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Westminster Hall

Volume 741: debated on Thursday 23 November 2023

Westminster Hall

Thursday 23 November 2023

[Mr Philip Hollobone in the Chair]

Batteries for Electric Vehicle Manufacturing

Business and Trade Committee

Select Committee statement

We begin with the Select Committee statement. Liam Byrne will speak on the publication of the first report of the Business and Trade Committee, “Batteries for electric vehicle manufacturing”, HC 196, for up to 10 minutes, during which no interventions may be taken. At the conclusion of the statement, I will call Members to put questions on the subject of the statement, and call Liam Byrne to respond to these in turn. Questions should be brief, and Members may only ask one question each. I call the Chair of the Business and Trade Committee, Liam Byrne.

It is a pleasure to serve under your chairmanship, Mr Hollobone. I am grateful to the Liaison Committee for making time available for this statement today. I understand that the Backbench Business Committee was reinstituted last night, so Select Committees and their Chairs will now have the opportunity to make applications to it, but I am grateful for the time granted by the Liaison Committee today.

When the great steam engine tycoon Matthew Boulton, who was from my neck of the woods, in Birmingham, welcomed people to the Soho manufactory—the first great steam engine factory in the world—he used to say, “I make here, Sir, what all the world desires—power,” and he was right. Just as power was at the heart of the industrial revolution all those centuries ago, so power will be at the heart of the green industrial revolution in the years to come. Our nation has to move fast now to transform the battery industry, to create jobs, and to safeguard the 165,000 workers in the automotive industry and the other 800,000 in the supply chain.

Batteries are big and heavy, and they are expensive to move around. We have to wake up to the risk that, if we do not build the gigafactories that make those batteries here in this country, our great automotive factories will up sticks and move to where the gigafactories are being built—perhaps in the United States or Europe. If we do not do that, we risk becoming dependent on imports from China, where, as we know, there are questions about the integrity of the supply chain and the labour that is used.

The challenge the Committee wants to flag is that we are now falling behind our competitors and need to take steps urgently to create a better environment for electric vehicle battery production. We have a huge gigafactory gap; the estimates are quite widely developed in the industry and academia, but even under the Minister’s own estimates, we are going to need about 100 GW of manufacturing capacity just to supply the automotive industry for us by 2030. But the demands will be much greater than that, because there will be all sorts of other applications too. Right now, we have online just 2 GW of capacity and deals in place that cover barely half the capacity we will need.

We conclude in our report that the Government have done well to reinforce this country’s strengths in battery research and development—we are, after all, the nation of Faraday. We also conclude that the lack of a stable, long-term industrial strategy has hampered our ability to secure long-term investment. As a country, we have real competitive advantages. We could harness the UK’s low-carbon energy sources to ensure that we become a global frontrunner in making sustainable and ethical batteries.

I am conscious that tomorrow is a big day for the Minister—she has just arrived back from Kazakhstan, and I am grateful she could join us today. We know that an advanced manufacturing plan and a UK battery strategy are coming. These things—or some of them—may arrive tomorrow but we do not know yet. We as a Committee wanted to set out the seven things we would like to see in those strategies, so that we could mark the autumn statement, and the House would have a way of judging whether the Minister’s strategy is what the country needs.

First, we cannot escape the fact that public subsidies will be needed. American cash for battery firms could total $150 billion over the next 10 years, which is an enormous amount of subsidy, while European subsidies are at around three times what we are currently providing. By contrast, the UK’s automotive transformation fund has just £850 million, and some of that has been burgled for other purposes. We think the Chancellor will need to put in more money for subsidies, and we call for an international study to benchmark what subsidies others are providing, so that we can ensure that our financial offer is internationally competitive.

Yesterday, the Chancellor announced £2 billion for zero-emission vehicles, batteries and associated supply chains over five years, but those five years begin in 2025. That was part of a £4.5 billion fund for advanced manufacturing. We do not yet know, but we assume, that the £2 billion extra is in addition to the £850 million already in the automotive transformation fund. Presumably, that fund will be the mechanism through which new funding is invested. There have been problems in the way the fund has been administered, and there are crucial questions about the timing of the funding, because the Government have only a very short window to get the advanced manufacturing money moving.

The autumn statement also said the Government are

“unlocking new sources of finance for advanced manufacturing.”

There was not a lot of detail about that, apart from a side reference to the UK Infrastructure Bank. I know that the Government’s priorities for the bank include investing in the critical mineral supply chain, on which the Minister has been working, but it is not yet clear what plans the Government have in place to unlock that new finance.

The Government also announced a ministerial investment group that will

“increase resourcing for the Office for Investment, strengthening the UK’s world-class concierge service for investors.”

In our report, we recommended that the Department for Business and Trade establish an office within the Department to bring together the various bodies involved in getting gigafactory investments to happen faster and more efficiently, so I hope what the Government have announced will help to address that point.

Our second key point was on energy and long-term certainty for battery supply chains on accessing electricity at comparable rates. From what we could see, there was nothing in the autumn statement on that. That is a big concern across the battery supply chain.

Thirdly, we wanted to see strategically important sites designated. There is a tiny bit of progress on that, and I hope the investment zone announced for the west midlands and around Coventry airport will help ensure that there is progress in Coventry. However, we wanted to see a bigger plan than simply Coventry; we wanted to see the key sites that are needed across the country designated.

Fourthly, we wanted to see real action on addressing skills gaps across the battery supply chain and gigafactories specifically. There is a tongue-twister in yesterday’s autumn statement: the Government say that they are going to support

“plans to catalyse the growth sectors by committing £50 million to deliver a two-year apprenticeships pilot to explore ways to stimulate training in these sectors and address barriers to entry in high-value standards.”

If we can interpret and understand what that might mean, and ensure that the training funding is in the right places, we may make progress, but right now we are not clear. Our key point was that we want to see devolved funding to those areas where there are gigafactory sites, so that they have the funding for adult skills that they are going to need.

Our fifth conclusion was that we needed to secure tariff-free access to global markets for electric vehicles so that we could trade easily and well. We advised the Government to seek a three-year extension to the rules of origin agreement with the EU, because we certainly do not have the battery capacity we need to meet those new rules, and we are not sure that Europe does either, frankly, because of displacement of investment into America.

Our sixth recommendation was about de-risking access to the requisite critical minerals and supply chains. I know that the Minister was working hard on that up to her flight home last night. It is hugely important that we work closely with our partners, particularly in Africa, to help unlock the $1.9 trillion of investment that is needed in critical minerals, and to help build a processing industry in Africa so that we are not critically dependent on countries such as China.

Finally, we need to continue something that I know the Government believe in: putting research and development in battery technology on a long-term footing. Power was always at the heart of the industrial revolution, and it will be at the heart of the green industrial revolution. It was Michael Faraday, the pioneer of the electricity industry, who, when explaining this to Gladstone, was greeted by the question, “Well, man, what is the use of it?” to which Faraday answered, “Well, sir, there is every chance that you may one day be able to tax it.”

We see the battery industry as mission-critical to safeguarding and growing the huge numbers of jobs in the automotive industry and the wider supply chains. The truth is that, if we are to compete with Beijing, Bidenomics and Brussels, we will have to raise our game. The time to do that is now.

I thank the right hon. Gentleman for his statement. Although it has been thrilling for all of us to hear it, I would not want him to be under the impression that he can make these statements only in Westminster Hall. He can apply for time in the main Chamber, and that may be something he wants to consider for the future.

I commend the Select Committee for its work, and my right hon. Friend the Member for Birmingham, Hodge Hill (Liam Byrne) for the way in which he introduced the Committee’s report.

One issue, I want to touch on, which the report rightly highlights, is the looming cliff edge in the trade and co-operation agreement, with much tighter rules of origin for electric vehicles from 1 January. As I understand it, Ministers have still not set up a key working group on automotive parts, which was agreed in the TCA. That group could have helped industry to get heard a lot earlier and in its understandable call, backed by the Committee, for a three-year extension to the current rules of origin. Ministers seem to have gone quiet on whether agreement will be reached on a three-year extension. Indeed, the Prime Minister appears to have taken little interest in what could be a significant drag on UK exports of electric vehicles in the coming months. Will the Chair of the Select Committee update the House on what he knows about the current state of negotiations and Ministers’ current efforts to win a three-year extension to the rules of origin?

I am grateful to my hon. Friend. As ever, he is on the money. The rules of origin framework was put in place with the best intentions, to try to incentivise people in Europe and the United Kingdom to get gigafactory investments in place, but that has not yet happened. We have a looming gigafactory gap in this country, and if we do not negotiate an extension to the rules of origin, we will have tariffs of up to 10% on some of our exports, which will have a really serious impact on hundreds of thousands of jobs. Given how much is at stake and how many jobs are in peril, we were surprised to see almost no news about where the renegotiation of the rules of origin had got to. That was one reason why we stated it so clearly as a requirement in our conclusions—so that the Government now have to go on the record to explain to the House, and indeed the country, precisely what they are doing.

I thank the Chair of the Select Committee for his statement. I have a specific question, which I spoke to him about beforehand. As I understand it, EV batteries used in the UK are likely to be sourced from Europe and elsewhere, so we very much welcome talk about British production of batteries. In my constituency of Strangford—the Chair of the Committee has referred to regionalisation, to which my question relates—there is much interest in electric and hybrid vehicles, and many engineering companies there are willing to get involved in the production of batteries. I have asked about this in oral questions in the main Chamber, but today I ask the Chair of the Committee the same question: does he agree that there is an opportunity for Northern Ireland and my constituency of Strangford to get involved in the production of EV batteries, and that any legislation that comes forward in this place must take on board, and extend to, the devolved institutions as well?

I am grateful for that question. Although I do not have the specific details of the opportunities in the constituency of the hon. Member for Strangford (Jim Shannon), the spirit of the Committee’s report is that we need to be using industrial policy to do three things: to de-risk supply chains, to decarbonise, and to decentralise the sources of economic growth. That is why we are so clear about the need for the Government to designate strategically critical sites for gigafactories in the future. As to quite how many we need, the Minister and I may have different views, but we know how much capacity we need, and that can perhaps be delivered by between five and eight gigafactories, depending on how much each factory can produce. But the broad point is that we cannot be producing batteries simply for the automotive industry; we need a wide range of applications for them in the future.

Once we have designated the sites, we need to think about how industrial policy helps to unlock the wide range of policy levers that any place will need. That includes access to low-cost electricity, skills, and incentives and subsidies to get factories built in the first place. Of course, we then need the trading arrangements, so that people can export and we can ensure that the export of EV batteries is a real growth sector for our economy. The point the hon. Member for Strangford made is therefore absolutely the right one, and we have sought to provide the checklist of things he needs to be asking of Ministers.

I thank the Chair and the Select Committee for putting together such a comprehensive and valuable report. As the chair of the all-party parliamentary group on electric vehicles and the all-party parliamentary motor group, I agree with him: my frustration is that we find ourselves behind our major competitors—China, the US, Japan, Germany, France and many others—in our capacity to manufacture battery units for electric vehicles and other uses.

That is frustrating because, from what I sense from the report and more widely, we have an energy advantage in the UK—indeed, we should have a huge energy advantage over other nations. In my constituency, National Grid reminds me of what we can do by bringing green energy to this country through the interconnectors. We also have organisations such as Warwick Manufacturing Group, which is at the forefront of the development of new battery units. We have two great advantages, but because of what the Chair of the Select Committee describes as a lack of industrial strategy, we are way off the pace.

I have a couple of points on skills—not just on the manufacturing side, but in terms of what we will need up and down the country in our franchise dealer network and other vehicle marketing sites. In terms of what we need to do on infrastructure for the consumer—

Order. The hon. Gentleman is meant to be asking a question, not making a second statement. We are running out of time, so if he could put a question to Liam Byrne, Liam Byrne might answer him.

I apologise, Mr Hollobone. My question is about infrastructure for consumers. Also, I hear that Europe will perhaps grant us a three-year extension on the issue of rules of origin, which would be advantageous. Does my right hon. Friend know any more about that? And what is his estimation of how long it will take the UK to catch up with our major competitors, such as Germany and France?

I commend my hon. Friend’s work; his leadership of the all-party parliamentary group on electric vehicles and the all-party parliamentary motor group has been so important in ensuring that we in Parliament can benefit from informed debate.

We are two to three years behind our European competition, and we therefore have to move quickly to catch up. The lack of certainty has damaged confidence—moving the goalposts on phasing out petrol engines, for example, has hurt confidence. Ultimately, despite the public investment that needs to go into building things such as gigafactories, the investment overwhelmingly comes from the private sector, and when we damage confidence, we damage the speed of that private investment. I am afraid that the Committee came to the conclusion that the lack of an industrial policy has hampered our ability to secure the needed investment.

It is not too late to catch up. There is a real risk that we cannot win a subsidy race with the United States, or indeed Europe, so we will need a smart policy framework—the seven things I set out. They include devolved funding on skills and guarantees around infrastructure and low-cost energy access. My hon. Friend is absolutely right that there is a niche—in the global market, it is a huge niche—for the UK to provide, build and sell batteries built with low-carbon energy and with the highest levels of integrity right through the supply chain. That is a big opportunity for the UK, which we should be seizing with both hands.

World Stroke Day

I beg to move,

That this House has considered World Stroke Day.

As ever, it is a pleasure to serve under your chairmanship, Mr Hollobone. I am grateful for the opportunity to raise this important topic. This year, World Stroke Day fell on 29 October. We had hoped to have this debate a little nearer to then, but the date we were originally given had to be vacated because of the Prorogation of Parliament. I am grateful to the Chairman of Ways and Means for so swiftly rescheduling it.

I refer Members to my interest as co-chair of the all-party parliamentary group on stroke. I am delighted to see one of the vice-chairs, the hon. Member for York Central (Rachael Maskell), in her place. I also declare a personal interest. My wife Anne-Louise suffered a stroke four years ago, as many in this House know. She made a courageous fight to recover, and I think we have discovered a number of areas where much more work needs to be done because stroke is very often, to a degree, a hidden condition. It does not receive as much publicity as heart attack or cancer, for example. Although we have made improvements and advances in recognising early stroke symptoms so that swift treatment can be given, the thrust of the debate is to say that much more needs to be done.

The hon. Member is making a powerful speech, and I appreciate his passion. He spoke of awareness, understanding and education about strokes. We need much more work on that; many people are unaware of stroke symptoms. They should be aware of what might be happening to a family member or friend before their very eyes.

That is right and that is why I commend the Stroke Association for raising awareness and recognition of symptoms. It promotes the Act FAST campaign, which details the symptoms that should be looked out for: if someone shows facial weakness, arm weakness or speech problems, then it is time to call 999. That has been important in raising awareness. I thank the Stroke Association for the briefing it has provided, as well as others who have assisted in the preparation of my comments, including the Royal College of Radiologists and, from the private sector, Ipsen UK, a biopharmaceutical company that works in this field. I will refer to its research.

The essence of the matter is this: stroke is not often recognised, but even when it is, the quantity is not talked about enough. In the UK, stroke strikes every five minutes and more than 100,000 people have strokes every year. It is a leading cause of adult disability; two thirds of stroke survivors leave hospital with a disability. Sadly, it is also a leading cause of death in the UK. Leaving aside the human cost, there is also an economic cost. Too many survivors are unable to return to work. A conservative estimate of the cost to the economy is some £26 billion a year. Some would suggest that it is even more. Never mind the care costs and the burdens on unpaid carers, which some of us know all too well.

Stroke is preventable. In about 80% of cases, it can be treated by changing risk factors, checking for high blood pressure and atrial fibrillation, but we still lag behind other countries on stroke outcomes. The Stroke Association told me that, for every minute a stroke is left untreated, nearly 2 million brain cells die. The brain is both extraordinary and fragile, which is why fast treatment and swift responses are so important. That means getting somebody to a specialist stroke unit as soon as possible. In Anne-Louise’s case, we were lucky that that was not far away, but sadly there will always be disability thereafter. However, that can be reduced through investment in treatments, such as mechanical thrombectomy. If a patient gets mechanical thrombectomy swiftly, their level of impairment is greatly reduced.

Sadly, access to mechanical thrombectomy greatly varies across the country. In Greater London, where my constituency is, the percentage of patients given a thrombectomy in 2021—there may be updated figures, but this is the latest one the Stroke Association had—was 7.8%. In the east of England, it was 0.3%. In most other parts of the country, it hovers around 2%. Even if that has grown somewhat, it is still far less than we would wish to see. I welcome the Minister and am grateful to see him in his place, and I am sure that he is aware that investment across the piece would greatly improve people’s outcomes. That needs to be mainstreamed into investment plans, and we certainly seek to do that. I hope the Minister will commit to removing that postcode lottery in survival according to where a person is when they have the misfortune of having a stroke. If we do not do anything about this, the cost I referred to is predicted to increase to about £75 billion by 2035. We cannot afford for that to happen, either economically or in human terms.

We have talked about prevention and thrombectomies, which can be a game changer, but we do not have anything like the numbers accessing them that other countries do and the figures are not in line with the Government’s own targets. Perhaps the Minister could tell us what is being done to catch up and spread availability across the piece, because at the moment only about a third of the people who need that treatment receive it. That is simply not good enough for the two thirds that were unlucky enough to be in the wrong place at the wrong time. That is important, but there is also the issue of the workforce. I am indebted to the Royal College of Radiologists on this point. Early diagnosis, of course, can help through either thrombectomy or other interventions, but we have a shortfall in the number of clinical radiology consultants of some 30%. They are needed to do the imaging—the MRIs and all the other things—that could enable those other treatments to take place swiftly. Without further action, that shortfall of consultants in radiology is forecast to increase to 41% by 2027—2,890-odd posts. What is being done to address the shortfall in that specialism and, indeed, others?

Only 48% of hospital trusts can provide adequate 24/7 interventional radiology services, largely because of that workforce shortage. I am sure the Minister will once again agree that that is not satisfactory. The use of interventional radiology—image-guided surgical treatments, effectively—is critical in the modern treatment of strokes. When we look at the national health service’s workforce plan, what are the plans specifically to recruit the workforce—the skilled specialists we need to support those new procedures, which will save lives and improve lives for survivors?

As well as the key issues of intervention and treatment, the other issue I want to touch on is what happens thereafter, because the outcomes can vary greatly. Some people, as we all know, are fortunate enough to be out of hospital quite quickly, whereas others—my wife included—spend much longer there. What troubled me was when Anne-Louise eventually left the rehabilitation unit in Orpington, where she had excellent care, we were lucky enough to be able to continue care at a proper level, through our own resources as a family. There was a young woman in there, probably in her mid-40s, who was a single parent. She lived on her own and had no one to take care of her. She was there before Anne-Louise arrived in the unit; she was still there when Anne-Louise left. What happens to someone in that condition is a real worry to us.

I am sure the Minister will rightly observe that the percentage of patients discharged into community stroke services has risen from 53% to 61% in 2022-23, but the quality and consistency of the community service provision is very variable. There are real shortfalls in the number of specialists—again—so we have a workforce problem in the community as well when it comes to physiotherapists, speech and language therapists and neuropsychiatrists.

We sometimes forget that, as well as the very real physical impacts of stroke—which can be a lack of mobility or balance, a level of paralysis, speech impairment and post-stroke spasticity, as it is called, which I will come back to in a moment—there is very frequently a degree of mental ill health associated with such a life-changing event. Many stroke survivors suffer from varying degrees of depression, and the lack of neuropsychiatrists and psychologists to assist them is very stark.

We know that nearly half of stroke survivors experience some degree of post-stroke spasticity within six months of having a stroke, and some will be classed as severely disabled. We then find that some 80% of survivors may develop it at some point unless they get that proper and consistent treatment. At the moment, we do not deliver the recommended levels of community care in the therapies, of all kinds, that are recommended by the nationally accepted guidelines. What is being done to improve that?

At the moment, in the community setting, post-stroke patients experiencing post-stroke spasticity may have to wait four to seven months to be seen for a multi- disciplinary-team assessment. That is far too long. I have a constituent who has been waiting for nearly a year to be assessed to receive the multidisciplinary treatment that she needs. Accessing that support surely should not be done on such a fragile basis.

Ipsen has recently published a report, “Neuro- rehabilitation: State of the Nation”, which discusses this issue. It found that there is a lack of foundational awareness about spasticity and that it is not picked up often or soon enough. In fact, there are issues with the sporadic nature of treatment and a five to six months average waiting time for spasticity services. One in four NHS sites in England do not have access to specialist services for spasticity—there are only 0.26 consultants per 1,000 in prescribed specialist services in England and Wales compared with two to three in most European countries. Something like two in three stroke survivors do not receive a six-month review of their care, and that is one of the fundamental targets set out in the national guidelines. If two thirds are not receiving it, then clearly something is failing us badly.

We would like the Government to designate stroke as a major condition, and they also ought to consider post-stroke spasticity management as an integral part of the major conditions strategy. Perhaps the Minister will take that away and consider it. What can be done to level up the commissioning and provision of those rehabilitation services? What can be done to look at the high-level priority areas for stroke research that have been identified? These are important matters and we would hope that that could be done. There are other things that I hope the Minister will take a look at. Can we continue to improve availability at community level? Can we ensure that everybody receives the treatment set out in the National Institute for Health and Care Excellence guidelines? As I say, at the moment we are falling significantly short.

In conclusion, having set out those points—I could go on for much longer if we wanted—I hope that my speech highlights some of the real areas of concern. I also want to say a word about the voluntary groups; most of us in the field have become aware of the work of the very well-established Stroke Association, but we have a number of other groups, and in some cases entirely survivor-led groups give each other mutual self-support without any support from public funding.

I want to pay tribute to one group—frankly, the one that helps my wife and that she has received a great deal of assistance from being a member of. It is called Sidcup Speakability Group, and, as the name implies, it operates in our part of south-east London. It is the group’s 10th anniversary, so I just wanted to put on the record what it has done. It works entirely off its own back, and the level of conditions that people have varies greatly. But it proves that there is willingness. It is also worth remembering, as any senior consultant in the field will say, that there is sometimes a myth that a patient gets to a stage where they can never improve any more. Obviously, a patient has the best improvement earlier on. That is why early treatment and interventions are so important, and why the waiting times are so unacceptable. But even if the rate might be less, if people work continually, gains can still always be made incrementally. That is what the people at Speakability have found. To do that, we cannot expect the burden to fall simply upon friends and families. We need specialist treatment to be consistently available. That can turn people’s lives around. In our case, it may not be enough to turn it around in time, but it will be for others. That will be worth our while. The more people we can get back into work, as they wish, the more people can lead enriching lives, to a greater or lesser extent, as many stroke survivors do. There is light at the end of the tunnel, but we have to give them those fundamental services to start with.

I am very grateful to the Minister for paying great attention to the issue, and I hope he will take away those specific asks. Perhaps he could keep in touch with us, as a group, on how we could roll out services much more consistently and give people the level of treatment they deserve. I know a number of us in this room have been affected by stroke within our families, and I think we all want to work together—there is no party political issue in this—to have a proper strategy to sort it out.

The debate can last until 10 minutes past 3. I am obliged to call the Scottish National party spokesperson no later than 2.37 pm. The guideline limits are 10 minutes for the SNP; 10 minutes for His Majesty’s Opposition; 10 minutes for the Minister; and then Sir Bob Neill will have three minutes to sum up at the end of the debate. We have half an hour of Backbench time, and I have to decide which of two stellar Members I should call first. I will go on the principle of ladies first, but also because I understand that the hon. Member for York Central (Rachael Maskell) is vice-chair of the all-party parliamentary group on stroke, so is probably far more qualified to talk about these issues than the delightful hon. Member for Strangford (Jim Shannon).

Thank you for those kind words, Mr Hollobone. I will open by saying that I used to be a physiotherapist working in acute care, specialising in stroke care, so I bring other experience to the debate as well. I serve on the all-party parliamentary group on stroke, and I am indebted to the hon. Member for Bromley and Chislehurst (Sir Robert Neill) for securing today’s debate. We work assiduously on this issue here in Parliament, and it is so important for all our constituents. We believe there is real scope for change within the Government’s approach to help our constituents not only to prevent stroke, but to survive stroke, and to benefit from that.

As the hon. Member for Bromley and Chislehurst said, every single five minutes, somebody will experience a stroke. For some people, it will be brief—a transient ischaemic attack. For other people, it will clearly be very serious indeed, and for some people it will lead to mortality. To bring that home, during the course of the debate another 18 people will have experienced strokes. The urgency is now, and we cannot lose time. Over the course of a year, around 100,000 individuals experience stroke, but that means that 100,000 families also come into contact with the NHS. As a result, it is really important that the Government renew their focus. Although we welcome the major conditions strategy, it is simply not enough. Of course, the major conditions strategy is so major that the necessary focus needs to be brought to the fore. I suggest that we make 2024 a year of stroke, so that we really bring that focus down to deliver. If we had that focus across the system, we could make such a difference.

I will not go into all the statistics that my hon. Friend the Member for Bromley and Chislehurst did, but I just want to say that stroke is very avoidable. Of the people who experience it, 80% will have risk factors that can be controlled. We must talk about prevention. As a vice-chair of the Health and Social Care Committee, I must mention our inquiry into prevention in health and social care, which I am sure the Minister will pay much attention to. We must look at how we prevent individuals having stroke. Of course, we can undertake monitoring, for instance around blood pressure, with high blood pressure being an indicator and also atrial fibrillation. This is also about lifestyle choices; it is really important that we remember that smoking is still a major cause of stroke. We must ensure that individuals have early help, not least if there is a familial issue with stroke, to see how we can avoid that.

I also want to talk about health checks. It is really important to make those early interventions. We heard today about a 41-year-old who experienced a stroke, and one in four people who experience a stroke are under retirement age, so we must remember that it is often younger people who experience the need for this process. As a result, we should monitor people. The health checks that came in for those aged 40 are not often applied within integrated care board areas. We need a real sea change there, because monitoring things such as what is happening with blood pressure as early as we can, with really quick tests, can make a sizeable difference.

The Health and Social Care Committee has just returned from Singapore, where we heard about the early healthcare interventions being made there and, of course, saw the outcomes. If the Minister is determined to make a difference in his short time in the role before my hon. Friend the Member for Denton and Reddish (Andrew Gwynne) takes charge, introducing those interventions to monitor what is happening could be a life-changer.

I also want to highlight how we need to respond. Response is too slow, and I want to challenge the system. For ambulances, a stroke is currently a category 2 call. I would like it to be made a category 1 call and the response expedited, because every minute that passes in the golden hour can make a difference to somebody’s future and whether they will experience severe disability—or, indeed, die—or receive interventions that could prevent such disability. Changing the categorisation would save both money and lives. It is important to look at that again. It could make a difference, not least because the time lags for the ambulance service on category 1 and category 2 calls at the moment mean that categorisations are insufficient to get patients to the right place at the right time in order to get the right interventions. I hope that the Minister will take that away and carry out some work in that area to expedite the process towards diagnosis and treatment.

I turn to diagnosis. In a country like Germany, individuals are diagnosed at the kerbside, at home, or wherever they have their stroke, and the process will start immediately. At the point that the patient is experiencing deficits—perhaps they are still going through a cerebral event—or as soon as the ambulance is called, the clock starts on the diagnostic process and then treatment. Using the best diagnostic techniques to scan at the kerbside, using AI to help, we know—[Interruption.] It looks like the Minister is in some pain; perhaps he needs my physio skills.

Being able to undertake the diagnostic process really early means being able to get the information into the stroke unit of the hospital as early as possible, so that when the patient arrives at the door, they are whipped through the system and interventions can start. The problem is that we have such a time lag that intervention is often too late. Will the Minister look at what is happening on a global scale with interventions that could really make a difference?

Of course, there are two types of stroke: some people have a cerebral bleed and some have an infarct, or a blockage, where the brain is starved of oxygen. As a result, different treatments are undertaken. There is thrombolysis, which is a medical intervention to blast a clot through, and mechanical thrombectomy, which the hon. Member for Bromley and Chislehurst talked about, where a wire is fed through the femoral artery into the brain, captures the clot and withdraws it. As a result, the brain can receive the oxygen it needs so that it does not experience the damage that we have heard about.

We need to increase the specialist interventional neuroradiologist workforce. It is a highly trained specialism; we need enough of them, and a sufficient supply. We should have a workforce plan for the specialism to ensure we are training sufficiently and expanding the workforce. In other countries, there has been a real increase in the number of people able to access this treatment. As we have heard, the average across the UK is 3.3%, but in other countries it is 10%. Not all patients can benefit from this life-saving treatment, but of those who can, only about a third get access to it.

We need to think about where the centres are based. It is important that they are in major centres because doctors need to do a lot of these procedures to be expert in them. We need people to be expert in them, but we also need more centres. I ask the Minister to look at the mapping of that, and at specialist commissioning through NHS England to ensure provision right across the country. Will he also work with the ICBs in this area?

We need a specialist workforce. It is positive that we are training more people in stroke specialisms, but in physiotherapy, for example, significant further training is needed on Bobath—a technique used in stroke rehabilitation—and we need to ensure that it is easily accessible. Other professionals do not get the same access to training budgets as medics, so there is often a lag in getting people through the specialist training that is needed. I ask the Minister to look at that to ensure that the workforce is trained in the best techniques to treat stroke, and to carry that specialism.

This is all about investing to save money, because the better the intervention, the better the outcome for the patient. We need physios, occupational therapists, speech and language specialists—there is a significant shortage of them—and clinical psychologists to work as a team around the patient. They often work together. To give hon. Members an idea of how long it takes, a physio can spend an hour a day with a patient, because they have to break down and rebuild their tone and spasticity, which takes time. But as they are sitting the patient up, the speech therapist often comes along and does a swallow test, and an OT may do some function work. That team needs to come together. Unfortunately, the gaps in the workforce mean that it is hard to have the quality of treatment that will benefit the patient, from the most acute phases of the stroke right through to rehabilitation.

Of course, we want patients to go to stroke units—specialist rehabilitation places—where they can benefit from therapeutic intervention and get the best outcomes possible to optimise their baseline before they are discharged back home. Being in that environment is really important, but at the point of discharge, after all that cost—we have talked about diagnosis, intervention and therapy—what happens? Well, experiences are very varied, and 45% of survivors feel abandoned, so we know something is going wrong. Individuals can easily lose confidence and function.

If an individual is on a pathway to a care home, the care home should be properly trained in supporting people who have had a stroke. Everything matters: the person’s positioning, how they lie in bed, how they sit in a chair and how their hand rests can make a real difference to their function, and their hygiene and personal care. It is necessary to ensure that, if they are mobilising, it has an impact. How patients are transferred can make a difference to those outcomes, so it is important that a person is discharged not just to a care home, but to a care home that has undergone proper training. If someone is moving to the community, we need to ensure that the family around them are trained in how to support them, just as carers who provide domiciliary care must be.

I want to pick up on what the hon. Member for Bromley and Chislehurst said about people seeing improvements in their baseline functioning. It is possible that individuals do and will. Through the process of neuroplasticity, a person’s brain changes and can make alterations and repair, so we need to ensure that, when somebody gets home, there is ongoing therapeutic intervention. It is easy to slip into bad ways and take shortcuts, which can undo some of that good work, and those interventions to top people up can make a difference and keep people functional, mobile and independent. If people miss out on those interventions, they will rapidly require more acute care.

I draw the Minister’s attention to that and ask him to look at the whole pipeline. The lack of support is clear: only 37% of patients got their six-month check last year, which is completely insufficient. We need the figure to be 100%, so there is clearly some work for the Government to do. We are talking about 40,000 people who missed out altogether, which affects ongoing care and support. In the same way that a cancer care navigator works with patients, we need somebody who co-ordinates care and individual support on the stroke pathway, as a permanent process.

As I have already said, we have an opportunity next year to make a seismic difference to individuals by focusing on stroke. I hope that the Minister will take that opportunity, with a laser focus on a new stroke strategy across the country. If he does not, I will badger my hon. Friend the Member for Denton and Reddish to take that on, whenever he gets the first opportunity. It is important that we do that.

Finally, research in this area could be improved, and investment in research is needed. As we have seen in recent times, investment in thrombectomy has been a game changer. It gives people who experience a stroke real hope. Other interventions can and will be made: we need to understand more about our brain health, therapeutic interventions, and how to use new technologies to help people to be independent and live full and comprehensive lives. I trust that the Government will look at the research base and at investment in research as an opportunity. I trust that they will also work with the voluntary organisations that work so hard in this area—they are real experts—to ensure that we have the best stroke strategy and stroke outcomes that any country could ever have.

You are most kind, Mr Hollobone; thank you for calling me. May I say what a pleasure it is to follow the hon. Member for York Central (Rachael Maskell)? Her contribution was truly magnificent. It was full of the detail, knowledge and experience that the hon. Lady brings to these debates. To be honest, I am a bit in awe of her contribution, because it was exceptional. We thank her for it.

I thank the hon. Member for Bromley and Chislehurst (Sir Robert Neill) for leading the debate. He has spoken on these matters in the main Chamber and in Westminster Hall, and he speaks from personal knowledge and experience. We all have him and his wife in our thoughts. I mean that sincerely and honestly; I cannot begin to understand the difficulties and experiences that he has had. He should be assured that he is in our thoughts.

As my party’s spokesperson for health, it is great to be here to mark World Stroke Day. I am sure that everyone present has been touched by the impact that strokes can have on families and friends. Over the years, I have had a number of friends who have had strokes, and they have been greatly physically disadvantaged. It is not just that; there is also an emotional aspect.

I was recently made aware of the “Neurorehabilitation: State of the Nation” report, published in October by Ipsen UK—which the hon. Member for Bromley and Chislehurst referred to—and Different Strokes. The report outlines the state of UK stroke rehabilitation services, with a focus on post-stroke spasticity, and uses 2022 data to assess the extent of post-pandemic recovery. Post-stroke spasticity is pain and muscle stiffness caused by stroke and nerve damage. Almost half of people who survive a stroke experience it within six months, and it quickly forms part of their physical disability and contributes to the loss of their ability to have a normal life. It interferes with someone’s normal physical function, speech and daily activities, and it is linked to poor health outcomes, including anxiety and depression. People are not able to do what they once did or follow their normal routine—that is the reality of their new physical condition.

The report’s findings demonstrate that many of the needs resulting from the impact of the covid-19 pandemic still have not been actively addressed. Its recommendations include levelling up neurorehabilitation service infrastructure across the United Kingdom of Great Britain and Northern Ireland. It is so important that we all do the same thing everywhere. The report also recommends the adoption of a standardised commissioning framework for those services to balance out regional health inequalities. We do not want to find that there is a postcode where services are good, but that in our postcode they are not so good. Other recommendations include better continuity of care after patients are discharged into the community, to ensure that they have access to rehabilitation and treatments needed to manage their spasticity, and better integration of post-stroke spasticity needs into wider stroke policy, such as the upcoming major conditions strategy.

Every three hours, someone has a stroke in Northern Ireland. There are more than 40,000 stroke survivors in Northern Ireland. Northern Ireland Chest Heart & Stroke is an active charity, and I put on record my thanks to it. The hon. Member for Bromley and Chislehurst referred to charities and volunteers. There are so many groups that do such great work; it is purely voluntary, but it really affects, challenges and helps people.

Stroke is one of the biggest killers in Northern Ireland and a leading cause of adult disability. In addition, we have the second-highest incidence of stroke in the UK and the second-highest mortality rate; in Northern Ireland, whether it is because of our lifestyle or the anxieties and problems of the last 40 years, we have a high mortality rate. For my constituency of Strangford, which is fairly rural, transforming stroke services is crucial in ensuring that patients have immediate access to the care that they need. The hon. Member for York Central outlined the necessity of stroke patients going to the right place and the right home. If they receive at-home care, it should be of a level that can give the necessary assistance.

The recommendations in the major conditions strategy are also applicable to Northern Ireland. While this debate is probably GB-specific, the recommendations and the way forward are clear, and they are things that we would wish to replicate in Northern Ireland. In summer 2022, the Northern Ireland Department of Health published its stroke action plan, detailing future steps in stroke care in Northern Ireland. However, progress implementing the plan is slow, with many stroke patients still not receiving treatment. The hon. Members for Bromley and Chislehurst and for York Central both mentioned that. It is so important, whenever someone’s life is changing physically and emotionally—and family weighs on top of that—that they have all the help they need to ensure that they can deal with their new condition and circumstances.

There is no doubt that there is still work to be done nationwide in our NHS. This debate will raise awareness of that and ensure that we move forward in a positive fashion. We must ensure that stroke patients are able to access the care and aftercare support that they require.

I look forward very much to hearing what the two shadow Ministers, the hon. Members for Denton and Reddish (Andrew Gwynne) and for Motherwell and Wishaw (Marion Fellows), have to say; I do not think there has been any Westminster Hall debate about health that the hon. Member for Denton and Reddish and I have not been in together—in most cases, we say the same thing. As I say, I also look forward to what my friend and colleague the hon. Member for Motherwell and Wishaw, who speaks for the Scots Nats, says. I especially look forward to hearing from the Minister. He is a man of compassion and understanding. I am quite confident that he will endorse what we are requesting.

One thing that we can all take away from this debate is knowledge of the earliest signs of a stroke, not only for ourselves individually but for the people around us—those whom we love and have been good to us, as we have been good to them, and our friends. With the right specialist support, research and campaigning, it is possible—this is the ambition—to rebuild even more lives and support people through their post-stroke treatment. That is my wish. I am sure it is also the wish of the hon. Members for Bromley and Chislehurst and for York Central, who spoke before, and the two who will speak after, the hon. Members for Denton and Reddish and for Motherwell and Wishaw.

I am pleased that we have been able to revisit this topic after Parliament was prorogued. I thank the Stroke Association and Ipsen in particular for their delightful and helpful insights into this debate.

It is a pleasure to serve under your chairmanship, Mr Hollobone. I congratulate the hon. Member for Bromley and Chislehurst (Sir Robert Neill) on securing this debate. It is always better in any debate if there is a degree of experience and I think we all benefited from his. It is very good of him to share it.

The Scottish Government recently published their Stroke Improvement Plan 2023. In many cases Scotland is more fortunate because we have our own NHS and a smaller area to cover; there are only seven health boards, so there is less difference across the country. I am not saying there is not any difference, but it is much easier for the Government to work with individual health boards and organisations and produce a plan that everyone has bought into.

Unfortunately, strokes remain a leading cause of death in Scotland. The Scottish Government’s new stroke improvement plan seeks to minimise strokes. It is difficult to imagine that anyone in this room will not have had contact with someone who has had a stroke or who knows of someone still suffering. It is still the leading cause of death and disability in Scotland.

I hate to say this, but age is the most important factor. A stroke is most likely to occur after the age of 55 —I will say no more on that at the moment—but younger people can be affected as well. It is the fourth single leading cause of death in the UK.

Some good news is that the number of deaths from stroke is going down, partly due to a reduction in the incidence of strokes, but also thanks to the greater awareness of symptoms. As the hon. Member for Bromley and Chislehurst told us, the FAST programme was the first advertising campaign. It was really useful: most people can now recognise what a stroke is, what the factors are and can try their very best to get people into hospital much more quickly.

I will not go down the path of describing the treatments available because that was done in an exceptional manner—in a way that even I can understand—by the hon. Member for York Central (Rachael Maskell). But it is really important that we are all aware of what we and Governments can do to help people have better health in general. If someone has high blood pressure, high cholesterol, an irregular heartbeat or diabetes, that makes them more likely to have a stroke.

One of the things the Scottish Government are trying to do is reduce health inequalities across Scotland. It is really important that the Scottish Government use a human rights approach on this basis. Poverty is also one of the leading factors for bad health. As Lorraine Tulloch, the programme lead of Obesity Action Scotland said, those facing the choice of heating or eating amid the ongoing cost of living crisis are likely to be more focused on ensuring that there is enough food to go around than noting the nutritional value of food. In Scotland, we are having to deal with the consequences of poor diet and higher weight—we also need to look at poverty, which is the leading cause of those two things.

In Glasgow, the Scottish Government are investing £500 million through the city region deal, and regional partners have secured £300,000 of Health Foundation funding as part of their work to align economic development and improved health conditions. This will include the development of a capital investment health inequalities impact assessment tool, which will ensure that the health inequality impacts on the people who live and work in the Glasgow region—which includes my own constituency of Motherwell and Wishaw—are considered throughout the life of the project. Again, the Scottish Government are doing all they can to minimise the impact of poverty, but it is really difficult.

It is also important that the plan looks at the psychological issues referred to by the hon. Member for Bromley and Chislehurst—and it does. Often, someone who has a stroke needs not only physical recovery, but the right recovery from depression and the psychological impact. I have had some personal experience of that with people I know who have had strokes. Often, they may be accepting of the fact that they will not recover all their mobility, but they find it quite difficult to lose the life they had. That is something we must all take into account. The range of disabilities stroke can give is greater than for any other condition: limb weakness; visual problems; language and communication problems; extreme fatigue; and depression, as I have already mentioned. They are all common. The really difficult thing is that two thirds of working-age survivors are unable to return to work. That leads again to further depression and anxiety.

In order for those who experience stroke to be best placed to navigate their journey, stroke care should be provided in line with the principles of realistic medicine, which include listening to and understanding the patient’s problems and care preferences; ensuring that patients are allowed to take part in the decision making; and ensuring that patients have access to the clear and understandable information required to make an informed choice about their care.

I am not quite finished. I would like to talk about something that I find really interesting and that is a wee bit more uplifting than what we have been hearing. The hon. Member for Bromley and Chislehurst referred to self-led post-stroke care groups. He and I have to declare an interest: my son’s father-in-law leads one of those in Wishaw. I know from him and some of the people in his group how beneficial they find that kind of thing. But it would be much better for everyone if they did not have the problem of finding premises and all the other things. Across the UK, that should be something that Governments can take on and fund, because it helps with the psychological distress, anxiety and depression.

I recently heard about a tech-enriched rehab programme that recently opened at University Hospital Wishaw—or “Wishy General”, as most of my constituents would refer to it. It is to help meet the overwhelming demand for rehabilitation. I talked to a patient who was treated there, and she says how wonderful it is and how good it is to get something like that locally. This incredibly exciting pilot between the University of Strathclyde and NHS Lanarkshire is aimed at reducing disability and bettering outcomes after strokes. Recent research conducted at the University of Strathclyde has shown this type of model to be safe and feasible when used by people in the chronic phase of stroke recovery and has led to improved outcomes. It is really exciting to hear of these kinds of trials; it is something the Minister might consider looking into in order to benefit folk across the United Kingdom.

I make no apologies for being a Scottish nationalist and for praising my Government for what they do, but I do not think anyone could ever accuse me of not caring about people across the UK. It is important that we share knowledge and understanding to benefit all the people in what the hon. Member for Strangford (Jim Shannon) refers to as this United Kingdom of Great Britain and Northern Ireland. I know that the Minister will have listened carefully. I hope he will take on board what has been said and look to Scotland for answers in some of the things that we do that might help to improve lives here in England and in Northern Ireland and Wales.

It is a pleasure to serve under your chairmanship, Mr Hollobone. Like others, I begin by thanking my hon. Friend—I will call him that, because we are friends—the Member for Bromley and Chislehurst (Sir Robert Neill) for securing this important debate to mark World Stroke Day. I thank him for not just his continued advocacy and the work he does here in Parliament, but sharing his personal experiences. On behalf of the whole House, we send our love to his wife and to him for the work he does to look after her.

We have had a small but perfectly formed debate. I want to thank my hon. Friend the Member for York Central (Rachael Maskell) in particular for her powerful contribution. She speaks with experience that I could only ever dream of; it is so important that her expertise, knowledge and past experiences should shape and inform the debate. I thank her for that. Likewise, I thank the hon. Member for Strangford (Jim Shannon) and the hon. Member for Motherwell and Wishaw (Marion Fellows), who leads on health issues for the SNP, for their contributions. We have had a good, thorough debate, covering a lot of issues. Hopefully we have marked World Stroke Day well in this place today.

It is stating the obvious to say that stroke can have a life-changing impact. As we have already heard, the statistics show that in the time we are here this afternoon, 14 people across the United Kingdom will have had a stroke—that is one stroke every five minutes. Although often a sudden event, the lasting impact of stroke for patients can be devastating. It is one of the leading causes of adult disability across the United Kingdom. Two thirds of stroke patients—let that sink in—will leave hospital with a permanent disability, often needing lifelong care. Sadly, stroke is often fatal, causing around 35,000 fatalities across the UK every year, making it the fourth leading cause of adult death.

What those statistics demonstrate to me is that however far we have come on the journey with stroke, we need more concerted action going forwards—not just from a patient care perspective, but given the significant impact that not acting on stroke has on the economy. There is an economic argument, not just a patient care argument.

I pay tribute to the work of the Stroke Association, which does incredible advocacy, campaigning and research in this area, as well as other organisations across the UK. Stroke Association research shows that by 2035, stroke is expected to cost the British economy £75 billion a year. That is up from £26 billion as recently as 2015—a rise of 190% in just two decades. Given the strain already on stroke pathways across our health and care system, that is simply unsustainable. The need is clear, and the need is now.

One of the issues holding us back in our fight against stroke is the workforce, as is so often the case and as we have heard today in other contributions. A well-skilled, well-resourced workforce is vital to saving lives and improving the outcomes for patients. However, for too many across the United Kingdom, the workforce is simply not there for them or not there for them in adequate numbers. Half of all stroke units across the country have at least one vacant consultancy post, with the average vacancy being left open for 18 months.

When it comes to thrombectomy—a life-changing treatment that can have a fundamental impact on patient outcomes, as the hon. Member for Bromley and Chislehurst set out—the postcode lottery for care only gets worse. A third of clinicians in this country who can perform thrombectomy are based in London. That is good for Londoners but not for other parts of the country. Given that speed of treatment is critical when it comes to long-term outcomes for strokes, this lottery facing so many people cannot be allowed to continue.

Further along the stroke treatment pathway, other issues persist. Only a quarter of community rehab teams and early supported discharge services are offering support seven days a week. That is not good enough. With patients waiting too long for treatment when they need it and too long for support in the community following treatment, it is clear that the system is broken. That is why I am proud of Labour’s firm commitments on giving our NHS the workforce it needs to get patients seen on time, by delivering an extra 7,500 medical school places, training an extra 700 district nurses each year and ensuring that at every stage of the treatment pathway stroke patients will have access to the care they need when they need it.

But there is so much more work we can do to break down the barriers that too many stroke patients face on their care journey. Breaking down those barriers will take innovation and all parts of the system to be pulling in the same direction. For stroke patients, that is exactly what is needed. Given the crucial role played by primary, acute and social care services in delivering positive, long-term outcomes for stroke patients, co-ordination is the key. However, in too many cases, that co-ordination is simply not happening, and patients are suffering as a result.

We have a primary care system with vast variety in detection of key stroke indicators, such as heart conditions, atrial fibrillation and so on. We have people not getting to the right place in hospital, with only 40% of stroke patients admitted to a stroke unit within four hours of arrival. We have a community care system without the resources it needs to deliver for patients, with the Stroke Association’s report about life after stroke highlighting that only 37% of stroke patients receive a six-month post-stroke review of their needs. It smacks of a system that is not working for anyone.

My hon. Friend is making an excellent speech. When it comes to social care, people are often untrained and as a result could cause more harm than good if they do not know how to care for a patient who has had a stroke. Will he ensure that Labour discusses how it will train our care workforce to have the right skills to deliver ongoing care?

My hon. Friend makes an important point. Some of the discussions that I have had, including this week, with professionals in the care sector have been about how we upskill care professionals working in our social care system so that they are able to genuinely—in an integrated fashion, with the NHS—work in accordance with the interests of the person they are caring for and take that person’s needs as a whole. It is also important for these workers to have the professional development, and parity of esteem, terms and conditions and so on with the NHS, to be able to take on those extra responsibilities. My hon. Friend is absolutely right, and that issue is certainly on the radar of the shadow health and social care team as we develop our plans—not just Labour’s workforce plan for coming into government, but our plans on the road map to a national care service.

Whether it is by training more GPs to ease the immense pressure on our primary care system, by putting an end to dangerous hospital waits or through a 10-year plan for fundamental social care reform delivered in partnership with users and their families, Labour is determined to get the system working again. We are determined to build a national health service that is fit for the future, with a long-term vision for a national care service firmly integrated within it. Only by doing all that, getting it right and taking people with us on that journey can we deliver on our long-term mission of cutting stroke deaths by a quarter within the next decade. That is a mission. It is something we are determined to do, because at the heart of this are people’s lives and we want to ensure that we have in place the stroke services that patients deserve.

It is a great pleasure to see you in the Chair, Mr Hollobone. I congratulate my hon. Friend the Member for Bromley and Chislehurst (Sir Robert Neill) on opening today’s debate, which is on such an important issue. He is a tireless campaigner for stroke survivors, and his experience is invaluable in bringing their voice into this place. I am sure that his wife is very proud of the work that he does.

I pay tribute to the hon. Member for York Central (Rachael Maskell) for her thoughtful contribution, drawing on her own professional experience, and for the helpful and constructive suggestions that she put forward during the debate. I also pay tribute to the hon. Member for Strangford (Jim Shannon) for his contribution and his kind words. As he knows, I have family in Northern Ireland, and I think it is vital that on issues as important as this, England, Scotland, Wales and Northern Ireland work together where we can to deliver the best outcomes for patients—something that I was also very grateful to hear the SNP spokesperson, the hon. Member for Motherwell and Wishaw (Marion Fellows), making clear in her response to the debate. I also thank the shadow Minister, the hon. Member for Denton and Reddish (Andrew Gwynne), for his contribution.

[Sir George Howarth in the Chair]

Finally, I thank my hard-working Parliamentary Private Secretary, my hon. Friend the Member for North Norfolk (Duncan Baker). He is not allowed to speak in the debate, but he was a founder member of the all-party parliamentary group on stroke. He lost his stepfather to a stroke in July 2019, just five months before he was elected to this place, and the stroke issue is a huge priority for him; he has done an awful lot of work on it since he was elected to the House.

I would like to start as my hon. Friend the Member for Bromley and Chislehurst and so many of the contributors today did, by paying tribute to the outstanding charities that support people up and down the country to thrive after stroke. I know that my hon. Friend works closely with the Stroke Association. I was pleased to meet its CEO, Juliet Bouverie, this morning while on a visit to the Royal Berkshire Hospital to see the innovative ways that the hospital is harnessing technology to improve stroke care. I look forward to continuing to engage with her, including on the major conditions strategy, which I will cover later in my speech. I also commend the many other charities involved in this field of work, such as The Brain Charity, Think Ahead Stroke and the other—many much smaller—charities referred to by many hon. Members today. They all do fantastic work to support patients and drive forward improvements in care.

Sir George, it is excellent to see you now in the Chair. In recent years we have made great progress in understanding the condition, but as has been said, more than 100,000 people have a stroke in the UK every year. As the hon. Member for York Central reminded us, that means that during this one debate alone, 18 people will have experienced a stroke. One third of them will be left with some form of long-term disability. I am grateful to hon. Members for giving me the opportunity, less than a month after World Stroke Day, to update the House on the work that the Government are doing in this space.

I will now address as many of the points that have been raised in the debate as I can. The Government’s priority is to prevent stroke in the first place. That is why I am pleased that we are rolling out an innovative, new digital NHS health check in the spring. The original programme saw the highest number of NHS checks between April and June since its creation in 2013. We are backing the programme with £17 million to deliver a million extra checks in the first four years. We have also appointed Professor John Deanfield to develop an ambitious vision for a modern, personalised cardio- vascular disease prevention service. We are investing up to £645 million over two years to expand services offered by community pharmacies, including expanding blood pressure services. That extra capacity in the first year could prevent over 1,350 cardiovascular events, including strokes.

One ambition of the NHS long-term plan is the inclusion of a national stroke programme, seeking to improve stroke services through increased access to specialist stroke units, with a flexible and skilled workforce and better rehabilitation services. We are making progress on expanding the range of scanning across the country. Between April and June, over 95% of stroke patients were scanned within 12 hours of arrival into hospital, and 87% of patients eligible for thrombolysis received clot-busting drugs to treat their stroke. While there is of course more to be done, stroke patients now have better access to scans than ever before, but as many have said, integration is key. That is why, since April 2021, we have established 20 integrated stroke delivery networks, which bring together key partners in our fight against stroke to deliver joined-up whole pathway transformation across integrated care systems. They are now responsible for delivering optimum stroke pathways and ensuring that patients receive high-quality specialist care from before they are admitted to hospital through to rehabilitation and life after stroke.

Over the past 10 years there have been clear improvements in access to community stroke care, and the percentage of patients discharged from hospital to community stroke services has risen to 61% from just 41% 10 years ago. Every patient with acute stroke should gain swift access to a stroke unit within four hours and receive early multidisciplinary assessment. The latest data shows that 60% of patients are currently admitted to a stroke unit within that time. We have to ensure that we do better across the whole United Kingdom. That has improved over the past five years, but I recognise, as many have said, that more needs to be done. I am pleased that NHS England is trialling a new virtual consultation project between paramedics and stroke teams. We are confident that these innovative pilots will ensure timely access for patients accessing stroke units. That is being promoted across the country, and I am pleased that phase 1 was successfully completed this month and phase 2 began last month.

The hon. Member for York Central made an interesting point about whether stroke cases could be classified as cat 1 by the ambulance service. That is something I am quite passionate about. For the past nine years, I have been a community first responder with North West Ambulance Service. She will probably be aware that at the moment only cardiac and respiratory arrests are classified as cat 1, so I am not sure that that is a change I instinctively would support. However, I completely and utterly agree that it is critical that ambulances arrive as soon as possible, and that we triage patients to the correct services as soon as possible. I am happy to look at that and some of the other suggestions she made because she suggested an awful lot of good things that if we are not already looking at, we should be.

There is strong evidence that, when used appropriately, thrombectomy significantly reduces the severity of disability caused by stroke. Thrombectomy is a suitable treatment for around 10% of stroke patients and is available now in 24 centres in England, with a further two non-neuroscience centres on the way. NHS England has assured me that it remains committed and on track to reach its 10% target for all eligible patients to receive a thrombectomy by the end of 2025-26. The latest data shows that the thrombectomy rate has more than doubled in the past three years. To reach the target, the General Medical Council has approved the thrombectomy credential to support neuroradiologists to perform the procedure and increase the number that can be conducted. We have made great progress in getting cutting-edge AI technology into now over 90% of acute stroke-care providers in England. AI brain-scanning is now installed in all these thrombectomy units, reducing the time between patients’ first experiencing stroke-like symptoms and receiving treatment by more than 60 minutes. I saw that for myself this morning at the Royal Berkshire Hospital and I was incredibly impressed.

We know that stroke survivors commonly experience serious psychological, emotional and cognitive effects. Those greatly impact a person’s rehabilitation, quality of life and ability to return to work. We understand that there is a high level of demand for space in hospitals for rehabilitation services, which play an important role in a patient’s recovery and discharge from hospital. NHS England has taken important steps to increase capacity as part of its winter planning by ensuring that functions such as physiotherapy have the space they need in hospitals to operate effectively.

Of course, stroke treatment is dependent on our amazing NHS staff providing the care. There has been good progress in addressing staff shortages in several rehabilitation areas, although again I appreciate that more needs to be done. Between 2019 and 2023, we grew the number of full-time equivalent physiotherapists working in the NHS by almost a fifth, to over 23,000. NHSE has been working to increase the number of available student placements, and we have developed the speech therapy apprenticeship. Clinical neuropsychologists are a flexible workforce specifically trained to intervene across multiple care pathways, including stroke, acquired brain injury and other conditions. By 2024, NHSE will have doubled the number of training places available compared with the start of 2022.

The major conditions strategy will tackle conditions that contribute most to morbidity and mortality across the population in England. The strategy will cover prevention and treatment for cardiovascular disease across a person’s whole lifetime. As I have already touched upon, some of the key planks of the strategy include prevention, unlocking the transformative power of AI, and tackling the comorbidities that cause ill health in the first place. We published the strategy in August, and I hope to keep my hon. Friend the Member for Bromley and Chislehurst and other Members across the House updated on progress.

My hon. Friend—and most Members who spoke—raised concerns about the variation of stroke services across England. The NHS England national thrombectomy implementation group is gathering data on regional variations in access to mechanical thrombectomy. It will report on the outcomes of that by the end of this year, and if I can, I look forward to sharing that information with the APPG and others. The major conditions strategy will set out that integrated care systems tackle clusters of disadvantages in their local areas. That will include addressing variations in outcomes and the care that people receive in the context of the recovery from the pandemic.

This Government have a profound ambition to improve the lives and health outcomes of people in this country who have survived a stroke. The contributions today have played a vital role in pushing this agenda forward. I am happy to reassure my hon. Friend, and the other Members who have spoken, that I will continue to do everything I can for this matter to remain a top priority for our health service, and that the thrombectomy target will stay on track. I am especially grateful to my hon. Friend for everything that he has done to encourage his constituents to sign up for the Our Future Health programme. Our work here will have huge benefits both to patients and to our NHS overall, so that all survivors may survive and thrive after stroke.

It is good to see you in the Chair, Sir George. I warmly thank all hon. Members who have spoken. I am grateful to them for their support from both the Front and Back Benches. I particularly thank my vice-chairman of the APPG on stroke, the hon. Member for York Central (Rachael Maskell), whose expertise in this area is phenomenal.

I also thank the hon. Member for Strangford (Jim Shannon) for his characteristically compassionate remarks, as well as the hon. Member for Motherwell and Wishaw (Marion Fellows) and the shadow Minister, the hon. Member for Denton and Reddish (Andrew Gwynne). We all agree that we want better outcomes for people who suffer from this condition and that there are ways in which that can be done.

I look forward to working with the Minister, as do all the members of the APPG, and I am glad that he paid tribute to his Parliamentary Private Secretary, my hon. Friend the Member for North Norfolk (Duncan Baker), who was a driving force in setting up the all-party parliamentary group. I know that he will kindly and discreetly, but firmly, hold the feet at the Department to the fire on this matter. That will make our task easier.

I appreciated the references to some interesting developments. The pilot in Strathclyde, which the hon. Member for Motherwell and Wishaw mentioned, is particularly useful and interesting. In the short time I have left, I would like to mention one more—an online speech therapy app called Beautiful Voice. It has finished a useability pilot, and is run by a mixture of entrepreneurs, therapists and academics with virtually no Government funding, apart from sometimes a bit of research funding. From our experience as a family, it has been useful. Given the shortage of speech and language therapists, anything that can enable people to undertake therapy in their own home is something that I hope the Minister will look at. The Beautiful Voice app, which is available online, is delivered in conjunction with Hobbs Rehabilitation and the MiNT Academy, so there is an academic background. I hope the Government will try to find out more about that and get behind it.

With thanks to everyone, I hope that we continue to keep up the pressure. I know that it is not for want of intention, but the fact is that there is still a way to go to get us to where we want to be. If it can be done elsewhere, this is a classic case in which some investment up front—in thrombectomy, for example—and support for some of these therapies can save the country money in the long run. Above all, it can save human life and it can save and improve human experience, which is more important than anything. I am very grateful for the opportunity to debate this issue.

Question put and agreed to.


That this House has considered World Stroke Day.

Sitting suspended.

Energy Social Tariffs

Before I call Marion Fellows to move the motion, I remind Members that if they wish to take part in the debate, they must bob.

I beg to move,

That this House has considered energy social tariffs.

It is a pleasure to serve under your chairmanship, Sir George, in this debate on the introduction of an energy social tariff to support disabled people with the cost of living crisis. I thank the Backbench Business Committee for originally timetabling it and the Chairman of Ways and Means for giving me the opportunity to bring this urgent issue here today.

As we enter the winter months, lots of us are really looking forward to the festive period, but for many the winter months, with their colder weather, are a time of genuine worry, stress and anxiety. That is the case for many vulnerable people, particularly in low-income and disabled households, who once again are greatly concerned about high energy bills over the coming winter. That concern has been relayed to me by constituents and all the disabled organisations I regularly meet, which have been stressing to me for months their members’ real concerns about energy bills. It is a top priority for them.

At the outset, I would like to thank the many organisations that sent me briefings for today’s debate: Sense, Scope, the Cystic Fibrosis Trust, Mencap, Marie Curie, Age UK, and Kidney Care UK, as well as Citizens Advice, National Energy Action, Warm This Winter and Centrica—a record amount of briefings for me. Yesterday’s disappointing autumn statement did nothing to address the concerns of low-income, vulnerable and disabled households about energy bills this winter.

Alongside that, Ofgem’s announcement means that households will start paying higher prices for their energy as they enter 2024. I was reliably informed that the new price cap represents a £94 increase on the current rate, but I have since received an email from National Energy Action saying:

“At first glance, it might look like prices are only increasing slightly, but they are not. That’s because Ofgem has just changed how it calculates ‘typical use’. Just three months ago this was a 2-3 bedroom household using 2,900 kWh of electricity and 12,000 kWh of gas a year. Now it’s based on a household using 2,700 kWh of electricity”—

2,000 kWh fewer—

“and 11,500 kWh of gas. It’s important to note the price cap isn’t a cap on the total bill but on the price per kWh of energy.”

I was originally given a figure for a typical annual bill of £1,928, which is now £2,023 if it is based on the same criteria used previously by Ofgem. This will only add to the worry of millions up and down the country.

During the autumn statement one year ago, this very same Government committed to developing a new approach to consumer protection in energy markets by working with consumer groups and industry to consider the best approach, including options such as social tariffs. That commitment has been repeated multiple times since, including by the Prime Minister and others. In April, the Department for Energy Security and Net Zero reiterated that pledge by promising to consult on an energy social tariff in the summer of 2023. However, despite multiple commitments, a consultation has never materialised, and as we approach the end of November there is a significant risk that no new protections will be in place in April 2024. All the while, the very real anxieties of low-income and disabled households over their ability to heat their homes this winter have risen exponentially.

The great need for an energy social tariff is best demonstrated by the wide and varied support for the implementation of one. Disability groups, debt advice groups, politicians across the political spectrum, consumer groups, local authorities, housing providers, Ofgem and even energy companies are in favour. That exemplifies the united front on this vital issue and makes it even more surprising that the UK Government have failed even to hold the consultation they promised. They have continued to bury their head in the sand, despite the fact that National Energy Action, Energy Action Scotland, Age UK, Scope, Citizens Advice, Money Saving Expert and 150 other organisations, as well as MPs, wrote to the Prime Minister in September to call for a consultation on an energy social tariff, as promised last year.

Sir George, you may ask what an energy social tariff is. It is a system of targeted support, through a reduction in energy bills for vulnerable, low-income and disabled households, in response to incredibly high energy bills. The need for a social tariff cannot be stressed enough, as one in three households will spend more this winter on energy bills than they did last winter, and the figure is closer to half for the poorest households. Citizens Advice research shows that energy bills are 61% higher than 2021 levels. Other research suggests that high energy bills will become the new normal for the rest of the decade, highlighting the desperate need for meaningful long-term support.

The year 2022 was widely seen as the turning point in the cost of living crisis in terms of energy bills. The Government continually said that global factors were responsible for the rise, but even though we are told that the energy market has stabilised, bills remain sky high, and 2023 is projected to be much worse due to the huge levels of energy debt accrued last winter. Ofgem and Citizens Advice research shows that energy debt is at the highest level ever. It is clear that action is needed to address the looming debt crisis. Additionally, Ofgem CEO Jonathan Brearley has said:

“we think there is a case for examining, with urgency, the feasibility of a social tariff”.

Furthermore, in the absence of an energy bill support scheme this winter, bills will be 13% higher than last, and today’s announcement confirms that. Rising costs have a huge impact on disabled and low-income households. Many people have to choose between heating and eating. They live in cold, dark homes, struggling to cook meals. For those with disabilities, the results can be catastrophic for their physical and mental wellbeing. Disabled households have significantly higher energy needs, as mobility and hygiene can require increased consumption of electricity—for example, to run electric wheelchairs or to use washing machines frequently. Additionally, some conditions require the constant charging of essential, life-saving equipment, such as oxygen concentrators or feeding pumps.

Scope’s 2023 disability price tag shows that the average monthly cost for a disabled household is already a staggering £975 extra. However, for some conditions, it could be even more. Last year’s Government support—the additional £150 offered to disabled people—did not come close to covering their additional costs. According to Mencap, half of all low-income disabled households have been in arrears on at least one household bill since winter 2022.

The impact is not just financial. The rationing of energy can have a devastating impact on the health of those with disabilities. Some 31% of those surveyed by Scope said that going without heating would severely impact their health, and 9% said it would put their life at risk. According to Marie Curie, there is also a huge impact on those receiving end-of-life care. Many have to spend their final days in hospital, rather than in their own home. That also puts pressure on the NHS, and the costs are significant. Marie Curie says that an NHS in-patient palliative care bed costs £349 a day. Currently, about 5.5 million bed days are required by people at the end of their life in England alone.

Age UK highlights the concerns of some of my constituents, of whom 8,000 live in fuel poverty, about the lack of Government support:

“I am so very tired of being old and invisible. I am frightened to death!!! I can’t seem to save anything to help us for the winter to come, not even credit on the energy bill which I was counting on to help this winter. I worry daily.”

To show the stark reality of the energy consumption that some conditions require, I was going to discuss the power use of life-saving machines such a nebulisers, extra fridges and all that, but I do not have time to go through them all. They are a huge cost for many disabled families, who worry about being able to run them. If they cannot afford to run them because of the cost of electricity, what does the Minister think will happen? People will end up in hospital, or they will not make it to hospital. Do we expect people to fall deeper into debt to protect their health, or do we simply let their conditions deteriorate? The disabled and most vulnerable need more support, and this Government must listen to them.

An energy social tariff is the best way forward. The organisations I have talked to say that such a tariff has five main principles: it must be additional to the warm home discount and the default tariff price cap; it must be targeted to those most in need and go beyond the benefits system—National Energy Action estimates that approximately two thirds of fuel-poor households are not in receipt of any social security payments; it must be mandated across all suppliers; all eligible consumers should be auto-enrolled using suppliers’ existing data and/or data shared by the Department for Work and Pensions; and the tariff must reduce costs for consumers to pre-crisis levels. It is important that people are able to stop worrying this winter about how they are going to deal with the increased prices, which, as I have explained, are even higher than I first thought.

National Energy Action believes that an energy social tariff should meet several tests. Although prices have dropped significantly, they are still high—the July price cap is 80% more than pre-crisis levels—so an energy social tariff must be sufficiently discounted to make a difference. We also have to consider whether an energy social tariff would capture enough households automatically and whether there would be enough support for eligible households. That is particularly relevant to disabled households that are medically dependent on high-demand medical equipment and need to—must—live in warmer homes. It is also relevant to those who live in a home that is not energy efficient, and the UK has the least energy-efficient homes in western Europe.

Will such a tariff work for the legacy prepayment meters used by some of the most vulnerable households in the country? Last year, 20% of the money earmarked for those households went unused, because of difficulties redeeming vouchers. Automatic enrolment is therefore essential. Will support be available for those in Northern Ireland? There must not be disparities across devolved nations in the roll-out. Will it be funded in a fair way? I am assuming that the Government are going to listen to this plea—not from me, but from all the organisations I have listed.

Let us be realistic: we all know that an energy social tariff will cost money. It is essential that the costs are met in a progressive way. If not, there is a risk that the tariff will create a significant cliff edge, where those who narrowly miss out will be much worse off. It is essential that that is avoided. National Energy Action, Citizens Advice and Centrica all say that an energy social tariff should be funded by general taxation, rather than a levy on everyone’s bills, as happens now. That would ensure the greatest level of fairness. If that cannot be done, low-income households on the fringes of support must be exempted from paying towards the social tariff.

A social tariff is affordable. Recent reports show significant headroom in Government finances, and the Prime Minister and Secretary of State have said that the Government’s new round of oil and gas licensing would raise money to reduce bills. A social tariff would have numerous economic benefits; it would also offset the costs. For example, illnesses brought on by having a cold and damp home cost the NHS between £500 million and £1.4 billion a year.

Energy debt is also dramatically reducing the spending power of households who can no longer spend money in their local communities and high streets. That point was reiterated by people interviewed by Scope. One member said:

“I want a social tariff for energy…What that would mean to my quality of life would be incredible…I’d be able to buy a wheelchair, I’d be able to pay for my medicine, I would be able to go to the cinema and I’d be able to eat without going to a food bank. It would change my life.”

Another Scope member in Scotland has highlighted how not being able to afford to pay energy bills puts additional strain on the NHS:

“The house has to be warm, due to my COPD. If it gets too cold, it can lead to chest infection and respiratory failure. If the house is cold, my arthritis pain increases, and mobility is impaired even more. If I get disconnected, I will most likely be taken into hospital.”

That perfectly demonstrates how an energy social tariff could change the quality of life for everyone.

There is additional money for the Government to pay for this. The warm home discount, energy bills support scheme, and energy bills support scheme alternative funding—all designed to help the most vulnerable households —had a cumulative underspend of £440 million last year. That is alongside an additional £1.1 billion extra that the Government generated in VAT from high energy bills. In Scotland, that totalled £96 million that could be distributed to low-income and vulnerable households. Dame Clare Moriarty, chief executive of CAB, has said:

“Energy affordability is a long-term problem that needs a long-term solution. A social tariff protects millions of people from spending excessive amounts on their bills.”

My question to the Minister is this: what level does this crisis have to reach before the Government will commit to supporting households facing high prices for decades? How many vulnerable constituents need to sit in cold, dark houses this winter? How many more years of anxiety do parents of disabled children have to endure, worrying whether they can afford to charge their child’s lifesaving medical equipment? I know things like that are true: my assistant has talked to parents who worry about them. When will people with disabilities get the support necessary to keep warm and manage their condition through the colder months? How many low-income households have to plunge themselves deeper into debt this winter and endure the mental health consequences?

The Government may feel comfortable breaking promises to the most vulnerable in society as the quality of their lives diminishes, but I will continue to fight their corner, as will many others, including all the organisations I have referred to. When will we finally see a consultation on energy social tariffs? It is now too late to introduce an energy social tariff this winter, because it will take about six months. Can we have progress next year? If we cannot have an energy social tariff, will the Minister commit to reinstating the £400 rebate on energy bills and put additional support in place for people with disabilities? Will she commit to expanding the eligibility criteria for the £300 cost of living payments, so that disabled households in receipt of contribution-based or new-style employment and support allowance are eligible?

I know that, in an independent Scotland, we could assist those in need of support, just as other small, independent countries are helping their citizens—for example, Ireland is giving €450 in support to all households. Will the Government extend the energy price guarantee for disabled households beyond March 2024, until a social tariff is introduced? Finally, will the Minister commit to reversing changes to the eligibility criteria for the warm home discount and expand the scheme to provide short-term help for those in need this winter?

It is a pleasure to serve with you in the Chair, Sir George. I congratulate the hon. Member for Motherwell and Wishaw (Marion Fellows) on securing this debate and setting out in comprehensive detail the evidence base for an energy social tariff. I also thank the Backbench Business Committee for granting the debate.

Everyone should have access to a warm and secure home. For the majority of people, that will be provided through the marketplace, although our energy market is imperfect and invariably, at all times, in the interest of fairness, there is a need for Government intervention. Before the current cost of living crisis, that intervention was provided predominantly through the energy price cap, which, while not perfect, performed an important role. The energy price cap has been increased today, although from what we have heard from the hon. Lady, and from the feedback that I am receiving, that will be of limited relevance to many of those who are struggling with their bills.

The dramatic increase in energy prices, primarily caused by the Russian invasion of Ukraine, has necessitated a different approach, and to their credit the Government have stepped in with more direct support over the past 18 months to two years. My right hon. Friend the Chancellor of the Exchequer continued with that strategy yesterday in his autumn statement, and I particularly welcome the increase in the local housing allowance. I have also heard that, as the hon. Lady has outlined, there is some concern as to whether he has done enough. I think he has tried, and I hope he has done enough, but in many ways I am on tenterhooks to see whether he actually has.

That said, it is clear that in the medium-to-long term—when I talk about the medium term, realistically I am now talking about 2024-25 onwards—a different approach is required to protect the most vulnerable. The energy price cap on its own has run its course, and it is thus appropriate to consider a social tariff, which can provide longer-term, more targeted support for the most vulnerable households.

The fact that we need such support is clear from the evidence base we heard about from the hon. Lady and from the feedback that we all receive in our constituencies from those who come into our surgeries, often with heartbreaking stories of the challenges they face. Those messages are reinforced by the briefings we all received ahead of this debate—as the hon. Lady said, we have received a great many of them—from such organisations as Citizens Advice, Mencap, Marie Curie, the Royal National Institute of Blind People, the Cystic Fibrosis Trust and Scope. All those organisations have one thing in common: their clients—the people they look after, whom they support and whose needs they articulate to us as Members of Parliament—are the most vulnerable. They are the people who are the most challenged at this time.

It is also important to thank those churches and other faith groups, charities and volunteers, aided by local councils right throughout the country, who have reached out and are supporting those who are struggling with their energy bills. A network of warm rooms has now sprung up across the UK, which shows British society operating at its very best.

From my perspective, as I have said, the case for a social tariff is proven. It is now necessary to move on to the more complicated and difficult challenge: how to design that tariff and then introduce it. We have received a great many representations ahead of this debate; the one I found particularly interesting and relevant was the report of the Social Market Foundation from March this year, entitled “Fairer, warmer, cheaper”. That report is a good starting point for the discussion about the form that a social energy tariff might take.

As we have heard, the Social Market Foundation concluded:

“The current system of policies supporting households with high energy bills is inadequate for an era of high energy bills”—

one that is, I fear, likely to continue for the foreseeable future. It recommends a social tariff arrangement whereby households that spend an excessive proportion of their income on energy bills should receive targeted financial support to reduce those bills in the form of a social tariff. The Social Market Foundation also points out that the precise form of the social tariff warrants further consideration, but its own analysis suggests that the most progressive and fiscally efficient form is a lump sum payment. I will return in a minute to the precise form that the tariff might take.

The Social Market Foundation believes that the social tariff should be funded from general taxation—a view that the hon. Member for Motherwell and Wishaw articulated and with which I concur. It also rightly emphasises that at the same time as we introduce an energy social tariff, we need to significantly expand the energy company obligation scheme so as to improve the energy efficiency of homes. As we have heard, we have a very leaky housing stock; we have made some progress in improving it, but there is a long way to go. It is absolutely vital that we are not diverted from that pressing and crucial task, and we must significantly step up our efforts in that regard, with funding for the ECO continuing to be raised via on-bill levies.

As I have mentioned, the issue on which there is some dispute and where there is a need for discussion is the form that the tariff should take: whether it should be a social tariff or what is known as a block tariff. That is a complicated debate and I am not going to go into it in any great detail now—that is why we need the consultation that I am going to plead for in a minute, and which the hon. Lady already asked for. National Energy Action, which does great work in this field, favours a social tariff: it believes that a block tariff would be distributionally unfair and would create very vulnerable users. The counter- argument in favour of a block tariff is that it would incentivise energy efficiency, which should be a long-term goal and objective and is a challenge we must not shirk.

In conclusion, although I shall not go into any detail as to the design of the tariff, we need to get on straightaway and talk about it. It is ironic that, as the hon. Member for Motherwell and Wishaw said, we are having this debate the day after this year’s autumn statement. If we go back a year to the autumn statement of 2022, my right hon. Friend the Chancellor undertook to

“develop a new approach to consumer protection in energy markets, which will apply from April 2024 onwards.”

That commitment was reiterated in the April just gone by the Department for Energy Security and Net Zero, which set out the intention to consult this summer.

This is a very important task, as well as an incredibly complicated one, and we need to be getting on with it as quickly as possible. April 2024 is six months away, and I am not sure that that provides us with sufficient time to have an energy tariff in place for 2024-25. I know that there will be other distractions but, for an awful lot of vulnerable people, it is vital that we put that longer-term arrangement in place. I am not begrudging the support that has been given—the sticking-plaster approach of short-term support—but the longer-term approach is vital.

I would be grateful if, in her summing up, my hon. Friend the Minister, who does great work in this policy area, could provide us with details of when the consultation will get under way. Time is of the essence. We will not have it in place this winter—no way— but we do need it in place for 2024-25.

It is a pleasure to see you in the Chair, Sir George. I congratulate the hon. Member for Motherwell and Wishaw (Marion Fellows) on securing this important debate.

It is pleasing that the Ofgem chief executive has called for a “serious assessment” of an energy social tariff and that energy suppliers are saying they stand ready to work with the Government to deliver one. That leaves me curious to know what the hold-up is. Surely it cannot be that difficult if water companies and broadband businesses already use this very approach. We are not used to congratulating water companies in this place, but I am aware that Severn Trent and, I believe, all the other water companies in the country use a scheme called WaterSure, which is a social tariff to cap water bills for vulnerable households. Ofcom goes out of its way to advertise social tariffs for broadband and phone packages for those on benefits—the very people I assume the Chancellor expects to work from home on pain of losing their benefits.

As we have heard, in last year’s autumn statement we were told that the Government planned to consult this summer on long-term measures, including a social tariff. Perhaps I missed the Chancellor’s update yesterday, but I would be grateful if the Minister could update us on what has happened to the consultation on the energy social tariff and when she expects to announce some progress.

This is a particular issue for disabled people and those with long-term medical conditions. A survey for the disability equality charity Scope, which the hon. Member for Motherwell and Wishaw mentioned—it is very active in Scotland and throughout England—found that in the west midlands, the region I represent, the number of disabled people getting into debt because of energy costs was double that of non-disabled households, and around 37% of disabled people said they were reduced to buying lower-quality food, skipping meals and often eating less than they felt they needed. There are numerous reports—I recall questions in the House and a debate on this—of people who need their homes at constant temperatures because of their medical conditions. Those who suffer from severe arthritis would be a good example, as would those who rely on medical devices to keep them alive. Those people are having enormous difficulty paying bills.

I assume the Minister will tell me that there is an NHS electricity rebate scheme for some kinds of equipment—I think dialysis machines are one example—but she will also be aware of recent research that suggests that that support is reaching only a relatively small proportion of eligible consumers, and often fails to reflect the costs of running the relevant technology. The problem is that it not only threatens their health but impacts on their general wellbeing and quality of life. In too many cases, as I think Scope puts it rather well, people cannot thrive because they are too busy trying to survive. There are even accounts of people having to give up their pets—their dogs and their cats; sometimes their only companion—because they have to choose between looking after them and trying to pay excessive energy bills.

The hon. Member for Motherwell and Wishaw touched on this, but I reiterate that four groups in particular would benefit from an energy social tariff: people who receive means-tested benefits, people who receive disability benefits, those who receive the carer’s allowance, and those who are struggling with bills but are just below the criteria for support from the welfare system. Poor pensioners who just miss out on pension credit would be a particularly good example. I am sure that the Minister will have come across the same kind of people in her constituency as I have—pensioners who just fail to meet the threshold for pension credit but are struggling by all other metrics to survive.

The Work and Pensions Committee, on which I serve, recently inquired into the cost of living payments and concluded that the £150 disability payment is just not enough to support disabled people during this cost of living crisis. The Committee advised that the Government should increase the financial support for those with disabilities in proportion to the additional costs that they actually incur. It would have been nice to have heard some recognition of that from the Chancellor yesterday. There are things the Government could do in the interim. They could, as we have heard, reinstate the warm home discount for 300,000 disabled people, who lost it when the Government changed the eligibility criteria. You will remember, Sir George, that they rearranged it so that it was determined by the size of the property, which meant that many people who had previously qualified lost access to that support.

The Government might also consider extending the proposed ban on prepayment meters to cover homes where there is a disabled person, and permit households where one has already been installed to have it removed. More than 30% of those in energy debt are on prepayment meters. As we have heard, in the absence of a scheme that, with the best will in the world, almost certainly will not be available this winter, the Government could extend the energy price guarantee for disabled households until such time as a social tariff is introduced. I do not doubt for a second that the Minister shares my concern about the struggles the people I have referred to are experiencing, but it would be good if she could reassure us that the Government have listened and will act to address the issue.

I will not go into great detail this afternoon on behalf of the Opposition on the background and the need for a social tariff, or a similar instrument, because the hon. Members who have taken part in the debate have made the case for one excellently. I congratulate the hon. Member for Motherwell and Wishaw (Marion Fellows), who introduced the debate, not only on the debate, but on the comprehensive way in which she presented the case for social tariffs and urged the action that needs to be taken.

I very much commend the contribution—thoughtful, as always—from the hon. Member for Waveney (Peter Aldous). On other occasions, I have said that he is virtually an hon. Friend on these issues. I commend him for the forthright and detailed way in which he not only made the case for social tariffs, but also talked about what we ought to be talking about this afternoon, which is what happens after we have concluded that this is the right thing to do. He covered the fact that the onus is on the Government to take action and what considerations we have to undertake to secure not just a sticking-plaster solution for perhaps one winter, but something that applies long term and targets the right people in society, giving them the help that they need to keep their energy bills affordable.

I also very much commend the contribution of my hon. Friend the Member for Birmingham, Selly Oak (Steve McCabe), my actual hon. Friend. Among other things, he set out the groups of people involved. In particular, he talked about those in very difficult circumstances that have not just arisen from the energy price shock that we had a little while ago, but that affect their daily living requirements on a longer-term basis. They are the people who would very much be eligible and we should think very seriously about ensuring that those people have that long-term social tariff support.

That point is very much underlined by Ofgem’s very recent announcement on the energy price cap. The announcement underlines—if underlining were necessary —just what a difficult situation the people we are talking about continue to find themselves in. The price cap comes to just under £2,000 for a dual fuel tariff. Of course, that is not the actual bill that anyone will pay; it is an average of the sort of bill that people can expect to pay under the price cap. A lot of people—particularly those in disadvantaged and difficult situations—will pay a huge amount more, either because of their need for constant heat, because of their circumstances, or because they have other issues such as a combination of difficult living circumstances, inadequately insulated homes and high heating bills all at the same time. The price cap is the very least indication of where a lot of those people will be. Not only that, but we know from projections that the cap will be something like that for a very long time to come.

The price cap is not a way station in the downward curve of energy bills for the future. All the projections we have, particularly from Cornwall Insight, are that it is likely to remain at the same level, certainly throughout 2024 and probably going into 2025, and that they will not dip much below about £2,000 on average. As recently as April 2021, the price cap was precisely half that amount.

The people we are talking about are faced with the prospect of paying twice as much as they were as recently as two years ago for the next two or three years, with all the affordability issues that that will continue to bring into play. That underlines the point made by hon. Members this afternoon. It would be great if we had a social tariff this winter that could effectively continue the price support that has been applied previously, but that energy price support is coming to an end. After this winter, at the latest, it is not being replaced. That underlines the fact that a social tariff should not just be for Christmas—it needs to endure in providing assistance and help for those groups in society.

That is the problem with the other key point that has been mentioned this afternoon—namely, where is the consultation? It is not that the Government have said that a social tariff is a terrible idea that will never be done by Government ever. It is difficult to remember exactly which Minister of State for Energy it was, because they keep changing, but in January the Minister said:

“we will look at a social tariff and at how vulnerable people are looked after, but we have to look at it in a considered manner.”—[Official Report, 25 January 2023; Vol. 726, c. 1031.]

On 18 April, the then Secretary of State for Energy Security and Net Zero said:

“We do think that things like a social tariff could be very helpful”.—[Official Report, 18 April 2023; Vol. 731, c. 111.]

Then, in May, the Government stated, in response to a petition:

“The Government is considering potential approaches to consumer energy protection post-April 2024. The Government intends to consult on options in summer 2023…Government officials are considering potential options, including discounted tariffs, for a new approach to consumer protection in energy markets that will apply from April 2024”.

They have said all these things. They have said that there will be a consultation. What has not actually happened is a consultation.

It is difficult for us in this Chamber to home in on what a social tariff might look like, because the Government have not said anything about the sort of area that the social tariff would fall into as part of any consultation. We do not need just a consultation; we need to see the substance of that consultation and what the Government are minded to do about the commitments they have already made. That is completely lacking at the moment.

We can speculate to some extent on why there has been no consultation. Personally, I think the Government were rather hoping that this energy price crisis would be completely a thing of the past by now, and that instead of the energy price trajectory going down and flattening out, there would be a more straightforward downward price trajectory so that we would return to the position in 2021, when prices were about £1,000. Then the Government could say, “Well, actually, we don’t need a social tariff because it is much more affordable for everybody now, and we can tweak various other forms of assistance to make sure that life is good.” That has not happened. The data from just the past few days shows that it has not happened and will not happen in the near future, which should concentrate minds about what solutions need to be proposed.

This may be a little bit of speculation, but perhaps the Government are thinking, “Well, maybe we do need a social tariff.” But as hon. Members have mentioned, where will that be funded from? Will it be smeared across customer bills? Will it come from general taxation or some other arrangement? Of course, because there is no consultation, we do not know what the Government are thinking.

I could see the Government thinking, “Ooh, we’ve spent all this money on price support during the height of the crisis. Do we want to commit ourselves to another fairly substantial amount of taxpayer support for energy bills for the future?” Many of us would say the answer is yes, they should. But the Government may have other views and, indeed, there may even have been tension between Departments on the enactment and funding of that policy. I do not know, but that could have been the case.

There are ways of establishing a social tariff—the hon. Member for Waveney alluded to this—that do not actually cost the amount of money that the Government perhaps think it will. They involve changes in how the energy retail market works, but can deliver very solid back-up arrangements for social tariffs on a sustainable basis, which is what we all want, without that necessary and apparently large chunk of money coming from the Treasury. Again, as was the case for the hon. Member for Waveney, it would be inappropriate to expatiate on that at great length this afternoon, but I think that there are interesting ways we can examine it.

I am extremely grateful to my hon. Friend, who is making a very valuable point. It would be very helpful if the Minister could tell us what discussions the Government have already had with the energy suppliers and the director of Ofgem, since they have both indicated that they are in favour of a social tariff. Some of the work referred to by my hon. Friend must have been done—we just need to hear what has been discussed.

My hon. Friend is absolutely right. Basically, what we need on the table now is—as they say about homework—for the Government to show their workings. That is why I emphasised that we need not just the promise of a consultation, but a consultation with some substance in the consultation document. We need to see how the thinking process has emerged and what propositions there might be. I agree that getting a social tariff right is quite a long way further on from deciding that there should be one.

It is absolutely right to undertake that process, but we have virtually no information. The Government have certainly not conveyed anything to me about their workings. All I know, along with everybody else, is that there is no consultation. It appears that no action is taking place at all. I would certainly be happy to talk to the Minister about ways to establish a decent social tariff without placing a substantial burden on the taxpayer in order to bring it into being over time. That is an open offer, but we will see whether it is taken up.

To conclude, the onus is on the Minister to stand up this afternoon to say that first, yes, there will be a consultation; secondly, that although we have missed out on help that could have come forward this winter, we will urgently consider what can be done in the meantime to help stabilise some of those bills in light of the new price cap for this winter; and, thirdly, that the Government, as my hon. Friend the Member for Birmingham, Selly Oak has said, will lay their workings on the table at a very early date so that we can collectively take part in the debate as to how we get a social tariff that works in the long term and that protects the people and makes their energy affordable in the way that we all want.

This is an incredibly important issue, and I thank hon. Members from across the House for their contributions to the informed, interesting and heartfelt discussion. I particularly wish to thank the hon. Member for Motherwell and Wishaw (Marion Fellows) for raising this important topic for debate and for the previous conversations that we have had on this subject—I have had similar such conversations with many Members across all political parties. I also thank the hon. Members for Birmingham, Selly Oak (Steve McCabe) and for Southampton, Test (Dr Whitehead) and my hon. Friend the Member for Waveney (Peter Aldous) for their valuable contributions to this important debate.

As the Minister for energy, consumers and affordability, I am working really hard to try to bring down bills for households and to tackle fuel poverty as it is clearly the most important thing on my mind. I recognise the challenges that families face and continue to stand firm behind energy consumers.

Last winter, as Members will know, we spent £40 billion on an unprecedented package of support for households and businesses. That meant that a typical family have saved £1,500 through the energy price guarantee and energy bill support scheme since last October.

The hon. Members for Motherwell and Wishaw and for Birmingham, Selly Oak both raised the important issue of support for disabled people, particularly those with in-home medical equipment. The Government’s support package assists the most vulnerable with rising energy bills, including charges incurred by patients dependent on medical equipment and devices as part of their homecare. I am reminded of my mother who suffered with chronic obstructive pulmonary disease and who sadly died at the age of 67, so I am very conscious of the kind of care that we should be giving to this important group of people.

We have certain specialised NHS services, which include the provision of financial support to offset increased energy costs faced by patients using medical equipment at home. Home oxygen suppliers, as I have previously mentioned, also reimburse patients for the cost of electricity that is required to run oxygen-concentrate devices in a patient’s home.

As the departmental ministerial disability champion, I am aware that energy prices are a major concern for those with a disability or a long-term health condition. I am proud of the support that the Government offer to those with disabilities. That includes, for example, more than 6 million people across the UK eligible for extra costs disability benefits who have already received the £150 disability cost of living payment. It also includes the personal independence payment, which pays up to £172.75 a week to those with the greatest additional needs. Our national disability strategy, published in 2021, sets out the actions that the Government are taking to improve the lives of disabled people.

Members have my assurance that I continue to discuss with charities how we can best tackle fuel poverty and other such issues. I have had many recent meetings with Mencap, Scope, the Motor Neurone Disease Association and Citizens Advice, as well as many other stakeholders.

We set out in our 2022 autumn statement that we were exploring the best approach to consumer protection as part of wider retail market reform. The outlook has improved significantly since then, with the Ofgem price cap more than halving since its peak earlier this year. However, even with prices dropping, energy bills represent a challenge to many low-income and vulnerable households, leading to debt and self-disconnections. We have taken additional steps to support those households. The term “social tariff” means different things, but ultimately it is about providing financial support to those who struggle to afford bills, for one reason or another. We are approaching that in three ways. First, we are working closely with Ofgem, which I have very regular meetings with, and suppliers—of course, as the hon. Member for Southampton, Test asked, I have meetings with suppliers —in relation to those facing energy issues such as debt. Secondly, we are supporting those who face challenges particularly linked to energy—for example, because they live in a poorly insulated home. Lastly, we are supporting those with cost of living pressures.

However, it is important to consider any further energy support in the context of wider changes to incomes and Government support, including that which my right hon. Friend the Chancellor of the Exchequer set out in yesterday’s autumn statement. Although prices have stabilised, they could rise in the future. It is important that any new approach can respond to a future price spike. I was listening to all the hon. Members when they talked about long-term solutions rather than just putting a sticking plaster over this. That is one of the challenges that we face.

The energy price guarantee will remain in place until the end of March 2024 to have protection in place should energy bills increase significantly during this period. The Government have also ended the prepayment meter premium by providing a discount to prepayment meter customers through the energy price guarantee. As laid out in yesterday’s autumn statement, the Government continue to invest in infrastructure and will deliver more than £600 billion of planned public sector investment over the next five years, underpinning our future growth and supporting energy security, net zero and, of course, vital public services. We have also highlighted proposals to offer electricity bill discounts for properties close to electricity transmission infrastructure. That could be up to £1,000 per year over 10 years for those properties.

In the past year, we have worked with Ofgem and energy companies to ensure better treatment for energy consumers. I chaired a supplier roundtable on 24 October. I have of course had previous discussions, but at this meeting we discussed how the energy market can work better for all consumers, including the most vulnerable. We have already taken steps to stop prepayment meters being forcibly installed where they should not be. Suppliers are no longer permitted to forcibly install prepayment meters in households with certain categories of vulnerabilities, including people over the age of 75 and those who may be medically dependent on a continuous source of energy or heating.

I acknowledge the work that the Government have undertaken on prepayment meters. Would the Minister be willing to consider extending that to households in which a disabled person is living?

I thank the hon. Member for that intervention. Of course, from a prepayment meter point of view, one thing that we really wanted to ensure was that we were not penalising those who were vulnerable. I am always very happy to consider anything that would help and enable us to ensure that.

We also welcome Ofgem’s new rules to ensure that all consumers get the service that they deserve. Suppliers will now be required to prioritise vulnerable customers first when they request help, offer timely repayment plans for those struggling with bills and make customer ratings easy to find on their websites. Furthermore, the Government and Ofgem have been working to progress towards a shared priority services register, which could make things easier for customers and better prioritise services to vulnerable consumers who are dependent on a regular energy supply.

Overall, the best approach to consumer protection is to have an effective retail market. That is why we are pursuing retail market reforms that will set us on a path to unlocking competition, investment and innovation, which will empower consumers and enable suppliers to succeed and usher in new business models.

The Government are reviewing the fuel poverty strategy for England. Under the current approach, we see energy efficiency as the best way to tackle fuel poverty as it contributes to the long-term reduction of energy bills, as well as reducing carbon emissions in line with net zero. There are multiple targeted schemes in place in England to deliver efficiency measures to low-income and fuel-poor households. Targeted energy efficiency support is provided to fuel-poor households in England, Wales and Scotland through the energy company obligation.

Last winter, we extended and expanded the warm home discount scheme, which supported fuel-poor households by taking £150 directly off their energy bills. For this winter, we expect over 3 million households to receive a rebate under the scheme. As the hon. Member for Birmingham, Selly Oak said, following a public consultation in 2021 we reformed the scheme in England and Wales to better target households in fuel poverty and provide the vast majority of rebates automatically. Last winter, around 95% of eligible households received their rebates automatically, without having to take any action, under this element of the scheme. The remaining 5% received their rebates after confirming their details to the Government’s warm home discount helpline.

Under the reformed scheme, we have focused the support to households in receipt of means-tested benefits who are living in properties that we estimate to be relatively costly to heat. We have used data on benefits and property characteristics to identify eligible households, and we estimate that the reformed scheme should enable around 560,000 more fuel-poor households to receive a rebate, including around 160,000 more households with a person who is disabled or has a long-term illness. At the time of the Government’s response to the consultation, we assessed that the proportion of rebates received by households with a disability or long-term illness should remain higher than the proportion of the fuel-poor population with a disability, and higher than the proportion of the overall population with a disability. Although the reforms were not possible in Scotland, because of differences in Government-held data, we implemented an expansion of the scheme in Scotland to support more fuel-poor households. The scheme obligates energy suppliers to provide additional energy-related and financial support, known as industry initiatives, to households in or at risk of fuel poverty. The industry initiatives may include benefit entitlement checks, energy advice, energy efficiency measures, financial assistance and debt write-off, and can be given to households regardless of their eligibility for a rebate.

The Government are also assisting households’ and individuals’ rising cost of living. That assistance will total over £94 billion for 2022-23 and 2023-24. For 2023-24, it will include providing over 8 million households on eligible means-tested benefits with additional cost of living payments that total up to £900, over 6 million people on eligible extra-costs disability benefits with a further £150 disability cost of living payment, and over 8 million pensioner households across the UK with an additional £300 cost of living payment.

The Government continue to stand firm behind energy consumers, especially our most vulnerable households. The Government are determined to drive down cost of living pressures, having already met our goal to halve inflation. As set out yesterday in the autumn statement, lower wholesale energy prices have been the main driver of lower inflation, but we recognise that we must continue to monitor the situation closely. We are committed, and I particularly commit, to delivering a fair deal for consumers, and most of all for vulnerable households.

I thank the hon. Members for Waveney (Peter Aldous), for Birmingham, Selly Oak (Steve McCabe) and for Southampton, Test (Dr Whitehead) for their contributions. I also thank the Minister for her perspicacity; she managed to go through everything that the Government have done for disabled people and to protect consumers. However, I am still waiting to hear that there will be a consultation on an energy social tariff. I am disappointed that I have not heard that there will, because so many disability organisations have listened to this debate and wanted to hear good news.

I thank the Minister, and I note some of the work that has been done. But in spite of all that work that has been done, and that the Minister said will be done, disability organisations are still—I will use the Scottish term, which the hon. Member for Birmingham, Selly Oak will understand—ragin. The Government have to do better.

Question put and agreed to.


That this House has considered energy social tariffs.

Sitting adjourned.