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Official Development Assistance Reductions
(1 day, 10 hours 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
Edward Morello (West Dorset) (LD)
I beg to move,
That this House has considered the impact of planned reductions in Official Development Assistance on international development.
It is an honour to serve under your chairship, Sir Desmond. I thank the Backbench Business Committee for granting this important debate, and my co-sponsors from across the House—the hon. Members for Rotherham (Sarah Champion) and for Chester South and Eddisbury (Aphra Brandreth), and my hon. Friend the Member for Esher and Walton (Monica Harding)—for their support in securing it.
It is almost a year since the Prime Minister announced sweeping cuts to official development assistance, a decision that prompted the resignation of a former Minister for International Development, the right hon. Member for Oxford East (Anneliese Dodds), who could not in good conscience support the dismantling of Britain’s global leadership in aid to fund increased defence spending. That decision marked a turning point. It signalled that Britain, once a leader in development and compassion, was willing to trade its soft power for short-term savings, instead of taking strong and bold decisions such as increasing taxes on tech giants or a bespoke customs union with the EU, as my party has so often urged.
The UK’s proud record as a global leader in aid has been left shredded. The previous Conservative Government reduced the aid budget from 0.7% to 0.5% of our gross national income. This Labour Government now plan to cut it further to just 0.3% by 2027—the lowest level this century. Nearly one third of what remains of the UK aid budget is being spent not on tackling global poverty, preventing instability and migration, but on in-country asylum accommodation. That leaves far less for the world’s poorest and most vulnerable. The very budget designed to prevent displacement is being used to pay for its effects. At far greater cost to society, we are left treating the symptoms, not the cause.
These cuts come even as global need rises. Over 123 million people are displaced by conflict. The World Food Programme warns that reduced funding for aid could push another 13.7 million people to severe hunger. In Sudan alone, 30 million people now need humanitarian assistance, with 25 million facing food insecurity. Children in Gaza are enduring unimaginable suffering, with families driven to starvation amid a humanitarian catastrophe. Over 640,000 people now face catastrophic food insecurity, and projections warn that as many as 43,000 children could die from malnutrition by June 2026.
The Liberal Democrats have always helped to lead on international development. We proudly enshrined the 0.7% target in law, because it was an investment in peace and prosperity, but also in long-term security. Aid is not charity; it builds peace, prevents conflict and addresses the root causes of instability and migration.
Alex Ballinger (Halesowen) (Lab)
The hon. Member is raising some good points about national security and migration. He is probably well aware that the top three nationalities that come to the UK on small boats are from conflict-affected states: Afghanistan, Syria and Iran. Does the hon. Member share my concern that the UK dismantling the Foreign, Commonwealth and Development Office’s conflict and migration department is the wrong decision at a time when we should be investing in conflict prevention, rather than withdrawing from it?
Edward Morello
I thank the hon. Member, who is my colleague on the Foreign Affairs Committee. His background and expertise in this area is unrivalled, and I agree 100% with his sentiment; it is money badly spent when we do not invest in conflict prevention. The decision to cut our official development assistance from 0.7% to 0.3% of GNI by 2027 comes at the worst possible time. It adds to the nightmare caused by earlier cuts in 2021 and the devastating aid freezes in the United States by Trump’s White House. If we stay on this trajectory, by 2027, Britain will be spending over £6 billion less on aid than if we had simply maintained the 0.5% commitment. That is equivalent to cutting the entire education or health portfolio from our overseas spending.
Sarah Dyke (Glastonbury and Somerton) (LD)
My hon. Friend speaks about security and education. A charity in my constituency, School in a Bag, based in Chilthorne Domer, has delivered 160,000 school bags filled with stationery to children all over the world, giving those who live in the most deprived circumstances the tools for an education and a lifeline out of hardship. Does my hon. Friend share my concern that the reach of brilliant charities such as School in a Bag will be shrunk without stable ODA-backed grants?
Edward Morello
I agree 100%. What is so wonderful about Britain is how, time and again, communities step into the void left by Government spending, but we cannot rely entirely on the charity and good will of others.
The UK’s contribution to global health, education and nutrition, which are the foundations of our stability, is being eroded. Nutrition-focused aid has fallen by 60% and education spending has declined by 83% since 2016. Aid for reproductive health has fallen by 68%, and primary education now accounts for only £71 million of the entire ODA budget. The list goes on, and they are not just statistics. They are classrooms that will never reopen; vaccines that will never be delivered; and children who will never have a fair chance in life.
As a member of both the Foreign Affairs Committee and the Joint Committee on the National Security Strategy, I have seen at first hand how aid and development are integral to our security. In recent weeks, we have seen the malign influence of China and Russia on our domestic politics. Those malevolent threats are already prevalent in the countries we support. We must not give them space to grow because, when we retreat, the vacuum is filled by those countries that do not share our values.
The strategic investments of Russia and China are already exploiting that space. China would have no difficulty stepping in to replace UK influence, especially in the global south, where its belt and road investments already run deep. But Beijing’s model of aid is transactional, not transformative. We should not be surprised when those nations fill the void, with motives far removed from our liberal and democratic values.
As Members of this House, we should never forget that the world watches what Britain does. When we lead, others follow. When we stand firm, others shrink back. Development and defence are not opposites; they are two sides of the same coin. Soft power—the influence we exert through compassion, diplomacy and culture—is what gives our country the moral legitimacy that has underpinned our diplomacy since the post-war era. It is what makes Britain a leader on the world stage. When we cut aid, we cut influence. When we weaken our global reach, we make ourselves less safe.
The Government have argued that the reduction is necessary to fund a rise in defence spending, to reach 2.6% of GDP by 2027. Yes, we must invest in defence, but we cannot defend Britain by turning away from the world. We cannot keep our citizens safe by cutting the very programmes that prevent conflict and suffering at source.
Richard Foord (Honiton and Sidmouth) (LD)
My hon. Friend is making a fantastic speech. This weekend, the Government announced £5 million for Sudan and £6 million for Gaza. By contrast, the Government are spending £2.2 billion of ODA on hotels to house asylum seekers in this country. Does my hon. Friend share my view that the money would be better spent on preventing conflict and keeping people safe in their own regions?
Edward Morello
I agree 100% with my hon. Friend. Purely on a value-for-money basis, it is wiser to spend money where people are, to prevent them from getting on the road, than to try to house them here.
Migration and global instability do not begin at our borders. They begin when climate change destroys livelihoods, when wars displace families and when hunger drives desperation. Compassion and prevention are not opposites of security; they are the foundations of it.
Climate change remains the single greatest threat we face. Carbon knows no borders; it does not respect treaties or national boundaries. If we cut funding to those on the frontline of climate vulnerability, we are cutting our own future resilience. Whether that is in the Caribbean, the Sahel, the middle east or the Pacific, our partners need leadership, and Britain should be that leader.
The Government’s commitment to meet their £11.6 billion international climate finance pledge by 2026 is welcome, but it is increasingly hollow if other aid streams are being dismantled. We cannot claim climate leadership while simultaneously cutting the very funds that protect vulnerable nations from its impact and help them to decarbonise sooner. The UK has always been at its best when leading with principle and pragmatism. We led on eradicating smallpox, on fighting HIV/AIDS, on girls’ education, on tackling modern slavery and, of course, on the creation of the United Nations.
Today we must show that same moral courage. The cuts to the ODA budget are not only a betrayal of those values, they are a strategic mistake. Every pound we invest in aid saves far more in the long term, by preventing wars, stopping pandemics and reducing the need for emergency interventions. We live in a globalised society. Our economies, supply chains and security are inter- connected. Disease, conflict and climate crisis spread across borders with ease. To imagine that Britain can isolate itself from those realities is naive; if we fail to act abroad, we will pay the price at home.
I pay tribute to the humanitarian workers who continue to serve in some of the world’s most dangerous environments, and who risk their lives daily to deliver aid. They embody the best of British values, yet their work is getting harder. From Gaza to Sudan, from the Democratic Republic of the Congo to Ukraine, aid workers face extraordinary challenges. In 2024, one in eight people worldwide was exposed to armed conflict. Humanitarian staff have been detained, attacked and even killed, and entire operations have been halted due to insecurity. Our response to that sacrifice should not be to cut funding for their organisations—they deserve not only our gratitude but our tangible support. We must ensure that safeguards and funding are extended to humanitarian workers, who represent British values in the most fragile corners of the world.
The Government expect aid reductions to provide £500 million for defence in 2025-26, £4.8 billion in 2026-27 and £6.5 billion in 2027-28. That may satisfy Treasury spreadsheets, but it will come at the cost of lives, stability and influence. In the coming weeks, this House will debate spending priorities at the Budget. The timing of this debate could not be more important. It is a time of hardship and high costs of living for all. There are difficult decisions to be made, both domestically and abroad. But we should remember that the choices we make here ripple far beyond our own borders. They shape how the world sees us, and how safe, stable and prosperous our shared future will be.
Uma Kumaran (Stratford and Bow) (Lab)
Does the hon. Member agree that at a dangerous moment geopolitically, with tensions high and multilateralism facing challenges—which, as members of the Foreign Affairs Committee, we are more than aware of—it is incumbent on all of us to advocate an approach that treats global co-operation, our international obligations and our defence and security as interconnected?
Edward Morello
I agree 100% with the hon. Member. The more we work with our partners, the more we can deliver. We are living in an interconnected society; there is no way we can do this alone. We must work with others, and we must show leadership in that space.
If aid spending remained at 0.5%, it would have reached £15.4 billion by 2027. Instead, it will stand at £9.2 billion, the lowest in real terms since 2012. When we retreat, Russia and China advance; when we stay silent, violence speaks for us. There can be no security without stability, and no stability without development. Development is not an add-on to security and foreign policy, but what that policy is built on.
I therefore urge the Government to reconsider the planned reductions ahead of the Budget, and to bring forward sustainable, long-term plans for funding both our defence and our diplomacy, rather than setting them in competition. I urge them to recognise that global leadership cannot be built on cuts and withdrawals, but on conviction and compassion. The world we are shaping today, through the choices we make on aid, diplomacy and climate will determine whether future generations—our children and grandchildren—inherit a planet of opportunity for all.
We must stand up for liberal values, for compassion and for the rules-based international order. Britain has always stood tall on the world stage. Our leadership has mattered. It must matter again.
Sir Desmond Swayne (in the Chair)
I call Sarah Champion. I suggest five minutes.
Sarah Champion (Rotherham) (Lab)
It is always a pleasure to serve under your guidance, Sir Desmond. I thank the hon. Member for West Dorset (Edward Morello) for his powerful and accurate speech, with which I associate myself.
Recent reductions have meant that UK ODA has dropped from the legally enshrined 0.7% to 0.5%, and it is now projected to be at 0.3% by 2027. That represents a significant retreat of UK leadership on international development and on the international stage. If ODA were to remain at 0.5% of GNI in 2027, it would total £15.4 billion; at 0.3%, it would be £9.2 billion, the lowest ODA in cash terms since 2012. That is a reduction of more than £6 billion in support for millions of vulnerable people around the world—people whose safety, health and long-term stability are in the UK’s immediate and long-term interest.
The Government acknowledge that this reduction requires many hard choices. In May, when Baroness Chapman appeared before my International Development Committee, she told us:
“The days of viewing the UK Government as a global charity are over”.
As I said to her then, money spent on aid and development is not charity; it is an investment. Let me give two examples.
First, the support that we give to fragile and conflict-affected states helps stabilisation efforts and prevents the creation of conditions ripe for generating extremism, which can lead to problems that end up on the UK’s doorstep and to a direct impact on our national security. Aid is now being cut for victims of the raging conflict in Sudan, from £146 million to £120 million, but the casualties, the victims and the devastation are only increasing. The many millions of Sudanese civilians displaced by the war are at severe risk of food insecurity and may seek security in Europe, worsening the pressure on the continent’s already struggling refugee protection systems. The lack of support for the Sudanese people over recent years has been devastating. My Committee was told last week by Shayna Lewis, an independent expert who works on the ground in Sudan, that the UK has refused to heed warnings and invest in atrocity prevention in Sudan over the past year, which could have been vital in preventing the horrors that are unfolding today in el-Fasher.
Secondly, UK ODA has been vital to global health programmes such as the Global Fund to Fight AIDS, Tuberculosis and Malaria, which has cut the combined death rate from those three diseases by 61%, saving 65 million lives—arguably the most effective global health initiative of all time. Experts have warned our Committee that cuts to such programmes will reverse the gains in disease prevention, maternal health and pandemic preparedness.
Similarly, the Government must protect investment in global nutrition. ODA reductions in 2021 led to a cut in nutrition spending of more than 60%, and in 2023 nutrition spending was drastically cut. In Afghanistan, it was down £87 million to £8.9 million; in Nigeria, it was down £11.8 million to £15.9 million; and in Myanmar, it was down £9.9 million to just £0.2 million.
How will the Department deliver the four essential shifts announced by Baroness Chapman when funding, staffing and support programmes around the world are being so dramatically scaled back? It is not clear how the Government will deliver more with so much less. With the United States Agency for International Development shut down, and with other Governments reducing aid, it seems that instead of stepping up to fill the gap, the UK is stepping further back.
What is most concerning is that the Government do not seem to have a strategy to manage the impact of the cuts on those who are affected. For example, the Government’s own equality impact assessment acknowledges the disproportionate impact of aid cuts on women and girls, risking the reversal of hard-won gains in that area. Previous cuts to ODA led to a 41% cut in programming to prevent violence against women and girls, and a 66% cut in funding for women’s rights organisations. Furthermore, even a 30% decrease in funding for sexual and reproductive health rights could lead to an additional 1.1 million unintended pregnancies. These programmes are vital for the safety of women and girls and the sustainability of societies around the world.
Reducing ODA is not merely a budgetary adjustment. It is a political choice: a choice not to consider the longer-term benefits of investing a small percentage of taxpayers’ money in return for vast benefits to the poorest communities around the world and to our own safety and security. I urge the Government to reconsider the damaging, deadly trajectory that we are on.
Several hon. Members rose—
Sir Desmond Swayne (in the Chair)
Order. I suggest four minutes from now on.
David Mundell (Dumfriesshire, Clydesdale and Tweeddale) (Con)
It is a great pleasure to follow the hon. Member for Rotherham (Sarah Champion), the Chair of the International Development Committee, because I want to refer to one or two things that the Committee has been doing. I thank the hon. Member for West Dorset (Edward Morello) for securing the debate.
Given that this is a major change in Government policy, there has been very little debate in Parliament about it. I fear, though, that we will not be able to secure an increase in spending unless we can increase public support for development. Those of us who have been committed to development have to concede that we have been complacent in thinking that that support would automatically be there, and that people would see good for what it is. That is not the case. As I think most Members would recognise from their mailbags, when this change was made there was very little public reaction.
Mr Gregory Campbell (East Londonderry) (DUP)
The right hon. Member hits on a very important point. There is not much wider public support, for two big reasons: corruption in some of the countries to which aid is going, and the misappropriation of food and other produce that is delivered. Until we address those issues, we will face an uphill battle in getting public support in the UK for more money.
David Mundell
That is partly right, because negative stories have prevailed and we have not had people on the other side rebutting them, as we have not had advocates on the ground. I feel that many non-governmental organisations became far too corporate in their approach: they did not have the local people who were able and willing to collect money or to stand up and make the case in their community environments.
The International Development Committee has visited the US, to try to find out what is happening there. One of the great ironies is that—subject to the budget currently being frozen—it looks as though the US cuts will be less than the cuts in the UK, because various interests in the US have pushed back on them. There is no doubt that what is happening in the US will significantly affect the global development structures, and we must react to that. We cannot simply say, “We want to go back to 0.7%, and it will all be all right.” That is not the world we are in.
We will have to demonstrate specific things that the UK can contribute in a leadership capacity. For example, we have heard that the US will not be funding any family-planning activity or LGBT activity, so others will have to step up in a strategic and co-ordinated way. Whether it is our Government, other Governments or philanthropists, we must find a co-ordinated way of doing this.
We must also look at how we can deliver most effectively with the reduced funding that we have. As the hon. Member for Rotherham knows, I have been a strong advocate for nutrition. One of the biggest disappointments to me of late has been that, after the International Development Committee conducted an inquiry into sustainable development goal 2, we received a very, very poor response from the Government. I accept that it took place during a period of change, but there was nothing concrete in the response. In fact, there was less in it than what was said a few months ago at the nutrition for growth summit in Paris.
It seems to me that the Government embarked on these cuts without a strategy. We might disagree with the strategy in the US, but at least there was one: there was a clear objective, and it took certain actions to pursue it. I am not aware of any clear strategy being pursued in the UK.
Finally, as co-chair of the all-party parliamentary group on HIV/AIDS, I want to make a pitch for the Global Fund. The Global Fund has been a huge success in combating HIV and AIDS, and I hope that the Government can proceed with a replenishment of £1 billion. I campaigned against my own Government to get £1 billion last time, and it would be very disappointing to find an incoming Labour Government cutting that.
Bambos Charalambous (Southgate and Wood Green) (Lab)
It is a pleasure to serve under your chairship, Sir Desmond. I congratulate the hon. Member for West Dorset (Edward Morello) on securing this important debate and on his excellent speech. I declare an interest as the chair of the APPG on global education. I will focus on the transformative nature of ODA for the education of children worldwide.
Education has been a crucial component of the UK’s international development effort over the past two decades. It has long been recognised that providing education improves health outcomes, contributes to economic growth, improves gender equality and reduces poverty. In 2013, the percentage of the UK ODA budget spent on education was 13.5% of 0.7% of GNI, but just a decade later it was 3.5% of 0.5% of GNI. With the further projected cuts to ODA—to 0.3% of GNI by 2027, equating to a real-terms cut to funding of roughly 73% since 2019—the situation in the education sector looks dire, with a projected 2.2 million fewer children in school and learning.
The Global Partnership for Education is the largest multilateral fund for education in the world. Its work started here in the UK and now reaches every corner of the globe. It works tirelessly to ensure that every child has, in its words, the “hope, opportunity and agency” that a quality education brings. In 2021, the UK pledged £430 million for GPE. That money has helped to enrol 5 million more girls in school, train 4.7 million teachers and support 372 million children with better education. Although 60% of partners have kept or raised their education budgets to over 20% of total spending, planned cuts raise the possibility of limited or no funding for the upcoming replenishment of GPE. Without UK aid, GPE will struggle to continue its life-changing work.
In the past, UK development has allowed the FCDO to support the strengthening of education systems world- wide, to improve teacher quality, to build accountability mechanisms and to reach the most marginalised children, particularly girls and those in crisis zones, but we cannot celebrate those achievements without recognising the dangers of the planned cuts. To understand the risks, we must understand what is being planned. By 2027, UK aid spending will fall to 0.3% of GNI. At the end of 2025-26, bilateral aid from the FCDO will be down £600 million on the year before. New aid spending decisions have been paused, and payments to multilateral bodies such as GPE have been delayed.
Alongside the planned cuts, the Government have set out new priorities for development aid: health, climate and humanitarian spending, all underpinned by economic growth. Funding allocations have not been confirmed, but those priorities cannot leave education behind. Without investment in education, low and middle-income countries cannot unlock jobs, trade and innovation, and economies cannot grow. The foundation of our priorities must be education.
Conflict zones are in desperate need of development aid. We have seen conflicts in Gaza, Ukraine, Sudan, Afghanistan and Yemen, to name but a few. One extra year of education can reduce the risk of conflict by up to 20%. Although I did not welcome the cuts, I ask the Minister whether she will commit to 0.7% when the economy allows. Will she confirm that the UK has committed to funding GPE and Education Cannot Wait in future rounds?
Charlotte Cane (Ely and East Cambridgeshire) (LD)
It is a pleasure to serve under your chairship, Sir Desmond. I congratulate my hon. Friend the Member for West Dorset (Edward Morello) on securing this debate and on his excellent speech.
As we have heard today, Britain’s aid budget supports international development in countries facing extreme poverty and conflict. We can see it every night on our television screens—in Gaza and Sudan, to name but two places. The aid budget also helps people in developing countries to address the impact of climate change. We have recently seen the devastating damage wreaked by Hurricane Melissa. Communities will need our help to rebuild their roads and housing and get clean water back again. Those are the sorts of things that our aid budget funds.
I am proud that in coalition the Liberal Democrats increased the aid budget to 0.7% of GNI. It is shocking that the Conservatives very quickly reduced it to 0.5%, and I cannot believe that Labour is now planning to reduce it further to just 0.3%. By 2027, as we have heard, that will be £6 billion less than it would have been even at 0.5%. That means £6 billion less for maternity care, vaccination programmes, food aid, education, clean water, flood protection and more. People at the sharp end of the climate crisis and in extreme poverty will die because of the cuts. We should not shy away from that.
At 0.3%, ODA stands at the lowest proportion of gross national income since 1999. That represents an abdication of our moral responsibility on the global stage. Of course, we have to strengthen our national security and defence in uncertain times, but not at the cost of withdrawing support from some of the poorest communities around the world. Does the Minister accept that not only is proper investment in ODA critical to tackling poverty, but it can help prevent conflict abroad? Strengthening national security and stability and addressing poverty and development abroad is not a binary choice: they are intertwined; they are essential for each other. The Government’s decision represents a further retreat into insular attitudes when we need to be doing what we can to tackle poverty and security threats abroad as well as here at home.
For decades, international aid has been vital in growing our nation’s stature through soft power and building a hard-won reputation for supporting the poorest countries in the world. In opposition, the Labour party agreed with us, so it is regrettable that it abandoned those values upon entering government. I hope that the Government will take the contributions to this debate in the spirit that they are intended. We want the UK to be seen as the gold standard for promoting international development, just like the Labour party said in opposition.
This cut is a risk to international security and plays into the hands of Russia and China, so I hope that the Minister will reflect on the message of this debate and explore alternative ways of meeting defence spending commitments, rather than this ill-thought-out cut. In the long term, will the Government consider increasing taxation on social media giants and tech firms to fund defence and increase official development assistance back to 0.7% of GNI? We live in dangerous times, and we are not alone in that. Now is the time to step up on the global stage, not step back.
Emily Darlington (Milton Keynes Central) (Lab)
Thank you, Sir Desmond, for chairing the debate, which I thank the hon. Member for West Dorset (Edward Morello) for securing. The huge amount of consensus from all parties shows that this is not a big-P political issue; it is about how we make the world, and the UK, more secure.
Development is about UK security. I agree that the new global reality means that we have to increase our defence spending, but we should be looking at how to increase our development spending at the same time, because the two serve each other. China and Russia have their own agenda, which is in conflict with our values of democracy and human rights. Their agenda is to destabilise the international rules-based system; they want to exploit, not support. I saw that with my own eyes when I lived in Kenya, where they promised roads in exchange for minerals, and also seemed to kill a bunch of elephants for their ivory on their way out.
The BBC World Service is being picked up at every opportunity, every time we step back. For so many around the world, it has been their only link to the outside world and to free and fair reporting. When we withdraw, desperate countries that need the infrastructure spend have only Russia and China to turn to, and that comes with a very heavy cost. It is destabilising our Commonwealth, which the King leads and for which we have a huge moral responsibility. Countries’ economies are collapsing and famine is returning. That drives migration, as people flee war looking for work and safety, and millions are dying.
We have an opportunity to change that. Malaria has been eradicated from many countries, HIV treatment is on the cusp, based on UK science, and polio has almost been eradicated. We could protect millions across the world, as well as in the UK—because we know that viruses know no borders. We are co-hosting the Global Fund replenishment, yet last time, under the Conservatives, the UK was the only country to cut its commitment. We risk global embarrassment by cutting it further at a time when the world needs global leadership again from the UK. Even the US is not cutting its commitment. There is a huge job ahead to rebuild Gaza and, now, Jamaica. We could demonstrate our generosity by using aid match—I should declare that I am the chair of the APPG for aid match—to show the public that, for every pound they contribute, the Government contribute too in helping to rebuild Jamaica and Gaza.
This is the time not for short-termism just to make the balance sheet work, but for long-term thinking—it is in our Labour values and our Labour history. The world needs the UK to lead. The Prime Minister said that this was one of the hardest cuts that he had to make and that it would be temporary, so what is the route out of the cut and how will we rebuild over the coming years to ensure that development spending is seen as spending on UK security, alongside our defence spend?
Mr Tom Morrison (Cheadle) (LD)
It is an honour to serve under your chairship, Sir Desmond. I thank my hon. Friend the Member for West Dorset (Edward Morello) for bringing this vital debate to Westminster Hall. I want to start with the words of Jane from Cheadle, who wrote to me to ask:
“How will the Government’s cuts impact the world’s most vulnerable children?”
I would like to put that very question to the Minister today.
The Liberal Democrats are deeply concerned by the Government’s decision to reduce the UK’s official development assistance from 0.5% of gross national income to 0.3%—the lowest UK aid contribution as a percentage of GNI since 1999—thereby diminishing the UK’s long-standing reputation as a global leader in humanitarian assistance and development. What will happen to the countless children across the world who will no longer receive healthcare, education, vaccines, social protection or climate disaster mitigation? Millions of children will grow up in a less stable world, more likely to be drawn into extremism or crime, more likely to suffer poor mental and physical health, and less likely to be educated, employed or able to participate in and contribute to democracy—the cornerstone of global security.
The statistics are stark: 2024 was one of the worst years on record for children in conflict. Almost 20% were affected—double the figure just two decades ago. This year, 63 million children have gone hungry, as food insecurity due to violence has increased. The Government’s decision to cut aid is deadly, dangerous and short-sighted. Although we agree with the importance of strengthening the UK’s national security and defence commitments, particularly in the light of increasing global security challenges, we recognise that cutting ODA diminishes the UK’s soft power.
There is an intimate connection between supporting international aid and preventing conflict abroad. ODA investment is an essential tool in tackling poverty, promoting stability and reducing the causes of conflict and migration, all of which serve the UK’s own security interests. It is concerning that the UK’s retreat from its status as an international aid superpower creates a vacuum into which Russia and China flow. The UK’s influence in the world comes through a combination of hard power and soft power, including our development funds. Further diminishing the UK’s soft power will only play into those states’ hands.
A recent briefing from key organisations including UNICEF highlighted the dire impact that these cuts will have on ground operations. Operations across the globe will be scaled back, causing serious harm to citizens of affected countries and those putting themselves in harm’s way to help others—the humanitarian workers. I have highlighted in this Chamber the impact that reducing the aid budget will have on those selfless workers and, as a consequence, on those who need aid. I am sure that everyone in the Chamber knows that 2024 was the deadliest year on record for humanitarian workers. Violence against aid workers has reached unprecedented levels, with injuries, harassment, kidnapping —the list goes on. Slashed budgets mean that the workers have fewer protections and less security, that less aid reaches victims of conflict, natural disasters and climate change in their hour of need, and that children in Sudan, Gaza, the west bank, Yemen, the Democratic Republic of the Congo and Ukraine will miss out on vital lifesaving support.
According to Plan International UK, in Sudan, at least 638,000 people are already experiencing famine conditions, and children are dying of starvation; there have been reports of mothers and children eating leaves from trees just to stay alive. The people of Gaza have suffered beyond anything that we could imagine; with a very fragile ceasefire now in place, we need unprecedented amounts of aid to be pumped into the region. According to Action for Humanity, nearly half of Yemen’s people are already at crisis-level food insecurity, with another million people expected to fall to that level in the coming months.
I will conclude with a quote from David, another resident of Cheadle, who said to me:
“Strengthening our defence should not come at the expense of international aid. These cuts are short-sighted and they are counter-productive.”
I have said before that we must not underestimate our soft power. We must invest in our future security to maintain democratic values, reduce displacement and decrease the chances of conflict. Ministers must reaffirm the UK’s commitment to global security. We can be a beacon of conscience and compassion. Helping now will help the world.
Several hon. Members rose—
Sir Desmond Swayne (in the Chair)
Order. I am imposing a formal four-minute limit.
Rachael Maskell (York Central) (Ind)
It is a pleasure to serve with you in the Chair, Sir Desmond. I congratulate the hon. Member for West Dorset (Edward Morello) on securing the debate.
I refer hon. Members to my entry in the Register of Members’ Financial Interests: I have recently met Unite representatives who work for development agencies. They set out the challenges that they face, professionally and personally, from the cuts to the aid budget. As they face job losses here and around the world, their greater concern is the impact of the cuts, not least given that $44 billion of development funding has been cut this year alone. That is a scandal, given that the UN highlights that for every $1 invested in peacebuilding and development initiatives, $16 are saved, and that for every $1 invested to stimulate economic growth and stability, $103 can be saved by averting future instability.
The World Health Organisation warns that the cuts will mean 38 million essential immunisations not being delivered to children, and that we will see regression in TB, AIDS, malaria and many other programmes. The UN World Food Programme will be starved of vital funds, and the loss of education will deny too many, especially girls, a future. This is a false choice between development, defence and diplomacy, which are now out of balance with one other, causing instability to grow.
I urge the Government to rethink and restore our 0.7% commitment, and to look to raise it to 1%, as we are now learning of the real climate devastation that is causing so much unrest around the world. The last Labour Government built global respect as we modelled our investment approach on building resilience and enabling local providers to sustain services for themselves, multiplying their impact. The erosion we have witnessed since we lost office—the shutting of the Department for International Development, the removal of a Cabinet member and the diversion of funds to pay for the asylum hotels scandal—has been stark. We need to reset our strategy and focus.
Climate and geopolitical challenges are unabating, so the UK approach is needed more than ever to de-risk and build stability in the system. Get this wrong and demands on defence will rise; cut too deep and diplomacy will lose impact. Scaling down funding will have a particular cost for women and girls—it is gendered. Yet fund them, and their empowerment and resilience is unparalleled. Cutting our aid presence gives countries such as China and Russia further space to intervene, as we have heard. Their interests are far removed from ours: while we seek independence, they drive dependence. Their economic models are self-serving; they seek power, control and extraction, and escalate risk for recipients and for us.
We have been such pioneers in providing leadership. Staff have excelled globally. Now they are fighting for others, so today I am fighting for them. The Minister knows the arguments all too well, and I trust that her powerful voice will echo around the Treasury over the coming days so that we can avoid this futile cut, which will cause such harm, cost lives, and cut hope and opportunity. We cannot afford to look away now, when the world is looking to us to step up and lead again.
Brian Mathew (Melksham and Devizes) (LD)
It is a pleasure to serve under your chairship, Sir Desmond. I thank my hon. Friend the Member for West Dorset (Edward Morello) for securing this important debate.
Getting UK aid spending to 0.7% of GNI was undoubtedly one of the Liberal Democrats’ proudest moments. It fulfilled a promise and it put us ahead of the game in the race to reach the Brandt target, but more importantly it meant that the UK was doing its bit to make poverty history around the world. The cut to 0.3% is a tragedy for the poorest on the planet, and it diminishes our reputation and influence.
I want to focus on my own area of expertise: water, sanitation and hygiene, or WASH. Sustainable development goal 6 is clean water and sanitation, but WASH also underpins most of the other SDGs. We know that the world could face a 40% shortfall of fresh water by 2030, and that progress on the sustainable development goals is way off track for meeting that 2030 deadline. More seriously, the UK’s annual budget for WASH has been cut by approximately 82% since 2018—from £206.5 million to a critical low of just £37 million in 2022. Two thirds of healthcare facilities in the 46 least developed countries do not have access to basic handwashing facilities, and without access to WASH, infections are more likely to spread. That increases the risk of antibiotic-resistant infections, which cause 5 million deaths annually.
There are also economic costs. Research by WaterAid has shown that infections developed in healthcare facilities cost seven countries across sub-Saharan Africa $8.4 billion each year. In Malawi, those infections are consuming almost 3% of the country’s GDP, and a staggering 10.9% of its annual healthcare budget is being absorbed in treating them. Many antibiotic-resistant infections treated by the NHS originate elsewhere in the world. Healthcare-acquired infections already cost the NHS at least £2.1 billion a year—a cost that will increase as those infections become increasingly resistant to antibiotics. To protect the NHS, we need to ensure global health security, and that requires investment in WASH.
Women’s health is disproportionately affected by inadequate access to WASH, because they are the primary household managers of water and sanitation, and because of their specific needs in childbirth and menstruation. Every year, more than 16 million women give birth in healthcare facilities that lack WASH, and infections associated with unclean birth environments account for 11% of maternal mortality. Some 1.7 billion people do not have a toilet, which makes managing periods much more challenging. With no facilities at school, at work or in public places, many women and girls stay at home every month. Many girls opt out of school altogether when they start their periods. I could go on at great length, but I will say this: let us do the right thing and restore the 0.7% aid spend.
Noah Law (St Austell and Newquay) (Lab)
It is a pleasure to serve under your chairmanship, Sir Desmond.
Official development assistance is changing. Just two weeks ago in Nigeria, one of the UK’s largest development partners, my colleagues and I from the International Development Committee had a glimpse of the future. Although the FCDO runs dozens of centrally managed programmes in the country, what stood out was not just the scale of the UK’s presence, but the way that we worked hand in glove with state Governments and public institutions to build the capacity that underpins long-term development. Whether that was in technical assistance to the revenue service or tax administration, support for reforming the public health system or advice on the macroeconomic reforms that Nigeria is beginning to implement, the emphasis was unmistakeable: partnership not paternalism.
That is a mature partnership that points the way to the future of international development. As painful as it is for a proponent of international development to say this, when the Government cut aid earlier this year, the writing was on the wall. The system must evolve from trade, not aid, and to transformation rather than transactions.
In that evolution, the UK possesses an extraordinary toolkit. We remain a leader in technical co-operation and capacity building, we are a pioneer in development finance and, perhaps most importantly, we sit at the centre of the global financial architecture. Nearly half of sovereign debt worldwide is governed by English law. That fact alone gives the City of London a moral and practical responsibility. If we want to see fairer, faster and more transparent debt restructuring and prevent another lost decade for low-income countries, the UK is uniquely placed to lead. Global debt reform will not happen in New York or Beijing unless it also happens in London.
In British International Investment—I declare an interest as a former employee—we have a leader among European development finance institutions, one that understands that development finance is not just about providing capital but about building markets. BII’s mission is to identify the bridges that must be built to get economic activity off the ground, create jobs and lift people out of poverty, while delivering a fair return, even when that return is concessional to the British taxpayer. That is smart, modern development policy, which will strengthen Africa’s hand.
Nowhere is the shift from aid to investment more necessary than in northern Nigeria. While parts of the south of Nigeria power on, the north is facing a humanitarian crisis, deep insecurity and environmental stress. Yes, there is an urgent need for aid to combat famine, strengthen healthcare systems and stabilise communities, but we must also confront the structural causes. A major driver of that instability is economic exclusion. Across the Sahel and the north of Nigeria, young people are being pushed off their land by drought, flooding and declining soil resilience. Many of those who end up in the orbit of Boko Haram or bandit groups are not idealogues; they are victims of climate and market failure.
Those problems are not insurmountable, but aid without investment is not the answer to that market failure. If we can give rural farmers the means to invest in sustainable crops and farming practices, agriculture can be a source of peace, dignity and security. The World Bank’s forthcoming Nigeria agricultural value chains growth project—on which I hope the Minister will comment—is now at concept stage, but it aims to do just that, and to mobilise more than $500 million to foster the kind of growth that I have described. I also commend the work that BII is doing with its investee Babban Gona in that realm.
Bobby Dean (Carshalton and Wallington) (LD)
I declare an interest in that my wife works for Save the Children. Indeed, I met her while working in the sector almost 11 years ago to this day.
I start by setting out some context around the erosion of the budget, because it has not just been reduced in absolute terms but as a proportion. That makes some of the arguments about not being able to afford official development assistance due to the lack of growth in the economy slightly disingenuous—because, of course, when the economy does not perform, the amount that we contribute goes down anyway.
There has also been a lot of salami-slicing of the budget. The merger with the FCDO was bad for the amount of aid being directed to the global south; we have also heard about the Home Office eating into the budget. With regard to the latest reason for reducing the aid budget—which is about defence—a lot of the uplift in the defence budget has been on the capital side. We are borrowing to invest in that capital. Therefore it is also slightly disingenuous to say that there is a direct transfer between the international aid budget and the money that is going into defence. That needs to be made clear.
The public misunderstand how much we commit to spending on international aid. In polls, they consistently overestimate it. I believe that if the British public truly understood that the commitment was 0.7%, they would stand by that commitment. It is like asking somebody who is down to their last £100 if they would give 70p to somebody more needy than them. I know that the British public are generous, and that they would not baulk at that figure. I think that they would maintain that commitment.
I now move to the points that were excellently put by the right hon. Member for Dumfriesshire, Clydesdale and Tweeddale (David Mundell) on how we have allowed public support to erode over time. The public’s perception of international aid is that a lot of it is wasted, that some of it is spent on woke projects, that it goes to corrupt Governments, and that the trade-off between investment in the poor overseas and the poor in the UK is a zero-sum game.
It would be easy for me to say that it is the fault of right-wing populists, the media and so on. However, I think that the sector itself has failed to communicate properly. It has failed to tell a long-term story of its success. For 30 years, we have had the same images on our screens—starving African children with flies hovering around their noses. That is the image that we consistently feed to the public, instead of telling some of the stories of progress, such as how we have halved infant mortality and lifted a billion people out of destitution. Those are the stories that we should have been telling the public all along.
I believe that the development sector was one of the most scrutinised in terms of its monitoring and evaluation. From time to time, I am sure that there have been pet projects that were useless. However, generally speaking we have achieved so much from our investment in international aid, so we need to get that message across.
The following points were made by the hon. Member for St Austell and Newquay (Noah Law), so I will not go into them in detail. However, we need to sell the changing purpose of aid—how it is about not dependency but creating independence, how we work in partnership because it is not mere charity, and how it is based on shared values because we all want a good future for our children. It is about telling those stories of progress.
Other Members have already made good points about how this is also in our self-interest—the raw, naked interest of Britain. If we vacate this field, it will be filled by others. When I lived in Uganda for a period, I saw how China is moving in where the UK is moving out, so this has an impact on soft power all over the world.
The points made about conflict security have been well put; whether we feel it in inflation or migration, these problems arrive back on our shores. The arguments against the aid budget are rooted in moral confusion, they demonstrate a poor analysis of the efficacy of aid, and they are strategically short-sighted. That is why we need to restore the 0.7% budget and recreate an independent Department for International Development, so that we can start marshalling that money towards the good, effective and important work that it has always done.
Jim Shannon (Strangford) (DUP)
It is a pleasure to serve under your chairship, Sir Desmond. I thank the hon. Member for West Dorset (Edward Morello) for setting the scene so incredibly well. International development aid has been significant in helping at-risk individuals and groups around the globe. As chair of the all-party parliamentary group for international freedom of religion or belief, I acknowledge the importance of providing financial and physical support to religious minorities that are facing threats, violence and persecution on a daily basis.
International aid has long served as a lifeline for minority groups to rebuild their lives, to provide additional education and to support local organisations. It is a reminder that we have not forgotten those facing the most horrific forms of persecution simply because they choose to believe, whether that is the Rohingya population in Myanmar, Christians in the middle east or the Ahmadiyya in Pakistan, all of whom face ongoing violence, forced displacement and deep-rooted discrimination.
The devastating effects of global cuts to international aid have been evidenced most clearly in the decision to dissolve USAID. In January 2025, thousands of humanitarian and international aid projects were put on a 90-day freeze, and over 80% of its projects were permanently terminated. Global organisations such as World Vision and Samaritan’s Purse, which are active in my constituency of Strangford, were directly impacted, as well as Catholic Relief Services.
Several affected projects involved a focus on freedom of religion or belief, such as Asia and ethnic freedom, or the documentation of religious freedom incidents in Sudan. The NGOs and faith-based humanitarian organisations have now been left with depleted resources, unfinished missions and heartbreaking reports from the field, where support is now absent. That is the effect of the cuts: the staff, volunteers and international partners, who are driven by compassion, conviction and service, now find themselves unable to meet human need because the infrastructure that enabled them to do so has been abruptly dismantled.
The termination of USAID has led to a global vacuum in which NGOs struggle to survive, rendering communities such as the Yazidis in Iraq increasingly vulnerable to the termination of psychosocial support and humanitarian aid. The effect is like a stone hitting water—it ripples the whole way out. Persecuted religious minorities are suffering more than ever without the commitment of permanent, ongoing support. The Government must ensure that their needs are protected and addressed.
The UK has long been a leader in championing freedom of religion or belief, and the Government made a good decision by renewing the appointment of a special envoy for freedom of religion or belief—the hon. Member for North Northumberland (David Smith) —in December 2024. To ensure that we are upholding our reputation and protecting the right to religious freedom, we must strongly oppose cuts in the budget that clearly harm the vulnerable individuals that we are striving very hard to protect.
I believe that we must remain committed to providing high-quality international aid that will contribute to a long-lasting positive change in areas where the persecution of individuals is most targeted. We cannot allow the most vulnerable to be left to suffer, and we cannot turn our backs on injustice.
I am always minded of Proverbs 31:8-9—I know you will appreciate this, Sir Desmond, as I do—which states:
“Speak up for those who cannot speak for themselves,
for the rights of all who are destitute.
Speak up and judge fairly;
defend the rights of the poor and needy.”
There must also be full transparency about how our international aid is being used to promote the fundamental right to freedom of religion or belief, particularly in countries such as Nigeria, Pakistan and Myanmar where so many continue to suffer simply because of their faith. While continuing the aid is vital, it is equally essential that receiving Governments uphold their responsibilities and adhere to the highest human rights standards. Our support must be accompanied by a clear expectation that Governments respect the dignity and freedoms of all people within their borders. I ask the Minister that, where aid is extended, so too must there be a commitment to protect vulnerable religious and ethnic minority groups.
Monica Harding (Esher and Walton) (LD)
It is indeed a pleasure to serve under your chairship, Sir Desmond.
I thank my hon. Friend the Member for West Dorset (Edward Morello) for securing this debate on a critical issue. It is critical because we are at a cliff edge. This year, with 120 armed conflicts, more than at any moment since the second world war; this year, with nearly 320 million people facing acute hunger; this year, when 2024 was the hottest year on record; this year, when the deadly trio of climate, conflict and hunger collide to force the displacement of 123 million people, this Government decided to slash the aid budget to the lowest level this century—after, because of or in spite of the United States Administration’s decision to close USAID, cut the foreign assistance budget by 85% and shed 10,000 jobs.
This year, under a Labour Government, we surrendered our global leadership on aid and development. That represents one of the most consequential and devastating decisions of recent years, with long-term consequences for our stability, security and prosperity, and it will cost hundreds of thousands of lives.
It is a mistake, both morally and strategically—strategically, because aid is not an act of charity, as we have already heard today. It is a long-term investment in our future; it is not a cash machine in the sky, but a deposit account from which we withdraw for our own prosperity. There is a reason why some of the most vociferous voices against these cuts are those of former military leaders. In contradiction of the Government’s attempt to reframe the cuts as a choice between defence and development, they argue instead that the two are mutually supportive. To undermine one, is to weaken the other; as former US Defence Secretary Jim Mattis said:
“If you don’t fund the State Department fully, then I need to buy more ammunition ultimately.”
These are short-term decisions with long-term repercussions—easy now, but so hard further down the line, and costing Britain more in the long run.
Through our development spend, we invest in peace and resilience building. We know that when fragile states collapse, they create breeding grounds for extremism and terror, and that preventing wars is cheaper than fighting them. The ONE campaign has emphasised that every dollar invested in conflict prevention saves more than $100 in emergency response. However, funding for the UK Integrated Security Fund has been reduced by over £130 million this year, leaving vital peace building efforts without support.
Strategically, cutting aid is a mistake because aid keeps our borders safe. When we invest in the economic development of a nation, we give people opportunity and a stake in the success of that nation, so they will choose to stay there rather than feeling compelled to seek those things in Britain by migrating to these shores. As the biggest humanitarian crisis in the world unfolds in Sudan, in 2024 alone more than 2,000 Sudanese nationals crossed the channel on small boats.
Strategically, cutting aid is also a mistake because development spend protects our health and security, and the NHS, keeping disease from our shores. Strategically, it is a mistake because development spend creates the conditions for trade and partnership, strengthening economies that become markets for British goods and services and promote growth.
Strategically, cutting aid is also a mistake because development is an investment in our soft power—the global influence that comes from being a trusted partner. When Britain leads on aid and development, our voice carries further in diplomacy, trade and security; when we withdraw, our influence diminishes and our adversaries, who watched us jealously, knowing the value of that influence, move in. As we cut our soft power tools, such as the British Council and the BBC World Service, China and Russia cement their influence across the African continent.
Those are the strategic arguments against cutting aid, but the moral arguments alone are enough. Government projections show UK aid spending falling from £14 billion to around £9 billion by 2027, a near one-third reduction in real terms, and the actual numbers are far worse. In-country donor refugee costs, or asylum accommodation costs, are consuming a fifth of our entire aid budget. What right have the Government to spend taxpayers’ money—including that of my Esher and Walton constituents—money that had been allocated to help the poorest in the world, in our own country to balance the inefficiencies of the Home Office?
Will the Minister ensure that the FCDO follows the International Development Committee’s recommendations, as set out in its report on the FCDO’s approach to value for money, published last week, that formal steps should be taken to cap the ODA that the Home Office can use for in-country donor refugee costs, including capping those costs at a fixed percentage of total ODA, and make a formal commitment that unspent ODA funding by other Government Departments is channelled back into the FCDO?
Analysis by Save the Children estimates that UK aid cuts will leave 55 million of the world’s poorest without access to basic resources, 12 million without access to clean water or sanitation and 2.9 million fewer children in education. This year’s cuts to Gavi, the Vaccine Alliance, alone will mean 400,000 fewer lives saved.
Let me be clear about what all that means on the ground: in the DRC, a flagship girls’ education programme that we supported will close early next year, and 170,000 children, mostly girls, will lose access to education. Other hon. Members have mentioned Yemen. In the DRC, around 27 million people face acute food insecurity, while cholera and measles spread unchecked. In Afghanistan, half the population—23 million people—require humanitarian assistance. All those are unprioritised by Government cuts. I could go on.
The Liberal Democrats believe Britain can and must reclaim its leadership on development. We need a clear road map to restore the legally enshrined 0.7% aid target. I ask the Minister: will the Government rule out any further cuts, and set out a plan to return to 0.7%?
We must embrace the role that the US has abandoned as the facilitating and convening power. I urge the Government to take up that mantle again, as successive Governments have done before, including Prime Ministers from the Minister’s own party—Blair and Brown, pledging to make poverty history. Before she retorts that those were the good times, I remind her that the coalition Government reached 0.7% for the first time, after the financial crash of 2008. Those were choices. This Government’s choice is to follow Boris Johnson, but to cut deeper, and to join the Conservatives and Reform in a race to the bottom.
I urge the Government to retrieve their progressive mantle; reverse these cuts; restore our legally enshrined commitment and reclaim our leadership on the world stage. Let us make sure that Britain’s generosity, leadership and belief in humanity remain not only a lifeline but a light in our ever-turbulent world.
Wendy Morton (Aldridge-Brownhills) (Con)
It is a pleasure to serve under your chairmanship, Sir Desmond. I thank the hon. Member for West Dorset (Edward Morello) for securing this timely debate. I also welcome the Minister to her place on the Front Bench; I think this is the first time we have met across the Dispatch Box in Westminster Hall, and I genuinely wish her well. I also thank in particular my right hon. Friend the Member for Dumfriesshire, Clydesdale and Tweeddale (David Mundell), who, as ever, demonstrates a very deep understanding and knowledge of development issues and, importantly, the challenges that we face in today’s world.
The UK has a proud record as a global leader in international development. I am proud that that record was shaped and delivered by successive Conservative Governments. On this side of the House, we have always believed that development is not simply about charity, but about partnership, soft power, security and the projection of our national interest. Over the past decade, Conservative Governments delivered real and lasting results that have made the world healthier and safer, and unlocked economic opportunities.
Millions of people were lifted out of poverty through targeted aid programmes and economic development initiatives. We were the single largest public contributor to Gavi, the Vaccine Alliance, which has saved over 18 million lives. Our water, sanitation and hygiene programmes reached over 120 million people worldwide. That is a record that we Conservatives can be proud of.
Today, though, the world we face is very different from that of just a few years ago. We are living through an era of multiple and overlapping crises: conflict in Europe and the middle east; state fragility in the Sahel and the horn of Africa; climate and weather-driven disasters displacing millions and a growing contest of influence, where authoritarian regimes ruthlessly exploit entry points. Against that backdrop, the UK must ensure that every pound of taxpayers’ money spent abroad delivers maximum impact and advances our critical national interests.
We need to focus our resources where they make the greatest difference, where they advance our economic prosperity, strengthen our national security and support global stability. Our country will always play its part internationally, but our development funding must work harder for Britain. Development assistance is a powerful tool of foreign policy: it helps us to prevent conflict before it reaches our shores, to tackle the root causes of migration, and to build the partnerships that underpin trade, investment and shared security.
Our approach should therefore be guided by one simple principle: every pound we spend abroad should strengthen Britain’s influence, advance our prosperity and help to keep our people safe. That does not mean turning our back on those in need—far from it: it means ensuring that our aid budget is targeted, effective and sustainable, not fragmented across hundreds of small programmes, but concentrated in areas that serve both moral purpose and strategic value.
To achieve that, we must also work differently. First, we need to harness the power of economic development. Development finance should not just be about grants; it should open markets, create opportunities and support British business too. When our aid helps to build capacity, digital connectivity and a resilient infrastructure, it lays the groundwork for trade and investment that benefit both sides. British International Investment is a vital vehicle for that. We should go further in aligning ODA with our export strategy and business partnerships. I ask the Minister what specific steps the Government are taking to ensure that private investment is being leveraged to its full potential. How is the FCDO supporting British International Investment and other financial instruments to deliver maximum value and measurable returns for both partner countries and the UK taxpayer?
Secondly, we must modernise our partnerships. Development should be about partnership, not paternalism. It should empower countries to build their own institutions, tackle corruption and take ownership of their future. That is how we strengthen democracy, counter malign influence and help our partners to become resilient, prosperous nations and reliable allies of the UK. We also need to be bolder in linking aid to security outcomes. Our support has helped to build resilience in countries targeted by Russian destabilisation, such as Moldova.
Those are examples of ODA directly strengthening our own national security. Will the Minister set out how the Department is embedding that security lens across its ODA portfolio, and whether new co-ordination mechanisms exist between the FCDO, the Ministry of Defence and the Home Office to align aid spending with defence and resilience goals, including in relation to combating disinformation from hostile actors? In doing so, we should continue to ensure that our support reaches those to whom it makes the greatest difference. Women and girls must remain at the heart of our international development approach. Targeted programmes save lives and support education, health and safety. This work is not only a moral responsibility. It is one of the most effective and value for money ways to deliver on our wider development and foreign policy goals.
Bobby Dean
The right hon. Lady is making an excellent case for international aid and is talking about the need for it to evolve and to be better and bigger in some ways. Why therefore is her party proposing cutting the aid budget to 0.1%?
Wendy Morton
I am grateful to the hon. Gentleman for his intervention; I was just going to come on to the point that I believe answers his question.
Our development partnerships must adapt to the changing geopolitical landscape that we face today. That is at the heart of this issue. The minilateral model, where like-minded countries pool resources for shared objectives can be a powerful force multiplier, nimbler and more accountable than large multilateral programmes. Can the Minister confirm whether the Government are exploring new minilateral partnerships to deliver aid more efficiently and to help to ensure that developing nations choose genuine partnerships of openness and mutual benefit with the UK over one-sided deals with authoritarian powers that can often lead to debt traps?
Within that same vein, the Commonwealth is an immense asset, so what are the Government doing to use ODA to strengthen democratic resilience, improve internal trade and support the new Commonwealth secretary-general’s priorities on prosperity and governance?
We owe it to the British taxpayer to ensure that every pound of ODA is well spent, fully accountable and transparently reported. That means rigorous evaluation, better oversight and a clear demonstration of value for money. It also means having the courage to stop funding programmes that are no longer effective or aligned with our priorities, and to focus on what works. I ask the Minister to set out how her Department is strengthening accountability and transparency mechanisms across its ODA portfolio.
We must recognise that defence, diplomacy and development are interdependent. Strategic flexibility matters in an increasingly dangerous world, and reprioritising elements of the aid budget to strengthen our defence and security capabilities is pragmatic and responsible. We must deliver on that. Security is the foundation of development. Without stability, prosperity and progress, it cannot take root.
Finally, I return to the question raised last week at the Dispatch Box by my right hon. Friend the Member for Witham (Priti Patel) regarding the United Nations Relief and Works Agency. Given the position expressed in recent days by the US Administration about its future role in Gaza, can the Minister confirm what discussions the UK has had with the US and other partners on that issue? What assessment has been made of the implications for UK aid, and what safeguards are in place to ensure that British taxpayers’ money is being used responsibly, effectively and in line with our values?
As we look ahead, our approach to international development must continue to reflect who we are as a nation: outward looking, confident and compassionate. My party’s approach stands for a proud record of global leadership, a focus on results and accountability and a belief that partnership, not dependency, is the path to lasting progress and security. Britain will remain a force for good in the world, not because of the size of our aid budget, but because of the clarity of our ambition, the strength of our partnerships and the integrity of our leadership.
The Parliamentary Under-Secretary of State for Foreign, Commonwealth and Development Affairs (Seema Malhotra)
It is a pleasure to serve under your chairship, Sir Desmond, and to respond to an incredibly thoughtful and important debate. I am grateful to the hon. Member for West Dorset (Edward Morello) for securing this debate, and I thank him for his work on the Foreign Affairs Committee and multiple APPGs.
The Minister for Multilateral, Human Rights, Latin America and the Caribbean, my hon. Friend the Member for Bridgend (Chris Elmore), who covers development in the Commons, would have been here to participate in the debate, but is currently representing the UK at the world summit for social development in Doha. I am sure that the House will understand his unavoidable absence. I am grateful to respond on behalf of the Government. I will endeavour to cover a number of the points that were raised today, but I am sure that my hon. Friend will also be willing to pick up on some of those issues that hon. Members have put on the record. I also thank the Chair of the International Development Committee, my hon. Friend the Member for Rotherham (Sarah Champion), for her work, her remarks today and the Committee’s recent report, which the Department will be responding to in due course.
A number of issues were raised today, and the same very important point was made by a number of hon. Members about the connection between our security and global security. We continue to be clear-eyed about risks to security, which are at the forefront of our minds. We believe that international development is an important lever in delivering mutually beneficial outcomes, including security for us and across the world. A number of other issues were also raised, including on soft power influence in the world, long-term planning, shaping the world of tomorrow and aid matching. Let me add context to those challenges and the question of whether this Government are looking inwards more than outwards. The whole direction of our Government over the last 18 months has been to step up on the global stage. We are a Government who inherited a very difficult set of finances, but more than that, we inherited a broken Government in so many respects, which had stopped looking outwards and had lost respect and trust across the world.
I am proud that we are a Government focused on our responsibilities and place in the world. I am proud of the work that we have done to bring stability to our economy, but we are also now focusing on the long term here and abroad. That is also illustrated through some of the main trade deals and resets that we have had with the US, the EU and India, but we have been upgrading our partnerships with so many countries. I recently participated in the Aqaba process in Italy, hosted by the Italian Prime Minister and the King of Jordan, with a focus on counter-terrorism, development and support in the Sahel region. It is important that we recognise the links between security and prosperity across the world.
Earlier this year, to enable a necessary increase in defence spending, the Government made the decision to reduce our official development assistance budget. We have consistently affirmed the UK’s commitment to international development and to restoring spending of 0.7% of GNI on ODA when the fiscal circumstances allow. It is also the case—this point has been made by a number of hon. and right hon. Members—that it is not all about how much we spend, but about how we spend. It is crucial also that we modernise our approach for today. A more volatile and uncertain world demands a new development model. With less money, we must make choices and focus on the greatest impact. Every pound must deliver for the UK taxpayer and the people we support.
I note the comments about corruption and misappropriation, and I will say that from the conversations I have had with Baroness Chapman, I know that ensuring that we are spending wisely and have value for money—this has been identified as a strength of the UK by the International Development Committee—are top of her list. It is important that we keep that focus.
It is worth spending a little time on our strategy and what is at the heart of our new approach and fundamental shift. First, we are moving from donor to investor, partnering with countries to unlock growth, jobs and trade through innovative finance and private sector investment. Secondly, we are moving from service delivery to system support, helping countries build their own education, health and economic systems, so that they can thrive without aid. Thirdly, we are moving from grants to expertise, leveraging UK strengths such as our world-class universities, the City of London, the Met Office, His Majesty’s Revenue and Customs and the education, health and tech sectors. Fourthly, we are moving from international intervention to local leadership, working increasingly in partnership with local actors, rather than through internationally driven interventions. That does speak to the point that a number of Members made about partnership rather than paternalism.
Several hon. Members rose—
Seema Malhotra
I have a number of points to make, but I will come back once I have made them. On changing from donor to investor, a number of comments were made about British International Investment and other development finance institutions. These are central to the UK’s shifts. BII deploys patient capital to stimulate private-sector growth in developing countries, balancing financial returns with development impact. Indeed, we have seen our partnerships grow, such as with the Gates Foundation. Our co-investments with the Gates Foundation in breeding wheat with higher zinc and climate resilience have benefited more than 97 million people in Pakistan, positively impacting their health and quality of life. In Ghana, the UK is using its development relationship to support Ghana’s goal to move beyond aid. A Ghanaian textile factory financed by British International Investment has grown into one of west Africa’s largest, providing 6,000 jobs, mainly for women, and exporting garments globally.
Sarah Champion
It is of course the Government’s right to make whatever policy decisions and budget cuts they feel appropriate, but how are they planning to do the four priorities with a 25% cut in staffing and a £6 billion cut in the available money?
Seema Malhotra
I will go through how we will take some of the priorities forward and some of the changes that we are seeing through our strategy. I hope that helps answer my hon. Friend’s question. I want to make a point about our investment in Gavi, of which we were a founding member under the last Labour Government. It has generated £250 billion in economic benefits through reduced death and disability. It is a partnership based on the UK’s world-leading expertise in not just funding but research.
From grants to expertise, that partnership comes up in conversations that I have with countries that I work with as Minister with responsibility for the Indo-Pacific. It is important in terms of how we are working to increase the expertise of partners, including the Bank of England, the City of London and the University of Cambridge. We are helping to train financial regulators across countries, and His Majesty’s Revenue and Customs’ partnership with the Ghana Revenue Authority used the UK’s expertise to increase Ghana’s tax revenue collection by £100 million last year—revenues that will help fund Ghana’s transition from aid.
I am conscious of time, but I will make a few further remarks. Reducing the overall size of our ODA budget will necessarily have an impact on the scale and shape of the work that we do. But we are sharpening our focus on three priorities, which match partner needs and the long-term needs of people in the UK, and are also in areas where we can drive real change. These priorities have been highlighted in this debate—humanitarian, health, and climate and nature—and they are underpinned by economic development. They will help maximise our impact and focus our efforts where they matter most.
I reassure the House that the UK will continue to play a key humanitarian role, including responding to the most significant conflicts of our era, in Ukraine, Gaza and Sudan. We will not let Sudan be forgotten. We are the third-largest bilateral humanitarian donor to Sudan, and in April we announced £120 million to deliver lifesaving services to over 650,000 people affected by the conflict.
David Taylor (Hemel Hempstead) (Lab)
On that point, will the Minister give way?
Seema Malhotra
I am sorry, but due to time I will be wrapping up. At the weekend, the Foreign Secretary announced a further £5 million of support to the crisis in el-Fasher. While we have seen cuts, we have avoided disproportionate negative impacts on women and girls and people living with disabilities in this year’s ODA allocations, as confirmed by the equalities impact assessment that we published. We will continue to strengthen actions to help mitigate some of the negative impacts on equalities, including by putting women and girls at the heart of everything we do.
I will make a final point in relation to the ODA budget for supporting refugees in the UK. The Government are focused on reducing asylum costs and ending the use of migrant hotels by the end of the Parliament, and we have already made progress on that. The UK remains committed to international development. We are working with our partners to shape the next stage of global development, and at the same time, we are strengthening the UK’s safety, security and prosperity—and global safety, security and prosperity—which is essential for delivering all the missions of this Government.
Sir Desmond Swayne (in the Chair)
Edward Morello, you have less than a minute.
Edward Morello
In that case, I will not thank everyone individually for their contributions. Thank you, Sir Desmond, for so wisely chairing the debate. I thank the hon. Member for Rotherham (Sarah Champion), for her continuing leadership in this area. I will use my one remaining minute to make the point to the shadow Minister, the right hon. Member for Aldridge-Brownhills (Wendy Morton), that the 0.1% that her party envisages will leave literally no money, once in-country costs are accounted for.
I am extremely grateful to the Minister for stepping in to respond. She made the point that the UK is a leader on the partnership model, but she failed to mention that when we withdraw from that leadership role, others step in. It will be China and Russia. Every Member in the Chamber made the same point about the importance of British leadership in this space, so I very much hope she will take the message back to her Department that we want to see the ODA budget restored.
Question put and agreed to.
Resolved,
That this House has considered the impact of planned reductions in Official Development Assistance on international development.
Royal Mail: Universal Service Obligation
(1 day, 10 hours ago)
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Sir Desmond Swayne (in the Chair)
I will call only Sir Ashley Fox and the Minister to make speeches. There will not be an opportunity for Sir Ashley to sum up after the debate.
Sir Ashley Fox (Bridgwater) (Con)
I beg to move,
That this House has considered Royal Mail and the universal service obligation.
It is a pleasure to serve under your chairmanship, Sir Desmond. It is also a pleasure to move the motion and introduce this debate on Royal Mail and the universal service obligation. This issue affects every household and small business in the country. The postal service is a vital part of our communities. Its future and the changes to the universal service obligation, or USO, particularly affect my constituents.
Our postmen and women are among the most remarkable workers in the country. Out on their routes, come rain or shine, they are often well loved in their communities. The pandemic showed us at first hand the impact that a good postie has—especially for elderly or vulnerable people who were shielding or who had little other human interaction in that period. People in rural areas rely on the service to stay connected.
Jim Shannon (Strangford) (DUP)
I commend the hon. Gentleman for securing this debate. I also respect the men and women of Royal Mail but, in my office, one major issue has been delay. For those who are elderly, with sometimes complex and severe health problems, the mail is not arriving in time. They miss their appointments and the follow-up. The fines from Government are not working. What else does the hon. Member think the Government should do to ensure that Royal Mail is accountable to our constituents for the delivery of mail?
Sir Ashley Fox
If the hon. Gentleman stays, he will find that I answer most of those points in the remainder of my speech. Since 1840, the principle of the USO has been simple: everyone in the United Kingdom, no matter where they live, should have access to a reliable and affordable postal service. It is a promise of fairness. If I post a letter in Bridgwater, it costs the same to deliver to an address in Inverness as it does to one down the road in Taunton.
Chris Coghlan (Dorking and Horley) (LD)
I fully agree with the USO, but in some postcodes in my constituency 20% of first-class mail is delivered late. In Buckland, there is no mail service at all when the postlady is on holiday. Does the hon. Member agree that the Government must work with Royal Mail to improve service?
Sir Ashley Fox
Indeed. The hon. Gentleman will find that if only 20% do not get next-day delivery, they are doing better than average; that does not speak highly of Royal Mail. Since I was elected last year, many of my constituents have told me that Royal Mail is not working as it should. After hearing those concerns first hand, I visited the sorting office in Bridgwater.
In January, I ran a sample survey to ascertain the scale of the problem in my constituency. I ensured that each town and village was sampled, as I wanted to ensure that every area was covered. I had hundreds of responses. Only one in three got a delivery every day; 15% said they received post once a week or less frequently.
In North Petherton, a constituent repeatedly received a bundle of letters delivered once a week, with no Royal Mail van spotted during the rest of the week. I had a report of no deliveries in Othery for more than a fortnight. My constituents had to travel to the sorting office in Bridgwater to collect post personally. In Cossington, a constituent’s weekend magazine subscription went missing for seven weeks in a row. No one area had a wholly good or wholly bad service. In Burnham-on-Sea, 48% of respondents gave Royal Mail 10 out of 10 for reliability of service, and 30% gave it zero out of 10.
It seems that if a household is on a route with a good postie, it gets a great service, but if that route is not allocated, the letters sit in the rack for days on end with nothing happening. That is simply bad management.
Daniel Francis (Bexleyheath and Crayford) (Lab)
I thank the hon. Gentleman for securing the debate. That situation has occurred at Bexleyheath sorting office in my constituency, and Royal Mail asked whether I could help advertise its vacancies. Should Royal Mail do more to try to fill vacancies on routes that are not filled?
Sir Ashley Fox
Indeed it should. We have evidence of poor management and, dare I say, occasionally unco-operative unions.
Anneliese Dodds (Oxford East) (Lab/Co-op)
I have found that local post workers are really keen to innovate where they can to try to deal with the issues. One thing they pioneered was putting the NHS barcode on healthcare-related letters. Does the hon. Member agree that the Minister should liaise with his colleagues in the Department of Health and Social Care to make sure that every NHS organisation puts that barcode on so that those letters can get to the people who need them?
Sir Ashley Fox
I agree entirely with the right hon. Lady.
I know that there are plenty of local problems, but I also want to look at the national picture. In the first quarter of this financial year, Royal Mail’s performance under the existing USO targets fell well short of expectations. The target for first-class deliveries is 93%, meaning that 93% of first-class post should arrive the next working day. In practice, Royal Mail managed only 75.9%. For second-class deliveries, the target is 98.5% delivered within three working days, yet only 89.3% were delivered on time. That is millions of items delayed across the country. When we look at daily deliveries, the story is even more concerning.
In 2024-25, the proportion of daily routes that were delivered was 87.8%. That is against a target of 99.9%. On any given day, more than one in 10 routes were simply not delivered at all. That explains why locally, even within a small village, some people appear to get a good service while others get next to no post at all. A constituent in Spaxton wrote to me to let me know that his postie had complained of severe staffing shortages and that the new contracts being offered were making the jobs unattractive to new starters.
Mr Angus MacDonald (Inverness, Skye and West Ross-shire) (LD)
I wrote to the Post Office in July, three and a half months ago, and it emailed a response this week—I think three and a half months might be a record. The posties in the west highlands, a very rural area, get paid an amount of money that is not attractive to them. We have areas in Wester Ross and Skye that are getting no post at all and have not for some weeks. Does the hon. Member not agree that the Post Office should use the flexibility that it has to pay a reasonable sum to attract postal staff?
Sir Ashley Fox
Yes, I agree. We can all agree that Royal Mail faces real challenges. Many people now communicate primarily online and fewer letters are sent, which impacts revenue.
Apsana Begum (Poplar and Limehouse) (Lab)
I refer to my entry in the Register of Members’ Financial Interests. The hon. Gentleman mentioned the unions earlier. We could perhaps acknowledge that the Communication Workers Union has called out the clear mismanagement of the senior leadership and the need for Royal Mail to fix its recruitment retention crisis.
Does the hon. Gentleman not agree with me that the issue is much wider across the sector in that it is vastly unregulated, creating an advantageous environment for parcel couriers such as Amazon? That has an impact on Royal Mail’s ability to deliver its services when it is being fined by Ofcom. Some see that as a very punitive measure, given that Amazon and other parcel couriers carry on unregulated and make no contribution to the universal network itself. They hive off profits and pay workers a pittance.
Sir Ashley Fox
I am grateful to the hon. Lady for reading out the Communication Workers Union press release. I did refer earlier to bad management and occasionally militant unions. I think good management will overcome the problems, but I do not think the solution lies in more regulation of other private operators. I want to make a little progress now.
The national figures that we see represent a consistent decline in performance over several years, despite the clear legal and moral obligations that come with being the nation’s postal service. Ofcom has noticed. In 2022-23, Royal Mail was fined £5.6 million for failing to meet its delivery targets. The following year, 2023-24, the fine almost doubled to £10.5 million. In 2024-25, it more than doubled again—a staggering £21 million penalty for failing to deliver the service that the public expects and deserves.
In the face of mounting pressures, changes to the USO have been adopted. I must admit that I am sympathetic to some of the arguments that have been made. If I asked many of my constituents whether they would rather have post delivered consistently every other day, they would gladly accept, but I worry that that will not happen.
Under the changes being discussed, the number of delivery days would be reduced, meaning fewer days on which post must actually be delivered. But that is not all. The performance targets have been watered down. On first-class mail, the target is set to drop from 93% to 90%. For second-class post, the target drops from 98.5% to 95%. The post will now come less frequently and Royal Mail expects to deliver even less of it on time.
In my local survey, residents scored reliability at an average of only five out of 10—some, of course, scored as much as 10, and others, zero. They already experience an unreliable service. These changes will not improve either the perception or the reality.
Let us be clear about what the situation means. This is not just a few percentage points on a chart; it is millions of people waiting longer for vital letters—legal documents, hospital appointments, prescriptions and personal correspondence. It is small businesses waiting an extra day or two to deliver goods. It is rural communities, already struggling with connectivity and transport, being pushed further to the margins. It also sets a dangerous precedent: instead of holding Royal Mail to the standards it has committed to, we simply move the goalposts to make failure acceptable.
A constituent in Bridgwater complained that his letters were being delivered in bundles of 16, 18 and, once, 23 at a time, and up to four weeks late. Does the Minister think these changes will reassure that constituent?
The Government and Ofcom need to remember that the universal service obligation is not just a technical regulation; it is a public promise. It is what makes Royal Mail more than just another delivery company and gives it a unique place in British life. Reducing delivery days, reducing targets and accepting lower standards risks eroding that promise. Once lost, it will be incredibly difficult to restore.
It is important to ask ourselves what message is sent when a national institution misses its targets so widely, is repeatedly fined, and instead of being required to improve, is allowed to relax the very standards it is meant to meet. If the argument is that letter volumes are falling, which they are, let us have an honest conversation about how that service can adapt. Right now, targets are being missed and the answer should not be, “Water down the targets until they are met.”
Royal Mail’s decline in performance is not inevitable. It is the result of choices about investment, priorities and accountability. The choice before us now is whether we accept decline or demand better. I urge Ofcom, the Government and Royal Mail to consider whether the changes, in the long term, will really improve services. Or do they, in fact, represent another step backwards?
The last time this matter was debated in Westminster Hall, in 2023, the hon. Member for Feltham and Heston (Seema Malhotra), who was then the shadow Minister for business and consumers and is now a Minister in the Foreign Office, said that
“Labour is committed to the universal service obligation as the company’s central mission. The next Labour Government will want to ensure that the USO is secure for the future and continues to be provided by Royal Mail in a way that is affordable and accessible to all users…We will also strongly oppose any attempts, whether by the Conservatives in the future or by the leadership of Royal Mail Group, to weaken or abandon the USO.”—[Official Report, 12 January 2023; Vol. 725, c. 324WH.]
Does the Minister agree with his hon. Friend? What do the Government think of these changes? Has Labour forgotten the promises it made only two short years ago?
I conclude by referring once more to my local survey. Of those who did not use the postal service regularly, over a third said that was because it was too slow or too unreliable. My residents already consider the cost of posting a letter to be too expensive. The new system risks being slower, more expensive and less reliable. That is not a way to attract new custom. In April 2025, Royal Mail was acquired by the EP group, a Czech-based company owned by Daniel Křetínský. I wish the new owners well, and hope that the acquisition leads to improved levels of service and efficiency so that we have a postal service that serves everybody, everywhere. Mr Křetínský can be assured that we will watch him very carefully.
The Parliamentary Under-Secretary of State for Business and Trade (Blair McDougall)
It is a pleasure to serve under your chairmanship, Sir Desmond. I congratulate the hon. Member for Bridgwater (Sir Ashley Fox) on securing this important debate on Royal Mail and the USO, an issue that matters deeply to households and to businesses across the country. Royal Mail is an iconic part of the UK’s infrastructure. The postie remains a familiar part of every city, town and village, providing a vital service to communities around the country. As other hon. Members have done, I pay tribute to the dedication of posties. I know, from spending time out on delivery with posties from the Barrhead sorting office in my constituency, the care that they have for their customers, and particularly their vulnerable customers. The USO underpins the network, guaranteeing that letters and parcels can be sent anywhere in the UK at a uniform price, six days a week. That principle ensures that businesses can reach customers nationwide and that families can stay connected.
Lizzi Collinge (Morecambe and Lunesdale) (Lab)
I represent a partly rural constituency, Morecambe and Lunesdale, so my constituents rely on the universal service obligation. They also rely on regular mail deliveries for vital information such as hospital appointments. But my constituents, particularly in villages like Endmoor, are suffering with irregular and delayed deliveries. Does the Minister agree that my rural constituents deserve a good postal service, and that Royal Mail should focus on delivering one? What steps is the Minister taking to secure that service?
Blair McDougall
My hon. Friend makes an essential point about the importance of the postal service in rural areas. The hon. Member for Inverness, Skye and West Ross-shire (Mr MacDonald) made that point as well. I know from my relatives in highland areas how essential that connection is. My hon. Friend raises the issue of NHS appointment letters—that point was also raised by my right hon. Friend the Member for Oxford East (Anneliese Dodds) and the hon. Member for Bridgwater. The trials of barcodes on those letters have been very successful, and I am happy to continue discussions with the Health Secretary to make sure that those barcodes are rolled out as widely as possible.
Patricia Ferguson (Glasgow West) (Lab)
I am grateful to my right hon. Friend the Member for Oxford East (Anneliese Dodds) for raising the issue of the barcodes. Royal Mail representatives came before the Scottish Affairs Committee when we wanted to discuss with them the problem of deliveries in rural and highland areas. They were particularly proud to talk about the barcode idea, but seemed to be concerned that perhaps in Scotland there was not the same alacrity in adopting that sensible suggestion. Given the Minister’s knowledge of the geography of Scotland, which is at least as good as mine, is that a point he might want to take up with colleagues in the Scottish Government?
Blair McDougall
I certainly will. As I mentioned a moment ago, the more dispersed geography of Scotland means that the postal service is often even more of a lifeline in our part of the world. I will certainly follow up that point with Scottish Ministers, and with colleagues in the Department of Health and Social Care. On the future of the universal postal service, I reassure the hon. Member for Bridgwater that we remain committed to a comprehensive USO that is financially sustainable and efficient, and that meets user needs within the open and competitive market. That is why the six-days-a-week, one-price-goes-anywhere universal service remains at the heart of the regulatory regime that is overseen by Ofcom, but of course the universal postal service faces challenges, as many Members have said.
Alex Mayer (Dunstable and Leighton Buzzard) (Lab)
It is also important to get letters into the postal service in the first place. In Bidwell West, which is in my constituency, residents face a 30-minute walk to the nearest post box. That is because Royal Mail refuses to put in new post boxes on unadopted roads, despite the fact that the developer is perfectly happy for there to be a new post box. Would the Minister consider raising that with Royal Mail?
Blair McDougall
I can certainly do that. Through Ofcom, Royal Mail has obligations in terms of the accessibility of post boxes, and I will raise my hon. Friend’s point with the chief executive of Royal Mail when I meet with him next week.
The challenges faced by Royal Mail are shared in most European countries, which are taking steps to reform their USOs. On 10 July, Ofcom announced reforms to put the USO on a more sustainable footing, and to push Royal Mail to improve reliability. However, changing those obligations alone will not be enough to guarantee a better service, so today, Ofcom has launched a call for input as part of its ongoing review of affordability, which will inform its consultation early next year. Reform of the USO is an ongoing process, which is being undertaken by Ofcom, the independent regulator, so I will not directly insert myself into that. However, I will certainly make sure that the voices of hon. Members are heard, widely and clearly.
Many Members raised issues relating to the quality of service. Experiencing delays is so frustrating, as many Members said. That is why, when EP took over Royal Mail, we secured the commitment through our golden share that before its new owners take value out of Royal Mail, quality of service must improve. Ofcom has powers to investigate and take enforcement action when failures in quality of service are identified, as it did recently when it fined Royal Mail £21 million for contravening its service conditions in 2024-25. Ofcom has told Royal Mail that it must urgently publish a credible plan that delivers significant and continuous improvement.
The changes to the USO that I referenced earlier include changes to Royal Mail’s quality of service targets, as the hon. Member for Bridgwater mentioned. They are intended to enable the business to more predictably deliver mail without delays, but I share his view that flexibility must ensure reliability, rather than lowering ambitions. Ofcom has committed to closely monitoring Royal Mail’s performance, and to ensuring that it meets the business regularly to have those conversations. It is evident from the contributions of hon. Members across the Chamber that Royal Mail’s quality of service has not been good enough. The Government have discussed that with the chief executive of Royal Mail, and I will do so again on behalf of the hon. Members who have raised issues today.
I will return briefly to the subject of the constituency of the hon. Member for Bridgwater. I know that there have been service issues because of resourcing difficulties in the Bridgwater, Burnham-on-Sea and Taunton delivery offices. I understand that Royal Mail is now actively recruiting staff to deal with that. Again, I will discuss that with the chief executive of Royal Mail next week. Royal Mail has publicly committed to delivering improvements to its quality of service, and is taking action to recruit additional frontline staff, improving delivery office efficiency and simplifying the network to make it more reliable and resilient. I am encouraged to see that Royal Mail is recruiting 20,000 temporary workers across the country to help deliver the Christmas items that we all expect during that peak period.
As I have set out, the Government remain committed to ensuring the provision of a financially sustainable and efficient universal postal service, one that is accessible and affordable for customers, and that works for workers and businesses. I fully recognise that delays in postal deliveries can have serious consequences for those, including small businesses, who rely on the post for important information. Now that Ofcom has made changes to the USO specification to ensure a modernised service, we need Royal Mail to work with its workforce and unions to deliver the service that we expect.
I hope that hon. Members will see Royal Mail’s service quality improve in the months and years ahead, but rest assured, I will continue to work with Royal Mail and Ofcom to make sure that that is the case. I emphasise that whatever criticisms we might have of Royal Mail, and whatever concerns we might have about the quality of service, we, across the House, are so grateful for the quality of service and the commitment of individual posties, who are an absolute lifeline to communities up and down the country.
Question put and agreed to.
Cross-border Healthcare
(1 day, 10 hours ago)
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David Chadwick (Brecon, Radnor and Cwm Tawe) (LD)
I beg to move,
That this House has considered cross-border healthcare.
It is an honour to serve under your chairmanship, Mr Dowd. Last year, hopes were raised that two Labour Governments working together would put an end to conflict between Cardiff Bay and Westminster, yet few issues trouble my constituents more than the daily reality of cross-border healthcare between England and Wales. Powys is a beautiful county, but it is also the largest in Wales, with no district general hospital of its own. Nearly 40% of the health board’s budget is spent commissioning services across the border in Herefordshire and Shropshire, because that is where the nearest hospitals are. When co-ordination between the Welsh and UK Government fails, it is Powys patients who feel it first and hardest.
Rachel Gilmour (Tiverton and Minehead) (LD)
My hon. Friend is making a point about the border between England and Wales, but I represent a constituent who lives in a spot equidistant between two hospitals in Exeter and Taunton. Only one hospital could provide the treatment she needed, but the consultant there recommended rehabilitation at a third hospital across the border in Tiverton. After a lengthy back and forth, she was allowed treatment on the grounds of extenuating circumstances. Will my hon. Friend join me in pressing for a clear, binding system to allow seamless cross-border referrals where clinically appropriate?
David Chadwick
My hon. Friend makes a valid point, and I am sure her constituents will be pleased to hear her make it. The 2018 cross-border statement of values and principles promised that no patient would face delay or disadvantage because of which side of the border they live on, but my constituents know that those principles are not being applied in practice.
The clearest recent example of what has gone wrong is the new waiting list policy introduced by Powys teaching health board this summer. From 1 July, the board instructed English hospitals treating Powys residents to deliberately and artificially extend their waiting times, bringing them into line with the longer averages elsewhere in Wales. Until now, Powys patients had been treated in hospitals, such as Hereford and Shrewsbury, in exactly the same way as English patients, but from this summer they have been asked to wait up to twice as long.
We are told that hospitals in Herefordshire and Shropshire are treating Welsh patients “too quickly” and that Powys’s budget does not allow for the current number of people being treated each year, so patients have to be spread out over more years. How appalling it is to say that a patient can be treated “too quickly”. Swift treatment should be an objective, not a problem.
Worse still, this supposed cost-cutting exercise may not save a penny, because both the Wye Valley NHS trust and the Shrewsbury and Telford hospital trust believe that it could cost Powys more, because they will have to bill Powys teaching health board for the administrative cost of running two parallel waiting list systems. That is before we consider the hidden costs: the human and financial price of patients deteriorating while they wait longer, needing emergency admissions, extended rehabilitation and, in some cases, never recovering the quality of life they once had.
My constituents are not just numbers on a spreadsheet; their lives are on hold. Those months are months of agony, of lost work, of isolation, and of watching opportunities and life slip away while waiting for operations that should already have happened. Agnes is a patient from Llandrindod with Parkinson’s disease. She has been told that she must wait another 52 weeks for a knee replacement after already waiting a full year. That means a total of two years waiting for surgery. The delay has made it increasingly difficult for her to stay active, even though regular exercise is vital to managing Parkinson’s symptoms. The prolonged wait is worsening her mobility and pain, and it is undermining her ability to live independently.
Hazel, from Builth Wells, is awaiting spinal surgery in Hereford. Her expected waiting time has doubled to 104 weeks. She has been unable to work during this period due to numbness in her legs and feet, and she now fears losing her job. Once financially independent, she now relies on family support—an experience she describes as “degrading and unfair”—through no fault of her own.
Kelly was diagnosed with serious spinal disc problems in September 2024. She was given a surgery date for December, then March, but both were cancelled. Even though her pre-operative assessment had been completed, she later discovered—on her own—that her operation had been postponed by at least another year under the new policy. This is despite her being classed as an urgent P3 case and being told that existing bookings would not be affected. The delay has left Kelly in constant pain, which has taken a serious toll on her mental health and has contributed to her losing her job.
Those stories are not isolated; they speak for hundreds of others who are being quietly told to wait, not because of capacity or clinical need but because of budgetary decisions. Behind every statistic is a person whose life is being diminished while they wait for care that should already have been delivered.
What makes this even worse is that patients are sometimes not being told that their treatment has been delayed. Many have found out only through news reports or by doing their own investigations. Labour Governments at both ends of the M4 talk about driving down waiting lists and getting people back into work, yet this policy, which Ministers could stop tomorrow, does the exact opposite. The health board and senior Welsh Labour politicians call it “fairness” that Powys residents should wait no less than anyone else in Wales. However, fairness and ambition should mean lifting standards everywhere, not dragging Powys down to the lowest common denominator.
It is not equality; it is equal punishment for the Welsh Government’s failure to fix the NHS after 25 years in power. The response from Ministers thus far, particularly in Cardiff Bay, has been nothing short of disgraceful. The Health Minister, Jeremy Miles, could not appear more uninterested if he tried—no action, no intervention and no urgency from the one man who has the power to stop the policy and to get people out of pain and back to their lives. Several constituents have told me that they have written personally to him and have received no response at all. That is despite the fact that it is his Government who are forcing Powys teaching health board to make significant cuts to its budget.
As for the First Minister—who, I remind the House, represents Powys in the Senedd, as well as being a Member of the House of Lords—she brushed off my constituents’ concerns, saying that she thinks it is just “smoke and mirrors”. I invite her to say that directly to Kelly, Agnes and Hazel, because months or even years of their lives have been stolen and spent living in pain.
The decision institutionalises inequality between Wales and England. If the waiting list policy exposes a failure of funding, the digital infrastructure of cross-border healthcare exposes a long-term failure of systems. Despite 25 years of devolution, we still have national health services across our four nations that cannot share data efficiently. Both NHS England and NHS Wales still operate separate digital systems that do not talk to each other. When a Powys GP refers a patient to Hereford or Shrewsbury, information often travels by post, fax or unsecured email. Discharge summaries arrive late or not at all. Test results are duplicated because clinicians cannot see each other’s records, wasting time and often causing distress for patients.
Even in emergencies, A&E doctors in England cannot automatically view a Welsh GP’s records, and vice versa. To paint the picture more vividly, one Powys resident told me that he was admitted to Shrewsbury hospital with a serious heart condition, yet staff could not access his medical records. Because it was a Sunday, they could not even reach his GP by phone.
That should not be happening in 2025. It puts lives at risk across our border regions. The lack of interoperability affects anyone moving between the four nations of the United Kingdom, as their health records tend not to move with them. The Welsh Affairs Committee has been calling for change since 2015, yet a decade later, nothing has happened. The Welsh Government alone do not have the funding to overhaul their systems, which is why we have called on Westminster to step in, as obviously this is a consequence of devolution. For a fraction of the cost of other Government digital projects, modernising NHS IT across the UK would directly improve patient safety, continuity of care and confidence in the system. Every week that remains unresolved, more patients are put at risk, which is a failure of politics, not just technology.
Jamie Stone (Caithness, Sutherland and Easter Ross) (LD)
I can bring a Scottish context to the subject. A doctor in my constituency had a cataract problem and was told that the waiting list was ages. In the end, because she knew how to do it, she found out about an operation that was available in the north of England. She paid for the travel and paid to go private. The point is that if the database that my hon. Friend is talking about could show patients where to look in other parts of the UK, saying, “This is on offer, if you are willing to travel”, it could make such a difference to health services across the four nations.
David Chadwick
My hon. Friend is right to say that these system failures are putting extra responsibility, extra stress and often extra cost on individuals, which is why the system needs to be improved. Beyond the funding and IT problems, our systemic weaknesses make cross-border care even harder. Many Powys residents are registered with GPs in England simply because of geography—they might be closer—while others just across the border stay with Welsh practices. GPs who want to work in both nations must register twice, fill out the same forms twice and follow two sets of rules, which wastes time and discourages flexibility.
A constituent of mine in mid-Wales with a rare artery condition needed ongoing treatment from Hereford hospital. Because the two NHS systems do not share results, they had to collect their own blood tests and email them to their consultant each month. Prescriptions issued in England were not approved in Wales, causing months of delay. That is the daily reality of an unco-ordinated system.
At the governance level, the 2018 cross-border statement of values and principles remains voluntary and unenforceable. Each Welsh health board negotiates its own arrangements with English trusts. There is no single tariff, no unified billing system and no consistent data reporting. Audit Wales has warned for years that this patchwork leaves patients in limbo, between two systems that both claim to care for them, but neither fully owns responsibility when things go wrong.
Those problems did not appear by accident. Powys residents do not mind which NHS logo is printed on their appointment letter; they care that their care arrives on time, that their doctors can speak to one another, and that they are treated fairly. The border should not be a barrier to treatment, data or fairness. I say to the Minister that although several of these issues fall within devolved areas, they are of direct concern to the UK Government because they are also directly influenced by NHS England and by decisions taken here in Westminster.
My asks are simple. First, convene a meeting with counterparts in the devolved nations to finally address these cross-border challenges, and invite border MPs to that discussion. Those of us who represent border communities see these failures at first hand and know where the solutions are needed. Secondly, provide the funding required to make NHS IT systems interoperable across the United Kingdom, so that clinicians can share patient information safely and instantly wherever care is delivered. Thirdly, work with devolved Governments to give the cross-border statement of values and principles legal force, turning it from a voluntary pledge into a real, accountable framework that protects people in border communities like Powys.
We owe it to the people of Powys, and to every border community, to end this quiet injustice and to build a system that treats them not as second-class citizens but as equals who are entitled to the same care, dignity and chance to live free from pain. Labour Governments at both ends of the M4 talk about driving down waiting lists and getting people back into work. However, this policy, which Ministers could stop tomorrow, does the exact opposite. I look forward to the Minister’s response and the contributions from other Members.
David Smith (North Northumberland) (Lab)
It is a pleasure to serve under your chairmanship, Mr Dowd. I congratulate the hon. Member for Brecon, Radnor and Cwm Tawe (David Chadwick) on securing this important debate—one that is very important to my constituents in North Northumberland.
A constituent of mine recently visited friends in the north of the county, near the border with Scotland, and sadly suddenly collapsed with a brain tumour. He was taken across the border to a Scottish hospital. But this hospital, as we have heard, could not diagnose him because it could not access English medical records. Imagine the scene: this constituent’s wife is now filling in her husband’s records from scratch, over the phone, while he waits and waits for an MRI that he cannot get in Scotland because he is under the care of Northumberland healthcare trust.
I am alarmed to realise that our country seems to have several invisible lines running through it. If someone has a stroke, heart failure or even a nasty cold on the wrong side of those lines, their illness and treatment come with strings attached. That is bad for my constituents and bad for our country. My constituents, like so many, live cross-border lives—that is just their reality. They move across the border all the time to see friends, to go shopping and to seek medical treatment. But as we have seen, if they take ill on the wrong side of the border, they will receive substandard treatment at times. That is not because there is anything wrong with the service of Scottish nurses or doctors—they are superb—but because they have no access to English medical records. There is no joined-up thinking.
Northumbria NHS foundation trust recently tried to offer the services of a new infirmary in Berwick to patients on the Scottish side of the invisible line, but up to now there has been a lack of take-up or interest from NHS Borders—something I hope to see change. The primary-secondary care link is in a bit of a black box. Patients have no idea where they will be referred by their GP. Will it be Melrose, Cramlington or Newcastle? Who arranges the appointment determines which organisation provides the referral.
It does not have to be this way. The technical solutions clearly exist, as we heard from the hon. Member for Brecon, Radnor and Cwm Tawe, but the SNP Government in Edinburgh frankly have no incentive to make cross-border care work. I am sad to see no SNP Members here today. They are ideologically opposed to the choices that could lead to a cross-border, British healthcare system that serves all British people equally.
It is worse than that. I was recently contacted by a young constituent who lives in North Northumberland, in the north of England, and works in the Scottish Ambulance Service. They hope to take up further training in Scotland so that they can continue employment, but the Scottish funding support will not cover them because they are not Scottish, and the English support will not cover them because they want to study in Scotland. A British student who wants to study at a British university in order to save British lives cannot do so. That is a farcical situation.
This is the reality for many of my constituents. We must get better at joining the dots and realising that real people live holistically in the geography of where they are, which should not be determined by what are, in British terms, invisible lines on the map. If that is the situation now, imagine the mess for healthcare if the SNP were successful in its policy of independence. Because of bad cross-border healthcare my constituents are suffering, and the Union that so many of us cherish is suffering too.
John Lamont (Berwickshire, Roxburgh and Selkirk) (Con)
It is a pleasure to serve with you in the Chair, Mr Dowd. I congratulate the hon. Member for Brecon, Radnor and Cwm Tawe (David Chadwick) on securing the debate. I am going to give a Scottish perspective, similar to that of the hon. Member for North Northumberland (David Smith) but from the Scottish side of the border.
My constituency runs along the border between Scotland and England, touching both northern English counties of Northumberland and Cumbria. To the east of my constituency, many of the people living in the southern Berwickshire towns and villages of Eyemouth, Hutton, Paxton, Burnmouth, Chirnside, Foulden and Lamberton look to Berwick-upon-Tweed as their economic centre for shopping, work and other services—I am pleased that the hon. Member for North Northumberland is taking part in the debate. To the far south of my constituency, residents of Newcastleton and Hermitage are drawn to Carlisle—similarly, I am pleased to see the hon. Member for Carlisle (Ms Minns) in her place.
For generations before devolution, and certainly long before the SNP took control of the Scottish Government, patients from those areas were able to obtain NHS treatment in Northumberland and Cumbria without any difficulty—not because it was necessarily any better or different, but because it was more convenient. It was a reflection of the transport links that cross the border between those communities: the bus links, shorter car journeys and community ties. The border between Scotland and England is, for those communities, simply a line on the map.
This is absolutely not a criticism of the quality of care provided by NHS Borders—quite the opposite. We have first-class NHS provision at Borders general hospital and across the Scottish Borders, provided by hard-working and dedicated health professionals, to whom I pay tribute. It is not about tearing up the devolution settlement. The NHS in the Borders is absolutely the responsibility of the Scottish Government, and no one is suggesting a retreat from the Scotland Act 1998 or taking powers away from the Scottish Parliament. But it is about recognising the day-to-day challenges that people face in terms of public transport links and fitting medical appointments around work and family life.
It is also about highlighting the fact that since the SNP came to power in Holyrood, the real-life experience of many people in the Borders is that the option of cross-border healthcare has been diminished. It is about reaffirming that we are still part of one United Kingdom, and that the NHS is rightly an institution that we should be able to use regardless of which side of the border we live on.
The easiest way to describe the challenges that people face in my constituency is to share some of the stories that have been told to me in recent weeks. Margaret Merry said:
“I live in Eyemouth. Once I had to take a full day off work and 4 buses to travel to the Borders General Hospital for an x-ray, when I was working in Berwick, a 5 minute walk from where I could have had it done and only taken maybe 15 minutes out of my working day. It is ridiculous.”
Pauline Hutton said:
“I am currently under the care of BGH for cancer treatment and have to travel from Ladykirk to BGH daily for chemo. The treatment is excellent and I can’t praise the staff enough…but a simple thing like giving a blood sample means a 40 mile journey as I can’t give blood at our local surgery in Norham (1/2 mile away) because it’s in England and Borders General Hospital can’t access my results cross border. In this day of technology I can’t fathom out why medical records are all computerised yet one NHS trust can’t have access to patients medical records from another trust.”
Dennis McKeen said:
“Some patients in Newcastleton would also prefer to go to Carlisle rather than a 90 mile plus round trip to the Borders General Hospital...it’s ridiculous”.
Brenda Walker said:
“I am currently travelling from the east coast 3 times per week for dialysis at Borders General Hospital thanks to their transport system getting picked up at 6.40 am. The nurses do a brilliant job looking after us”.
Trixie Collin said:
“Currently I live in Scotland but was told that if I moved to England I would no longer be able to be seen by the consultant at Western General who had been treating me for 10 years.”
The Brucegate dental practice in Berwick-upon-Tweed said:
“As a healthcare provider in England it’s a daily problem on both sides of the border. I get rejections of referrals from both England and Scotland based on postcodes. Thanks for standing up for common sense.”
Kirsty Jamieson from Berwick-upon-Tweed said:
“We campaigned hard for reciprocal care between people living in the Borders and North Northumberland, during the 2018 A Better Hospital for Berwick campaign. No joined up thinking whatsoever.”
Lastly, Kate Tulloch highlighted the fact that this is not just a Scotland-England problem. Kate lives in Cockburnspath, which is Berwickshire in Scotland. Her GP is in Dunbar, which is also in Scotland, but Kate cannot get NHS Borders results because the two health boards, despite both being in Scotland, do not communicate. So this is not just a cross-border issue for Scotland and England; it is an issue of different health boards in Scotland not communicating properly.
All these stories clearly demonstrate the difficulties that my constituents face in accessing treatment across the border. I appreciate that this is not the Minister’s direct responsibility, but I would be grateful if she could relay my asks to her colleagues. First, will the Minister meet me to discuss how we can address the challenges that some of my constituents face when it comes to cross-border healthcare? Secondly, does the Minister recognise that we need to find a solution, and can she commit to working with the Scottish Government to overcome the perceived challenges that they are putting in place?
This is not just about extra money or funding; it is about putting in place common-sense solutions. NHS Northumberland has indicated that it is more than willing to accept patients from the Scottish Borders and other parts of Scotland, and NHS Cumbria has indicated similarly and is, I think, currently doing that for some patients. We must break through the ideological barrier that many of us believe the Scottish National party Government have put in place to stop what has happened for many years—people accessing NHS treatment on either side of the border.
Ms Julie Minns (Carlisle) (Lab)
It is a pleasure to serve under your chairship Mr Dowd. I congratulate the hon. Member for Brecon, Radnor and Cwm Tawe (David Chadwick) on securing this important debate.
As the Member of Parliament for Carlisle and north Cumbria, I represent a region where the realities of geography often challenge the neat lines that we find on maps, and those drawn by policy and practice. For example, earlier this year, during a prolonged power cut that affected the village of Kershopefoot, to the north-east of Carlisle, staff at ScottishPower Energy Networks were somewhat surprised to discover, after I contacted them, that they served customers in England who had a Scottish postcode.
When it comes to health, my constituents quite often face more serious issues. For some, their nearest GP might be in Scotland, but the nearest hospital is in England—in my case, the Cumberland infirmary. This can and does lead to issues.
I acknowledge the Government’s excellent work to improve healthcare access across the UK and in my constituency. In Carlisle and north Cumbria we have seen real progress: waiting lists have been cut and the urgent dental centre that opened last year is beginning to address many of the challenges we experience with NHS dental care. Those meaningful steps forward were made possible by this Government, but progress must be matched by policy that works for everyone, and especially those who live on the edge of systems, maps and borders.
One of my constituents, who lives in the northernmost part of the constituency, found himself facing a deeply troubling situation when he became very ill. He is geographically closer to Scotland and therefore registered with a Scottish GP. However, when he needed hospital care he was told he could not be treated at his local hospital in England—in Carlisle—because he was registered with a Scottish GP. Instead, he was advised to travel to Glasgow, a round trip of over 200 miles, rather than take the 40-mile trip to Carlisle.
This is a man who lives in England, pays his taxes here and has his bins collected by an English local authority, and whose nearest hospital is in England, but he was told to travel to Glasgow for care—not because of clinical need or even capacity, but because of outdated guidance. Thankfully, after the intervention of his GP and other dedicated health professionals, he was able to receive the treatment that he needed locally, but his case should not have required such extraordinary effort. It should never have required the negotiation it took and should not have required escalation. It should have been common sense.
The English guidance does not adequately cover cross-border scenarios, and I am told the Scottish guidance predates the creation of the integrated care boards altogether. I am very grateful to the Minister for Care for giving me his time a few weeks ago to discuss this issue. I know he recognises that this needs to be urgently resolved. I would welcome any update that I can share from the Minister today on whether the guidance is now to be reviewed and improvements are under way. We must ensure that all relevant healthcare providers are equipped with clear, up-to-date information, because we all want the same thing: a system that works for patients, wherever they live.
This is not a question of politics, as we can see from the cross-party presence at this debate—although the absence of the SNP is notable. I am pleased to see my constituency neighbour, the hon. Member for Berwickshire, Roxburgh and Selkirk (John Lamont), in his place. This is a question of practicality, compassion and, as the hon. Gentleman said, common sense. We must ensure that our healthcare system reflects the lived realities of our constituents, and not the lines on a map. I urge the Minister to take this issue forward with urgency. I stand ready to support any efforts to improve cross-border healthcare.
Robin Swann (South Antrim) (UUP)
It is a pleasure to serve under your chairship, Mr Dowd. I congratulate the hon. Member for Brecon, Radnor and Cwm Tawe (David Chadwick) on securing a debate on cross-border healthcare, because we in Northern Ireland know only too well that health outcomes are not, and should not be, defined by borders—whether an internal UK border or one with an entirely separate sovereign jurisdiction. Sickness does not discriminate.
In fact, as the only part of the United Kingdom to share a land boundary with another nation, the issue of cross-border healthcare is something on which every Northern Irish MP, I am sure, will have an opinion. Despite our constitutional sensitivities, I for one have absolutely no hesitation in saying that I am deeply proud of the progress we have made in cross-border healthcare in both Northern Ireland and the Republic of Ireland. The progress in recent decades has shown what can be achieved when we actually work together with a shared purpose.
I take note of what other hon. Members have said about the challenges across an internal UK border, which I believe we should not have in healthcare. Despite that, in Northern Ireland we need only to look at the success of the radiotherapy unit at our hospital in Altnagelvin, and more widely the north-west cancer centre based in Londonderry. Those services demonstrate the tangible benefits of co-operation for patients and communities from both sides of the border.
When I was Health Minister in 2021, I was pleased to come together with the Governments of Ireland and the United States of America to sign a new memorandum of understanding to reinvigorate the Ireland-Northern Ireland-US National Cancer Institute cancer consortium, which is an often forgotten and unsung part of the negotiations of the ’98 Belfast agreement. When it comes to cancer, we should leave no stone unturned. There are undoubtedly people on both sides of the border who are alive today because of that practical and sensible co-operation. By continuing to refine that service level agreement, expanding areas such as skin cancer treatment, and deepening our joint research in clinical trials, Northern Ireland will once again be strengthening cancer services and helping to advance the fight against rare and specialist cancers across the island.
The same collaborative spirit is exemplified in paediatric cardiac care. Our all-island congenital heart disease network—an issue to which my family is as close as we can be—has ensured that children with complex needs can access world-class treatment without unnecessary delay or travel. I have seen at first hand that such cross-border co-operation works. Our youngest son was eight months old when he needed his first open-heart surgery, and that was conducted at Birmingham children’s hospital. He was 10 years old when he needed his pacemaker replaced, but that was done in the children’s hospital in Dublin because of that cross-border work. We in Northern Ireland know all too well about our reliance on the working relationships that we have across borders, should that be across the UK or with our partners in the Republic of Ireland.
Jamie Stone
The hon. Gentleman may know that I have family living in the north, in Armagh and Antrim, and a daughter living in Donegal. What he says is absolutely correct—I can vouch for that, and it is an example for us all. When somebody is sick and we are worried about what will happen next, we do not care about lines on maps. The point I want to make is this: it strikes me that this is an easy issue for the present Government, because it need not cost lots of money. Often, we ask for stuff and there is a huge bill attached, but just knocking heads together and saying, “Get real. Get the computer system online. Talk to each other,” is doable, and it would make such a difference for people even up as far north as where I represent.
Robin Swann
I thank the hon. Member for raising a valid point that comes to the crux of this debate and of what has been said by every Member so far. It is about putting the “national” back in our national health service, and doing so across borders without the unnecessary bureaucracy that often comes with how we look after our patients.
There is still more to do on this issue, and no system is perfect. I know from engaging with our current Health Minister in Northern Ireland, my party colleague, that there is potential for further north-south co-operation in other specialist paediatric services that lend themselves to an all-island approach, including the hugely emotive and sensitive issue of perinatal and paediatric pathology. Northern Ireland has been without a paediatric pathologist for some time, so an all-island solution should be looked at.
As the hon. Member said, ambulances in Northern Ireland regularly cross the border in both directions to save lives. Our two ambulance services have an agreement in place to provide mutual aid, with personnel from either service able to cross the border to assist in emergencies.
I believe that the future of healthcare will be defined by the digital innovation that has been referred to, and it will be a great step forward when we can get the national health services talking to each other—it is only recently that we have been able to get our five trusts in Northern Ireland sharing digital information. The will is there if the finance and support are there on genomic medicine, workforce planning and the interoperability of electronic health records. By collaborating on the genomics of rare disease and planning jointly for a workforce that can identify and close future gaps in work, we can ensure that the entire island—and islands—benefit from technological and medical advances.
Our co-operation should not just be practical; it should actually improve outcomes. It is proof that where health is concerned, cross-border partnerships really work. I encourage the Minister to take forward the recommendations made in this debate today.
Several hon. Members rose—
Peter Dowd (in the Chair)
Order. Although there is no time limit, four more Back Benchers wish to speak and we are going to move on to the Front Benchers at half-past 3, so I ask Members to bear that in mind.
Julia Buckley (Shrewsbury) (Lab)
It is an honour to serve under your chairship, Mr Dowd. I congratulate the hon. Member for Brecon, Radnor and Cwm Tawe (David Chadwick) on securing this important debate.
Cross-border healthcare affects us in Shropshire because our Shrewsbury and Telford hospital NHS trust serves not just 353,000 residents across Shropshire but a further 70,000 residents just over the border in Wales, including the hon. Member’s constituents in Powys. He will be aware that, for many years, the trust languished at the bottom of the national league tables. We had the worst waiting times for both elective care and emergency treatment, as well as for ambulance pick-ups. Worse still, when we finally got an ambulance, it would then spend many hours waiting outside A&E because there were not enough beds to treat urgent patients. Much of that was documented in the TV programme “Dispatches” two years ago, which was a blow to the morale of our hard-working NHS staff.
Since then, I am delighted to report, there have been radical changes at the Royal Shrewsbury hospital in my constituency. Thanks to a significant capital investment project of more than £320 million, we have been the recipient of a hospital transformation programme to improve health and care services across the piece for Shropshire, Telford and mid-Wales. We are now one year into that construction project, with more than half the structure completed—a four-storey building at the front entrance. I visited last week, and the whole area is unrecognisable from when I gave birth to my daughter there in a very old, outdated ward. The new infrastructure will provide much-needed modern facilities and clinical space to improve care for everyone, and it will interconnect with the refurbished existing hospital.
In September we opened the next phase of majors and resus as part of refurbishing the emergency department. This has seen the space in the old A&E transformed; we have doubled the number of bays, improved and upgraded “fit to sit” space and created a new ambulance assessment area. We will be opening two new wards this winter, providing new facilities for gastroenterology and colorectal services, and providing more joined-up and improved services between surgical and rehabilitation teams, often out in community hospitals. Following the delivery of a modular ward unit by the treatment centre entrance, on 8 December we will celebrate a new acute ward with 56 additional beds, which will have a major impact on flow out of the emergency department. That will be felt in shorter waiting times.
Since the first phase of improvements took place, the impact on our hospital has already been significant. Waiting times are down, and we have moved up more than 20 places from the bottom of the league tables. Staff morale is climbing and recruitment is buoyant. I am so proud of our hard-working NHS staff and, in particular, the hospital transformation programme led by Matt Neal and our new chief executive, Jo Williams.
I am incredibly grateful for the support of the Department of Health and Social Care and NHS England, whose investment is not just saving lives but improving lives across my constituency and beyond into Wales. I hope the Minister will visit the hospital to see it for herself when the project is completed. I have every confidence that the work to improve the Royal Shrewsbury will continue to transform the hospital, our community and health outcomes for all our residents. It is right that a major hospital serving cross-border communities be prioritised for investment in this way.
Jim Shannon (Strangford) (DUP)
It is a real pleasure to serve under your chairship, Mr Dowd, as always. On behalf of us all, I look forward to your deliberations. I thank the hon. Member for Brecon, Radnor and Cwm Tawe (David Chadwick)—I think I pronounced that right—for securing this debate. [Interruption.] Did I get it wrong? My apologies; the Northern Ireland accent gives it away nearly every time. While we are one United Kingdom, it is always important to remember the differences that we have in devolved matters, and in healthcare specifically—especially in Northern Ireland, where we have witnessed major disparities. It is a pleasure to make a contribution on that.
I want to talk about a cross-border health scheme that was used in Northern Ireland some years ago before our official exit from the European Union—although it appears that we never exited—and when we were all in the United Kingdom. The scheme meant that patients in Northern Ireland who had been on health and social care waiting lists for two years or more could apply to receive private treatment in the Republic of Ireland and claim reimbursement from the Northern Ireland Department of Health. When I was a member of the Northern Ireland Assembly and in my early years here at Westminster, I saw numerous examples of hip replacements, knee replacements and cataract operations being done down south because the patients had waited two years. The payment for the scheme then came from us in Northern Ireland. There are systems that work.
I thank the hon. Member for South Antrim (Robin Swann) for his contribution. He will probably be embarrassed by this, but I want to put on record that he was a great Health Minister when he was in the Northern Ireland Assembly, and I thank him for that. I never heard anyone say a bad word about him—and I talk to plenty of people, by the way—so I would say that he is an example of a Minister who really worked hard.
I know of a couple of constituents who availed themselves of the scheme and to say that their surgery was life-changing is an understatement. The hon. Member for South Antrim referred to his son. One of my constituents had a hip replacement and one had knee surgery. They could have been waiting up to 10 years for that surgery in Northern Ireland if they had not been able to avail themselves of the scheme with the Republic of Ireland. Those are some examples of how strategies like these work; I listened to hon. Members’ examples of similar processes in their constituencies.
I want to talk briefly about the importance of medical records. I spoke to the Minister about that beforehand, and others have referred to it. Through working closely with universities, I have witnessed a few examples where a young person lives in Northern Ireland and goes to Scotland or England for university. When they come back to Northern Ireland three or four years later, healthcare professionals cannot access their information as there is no shared provision for medical records. I hope that the Minister will forgive me, but it seems illogical not to have a system that takes that on board.
One of my staff members who went to Chester to study was in that exact scenario around 10 years ago. She had to travel back to England and pay £50 for a printout of her records to take to her GP back home. We must not forget that £50 was a lot of money for a student 10 years ago. It might be expected that the cost has now gone way beyond that.
This debate is really important, so I want to make sure that other hon. Members get their five minutes as well. There are clear examples of where cross-border health initiatives work and are beneficial to supporting people who are faced with extensive waiting lists and serious conditions that alter their day-to-day life. I look to the Minister—as I always do, because she answers us and listens to our requests—for a commitment to ensuring that our constituents have access to the care that they need, whether it be cross-border or within our healthcare systems in England, Scotland, Wales and Northern Ireland. Furthermore, hon. Members have shared experiences of the medical records issue within our constituencies. When so many people travel to different parts of this nation to study, more must be done to ensure that their records can flow smoothly and without hassle. My goodness, Mr Dowd, a life without hassle—it would be a miracle.
Steve Witherden (Montgomeryshire and Glyndŵr) (Lab)
It is a pleasure to serve under your chairship, Mr Dowd. I thank the hon. Member for Brecon, Radnor and Cwm Tawe (David Chadwick), with whom I share a health board, for securing this important debate.
Montgomeryshire and Glyndŵr is served by two of the three Welsh local health boards that directly border England—65% by Powys teaching health board in mid-Wales and 35% by Betsi Cadwaladr university health board in the north. Powys is unique: it is the largest county in Wales by area, yet it has no full-service hospital. As a result, many of my constituents in the Montgomeryshire area rely on hospitals in England for their secondary and specialist care.
Recently, Powys teaching health board asked NHS England to delay care for Welsh residents in order to meet its savings targets. English hospitals have pushed back, arguing that such measures increase clinical risk and undermine the trust on which the system depends. We cannot allow a two-tier system to develop, whereby Welsh patients become second-class citizens. Patient data is delayed or simply fails to cross the border, leading to unnecessary delays and confusion. To reduce cost or manage a scarce resource, services are centralised in one location, causing either significantly more travel in an already huge geographical area with poor public transport, or significant delays in an emergency, with ambulances commissioned to serve Wales being diverted to calls in Staffordshire.
Let me give two examples from my constituency that demonstrate how the system can fail those it is supposed to serve. First, one resident from Powys was for many years referred to the dermatology clinic in Shrewsbury. Following a reorganisation by the local integrated care board, diagnostic services were moved to Telford while treatment remained in Shrewsbury. The result was a 120-mile round trip for a single course of care. That is a heavy burden for any patient, especially those managing long-term conditions.
Secondly, a woman living close to the border, who was registered with a Shropshire GP, was diagnosed in September with breast cancer. She was told she would need to wait to be seen by the north Wales genetics clinic. Because of delays, she was advised to begin chemotherapy before surgery—a course that carries more side effects and lengthens recovery. A private consultant later questioned whether the chemotherapy had even been necessary. In the end she felt forced to pay privately, to receive timely treatment. That is simply unacceptable in a publicly funded health service.
We all know that we need effective care as close to home as possible, and a crucial part of co-operation must be data sharing. The solution is openness, communication and shared standards. I meet regularly with the NHS trusts and integrated care board that provide health care for my constituents. I have been impressed by their openness and frankness, and their desire to tackle the issues they face with practical enthusiasm. I am currently organising a meeting to understand the issues from their point of view and address cross-border issues.
I know that both Powys teaching health board and the English trusts ultimately want the same thing: to provide the best possible care for those who need it. I want patients to receive the best possible care as close to home as possible. I want clinicians to have the information, resources and support they need to treat people swiftly and safely. Finally, after years of austerity and underfunding, it is vital that we keep PFI and private interests out of our NHS. We must defend it as a truly public service, just as Nye Bevan, our great Welsh hero, intended.
Llinos Medi (Ynys Môn) (PC)
It is a pleasure to serve under your chairmanship, Mr Dowd. I, too, congratulate the hon. Member for Brecon, Radnor and Cwm Tawe (David Chadwick) on securing this important debate.
In January, the Welsh mental health charity Llais reported to the Welsh Affairs Committee that
“15-20% of people living in Wales use NHS services in England. In the border counties, this percentage is far higher and can be nearer 50%.”
Existing provisions aim to ensure that no patient’s treatment is denied or delayed due to differing rules or funding responsibilities across health systems on either side of the Wales-England border. None the less, the British Medical Association reports significant issues in how these provisions are offered. These systems can be complicated for patients, who are not always clear about who is responsible when their care and treatment cross the border. People living in Wales continue to face a range of challenges if they need care and treatment in England. Llais’s evidence referred to issues around announcements made by the UK media covering England-only stories. It is not clear whether the announcements apply for the people who live in Wales.
Ann Davies (Caerfyrddin) (PC)
My constituent Michael Riordan has asked his GP to refer him to a facility available to armed forces veterans located in Shropshire but, due to an issue with cross-border funding, the Welsh NHS will not fund that facility, despite his residence not being an issue when he volunteered for service to his country. This excellent facility is now unavailable to Michael. Does my hon. Friend agree that current issues in cross-border funding must be addressed for the sake of our constituents?
Llinos Medi
That is another example of what we have already heard, where cross-border work is not working for a timely patient outcome. I agree with my hon. Friend.
Ensuring that cross-border health is as seamless as possible means developing strong partnership, introducing effective ways of sharing information and learning, communicating well, and making advice and information easily available and accessible. Solving these issues needs co-operation between Governments on both sides of the border.
It is just over a year since Eluned Morgan, the First Minister of Wales, announced a cross-border health plan. The Secretary of State for Wales, the right hon. Member for Cardiff East (Jo Stevens), vowed to deliver “additional surgical procedures”. When asked to provide an update on that programme in the Senedd last month, and on how many more patients in Wales have been treated in England over the past 12 months, the First Minister’s answer was vague and non-committal. It is obvious that the bureaucratic problem in making cross-border referrals, as evidenced by the British Medical Association and by Powys health board, which has asked to reduce the number of patients sent for treatment due to financial constraints, is completely at odds with the promise made by the First Minister and the Secretary of State. It seems increasingly clear that this announcement has not led to the changes that we all, and our constituents, would like to see on our waiting lists. Those remain stubbornly high in Wales, with figures showing 794,500 to 796,000 patient pathways as of mid-2025.
We are all aware of the huge pressures being placed on the NHS in Wales by social care. In April, the Welsh Local Government Association warned that plans to reduce NHS waiting lists in Wales will fall short unless we see targeted investment in social care. This week, my Plaid Cymru colleagues in the Senedd will follow that advice by calling for the establishment of a national care service for Wales. That would be a serious step in the right direction.
The people of Wales deserve better than poorly planned announcements leading nowhere. I encourage the Minister to impress upon her Welsh Government colleagues to throw their support behind our plan to get to grips with the high waiting list blighting our health service. Diolch.
Helen Morgan (North Shropshire) (LD)
It is a pleasure to serve under your chairmanship, Mr Dowd. I also thank my hon. Friend the Member for Brecon, Radnor and Cwm Tawe (David Chadwick) for securing a debate that is really important along both the Welsh and Scottish borders.
It is always a pleasure to respond for the Liberal Democrats. This is an issue that my own constituents deal with daily, because North Shropshire has a very long and winding border with Wales. My office, as a result, has dealt with many upsetting pieces of healthcare casework that stem directly from the broken and disjointed system that serves our border counties and, critically, the lack of information that flows between them, as we have heard.
Take for example many of my constituents whose GP will be in Wales because that will be their closest GP, and who usually attend Wrexham Maelor hospital for investigations and procedures, because if they live in north-west Shropshire that is almost as close as the hospitals in Shrewsbury and Telford. It is certainly closer than Telford. In an emergency, because their address is in England, the ambulance that they are sent comes from the West Midlands ambulance service and it is most likely that they will be taken to Shrewsbury or Telford hospitals as a result. When they get there, those hospitals are unable to access their medical records, including any recent blood reports or clinical history. I think the Minister will agree that that is inherently dangerous for those patients, whose only “fault” is to live close to the border.
The 2018 cross-border statement promised that no patient would face delay or disadvantage because of which side of the border they lived on, but in reality that promise has not been kept. Another constituent of mine who is registered with a GP in Wales was unfortunately diagnosed with breast cancer about 18 months ago. Her GP in Wales was very good; her initial care was excellent, and she was set to have a mastectomy and reconstructive surgery in Telford, but a couple of days before the surgery she was told that the Welsh health board would not be paying for the reconstructive element of the surgery. Obviously she was distressed and very scared about her future, and worried about having to wait longer to have that vital surgery because the funding issue needed to be sorted out. Although my office resolved the issue fairly quickly, it should not be necessary for an MP to get involved in a funding flow across the border. That is not acceptable, and not how we should be dealing with cross-border care.
As my hon. Friend the Member for Brecon, Radnor and Cwm Tawe and the hon. Member for Montgomeryshire and Glyndŵr (Steve Witherden) have described, Powys teaching health board has set waiting times for elective surgery that are arbitrarily long and without reference to clinical need. That means that Shrewsbury and Telford hospital NHS trust, which treats my constituents, and the Robert Jones and Agnes Hunt orthopaedic hospital, which is in my constituency and provides the veterans centre that the hon. Member for Caerfyrddin (Ann Davies) mentioned, are being asked to prioritise waiting lists based not on need, but on nationality.
I am an accountant, not a medical expert, but how can clinicians at those trusts be expected to manage their lists if they must take into account nationality before clinical need? The teams in both trusts are working incredibly hard to bring down their own long waiting lists. They have ambitious targets to meet, but they are being instructed to leave some patients longer, for no obvious reason. It is clearly an untenable situation for those hospital trusts. The patients, who may be living with chronic pain, are being told to wait longer than necessary because they live in Wales. That is not fairness; it is failure. I ask the Minister to ensure that the Labour-led Welsh Government are working hand in hand with our English integrated care boards and hospital trusts to ensure that residents on the border—on the Welsh side and the English side—are provided with the care that they need and deserve.
Behind the problem with funding flows lies another problem—the data-sharing chaos. After 25 years of devolution, NHS England and NHS Wales still cannot share patient records properly. Although England uses the NHS e-RS, or e-referral service, Wales uses the Welsh clinical portal, I am reliably informed. Clinicians often need multiple logins to access cross-border data, and GP-to-GP digital record transfers do not work between nations, with referrals, test results and discharge letters still moving by post or fax, which is an absurd situation in 2025. As we have heard from our Scottish colleagues in today’s debate, there is a similar situation on the Scottish border.
A fundamental difference in national strategies has left those on the border torn between two healthcare systems and two sets of priorities. The pilot project between Powys and the Wye Valley is a glimmer of hope, but progress on that is too slow. This is leading to a situation in which it is harder to recruit GPs, referrals take longer and patients fall through the cracks, because the two systems do not talk to each other. Treatment pathways can be confusing and fragmented, as we heard from my constituent’s example. Patients are facing delays and disputes not because of medical need, but because of bureaucracy.
The 2018 “Statement of values and principles” has no legal force; it is a voluntary agreement that leaves patients powerless when things go wrong. What we really need is proper accountability, shared data and transparent funding, so that the border does not become a barrier to care. It should not decide how long people wait, what care they get and whether their doctor can access their records.
One of the communities hit hardest by these challenges is St Martin’s—the largest village in Shropshire and, of course, in North Shropshire. Its GP surgery was a branch of the medical practice over the border in Chirk and it was overseen by Betsi Cadwaladr university health board. In 2022 it was closed, despite strong opposition from me and the village residents.
The Betsi Cadwaladr university health board has no official responsibility for my constituents over the border in North Shropshire, but it does get funding from the Welsh NHS for each individual registered in Chirk. Shropshire, Telford and Wrekin ICB presumably cannot afford a new surgery for the village, despite its being Shropshire’s largest village—it is also rapidly expanding—which means that residents must travel into Wales to see their nearest GP, with all the complications that entails. The best interests of English patients were disregarded by Betsi Cadwaladr health board because it was not responsible for those patients’ outcomes. It is essential for the health and wellbeing of residents on both sides of the border that we move to a system that focuses on a smooth flow of information between the nations and, crucially, that prioritises patient outcomes.
Improvements should be built on existing systems and border projects, rather than attempting some kind of long-winded, full national integration. As a party, the Liberal Democrats believe that the best way to do it is by, for example: extending England’s secure nhs.net to Welsh GP practices to allow safe patient data exchange; expanding English clinicians’ access to the Welsh clinical portal, which is currently available just in Wye Valley, to improve safety and efficiency; implementing any further sensible measures integrating English, Welsh and Scottish secure email systems; broadening the Welsh clinical portal, including expanding the Powys teaching health board and Wye Valley trust data-sharing model to other border trusts; and investigating interoperability of the NHS app between countries to support patient communications.
In 2025, we should be in a place where the flow of information is smooth and patients in the UK need not worry where they are located or what nationality they are if they need healthcare. I call on the Minister to work with her colleagues in the Welsh Government to ensure that their health system works in harmony with ours. Devolution should not mean having a dysfunctional border region. It should help deliver the localised care that residents need. I look forward to the Minister’s response.
Mims Davies (East Grinstead and Uckfield) (Con)
May I take a moment to say how pleased and honoured I am to respond to this important debate—we have heard why it is important—on behalf of His Majesty’s loyal Opposition, as the shadow Secretary of State for Wales? It is a pleasure to serve under your chairmanship, Mr Dowd.
I sincerely thank the hon. Member for Brecon, Radnor and Cwm Tawe (David Chadwick) for securing this incredibly timely debate examining cross-border health services, constituents’ experiences of them and the wider challenges across the health service in Wales and Scotland. Some formal points have been put on the record about Wales in particular. There have been passionate and concerned approaches from Members this afternoon, particularly the hon. Member for Montgomeryshire and Glyndŵr (Steve Witherden).
Today, the Chamber has heard pertinent and passionate contributions from across the political divide regarding disappointing healthcare affecting people, despite the best efforts of staff members, as has been drawn out in the comments today. These first-class, dedicated and hard-working teams are in essence grappling with the challenges of devolution. My hon. Friend the Member for Berwickshire, Roxburgh and Selkirk (John Lamont) rightly highlighted that before devolution, services were connected to people’s communities, places of convenience or connection and shorter car journeys. It led to services that actually worked for them, and that matters. The challenges of the reality facing our constituents and those we care for have been highlighted in today’s debate.
The hon. Member for Brecon, Radnor and Cwm Tawe rightly mentioned the ridiculousness of “too quickly” and how some constituents looking for hospital care were asked to give slower responses. How on earth can someone receive that message and be able to manage it? That affects not only the staff on the ground.
Lack of access and issues around medical records were raised today. The hon. Member for North Northumberland (David Smith) rightly talked about joined-up thinking. It is not clear where people will be sent and referred to, whether in Scotland or around the English border. We need a British healthcare system that works in the situations that people or their loved ones may find themselves in. Staff on the ground are putting in their very best efforts. It is simply not good enough to be still looking at this issue.
Since taking up this role, one of the things that has been front and centre when meeting and listening to people is their experiences across the NHS in Wales as a whole: how they worry about their families and their care, the disjointed nature of the process and, frankly, what feels like a lack of interest and joined-up approach from Ministers. I ask that the Secretary of State for Wales takes note of what is said in this Chamber this afternoon—and indeed the Secretary of State for Scotland. Similarly, I hope that the Minister for Care, the hon. Member for Aberafan Maesteg (Stephen Kinnock) will take a similar interest, given that it is the Welsh NHS that delivers for his constituents.
We know too many people, whether our family or friends, who are waiting in pain and in vain. Given the changes in the NHS in England, they want this Government to be interested in what happens in Wales and Scotland, and that they are using the fabled two Governments. I know the need for this debate, which in parts has been strident. We are here to make sure that this challenge is taken up and pursued in the places where it exists, by both Labour Governments in Cardiff Bay and in Westminster.
Since I have taken on this role, I have continually pointed out that since 1999—yes, since Tony Blair was Prime Minister—the Labour Welsh Government have controlled the health service in Wales. Despite some pleasant colleagues from Plaid Cymru and the Liberal Democrats, it is important to remember that parties there have been backing the Labour Government in Wales, and there has been far too little change. I was particularly pleased to hear the hon. Member for Ynys Môn (Llinos Medi) taking the opportunity, rightly, to point out that for her constituents, change needs to happen. The people of Wales and those using cross-border health services will not accept it if this debate does not lead to change. The answer is simple. People should not be holding their breath to see a change in their experiences; they should be seeing different outcomes.
The Conservatives tried to take up this task, but as we heard today, the challenge around devolution has left it in a difficult state. During the last Parliament, the then Secretary of State for Health and Social Care, my right hon. Friend the Member for North East Cambridgeshire (Steve Barclay), reached out to the Health Minister in Wales—the now First Minister, Baroness Eluned Morgan —recognising the disparities. He asked that they bring officials together—as has been asked for again today—to see how all our UK nations could work together to reduce NHS waiting lists and support the people of Wales. It was bitterly disappointing to see that opportunity to engage not taken up. It was a vital and genuine offer, based on all the reasons that we have heard in the Chamber this afternoon. I would love to hear the Minister tell the House whether that decision is regretful. It seems short-sighted, especially given the ongoing messages in today’s debate.
Can the Minister reveal whether she would like to do the same thing and reach out and offer to assist Welsh Government Ministers, as my party did? We would all be assured by that, and we would all assist in any way to make this change. We also committed in last year’s general election to accelerate investment into new hospitals in Llandrindod Wells, Flint and Newtown to improve cross-border services. Can the Minister commit to an update on that, as it will make a real difference in people’s lives?
I was fascinated to hear from the hon. Member for South Antrim (Robin Swann), that where technology, co-operation and partnership is focused, it can change lives. That is the outcome we are looking for here. Despite the feeling that this issue is about funding, it feels more about delivering and making sure that cross-border services work, no matter what party someone belongs to or what part of the country they live in. Wales desperately needs more nurses and doctors, not more politicians in Cardiff Bay. My colleagues, the Welsh Conservatives, led a debate on this topic in July, making it clear that they felt some of the funding could and should have been redirected at cross-border waiting times.
I will conclude by asking the Minister—given the cross-border experiences discussed and what hon. Members have pleaded for on behalf of their constituents—whether she will work with the Wales Office to deliver an inquiry into the preventable deaths, particularly those under the Betsi Cadwaladr university health board. David Jones from Flintshire and many others want that inquiry to be delivered under the Inquiries Act 2005. I look forward to hearing from the Minister on how, by delivering on our commitment and listening to what has been said in this debate, she can take forward people’s experiences so that they are at the heart of what Parliament discussed this afternoon, and real change can be delivered.
The Minister for Secondary Care (Karin Smyth)
It is a pleasure to serve under your chairmanship, Mr Dowd. I am grateful to the hon. Member for Brecon, Radnor and Cwm Tawe (David Chadwick) for securing this important debate. I knew that hon. Members from across the United Kingdom would come here for it, and so it has proved. There are no end of technicalities that devolution has brought us, but we respect devolution and difference while recognising that we are all citizens of the United Kingdom. On the initial point made by the hon. Member, I gently remind him that an extra £1.5 billion has been allocated by the Welsh Government to public services in Wales, to put Wales on a path back to growth, undoing the damage of the last 14 years. That money includes an extra £600 million for health and care, which was voted against by the Welsh Conservatives and by Plaid Cymru. That is the difference made by having a Labour Government at one end of the M4 and a Labour Senedd at the other. Let us hope that arrangement can continue into next year so that we can get on with resolving those issues for the people of Wales.
I am very proud of my Irish heritage, with family on both sides of the Irish border, and I represent a city just across the Severn from Wales, so I am no stranger to the issues that arise from sharing a border. I spent many years in the British-Irish Parliamentary Assembly and on the Public Administration and Constitutional Affairs Committee, looking at constitutional issues across the United Kingdom. As my hon. Friend the Member for North Northumberland (David Smith) said, given the reality of people’s lives across our borders, we need to be better at joining those dots, and—as my hon. Friend the Member for Carlisle (Ms Minns) said—at remembering those people who live at the edge of some people’s maps.
To assure everybody, with my hon. Friend the Member for Aberafan Maesteg (Stephen Kinnock) as the Minister for Care and with my hon. Friend the Member for Glasgow South West (Dr Ahmed) as the Minister for Health Innovation and Safety, on whose behalf I am speaking, we in the Department of Health and Social Care are well served by all voices in the United Kingdom. I reaffirm our commitment to ensuring that all patients on both sides of borders can access timely, high-quality care. Healthcare is devolved but patients cannot be left to navigate a fragmented system or face delays just because of where they live.
I assure hon. Members, in response to points made by the Opposition spokesperson, the hon. Member for East Grinstead and Uckfield (Mims Davies), that officials meet regularly. That co-operation is happening, and they will continue to meet. My colleagues and I also meet members of those Governments. However, I will come on to that at the end when discussing the requests for my colleague, the Minister for Health Innovation and Safety, to meet with hon. Members.
The spiritual home of the NHS is Tredegar. This Government will not leave anyone behind, not least patients in Welsh border communities who rely on services in England—the point of the debate. My hon. Friend the Member for Montgomeryshire and Glyndŵr (Steve Witherden) raised problems with data sharing and patient record transfer, confusing and inconsistent referral pathways and some of the disputes across borders. However, as we have heard, such disputes sometimes happen within countries and over more local borders. As we heard from the hon. Member for Berwickshire, Roxburgh and Selkirk (John Lamont), they happen internally as well, so let us not underestimate how hard it is to resolve such disputes.
Around 30,000 people who live in England have a GP in Wales, and vice versa. That is why the statement of values and principles for cross-border healthcare was published in 2018. That statement remains the foundation for our approach. It sets out clear expectations that patients living in defined border areas, whether they are registered with a GP in England or in Wales, should receive care without delay or administrative burden. Emergency care is available to all patients, regardless of residency or GP registration. We expect both integrated care boards in England and local health boards in Wales to consider the impact of commissioning decisions on cross-border communities.
The hon. Member for Brecon, Radnor and Cwm Tawe raised the issue of waiting times for residents in Powys who seek treatment in England. Waiting times on both sides of the border are falling. Whenever I appear in the media or speak in a debate, I hear people still saying, even to their television, “Well, where’s my appointment?” Nevertheless, it is the case that waiting times are falling, which is helped by the allocation of money from the Welsh Government to reduce waiting lists.
Karin Smyth
I will get through all the points, if I can, because I know there are lots of issues to address.
As I was about to say, too many people are still waiting, but we are committed to working with the Welsh Government to keep the cross-border arrangements fair, transparent and patient-centred.
Patients also face challenges in accessing specialist services. NHS England commissions a number of these services on behalf of the devolved nations and we are willing to explore further contract arrangements with NHS Wales to improve access to them.
As we have heard this afternoon, travel to appointments can be a barrier. In England, patients referred for specialist NHS treatment may be eligible to claim a refund of reasonable travel costs under the healthcare travel costs scheme, and a similar scheme exists in Wales. I join my hon. Friend the Member for Shrewsbury (Julia Buckley) in welcoming the tremendous changes that we are seeing at Shrewsbury and Telford hospital, which are starting to benefit not only her constituents but people travelling from Wales. That is really good to see. It is a long way for people from Wales to travel, but we are still very pleased to see those changes being made.
The hon. Member for Brecon, Radnor and Cwm Tawe also raised the issue of digital interoperability. Again, I wish I could say that that was only a problem for hospitals on the border between England and Wales, but I am afraid that it is an issue for trusts across the country and across each country. It does not help that, after 14 years of under-investment, IT in the NHS lags behind IT in the private sector by at least a decade. That is why this Government are investing £10 billion into improving how patients access services through technology. My hon. Friend the Minister of State for Science, Innovation, Research and Nuclear, Lord Vallance, is currently giving the NHS the biggest digital makeover in its history as part of our 10-year plan.
I can also tell the hon. Member for Brecon, Radnor and Cwm Tawe that NHS England is working with NHS Wales to improve interoperability, especially through the shared care record and technical collaboration on the so-called fast healthcare interoperability resources, or FHIR for short, which allows systems from different manufacturers to exchange messages and data, regardless of the setting that care is delivered in. I commend my hon. Friend the Member for Montgomeryshire and Glyndŵr on meeting leaders in the local cross-border system to understand that issue better. However, I gently say to him that we cannot get very far without the private sector working with us, not only across genomics and future healthcare but in IT and the way that we develop some of these services.
In October, the chief information officers across all four nations agreed to start looking at digital architecture and standards. They are exploring what we can do to improve how we use shared systems, common standards for better communication, which was raised by nearly everyone this afternoon, and the potential of future alignment. This work should lead to some progress in the short term, ahead of our long-term ambition of building a single patient record.
We are also making cross-border billing arrangements easier. Although the NHS payment scheme applies only to services in England, we sat down with the Welsh Government and agreed that Welsh commissioners will pay English tariff prices for Welsh patients who are treated in England. For English patients who are treated in Wales, local agreements are in place and we are open to making those agreements more efficient through the provision of clearer guidance.
As for our constructive co-operation with devolved Governments, the Government were elected on a manifesto to reset our relationship with the devolved Governments, and from day one that is what we have been doing. In that spirit, and without downplaying many of the issues that the hon. Member for Brecon, Radnor and Cwm Tawe and others, including the hon. Member for Ynys Môn (Llinos Medi), have raised today, I will highlight some of the positive examples of collaboration between our healthcare systems.
In many areas along the border, NHS staff in England and Wales are showing the rest of the UK how joined-up care is done. For example, patients in south Wales regularly access paediatric intensive care services in my home city of Bristol, and there are long-standing arrangements for cancer care, renal services and mental health support that cross the border seamlessly. Such partnerships are a testament to the professionalism and dedication of our NHS workforce, but cross-border healthcare is just one part of our partnership.
First, we have seen immense progress through the Interministerial Group for Health and Social Care, which met last September. Such meetings are really important. They bring together all four nations to find common ground on key priorities, such as elective recovery for those on waiting lists, innovation and health reform, and we look forward to continuing these discussions at the next meeting in December.
Secondly, all four nations are working to protect our kids through the Tobacco and Vapes Bill, which is UK-wide in scope but tailored to the specific needs of each nation. If the representative of the Opposition, the hon. Member for East Grinstead and Uckfield, could indeed talk to her colleagues in the House of Lords, who are battling very hard to get some of this legislation through, we could start making this generation the first smoke-free generation and support kids with this public health measure.
Thirdly, the Mental Health Bill that applies to England and Wales has been a masterclass in constructive engagement between compatriots who want to put their differences aside and get stuff done. May I echo the words of the hon. Member for Strangford (Jim Shannon) and add my support to the hon. Member for South Antrim (Robin Swann) in his efforts to ensure progress on that often forgotten part of the Good Friday/Belfast agreement that deals with healthcare? It is not easy. If they can do it over there, it is not beyond the rest of us to do it in Scotland, Wales and England. I was so grateful when my own mother was being cared for at Altnagelvin hospital during the covid crisis in 2021 to see the co-operation across the border and staff just getting on with treating the patients wherever they came from. We have a lot to learn from our colleagues in Northern Ireland.
In conclusion, I want to assure colleagues that the UK Government remain committed to supporting cross-border healthcare arrangements that work for patients. I will not offer hon. Members lots of individual meetings, but what I have heard today is that there is a lot of good work going on among officials. People here have issues to raise, including things from the past. I will take that up and share that more widely. I will also endeavour to write to the hon. Member for Strangford on the issue he raised to do with university students.
We are building bridges with Wales to work through our issues in the national interest, but I am afraid to say that although waiting lists are falling in England and Wales, in Scotland they are rising, which is a great shame. My friend Anas Sarwar, a former NHS dentist, is committed to resolving that. The NHS is in his DNA, given his own professional work. Getting waiting lists down will be his No. 1 priority, should Labour be successful in Scotland next year. It is a shame for Scottish people to see waiting lists rising while we make progress in England and Wales.
The greatest Welshman in history, Nye Bevan, founded our national health service. The hon. Member for Brecon, Radnor and Cwm Tawe might want to dispute that and give the title to Lloyd George—we will politely disagree on that one. But the serious point is that Bevan’s vision was for a health service where no one was left behind, not least in his own country of birth. Working in partnership, we will fix the NHS across the United Kingdom and make it fit for the future.
David Chadwick
First, NHS waiting lists in Wales are not falling; Wales has the highest waiting list in the United Kingdom. Nearly a third of our population are stuck on waiting lists. I wanted to intervene to make the Minister aware that I agree that extra funding is required to tackle the waiting list that we face in Wales. But when extra funding was announced for the Welsh NHS in June by the Welsh Government, it later transpired that none of that money could be spent on this issue because none of it could be spent on English commissioned services, which meant that the problem we are here today to discuss could not be solved. That is why it is so important to bake in a sort of border by design when designing national healthcare systems, because, as we have heard today from so many Members, it is often very typical and much easier for our constituents to cross borders to access their nearest hospital or their nearest GP practice; and it is important for our Union to facilitate that practice by making it easier and faster.
The hon. Member for Shrewsbury (Julia Buckley) talked of the progress being made in her constituency to bring down waiting times. Clearly, that is good news and shows what can be done—I know that my hon. Friend the Member for North Shropshire (Helen Morgan) has campaigned very hard for that. That is why it is so frustrating for my residents and constituents in Powys to know that access to faster healthcare is available just on the other side of the border, but their own Government and health board are preventing them accessing that treatment. Today we are calling on that to end.
What this debate has shown is that for too long, Powys residents have lived with a system that treats them as an afterthought. The waiting list policy introduced this summer has made that painfully clear. People are waiting longer not because of medical need or capacity, but because the funding simply is not there to pay for it. We have heard today that the problems run deeper than just funding alone. They are about systems that cannot talk to one another, Governments that will not work together, and patients who are left to navigate the gaps.
These are man-made problems, and they can be solved if there is political will. My message to Ministers in both Cardiff Bay and Westminster is simple: sit down together, bring in those of us who represent border areas, and fix this. Every week that passes without action means more people living in pain, more lives on hold and more families watching their loved ones deteriorate while they wait. This debate is about more than party politics; it is about people who simply want to be treated with the same respect and urgency as everyone else. We owe it to them to get this right. Diolch yn fawr.
Question put and agreed to.
Resolved,
That this House has considered cross-border healthcare.
Global Fund to Fight AIDS, Tuberculosis and Malaria
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.
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Dr Danny Chambers (Winchester) (LD)
I beg to move,
That this House has considered Government support for the Global Fund to Fight AIDS, Tuberculosis and Malaria.
It is an honour to serve under your chairship, Mr Dowd. It is 2025, and we find ourselves discussing whether the United Kingdom will continue supporting an organisation that has saved millions of lives. This is an important and timely debate, and it should remind us how much progress we have made, and how much we stand to lose if we step back now.
When I spoke earlier this year about the US cutting funding to the World Health Organisation, I said then, and will repeat today, that global health is not charity; it is security and self-interest. Supporting international health systems does not just save lives overseas; it keeps us safer here at home. Stronger systems abroad mean fewer outbreaks reaching our shores, more stable trading partners and a healthier global economy, which Britain depends on. Investing in the Global Fund to Fight AIDS, Tuberculosis and Malaria is not only the right thing to do morally but the smart thing to do economically and strategically.
Jim Shannon (Strangford) (DUP)
I am very much informed by my constituents in Strangford, where local church groups undertake fantastic work to support those in other countries plagued with the likes of malaria, tuberculosis and AIDS. I think specifically of the Ards Elim church in Newtownards in Strangford, which sends groups out every year to support those facing the devastating impact of those diseases. Does the hon. Member agree that more must be done, either by helping to fund their work or working in partnership with them, to ensure that we are doing everything necessary to help them do their bit to help others?
Dr Chambers
The hon. Member is completely right about the work that voluntary and church groups do on global public health.
Edward Morello (West Dorset) (LD)
I congratulate my hon. Friend on securing this important debate. He mentioned the importance of investing in funds to protect our security. He will know better than anyone that malign-influence powers such as Russia and China are eager to step into the void that we leave when we withdraw our aid. Does he agree that if we do not fund the Global Fund properly, malign powers such as those will step in and shape global health policy in their own image?
Dr Chambers
I totally agree with my hon. Friend, who sits on the Foreign Affairs Committee; that is an insightful point.
Many of us will remember “It’s a Sin”, Channel 4’s extraordinary drama about the HIV/AIDS crisis in the 1980s. It was joyful and heartbreaking, and it reminded us that behind every statistic was a real person—sons, daughters, friends and partners, all with lives full of love and potential. But HIV today is not a death sentence. Science has done its job. Because of one pill a day, or even a single injection every few months, people can live long and healthy lives. The UN’s 95-95-95 target—that 95% of people living with HIV know their status, that 95% of those are on treatment, and that 95% of those are achieving viral suppression—is within reach, but it will not happen by accident. It requires commitment, funding and global co-operation.
Steve Race (Exeter) (Lab)
I am delighted that the Prime Minister has chosen to co-host the eighth replenishment of the Global Fund, alongside the Republic of South Africa. I put on record my thanks to my hon. Friend the Member for Gedling (Michael Payne) for working hard over the last year to corral myself and other colleagues to work with the Government to make the case for the Global Fund. Does the hon. Member agree with me that by co-hosting the summit, which is a good thing in itself, we are showing that the UK remains at the forefront of global development, and that doing so in partnership with South Africa exemplifies our commitment to working with other nations to achieve our shared ambitions?
Dr Chambers
Yes, these are really important summits, and it is important to show international co-operation.
The Global Fund has been central to the progress I have spoken about. It has helped to save millions of lives and allowed millions of babies to be born HIV-free. Yet progress is fragile and without the sustained investment mentioned by the hon. Member for Exeter (Steve Race), the gains made will unravel and history will repeat itself.
The United States AIDS programme—the President’s Emergency Plan for AIDS Relief—launched more than 20 years ago, has saved around 25 million lives. It supports testing, treatment and prevention in more than 50 countries. To show the impact of cuts on these programmes, following funding cuts to that initiative earlier this year, an estimated 120,000 people have died—more than the population of a constituency.
Monica Harding (Esher and Walton) (LD)
I congratulate my hon. Friend on securing this vital debate and powerfully laying out the success of the Global Fund. Stepping back now and cutting our contribution to the fund, just as the United States is abandoning vaccination programmes altogether, would be devastating for some of the world’s most vulnerable people, and a step back in the progress made. Does my hon. Friend agree that, if the Government do not commit to replenishing the Global Fund sufficiently this year, that not only betrays our extraordinary progress and leadership but, as co-hosts, gives a signal that it is okay for others to do the same?
Dr Chambers
I completely agree about the importance of demonstrating international leadership on this issue. If international support declines, from us and other countries, an additional 10 million new HIV infections, including up to 880,000 in children, could occur by 2030. Those are preventable deaths—people who could be alive this time next year if we choose differently and maintain funding.
Tuberculosis, often called a Victorian superbug, is on the rise again, with cases in England up 13% last year. Globally, it remains one of the leading infectious killers. It is largely preventable, treatable, and curable in the vast majority of cases, yet is too often neglected. Malaria is a microscopic parasite, spread by something as small as a mosquito, that continues to kill half a million people a year. There is a saying, “If you think you are too small to make a difference, you have never spent the night in a tent with a mosquito.” We know what works: mosquito nets, repellents, rapid tests and education. The challenge is not the science but the access. The tools exist but too many communities cannot afford or reach them.
When it comes to global public health,
“Nobody wins unless everybody wins.”
Those are not my words but Bruce Springsteen’s. They apply just as much to global health as they do to any other struggle. If we allow international health systems to weaken and turn our backs on collaboration, we are failing not only others but ourselves. Every time we strengthen a health system abroad, we strengthen Britain’s safety at home. We reduce the risk of the next pandemic reaching our shores, protect supply chains, stabilise economies and open new opportunities for trade and innovation.
If we invest now, we can cement the UK’s reputation as a global leader in health innovation, not just through our laboratories and universities, but through partnerships such as the Global Fund that translate research into real-world impact. British expertise in vaccine development, diagnostics and data science already help to shape programmes that have saved lives across the world. Continued investment allows us to share knowledge, strengthen health systems and, in doing so, build influence and resilience that benefit the UK and our global partners.
We also need to be honest about the wider picture. The UK’s official development assistance budget has already been reduced from 0.7% to 0.5% of national income. The Government are now reducing it further, to around 0.3% by 2027. The Fleming Fund, which monitors and helps to tackle antimicrobial resistance, has been scaled back, and the UK’s contribution to Gavi, the Vaccine Alliance has fallen from about £1.65 billion to £1.25 billion for the next funding cycle, which is a real-terms reduction of roughly 40%.
Taken together, those decisions risk sending a message that Britain is retreating from its proud record of global health leadership. If we are serious about being a world leader in science, public health and international development, maintaining our commitment to the Global Fund is one of the clearest and most effective ways to show it. A rushed transition from global aid to self-financing, forced by rapid funding reductions, will result in direct harm through reduced healthcare, stock-outs of essential medicines and untimely deaths. When this is done in the context of infectious disease, the long-term cost will rise in exchange for short-term savings.
Richard Foord (Honiton and Sidmouth) (LD)
My hon. Friend talks about infectious disease. The cost of the malaria vaccine is now thought to be just under $5 a dose, which is amazing purchasing power. By contrast, the UK, under the last Government, who are not represented here today, was spending 29% of UK aid on in-country donor costs—that is, on hotel accommodation. Does he think this money could be better spent?
Peter Dowd (in the Chair)
Order. Just before the hon. Gentleman responds, I remind Members that the Minister will speak at quarter past 4. The Minister is entitled to 15 minutes. I know other Members wish to speak; however, that is the way we must operate. I remind the hon. Member of that.
Dr Chambers
I thank my hon. Friend for his intervention, and I am finishing up now, Mr Dowd.
Britain has always punched above its weight when it comes to science, health and compassion. We helped to eradicate smallpox. We led on vaccine distribution. We have the knowledge, compassion and credibility to lead again, if we choose to. During the covid-19 pandemic, we all waited for the science to catch up—for a vaccine and for hope. When it finally arrived, the world changed overnight. With HIV, TB and malaria, we do not have to wait. The science is already there. The treatments already exist. What is missing is the political will and the funding.
Dr Beccy Cooper (Worthing West) (Lab)
It is a pleasure to serve under your chairship, Mr Dowd. I will be brief, as I appreciate there is not much time left.
I wanted to speak in today’s debate because, as a public health consultant who has worked in international development for 20 years, I have watched the Global Fund and have not always been its greatest fan, I have to say. It has employed funding through vertical programmes for AIDS, TB and malaria.
However, I stand corrected—politicians do not say that very often, but I do. I have seen the great work that the Global Fund has done. I have understood how it has taken a large amount of donor funding and put it to excellent use, resulting in serious reductions in three major infectious disease scourges of our time, including malaria, which 21 countries are now free of, thanks in major part to the Global Fund.
It is not just about the three major diseases that the Global Fund works on; it is about health systems strengthening, which is where it has won my heart. It now understands that we cannot just have vertical health programmes to address those three major scourges; we have to invest in systems strengthening.
I thank my friend who secured this debate, the hon. Member for Winchester (Dr Chambers). He talked about the Fleming Fund. As it comes to a close, we can address antimicrobial resistance through the Global Fund’s work on systems strengthening.
I will conclude by talking about the UK pledge coming up imminently. In 2022, we pledged £1 billion. I am incredibly proud of the leadership the United Kingdom has shown in global health, and I very much hope—as has been alluded to, with regard to our co-hosting in South Africa—that we continue to show that leadership.
I put on record that a potential 15% cut to that £1 billion would result in 220,000 fewer lives saved; 270,000 fewer people provided with antiretroviral treatment; 240,000 fewer people provided with tuberculosis treatment and care; and 20 million fewer people having access to mosquito nets, which provide much needed protection to children and families from this absolutely terrible disease.
We have led the way in global health and we have been a systems leader. Do not get me wrong: this is not simply about funding—but a strong pledge by the UK at this eighth replenishment will absolutely signal that the UK remains dedicated to global health, and how important it is to our health systems as well as to the rest of the world.
Imogen Walker (Hamilton and Clyde Valley) (Lab)
It is a pleasure to serve under your chairmanship, Mr Dowd. I am grateful to the hon. Member for Winchester (Dr Chambers) for securing this debate. I pay tribute to his work on global health as secretary to the all-party parliamentary group on antimicrobial resistance and as a member of the APPG on maternity. I am also grateful for the efforts of so many here who have dedicated themselves to the fight against HIV/AIDS, TB and malaria for years. I am thankful for the contribution of every hon. Member, including the thoughtful and passionate speech from my hon. Friend the Member for Worthing West (Dr Cooper). I will do my best to address the points that have been raised in the time I have.
I know that hon. Members will be aware of this Government’s commitment to the mission of the Global Fund. Indeed, we can all be proud that the United Kingdom helped to establish the Global Fund back in 2002. The UK is the fund’s third largest investor, contributing £5.5 billion so far. Members should be in no doubt that this Government value our ongoing partnership with the Global Fund; it is essential to maintaining and accelerating progress in global health.
It is hard to overstate the importance of the Global Fund in transforming the fight against these diseases. Since 2002, with support from the UK and many others, the Global Fund partnership has helped to save 70 million lives and reduce deaths from AIDS, TB and malaria by 63%—that is remarkable. Importantly, the Global Fund has helped to build more resilient and sustainable health systems that help us to fight AIDS, TB and malaria, and it helps countries to support and improve the health of their populations more broadly, from addressing the threat of antimicrobial resistance to making progress on preventing new diseases from becoming epidemics, or even pandemics.
Yet our work is far from done. Tragically, every passing minute, a child under the age of five dies of malaria. Notwithstanding all the progress that we have made, tuberculosis remains the world’s deadliest infectious disease. Nearly 14 million children are growing up without one or both of their parents—lost to AIDS-related causes, mostly in sub-Saharan Africa. Sibu Sibaca from South Africa spent her childhood caring for her parents, until AIDS took them from her when she was just 16. Her adult life is devoted to making the case for action to ensure that others do not have to go through this, and she spoke so powerfully alongside my right hon. Friend the Foreign Secretary at the United Nations General Assembly in New York, and at a reception co-hosted with South Africa’s Foreign Minister in London a few weeks ago. My hon. Friend the Member for Exeter (Steve Race) has spoken about the importance of co-operation, and of course he is right.
Wherever we can, we are making the case for how the Global Fund can continue to be a powerful solution multiplier—pooling investments, making economies of scale and maximising our collective impact. Let me take this opportunity to shine a light on how cutting-edge advancements are changing what is possible now. Take Lenacapavir, a twice-yearly injectable that could be a game changer in the fight against HIV. Thanks to partners, including Unitaid, a recent landmark deal will bring it to market at $40 per person. That is a staggering drop from the original price of over $28,000. Thanks to the Global Fund, 2 million doses will be distributed to people in low and middle-income countries over the next two years, saving lives and giving people a chance at a better future.
The final replenishment summit in Johannesburg on 21 November matters immensely, and we are proud to be working in partnership with the Government of South Africa to make it happen. We celebrate all that we have achieved through the Global Fund in its 23 years so far, and we focus on what comes next: raising billions for the fight against AIDS, TB and malaria, with public and private investors working together; backing countries’ ambitions to invest more in health; harnessing private sector expertise, including world-class UK science to make the most of the latest innovations and improve access to medicines; and committing to work together in new ways to support countries on their path to self-reliance, and to reshape the global health architecture for the future. That is how we make sure our efforts add up to more than the sum of their parts so that the Global Fund can continue its lifesaving, life-changing work around the world.
I want to build on what other hon. Members have said by underlining what we stand to gain if we continue to make progress in the months and years ahead. As the hon. Members for Strangford (Jim Shannon) and for Winchester said, there will be more children growing up with their parents, more parents spared the heartbreak of burying a child, more families spared from devastating loss, more communities able to thrive and more economies able to prosper. That is what people everywhere want to see. I am not foolish enough to attempt to match the poetry of Bruce Springsteen, but we will keep working until people everywhere feel the benefits of better health in our lives.
Question put and agreed to.
Houses in Multiple Occupation: Planning Consent
(1 day, 10 hours ago)
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Steve Yemm (Mansfield) (Lab)
I beg to move,
That this House has considered planning consent for houses in multiple occupation.
It is a pleasure to serve under your chairmanship, Mr Dowd. I speak today about an issue that is deeply personal for people across my constituency: the rapid spread of houses in multiple occupation, or HMOs, and the growing frustration local communities feel at being powerless to manage their impact.
Let me be clear at the outset that HMOs have a place. They can provide flexible, affordable housing for students, young workers and those getting started in the housing market. For example, a constituent recently told me that, after moving out of her parents’ home, she found an affordable room in a well-kept, clean and safe HMO, which enabled her to save a deposit to buy her own property. It is important to recognise that HMOs have a place.
Jim Shannon (Strangford) (DUP)
I commend the hon. Gentleman for securing this debate. In September, it was alleged that more than 20 HMOs in Northern Ireland did not have appropriate consent. Does he agree that, whether the HMOs are student accommodation, private housing or Home Office housing, there must be planning consent, and planning enforcement must be swift to act on any breach, even if the party breaching planning rules is a Government body? Planning regulations apply to us all equally, without favour.
Steve Yemm
I agree that whoever falls foul of planning regulations should be held to account.
Although HMOs have a place, in Mansfield, as in so many proud towns across the country, we have seen what happens when the balance tips too far—when too many family homes are converted too quickly without proper local control or consideration. My constituents know the streets I am talking about in Mansfield Woodhouse, Forest Town, Warsop and parts of my town centre, where once-stable family homes are being turned into short-term lets or high-density HMOs almost overnight. The result is more noise, parking pressures, more rubbish and fly-tipping, higher turnover of residents, less community cohesion, and a growing feeling among residents that they have lost their say on what happens on their own street.
I have spoken to lifelong residents—people like myself who have raised their children and grandchildren in Mansfield—who remember when every family on their street knew every other family by name. In some areas, they now see bins overflowing, cars blocking their pavements and transient visitors who stay for a short while and are not invested in the area.
Dr Al Pinkerton (Surrey Heath) (LD)
We also have the phenomenon of HMO properties in my constituency. If someone were to apply to build a block of six apartments, they would have to go through a proper planning process, with things such as parking being considered. Does the hon. Gentleman agree that the licensing regime needs to be significantly tightened to give local authorities the power to think about things such as parking and bin storage prior to an HMO licence being issued?
Steve Yemm
I agree, and I will turn to that later in my remarks.
Mansfield is built on community, and people look out for one another, but when planning makes it easier to convert family homes than to build them, the fabric of community life starts to fall apart a little. This is not an anti-HMO message; it is a pro-community message. Good landlords—I meet many of them—should be recognised and supported, but those who ignore rules should face real consequences, which speaks to the point the hon. Member for Surrey Heath (Dr Pinkerton) made.
Mansfield district council is doing all it can. It is using selective licensing powers to help address antisocial behaviour and poor housing in the private rented sector in certain designated areas, and I fully support it in doing so. It has also looked at using an article 4 direction to bring HMO conversions back under local planning control. I would also support that, but the process is relatively complex and costly, and feels a little stacked against local authorities.
Mansfield council would first have to gather extensive evidence to prove that uncontrolled HMO growth is genuinely harming the local area, whether that is parking pressures, waste issues or the erosion of family housing and so forth. That process alone involves months of costly data collection and consultation, and it puts more pressure on planning teams at a time when councils are recovering from years of cuts under the previous Government. We cannot expect them to do more with less while trying to respond to these real concerns from the community. Even with clear evidence—and Mansfield has plenty—councils have to jump through many hoops to justify what should be a straightforward decision giving local people a voice in what happens on their own streets.
So today I am asking the Minister to consider three things. First, we should simplify and strengthen the process for councils to use article 4 directions when there is a clear local need. Councils such as Mansfield should be trusted more and given the ability to protect their neighbourhoods. We should reinstate the principle that local authorities know their communities best.
Secondly, we should think about introducing a national framework that prevents over-concentration of HMOs in defined areas. Part of that could include the creation of a national register for HMOs, linking planning, licensing and council tax data so that local teams can more easily identify areas and locate unregistered properties.
Thirdly and finally, we should properly resource local authorities to enforce the rules they already have. Powers on paper mean nothing if councils do not have the people or funding to use them. We might consider, for example, the provision of ringfenced funding or allowing councils to use planning fees or licensing income to support enforcement.
Carla Lockhart (Upper Bann) (DUP)
I commend the hon. Member for securing this important debate. As he said, the frustration among communities is felt deeply. Does he agree that whether it is HMOs, buy-to-lets, which are often problematic, or hostels, if there are breaches within them, or if landlords are not keeping to the rules, action should be taken swiftly by the authorities?
Steve Yemm
I agree with the hon. Member, but we need to get the balance right between the failing landlords and the very many good landlords we see.
Daniel Francis (Bexleyheath and Crayford) (Lab)
I thank my hon. Friend for bringing forward this debate and for the recommendations he has made. In the London borough of Bexley, we have an article 4 direction, but we are beginning to see landlords setting up charities and housing associations that do not appear to comply with the ethos of such organisations, simply to get around the rules. They do not then require planning permission, as we have recently seen in Highfield Avenue in Northumberland Heath. Does my hon. Friend agree that we also need to look at landlords setting up those organisations to get around the rules?
Steve Yemm
As my hon. Friend would expect, I am sympathetic to that suggestion. However, that is not an experience I share, because I have a local authority that makes virtually no use of article 4. Certainly, if people are circumventing it, there is clearly a case for reform there as well.
To conclude, my overall message is that we need to think about how we reform article 4 to make it easier to justify, quicker to implement and fairer to landlords and residents. It should also be anchored in local decision making, rather than just about top-down approval. And we must ensure that our councils are funded properly to undertake compliance.
All we are really asking for are the tools to protect our towns and make sure that every street remains a place where people can live, grow and thrive together. Let us act now, trust councils and residents and make sure that planning policy works for our people, not against them.
Several hon. Members rose—
Peter Dowd (in the Chair)
Things have moved on since I made my announcement during the suspension a few minutes ago, so I am going to put a formal two-minute limit on speeches. Regrettably, I still cannot guarantee that everybody will get to speak, and I will have to intervene as soon as your two minutes are up.
Wera Hobhouse (Bath) (LD)
As a university city, Bath has an increasing number of HMOs, not only but mainly because of increasing numbers of students. As we have heard, constituents living around HMOs face increasing pressure on parking, noise issues and waste collection issues. Meanwhile, more and more valuable family homes are snapped up by developers to squeeze more profit from single dwellings.
Bath council has started to control the mass conversion of properties into HMOs by imposing a 10% cap in certain areas on the number of homes that can be converted, and it is also protecting some families from being sandwiched between two HMOs. However, we still lose too many homes to HMOs, and the shortage of affordable family homes—especially two and three-bedroom homes—is particularly stark in the city centre. Bath is currently consulting on a new policy to ban turning three-bedroom family homes into HMOs where there could be family homes, and I urge all Bath residents to take part in that public consultation. Bath council is also ambitious about building 1,000 more social homes for rent to ease the desperate need for affordable homes. It is still waiting to hear from the new Government how they can support it, and I would also be happy to hear a response from the Government on that.
I am asking the Government to create a new planning class for short-term rentals such as Airbnbs. We need a planning system that can help reverse the loss of family homes from the housing market, and we must be serious about the current housing crisis. HMOs are not the only cause of that, but they are part of it.
Mr Jonathan Brash (Hartlepool) (Lab)
It is a pleasure to serve under your chairmanship, Mr Dowd. If I had to choose three letters to sum up my inbox when it comes to planning matters, it would be HMO. Nowhere in my constituency illustrates that more starkly than Windsor Street. I first saw the challenges there when I served the area as a local councillor, and they have not gone away. On a street of around 40 Victorian terraces, as many as seven are now HMOs. For the 20 years that I have been involved in Hartlepool politics, HMOs have been a perennial source of concern for local people.
As we have heard, there are good HMOs, but there are also far too many bad ones—ones that are poorly managed, in a state of disrepair, magnets for crime and antisocial behaviour and a blight on communities, and that erode social cohesion.
There are two things I want to raise in my brief time. First, Hartlepool effectively has two planning authorities. The first is the council, which is democratically elected, with officers who understand the streets, our history and our needs. The second is the mayoral development corporation, which covers a large part of the town centre and outsources most of its decisions to a private company based in Manchester.
My first plea to the Minister is that she please review these development corporations and not allow local authorities to have their planning powers stripped and exercised by a private company. My second plea is around article 4. One of the perverse aspects of applying for an article 4 direction is the 12-month notice period. We are applying, but in those 12 months developers rush to get as many HMOs through as they possibly can before the direction comes into force. My second plea to the Minister is therefore to review that timescale and reduce it to a matter of weeks, so that democratically elected people in Hartlepool can protect their communities from bad HMOs.
Wendy Morton (Aldridge-Brownhills) (Con)
We are seeing more and more HMOs across Walsall borough and in my constituency, and it is leaving my local residents feeling that they have very little say on what is happening in their streets. Walsall council has worked on this. I welcome its new article 4 direction, which came into effect in October 2025 and is a much-needed step in restoring local accountability. However, the issue does concern me. The conversion of family homes into HMOs reduces the availability of affordable family homes and risks changing the nature of settled communities. There is also a growing fear and concern about the use of HMOs to accommodate illegal migrants or newly arrived asylum seekers, so once again I seek reassurance from the Government that, as those people are decanted from hotels, we will not see an automatic rise in the number of HMOs. The Government need to get a grip on this issue; a starting point would be a national assessment of the impact that HMO concentrations are having on community cohesion.
Underpinning all this is the fact that our communities need to feel that they are being listened to. I urge the Government to take note and take action.
Alex Ballinger (Halesowen) (Lab)
It is an honour to serve under your chairmanship, Mr Dowd, and a pleasure to join this important debate, called by my hon. Friend the Member for Mansfield (Steve Yemm), which gives me a chance to raise an issue that really matters to my constituents in Halesowen—the rising number of houses in multiple occupation.
We all recognise the need for more housing, especially during a cost of living crisis, but it must be provided in an appropriate manner, and not in a way that undermines safety or community cohesion. In Halesowen, the biggest concerns that I hear regarding HMOs are parking, road safety and antisocial behaviour. Parking is already a challenge in our town; when HMOs are approved without adequate spaces, cars spill on to residential streets, causing frustration, congestion and preventable accidents. I am pleased that recent applications in relation to Nimmings Road and Olive Lane have been rejected for failing to meet those standards and for compromising safety.
Road safety is also an important concern. More cars on already narrow roads mean greater risk, especially where speeding is already an issue. Main routes such as Stourbridge Road and Long Lane are already gridlocked at peak times, and poorly planned HMOs cause further strain and risk making our roads less safe for local residents.
There is also the issue of antisocial behaviour. When HMOs are rushed through without proper consultation, they can change the character of our neighbourhoods. West Midlands police has found links between HMOs and increased reports of crime and drug offences, so these are genuine concerns that deserve to be taken seriously.
I will ask my hon. Friend the Minister two things. First, will the Government review planning guidelines for HMOs, to ensure that local authorities have the flexibility to consider parking, infrastructure and community impact before granting permission? Secondly, will the Minister consider introducing stronger licensing frameworks to prevent over-concentration of HMOs in particular streets or wards, so that growth is genuinely sustainable and in keeping with local needs?
Sarah Pochin (Runcorn and Helsby) (Reform)
It is a pleasure to serve under your chairmanship, Mr Dowd. It was in the Runcorn and Helsby by-election that I became aware of the issue of HMOs in our communities, and now I speak endlessly on this topic to highlight their impact on often deprived and forgotten communities that are bearing the brunt of the problem of housing people who are often asylum seekers.
In my Runcorn and Helsby constituency, there are 200 HMOs in the Halton borough council area; 127 of them are licensed, which means that they have more than five tenants. These are statistics that I can evidence. I also know, because the Home Office statistics tell me, that more than 600 asylum seekers are dispersed across the same area. It is not student accommodation in my local HMOs—that is not an issue in my constituency —it is an issue of asylum seekers. The impact on the community locally is illegal working; it is gangs; it is drugs; it is crime; it is the limiting of housing possibilities for local people; it is increases in rent prices because of the agreements that housing suppliers such as Serco have with the private landlords; it is antisocial behaviour. I have endless stories of criminal activity, sexual assaults and rape.
I urge that, under article 4, no new planning consent is given or granted in my constituency for HMOs. I urge the Home Office to give local authorities full power to act under article 4. Finally, I urge the Home Office not to send any more asylum seekers to my constituency.
Rachel Hopkins (Luton South and South Bedfordshire) (Lab)
It is an honour to serve under your chairship, Mr Dowd. I thank my hon. Friend the Member for Mansfield (Steve Yemm) for securing this important debate on HMOs. Concerns around access to safe, good-quality and genuinely affordable housing have consistently been raised with me throughout my time representing my constituency. It is the No. 1 casework issue in my inbox. As a consequence of rising demand for affordable housing, alongside a cost of living crisis and regulatory changes, it is more profitable for landlords to operate houses in multiple occupation, and we have seen a year-on-year increase of HMOs in many regions across the country.
As we have heard from many other Members today, HMOs present difficult issues for tenants and wider communities if they are not properly licensed or managed. For some tenants, that may mean substandard housing facilities, without adequate access to toilet, bathroom or cooking facilities, or appropriate fire safety precautions. There is also the wider community impact: parking shortages, increasing levels of rubbish due to poor waste disposal and, sadly, the demise of family homes, just when the demand for good-quality family homes is rising.
Many of these issues go under the radar of local authorities if they are not reported, although many authorities recognise these issues and have taken action under article 4 directions, which relate to the removal of permitted development rights for HMOs and require planning permission to be sought. These can be targeted, but they are often challenged by landlords. Can the Minister provide an update on how the Government might be able to support councils to invoke article 4 directions despite challenges, so that they can effectively monitor and manage the number of HMOs in their areas? Is there any further update on how to tackle unlicensed HMOs, ensuring that tenants are not being taken advantage of?
Uma Kumaran (Stratford and Bow) (Lab)
The Government are rightly increasing regulation on social housing landlords, but we know that we have dodgy landlords in the private sector who are flouting the rules. As things stand in my constituency and across east London, we know there are huge problems with unlicensed HMOs, which are causing people to live in unsanitary and unsafe conditions. Does my hon. Friend agree that we also need to give councils more powers to tackle the scourge of unlicensed HMOs?
Rachel Hopkins
I thank my hon. Friend for making that really important point about unlicensed HMOs, and I thoroughly agree.
Sam Carling (North West Cambridgeshire) (Lab)
It is a pleasure to see you in the Chair today, Mr Dowd. I thank my hon. Friend the Member for Mansfield (Steve Yemm) for securing this debate.
HMOs can work for some people, such as students. With the average house price now more than 7.5 times the average salary, compared with the ’80s when it was three times, HMOs are increasingly becoming the default living arrangement for young professionals. After university or college, the last thing young people want is another year—or many years—sharing a space with others they do not know very well. It also does not mean that these people have significantly lower housing costs because, while cheaper than a full home, many of these places are still exorbitant. While HMOs have their place, their proliferation points to a bad housing market, one in which people are forced to share with strangers because other options are too expensive.
As we know, by default, a family home can be converted to a small HMO without needing an application for planning permission, meaning that an awful lot of HMOs, which put an awful lot of pressure on local services, are being created without planning oversight. Peterborough city council’s article 4 directions mandate developers to apply for full permission in parts of Fletton, Woodston and Hampton in my constituency, which is welcome, but that varies by council and area, meaning that HMOs can still build up in one place. That inevitably strains public services; it means difficulties for waste collection, oversubscription to local GPs and—this is one of the most visible issues—not having anywhere to park.
I join others today in calling for a simpler, stronger process for councils to issue article 4 directions. We need stronger regulation alongside a drive to build more appropriate housing, to increase supply and counter demand. We also need to have a real conversation about the housing mix that we are building. There are more and more single-person households now, who have nowhere to go other than the most expensive types of housing. Let us provide for them and slash the need for HMOs.
Tristan Osborne (Chatham and Aylesford) (Lab)
It is a pleasure to serve under your chairmanship, Mr Dowd.
As my hon. Friend the Member for Mansfield (Steve Yemm) has said, we should be looking to create streets in which our residents can live, work and thrive together. However, it is indeed the case that the in-boxes of Members in this Chamber are full of messages about HMOs. There are 1,018 HMOs in the Medway council area, 658 of them in the most socially deprived wards, and one in five of those 658 HMOs has issues relating to at least one serious hazard, including mould, fire safety and electrical problems. We know that many HMOs are well run, but a significant number are not.
It is welcome news that in my local area, Medway council is looking at the article 4 direction and considering selective licensing as a solution. We need to promote that as a policy to ensure that all our residents can live in safe and secure homes. I look forward to seeing that report from my council shortly.
I would like the Minister to answer some questions. How can we strengthen and streamline the article 4 process to allow councils to engage in it? As my hon. Friend the Member for Hartlepool (Mr Brash) has said, at the moment the process is onerous and can take many months. Can we look at introducing a national framework? Can we also look at unlicensed HMOs and ensure that our planning teams are resourced, so that we can ringfence money and support residents, and get the most appropriate type of housing for our communities?
Lastly, the process of completing an article 4 direction is cumbersome, as I know from experience. What more can we do to give statutory guidance to authorities to ensure that they engage with landlords to prevent bogus charities and other types of bogus operators, as my hon. Friend the Member for Mansfield mentioned, from trying to get through the process?
Gareth Snell (Stoke-on-Trent Central) (Lab/Co-op)
It is a pleasure to serve under your chairmanship, Mr Dowd, and I welcome the Minister to her new role.
In this debate, I have found myself feeling slightly envious, listening to hon. Members around the Chamber talk about the work their councils are undertaking to achieve better regulation of HMOs. Sadly, in Stoke-on-Trent we are far behind others in that process. My residents in Hartshill and Basford, in Penkhull, in Fenton and in Birches Head are seeing many three-bedroom family homes being converted to six-bedroom HMOs. Then, rather naughtily, those six-bedroom HMOs become eight-bedroom HMOs with a retrospective application, at which point the council says, “Well, we only really have to consider the additional two bedrooms, because they had the right to do the six in the first place.”
That puts unimaginable strain on communities, such as the community in Claridge Road who now have exactly that—an eight-bedroom HMO sitting within a residential family area. As my hon. Friend the Member for Mansfield (Steve Yemm) said, HMOs have a really important part to play in the housing mix in towns and cities, but they have to be in the right place and controlled.
I have asked my council how many HMOs we have, but it cannot tell me; it does not keep a register, because it has never had to. I also asked my council how many six-bedroom HMOs we have and how many are licensed. Again, the council cannot tell me because it has never had to keep such a record.
I am working with Councillor Daniela Santoro in Hartshill Park & Stoke, and with Councillor Shaun Pender in Basford & Hartshill, to try to launch a pilot to cover those two wards and the Penkhull ward and to demonstrate that, if we could map even some of that housing stock, it would show a huge proliferation of out-of-family homes. We are pushing Stoke-on-Trent city council to introduce a saturation limit and to say that, although permissions might still be granted, certain streets would have a certain threshold over which the number of HMOs could not go.
Unfortunately, we are getting nowhere. I ask the Minister this: where councils are reticent to undertake such work themselves, could there be a mechanism whereby local communities could trigger a process so that, where people know there is a problem, it can be addressed from a grassroots level?
Naushabah Khan (Gillingham and Rainham) (Lab)
It is an honour to serve under your chairmanship, Mr Dowd, and I am grateful to my hon. Friend the Member for Mansfield (Steve Yemm) for securing this debate.
In my constituency, the rise of HMOs has been nothing short of dramatic. In particular, streets in Gillingham that were once lined with family homes are now dominated by houses in multiple occupancy, which have often been converted at speed and without proper oversight. Permitted development rights have enabled this trend, coupled with relatively low-cost housing and a limited licensing regime. In fact, my town was rather scrupulously promoted by one website as being among
“the four hottest HMO investment areas.”
I understand that behind each of those conversions lies a simple market logic. However, I also fear a quiet erosion of the social balance, which will change the shape of our communities.
Like other Members, I do not oppose in principle the existence of shared housing, or HMOs—we need them. The demand for HMOs exists among students, key workers and professionals, who are often priced out of traditional tenures. However, the problem is that when such conversions happen en masse in one area, and when the planning system is unable to manage that pace or even to track the number of HMOs, the cumulative impact is the fury that we all see at our surgeries and in our inboxes.
Members will be aware that the root of this issue is structural. Conversions can take place under permitted development rights and therefore they can bypass planning consent altogether. Once councils such as mine, Medway council, have a mountain of evidence to support them, they can issue an article 4 direction, a licensing scheme and supplementary planning documents. However, by that time half the street has already been converted.
We all know that saturating an area with one housing tenure type is never a good idea; it can create not only social challenges, but problems in the local housing market. That is why now is the time for a strategic approach. We must empower our councils to act.
Jo Platt (Leigh and Atherton) (Lab/Co-op)
It is an honour to serve under your chairship, Mr Dowd. I thank my hon. Friend the Member for Mansfield (Steve Yemm) for securing this important debate.
In my constituency, the rise of HMOs is a growing concern. As other Members have said, HMOs provide vital accommodation for key workers, students and single people; however, we must confront the reality on the ground. In Leigh town centre alone, there are over 30 registered HMOs that we know of. Residents are rightly worried about overcrowding, noise, waste issues and pressures on public services, which is why I joined local councillors to campaign for a borough-wide article 4 direction. That is now in effect, giving communities a voice, and some applications have rightly been refused.
We also need national action. Councils are asking how they hold the landlords of smaller HMOs accountable. What powers do they have to intervene? How can they get a sense of the scale of the issue when, currently, smaller HMOs can escape scrutiny? This must change. Will the Minister consider giving councils the power to retrospectively require all HMOs to join a register, and support comprehensive licensing for HMOs, regardless of their size?
A full register would improve oversight, uphold safety standards and help to reduce antisocial behaviour. It would also allow planning departments and residents to understand the true cumulative impact, especially in areas that are at risk of oversaturation. But this will require resources. Councils need support from the Government to implement and enforce changes.
Ultimately, HMOs must be safe, respectful and properly regulated. They must not erode our communities or compromise the wellbeing of residents. People in Leigh, Atherton, Tyldesley, Lowton and Golborne deserve a say in shaping their neighbourhoods.
Sarah Hall (Warrington South) (Lab/Co-op)
It is a pleasure to serve under your chairship, Mr Dowd.
On roads where people have raised families for decades, homes are being bought up, divided and converted into HMOs, often in what feels like a matter of days, and often by scalpers from out of town who are looking to turn a quick profit. My constituents tell me that they wake up one morning to find a skip outside, walls being knocked down and new tenants moving in next door—with no consultation and no conversation. That is what happens when planning rules overlook communities.
It should be about balance, respect and the right of communities to have a voice in the places they call home. People are worried about noise, parking, waste and antisocial behaviour, but they are also worried about something deeper: the fabric of their streets and communities. A new mum told me that she can no longer open her baby’s window at night because of the constant comings and goings next door. Another resident said they felt powerless, like they were watching their community disappear before their eyes.
At the same time, young families are being priced out of the very homes that once offered their parents a start in life. These are not isolated frustrations; they are warning signs that planning rules have not kept pace with reality. Right now, a family home can be turned into a small HMO without the need for planning permission, and that loophole has left councils and residents powerless to manage overconcentration without entering a laborious process.
I welcome the steps that Warrington borough council is taking, with an article 4 direction for the central six wards, but that still leaves the rest of my constituency without the additional layer of protection. Local councils need the power to plan with purpose, not just to react after damage is done. A national framework and a change to the rules that respects local communities would give residents faith that development is something done with them and not to them.
Yes, we need affordable rooms, but not at the cost of affordable homes. Fair rules, good homes and tidy streets— that is the foundation of trust that local communities deserve. Until planning rules catch up with the reality on our streets, communities like mine will keep paying the price. It is time the system worked for the people who call these streets home.
John Slinger (Rugby) (Lab)
It is a pleasure to serve under your chairship, Mr Dowd.
I previously served as a councillor in the New Bilton ward on Rugby borough council, and I campaigned partly on a petition on HMOs. I called for an article 4 direction, and other councillors, including Councillor Richard Harrington, have since taken up the baton. Residents raised massive concerns with me about litter, antisocial behaviour, parking, the impact on house prices and the fundamental change in the nature of the community when family homes for two adults and two children are transformed into homes that house four, five, six, seven or more adults, each with a car.
I was a councillor on the planning committee, and although residents came before the committee to express their concerns, it did not count for anything because those concerns were not material planning concerns. I concluded that HMOs are a flawed, market-based solution to a flawed market, despite them being, in some cases, a good form of housing for some people. People feel powerless as their community is transformed. An article 4 direction does not prevent conversions; it just ensures that the applications come before the planning committee, which then has to apply the law, and that often means the application is approved.
The problem in Rugby was that the previous Conservative administration did not refer to HMOs in the local plan, which meant that everything defaulted to the national planning policy framework. The current Labour-led council has introduced an article 4 direction and has a radius-based approach in the current draft plan. That should help, but it will take time to be implemented.
Will Ministers take another look at the guidance and the powers that may be available to local authorities in the Planning and Infrastructure Bill, in other legislation and in the national planning policy framework? This is about empowering local communities and enabling them to have pride in place, by controlling the over-concentration of HMOs in the urban areas of our communities.
Matt Rodda (Reading Central) (Lab)
It is a pleasure to serve under your chairship, Mr Dowd. I commend and thank my hon. Friend the Member for Mansfield (Steve Yemm) for securing this important debate.
Reading constituents are concerned about this issue. We are lucky to live in a beautiful Victorian town, but sadly many historical streets and local communities are blighted by HMOs. I support more housing, but HMOs are not necessarily the most effective way to provide it. Issues include antisocial behaviour, bins overflowing and parking problems on very narrow Victorian streets. I have heard dreadful reports of noise from student parties linked to HMOs. The noise often carries, particularly in the summer when windows are open at night, and it can cause disruption to many residents over a wide area.
I support and commend Reading borough council for introducing article 4 directions. I should declare an interest: I was a councillor in Reading, and I was consulted on implementing HMO article 4 directions. Might it be possible for the Minister to look again at the process for implementing the directives and the way that they work in practice? My experience is that they can be very helpful—councils are often brave to take on HMOs, and I thank Reading borough council for its work on them—but there is still the possibility of HMOs being created within an article 4 direction area.
Is it possible to tighten up the article 4 regime to make it even harder for HMOs to operate in such areas? I appreciate that there is a need for them in certain parts of towns, but the clustering effect, particularly on certain streets where there are serious parking and bin issues, among other issues, can be overwhelming for residents. As my hon. Friend the Member for Mansfield quite rightly said, HMOs can change the nature of a settled community. Residents often know all their neighbours by their first name and have wonderful relationships on a street, and to have transient residents can cause real challenges.
Gideon Amos (Taunton and Wellington) (LD)
It is a pleasure to serve with you in the Chair, Mr Dowd. I warmly congratulate the hon. Member for Mansfield (Steve Yemm) on securing this important debate on a matter that clearly resonates, as we can see from the number of Members present. I recognise entirely the concerns that he and other hon. Members raised about the impact of high concentrations of houses in multiple occupation and their effect on local housing and local housing markets. When family homes rapidly convert into houses in multiple occupation, it can fundamentally alter the character of a neighbourhood and put genuine pressure on affordability for families who want to put down roots in an area. Those concerns are legitimate, and they need to be taken seriously.
Antisocial behaviour can also have devastating impacts on individuals and neighbourhoods. That is not and should not be regarded as a low-level issue. Whether it is excessive noise, discarded rubbish, parking difficulties from overcrowded properties or more serious issues of intimidation and disorder, these real issues affect people’s daily lives and their sense of safety in and around their own homes. No one should have to live with that. I know the frustration of residents who see neighbourhoods change in ways that make them feel less secure and less able, as other Members have said, to affect the future of their neighbourhoods.
The loss of family housing stock is a particular concern for local communities. When properties that once housed families, with the children attending schools and people contributing to the fabric of the community, are converted into transient accommodation, it erodes the stability that makes neighbourhoods thrive. That is why many councils and residents are looking for solutions.
The issue is far greater than just HMOs themselves. Often people living in HMOs are those on the lowest incomes, who simply cannot afford to live elsewhere. They do not always choose HMOs as their preferred housing; they are there because they cannot access affordable housing and because the housing market fails them. Statistics on social housing tell the story starkly. There are 1.3 million households—many of them families —on the social housing waiting list who need affordable, stable homes and cannot access them.
We are deeply concerned that the Government’s target of 20,000 social homes a year is not sufficient and is nowhere near enough. The Liberal Democrats have pledged a target of 150,000 council and social rent homes a year, because a massive public house building programme is exactly what is required to address this crisis. A fundamental lack of social housing to support those on lower incomes is driving people into HMOs in the first place. I am sure that many HMO occupants and residents would far rather be in secure, affordable housing.
We support and respect the use of article 4 directions by local communities to require planning permission for HMOs in certain areas, where necessary, to preserve the character of neighbourhoods or to protect a dwindling stock of family housing. We agree with the hon. Member for Mansfield that streamlining those processes would be worth while. Will the Minister consider removing the requirement for the Secretary of State to approve article 4 directions, so that councils can put them through more easily and quickly? After all, local authorities know their areas best, and they should have the tools to manage development in a way that reflects their priorities and concerns.
As my hon. Friend the Member for Bath (Wera Hobhouse) so eloquently pointed out, in areas with high levels of second homes and holiday lets, such as Cornwall and the Lake district, councils lack the powers to control housing stock. The last Government promised to legislate to make planning permission a requirement for change of use to holiday lets, as is already the case in Wales. Will this Government deliver on that issue, which is vital to particular communities around the country?
On controlling the proliferation of HMOs, article 4 directions are ultimately a blunt, short-term instrument. They may prevent conversions in one area, but they can shift the problem elsewhere. Vulnerable people must not be pushed into even more precarious housing situations. The only way to genuinely relieve pressure on family homes is to increase the supply of social housing. If sufficient social homes were available, those on the lowest income would not be forced into the private rented sector and HMOs. Family homes would remain available to families and the housing market would function more effectively. That is the fundamental solution.
Where there are genuine problems with antisocial behaviour, waste or parking, councils should use the powers at their disposal. Acceptable behaviour contracts, pioneered in 2003, can be effective in that regard. Additional licensing for HMOs for three or more tenants, which many councils have introduced, sets standards for management and gives authorities real teeth against rogue landlords, but the processes should be simplified for that avenue of action, too.
A comprehensive approach is needed. That means building far more social housing to meet demand, properly licensing and regulating HMOs, and using article 4 directions as part of a wider housing strategy. We must not lose sight of the fundamental need for more social housing.
David Simmonds (Ruislip, Northwood and Pinner) (Con)
It is a pleasure to serve under your chairmanship this afternoon, Mr Dowd, and to speak in this debate called by the hon. Member for Mansfield (Steve Yemm). He gave a clear exposition of the issues facing his constituents, which mirror the experiences of mine. I was out at the weekend talking to people in Lovett Road and Ash Grove in Harefield who told pretty much the same story that hon. Members on both sides of the House have set out. I have huge sympathy for the Minister and the Government because that story encapsulates the housing challenge: everybody is generally in favour of providing more housing, but they are not very keen on this specific form of more housing when it has an impact on their constituency.
The Opposition recognise that HMOs have always been a helpful source of additional housing. They have provided for temporary workers over the years and are a key plank of our student housing market. They are extremely important, especially for people who may be trying to put their lives back together and make the first step into social housing. Their numbers have grown in a housing market where, although private rented homes have the highest level of occupier satisfaction of any type of housing, there is none the less an acute need to ensure that people are found homes and are off the streets. There is a high degree of commonality and agreement, but I am sure we all recognise that that need will remain a significant challenge in the context of a collapsing housing market, especially here in London where the mayor is on track to deliver less than 4% of the housing target set by the previous Government.
The Opposition support the Government in bringing forward new provisions to improve the licensing process for HMOs, which several hon. Members on both sides of the House have called for. Historically, we have always sought to make that process as straightforward as possible to swiftly meet rising local demand for housing. However, we recognise that there has been growing pressure, particularly because of the unneighbourly behaviour that we have seen from some landlords, that needs to be swiftly and robustly tackled.
We also support a more straightforward implementation of article 4 directions. We recognise that where they have been implemented, their operation was restricted to ensure that the supply of this type of accommodation was not choked off by blanket application. When I was a councillor, my local authority applied one in very restricted areas where it was seeking to protect the student housing market, rather than using a whole-borough approach, but it is now considering implementing that more widely to address the kinds of concerns that hon. Members have highlighted.
The Government have just gained Royal Assent for the Renters’ Rights Act. As they look at leasehold legislation, as well as the devolution Bill, which contains housing elements, and the Planning and Infrastructure Bill, about which I think the Commons is due to receive Lords messages next week, I encourage them to look at the opportunity for further amendments to those pieces of legislation that would enable local authorities to more effectively address these concerns through different routes.
It is very clear that there is a degree of community concern, particularly given the backdrop. We have heard the Government say that they are committed to shifting the asylum accommodation estate away from hotels, the use of which has grown very rapidly in the last 12 months, towards other types of accommodation. We have heard a lot about houses in multiple occupation and former military bases being put to use for that purpose.
I therefore encourage the Government to consider the Opposition’s proposals for a specific use class for asylum accommodation so that there is an effective public consultation, and so that residents understand the purpose of the HMO change. That would help to allay concerns and allow time for the local authority to consider in advance the impact of having families with children who need education provision and the impact on the NHS of providing support for people who may have war injuries or have suffered other circumstances that brought them to our shores as asylum seekers, for example. It would also enable representations to be made to the provider if it was clear that a locality was not able to provide the support needed by a household or class of users. Introducing an additional use class would bring about a higher degree of transparency and ensure that many of the genuine community concerns that hon. Members on both sides of the House have outlined could be effectively addressed.
The Parliamentary Under-Secretary of State for Housing, Communities and Local Government (Samantha Dixon)
It is a pleasure to serve under your chairmanship, Mr Dowd. I congratulate my hon. Friend the Member for Mansfield (Steve Yemm) on securing today’s debate. I appreciate his speaking about this important issue with force and passion on behalf of those he represents. I thank all hon. Members for their contributions to the debate.
I acknowledge the concerns that my hon. Friend raises on behalf of the residents of Mansfield about the concentration of houses in multiple occupation in some parts of his constituency. As he mentioned, houses in multiple occupation provide relatively low-cost accommodation for rent and can play an important part in the housing market, as hon. Members from both sides of the House acknowledged. However, it is right that local authorities should be able to take action where necessary to minimise any negative impacts that concentrations of such accommodation might have on local areas.
As we have heard, national permitted development rights allow existing homes to change use to a house in multiple occupation for up to six people without the need for a planning application. Such smaller HMOs are also able to change to a standard family home under similar rights, but we acknowledge that those nationally set permitted development rights are not necessarily suitable in all areas. Therefore, local authorities can remove permitted development rights in a specific area by introducing an article 4 direction after consultation with the local community and an assessment of the local evidence that such a direction is required.
The introduction of an article 4 direction would mean that any change of use to large or small houses in multiple occupation would require an application to the local planning authority for planning permission. All applications for planning permission are considered by the local planning authority, in line with the development plan for the area and in consultation with the local community. A clear policy for HMOs can support the assessment of future applications. Indeed, when I served as a ward councillor on Cheshire West and Chester council, we took through an article 4 direction relatively smoothly and with the support of the local community, and it is still in force in that area.
Whether or not Mansfield district council chooses to consult on introducing an article 4 direction to remove the permitted development right that enables existing homes to change use to a smaller HMO will be a decision for the council to take locally. It is not something the Government should seek to influence. Having experienced it myself, I can say that the process is not costly or burdensome. Approximately 75 other councils have put in place article 4s for HMOs in parts of their boroughs. I urge my hon. Friend the Member for Mansfield to continue to discuss this issue with the council if he believes that such a direction would be appropriate.
None the less, if the existing powers are not working—we have heard evidence of that today from hon. Members on both sides of the House—we want to engage and find out why. It is important that HMOs are managed well, which is why all HMOs are subject to management regulations. Those regulations set out duties for managers to take safety measures, maintain the supply of gas, electricity and water, and maintain common parts and living accommodation.
In addition, all local authorities are required to license HMOs with five or more people from two or more separate households who share facilities such as a kitchen or bathroom. Through additional licensing, local authorities also have the power to license HMOs with three or more people from two or more separate households who share facilities. That means that most HMOs can be licensed, providing local authorities with the means to address concerns around how they are being managed.
I note that Mansfield district council recently introduced selective licensing in designated areas, and since 12 June this year landlords have been able to apply. I hope that that begins to improve the issues that we have heard about today. Local authorities have strong powers where landlords breach HMO regulations. These include powers to prosecute, to impose penalties of up to £30,000 as an alternative to prosecution, and to seek banning orders for the worst offenders.
I once again thank my hon. Friend the Member for Mansfield for a useful and constructive debate. I hope that I have set out the measures that we have in place to enable local authorities to control HMOs in their areas, and that I have made it clear that the Government are keen to engage to see how the existing powers are being exercised and how they can be improved.
Steve Yemm
I thank everyone who has participated in today’s debate. I think it comes down to something quite simple about fairness and local control. No one is saying that HMOs do not have a place—they do—but in many parts of my community people think that they deserve the right to shape their own street and protect their own community. I want to fix this issue, whether that means giving councils the right tools or getting them to utilise the tools they have, together with giving them the funding and the trust to act. Our planning should be about people and communities. Mansfield, like all our communities, deserves nothing less than that.
Question put and agreed to.
Resolved,
That this House has considered planning consent for houses in multiple occupation.