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Ambulance and Emergency Department Waiting Times
(1 year, 9 months ago)
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Westminster Hall is an alternative Chamber for MPs to hold debates, named after the adjoining Westminster Hall.
Each debate is chaired by an MP from the Panel of Chairs, rather than the Speaker or Deputy Speaker. A Government Minister will give the final speech, and no votes may be called on the debate topic.
This information is provided by Parallel Parliament and does not comprise part of the offical record
Wera Hobhouse (Bath) (LD)
I beg to move,
That this House has considered waiting times for ambulances and emergency department care.
It is a pleasure to serve with you in the Chair, Mr Stringer, and I am pleased to see so many Members here to discuss the highly concerning issue of the unacceptably long waiting times patients in our constituencies endure to access emergency care.
Our urgent and emergency care system provides a vital service supporting a significant number of patients with a huge variety of medical conditions, ranging from acute emergencies and trauma to mental health crises, the care of our homeless population and care of elderly patients. Emergency care should be there for all of us when we need it. Few of us plan to attend emergency departments, but we are all potential patients.
Covid-19 has had a detrimental effect on our ambulance services. More and more people are calling ambulance services or attending A&E because they are having difficulties accessing other, more appropriate parts of our health system. National NHS performance figures illustrate that our healthcare service does not have the capacity to meet demand, and during May 2022, only 60% of patients were seen, admitted or discharged within four hours of their time of arrival. We should all be worried by those figures, which demonstrate that the health service is unable to meet the needs of patients with current levels of resource and capacity.
I want to share the example of the Royal United Hospital in my Bath constituency. It demonstrates the severity of the problem and the way in which hospitals have to step in because the Government are not willing to accept that there is a real crisis. There have been several cases in Bath in which residents waited many hours for an ambulance. Recently, an elderly man was forced to sleep on the floor of a local church as it took 12 hours for an ambulance to arrive—12 hours. A GP surgery ran out of oxygen for a patient due to the time it took for the ambulance to arrive. Ambulance handover delays are a significant patient-safety risk at the RUH, and up to 90% of the causes of delay are linked to the availability of beds in the hospital.
The RUH has consistently been running with a bed occupancy of over 90% for the past year, which is significantly impacting the hospital’s ability to move patients out of the emergency department. The hospital is one of the most challenged in the south-west for “non-criteria to reside”—in other words, medically fit for discharge—patients, and NHS England is reporting that the RUH has 24.3% of its beds occupied by patients who are medically fit, which is the third highest figure in the south-west. That is driven by gaps in the domiciliary care and social care markets.
My local authority, Bath and North East Somerset Council, has been short of 1,600 hours per week, community teams are struggling to recruit and our local care group has a vacancy rate of more than 30%. The RUH is working with the council to develop its own in-house domiciliary care to try to plug the gaps, but the recruitment crisis remains acute. NHS England is assessing the trust and is trying to help to reduce the bed gap at the RUH. The hospital recently launched a “home is best” transformation programme that aims to increase the number of patients who go home instead of into a community hospital bed. Our hospitals are trying all this, yet there is a crisis. It is important that we recognise that, and that the Government recognise it and step in on behalf of the hospitals.
Our hospital in Bath is also working out ways to reduce the number of patients who need to go into the emergency departments in the first place, and has launched a same-day emergency care offer for frail patients. However, nationally, the lack of staffed beds has resulted in staggering numbers of patients waiting beyond 12 hours after the decision is made by the A&E doctor. There have been more patients waiting 12 hours or more from the decision to admit this year than there were in the entire reporting period leading up to 2022. In May, there were more than 19,000 patients waiting 12 hours or more from the decision to admit, yet research from the Royal College of Emergency Medicine shows that that number is only the tip of the iceberg. We know that far greater numbers of patients endure waits of 12 hours or more if the clock is started as soon as they set foot in A&E. Many more patients endure extremely long waits but are not captured by the current metric. We need to understand the true scale of the problem. If we do not know about the extreme delays that our patients are enduring, we cannot take action. Transparency is key, and reporting metrics from the moment of arrival at the A&E department must be the starting point.
Such delays mean that emergency services are not able to respond to 999 calls from critically ill patients. Instead, they are being held in stacks of hundreds each day, and staff are forced to prioritise among even the most serious cases. Staff have to wait with the patients in corridors, and sometimes even outside the hospital, unable to have them treated and unable to respond to new emergency calls. We must think very carefully about what that means. Behind every statistic is a patient. Those patients are stuck and have no choice but to wait for a bed to be freed up so that they can be admitted and can receive the care they need. Unfortunately, some patients end up on trolleys in crowded corridors with many other patients. We should be treating patients with dignity. We know that crowding is dangerous and is linked to avoidable harm and, in some cases, death.
The pressure that the NHS faces, which has been building over recent decades, has real detrimental consequences on the emergency medicine workforce and patients. Staff are considering reducing hours, changing careers or retiring early. Additionally, emergency staff face constant abuse from those left waiting, which is hugely distressing. The more people leave, the more pressure is created.
The Royal College of Emergency Medicine’s “Retain, Recruit, Recover” report detailed findings from its survey of emergency medicine clinicians. It found that 59% of respondents experienced burnout during the second wave of the pandemic, and described their levels of stress and exhaustion from having worked the second wave as higher than normal. The report found that operational pressures, patient safety and staff wellbeing are intrinsically linked. In 2021, the Royal College of Emergency Medicine highlighted a UK-wide shortfall of 2,000 to 2,500 whole-time equivalent emergency medicine consultants. The needs of our population’s health and wellbeing are greater now than they have ever been. We cannot afford to lose even more of the workforce at this critical time of need.
It is clear that this very serious issue is a matter of life and death for many patients. Among those who are suffering from serious but not necessarily prioritised issues, it is elderly and frail patients who are being hit the hardest. Although it is easy for the Government to point the finger at hospitals and management, it is clear that this issue needs to be addressed centrally at Government level. It is not exclusive to Bath or north Shropshire; it is a national problem, as the range of MPs in the debate demonstrates.
What is more, the consequences of a failed social care system, which does not allow for the timely discharge of patients who are medically fit to leave hospital, has resulted in further crowding and corridor care in our hospitals. The chief executive of NHS England recently acknowledged the important role that social care plays in supporting patient flow through hospitals. The Government must outline the steps they will take to ensure the social care system is adequately equipped ahead of next winter.
Last autumn, the NHS published a 10-point plan for the recovery of the urgent and emergency care system. It has no targets or timelines, and it lacks any indication of how progress will be reported. It details only how the whole system will work together to recover urgent and emergency services, focusing on immediate and medium-term activities. The plan aimed to
“mitigate against the current pressures felt across systems and improve performance in all settings”—
great words, but where are the outcomes? All that is happening is that the situation is getting worse.
The NHS standard contract 2022-23 was recently amended to change the way in which 12-hour waits in A&E are calculated. As a result, A&E is now collecting 12-hour data from the patient’s time of arrival, not from the decision to admit. Despite that, the Government and NHS England have not indicated when the data will be publicly available. Publishing the figures nationwide will allow for transparency across the system, so perhaps the Minister will tell us when that will be publicly available. That should lead to improvements.
The Liberal Democrats have been sounding the alarm bells for months, calling for an urgent investigation into England’s ambulance services and a review of ambulance station closures, but the Government keep turning a blind eye to the crisis. We are calling for more investment in local ambulance services, an urgent campaign to recruit more paramedics, and enabling trusts to restore community ambulance stations in rural areas in Devon, where waiting times are unacceptably long.
Richard Foord (Tiverton and Honiton) (LD)
I found on the doorsteps in my part of Devon over the last month that pretty much every door I knocked on had somebody behind it with an anecdote about how ambulance waiting times had affected them personally. In south-west England we have the longest waiting times in the country. One paramedic told me that despite his very best efforts to treat patients, there were times when he came across very undignified scenes. He talked about one example of how he came across a lady who had fallen down and had to wait 14 hours for an ambulance to arrive.
Graham Stringer (in the Chair)
Order. I realise that the hon. Gentleman is new, but interventions should be short and to the point. I did not want to interrupt him, but I ask him to remember that interventions should be as brief and to the point as possible.
Wera Hobhouse
Thank you, Mr Stringer. I think every one of us has such stories from the doorstep. Almost everybody knows of a loved one or a friend who has waited an unacceptably long time. That is why it is so important that we get the urgent review that Liberal Democrats have been calling for.
We are calling for a formal inquiry. The Government need to fund thousands of extra beds to stop handover delays in A&E so that ambulances can get back on the road as soon as possible. Will the Minister comment on a formal inquiry into the crisis?
Ian Paisley (North Antrim) (DUP)
Fifty per cent. of the entire Northern Ireland budget is spent on the health service, which is a higher proportion than in the rest of the UK. But this is not just about the money. Does the hon. Member agree that it is about how the money is spent and managed, and that that is critical to any review?
Wera Hobhouse
Indeed. Not everything is always about money; it is also about proper management. At the heart of it all is transparency. We need to have the figures and to understand what the problems are. I echo the Royal College of Emergency Medicine: unless we have transparency, we cannot get to the bottom of the problem.
The Royal College of Emergency Medicine has already stated that A&E departments are not confident they will cope this winter. The Government simply cannot ignore this looming crisis on top of the existing challenges we face. They are running the NHS into the ground. With A&E wait times measured in hours instead of minutes, people are no longer confident that they can get urgent medical help when they need it. The Government need to start working with NHS staff to draw up a robust plan now to tackle the crisis in ambulance waiting times and emergency care, and start delivering. Thousands of lives depend on it.
Several hon. Members rose—
Graham Stringer (in the Chair)
I think there are 10 hon. Members wishing to speak. I intend to start calling the Front-Bench spokespeople at 10.40 am. Therefore, Members have approximately five minutes each. I will not impose a time limit unless people abuse this privilege.
Duncan Baker (North Norfolk) (Con)
I thank the hon. Member for Bath (Wera Hobhouse) very much for obtaining this very important debate. The very first subject that I raised when I was a newly elected MP was the state of ambulance response times in North Norfolk. That is a particular worry for me, because up on the North Norfolk coast I have the oldest constituency demographic in the entire country, and Wells, a beautiful seaside village, has had the very dubious honour of consecutively having the worst response times. Over the last few years, whereas the category 1 responses have flatlined, the C2 and C3 response times have got worse. Constituents are coming to me almost every other day to tell me about the appalling situation that they have encountered in calling an ambulance. The worst cases are of people having strokes in the back of their car while family members are driving them to the hospital. When we hear those accounts, we get some sense of just how bad the picture is.
I agree with many of the comments made by the hon. Member, but we have to recognise that this is not a simple issue that can be solved with a single magic bullet, and it is certainly not all the fault of the ambulance service, which is working under extreme pressure. All our health systems at the moment are really buckling under the issues that have been caused by the pandemic. That is the case in social care systems, mental health care and dentistry. There are serious problems in all places at the moment.
Let us take the Norfolk and Norwich Hospital, which is my emergency department. It has the honour—I call it an honour; it is dreadful—of being the worst in the east of England. In the first 13 weeks of the year, 723 equivalent ambulance shifts were lost. The third worst performing facility for ambulance response times is the Queen Elizabeth Hospital, with 442 equivalent shifts lost. Both ED units that serve my constituency are in the top three worst facilities in the entire east of England. It is a huge problem, with hundreds upon hundreds of hours lost every single week when ambulances are queueing up outside a hospital because they cannot get patients out of the trucks and into the A&E department. Equally, the social care system is so poor that they cannot get people back into the community, with the respite that they need.
We know that there are serious issues about sickness; there are rising levels of covid. But there are other issues also. I am told that 50% of the calls that are made to the ambulance service in Norfolk are calls that simply should not have been made; they could have been for something that was not life-critical. That is coupled with ambulances pulled off the patch to go and service other areas; actually, there would be enough ambulances in North Norfolk if they were used within North Norfolk. That just adds to the problem.
However, the most pressing issue is the sheer numbers—the hundreds of hours lost every week from ambulances queueing up. The question is why, and it is a very easy answer: 95%-plus occupancy all the time is the problem. We simply cannot have the capacity in place. It is no good saying, “Well, if we just build a bigger hospital or build a bigger ED, that will solve the problem.” I do not think it will, because the problem is so multifaceted.
The hon. Member for Bath was right: transparency of data is incredibly important. But when we drill down into the information, we realise that all the issues that I have set out are working in tandem; they are all conspiring to cause the problem. In the last minute or so available to me, I want to ask what we do about it, and there are some practical suggestions that I want the Government to take really seriously.
First, the role of our community first responders should not be underestimated. We are not treating this problem seriously enough. Why on earth are we not paying community first responders, as is the case with the retained fire service? We are asking volunteers in our community, who have to be fit men and women and who, frankly, are probably not going to be people approaching their retirement age of nearly 70. Not enough people are going to be volunteering in our communities, and that is why we suffer with the numbers. If we really got some energy behind this in order to recruit these people, help them and make it economical for them to do it, we would see, I think, uptake of that. They are the first line of defence in helping to support people.
The second issue we should be looking at is rapid response vehicles. A rapid response vehicle was nearly taken away from North Norfolk, which was absolutely appalling. These vehicles offer far better economic value than ambulances. The clue is in the name—they are able to rapidly respond. They can be stationed virtually anywhere and help suffering patients while an ambulance gets to them. They are incredibly important in rural areas, so I ask the Minister to take those issues seriously.
Finally, I will be spending the first week of the forthcoming recess volunteering with the East of England Ambulance Service so that I can see at first hand the problems it faces. Those who work there are heroic people, but, my word, they need some help.
Naz Shah (Bradford West) (Lab)
It is a pleasure to serve under your chairmanship, Mr Stringer.
“24 Hours in A&E” is not just a television show, but a reality that patients across the UK now face. It is no longer a short trip to the accident and emergency department, but a short stay in an accident and emergency ward, which means staff are effectively running two wards: the A&E ward and the ward where patients should have been moved to be treated. In Bradford, the demand for urgent and emergency care outstrips the capacity of hospitals to support patients, and that reflects the reality across the country. Unsurprisingly, the waiting time for emergency services and emergency department care will vary across the country, with waiting lists in the most deprived areas having increased by more than 55% compared with 36% for the least deprived areas.
As I have previously highlighted, children in Bradford wait 800 days longer for mental health intervention. The Government keep telling us that covid-19 is to blame for the waiting time, the backlog and the lack of resources and funding, but that could not be further from the truth. In fact, the Secretary of State for Digital, Culture, Media and Sport admitted that in her attack on the former Health Secretary, the right hon. Member for South West Surrey (Jeremy Hunt), for failing to prepare for covid.
When a stroke patient does not get the urgent support they need, that can mean further damage to their health and life-long injuries, which in turn costs the NHS more. On the subject of ambulances, a dear friend of mine who is chief executive of My Foster Family, based in my constituency and with whom I have worked a lot, suffered a stroke last week. Shadim Hussain, who is 43 years old, is in the intensive care unit as we speak and I hope he will recover, although it will no doubt take a long time. When there is a 45-minute wait for an ambulance, there are two victims: the person in the ambulance who is waiting to be offloaded into the hospital and the person in the community who is waiting for the ambulance to get them to hospital. Shadim Hussain was taken to hospital in a car while he was being sick and suffering from a very serious bleed to his brain.
The UK has the second lowest number of beds per 1,000 inhabitants in the EU and the third highest decline in beds per 1,000 inhabitants in the EU. When Labour left Government in 2010, there were 144,000 hospital beds available, but at present there are around 128,000 hospital beds available.
When an 18-year-old woman suffering from a mental health crisis is forced to wait eight and a half days in A&E before getting a bed in a psychiatric hospital, that also costs the NHS more, but it is not just about the cost. The NHS was set up on a moral basis to provide care for our people; it was its birthday yesterday. Instead, people wait and pray, and some go home with more injuries or trauma. According to the Royal College of Emergency Medicine, whose representatives I met yesterday, the situation is 14% worse than the current statistics tell us.
However, the most recent British social attitudes survey recorded an unprecedented fall in public satisfaction with the NHS. When we left Government, we had the highest rates of satisfaction in the NHS as we had eliminated waiting times. We now have the lowest levels of satisfaction since 1997, with long waiting times at the top of the list of reasons given for dissatisfaction. That dissatisfaction is not due to the doctors, nurses, ambulance staff, receptionists or cleaners. As the hon. Member for Bath (Wera Hobhouse) said, the staff are often abused. The dissatisfaction is because of the lack of resource provided by the Government.
In Bradford, we have an increase in emergency department attendances, with some very busy days when we exceed 400 attendances in any given 24 hour period. Bradford Royal Infirmary is around the corner from where I live. There are currently 46 covid-positive patients in the hospital, or 1.5 wards-worth. The segregation of covid patients, elective and acute patients is impacting on the ability to place patients in the correct bed in a timely fashion, and all that exacerbates the strain on an exhausted workforce. The continued focus on the clearance of elective backlogs means that we are trying to undertake more elective procedures at the same time as dealing with all that, and there are workforce challenges associated with staff with covid infections and colleagues who have worked relentlessly through the pandemic. Despite all that, the trust continues to perform in the top quartile across a number of key metrics, including urgent, cancer and elective care.
I put on the record my thanks to all the staff, from the chief executive’s team to the porters who run the hospital, not just through covid—they continue to do so—in spite of the underfunding for years and years, before we even got to the pandemic, and despite not having the right resources now. The Government clapped for the NHS workers during the pandemic, but the claps were never enough. It is now time for action, not political slogans and gestures.
Peter Aldous (Waveney) (Con)
It is a pleasure to serve with you in the Chair, Mr Stringer. I congratulate the hon. Member for Bath (Wera Hobhouse) on securing this debate. I will focus my comments on the work of the East of England Ambulance Service NHS Trust and the James Paget University Hospitals NHS Foundation Trust, which together serve north Suffolk and east Norfolk, including the Waveney constituency.
The staff and management of both NHS trusts are under enormous pressure at the current time and are working incredibly hard to meet a challenge that is largely not of their own making. The East of England Ambulance Service has faced a number of institutional and cultural challenges over the past decade, which the current management are addressing. During that time, for the most part, it has provided the local community with a good service, although there have been three occasions when it has not done so: in 2012, when the system broke down very badly, at around Christmas time in 2017-18, when the then management failed to properly plan for seasonal pressures, and today, as it works against a very difficult backdrop.
For the week ending 26 June, the average arrival-to-handover delay at the James Paget was one hour 30 minutes. For the previous week, it was one hour four minutes. For the week before that, it was 49 minutes. The trajectory is very much upwards. The worst individual case that has been brought to my attention is a wait of 16 hours, and I am also aware of the situation with poor triaging.
Working collaboratively and in a co-ordinated way, the ambulance service and the James Paget hospital are putting in place a range of measures to relieve the pressures. The hospital has expanded its emergency department, launched a new surgical assessment unit and invested £900,000 in a new GP streaming service aimed at providing care for patients who attend A&E and who need a doctor rather than hospital treatment. For its part, the ambulance service is putting more ambulances on the road, developing co-responses with the fire services and local communities, and staffing cohorting areas at the Paget with its own HALOs—hospital ambulance liaison officers.
Those initiatives are welcome, and the two trusts should be commended for putting them in place, but they are, in many respects, a sticking plaster. They do not address the root cause of the current crisis, which is the logjam caused by the difficulty that the James Paget and other hospitals are facing in discharging patients to free up beds.
The Paget regularly has an average of 100 patients—the equivalent of four wards—who are ready for discharge, but have nowhere to go. They have opened 22 beds at the Carlton Court Hospital, a facility that the Paget now shares with the mental health trust, but there is an urgent need for more beds to be made available in the community, whether at home, or in care and nursing homes.
The problem with care at home, which in many respects is to be preferred, is that councils such as Suffolk County Council and its social services department are struggling to recruit carers and agencies to go into people’s homes to look after them after they have left hospital. In the long term, there is a need for strategic workforce planning in both the health and care sectors.
In the short term, Government need to work with councils such as Suffolk, with the East of England Ambulance Service and with hospitals such as the James Paget hospital—as well as with the wider care sector—to remove the blockage that is impacting all the way along the ambulatory care pathway. I look forward to hearing from the Minister the Government’s plans for doing that.
Helen Morgan (North Shropshire) (LD)
It is a pleasure to serve under your chairmanship, Mr Stringer. I am grateful to my hon. Friend the Member for Bath (Wera Hobhouse) for securing the debate. On 25 May this year, the nursing director of the West Midlands Ambulance Service, Mark Docherty, said that the ambulance trust would face a “Titanic moment” and collapse entirely this summer. He gave the specific date of 17 August. Mark went on to say that patients were “dying every day” from avoidable causes created by ambulance delays. That was 42 days ago. He predicts that we now have another 42 days before the ambulance service in my community collapses.
I have had an Adjournment debate with the Minister on that subject, and a meeting with the former Secretary of State for Health, the right hon. Member for Bromsgrove (Sajid Javid), yet this Government still have not got a grip on the problem. As a proud resident of North Shropshire, I was aware of our ambulance crisis before I was elected in December, and before I started campaigning in November. However, on the campaign trail, and since being elected, it has become evident that the scale of the crisis is absolutely shocking.
Just last week, I was contacted by a constituent whose 85-year-old mother, who suffers from dementia, had fallen and suffered a suspected broken hip. Her son called the ambulance, but she sat in agonising pain in their living room for 18 hours before the ambulance arrived at her home. Everyone in this Chamber will agree that this should not be happening in this country, or in this century. It is one of many stories I have received. Many other people are attended by the ambulance crew in fairly reasonable time, but then wait 12 or 13 hours in the ambulance before being transferred into the hospital.
The focus of this debate should be on solutions to the problem, but it is also crucial to understand how we got here. Ambulance service delays are a symptom of wider issues plaguing the NHS and health services across the country, and the issue of staff shortages is critical to that, as colleagues have alluded to today. So far, the Government have failed to address that. They have thrown our hard-working doctors and nurses pretty much under the bus. We are short of nurses, carers, GPs and decision-making doctors in A&E. In February, the all-party parliamentary group for rural health and care published a report concluding that the 10 million people who live in rural and coastal areas in the UK deserve better healthcare outcomes. Colleagues here representing rural constituencies know from first-hand accounts that it is not just access to healthcare that is compromised but, in the words of the APPG report,
“the very determinants of health itself.”
That is why our ambulance crisis is even worse than in some of Britain’s more urban areas. Worse still, it is hidden by the published data. West Midlands Ambulance Service reports some of the better response times in the country, but a decent outcome in Birmingham and the black country conurbation is masking a deep crisis in the countryside.
How are the hard-working professionals in our NHS to deal with another significant rise in covid admissions? They are struggling to deal with the broken social care service, a hospital bed crisis and people who cannot access a GP and so are turning up at A&E. I know those professionals have the best will in the world, but they simply cannot deal with that. That is why Shrewsbury and Telford Hospital NHS Trust has declared yet another critical incident this week. I have lost count of the number of times that has happened this year—I think it is the fourth or fifth—but a summer incident is unprecedented. The winter is coming at us fast, and now we need to understand what we can do to fix the problem.
We know there is no quick fix, but one thing the Government could do now to understand the problems and come up with effective recommendations is commission the Care Quality Commission to investigate delays in the ambulance service and their underlying causes. In my Adjournment debate before easter, the Minister said it was open for me, or others, to raise that with the CQC. However, they have subsequently written to my hon. Friend the Member for St Albans (Daisy Cooper)—the Liberal Democrat health spokesperson—to confirm that that is not the case. It is clear that while the Health Secretary has the power to commission the CQC, unfortunately I do not. Crucially, Mark Docherty, the nursing director of West Midlands Ambulance Service, has also called for the CQC to investigate the issue. I would like to take this opportunity to urge the newly appointed Health Secretary to commission the CQC to conduct an investigation to identify the measurable actions we need to take to resolve the issues that we face across the country.
The Government could also adopt the recommendations of my hon. Friend the Member for St Albans by commissioning ambulance waiting times by postcode, so that we can direct the resource where it is needed and not just over large regions. They could also act on the recommendations of the APPG’s February report to deal with the health inequalities faced by the one fifth of our population who live living in rural or coastal communities. There are positive steps that can be taken to fix this crisis. I would like the Minister to say exactly what is going to happen now.
Jack Brereton (Stoke-on-Trent South) (Con)
I start by thanking all our NHS and care workers, who do an incredible job every day in dealing with the huge pressures on our local health services.
As I have said on a number of occasions, we are seeing significant challenges in north Staffordshire with ambulance delays and demand at the Royal Stoke A&E. Many of my constituents have contacted me after waiting for many hours for an ambulance. I have had to intervene on more than one occasion to get West Midlands Ambulance Service to respond to patients who have waited for 12 hours or more.
It is totally unacceptable for elderly and vulnerable people to be left to suffer without the emergency response that they need. Ambulances are now frequently queuing up outside the Royal Stoke A&E due to the lack of space to admit people. Our experience is similar to that of many other Members, with occupancy levels in the Royal Stoke hospital at over 90% much of the time. Despite the efforts to increase flow through the hospital, we still see too many patients fit for discharge not being able to be discharged, due to the lack of social care beds or not having care packages in place.
The availability of social care places across Staffordshire has continued to be significantly affected by covid, with homes locked down to new admissions, and a number of places have been lost due to quality and staffing issues. Our health and care services are still being impacted by the effects of the pandemic, and work to recover them from the pandemic is ongoing. What is clear is that these pressures cannot be sustained and that the situation must improve, but there are multiple causes that cannot simply be fixed overnight. Many of the pressures in the local health care system predate the pandemic. These relate to the period when the new private finance initiative hospital was built by the last Labour Government. That hospital has fewer beds and faces more demand following the Stafford Hospital scandal—also under Labour’s watch—as well as the amalgamation of Staffordshire Ambulance Service into West Midlands Ambulance Service.
We must address some of these deep-seated challenges. I commend the Government’s work to invest £36 billion in our NHS and care services, which are record levels of Government investment. However, this is not just about more money. We will not put our health and care services on a sustainable path by just pumping in more money. We must also use the opportunity that this investment provides to fix some of the wider systemic problems.
One of my constituents who is a student paramedic contacted me this week. He described the huge overcrowding at the Royal Stoke A&E and on occasions having to spend his whole 12-hour shift with frail, elderly and vulnerable patients just waiting outside A&E to be admitted. He hits the nail on the head when he said that many are turning to A&E and calling ambulances due to failures to properly manage their conditions in the community, with the challenges of accessing primary care. Accessing primary care and GP services are all too common problems, with people needing to resort to far more costly acute and secondary care.
I do not doubt that many working in primary care are equally overloaded and are doing their best to support patients, but primary care services need to be prioritised more. Access to primary care in our communities needs to be improved, as this is the route to greater prevention and earlier intervention to reduce some of the demands on the wider healthcare system. I very much support the improvements that the Government are making through the Health and Care Act 2022, which will help to better integrate healthcare services with integrated healthcare systems, which went live from the start of this month. I hope that the key focus of our ICS in Stoke-on-Trent and Staffordshire will be on better integrating primary, secondary and social care, so that we develop a more patient-focused service. That requires all healthcare partners, and partners more broadly, to work together. We must see greater collaboration to help to address some of these challenges.
Key to reducing demand will be greater prevention and early intervention, whether in physical or mental health. This will also very much rely on communities and the charitable third sector, which have much to give when it comes to prevention of illness and improving quality of life. Pharmacies can also do more, and I was pleased to attend the event in Parliament just down the corridor from here yesterday to support pharmacies. As the Minister knows, I have also raised before the keenness of Staffordshire Fire and Rescue Service to do more to help West Midlands Ambulance Service out. It has first-aid trained professionals; indeed, those professionals are already responding to more minor emergencies in some parts of the country when demand on the ambulance service is high.
For north Staffordshire, it is also particularly vital that we see the delivery of the four proposed integrated care hubs, especially the one in Longton in my constituency, completing the second phase of the new Longton primary care centre. These will bring together healthcare services and significantly improve access to NHS and care services right at the centre of the community. We have been talking about those improvements and going through consultation after consultation for far too long. We need to get on and deliver them. I very much hope the new community diagnostic hub will also be located on the site in Longton in a new, purpose-built facility.
Overall, what is most important is that we continue to support the NHS and care workforce and ensure the necessary investment that the Government have committed so that we see more of those doctors and nurses directed straight on to the frontline. I will continue to support our local NHS system in Stoke-on-Trent and Staffordshire.
Rachael Maskell (York Central) (Lab/Co-op)
It is a pleasure to see you in the Chair, Mr Stringer. I congratulate the hon. Member for Bath (Wera Hobhouse) on securing this debate, which we all, across the House, recognise is needed, as are the solutions.
The issues in York are no different from those that I have heard about today from Members of all parties. We know the diagnosis of what is wrong: we do not have the staffing or the capacity and our hospitals are running hot the whole time. In York, we have been in OPEL 4—that is the operational pressures escalation level—for a considerable amount of time. We are all wrestling with sufficiency in the ambulance service.
The statistics I have heard this morning map on to many of the statistics in York. In May, handover took more than an hour in 752 cases—24.6% of arrivals—and then there are the trolley waits for hours on end. The mean waiting time for non-admitted patients was four hours and 18 minutes in A&E, while for admissions it was nine hours and 22 minutes. There are then the challenges on the wards as patients progress through their journey. We know that there are challenges across the system, but receiving timely emergency care is the most important thing and what we are focusing on today.
Before proposing a couple of solutions to the Minister, I want to reflect on the impact that this situation is having on staffing. We have heard about the need for a workforce plan, which is crucial, but retaining staff is important too. Many people are leaving because the pressures are bearing too heavily on them. Working long hours is one thing—it is almost a social contract that people have to acknowledge, wrongly, I say, as part of working in the service, in either an emergency department or an ambulance service—but on top of that there is the trauma that people face. We cannot describe the impact that has on individuals.
What hurts the most is hearing the radio and knowing that there is another call, another person, another life that could be saved, but being tied down and unable to reach that call, or turning up incredibly late to see a patient, knowing that the life chances of that person in your hands have been changed because of the minutes or even hours of delay. Those are the pressures that bear down on our incredible NHS staff, making the job intolerable and eventually breaking them.
We have to look specifically at what we are doing for staff so that they can carry on with their jobs. Some 69% of emergency responders said that their mental health deteriorated during the pandemic, while just 26% described their mental health as good or very good. We know about the impact this situation is having on people day in, day out, while working those long hours. It is unsustainable. We are seeing that in the retention rates. My plea to the Minister is to introduce a good mental health support programme for staff to maintain that sufficiency. That means fixing the system as well; we cannot have one without the other.
I want to pick up on something I am very mindful of, having spent time talking to paramedics. A constituent contacted me about the poor mental health of their patients, its increased acuity and the impact of that on the service. I have met a group of campaigners who are calling for a specific mental health service with a specific phone number—instead of people having to call 999 or 111—through which people can be triaged by mental health experts and put in the right place in the service. It is about building a proper acute mental health service around people, because A&E may not be the right place for them, yet where else can we take them? It is important not only to look at the whole clinical pathway for people in crisis but to ensure that paramedics can focus on and spend their time on people with acute physical illness. I would like the Minister to reflect on the opportunity that that could bring.
In the short amount of time I have left, I want to touch on an issue in Germany, where they are doing medical thrombectomies in ambulances at the side of the road, as opposed to losing precious time taking people to A&E departments. We can do a lot more to reformulate the way our acute services work to take medicine to the patient, as opposed to taking the patient to hospital. [Interruption.] The Minister is nodding, so I will stop there but I look forward to his response.
Jerome Mayhew (Broadland) (Con)
I congratulate the hon. Member for Bath (Wera Hobhouse) on securing a debate that, as a number of speakers have said, affects politicians of whatever party right across the country. I am lucky enough to represent a Norfolk seat, so my Broadland constituency is served by the Norfolk and Norwich University Hospital and, to a slightly lesser extent, by the James Paget Hospital and the Queen Elizabeth Hospital. All three have been mentioned in the debate.
The problems for ambulance waiting times are multifaceted and have been well rehearsed by other speakers, so I will not go through them all. I will focus on one area: hospital handover delays. The national standard is that handover should take no longer than 15 minutes, but 60% of all handovers nationally fail to meet that standard. I will focus on the Norfolk and Norwich, the most recent statistics for which show that in June the average handover time was not 15 minutes or less, but 57 minutes—almost an hour.
When we look at ambulance times, we think it is surely the front door of the hospital that is the problem—getting people into A&E—but when I spoke to the leadership of the Norfolk and Norwich, they told me that it is overwhelmingly the back door that is the problem, by which I mean people leaving the hospital. People are medically fit to be discharged but there are not appropriate intermediate care spaces for them to be discharged into, or their care packages have not been agreed or put in place. We should focus on that more than any of the other important aspects.
If we look at the data, we see that in April this year, across the nation, 20,155 people who were medically fit for discharge were still retained in hospital beds. During the covid pandemic I learned that we have around 100,000 beds in the NHS. More than 20,000 of them are bed-blocked—a deeply unfair term because it implies that the people in the beds are refusing to leave when, of course, nothing could be further from the truth—which means that fully a fifth of hospital beds are out of use for no medical reason. That is crucial to solving this problem. How many extra hospitals that we are building is equivalent to those 20,000 beds? It is an enormous change.
We need to look at why medically fit patients are not being discharged. In my submission, a key reason is the disparity of funding and where funding comes from in respect of the move from NHS beds to care. Everyone in this room knows that one provision is funded by the NHS and the other by county councils. There is often an unedifying dispute about who should pick up the bill and how to transfer responsibility for a patient, so there is no such thing as continuity of care in the discharge process.
If we can do one thing radically to improve not only ambulance times but the service that is provided in our hospitals more generally, as well as act on the burnout that hon. Members have described—the pressures on staff and the number of staff required—it is to solve the problem of continuity of care between the back door of the hospital and the front door of intermediate care and care in the community.
My question to the Minister is: am I wrong in that basic analysis? If I am, perhaps he will tell me where I have gone wrong. If I am right, or even substantially right, I would be grateful if he set out his views on how we could take the bold step from siloed funding and responsibility between the NHS and secondary care to the transition to what we desperately need, which is continuity of care for the patient, thereby solving all the other problems we are discussing today.
Mike Amesbury (Weaver Vale) (Lab)
It is a pleasure to serve under your chairmanship once again, Mr Stringer. Like everybody else, I thank the hon. Member for Bath (Wera Hobhouse) for her insightful contribution to the debate, which is giving us the opportunity to speak as we celebrate this very week the 74th birthday of the NHS.
The NHS was founded by a Labour Government to provide healthcare for all, free at the point of delivery, and it has been a life saver and a life changer—a marvel to this day throughout the world. Another Labour Government in 2010, which is some time ago now, left the NHS with the lowest waiting lists on record, reduced waiting times and the highest satisfaction rating in history.
What have we got now, 12 years later, in the dying days or dying weeks of this Conservative Government? We have an NHS and a care system cut back to the bone—well before covid, which has been referred to. That has left, in particular, elderly and disabled people without the care they have needed. That has been reflected in today’s debate, from all sides of the House.
We have a workforce crisis that has left the NHS with a shortage of 94,000 staff. There is a lack of beds caused by about 400,000 patients a month being unable to leave hospital because of care shortages, which have been acknowledged and debated here today. The social care precept, which the Minister might refer to, is nowhere near sufficient. He would probably agree with that, if he decided to leave his post in the not-too-distant future. That is a decision for him to make.
Nye Bevan will be turning in his grave at this crisis, which is perhaps most apparent when we look at emergency care provision. As is the case in the rest of the country, the North West Ambulance Service NHS Trust is missing ambulance response targets by a country mile. For the most serious cases, in which there is an imminent risk to life, average response times are almost two minutes over target.
Category 2 cases are not the highest category of emergency response, but they include people who are having a stroke or a heart attack, or who are suffering from major burns or sepsis. Such cases should be responded to in 18 minutes on average, and 90% of calls should be responded to within 40 minutes, but last year, the service took, on average, 48 minutes to respond to a category 2 call, and responded to 90% of incidents within an hour and 45 minutes. That is 150% longer than it should have taken, and 10 minutes more than the national average.
It is so obvious that it should not need pointing out, but when it comes to strokes and heart attacks, every minute counts. The difference between 18 minutes and 48 minutes absolutely can mean the difference between life and death.
For cases considered less serious than the two higher categories—but still urgent—the targets state that 90% of the time ambulances should arrive within two hours. Instead, in the north-west, nine out of 10 times people can expect to see an ambulance within seven hours and 15 minutes. It is not hard to imagine how, within seven hours, an urgent case can become incredibly serious.
Non-urgent cases fair even worse. In the north-west the 90% target is missed by seven hours, meaning that some people who still need hospital treatment will be waiting 10 hours to get help. Just last year one of my constituents, Jim Rotherham, who is a veteran and 89 years of age, fell at home and broke his hip. He waited seven hours on the floor in utter agony for an ambulance. While that complaint was still live, weeks later, Jim fell again and had yet another long wait. It is simply not good enough, and I know that feeling will be shared across the House.
I am hugely grateful to everyone in my constituency, and indeed across the region, who works as a call handler, paramedic, doctor or nurse. They are working tirelessly, under pressure, but not with the resources they need, either for their own health and safety or for the health and safety of those they serve. They are being put in an impossible situation, they do not have the resources they need and the Government simply are not governing at the moment.
Some 40% of patients in my constituency covered by the Mid Cheshire Hospitals NHS Foundation Trust now face a wait greater than four hours to be seen in A&E, as do 30% covered by the Warrington and Halton Hospitals NHS Trust. A Halton resident, Josh, told me that it is impossible to see a doctor. That situation pushes people to urgent care centres, which he tried. He was told that he could not be seen by urgent care because there was not a doctor. He went along to A&E, but he could not be seen by A&E. The situation is putting pressure on beds, more pressure on ambulances, and really is risking lives.
Two days ago, the Warrington and Halton trust alerted the public to the fact that Warrington A&E was exceptionally busy and asked people to keep the service clear for the critically injured or sick. It is a story we have heard from many Members today and that we see in the media every single day.
On the 74th anniversary of the introduction of the NHS, let us hear it from the Government—let us hear it from the Minister, while he is still in his place: how are they going to relentlessly bring those waiting times down? How will they ensure that we have sufficient GPs trained, and staff training to support GP practices? After 12 years of the Conservatives in power, we need a national care service that is properly resourced.
Margaret Greenwood (Wirral West) (Lab)
It is a pleasure to serve under your chairmanship, Mr Stringer. I congratulate the hon. Member for Bath (Wera Hobhouse) on securing this important debate and on her speech. The Royal College of Emergency Medicine put out a press release today saying that their new survey found that:
“Two-thirds of A&E clinical leads…are not at all confident that their organisation will cope this winter”.
Its president, Dr Katherine Henderson, said:
“This is the height of summer and yet we are seeing a state of affairs that we’d be dismayed by even in the depths of winter.”
In the north-west, the average ambulance response time for a category 1 call was eight minutes in May—better than the national average, but still a minute above the average response time target of seven minutes. The average response time for a category 2 call was around 34 minutes—again, better than the national average, but well over the target of 18 minutes. We all know that, in an emergency, every minute counts.
We all want to be confident that a well-resourced ambulance service is there should we need it, along with a properly staffed and resourced A&E department. We are aware, too, that the ambulance services and A&E are under immense pressure—because of covid, but also because of staff shortages in the NHS. There are shortages in hospitals, making it more challenging to transfer patients to hospital beds in a timely manner, and in general practice, meaning that people are going to A&E out of frustration at their inability to secure a GP appointment. Of course, that all impacts on patients, sometimes with devastating consequences for them and their families. I want to highlight the tragic case of Sheila, the 72-year-old mother of my constituent, Shirley. I thank Shirley for sharing this information with us. Sheila suffered a heart attack and passed away at home on 1 December 2021. When she began gasping for breath two days after she had been diagnosed with a chest infection, her son called 999. There were two points of failure within the service. First, the ambulance did not arrive within the target time for a category 2 call. Secondly, when Sheila’s son rang 999 for a second time, the call was kept in category 2, instead of being moved to category 1 by the emergency medical dispatcher who took the call, despite the fact that Sheila had asthma and could be heard in the background saying that she could not breathe. Tragically, 106 minutes after the first 999 call and 79 minutes after the second, Sheila’s son made a third call to explain that his mother had passed away approximately 40 minutes earlier.
The findings of the serious incident investigation lay bare some of the pressures on ambulance services. It found that the main contributory factors of the delay while the call remained category 2 were the ambulance trust’s capacity not meeting demand, and the effect that hospital turnaround delays had on its ability to respond to patients. The investigation also pointed out that, even with 100% funded operational staffing, the trust had not been able to meet targets.
The investigation into Sheila’s case also raised the issue of the training of those taking the calls, who are known as emergency medical dispatchers. As I mentioned, the emergency medical dispatcher taking the second call missed hearing Sheila say that she could not breathe, so did not change her case to category 1, which would have resulted in an ambulance being dispatched more quickly. The investigation reported that the emergency medical dispatcher noted that the call was taken not long after she had finished her mentoring, and she was still unsure about ineffective breathing. She also advised that at the time of the call she felt that there were mixed messages from supervisors and other staff on ineffective breathing, and that it was not very clear, hence she misjudged the call.
That raises important questions about the training that emergency medical dispatchers receive. Are they getting the right kind of training? Is it being delivered in a way that allows them to express themselves if they are not sure about something? Do they receive sufficient support in the workplace? They carry out an incredibly important role, which doubtless can be extremely difficult, and comes with enormous responsibility. My constituent Shirley said:
“We did not blame the paramedics or the centre staff, but understand how short staffed and underfunded the service was, and how much strain the service was under.”
I hope the Minister will respond to the issues raised in this debate with care and a commitment to improve the situation rapidly. The Government must do their first duty—namely, to keep their citizens safe. Right now, as they fail to tackle ambulance and A&E waiting times and NHS staff shortages, they are failing badly.
Kate Osborne (Jarrow) (Lab)
It is a pleasure to serve under your chairmanship, Mr Stringer. I thank the hon. Member for Bath (Wera Hobhouse) for securing the debate.
In the north-east, as across the UK, our healthcare system is in crisis. We have an NHS staffing crisis and a lack of GPs, millions waiting for routine operations, a loss of hospital beds, and direct cuts to mental health services funding. The Health and Care Act 2022, which came into force this month, fails to address the serious challenges facing the NHS and public health and social care, and will likely make all the problems worse as local boards will make decisions based on financial constraints, rather than patient health.
The North East Ambulance Service claims to be one of the best performing in the UK on ambulance waiting times, but that ignores the unacceptable waiting times that individuals face even in the most serious cases. Ten per cent. of people who had emergencies such as strokes or serious chest pain were left waiting for 40 minutes—more than double the target wait time—and some waited for more than 90 minutes. Shockingly, 10% of individuals with urgent conditions who needed treatment and transfer to hospital waited more than three hours, and some waited as long as five hours.
Disgracefully, just a few weeks ago, reports emerged of a cover-up in the North East Ambulance Service regarding patient safety and possible deaths. There were allegations that the service withheld details from coroners in more than 90 cases between 2018 and 2019. My constituency of Jarrow is covered by the North East Ambulance Service, and such reports are obviously very concerning.
NHS England is now investigating the tragic failings of NEAS, but it is clear for everyone to see that our NHS is at crisis point. That is not the fault of individual staff members who do their best to cope with an under-resourced and understaffed NHS; nor is it just the impact of the pandemic. For too long our NHS has been pushed to the brink by the Tories. We entered the pandemic with the longest financial squeeze in NHS history, with thousands waiting longer for cancer treatment and the A&E target not met for six years. A&E waiting times are at an all-time high with 30% of people waiting more than four hours in A&E. Those waiting times have become progressively worse over the last decade.
The South Tyneside and Sunderland trust in my constituency has 39% of people waiting longer than four hours to be seen. Our emergency services are there for us in times of crisis, making life and death decisions in an instant and providing care and comfort to us at our moment of need. They need our support and they need the Government to start investing directly in our NHS. I want to put on the record my thanks for the great work that the Save South Tyneside Hospital campaign is doing in its campaign for the future of South Tyneside Hospital and its acute and emergency services.
Instead of investing in our NHS and staff, the Government insist that staff take a real-terms pay cut and attack staff sick pay, at the same time privatising as much as they can get their grubby little hands on. Our NHS cannot sustain the current level of attacks from this Government. Inevitably, both staff and patients will suffer. It is a disgrace that the Government are attacking the workers who have kept us going through covid—the workers who put themselves at risk every day and who go to work to protect us, who are called heroes one minute and vilified the next.
More and more is being outsourced to private companies using a false narrative of bringing down waiting times. The more the private sector becomes involved, the worse the situation becomes as capacity in the NHS is reduced and private companies cherry-pick easy and lucrative cases. All of that has the devastating consequence of forcing more and more people in pain and desperation to take out loans and crowdfund on the internet to pay for an operation because the wait is too much for them to bear. A two-tier health system is being privatised by the back door.
It was the NHS’s 74th birthday yesterday. Nye Bevan said:
“Illness is neither an indulgence for which people have to pay, nor an offence for which they should be penalised, but a misfortune, the cost of which should be shared by the community.”
If we want to make sure that future generations do not have to pay when they are ill, we must urgently ensure that our NHS is funded, and that all the parts that have been privatised are brought back in-house.
Karin Smyth (Bristol South) (Lab)
It is a pleasure to serve under your chairmanship, Mr Stringer, and to listen to this very well-informed debate. I commend the hon. Member for Bath (Wera Hobhouse) on securing it and on highlighting this important issue. We share boundaries across the south-west. I also thank the Minister for staying in the Chamber for the entire debate. He is now free to use his time. We will all be with him.
We know that under this Government record numbers of people are waiting for care, and they are waiting longer than ever before. Waiting times for ambulance and emergency department care are a symptom, as we have heard this morning, of the problems across the entire health and social care system. A record six million people are waiting for NHS treatment. There is a shortage of 100,000 staff and 17,000 fewer beds. That is not due to the pandemic, but deliberate underfunding of the NHS by a government who themselves admit—as the Culture Secretary recently did—that a decade of Conservative mismanagement had left our NHS “wanting and inadequate” even before covid hit.
I welcome the hon. Member for Tiverton and Honiton (Richard Foord) to his place and commend him on the points that he made. As we all know, on the doorstep, waiting times matter to constituents—a point that he made eloquently.
Waiting times for emergency care are nothing short of shocking. Like many Members of Parliament, I hear that every day from constituents. It is very distressing—and dangerous. There are cases of people waiting in agony outside the emergency department in an ambulance for over four hours, and waiting in the road for an ambulance for more than five hours. The average response time for an ambulance call-out for a stroke or suspected heart attack is 51 minutes and 22 seconds. The target, introduced by the last Labour Government, is 18 minutes. In May 2022, more than 19,000 patients were reported by NHS England as having spent more than 12 hours from the decision to admit to their admission to hospital. That really is a damning indictment. This winter, 89.8% more ambulances than the previous year were subject to delays of more than 30 minutes or more. My hon. Friend the Member for Jarrow (Kate Osborne) told us of the shocking incidents in the North East Ambulance Service and the investigation.
I could go on. What I am really interested in is the solution to this appalling state of affairs, as many hon. Members have said this morning. In fact, many hon. Members, particularly those on the Government side, have written my speech for me. Our highly skilled emergency department staff and paramedics show incredible courage and quick thinking on a daily basis. They need our support and they need a proper workforce plan that addresses shortages not only in emergency care but across the whole NHS.
Alarmingly, the Government’s manifesto commitment to improve waiting times for emergency departments was downgraded in the mandate from the Department of Health and Social Care to the NHS. The aim is now to improve performance “as conditions allow”. Under this Government, that will be never.
The hon. Member for North Shropshire (Helen Morgan) raised the case of the West Midlands Ambulance Service predicting a date on which it felt it would not be able to cope. This is not just about funding; it is also about the incoherent policies that leave patients and the public perplexed—a point that was touched on by the hon. Member for North Norfolk (Duncan Baker). Most urgent care takes place outside hospitals, but the complex mix of 111, GP out-of-hours, minor injuries units, walk-in centres, urgent care centres, as well as the plethora of online advice, is part of the chaos of fragmentation caused mostly by the now-discredited fetish for outsourcing and competition.
Currently, as we heard from the hon. Member for Waveney (Peter Aldous), schemes such as HALOs—hospital ambulance liaison officers—are just a sticking plaster. If we look at this as an A&E problem or just an acute hospital problem and do not incentivise all the ambulance services and primary care bits of the system to work together, we will not address the demand, which is a point made by the hon. Member for Broadland (Jerome Mayhew). The incentives, particularly after the Health and Social Care Act 2012, really do not help.
We need to make it simple for patients and their families to access the right care in the right place. That means supporting primary and community care, as well as ambulance services. As my hon. Friend the Member for York Central (Rachael Maskell) said, it is about bringing medical care to where people are and not expecting them to keep moving into the system.
Our highly skilled emergency teams must be free to manage all but the really serious acute cases referred to them, and then some of the problems would lessen, but the crux of the matter is that unless we improve discharges from hospital—as all hon. Members have said this morning—and ensure that our social care system is fit for purpose, we will not resolve the issue at the front of the hospital and we will not be helping patients. The pressures in leaving hospital has a direct impact on waiting times in emergency departments, and they put staff under pressure and patients in danger.
As my hon. Friend the Member for Weaver Vale (Mike Amesbury) said, the Government’s so-called fix for social care is not a fix at all. It is due to start in 2023. We need action now. We need to increase capacity in social care, improve pay and conditions for staff and ensure that we have a sustainable, working care system that will alleviate the pressures on the NHS, as well as support our constituents. There is no quick fix, but if the Government are serious about improving waiting times, they must look at the whole system.
We know the serious harm that waits and crowding in emergency departments have on patients and staff. Crowding is undignified and inhumane for patients who are left waiting for treatment in precarious circumstances. As well as impairing the efficiency of hospitals, it contributes to staff burnout, morale injury and the loss of emergency care professionals. It is associated with increased mortality and increased length of hospital stay.
Last year, the Royal College of Emergency Medicine estimated that crowding was potentially associated with more than 4,500 excess deaths. My hon. Friend the Member for Wirral West (Margaret Greenwood) noted the Royal College’s point that we are in the summer. This is not the critical time. We will go into another winter—winter follows summer every year, but it seems to be a shock to the Government. This is a very serious problem.
To prevent delays, I would welcome the Minister’s commitment to primary and community care and to supporting the timely discharge of patients when their hospital care is complete. Does he agree that there is an urgent need to support the social care workforce to ensure that it can offer the provision that meets the needs of our growing and ageing population? Will the Minister commit to the safe staffing of our emergency departments?
Graham Stringer (in the Chair)
Before I call the Minister, I ask that he leaves two minutes at the end for the proposer of the debate to wind up. I call Edward Argar.
The Minister for Health (Edward Argar)
I am happy to do so, Mr Stringer.
It is a pleasure to be here on the Front Bench responding to this very important debate. If I am still in this role on Sunday, I think I will be the third longest-serving Minister for Health since 1970, which says something about either longevity or churn in this role. It is a genuine pleasure to respond to the hon. Member for Bath (Wera Hobhouse), and I congratulate her on securing this debate.
As hon. Members across the House have acknowledged, the NHS has faced extraordinary pressures over the course of the pandemic and continues to face them. Although I suspect that not everything I say will meet with agreement from Members from both sides of the House, I join them in expressing our gratitude to all those who work not just in our NHS and health services but in social care.
I will start with a couple of words of caution about the use of history and statistics. Hon. Members made a number of points. I have been doing this job for almost three years, and I have often found that assertions are made with statistics or other facts from the history of the NHS, and I want to provide a counter-narrative to three or four before turning to the specifics of the hon. Lady’s debate.
First, I urge a little caution from Opposition Members when raising bed closures, not least because between 1997 and 2007, about 32,000 beds in the NHS were closed, which is more than double the number that were closed between 2010 and now. I say that simply to caution hon. Members that statistics can be used in different ways. There has been a long-term trend under Governments of both parties as the nature of care has changed.
Edward Argar
I just want to make a few more points, and then of course I will give way to the shadow Minister. She and I spent many happy hours in the Health and Care Bill Committee over many days.
On engagement with the private sector, again I would urge a little caution. It was of course the Labour Government in 2004 who first introduced the private sector into the provision of frontline clinical services with the out-of-hours contract. A Nuffield Trust blog in 2019 highlighted the fact that the increase in the use of the private sector in the NHS began before 2010 under that Government. I do not think the hon. Member for Jarrow (Kate Osborne) was asserting anything other than that, but it is important that I put that on the record.
Of course resources are hugely important. One of the first pieces of legislation that we introduced following the 2019 general election was the NHS Funding Act 2020, which will increase funding by £33.9 billion—a record amount—by 2023-24. As the hon. Member for Weaver Vale (Mike Amesbury) would expect me to say, we introduced the health and care levy to bring more funding into our NHS and social care. It was disappointing that Opposition Members voted against additional funding for the NHS when that was put to a vote.
Karin Smyth
The Minister talks about the bed reduction, but that was in the context of massively increasing primary and community care, and the private sector capacity was brought in to reverse the horrendous waiting lists following 18 years of Conservative government. We decided to govern. The point that hon. Members are making is: why does the Minister not govern?
Edward Argar
That is exactly what we are doing: we are leading and putting forward measures. Disappointingly, Labour voted against that extra funding.
Edward Argar
I just want to finish this point, but I will give way to the hon. Lady because it is her debate.
My hon. Friend the Member for Broadland (Jerome Mayhew) and others are right in their analysis that this is about patient flows. It is about a whole-system approach and the challenges across the system. My hon. Friend asked what the solution is to making the join-up work better. A key element of the solution is the new integrated care boards and integrated care systems, which genuinely seek to bridge the gap between two parts of the system, to which the hon. Member for Bath—health and social care. They both have, for want of a better way of putting it, different DNA. The NHS, since the legislation in 1946 and its implementation in 1948, has been essentially a vertical system, whereas we have retained local care by local councils on a social care level. This is an attempt to integrate them far more effectively.
Wera Hobhouse
It is not very helpful that we are entering into a party political ding-dong. There is a crisis, and we owe it to our constituents to face it. We are asking the Government, who are in charge, to do something about it.
Edward Argar
I am grateful to the hon. Lady, but when hon. Members raise party political points, it is incumbent on me as Minister to respond and to put the facts on the record. I will turn to the specific points she has raised. I will also turn, in that context, to the various points that she and the hon. Member for North Shropshire (Helen Morgan) made about various tangible suggestions from the Liberals on the issue.
The hon. Member for Bath is right to have secured and introduced the debate, because this issue is one of growing concern, understandably, and not just for all our constituents but for those who work on the frontline of our NHS. I think it was the hon. Member for Weaver Vale who highlighted the challenges faced by those staff, who want to be there and want to help. When someone rings for an ambulance, it is not a case of making an appointment with their GP; they are deeply concerned for their health, or the health of someone else, in an emergency. All those staff want to do—I have met many of them—is be there for those people, and the hon. Gentleman was right to highlight that issue.
As the hon. Member for Bath will be aware, the pandemic has caused significant strain across the NHS and the social care sector, and emergency care performance, as hon. Members have been open in acknowledging, is recognised as a whole-system issue. The challenges in performance can be traced along the entire patient pathway. Indeed, as I think the hon. Lady acknowledged in her Adjournment debate in the main Chamber on 31 March, although there are elements of that that we need to look at, we also need to look at the issue as a whole. She was right to say that.
For example, as hon. Members have said, the problems and delays in discharging patients home or to community services once they have recovered have a genuine impact on hospital bed occupancy—taking up beds that could otherwise be used by patients who need them. I want to give my hon. Friend the Member for Broadland a slightly more optimistic picture, which is in no way to diminish the challenge that remains. The number of beds taken up by people who are clinically fit to be discharged is not 20,000; it hovers at around 10,000. We have set up a national discharge taskforce, which is working actively with trusts and across local systems, particularly those that are most challenged, to support that discharge work. The situation is not as acute as he suggested, but it remains challenging because every one of those beds could be used to admit patients from an urgent and emergency care setting, or indeed to tackle elective backlogs and waiting lists.
Edward Argar
I would like to make a little progress before giving way again. I am conscious that I need to leave enough time for the hon. Member for Bath to respond.
That affects how quickly patients can be admitted from A&E, and such delays increase waiting times, as has been said, and lead to that crowding in departments, which has an impact on how quickly new patients arriving in A&E can be seen and treated, including those arriving by ambulance. When this causes ambulance queues to form, the local ambulance resource available to be dispatched to incoming 999 calls is reduced. It is fair to say that although the ambulance queues and delays are often the most visible manifestation of challenge, they are in many ways a symptom of that broader patient flow and the systemic challenge we face.
The root cause of these issues is hospital bed occupancy. That has consistently remained nationally at around 93%—a level usually seen only during winter pressures, as hon. Members have said. The pandemic has played a significant part in driving those pressures, and there are nearly 9,500 in-patients either with covid or for covid in clinical settings, as of 1 July. That is about 10% of all general and acute beds in the NHS.
Edward Argar
I will give way to the hon. Lady, but I want to make a little progress. There are points I want to make before I run out of time, but then I will give way.
That number, as we know, has frequently been higher during the pandemic, and there is the challenge of staff absences during waves.
Margaret Greenwood
The Minister will be aware that I have expressed extreme concern and tabled written questions about what happens to those people who are discharged under what was known as discharge to assess and their clinical outcomes. Will he commit to carrying out a review of the patient outcomes of all the patients discharged in that way, to see how many were readmitted to hospital within 30 days of discharge?
Edward Argar
I will not commit myself to what the hon. Lady specifically asks for because of the challenge of data collection, but I will say that I see where she is coming from and appreciate the underlying point, which is about understanding the impact of the policy. It has been in use since 2020 as a pandemic measure and is now in statute. The NHS will be monitoring it carefully. We do not agree on everything, but I am always happy to talk to her about these matters because she takes a close interest in them.
With regard to local actions in the patch covered by the hon. Member for Bath, as an illustration of the sorts of measures being put in place across the country, the local integrated care system is working to improve patient flow and reduce handover delays at acute trusts, including the Royal United Hospital in Bath. I join her in paying tribute to the work that her local team there are doing. That hospital is working well with community partners to help patients to return home as soon as they are well. That includes work with the hon. Lady’s local council to develop its domiciliary care provider, which will provide an additional 1,000 hours of domiciliary care a week. A £2 million investment will also be made in the Home First programme, whereby experts from across health and care help patients to get safely back home as soon as possible. The system is also working on opening an additional 20 beds at St Martin’s Community Hospital, while also developing same-day emergency care for frailty to avoid unnecessary admissions to hospital and to care for patients safely in the community.
There is of course nationally a wide range of support in place to improve urgent and emergency care more widely. That includes growing the number of call handlers for 999 and 111, and the investment that we have seen going into our ambulance services and A&Es. It is the case that £450 million of capital investment has already gone into increasing capacity in urgent and emergency care departments. In addition, we have kept, I think, over 155 more ambulances on the road over winter with our investment of £55 million more going into ambulance services. We are investing those resources in the frontline. If I recall my statistics correctly, there has been a 38% increase in the paramedic and ambulance workforce since 2010. The hon. Lady and her party can rightly claim a degree of credit for that, because a degree of that took place between 2010 and 2015. We do continue to grow the workforce.
Turning to workforce issues more broadly, it is absolutely right that, as well as providing the support to which the hon. Member for York Central (Rachael Maskell) alluded—mental health and physical support for the workforce—we continue to grow the workforce in order to ease the workload pressures. We have already witnessed over 30,000 more nurses in the NHS since that pledge was made in 2019. We continue to grow all workforces. In section 41 of the Health and Care Act 2022 we set out a very clear duty on the Secretary of State in relation to workforce planning, and that work is already under way.
I will turn to a couple of further points very briefly, because I want to give the hon. Member for Bath her two minutes at the end. She raised a number of specific points. She called for greater resources to be put in. That has been done. She called for an increase to be made in paramedics and ambulance staff. That has been and continues to be done. None of these are completed works, but they continue to be done. She called for action to stop ambulance station closures or community ambulance station closures. I have to say that those decisions are made clinically by local trusts; the power was not there for the Secretary of State to intervene. In fact, it was the Labour party that argued against giving the Secretary of State and Ministers the power to take action on those things when it voted against and spoke against that measure during the passage of the Health and Care Bill. It is right that clinicians determine what is the best set-up for clinical services in their area. I just gently make that point.
In summary, I think that both sides of the House recognise fully the challenges faced in these unprecedented times by our urgent and emergency care sector, and particularly by patients and those who work in the sector. We have a plan to fix it. We continue to invest in that plan and to support our workforce, and we will continue to do that for the benefit of patients.
Wera Hobhouse
I thank everybody who have taken part in today’s debate to highlight the deep crisis over ambulance and emergency care services. We owe it to all our constituents to ensure that the crisis is fixed, because it can be a matter of life and death. Last but not least, I want to thank the incredibly hard-working doctors, nurses, paramedics, ambulance drivers, reception staff and call handlers who work in our emergency care and ambulance services. They are doing an impossibly difficult job at a very difficult time. We cannot ignore the workforce crisis, and the stress and impact on the lives of the current workforce. We owe them our support here, and I want to assure all of them that all of us here will not go away until we see real progress and real improvement.
Question put and agreed to.
Resolved,
That this House has considered waiting times for ambulances and emergency department care.
Energy-intensive Industries
(1 year, 9 months ago)
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Judith Cummins (Bradford South) (Lab)
I beg to move,
That this House has considered support for energy intensive industries.
It is a pleasure to serve under your chairmanship, Mr Stringer. I am grateful that we have the opportunity to address the mounting problems currently facing energy-intensive industries. Over the past few months there has been increasing concern—turning to panic—about the energy crisis and the huge rises in gas and electricity bills. Households and families are struggling, as are many of our businesses.
As we all do in this place, I spend a significant amount of time in conversation with businesses and workers in my constituency and across the country, hearing about their concerns, anxieties and plans for the next few months and years. Those industries are the lifeblood of our economy, and those workers are the beating heart of this country’s wealth, growth, production and potential. Energy-intensive industries, such as steel, food manufacturing, chemicals and building materials, are fundamental to our economy. Those industries tell me, time and again, about rising energy prices. I am aware of case after case of businesses, having survived a very difficult few years during the pandemic, being brought to their knees by eyewatering energy prices.
Ms Marie Rimmer (St Helens South and Whiston) (Lab)
I thank my hon. Friend for securing the debate. Once energy-intensive industries are gone, it is very hard to get them back. Does she agree that the Government need to support our energy-intensive businesses, as other countries are doing, before it is too late?
Judith Cummins
I absolutely agree; these industries are fundamental to the future of our economy. The Minister can imagine my dismay when I raised one of the cases from my constituency with the Minister for Energy, Clean Growth and Climate Change, the right hon. Member for Chelsea and Fulham (Greg Hands), at Business, Energy and Industrial Strategy questions on 7 June, and I was told that my example was just an “extreme” case. Therefore, presumably, it was not worth his time addressing. The case in question is an energy-intensive business in my constituency, whose energy bills have risen from £7 million to £35 million. However, that is not an extreme case. In fact, industry after industry have been warning for months about the impending problems, and raising the alarm on the dire situation they now find themselves in.
Mike Amesbury (Weaver Vale) (Lab)
One such industry is in my constituency, Tata Chemicals Europe. The managing director has fed back to me exactly your concerns; it is a real live issue across the country.
Judith Cummins
My hon. Friend is absolutely right that it is a national problem and needs a response from the UK Government. Almost all industries are feeling the effects of soaring energy prices. However, for some industries, such as chemicals, steel, ceramics, cement and shipping, it is their extreme energy intensity and the singularity of their outputs that make it nearly impossible for them to react to energy price fluctuations. Those energy-intensive industries face a unique set of challenges that need to be addressed directly by the Government or they will face significant job cuts, lost investment and, ultimately, factories closing. There are good jobs at risk here.
If that seems too extreme for the Minister, he should know that Make UK, which represents Britain’s manufacturing industry, has made it clear that more than two thirds of companies claim that rising energy costs are causing “catastrophic” or “major” disruption to their businesses. Make UK has said that eyewatering energy costs have become “a matter of survival” and has called on Ministers to do “whatever it takes” to support businesses and protect jobs. Without that, they face pushing these essential industries closer to breaking point.
The UK’s glass industry also faces an increasingly challenging position. With energy prices tripling and gas bills quadrupling, the glass industry has repeatedly asked the Government to recognise the unbearable pressure these prices have placed on an industry that is so vital to the UK. It needs support—any support—because price hikes are putting UK glass manufacturers at a competitive disadvantage, risking undoing the hard work on decarbonisation, quashing inward investment and, ultimately, passing on a rise in prices to consumers at a time when we all know that inflation is already ballooning out of control.
While the Government continue to bury their head in the sand, it is working people who will pay the price and suffer. British Glass states that
“without firm action to address the industrial energy crisis, we risk…loss of employment across the north of England.”
I say to the Minister, this is not levelling up; this is the Government playing fast and loose with other people’s jobs.
The Government’s own figures, laid out in the latest energy price comparisons, reveal that industrial electricity prices in the UK are significantly higher compared with the rest of Europe, and indeed the world, with extra-large consumers facing prices 40% above the median of the EU14. It is worth noting that under the coalition Government, BEIS used to publish annual energy prices and bill impact reports, but that has been stopped. Minister, will you outline when those reports will be reinstated?
The energy White Paper in 2020 called for
“a strategic dialogue between government, consumers and industry on affordability and fairness”,
but that has not happened yet. Will the Minister update me on any progress in those conversations?
The petrochemical group INEOS has also warned that British manufacturing is now under serious threat from competing regions, such as the US, because of high energy costs. It cites our producers facing gas prices seven times higher than the levels paid by US competitors. To put the size of the problem into perspective, INOVYN, a chlorine manufacturer operating in Runcorn, on the banks of the Mersey, uses as much electricity as the nearby city of Liverpool.
However, the problem is not new. Last year, UK Steel published its report into the huge structural barriers it faces because of out-of-control energy prices.
Dr Dan Poulter (Central Suffolk and North Ipswich) (Con)
The hon. Lady is making some very good points and I congratulate her on securing the debate. She is right to highlight the challenges faced by manufacturing business. Does she recognise, as I do, that rural businesses, including smaller rural businesses, are often reliant on oil for their heating? They face a quadrupling, or worse, in the cost of the oil to heat the buildings in which they operate and their staff work. Will she join me in asking the Minister to look not just at oil for heating homes, but specifically at the oil that businesses in rural areas depend on to heat offices, and to come up with a solution to support those businesses?
Judith Cummins
I absolutely agree with the hon. Member about the importance of all businesses needing support at this perilous time.
Last year, the Government declared that they were
“firmly committed to ensuring the UK continues to be one of the best locations in the world”
for car manufacturing. Fast forward to June 2022 and the Society of Motor Manufacturers and Traders has seen its energy prices surge by 50% in a single year and is facing a £90 million hike or the equivalent of 2,500 jobs.
Nissan has contacted me to make clear that the viability of its £1 billion investment in British projects is on the line because its energy costs have risen almost 150% beyond expectations. I remind the Minister that the car industry delivers £5.7 billion into the economy every year. This vital sector, which contains multiple industries—some of which the Government have deemed energy intensive, and some of which they will not—cannot and should not be left to falter. Some 22,000 jobs are on the line, when it comes to our transition to battery-powered cars, and with manufacturers currently making decisions about where to invest, the Government are demonstrating that they cannot be trusted to make energy-conscious decisions for energy-intensive businesses.
Energy security is equally essential for energy-intensive industries. While British businesses are paying through the nose for gas, electricity and oil, the Government cannot even guarantee that the lights will be kept on this winter. The Government describe such suggestions as alarmist, but it is their own modelling that suggests that, due to shortages, 6 million homes could face power cuts this winter, and heavy industrial users of gas—including gas-fired power stations, which are essential to our electricity production—could be told to stop production. The Government have failed time and again to get this right. Quite frankly, it is shocking and completely unacceptable that they have mismanaged the situation to such an extent that their own modelling cannot guarantee a consistent energy supply for industries this winter.
This was all foreseeable and foreseen. In September 2021, I raised the flag that the Government’s decision to disinvest from gas storage was a mistake, but the Government chose not to listen. The Business Secretary told me that we are less reliant on storage than our European neighbours, and we could simply rely on our diversified energy portfolio, including 30% of our natural gas coming direct from Norway. Well, that comment has not aged well. Yesterday, the Financial Times revealed that Norway’s state-owned pipeline could stop totally, with shut-off as soon as this weekend—a crisis only narrowly averted by the Norwegian Government’s intervention late last night. This all highlights the complete instability of our energy supply and the energy situation. During the biggest energy price crisis in living memory, the UK has more gas than we know what to do with, but we cannot store it in readiness for a difficult and harsh winter, leaving us in the maddening crisis of wasted gas resources and extortionate energy bills.
Months after dismissing my concerns and those of energy-intensive industry leaders and trade unions, the Government are left scrambling to find an emergency solution to secure extra energy supplies ahead of this winter. Centrica has announced that it is in exploratory discussions with the UK Government about reopening Rough, which closed in 2017 and was Britain’s largest gas storage facility. Will the Minister outline exactly what the plan is for gas storage in the UK? Will he address Rough, in particular, and timescales, so that we can be reassured of getting through the harsh winter?
Against the backdrop of high energy bills, strategically important energy-intensive industries need proper support to protect our economy and workers’ jobs and to keep our country’s energy supply secure. Baker and Baker, a leading European manufacturer of bakery products, headquartered in the UK and with hundreds of employees in my constituency, is a high energy-intensive industry, which has invested widely in state-of-the-art equipment to stay competitive. Its energy costs have increased by almost 200% in a single year, which has a significant impact on its business and a knock-on effect of increasing the prices that customers pay for products at all our major supermarkets.
The Government’s energy-intensive industries compensation scheme, which was extended at the end of April, was a welcome step to alleviate some of the electricity costs that those industries face, but they must do more. The scale of the challenge demands Government intervention to support the industries. Both the Chemical Industries Association and the Society of Motor Manufacturers and Traders have cautioned the Government that the prolonged energy costs that they face could see factories reducing operations and foreign firms taking their business elsewhere.
The Government must act now to support these businesses and protect British jobs and British production. The longer this goes on, the higher the risk to those industries and our economy, but also to our national security. Businesses face a 500% increase in wholesale gas prices, which is completely in line with the fivefold increase to energy prices in my constituency. UK Glass faces a quadrupling of energy costs through gas prices. Car manufactures face a £90 million spike, or worse, with Nissan facing a 150% increase. UK energy prices are 40% higher than those of competitors when it comes to extra-large consumers. These examples are not extreme; they are the reality for British businesses.
Will the Government introduce a proper pack of measures to support energy-intensive industries? Can the Minister outline what those measures would be and when they will be available? We need to ensure that there is a level playing field for British businesses and industries to survive, let alone compete. Finally, can the Minister guarantee that no energy-intensive business will be left in the dark because of energy supply issues this winter or allowed to fail because of the astronomical energy costs? That would be a disaster.
Minister, to put it simply: the Government need a plan. What is it and where is it?
The Parliamentary Under-Secretary of State for Business, Energy and Industrial Strategy (Lee Rowley)
It is a pleasure to serve under your chairmanship, Mr Stringer. I am grateful to the hon. Member for Bradford South (Judith Cummins) for calling this debate today. It is an important issue and it is right that we debate it in the detail and depth it deserves. I recognise how important this issue is in many parts of the country, both from the perspective of my constituency and from being a Minister for the past 10 months. I know that there are hon. Members, both present and not in attendance, who have a very extensive interest in this and are very concerned about the challenges— which we hope are temporary—that the industry faces. We recognise those challenges.
First, lest it be suggested otherwise—I am sure that is not the intention of the hon. Lady—I want to say that energy-intensive industries are important to the United Kingdom and important to the UK Government. They are important because they provide resilience within our supply chains over the long term; are representative of British manufacturing and the fantastic things it does; and provide a historic link to our past and our proud energy and manufacturing background.
That importance is why I have spent much of my time as a Minister over the past 10 months talking to our energy-intensive industries. I speak almost weekly with at least one representative—sometimes more—from the energy-intensive industries. I have been on regular visits, including to glass factories in the north-west, paper mills in the east midlands, steel factories in Wales—the UK Steel representatives in the Public Gallery are very welcome—and chemical factories in Teesside. Over the past 10 months, I hope that I, as Minister, have demonstrated to the industries that I am interested in hearing their views—views that the hon. Member for Bradford South has articulated—and in engaging in open dialogue.
We want to understand the industries’ concerns and issues and to work through them in a careful, calmed and reasonable process—in the way that public policy should be created—to work out what is reasonable and proportionate. We discussed the issues on Monday in one of our regular UK steel discussions with unions and companies representing the industry. At those meetings, we come together and have exactly the kind of strategic dialogue that the hon. Member for Bradford South was talking about. The Government will continue to do that in the coming months. I want to make very clear that energy-intensive industries are important in terms of what has been done, and we need to ensure that they are listened to and heard on an ongoing basis.
I want to be clear that there is a challenge. When I speak to colleagues, including my hon. Friends the Members for Scunthorpe (Holly Mumby-Croft) and for Stoke-on-Trent South (Jack Brereton), and Opposition Members who feel just as strongly, I know how important it is that we acknowledge that there are difficulties. There are global difficulties because of unprecedented circumstances—we all accept that—which we did not anticipate. It is very difficult to anticipate the first invasion of a sovereign country on European soil for 70 years, which is what Putin did. It is difficult to anticipate the price spikes and the volatility in the market that comes from that. That is not something that can be easily managed away, but none the less it has caused issues for a number of energy-intensive industries as well as the wider sector. The Government are working through how they can support that.
We recognise that this follows a number of years where energy-intensive industries have been clear that while the Government have brought forward support, undertaken dialogue and are doing what they can, there is a price differential compared with Europe, and we understand that. That is one reason why we brought forward the British energy security strategy in April. It includes many elements, addresses the long-term approach to energy and indicates our continuing support for industry.
Jack Brereton (Stoke-on-Trent South) (Con)
The ceramics industry in Stoke-on-Trent has been incredibly successful since the Conservatives came to power. We have virtually doubled gross value added. However, we now face serious challenges, particularly because of energy costs. Most or all of the ceramics industry has not been eligible for Government support because most of the industry is too small and many of the NACE codes do not qualify. Does my hon. Friend agree that there must be a level playing field and we must address this issue to ensure that support in place for the ceramics industry?
Lee Rowley
My hon. Friend is an absolute champion of the ceramics industry, and I know how important it is for his constituency. As he indicates, it has been a real success story for our country, and we want to ensure that it continues to be a success story. His advocacy in this place is absolutely the way to ensure that that happens. We accept that there is a challenge—there is no question of that. Over recent months, the Government have acknowledged that challenge in papers such as the British energy security strategy, which is important and has been welcomed by a number of industries as part of our ongoing dialogue, and have started doing things to address it.
I am glad the hon. Member for Bradford South has acknowledged and welcomed the compensation scheme. It is not something to quickly pass over; it is a substantial increase in money—if that is the yardstick we are using. It is substantial confirmation that we are serious about supporting our energy-intensive industries. From the extensive conversations I have had with colleagues in this place and with the industries themselves, the changes coming from that have been welcomed. When people say, “The Government need to do something”, the Government have done something.
The energy security strategy is clear that there will be a further consultation on a further element of what we are seeking to do, and I expect that to begin shortly. We are considering using that strategic dialogue, which the hon. Lady indicated is important, about what else is reasonable and proportionate to do over a longer period of time. None of these issues is straightforward or has a simple solution; otherwise, this Government or previous ones, including the Labour Government pre-2010, would have done it. It is a difficult and challenging problem and we need to do something about it, as the Government have done, and look at what can be done in the future.
I will address a few of the hon. Lady’s points. Unless we contextualise this conversation and conduct it in a reasonable manner, it will go off in all sorts of directions that are ultimately unhelpful. I understand that ultimately it is for other people to choose their words, focuses and emphases, but there has been progress on this agenda in recent months and that should be acknowledged. It is recognised that the Government are absolutely serious about supporting these industries.
Judith Cummins
I take that as some kind of criticism of my words, many of which were given to me to represent British industrial businesses. We have heard so much from the Minister about the difficulty, accepting that there is a challenge and listening, but he needs to act because British businesses and energy-intensive businesses are suffering and crying out for more help.
Lee Rowley
Those are exactly the kinds of statements that I think, with the greatest of respect, are not entirely helpful. The Government have acted, and it should be acknowledged that we have done so. Hundreds of millions of pounds have been brought forward in recent weeks, which should be acknowledged as a significant step forward. As I have already said during the past 10 minutes, we accept there is a challenge, and we are going to do more. We have already committed to bringing forward at least one additional consultation—
Lee Rowley
I am happy for the hon. Member for Bradford South to take some of my time. What exactly should we do?
Judith Cummins
I am happy to take up some of the Minister’s time. Shall I repeat the eight questions that I asked in my speech that he has not—[Interruption.]
Graham Stringer (in the Chair)
Order. Interventions should be brief and to the point. It is not a dialogue.
Judith Cummins
I am happy to send the Minister a copy of the eight questions I asked him in my speech. He is yet to address a single one of them.
Lee Rowley
The challenge with this debate is that we all accept there is a problem, and we all accept that there is a wider context of global issues—some of which are beyond our control—but ultimately, the hon. Lady needs to propose as well as oppose. If she has a proposition, I would be very happy to hear it, as would the Government, but I did not hear a proposition in the 20 minutes that she spoke for.
“Do more” needs to be followed by another sentence that says precisely what to do, because when you talk to energy-intensive industries—I am not suggesting that the hon. Lady does not—and have detailed dialogue with them, you realise that there is a significant amount of nuance underlying this discussion. As my hon. Friend the Member for Stoke-on-Trent South has outlined, you have some energy-intensive industries that are very heavily based on gas. You have other energy-intensive industries that are very heavily based on electricity, as my hon. Friend the Member for Central Suffolk and North Ipswich (Dr Poulter) has indicated. Other businesses that are not energy-intensive industries are also reliant on some unusual ways of procuring and using energy, and if we do not recognise that nuance in any solutions that we propose, ultimately—
Graham Stringer (in the Chair)
Order. I have let it go so far, but I do not have views on these things when I am in the Chair. The hon. Gentleman is not the only Member who has transgressed that rule during the debate, but can he refer to hon. Members, not “you”?
Lee Rowley
My apologies for not using the correct nomenclature, Mr Stringer.
The point I am making is that there is a variety of nuances underlying this discussion. We have energy-intensive industries that are heavily dependent on one source of fuel, and energy-intensive industries that are heavily dependent on another. We have some industries that are very heavily hedged and some that are not. We have some differences when it comes to the significance of the change in energy costs. We have some industries that are within the compensation scheme, and some that are without it. Some are in other schemes, and some have already applied for schemes that are already open, including the industrial energy transformation fund, which is another £300 million of Government funding—of taxpayer subsidy—to help the sector.
The point I am making to the hon. Member for Bradford South is not that there is not a challenge—I have repeatedly indicated that there is. It is not that we do not value energy-intensive industries, nor that I do not want to listen, and I accept that she is acting completely in good faith in trying to record and highlight the challenges that energy-intensive industries in her constituency face. However, the question is exactly what we do about it, and that strategic dialogue is under way at the moment.
Mike Amesbury
CF Fertilisers, which employs many people from my constituency of Weaver Vale, is located in the constituency of my hon. Friend the Member for Ellesmere Port and Neston (Justin Madders) and also has many employees there. Over 300 of those people now face losing their jobs. I know there have been discussions with a consortium that has come forward and some reference to a bridging loan, but that would require some intervention, hopefully from the Government, with a potential purchase. It may be beyond the scope of today’s discussion, but I would be interested to know how that is progressing.
Lee Rowley
I thank the hon. Gentleman for his intervention. I know that this matter is important to employees at the Ince factory, just as it is important to those at the Billingham factory. I have 50 seconds left of my speech, so I am afraid I cannot address that issue directly, but the hon. Gentleman has absolutely made his point and has been clear about the implications for that locality.
In the few moments I have to sum up, the key point I want to make is not that the Government do not agree there is a challenge, or that we do not think energy-intensive industries are valuable to the United Kingdom—they absolutely are. The point I am trying to highlight is that we are talking to those industries in a careful, calm and methodical manner, working out all the nuances and differences that underlie this issue, and seeking to determine how, over time, we can bring forward solutions that work for the long term. However, we must also recognise that £2 billion in support has been provided since 2013, and that we have done much in recent weeks, too.
Motion lapsed (Standing Order No. 10(6)).
Home Energy Efficiency: North of England
(1 year, 9 months ago)
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Mr Laurence Robertson (in the Chair)
It feels somewhat hot in here to me. If hon. Members wish to remove their jackets, that is perfectly in order.
Peter Gibson (Darlington) (Con)
I beg to move,
That this House has considered energy efficiency of homes in the north of England.
It is a pleasure to serve under your chairmanship, Mr Robertson. I am delighted to bring this debate to Westminster Hall. At the outset, I declare my interest as a vice-chair of the all-party parliamentary group on housing and planning and of the all-party parliamentary group for housing market and housing delivery. I also place on the record my thanks to North Star Housing, the Conservative Environment Network, the Northern Housing Consortium and the National Housing Federation for their insightful and helpful engagement with me on this important issue in preparation for today’s debate.
Twenty-six per cent. of the north’s carbon emissions come from our homes—26%. If we are to tackle climate change and meet net zero, we have to do something about that 26%, in addition to all the other things that we are doing. Despite all the house building going on around the country, the UK’s housing stock is generally older than that across the rest of Europe. And in the north, we have a higher percentage of older properties than the rest of the country: 24% of all homes in the north were built before 1919, and 41% were built before 1944. These older homes are largely beautiful, characterful properties that provide us with the backdrop to much of our northern constituencies, but they pose serious issues when it comes to energy efficiency. Solid walls prevent the use of cavity insulation, and planning constraints require buildings to retain their character, making exterior work harder. That is alongside many other issues. Our Victorian terraces have proved particularly difficult to treat. However, we must find solutions to ensure that these homes are fit for the future. Future generations will thank us for our foresight in preserving these homes and doing our bit to save the planet.
The poor energy efficiency of homes in the north only serves to make our higher rates of fuel poverty even worse, compounding the problem. In my region, the north-east, we have the third highest levels of fuel poverty in England. Even before the price cap increased, 14% of households in Darlington and 15% in County Durham were classed as fuel-poor. Decarbonising homes and making them more energy efficient has the potential to offer part of the long-term solution to fuel poverty. Insulating homes better and reducing the reliance on fossil fuels to heat homes means less money spent on wasted energy, less money spent. It is a win-win for our homes, their residents and the environment.
Tulip Siddiq (Hampstead and Kilburn) (Lab)
I recognise the argument that the hon. Member is making about the north of England. I hope he will not mind my saying that my constituents in the north of London face similar problems and issues of fuel poverty. I am sure that all MPs here would say that emails on those issues are clogging our inbox. People up and down the country have been left uniquely exposed to the global gas crisis, because of the slashing of gas storage, the failure to regulate the market properly and the failure to invest in nuclear and renewables. Does the hon. Member think that we need a radically new approach to energy efficiency from the Government, and does he agree that they should seek to match Labour’s pledge to insulate 19 million homes over the next decade?
Peter Gibson
I thank the hon. Member for her intervention. If she is referring to homes in her constituency, I can well understand and imagine that they have the same issues as homes in the north of England. My objective in calling this debate was to have a constructive and non-partisan debate in order to raise the important issues that are relevant to my constituents and to concentrate on what the Government can do on top of what they are already doing. I am sure my right hon. Friend the Minister will do in his summing-up.
Energy efficiency also presents an opportunity to improve health outcomes in the north. Each winter, there are around 30,000 more deaths due to inadequate heating in homes. Retrofitting homes has the potential to seriously improve the health outcomes of those who currently live in poor housing. Health and wellbeing rightly have a prominent place in our levelling-up missions, and I want to impress on the Minister the real need to look closely at the benefits of retrofitting northern homes for that purpose. It is not cheap, but we all know that if you buy cheap, you buy twice.
Now, Darlington is a beautiful town, rich in heritage and filled with many traditional homes. We are, of course, the birthplace of the railways, and it is indeed the railway heritage and engineering industry that caused the expansion of our town. In Darlington, 65% of energy performance certificate ratings given to our homes are band D or below. That piles the extra cost of wasted energy on to the residents of those homes—at current energy prices. Merely upgrading homes from EPC band D to band C would cut heating demand by 20% for millions of households and would represent an estimated £2.9 billion bill saving per year in the north-east region.
However, with 62% of homes—around 4 million—in the north below EPC band C, that is a huge challenge. Currently, many stakeholders feel it is simply not financially viable to achieve. I want the Minister to know that I do not underestimate the scale of the challenge. The complexities of private ownership, private renting, and social housing in the mix make it a difficult puzzle to solve.
Paul Blomfield (Sheffield Central) (Lab)
In the spirit in which the hon. Member framed his earlier comments, I agree with everything he has said so far. He is right both to highlight the significance of domestic carbon emissions and to link it to fuel poverty. He may be interested to know that, in Sheffield, pretty much in line with the figures he has given, 60% of homes fail the EPC band C standard. The figure across Yorkshire and the Humber as a whole is worse, at 65%.
The hon. Member talked about a win-win. Does he agree that it would be a win-win-win-win-win if we did more on retro-insulation, because it cuts carbon emissions and fuel bills, tackles health issues, reduces our reliance on gas imports and creates jobs? Does he therefore share my desire for the Government to have greater ambition on retro-insulation?
Peter Gibson
It is as though the hon. Member has read a paragraph later in my speech. It would, indeed, be a win-win if we tackle this issue. Can we afford to not tackle the issue? Can we afford to not reap those health benefits, the energy cost savings, the wasted energy usage savings, and the preservation of our built environment?
I must acknowledge the work that the Government have done so far to tackle this issue. The heat and buildings strategy was published in October 2021, setting out the Government’s planned approach to reducing emissions from heating buildings. The social housing decarbonisation fund has awarded £179 million to 69 projects.
Scott Benton (Blackpool South) (Con)
My hon. Friend is articulating well the need for further measures to improve our housing stock. I am sure he will agree that now is an opportune moment to move ahead with this, given the pressure on household budgets. Blackpool received £1.4 million from the social housing decarbon-isation fund, and I am sure his constituency has benefited, too. Will he welcome those grants already given and support the need for further action to drive down those household bills?
Peter Gibson
Being familiar with my hon. Friend’s constituency, I well understand the situation and issues that his constituents face, as they are similar to those in my own. I was about to say that the Tees Valley Combined Authority has secured £2.6million from the social housing decarbonisation fund, from which homes in Darlington will benefit. I am grateful for that, and I welcome the contribution that my hon. Friend has secured for his constituency.
The local authority delivery scheme is also helping to improve energy efficiency: it is expected to save households across the country more than £2 million on energy bills every year. It is welcome that nearly 40% of the households that have been upgraded under the scheme are in the north. I also welcome the decision of the former Chancellor, my right hon. Friend the Member for Richmond (Yorks) (Rishi Sunak), to cut VAT on home upgrades in the spring statement, encouraging people to invest in wall and loft insulation. I know that the Minister will agree that we must continue this good work, and I ask what the Government can do to roll out the schemes more widely.
Although progress is under way on decarbonisation and retrofitting, we still have a long way to go, but I want to focus on the need to tackle the huge cost currently associated with making our homes more energy efficient. We cannot achieve decarbonisation while it remains financially unviable for homeowners, private landlords and housing associations to pay for the work. We also need to ensure that we bring communities with us as we embark on this challenge. Recent research by Onward found that people think that the invasion of Ukraine means we should be moving more quickly on net zero, but retrofitting a home is intrusive work, and many people do not see it as a priority for them. We need to be clear what the benefit of this work is to our communities, and the connection between home heating and reaching net zero must be emphasised. How can the Government make it clear to communities how they stand to benefit from more energy efficient homes? That is a challenge that I hope the Minister can respond to.
As part of my preparation for the debate, I have been in contact with Angela Lockwood and Emma Speight at North Star Housing to discuss the difficulties faced by housing associations when it comes to decarbonisation and retrofitting their properties. In short, they are fully supportive of moves to decarbonise homes, but the costs involved are prohibitive. To illustrate this, they made me aware of a pilot decarbonisation project that they are carrying out on a two-bedroom, late-Victorian terraced house in Middlesbrough that they are aiming to get to EPC level A, so that they can then monitor the performance of the building.
I have the figures in front of me. North Star Housing calculates that the cost of decarbonisation work will be £45,500, with £12,000 going on solid wall insulation alone. While the work is being carried out, the property must sit empty for around 20 weeks, resulting in a void period and a loss of rental income. Given that other houses on the same street are valued at around £70,000, North Star Housing is looking at spending well over half of the value of a property in order to decarbonise it. It is simply not viable for housing associations to be spending that much to decarbonise their stock without targeted support and assistance.
Equally, private owners of those properties will face similar costs. However, although the up-front costs may be high, investing in the region’s homes now is, as the hon. Member for Sheffield Central (Paul Blomfield) said, a win-win scenario for northern communities, because it will lead to warmer, healthier homes. Upgrading a home from EPC E to EPC C would reduce bills by an average of £595 a year, whereas upgrading from EPC F to EPC G would reduce bills by £1,339 a year. These are not short-term cuts to energy bills, but permanent reductions in household energy consumption, meaning that more of people’s money will be spent in our local economy.
The Government have seen that their retrofitting schemes can and do work. Data from the Department for Business, Energy and Industrial Strategy shows that the total estimated annual bill saving for the 12,143 households upgraded in phase 1 of the local authority delivery scheme is £1.2 million. I therefore ask my right hon. Friend the Minister to outline what more the Government can do to ensure that we continue to deliver these schemes.
Retrofitting homes in the north will also play a huge part in delivering on our levelling-up agenda, with the north having the best chance to reap the economic benefits of our transition to a low-carbon economy compared with other regions of the UK. The large-scale retrofitting of homes in the north has the potential to deliver new skilled jobs in the green industries of the future—again, as the hon. Member for Sheffield Central said, a win-win.
The Northern Housing Consortium’s “Northern Powerhomes” report showed that a large-scale programme of social housing retrofitting could lead to the creation of 77,000 jobs in the north by 2035, 15,000 of which could be in the north-east. However, we have only around 1,200 qualified heat pump installers across the UK, so we clearly have a skills gap. I urge the Minister to do all he can to plug that skills gap and attract new entrants to the good green jobs that a focus on northern housing can deliver.
I also ask the Minister when the new energy company obligation scheme will begin. In the north, a high proportion of homes are fitted with insulation measures through ECO, and the support the scheme gives to low-income households is highly valuable. I understood that ECO4 was expected to begin in April. I would welcome any clarity the Minister can provide on the potential expansion of the scheme and when we might expect it.
We are now free of the bounds of Europe, and we can be bold, imaginative, creative and entrepreneurial. If we can lead the way in the north-east with carbon capture technology or hydrogen production, with vision our region can lead the way in innovating the retrofitting our old homes.
The north-east already has some innovative solutions. The Coal Authority in Gateshead is using mine water to generate heat for local homes and businesses. Will the Minister look closely at that project to see how it can be exploited at scale? Many gas boilers can already be made hydrogen-ready. As we transition away from fossil fuels, will the Minister look at what steps he can take to make every new boiler installed hydrogen-ready as soon as possible, rather than waiting for some date way off in the future?
Millions of homes across the country are just like those in the north, so the Government need both the carrot and the stick to drive this forward. We have no time to lose. I am proud of our built environment and want it to be preserved and protected for future generations, but I want my constituents’ homes to be warm and efficient too. There should not be a binary choice between two ambitions. There is a range of imaginative policy solutions and ideas to accelerate this process, including changes to stamp duty, incentives for home buyers to carry out these works at the beginning of their ownership, and creative financing through green mortgages, whereby the lender provides an initial sum on the original drawdown to fund the works, with the necessary conditions in place to ensure that the funds are not diverted elsewhere. We can even use the taxation system, through salary sacrifice. If it is good enough to fund car hire, the purchase of a bike or childcare, it should be good enough to provide improvements to our homes.
It is clear that improving the energy efficiency of homes in the north is a huge challenge. However, it can bring huge benefits to communities such as mine in Darlington. We can permanently bring down heating costs for millions of households, improve health outcomes for some of the most vulnerable in our society and level up communities that have been left behind by getting behind new, innovative green industries and delivering highly skilled jobs for our constituencies. I hope the Minister will give serious thought to all the points I have raised, and I look forward to hearing the rest of the contributions from across the Chamber.
Navendu Mishra (Stockport) (Lab)
It is a pleasure to serve under your chairship, Mr Robertson. I congratulate the hon. Member for Darlington (Peter Gibson) on bringing this important debate to the House. Some of us were not sure whether the Government would be able to field a Minister for this debate, but most of us are glad to see the Minister in his place. Hopefully, he will be able to address some of our queries and concerns.
The cost of living crisis is hurting every constituency represented in the House of Commons. We have to be up front about the impact of housing on the cost of living, physical health and mental health. We have a housing crisis in this country. Many people cannot afford to rent, let alone pay the large deposit that is needed to purchase a home. We need a wider debate on the housing crisis across Britain, but particularly in the constituencies represented by northern MPs.
I agree almost entirely with what the hon. Member for Darlington had to say about the measures that the Government should take, but I will also highlight the fact that recently the standing charge for gas and electricity has increased. The unit charge has gone up significantly in the past few months, but the standing charge has doubled or increased even more in some cases, so that needs to be highlighted. Energy efficiency for a home or a house has a direct impact on the amount that people pay out for the use of gas and electricity. I appreciate that the standing charge will be the standing charge, but if we made our homes more efficient and cut carbon emissions, that would help people with the cost of living crisis.
The Government always talk about the progress that they have made in improving the efficiency of homes over the last 12 years, but the reality is that schemes are often poorly thought out and badly delivered. On that note, I will highlight a case from my constituency.
A constituent contacted me regarding the cavity wall insulation scheme. In 2013, he had cavity wall insulation fitted in his house for free through a Government initiative. He says that the work should not have been carried out because his house was not suitable, but the Government were funding this scheme so, in his words, many “cowboy firms” signed up to do such work and made an enormous amount of money.
Unfortunately, my constituent has not been able to let out the house where the work was done, or use it himself, because there have been lots of problems as a result of that work. He took the firm to court and was awarded £37,000 to repair his property, but he has never received that money because the firm that did the work has ceased trading.
My constituent works full time as an electrician, working between 46 and 50 hours a week, and he is facing serious financial hardship. That is having an effect on his mental and physical health, and he is in a lot of debt. He contacted my office and he feels that the Government have let him down badly. I have highlighted that case and I will write to the Minister after the debate, and I hope that he will be able to respond with something positive for my constituent.
The second case that I will highlight is that of Ms Phoebe Spence. I visited her a few months ago. She feels that it is very troubling that the Government are not making any effort to insulate homes effectively, are lacking in a strategy and are not addressing fuel poverty. I visited her home, which is a three-bedroom former council house that was built in 1920 on the first council estate in the Borough of Stockport. She had it retrofitted with external wall insulation and she has also had an air source heat pump installed. I was lucky enough to visit her and have a cup of tea with her, and she took the time from her day to show me all the changes that she has had carried out on the property. She said that she was able to fund that work because she had received a redundancy pay-out and also some savings, but unfortunately not everyone can afford such work.
I was elected in 2019, but in the years since I have submitted several written parliamentary questions on this issue. Parliamentary question 87882 was tabled on the health inequalities that exist as a result of inadequate housing in Stockport, Greater Manchester, the north-west and England. The Minister who responded was the now infamous right hon. Member for Tamworth (Christopher Pincher), but his answer did not really address the question. I hope that the Government will listen to Members on both sides of the House and that the Minister will be able to respond with something positive for both the constituents I have mentioned. Thank you for calling me early in the debate, Mr Robertson.
Paul Howell (Sedgefield) (Con)
It is a privilege to speak in this important debate, Mr Robertson, and it is a pleasure to serve under your chairmanship.
I begin by congratulating my constituency neighbour, my hon. Friend the Member for Darlington (Peter Gibson), on securing this important debate. Although energy efficiency has always been important from an environmental standpoint, the significant increase in energy costs that the UK is experiencing has made it more relevant than ever. Cost of living pressures, and the changing economics of gas and green energy, have significantly increased the opportunities provided by energy efficiency. The cost of gas has increased dramatically, but the cost of installing a heat pump or something similar has not moved. However, the economics are changing massively, in terms of how this will play out.
Sedgefield surrounds Darlington, and it has many villages, from Hurworth to Ferryhill, and from Wheatly Hill to Piercebridge. It has a variety of different properties. Given that the constituency also covers almost 240 square miles, it has many farmhouses and outlying buildings that present energy efficiency challenges.
According to statistics from the Department for Business, Energy and Industrial Strategy produced in April, the north-east has one of the highest rates of fuel poverty in the country. Energy efficiency is one of the three factors that cause fuel poverty, according to the End Fuel Poverty coalition. Although improvements to energy efficiency in households that are struggling with energy costs will not solve the problem on their own, they are certainly a welcome step.
Durham County Council estimates that improving energy efficiency in homes in former mining villages could save households around £250 a year on bills. I think that figure was calculated before the current inflationary price increases, so it is probably much more than that now. The Government have a role to play in enabling residents to make their homes more energy efficient. Although it was not perfect, the green homes grant voucher scheme was broadly popular in providing a substantial subsidy for those who wanted to make their home more energy efficient, but could not cover the entire cost of doing so. The local authority portion of the scheme, which awarded councils funding to upgrade homes for low-income families, was particularly necessary, given how expensive such upgrades can be. For example, the tradesperson site My Builder estimates that insulation work starts at around £200 per external cavity wall. Such work on a two-storey terraced house would cost about £400, but the price increases steeply for buildings built before the 1920s, which usually have solid walls. In that case, internal wall insulation starts at £4,000, but can cost much more depending on the size of the house. Solid wall insulation is even more expensive, starting at around £7,000, and without some help, it is likely that many households in need of insulation would not be able to afford it.
To make rural homes energy efficient is a particular challenge, because they are often, or rather always, somewhat isolated and not connected to gas mains. To enable those properties to have a low-carbon heating scheme was one of the measures covered by the green homes grant. To be fair, Durham County Council took full advantage of it, using more than £5 million of Government funding to install more than 100 low-carbon heating systems in rural homes across the county. It also used to funding to install insulation in villages such as Chilton and Ferryhill. I was pleased to join Lord Callanan when he visited to inspect the properties and to see how delighted the residents were with the scheme, and how much it had improved their situation.
Another barrier to making homes energy efficient, which was mentioned by my hon. Friend the Member for Darlington, is absentee landlords. We may have a terrace of low-value houses and while it is all well and good for someone to insulate their own house and the two walls adjoining the other properties, if the house next door is empty, there will be a great deal of leakage from the heating system. That situation does not incentivise people to make their properties energy efficient. Similarly, a tenant whose landlord has refused to make their house more energy efficient has no option but to pay more for their energy.
My hon. Friend the Member for Darlington has also referred to the fact that the cost of updating a property compared with its value is a major problem in the north. In some of my villages, property can have a value as low as £40,000 or £50,000. If someone has to spend between £5,000 and £10,000 on insulation, even at a basic level that represents a substantial amount of the value of the property. Neither the individual, nor a social landlord or private landlord, will see value in trying to do that. However, it is important for that work to be done so that householders have a better economic base for paying their ongoing fuel costs. We need to make sure that we support them in that endeavour.
We have many different styles of housing in the constituency, so we need a range of insulation options. The same is true about our move to green energy. The local geography provides particular challenges and opportunities. Former mining villages, where houses are close together, are suitable for district heating systems. Geothermal heating is also a possibility in County Durham due to the former mines. Some of my colleagues recently wrote in The Times that the Durham Energy Institute at Durham University has led the way on that research for a while. Support of such solutions can make a huge difference for residents and home owners, whether they are individuals or landlords. I believe that the solutions are out there, and I would like to continue to support the variety of initiatives that help, whether that is supporting insulation, addressing empty properties or promoting the transition to options that could be greener and more cost efficient in the long term, such as a district heating system—possibly even driven by the utilisation of mine water heating. Those opportunities, once in place, can be cheap to run and environmentally efficient. I am confident that we have the solutions to the north-east’s domestic energy problems, but it is a question of ensuring that they reach the households that need them. The Government have made progress in this area. I look forward to them continuing that and taking further steps.
Mike Amesbury (Weaver Vale) (Lab)
It is a pleasure to serve under your chairmanship once again, Mr Robertson. I thank the hon. Member for Darlington (Peter Gibson) for giving us all the opportunity to be here to debate and ask questions of the Minister on this vital subject. Retrofitting homes, and ensuring that new homes are built to meet energy-efficient standards, is one of the most important things we can do to meet our net zero commitments by 2050. It was only in 2019 that Parliament declared a climate emergency. To reach net zero, we have to insulate Britain and if we do not, we will miss those targets by a mile.
The challenge we have before us is, of course, immense. The UK’s housing stock, as the hon. Member pointed out, is among the oldest in the world and the leakiest in western Europe. It is thanks to the Government’s inability to build the necessary number of houses of the right tenure and in the right places that things are going at a snail’s pace. There is considerable debate about the immediate challenges facing the Government around targets, but the consensus is around the 300,000 mark, which is highlighted in the Bill currently going through Parliament. As we speak, new homes are not, in the majority of cases, being built to the standard of energy efficiency we would expect. In fact, 1.5 million new homes have not met that standard over recent years. As hon. Members across the Chamber have rightly pointed out, that contributes to the dire situation on energy costs for every family in this country. There were reports in the media today—despite lots of other things we are focusing on, particularly the Government—that those bills are projected to rise to £3,000, so this is more important than ever. The failings on residential energy efficiency must be seen through the lens not only of the Government’s failure on climate policy, but of their failure to ensure that everyone in this country has a good, safe home.
Across the north, 19% of all homes are classed as non-decent and 12% fail to meet minimum standards, posing a category 1 health hazard to residents, which means potential death, permanent paralysis or serious injury. What kind of society lets 12% of its constituents live in those conditions? The energy efficiency of homes in much of the north is below the English average, which has been rightly pointed out as being shockingly low in itself. Across the country, nearly 60% of homes are not in the top three bands for energy efficiency. The north-west comes in just under the national average and the north-east just above, but Yorkshire is falling far behind and has the lowest proportion of any English region, with only one in three houses meeting efficiency standards.
Applying regional figures on energy certificates to the number of dwellings in the two local authorities covered by my constituency of Weaver Vale gives a rough idea of the scale of the challenge more locally. Some 35,000 homes in Halton alone need to be upgraded, alongside an incredible 96,000 in Cheshire West and Chester. As well as being a huge challenge, upgrading 19 million homes nationwide is an incredible opportunity. The economic case for making homes green is clear in the levelling-up White Paper, which has been referenced. In fact, the White Paper talks about an intervention in skills creating opportunities and 240,000 jobs by 2035 for the upgrading of homes. The hon. Member for Darlington referred to 77,000 jobs in the north. It is a strong case that has political consensus.
Can the Minister outline what the Government are doing to work with businesses, schools, universities, colleges and training providers to ensure that our localities have the skills that we need? I was at an event yesterday—just as other events were unfolding—at the Royal Society of Arts. Mayor Burnham was there, as well as Mayor Andy Street. Their asks of Government at the moment are to turbocharge devolution, particularly around the skills agenda, and ensure that the budget captured from Whitehall is put into the localities, whether that is Greater Manchester or the west midlands, to drive forward this agenda. Again, it is about common sense and political consensus.
Despite the hon. Member for Darlington referring to the non-partisan nature of the debate, we are of course politicians, and we do have different values and ideas, whether we are social democrats or conservatives. At times, political choices have consequences. Certainly in the past, the Conservative story of green homes has been one of short-term thinking and broken promises. To evidence that, back in 2013, the Conservative-led Government cut energy efficiency programmes. I will of course not let the Liberal Democrats off there, because, despite much denial, they were part of that Government at the time.
Peter Gibson
I beseech the hon. Gentleman to recognise that this is a failure of Governments of all colours over many decades to sufficiently and completely resolve this problem. It is a massive problem that every previous Government have failed to tackle. I welcome the steps the Government have taken, and I have urged the Minister to invest more. If we are going to be party political in this debate, I would love the hon. Gentleman to outline what his Government between 1997 and 2010 did to tackle this problem, because these constituencies that we are talking about were largely Labour-held constituencies at that time.
Mike Amesbury
The standards that were ditched would have come into play in 2015, which would have meant that hundreds of thousands of homes would be retrofitted and insulated and built to better standards. The new standards do not come into play until 2025—that is if the current Government exist over the next few months or even weeks.
There was also the green homes grant flagship scheme, which was scrapped just six months after its launch. There has been reference to the current social housing programme, which I welcome. Certainly, social housing providers in my constituency are trying to capture that investment, but again, it is insufficient, short term and bureaucratic. It could be better. That is feedback we will all get, regardless of our political persuasions.
I doff my cap slightly to the Welsh Labour Government, who have just announced £33 million in green funding for residential developers to help them deliver thermally efficient and lower-carbon homes, many of which will be available for social rent. The Government could do better on that—fewer than 6,000 homes for social rent were built last year. We need to be more ambitious.
Having spoken to developers, social housing organisations and councils, what they really need from the current or future Governments is leadership, clarity and a long-term strategy. If housing associations want to plan for the future, they need to do so in 10 or 20-year cycles. At the moment, with some schemes running for only six months, it is very difficult to plan or invest in some of the basics to do with upskilling our local communities.
In conclusion, I have three questions for the Minister. How will he respond and focus on the long term—despite the current challenges—rather than on the short term, in getting to net zero by 2050? What support will be given to the private rented sector and landlords on retrofitting? What investment is going into stimulating green hydrogen, beyond blue hydrogen, with our various projects, whether in the north-east or in the north-west, which are fantastic for energy-intensive industries? We need that investment, and we need it now.
Margaret Greenwood (Wirral West) (Lab)
It is a pleasure to serve under your chairmanship, Mr Robertson.
I congratulate the hon. Member for Darlington (Peter Gibson) on securing this important debate. The energy efficiency of homes is incredibly important as we face the challenges of climate change, cutting emissions and the cost of living crisis, with sharp increases in energy costs that will be devastating for many of my constituents. It goes without saying, but we all know that the north is colder than the rest of the country, so I am not surprised that he chose to focus on that part of the country for the debate.
I am very concerned about what this winter will bring for those people on low incomes. Many Members have spoken about fuel costs and so forth. The hardship, grinding poverty and health implications should not be underestimated. One of the things that we can do, therefore, is to improve the energy efficiency in existing homes as a matter of urgency.
Citizens Advice has been in Parliament today, and it highlighted the issue. It has talked about how effectively insulated homes will help to reduce soaring energy bills by making heating our homes easier and cheaper by ensuring that heat is retained better. As my hon. Friend the Member for Weaver Vale (Mike Amesbury) mentioned, however, the UK has the least energy-efficient housing in Europe.
The Government must match the ambition shown by Labour to insulate 90 million homes within a decade. That move would save households an average of £400 a year on their energy bills. I am keen to hear the Minister commit to that. In the Liverpool city region, metro Mayor Steve Rotheram, has invested nearly £60 million to retrofit more than 5,500 homes. Funding is being targeted at the most disadvantaged households, making their homes more energy-efficient and cutting their fuel bills. Many of the more than 700,000 homes across the region could be retrofitted, if the Government were to come forward with more funding. Will the Government provide additional funding to local areas such as the Liverpool city region so that more homes can be retrofitted?
Will the Minister also tell us what he can do to ensure that we see an increase in the number of apprenticeships in the building skills we need for both retrofitting old homes and building new eco-friendly homes, so that young men and women can acquire the skills we need for our housing stock, secure well-paid and skilled employment, and contribute to their communities in an incredibly practical way?
Finally, I want to say a few words about new build. My constituent Colin, who is an architect, has designed a series of ultra low energy net zero carbon homes. The homes follow the same principles of the award-winning Passivhaus that Colin designed for himself and his wife Jenny in 2013. I have visited the house on a number of occasions and it is incredibly impressive. The house is based on the Passivhaus energy design standard developed in Germany and is designed to provide a high level of comfort, while using very little energy for heating and cooling. Colin and Jenny’s home features triple glazing, LED lighting and an air source heat pump. It costs less than £70 for a year’s supply of energy for heating, lighting, hot water and cooking. It is inspirational and I think we are all quite shocked to hear that figure, but it shows that it can be done and, with political will, the Government could make that happen at scale.
The issues we are debating today are incredibly urgent. I hope that the Minister will come forward with a clear commitment and set out how the Government intend to step up to this challenge.
Dr Alan Whitehead (Southampton, Test) (Lab)
We have had a good and important debate this afternoon. I congratulate the hon. Member for Darlington (Peter Gibson) on bringing forward the debate and on the exemplary way in which he put forward his case. I largely agree with what he said, particularly his emphasis on conditions in homes in the north of England and the work we need to do on retrofitting. He gave a number of instances of homes in the north of England and their circumstances, particularly the average age of properties, and the fact that it is rather colder up north than it is down south—I say that as the Member for Southampton, Test.
In the north of England, property stock is substantially older than the average for the UK and, as the hon. Member for Darlington mentioned, that older stock is substantially single-skinned properties, which need different forms of treatment from properties with cavity wall insulation. From energy efficiency surveys, it is interesting to see that pre-1930s properties have a median energy efficiency score of 56, according to the report I am looking at, whereas buildings built from 2012 onwards have a median energy efficiency score of over 80. So we have a huge block of properties in the north of England that have very low energy efficiency scores, and it is difficult to do anything about them other than provide whole-house treatment for the amelioration of their problems.
Bearing in mind that issue, we also have a huge gap between the emissions from new build properties and those from existing dwellings. Indeed, the north-east has one of the largest gaps between emissions from new and old properties. In the north-east, there are emissions of just over 1.5 tonnes of carbon dioxide per year from a new property, compared with over twice that amount—3.6 tonnes per year—for existing properties. So there is a huge job to be done, particularly in properties in the north of England, to help us get to our net zero targets and to retrofit properties throughout the country.
The call from the hon. Member for Darlington for much more work to be done on the energy retrofit of properties is important for climate change purposes and for future energy bills. It is estimated that £400 to £500 can be saved from energy bills in an uprated energy-efficient property. It is also important for the comfort and good living that we expect in any household in the country. The problem relating to damp and older properties is not just in his part of the world, but in the north generally. This debate is timely and important, and we must have the retrofit debate in the not too distant future.
I cannot be entirely non-political in this debate, as the hon. Member suggested we should be, although we all agree in this Chamber on what we want to do with retrofitted properties and on why it is important and relevant to climate change, fuel poverty and the welfare of citizens.
Peter Gibson
I am pleased to hear the tone of the hon. Gentleman’s speech up to this point. Although the debate is focused on the north and north-east, and on the types of housing stock in my constituency and other northern constituencies, I am sure that the type of housing stock in his own constituency—perhaps he will mention that—would benefit from some of the improvements, even though his constituency is on the south coast.
Dr Whitehead
I can assure the hon. Member that I am not approaching this debate as if all the retrofit problems are in the north of England and not in the south. It is a national scandal that homes across the UK have got some of the worst energy efficiency performances of any properties in Europe. On other occasions the Minister has said that it is not such a big problem because of the way in which energy efficiency has increased in our housing overall in the last few years.
However, if we look at all parts of the country, there is a big lag between the energy efficiency, albeit under slightly different circumstances, across the country and the energy efficiency of new properties, so the figures do not quite tell the truth as far as energy efficiency improvement is concerned. Most of that improvement is because newer housing, recently built properties, are so much more energy-efficient than older properties. In fact, as we can see from the collapse of energy efficiency retrofit arrangements after 2012, there has not been a great deal of movement in the energy efficiency of properties in all parts of the country. The north of England faces even worse problems in getting its property up to retrofit standards than other parts of the country.
Peter Gibson
All of us in this Chamber have alluded to the scale and size of the problem. Does the hon. Gentleman agree that this is also a really complex problem because of the types of ownership of some of our properties? We are not talking about just one type of ownership. There are private landlords, social housing providers, absentee landlords and private homeowners, which makes the problem particularly complex. As we have so much time remaining in the debate, I would be incredibly grateful to the hon. Gentleman if he could outline some of his suggestions and proposals to tackle the problem.
Dr Whitehead
The hon. Member invites me to make a lengthy speech about what my party has in mind for energy retrofit, but also about what my party has in mind for dealing with complex situations in different sectors of the housing market. He rightly says that the question of energy efficiency standards is very different in different tenures of property—social housing, private rented sector and owner-occupied housing—and the solutions that one needs to put forward have to be different for different kinds of tenure. Furthermore, as I am sure the hon. Member has noticed, those tenures are intermixed with each other in most areas, so there are very few parts of the country where there is just one kind of tenure.
In my constituency, one of the issues is that there is a very high level of houses in multiple occupation and properties that are rented out by private landlords. There is also a substantial student population in my city, so a number of the houses are rented out by private landlords on a quick turnover, and with very little regard for the energy efficiency of those properties in the long term. Although one might say that the general housing arrangements in my city are better for energy efficiency than in some other parts of the country, there are specific issues relating to how energy efficiency might be looked at. One issue is just how bad energy efficiency is in the private rented sector and what measures need to be undertaken to get those houses to a decent level of energy efficiency in order to make them marketable rental properties.
In the past, a specific part of the legislation was on minimum energy efficiency standards. We think that needs to go a lot further by addressing the marketability of homes and the requirement on landlords to get those properties up to a decent energy efficiency level in order to rent them out in the first place. As the hon. Member for Darlington will know, there is legislation in place that requires landlords to bring their properties up to the band E energy efficiency requirement, but that is grossly insufficient for the targets that we need to set on getting the private rented sector up to scratch with energy efficiency.
Peter Gibson
I am grateful for the hon. Gentleman’s indulgence in giving way a third time, and for him talking about putting the burden of meeting those property costs on some of our landlords. We have seen examples of landlords being forced to do some of the work that is required to bring their properties up to standard. As a result, they are exiting the market—some people might say that is a good thing—and then selling the properties, which is having a deflationary impact on the value of properties in specific localities. In turn, that compounds the problem of the ratio between the cost and value of the asset and the cost and value of the investment required, which can actually have the opposite effect to the one desired.
Dr Whitehead
The hon. Gentleman is admirably setting out a series of concerns about how we address the process of retrofitting, which we need to think about very carefully. One of the things that concerns me—here I get a bit political—is just how bad the Government’s overall retrofit programme has been over a long period. It is not just about the collapse of schemes from 2012 onwards. In the previous debate, somebody asked what happened in energy during the previous Labour Government. Well, a lot happened: the carbon emissions reduction target, the community energy saving programme and warm home grants.
There has been a real noticeable increase in standard assessment procedure ratings in properties over the years. From about 1990 to 1995-96, the schemes really started working, and they were publicly funded. What happened in 2012 is that the publicly funded schemes were removed, and after that the schemes were entirely market based. The green deal died a death. Recently, the green homes grant was sort of publicly funded, but it also rapidly died a death.
Significantly—I want to emphasise this point, in terms of how we treat retrofit—the only part of the green homes grant that was successful was the part that applied to local authorities. Local authorities were and are able to take some of that grant and do a lot of good work. The hon. Member for Sedgefield (Paul Howell) said that his local authority has done a lot of public work on that, yet the Government systematically set their face against the idea that local authorities can play a substantial leading role in retrofitting.
I suggest—the hon. Member for Darlington and I spoke about this a moment ago—that the case has overwhelmingly been made for retrofit funding. We are saying that there should be a 10-year programme to retrofit 19 million homes of all tenures through a combination of loans, grants and direct local authority schemes, with two million homes retrofitted immediately. That would be a comprehensive programme of retrofitting across the country, with the emphasis on area-based schemes so that local authorities can look at where their areas are worst and at what needs to be done in their particular circumstances, and concentrate resources accordingly on retrofitting with that knowledge and those concerns at the front of their minds. How much better would that be than the sorts of schemes we have had over the years? In this case, energy companies have been asked to go around and pick out individual properties to do up to a greater or lesser extent.
Paul Howell
I declare an interest: I am a private landlord. Does the hon. Gentleman agree that, in terms of segmenting the approach and trying to make sure it is right, we need a different approach when considering the economics of the north, for landlords and owners, in contrast to the high-value property areas of the country, to ensure that we focus on absentee landlords and people who are not doing the right thing? In parts of the north they almost walk away because the value of the property is so low. We need to ensure that does not result in the properties becoming derelict. Rather, they should either be resold or go back into the rental market properly.
Dr Whitehead
I agree with the hon. Member that we need to ensure that we tailor our programmes, not just to the particular areas of the country but to the particular resources that we will need in order to deal with the arrangements in different parts of the country. Labour’s programme would not only allow that to happen, but ensure that, right across the country, we were not applying a one-size-fits-all arrangement and we were allowing local authorities in particular to tailor their programmes. We can imagine the equivalent of the old housing improvement areas or general improvement areas being applied in the form of energy efficiency improvement areas in various local authority areas. They would be chosen by those local authorities, and would be able to concentrate on different tenures in the way that the hon. Gentleman outlined. The difference is like night and day between what Labour is proposing at the moment and what the Government—albeit they have spent some money on retrofitting—continue to try to do.
I just want to take a few more minutes, because I appreciate that we will in the end run out of time—even though we have more time than we thought—and I want to give the Minister ample time to reply to the debate. I would like him to address his thoughts to three particular questions.
One of the only schemes that is doing any serious work on retrofitting at the moment is ECO—the energy company obligation. The ECO scheme is now in its fourth iteration; ECO4 was supposed to come onstream in April this year, and the hon. Member for Darlington asked, “Where is ECO?” There is an answer in the press release for the Energy Security Bill that appeared on my desk today. That press release states:
“The current ECO4 scheme came into force in June 2022 and will run until March 2026.”
That is just not true. No ECO4 scheme is in operation at the moment, because the regulations have not yet been sorted out as far as this House is concerned; we still have to discuss them and put them into being. Today, I was at a lunch where an energy management and building company guy sitting next to me was bemoaning the fact that the people there could not just get on with ECO4 because they just do not know what is going to happen with the regulations.
Therefore my first question to the Minister is this. When will that happen so that we really can get under way with ECO4? Why has he put it in the Energy Security Bill that ECO4 has already started when it has not? Can he get it started as soon as possible so that the people I have been talking to recently can actually have some security about the future arrangements for retrofit? We obviously consider that the uprating for ECO4 that has already taken place, from £750 million to £1 billion, is welcome but not enough. Certainly we would want to see that programme substantially increased in size at a very early stage in order to get this retrofit programme going as quickly as possible.
The second question is this. Why is there nothing in the Energy Security Bill—as far as I can see—that takes us beyond the level of ECO4? Certain things in the Bill suggest some amendments to ECO4, but there is nothing to take us beyond that particular scheme in the way that has been described today in this Chamber. I do not know whether the Minister—because I suspect that the Energy Security Bill is a Bill in progress even as it is published—will want to bring forward amendments, during the passage of the Bill, that allow those further things to take place, but I will be interested to know this afternoon whether that is under serious consideration.
As I think every Member present this afternoon has said, this is a pressing problem that needs to be sorted out as quickly as possible, and on the widest scale that is compatible with our net zero commitment and the duty we have towards our citizens’ style of living, energy bills and expectations of what their housing will look like in future years. Pushing forward on that is something we in this Chamber are completely united on, and I look forward to hearing the Minister’s response to that unity of purpose.
The Minister for Energy, Clean Growth and Climate Change (Greg Hands)
It is a pleasure to serve under your chairmanship, Mr Robertson. I congratulate my hon. Friend the Member for Darlington (Peter Gibson) on securing this important debate. As ever, it is excellent to have so much good representation in the north of England from our party.
This Government’s unwavering commitment to decarbonise the country’s 30 million buildings has the welfare of those who most need energy-efficient homes at its very core. Getting to net zero is not just a legal commitment; it is the right policy for this and future generations. Improving the wellbeing and living conditions of northern communities is a key part of the levelling up of all our towns, cities and regions as we build a green Britain that works for every part of the country.
Underpinning all our work in that area is the heat and buildings strategy, a copy of which I have brought to this debate, published at the end of October 2021. It explores different options for low-carbon heating, from hydrogen trials to heat networks and increased use of heat pumps, to meet the challenges of each region of our country, recognising that there can be no one-size-fits-all approach.
At the same time, we are taking a fabric-first approach to retrofit, ensuring that emissions are reduced first, regardless of how buildings are heated. That will be supported through a commitment to invest £6.6 billion during this Parliament, which is funding technology trials and capital schemes such as the home upgrade grant and the boiler upgrade scheme. In the past year alone, we have committed more than £1.3 billion to domestic retrofitting schemes, which was one of the central points raised by my hon. Friend the Member for Darlington and, indeed, other Members.
We have prioritised the worst performing low-income homes to receive measures such as external wall insulation and clean heating systems. That has already lifted thousands of households out of fuel poverty, and future phases of home decarbonisation will upgrade over half a million more. Families who would not be able to afford energy efficiency improvements for themselves will be able to face future winters knowing that they will be warm, sometimes for the first time.
Our local authority delivery scheme and home upgrade grant empower local authorities, which know their communities and housing stock best, to decarbonise local homes according to specific needs. In the north, around £226 million of funding has been allocated to local areas through the latest phases of those schemes. As many Members have said, the north of England has benefited disproportionately from the energy company obligation. Since that scheme started under this Government in 2013, over 13% of homes in the north-west and over 12% of homes in the north-east have received energy efficiency measures. Indeed, 12.2% of households in Darlington have had their homes improved under the energy company obligation, compared with an average of 9% across Great Britain.
My hon. Friend the Member for Darlington, who is vice-chair of two relevant APPGs and knows the engineering heritage of his town so well, made an excellent speech. In researching it, he sat down with local housing providers such as North Star Housing, which quoted some striking sums regarding the costs of retrofitting a home relative to the value of that home. My hon. Friend made some thoughtful arguments about how we should evaluate the cost efficiency of those different measures. He also pointed out that 64% of properties in Darlington are rated below brackets A to C on energy efficiency, which shows that despite the progress we have made on energy efficiency—particularly over the past decade—there is still much work to do. That is why we are investing £6.6 billion over the course of this Parliament.
We had an intervention from the hon. Member for Hampstead and Kilburn (Tulip Siddiq), who is not in her place anymore, to say two things. She attacked the Government’s record on renewables, nuclear and energy efficiency. I found it startling, considering that when the last Labour Government started their period in office, they said that when it came to nuclear, they saw no economic case for new nuclear power stations in this country. That was at the start of their 13 years in office.
On renewables, we have taken the amount of energy generated from renewable sources since 2010 from 7% of the energy mix to 56%. That is an incredible increase in our renewable output as part of our energy mix.
Margaret Greenwood
The Minister is right that my hon. Friend the Member for Hampstead and Kilburn (Tulip Siddiq) is not in her place, but would he not agree, or concede, that it was a Conservative Government that pulled the funding for solar on people’s roofs, stymying an industry and making it much more expensive for people to install solar? Precious years have been lost, and we could have had many more solar panels on our roofs.
Greg Hands
I fundamentally disagree. Solar has done incredibly well in this country. We have a big capacity in solar—I think around 14 GW. Our ambition is to grow that to 70 GW. Part of that is thanks to the VAT reduction that we saw this year. I do not remember the hon. Lady supporting that VAT reduction on solar panels. The Government are taking active measures to increase and support solar energy.
On energy efficiency, when we took office in 2010, just 14% of properties in England were rated “energy efficient”. That has risen to 46%, which in 12 years is an incredible increase. However, that shows that 54% of our properties are still not sufficiently energy efficient, so we still have work to do, but we can only do it by making investment. The last Labour Government said there was no money left. Perhaps if they spent a little more on energy efficiency in those 13 years, we would not have been in a position where only 10% of homes were rated A to C when we took power.
My hon. Friend the Member for Darlington asked when the new energy company obligation scheme will begin. I think the shadow Minister, the hon. Member for Southampton, Test (Dr Whitehead), also raised that same point. A three-month interim delivery phase was introduced between 1 April to 30 June 2022 under the previous scheme rules to enable delivery to continue subject to some measure limitations. Obligated suppliers may choose to deliver under the new scheme rules backdated to April 2022, when the underpinning legislation was put in place. We are pleased to announce that we laid the draft Electricity and Gas (Energy Company Obligation) Order 2022 before Parliament on 22 June. We expect the regulations to be made and come into force in July.
My hon. Friend the Member for Darlington also asked about energy advice. Our simple energy advice service, launched in 2018 in response to the Government-commissioned “Each Home Counts” review, provides homeowners with impartial and tailored advice on how to cut their energy bills and make their homes greener. The service has been accessed by over a million users.
Greg Hands
I will make some progress and respond to the points made in the debate. My hon. Friend the Member for Darlington and the hon. Member for Weaver Vale (Mike Amesbury) raised the really important point of skills. I chair the newly established green jobs delivery group with Michael Lewis, CEO of E.ON UK. In 2021 the Government invested £6 million in a BEIS skills training competition, resulting in 7,000 more training places for heat pumps and insulation. The hon. Member for Weaver Vale also commended an event about skills attended by Andy Burnham and Andy Street. It is good to see constructive cross-party work. I only wish that the Mayor of London would follow such a constructive approach to cross-party work, as the Mayors for Manchester and Birmingham often do.
The hon. Member for Stockport (Navendu Mishra) asked about using legitimate builders, not cowboys. All insulations under Government schemes, including ECO, the social housing decarbonisation fund, the home upgrade grant and the local authority delivery scheme, must be completed by TrustMark-registered businesses, adhering to the latest requisite standards. These requirements are based on the recommendation of the “Each House Counts” review, an independent review of consumer protections and standards.
Greg Hands
If the hon. Gentleman has a specific case in mind, I would urge him to take that up with the local authority trading standards.
In an excellent contribution, my hon. Friend the Member for Sedgefield (Paul Howell) mentioned fuel poverty, which is actually falling in this country. Last year, it accounted for 13.2% of English households and this year it accounts for 12.5%. Obviously, that is not satisfactory, and we need to keep bearing down on fuel poverty, but that situation is improving. I am glad that he welcomed my ministerial colleague, Lord Callanan, to the north-east; he leads the ministerial team on energy efficiency.
My hon. Friends the Members for Sedgefield and for Darlington referred to retrofitting, as did other hon. Members. Our £1.8 million green home finance innovation fund, which completed in March 2022, was a key early step in supporting the lending community to design, develop and pilot green finance products for homeowners. The Government will provide up to a further £20 million to support the development of innovative green finance products and services that will diversify the green finance market and enable both owner-occupiers and private landlords to decarbonise their homes and improve thermal comfort.
My hon. Friend the Member for Sedgefield asked about VAT. We have introduced a zero-rating VAT for the installation of insulation and low-carbon heating for the next five years, which will give real certainty to the market. That will save between £1,000 and £2,000 on the cost of an air-source heat pump. My hon. Friend also raised the private rented sector, and I can tell him that we consulted on raising the standard to EPC band C for new tenancies from 1 April 2025, and for all tenancies by 1 April 2028. We have analysed the responses and we will be publishing a Government response in due course. In the meantime, we will continue to invest in energy efficiency and support homeowners outside such regulations. We also published the White Paper “A fairer private rented sector” on 16 June 2022, which sets out support for those in the private rented sector, including ending so-called “no fault” section 21 evictions, and giving all tenants a strong right of redress.
The hon. Member for Wirral West (Margaret Greenwood) asked whether we will give money to local regions, such as Liverpool City Council, to retrofit. I can tell her that phase 2 of the local authority delivery scheme allocated £300 million to the five local net zero hubs, which will work with their local authorities to continue to deliver energy efficiency upgrades to up to 30,000 homes across England to those most in need. In this Parliament £6.6 million has been spent on energy efficiency, and a great deal of that has been assigned to local authorities via the home upgrade grant, the LAD scheme and the social housing decarbonisation fund. In LAD 2 funding, the regional allocation of £52.8 million is going to the north-west—the hon. Lady’s region.
The hon. Lady also asked about new-build homes being built to passive housing standards to create lower bills. On new build, the Government have announced that the new future homes standard will be introduced from 2025. That work is ongoing, and in the interim an improvement to part of the loft building regulations came into effect on 15 June 2022.
The hon. Member for Weaver Vale asked about training providers and businesses. As I have already said, we have invested £6 million in the BEIS skills training competition, resulting in more than 7,000 training opportunities.
The hon. Member for Southampton, Test lauded the big increase in energy efficiency across the country. I think he argued that the figures are due to the better energy efficiency of new homes. We are not looking at an average figure—the increase from 14% to 46% of the housing stock—rather we are looking at the percentage of the total number of homes that are rated A to C. The fact that a new home will be particularly, staggeringly, energy efficient will only count as one home in the denominator. The key thing is moving homes in the numerator to make sure that more new homes are created energy efficient and that older homes are retrofitted to get them into the A to C bracket.
The hon. Gentleman asked what the Government are doing to support consumer bills. The Government have acted to protect the 8 million most vulnerable British families through a £37 billion package of support to help those households with the cost of living crisis. That includes at least £1,200 of direct payments this year, with additional support for pensioners and those claiming disability benefits. Three quarters of the total support will go to the vulnerable households who need the most help.
Later this year, the social housing decarbonisation fund is due to launch its second wave of funding to 2025, from the £800 million committed in the heat and buildings strategy to install energy efficiency measures in social homes. The first wave of that funding is investing £63 million in retrofitting around 8,000 homes in the north of England.
Improving the wellbeing and living conditions of northern communities is a key element of the levelling-up agenda that we have embedded across all Departments, with the ambition that by 2030 the number of non-decent rented homes will have fallen by 50%, with the biggest improvements in the lowest performing areas. We know there are significant regional variations in emission levels and communities will face different challenges when meeting net zero commitments. The north accounts for around a quarter of the UK’s emissions, so it is well placed to make a huge contribution to UK decarbonisation.
As Government-funded energy efficiency work rolls out in the coming years, there will be a need to scale up the supply chain and build a skilled workforce, which will take time. To meet that long-term challenge, we have provided £4.7 million of funding to test how we can grow the installer supply chain and a further £2.5 billion in a national skills fund, helping to support hundreds of thousands of green jobs.
The north is in a key position at the centre of net zero innovation, growth and opportunities for green jobs. For example, the new Lancashire Energy HQ, part of Blackpool and The Fylde College provides state-of-the-art training for excellence in energy standards; it was good to hear an intervention earlier from my hon. Friend the Member for Blackpool South (Scott Benton). Centres like that may provide job and skill development opportunities for many in communities benefiting from our domestic retrofit programmes. In fact, we expect the decarbonisation of buildings to support up to 240,000 jobs by 2035, resulting in £10 billion additional gross added value by 2035.
In my Department, we know that we need to remove virtually all emissions from buildings to reach net zero. We also know that we have a duty to protect those who are most vulnerable, and to support consumers and businesses as we decarbonise our buildings. I want to ensure that consumers will benefit from higher energy performance in homes and workplaces, from improved health and comfort and from lower emissions and lower bills. I thank my hon. Friend the Member for Darlington for proposing this excellent and well-informed debate.
Peter Gibson
It is a pleasure to follow the Minister, and I thank him for his response to today’s debate. It has been a healthy debate. We heard some great speeches from my hon. Friend, neighbour and constituent the Member for Sedgefield (Paul Howell), the hon. Members for Stockport (Navendu Mishra), for Weaver Vale (Mike Amesbury) and for Wirral West (Margaret Greenwood), and the Opposition spokesman, the hon. Member for Southampton, Test (Dr Whitehead), although I was disappointed to not actually hear the meat and drink of Labour’s plans to tackle the problem.
We had interventions from my hon. Friend the Member for Blackpool South (Scott Benton) and the hon. Member for Sheffield Central (Paul Blomfield), who gave me the great line that tacking this problem is a “win-win-win-win-win” situation. We also had a deeply political intervention from the hon. Member for Hampstead and Kilburn (Tulip Siddiq), who is no longer in her place.
It is clear that the Minister understands the challenges of our housing stock—the energy, retrofitting, disruption and lost income costs and the energy wastage—but also sees the benefits of warm homes, less leakage, improved health, skills and jobs that tackling this problem will bring. It was wonderful to hear the progress that has been made over the last 10 years, taking us from 14% to 46% of homes having an energy performance certificate of C or better, but let us accelerate that and make sure this is a win for the environment, homes, bill payers, jobs and skills.
Question put and agreed to.
Resolved,
That this House has considered energy efficiency of homes in the north of England.
Mr Laurence Robertson (in the Chair)
Order. The mover of the motion for the next debate is not here. I will give him a couple of minutes, but I will otherwise have to suspend the sitting until 4.30 pm.
Gynaecological Services: Waiting Lists
(1 year, 9 months ago)
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Emma Hardy (Kingston upon Hull West and Hessle) (Lab)
I beg to move,
That this House has considered waiting lists for gynaecological services.
It is a pleasure to serve under your chairship, Mr Robertson. I start by thanking the many women who have contacted me about this issue, whether in my role as co-chair of the all-party parliamentary group on endometriosis or as chair of the all-party parliamentary group on surgical mesh. The APPG on women’s health has been in contact, and we have also received testimony through the House services from so many women raising their concerns about gynaecological treatment. I thank the Minister for still being in his place to respond to me at the end of today’s debate—it is appreciated.
The debate will focus on the length of waiting lists for gynaecological treatment, and the amount of time people spend on those lists. It has been prompted by the findings of the Royal College of Obstetricians and Gynaecologists report, “Left for too long: understanding the scale and impact of gynaecology waiting lists”. However, I remind Members that when we talk about statistics, it is easy to forget the real people who lie behind them—those individual lives—who do not exist in isolation. When people’s health is impacted, it impacts their families, their friends, their communities and their work. As we will hear, the length of waiting lists is prolonging the suffering of tens of thousands of women, and that suffering has physical, economic and emotional costs.
Gynaecological waiting lists across the UK have now reached a combined figure of more than 610,000—a 69% increase on pre-pandemic levels. An observer might say, “Well, of course. There’s been covid, there’s been a pandemic—what do you expect?” The total pausing of elective care at the start of the covid pandemic has, of course, had an impact. That observer might add, “Our NHS has been chronically underfunded for the past 12 years. There was a steady increase in waiting lists even before the pandemic, and the 18-week waiting time standard for planned elective care has not been met since 2016, so why are you just having a debate on gynaecological treatments? Why not have a debate on waiting lists in general?”
The answer is that RCOG’s analysis shows that gynaecology waiting lists in England have seen the largest percentage growth of all elective specialities, and the largest percentage increase in patients waiting over 18 weeks from referral to treatment. The number of women waiting over a year for care has increased from just 66 in February 2020 to nearly 29,000 two years later, at the end of April 2022—the highest number ever recorded. Concerted efforts across the NHS to focus on longer waiters—that is, patients who have been waiting over a year—have resulted in a drop across all specialities combined from the peak in 2021. However, for gynaecology procedures, the numbers are going in the opposite direction: while we are seeing a reduction in waiting over a year for other treatments, we are not seeing the same for gynaecological treatment.
In addition, we have the prospect of even more cases in the pipeline. Analysis by Lane Clark and Peacock’s health analytics team on behalf of RCOG shows that between March 2020 and November 2021, more than 400,000 women who were expected to join the waiting list based on referrals in previous years did not do so. Therefore, those people are missing from the data I have just mentioned. The number of missing referrals tended to be higher in areas where the waiting lists were already larger. Perhaps that means that women in areas with longer waiting lists are, coincidentally, not going to their GPs, or perhaps it is because they are not able to see their GPs, or their GPs are not responding to those longer waiting lists. We are not quite sure what is going on, but what we do know is that lots of women are not getting the treatment they need.
As I mentioned at the beginning of my speech, I am co-chair of the all-party parliamentary group on endometriosis and chair of the APPG on surgical mesh. Both come under the heading of gynaecological conditions, and both are being impacted by increased waiting times. Endometriosis is the second most common gynaecological condition. It impacts around 1.5 million women—one in 10—in the UK and can affect all women and girls of childbearing age. It is caused by cells that usually form part of the womb lining growing elsewhere in the body, but they still react to the monthly cycle of hormones that regulate a woman’s period. That can create extreme pain and fatigue, because the cells are growing in completely the wrong place.
Part of the APPG’s role is to raise awareness of the condition and get people to talk about it. One in 10 women have it, but I am not sure that one in 10 people in the country know anything about the condition or the fact that it even exists. Many of the sufferers are facing increased waiting time for the procedures I am highlighting today. Even pre-pandemic, people were waiting on average seven and a half years for a diagnosis.
I want to quickly mention surgical mesh, because tomorrow is the second anniversary of the report “First Do No Harm”, which was commissioned by the then Secretary of State for Health and Social Care, the right hon. Member for South West Surrey (Jeremy Hunt), and undertaken by Baroness Cumberlege, to look at the condition. Surgical mesh was used in the surgical repair of pelvic organ prolapse and to manage stress urinary incontinence. It was promised to be simple and quick, but for some it has resulted in severe complications, including chronic pain, infections, reduced mobility, sexual difficulties and autoimmune issues. Lives have been shattered and the issue of mesh injury, along with the scandal surrounding hormone pregnancy, resulted in the “First Do No Harm” report.
Women have been left disabled by the mesh treatments. One of the key recommendations of the report, which, to the shame of this Government, are still not fully implemented two years on, was the establishment of specialist mesh treatment centres. Some of these have opened, but they are beset with problems over access, waiting times and cancellations. Through my involvement with these centres, I have heard at first hand the testimony of so many women whose lives have been blighted by what are currently referred to in the NHS as “benign” conditions. Yet, as we have heard, these conditions can be so painful and debilitating that they impact on every aspect of family, social and work life.
One lady, Kelly, said:
“The impact the long waiting lists have on my life is horrendous. I have endometriosis and adenomyosis and the daily pain these conditions cause me is terrible. Some days simple tasks like walking are unbearable. I have been on the waiting list for surgery for my endometriosis since 2019, and the length of time I am currently having to wait and the symptoms I am having to deal with daily are massively affecting every aspect of my life and having a profound effect on my mental health. I have been told that despite going on the waiting list for surgery in 2019 I will likely be waiting 4 years to get my surgery. Every day is a struggle.”
These conditions are not benign and cannot wait.
“Benign” suggests that there is no harm in delaying treatment, but that is emphatically not the case. For both endometriosis and mesh injury, longer waiting times can have a significant impact on progression. As time passes, options narrow, opportunities are lost and surgery becomes more lengthy and complex. Mental health deteriorates and depression, anxiety and suicidal thoughts become more common.
This is borne out by the most recent data from RCOG. Nearly three quarters of the members surveyed felt that they were seeing women with more complex care and treatment needs as a result of waiting longer for care, resulting in worsening and often extremely debilitating symptoms. Four fifths of the women surveyed reported that their mental health had been negatively impacted while waiting for care. So why are the waiting lists for gynaecological treatments growing? Is it the lack of priority they have been given simply because they are considered benign and not a threat to life? Or is it because gynaecological treatment is the only elective treatment unique to women?
There is undeniably a problem with the health service’s attitudes, in some places, to women’s health, where it involves reported symptoms and the voice of the patients themselves. I stress that I continue to give my wholehearted to the medical profession and everything it does, but there seems to be a concern particularly around the treatment of women’s health conditions.
“First Do No Harm” contains a section headed, “‘No-one is listening’—The patient voice dismissed”. In this case, “patient” is synonymous with “woman”. Although the following passage from the report refers to “mesh complications”, it applies equally to any other gynaecological condition. The report, published two years ago tomorrow, says:
“Women, in reporting to us their extensive mesh complications, have spoken of excruciating chronic pain feeling like razors inside their body, damage to organs, the loss of mobility and sex life and depression and suicidal thoughts. Some clinicians’ reactions ranged from ‘it’s all in your head’ to ‘these are women’s issues’ or ‘it’s that time of life’ wherein anything and everything women suffer is perceived as a natural precursor to, part of, or a post-symptomatic phase of, the menopause. For the women concerned this was tantamount to a complete denial of their concerns and being written off by a system that was supposed to care.”
Amatullah said:
“My GP actually laughed at me when I initially expressed concern that my condition was worsening despite my family history. I had to be hospitalised with suspected appendicitis before I was taken seriously enough to have more testing to see if my fibroids had grown. They had doubled in one year.”
Joanna said:
“As a newly qualified junior doctor, who hopes to specialise in gynaecology, I can’t stress enough how important this debate is. For too long, women’s pain has been ignored or dismissed. The topic is considered taboo despite it being something that a significant percentage of women experience.”
Do such attitudes reflect the prioritisation of gynaecological procedures? The facts certainly point to its neglect in comparison with other procedures. In the RCOG report, both the women and the RCOG members surveyed describe the way in which gynaecological conditions were perceived and prioritised as one of the biggest barriers to reducing the length of the wait time.
I want to quickly mention the data that I was sent from the APPG on women’s health. This is from its “Informed Choice” report of 2017. The APPG’s survey of 2,600 women showed that 42% were not treated with dignity and respect; 62% were not satisfied with the information that they received about treatment options; and nearly 50% of women with fibroids and endometriosis were not told about the short or long-term complications from their treatment. That information is from 2017, so we cannot put all that down to the pandemic. I hate to say this, but there is a problem with people’s attitudes to women’s health when it involves reported symptoms and the voice of patients.
When the Government finally publish their women’s health strategy—something the Labour party has been calling for since 2019—they should include an investigation into possible gender bias in the prioritisation of gynaecological services, and an end to the use of the term “benign gynaecology” to describe gynaecological conditions such as endometriosis, fibroids and polycystic ovary syndrome. There needs to be a shift in the way gynaecology is prioritised as a speciality across the health service. I understand that the RCOG is keen to engage on that with the NHS in all four regions.
I have given a few examples, but there are so many more. I really was inundated with testimonies from women ahead of this debate. There were so many cases and examples of the terrible effects that a prolonged wait for treatment can have. The prioritisation of care as part of NHS recovery must look beyond clinical need and consider the wider impacts on patients waiting for care. There must be a significant re-think in the development of a prioritisation framework for recovery that considers the impact of ongoing symptoms on an individual’s physical and mental health, their quality of life, their fertility, and their ability to participate in work, family and social life.
The RCOG has offered to work with stakeholders across all surgical specialties and the NHS to look at what the framework could look like in practice. We have an unequal growth of gynaecological waiting lists compared with other specialities, and that must be addressed as a matter of urgency. We have seen that there is in all likelihood a huge reservoir of unreferred cases, which will only worsen an already unacceptable situation. The RCOG is seeking a national ringfenced budget for recovery and long-term sustainability of elective gynaecology, with national funding to support local solutions. We obviously need to focus that funding on areas with the longest waiting lists and where disparities are greatest.
The NHS in each nation should commit to tracking and publishing progress on reducing disparities in elective waiting lists. The Government must use the women’s health strategy to commit to mandating co-commissioning of sexual and reproductive healthcare, removing the barriers for services outside of hospitals to support women in their communities.
Finally, Conservative Governments have presided over more than a decade of underfunding in our NHS, and that must be addressed. RCOG members were very clear that staffing is the biggest barrier to reducing waiting lists in outpatient settings and in theatre, and to increasing the number of beds. In March, unfilled posts across health services in England rose to more than 110,000, including nearly 40,000 nurses and over 8,000 doctors. Yet nearly 800 medical undergraduates who applied to start training as junior doctors at the start of August this year have been told that there are no places for them—that is the highest number ever. And despite an increase in applications for nursing degrees this year, the number of applicants remains below that of 2016, which incidentally was the last time that a bursary was available to financially support student nurses before it was scrapped.
The answers to gynaecological waiting lists lie in front of us. However, without the necessary action from Government and the funding to increase staff numbers, there will be no sustainable solution to reducing them. Instead, the Government are content to let the NHS limp along, understaffed, overstretched and with record waiting lists and the personal suffering and wider damage to society that they bring.
Ms Lyn Brown (West Ham) (Lab)
It is an absolute pleasure to serve under your chairship, Mr Robertson. I will not detain hon. Members long with my speech, but I do want to say how grateful I am to my hon. Friend the Member for Kingston upon Hull West and Hessle (Emma Hardy) for securing this important debate and what a privilege it is to follow her excellent contribution. So much of what she said about waiting causing harm and the attitude of health services to women I will echo in my speech, because today I want to talk about waiting lists for women who need hysteroscopy.
The thing that I want to emphasise today is that many of those women are having to make a terrible choice—a Hobson’s choice. Either they have that really important procedure—it will determine their health prospects—as soon as they need it and without an anaesthetic, or they can wait and wait and wait until an anaesthetist and a theatre are available. I have now spoken about the issue of painful hysteroscopy in the House nine times, trying desperately to get Ministers to secure a change in the behaviour of the NHS towards women. And every time I speak, more and more women contact me afterwards to tell me about the brutalisation that they have experienced. The stories never stop. Although I am assured by Ministers that action is being taken, will be taken and so on, the stories just go on.
I will share just two stories today. Had I known that only my hon. Friend the Member for Kingston upon Hull West and Hessle and I would be here on the Back Benches, I would have brought more—because I love to watch a Minister squirm—but I have only two stories with me today.
I want to talk about Emily, who is in her 70s. She gave birth twice—once without pain relief, after a very long labour. Therefore, we are talking about a woman who can cope with a certain level of pain without difficulty. When Emily, who is, I repeat, in her 70s, had her hysteroscopy, she was not offered any pain relief, and her procedure was excruciatingly painful. The word that she uses and that many, many women who have written to me use also is “brutal”. The pain was so bad that Emily, in her 70s, passed out. It is appalling, and every single person sitting in this room and watching from home knows that. Emily should have been given the decent, fair choice of having the procedure with an effective anaesthetic and without having to wait months.
We all know that hysteroscopies can be absolutely essential to investigate and diagnose serious medical conditions. But frankly, given the state of the NHS at the moment, women are in effect told to tolerate no pain relief or wait months. That is not acceptable. It means week after week of waiting while knowing that they may have a cancer. It is not acceptable to give them the choice of either having the procedure without pain relief or waiting months to have it with pain relief. They remain undiagnosed and untreated for months.
Imagine being one of the increasing number of women who are aware that hysteroscopy could cause, or has caused, them horrific pain and lasting trauma. Imagine having to wait to make a decision about the diagnostic tool. Imagine what it is like waiting. Imagine having to make that decision.
Let me highlight the pressure that women are under by talking about Francesca. Francesca was referred for a hysteroscopy after experiencing heavy bleeding, but the procedure was so painful that she asked the consultant to stop halfway through. These stories go on and on in the same vein—women begging for procedures to stop and being ignored. In that instance, shamefully, the consultant made light of Francesca’s discomfort, making her believe that she was making a fuss about nothing.
As it turned out, Francesca had pre-cancerous cells in the lining of her womb, and she required a follow-up procedure. This time, she insisted that she was given a general anaesthetic. The consultant’s response to that totally reasonable request made Francesca believe that she was asking for the impossible. The consultant warned Francesca that delaying her appointment could increase her risk. Francesca knew—we all know—that leaving cancerous cells untreated is truly dangerous, and having asked for pain relief from the chronically underfunded NHS, she believed that she was guilty of asking for something that she could not and should not have. She felt belittled and bullied, and she was terrified, so she gave in and agreed to have the procedure without the pain relief that she needed. That is so obviously wrong.
Women should not have to choose between their basic right not to suffer avoidable pain and their right to decent, prompt and respectful treatment from our NHS. They should have an anaesthetist there and a range of effective anaesthetics, so that the women are given a real choice. I beg this Government finally to understand that that cannot go on any longer. The NHS needs to be funded to create the capacity, so that women get the treatment they need in time and free from pain. They need to be treated with dignity because, frankly, what is the point of the Government’s women’s health strategy if it cannot even do that?
Feryal Clark (Enfield North) (Lab)
It is a pleasure to serve under your chairmanship, Mr Robertson. I thank my hon. Friend the Member for Kingston upon Hull West and Hessle (Emma Hardy) for securing this important debate and for her continued advocacy of this issue and many issues affecting health inequality, which predominantly affects women. I praise the contribution of my hon. Friend the Member for West Ham (Ms Brown), who set out some harrowing stories of women undergoing hysteroscopy, such as Emily and Francesca, who are ignored and brushed aside. We know that there are thousands more Emilys and Francescas.
That is why the debate is so vital—not just because of the need for meaningful progress on the long-promised women’s health strategy, but because fundamentally we are discussing issues that affect more than 50% of the population. Too often women’s health is pigeon-holed as niche and as a subsection of healthcare. The idea that gynaecological conditions are manageable for long periods of time, and can be deprioritised as a result, is just not acceptable.
Let me set out what that deprioritisation means. It means endometriosis surgery being delayed five times, resulting in irreversible fertility loss, and severe chronic pain. That perception must change, and women must be given the access to healthcare that they desperately need. Any other area of public policy that affected more than half of the population would not be treated in that way, and quite frankly, women have had enough.
We know that timely access to healthcare matters to women, and to young women in particular—the Government’s consultation on women’s health strategy tells us so. Gynaecological conditions were the No.1 topic chosen by women under 30, yet they are being consistently let down and made to wait day after day, year after year. Waiting lists are spiralling in all parts of the NHS, with records being broken consistently, but in gynaecology those spiralling lists are having a disproportionate impact. As we have heard, the Royal College of Obstetricians and Gynaecologists has found that gynaecological waiting lists across the UK have now reached 610,000—an increase of more than 106% since 2008. That backlog is made worse by significant geographic disparities in care.
Waiting lists are growing across the country: there has been an 89% rise in the north-west; a 97% increase in the midlands; and a 144% increase in the east of England. That means that the chance of getting what little care is available is down to a complete postcode lottery. That is disgraceful.
In my own clinical commissioning group area, north central London, the situation is absolutely dire. There are more than 10,000 women on the gynaecological waiting list, and 311 of them have been waiting for over a year. That not only puts pressure on gynaecological services, but has a knock-on effect on the rest of the NHS. Since 2010, emergency admissions for endometriosis have increased by 87%. Women are in A&E for ruptured cysts after their appointments and surgery are cancelled.
If women were listened to, and the services that they rely on were properly resourced, we would not be where we are. For women, the waiting times are having an impact that is far wider than just on their physical health, as we heard from my hon. Friends. The RCOG survey also showed that 80% of women surveyed felt that their mental health had been negatively impacted while waiting for care. If the problem is not tackled as a matter of urgency, the figures will only get worse and the impact will be more devastating.
Tinkering around the edges simply will not cut it. We need a fundamental rethink of how women’s healthcare is treated. We are in a situation in which, in some cases, we do not even have basic frameworks and clinical guidance in place. For example, there is no National Institute for Health and Care Excellence guidelines on how polycystic ovary syndrome should be treated. Just 8% of women feel that they have sufficient information when it comes to gynaecological conditions. What practical steps will the Minister take to ensure that women have the information that they need to make informed decisions?
I am sure that the Minister will tell us that the Government have listened and that the women’s health strategy will make a real change, but let us just look at how they have been listening. In the women’s health strategy consultation only 0.5% of respondents were from the north or the midlands, and only 7% were from non-white backgrounds. A women’s healthcare strategy that considers the experiences of only a small group of women will not be worth the paper it is written on. When it comes to gynaecology, the Government’s own vision for the women’s health strategy recognises that there is a problem. The unconscious bias that sees women’s health less well served than those in other parts of the system, and consistently losing out and being deprioritised compared with other surgical specialties, must be challenged.
Can the Minister confirm today whether the strategy will be published before recess and will follow through on the issues identified in the vision document? Furthermore, will he include an action plan to ensure that the strategy does not just remain a plan but makes practical changes to the way healthcare is delivered for women? Women who are suffering day after day, as they are being made to wait, deserve action. I hope the Minister has heard the asks from my hon. Friends the Members for Kingston upon Hull West and Hessle and for West Ham. I look forward to the Minister’s response.
The Minister for Health (Edward Argar)
I would just say that if I am still in post on Sunday, I will be the third-longest serving Minister of State for Health since 1970, but only time will tell. I congratulate the hon. Member for Kingston upon Hull West and Hessle (Emma Hardy) on securing this debate about waiting lists for gynaecological services. I know this is a very important subject for her, and I would like to take a moment to highlight her well-known focus in this House on women’s health matters and the work she has done in that space, which reflects the importance many of our constituents attach to these issues.
As has been alluded to, the hon. Member for Kingston upon Hull West and Hessle has done important work on the suspension of the use of vaginal surgical mesh. She has also worked to promote menstrual wellbeing and worked with Endometriosis UK. I congratulate her on that. It is always a pleasure to answer a debate of hers or to respond to her in the Chamber. It is also a great pleasure to be able to respond to the hon. Member for West Ham (Ms Brown), who as ever gave a typically powerful and forthright speech. She highlighted some harrowing examples—as the shadow Minister put it—that illustrate the broader issues around hysteroscopy and particularly the challenges around the NHS listening and acknowledging patients’ genuine concerns and requests. I will return to that in a moment. Normally at this point I would offer to meet with the hon. Member for West Ham to discuss this, but I will instead offer that the relevant Minister meet with her to discuss this matter further and the specific points she raised with her typical forthrightness and expertise.
The covid-19 pandemic has left a large backlog of people needing care. The latest figures show that 6.53 million people are waiting for NHS care, with 1.55 million of these waiting for diagnostic tests. As part of this, the waiting list for gynaecological services has over 28,800 people waiting longer than a year for care. We are working hard to reduce the number of people waiting for these vital services as swiftly as we can. It is promising that activity levels have reached 95% of their pre-pandemic levels in this area, but that is still 5% short of what normal activity would have been pre-pandemic. We recognise that more needs to be done in this space.
We are increasing capacity for gynaecological surgery to tackle long waits in two key areas: first, through surgical hubs, which allow for higher volumes of care to be carried out in protected circumstances, reducing the risk of covid-19 infections; and secondly, through the high-volume, low-complexity programme, which allows increased volumes of surgical procedures to be carried out. To support services further, we have grown the workforce in gynaecology with the addition of 108 consultants this year, bringing the total number working in obstetrics and gynaecology to over 6,400, an increase of 681 since 2019.
The hon. Member for Kingston upon Hull West and Hessle rightly highlighted a number of key points, one being staffing and another being funding, which is also about facilities and their availability. That is why we increased funding by £33.9 billion in the legislation passed in early 2020 to reach a certain level by 2023-24, plus we provided additional funding throughout the pandemic. We recognise that there is a lot more to do.
The hon. Lady also talked about prioritisation and ringfencing. The only note of caution that I will set out about ringfencing particular parts of budgets is that often it is more effectively done by local clinical systems than by me or another Minister. Often those systems are best placed to work out what their priorities are, based on their waiting lists, population health and population need. I hope that integrated care systems will play an increasingly large role in understanding that, and adapting to the needs of local areas.
Turning to the women’s health strategy, which I know is a central element of the way the Government propose to move forward. Across women’s health we are working to deliver better care through the first women’s health strategy for England, which will reset the way in which the Government are looking at women’s health. That will correct the way in which the health system has in the past been set up—it is fair to say, although hon. Members may disagree—by men and for men. That is the historical evolution of our health service. Huge progress has been made, but there is more to do, which is why that focus is necessary.
Work on the strategy began in December 2021, when we published “Our Vision for the Women’s Health Strategy for England”. We announced in that vision that we are appointing the first ever women’s health ambassador for England. In June we announced the appointment of Dame Lesley Regan to that role. She will focus on raising the profile for women’s health, increasing awareness of taboo topics, and bringing in a range of collaborative voices to implement the women’s health strategy. To reassure the hon. Member for Kingston upon Hull West and Hessle, we do aim to publish the strategy before the summer recess. The relevant Minister will aim to do that.
Emma Hardy
When that is published, will it include the point I made about looking at whether there is a gender bias in the prioritisation of health treatment? That was something that the RCOG was really keen to emphasise. Everyone understands that covid meant waiting lists for everything. One of my key points was whether there is a gender bias? Is that partly why gynaecological treatment seems to be delayed more than others?
Edward Argar
I do not want to prejudge the specifics of that strategy. In broad terms, I hope that I can reassure the hon. Member that we are seeking to look at all the drivers of the challenges that she and other Members have highlighted, and seek to address improvements. Without prejudging, there are points made by hon. Members that I would expect to see included around information, engagement, guidance and empowerment. The importance of empowering women, believing them and engaging with them came through very clearly in the hon. Member for West Ham’s comments.
Ms Brown
I am grateful to the Minister for what he is saying. It is about empowerment, but there is no empowerment when the choice is either to go for it now or to wait for months. Over and over, I have correspondence from women who are being belittled by those in gynaecological services, telling them not to make such a fuss “dear”. That is despite the fact that getting up off the floor after something is often awful. I have had meetings with Ministers; what I really want is some action.
Edward Argar
I am grateful once again for the hon. Lady’s typical forthrightness. I have debated with her on a number of occasions—I was going to say “crossed swords” but that is unfair—and I know that she means it with good intentions, even when she is being rightly firm with Ministers in pressing a case. She is absolutely right. When I talk about empowerment, I envisage that encompassing a whole range of things. That includes believing people, treating them with respect and listening to them.
In terms of action, one Opposition Member—forgive me; I do not remember who—mentioned the need for a clear delivery plan. I have been in the Department for almost three years now. Governments of all complexions are often very good at coming up with strategy documents, which are important. However, the key to whether they deliver the outcomes for all of our constituents is how we deliver and implement them on the ground. We have to get the strategy right; that is the first step and we anticipate publishing that before the summer recess. However, it is then important that we focus on delivery, and that we work not just with the NHS but with patients and relevant campaign groups to work out how we deliver on the intentions in that strategy.
More generally, we set out in our elective recovery plan how we intend to build back from covid-19 and reduce waiting times across all elective services, including gynaecology and menstrual health. The plan included our commitment to tackling long waits, eradicating waits of longer than two years by the end of July 2022, and eliminating waits of over one year by March 2025. We will also ensure that 95% of patients waiting for a diagnostic test will receive it within six weeks by March 2025. To support that, we have committed to spend more than £8 billion from 2022-23 to 2024-25, in addition to the £2 billion elective recovery fund and the £700 million targeted investment fund already made available to systems.
That will hugely increase the capacity in the system. However—this also relates to the point made by the hon. Member for West Ham—one of the aims of the elective recovery plan, My Planned Care, and similar, is to increase, not just in the space of gynaecological services but more broadly, the opportunities for patients to exercise choice over whether they want something immediately or would prefer to wait, and potentially where they would prefer to have that procedure performed. We are continuing, through this, to try to build in more choice, not just for the patients—although that is crucial—but to help maximise the capacity within the system, to help avoid people having to wait longer than necessary.
Ms Brown
What research, if any, has the Minister done on hospital trusts, for instance, that might have people in a number of different geographical areas being served by a group of hospitals, and whether there is any real choice about which hospitals in those families people can elect to visit?
Edward Argar
The challenge that the hon. Lady poses is that if we are talking about, essentially, the multi-hospital trusts or similar, as they have grown up, they have often designed their services in x specialism in one hospital, and moved things around like that. In those cases, there are often only one or two hospitals within the trust that do it. We are seeking to try to create greater choice across the entire system, including regionally, which genuinely builds choice. That is a big challenge—Governments of both complexions have tried it with varying degrees of success—but that is what we are seeking to do here. However, there is a lot of work to do in that space. I hope that when she sees the strategy she will recognise the degree of underpinning research that has been done. It may not necessarily cover every point that she has focused on, but I hope she will recognise the amount of work that has been done.
Emma Hardy
I thank the Minister for again giving way. When we see the women’s health strategy, will it respond to all of the recommendations from the Cumberlege review? We had a bit of an interim response to the review, but I am sure the Minister will be aware that there is still a cross-party campaign to ensure that all of those recommendations are fulfilled. If he ever does happen to find himself on the Back Benches, he is more than welcome to join any of my APPGs, and any of those campaigns, from a different side. I would be keen to know whether he is aware of any plans to fully address the report and fulfil those recommendations.
Edward Argar
I am grateful to the hon. Lady. She highlights an issue that I know has exercised Members on both sides of the House. Although progress has been made, I know that a campaign on other elements continues. This makes me sound as I used to occasionally, doing the morning media round and talking to Kay Burley or similar, but I do not want to prejudge what might be said in due course—that was sometimes a wise thing to say when discussing infection rates, restrictions or similar. I do not want to prejudge or predetermine what will be in that strategy, but I genuinely hope and believe that the hon. Lady will be pleased when she sees it. I would not for a moment expect her not to challenge it and seek to improve it, because I have worked and interacted with her before, and that is what Members do in this House. However, I hope that she will see progress in there.
We know that diagnostics are a key area in many gynaecological pathways. As such, we are establishing up to 160 community diagnostic centres across the country by 2025. There are currently 90 such centres operating across the country, including supporting spoke sites, and they have delivered 1 million tests and scans since July 2021. The expansion of the centres will mean that the NHS will have just shy of 38% more MRI capacity, 45% more CT capacity, 26.8% ultrasound capacity improvements, and an increase of around 19% in endoscopy capacity by March 2025, compared to pre-pandemic levels. That will allow more patients to be seen more quickly, meaning they can be diagnosed sooner and then start any treatment they need.
I will turn briefly to general practitioners, who are often key in the treatment of gynaecological conditions. As we all know, general practices are still very busy and are caring for patients in the community who are on waiting lists for secondary care. I pay tribute to the work of general practitioners and their teams throughout the pandemic. We know that some patients have struggled to get through to their GP practice on the telephone, which is why the NHS offered practices an interim telephony solution that enabled them to use Microsoft Teams to free up lines for incoming calls.
We made an additional £520 million available to improve access and expand general practice capacity during the pandemic. I mention this in passing because it is important to recognise that for many the general practitioner is the front door to the system and being able to get access to a general practitioner is a crucial part of being able to get into the care pathway, be that for diagnostic tests or for acute treatment, should that be needed.
I will wrap up now and I hope that will give the hon. Member for Kingston upon Hull West and Hessle a few minutes to respond. In conclusion, I pay tribute to her for securing the debate and bringing it to the Chamber. What this Chamber may lack in numbers, for various reasons this afternoon, is made up for in quality and in the importance of the subject of debate. As ever, I am grateful to the hon. Member for West Ham and to the shadow Minister, the hon. Member for Enfield North (Feryal Clark), who it has always been a pleasure to appear opposite in this Chamber. I hope that I have offered some reassurance to hon. Members about the extent to which the Government take the issues that they have raised extremely seriously, and I too look forward to the publication of the strategy.
Emma Hardy
I thank everyone who has taken part in the debate. In different circumstances this would have been a very full debate. I look forward to seeing the women’s health strategy as soon as possible. I feel I have been unable to give coverage to the number of women who have contacted me, but I say to them that I have read each and every one of their messages. The testimony that they give is incredibly moving, and clearly something needs to change.
Issues around women’s health appear to be disproport-ionately impacted, and that is not right. I am sure we will all raise this subject again and, in all sincerity, the Minister is always welcome to campaign with me on this issue from the Back Benches.
Question put and agreed to.
Resolved,
That this House has considered waiting lists for gynaecological services.