance deals with all those inequalities in provision.

Stonewall and DIVA’s 2021 LGBTQI+ Insight survey found that 36% of LGBTQI+ women and non-binary respondents who had children experienced barriers or challenges when starting their family. One in five of those stated that the greatest barrier or challenge was the high cost of private fertility treatment.

Stonewall’s latest research shows that 93% of ICBs are still falling short of the women’s health strategy’s target. The Government and NHS England have said that they have a 10-year strategy to tackle that. Most women cannot wait 10 years for the rules to change. For the majority of people, raising tens of thousands of pounds is impossible. The policy is making them financially infertile.

I congratulate the hon. Lady on securing this debate. As well as the point about the strategy’s length of time, there is the age of some of us in the LGBT community. The fact that same-sex marriage did not come until some of us were older, and that many of us came out later in life, means that there is a very short window for older LGBT people to take the opportunity to get pregnant or be parents.

The hon. Lady is absolutely right. Generally, couples are starting their families later, and all these barriers make it almost impossible for so many to start a family.

Many organisations have been in touch with concerns about IVF provision, such as the Royal College of Obstetricians and Gynaecologists, the British Pregnancy Advisory Service, the Progress Educational Trust, the National AIDS Trust and many more. The National AIDS Trust has been challenging discriminatory legislation that prevents many people living with HIV from starting a family.

Under UK law, people living with HIV do not have the same rights as everyone else in accessing fertility treatment. Scientific evidence has demonstrated that there is no risk of HIV transmission through gamete donation, due to advances in HIV treatment. That has been accepted for people in a heterosexual relationship. Heterosexual couples are classified as being “in an intimate relationship” by the Government’s microbiological safety guidelines, and people living with HIV are allowed to donate gametes to their partner. However, that intimate relationship designation is not available to LGBTQ+ couples, creating yet another layer of discrimination on access to fertility treatment for LGBTQ+ people living with HIV.

Yesterday, LGBT Mummies told MPs that, in some cases, when people are denied fertility funding access, they look to alternative routes, such as home insemination. Going down that route comes with physical, psychological and legal implications, which, in turn, cost the Government and the NHS more than if the treatment and chance of family creation were offered in the first place. Laura-Rose told us that although home insemination has really worked for some people, and they have a great relationship with their donor, it can be dangerous for others. It has led to inappropriate proposals to donate only if people have intercourse with the donor. As well as the health risks, if people do not use registered banks or clinics to obtain sperm, there is the possibility that a donor could later try to claim parental rights over a child.

Laura-Rose spoke about how lucky she is to be a parent, but she is still paying off the debt after incurring costs of more than £60,000. So many families she is working with are simply priced out of having a family. TwoDads UK also raised similar concerns in their briefings and contact with MPs, with Michael setting out that the inequality is pushing a community of people to take risks. The Royal College of Obstetricians and Gynaecologists told me that there is significant and unacceptable variation in the availability of NHS-funded fertility treatments in the UK, and that it strongly believes there should be equal access to fertility treatment for same-sex couples. It called on the Government and NHS England to support integrated care boards to ensure that that commitment is realised as soon as possible.

I hope that the Minister has listened to all the concerns and evidence from the many organisations I have mentioned, and others will no doubt be referenced in the debate. Ministers and NHS England can put an immediate end to the discrimination in IVF provision facing LGBTQ+ couples. It is unacceptable that the fertility treatment available for women through the NHS varies depending on where they live. The financial burden on same-sex couples is unacceptable, and we cannot wait any longer. The Government’s guidance and timetable for this to end should be published now. The Minister has recognised that the discrimination is unacceptable, and I hope to hear in her response that immediate action will be taken to remove these unnecessary additional practical and financial burdens from LGBTQ+ couples.

It is a pleasure to serve under your chairmanship, Mr Robertson. I thank the hon. Member for Jarrow (Kate Osborne) for securing this important debate about IVF provision for the LGBT community, but I think we need to talk about the whole of IVF provision across the country. This is so important, particularly in the week before National Fertility Awareness Week. We are not here next week, unfortunately, so we have to speak about it this week.

IVF has become a focal point for much of the work that I am doing in Parliament, ever since I received disturbing correspondence from a constituent. She told me her story and when I looked into it, I found that it resonated with women across the country. She was working in the financial sector and had had a very successful career for 20 years. She decided to use IVF to get pregnant because of her fertility issues. After complications, her employers discovered that she was undergoing IVF treatment, and from that day onwards, they put pressure on her to move from the UK to Switzerland for her job, which meant she would not be able to continue with her IVF treatment.

My constituent made the really difficult decision to leave her job. She went to an employment tribunal and ended up getting a non-disclosure agreement. She has not been able to speak publicly about her experience and the unfairness that so many people face when it comes to IVF provision, whatever their sexuality or gender, and that is why I have taken up her case.

Unfortunately, stories like that are repeated too often across the country. To make matters worse, the issues relating to the availability of treatment—the inability of people to access it due to work commitments—are countrywide. Work commitments are not the only constraint on accessing IVF treatment. For example, the availability of treatment has, for years, been based on where an individual lives. However, 2023 has provided us with reasons to be hopeful for the future: for the first time in over a decade, all areas of England now have access to NHS-funded facility treatment. But as we heard from the hon. Member for Jarrow, that does not always mean that people can get instant access to it. It is vital that we end the postcode lottery that has been established in this country when it comes to accessing IVF treatment.

The NHS estimates that one in seven couples may be struggling to conceive, and obviously, for the LGBT community that is higher because of same-sex marriages. I have always said that infertility does not discriminate. It does not matter what a person’s background is. I have heard some really emotional testimony from people from ethnic minorities who have struggled even further in this country because of egg donation, and who have to go to Nigeria, in particular, to get their eggs. We have to widen the understanding of how people from ethnic minorities in the LGBT community struggle even more than same-sex white couples in this country. That is why it is so important to have this debate.

There are, of course, many in the LGBT community who will suffer from infertility, but the reality is that, as a starting point, it is not necessarily the infertility that is the issue; it is that we are same-sex. Does she recognise that the guidelines are based on infertility rather than recognising the unique nature and differences of various LGBT families?

Absolutely, and I will come on to that point. It is always about infertility, is it not? It should be about fertility and fertility treatment.

According to the UK fertility regulator—the Human Fertilisation and Embryology Authority—it takes, on average, three cycles of IVF to achieve success. I would like to praise the regulator for its recent announcement— I think from last week—regarding its grading of supplementary fertility treatment to help individuals and couples to determine what is a proven treatment and what is safe and cost-effective. That is most welcome, and I have had so many people come to me over the past year or so saying that the cost of IVF can be added on to all the time. In particular, people in clinics say, “Oh, you should have this scan” or “You might need to have this blood test—it might prove more successful.” When a person is in that situation, they will do anything they can to get pregnant. The costs do add up, so I am really pleased that the HFEA has released that guidance. I hope clinics across this country will take note.

Nevertheless, fertility treatment is still an emotionally draining, costly, risky and very long process. Undergoing treatment while juggling a job is particularly tough, regardless of gender or sexual orientation. Unlike employment legislation on pregnancy, maternity and paternity, there is no enshrined legislation that compels employers to give time off work for fertility treatment or any initial consultation. The Equality Act 2010 was well intentioned and removed some forms of discrimination in the workplace, but unfortunately it does not help to prevent discrimination against those who are pursuing fertility treatment, as it does not class infertility as a disability. For example, most workplace protection policies exclude elective medical procedures, putting fertility treatment on a par with cosmetic surgery.

Last year, I introduced the fertility workplace pledge. While my private Member’s Bill, the Fertility Treatment (Employment Rights) Bill, has faced its difficulties progressing through the House, the fertility workplace pledge that I launched asks businesses to sign up voluntarily to provide employees undergoing IVF treatment with the support and the time off they need. We have consistently seen new businesses signing up over the past year, including the likes of Channel 4, Aldi and NatWest—even the Houses of Parliament have signed up to become a fertility workplace ambassador. More and more businesses are signing up, and there are now several a week. I ask hon. Members to encourage employers in their constituency to look at the fertility workplace pledge and consider signing up. If we can do this voluntarily rather than through employment law, all the better, because it changes the debate, the discussions and the attitude towards fertility treatment.

The hon. Member is making a brilliant speech; I thank her for all her work in this area. One of the problems is that the societal stigma around fertility treatments persists and is quite vicious and vocal. Infertility is not seen as a disease, and it is not seen as something with equal weight to other conditions. We need to change this in schools. There has been a lot of talk today about the Government’s sex education programme. In school we are taught how not to get pregnant, but we are never told that we might not be able to get pregnant. There are serious conversations to be had about how to change the cultural stigma around fertility treatment. That starts with education in schools.

The hon. Member makes a very good point. On sex education in schools, it is imperative that we teach our children about all types of relationships, including same-sex and heterosexual couples, at an age-appropriate time. In my opinion, four and five-year-olds need to be taught about same-sex couples as much as about heterosexual couples. I really hope that that goes ahead—but I digress.

I want to pay tribute to all the organisations that have been helping me on my fertility workplace journey: Fertility Matters at Work, Fertility Network UK, TwoDads UK and many more whose help has unquestionably been vital to push towards the fertility workplace pledge and improve access to IVF for everyone.

As we have heard, there is one particular group who can benefit greatly from IVF and deserve equal access. The LGBTQ+ community are reliant on IVF to have their own biological children. I was pleased to hear the Government promise to make access to fertility treatment fairer last year. For too long, many in the LGBTQ+ community have faced what has been labelled the gay tax. This is because LGBTQ couples have to pay privately for their first six to 12 rounds of artificial insemination to prove their infertility, which would then grant them access to NHS IVF treatment or, as the hon. Member for Livingston (Hannah Bardell) said earlier—

I remind the hon. Lady—not to boast too much, but to share positive experiences—that that is only in England in Wales. People in Scotland do not have to go through that process.

I thank the hon. Lady for pointing that out. It is not often that Scotland is ahead of England on the NHS. I am delighted to hear that.

I acknowledge that the change in policy will take time to implement. However, I ask the Minister to look into speeding up support to our LGBTQ communities. Such support is needed desperately in this area. They should not have to wait longer even than heterosexual couples.

Ultimately, I believe that we are on the cusp of real progress in access and attitudes. As the hon. Member for Pontypridd (Alex Davies-Jones) made clear about attitudes towards IVF, it is important that we break down the barriers from as early an age as possible. I know that the Minister is as passionate as I am about supporting individuals as they decide to go through fertility treatment. I therefore see it as vital that we all work together to bring down the remaining few barriers to make IVF treatment a viable option for everyone and anyone who wishes to start their own family, and to make it as stress-free as possible.

It is a pleasure to speak in this debate. I thank the hon. Member for Jarrow (Kate Osborne) for raising the issue of IVF provision and setting the scene so well. I will raise some examples from my constituency, where IVF treatment issues have had a detrimental effect on ladies who wish to have a family, with costs and financial implications for their lives, which have been changed in dramatic ways. A number of my constituents have contacted me about the issue over the years.

I am ever mindful that the Minister present does not have responsibility for the figures or the subject matter in Northern Ireland, but there is a real anomaly that I have to put on the record. I always bring a Northern Ireland perspective to these debates, as everyone knows. I do so because I hope to add to the conversations that we are having and perhaps show where the shortfalls are.

This important issue has an impact on many parents daily—it is indeed daily—and it is a pleasure to speak about it as my party’s spokesperson on health issues. Nothing is more precious than the gift of life. It is awful that for so many it is a struggle, so it is great to have the opportunity to debate, discuss and request further provision of IVF across the United Kingdom.

I will first highlight some differences between the mainland and Northern Ireland to add perspective to the debate. It was recently brought to my attention by a young constituent going through the process of IVF that on the mainland a person whose BMI is 35 can access medicated ovulation support, but in Northern Ireland it is 30. Sometimes that request is difficult for people in Northern Ireland to achieve. On the mainland, too, a person whose BMI is 30 can qualify for IVF, but in Northern Ireland it must be 25. Again, the criterion set in Northern Ireland is more stringent and difficult to achieve than that on the mainland. That is not the Minister’s fault, but it provides perspective for the debate.

Many women in Northern Ireland have stated that the BMI issue is by far the biggest, and it leaves them with a feeling of sheer inequality. We have a clear issue of inequality in the system. Some of my constituents have come to the mainland to get IVF treatment. It can have a significant cost for them, which cannot be ignored. Why do they have to have a lower body mass index and be smaller to achieve the same fertility treatment as their English counterparts?

There is definitely an equality issue to be addressed. The hon. Member for Jarrow set out inequality in the system, and I support what she said. I reiterate the clear inequalities that my constituents face in comparison with those here. It is also worth mentioning that a woman suffering from polycystic ovary syndrome will struggle to lose weight at the same pace as someone who does not have PCOS.

There is already a prolonged process in place before people even achieve the criteria set back home. In England, according to NICE, women under 40 should be offered three rounds of NHS-funded IVF treatment if they have been trying unsuccessfully to start a family for two or more years. In Northern Ireland, it is only one round, and if the person or their partner has prior children, the entitlement is zero. As the hon. Member for Jarrow set out, the inequality is very apparent. Additionally, given that the chances of success vary depending on age, one round can be completely worthless in some cases. Unfortunately, some of the ladies who have come to me over the years have put themselves into debt in excess of a five-figure sum just to have a child, and the treatment may not be successful. Some of them are still paying the money back, and they have not had the child they sought to have in their life. It really is frustrating.

The Stormont Executive committed in 2020 to increase the number of funded cycles for a woman to have a baby. However, this is purely dependent on the money that Northern Ireland receives under the Barnett consequentials. Financial capacity restraints are the reason why the change has not been implemented. In this afternoon’s Westminster Hall debate on the future of NHS funding, I will highlight the issue of IVF funding and how it affects my constituents. We cannot expect to have a sustainable NHS if we do not make the effort to fund it properly.

I understand that capacity is different in Wales, where women are able to have only two rounds of IVF treatment. The fact that women in Scotland and England get three is completely unjust, as those in Northern Ireland get only one. It is a clear example of how we continue to be left behind, and it demonstrates the inequalities in the system for us in Northern Ireland.

NHS funding for IVF cycles varies considerably across the United Kingdom. In 2021, Scotland had the highest rate of NHS-funded IVF cycles, at 58%, compared with 30% in Wales and 24% in England. I know that the hon. Member for Livingston (Hannah Bardell) will give the figures for Scotland; I commend the country for achieving that percentage. Let us give it credit for doing so, because we should all be trying to achieve that.

The figures for Northern Ireland are not available, although I have sought hard to get them. I have written to the Department of Health back home to see whether they can be accessed, so hopefully I will have them in the next week or two. Self-funding is not always an option for couples due to the sheer cost of the process, but it is important to note the comparison.

Every time a lady undergoes an IVF cycle and is not successful, anxiety, depression and disappointment creep into the process. Then she might do it again and again. I know of one lady who has had IVF treatment at least five times, but it has never been successful. I feel for ladies who are keen to have a child and who go through the cycles of IVF treatment but are not successful. I believe that children make a marriage or a relationship. They might sometimes stress parents out but, at the end of the day, children are a bonus and a pleasure to have. I am pleased that at least some of us have had that opportunity.

I urge the Minister to take my comments into consideration and to discuss these matters with the Department of Health in Northern Ireland. I seek the Minister’s input; she always responds with compassion and understanding, which we appreciate. In relation to where we are in Northern Ireland, will she accept my request to have discussions with the Department of Health back home and see whether there is some way we can work together better to help my constituents and those across Northern Ireland who do not have funding for IVF? We must allow people in Northern Ireland the same right as those in the rest of the United Kingdom, and implement NICE’s recommendation to have three cycles of IVF for women struggling to conceive.

I wanted to make this small contribution to the debate, because it is important that we share our experiences. For those in Northern Ireland whose IVF treatment has been successful, the experience has been wonderful, but for many people it has not. The inequalities are clear.

It is a privilege to serve under your chairship this morning, Mr Robertson. I thank all colleagues for their contributions, which really have been excellent. This is the best of Parliament. I particularly congratulate my hon. Friend the Member for Jarrow (Kate Osborne) on her fantastic speech and on securing this vital debate.

It is fair to say that we are living in difficult times, with a huge range of issues facing us as parliamentarians, from healthcare to education and from energy prices to job insecurity. They all have an impact on our constituents up and down the country, but there is absolutely no reason why fertility and IVF provision—issues that clearly impact so many people—should not take centre stage.

It has been genuinely fascinating to meet and hear from so many families impacted by infertility and access to fertility treatment, including some who are here today. The brilliant Megan and Whitney Bacon-Evans, Michael Johnson-Ellis from TwoDads UK and Laura-Rose of LGBT Mummies are some of the many who have campaigned hard on this issue for many years.

As we have heard, one in six couples suffer issues related to fertility. My IVF journey began in 2018, and I have been open that I knew right from the start that my road to pregnancy would not be easy. I am certainly one of the lucky ones—I was able to take out a loan and borrow from family to pay for my treatment, and after only one round of IVF I was blessed with my beautiful son Sullivan—but I still had many eye-opening experiences during my fertility journey that have led me to this point today. Ask anyone who has experienced IVF, whether personally or from watching loved ones go through the process, and they will say that IVF is one of the most emotionally, mentally and physically challenging and financially demanding processes that anyone can ever undertake.

We must be clear that the current state of the IVF and fertility treatment offering across the UK is far below what would-be parents deserve. It is vital that we right those wrongs that I am many others have experienced at first hand as IVF patients. The main issue, as has been discussed today, is the sheer lack of consistency across the UK in IVF services and provision. I was incredibly fortunate because I was in a position to pay privately for my IVF and because my partner already had two children from a previous relationship, although that meant that we suffered from what we call the step-parent tax. It should not have to be that way.

As we all know, the NICE fertility guidelines are crystal clear; we have heard them this morning. The NHS should offer women under 40 three full cycles of IVF if they have been trying for a child for more than two years. When policies and cycles offered are so different between integrated care boards, and do not take same-sex provision into account, that means that women and would-be parents across the UK are not being offered IVF services in a fair and transparent manner. That is an incredibly important point, made even more complicated by the huge discrepancies between fertility treatment providers in the data they publish.

Colleagues may be aware of my private Member’s Bill, the Fertility Treatment (Transparency) Bill, which is due to have its Second Reading on 24 November. The Bill will

“require providers of in vitro fertilisation to publish information annually about the number of NHS-funded IVF cycles they carry out and about their provision of certain additional treatments in connection with in vitro fertilisation”.

Those add-on treatments, as we have heard from the hon. Member for Cities of London and Westminster (Nickie Aiken), have been offered to patients who are at their wits’ end and will do absolutely anything to improve their chances of having a child. I know their pain, because I was one of them. That is why I work closely with the HFEA, the Progress Educational Trust, Fertility Network UK and many others in the fertility sector who are concerned that many patients are frequently being offered and charged for optional extras to their treatment that claim to improve their chances of having a healthy baby, but are really exploiting people at their most vulnerable.

I was particularly pleased to see last week that the HFEA launched a new rating system to support patients undergoing fertility treatment. Patients are offered add-ons that claim to increase the success of treatment, but for most fertility patients the evidence to support that is missing or not very reliable. The HFEA add-ons rating will help patients to make better informed decisions about their treatment, although it is still only guidance and clinics have the right to ignore it. There is no right to enforce it: as we have heard, the HFEA as a regulator has very few teeth for enforcement. I urge the Minister to look at the issue more carefully and ensure that the regulations are being adhered to and that clinics are adopting the guidance. The new rating system, developed with patients and professionals in the fertility sector, has five categories giving detailed information for patients on whether add-ons increase the chances of success, along with other outcomes that also have an impact on miscarriage rates.

Although I welcome the progress, the wider issues on accessing IVF persist and we clearly have a long way to go in improving the situation. The Government’s women’s health strategy was a good starting point, but sadly we have still not seen any commitment on concrete action to improve access to IVF and fertility treatment. The strategy was published more than a year ago and was an opportunity for the Government to finally take some direct action, but instead it is once again clear that IVF is not an immediate priority.

I know that the Minister is listening. She has made her position very clear in previous debates on this subject, and I thank her for that engagement, but I sincerely hope that her colleagues in the Department and across Government are also listening and are taking the issue seriously. We have heard the strength of feeling this morning. I know that the Government are listening and that the Minister is listening; I just urge some direct action.

It is a huge pleasure to serve under your chairship, Mr Robertson, and I sincerely thank the hon. Member for Jarrow (Kate Osborne) for bringing forward this debate. She spoke beautifully and eloquently about her experiences; it enhances debate when Members, like the hon. Member for Pontypridd (Alex Davies-Jones), bring their own personal experiences.

It is very clear that there is unanimity, which does not happen often. I trumpet and champion the positive equality and the better standards that we have in Scotland, but I would love to see those standards rolled out, so that they were the same throughout the UK. It is not about political point scoring; it is about genuinely working together and sharing best practice. However, although it is significantly better in Scotland, we still have arbitrary limits across the board on the age when women are offered IVF. That is global—not just in the UK.

A recently-published report showed that, for the first time since the second world war, more women in their 40s than women in their 20s are having children. That is just a reality. There are all sorts of reasons for that—the cost of living crisis, the cost of accommodation, women’s career paths and the lack of childcare. All Governments in the UK are trying to do more around childcare and I recognise those challenges, but the reasons are varied and complex.

A Conservative Member recently said that more people need to have babies. I will not mention the Member, as I have not given due notice. It was an offhand comment and it rightly came in for a lot of criticism because of the intent. However, there is an irony there in that some on the Government Benches are saying that, yet we need more action from the Conservative Government. They need to reflect on that. They should look at the reasons why we have a stagnant birth rate and fewer people having children, and at what more can be done.

We have heard, particularly from the hon. Member for Jarrow, about the issues with the women’s health strategy: it is ambitious and the guidance is good, but it is not mandatory. We need it to be. We need to move away from the pot-luck nature of treatment, particularly in England and Wales. I was struck by the briefing, which led through the different levels of care, all the different boards across England and Wales and how challenging that must be for people—not just LGBT people but anyone seeking fertility treatment.

The hon. Member for Jarrow also spoke about the outdated BMI criteria and how those can vary. That is particularly challenging as well. Women’s bodies come in all shapes and sizes and for all different reasons. We must recognise that. The hon. Member for Strangford (Jim Shannon) also spoke about that issue in relation to Northern Ireland: that arbitrary line is discriminatory. We need to remove the discrimination and those barriers.

The hon. Member for Jarrow also spoke about those with HIV and how they are being discriminated against, and both she and the hon. Member for Pontypridd talked about black-market sperm. Members may remember the 2017 BBC Three documentary. I watched it and was horrified. It showed LGBT couples and female same-sex couples searching the internet for donors and often facing quite dangerous situations. In 2023, people who so desperately want to have a family and to have children should not be forced into those situations. It is unthinkable.

Someone very close to me has been through several rounds of IVF. It cost her tens of thousands of pounds. She talked to me about going to a fertility fair in London, and all the different stalls and what an amazing experience that was in her journey; but a man came up to her and, in the middle of the fair, handed her a note with his phone number and a really inappropriate message, basically trying to push himself on to her to offer his sperm. She reported it and that person was removed, but that is a truly shocking story, showing just how predatory some men can be in such situations.

We also have to recognise that there are a lot of incredible men out there who donate their sperm and make it possible for others to use it, and there are also incredible women who donate their eggs. Such people make it possible particularly for those in the LGBT community but also heterosexual couples to have children.

It is a particular privilege to be able to represent Scotland’s approach to IVF, which, as I said, I am extremely proud of. Not only are we providing a higher proportion of NHS-funded cycles of treatment, but that means that the ability to have a baby is less affected by income.

There are particular challenges for LGBT couples, but I think we are pioneering some work in relation to those challenges. In addition, one of the things that happens if there is more standardised NHS treatment is that the clinics across Scotland—in Edinburgh, Glasgow, Dundee and Aberdeen; I think that is correct—collaborate, whereas when people are moving around, particularly in the private sector, they find that those private clinics keep their pioneering work—I am afraid to say—to themselves. I am sure that there is some collaboration, but that seems to be the case.

So, under the SNP-led Scottish Government, we have become a “gold standard” for IVF treatment. Those are not my words but those of Sarah Norcross, the director of Progress Educational Trust, which is an independent, London-based charity that advocates for people affected by fertility issues.

I must say that this is an area where the priorities of the Scottish Government and those of the UK Government are different. I hope that the UK Government will follow our lead; if they did, I am sure that my colleagues in the Scottish Government would be happy to share their experiences and best practice. Ms Norcross said that in Scotland IVF services were

“as good as it gets”.

The UK Government obviously have a different standard. So, as I say, I hope that this is something that we can share best practice on.

I also recognise that, as has already been mentioned by other hon. Members, the briefing yesterday by Megan and Whitney, LGBT Mummies and TwoDads UK was particularly powerful. It was really stark about the challenges that our community—I say this as a member of the LGBT community—has to face.

However, I also have heterosexual friends who have been through IVF. I have one friend who was fortunate enough to have her first baby through natural means. However, for various reasons she then went on to have secondary infertility. She cannot get fertility treatment on the NHS in Scotland. We will offer it to blended families. So, in the situation of the hon. Member for Pontypridd, I can tell her that if she had lived in Scotland, she would have been entitled to treatment. However, if someone has one child and wants to have more children with the same partner, unfortunately they would not be entitled to treatment. That is something that we need to look at in Scotland. Blended families are very much the norm now. If it is the case that someone has a child, or they and their partner both have children from previous relationships, and they are unfortunate enough to experience secondary infertility, they should have access to fertility treatment.

NHS-funded cycles in England decreased in number from 19,634 in 2019 to 16,335 in 2021, which is a 17% reduction. Covid will undoubtedly have played a part in that. In Wales, the number of NHS-funded cycles decreased from 1,094 to 704 over the same period. In Scotland there was a slight decrease, of just 1%, in that period.

In England, treatment is much more likely to be outsourced to private clinics, even when the costs are covered by the NHS, which has a serious negative impact on overall services. Fertility experts have pointed out that the major reason that fertility care in Scotland is so consistently excellent is that there is the collaboration that I mentioned.

I have also heard from a number of people I have spoken to that people are going abroad for fertility treatment. It would appear that they are going to clinics in Europe because the service there is better. That IVF tourism, as some people call it, is cheaper and seems to be better than the treatment here in the UK, but we do not want people to have to go abroad for that reason; we want people to be able to have their babies here.

The hon. Member for Cities of London and Westminster (Nickie Aiken) spoke very powerfully about her work in workplace fertility support. That is interesting, because a lot of people will not want to disclose information about their fertility, or they will not feel comfortable about doing so unless their employer is being open. I have perhaps a slightly different opinion from that of the hon. Member. Of course businesses should just provide such support, but businesses have a lot of pressure on them, and sometimes legislation can be the precursor or the catalyst for changes in behaviour and lead to the provision of real, solid support for people who are going through things such as IVF treatment.

Obviously, National Fertility Awareness Week is coming up; however, it was Baby Loss Awareness Week just the other week. I know somebody who, having gone through expensive fertility treatment, only managed the one embryo transfer, which unfortunately did not work. It can be very upsetting when an embryo transfer does not work, no matter the person’s sexuality.

I thank LGBT Mummies for the excellent job it has done on briefings. I will briefly go through its asks for the LGBT community, which include equal and equitable access, national mandated funding policy and provisions for all LGBTQI people. As the hon. Member for Jarrow powerfully highlighted in her speech, the LGBT community is facing discrimination and attacks like never before, including the removal of health services, which is something we all have to reflect on and look to improve. Its asks also include personalised fertility care and education for staff—something I have experienced myself, in the language health practitioners use and in their understanding of the different healthcare requirements of the LGBT community. They also include access to funded medication and tests for home insemination, co-produced funding provision with the community, and the ability to create our families safely by our chosen routes—not being forced down a route.

The difference in Scotland is that we do not have to go through those IUI cycles, but a challenge we have across the board is the arbitrary two-year timeline, where people have to have been in a relationship for two years. I do not know of anywhere where we say to heterosexual couples, “Don’t be having a baby until you’ve been together for two years.” We don’t do that, do we? So why are we doing that to LGBT people? That really does not make any sense.

Briefly, I want to reflect on my personal experience. I had a partial failed attempt at IVF with a former partner—I will not go into the details—but I did not start my journey until after I turned 40. I now regret that, because I am 40 and I will get only one shot, rather than three. I am only at the very beginning. I want to highlight to the Minister that piece about those of us who came out later in life. When I came out at 32, most of my friends were getting married and having kids, or already had kids, and I was just working out who I was. One reason that I did not come out earlier was that I so strongly wanted to have a family, and I did not think that would be open to me if I was gay. Equal marriage came much later in life for many people. Like many of us who did not start life as their authentic self, as some people say, until much later, I have felt like I am perennially playing catch-up, and I have now decided to just do it on my own. I do not know where my journey will take me, but I know there is a lot of support out there, and a lot of incredible people.

I am in a very fortunate position, but not many are that fortunate. As we have heard, people are going to the black market and putting themselves in massive debt; we should not be putting anybody in that situation. I hope the Minister will hear the calls from across the House, and I look forward to working with colleagues on this very important issue.

It is a pleasure, as always, to serve under your chairship this morning, Mr Robertson. I congratulate my hon. Friend the Member for Jarrow (Kate Osborne) on securing this important debate, and thank her for championing such an important issue so eloquently today. She talked about the barriers that LGBTQI+ couples face to having children, particularly being priced out, and the fact that while the guidance is good, more work needs to be done.

I thank Megan and Whitney for sharing their hard-hitting story, along with many others who have done so much work to ensure that we are informed about these challenges. I know that there was an urgent briefing yesterday on IVF provision. I am sure everyone will agree with me that this has been a good debate, and that it is clear that a number of changes need to be made for the sake of equality and fairness.

I also thank the hon. Member for Cities of London and Westminster (Nickie Aiken), who has clearly done a lot of work in this area, for talking about the barriers that individuals may face in the workplace when undergoing IVF treatment. She mentioned businesses signing up to the fertility workplace pledge. The hon. Member for Strangford (Jim Shannon) spoke about how the IVF process was impacting his constituents and, as always, gave a helpful picture of the situation in Northern Ireland. I also thank my hon. Friend the Member for Pontypridd (Alex Davies-Jones) for sharing her personal story and for her work on the private Member’s Bill, the Fertility Treatment (Transparency) Bill.

As we all know, becoming a parent can be a special and rewarding time for many people. It is the start of an exciting journey into parenthood and a time to celebrate new life. However, as we have heard, there are many challenges that women and families face when conceiving and many challenges in the way of those who seek NHS fertility treatments. As my hon. Friend the Member for Jarrow powerfully said, the challenges—both financial and emotional—for LGBTQ+ couples are so much higher. IVF is one of several techniques available to help people become pregnant. This medical procedure has transformed countless lives, providing hope and the possibility of parenthood to those who might otherwise never experience it.

While IVF is a celebrated medical advancement, the lack of accessibility and the inequality of provision in England and across the UK are issues that cannot and should not be ignored. The National Institute for Health and Care Excellence is responsible for making recommendations about who should have access to IVF treatment on the NHS in England. The current guidelines for England recommend that IVF should be offered to women under the age of 43 who have been trying to get pregnant for two years, as has been mentioned. The exact NICE recommendation is three full cycles for women under 40 and one full cycle for women aged 40 to 42. While in some areas women under 40 can access three cycles of IVF, in other areas they are offered one or even none.

For example, in 2020, the British Pregnancy Advisory Service used freedom of information requests to find out that 86 clinical commissioning groups—now ICBs—funded only one cycle of treatment. More concerningly, it found that three CCGs in England did not provide any funding for IVF services at all. In fact, only 23 CCGs funded three cycles as recommended by NICE.

Unsurprisingly, the provision of IVF services across England, as pointed out by my hon. Friend the Member for Jarrow, has been described as a postcode lottery. I am sure we all agree that this is not right, that the policies are unfair and out of date, and that they must be updated as soon as possible.

I want to tackle the important issue raised by my hon. Friend about the need to break down barriers for all couples. As Stonewall has highlighted in its campaign on this issue, LGBTQI+ couples face incredible financial costs to achieve the same outcomes as everyone else. While the women’s health strategy pledged to remove financial barriers for female same-sex couples in England, the statistics prove that little progress has been made. According to Stonewall’s research, only four of the 42 ICBs in England officially provide NHS funding for artificial insemination, and nine in 10 ICBs in England still require same-sex couples to self-fund at least six cycles of intrauterine insemination before they are eligible for IVF treatment on the NHS. As the Minister will know, that means that LGBTQI+ couples are forced to go privately and end up paying large sums of money—thousands or even tens of thousands of pounds— before they can access NHS fertility services.

I agree with the crucial point that the Government must commit to tackling inequality in access to NHS-funded fertility services. ICBs should ensure fair access to treatment for all, and ensure that individuals within the LGBTQI+ community, including lesbians, bi women and trans individuals, are not left behind but have the same access to NHS-funded care. However, sadly, going private is now not the last resort but the norm for all individuals in England. In recent years, fewer and fewer women can access IVF treatments on the NHS, with everyone else having to go private. In fact, the use of privately funded IVF cycles by patients across the UK aged 18 to 34 increased to 63% in 2021 from 52% in 2019. That coincides with a fall across the board in numbers of NHS-funded IVF cycles. It is a damning result, highlighting the lack of support available on the NHS for women in the UK. Women are being forced to go private, and parents and families up and down the country face the added financial burden.

The Government must acknowledge that one of the main reasons for the falling levels of provision has been the extraordinary waiting times that women face prior to starting treatment. As the Royal College of Obstetricians and Gynaecologists has shown, although waiting lists were growing too quickly before the pandemic, the impact of the pandemic has made the situation significantly worse. There is an urgent need to reverse the growth of NHS waiting lists in gynaecology, and to ensure that women can access high-quality, timely care and treatment. I know that the Minister and this Government have committed to tackling those extraordinary waiting times, and I hope that she can update us regarding their progress on this critical issue. We all know that the quicker women are seen, the better the outcome will be.

Another critical factor is non-clinical access criteria, where mothers and parents can be denied access to treatment because of their relationship status—as pointed out by my hon. Friend the Member for Jarrow—their body mass index, or the fact that one partner has a child from a former relationship. The women’s health strategy seeks to remove non-clinical access criteria to fertility treatment, and to address geographical variation in access to NHS-funded fertility services. We on the Labour Benches welcome that ambition, but we know, as do the Government, that it cannot be realised without providing the NHS with the staff and resources it needs. As part of the work, the Minister has said that her Department will work with NHS England to assess fertility provision across ICBs, with a view to removing non-clinical access criteria. Can she confirm the extent of her conversations with NHS England and update Members on the timeline for making the changes?

For far too long, women and their partners have faced unnecessary obstacles to accessing IVF treatment. The Government have had 13 years to address those problems. Instead, I am concerned that they have weakened standards for patients, who are paying more tax but getting worse care. On the important issue of provision of IVF treatment, I welcome the ambitions outlined in the women’s health strategy. I hope that, along with Megan and Whitney’s powerful story, the Minister has been listening to hon. Members, especially my hon. Friend the Member for Jarrow, who has made it clear that the reforms need to happen sooner rather than later.

I urge the Minister to assure us today that there will be full implementation of these aims, and to give us a timeline for when they will occur. I urge her to give us hope that there will be an end to the postcode lottery, and to the inequality in provision faced by so many individuals and partners across England and the UK.

It is a pleasure to serve under your chairmanship, Mr Robertson. I thank the hon. Member for Jarrow (Kate Osborne) for tabling this important debate, and all Members across the Chamber for their contributions. It has been a positive debate—a good example of putting politics aside and debating how to do the right thing. While I am not denying the challenges for the LGBT+ community raised by the hon. Member, I want to highlight that the Government have brought in major changes over the years with the introduction of same-sex marriage, and the transformation of the management of HIV with the roll-out of opt-out testing and PrEP treatment.

I am pleased to announce that, following the advice from the Advisory Committee on the Safety of Blood, Tissues and Organs, the Government will be introducing secondary legislation to allow the donation of gametes by people with HIV who have an undetectable viral load; we will be introducing that as soon as we can. We will also be addressing the current discriminatory definitions of partner donation, which result in additional screening costs for female same-sex couples undergoing reciprocal IVF; again, amendments through statutory instruments will be introduced as soon as possible.

Those are some of the measures that we have been working on, but I absolutely understand from what I have heard today that there are many issues still to be dealt with, and I welcome the hon. Member for Jarrow holding my feet to the fire to deliver change. Hopefully some of these updates will provide reassurance. This is a priority area, which is why IVF, fertility, and particularly same-sex access to IVF, were in the first year of the women’s health strategy, and it is why we are not going to wait for the 10 years of the strategy to introduce the changes.

To be clear, the Government are implementing a policy that no form of self-financed or self-arranged insemination is to be required for same-sex couples to access fertility treatment. I acknowledge that is taking a little while to be rolled out across the country. Hon. Members, especially the hon. Member for Pontypridd (Alex Davies-Jones), have spoken about infertility a lot. We absolutely recognise that it has a serious effect on individuals and couples, which is why it is a priority—particularly for the women’s health strategy.

As the hon. Members for Strangford (Jim Shannon) and for Livingston (Hannah Bardell) pointed out, I can only speak on the provision of IVF in England, but I am very happy to work with colleagues in the devolved nations of Scotland, Wales and Northern Ireland to achieve a consistent approach. Although we are dealing with the inconsistencies in England, if we are a United Kingdom, these matters need to be addressed across all four nations and I am not precious about stealing best practice from other parts of the UK.

In our call for evidence for the women’s health strategy, women told us time and again that fertility was a key issue and that they felt very frustrated about the provision of, and access to, fertility treatment. Colleagues have made a number of important points which I will respond to in turn, but it has been recognised that there has been unequal access to IVF in England since the treatment was introduced; that is why this is such an important issue. There is resistance in some parts of the country to the changes the Government want to make, but I think we will be able to make progress on them.

NICE is reviewing its fertility guidelines, taking account of the latest evidence of clinical effectiveness. These will be published next year and we will be working with NHS England to implement these guidelines in England quickly and fairly. I am told that they will end regional variation and create a compassionate and consistent fertility service across England, but that does not mean that we cannot improve services in the meantime.

As has been set out, integrated care boards are now responsible for delivering IVF services. They were previously determined by CCGs, but from July last year the 42 ICBs across England are now responsible. Since the ICBs were created, we have seen a levelling up of IVF provision in many. Where CCGs have come together, ICBs have often adopted the higher rate of provision, rather than the lowest level. That is to be welcomed, but by no means does it mean that the level of provision is where we want it to be. Some, but by no means all, ICBs, including in north-east London and Sussex—I declare an interest as a Sussex MP—are now fully compliant with the current NICE guidelines and the provision of three cycles. Others are improving their integrated offer, but some ICBs have kept their pre-existing local offer. That is not good enough, and we are aiming to tackle it.

What conversations has the Minister been having to make sure that ICBs are currently being updated to be as robust as possible?

I will go through that. One of the first things we have done is to be transparent about what is being offered. We have asked every ICB—the whole 42—to detail their provision. We are now publishing that on, so if is entered, the table will come up. That illustrates the number of cycles offered by every ICB, the age provision, the previous children rule and what funding is offered for cryo-preservation. That is not just to say, “This is what’s on offer” so that women and couples can see what is available in their area; it is also the start of the process of holding ICBs’ feet to the fire—and for local MPs to be able to say, “Look, they’re offering free cycles in Sussex; why are we not offering that in our local area?”

The Minister may be about to get to this point, so I apologise if I have intervened too quickly. In terms of transparency, it is great that the Minister is publishing the data, but what are the Government doing to make sure that more work is being done by ICBs to provide a better—or adequate—service, given that publishing data does not require them to take any action?

As the hon. Lady will know, it was only last year that we published the women’s health strategy. IVF was front and centre of that—the first year priority. Getting that information is the first step, and then we are able to look at the ICBs that are not offering the required level of service, have those conversations about why and have a step change to improve the offer. That is just one tool in our box to fulfil our ambition to end the postcode lottery for fertility treatment across England.

Colleagues have also raised the issue of lack of information about IVF, both for the public and healthcare professionals. We are working closely with NHS England to update the NHS website to make IVF more prominent, and also with the royal colleges to improve the awareness of IVF across healthcare professions. One area we are dealing with is that of add-ons, which the hon. Member for Pontypridd (Alex Davies-Jones) and my hon. Friend the Member for Cities of London and Westminster (Nickie Aiken) addressed. As part of our discussions with the HFEA, it now has the add-on rating system, so that people can see what percentage difference an add-on would make and make an informed choice about whether they want to do that as part of their IVF treatment.

I have also just received the HFEA’s report about modernising the legislation, with particular regard to its regulatory powers. That will cover the provision of add-ons, and I hope to be able to respond to the report as quickly as possible. We are making really big changes to some of the issues that have been holding back IVF for a long time. I know that for many people this is not quick enough, but I reassure hon. Members that progress is being made.

For female same-sex couples and same-sex couples across the board, I know that this is a really important matter. I took the position that it was unacceptable for female same-sex couples to shoulder an additional financial burden to access NHS-funded fertility treatment. On the transparency toolkit now on the website, we can easily see which parts of the country are asking for six cycles of self-funded insemination, for instance. In Cambridgeshire and Peterborough it is 12 cycles, in Bristol and north Somerset it is 10. As the hon. Member for Erith and Thamesmead (Abena Oppong-Asare) said, that is exactly the information we need so that we can tackle the issue head-on and directly with the ICBs. Indeed, one of our key commitments in the women’s health strategy was to remove this injustice once and for all. We were hoping to do that completely in the first year; it will in fact take us a little longer, but it will not take us 10 years.

It is certainly comforting to hear that, but I urge the Minister to supercharge that work, so that female same-sex couples and, indeed, the trans community can make sure they can access that. Will the Minister say something about surrogacy, because I know that across the UK—though, again, we have somewhat better standards and access in Scotland—there are still major challenges, legal and otherwise, for male same-sex couples accessing surrogacy?

The Law Commission has recently produced a report on changes to surrogacy, which we are in the process of responding to. It will address some of the issues raised today. The Government’s position is to abolish the requirement for female same-sex couples to undergo six cycles of self-funded treatment before they can access NHS-funded treatment. We have been clear that the NHS-funded pathway should now offer six cycles of artificial insemination followed by IVF to female same-sex couples, giving everyone access to NHS-funded fertility services. Some ICBs are doing that already, but others have delayed implementation, and that is what we want to focus on now. We are clear that that needs to be urgently addressed, because same-sex couples’ expectations have rightly been raised and the service has not met them swiftly enough. I take that on board from the debate today and reassure colleagues that that is a priority.

To accelerate action, NHS England is developing advice to assist ICBs. I hope they will be able to share that soon. I will share that with the House as soon as it is available. When it is published, we expect ICBs to update their local policies. There should be no further delay and no waiting for NICE guidelines when they are published next year. ICBs must urgently address all local inequalities in access to fertility treatment. There is a reason that IVF was made a priority in the women’s health strategy and a reason it was a priority in the first year.

Our health service pioneered the use of IVF in the 1970s. It is a great British invention that should be available to every couple who want to start a family, because the Government back women and families and the accessibility of IVF to those who need it. I look forward to the hon. Member for Jarrow continuing to hold my feet to the fire until we have delivered the change—deliver it we must.

I thank everyone for their valued contributions and support for this important issue. I am pleased to have been able to secure this debate ahead of National Fertility Awareness Week. I thank the hon. Member for Cities of London and Westminster (Nickie Aiken) for an excellent contribution and for all the work she has done on fertility and employment practices, and for highlighting the disproportionate impact on black and minority ethnic women who need fertility treatment.

I apologise to the Minister for not being here at the start of this debate on a subject that is very important to me. I echo the concerns about the dangers of the current system, which may drive same-sex couples towards potentially unsafe methods, such as seeking sperm donors who might not be known to them. I have friends who have experienced that very thing. If not married or in a civil partnership, the donor will be considered the legal parent of any children, giving him rights over and responsibilities for the child. The safety of sperm is also a concern as the donor might be less likely to have their health and medical history fully screened, which is important.

I thank the hon. Member for her intervention. In my contribution I touched on the unsafe and inappropriate online advances facing same-sex couples, which the hon. Member has just raised, as did my hon. Friend the Member for Pontypridd (Alex Davies-Jones). Megan and Whitney told us yesterday of horrific, very detailed, explicit and inappropriate proposals that they have received online, and many other couples have reported the same. In 2023, we should not be forcing desperate women to turn to black market sperm and be pushed into tens of thousands of pounds of debt.

I thank the hon. Member for Strangford (Jim Shannon) for describing the situation in Northern Ireland and adding to the concerns that I raised around the inappropriate use of BMI as a factor in deciding IVF provision, particularly how BMI is different for people with PCOS. I would add other conditions such as lipoedema. BMI is not an adequate measure to deny people IVF. Indeed, I believe that BMI is not an adequate measure in pretty much anything.

I thank my hon. Friend the Member for Pontypridd for sharing her story, for highlighting financial risks taken and the concerns about regulatory practices in fertility clinics, and for her incredibly important private Member’s Bill.

One other condition or disease that has not been spoken about is endometriosis. Endometriosis sufferers often have a terrible time conceiving and face significant challenges. I hope the hon. Lady will recognise that we must include them in all our conversations.

I absolutely agree that we should include those sufferers. The hon. Lady’s own contribution to the debate was incredibly powerful. She shared her personal story and pointed out how much better the situation is in Scotland, although improvements can always be made. She rightly pointed out that people are going abroad for treatment. TwoDads UK made that point eloquently in our briefing yesterday.

My hon. Friend the Member for Erith and Thamesmead (Abena Oppong-Asare) spoke about the need to end the postcode lottery, with that additional emotional and financial toll. I am pleased the Minister confirmed that she will remove discrimination against HIV as soon as possible through secondary legislation. I hope that “as soon as possible” means imminently and that we are not still talking about this in a year’s time.

The Minister mentioned the HFEA and changes to regulation. The 2021 guidelines for fertility clinics highlight the need for improved understanding of consumer law and how it applies to clinics and patients. The guidance significantly improves the availability of knowledge of the topic, but it still misses out conditions and vulnerabilities faced by same-sex couples and transgender people, so I look forward to receiving her update.

I am glad that the Minister welcomes me holding her feet to the fire on discrimination in provision for IVF. I will continue to do so. She said that it has taken a bit longer than she would like—but not 10 years. I want to see an urgent timeline from her. The inconsistency in IVF provision across the UK is unacceptable. We must end the postcode lottery for fertility treatment and the unacceptable financial burden on same-sex couples. As has been pointed out today, many women cannot wait any longer.

Question put and agreed to.


That this House has considered the matter of IVF provision.

Sitting suspended.

BBC Commissioning: Oversight

I beg to move,

That this House has considered the oversight of BBC commissioning.

It is a joy to serve under your chairmanship, Mr Robertson. I will start by using a number of quotes from the BBC that are directly relevant to the topic. On editorial integrity and independence, the BBC describes itself as

“independent of outside interests and arrangements that could undermine our editorial integrity. Our audiences should be confident that our decisions are not influenced by outside interests, political or commercial pressures, or any personal interests.”

On fairness, the BBC says:

“Our output will be based on fairness, openness, honesty and straight dealing.”

Finally, on transparency, the BBC says:

“We will be transparent about the nature and provenance of the content we offer online. Where appropriate, we will identify who has created it and will use labelling to help online users make informed decisions about the suitability of content for themselves and their children.”

Those principles have been burning issues at the heart of the BBC for several years. For example, the salaries of the BBC’s highly paid employees were a closely guarded secret for a long time. That was indefensible even if some of those employees were not questioning others who were also paid out of the public purse, but the double standards jumped out at the viewing and listening public when they regularly probed others yet hid behind BBC executive decisions when asked about their own salaries. That position was gradually worn down, and now there is an annual disclosure without the mass exodus of talent that the corporation had used as a defence when it resisted disclosure.

Now that one issue of transparency regarding directly paid salaries has been largely resolved, we have the overlapping issue of payments made by the corporation for the commissioning of contracts, particularly when contracts are awarded to private companies owned or partially owned by several BBC presenters.

There is one player on the Northern Ireland commissioning pitch whose commissions have been paid millions of pounds in revenue for years. It is now nearly 10 years since the company Third Street Studios first received commissions. Third Street Studios was owned entirely by a BBC presenter, Mr Stephen Nolan, until last year, when a leading bookmaker in Northern Ireland became a person with significant influence in the company. According to the Belfast Telegraph, Stephen Nolan

“transferred all shares in his production company to a firm solely controlled by bookmaker Paul McLean.”

The director general of the BBC has indicated that he is favour of all the outside interests of employees being made public. Why would money earned by an employee who also has his own company, which bids for and gets numerous commissions for programmes, not also be disclosed?

The issue of fairness is relevant here, as a number of companies from the independent sector make excellent and innovative programmes but find it difficult to compete when, as regularly happens, a highly paid BBC employee gets commissions and is then able to advertise them on their own BBC radio programmes. That obviously puts someone from the independent sector at a disadvantage when the next round of bidding for commissioned programmes begins. If the BBC insider, due to excessive advertising on their own behalf, can point to good audience figures and claim they are best positioned to get yet another contract, the independent sector is likely to lose out.

I commend my hon. Friend for securing this debate. In previous debates I have raised a number of issues that were slightly different but nonetheless important. Does my hon. Friend agree that although there seems to be an unending budget for investigatory programming, the programming for diversity—in the form of Ulster-Scots programming or Christian shows and episodes—has been cut back beyond recognition? A rebalance of interest needs to take place. Does my hon. Friend accept that point, to which I have brought his attention in the past?

Yes, indeed. There has to be diversity in the range of directions that the BBC gets involved in. It is equally important that when programmes of the type my hon. Friend mentioned are commissioned, there needs to be transparency in how they are contracted and shown.

I have raised these issues previously, in debates on transparency in 2017 and on commissioning in 2019. In between those debates, I met senior BBC executives in both Belfast and London. I also met senior executives from the Audit Office and Ofcom to try to ensure that matters would be thoroughly investigated. Movement either ground to a halt or went exceptionally slowly. I get the impression that, just like with the salaries escapade, the BBC feels that if it can grind the process down, the issue will eventually go away. It did not manage that with salaries, and I intend to ensure that it does not with the commissioning of contracts. It is important that licence fee payers can see how much has been earned, the process followed, and how it is discharged—with the responsibility of oversight being within the ambit of the BBC.

On transparency, I understand the arguments about the commercial sensitivity of contracts, but what can the commercial sensitivities possibly be many years after a commission is broadcast? Even the Government have moved from a 30-year rule to a 20-year rule on the publication of documentation, but the BBC still seems to live in an age in which it believes we should never know how much it costs the licence fee payer to fund such an outstanding series as “The Fall”, which was filmed in Belfast and funded in part by Invest NI and Northern Ireland Screen. Series three was commissioned by the controller of BBC 2.

“The Fall” was sold in over 200 countries: in the United States via Netflix; in Australia via BBC First; in Canada via Bravo; in Latin America via DirecTV; in Brazil; in the Republic via RTÉ; across Asia via Fox international channels; and with a multi-territory deal in Germany. It had all the hallmarks of a tremendously successful project funded by the licence fee payer and carried out by the BBC. Why, then, are the details not available, as they are for any other publicly funded project? The commission was broadcast seven years ago and we still do not know how it was done.

The simple message I have for the BBC and the Government today is that if public money is used, every effort should be made to ensure that there is integrity in the system for spending it. Secrecy leads to suspicion; if there is nothing to hide, there should be no secrecy.

I come now to employees’ declarations of interest. Previously, I raised a case in which a BBC journalist in Northern Ireland was involved in presenting an investigative programme that was critical of elements of policing. After the programme was aired, I discovered that several years earlier the same journalist had been a serving police officer. She had appeared in court, had been bound over to be of good behaviour, and had left the police shortly after. That was an obvious case in which a BBC executive should have taken a prior decision about the suitability of someone like that fronting a programme that was “critical of policing”.

Viewers were of course unaware, at the time of the broadcast, of the journalist’s previous history. I mention that because similar types of issues could well emerge if commissioned programmes were to deal with, for example, the topical matter of addictive gambling and Premier League football clubs, many of which have huge gambling companies as sponsors on their shirts. How would a conflict of interest be handled if such issues were to be dealt with by a company in which a leading bookmaker had a controlling interest?

I come now to integrity. During the summer recess I was given a large volume of disturbing internal BBC material, including some from human resources and some text messages between production teams. Most seriously, I received a disturbing and alarming piece of information. The public need to have confidence in the commissioning process, because some of the processes are worth hundreds of thousands—indeed, in some cases millions—of pounds. We have to have confidence in the BBC’s internal processes when projects are awarded.

I have been given an account of a BBC internal process: an interview for a highly sought-after job in the production team for “The Stephen Nolan Show”. For context, this was a widely listened-to radio show in Northern Ireland at the time, and to work on the programme was a highly prized and much sought-after position. Indeed, a number of notable people in the Northern Ireland media sector applied for the role. Only one person was successful, while at least 10 internal and external candidates lost out.

But the process was rigged. It was not fair and lacked integrity, because the unsuccessful applicants did not necessarily lose out because they were unprepared for the interview process. They lost out because, unlike with the winning candidate, the presenter did not ring them up and give them the interview questions in advance, nor were they treated to a nice meal by the presenter before the interview.

A former BBC employee is prepared to come before this House and testify in Committee that Stephen Nolan corrupted a BBC recruitment process by giving one applicant the interview questions in advance and coaching them on how they should answer questions. I can further inform Members that in October 2018 this former employee wrote to the then BBC Northern Ireland director, Mr Peter Johnston, and told him about the corruption of the process. He is unaware of any investigation or action. The alarming thing is that that same Mr Peter Johnston now leads the investigation into the complaints against Russell Brand here in London.

This is appalling. These are not the actions of what was once a proud bastion of truth and integrity, informing, educating and entertaining without fear or favour. Truth and integrity demand a thorough investigation, with Government Ministers telling the director general that he needs to act, and he needs to act now.

It is a pleasure to serve under your chairmanship, Mr Robertson. I congratulate the hon. Member for East Londonderry (Mr Campbell) on securing the debate and on raising what are important matters. I know that he has campaigned on this issue for many years. I have read his previous debates and parliamentary questions on the subject, and he has been assiduous. In a number of areas, I have considerable sympathy with him. I have been overseeing the BBC for a very long time in one capacity or another, and a number of the issues he raised are ones on which I, too, campaigned.

There are three issues on which we have made great progress, and for which I would like to take some credit, but I absolutely recognise the hon. Gentleman’s role. All the issues relate to the area of commissioning. The first is the National Audit Office’s access to the BBC. The extent to which the NAO was able to examine the BBC’s financial accounts was limited for quite a long time. As he knows, the BBC argued strongly that the NAO should not be given full access, with a succession of what I regarded as somewhat spurious excuses, such as that it would somehow interfere with the BBC’s independence from the Government. Well, the BBC is independent of the Government, but that does not mean that the BBC should not be held to account for the fact that it spends a very large amount of public money in the form of the licence fee. I am glad that, in the charter, we ensured that the NAO had full access to the BBC accounts.

The second matter is on the commissioning of programming. Previously, the BBC produced 50% of its content in-house. It was subject to a quota for indie productions of 25%, and then there was something known in the trade as the window of creative competition, or WoCC, which was the remaining 25% that could be opened up to either BBC in-house production or the independent sector. We reached the agreement that the BBC should move towards opening up the entirety of its schedule to competition from BBC production and independent production. The BBC is on track to achieve 100%, I think by 2027, which has provided a huge boost to the independent production sector. It was very strongly welcomed at the time by the Producers Alliance for Cinema and Television, the body representing independent producers. Opening this up does mean that the BBC’s public money, through the licence fee, is being used to commission programmes from private companies. That obviously needs to be done in a transparent and accountable fashion, which is one of the requirements of the charter, as the hon. Member for East Londonderry quoted.

The third area, which we also addressed in the last charter renewal—I, too, have campaigned on this issue and the hon. Gentleman also raised it—is transparency over the payment of public money in the form of salaries to high-earning BBC employees. Initially, the BBC resisted very strongly, believing that it would make it harder for them to recruit and that it would somehow give an unfair advantage to their competitors, but eventually, the BBC agreed to this at a higher threshold than was ultimately introduced. Actually, the Prime Minister who appointed me to oversee the task, David Cameron, agreed to that higher threshold, but when my right hon. Friend the Member for Maidenhead (Mrs May) became Prime Minister, she insisted on bringing it back down to £150,000. It has risen in line with inflation, so I think the figure for the publication of salaries is now £178,000.

The publication had an unforeseen consequence, as the hon. Member for East Londonderry mentioned. When I insisted on the publication of information about individuals earning high salaries, for the reasons that he gave, I did so on the basis that I thought it right that the licence fee payer should know where large amounts of the money were going. We did not realise that it would also expose the shocking gender pay gap between the salaries of men and women doing essentially the same jobs at the BBC. It had the consequence of making the BBC address that issue as well, and that was a very good demonstration of why transparency is so important.

The hon. Gentleman went on to talk about the way in which the BBC has to publish the names of its employees directly earning money over a certain threshold, but a number of people obtain payment from the Government through the intermediary of a private production company—a number of individuals have set that up. I agree with him that it is not entirely satisfactory that one person who earns a large amount of money from the BBC has their name published, and another does not, just because the way in which the BBC pays them is done through a slightly different route. I hope that is something we will continue to look at. I raised the issue when I was chairing the Culture, Media and Sport Select Committee, and I have raised it since, and I hope the BBC will continue to look at ways in which it can increase transparency, which is the right way forward.

The charter increased the level of independent oversight of the BBC by bringing in Ofcom as an independent regulator. We have a system whereby complaints about the BBC go first to the BBC, but can then be escalated to Ofcom. The Government does not get involved in that process. I think that is right, and for that reason, I cannot directly respond to some of the hon. Gentleman’s specific complaints. Those are for the BBC to examine. I agree that he has raised some important matters that I hope the BBC will look at, and indeed that Ofcom could investigate as well.

The hon. Gentleman will be aware, as is written into the charter, that the Government said there would be a review of the governance arrangements—called the mid-term review—that needs to be completed by 2024. We will publish the outcome of that very soon actually. While I cannot reveal that at this stage, I can say that one of the areas that has been raised with the Government a number of times, and which the hon. Gentleman raised again today, is the way in which the BBC has dealt with complaints and the fact that so few have been upheld. The Government’s view is that that process needs to be strengthened. We will have more to say about how we believe it can be strengthened—the BBC has agreed that it should be strengthened—when we publish the mid-term review.

I am grateful for the Minister’s attendance and for what he has just shared. A perception arising from some issues that my hon. Friend the Member for East Londonderry (Mr Campbell) raised is that some people in the BBC are too popular to be criticised, too successful to be touched, and too important in the ratings game to have issues raised about their conduct. Some of the points that my hon. Friend made touch on questionable, if not corruptible, practices around commissioning and around individuals and their behaviour. The Minister is right that Ofcom is there for when the BBC has completed its investigations, but Ofcom looks very particularly at regulatory matters. He mentioned the ongoing review, but can he give us any assurance that there will be a level of stringent and independent oversight in the BBC and through its management structure, so that when such issues are raised, which touch on malpractice or questionable practice around the allocation of financing and the commissioning of resources, the public and we all know there is integrity in the process of investigating them?

I am grateful to the hon. Gentleman, and I agree that nobody who is in receipt of public money or who holds a senior position in a publicly owned and publicly funded organisation should be exempt from scrutiny to make sure that they are carrying out their functions properly, and that any concerns around that need to be investigated.

As for whether anybody is too popular or too senior to be examined or held to account, the hon. Gentleman will be aware that the highest-paid BBC employee is Gary Lineker, and there has been quite a lot of controversy over some of his remarks. That is absolutely right and, as a consequence, the BBC has recently carried out a further consideration of their social media guidelines for highly paid staff and has brought those into play, partially as a result of some of those controversies. That matter is very different from the kind of issues that the hon. Gentleman raised. They relate to allegations that have been received about possible corrupt behaviour, and, obviously, that would also need to be investigated. The particular show that he referred to is presented by the fourth highest-paid person at the BBC. That, again, is another reason why a large amount of public money is spent, and we need to be satisfied.

As I said, this is not a matter that the Government can or should investigate, but there are independent bodies that do so. The first port of call I suggest the Gentleman might talk to is the BBC board member for Northern Ireland, Mr Michael Smyth. He was recently appointed and has taken up his post. Part of his role is to oversee the BBC’s activities in Northern Ireland, as well as to act as a member of the board as a whole. I am sure the hon. Gentleman will draw his concerns to Mr Smyth’s attention, and also take advantage of the BBC first complaints process.

I hear what the hon. Gentleman says about the individual who runs the editorial standards and guidelines committee, but there are also independent board members who sit on that committee. He could certainly draw his concerns to their attention. Ultimately, as we have discussed, the NAO has full access under the charter. If there are concerns about the way in which public money has been spent, that, too, is a matter that the NAO could investigate.

I do not in any way suggest that the hon. Gentleman has not raised some serious concerns; I hope they will be examined to his satisfaction. I think he is best placed to pursue them through the routes that I have suggested, but I am grateful to him for raising these matters this morning.

Question put and agreed to.

Sitting suspended.

Future of the NHS

[Mark Pritchard in the Chair]

I beg to move,

That this House has considered the future of the NHS.

It is a pleasure to serve with you in the Chair, Mr Pritchard. I am grateful for having been granted this debate, and I thank Members for attending.

The highly respected professor of epidemiology and public health Sir Michael Marmot said earlier this year:

“If you had the hypothesis that the Government was seeking to destroy the national health service—if that were your hypothesis—all the data that we’re seeing are consistent with that hypothesis.”

When asked if we are stumbling or sleepwalking towards a privatised healthcare system, he added:

“I have no special insight into what motivates Ministers, but they are not behaving as if they want to preserve our NHS”.

A few months ago, Professor Philip Banfield, the British Medical Association’s chair of council, said:

“This government has to demonstrate that it is not setting out to destroy the NHS, which it is failing to do at this point in time…It is a very common comment that I hear, from both doctors and patients, that this government is consciously running the NHS down.”

Professor Banfield also commented that the NHS is in a state of “managed decline” because recent Governments have made “a conscious political decision” to deny it adequate resources and not to tackle staff shortages. I think that he is absolutely right.

Legislative change brought in by the Conservative-Liberal Democrat coalition Government in 2012, and by the Conservatives in 2022, fragmented the NHS and increased opportunities for privatisation. The Health and Social Care Act 2012 allowed NHS foundation trusts to, in effect, earn 49% of their income from treating private patients, and the Health and Care Act 2022 allows representatives of private companies to sit on integrated care partnerships and so play a part in preparing the integrated care strategy for an area, influencing where huge sums of public money will be spent.

It is underfunding, however, that is proving to be the Conservatives’ greatest tactic when it comes to undermining the NHS. The report “The Rational Policy-Maker’s Guide to the NHS”, published in July by The 99% Organisation, presents statistics based on research by Appleby and Gainsbury on the average annual change in per capita health spending by UK Governments since 1979, adjusted for population and demographic factors. The stark differences in commitment to the NHS along party lines are clear to see.

Under Labour between 1997 and 2010, there was an average annual increase in per capita health spending of 5.67%. Between 2010 and 2015, the Conservative-Liberal Democrat coalition Government oversaw an average annual reduction of 0.07%. Between 2015 and 2021, under the Conservatives, there was an average annual reduction of 0.03%. This Conservative Government’s committed spend up to 2024 represents an average annual increase of just 2.05%.

Put simply, Labour in government has increased per capita health spending on average significantly more than Conservative Governments. Public satisfaction levels have reflected the success of that approach. Public satisfaction in the NHS was at its highest, at 70%, in 2010, the year Labour left office. In 2022, after over a decade of Conservative government, it fell to a record low of 29%. It is no coincidence that satisfaction plummeted following more than a decade of the Conservatives’ being in power and failing to give the NHS the funding it needs.

“The Rational Policy-Maker’s Guide to the NHS” uses respected international data produced by the Commonwealth Fund in 2014 to show that, among the countries studied, the UK’s has often been the best-ranked healthcare system for effectiveness, equity and efficiency. The report also demonstrates how the UK’s spending on healthcare, which by 2009 had caught up with that of many of our peers, has drifted back far below the average for a developed-world country. For example, we spend less as a percentage of GDP than Canada, Sweden, Belgium and the Netherlands.

Our spending has not kept pace with the combination of inflation, population growth and population ageing. If we continue to underspend, performance will continue to be poor. Nigel Edwards, the chief executive of the Nuffield Trust, points out in the foreword to the report that

“the inability of too many of those in policy-making circles to recognise that underfunding the NHS—quite apart from any moral arguments against it—is not an economically sustainable strategy. Since 2010, the focus has been containing expenditure; the results of this are now very evident”.

The report asserts that

“the fundamental business model of the UK NHS is better than that of any other in a high-income country,”

and it puts forward the view that

“the rational strategy is to recommit to the fundamental model of the NHS, fund it properly and introduce operational improvements over time”.

That makes a great deal of sense.

The hon. Lady is saying that more money needs to be put into the NHS. It is receiving record investment this year—more than it has in its history. Where does she anticipate that extra money coming from? Does she want to move money from other Departments into the NHS, or to increase taxation, or to increase borrowing?

First, in challenging the hon. Gentleman’s opening remark, I refer him to the point earlier in my speech when I spoke about the Government’s current spending commitment. I also ask him to listen to the rest of my speech, as I will come on to the economy.

It is not the fundamental model of the NHS that is broken; it is the fact that it has been underfunded that has led to us to where we are now. As is clear for all to see, we are at a point of crisis. Waiting lists for routine treatments recently hit a record high of 7.75 million, with more than 9,000 people waiting for more than 18 months. It is truly devastating that last year, more than 120,000 people in England died while on NHS waiting lists for hospital treatment. That is double the number who died in 2017-18. There are over 125,000 staffing vacancies, including more than 43,000 vacancies in nursing and more than 10,000 medical staff vacancies. Many of the staff who are in post are burned out, with not enough colleagues to work alongside them.

The “Fit for the Future” report published by the Royal College of General Practitioners last autumn revealed that the situation in primary care is dire. It found that 42% of GPs in England are either likely or very likely to leave the profession over the next five years. As of August 2023, there were 27,246 fully qualified full-time equivalent GPs in England, 3.1% less than in 2019 and 7.4% less than in 2015. That downward trend simply cannot go on.

Last week, the Care Quality Commission rated almost two thirds of maternity services in England either “inadequate” or “requires improvement” for the safety of care and said:

“The overarching picture is one of a service and staff under huge pressure.”

Cancer Research UK has pointed out that cancer waiting time targets continue to be missed in England, and recent months have seen some of the worst performances on record.

With regard to cancer waiting lists, the Rutherford Cancer Centre, a specialist proton beam centre in my constituency, has been lying idle for almost two years, since Rutherford centres across the country went into liquidation. Does my hon. Friend agree that the NHS should take control of the Rutherford centres, and that that in itself would help to reduce waiting lists for cancer treatment?

I am not familiar with the centre that my hon. Friend speaks of, but I do believe that the NHS should control the assets and make sure that the service is there for people when they need it. I would like to hear more about the centre from him at another time.

By deliberately underfunding the NHS, the Conservatives have undermined it as a comprehensive, universal public service. Their desire to privatise the NHS has been evident for a very long time. It is a shocking agenda to essentially destroy our most cherished institution.

This determination to dismantle the NHS, which has been proven to be a world leader in terms of effectiveness, equity and efficiency, is not only immensely damaging to patients and the staff who work in the service, but damaging to the economy. Last year, an estimated 185.6 million working days were lost because of sickness or injury—a record high. Similarly, the Office for Budget Responsibility reported in July that the 15 to 64-year-old economic inactivity rate

“has increased in the UK by 0.5 percentage points”

since the covid pandemic.

The hon. Lady is being very disparaging about the private sector. Has she ever worked in the private sector?

I did write a book once, and the publisher was a private organisation. I am not disparaging the private sector. The point I am making is that the national health service is a public service.

Order. If the hon. Gentleman wants to make another intervention, then he can try to do so. If the hon. Lady—

The answer, clearly, is yes, I have. What I am talking about is the national health service, which was set up as a public service—publicly run and publicly owned. That is what we are talking about here today. I am going to make more progress. [Interruption.] If the Minister wants to intervene, he can.

Order. Let me say something for the orderliness of the debate. Understandably, emotions run high around NHS issues, but there is a convention and there are protocols. If people want to make contributions they can make interventions or speeches, but Members may intervene only if the hon. Lady wants to take their intervention. I just caution everybody that I will not have any unruliness in this debate. The debate has been tabled and the hon. Lady’s constituents have a right to be heard.

Thank you, Mr Pritchard.

I was talking about ill health being a big factor behind inactivity in the labour market, and I will repeat a point. The Office for Budget Responsibility reported in July that the economic inactivity rate for 15 to 64-year-olds has increased in the UK by 0.5 percentage points since the covid pandemic, and ill health has consistently been a bigger factor behind inactivity in the UK than in most other advanced economies. The Government must understand that a Government that fails the NHS fails the wider economy.

As well as focusing on the importance of investing in the NHS for the good of the economy, the Government must focus on tackling poverty and inequality, not only as a matter of social justice but because we know that poverty is a key cause of ill health. As the King’s Fund has noted, poverty

“drives inequality in health outcomes and increases use of health services.”

In its recent research on the state of child poverty, the charity Buttle UK said that it had received some of the most distressing accounts of children in need that it had ever seen. Buttle was keen to stress that it was

“talking not just about significant hardship but life-changing and life-limiting deep poverty.”

Today we read that the Joseph Rowntree Foundation has found that more than 1 million children in the UK experienced destitution last year, meaning that their families could not afford to feed, clothe or clean them adequately, or keep them warm. This extreme hardship will have a profound impact on the individuals concerned and it will lead to greater demands on the NHS. The King’s Fund points out that

“poverty is...expensive, in direct costs to the state and in lost opportunity and productivity.”

We need to see a virtuous cycle of improvement when it comes to addressing poverty, funding the NHS and supporting economic growth. Sadly, under this Government we are seeing the reverse. Will the Minister take up this issue of the inter-relationship between poverty, NHS provision and the economy with his colleagues in the Department for Work and Pensions and with the Chancellor, and impress on them the importance of significantly increasing funding for the NHS and tackling the deep poverty faced by many people in our constituencies? The Chancellor will have the opportunity with his autumn statement to increase spending in the NHS, and to tackle poverty and inequality, and I ask the Minister to urge him to do that.

The impact of the Government’s squeeze on funding is being felt throughout the NHS. In May, it was reported that integrated care systems will have to make average efficiency savings of almost 6% to meet their financial requirements. According to the Health Service Journal, one integrated care board said of its financial plan for 2023-24:

“We do not have confidence that we can deliver it in full but are committed to trying.”

Sir Julian Hartley, the chief executive of NHS Providers, has described

“the efficiency challenge for 2023-24”

as being

“significantly harder than 2022-23”,

while one ICS director described their system as running out of the non-recurrent savings that made balancing the books last year “vaguely possible”. It is clear that the Government are simply not giving the NHS the necessary funding to meet the needs of patients.

Before I conclude, I want to pay tribute to those who work in the national health service. As I have touched on, many of them are exhausted because of the staffing shortages and many work beyond the end of their shifts because there are not enough staff to take over from them at handover times. They do so because they care deeply about the welfare of their patients.

I will specifically mention clinical support workers in my constituency in Wirral, who are currently on strike over back pay to recognise the years that they have been working above their pay band. I have joined them on the picket line in solidarity and listened to their concerns. They are immensely hard-working people who care deeply about their patients, and they deserve fair back pay that reflects the additional duties that they have been carrying out. I urge their employer, Wirral University Teaching Hospital NHS Foundation Trust, to continue engaging with the union, Unison, and to provide an offer that is acceptable to it and to staff.

What is the future of the NHS? I believe that the NHS faces an existential threat from the Government’s privatisation agenda and underfunding of the service. Patients and staff continue to suffer. There are further potential implications for staff as a result of the 2022 Act, not least the provision to remove professions from statutory regulation. The new NHS payment scheme contains rules for payment mechanisms, one of which is “local payment arrangements”, whereby

“providers and commissioners locally agree an appropriate payment approach.”

There are real concerns that that will impact national pay bargaining and the scope of “Agenda for Change”. Can the Minister give a commitment that the NHS payment scheme has not had and will not have any negative impact on the pay rates of “Agenda for Change”, pensions and other terms and conditions of all eligible NHS staff? Can he also commit to protecting national collective bargaining across the NHS? I appreciate that there is a lot of detail here; I would really like it if the Minister wrote to me on this point.

Without such a commitment, I fear that we could see a race to the bottom in the pay, terms and conditions of NHS staff, and so too an erosion of the quality of healthcare that we as patients receive over time. We need a Labour Government that will, among other things, improve GP access, boost mental health support, train thousands of extra staff every year, provide mental health support in every school and hubs in every community, and reform social care with a national care service. The next Government must also significantly increase health spending each year. History tells us that this works. It works in terms of the equity, efficiency and effectiveness of the NHS, and it works in terms of public satisfaction.

The NHS is arguably our country’s greatest achievement. We know that it is there for us, free at the point of use, if we become ill or have an accident—or at least it should be. Under the Conservatives, the service is being decimated, but there is still time for them to change tack, turn the situation around and give the NHS the funding it needs. Will the Minister impress upon the Secretary of State for Health and Social Care the importance of boosting investment in the NHS so that the needs of patients can be met and the economy can draw on a healthy workforce? Will he also call on the Secretary of State to be ambitious in his dealings with the Chancellor ahead of the autumn statement?

Finally, I want to thank health campaigners across the country who are fighting to save our NHS from privatisation and obliteration. I thank them for all that they do to fight for an NHS that is a comprehensive, universal, publicly owned and publicly run service that is there for all of us when we need it. People believe in the NHS, and I believe it is vital that we save it.

Order. Before I call Anna Firth, could hon. Members check that their mobiles are switched off? There is one on at the moment that is receiving messages.

It is a pleasure to serve under your chairmanship, Mr Pritchard. I congratulate the hon. Member for Wirral West (Margaret Greenwood) on securing this important debate. I want to put on record straightaway my thanks to all the hard-working hospital and ambulance staff at Southend Hospital, and to everybody working in the NHS across Southend and Leigh-on-Sea—they do a fantastic job.

I want to start with the question of money. I do not agree at all with the characterisation of this Government as one that does not invest in the NHS. This Government are putting record investment into our NHS. Using the latest figures for which we have comparable international data—I noticed that the hon. Lady was selective about the years she chose—public spending on healthcare in this country totalled £177 billion in 2018-19, the equivalent of 8% of GDP. That is more than both the OECD and EU14 averages. Healthcare spending has only gone up since then. We are now spending £182 billion, amounting to £3,409 for every man, woman and child in 2022. This is simply not a Government who are not investing in their NHS.

I think we would all accept that reform is always welcome. Any attempts to talk about reform are generally met by the Opposition with accusations of privatisation or of needing to spend yet more money. I cannot help but observe that the hon. Member for Wirral West does not disappoint: we have heard both those accusations this afternoon. Let me give a recent quote from a senior politician:

“The reason I want to reform the health service is…I want to preserve it. I think if we don’t reform the health service we will be in managed decline”.

I hope that the hon. Lady recognises those words, as they are the words of her own party leader.

This is what people get from a Conservative Government. It is a Conservative Government who have funded the NHS more and who promise reform, and that is the way we will get better outcomes for all our constituents. One thing I will say, though, is that that investment must make its way down to our individual hospitals and NHS services.

That brings me to my first point. My hon. Friend the Minister is well aware that £118 million of capital investment was promised to South Essex hospitals in 2017. The lion’s share—£52 million—of that was earmarked for Southend Hospital. The Minister is also aware that I have raised this issue—I have termed it the missing millions—in Parliament 10 times and with Ministers on numerous other occasions. It is utterly incredible that here we are, more than six years later, and that money has still not, finally, made its way down to my local trust.

Is my hon. Friend aware that the state-run, socialist model of the NHS has meant that despite my local NHS trust in Shropshire securing more than £312 million for modernisation of A&E services seven years ago, construction has still not started in Shropshire? The socialists believe in state-controlled services, but they are the most inefficient imaginable.

My hon. Friend makes an extremely valid point. It is how we get the investment through the state bureaucracy that is so important. I thank the Minister very much indeed for his support last year, when I secured an advance payment of £8 million, which is already going towards improvements at Southend’s emergency department in preparation for the winter. But I stress once again, using the famous words of Cuba Gooding Jr that I have already said in the main Chamber but have not yet said in this one: when, please, are the Government going to “show me the money”, because Southend Hospital and Southend residents deserve it?

I want to move on to the future of the NHS. The focus has to be on prevention and on community care. The old adage that prevention is better than cure is clearly the way forward, and I want to focus on some examples from Southend. I recently visited the fracture clinic at Southend Hospital, which is about to launch a new fracture liaison service next spring. That will be the first FLS in the UK to focus across one area: it will be a consistent service, providing consistent care, across Mid and South Essex. The figures show that, over five years, the FLS will help to prevent 550 fractures, save the trust £472,000 and also save 1,300 bed days every year. Every single pound that the NHS is investing in the FLS will save £3.26 for our NHS. Outstanding, groundbreaking, innovative services like that are the future of our NHS, and I will just remark again that it started in Southend West.

The second thing that I want to talk to the Minister about is community pharmacies, which already save 619,000 GP appointments every week; roughly 32 million appointments are saved per year. We must continue to move services out of secondary care and into the community, and community pharmacies are a perfect example. We have the brilliant Belfairs Pharmacy and French’s pharmacy in my constituency. Both are run by an inspirational pharmacist, Mr Mohamed Fayyaz Haji, known to us as Fizz. The Minister will be well aware of everything that community pharmacies can do, but Fizz provides cholesterol and blood pressure checks, health advice, prescribing, ear syringing, community phlebotomy, earlier diagnosis measures such as measuring prostate-specific antigen levels, electrocardiograms, and ultrasound screening for sports injuries and pregnant women. That is a model for community pharmacy around the country, which, again, has to be the future of our NHS.

The final point that I want to talk about is hospice care and care homes. In Southend West we have an average age that is 20% higher than England’s as a whole. The triple whammy of people living longer but not necessarily in good health, coupled with more and more people working full time, means that good quality nursing care and end-of-life treatment will increasingly become a necessity for all of us.

Hospices such as Havens Hospices in Southend perform an incredibly compassionate service for our community, which is incredibly good value. They could play a vital role in reducing pressure on the NHS. They are an exemplar, and the NHS should look at the hospice service and learn from it, just as it should look and learn from brilliant care homes such as Cavell Lodge, which is managed by Michael Daley.

Regrettably, awareness of the role and value of our hospices and care homes often does not come until the point that it is needed. Hospices in particular are funded primarily, as the Minister knows, through charitable giving. Havens Hospices need £124,000 each week to provide their services. Overall, UK hospices are budgeting for a deficit of £186 million per year. Hospices save the NHS money in the long term by reducing pressures on hospital beds, ensuring our hospice sector—I would also add our care sector—not only survives but thrives. It is a win-win for all us.

I do not believe that more money is the answer or has to be the future of the NHS. A focus on prevention, on more care in the community and on an integrated health service that takes full advantage of the learnings available in the charitable and sometimes private sector can provide solutions to reduce pressure on the frontline services. All of that is deliverable, but only a Conservative Government will deliver it.

It is a pleasure to serve under your chairmanship, Mr Pritchard. I pay tribute to my hon. Friend the Member for Wirral West (Margaret Greenwood) for securing this vital debate today. I also wish to pay tribute to all those who work in St Helens South and Whiston hospitals and those who work in social care for St Helens Borough Council, as well as all the other agencies—police, housing—involved in our health and social care integrated service.

Our NHS is struggling: waiting lists are far too long; cancer survival rates are too low; and too many patients are kept in hospital when they could be, and want to be, at home. None of that can be fixed unless the NHS and social care is staffed to adequate levels. Right now that is not the case. Far too many medical professionals who are trained here are leaving the service. Not enough doctors and nurses are being trained here at home. That is a problem not just for recruitment but for retention.

Recruiting new staff is not good enough if the experienced are leaving. That is true of most professions, yet for some reason the Government are not doing more to retain the skills and expertise we so badly need. It takes years to train a doctor. Once they leave the NHS, they take their years of training and expertise with them. Instead, the Government try to plug the gaps by spending £3 billion a year on temporary or agency staff. A short-term solution to a long-term problem does not work. The UK is left with fewer practising physicians and nurses per person than the EU average.

One way the Government are attempting to fill the gap is by hiring physician associates, who are expected to perform duties similar to a doctor’s without the required training. Physician associates are not empowered to prescribe, so doctors are charged with the duty of prescribing for the patients. That is one of the many problems that our NHS faces caused by the workforce crisis. The remedy to the crisis is a two-pronged approach. First and foremost, the number of medical school places needs to be dramatically increased. The same needs to be done for nursing and midwifery clinical placements. The only sensible and viable long-term solution to the NHS staffing crisis is to train more homegrown professionals and to value them. Medical school placements need to be prioritised in current understaffed areas to help reduce the health inequality that exists across our country, which covid tragically put a spotlight on. Any long-term NHS workforce strategy needs to address that issue.

The second part of the approach needs to be retention. There is no better short-term solution than to keep as many trained medical professionals in the NHS as possible, yet this is more than just a short-term solution. Keeping experienced and skilled staff in the NHS helps us both now and in the future, and is about more than simply money. The general working terms and conditions, whether that is work-life balance, job flexibility or pension allowance, need looking at.

Yes, it costs money to improve the living standards and working lives of our medical professionals. What costs more money is having to recruit temporary or agency staff to plug the staffing gaps and losing the existing expertise in the workforce. What costs more money is having to send patients to private appointments due to lack of NHS staff.

Our doctors deserve respect. The title “junior doctor” can be misleading to the public. Junior doctors are trained professionals who could have 10 years, or up to 20 years, under their belts. The term “junior doctor” does not give doctors the respect they deserve with their skills and experience. Adopting the use of “postgraduate doctor” or another term would be more befitting and give doctors more of the respect they rightly deserve. The Government should be speaking to those doctors to find out how to improve their working conditions.

Believe me, I was horrified when I learned of the working conditions, and I thought I knew quite a bit about health. In some hospitals, the NHS staff—doctors—are lucky if they have a mess like a sixth form might have. Surely our doctors are worth more than that. Solving the NHS workforce crisis cannot just be a one-off solution. There needs to be continuous assessment of our future needs as a country, so we do not find ourselves in this situation again.

It takes years to train medical professionals, so the Government must plan continuously and years in advance. That is what a Labour Government will do; Labour will provide the short-term solutions along with a long-term strategy to ensure our NHS is never in the state that the current Government have driven it to. Looking after the health of the nation must be the top priority of any Government; looking after the health and wellbeing of all NHS staff is simply a must.

I pay tribute to the doctors, nurses, porters, kitchen staff and many other hard-working people at the Royal Shrewsbury Hospital, who do an outstanding job for my constituency of Shrewsbury and Atcham. My concerns are with management of the NHS trust and the chief executive. My right hon. Friend the Member for Ludlow (Philip Dunne) and I, with others, secured £312 million seven years ago—the biggest investment in the NHS in Shropshire for decades—for the modernisation and reconfiguration of A&E services.

All Members of Parliament will recognise that there is nothing more important for their constituents than the safety and care of their families when they go to A&E. Imagine: we secured £312 million for that modernisation of our local hospital trust seven years ago, and still not a single brick has been laid. Those were not proposals envisaged by politicians or Ministers, but by 300 local surgeons, who were at the forefront of championing this modernisation and reconfiguration. Those 300 local surgeons are at the coalface of providing those services every day to our constituents. Yet, the NHS trust has allowed itself to be bullied by the Labour leader of Telford and Wrekin Council to prevent the changes taking place.

The Labour leader of the council does not have a single medical qualification, yet under the society we live in he can prevent those changes, which are propagated as being absolutely essential by local surgeons at the coalface of providing those services. There is no comprehension of the interdependence between these two hospitals for citizens across the whole of Shropshire and mid-Wales. Let us not forget that in Shropshire—you are a Shropshire MP and will know this, Mr Pritchard—

Order. For the record, while I am chairing, I am completely neutral. I take the hon. Member’s point, but this is a generic debate. He is talking about specifics, and the Chair is completely neutral.

Yes. These two hospitals, 12 miles apart, cover the whole of Shropshire and mid-Wales, yet the Labour leader of Telford and Wrekin Council refuses to recognise their interdependence. No decision has been taken by the trust for seven years. I have attended hundreds of meetings with the local trust over that time to find out when it will finally take the decision to start construction. “It’s coming”, “It’s just around the corner” and “It’s nearly there”—that is what we have heard for the past seven years. That lack of accountability and transparency would never be tolerated in the private sector, and I speak as somebody who spent 13 years working in the private sector before becoming a Member of Parliament.

There is a massive turnaround of staff at the local NHS trust. I think I am on my seventh or eighth chief executive; there is no accountability, transparency or sense of urgency. Meanwhile, A&E services continue to deteriorate in our local hospital trust. Shropshire Community Health NHS Trust and Shrewsbury and Telford Hospital NHS Trust are the worst performing A&E trusts in the whole United Kingdom. As a Member of Parliament, I get heartbreaking letters from constituents about the difficulties that their family members have experienced in our local A&E services, because that £312 million has not been spent and implemented.

I speak as the only Conservative Member of Parliament to have been born in a communist country, where the state controlled everything. That is what my antipathy to this state control is rooted in. The socialist model created in the 1940s leads to inefficiency, poor value for money and corruption. We need to create the right regulatory and taxation framework to allow the private sector to thrive in this country. I completely disagree with the hon. Member for Wirral West (Margaret Greenwood); we need to allow private sector hospitals to thrive and to take on the NHS, and ultimately say to citizens, “If you need an operation, we will send you to a private hospital and pay for your operation there.” We cannot continue to allow this level of negligence, corruption and inefficiency, with £130 billion into the NHS just this year alone and horrendous outcomes. We need privatisation and competition for the NHS.

It is a real pleasure to serve under your chairship, Mr Pritchard. I thank my hon. Friend the Member for Wirral West (Margaret Greenwood) for securing this important debate and for her tireless defence of the NHS. This year we celebrate 75 years of the NHS. It is the greatest achievement of this country and of the Labour party: delivering a universal healthcare system based on need, not profit. We know the fight for this system is now existential. Thirteen years of austerity and the systematic defunding of public services have left our communities facing abject poverty and inequalities—conditions not dissimilar to those of the 1940s when the NHS was first introduced. Health inequalities are rampant and growing: children living in poverty are now diagnosed with Victorian diseases, life expectancy is falling for the first time in recent memory, children’s height is now reducing year on year, and chronic ill health, both physical and mental, is increasing. Systematic underfunding, private sector plundering, decades of privatisation via the back door and the fragmentation of diagnostics and treatment services have brought the NHS to its knees.

Before the NHS existed, there was a complex, fragmented and chaotic patchwork of services. This led to poor and inconsistent practices motivated by profit, rather than best practice. This is the direction in which many on the Government Benches are now pushing, with demands for a public-private partnership and insurance-based funding models—the privatisation of sections of the health service being touted under the guise of reform. It did not work then, and it will not work now. The evidence is clear: health services are of a better quality, more equitable and more cost-effective when nationally planned and provided by democratically accountable public bodies with expertise.

The hon. Member for Shrewsbury and Atcham (Daniel Kawczynski) has talked about the benefits of the private sector. I want to point out that Carillion, which was building an NHS hospital in Liverpool, went bust. This had a significant impact on the delivery of services to my constituency of Liverpool, Riverside.

We must repeal the Health and Care Act 2022 and reverse and eliminate the US-style integrated care systems which enable corporate influence over policy and profiteering, at the expense of patient care and workers’ pay. We must tackle health inequalities head on and push back attempts to establish a two-tier health system, which would only entrench these inequalities yet further. We must completely abolish the private sector in the delivery of NHS services and instead restore much needed funding levels, with a serious programme to recruit and retain the staff needed to end the exodus of NHS staff.

Only with this bold action to restore the fundamental model of the NHS—universal provision free at the point of need—can we once again make the NHS a world-leading institution. I will end by thanking all the hard-working staff across the NHS services in my constituency of Liverpool, Riverside.

It is an honour to speak with you in the Chair, Mr Pritchard. I thank my hon. Friend the Member for Wirral West (Margaret Greenwood) for securing such an important debate.

The NHS was set up in 1948. It was the first of its kind in the western world, leading the way for free medical care—what a great achievement. So many societies still wish that they had what we have.

As has been said by other hon. Members, we have already had 13 years of the Conservatives leading the way—unfortunately with much failure and neglect. We do not have enough doctors or nurses, there are long waiting lists for appointments, and primary care is also not what it should be. People are finding it very difficult to get a GP appointment, there are no NHS dentists, and even pharmacies are really struggling to ensure they have enough medicines to give to people. In addition, mental health services remain the poor relative to the NHS. Under this Government, there has never been enough investment in NHS mental health services.

I will focus my remarks, conversations and questions on the future of the NHS for sickle cell patients. Sickle cell disease is a serious condition which predominantly occurs in people with African and Caribbean backgrounds, and approximately 15,000 to 18,000 people live with it. It has been two years since the “No One’s Listening” report was published by the Sickle Cell Society, which found evidence of serious failings. Failings were found in acute services, and there was evidence of attitudes “underpinned by racism”, meaning that patients were not treated with care. They were ignored, often not believed, and not given the pain relief and oxygen they needed. Unfortunately, we have seen many fatalities because of this.

In January, the NHS Race and Health Observatory found that sickle cell patients undergoing a crisis were deprioritised and undermined. This is in keeping with the “No One’s Listening” report, which presented evidence regarding the death of Evan Nathan Smith in North Middlesex University Hospital in April 2019. The inquest found that Evan’s death would not have happened if it were not for failings in the care that he received. It is shocking every time I say that and every time I mention that.

I have worked with Government Ministers, the NHS and other important bodies to get implemented in full the recommendations that have come out of the “No One’s Listening” report. I ask the Minister to go further and to focus more on those recommendations. If we are looking at the public purse, which has been mentioned a few times in this Chamber, we see that it is more cost-effective to put in preventative measures that help and support people to not get into a crisis where they need to be in hospital.

I therefore ask the Minister: will the NHS develop individual care plans in partnership with the sickle cell patient? Will all NHS trusts require haematology teams to be told when a sickle cell patient accesses outpatient or inpatient care? Will the Minister instruct all integrated care systems to develop plans to provide community care in this area? Will the Minister ensure specialist training opportunities for nurses? Will the Department co-ordinate work between organisations and senior sickle cell service representatives to engage in effective workforce planning for sickle cell services?

If the Minister cannot answer all of those questions towards the end of this debate, I ask him to put it in writing, to do his best, and to also attend the all-party parliamentary group on sickle cell and thalassaemia, which I chair.

The Minister is nodding, so I take that as an indication that he is willing to do that, which is really good. I also implore him to consider that sickle cell is a long-life disease, a hidden disease, a disability, and very serious.

The disease, however, has not had the research funding that it really needs. Looking at people with cystic fibrosis and haemophilia, we that they have had so much more funding invested into medicines to improve the treatment of those illnesses. The National Institute for Health and Care Research funds research programmes, but sickle cell research is woefully inadequate compared with the diseases that I have already mentioned. According to the data produced by that organisation, approximately 18,000 people are living with sickle cell, compared with the 10,000 that are living with cystic fibrosis, but in 2017-18 over a million pounds more was spent on research for cystic fibrosis. In the present day, 2022-23, still over a million pounds more is being spent on research for cystic fibrosis compared with sickle cell. That is entirely unacceptable, especially when there are more people living with sickle cell. I do not wish to take away funding from other research, but I do want equality of funding. I am sure the Minister also wants this as well.

As I draw to a close, I have already mentioned that prevention has to be the ultimate way to help people live a good quality of life and to keep them out of hospital, and it also helps to take of care of the public purse. In conclusion, the NHS is a wonderful creation that has helped every single person in this Chamber, and indeed every single person in our country.

I am afraid that we are going to have to restrict the last two Back Bench contributions to five minutes each.

It is an honour to serve under your chairship, Mr Pritchard. The NHS is one of our country’s defining achievements. From the ashes of the second world war, we built a world-leading health service, delivering free care at the point of use for everyone in the country. My points today are going to focus on waiting times, dentistry and the link to social care.

In recent years, this grand vision has been steadily eroded. More and more people are struggling to get the care they need, and waiting lists continue to spiral. As of two weeks ago, 7.75 million people were on NHS waiting lists. Nearly 9,000 people in England are estimated to have been waiting more than 18 months to start their treatment, while the number of people waiting for more than a year was just under 400,000. I can think of specific examples. I represent over 75,000 people in my part of Devon, one of whom is David Crompton from near Bampton. David is a deer farmer, and he needs to be mobile to do his job. He needs a knee replacement. He wants to be useful to the economy and to society, but he has been told that it will probably be two years before he gets a knee replacement.

With cancer waiting times, the situation is little better. Every single cancer waiting time target was missed, and ambulance and A&E waiting times increased. This is a shocking situation, which will only lead to more long-term problems. We know that every day that someone waits to start treatment, or every time that someone is stuck in the back of an ambulance or an A& E department, it is because there is not a bed for them to be transferred to, which leads to worse outcomes. Then, of course, long-term health conditions can develop.

Obviously, this is not just a problem in hospitals; it is also a problem in other areas, such as primary care and social care. On primary care, the Liberal Democrats are calling for 8,000 more GPs. A very astute constituent of mine, a medicine student called Jonty Eaton-Hart, wrote to me recently. He has written a lot on rural and remote health. He pointed out that at the moment in general practice, the situation is almost similar to that of a frog being boiled in a pot, whereby there is so much pressure now on people working in general practice that at some point the frog is going to hop out of the boiling water. Retention of staff is absolutely key.

As I say, Jonty has written a lot about rural areas. In rural areas such as my corner of Devon, the very notion of NHS dentistry is another area of health that feels like some sort of vaguely recalled legend from years gone by, with people being left in agony because they cannot get an appointment. So many constituents have written to me complaining that they have to pay huge sums to travel long distances. But if people cannot travel long distances or cannot pay the large sums required for private treatment, then they have to suffer in agony.

This Conservative Government simply cannot go on as if nothing is wrong. It is plain that the dental contract needs reform, but the fact that they are not reforming it properly suggests that they simply do not care. They cannot go on pretending that somehow dentistry is available everywhere on the NHS; that is simply not the case in rural areas.

Another area that needs a major rethink is the way in which social care is integrated into our national health service. Of course, such integration has notionally happened now that we have a Department called the Department of Health and Social Care, but actually that is just rhetorical; we are not seeing proper integration of health and social care.

The Government have repeatedly shelved plans to overhaul social care and instead are content to tinker round the edges while people are unable to get the care they need. We have seen chronic workplace shortages; there are over 150,000 vacancies in adult social care. Yet the Government have repeatedly rejected Liberal Democrat proposals for a carer’s minimum wage, which would see an uplift of £2 per hour in the minimum wage paid in these crucial social care jobs.

The Liberal Democrats reckon that investing an extra £5 billion in social care will lead to savings in the NHS—not to the same level, of course, but we reckon that that would bring £3 billion in savings for the NHS. Therefore, a £5 billion investment in social care would actually involve only a net cost of £2 billion. At present, publicly funded social care is mainly financed through local government. We know that local government finances have been squeezed really hard in recent years, so we have to shift some of this burden of taxation back to Westminster.

The Liberal Democrats are also calling for cancer patient treatment to start within two months of an urgent referral. That ought to be the case now. We are calling for an extra £4 billion to be spent over five years in this area. My right hon. Friend the Member for Kingston and Surbiton (Ed Davey) was exactly right when he said:

“Voting Conservative is bad for your health.”

First of all, I thank the hon. Member for Wirral West (Margaret Greenwood) for leading this debate and for setting the scene so very well. It is great to have such debates to remind us of the importance of our NHS to society across the United Kingdom as a whole. This really gives us a wee chance to say thank you. I strongly concur with the comments of others, and as health spokesperson for my party, these issues mean so much to me. It is great to be here to give all our NHS staff across the United Kingdom of Great Britain and Northern Ireland the recognition that they deserve. I thank them.

I commend the NHS staff who work day in, day out to provide for local people. It is fair to say that we have had a tough four years in terms of healthcare, with the pandemic having a devastating impact on day-to-day treatment. More recently, the impacts of covid are ongoing in terms of delays and waiting lists. We will never be able to truly understand the feeling of working in that environment, as Members were able to partake in debates from home. Recognising the sacrifices that our NHS workers made at times, which were unknown and dangerous, is an important reminder of the covid pandemic.

My hon. Friend is making a powerful contribution. He will know all too well that in Northern Ireland our healthcare workers and nurses are the very backbone of our NHS. Does he agree that it is time for the Government to step up and award our healthcare workers and nurses with the pay they deserve, and to stop hiding behind the cloak of there being no Stormont? We know that if Stormont was back up and running in the morning there is not the money to do it. Will he encourage the Minister to take that back to the Government?

I wholeheartedly agree with my hon. Friend and will go on to comment on that shortly. Given the circumstances of our NHS right now, on paper the future does not seem too bright. We have people waiting years for surgery and consulting appointments, people struggling to get appointments with their GPs and, in some cases, people waiting for 12 hours to be seen by a doctor at A&E.

However, we will always remain hopeful for the future of the NHS because of the people who work in it and who truly make it what it is: those who work the extra hour, in many cases without pay, after their shift ends to ensure everything is up to date; those who come into their work on their days off due to short staffing; and those who do not have lunch breaks either, as they are too run off their feet. They are the NHS staff who I know, and they are the NHS staff that my words speak to.

The key to fixing those issues lies within this very building. It is for our Government to make the decision to fund the NHS properly. I have constituents, friends and family members who contact me all the time about the condition of the NHS, especially in terms of funding. My hon. Friend the Member for Upper Bann (Carla Lockhart) is right to make that comment on behalf of the doctors, nurses and NHS staff who do so much.

Only this time last year I went to the picket line in Newtownards, one of the towns in my constituency, as the hon. Member for Wirral West said she did in her introduction to the debate. I joined the picket line because I felt that their request for pay was right, and that we should support them to the utmost of our ability. I hoped that would be the case—again, I look to the Minister for that. It is important that those issues are relayed to parliamentarians so that we can get the full scope of just how much people are struggling with the current rate of pay.

With sufficient funding and recognition of the issues, we can improve and build on our NHS. If we reflect on the NHS from 1948 to now, the enhancements are incredible. Medical technology is always being improved and new medicines are being discovered. Queen’s University Belfast is key to that, through the partnerships it has with business. We are finding more efficient ways of diagnosing diseases. As we look ahead to the next decade, we can expect to see more of those medical advancements as technology is always improving. It is incredible to see how far we have come. This week, Queen’s University Belfast has come forward with a new prostate cancer centre in Northern Ireland, which will be to the fore of finding treatments and the cure for that disease.

The next generations of nurses and doctors are going to feel the impact of our decisions today, so let us make the right ones, right now. We must build bridges and remind ourselves of the compassion that the NHS provides. We have a duty to deliver for the people we represent right across this great nation. They are telling us that currently things are just not good enough. I strongly encourage a regional discussion on the improvement of funding for the NHS so that no nation is left behind, and that, more importantly, all the NHS staff of the United Kingdom and Northern Ireland get paid suitable wages to help them make ends meet. We must ensure that the services are up to scratch to allow them to do their jobs to the best of their ability, as they all wish to do. We wish to support them in that.

It is a pleasure to see you in the Chair, Mr Pritchard. I congratulate the hon. Member for Wirral West (Margaret Greenwood) on bringing forward this important debate. She made an insightful opening speech, and I thank her for this opportunity to highlight the incredible work of the Scottish Government despite real-terms cuts to funding. It is a privilege to contribute to the debate as the SNP health spokesperson and as someone who understands the true value of our NHS. I will break down my contribution into two core components—funding and staffing—and explain why British Governments of any colour are causing real and lasting damage to both of them.

I turn first to funding. With more and more privatisation creeping in through the back door in NHS England, there are dire consequences for our NHS in Scotland through Barnett consequentials. The reality is that how much is spent by the British Government on England’s NHS dictates how much the Scottish Government have to spend on our NHS up the road. Despite cuts to Barnett consequentials, our NHS, run by the Scottish Government, is continuing to invest in new and innovative ways to reduce health inequalities and protect our NHS for future generations; the young patients family fund comes to mind. We are leading the way in Scotland, supporting young patients and their families to get through ill health without suffering financial detriment, too. The other nations across these isles should take note and replicate the young patients family fund to improve health outcomes. The First Minister’s pledge of £300 million to cut NHS waiting times is another example. There will be 100,000 fewer patients on NHS waiting lists come 2026 because of that investment.

What happens down here is that the Treasury gives money to private companies to provide a service for NHS England. That means less capital investment in NHS England, which means less money for the Scottish Government to spend on NHS Scotland. Despite the year-on-year reduction in Barnett consequentials for health, NHS Scotland staff remain the best paid across these isles. What does that look like in practice? A band 2 porter in Scotland earns £2,980 more a year than their counterpart in England, and a band 5 nurse in Scotland earns £3,080 more a year than their counterpart in England. That is all despite the increased privatisation in NHS England.

I have two questions for the Minister on funding. What representations has he made to the Treasury ahead of the autumn statement? And will there be a change or, indeed, an increase to the money given to private enterprises to provide services to NHS England?

I will move on to staffing. Our staff are our NHS—past, present and future. The staffing issue we face because of being dragged out of the European Union is the single biggest issue for our NHS in Scotland. The future of our NHS hinges on staff recruitment and retention. As I said, our NHS in Scotland pays comparatively higher wages than the rest of these isles. The hon. Member for Liverpool, Riverside (Kim Johnson) rightly pointed out the urgency of ending the exodus of NHS staff. Despite that, attracting and retaining top talent remains our biggest concern, indicative of broken Brexit Britain.

The British Government’s shift to being increasingly insular has significant consequences for our NHS in Scotland. That is why the SNP has repeatedly called for the devolution of powers over migration, because we in Scotland are committed to expanding our workforce. The toxic, hostile atmosphere created by the British Government is a barrier to that recruitment. What representations has the Minister made to Cabinet colleagues about the devolution of migration powers to the Scottish Government?

The hon. Member for Wirral West rightly pointed out that underfunding the NHS, quite apart from the harm it does to our constituents, is not a viable economic strategy. Poverty is expensive, as are health inequalities. Cuts to NHS funding are totally false economies that have real costs in the form of longer waiting lists, lost productivity and pain. As the hon. Member pointed out, it is not the model of the NHS that is broken, but the chronic underfunding that has led us here.

The hon. Member for Shrewsbury and Atcham (Daniel Kawczynski) made the point that NHS England is receiving higher funding than ever before. However, he failed to mention the capital given to private companies to provide services, instead of that funding going directly into NHS England.

I will repeat the question that I posed to the hon. Member for Wirral West, who instigated the debate. We are putting record levels of investment into the NHS. Where will the hon. Member for East Dunbartonshire (Amy Callaghan) get the extra money that she wants to put into the NHS?

We look at progressive taxation measures in Scotland to generate income and revenue to put into our NHS, but we are experiencing cuts to Barnett consequentials because of how the British Government down here are spending money on the NHS, with investment in private enterprises as opposed to capital going directly into the NHS. We are experiencing real-term cuts to our funding despite our generating money through other means.

It will come as no surprise that the financial and staffing issues facing our NHS in Scotland are a result of being tied to this broken Union. We cannot afford to be in this financial Union. Our NHS cannot afford for us to be in this financial Union. I look forward to the day when Scotland is an independent nation within the European Union, with a fully funded NHS and no recruitment or staff retention issues because we have created an inclusive and welcoming environment for all.

Before I conclude, I will say that it is fitting, with World Stroke Day just around the corner, that I am standing here talking about the future of our NHS. I have a future because of our NHS. We must provide proper funding and staffing to ensure that there is a future for the NHS and the millions who will need it for generations to come.

It is a pleasure to serve under your chairmanship, Mr Pritchard, and I add my thanks to my hon. Friend the Member for Wirral West (Margaret Greenwood) for securing the debate. She is a committed campaigner for our national health service, and she set out clearly how the NHS faces an unprecedented challenge. We have heard powerful cases put forward about the need for reform, including from the hon. Member for Southend West (Anna Firth). My hon. Friend the Member for St Helens South and Whiston (Ms Rimmer) focused on the workforce strategy for the NHS. I also thank my hon. Friends the Members for Liverpool, Riverside (Kim Johnson) and for Lewisham East (Janet Daby), who talked about sickle cell disease and equality in the NHS, and the hon. Member for Strangford (Jim Shannon).

This debate on the future of the NHS is timely as it is our first opportunity to put to the test the Government’s new slogan, which was unveiled at their conference:

“Long-term decisions for a brighter future”.

Personally, I would say that 13 years is long enough. What has been the result of that? Where we once spoke of winter crises, we now face crisis in the NHS all year round. Patient outcomes are declining, public satisfaction is at a 40-year low and improvements in healthy life expectancy have stalled.

One in seven of us are now stuck on waiting lists. Some 2.6 million people of working age are out of work and long-term sick—a record high. Across swathes of the country, dental deserts mean that patients are pulling their own teeth out because they cannot get the care they need. This Government was the future once, and their record is historically bad.

As the CQC warned last week in its “State of Care” report, the risk is that healthcare in this country becomes a two-tier system, where those who can pay get treated and those who cannot have to wait. My party will never accept that. We will always defend the principle of an NHS that is there for everybody when they need it, free at the point of use.

As we have heard, we need a serious plan for investment and reform if the NHS is to realise that promise. If the Government cannot deliver, we will. We will train thousands more doctors and nurses so that the NHS has the staff it needs, armed with cutting-edge technology to treat patients sooner and faster. We will get doctors and nurses to help to address the backlogs and pull the NHS out of permacrisis. We will reform the system to shift more care to the community, fix the front door to the NHS, and deliver a prevention-first revolution to shift focus from the NHS as a sickness service to it being a genuine, holistic health and care service.

One thing that will define the future of the NHS is the disease burden of the country. Children in school today will live into the next century. Our NHS has been there for us for 75 years and will need to be there for 75 more, but it will not be there if we carry on as we are. The change we need to make is the shift to prevention. Right now the situation is scandalous, given the clinical time and need that is taken up with treating illnesses that could have been avoided in the first place. Many of the biggest killers, from cancer to heart disease, could be drastically reduced through healthier lifestyles and environments, yet as we saw with the latest child measurement programme statistics released last week, primary schoolchildren are some of the least healthy there have ever been. Nearly one in four children are now obese by the time they leave primary school, which is absolutely shocking. Some prevalence studies show that four in 10 obese children have evidence of fatty liver disease.

Yet more shocking is the fact that, while these children are bombarded with adverts for junk food, such as KitKat cereal, or are begging their parents to fork out more than £10 for a bottle of Prime energy drink, the Government have seemingly abandoned their plan to tackle junk food promotions and adverts targeting children. I ask the Minister: when will the Government publish the consultation into the pre-watershed junk food ads ban? Where is the secondary legislation that they promised? They said that the delay was to allow time to consult, yet the consultation has been done and is probably sitting in a drawer in Whitehall somewhere. What is the hold-up? Will the Minister back Labour’s plan to ban junk food ads before the watershed and to introduce free breakfast clubs serving healthy food at school, so that every child gets the best start?

The future of NHS dentistry is also hanging by a thread. Dentists are leaving the NHS every year. Huge parts of the country are dental deserts, where practices are not even taking on NHS patients. The No. 1 reason that children end up in hospital is to remove rotting teeth. It has been six months since the Government announced their dental recovery plan, but where is it? Their response to the excellent Health and Social Care Committee report into NHS dentistry is also overdue; when can we expect that?

In the meantime, Labour has set out our rescue plan. We will have 700,000 more urgent appointments a year to bring down the backlogs. We will target funding to train up dentists in left-behind areas, and, of course, we will have a national supervised toothbrushing scheme for schoolchildren, because we know that the cheapest intervention means not needing to see a dentist at all.

Securing the future of general practice is also integral to the future of the NHS as a whole. People trust their GPs, and the relationships that they build with their patients are irreplaceable, but despite the Government’s much-vaunted primary care recovery plan, record numbers of GPs are still leaving the profession. In 2019, the Government promised to deliver 6,000 extra NHS GPs. Will the Minister explain why that promise has been broken? How does he expect to move more care from acute settings to the community if general practice continues to decline at this rate? Where is his equivalent to Labour’s fully costed plan to recruit 8,500 mental health professionals, with support in every community and every school, to relieve the pressure on frontline GPs? And will the Minister say what proportion of the community diagnostic centres that have been set up in recent years are actually in the community, rather than in an existing healthcare site?

The Minister will surely acknowledge the point that there will be no sustainable future for the NHS without tackling the crisis in social care. Thousands of people are stuck in hospital beds who are medically fit to leave but are unable to do so, because the care that they need in the community is not there to support them. Can he explain how he expects to find a sustainable solution to that persistent problem without getting serious about pay and standards and addressing the chronic workforce shortage in the sector?

It is also a poor reflection of this Government’s long-term planning that the NHS is still stuck using creaking, outdated equipment, and has fewer scanners per person than Greece. Freedom of information responses from NHS trusts have revealed that half—48%—still have an MRI or CT scanner in operation past the recommended lifespan of 10 years. One in five trusts are using the same scanners that they had when the last Labour Government left office in 2010.

Does the Minister not agree that it is time for an upgrade? There are currently 1.6 million people waiting for diagnostic scans and tests in England—three times as many as when the last Labour Government left office in 2010. Slow, outdated equipment is part of the problem, so will the Minister follow Labour’s lead, with our “Fit for the Future” fund to double the number of CT and MRI scanners?

To really make the NHS fighting fit for the future, we should grasp the opportunities in the explosion of innovation in health technologies, too. Right now, a revolution is taking place in medical science, technology and data that has the potential to transform our healthcare. By using Britain’s strengths in life sciences and NHS data, we could transform the model of healthcare in this country using prediction, prevention and highly targeted precision medicine.

Today, genomic screening can spot predisposition to big killers such as cancer or heart disease. Let us imagine: if every family could choose to screen their baby’s genetic information, they would be empowered to give their child the healthiest start in life. Last month, I visited the Precision Health Technologies Accelerator at the University of Birmingham, part of the life sciences park that it is building there. Over time, it hopes that the campus will grow into a leading life sciences hub, bringing together the best of our university, business and the NHS, and creating more than 10,000 jobs in the process. That is really exciting.

The next Labour Government will build on the strength of our life sciences sector. The development of coronavirus vaccines shows us how industrial policy can work, with the state playing a crucial role in partnership with the private sector. Yet the Government scrapped the Industrial Strategy Council and, since 2019, the UK has dropped from second to ninth in global life sciences league tables for inward foreign direct investment. Where is the Government’s strategy to put the NHS at the front of the queue for cutting-edge innovations in the health sector and end the postcode lottery in the adoption of new treatments and diagnostics?

Bearing in mind that the Shrewsbury and Telford Hospital NHS Trust is the worst-performing for A&E in the United Kingdom, will the hon. Lady commit, if there is a Labour Government, to backing the £312 million investment in our local trust—yes or no?

I thank the hon. Gentleman for his question, but I do not have the level of detail to be able to make any such commitment. He needs to speak to the Minister to ensure that the valuable investment they have been able to obtain for people in Shrewsbury is actually realised. That is really a conversation for him to have with the Minister.

There is no doubt that the NHS needs serious reform if it is to serve for the next 75 years. Since the Prime Minister and Health Secretary made a pledge in January for 5,000 more beds in time for winter, the number of hospital beds in England has fallen by almost 3,000. After a promise to clear all patients waiting 78 weeks or more for treatment by April this year, which was a shockingly low bar, the number rose last month from 7,300 to 9,000 patients. Despite making it one of their flagship five pledges to cut waiting lists, the Government have again broken their own record this month, with the number of patients waiting now at 7.8 million.

This Government cannot be trusted with the future of the NHS. Whether it is the social care crisis or the RAAC—reinforced autoclaved aerated concrete—scandal, the Government have literally failed to fix the roof while the sun was shining. The NHS will not survive another five years of this. Labour’s 10-year plan of change and modernisation will build an NHS fit for the future, shifting the focus of healthcare from the acute sector into the community to boost prevention, diagnose conditions earlier and provide treatment closer to people’s homes.

In closing, I want to put on the record my deep thanks to all our NHS staff for going above and beyond for patients, and especially everyone at the University Hospitals Birmingham trust in my constituency, which is the largest trust in the country.

The Minister of State may speak for 10 minutes, but there are a couple of extra minutes as well. In addition, the convention is to allow the mover of the motion a couple of minutes to wind up, so he has a lot more latitude than usual.

It is a pleasure to serve under your chairmanship, Mr Pritchard. I am grateful to the hon. Member for Wirral West (Margaret Greenwood) for securing a debate on this important matter. A debate of this nature is almost impossible to respond to in a relatively short period of time—although it is slightly longer now. I could easily fill the 90 minutes on the future of the NHS, as I know could all hon. Members across the Chamber today. I will endeavour to respond to as many of the issues and themes raised as possible in the time left available to me and, if I can, before the Front Benchers in the main Chamber conclude and we are all summoned over to vote.

While we will not always agree on the best approach—in fact, I strongly disagree with so much of what the hon. Lady said in her opening speech—I can assure her and Members across the House that I share her passionate desire to see an NHS that delivers and continues to deliver excellent care to all its patients, both now and in the future. Similarly to the Opposition Front-Bench team, the Government believe that the NHS should be free at the point of delivery and that its offer should be comprehensive, with services provided based solely on need. Let me absolutely clear: that will never change. In response to the themes raised in the debate, I will start by focusing on three broad areas: funding, workforce, and finally transformation and innovation.

Turning first to funding, as my hon. Friends the Members for Shrewsbury and Atcham (Daniel Kawczynski) and for Southend West (Anna Firth) set out, we have invested record amounts in the future of our healthcare system. By the end of this Parliament, core spending will have increased from £140.5 billion in 2019-20 to £193 billion in 2024-25. For those good at maths, that is a cash increase of £52.6 billion or 37%. At the beginning of this debate, several of us got a little excitable when the issue of privatisation was raised, and you rightly shut us down, Mr Pritchard. People have managed to make their contributions, but this is perennial accusation levelled at the Government, so let me absolutely clear: it is not our policy and it is not our plan. The NHS is not, and never will be, for sale.

Look at the actual facts on this. In 2013-14, around 6.1% of NHS funding was spent on the independent sector. Now let us jump to 2021-22, when it was 5.9%. What we are doing, however, is using the independent sector to enable us to fully realise our healthcare system’s capacity, and of course to improve performance. This is an approach that I understand is supported by the shadow Secretary of State for Health, the hon. Member for Ilford North (Wes Streeting). It is an approach that is better for patients and for our NHS. We are giving our patients greater choice and control, and empowering them to shape and manage their own healthcare.

I am very grateful to my hon. Friend for highlighting the extraordinary increases in Government funding for the NHS, but has he recognised during the course of this debate my concern that, seven years after securing the £312 million for modernisation of A&E services in Shropshire, not a single brick has been laid? How sustainable is this NHS model when the managers of our local trusts are so incapable of delivering the construction with what we have secured for them?

I hear my hon. Friend’s concern. I have met with him and other Shropshire MPs on this issue and committed to meet with him to discuss it again. We are very keen to resolve the situation.

Before I move on from privatisation, let me gently say to Opposition Members—some of whom raised it and some of whom did not—that patient choice and the ability to use the private sector has been part of the NHS since its formation. It is a fundamental part of the NHS constitution. Let us be clear what those who call for private sector involvement to be entirely removed from the NHS are calling for: they are calling for charities, independent sector providers, GPs, dentists and community pharmacies to be removed. So let us be very careful, and very clear about exactly what we are calling for, because the independent sector plays an important role.

While the Minister is on the subject of privatisation, I would like him to respond to two points. First, the Health and Social Care Act 2012 allowed NHS foundation trusts to earn 49% of their money from private patients. Can he explain how that benefits ordinary patients? Clearly, if half a hospital is given over to private patients, the waiting time doubles. Secondly, representatives of private companies sit on integrated care partnerships, which are responsible for preparing the integrated care strategy for an area. How can it be right that a private company can influence how a huge amount of public money is spent?

I thank the hon. Lady for her question. I have already committed to write to her on some of the points relating to the 2012 Act, because she raised a number of questions. On the broader point about whether the independent sector should be part of integrated care boards and partnerships, I think it is helpful if it is, because individual systems need to know the full capacity available to them, and that includes the independent sector, which plays an important role because it is part of the health ecosystem in an area.

I will come back to the hon. Lady, but I am conscious of time.

The second area widely covered today was workforce. I echo the hon. Lady’s thanks to our NHS staff. I want to put on record my personal thanks to all those working in our health and care system: doctors, nurses, allied health professionals, managers, carers—all those who work in our NHS—for their hard work and dedication. We remain deeply grateful to them for all their work during the pandemic, in facing the new challenges of tackling the backlog, and of course the routinely excellent care they provide day in, day out. Our long-term workforce plan embodies the Government’s commitment to NHS sustainability: we are funding more doctors, more nurses and healthcare workers employed on NHS terms and conditions by NHS providers. That is backed by an additional £2.4 billion over the next five years, and at the heart of it is a significant increase in training places.

The third theme I want to focus on is transformation and innovation, which has also been touched on. We are committed to making our NHS more integrated, more strategic and better able to tackle the challenges it faces. The hon. Lady referenced the Health and Care Act 2022 numerous times—I hear her questions and points, and I will write to her on them. We put those issues on a statutory footing. We know that an increasing number of people are living with chronic medical conditions and complex care needs, which is where more integrated services can and will make an enormous difference. We want partners focusing on improving services rather than competing with each other when it is not in the interest of patients. I believe—we believe—that is the right approach because local areas know best, and certainly know far better than Ministers in Whitehall how best to organise themselves and design and deliver the best possible care for patients.

I have to make some progress—I am conscious of time.

In addition, we have digital transformation and technology, which are critical to the future of the health and social care system. Embracing digital provides a significant opportunity for us to improve clinical service to deliver better care for patients and reduce pressures on the NHS. That is why we are investing around £1.5 billion a year in digital transformation to run live services and drive those transformation ambitions. That also includes plans to improve our NHS app, digitise the frontline and improve services. We are also working with trusts to deliver things such as electronic discharge and electronic bed management systems, which also improve efficiency within the NHS.

The hon. Member for Lewisham East (Janet Daby) mentioned NIHR research, which I want to touch on briefly. We spend around £1 billion a year on that, but the Government do not commission research directly; indeed, it would be totally wrong for any Minister or shadow Minister to direct our clinicians and researchers to look into a particular area. However, we encourage and rely on organisations to come forward with bids for research, which clinicians then look at. That is rightly independent from Government, and I will be happy to work with the hon. Member to see how we can get more research into that area.

I wanted to say so much more, but time is short and I want to ensure that the hon. Member for Wirral West has time to respond. The hon. Member for Birmingham, Edgbaston (Preet Kaur Gill) touched on the life sciences space. We are putting a huge amount of work into life sciences with the Life Sciences Council and the life sciences vision, and we have launched the dementia, mental health, cancer, obesity and addiction missions, with more than £210 million in Government investment and world-leading chairs to support them. There is also our additional investment in genomic medicine, which the hon. Member rightly touched on and which is a hugely exciting field. The ability to screen for and identify the prevalence of future disease and the ability to screen babies in future will be hugely exciting. This is definitely the future of medicine.

This is a hugely important debate and I have far more to say, as you can tell, Mr Pritchard. The NHS is a vital part of the fabric of our public life. It is beloved by the public and rightly held in the highest esteem. The Government believes in the NHS; I believe in the NHS. That is why we are taking the right long-term decisions to protect its future.

Margaret Greenwood to wind up. The Minister has very generously given the hon. Member three rather than two minutes.

I thank all Members who have spoken in what has been a worthwhile debate this afternoon. We have heard from speakers across the Benches, and it is clear that the NHS is in crisis. With waiting lists for routine treatment of more than 7 million and more than 125,000 staffing vacancies, it is clear that patients’ needs are not being met. Patients are suffering as a result and existing staff members are being put under incredible pressure.

The fundamental model of the NHS is not broken; we need to see the Government recommit to the service through a significant increase in funding. We must see an end to the privatisation agenda and rebuild the service as comprehensive, universal, publicly owned and publicly run, there for anyone of us should we need it. I want to end by reiterating my thanks to NHS staff for their work and for their commitment to the NHS as a public service.

Question put and agreed to.


That this House has considered the future of the NHS.

Importation and Sale of Foie Gras

I beg to move,

That this House has considered the matter of the importation and sale of foie gras.

It is a pleasure to serve under your chairmanship, Mr Pritchard. I am grateful to have secured this important debate about the dreadful and totally unnecessary cruelty to animals in creating a so-called delicacy. I wish to make it clear that, while today’s debate is about the importation and sale of foie gras, I understand that we cannot ban a product. Instead, we can deal with the process through which it is made. In this case, the product, foie gras, is produced by forced feeding.

I wish to offer my thanks to Abigail Penny from Animal Equality UK, who should be shortly joining us in the Public Gallery. I can proudly say that she hails from the sunshine coast and resides in Clacton, which is a place of animal lovers.

I commend the hon. Gentleman for securing this debate. There was an Adjournment debate on this matter in the Chamber some time ago. I supported the principle referred to by the hon. Gentleman. He probably shares my frustration that, although Government have made it clear that the production of force-fed foie gras raises serious welfare concerns, unfortunately no steps have been taken. What does he feel that the Minister and the Government need to do to make that happen?

I thank the hon. Gentleman for his intervention. I raise the matter here today precisely because I do not think enough action has taken place since that previous debate.

Order. There is a Division in the House. We will suspend for 15 minutes for the first vote. If there are subsequent votes, it will be 10 minutes. Then, as soon as the mover of the motion and the Minister are here, we can proceed, so I ask hon. Members to go quickly as possible, please.

Sitting suspended for Divisions in the House.

On resuming

After the interruption, I am pleased to say that we now have a full house in the Public Gallery. I pay tribute to and thank Abigail Penny from Animal Equality UK for her hard work on this cause. I can proudly say that she comes from Clacton, the sunshine coast, and Clacton is a place of animal lovers, which is probably why I am chairman of the all-party parliamentary group for animal welfare. Her charity has provided a brochure, which colleagues are welcome to take back with them, highlighting the issue in further detail.

Foie gras results from the process of forcibly putting a tube down a goose’s throat into their stomach and pumping food until their liver swells. The liver is then cut out and sold to the markets. I am sure that many meat eaters are present. One of my twin daughters champions the vegan cause, and I have to admit that I am not quite there. The point I wish to make is that the normal kinds of meat that the average consumer buys are not created in this barbaric and cruel fashion. We have strict laws in this country on how our industry produces meat and other animal products, avoiding unnecessary suffering where at all possible. Sadly, that is not the case with the production of foie gras.

Labour attempted to ban the importation of foie gras during the passage of the Agriculture Act 2020. The Conservative Government voted our proposals down, but Labour is committed to introducing a ban on these imports as soon as we can. Can we count on the hon. Member’s support?

I am grateful for the hon. Lady’s intervention; I am not sure whether she was here earlier when I answered another point of a similar nature. One of the reasons why I am bringing the debate today is that there has been inaction. I would like to see action on this issue, and very soon.

I could quite easily go on regarding the emotional argument against foie gras and for animal welfare standards to be improved, but it seems impossible to have a reasonable method of producing foie gras. Instead, I shall raise a more practical argument. There have been many recorded incidents of disease outbreak in France. As we have seen with the growing bedbug issue, we are not safe from disease and pests just because we have the English channel. The crowded conditions of the farms act as a breeding ground for disease, much like any other form of intensive farming. As a representative of a constituency that has vast areas of rural land, I would not want to endanger my local farmers. We must be especially alert to that risk and not accelerate another potential pandemic given the serious consequences of covid-19. Although bird flu has not yet jumped to humans, I understand that scientists are concerned that it could mutate.

Foie gras is an expensive luxury item. By defending foie gras sales or not acting on the trade during times of spiralling financial hardship across the country, I fear that we risk appearing to be totally out of touch with the British people. If I were to stand on Christmas Tree Island in Clacton and take a poll of constituents who have ever purchased foie gras, I can only imagine the response. This is especially important to keep in mind with the looming general election ahead. It is a low-hanging fruit for the Government, so we should move on it.

I congratulate my hon. Friend on securing the debate; I had a similar debate on the banning of the importation of foie gras on the Floor of the House of Commons a while ago. Does he agree that if we deem foie gras too cruel to be produced in this country, we should also agree that, by definition, it is too cruel to be imported?

I absolutely agree that it is too cruel. As with the much-desired ban on trophy hunting, which is a ridiculous sport, we should ban such imports. From Abigail and Animal Equality UK, I understand that the petition to ban foie gras by force-feeding was signed by no fewer than 280,000 people. That is an enormous amount of people concerned for the lives of these birds and the way they live them, and it is impressive to see.

I can confirm that e-petition 608288 to ban the importation and sale of foie gras has been signed by 6,878 people, including six of my constituents in Clacton, and e-petition 609129 to ban fur and foie gras imports has been signed by 528 people. There is a case to be made that public opinion is now moving in a very clear direction.

However, colleagues and viewers of this debate alike might ask why it is focused on the importation and sale of foie gras produced by force feeding. It is because, as we have just heard, producing foie gras by force feeding is already outlawed in the UK. Nevertheless, despite the cruelty that goes into the production of foie gras, we still allow it to be imported. When applying the law, judges consider how consistent it is; in this case, in my view, the law is not very consistent at all.

As my hon. Friend the Minister might mention—I do not wish to take away any of her thunder—the Government have successfully ended the imports of whale meat, seal fur, elephant ivory, and cat and dog meat; I personally ran a campaign against cat and dog meat, to end its production globally. If personal choice is a valid reason for failing to ban the import of foie gras, why have other bans been introduced?

I also think it is prudent to note the Government’s support for the private Member’s Bill introduced by my hon. Friend the Member for Crawley (Henry Smith) on the importation of hunting trophies, which I mentioned earlier. If you will excuse the pun, Mr Pritchard, there is clearly an appetite in the Government to go down the route of banning cruel imports.

Lastly, foie gras has been banned in royal residences since last year. I will not break any protocol by speaking here, but I think it prudent to mention that this place is a royal residence and still belongs to the Crown as a royal palace. Like all colleagues, I am a humble and obedient servant of the Crown, and I have sworn an oath of allegiance. Although it is my understanding that foie gras is not on any menus on the parliamentary estate, a strong act of symbolism would be to ban the product here, too—something that I will raise with Mr Speaker.

I thank my hon. Friend the Member for Clacton (Giles Watling) for securing this debate today. As he pointed out, he is chair of the all-party parliamentary group on animal welfare, a role he takes really seriously—as did I when I chaired the same group as a Back Bencher. Some really great work has been done by that APPG.

My hon. Friend said that many of his constituents who are also great animal lovers are here today, because they take animal welfare very seriously. I was very pleased to hear that. However, I believe that we are an entire nation of animal lovers, and animal welfare has been an absolute top priority for the Government since 2010. Our standards of animal welfare are already world-leading. According to World Animal Protection’s animal protection index, the UK has the highest animal welfare score in the G7 and some of the highest animal welfare standards in the world, which we should all genuinely be proud of.

The Minister says that we have the highest animal welfare standards. May I ask her, very gently: why has the Animal Welfare (Kept Animals) Bill gone, why has the Hunting Trophies (Import Prohibition) Bill gone and why did we not take the chance to ban foie gras in 2020?

I thank the hon. Lady for that intervention. If she will bear with me and listen to my speech, I think she will see that so much proposed in the Animal Welfare (Kept Animals) Bill has either already been brought forward in legislation or is in the process of being brought forward, so great is our commitment to animal welfare. I will list some of those things.

Since 2010, we have raised animal welfare standards for farm animals, companion animals and wild animals. We have banned the traditional battery cages for laying hens and we have raised standards for chickens reared for meat. We have implemented and upgraded welfare within our slaughter regime, including introducing CCTV cameras in slaughterhouses. We have revamped the local authority licensing regime for commercial pet services, including selling, dog breeding, boarding and animal displays, and we have banned third-party puppy and kitten sales through Lucy’s law, which we particularly worked on all those years ago in the APPG on animal welfare. We have also introduced protections for service animals through Finn’s law and we have introduced offences of horse fly-grazing and abandonment. Some colleagues in Westminster Hall now were involved in those pieces of legislation. We have also banned wild animals in travelling circuses.

Our manifesto commitments demonstrate our ambition to go further on animal welfare. In 2019, we committed to bringing in new laws on animal sentience; to introducing tougher sentences for animal cruelty; to implementing the Ivory Act 2018 and extending it to other species; to ensuring that animal welfare standards are not compromised in trade deals; to cracking down on the illegal smuggling of dogs and puppies; to bringing forward cat microchipping; to banning the keeping of primates as pets; to banning live shipments of animals; and to ensuring that farmers, in return for funding, safeguard high standards of animal welfare.

Ducks and geese are sentient animals; they have feelings. Imagine all of us stuck in a cage with someone opening our mouths and stuffing stuff down our throats—God, how awful that would be! We have to get rid of this stuff.

I thank my right hon. Friend for that intervention and I am not going to disagree about the horrible cruelty—that is why we have banned the practice in this country. I think he makes the point exactly.

Those are the manifesto commitments but I would like to list the things that we have already delivered, to make it clear how seriously we take animal welfare: we have increased the penalties for those convicted of animal cruelty from six months to five years; we have passed the Animal Welfare (Sentience) Act 2022, which has just been referred to, and we have launched the dedicated Committee to work on it; we have made microchipping compulsory for cats as well as dogs; and we have announced the extension to the Ivory Act 2018, which came into force last year, to cover five more endangered species—hippopotamus, narwhal, killer whale, sperm whale and walrus.

On top of our manifesto commitments, we published our ambitious and comprehensive action plan for animal welfare in 2021. The plan set out the work that we are focused on pursuing, to deliver a better life for animals in this country and abroad. The commitments in the action plan last through this Parliament and beyond it. Our action plan relates to farmed animals, wild animals, pets and sporting animals, and it includes legislative and non-legislative reforms. In addition, we have provided for penalty notices to apply to animal welfare offences; introduced new police powers to tackle hare coursing—that needed tackling and we have worked hard to bring forward a better crackdown on hare coursing; we banned glue traps; and we have supported the private Members’ Bills to ban the trade in detached shark fins and to ban the advertising here of low-welfare animal experiences abroad.

This debate, raised by my hon. Friend the Member for Clacton, deals specifically with foie gras. As hon. Members will know, the production of foie gras by force-feeding is banned in the UK because it is incompatible with domestic legislation. Foie gras production is covered by the general provisions in the Animal Welfare Act 2006, which make it a criminal offence to allow an animal to suffer unnecessarily and place a duty on people responsible for animals that requires them to do all that is reasonable to ensure the welfare of their animals. That includes an animal’s need for a suitable diet and to be protected from pain, suffering, injury, and disease.

While we have domestic restrictions on the production of force-fed foie gras, it is of course possible to import foie gras from abroad—clearly, there is a market trading in that. It is absolutely vital that we develop any future policies on the basis of robust evidence in line with the Government’s commitment to improving animal welfare standards as set out in the action plan for animal welfare. We are committed to building a clear evidence base on foie gras to inform our future decisions, and we are looking at what other countries that have banned it do. As my hon. Friend will know, a certain number of countries have banned the production of foie gras just as we have—Germany, Italy and Luxembourg. As he will also know, the EU does not have an overall ban. We are also looking at how the World Trade Organisation operates if a ban is introduced.

All those things need to be considered carefully. One of our strongest levers is the work that we do on the international stage to influence the strengthening of animal welfare standards across the globe recommended by the World Organisation for Animal Health and other global organisations and applied to different countries. As my hon. Friend will know from his work on dog meat—we did some work on that jointly as Back Benchers—that is a strong way to influence and encourage other countries not to use these methods. All that will be looked at in the evidence base, and we will work with relevant Departments on disease—he mentioned disease and avian flu—as part of the evidence building.

I am standing in for my right hon. Friend the Minister for Food, Farming and Fisheries, and I will make sure that comments made in the debate are passed on to him, as he was unable to attend. My hon. Friend the Member for Clacton will know that some supermarkets have banned foie gras and, as he said, King Charles does not allow it to be served. Customers already have a choice not to buy it and certainly not to eat it—I would certainly never buy it.

On that very point about banning the product and its import, many businesses in the private sector have banned the product and refuse to sell it. Fortnum & Mason—a short walk from Parliament—banned it from its shelves in 2021. By allowing restaurants and retailers to sell foie gras the United Kingdom, we are permitting animal torture and suffering. It is time to take an ethical stance, because those who still sell foie gras have a business advantage, as it is still legal and possible to do so.

I hear what my hon. Friend says, and I will certainly pass on his comments. I have made the point that we have a choice as to whether or not to buy the product if we do not support those methods of production. The evidence base is being established to inform future decisions, and I want to conclude by reiterating that animal welfare is a huge Government priority. We recognise the massive contribution that animals make to our planet. We are proud of what we have achieved on animal welfare.

I thank the Minister, as she has been generous with her time. On animal welfare, a senior Tory MP has stated that hormone-injected beef is “delicious” and that

“you’ll be absolutely fine with chlorinated chicken”.

Why should we believe the Minister when she says that our animal welfare is the best in the world?

Actually, the Secretary of State for Environment, Food and Rural Affairs dismissed those comments completely and said, “Absolutely not”. I reiterate that very strongly.

To conclude, we are really proud of what we have achieved on animal welfare. I do not think that anyone in the Chamber could disagree with the long list of things that we have achieved between us. We have made a huge step forward, but there is more to do and we keep prioritising caring for, protecting and respecting the animals with whom we share the planet.

Question put and agreed to.

Sitting suspended.

Funding for Parks

I beg to move,

That this House has considered funding for parks.

It is a pleasure to be in the Chamber with you, Mr Pritchard, a fellow Shropshire person and product of the open spaces of Shropshire. I will speak generally about parks and then in more detail about the problems faced by our parks and open spaces.

Parks are a major feature of our lives, providing opportunities to recreate, play games and observe nature, and for children to grow up. They are wonderful spaces. The oldest public park in Britain is in Birkenhead. Conceived in 1843 by Joseph Paxton, it developed into a wonderful open space—it is one of the largest parks in the country—and became iconic. It inspired Central Park in New York, which then inspired Golden Gate Park in San Francisco. So from Birkenhead we get San Francisco and the whole process of developing parks and open spaces. The park was an amazing achievement, and Paxton was, of course, the one who designed the Crystal Palace, which was built in Hyde Park for the Great Exhibition.

Throughout the 19th century there was big development of parks, as benefactors provided money for them. There were redoubtable fighters for public open space in every city who were concerned about growing industrialisation and people’s loss of amenity and contact with nature. Hampstead Heath came from that process. In some cases, parks were developed from what had previously been common land. Sadly, in many other places, they were not, and we became a country of very densely populated urban areas. The demand for parks grew. In some cases they were developed. In some cases there are more parks in suburban parts of our cities than in the centre because of the way industrial development happened.

In a sense, the parks came into their own in this country during the covid pandemic. When we were locked down, people could recreate in parks. I have a bizarre memory of a man riding around Finsbury Park on a bicycle with a loudspeaker telling people to go home because it was too full. I could, of course, see his point, but I could feel the sadness of people who wanted to be outside enjoying a bit of urban space.

It is inner urban open space that I want to say the most about. My borough, Islington, is geographically quite small. It is one of the most densely populated boroughs in the country, if not the most densely populated. Until the end of the second world war in 1945, the only real open space in my constituency was Highbury Fields—there was Arsenal football ground as well, if we want to call that a public open space—in the south of the borough, on the edge of the City of London.

In 1945, something interesting happened across London and the other cities. The Abercrombie report, which was written during the war and was a planning idea for how London would develop after the war, was an incredibly far-sighted document. I might disagree with some of it—it was too keen on road building and not keen enough on other forms of transport—but it had a real vision for greening cities and enabling people to live with nature and have public open space near them.

At that time, in some parts of London there was less than 0.1 acres of open space per 1,000 people. In other words, there was no open space for many people in many parts of London. Abercrombie’s proposal, which has not totally been realised, was that London should aspire to have 4 acres of open space per 1,000 population. He realised that that would be very difficult, so he proposed a series of green routes that would link large open spaces in different parts of the city.

Most of the parks in my borough have been developed since 1945; some have been developed very recently. I have an aerial photograph in my office of a place called Wray Crescent, which, as the name indicates, is a crescent of housing; the picture shows the houses and gardens and so on. It is not there any more. The houses were all bought by the local authority and demolished, and a park was created in that space. There is a school next to my office that once had houses in what is now the school’s garden. Those houses were bought by the Inner London Education Authority and demolished to make a garden for the school. That is an incredibly brave thing for any public authority to do. Now, we would not even think about buying houses in order to create a park or open space because of the costs involved. We have to remember that some of this work was done by very far-sighted people.

We have nearly always achieved parks through a combination of wealthy benefactors—in some cases big charities, or even big landowners—and campaigns by ordinary people who just want something decent and to create more open space. One of my favourite parks in my constituency is Gillespie Park. I even led an Adjournment debate on it in the 1980s—[Laughter.] I have been here a long time, you see. At the time, Gillespie Park was a disused railway sidings. British Rail wanted to sell it, and there was a huge debate and campaign locally. Eventually, it won recognition as an open space, partly because British Rail made the fundamental public relations error of allowing people to use it on a temporary basis. Once people have been allowed to use a public open space temporarily, they are not going to give it up—and they did not give up Gillespie Park.

I was at the park on Sunday. It is beautiful: it is heavily wooded, with an amazing variety of bird and plant life, as well as fish life in the pond. We are very proud of it. There was an “apple day” on Sunday; hundreds of people came to enjoy different varieties of apple. I spoke to many of them, and I would guess that more than half of them have no open space of their own. They have no gardens or balconies—no open space whatsoever. The park is their lung. We have to remember that parks are there for everybody. We in this Chamber may have our own gardens at home, which we probably enjoy and love, but the vast majority of my constituents do not. Their only open space is the street or the park. They have no open space of their own. We should think very hard about that.

I was encouraged to seek this debate by the issues surrounding Finsbury Park, which is in the Tottenham constituency, just outside mine; I let the right hon. Member for Tottenham (Mr Lammy) know that I would be raising it. Finsbury Park, which was established 150 years ago by the Metropolitan Board of Works, was designed to be very much bigger, but the board gave up on its expansion and sold some of the land for housing. It is still a substantial park, and a vital open space. After its development by the Metropolitan Board of Works, the park was taken over by the London County Council, and then by the Greater London Council, which actually ran it very well. The history of the park shows all kinds of things, from balloons taking off to anti-aircraft guns during the second world war and peace demonstrations in 1914. It has been a place for people all that time.

Like every other council, Haringey has funding problems, and it frequently lets out large parts of the park for concerts and entertainment and so on. The most recent figure I could find on the council’s income from concerts was £1.2 million for one year, which is a great deal of money. That involves a very substantial part of the park being taken over for several weeks on end, which causes a great deal of resentment. I am a patron of the Friends of Finsbury Park. Some time ago, a legal action was taken against Haringey Council to require it to spend the benefits of the concerts on the park, rather than on the generality of council expenditure. Although that action was successful, the park is still denied to a lot of people for quite a long time.

Managing the use of parks is always complicated and difficult; there are many demands, and it means trying to work out everybody’s life in a park. There are those who want to play football, cricket or baseball; those who want to just sit around doing nothing and playing music; those who want to play informal games; those who want to have birthday parties, and all the other things. There are also those who are keen on protecting trees and improving the biodiversity and natural life of parks. Managing parks is not simple. If we throw into the mix underfunding of the park, and pressure on the relevant local authority to raise more and more money from it in order to maintain it, we end up in a self-defeating circle where we lose the use of the park in order to make money to keep the park, which we cannot use. We have lost the use of it because of the many concerts that go on.

I am not against having concerts, festivals and parties in parks—absolutely not. I just think there has to be a balance and a limit on the numbers of them. They are not cheap and therefore not necessarily completely available to everybody. For example, the lowest priced Live Nation tickets last year in Finsbury Park were £190, way beyond the likely spending power of young people in the immediate area.

The problem affects my favourite local park, which I often use. It is a wonderful place and I am worried for its future, as I am worried for every other park’s future, unless we have some degree of guaranteed funding and protection of them. I can see the Minister becoming anxious, because I told him that I would say nothing he could possibly disagree with. I look forward to an intervention from him agreeing with my view.

The right hon. Gentleman is giving a great speech and articulating the value of parks to our many local communities, including those across north London. Many parks are under unprecedented threat, whether from financial interests or from development—not least Stanley Park in my constituency, which was voted England’s best park last year. A local authority-led plan to develop part of the park has caused enormous disquiet in my constituency. Will the right hon. Gentleman join me in urging local authorities to be mindful of the health and wellbeing benefits of parks and to be conscious about protecting their status?

I thank the hon. Member for his intervention. Stanley park is a wonderful park and a great place. Many other parks around the country are iconic and beautiful and all are at risk because of the danger of local authorities agreeing to a planning rule change that would allow parts of parks to be sold off.

It all seems very attractive at the time. Somebody in the council says, “Okay, we will sell off this bit of the park and get x million for this piece of land, and that will enable us to plug a spending gap somewhere else.” It is always a very attractive option. The problem is we will never, ever get the park back. Once it is gone, it is gone. It will not return. That is why I look forward to the Minister’s response and to the response to the Select Committee report.

We need to look again at the strength of legislation protecting public open spaces from development and from sale by local authorities so that that option is simply not available to local authorities. I am not saying that most local authorities want to sell parks—they do not—but we have to make sure parks are protected for all time. Fields in Trust has produced some interesting information. Between 2010 and 2021, there was a loss of £690 million in park funding across the whole country. Some 32% of parks have recorded a loss of frontline staff and 41% a loss of management; 23% have cut their development plans for any park; and 62% of local authorities—this is the saddest figure of all—expect to see the quality and appearance of their parks decline in the coming years.

The Government have said that they want money to be put aside for the development of new parks, and they have done that through the levelling-up fund. The number of new parks proposed is not very many—I think it was 100. Unless I have misunderstood the information that I have read in the various reports, only £9 million has been set aside for them. Well, we cannot develop even one park with £9 million, so I think that needs to be looked at carefully. If we want new parks, they have to be funded from somewhere, which I will come on to in a moment.

The Communities and Local Government Committee inquiry in 2016-17 was an important one, and it was revisited by the Levelling Up, Housing and Communities Committee and by the Government in 2022. Clearly, a lot had changed in those five years. Covid had come, which enhanced the importance of parks but also led to a new round of funding problems for local authorities—£330 million less than in 2010 is now being spent on parks. The cuts in park expenditure have gone on and on. It is not clear what level of urban uplift is going to go on parks.

In a reply to a request from the Chair of the Select Committee, the hon. Member for Sheffield South East (Mr Betts), the Minister said that he thought local authorities were best placed to decide how money is spent. Yes, that is absolutely true, but unless there is overall protection for the level of expenditure on parks they will obviously be a place where cuts are made. If a councillor is faced with a massive bill on social care, or other aspects of key services, people will say that the parks do not matter, so they can be cut a bit more. What people forget in that short-sighted view of things is that we can help to alleviate the mental health crisis with the provision of open spaces.

I welcome this point being made, because parks have a clear benefit for our communities. They are an important cultural asset, but also improve people’s health and have an important role to play in maintaining our natural environment. Public Health England recognises the value of parks for people’s physical and mental health. It is understood that people who are living in areas with higher amounts of green space have a reduced likelihood of cardiovascular disease, for example. We must protect the funding of parks and ensure that these important cultural assets are maintained.

The hon. Member is quite correct. There are numbers of people who are going through a mental health crisis who feel that it is alleviated to some extent by going to a park. I have met people with mental health conditions who are going through group therapy who meet and walk around a park together; they feel that that is a way of coming together in a calm atmosphere. We should never underestimate the value of parks to all of us, in every way. They are a place for nature, recreation, sport, and a place to give us a sense of calm in our lives.

There is an inequality of park provision, however, around the country. We need to look at that. We need to look at protecting funding by central Government to local government so that it can be ringfenced for parks. One suggestion in the Committee report was that every local authority should be required to try and achieve the green flag standard in their parks. Many councils try and do that anyway because they want to—which is good—but they need to do it more.

The funding of parks improved a bit when the lottery was introduced, which put quite a lot of money into the improvement of some parks. Lottery funding, like charity funding and donations for parks, is welcome, as that it can be used to improve sports facilities, planting and maybe bring in allotments and growing spaces. What gifts never do, however, is take into account the longer-term requirements of funding, such as the need for staff and the need to keep the thing going. That is where central Government expenditure and their relationship with local authorities is so important.

My fundamental point is that the lesson from my lovely local park, Finsbury Park, is that, while we love that park, it needs to be properly funded so that it does not have to give up so much space every year for expensive concerts. The same thing applies elsewhere. Hyde Park is taken over by Winter Wonderland for several weeks. It is fine that people enjoy Winter Wonderland, but what about people who just want to go to Hyde park to walk about? They cannot do it because of that. The same applies in many other places, so we need balance.

I hope the Government will look again at the two Committee interventions on this issue, which were helpful and designed to improve parks and open spaces, and realise their value. I hope the Government will say that they are prepared to ensure there is guaranteed funding. When dealing with overall planning, it is important to protect our green belt but also to protect our public open spaces and parks. We should also ensure that, with every major planning operation, there is improvement in the amount of open space and the creation of allotments and community growing spaces.

Our children need to be brought up to understand that we have to live with nature, not on top of nature. That creates a better understanding and more support for progressive environmental policies in future. I put this forward today because I hope it will provide an opportunity for the Opposition and the Government to give their proposals for the funding of our beautiful parks all over the country.

I thank the right hon. Member for Islington North (Jeremy Corbyn) for introducing this important debate, and for the opportunity to speak on it. As I said in my intervention, parks have a clear benefit for our communities, even in very rural areas such as Somerton and Frome, which I am proud to represent. Victoria Park, the oldest park in Frome, which opened in 1887, continues to hold many events throughout the calendar year.

It is therefore concerning to read that something approaching one in 10 of the UK’s parks are classified as in poor condition. A gradual decline in funding has seen hundreds of thousands—millions—taken away from park budgets, as local authorities have had a reduction in finances as a result of austerity measures. That decline in funding results in cuts to the hard-working, talented staff who take care of and love our public parks, and who ensure that they are an asset to our communities.

As many as 32% of our local authorities have had to cut frontline staff such as park rangers and litter-pickers, while 41% have had to cut management staff as well. The loss of staff inevitably leads to a reduction in the quality of the parks. Somerset Council, of which I was proud to be a member, and South Somerset District Council before that, have demonstrated the benefits of securing good funding for parks and rangers. I invite everybody to come to the parks in my part of my world. They have offered apprenticeship schemes to employ young people, training them in a variety of skills that are needed to maintain our public parks. That work is important on so many levels.

The Association for Public Service Excellence has tracked the age profiles of park staff over 10 years. The over-50 age range makes up 50% of the workforce, with most other age groups falling. With already stretched staffing, and as park staff reach retirement age, that could cause a significant issue in coming years. Initiatives such as those by Somerset Council demonstrate the importance of tackling this problem head on, although more funding is needed to continue programmes in Somerset and extend them around the country.

Local authorities such as Somerset Council have used the importance of parks to build up and emphasise important local cultural events, such as those mentioned by the right hon. Member for Islington North. There has been a focus on providing top-class facilities for visitors and improving people’s access to nature by putting on local events. Somerset’s parks offer a variety of events from dog shows to astronomy evenings to bring people in and experience what is on offer.

Work has also been undertaken to ensure that our parks are accessible. For example, there are mobility walking areas for people to access the spectacular nature of Somerset. That showcases how important parks are to Somerset. The county has around 95.4 square metres per person of public park and green space, well above the national average of 30 square metres. We are extremely lucky in my county. In order to protect our important green space, Somerset Council has worked with Fields in Trust to protect our parks. I welcome the clear steps taken by the council to safeguard those spaces. It is important that we do that to protect the natural biodiversity of the parks and green spaces that we love.

We live in one of the most nature-depleted countries in the world. More than 40% of native species are in decline. To arrest those changes, we must protect park funding. Our parks are also valuable for the health and welfare benefits they provide to us all. Public Health England has recognised the value of parks for people’s physical and mental health and, as I have already mentioned, it is understood that people living in areas with higher amounts of green space have shown reduced mortality and a reduction in the likelihood of cardiovascular disease.

Public parks are important cultural, environmental and public health assets. We must safeguard them for future generations. We must do that by protecting their funding and allowing local authorities the opportunity to maintain their parks.

It is a pleasure to see you in the Chair this afternoon, Mr Pritchard. I shall begin by welcoming the Minister. This is our first outing together. Maybe we will have a few more before we go our separate ways again, but I do not think this is something we will fall out about.

I congratulate the right hon. Member for Islington North (Jeremy Corbyn) on his excellent speech about the importance of parks. He articulated very well how important they are and how, during the pandemic, we all came to a greater understanding of their importance. He set out the historical context as well, with many wealthy benefactors often the progenitors of local parks. Local communities have worked together and, indeed, local authorities have also done a great deal of work over many years to secure and preserve those open spaces that otherwise might well have been concreted over.

I thank the right hon. Member for mentioning Birkenhead Park. It is not quite in my constituency, but it is not that far away. It would be remiss of me not to mention some of the excellent parks in Ellesmere Port and Neston. We have Whitby Park, Rivacre Valley, Stanney Wood and Lees Lane, which are all important open spaces. They are often kept going by friends groups and volunteers, who do a really important job in covering the sometimes difficult job of local authorities in maintaining those spaces to the levels we would like to see. The right hon. Member for Islington North has referred to that and I will come back to it shortly.

The right hon. Member referred to the Select Committee reports, and the 2017 report in particular clearly spells out the health and economic benefits that parks and open spaces can have. The report quoted studies that found that, every year,

“green spaces in England contribute £2.2 billion to public health.”

It was also mentioned that the UK Natural Environment Assessment found that caring for ecosystems had the potential—I use the word “potential” advisedly—to add £30 billion a year to the UK’s economy. The Select Committee also noted the benefits that accrued to local areas in terms of attracting investment and securing jobs, referring particularly to Edinburgh City Council’s social return investment model as proof of the basis for economic benefits and how it was concluded from that scheme in particular that every £1 invested in parks resulted in a £12 return in benefits delivered. That is not something that any of us can ignore.

Both the right hon. Member for Islington North and the hon. Member for Somerton and Frome (Sarah Dyke) have spelled out clearly that there are many positive impacts in our communities from parks and green spaces. It is perhaps counterintuitive, possibly disappointing and almost certainly frustrating that our general impression is that parks have been undervalued in the past decade.

The Association for Public Service Excellence noted in its “State of UK Public Parks 2021” report that in the past decade, funding for parks from local government has collapsed. It estimated that since 2010, parks have lost £690 million-worth of funding, with parks now making up less than 3% of local authority budgets on average. With constricted budgets, staff maintaining parks have also had to be cut, which is where the important work of friends groups comes in. The APSE survey found that 32% of local authorities have had to make frontline cuts to staff during this period. Sadly, those cuts were not even distributed evenly across the UK. We know that 87% of the UK’s most deprived councils have had their spending cut since 2010, compared with only 58% of those in the most affluent areas. Given what we know about the importance of parks in driving down health inequalities, the fact that that funding cut has disproportionately affected those areas with less economic power is a cause for double concern. We all know that the austerity enforced on local authorities since 2010 has had a huge impact on their ability to deliver. We know that their spending power fell by almost 20% between 2009-10 and 2019-20. Despite a partial recovery in recent times, spending power is still more than 10% below what it was before. That has resulted in many local authorities really struggling.

We know that there are huge, increased pressures on local authorities, particularly in children’s services and social care, and more pressure is on the way. It is not surprising, with the financial pressures faced by local authorities, that there is a temptation for them to monetise some of these assets a little more. I do not criticise them for that—we know that they are in a difficult position—but we must be alive to the risks that brings: restricting access to all, reducing the quality of the environment and ultimately undermining the very essence of what parks are meant to be there for. The right hon. Member for Islington North talked about how Finsbury Park can be out of action for several weeks at a time. I agree with him that there is no problem with using parks for these events if they raise funds, but a balance must be struck between the local authority’s ability to use the park for those events and the rights of other users to enjoy the benefits of the park.

One other way that the pressure on local authorities and open spaces has manifested itself is through the introduction of estate management fees, whereby management companies simply adopt the work that the local authorities used to undertake, leaving homeowners having to pay twice for exactly the same services. I have said before that unless we get a proper grip on estate management fees, they will become a new payment protection insurance scandal. What do we say to residents who pay additional fees but then see non-residents, who have not paid the fees to clean up and maintain the park, using their facilities? How long before residents demand that open spaces are open only to those who have paid management fees? Be in no doubt: this issue will continue to corrode community cohesion unless we find a compelling answer to these questions. The Minister knows that I will come back to this repeatedly, because I do not think that we have really understood the scale of the issue just yet.

The concerns articulated by the right hon. Member for Islington North about the need to protect and preserve our parks and open spaces are very much a live issue. I look forward to hearing the Government’s response from the Minister, particularly to the Select Committee recommendations that we have heard about.

It is a pleasure to serve under your chairmanship, Mr Pritchard. I thank the right hon. Member for Islington North (Jeremy Corbyn) for calling this important debate and articulating so clearly the value of our parks estate and the challenges that it faces. I also thank the hon. Member for Somerton and Frome (Sarah Dyke) for her remarks. I recently visited her constituency a number of times, and I can fully attest to the beauty of Somerset and its parks. Like the Labour Front-Bench spokesperson, the hon. Member for Ellesmere Port and Neston (Justin Madders), I will shamelessly plug some of my local parks, such as Locke Park, Lily Park, the Saltburn Valley gardens and Smiths Dock Park. Like him, I commend the friends groups who care for our parks and cemeteries too, such as the Friends of Redcar Cemetery and the Friends of Eston cemetery.

The UK’s 27,000 public parks are treasured assets that have been enriching the lives of our communities for more than 150 years. They provide opportunities for leisure, relaxation, exercise and connection to nature. However, parks are also fundamental to community cohesion, physical and mental health and wellbeing, biodiversity, climate change mitigation and civic pride. As the right hon. Member for Islington North said, during covid they were also a lifeline, providing a breathing space where people could relax, exercise and enjoy the outdoors, even in the most difficult of times.

The Government are fully committed to creating better access to parks and green spaces for all our communities. Although the main responsibility for urban parks lies with local authorities, the Government have made a number of targeted investments to support the sector. In 2022, as the right hon. Member mentioned, we launched the £9 million levelling-up parks fund to improve access to green spaces in disadvantaged neighbourhoods across the UK. I am pleased to share with the House today the fact that 90% of funded local authorities reported increased access to green spaces in disadvantaged urban areas, such as those that the hon. Member for Somerton and Frome mentioned.

The levelling-up parks fund is an immediate example of the Government’s commitment to levelling up communities across the country. However, as has also been touched on, there is also lottery funding. Since 2019, the National Lottery Heritage Fund has invested over £36 million in parks and green spaces. Since that fund began in 1996, it has awarded over £950 million to create and restore more than 900 individual parks. As the right hon. Member may know, Caledonian Park in Islington received a grant of almost £2 million from the National Lottery Heritage Fund in 2016 to restore the historic clock tower and market railings.

Furthermore, in two rounds of pocket park funding in 2018 and 2019, the Government awarded grants of over £5 million to 266 community groups working in partnership with local authorities to create new community green spaces or to transform existing parks. Also, through the community ownership fund, the Government are awarding funding to a range of assets that are important to local communities. The fund has already invested over £500,000 to support five parks and green spaces. I should also mention the £2.6 billion UK shared prosperity fund, which is providing new funding for local investment. Local authorities will decide how to use that funding to best serve their communities, including by investing in improving and developing their parks.

The Government have always been clear that local authorities must have the freedom to choose how to use their budgets to best serve their local areas and priorities, which includes how they support their parks and green spaces. I am pleased to see that there are many examples across the country of local authorities developing innovative practice and partnerships to manage their parks estate. However, as the right hon. Member mentioned, it is important that those partnerships do not impinge on communities’ access to those parks. A balance has to be struck.

The right hon. Member may know that, in order to support parks, Camden Council and Islington Council have agreed a joint parks for health strategy. Health-related projects and social prescribing are being rolled out across both boroughs, and Islington Council is incorporating parks for health in its public realm by greening its highways and creating new green spaces.

Central Government continue to support local authorities in this regard. The Government have helped local authorities to develop innovative practice through the future parks accelerator programme, which we jointly funded with the National Lottery Heritage Fund and the National Trust in 2019. That programme funded eight local authority areas to pilot new ways of managing parks estates. The results are currently being evaluated and disseminated across the sector.

The green flag awards have been mentioned a few times already. The addition of the green flag awards scheme—which is owned by my Department and run by the Keep Britain Tidy charity under licence—promotes the national standard for parks and green spaces across the UK. Over 2,000 green flags were awarded this year, demonstrating that the parks that won them had met the highest-quality standard. I am also proud of the contribution of community groups and volunteers, such as the friends of parks groups, which have already been mentioned, in designing and managing local parks. Over 400 green flag awards have already been awarded to community-led parks, with many more to come, I am sure.

Getting the best for our parks is not just about spending more or dictating how local authorities should use their budgets. It is about communities, health authorities, park sector stakeholders, and local and national Government working together to get the best outcomes for our parks estates. That is why the Government have reflected on the importance of access to good-quality green space as a key factor for health in a wide range of policies, including the childhood obesity strategy, the loneliness strategy, the clean air strategy, “Sporting Future” and “The Five Year Forward View for Mental Health”. The Government have set clear expectations for how parks and green spaces should be incorporated into our communities in the national planning policy framework and the national design guide and code. We have outlined our ambition to ensure that every household is within a 15-minute walk from a quality green or blue space in our environment improvement plan, which we published in January this year.

I thank the Minister for what he is saying. Does he think that there should be guidance from central Government about the amount of time that a park can be exclusively used for private interests or private commercial interests, in order to protect the generality of public access to what is valuable open space?

I thank the right hon. Gentleman for that contribution. It touches on his points about what he feels are abuses happening in places such as Finsbury Park and Hyde Park. I would say that those decisions are best made locally. Obviously, there is a local democracy angle at play in local authorities, and authorities are held to account at the ballot box every couple of years. Certainly from my party’s perspective, we would always go to the ballot box ensuring that access to local parks was important.

Finally, if the House will indulge me, I want to share briefly my memories growing up as a child, visiting Albert Park in Middlesbrough. As the right hon. Gentleman said, it was a park gifted by a wealthy benefactor—our first mayor, Henry Bolckow—to the people of the town in 1865. Over 150 years later, that park is still in the centre of the town. When I was growing up, it played host to the Middlesbrough Mela—a celebration of the south Asian community in Teesside. We also have Stewart Park, where as a kid I would go and see the animals. Years later, I visited when it played host to BBC Radio 1’s Big Weekend in 2019.

As we have heard, parks are about history, celebration, memories and culture. They are the centre of communities and key to healthy communities. I add my thanks to those who protect and maintain our parks, particularly those in Redcar and Cleveland but nationally too, and to the armies of volunteers who do the same. Going forward, we must ensure that our parks’ workforces are well equipped with the skills to meet the current and future expectations of our communities. Learning and best practice from current park programmes needs to be embedded to develop and protect our parks for the future. We must work together to ensure that these treasured assets are passed on to future generations in the best possible condition, so that our children and grandchildren can enjoy them just as much as we have.

I am pleased that we had this debate today; it gave us the chance to set out the issues facing us. I understand what the Minister said about the use of parks for mental health recuperation and the generality of people’s needs, and I fully support that. I hope that we will recognise that increasing pressure on local authorities to get an income from parks can be detrimental to the basic needs of parks. I look to the Government to at least set out guidelines on the amount of time that a park, or even part of it, should be taken out of public use and into exclusive private use, because I see a trend that is rather worrying—to me in my own area and, I suspect, to people all over the country.

I thank the Minister and the Opposition spokesperson, the hon. Member for Ellesmere Port and Neston (Justin Madders), for what they said, and I thank the hon. Member for Somerton and Frome (Sarah Dyke). We value our parks; we love our parks, and they are the only open space that so many of our people ever get access to. We should value them.

Question put and agreed to.


That this House has considered funding for parks.

Sitting adjourned.