Westminster Hall

Wednesday 4th March 2026 Westminster Hall

Wednesday 4 March 2026

[Matt Western in the Chair]

NHS Capital Spending

Wednesday 4th March 2026 Westminster Hall

00:00

[Bobby Dean (Carshalton and Wallington) (LD)]

I beg to move,

That this House has considered NHS capital spending.

It is a pleasure to serve under your chairship, Mr Western. I am grateful to have secured this debate on NHS capital spending. This subject goes right to the heart of how the NHS functions, and yet it is not discussed enough in this place. I had a look through some ministerial statements and questions in preparation for this debate, and I found that we often talk about staffing, specific illnesses, waiting times and other operational performance issues, but the simple truth is that all these challenges will be much more difficult to deal with until we improve NHS buildings, equipment and technical infrastructure. I get it: it feels much more impactful and immediate to talk about lifting nurses’ pay or commissioning a new medicine, and those things are important. But however arduous the process, or however far beyond our electoral terms the output of capital investment may be, it is vital for the long-term healthcare of our constituents that we fight for these slow returners, too.

[Lisa Smart (Hazel Grove) (LD)]

My hon. Friend is starting to make a compelling point. In my local area, Stepping Hill hospital has a reported repairs backlog of £138 million. That means, in practice, that only four of the 14 lifts are working, staff are having to physically take meals upstairs to patients, and family members with a mobility issue cannot visit their relatives on higher floors. Does he agree that, while we are talking about bricks and mortar, we are also talking about people and their quality of life?

[Bobby Dean]

I am grateful for the point my hon. Friend made, and I will come to make very similar points about the impact that maintenance backlogs are having.

It is partly because of the slow payoff of capital investment that we are in this mess. The last Conservative Government completely undermined the NHS’s future by overpromising, underdelivering and sacrificing long-term investment to plug holes in their mismanagement of the public finances. While capital underspends being plundered for revenue black holes is not a total innovation, it did accelerate under the Conservatives, with the most acute period seeing more than £4 billion raided from the capital budget in the five years up to 2019 to cover deficits in day-to-day spending. I note that that was prior to the pandemic, when operational pressures were clearly stress-tested to the limits, and I have no doubt that that under-investment left us more exposed than we otherwise would have been during that period.

The outfall is staggering. If we had simply matched existing levels of capital spend, more than £30 billion of additional capital would have flowed into the NHS. Instead, we watched buildings decay, equipment age, diagnostics fall behind and maintenance backlogs soar.

[Caroline Voaden (South Devon) (LD)]

Medical devices and equipment are increasingly becoming pressure points as trusts rely on ageing, life-expired kit. Torbay and South Devon NHS foundation trust has had fantastic results in bowel surgery from a free trial of a robotic surgery system that it was offered, but it cannot afford to buy the system because it has to replace other equipment that is on its last legs. Does my hon. Friend agree that the Minister should set out how the Government will ensure that NHS capital policy supports not just buildings and maintenance backlogs, but clinical equipment and the technology needed to deliver safe, high-quality, innovative care for patients?

[Bobby Dean]

My hon. Friend makes an excellent point: this is about not just buildings, but equipment and digital and technical infrastructure, all of which are crucial to getting the NHS to operate in the way it should. She also highlights how we need to upgrade ageing equipment to a very basic level, let alone take advantage of all the opportunities that the latest innovations in new equipment could provide us with, if we were able to purchase those.

I mentioned that maintenance backlogs are soaring. They have doubled from around £6 billion in 2015 to over £13 billion in 2024. The critical thing to stress is that it did not have to be this way. The UK invested around a third less in health capital during the 2010s than other comparable nations. According to OECD data, the UK has 10 CT scanners per 1,000 people compared with an average of nearly 20 per 1,000 across Europe. We have 8.5 MRI scanners per 1,000, compared with an average of 12 per 1,000 across other EU nations, and our bed capacity is pitiful. We operate at around 2.4 per 1,000 people, compared with an OECD average of 4.4. The issue has not only been a lack of money; it has also been a lack of certainty and flexibility.

The approvals process for capital bids is slow and cumbersome. Even when capital is available, trusts often receive final sign-off so late in the year that they physically cannot begin procurement, get survey work done and start construction in time. The money therefore goes unspent not because of poor planning locally, but because the system itself creates delay.

[James Naish (Rushcliffe) (Lab)]

On that point, my local authority is currently sitting on £50 million of developer funds that it was paid, but those funds are not being spent in the local community because there is not the total money needed to invest in health, infrastructure, schools and other things. Does the hon. Member agree that that is something we must look at, to make sure that money set aside for development is spent with urgency in our communities?

[Bobby Dean]

The hon. Gentleman highlights the complexity in putting together large capital projects. Funding is not often from one source. It is from multiple sources, and everybody providing the capital needs to have greater flexibility for the schemes to become deliverable, or the funds end up getting clawed back and put elsewhere, as has been done in the past.

The yearly cycle that I speak about is important because, in the past, capital departmental expenditure limits rules—Treasury CDEL rules—have meant that any unspent capital must be returned to the Treasury at the year end. Not being able to carry it forward punishes good financial management, prevents multi-year planning and leaves trusts scrambling to spend money before deadlines, rather than investing it strategically. The result is a system where underspends exist at the same time as record levels of urgent capital need. Trusts want to invest and start work, but the system ties their hands.

The effect of all that has not been abstract. The buildings maintenance backlog includes high-risk failures: operating theatres closed due to ventilation problems, leaks near electrical systems, sewerage failures and outdated wards where modern clinical standards simply cannot be delivered. A 2022 British Medical Association survey found that 43% of doctors reported that building conditions negatively impacted patient care.

[Alex Brewer (North East Hampshire) (LD)]

My hon. Friend is giving a powerful and important speech. Half the residents in my constituency are served by Basingstoke hospital, which was included in the now infamous promise of 40 new hospitals by 2030. Now it seems completion could be as late as 2046. The delay means another 20 years of spending taxpayers’ money on a building with leaking windows, exposed wiring, an uninsulated roof and countless other physical problems, with a bill that goes up and up every year to maintain that crumbling building. Does my hon. Friend agree that asking taxpayers to pay twice is a waste of public money, and Basingstoke hospital and others should have their rebuilds brought forward?

[Bobby Dean]

I do agree with my hon. Friend. I will come on to the new hospitals programme, as my constituency stands to benefit from it, too—if it comes soon enough. In the meantime, as she says, we are paying twice to pay for the repairs and patchwork, and never keeping up with the investment we need.

Ageing diagnostic equipment also means fewer scans, longer waits and more delayed diagnosis. Last year I had the pleasure of visiting my local hospital’s nuclear medicine unit, where I was shown a new machine that was driving down diagnosis times from hours to minutes. Obviously that is a fantastic sign of good capital investment, but when I spoke to the trust I was shocked to discover it is one of the only hospitals in the country with that particular piece of kit, and I thought to myself how much more productive the NHS would be if such equipment was rolled out routinely across the country as soon as it became available.

Then there is the infamy of poor IT systems. More than 13.5 million clinical working hours are lost every year due to poor IT. We have all heard shocking stories of hospitals running on Windows operating systems that we were talking to a paperclip on 20 years ago. As the age of artificial intelligence promises to transform the workplace, it would be great if the NHS could catch up with the last decade or so.

I recently met an AI developer who thinks they have come up with a solution to the elective surgery booking system. His system auto-calls patients and offers them a choice of appointment, making hundreds of calls in just minutes. They say it beats the old system on two counts. Patients usually receive a date by post without a choice, but the trial in the midlands saw “did not attend” numbers drop by 50%, which they put down to patient choice in the appointment time, and delivery was guaranteed because they had answered the phone. Think of the potential productivity gains if such technology was picked up at scale.

I have explained a little about the past state of NHS capital spending and will now turn to where the Government are today. Part of the reason for this debate is to find out where the Government think they are. It is worth saying that the Government’s stated intention has been a step in the right direction. There has been more certainty, more money and more flexibility. After the initial one-year capital settlement for 2025-26, with assurances that things would continue, the spending review confirmed capital budgets through to 2029-30. Those decisions will provide some stability, though it is still uncertain whether the Treasury clawback system remains in place on an annual basis or over the spending review period.

There was a substantial uplift of money in the year 1 allocations, but that is followed by a relatively flat commitment going forward, albeit at a higher level due to the initial uplift. I do not think we should be churlish about that—an increase in investment is inarguably good—but equally, we should not kid ourselves that investment is now at the required level. It does not fully address the inadequacy of past investment, nor does it bring it in line with international comparators. The King’s Fund has described the failure to reverse the historical underfunding by the previous Conservative Government as “extremely disappointing”. The NHS Confederation is asking for the commitment over the spending period to be doubled in real terms, from £3.1 billion to £6.4 billion.

There has also been greater flexibility, with Treasury approval now only required for capital projects in excess of £300 million, up from the previous, pitiful £50 million. The new delegated authority will cut out layers of bureaucracy and speed up delivery on the ground for ward refurbishments and equipment purchases. It will not address issues inherited in the largest NHS capital schemes, however, which brings me on to the new hospitals programme.

The programme was imagined by former Prime Minister Boris Johnson—I say “imagined”, because for some time the only place it existed was in his imagination. Conservative leaflets in my patch were emblazoned with a promise that the money had been secured for a new hospital building that would be delivered by 2024. I am sure that experience holds true for many in this room. When 2024 came, hardly a brick had been laid across the country. When the new Government came in, they told us no money had ever been allocated for those schemes.

The programme was reset by this Government, with an updated timetable and revised waves of projects. My local hospital’s building was put into the second wave, meaning that work will not begin until the 2030s, which was a bitter disappointment. Since the announcement of delay, things have gone a little quiet overall. A year or so on from the announcement, people are wondering how the programme is getting on. There are rumours that are some in the first wave are not keeping pace and could already be underspending allocations. Mostly, that is put down to the adaptation period of the hospital 2.0 model, an attempt to homogenise design across the country that is broadly welcome.

Any delays will spark questions about what will happen to that allocated spend. Hospitals such as mine will want to be at the front of the queue for any reallocation, if such an opportunity should arise. I have already mentioned my local hospital, but there is no clearer case of capital neglect than St Helier hospital in my constituency. It is as old as the NHS itself, overcrowded and cramped, and the specialist emergency care functions are simply not up to modern-day clinical standards.

Let me be clear: staff at St Helier are working heroically and patients are safe, but they are in a building that is not designed for 21st-century emergency care, with patients routinely treated in corridors. Key recommendations for improving service delivery simply cannot be implemented because there is physically not enough space. Despite tens of millions having been spent on basic repairs in recent years, the building is deteriorating faster than the trust can fix it.

The new hospital programme promised to resolve many of those issues with a new building for emergency and maternity care but, with that delay well into the 2030s, my constituents are left facing another decade of care in a building that is visibly past its lifespan.

[James Naish]

I am based on the outskirts of Nottingham, and already this year we have had three critical incidents at Queen’s medical centre, which is the main hospital in the city. They have all been based around A&E, and they were all the exact situation that the hon. Member describes. A&E has capacity for 350 patients, but it has routinely been seeing over 500. Does he agree that, in addition to the pressures he describes, there is a reputational risk to the NHS when such incidents are being declared because of physical capacity issues?

[Bobby Dean]

I agree with the hon. Gentleman, and I am sure that, like me, he hears constituents say that they do not want to attend their local A&E because they do not trust that they will be seen in time. I am sure that the figures he is describing are an undercount of the people who should be in there. Like me, he will have received emails about corridor care for some time. I had hoped that corridor care was a peak crisis moment and that it would subside, but it has become the norm and that is extremely worrying. It is not acceptable for patients, it is not fair on staff, and it is not a sustainable way to run our NHS.

If the Government are to reconsider which schemes should be in which waves of the new hospital programme, let me assure the Minister that my local trust is ready to go. Plans have been drawn up, land has been secured, and teams can move at pace. We need this, we want this, and we are ready. If that is not possible, but other pots of capital to be reallocated still remain, I make a separate plea: extend St Helier’s emergency department now. That is a smaller ask than delivering a whole new building, but it will make a big difference. The only thing more full than the corridors at my local hospital right now is my inbox, which is filling up with constituents describing their traumatic experiences.

St Helier hospital emergency department sees around 250 patients a day, with routine overcrowding leading to the trust being placed into national oversight measures. Kirsty, one of my constituents, was left anxiously waiting for her 83-year-old mum to be seen, witnessing elderly patients crying, vomiting, screaming and walking around in severe pain in the corridors. The father-in-law of Muhammad, another constituent, waited over 13 hours only to return home without seeing a doctor at all. Others have shared deeply personal details of their stories; their conditions were explained to them alongside countless others in the same corridor. It is undignified, unjust and unsafe.

The trust has come up with a plan. It believes that it can redesign the existing estate, creating a new urgent treatment centre and expanding the same-day emergency care service. By doing so, it would dramatically increase the number of patients it can see. The urgent treatment centre would be able to handle up to 30% of patients—up from 14%—and SDEC could get to 20%, up from 8%. That would prevent unnecessary overnight stays, free up hospital beds, speed up ambulance transfers, and reduce delays for patients needing hospital admission. The plan would also address £15 million of the trust’s ageing estates backlog. It is immediately deliverable; the trust believes that work can begin as early as autumn 2026. It would make an incredible difference, so I ask the Minister to make use of any influence she has over the matter to help the proposal get over the line.

Before I conclude, let me raise one further point about NHS capital expenditure that I suspect will not make me popular, but that I believe is right. The Government have tentatively re-entered the world of public-private partnership models with their announcement of neighbourhood health centres late last year. We all know how disastrous that model of financing was in the past, with the long-term costs to the taxpayer far outweighing the short-term benefits. Britain was among the first in the world to pilot such a scheme, and it failed fast.

It must be said, however, that other nations have learnt the lessons of our failures and successfully delivered social infrastructure at scale, on budget and on time. Indeed, I believe that is one of the reasons why we have fallen behind so badly. As a member of the Treasury Committee, I recently guested on a Public Accounts Committee inquiry into PPP, which concluded that if we get procurement, contract management, and the risk allocation of projects right, then we can massively accelerate the delivery of infrastructure in our country in a way that delivers real value for money for the taxpayer.

[Mr Gregory Campbell (East Londonderry) (DUP)]

I congratulate the hon. Member on securing the debate. To summarise what he is saying, we need to better spend the money that is currently being deployed in the NHS. Does he agree that this has to be the underpinning feature going forward? More and more money has been poured into the NHS; we all think it is a fantastic organisation and praise those who work in it, but we need to spend that money better and modernise the monolith that is the NHS.

[Bobby Dean]

I agree with the hon. Gentleman, who hits on one of the central points of this debate. We can continue to pour money into the operational side of the NHS, but if we do not get the capital expenditure right and improve the equipment, systems and buildings, we will always be pouring good money after bad.

I know that PPP is fraught with political risk, particularly for a Labour Government who are scarred by what happened in the past, but I urge them to look at the National Audit Office’s report and the experience of others internationally. They should also listen to the NHS Confederation, which is pushing them to go further and experiment with different financial models for delivering the infrastructure that we need at scale.

NHS capital has been insufficient, uncertain and inflexible for far too long. The new Government have good intentions to improve on all three, but now is the first moment at which we can start to look at their delivery. After what I have outlined today, I would like to put several questions to the Minister. Will she update us on the current level of capital underspend under this Government? Where in the system is the underspend occurring, and what is being done about it? Will the Government allow trusts to carry forward any unspent capital to future years? Will that exist beyond the current spending review period? What assessment has the Department made of the delivery of the new hospital programme, and will any schemes be reconsidered for movement between the waves? Will the Minister outline whether the Government plan to reform the capital allocation system to allow multi-year planning and reinvestment of trust surpluses permanently?

The NHS cannot function without modern, safe and efficient infrastructure. No Government can deliver improvements in performance or productivity without addressing the capital crisis at the heart of our system. I urge the Minister to use this moment to reset the capital regime and put it on a footing that prioritises long-term investment, accelerates delivery and gives patients and staff the facilities they need and deserve.

[Several hon. Members rose—]

[Matt Western (in the Chair)]

Order. I remind Members that they must bob if they wish to be called in the debate. I first call Gareth Thomas, who will be followed by Steve Darling.

09:51

[Gareth Thomas (Harrow West) (Lab/Co-op)]

The White House in Harrow, thanks to NHS capital money, will shortly become even better than its American namesake. I pay tribute to the hon. Member for Carshalton and Wallington (Bobby Dean) for the way in which he introduced the debate. I agree very much that levels of capital investment into the NHS do not get the attention that they deserve in this place. He is certainly right about the impact on NHS capital spending of the austerity over the previous 14 years of Conservative health administrations. He rightly referenced the shameful spectacle of Conversative Health Secretary after Conservative Health Secretary handing back capital moneys to the Treasury at the end of March. My hon. Friend the Minister will be pleased to know that I have a solution to that problem if she faces it this year.

The White House, which is located at Harrow college, close to Harrow-on-the-Hill station, is set to become one of Harrow’s neighbourhood care centres thanks to NHS capital. NHS capital is allowing the local NHS to convert the White House, which is part of the college at the moment, into a new, expanded GP surgery and care centre. It will offer two opportunities for students enrolled at the college to begin a career in health and social care. Crucially, it will create a hub for care services that can keep people out of hospital and, in particular, out of accident and emergency queues.

The White House is set to be one of a number of new neighbourhood care centres, including Belmont health centre, Alexandra Avenue health and social care in Rayner’s Lane in my constituency and the Pinn medical centre in Pinner. This planned expansion of primary care over the next two years, using NHS capital moneys, builds on a recent significant increase in the number of GP surgery appointments. The nightmare of having to get an appointment to see a GP once lines open at 8 am is beginning to ease, but much more progress still needs to be made. GP appointments in Harrow have increased substantially since July 2024. Just under 120,000 appointments took place that month, but by October last year the total number of appointments each month had risen to more than 145,000—a 22% increase. For face-to-face appointments in particular, there had been a 30% increase.

I welcome the difference that NHS capital allocated to Harrow will make for primary care in the coming years. The funding for GP Direct, a surgery currently based in west Harrow, to expand and offer more and better primary care services, and for a neighbourhood healthcare centre located at the Alexandra Avenue clinic, is set to make even more of a qualitative difference to primary care services in my constituency.

However, I hope to make the case to the Minister for the allocation of further NHS capital investment at Northwick Park hospital. Waiting lists are beginning to come down at Northwick Park, but, again, there is much more to do. To help maintain that progress, Northwick Park needs a new 36-bed critical care unit, with space for further expansion. A series of NHS and independent assessments of critical care across north-west London have identified a shortage of critical care beds, particularly on the Northwick Park site. The existing intensive care unit there has a series of problems that compromise the current delivery of critical care. It is not co-located with other key NHS services on site, such as the emergency department or operating theatres. It is outdated, noisy, cramped and unfit for purpose for patients and families facing critical illness—or, worse, potential end of life.

The trust has put together a proposal for a new UK-leading exemplar intensive care unit that provides additional critical care beds and a new CT scanner, which would embed modern standards of patient experience and family support. The proposal is for a 36-bed unit and allows for a potential future expansion for a further 24 critical care beds. The new unit that is immediately proposed allows for 30 of the 36 beds to replace existing critical care beds that are located in other parts of Northwick Park hospital, which will free up extra bed space and, in turn, help to alleviate pressures on other parts of the hospital, notably in accident and emergency. It will also play a useful role in helping to prevent the cancellation of elective operations.

The recommended bed occupancy for critical care beds is set at 85%, according to the National Institute for Health and Care Excellence. Northwick Park has been consistently above that level for some time. The hospital has one of the busiest A&E departments in the country, receiving an average of 90 ambulances a day, rising to 140 on its busiest days. Critical care admissions are also up by more than 16% since 2018-19, and more than 80% of admissions to the trust are at Northwick Park hospital. It is worth reflecting on the experience of covid. Northwick Park was the first hospital during the covid pandemic to declare a critical incident, as the number of intensive care beds simply ran out.

An expansion in critical care beds at Northwick Park needs funding. It needs funding to improve services now, but also to better prepare north-west London for future health emergencies. The bid for funding is strongly supported by the trust board and, I understand, by the local integrated care board as well. I hope that the Minister, her Health colleagues and the Treasury will support it, and that the Minister will commit to doing all she can to give it a strong push.

Work on cancer care services is also taking place in the London North West University NHS trust. Northwick Park already sees more than 50,000 people with suspected cancer each year, and diagnoses more than 3,000 cases. However, too many cancer cases have to be dealt with outside of our area, and the quality of the experience for those being treated for cancer could be significantly improved with further investment. I hope that the Minister will duly make sure that Northwick Park is flagged up early for further investment as part of the national cancer plan.

[Matt Western (in the Chair)]

I expect speeches to be around five minutes so that we can get everyone in. Please be respectful to colleagues.

10:00

[Steve Darling (Torbay) (LD)]

What a pleasure it is to serve under you as chairman, Mr Western. I congratulate my hon. Friend the Member for Carshalton and Wallington (Bobby Dean) on securing this important debate. Sorting out Torbay hospital, the hospital that serves my constituency as well as the constituents of my hon. Friends the Members for South Devon (Caroline Voaden) and for Newton Abbot (Martin Wrigley), is my No. 1 priority as the Member of Parliament for Torbay.

I knew that the hospital was in a difficult place prior to my election, but as I began to immerse myself in the challenges facing it, I was shocked. I was shocked by what was effectively wanton vandalism—corporate vandalism, even—undertaken by the previous Conservative Government by making promises that they just could not keep. The vandalism—the fact that they chose not to invest—made it much harder to invest in the longer term and actually made it more costly. It is that old proverb: a stitch in time saves nine.

In Torbay we face some massive challenges. We have seen more than 700 sewage leaks at our hospital. These sewage leaks do not just happen in the corridors; they happen in clinical areas and affect wards where patients are. There have to be deep cleans, and there are delays for patients in getting on to lists and, most importantly, delays in supporting people who need medical interventions.

We heard from my colleague, my hon. Friend the Member for Carshalton and Wallington, that delays are occurring because of poor ventilation, and we have heard about the impacts—indeed, there have been very significant impacts in Torbay hospital. However, approaching the hospital, someone might think that the seventh cavalry was coming over the horizon—the tower block is wrapped in scaffolding, so it must be being sorted. However, the reality is that the £1 million scaffolding is there purely to stop bits of the building falling off and braining staff and members of the public as they go past. Having to spend so much of our NHS money just maintaining a crumbling building is not good. The Torbay and South Devon NHS foundation trust has some bids in with the Minister around the challenges in the tower block; I am sure she is considering those at the moment and I hope she will look upon them kindly.

I also want to reflect on what works well in Torbay hospital. I recently visited and saw some really exciting changes. There are millions of pounds-worth of investment in the emergency department, for example, which is really welcome. The daytime operations area, where people come in for a short period in the hospital, is calm and businesslike, which is what we want during hospital visits, but that is very different from other parts of the hospital, particularly for those people who suffer from cancer, for whom the offer is chaotic and situated all over the estate. Cancer sufferers deserve a better experience.

We have seen investment in the endoscopy unit, and 90% of patients are being seen within five weeks, which is a massive improvement. However, looking at the estate of Torbay hospital as a whole, 85% of it is not up to standard. The £350 million investment supports only half of the hospital.

We have also seen a toxic change to the spending power of this capital programme. We have seen Brexit, we have seen the pandemic, which has impacted on the spending power of capital programmes, and we have seen the war in Ukraine, which has seen building prices spiral. Some of the management in the hospital field say that, since the pandemic, the spending power of capital programmes has halved, so can the Minister tell us how the Government have taken account of the fact that money is going only half as far as it did historically?

In conclusion, Torbay is one of the most deprived communities in the country and the NHS often picks up the rough end of that. Only recently, a director told me she has patients who believe that living to their 60s is a good span of life. I am sure the Minister agrees that is not the aspiration we should have for our communities. In the south-west we have seen a lack of capital investment, whether in our railways or NHS infrastructure. I hope the Minister will tell us how the Government are planning to invest in the NHS in the south-west and, as my hon. Friend the Member for Carshalton and Wallington asked, what innovation there is to bring forward that investment. Sadly, Torbay has been kicked into the long grass until the mid-2030s. The staff are our most important asset, and they deserve that investment much sooner.

[Matt Western (in the Chair)]

The next speaker will have five minutes. Thereafter, I am afraid I will have to drop to four minutes.

10:05

[Gideon Amos (Taunton and Wellington) (LD)]

It is a pleasure to serve with you in the Chair, Mr Western. I congratulate my hon. Friend the Member for Carshalton and Wallington (Bobby Dean) on securing such an important debate.

The No. 1 issue that I promised during my election campaign that I would focus on and prioritise, if elected, was care in the NHS, specifically Musgrove Park hospital and the dire state of the maternity unit. Of course, the Conservatives did not just promise to help; they promised 40 entirely new hospitals, including one in Taunton. As has been pointed out, there were not 40 of them, many of them were not hospitals and they certainly were not new. According to data from the House of Commons Library, as my hon. Friend the Member for Carshalton and Wallington pointed out, a staggering £4.3 billion of NHS capital spending was cut to cover revenue challenges under the last Conservative Government. It is hardly surprising that their enormous promise turned out to be entirely fictious.

What is the result? In the summer, we have medical staff fainting in the 30° heat in single-storey buildings that were built in world war two, and in the winter, we have holes in the walls and rows of buckets in corridors to catch the water. We even have roof guttering mounted inside the building in several locations to deal with the leaks. I trained as an architect and I was not expecting to see external roof guttering inside hospital rooms.

I genuinely welcome the Government’s increased capital spending for the NHS. Last year, as a result of cross-party campaigns and to the Government’s credit, Taunton and Somerset got a glass-half-full announcement about the hospital programme: it was included in the second wave of funding. Unfortunately that is not until 2033, which is later than is needed. We need action before that. I was delighted to hear the Secretary of State for Health and Social Care being challenged on the radio recently by the redoubtable Emma Britton, the voice of BBC Somerset. He said of the new maternity unit:

“If I can bring forward the timetables of these schemes because we can get not just the money, but the contractors and the suppliers and everything else that is required—the planning to do that—we will do our best to bring forward schemes."

I am working closely with the trust. They have sensible plans that could expedite those projects and get on with the vital planning work that we know needs to happen so far ahead of the project. That could be started next year. Can the Minister meet with me at some point to look realistically at the trust’s proposals to expedite the vital need for a maternity unit in Musgrove Park hospital in Taunton? A meeting was proposed earlier in the year, but got postponed.

I understand the pressure the Minister is under. I know she understands the challenges and has many hospitals to think about, and I genuinely appreciate the work that she is doing. But, given what the Secretary of State told Somerset over the airwaves only a few weeks ago, and given the dire need at Musgrove Park hospital, I urge the Government to make a start on that key project as soon as possible. We know that care and our NHS are the key levers to getting our public services back to where they need to be, to helping people back to work and to boosting our economy. We also know it is the right thing to do for mums and medical staff in Taunton and Wellington.

10:09

[Jim Shannon (Strangford) (DUP)]

It is a real pleasure to serve under your chairship, Mr Western. I thank the hon. Member for Carshalton and Wallington (Bobby Dean) for setting the scene incredibly well. Of course, I want to give a Northern Ireland perspective, but I want to put forward two areas where possible savings could be made, and I wonder whether the Minister has had a chance to look at that, collectively or individually.

The hon. Member for Carshalton and Wallington, who set the scene, had 1,000 petition signatures for this debate—well done to him for garnering that interest. Our hospitals are so important and their services are lifesaving, so in terms of our finances they are priority No. 1. It is absolutely no secret that NHS capital spending has a direct impact on patient flow, waiting times and staff morale, and also on the quality of care.

Each year, my colleagues and I listen to the Budget and assess how our block grant can benefit the people of Northern Ireland through our healthcare system. It is clear that we must invest heavily in our facilities as well as our day-to-day spending. In her spring Budget yesterday, I think the Chancellor said that an extra £380 million was coming to Northern Ireland in the block grant. That should hopefully go some way to helping balance the books.

Around two years ago in my constituency of Strangford, our minor injuries unit closed following the opening of an urgent care unit in Ulster hospital. It was one of the most modern acute hospital sites following more than £235 million in capital investment, including in the new emergency facilities, patient accommodation and surgical and research infrastructure. Rather than planning a completely new hospital, the Department of Health has focused on transforming the Ulster into the regional acute hub. That is the right strategy, aligned with wider NHS reconfiguration plans for Northern Ireland.

Furthermore, there are plans for a new maternity hospital at the Royal Victoria hospital in Belfast. That is one of Northern Ireland’s largest capital projects, with more than £100 million already invested. Further investment is also planned for the surgical hubs, elective facilities and rapid diagnostic centres. I am pleased that hospitals in Northern Ireland have witnessed increased capital investment but, in comparison to St Helier hospital, as the hon. Member for Carshalton and Wallington described, it is clear that some hospitals are still struggling drastically, and he underlined that point incredibly well. More needs to be done to ensure that they are fit for purpose.

I have two points on savings, which I put to the Health Minister back home, Mike Nesbitt. A level of middle management has been created, which is not always necessary. I am not saying that people should lose their jobs; I am just looking at how it can be done in a good way to ensure value for money. The second point is about agency staff. Back home—and I understand it is the same over here—agency staff are sometimes employed rather than full-time nurses. That is never cost-effective, because it is better to pay a nurse a good wage than it is to employ agency staff. Those are two thoughts that might be helpful.

NHS capital spending is not a luxury; it is a necessity. It is the foundation of safe buildings, modern equipment, efficient services and dignified patient care. Without sustained investment, we will continue to see rising waiting lists, staff burnout and crumbling infrastructure. The Minister is always very responsive, and we are glad to have her in her place. The hon. Member for Carshalton and Wallington is asking for the Government to commit to sustained strategic capital investment that will secure the future of our NHS and deliver the standard of care that patients and staff both deserve. Those two ideas to save money are worth looking at as well.

[Matt Western (in the Chair)]

I call Josh Taylor—sorry, I got that wrong; I call Luke Taylor.

10:13

[Luke Taylor (Sutton and Cheam) (LD)]

Thank you, Mr Western. An MP Josh Taylor—that would be a beast, would it not? It is a pleasure to serve under your chairship. I thank my constituency neighbour and hon. Friend the Member for Carshalton and Wallington (Bobby Dean) for introducing this incredibly important debate. He and I have written op-ed articles for our shared local newspaper in recent weeks, describing our constituents’ despair at the state of emergency care and facilities at St Helier hospital.

When I posted my article on Facebook for local residents to read, somebody commented on my post to say that they were fed up of the endless discussions on the topic, and they rightly pointed out that St Helier has been a totemic issue in Sutton for decades. They angrily demanded action, not words, from us all to get something done about it. The truth is, I could not remotely fault my constituent for their outrage at the imbalance of words and action that they, and everybody in Sutton, have had to live with for far too long. This is what happens when Governments fail to act; people lose faith that the system and their politicians can deliver results. When people hear grand words but see no action, it is no wonder that politicians are the least trusted profession in the UK.

Before I was elected I was an engineer, which is one of the most trusted professions. Then, with the support of more than 16,000 of my constituents, I instantly became a member of one of the least trusted—it is a funny old world, is it not? When the policy area at hand is something so visceral as whether people and their families can go to their local hospital safe in the knowledge that it is equipped to care for them properly, that loss of faith is absolutely corrosive to all faith in politics.

[James Naish]

The Minister will know the health centre I am about to mention. It is in East Leake in my constituency of Rushcliffe, and it has been talked about for over 20 years. It has clinical rooms that are out of action because there has not been the appropriate investment. The hon. Member for Sutton and Cheam (Luke Taylor) represents a relatively affluent part of the country, but does he agree that there is something called building deprivation? The reality is that health centres are not in a good enough condition for our constituents and, irrespective of the relative affluence of an area, we still need to invest in our infrastructure.

[Luke Taylor]

I could not agree more with the hon. Member’s point. When the condition of an asset does not attract staff, particularly in more deprived areas, the challenges will be greater. Those compounding challenges are borne out visibly through the physical asset, and everything becomes much more difficult.

I should not have to be here making points about political faith and delivery—or the economic arguments that have been made by other Members—but I will make the important humane case, based on the experiences of my constituents. I recently did a health survey where residents wrote in and told me their stories. One of them was a woman whose husband spent 54 hours in A&E with sepsis, lying on a trolley in a room so small it could have been a broom cupboard. Another, who is in her late 80s, sat waiting on a chair for 10 hours after a suspected heart attack, while another woman, who was unable to sit on a chair because of her pain, had to lie on the floor crying and wait for several hours.

Almost half of those who responded to the survey said that they had waited for more than four hours in A&E at St Helier hospital. We have the NHS numbers, too: across the Epsom and St Helier trust, 18,600 people waited for more than 12 hours in 2025. That is sickening; it is an example of a system that is not working. “Sickening” is the right word: like thousands of people across Sutton, I am sick to the back teeth with the endless delays that have got us here.

There is another important angle. In almost every one of the stories I was told, there was nothing but deep appreciation for the dedicated staff on the estate, many of whom the respondents credit with saving their lives in spite of—not because of—the conditions that they find themselves in. How can we keep recruiting into the NHS or uphold its public image if these are the conditions that we are expecting staff to work in? This is normally the part of the speech where I talk about the Government’s awful inheritance from the Conservatives, but I do not feel like making that point any more, because the people of Sutton have had enough context-setting and this Government is almost two years old now.

I thank the Minister for her discussions of this topic with me and other colleagues. I feel that we are engaging openly and positively, and I want to make that very clear for the record, but I ask the Government to listen to the pleas of our constituents, and to please provide the money to expand our emergency department. At risk of returning to my point about trust, if we do not fix this, we risk a catastrophe in Sutton that might undermine the faith of my residents and the broader public in the entire model of the NHS.

My speech has been about expanding, refurbishing and fixing St Helier hospital, but there is the separate issue of the real and urgent need for the specialist emergency care hospital that our NHS and residents were promised by the previous Government. We need that too, and we need it quickly. The expansion of our A&E would complement the provision in Sutton, and it needs to be brought forward.

[Matt Western (in the Chair)]

I now call Josh Babarinde.

10:18

[Josh Babarinde (Eastbourne) (LD)]

Thank you, Mr Western. I was half expecting to hear “Luke Babarinde”, but we got there in the end. I thank my hon. Friend the Member for Carshalton and Wallington (Bobby Dean) for securing this critical debate.

I will focus my remarks on Eastbourne district general hospital, where I was born. It is at the core of life in Eastbourne. I want to pay tribute to the amazing staff at that hospital, who deliver for the people of Eastbourne and beyond day in, day out. However, over the years we have lost key services at Eastbourne district general hospital to hospitals such as the Conquest in Hastings, forcing Eastbourne residents to travel even further for the care they need. As well as that, our buildings are falling into a state of disrepair. Indeed, the trust has said:

“The age and standard of the current hospital buildings presents challenges for the consistent delivery of safe, effective, responsive and efficient care”.

The half a billion-pound maintenance backlog bill that the trust faces is a financial representation of that.

We were grateful to be included in the new hospital programme by the last Government—I am very sad not to see more representatives of that Government in attendance at this debate—but of course nothing happened under the Johnson Government. Eastbourne was therefore even more grateful to this Government for making a much more serious commitment to include it in the new hospital programme and to fund the DGH through the programme. It is of grave concern to us, however, that we are in the last wave of that programme, which means that investment will not land with us until 2037 at the earliest.

Meanwhile, many of our fears in Eastbourne have materialised. On 6 January, Eastbourne district general hospital suffered a power outage that hit many areas of the hospital. Nurses told me that they were forced to use their iPhone torches to light the way for the several hours that the power cut occurred. Because of that outage, operations were cancelled and our midwifery unit was closed for days. It stemmed from the insufficient power infrastructure that is in need of urgent investment—the very reason, in fact, why Eastbourne district general hospital was included in the new hospital programme full stop.

I have appealed to the Minister and the wider Government numerous times to accelerate that investment to Eastbourne and to bring forward our plans—after all, we were ready to go, but we were asked to pause. If the Government will not do that, however, will the Minister at least meet with the trust and me to discuss accelerating the release of the £42 million needed to replace the failing electricity substation that was responsible for the power cut, to ensure that Eastbourne residents get the consistent care and urgent investment that they need and deserve? I really do appeal to the Minister—if I need to, I will beg her—for that meeting so that we can figure out how to unlock that critical investment.

10:22

[Ian Roome (North Devon) (LD)]

I thank my hon. Friend the Member for Carshalton and Wallington (Bobby Dean) for introducing this important debate. I thank the Minister for visiting North Devon district hospital to see the estate for herself and for listening to the passionate pleas from NHS clinicians serving on the frontline.

The hospital is now the third of nine hospitals in wave 3 of the new hospital programme and faces a further 10-year wait for the capital funding it needs. That investment is desperately needed to replace an ancient intensive care unit and operating theatres that are nearly 50 years old. I thank the Government for approving phase 1, building new residences for staff and medical students, which will also recover land for the all-important clinical rebuild. On paper, however, phase 2 is unlikely to begin before 2035.

The cost of keeping these facilities running for another 10 years will be immense. Our hospital has a maintenance backlog of “high” and “critical” grade work of over £40 million, the most per square metre of any hospital in the south-west, higher even than many of the hospitals afflicted by reinforced autoclaved aerated concrete, or RAAC. Our NHS trust worries, as I expect many people in this Chamber worry, that that is simply throwing good money after bad.

In January, the National Audit Office released its update on the new hospital programme, which makes it clear that the current Labour Government have tried to financially rescue a programme that the last Conservative Government had doomed to disaster. However, many of my constituents feel that they have lost out yet again. It is not only that patients in northern Devon are being asked to wait another 10 years for new critical care facilities, but the ever-increasing maintenance costs of keeping their ageing hospital going will demand a bigger and bigger share of NHS funding from the area.

Worse still, the Department of Health and Social Care says that hospitals built to the new hospital 2.0 standard are expected to deliver operational savings. Whose hospitals will really benefit from that approach? When I queried it in a written question, the Minister said on 13 February that trusts and integrated care boards manage budgets, and that the centralised new hospital programme does not redistribute savings. If an NHS trust is lucky enough to receive the capital spending for new facilities sooner rather than later, patients in that community will benefit twice; if not, tough luck.

Furthermore, the estimated cost of the scheme in my area given in the new hospital programme review seems to bear no relation to the bid originally submitted by the trust. The Government will not answer questions on the multi-criteria decision support analysis tool that is being used to score the bids for capital funding under the new hospital programme, nor even answer freedom of information requests to state the name of the provider of the tool. Consequently, we as parliamentarians are unable to scrutinise that detail.

I have some questions for the Minister. First, will the Department explain these cost estimates, because £1.5 billion is a vastly inflated figure, which is far beyond the 50% adjustment stated in the review? That should not delay work on NHS hospitals such as mine in North Devon. The trust is ready to build the next phase now, so if there is any capital available, please bear North Devon in mind. In addition, what else can the Government do in the coming years to avoid entrenching real health inequalities in communities such as mine in North Devon?

10:26

[Clive Jones (Wokingham) (LD)]

It is a pleasure to serve under your chairship, Mr Western, and I thank my hon. Friend the Member for Carshalton and Wallington (Bobby Dean) for securing this extremely important debate.

Let us make no mistake: what we are talking about today is a national scandal. Many parts of our hospitals are falling to pieces. That is not just political rhetoric; it is a statement about genuine risk. Some of my constituents, for example, use Frimley Park hospital, which is primarily built out of RAAC, and it has already lasted for twice as long as it was supposed to. In January, the National Audit Office reported that the most urgent RAAC-related phase of the new hospital programme would be completed at least two years later than originally planned, and could take even longer, despite the pressing safety risks posed by buildings with RAAC. We need to do better.

My hon. Friend spoke eloquently about the challenges with capacity at his local hospital, St Helier. Such hospitals are suffering from many years of Conservative under-investment and neglect. The story is repeated across the country: crumbling buildings; leaky roofs; sewage leaks, in some cases; and equipment faults that delay diagnosis and care. That did not happen in just the last two years, so I hope the Opposition spokesperson, the hon. Member for Hinckley and Bosworth (Dr Evans), will show some contrition for the part that the Conservatives played in there being a lack of capital investment over many years, which allowed those conditions to develop. The promise of 40 new hospitals, which was made by the Conservatives but had nothing at all behind it, will not be forgotten for generations.

Labour is not addressing this crisis with the urgency that it demands. The response has been to delay the new hospital programme even further, which is a staggering miscalculation. It will cost the country billions to keep old—indeed, dying—hospitals on life support, including around £400 million for the Royal Berkshire hospital alone. I draw Members’ attention to my entry in the Register of Members’ Financial Interests, as a governor of that hospital, and a family member works there as well.

The Royal Berkshire staff are hard-working, compassionate people, as are the doctors, nurses and other clinical professionals working across the country. Our NHS staff are truly the best of us. Despite the best efforts of the hospital trust, the conditions they work in are very poor. The building—parts of it almost 200 years old—is quite literally sinking. Cancer patients receive chemotherapy in a children’s ward from 1910. Wards and offices are inadequately ventilated. Parts of the hospital are poorly accessible, and 50 operations were cancelled in 18 months, not due to staff unavailability or incompetence or for medical reasons, but because the building was simply inadequate on the day. Labour’s response has been to make that hospital struggle on for at least another seven years, on top of the Conservatives’ already lengthy delay, at huge cost to both the taxpayer and patient dignity.

It is not a problem confined to the Royal Berkshire hospital. Between 2019 and April 2025, there were at least 5,000 cancellation incidents caused by crumbling infrastructure at our hospitals. These incidents are only recorded when the care of at least five patients is affected, so that is a minimum of 26,000 people who have had vital care delayed or cancelled simply because the hospital was not in an acceptable condition. Once we consider the incidents affecting fewer than five patients, the actual number may well be much higher.

We must also not forget those hospitals that are not part of the new hospital building programme. Yesterday, my staff spoke to an NHS consultant working in accident and emergency at such a hospital, who has asked not to be named. The consultant described an incident this very week where family members had to be moved out of the resuscitation relatives’ room at the hospital because raw sewage was flowing through the room. Simply imagine that: your loved one critically unwell in resuscitation—your whole world turned upside down—and in that moment, you are hurried away from a stream of vile effluent. It is a national disgrace that this is the reality of our NHS today. That happened just this week. There is no new hospital coming for those patients, or for that consultant. The Government must today commit the money needed to maintain our entire hospital estate properly.

Care, of course, starts in the community, before a patient ever reaches a hospital, but we all hear from our constituents that our primary care system is also not coping due to under-investment. In my constituency, we have seen thousands of new homes built in the last 10 years, but no new GP practice to serve those thousands of new residents, and I know that many Members will recognise that problem in their constituencies as well. The investment in facilities is just not keeping up with the reality on the ground. That is why I am fighting for a new GP practice at Arborfield Green, although the sad reality is that the lack of capital investment in this infrastructure and the incredibly complex commissioning rules stand in the way. I hope the Minister will have something to say about investing in primary care as well as hospitals.

Let us not forget the outdated equipment currently in use in our NHS. Data uncovered by the Liberal Democrats has revealed that 80% of hospitals are using outdated X-ray, MRI or radiotherapy equipment. Imaging is critical for the diagnosis of so many medical conditions. NHS England itself says that CT, MRI and X-ray machines need to be replaced every 10 years to be reliable, but 38 out of the 48 trusts that responded to the request for information reported having X-ray machines over that age in active use. Some 21 of them were using MRI machines that were more than 10 years old. Shrewsbury and Telford hospital NHS trust reported an X-ray machine that was 30 years old—older than some Members of this House. It should be a national scandal that lifesaving diagnoses are being left to equipment that we cannot safely rely on. Patients are at risk and staff pushed to breaking point.

I would like to recognise the hard work of my hon. Friend the Member for Westmorland and Lonsdale (Tim Farron) on radiotherapy. Like him, I was disappointed to see that the national cancer plan was not more ambitious in its investment in radiotherapy. Anyone who talks to him about this issue will hear about how outdated radiotherapy units are being pushed well beyond their life across the country. We must do better than that for our cancer patients. The national cancer plan, which I called for in this Chamber some 16 months ago, was a welcome step by the Government, but on radio- therapy investment—as with the new hospital programme —Labour has not met the moment.

At this point, I pay tribute to the hon. Member for West Lancashire (Ashley Dalton), who was the Minister who made the national cancer plan happen. I am sorry that she has decided that she needs to stand down from her post. She did a really good job.

The Liberal Democrats would implement a 10-year capital investment programme that allows the NHS to plan for its future, not just its next budget cycle. That would include £10 billion to end the scandal of crumbling hospitals and GP practices, improving outcomes for patients and cutting daily costs for our national health service. We would establish a winter taskforce with a ringfenced £1.5 billion fund to deal with winter pressures, ending the cycle of raiding the capital budget just to cope with the latest predictable emergency. We have said on many occasions how that will be paid for. The question before the Minister today is not whether something needs to be done; we all know what needs to be done—investment on a huge scale—but the question is when. When will the Government deliver?

10:36

[Dr Luke Evans (Hinckley and Bosworth) (Con)]

I, too, associate myself with the comments about the hon. Member for West Lancashire (Ashley Dalton) on her stepping down as a Minister. She was a formidable opponent and will be sorely missed. I am sad to see her step back, but she has made the right decision for her, as in this place we should all do.

I thank the hon. Member for Carshalton and Wallington (Bobby Dean) for securing this debate. He was absolutely spot on when he said we do not scrutinise the process of NHS capital spending nearly enough. I was taken by what he said on that point, but less surprised that not many solutions came forward, although that is key to having this debate, because it is hugely technical.

I will use an example from my constituency for both the pros and the cons, the good and bad stories about capital investment. I was elected in 2019 and Hinckley is my biggest town. Healthcare is an important priority for my constituents and talk of improved hospital services there has been ongoing for 30 years now. On the good side, we were lucky enough to be picked to have a community diagnostic centre, a £24 million investment, and I was lucky enough to open it last year. That shows what good can come of capital investment. Under the previous Government, at August 2024, there were 165 similar good news stories of community diagnostic centres being opened across the country, not to mention the 108 surgical hubs that have not been talked about, but that are increasing patients’ ability to be seen and treated quickly, helping to deal with the waiting lists.

I also come with a negative story related to the same hospital. We were looking for a second project, a £10 million day case investment, but unfortunately, despite funding having been secured, delays in the system and difficulties with changing need have meant that that has been cancelled. The NHS papers specifically on that case state:

“The STP Capital business case for the Hinckley Day Case Unit received national approval in March 2024”—

but then struggled. The papers go on to say:

“However, since business case approval there have been further key changes… Changing financial context nationally and local financial challenges… Increased capital costs of the scheme circa £2m compared to that approved by the board… Programme delays resulting in a significantly reduced capital resource”.

They go on to explain that further delays to the programme occurred due to

“Cost pressures that exceeded the STP capital allocation…Since the approval of the STP Capital Business case in 2024, delays can be attributed to…The planning application phasing (considering the contention surrounding the demolition of the Hinckley District Hospital…The delay in submitting the planning application to allow the development of a robust design to address the Local Planning Authority’s concerns”.

We can already see the difficulties in how need is being allocated across Leicestershire and how planning and inflation interfere. That is the process issue at the heart of making these capital decisions.

That leads us to the bigger picture that confronts the Government today. As has been mentioned, funding is important, so what is the best document we can look at to see what the Government are trying to do? The 10-year plan is clear:

“We will continue to use private providers to improve access and reduce waiting times, to return the NHS to its constitutional standards. As we outlined in our Plan for Change, we will not let spare capacity go to waste on ideological grounds. We will continue to make use of private sector capacity to treat NHS patients where it is available, and we will enter discussions with private providers to expand NHS provision in the most disadvantaged areas.”

The Opposition agree with that, but I am not sure that all Government Members will, so I am interested to know whether all the Minister’s hon. Friends are aligned with it. I agree with the concern that the previous Government’s private finance initiatives, which brought in £13 billion of investment for new hospitals, cost the taxpayer more than £80 billion in repayments. We are still paying for that now.

Turning back to the NHS 10-year plan, a section called “Harnessing new investment” states that

“we will learn from previous experience with the Private Finance Initiative…In other cases, however, PFI was a costly mistake which represented poor value for money. Contracts were too complex and lacked proper transparency.

As the government considers new sources and models of private investment, we do so with this experience in mind.”

How do we know that? Where is it set out that the Government have learned this time? In the same section, the Government tell us they will “evolve” their

“infrastructure finance models and…consider the use of Public Private Partnerships…where there is a revenue stream, appropriate risk-transfer can be achieved, and value for money for taxpayers can be secured.”

Those are not small tests; they are the fundamental ones that we must ensure are in place, so my simple question is this: what is different this time? How will we assure value for money, and who will make that decision? How will we see genuine risk transfer being assessed, rather than simply pricing it into decades of payments? How will that work?

The 10-year plan also states:

“We will codevelop this with the National Infrastructure and Service Transformation Authority (NISTA), building on the successful NHS Local Improvement Finance Trust programme, and will look to drive competition in the market to incentivise others, including third party developers, to improve their offer to deliver better services at lower cost to the taxpayer.”

That is great—but LIFT is used only for small practices, so what model will come forward for everything else? The plan states:

“We will engage with the market on this programme and support NISTA in its wider market testing of a new PPP model.”

What is that model? Can we see it? What does it look like?

I note from the Minister’s answers to written questions that 120 neighbourhood health centres will be operated by 2030; 70 will be new buildings, 50 will come from refurbishment and, of those, 80% will be funded through PPPs. However, there are no plans to publish the business case. That raises legitimate questions. Why are the Government hiding this? We have been here before, and the country is nervous about this, so why can we not see what is being brought forward? If a new model is genuinely different, transparency should not be a threat; it should be a strength. Why will Parliament and the public not see it?

[Luke Taylor]

It would be remiss of me not to ask at this point, while the hon. Gentleman is speaking about transparency and funding for hospital projects, about the previous Government’s imagined 40 new hospitals. I invite him to give some transparency as to where the money to fund that hospital programme was supposed to come from and where it ultimately disappeared to. My residents are still suffering from the impact of his Government’s not providing that money. Can he expand on what happened to that money, which never arrived?

[Dr Evans]

I am grateful for the chance to put this on the record. The health infrastructure plan 2019 had the £3.7 billion, which was the seed funding to look into the projects to bring things forward. That also dealt with the first wave—the three hospitals that were brought forward to allow the second and third waves to come on. The hon. Gentleman will also know that, as the Government and the Opposition have stated, all big national infrastructure is done through a series of spending reviews. The money—£20 billion—was committed through those stages on the basis of that plan. The Government throw the same argument back at us when it is convenient for them to say, “We are not increasing defence spending because it needs to come in a spending review.” Both sides are playing politics, but there was money allocated in that plan. I appreciate that the hon. Gentleman was not in Parliament at that time, but he can ask the House of Commons Library to look at it so that he understands it, and he can then pass that on to his constituents to answer that question.

If we have a new model, we in this House need to be able to scrutinise it. GPs’ rents and rates are reimbursed, but there is concern that if we have further PPPs, similar to the previous PFIs, GPs may be on the hook for ongoing premises costs. We must have crystal clear guarantees, so they understand what they are and are not accountable for.

The 10-year plan states:

“We will also work with NISTA to consider the opportunities for health that could be achieved through private financing of revenue-raising assets (such as key worker accommodation and car parks)”.

That will set alarm bells ringing, as it looks like the Government will use key workers, or staff and patients coming into car parks, to generate funds. I would be grateful for clarity about what the Government actually mean by that statement, because this is a contentious issue. People know that we need to have funding coming into the health services, but where will those streams come from and what will they look like? If the 10-year plan is looking at revenue-raising assets, I am keen to understand exactly what that looks like.

Overall, there is a desire in the 10-year plan, which is shared across the House, to improve healthcare. Nobody disagrees with that, but the criticism of the 10-year plan is that there is no delivery chapter. I am grateful to the hon. Member for Carshalton and Wallington for securing this debate so that the Opposition can ask questions about what delivery will actually look like when it comes to improving the health of the nation.

10:47

[The Minister for Secondary Care (Karin Smyth)]

It is a pleasure to serve under your chairmanship, Mr Western. I thank colleagues for their kind remarks about my hon. Friend the Member for West Lancashire (Ashley Dalton). We will miss her. She has set a great example, not only by continuing while undergoing cancer treatment but, as hon. Members have said, by recognising that sometimes we need to look after ourselves and prioritise our constituents. No doubt she will be doing that very well, and I look forward to her contributions from the Back Benches.

I congratulate the hon. Member for Carshalton and Wallington (Bobby Dean) on securing this important and timely debate. I hope that my name came up occasionally when he was perusing previous debates on this issue, because I am one of the few Members of Parliament over the past 10 years who has banged on quite a lot about capital. I am delighted to be the Minister, because the sound management of that capital is absolutely crucial to the provision of healthcare for all our constituents. I agree that it does not get enough airtime, and the hon. Gentleman made an excellent speech outlining most of the issues. We have heard a lot of contributions today, and I will try to do justice to this very wide-ranging debate.

Let me remind hon. Members of the problem. I have with me Lord Darzi’s report, which said:

“The NHS has been starved of capital and the capital budget was repeatedly raided to plug holes in day-to-day spending…Some £4.3 billion was raided from capital budgets between 2014-2015 and 2018-2019”.

It said:

“The result has been crumbling buildings”

and

“services were disrupted at 13 hospitals a day in 2022-2023. The backlog maintenance bill now stands at more than £11.6 billion”.

The report also said that the NHS was “in the foothills” of the digital transformation that the rest of the country—indeed, the rest of the world—was undergoing. There was also a shortfall in capital investment.

I kind of admire the hon. Member for Hinckley and Bosworth (Dr Evans) for defending that situation—it is a tough gig—but we all see what happened in our constituencies. I am very proud of the capital investment under the last Labour Government, and I will come back to PFI in a moment.

Reversing that trend and repairing and rebuilding our healthcare estate is a vital part of our ambition to create an NHS fit for the future. That is why we are prioritising the estate to support that task. First, we are prioritising core and safety technology equipment and—this is an important measure introduced by the Chancellor—changing the rules on capital to stop capital-revenue transfer. We are also incentivising the system and streamlining the processes; the hon. Member for Hinckley and Bosworth tells us how terrible the processes were, but his party was in government. We have taken control and used Government to good effect to start streamlining those processes. Part of that is about moving towards making one team of NHS England and the Department of Health—I hope hon. Members will support us in that. We are also building the capacity and capability of the staff in order to develop and do the work we need them to do. That capacity has been completely depleted over the last 14 years.

We have put a lot of information into the system to move things quickly, and I think we are all seeing the benefits of that in our constituencies. We will bring forward a capital plan in the spring to make all of that clearer for the system and for hon. Members.

[Helen Maguire (Epsom and Ewell) (LD)]

The Minister is making an important point about the vital need for capital funding in the NHS. I and a number of colleagues are here in the Chamber because St Helier hospital is falling apart, and unfortunately patients are being affected, but the hospital build programme has been delayed another three years. There has been lots of goodwill in the debate, but we are looking for additional investment in the A&E. I hope the Minister will take that away, and that there might be something about it in a statement soon.

[Karin Smyth]

The Chancellor has made her key decision to put us back on track, announcing in the Budget that capital health spending would increase by £15.2 billion by the end of the spending review period in 2029-30. That funding will be used as intended; in previous years, as we heard, capital funding was diverted to cover day-to-day costs. We have tightened the Treasury rules; we have changed them, because that is what Government can do—who knew! As a result, capital funding will now be fully focused on repairing, upgrading and expanding NHS buildings and facilities to support long-term productivity. This settlement represents record levels of capital investment into healthcare, and it will support the three shifts set out in the 10-year health plan: moving care out of hospitals into the community, replacing outdated systems with modern digital services and focusing on preventing illness rather than just treating it.

Of course, rebuilding NHS infrastructure cannot happen overnight. I assure hon. Members that the Government do understand that long-term certainty over capital funding is needed for the NHS to move from these short-term fixes to more strategic investment. That is another key decision made by the Chancellor. That is why, through the 2025 spending review, we have delivered a four-year capital health settlement, extending to 2029-30. That is backed by a further five years of certainty for estates maintenance funding. I am genuinely grateful to hon. Members for recognising that that is a massive change that we have engineered into the system, and I think we are all seeing the benefit.

That change means there is a £30 billion commitment in capital funding over five years to support the day-to-day maintenance and repair of the estate, with a further five years of funding certainty, as set out in the 10-year plan. For the first time, NHS trusts have also been given multi-year operational capital allocations, with clear funding set out until 2029-30, and indicative funding for a further five years. This is an unprecedented opportunity for local health systems to plan with confidence over a nine-year period, and I continue to encourage all Members to engage with their integrated care boards, which will be prioritising schemes over that period.

Within the £30 billion, the estates safety fund will continue, providing £6.75 billion of investment over the next nine years to target the most critical building repairs, alongside £2 billion to continue supporting NHS England’s RAAC programme across the spending review. Additionally, £21 billion in operational capital over the five-year spending review will empower NHS organisations to invest in local priorities, including hospital infrastructure. It will take time to build up capacity and capability, but this marks the beginning of our rebuilding of an NHS that is fit for the future.

I also assure Members that this Government recognise the pressures faced across the system and are committed to bringing performance standards back to what patients expect. That is why we are investing to expand hospital and emergency care capacity, helping to reduce waiting times and improve care for patients. Over the next four years, there is £1.9 billion for urgent emergency care to support A&E departments, as well as to support ambulance services in reducing handover times.

There is also £1.5 billion for diagnostics, including funding to expand the hours of community diagnostic centres, shifting care from hospital to the community. The hon. Member for Hinckley and Bosworth noted that those centres were started under the previous Government, but we have ensured they have expanded hours and that there are more of them. Crucially, they are not built as add-ons, but are fundamental to the pathways experienced by patients in the system and ensure we have good value for taxpayers’ money.

There is £473 million for mental health services, including for people with learning disabilities and autism. I think we would all agree that the mental health estate needs recognition. There is more than £280 million for community care, supporting services closer to home, and more than £139 million for electives across the next two years. To move away from paper-based systems towards modern digital services, the autumn Budget confirmed £300 million in capital investment in technology, building on the combined revenue and capital investment announced at the spending review of up to £10 billion by 2028-29.

We are transforming healthcare by shifting care out of hospitals and into the community. Over the next four years, we are investing more than £400 million to upgrade primary care buildings and deliver neighbourhood health centres, as part of our commitment to those 250 neighbourhood health centres through the rebuild programme.

[Dr Evans]

Will the Minister give way?

[Karin Smyth]

I will finish these points and answer some of the issues that have been raised.

The first 120 neighbourhood health centres will be operational by 2030 and will, as we have heard, be delivered through a mixture of public and private partnerships. I thank the hon. Member for Carshalton and Wallington for being one of the few to acknowledge that that is difficult—there is some controversy around it—but I am a strong supporter of the previous local improvement finance trust schemes and of the scheme at Southmead hospital in my local area, which was one of the better PFI schemes, and delivered unprecedented levels of care to the people of Bristol, including myself. It is important that we learn the lessons of the past, and we absolutely have, including those in the NAO report. Working with NISTA, as has been outlined, we will continue to pursue this issue and bring forward cases.

I do not want to rehearse the lack of funding for the new hospital programme.

[Dr Evans]

Will the Minister give way?

[Karin Smyth]

No, I will not, because I want to get through my final comments.

We put the new hospital programme on a sustainable footing. I understand that local people across the country were led up the garden path and told something was going to happen. I think we all recognise that the money was not there and that the programme was not on a sustainable footing. We have backed it with the appropriate investment, which is rising to £15 billion over each consecutive five-year wave from 2030, averaging £3 billion a year. The exact profiles of funding will be confirmed at future spending reviews, and that is weighted to ensure that the schemes profiled most are caught in that.

We are progressing wave 1, and I will continue to liaise with hon. Members on progress. My message every week to any NHS trust, to any Member of Parliament, to NHS England and to the team running the new hospital programme is that we need to deliver these hospitals. There is a large queue behind them, and we have heard about some of them today. I also understand that a number of colleagues do not have a hospital being progressed in the scheme. The Government are keen to get on with building these hospitals. As hon. Members have said, a lot of this is about trust and commitment. I want hon. Members and anyone paying attention to know that I am clear about the importance of getting on with this programme, delivering on the ground and ensuring that the programme is robust.

Finally, alongside increased capital funding, we are improving how that funding is managed. As we have heard, the old processes did not work: a local scheme went to the ICB, to the region, to NHS England, to the Department, to the Treasury and back again, with huge amounts of sign-off but no control or accountability, and with no one locally understanding what was happening. We are transforming that, bringing together a team and streamlining the process, ensuring it is well governed. That will ensure that things happen more quickly, and we are already seeing that. With underspends this year, we have got the money out and into schemes already in the system. We are getting more DEXA scanners. That is how we ensure this happens on the ground.

It is up to ICBs to prioritise proposals, and we are working more closely with them to support them to bring things forward. I urge all hon. Members who have spoken today, including my hon. Friend the Member for Harrow West (Gareth Thomas), the hon. Member for Torbay (Steve Darling), my hon. Friend the Member for Rushcliffe (James Naish), the hon. Members for Taunton and Wellington (Gideon Amos), for Sutton and Cheam (Luke Taylor), for Eastbourne (Josh Babarinde) and for North Devon (Ian Roome), to keep working with their local systems on particular schemes. I am happy to keep talking to people.

To the hon. Member for Taunton and Wellington, let me say that I have met NHS England about looking at maternity in the area, which I know is a huge concern, and I am happy to meet him. I will get back to the hon. Member for North Devon about some of the numbers he outlined, which are not familiar to me. On another point that was made, we are ensuring that we are building in contingency for the future, because we live in volatile times.

Motion lapsed (Standing Order No. 10(6)).

Work Capability Assessment Timescales

Wednesday 4th March 2026 Westminster Hall

09:35

[Wendy Chamberlain (North East Fife) (LD)]

I beg to move,

That this House has considered Work Capability Assessment timescales.

It is a pleasure to serve under your chairship, Mr Western. I welcome the Minister to his place to discuss this important issue. I am grateful to him and his office for their recent engagement with my office on this issue. I am sure he has gathered from our recent correspondence that the focus of my remarks today will not be about the timescales for first-time applications for work capability assessments, but those for people who have requested a new assessment or a reassessment.

There are lots of reasons why someone might need a new assessment. No health condition follows a set path. Although we hope that someone’s health might stay stable or improve, often that is not the way it works out. I do not know how many applicants are waiting for brand-new work capability assessments, but I know that the Minister wrote to me last month to tell me there was a backlog of 35,000 reassessments waiting to be seen. That is a lot of people struggling or unable to work and arguably not getting the support that they need. In response to recent parliamentary questions, I was told that the Department has no breakdown on that backlog, which I find quite concerning. I hope the Minister will take that away. I hope he will tell me in his remarks all the ways they are trying to fix the backlog, but I put it to him that we cannot add capacity if we do not know where to target, so we need a breakdown of that backlog.

[Jim Shannon (Strangford) (DUP)]

I commend the hon. Lady for securing this debate. To add my support from a personal point of view, in my office I have a lady who looks after nothing else but benefits. She has told me that there are major issues regarding reassessment waiting times for those who are up for review. The official internal figures for Northern Ireland show that the mean average wait was around 290 working days—58 weeks—and some people are waiting as long as seven to eight years. I have to say, in all honesty, those are extremes, but it does underline the very issue that the hon. Lady is talking about. Does she agree that the one way to solve this problem is more staff? They must be hired to deal with the backlog, as applicants are feeling stressed and anxious that their financial stability might change.

[Wendy Chamberlain]

I am grateful to the hon. Member for his intervention. I will go on to talk about my own caseworkers’ experience. It is right that we recognise that they are the people dealing with the brunt of this. I am going to outline some of the challenges and what I hope the Minister might tell us he is doing to address those.

There are different assessment providers across the UK. Maximus serves my constituency of North East Fife, whereas other assessment contracts sit with Capita, Serco and Ingeus. I would be grateful for more staffing near North East Fife, but the Department for Work and Pensions seems to have no knowledge of whether the problems are greater in Scotland or Skegness. When I talk about delays, I am not talking about a service standard being missed by a few weeks or even a few months. Like the hon. Member for Strangford, I have cases where wait times are 18 months or more.

I want to talk about the impact of such delays on people on the waiting list. I hope the Minister and you, Mr Western, will understand that for the security and wellbeing of my constituents, I am not going to share individual details. There are common denominators across the cases that can paint a picture but, as most MPs know, the people we support are often vulnerable and have suffered considerably in their lifetimes, and it is important that we safeguard their welfare.

The common denominators are backgrounds of serious abuse, sometimes back to childhood—abuse that is hard to imagine and has a serious impact on adult mental health and wellbeing; severe anxiety, depression and post-traumatic stress disorder; physical symptoms and pain, sometimes linked to external factors like car accidents and other times linked to past and ongoing trauma. I also have at least one case waiting for a diagnosis of attention deficit hyperactivity disorder. In general, there is extreme vulnerability across the board.

Summer 2024 seems like a long time ago. There were 243 happy and optimistic newly elected Labour MPs filling the Palace, the Paris Olympics were just kicking off, London was full of Swifties for the Eras tour, and my constituents were taking the difficult decision that their health struggles were too much to manage to hold down a job and starting the process of requesting support from the DWP. That illustrates how long they have been waiting. These extended waits are absolutely debilitating. The not knowing is incredibly difficult. I think all MPs know from experience that these people worry to the point of obsessive hyper-fixation that their existing benefits will be taken away. That is added to by the stigma people feel for not being able to support themselves or their children, relying on the food bank and not being able to meet their basic needs for energy or clothes, and the anxiety of being judged by those around them.

The hon. Member for Strangford mentioned his caseworkers. I spoke with my caseworkers in the run-up to this debate. I want to take a moment to appreciate our caseworkers, because we need to remember that they are not trained as benefit advisers, counsellors or welfare specialists, but they are the ones picking up the phones day in, day out, trying to unpick what has gone wrong and providing back-up to constituents who find themselves in crisis with nowhere else to go. That is true of all MPs’ offices.

[Steve Darling (Torbay) (LD)]

As a former caseworker, I can reflect on how it can impact you as an individual. I used to play ABBA after hearing about particularly traumatic events on the phone with constituents of the MP I used to work for. We need culture change, and to make sure that those who undertake this service to the public, whether it is Capita or other providers, use a trauma-informed approach. Have you seen such a culture change within these organisations? I hope the Minister will reflect on that in his remarks later.

[Matt Western (in the Chair)]

Order. I remind hon. Members to refer to each other as hon. Members, as opposed to “you”, which is, of course, me.

[Wendy Chamberlain]

Culture does seem to be part of the problem in these circumstances. My view is that my caseworkers work incredibly hard, but if systems, processes and institutions worked the way they were supposed to, the casework often would not come to us in the first instance.

One of my caseworkers told me that, on the phone, someone can go from being completely fine and talking about their application and their health treatment to being in floods of tears and expressing suicidal thoughts with next to no warning. The DWP is not responsible for the underlying factors and histories of my constituents—let me make that clear—but it is here to provide a safety net. Leaving my constituents in limbo has made everything much worse. Mental and physical health are worse, and trauma responses are triggered. One of my constituents has been advised that there is no point pushing on with investigations and treatment for her pain while so many anxiety-inducing factors are ongoing, so recovery is being impacted too. Being unable to work without the additional health element of universal credit can make it incredibly difficult to make ends meet. As we all know, poverty and ill health is a terrible cycle.

The constituents I am working with are trying their best, and I am grateful to the local agencies that offer support. I would like to highlight the work of Fife Women’s Aid and Square Start. The former offers invaluable trauma support and counselling, and the latter can help with all sorts of essential life skills. Many of my constituents have particularly benefited from help with budgeting and managing their finances. However, the reality is that we are all stuck in a holding pattern until the assessments are carried out and decisions are made. My constituents are not alone; they are in a cohort of 35,000 others.

The Minister mentioned the steps the Government are taking to reduce the backlog in his letter to me last month. He will be unsurprised to know that I have some questions that I hope he will be able to address today. First, can he explain why his Department has prioritised new work capability assessments over applicants who have notified the DWP about a change in condition? I am not saying that existing claimants should be prioritised, but a “first come, first served” process, or some other type of prioritisation system, might be fairer. Can the Minister explain how the backlog has got so big? If it stems back from before the 2024 election, why is it taking so long to tackle it? What grounds does his Department use for considering expediting reassessment?

My caseworkers, coincidentally, went to an information session run by Maximus yesterday, and they, with the 50 or so other staffers on the call, were told that the DWP has the power to approve reassessments being processed if it thinks there are reasonable grounds for doing so. That was news to my team and me, because DWP case handlers have consistently said that Maximus is independent and that it has no influence over its operations.

However, we were told yesterday that Maximus is under instruction from DWP to prioritise all new applications, and to look at the backlog of reassessments only if it finds spare capacity. If we write to Maximus and make the case for a reassessment being prioritised, it can escalate it to DWP, and that is where the ultimate decision lies. I would be very keen to hear more about that and confirmation of what we were told yesterday from the Minister.

On making things faster, will the Minister please give more details of what is entailed in rapidly expanding reassessment capacity and accelerating the recruitment of health professionals? That goes to the point made by the hon. Member for Strangford. Given work capability assessments are outsourced to companies such as Maximus, what conversations is the Department having with providers about increasing that capacity? How will that be carried out and how will it be allocated geographically? The DWP already carries out some PIP assessments in-house. Has the Department considered adding capacity to work capability assessments with in-house resource?

The Minister said in his letter to me that health professionals are being encouraged to make recommendations based on the papers, rather than in person, where possible. What is he doing to make sure those decisions are being made correctly? I am aware, for example, that at least one of my constituents is stuck on a very long waiting list for PTSD and ADHD diagnoses. There are NHS backlogs everywhere, and Scotland, regrettably, is no exception.

That leads me on to my next question: how does the Minister intend to ensure, with this rapid expansion, that the right decisions are being made overall? Rushing at this stage and getting it wrong will just push the backlog into mandatory reconsideration, which helps nobody, and will lead to more delays for our constituents and more administration costs for his Department.

On a final note, although this is not why I secured this debate, I am aware that the Minister might be minded to mention the planned long-term reforms for work capability assessments. I make a plea for him to think very carefully about what assessments will be used for Scottish applicants, and how those systems will be linked with the DWP. As he knows, we have the adult disability payment under Social Security Scotland, and there are already so many problems that need fixing in how these two systems talk to each other—or do not, as the case may be. My caseworkers have to be experienced in both of these systems. At the moment, failing to fix those foundations and ensuring that the right conversations take place between the Scottish Government and the DWP would be unhelpful for everyone.

To conclude, 35,000 people waiting sounds like just another number, but it is the size of a medium town in the UK, or just a little bit smaller than the population of Lichtenstein. There is a significant cost for every person left in limbo, to us as a population and to our wider economy. I hope I have demonstrated that today.

11:13

[The Minister for Social Security and Disability (Sir Stephen Timms)]

I am delighted to serve under your chairmanship this morning. I congratulate the hon. Member for North East Fife (Wendy Chamberlain) on securing this debate.

I welcome the opportunity to consider journey times in the work capability assessment, both for initial assessments and reassessments. I take the point that it is the latter group in which the hon. Lady is particularly interested. I echo her tribute to MPs’ caseworkers, which was very well made. I agree with the hon. Lady that it is important that people claiming health and disability-related benefits have their entitlement assessed as quickly as possible, so that they get the support they need.

Let me set out the Government’s policy on the work capability assessment. It was introduced in 2008 as the gateway to the employment and support allowance, which was the then new benefit to replace incapacity benefit. As it happens, I was the Minister responsible at the time. I remember being told that the WCA had been devised across Alan Johnson’s kitchen table in the period when he was Secretary of State. Since 2013, it has also been the gateway to the additional health-related sum in universal credit.

Two people with the same condition can be affected in different ways, so they can have different outcome decisions from their WCA. The three possible outcomes for a UC applicant are: fit for work, where the individual is not entitled to the additional health element of universal credit; limited capability for work, where the individual gains access to the work allowance in universal credit, but gets no increased rate of benefit; and limited capability for work and work-related activity, so-called LCWRA, which gives access to a higher rate of benefit with no requirement to take part in work-related activity.

The WCA links capacity to work to additional financial support. In our Pathways to Work Green Paper last year, we outlined our plan—and the hon. Lady touched on this matter—to abolish the WCA and end the binary categorisation of people as “can work” or “cannot work”. We do not think that black and white categorisation works. One of the problems with it has been that although people deemed not capable of work are still offered help to look for work, there is no requirement to take it up and, in practice, they rarely do. The system has given up on them, but we are now changing that. Work coaches with a new specific brief to support people classified as LCWRA say they are getting a positive response from the people they are contacting.

In future, eligibility for additional health-related financial support in universal credit will be assessed in England and Wales via the personal independence payment assessment. It will be based on the impact of disability on daily living, rather than on capacity to work. The hon. Lady is right to make the point about how arrangements might work in Scotland and we are already discussing that with the Scottish Government.

Our ambition is a system that is simple to navigate, can be trusted by those who use it, provides a good experience and, generally, obtains the right decision the first time. Due to its link with the PIP assessment, the WCA abolition will not proceed until after the conclusion of the review into PIP that I am currently co-chairing. The co-chairs have recruited a steering group of a dozen people to oversee the co-produced review of PIP. Almost all of the steering group have lived experience of a disability or long-term health condition. We are going to have a full day together tomorrow, considering how to secure external input to our consideration of how the system should work in the future. The review’s recommendations will be submitted to the Secretary of State in the autumn.

In the meantime, the WCA process, as the hon. Lady rightly highlighted, needs to be as efficient and supportive as possible. WCA waiting times can vary depending on individual circumstance, including the complexity of the case, the need for further medical evidence, and customers’ availability and assessment capacity. The latest reported median end-to-end journey time for new employment and support allowance work capability assessments is 87 working days. That is broadly comparable with what it was before the pandemic. It includes the four weeks that people applying for the benefit have to complete and return their WCA50 questionnaire, as well as time for the providers to request and receive further medical evidence from a GP or another healthcare professional.

New benefit applications are primarily for universal credit rather than for ESA. Clearance times for WCAs in universal credit are not yet published, but they will be in phase 6 of the proposed development of universal credit statistics. There is a big plan for how those are going to be rolled out.

As the hon. Lady explained, she has a particular interest in claimant-led WCA reassessments—when somebody already in receipt of benefit reports that their condition has worsened. She has made representations to me on behalf of constituents about that. I think I have now replied to all the letters she has written to me about that, although one of them was just earlier this week, so we have only just managed that.

As the hon. Lady said, the Department prioritises initial assessments for new benefit customers. The reason for that is to make sure that people receive the correct entitlement and employment-related support as early as possible. It is right to prioritise for those assessments people who have not got any help at all yet, ahead of those wanting a fresh look at the amount they are receiving in benefit. Reassessments are carried out when there is capacity in the system to do them.

The background to the backlog that the hon. Lady referred to is that, in late 2024, after the general election, there was a surge of new benefit claims, so there was a need for a lot of new WCAs. Handling that surge led to a backlog of claimant-led reassessments, which built up from September 2024 until May 2025. When I was advised that we had a backlog of 35,000 claimant-led reassessments, I told officials to prioritise that group, and I am pleased that most of that backlog was cleared by the start of this calendar year. The vast majority of it will be cleared altogether by the end of this month. That should mean that the problems quite rightly highlighted by the hon. Lady will be behind us.

Alongside claimant-led reassessments, there are Department-led reassessments, where the Department decides that a reassessment is needed to check that the benefit being paid is correct. They are often carried out after a benefit award has been in payment for a specified period. Those Department-led reassessments stopped altogether for a period in the pandemic and for some time after, while the backlog of new claims left by the pandemic was processed.

In the Pathways to Work Green Paper last year, we said that we would turn on scheduled WCA reassessments as we build up capacity in our assessment providers. We are prioritising scheduled reassessments for people who are most likely to have had a change in their circumstances—for example, those with a short-term prognosis, for whom we can reasonably anticipate that a change in their health condition has occurred. That includes those with risks from pregnancy complications, or those who have recovered following cancer treatment.

We intend to do that while simultaneously reducing delays and improving timescales for those awaiting a reassessment—the group that the hon. Lady highlighted. That will mean that people who have asked for a review of their capability for work due to worsening health can be seen and receive an outcome as quickly as possible.

To do that, we will continue to increase assessment capacity significantly, through accelerated recruitment of healthcare professionals. Our providers have also expanded appointment availability, including some evening and weekend slots, and improved triage processes to identify cases that are suitable for paper-based or remote assessment, which can be dealt with particularly quickly. Those steps will continue to help improve the overall experience and ensure timely access to assessments for those who need them.

However, ensuring that people are assessed and get the support they are entitled to as quickly as possible is not everything. The hon. Lady rightly made the point, as she said in her most recent letter, that we need to “avoid cutting corners which could lead to wrong decisions being made”. She is absolutely right on that.

One important factor is whether assessments are carried out face to face. Before the pandemic, face-to-face assessments were the standard. Those stopped in lockdown and, for obvious reasons, assessments were carried out by telephone or by video call—mostly by telephone. Looking back, that worked rather better than people might have anticipated, but it meant that in 2021, only 5% of work capability assessments were carried out face to face. After the pandemic, there was a very slow return to face to face: in 2024, only 13% of work capability assessments were face to face. We think it is very important for accuracy and fairness that many more of them should be carried out face to face, so we have committed to increasing that proportion to 30%. We are making good progress in that direction; the statistics will be published in due course.

The hon. Member for Torbay (Steve Darling) rightly asked about a trauma-informed approach to assessment. Assessment providers adhere to a comprehensive quality and clinical governance assurance framework that aligns with the Department’s contractual and professional standards. All healthcare professionals conducting work capability assessments have to be fully qualified and appropriately registered, and have completed the necessary specialist training, before carrying out any assessments. Once they are in the role, they also have a full programme of continuing professional development to support them.

To maintain consistent standards of accuracy, justification and clarity, providers carry out regular audit sampling of their assessment reports, which helps them to identify areas for improvement. Alongside that, the Department conducts a programme of independent assessment quality audits. Where those identify problems, the Department makes sure that providers put things right through enhanced training, additional coaching or whatever is needed. Providers maintain a collaborative relationship with the Department, taking part in performance reviews to ensure that expectations are met and improvements are embedded.

Where performance falls below contractual quality thresholds, providers have to act promptly, perhaps with detailed improvement plans, strengthened audit processes, increased supervision or further training. The Department monitors progress closely and, if there is a significant or persistent problem of underperformance, is able to apply contractual remedies to address the problem.

Having said all of that, there are of course times when things go wrong. Earlier this week, I met with a Member who expressed concern about the outcome of a PIP assessment. I raised the case with officials in the Department who had a look at it. The assessment had been carried out by one of the assessment providers and, when the provider checked it, it agreed that the assessment was wrong; I think the individual who carried out the assessment was suspended. Things do sometimes go wrong, and it is absolutely right that Members raise these things with me so that we can address them.

One of the main reasons why maintaining quality is so important is that, as the hon. Member for North East Fife said, some of those going through the WCA are among the most vulnerable people due to the nature or severity of their disability or health condition, or for some other reason. We have in place a range of measures to identify, prioritise and safeguard vulnerable customers from the earliest stage, including helping them to complete the WCA50 questionnaire, encouraging people to have someone with them when attending an assessment and the provision of home visits, if that is needed.

We know that some people need more support than that. The hon. Lady raised that with me in a letter last October. We are not planning a triage system for prioritising such cases, because we are really focused on getting all the cases cleared as quickly as possible, but the Department has committed to a new safeguarding approach, as my right hon. Friend the Secretary of State outlined in a written ministerial statement in December, and a lot of work is going into that.

I am most grateful to the hon. Member for North East Fife for drawing this matter to the attention of the House, for her long-standing interest in this very important subject and for the contributions of others who have intervened in this debate.

Question put and agreed to.

11:29

Sitting suspended.

NATO and the High Arctic

Wednesday 4th March 2026 Westminster Hall

[Dr Rupa Huq in the Chair]

10:29

[Alex Ballinger (Halesowen) (Lab)]

I beg to move,

That this House has considered Government policy on NATO and the High Arctic.

It is a pleasure to serve under your chairship, Dr Huq. There are slightly fewer people here than I was expecting—I think we have a clash with the Ministry of Defence estimates debate—which is a bit of a shame, but I am delighted to see that we have a brace of bootnecks in the debate. I was hoping to see the Minister for the Armed Forces joining us—then we would be nearly a fire team. I note that the hon. Member for Exmouth and Exeter East (David Reed) has just told me he has never been to Norway and therefore is not a proper bootneck. The Minister for the Armed Forces went earlier this year, so maybe he has had his fill of the ice-breaking drills.

This debate is happening at the same time as the war in the middle east, which reinforces not only the importance of naval assets, as we see the impact of the closure of the strait of Hormuz on our economy at home, but the importance of naval air defence. I am pleased that HMS Dragon will be joining the US taskforce in the Mediterranean very soon.

The importance of the Navy cannot be overstated in the middle east, but it is even more important in the High North. That is because the High North is central to the UK’s security, to its economic resilience and to NATO’s ability to deter Russia. If we get our posture wrong, we do not just lose influence in the polar region; we take risks in the north Atlantic, take risks with our critical national infrastructure and risk our ability to reinforce our allies during a crisis.

I will make three points in the debate today: why the High Arctic matters, what has changed in the recent past, and what NATO and the UK should do about it. The High Arctic matters because climate change is changing the geography. Receding ice is extending operating seasons, opening access and drawing in more strategic interest in shipping, minerals and energy. Those create opportunities for states bordering the Arctic, but they also create risks. More access means more traffic. More traffic means more accidents and more opportunities for coercion, especially in a region with vast distances and limited infrastructure.

The Arctic is becoming busier and more contested at the same time. Undersea competition is now a frontline issue. Our economy relies on seabed infrastructure for fibre-optic communications, power cables and gas pipelines. A single major incident with this critical undersea infrastructure can cause disruption beyond the immediate area.

[Graeme Downie (Dunfermline and Dollar) (Lab)]

I thank my hon. Friend for leading a debate on one of the most important security and defence issues that we face. I was in Estonia at the start of January, in my role as chair of the all-party parliamentary group on Estonia. I met members of its military, as well as the British troops in Estonia, to talk about the importance of the High North and Arctic. Does he agree that partnerships such as the joint expeditionary force and other work being done in the area are vital to the protection of the undersea cables that he correctly highlighted? It is important that we look for those effective models to defend the High North and the Arctic.

[Alex Ballinger]

I absolutely agree that the JEF is a vital alliance for our operations in the High North. I met the Estonian ambassador only a couple of weeks ago, and we were pleased to discuss opportunities for co-operation, in addition to the UK forces that are based in Estonia, as part of deterring the Russian threat to that part of the world.

Importantly, the High Arctic is a top priority for Moscow strategically, militarily and economically. Russia has been building up its military presence, and it is not subtle about it. The northern fleet is modernising: it has a more capable navy and increasingly active submarine operations, and it focuses on controlling access to the European High North. We should be clear about what that means for the UK. Russia’s sea-based nuclear forces are concentrated around the Kola peninsula, and the High North is central to its nuclear deterrent strategy. That raises the stakes for NATO.

The Royal Navy has also seen a 30% increase in Russian vessels threatening UK waters over the past two years. Russia’s navy is increasingly capable and willing to test our defences from the High North. Russia wants to exploit the Arctic for more than military leverage; it wants to dominate access to sea routes and mineral resources. For Russia, this is about economics and security, which is why we cannot treat Arctic competition as “just defence”.

Recently, the big change we have seen in this region is what is happening in Ukraine. Russia’s invasion has transformed European security, and the Arctic is a part of that. Two Arctic countries, Finland and Sweden, joined NATO because they concluded that, in the context of Ukraine, neutrality no longer protected them. As a result, every Arctic country except Russia is now a NATO ally. That strengthens NATO’s hand, but it means that NATO’s northern responsibilities have expanded.

The second development is Greenland. We all saw Trump’s threats and rhetoric, which have thankfully receded. I am pleased that European countries were united in saying that Greenland’s sovereignty should not be a bargaining chip.

[Liz Saville Roberts (Dwyfor Meirionnydd) (PC)]

I was fortunate to visit Nuuk in Greenland with the APPG for Greenland—of course, we discussed NATO and Trump. It is important for us to remember that the 1951 agreement between the USA and the Kingdom of Denmark gave the US rights of access to military defence. When it comes to what the United Kingdom could be doing for Greenland to develop what will none the less be geo-significant in the future, surely it is time that we should call for a consulate for the United Kingdom in Greenland.

[Alex Ballinger]

The Foreign Affairs Committee is going to Greenland in a couple of weeks. We hope to meet the Foreign Minister of Denmark, among other leaders of the Greenlanders, and that sounds like the kind of sensible suggestion that we should be talking about.

Certainly, there are lots of opportunities for NATO to base troops in Greenland already; we did not need a change in sovereignty to do that. I am pleased that that has fallen off the radar. It is concerning that Trump’s interest in Greenland is not a one-off. The US security strategy is explicit that the Arctic is becoming more important to America and to American national security, whether it is because of Russia, China, geography or critical minerals. We should not pretend that this was just a single passing storm.

In the Arctic, NATO is responding, but we need to be honest about the scale of the task. With the Arctic sentry, the alliance is trying to pull together a more coherent posture in the High North, with better visibility, better co-ordination and a clearer framework for operating in the sea, air, space and undersea environments.

We should also underline the importance of the Greenland-Iceland-UK gap. That strategic choke point is vital to NATO. It affects how Russia can move submarines into the wider Arctic, it affects the security of reinforcement routes in a crisis and it sits alongside the undersea infrastructure that we rely on every day.

I will raise the joint expeditionary force, which my hon. Friend the Member for Dunfermline and Dollar (Graeme Downie) raised earlier. The UK-led JEF has real value in this part of the world; it is practical, northern-focused and moves faster than the full NATO machine in the early stages of a crisis. That is exactly the sort of framework we should use to build readiness, interoperability and credibility.

[Ben Obese-Jecty (Huntingdon) (Con)]

The hon. and gallant Member is making a hoofing speech. He mentioned the Greenland-Iceland gap. We have committed to Operation Firecrest later this year, which will see the carrier strike group go to the High North as a deterrent against the Russian northern fleet breaking out of the Kola peninsula and moving across the Barents sea and into the open ocean. With the emergence of the conflict in the middle east, a potential commitment to a post-conflict force in Ukraine, a commitment to troops in Norway and Operation Firecrest, does he share my concern that we may have to make some very difficult decisions about how much capability we are able to deploy to ensure that our interests are looked after across all those fronts?

[Alex Ballinger]

The hon. Member makes a good point. Our naval capability has sadly diminished; we have fewer destroyers and frigates than we used to, and we are rightly deploying some of those to the Mediterranean and the middle east at the moment.

There will have to be hard choices as we approach that timescale. I think those will depend on the situation in the middle east at that point, but maybe the Minister can address that in her remarks. Later in my speech, I will raise what we might want to do about capability. It is important that NATO is backed by increased capability regarding ships, aircraft, sensors, munitions, trained people and deployable logistics; otherwise, our response will fall short.

The First Sea Lord has made the case for UK action in the High North repeatedly. In recent speeches, he has said that the High North is a critical area, that Russia’s submarine force is a huge concern and that we need more warfighting readiness now, not a peacetime posture. He has also said that

“the advantage that we have enjoyed in the Atlantic since the end of the Second World War is at risk”

unless we take action soon.

I want to ask the Minister whether we are resourcing this crucial area sufficiently. We continue to retire Type 23 frigates—anti-submarine ships. Five have retired since 2021, including HMS Lancaster most recently, but are we retiring them before replacements are ready? We have the Type 31 programme coming on soon, but it would be nice to have reassurance on the timelines and the risk that we are taking if there are gaps. If we are relying on future ships for future threats, we need confidence that they will arrive before the threat does.

We cannot talk about the High North without talking about the vital contribution of the Royal Marines—our Arctic-trained troops—who are ready to operate alongside Norwegian, Dutch and other forces. That is a genuine strength, but cold weather expertise must be backed by enablers—lift, sustainment and surveillance assets.

That brings me to the most important point: the defence investment plan. We can announce deployments, launch missions and make speeches about the High North, but if we do not publish a clear investment plan that is costed and credible, our adversaries will conclude that the UK strategy is stronger in rhetoric than in reality. The Chairs of the Defence Committee and the Public Accounts Committee have warned that delay sends damaging signals to our adversaries, and they are right. We are serious about the Arctic. We need serious choices, and we need them now, not in a year’s time.

There is a practical, day-to-day test. We are facing concurrent pressures in other theatres, including recent deployments to the middle east. The question is not whether we can deploy ships to other regions on paper; it is whether we can do it without hollowing out our commitments to other parts of the world.

I want to put three questions to the Minister. First, when will the defence investment plan be published? Secondly, do we have sufficient ships that are suitable and available to operate credibly in the north Atlantic and respond to the serious crisis in the middle east at the same time? Thirdly, what steps are the Government taking bilaterally and through NATO to reassure Denmark and strengthen stability around Greenland while making it clear that sovereignty is not negotiable and that influence operations will be resisted?

The High Arctic is becoming a sharper edge of competition. Climate change is opening access, Russia is militarising, undersea vulnerability is rising and NATO is adapting. The UK has a choice. We can treat this as a niche theatre and muddle through, or we can treat it as what it is: a direct test of our seriousness as a north Atlantic power. Deterrence is built on credibility, credibility is built on capability, and capability requires investment. That is why the defence investment plan and ship availability matter.

[Several hon. Members rose—]

[Dr Rupa Huq (in the Chair)]

Order. I remind Members to bob if they want to speak, and then we will work out who is next.

14:42

[Jim Shannon (Strangford) (DUP)]

It is a real pleasure to serve under your chairship, as always, Dr Huq. I thank the hon. Member for Halesowen (Alex Ballinger) for leading the debate in such a helpful way. He set the scene, the focus and the strategy, and he asked questions that I was going to ask—great minds think alike. He has a greater mind than me, by the way. I thank him for all that he does in this House. In the year and six months or thereabouts that he has been here, he has made a name for himself in canvassing the Chamber and in the way that he presents his case. He has done his constituents proud today, and he should be congratulated on that.

The High Arctic may lie far away from our coastline, but the sea lanes, the airspace and the critical undersea infrastructure are fundamental to the United Kingdom’s security and economic wellbeing. Defence is obviously about protecting our people and our assets, whether they be around the United Kingdom or further afield, but it is also about economic wellbeing. I am very impressed by the Government’s commitment to the defence industry on the mainland and in Northern Ireland. The Minister has always told us about the Government’s commitment.

We have seen the financial commitment to weapons and cyber-activity through Thales and SPIRiT, and the Government have been keen to build on that. After the south-east of England, Northern Ireland is the most credible part of the United Kingdom when it comes to cyber-security, and I welcome that very much. That is down not only to the companies that we have but to the Government’s commitment to that, and we thank them for that.

Complacency must never be an option. I am pleased to be here to discuss this issue and see what more we can do to support the High Arctic. I am a fair weather person who likes sunshine and heat. It is highly unlikely that I would be seen in Norway and I have no interest in skiing because it looks too cold for me. I enjoyed watching the winter Olympics on TV and it was good to see our team doing well. Five times we came within 0.2 seconds of winning another medal. That tells us about the achievements of this wee country and makes us proud to be British.

Over the past few days we have heard all too well the importance of national security and infrastructure. My goodness—not a day goes by when we know what will happen next. I am a man of faith, so I trust in someone better in control who is in heaven looking down at us. I am quite clear in my mind where my faith and trust lie. In the world, there are 67 wars: think of that. It is almost a world at war, and we have seen that reflected in the middle east in the past few days.

The High Arctic has proven central to Atlantic security and maritime trade routes and the importance of the Greenland-Iceland-UK gap. Sometimes that is forgotten about. Some hon. Members have travelled to Greenland, but President Trump’s focus on the country has made us think about its importance. Maybe we did not see it in the way we should. I thank those hon. Members who have been instrumental in that. I understand that the hon. Member for Halesowen is going there shortly.

[Liz Saville Roberts]

Of course, we are at risk in our democracy of looking at things in the very short term. With climate change, 30 years from now the access to key rare earth minerals, and possibly shipping lanes, in the far north may have changed considerably.

[Jim Shannon]

That is the focus we need to have. Climate change is affecting the world. We might find ourselves in a slightly different geographical position in a short time. The right hon. Lady has illustrated that to our advantage.

The Greenland-Iceland-UK gap remains vital for monitoring submarine activity. I can never understand how anybody can get into a submarine; it is too claustrophobic for me, but I admire those who do, as they play a vital role in the defence of this great nation. It is no secret that Russia has expanded its Arctic military footprint, which may be what Trump is looking towards. We need to be aware of Russia’s input, especially its submarine operations, air bases and missile systems. The Arctic region is a key domain for undersea infrastructure. Protecting the integrity of UK security is a major priority. NATO allies must remain as a cornerstone of support in doing that.

When we focus on the importance of where we are, we support the policies that strengthen deterrence rather than encourage confrontation. I cannot remember which one, but a US President said:

“Speak softly but carry a big stick.”

That reminds us that we must have a deterrent—the nuclear power and the submarines and the strength of the Army—to persuade others not to go to war. That is the ultimate goal we all try to achieve. We must also maintain readiness to respond to threats and ensure that military deployments to Norway and the north Atlantic are exercised and fully trained. Again, we see commitment from the British Army and NATO, Estonia, Lithuania and Latvia, as well as Poland. Those troops are the best.

The hon. Member for Halesowen mentioned the Marines, and there are none better. When I was a wee boy, I was always saying, “I am going to be a Royal Marine.” As an eight-year-old, that was my big ambition. It obviously never happened, but I did serve part time in the Ulster Defence Regiment and in the Royal Artillery. It was a slightly different role and not as exciting as the Marines—it never could be—but it was an incredible role.

We often have discussions around defence spending. A proper budget is needed to perfect intelligence and surveillance of the High Arctic. In strategic terms, sea lanes and undersea cables are vital. I asked the Minister a question over recess, and the Joint Committee on the National Security Strategy came to the main Chamber maybe six or eight weeks ago and referred to undersea cables. In my question to the Select Committee Chair, the hon. Member for Warwick and Leamington (Matt Western), I asked about the undersea cables that come across the North sea, down to England and across to Ireland. The Republic of Ireland is a soft belly. Do we have a role to play in securing the undersea cables that go from there across the Atlantic as well? Of course, the Republic of Ireland does not have the Royal Navy, the Army or the personnel that we have. Are there discussions, or is there a relationship or a defensive agreement, between the United Kingdom and the Republic of Ireland to ensure that the undersea cables that go across the Atlantic are protected? The Chair of the Select Committee was unable to confirm that. That is not a criticism; I am just saying that I asked a question and the answer could not be given.

The undersea cables and the Arctic’s stability affect trade, energy and global security. Furthermore, the United Kingdom and the United States have shared interests in terms of the Arctic region. Of course, President Trump has made his opinions clear in relation to Greenland, but close co-operation ensures that NATO can respond rapidly to threats, particularly from Russia. The United States, as the right hon. Member for Dwyfor Meirionnydd (Liz Saville Roberts) and the hon. Member for Halesowen mentioned, has bases in Greenland. It has feet on the ground and it is building up to using that footprint as a protection or a launchpad. It is important that we have that relationship with the United States.

To conclude, I stand firmly for a united NATO, a credible deterrent to aggression and robust investment in our armed forces to ensure they are equipped for operations in the High Arctic. We have an enduring partnership with the United States of America and we must strengthen our ability to defend vital waters and airspace. The hon. Gentleman asked about the number of ships being built for the Royal Navy to enhance its position. I know the Government are giving everything to enhance investment—that is never in doubt—but maybe the Minister could tell us about their commitment to the Royal Navy, which is clearly needed.

I say this with incredible respect. For 10 days our base in Cyprus was potentially under attack. My comment is not an attack on anybody, but why on earth did we not send a ship to protect Cyprus 10 days ago? It niggles me whenever we see the French and the Germans giving us protection.

[Alex Ballinger]

I am sure the Minister will respond, but the hon. Gentleman will know that there are allies of ours in the Mediterranean as well, including a large American flotilla. It is appropriate for us to work closely with other air defence assets. The single ship that we have sent would not have changed the situation entirely; there are other assets out there as well.

[Jim Shannon]

The point I am trying to make is that there is a perception across the world that the United Kingdom, who ruled the waves 300 years ago or whenever it was, has not got a ship that it can send. That sends a message. The hon. Gentleman is right about working with our allies. We cannot fight a war on our own any more; we have to do it collectively, but there is something that niggles me whenever I recognise that. It is not meant to be an attack on anybody; I am just making the point that we need to be seen to be proactive.

14:54

[Amanda Martin (Portsmouth North) (Lab)]

It is a pleasure to serve under your chairmanship, Dr Huq. I am grateful to my hon. Friend the Member for Halesowen (Alex Ballinger) for securing this debate and also for his service. I have not served myself, unlike the hon. Member for Exmouth and Exeter East (David Reed), who is speaking for the Opposition, but I have been to Norway.

I am grateful for the opportunity to speak in the debate, because last month I spent five days in the High North with the armed forces parliamentary scheme, visiting British Marines, sailors and soldiers training in northern Norway. From my arrival in Tromsø to field exercises in the Mauken training area and aviation operations at Bardufoss, I saw at first hand what Arctic readiness really means. It is impossible to witness that work and not conclude that the High North is central to Britain’s security in some of the harshest conditions imaginable—sub-zero temperatures, deep snow, limited daylight. Our personnel demonstrated extraordinary mobility, reconnaissance capability and survival skills. They operated seamlessly alongside Norwegian and other NATO allies with professionalism, pride and determination. They understand that what they are doing matters not just to the alliance, but to the safety and prosperity of the people back home.

The High North is not a remote periphery. It is strategically vital. Maritime routes are opening; energy infrastructure is concentrated there; and critical undersea data cables that power our digital economy run through those waters. That is without the impact of climate change, which we have heard about. As competition intensifies, allied readiness in the Arctic is not optional—it is essential. The Government have recognised the realities, as has the First Sea Lord.

As vice-chair of the APPG for the armed forces, representing the Navy, and as the Member of Parliament for Portsmouth North, it would be remiss of me not to mention our two aircraft carriers, His Majesty’s ships Queen Elizabeth and Prince of Wales. HMS Queen Elizabeth deployed to the High North in autumn 2021, as part of the UK carrier strike group 21 deployment. During that period, the ship operated in the north Atlantic and near the Arctic circle, including in exercises with Norway and our NATO allies. She returned to northern waters again in 2023 for further NATO and joint exercises, focusing on cold-weather and Arctic operations. I am proud to say that when she returned in 2023, my son was serving on that ship.

In 2022, His Majesty’s ship Prince of Wales also deployed on a major NATO maritime deployment in the north Atlantic, following Russia’s invasion of Ukraine. The ship operated again in northern waters early in 2024, taking part in NATO’s large-scale exercise in Norway and the surrounding Arctic region. We have committed to her returning there in the near future. All the evidence is that we, as a Government and as the armed forces, as the First Sea Lord has said, are taking our national security very seriously.

Our national security policy positions the United Kingdom at the forefront of efforts to make NATO stronger, fairer and more effective, and commits us to strengthening our armed forces and protecting our national security in the face of growing threats from state actors. Those commitments are not abstract, because they underpin the Government’s defence investment pledge, agreed with NATO allies, to raise defence and security spending to 5% of GDP by 2035, reinforcing our broader national resilience and collective deterrence.

The UK’s preparations for Exercise Cold Response demonstrate our commitment to NATO and our collective defence. They send a clear signal that we stand shoulder to shoulder with Norway and our allies, and that we are prepared to operate and, if necessary, defend in the most demanding of environments. Since taking office, this Government have doubled down on our strategic posture in the High North, including with plans to double the number of UK troops deployed to Norway over the next three years to strengthen security in the Arctic and the High North.

Readiness, however, is not only about kit and capability; it is about people. I not only observed exercises, but spoke at length with those deployed about welfare, sustainment and the realities of repeated operations far from home. They spoke candidly about separation from their families, the physical and mental demands of Arctic conditions, and the importance of clear political direction and sustained investment—as well as about the kit.

If we are serious about Arctic readiness, we must ensure that our defence policy reflects operational reality and not assumptions, and that our people at home and abroad get what they need. That means listening carefully to those who deliver the missions, ensuring that equipment is fit for purpose, guaranteeing that logistic chains are resilient, and recognising that deterrence begins long before a crisis emerges. It also means that we must champion the alliances that make our security possible. Labour’s manifesto reaffirmed our absolute commitment to NATO, and to ensuring that Britain plays its full part in collective defence.

While I was in the High North, our Norwegian partners spoke about their genuine respect for the capability and reliability of our British forces. Their trust has been built over decades of partnership and a real shared endeavour. In the High North our forces are prepared and professional, and they are proving that Britain remains a serious and dependable ally. Our responsibility is to match that commitment with our own, to provide the strategic clarity, resources and long-term vision that Arctic readiness demands.

I echo the three questions put by my hon. Friend the Member for Halesowen and add one of my own: a request from service personnel. In terms of our troops on the ground, how can we ensure that what are often seen as soft materials—their gloves, jackets, uniforms, boots, body armour and backpacks—are the best they can be? How can we ensure that they are listened to when it comes to the real things used by real people?

15:00

[Dr Al Pinkerton (Surrey Heath) (LD)]

As ever, Dr Huq, it is a great pleasure to serve under your chairmanship. I thank the hon. and gallant Member for Halesowen (Alex Ballinger) for securing this geostrategically important debate and drawing this issue to the attention of the House.

At a moment when the world’s attention is understandably distracted and drawn to other parts of the world—whether to the brutal war in eastern Europe or the escalating tensions in the middle east—it would be all too easy to park an issue such as this and see it, perhaps, as something for the future rather than as something for immediate attention. I contend, however, that that would be an enormous strategic error; history, after all, has a terrible habit of punishing those who overlook the vital importance of geography.

The opening up of the Arctic is undoubtedly one of the most consequential geopolitical shifts of the 21st century. As we know, climate change is transforming the region at extraordinary speed. Retreating sea ice is opening new maritime routes and increasing access to energy resources and critical minerals, drawing renewed strategic interest from major powers.

At the same time, the co-operative governance structures that once defined the Arctic are under strain. For much of the post-cold war period, the region was described as “High North, low tension”. That description no longer holds. The era of Arctic exceptionalism seems to be over. Russia’s invasion of Ukraine has fractured the Arctic Council and accelerated the wider geopolitical tensions that now shape the region. Strategic competition is returning to the High North—not as a distant possibility, but as a clear and present reality.

Although the United Kingdom is not an Arctic coastal state, we are undeniably a near-Arctic nation. We are geographically proximate, strategically exposed and directly affected by developments in the High North. Instability in the Arctic affects our maritime approaches, north Atlantic shipping lanes, subsea cables, offshore energy infrastructure, and ultimately the deterrent posture of the Royal Navy. For the United Kingdom, the Arctic is not a remote frontier; it is part of our immediate strategic environment.

A few weeks ago, I had the enormous privilege of visiting Greenland and Denmark, alongside my Liberal Democrat colleague, my hon. Friend the Member for Bicester and Woodstock (Calum Miller). I can report that in Nuuk, Greenland’s capital, life often appears outwardly calm. The harbour is busy and the cafés are full. The rhythms of daily life continue, despite the long Arctic winter and the limited daylight available in February, when I was there. However, anyone spending any time talking to Greenlanders will hear something quite different: a persistent and gnawing anxiety about what might be coming down the tracks from not Moscow or Beijing—nobody realistically thinks that either Russia or China pose an immediate threat to Greenland—but, extraordinarily, from Washington.

[Richard Foord (Honiton and Sidmouth) (LD)]

My hon. Friend knows a great deal about this subject; I am also grateful to the hon. Member for Halesowen (Alex Ballinger) for securing this debate.

Yesterday, President Trump suggested that our current Prime Minister is no Churchill. Should we not add that the current President of the United States is no Franklin D. Roosevelt? FDR was a big supporter of the development of the United Nations and knew about the importance of sovereignty. Does my hon. Friend share my view—I think he will—that who governs their countries is a matter for the Danes and Greenlanders alone?

[Dr Pinkerton]

I am grateful to my hon. and gallant Friend for his intervention; the President of the United States is perhaps more Teddy Roosevelt than Franklin Delano Roosevelt. He seems to be living every day under the impression that his mission should be to expand US territory and to plant the US flag, no matter how loyal and allied the country in question has been in the past.

I clearly recall the deeply offensive remarks that the President of the United States made about both Britain and Denmark’s past military contributions to US international adventurism. I remember watching a film called “Armadillo” about the extraordinary work that Danish troops did on the frontline in Afghanistan. I agree with my hon. Friend’s comments wholeheartedly.

For Greenlanders, this is not a recent experience; they have been living with the threats of Donald Trump for the best part of 12 months. Over the past year, he has repeatedly suggested that the United States should “acquire” Greenland, presenting the idea as a matter of American national security. Sitting here in Westminster, it may be tempting to dismiss such remarks as rhetorical theatre, but in Nuuk they are experienced profoundly differently. Greenland is a self-governing Arctic society of 56,000 people. When the world’s most powerful country repeatedly discusses one’s homeland as though it were a strategic asset to be acquired, the effect is not abstract.

During my visit, we heard accounts of families stockpiling supplies. Some described moving savings abroad in case of financial disruption to their homeland and their lives. Others spoke of delaying vital, essential medical treatment in Denmark—treatment that many Greenlanders rely on—because they feared that further escalation would mean that they would not be able to return to their homeland afterwards.

Greenlandic commentators have described the psychological effect of the campaign from the United States as a form of “mental terror”. It is a striking phrase, but it captures an important truth: security in the Arctic is not solely about missiles, submarines and military installations; it is also about trust, stability and the ability of societies to live without fear.

There is also a profound strategic irony here. The United States already enjoys extensive rights in Greenland under the 1951 US-Denmark defence agreement, including the operation of the Pituffik space base—formerly, the Thule air base—and any other base that it may wish to re-establish in the present moment. Greenland sits inside NATO’s security architecture through Denmark and benefits from the protections of article 5. The idea that Greenland must somehow be owned to be defended simply does not withstand any scrutiny. What it challenges, however, is something far more fundamental: the principle that people are not property and that sovereignty cannot be negotiated away for strategic convenience.

Across Greenlandic politics, the response has therefore been consistent and unequivocal: Greenland is not for sale. For liberal democracies, that principle should not be negotiable. If western democracies cannot defend the idea that territories cannot be simply acquired by powerful states, then the rules-based order that we claim to uphold begins to look increasingly selective and fragile. Nowhere are those principles more important than in the wider strategic geography of the North Atlantic.

At the heart of that geography lies the Greenland-Iceland-UK gap: the naval corridor between Greenland, Iceland and the United Kingdom. During the cold war, NATO prioritised that corridor to detect and constrain the submarines of the Soviet northern fleet departing the Kola peninsula into the Atlantic. Today, it has again become central to NATO’s strategy. Russia’s northern fleet must transit through or around the GIUK gap to reach the north Atlantic.

Monitoring the corridor remains essential to tracking submarine activity and protecting the integrity of the north Atlantic. The corridor also safeguards the sealines of communication between North America and Europe. In any NATO contingency, the transatlantic reinforcement route would pass directly through those waters. If the GIUK gap were compromised, the United Kingdom’s western maritime flank would be exposed. Control and surveillance of the space are therefore fundamental to preventing adversaries from projecting power into the north Atlantic or threatening western Europe and North America.

Within the strategic geography, Greenland’s importance cannot be overstated. Its location makes it pivotal for missile early-warning systems, Arctic sea routes, access to the north Atlantic, and space-based infrastructure. Destabilising Greenland or undermining Danish sovereignty would fracture NATO cohesion, complicate security in the GIUK gap and weaken Arctic governance structures at precisely the moment when unity is most needed.

The Liberal Democrats are therefore clear: sovereignty and international law are not negotiable principles. I am deeply concerned that the Prime Minister has yet to state unequivocally that British soil, British bases and British facilities would never be used to propel American troops on to Greenlandic territory by force. The Government must put that matter beyond doubt.

Any suggestion that one NATO ally could coerce another would erode alliance cohesion, weaken deterrence and play directly into the hands of President Putin. Fragmentation in the Arctic theatre would directly benefit Russia’s northern fleet posture and its wider Arctic military strategy. Again, this is not about abstract diplomacy; it is about the credibility of collective defence. The UK must therefore deepen its commitment to Arctic security and north Atlantic resilience. That means strengthening anti-submarine warfare and maritime domain awareness, investing further in north Atlantic patrol and surveillance capabilities, and reinforcing defence co-operation with our Nordic and Baltic partners.

Crucially, the Government should invest further in the Joint Expeditionary Force, and convene a summit of JEF leaders here in the United Kingdom to address the rapidly evolving security environment in the High North. The reality is simple: the Arctic is no longer a peripheral concern; it is at the frontline of strategic competition, alliance solidarity and international law.

I leave the Minister with three questions. First, what concrete steps have the Government taken to ensure that the UK is prepared for the reality that I have just outlined? How is the UK strengthening defence co-operation with our Arctic allies, including considering enhanced diplomatic presence in Greenland and perhaps the establishment of a permanent consulate in Nuuk?

Finally, the strategic defence review mentions the High North as a space of geopolitical and geostrategic interest, but does not offer a defence strategy per se. Do the Government intend to bring one forward? How does the Government’s future procurement reflect that strategic concern?

15:12

[David Reed (Exmouth and Exeter East) (Con)]

It is a pleasure to serve under your chairship, Dr Huq. I echo the initial comments of the Lib Dem spokesperson, the hon. Member for Surrey Heath (Dr Pinkerton), in thanking the hon. Member for Halesowen (Alex Ballinger), a fellow former Royal Marine, for bringing this debate to the House today. This is a massively important subject, and I am glad that we have the opportunity to discuss it. I hope that we will continue to discuss it because the area will only increase in importance.

We all know that the High North is no longer a distant theatre of academic interest or a place for explorers’ delight. It is fast becoming the new frontier of great power competition. As the ice retreats through climate change—we have heard about that from many Members today—strategic rivalry advances. Sea routes are opening, undersea infrastructure is exposed and military activity is increasing.

The Arctic is no longer insulated by geography or climate, and it is becoming a central arena in the contest between major powers. The decisions that we take now will shape the security of the north Atlantic for decades. The hon. Member for Halesowen outlined that very clearly in his opening remarks. Russia views the Arctic as a core strategic bastion. Its northern fleet operates from heavily defended bases in the region, protecting its nuclear deterrent and projecting power into the north Atlantic. Moscow treats Arctic territory and resources as central to its long-term security and economic resilience.

On the other hand, the United States sees the Arctic as integral to homeland defence and the security of the transatlantic alliance. Greenland, which we have heard about today, and the wider north Atlantic have returned to prominence in American strategic thinking, as reinforcement routes and early warning systems regain importance.

Lastly, China, although not an Arctic state—it claims to be a near-Arctic state, whatever that means—has steadily expanded its presence through research, commercial investments and polar shipping, signalling long-term interests in Arctic trade routes and resources. That will only increase as climate change reduces the ice.

The Arctic is a theatre where Russian militarisation, American strategic recalibration and Chinese expansion intersect, as many Members have set out clearly. That is why NATO now treats the defence of the High North as a strategic imperative. The accession of Finland and Sweden has transformed the strategic geometry of the region, as the hon. Member for Halesowen rightly said. We have seen over recent years that NATO’s northern flank is stronger and more coherent.

The GIUK gap and the north-Atlantic sea lanes—the arteries through which reinforcements would flow in a crisis—have regained their cold war significance. NATO’s launch of Arctic Sentry earlier this year reflects that reality, and I am glad that has happened. It signals a recognition that deterrence in the High North must be persistent, co-ordinated and credible.

The United Kingdom says that it understands the shift. Under the last Government, the 2023 “Looking North” policy framework set out a whole-of-Government approach across security, science and the environment. Fast-forwarding to this Government, the strategic defence review acknowledged that developments in the High North have direct consequences for the Euro-Atlantic and the United Kingdom’s place within it. Ministers have also highlighted the Royal Navy’s approach to Atlantic Bastion, which is intended to secure the north Atlantic through a networked mix of warships, aircraft and autonomous systems.

Important steps have been taken. The United Kingdom is strengthening co-operation with Norway through the Lunna House agreement and the JEF, to counter undersea threats and protect NATO’s northern flank. The Royal Marines—my old outfit, and the hon. Member for Halesowen’s—continue to train in Norway, including through exercises such as Cold Response and our training presence at Camp Viking, which is set to expand. I put on the record my thanks to the Royal Marines delegation that recently came to Parliament, under Brigadier Jaimie Norman, to educate us on the High North. It was a fantastic day that left a lasting impression on us all.

The UK will contribute to NATO’s Arctic Sentry mission, with the carrier strike group deploying to the north Atlantic later this year under Operation Firecrest. I hope the Minister will expand on the point raised by my hon. Friend the Member for Huntingdon (Ben Obese-Jecty).

The actions I have mentioned demonstrate intent, but the House must distinguish between intent and delivery. The Government have chosen not to publish a refreshed stand-alone High North defence strategy; instead, Arctic policy has been folded into broader defence frameworks. I am sure there is a good reason for that and look forward to hearing the Minister’s rationale for it, but the Opposition, if we are playing a good friend to the policy, think it risks diluting focus.

If the High North is truly the new frontier of great power competition, the United Kingdom’s objectives there should be clearly defined. Are we primarily focused on securing reinforcement routes across the north Atlantic, or on protecting critical undersea infrastructure, which the hon. Member for Strangford (Jim Shannon) referred to? We need a much better strategy across all our partners. I think that is being developed, but the question is whether it is being developed fast enough.

It has been made quite clear in the debate that the United Kingdom does not currently maintain capabilities dedicated specifically to Arctic operations. Without additional capacity, Arctic ambition risks becoming a competition for scarce assets rather than a sustained strategic commitment, as I think would be acknowledged by anyone who sees themselves as our adversaries.

The Royal Marines are a good microcosm through which to see the challenge clearly. They are being asked to pivot towards High North operations—they are specialists in that environment—while continuing special operation roles and global deployments.

I want to put on the record, as the hon. Member for Halesowen did, that I never spent any time in the Arctic, even though I am a former Royal Marine, and it is said that until someone has spent time in Norway, they are not a proper bootneck. Given that the hon. Member for Portsmouth North (Amanda Martin) has spent five more days in the High North than me, I defer to her more recent knowledge. Before the debate started, the Minister offered to join me back up again; I am still unsure whether that was a threat or some sort of treat; given that the hon. Member for Strangford also wants to join the Royal Marines, maybe we can do it together.

Cold weather warfare cannot simply be improvised, as the hon. Member for Halesowen will know, having been deployed up in that area, nor can credible specialist capability exist without, as he said, the lift, logistics and sustainment that enable it. In the undersea domain, the stakes are even higher. The North Atlantic seabed carries the cables and energy links that underpin our economy and communications; the hon. Member for Strangford talked about the economic security that we all rely on.

Deterrence in the High North will increasingly be measured below the surface, in the submarines tracked, cables monitored and infrastructure protected. The Lunna House agreement with Norway, which includes co-operation on anti-submarine warfare and the protection of undersea infrastructure, is strategically sound, but the interoperability on paper must translate into persistent operational presence at sea. That means modern anti-submarine capabilities, sufficient hulls available for deployment, and the crews required to sustain them.

The strategic defence review acknowledged that the Arctic is a region of increasing competition in the United Kingdom’s wider neighbourhood, yet it did not outline specific capability adjustments tailored to the theatre. If the High North is becoming central to NATO deterrence, treating it simply as an adjunct to other priorities will not suffice. To go back again to the overriding point that we keep hearing, I really hope there is clear detail in the defence investment plan, whenever it is released, and that the Minister can give a clearer view on when that will be. The House of Lords has also raised concerns that the United Kingdom risks aspiring to a meaningful security presence in the High North without the resources to sustain it. Those concerns have not yet been fully answered.

Recent events elsewhere underline the importance of readiness. When crises escalate, forces held at high readiness must deploy rapidly. Air and missile defence must be integrated, munition stockpiles must sustain operations over time, and the growing cost imbalance between high-end interceptors and low-cost threats cannot be ignored. These challenges go to the heart of credibility. NATO deterrence in the High North depends on the confidence that allies can reinforce Europe across the Atlantic, defend sea lanes and protect the northern flank under pressure. If we speak of Atlantic Bastion, we must demonstrate the ships, aircraft and trained crews required to make it real.

Let me be clear: the Opposition support a strong NATO presence in the High North, and we want to work with the Government to strengthen it wherever we can, but we cannot support some of the plans without being a critical friend. We will therefore ask the Government to define clearly the objectives of the United Kingdom’s contribution to Arctic Sentry. We will ask how Atlantic Bastion is being resourced and crewed, how the expansion at Camp Viking will be sustained alongside global commitments, and how the protection of undersea infrastructure is being operationalised in practice.

The High North is becoming the northern gateway to the United Kingdom’s security. It is the corridor through which allied reinforcements would flow, and it is where deterrence will increasingly be tested below the surface. If this is the new frontier of great power competition, we must treat it with the seriousness that such a frontier demands. The strategy must be clear, the capability must be credible, and the resources must match the ambition.

15:22

[The Minister for Veterans and People (Louise Sandher-Jones)]

It is a pleasure to serve under your chairship, Dr Huq. I am grateful to my hon. and gallant Friend the Member for Halesowen (Alex Ballinger) for initiating this debate on the high Arctic and its increasing importance to our security—an incredibly important topic.

As my hon. and gallant Friend knows well from his time as a Royal Marine, the UK has a long and storied history in the High North, and for some 50 years the Royal Marines have practised Arctic warfare alongside our Norwegian allies. Indeed, he may have taken part in the rite of passage of plunging into the ice, as I believe the First Sea Lord did again when he visited troops there only last week.

As the threat from Russia has cast an increasingly long shadow over Europe, our High North capabilities have grown only more important, and today High North deployments of Royal Marines are up 40%, with year-round cold-weather operations. The reality is that we have a frontline with Russia in the North Atlantic, and the Russian threat is higher than it has been for decades. We have seen from the activities of the spy ship Yantar that Russia is an increasing threat to our critical underwater infrastructure. We see Putin rapidly re-establishing military presence in the region, including reopening old cold war bases. Last year, Russia and China conducted their first joint air patrol into the Arctic circle. China has declared itself a near-Arctic state and expanded its icebreaker and research vessel presence.

The changing military picture is fuelled by the changing climate and rising temperatures, and a number of Members rightly raised how pivotal it is to understand climate change and recognise the huge threat it poses to our security. It is vital to consider it in that way. The Arctic is warming up four times faster than the global average, and the strategic defence review projects the region to be ice-free each summer by 2040, opening new routes, trade dynamics and flash points. Our responses to those challenges were set out in the SDR: we need increased investment, new technologies and stronger alliances. We are prepared to meet those challenges.

Spearheading our capabilities is our littoral response group north, which is our specialised Royal Navy task group that deploys across the north Atlantic, the Baltic and the High North, with dedicated personnel, ships and helicopters to project power and respond to crises. We have also launched Atlantic Bastion, which is our groundbreaking programme to protect the UK from Russian undersea threats using an AI-powered network of sensors.

We are working ever more closely with our nine partner nations that make up the joint expeditionary force. We established Operation Nordic Warden with JEF allies, working together to track threats to undersea infrastructure from Russia’s shadow fleet—a responsibility now assumed by NATO. Last autumn, we conducted Exercise Tarassis, which was JEF’s largest ever military exercise, involving more than 1,700 British personnel, alongside air, land and naval forces from Scandinavian and Baltic nations.

On a visit to Norway last month, the Secretary of State went further still, announcing that Arctic and High North security will be strengthened against rising Russian threats as Britain steps up its presence in the region. He also announced a major joint expeditionary force, Exercise Lion Protector, which will see air, land and naval forces from JEF nations deployed across Iceland, the Danish straits and Norway, and trained to protect critical national infrastructure against attacks and sabotage, and enhance their joint command and control capabilities. The Secretary of State confirmed that the number of British troops deployed to Norway will double over three years, from 1,000 to 2,000 personnel.

Finland and Sweden’s accession has transformed NATO’s northern posture, meaning that seven of the eight Arctic states are now NATO allies. The whole alliance is consequently more focused on the threats and challenges to our north.

As can be expected from a Government who have put NATO first, NATO is at the heart of our response to growing threats and tensions in the region. The UK is playing a full part in NATO’s Arctic sentry mission, which is enhancing NATO’s posture in the Arctic and High North, and we currently have 1,500 commandos deployed across Norway, Finland and Sweden as part of Exercise Cold Response. Planning is at an advanced stage for Operation Firecrest, and the upcoming deployment will see our carrier strike group across the Atlantic and High North. Of course, we continually review threat levels and will change our policies accordingly. The thousands of personnel from the three services are spearheaded by HMS Prince of Wales, and parts of the deployment are under NATO command.

Our military co-operation in the Arctic is underpinned by key bilateral partnerships that have all been strengthened under this Government. Russia’s growing activity across the Arctic, High North and north Atlantic has changed the security picture for the region. The UK, with its 50-plus years of history operating in the Arctic, and through our deep partnerships with allies, including Norway, Sweden and Finland, will be at the centre of NATO’s northern response from day one.

In December, the Defence Secretary signed the historic Lunna House agreement with Norway, which will see the UK and Norway jointly operate a fleet of submarine-hunting Type 26 warships, expand joint Arctic training and pre-position British military equipment in Norway to be better prepared for future crises. We have stood resolutely with Denmark over Greenland, the future of which is for Greenlanders and Danes alone. I welcome the uplift in Danish Arctic defence spending, worth more than £10 billion.

We have also worked closely with the Finnish military, including through NATO’s Exercise Dynamic Front, with the British Army conducting its first live firing of our Archer mobile howitzer on Finnish soil—the Army is getting in on the High North joy. We currently have three P-8 Poseidon aircraft carrying out RAF NATO air policing from Keflavik in Iceland—the largest-ever P-8 overseas deployment.

Let me turn to a couple of questions that Members asked. We are working flat out to deliver the DIP. I am sure I do not need to stress to every Member here that it is important to get this hugely important piece of work right before we commit to it. We have ordered five Type 31 frigates, and HMS Venturer should be the first of those to deliver by the end of the decade.

The hon. Member for Strangford (Jim Shannon) asked about Ireland. the Prime Minister is due to meet with the Taoiseach at the bilateral in just a few days’ time, and I know that the Secretary of State will call his counterpart and have discussions around some of the points the hon. Gentleman raised.

I thank my hon. Friend the Member for Portsmouth North (Amanda Martin) for her contribution. She has been to Norway; I have never made it there—I have only been as far as Denmark—but I am sure there is time to rectify that. She is a doughty campaigner for families, and as we say in the military, although personnel join the military, their families serve too. It is within my purview to do everything I can to support families through the very difficult challenges they face when their loved ones deploy. My hon. Friend rightly noted the importance of not only the larger pieces of shiny equipment that we must procure, but simple items such as gloves. Having worn military-issue gloves, I concur. We must make sure that we have a good standard of personal protective kit and equipment.

Real tribute has been paid to the mighty Royal Marines, who have been excellent guardians of our Arctic warfare capability. It is a very difficult operating environment, and I pay tribute to those who operate there on our behalf to keep us safe. The Royal Marines are a fantastic career choice for those considering starting their careers or who might be interested in joining the reserves. Other armed services are available, including the British Army, should anyone be interested.

Politically and environmentally, the Arctic is in flux. While the eyes of the world are currently focused on the middle east, we are clear that there can be no national or global security without security across the Arctic and northern Europe.

[Richard Foord]

In its negotiations with the United States, Denmark pledged to raise defence spending from 2.4% of GDP last year to 3% of GDP this year and next. Does the Minister think that the example Denmark is setting is a good one for the United Kingdom?

[Louise Sandher-Jones]

I am very proud of the steps that the Government have taken to raise defence spending, which are very welcome off the back of many years of underspend. In fact, this is my very next line: defence spending will rise to 2.6% in 2027, 3% in the next Parliament and 5% by 2035. Just as important as raising defence and security spending is making sure that we continue to pursue a NATO-first defence policy. We are a Government who are delivering the largest sustained increase in defence spending since the cold war, to keep Britain secure at home and strong abroad.

[Liz Saville Roberts]

I appreciate that the Minister is talking about defence spend, but in my earlier intervention I raised a point about having a consulate. Many of our European neighbours are ensuring that they have a presence in the area, alongside China and the United States. Surely that would be an effective way of spending Government money at a time when we are looking to spend effectively for the future of the UK’s best interests.

[Louise Sandher-Jones]

I am sure the right hon. Member will understand that consulates are a matter for the Foreign, Commonwealth and Development Office. I will make sure that the FCDO is aware of her comments.

15:30

[Alex Ballinger]

I am grateful for the excellent contributions from my hon. Friend the Member for Portsmouth North (Amanda Martin), the hon. Member for Strangford (Jim Shannon), the right hon. Member for Dwyfor Meirionnydd (Liz Saville Roberts), my hon. Friend the Member for Dunfermline and Dollar (Graeme Downie), the hon. Member for Surrey Heath (Dr Pinkerton), the hon. Member for Exmouth and Exeter East (David Reed) and, of course, the Minister.

I think this is the first debate I have been in where there has been almost unanimous agreement across the piece about the importance of Arctic security, outrage at the position the Americans took on Greenland, and agreement on the necessary steps we need to take to reinforce the capability of our troops. I am also grateful to have heard the Royal Marines being spoken about so much in this Chamber—we need that to continue.

Question put and agreed to.

Resolved,

That this House has considered Government policy on NATO and the High Arctic.

15:30

Sitting suspended.

Energy Security and Net Zero: Scotland

Wednesday 4th March 2026 Westminster Hall

16:00

[Dr Rupa Huq (in the Chair)]

I will call Susan Murray to move the motion and then the Minister to respond. I remind other Members that they may make a speech only with the prior permission of Susan Murray and the Minister. Because this is a 30-minute debate, there will not be an opportunity for Susan Murray to make a winding-up speech at the end.

[Susan Murray (Mid Dunbartonshire) (LD)]

I beg to move,

That this House has considered Scotland’s contribution to energy security and net zero.

It is a pleasure to serve under your chairship, Dr Huq, and a privilege to lead this debate on a matter that will have such an impact on Scotland’s economy, our cost of living and our national security. Let me be clear at the outset that Scotland plays a disproportionate role in keeping the lights on across Great Britain, and it is leading the way in the shift to clean power.

The evidence is clear: the House of Commons Library noted that in 2024, clean power made up 90% of the generation in Scotland. The Department for Energy Security and Net Zero has published figures showing that Scotland produces significantly more energy than it consumes, and that it transferred 17 TWh of excess energy to England in 2024. In terms that we can all understand, that is enough energy to power every home in London for two years.

That production benefits us all—it supports energy security, making us resilient to international events, and helps to decarbonise the grid for everyone—but there is a problem that we cannot ignore: despite that enormous contribution, too often Scots do not see a fair share of the benefits in good jobs, local investment or lower bills. The case that I want to make today is simple: Scotland is delivering, so the UK’s policy and delivery machine must now match that pace with fairness, infrastructure and security. The North sea is the place to start.

The Scottish Affairs Committee set out the stark reality: in 2024, oil and gas production reached a 21st-century low—about 75% below the 1999 peak. Decline is not an abstract theory; it is measurable across Scotland. The workforce impact is already significant. The Library notes that there were 121,000 direct and indirect jobs supported by the oil and gas industry in 2023—a 51% fall compared with 2014. If workers leave before the clean energy pipeline reaches its potential, we will lose the skilled labour that is vital to a successful transition.

[Harriet Cross (Gordon and Buchan) (Con)]

I thank the hon. Lady for securing this debate. I completely agree that the oil and gas sector is vital, and that we must secure the workforce in our energy industries, but I would like some clarity on the Liberal Democrats’ position. My understanding is that they support Labour’s ban on new licences, and that they had a manifesto pledge to backdate the energy profits levy. Is that still the Liberal Democrats’ position on the North sea?

[Susan Murray]

The Liberal Democrats are keen that we move to a source of green energy. We are calling for the energy profits levy to be looked at again, as it was introduced as a windfall tax in particular circumstances, when there were very high profits.

[Jim Shannon (Strangford) (DUP)]

I commend the hon. Lady for bringing this debate forward; she is absolutely right to do so. The devolved institutions’ contribution to net zero targets are important, and I am pleased to hear of Scotland’s success. I look forward to the Minister’s response.

Northern Ireland shares the commitment to a net zero future by 2050, but our smaller grid, limited renewable capacity and reliance on imported electricity means that achieving that goal is more challenging. Does the hon. Lady agree that we must make sure no part of the United Kingdom is left behind? I wish her well for Scotland, but all devolved nations must be given the necessary tools to succeed in the green energy transition.

[Susan Murray]

I absolutely agree. Although I am focusing on Scotland, it is Scotland as part of the UK and not Scotland alone.

We want to make sure that we do not lose the skilled labour that is vital to a successful transition, because we would then have to pay more later to import the labour and expertise that we should have retained to do the work.

I want to be clear about a point that is often overlooked or used by those with a vested interest against renewables: the UK will need oil and gas for the foreseeable future, even as we decarbonise. In that context, and to secure our own energy security, we should meet as much of the demand for hydrocarbons as possible from a secure, well-regulated domestic supply, rather than simply importing more and losing or exporting jobs.

Importing more does not stop consumption; it simply shifts production elsewhere, often to jurisdictions with lower standards and higher geopolitical risk. Domestic supply, properly regulated, can be the safer bridge while we build out our new low-carbon system at scale and ensure security of supply. Will Ministers pull together existing work into a single transition pathway that links North sea decisions to a workforce plan, covering skills mapping, retraining and support where needed?

If we want a managed transition, we also have to be honest about the urgency of the whole-system needs of a clean grid. A net zero system is essential—Scotland shows that it is possible, and it should be the goal—but a renewables-heavy system needs predictable, low-carbon power alongside renewables, storage and interconnection. That is why I support nuclear, and why small modular reactors should be part of the plan to achieve net zero in Scotland.

The SNP Government’s position is that they do not support building new nuclear power plants in Scotland under current technologies. Meanwhile, the UK Government have confirmed Wylfa in Wales as the site for the UK’s first small modular reactor. The risk is obvious that Scotland will end up hosting more of the infrastructure footprint of the transition but without the benefits, while other parts of the UK will capture more of the firm power investment and the supply chain jobs.

In Scotland, the devolution framework really matters. Nuclear market frameworks and regulations are reserved, while planning and community impacts, along with local skills delivery and many aspects of economic development, are devolved. This cannot work without co-ordination.

Will Ministers request UK-Scottish Government talks on Scotland’s nuclear policy, with SMRs explicitly on the agenda, to highlight the positive economic benefit for Scotland, and to push for equal access to jobs and development across the UK? Scotland hosts major clean power generation and transmission infrastructure, but fairness must follow that footprint.

[Patricia Ferguson (Glasgow West) (Lab)]

It is a pleasure to serve under your chairpersonship, Dr Huq. I thank the hon. Member for securing the debate. I intervene in my capacity as Chair of the Scottish Affairs Committee, of which she and many other hon. Members here today are valued members. As she knows, our Committee has been examining this entire topic as part of a large-scale inquiry into energy and a just transition.

One of the areas we have turned our attention to is the question of fairness across the UK as we transition to cleaner energy systems. We have heard evidence from Scotland’s community-owned renewable energy sector that they face a significant number of barriers when it comes to connecting their projects to the grid. They also have some unique challenges created by the differences between the grid in Scotland and the grid in England and Wales. Does the hon. Member agree that we must turn our attention to that area if we are going to enable communities to generate their own electricity and power and be the beneficiaries of that?

[Susan Murray]

I absolutely agree. We have a real opportunity with Great British Energy, in the current environment, to take advantage of what the commercial companies are offering with regard to reducing costs for individual homeowners and to use digital technology to ensure that community energy generated into the grid benefits the communities that host the infrastructure that generates that energy.

Communities see the turbines, substations and pylons; as the grid expands, they see that infrastructure expand, too. They live with disruption during construction and operation, and too often they do not see fair value for the disruption that they face. That means that there is an opportunity here. The Government have already been developing the policy infrastructure. DESNZ published a working paper seeking views on the design of a potential mandatory community benefit scheme and the facilitation of shared ownership for low-carbon energy infrastructure. That is not a small thing; it is a recognition that we cannot build at the pace required without public consent, and public consent is strengthened when communities are well-informed and share in the long-term value.

[Mr Angus MacDonald (Inverness, Skye and West Ross-shire) (LD)]

Do you agree that £9 million in total community benefit for the highlands, and £30 million for Scotland as a whole, is a paltry amount for a multibillion-pound industry?

[Dr Rupa Huq (in the Chair)]

Order. Can I just remind the hon. Member about use of the word “you”? I always get told off by the Deputy Speaker for it. “You” means me, because I am in the Chair. It should be, “Does the hon. Member agree?” But I think we get the point.

[Susan Murray]

I thank the hon. Member for his intervention, which I absolutely agree with. As I have just said, this is something that needs to be looked at, and there is an opportunity to make sure that communities all across the UK benefit from the power generation that they have to live with locally every day. Will Ministers commit to introducing a consistent community benefit and community energy framework for major low-carbon infrastructure, so that host communities—especially in rural and off-gas-grid areas—share in any long-term benefits?

Beyond the initial generation of power, we forget about the grid. None of our ambitions on net zero or energy security will be met if we cannot move the power that we generate around the UK. We must fix the grid; we must stop paying to waste clean energy. We have built the infrastructure to generate power faster than we have built the network to connect and transport it. The result is that bill payers are burdened with the cost of electricity that they cannot use and that cannot be brought to them.

The National Energy System Operator’s annual balancing costs report sets out the scale of the problem. It reports that grid constraint costs increased by 64% in 2024-25, totalling £1.7 billion. The total energy lost to that failure was 13.5 TWh, which is nearly as much as Scotland sent to England. This is not a theoretical cost; it is money that households and businesses pay because the network cannot always carry the clean power that is available. Will Ministers pledge to accelerate grid development and to drive connections reform at pace and with clear milestones, so that we stop paying for unused electricity and improve resilience, particularly for rural and remote communities?

The grid is not just an infrastructure issue; it is an opportunity to redevelop our industrial heartlands. If Scotland is powering the transition, Scotland should also help to build it. Scotland has a proven history in heavy engineering and industrial delivery, with ports, fabrication, and a supply chain shaped by decades of offshore work. The transition should not become a story of “import the kit, export the jobs”.

[Graham Leadbitter (Moray West, Nairn and Strathspey) (SNP)]

The hon. Member has already covered the EPL, but it is important to recognise that Scottish Renewables and Offshore Energies UK wrote jointly to the Secretary of State and the Chancellor of the Exchequer expressing their deep concerns about its impact on the transition. It will not be possible to deliver the renewables transition we all want if the North sea is allowed—or even forced—to decline at the rate it is doing, and not enough effort is put into the renewables side and supporting that transition. Does the hon. Member agree that the Government need to address that rapidly? We need pace of decision making and certainty for investors and developers if we are to ensure that we make that transition effectively, which will provide the jobs for the skilled workforce she rightly referred to.

[Susan Murray]

I absolutely agree: the vision is there, but we take too long to make decisions. When that happens, our workforce make their own decisions, and businesses do not come that might have considered coming. We have to support the opportunity that is available to us.

We must look seriously at how we encourage companies to build the components of the green revolution here. We have the skills and a history of great steelworks and dockyards. Those can be revitalised, and our communities alongside them.

However, building at home extends further than just good practice: it reduces risk to supply and security. The National Cyber Security Centre publishes dedicated supply chain security principles to help organisations manage supply chain risk. That is the mindset we need for critical national infrastructure, and we have seen why it matters. UK authorities have been looking into reported cyber-security concerns linked to remote-access features in some electric buses imported from China—the same place that much of our green technology comes from. This is not about sensationalising or point scoring: if supplier risks matter for buses, they certainly matter for the systems that keep the lights on and our countries running. Will the Minister use the industrial strategy to set out clear UK content and supply chain commitments, to ensure that demand for grid and energy production components is not only met in a timely manner but protected from foreign interference?

I finish by returning to the household reality, because net zero will not be delivered by megawatts alone; it will be delivered in homes and communities, and it must be made simple, safe and scalable. The Climate Change Committee’s progress report found a 56% increase in heat pump installations in 2024, driven by increased support from Government schemes, but it is clear that scaling remains the challenge. Households respond to a simple proposition: reliable installers, clear standards, stable support and aftercare. That too should be treated as part of the mission to build a UK production base. A national retrofit and heat pump supply chain would create skilled work in every community. Will Ministers treat heat pumps and retrofits as part of the same mission, supporting an installer pipeline, quality assurance, consumer protection and an end-to-end journey from advice, to finance, to installation, to aftercare?

Scotland is delivering Britain’s energy security and clean power. Now the Government must deliver for Scotland, with fairness, jobs and infrastructure that turn Scotland’s contribution into lower bills and better energy security for everyone.

[Dr Rupa Huq (in the Chair)]

I call Minister—and birthday boy—Michael Shanks to respond for the Government.

16:18

[The Minister for Energy (Michael Shanks)]

Thank you, Dr Huq. There is genuinely nothing I would rather do on my birthday than answer an important Westminster Hall debate on this topic. It is a pleasure and a privilege to be here—cake to follow.

I thank the hon. Member for Mid Dunbartonshire (Susan Murray)—that beautiful constituency on the other side of Glasgow from my own—for introducing this important debate, and it is a pleasure to see so many members of the Scottish Affairs Committee to the Chamber. As an alumnus of that Committee in the last Parliament, it is a pleasure to see it continue to go from strength to strength. As a proud Scot, I reflect many of the things the hon. Lady said about the contribution that Scotland has made to Britain’s economic past, and the critical role it plays at the moment and will continue to play in the future. I will return to that theme later.

I also want to reflect on the fact that it is the strength of us working together across the United Kingdom that has driven much of the investment into Scotland to make these projects a reality. I will come back to that point later because I know that the hon. Member for Strangford (Jim Shannon) will appreciate that, if nothing else.

I want to reflect on some general points, and then I will come briefly to each of the points the hon. Member for Mid Dunbartonshire made, because they are all incredibly important and things we are working towards. On the general argument about what the Government are trying to achieve, we are trying to tackle the energy trilemma—the question of security, affordability and sustainability—by driving as quickly as possible towards clean power. Our target—our mission—of achieving clean power by 2030 is partly about how we get off fossil fuels, and the past few days have demonstrated why that is so important in an uncertain world. It is also, as the hon. Lady rightly said, about how we take the industrial opportunity that goes along with that. How do we get the good jobs and industrial opportunity to go with it?

[Harriet Cross]

Of course, we cannot ignore the events of recent days in the middle east and the impact on oil and gas prices and supply. However, those events make it more obvious why we should be preserving and making the most of the supply and production we have in the North sea. The oil goes into the European market—not through the strait of Hormuz—so it stays accessible, and the gas all comes into our networks in the UK. It is vital that we secure our own production, and the Minister surely recognises that the energy profits levy and the ban on new licences put that at risk.

[Michael Shanks]

I was going to come on to the North sea later, but let me do that now, because the hon. Lady raises important points. Yes, our domestic supply is important—particularly the gas that goes straight into the pipes around the country—and it creates jobs for thousands of people in the industry, many of whom I have got to know over the past 18 months. However, it is also important to know that it has been in decline for a long time, with a 75% reduction in production between 1999 and 2024. Although it continues to play an important role, we have been a net importer since 2004, and that will only continue in the years ahead. Yes, we should continue to support domestic production, and it will continue to play a part for years to come, but our long-term energy security does not come from fossil fuels in the North sea.

Returning to the points the hon. Member for Mid Dunbartonshire made about the North sea, she asked whether we could pull together a plan for the North sea transition. We did that and published it at the end of last year. The North sea future plan is a fantastic read, and I encourage everyone to read it. It seeks, for the first time, to bring together projections on the future of the North sea, skills and workforce planning, and the opportunity that comes from renewables.

We need to look at both sides of the North sea. It has been hugely important for 60 years, producing oil and gas, and it will continue to be important for decades to come. Equally, we need to build up industries that have been important in recent years but that have not grown as much as we would like, and where we have not seen as many jobs as we need. So there is a workforce plan. A North sea future board has also been set up; it met for the first time in Aberdeen in January, and it will meet again in the coming weeks. It is about driving forward actions—not talking about the transition, but working through the solid things we now need to do to make it a reality.

I am conscious of time, and I want to pick up on a number of points. On new nuclear, we absolutely see nuclear as a critical component of the clean power plans of the future. It will be the backbone of a clean power system and will deliver energy security in uncertain times. We need to build nuclear faster, which is why we will respond in due course to the Fingleton review on how to improve regulation. As the hon. Member for Mid Dunbartonshire outlined, we have also invested in the first small modular reactors at Wylfa in Wales.

I genuinely hope we will see a change of Government in Scotland in May, to one that will look at the opportunities that come from nuclear. I had the great privilege recently of visiting Torness and meeting workers who have worked there for 20 or 30 years in good, well-paid, highly skilled jobs—jobs that Scotland is currently missing out on because of an ideological block from the SNP, which we have to remove so that we can build the power we need.

[Graham Leadbitter]

I take the point the Minister makes on nuclear, but the Government have not articulated what they plan to do with nuclear waste. The current projected price for a radiological disposal facility is about £60 billion, and it is marked as red—as unachievable —yet the Government say it is critical. It has not been articulated how any of that will be paid for, how much will come off bill payers in Scotland and why Scotland needs that when we produce more energy than we currently use.

[Michael Shanks]

That is a well-trodden argument that, unfortunately, the facts do not bear out. The energy produced in Scotland is more than it uses, but at any given time Scotland often relies on nuclear energy; in fact, it is quite often imported from England when necessary—when the wind is not blowing and the sun is not shining. Nuclear is critical, and Scotland was relying on gas from Peterhead power station recently because Torness was undergoing renovation work. Scotland does in fact rely on nuclear, and it is important. Furthermore, the argument about costs would be well placed in the SNP’s own plan on this issue, which says that there would be a third off energy bills with independence. There are absolutely no figures to back that up.

Let me move on in the time I have left to the key points that have been made. First, it is absolutely right to centre the future of the country’s economy and of the clean power that we need to get to households and businesses on improving the grid. For far too long, we have not invested in what is probably one of the most important pieces of infrastructure that this country has. As a result, it is taking far too long to connect projects. As the hon. Lady for Mid Dunbartonshire rightly outlined, every single minute of the day we are wasting clean power, which could be bringing down bills, because we cannot get it through the necessary constraints. We have to build that grid, and with that will come tens of thousands of jobs across the country, so it is a hugely important economic opportunity.

I was glad my hon. Friend the Member for Glasgow West (Patricia Ferguson) referenced the importance of community energy and of the local power plan, which was published recently—another fantastic read that I encourage all hon. Members to read. This is about the biggest transfer of wealth and power in the energy space in British history, putting communities right at the heart not just of building energy infrastructure, but owning that infrastructure and benefiting from it. Tomorrow I am going to the Western Isles to see a project that has benefited greatly from being able to own that energy and take the profits that come with it.

Community benefits remain important as well. We did consult on making them mandatory, and we will announce the outcomes of that consultation soon. We have announced bill discounts for people in the proximity of transmission infrastructure and community benefits from that. We also want to see much more shared ownership of energy, with communities having the ability to take a stake in much bigger projects and take the profits that come with that to invest in their local areas. That is hugely important.

Consenting decisions on these projects are devolved in Scotland, and I urge the Scottish Government to move as quickly as possible on making those decisions. Every delay to a piece of grid in Scotland means we are not getting cheaper power on to people’s bills, which could make a huge difference now. Those delays are significant, so I urge them to make that happen.

Finally on the grid, the industry is working collectively to make sure that the billions of pounds of investment going into building the grid results in supply chain jobs across the country.

There were many other things that the hon. Member for Mid Dunbartonshire raised that I would love to spend longer talking about. However, at the outset she made absolutely the right point about Scotland’s contribution to the UK’s energy security. It is not a story of the past or a promise of the future, but a reality at the moment. We have to seize the opportunities that come from the energy transition. That means creating the jobs that go along with the infrastructure we are building, so that Scotland benefits and gets that economic potential.

I am glad there is some consensus on many of the actions we have to take in this space, but the question is how we move further and faster to make this happen. Communities cannot wait for those community benefits or for cheaper power, and we should always root this issue in the Government’s No. 1 priority: tackling the affordability crisis facing households across the country. The clean power mission is the way to do that. In an increasingly uncertain world—not least the one we see on our TV screens right now—the answer is to move further and faster away from fossil fuels and to the cheaper, cleaner power that is an economic opportunity for Scotland and the whole country.

Question put and agreed to.

Healthcare in Rural Areas

Wednesday 4th March 2026 Westminster Hall

16:29

[Blake Stephenson (Mid Bedfordshire) (Con)]

I beg to move,

That this House has considered healthcare in rural areas.

It is a pleasure to serve under your chairship, Dr Huq. I hope that this debate can be a constructive discussion of the particular challenges that rural communities face in accessing healthcare. In that spirit, I will open the debate by saying some things that I hope no one will find controversial.

Rural communities are bigger and further apart than urban ones and have fewer people in a wider area, which makes the delivery of basic services much harder than in major conurbations. The time and money lost to travel is higher because the distance between places is larger, and it is more challenging to recruit and retain staff in public services such as healthcare. Accessing online support—often seen as a silver bullet for the future of healthcare—can be challenging in rural areas where high-quality broadband and mobile signal have not yet arrived. All that means that securing equal access to healthcare in rural areas as in urban areas is more challenging and expensive, which has practical implications. In the Health Secretary’s constituency of Ilford North, there are 20 main GP surgeries. In my constituency of Mid Bedfordshire, there are just nine. The age of the village doctor is gone.

When my constituents heard of the plans for a neighbourhood health service, with a neighbourhood health centre, within the Government’s 10-year health plan, there was some optimism that that age might return, even if not necessarily in the same way as before. In principle, neighbourhood health centres are absolutely the right step. They are a way to empower people to get the healthcare that they need on their doorstep and to keep them out hospitals, which could then focus on those who need the most specialised care.

[Sarah Gibson (Chippenham) (LD)]

Does the hon. Member agree that rural communities, such as mine and his, and villages such as Lyneham, which is famous for its serious airbase and is full of veterans, now find themselves with poor GP surgeries and no future for that? People in those villages are waiting longer and longer to get that care and feel completely left behind, as they have no access to any form of health service.

[Blake Stephenson]

I know Lyneham quite well; it is a beautiful part of the world—although of course, Mid Bedfordshire is far more beautiful. I have to agree with the hon. Lady. The situation is deeply concerning for those in rural communities who are struggling to access GPs, and, given the growth and development in our communities, access is becoming much more difficult as the years roll on.

[Jess Brown-Fuller (Chichester) (LD)]

The hon. Gentleman is making a valid point about development. In the rural village of Bosham in my constituency, a resident was recently told that they would have to wait four months for a GP appointment. Meanwhile, they have seen plans come online for the development of 300 homes behind the GP surgery, and the surgery is now expecting 600 new patients. Does the hon. Gentleman agree that we need to have an infrastructure-first principle, because the reason that residents get so frustrated with development is that they cannot see those extra GP appointments coming online once those homes have been built?

[Blake Stephenson]

The hon. Lady front-runs entirely a point I will make later, and I thank her for doing so.

Unfortunately, that early optimism about neighbourhood healthcare was somewhat tempered by a response I received to a written question, indicating that the Government expect neighbourhoods to have a geography of around 50,000 people. I am afraid that that will do nothing for people in Mid Bedfordshire. It will mean either that rural communities on the edge of urban catchments will be split up and served by “neighbourhood” health hubs in nearby major settlements, which will likely be Hitchin, Bedford, Luton or Milton Keynes, or that one rural “neighbourhood” will cover the vast majority of rural communities, meaning that constituents will have to travel to a central location to access the services that they need. In either case, that is what already happens now.

People in rural communities can only get to healthcare services in big towns that are often a distance away. They deserve better than to be viewed as the hinterland of larger urban areas. They deserve a neighbourhood health service designed not as a one-size-fits-all solution, but as genuinely local to their needs. I appreciate that funding is not unlimited and that tough choices need to be made, but those tough choices always seem to result in rural communities losing out when it comes to access to healthcare.

[Aphra Brandreth (Chester South and Eddisbury) (Con)]

My hon. Friend is making an excellent speech. Does he agree that allocating NHS resources on a strictly per head basis disadvantages rural communities, particularly when nearly a quarter of rural residents are over the age of 65 and the rural population is ageing faster than in urban areas? Will he join me in encouraging the Minister to commit to reviewing the funding formula to reflect age profile, travel times and sparsity?

[Blake Stephenson]

Absolutely. I do join my hon Friend in asking the Minister to respond to that specific point in summing up. I know many MPs who represent rural communities have concerns about the fairer funding formula. In fact, it is not fair, particularly for rural communities. It would be helpful if the Minister were to reflect on that in his speech.

I would like the Minister to give serious consideration to amending the Government’s plans on neighbourhoods. Neighbourhoods in urban communities can likely afford to be larger. The relative impact of that in many urban communities will be minimal. However, in rural areas, we need neighbourhoods in the region of 10,000 not 50,000, so that people living in small rural towns such as Flitwick and Ampthill in my constituency do not have to leave their towns to access “neighbourhood health services” and so that people living in villages large and small only have to travel to the next village over and not to a big town many miles away.

My concern over the Government’s plans for healthcare in rural areas does not end there. In Bedfordshire, we have recently seen our integrated care board—initially serving Milton Keynes, Luton, Bedford and central Bedfordshire—absorbed into a huge conglomerate ICB covering Hertfordshire, Bedfordshire, Cambridgeshire, Peterborough and Milton Keynes. That is an area of around 3.5 million people. It is hard to see that the new ICB will be able to give the level of attention to people in our rural communities that they need and deserve.

In Wixams, a new town being built in my constituency, a GP surgery has long been promised. It was promised when shovels first went into the ground in 2007, and it has been promised ever since, but the empty field remains, waiting for a building and some doctors. Wixams now has roughly 5,000 residents, and it made up about 0.4% of the population of the previous ICB area. It needs its promised GP surgery, but residents have found it incredibly difficult to get action from the ICB. Under the Government’s new ICB arrangements, Wixams’ residents represent just 0.1% of the ICB’s population. It seems obvious to me that an already small but growing community that needs healthcare services will find that this centralisation of leadership structures will make it even harder for them to get the healthcare they need.

To give credit where credit is due, the new ICB leadership have been very responsive to my representations on Wixams. After nearly two decades of delay, it feels like we are finally making some progress, together with the Mayor of Bedford and the hard work and commitment of local councillors Graeme Coombes, Marc Frost and Andrea Spice—all of whom I thank for their hard work. However, the point remains the same: when the area covered by ICBs is made bigger, the influence of our smaller rural communities and their healthcare needs becomes smaller.

What the Government are doing in Bedfordshire is in no way an isolated incident. I understand that the 42 ICBs that existed before will be reduced to just 26 super-ICBs once the Government’s process finishes. That means thousands of rural communities across England will have less control over their local healthcare overnight, and it was confirmed almost in the same breath as the Government’s plans to bring healthcare closer to communities. That is particularly short-sighted when put against the Government’s plans for mayors. The Government have previously spoken of their desire to line up the boundaries of mayoral areas and integrated boards. Even as part of the 10-year health plan, they stated that their aim is that:

“integrated care boards should be coterminous with strategic authorities wherever feasibly possible.”

What a fantastic idea. Doing so would give proper political accountability to integrated care boards. It would mean that the rural village has a proper elected voice at the table when decisions about the future of healthcare are being made, and a representative that they could hold accountable at the ballot box if their local healthcare needs were left wanting. That is exactly what rural communities need to ensure they get the healthcare they deserve.

The proposals, like so many others, seem to have been put back on the shelf and watered down. Now ICBs will be coterminous with lots of strategic authorities. In Bedfordshire, we are to be forced to have a mayor covering Bedford, Luton, Milton Keynes and central Bedfordshire. Our new ICB would therefore be covered by three mayors, including a mayor for Hertfordshire and a mayor for Cambridgeshire and Peterborough. That dilutes the political pressure our mayor can bring and the impact that rural Bedfordshire communities covered by that mayor can reasonably have.

If the Government change course back to the sensible idea of having an ICB and a strategic authority be coterminous, that will have been a whole lot of money wasted in two needless restructurings that could have gone into more doctors and nurses. It makes absolutely no sense—we need more doctors and nurses. In Bedfordshire, in the decade since 2016, we now have 18% more patients per fully qualified GP. That reflects the reality that in that same decade, our rural communities have been targeted for more and more development—a point made by the hon. Member for Chichester (Jess Brown-Fuller).

In central Bedfordshire alone, more than 20,000 houses have been built in that period, with many more in Luton, Milton Keynes and Bedford, including significant build-out in Wixams, as I mentioned earlier. There is barely a village in Mid Bedfordshire that has not been expanded significantly over the past decade. We expect to see many thousands more built in the coming years, including potential new towns at Tempsford and expansions east of Milton Keynes.

The old argument for healthcare with development no longer works. The argument would go, “Build a large development or new settlement. Give up a bit of what makes your rural community special, and in return you’ll get the new GP surgery or healthcare hub. You’ll get the infrastructure your community needs”. That just does not happen anymore. Now we get the houses, but the field where the GP surgery was promised remains empty, just as it has for two decades in Wixams.

The same argument has been made for the Government’s flagship new towns: build a big new town from scratch and it will come with the right infrastructure. However, the Department of Health and Social Care has not been able to confirm to me that additional funding will be provided for GP surgeries, and there does not appear to be future funding provided from the Treasury. That leaves open the prospect that GP surgeries in new towns will be funded at the expense of new GP surgeries in areas such as Wixams and other rural communities across the country, which have been waiting far too long. I would be grateful if the Minister could assure me on that point specifically.

The overall point is clear: where rural communities see development, they need infrastructure to cope with it. That is common sense; it is simple, and it is what our constituents want to see. They need to see that infrastructure arrive before the houses are occupied, and not for the burden on overstretched existing infrastructure to be relieved at some indeterminate point in the future.

It has been proposed a few times in this Session, but I fundamentally believe something must be done to allow councils and ICBs to benefit from developer contributions from the day that planning permission is granted, not as development is happening. That could be achieved by something as simple as the Government providing funding up front and reclaiming it from the developer via section 106.

This is one of the biggest issues facing my residents. When the wait to see a GP soars because of a new housing estate next door, nobody wins. I know this is not confined solely to rural areas, but it is in rural areas where existing infrastructure is strained to capacity, and where a good proportion of the Government’s 1.5 million homes are expected to be built.

I will bring my remarks to a close, and I look forward to hearing the views of others in this debate. There are particular challenges for rural communities in accessing healthcare. For too long the approach has been to centralise care in larger and larger towns, and in doing so take it away from villages and small towns. The Government’s move to centralise local healthcare decision making over much bigger areas risks leaving rural residents further behind.

The planned shift to a neighbourhood health service is welcome, but it must be a truly neighbourhood-based service. While a neighbourhood of 50,000 people might make sense in our big towns and cities, it risks leaving our rural small towns and villages out in the cold, served only as a bit on the edge of a larger urban area. Equally, as services move more and more online, consideration must be given to the challenges in rural communities that cannot get good broadband or wi-fi, for reasons beyond their control. Finally, we must ensure that development in rural areas comes with the local healthcare infrastructure that we know communities need. For too long, that has not happened, and communities such as mine in Mid Bedfordshire have paid the price.

[Several hon. Members rose—]

[Dr Rupa Huq (in the Chair)]

This is a popular debate, so there will be a time limit of three minutes to begin with, but it might drop down. The first exemplar of perfect timing will be Samantha Niblett.

16:45

[Samantha Niblett (South Derbyshire) (Lab)]

Thank you, Dr Huq—it is a pleasure to serve under your chairship. I am really grateful to the hon. Member for Mid Bedfordshire (Blake Stephenson)—I will call him my hon. Friend; we were in the armed forces parliamentary scheme together—for the opportunity to speak in this important debate on healthcare in rural areas.

In my constituency, we are proud of our strong sense of community, but too many of my constituents face growing barriers when it comes to accessing healthcare. For many residents, the first challenge is distance: GP surgeries are fewer and farther between, community hospitals have been hollowed out, and public transport is limited or unreliable. When appointments are moved online or centralised miles away, what is described as efficiency can feel more like exclusion, and older residents, carers and those without access to a car are too often left struggling.

Rural practices find it harder to attract and retain GPs, nurses and allied health professionals. Smaller patient lists and higher operating costs make practices less financially viable, placing additional strain on already overstretched staff. The result is longer waiting times, fewer appointments and growing frustration for patients who simply want timely care close to home.

Those pressures are compounded by wider inequalities. Rural communities tend to have older populations and higher levels of chronic illness, yet funding formulas do not always reflect the true cost of delivering care across a large, sparsely populated area. It is also worth mentioning that South Derbyshire has a high number of falls, which accounts for a large proportion of emergency hospital admissions for people over 65, and has other negative consequences such as impacting people’s confidence and their sense of independence. Mental health services are also particularly patchy, leaving many people waiting far too long for support, if they can access it at all.

Tracey Thorneloe, one of my constituents in South Derbyshire, experiences debilitating pelvic girdle pain as part of a chronic health condition. While pelvic girdle pain is normally experienced during pregnancy or childbirth, she began experiencing this pain six years ago and has had great difficulty accessing physio. There are no specialist physios for her condition in South Derbyshire, and access to hydrotherapy is very limited.

Wheelchair provision is also an ongoing issue in my constituency. My constituent Amanda Storer has told me of her year-long battle to get a wheelchair for her son Derrick, who has Down’s syndrome. A wheelchair allows him to be more independent and allows Amanda to get out and about more as he grows. We have helped her as much as we can, but we have been struggling too.

All that does not have to be the case; with the right investment and planning, rural healthcare can thrive. We need fairer funding that properly reflects rural need, stronger incentives to recruit and retain healthcare professionals in rural areas, and a renewed commitment to community-based services. Digital healthcare has a role to play, but it must complement, rather than replace, face-to-face provision.

16:48

[Charlotte Cane (Ely and East Cambridgeshire) (LD)]

It is a pleasure to serve under your chairship, Dr Huq. I congratulate the hon. Member for Mid Bedfordshire (Blake Stephenson) on securing this important debate.

The delivery of quality rural healthcare has been neglected for too long. After years of chronic underfunding, and a pandemic from which many areas have not fully recovered, health outcomes in rural areas are on a dangerous downturn. In my own constituency, local populations are growing fast, while GPs and hospitals struggle under the strain. Dental provision in Cambridgeshire is particularly poor, with more than 2,300 people for every single dentist providing NHS services.

The picture is particularly bad among children; recent data showed that at least 45% of children have not seen a dentist in the past two years. That is simply not good enough. We know how important it is for children in particular to see a dentist: good oral hygiene has a strong link to heart health, as infections and inflammation can increase the risk of cardiovascular diseases. It is vital that all children have ready access to a dentist to prevent such debilitating conditions and to introduce important hygiene practices.

Delivering rural healthcare is not simply about hiring GPs, dentists and other healthcare professionals; it is about delivering access, with reliable transport and connectivity infrastructure that is integrated with local healthcare. In rural areas like mine, many rely on cars for travel, but many older and vulnerable residents are left to manage with public transport, which is too often unreliable and does not always take them where they need to go. A constituent might be referred to a GP in a neighbouring village that is only a short distance away, but entirely inaccessible by foot and served by perhaps only a few buses a day, or in some cases no buses at all. The Government and local ICBs must start using such real-terms information when assessing access to healthcare, to avoid rural communities being left even further behind.

I am encouraged that new technologies allow at-home testing and monitoring, which can prevent the need for regular access to GPs and hospitals, but many of my constituents face connectivity barriers as a result of poor broadband and poor mobile reception. Does the Minister agree that the Government must bring forward a strategy to end the neglect of rural healthcare, with new services for left-behind areas and a comprehensive approach to rural connectivity?

16:51

[Lizzi Collinge (Morecambe and Lunesdale) (Lab)]

It is a pleasure to serve under your chairship, Dr Huq. I thank the hon. Member for Mid Bedfordshire (Blake Stephenson) for securing this important debate.

I represent a semi-urban, semi-coastal, semi-rural constituency, and I know that delivering healthcare across a wide and dispersed population brings very real and practical challenges. I want to speak briefly about three things: hospital trust funding, staff recruitment and transport.

Unfortunately, our funding formulas do not fully recognise the additional costs of providing services over a larger geographical area. Major cities can rely on one large hospital with everything in one place, covering a range of specialities. My local trust serves a similar population size, but it goes from the south of Lancaster all the way to Barrow, around the beautiful Morecambe bay. It is not safe or practical for one hospital to try to do the whole job, yet the funding arrangements do not fully recognise those costs and tend to treat them as inefficiency, rather than as an inherent part of delivering over that geography.

Although funding rightly takes into account deprivation, deprivation can look different in different areas of the country. In my constituency, we have a mix of wealthy and low-income households in the same larger geographical area, and that often determines the funding. Pockets of deprivation get diluted and sometimes miss out on vital funding pots or targeted interventions that would really help. At the same time, my population is older, with higher rates of dementia, which is caused not only by ageing, but by poor cardiovascular health and inequalities.

Hospitals in coastal and rural areas often have persistent issues with staff retention. Professional development opportunities are often focused on the big cities, so services such as major trauma, where people need to go to do their training, are more likely to be there.

For patients living in rural areas, the cost of and lack of access to transport place huge burdens on their time and finances. I do a lot of work with Lancaster Bus Users’ Group and Sedbergh and District Public Transport Users. We all know the challenges facing rural bus services. One of my constituents was waiting in A&E with her sick child, but they had to leave the hospital before they were seen, because they simply could not afford a nighttime taxi journey.

Progress has been made; I really welcome the 10-year health plan, particularly the shift from hospital community care, which will ensure people are seen closer to home. However, I urge the Minister to consider the points I have made today about recognising the true scale of the real and unavoidable costs of serving dispersed rural communities.

16:54

[Katie Lam (Weald of Kent) (Con)]

It is a pleasure to serve with you in the Chair, Dr Huq. I thank my hon. Friend the Member for Mid Bedfordshire (Blake Stephenson) for securing this debate on such an important topic.

Any Member who represents a rural constituency can attest to the practical challenges that our healthcare system faces in the countryside. It can often be difficult to sustain genuinely local GP services, and that forces people to travel long distances to access care. Where services do exist, they are often unable to provide the full suite of care owing to resource shortages or manpower deficiencies. Hospitals, of course, are even further away.

The current make-up of the workforce and workload cannot meet those challenges, so I was heartened by this Government’s plans, introduced earlier this year, to prioritise British medical graduates over foreign-trained doctors, though there is still much work to be done on ensuring that our medical training system rewards our most talented graduates.

I have also been heartened by some of the Health Secretary’s rhetoric on Pharmacy First, and the need to reduce the workload on doctors, so that the public can access basic services without contributing to the NHS waiting list. It is a superb initiative, and was launched by my right hon. Friend the Member for Louth and Horncastle (Victoria Atkins) under the previous Conservative Government. Clearly we need to move the healthcare service towards a model that reduces the workload on doctors, trains more of our workforce here and rewards our best-performing practitioners. That would be better for doctors and patients alike, and would be particularly welcomed in rural areas, where it is often much more practical to have a pharmacy in a village than a full GP surgery.

In principle, the Health Secretary’s public statements on this issue represent a step in the right direction, but since coming to power, this Government have conceded to medical unions such as the British Medical Association, which takes an altogether different line. For example, on Pharmacy First, a scheme that allows people to be treated for simple conditions at their local pharmacy, the BMA said that patients are

“being seen by less-skilled people to further enable the steady downgrade of patient expectations”.

It has since retracted those comments, but that the sentiment exists within the BMA at all is deeply troubling. On physician associates—a group of healthcare professionals who can carry out certain assessments and tests to reduce the workload of doctors—the BMA has launched legal action over whether they can even be called “medical professionals”. Fortunately, it lost the case, but again, its overwhelming hostility towards the reforms that our healthcare system needs in rural areas is concerning.

Enabling local health services such as pharmacies to provide care is particularly important in the countryside, where it will never be possible to sustain a large hospital in a rural area. I very much welcome the Government’s rhetorical direction on Pharmacy First and on reforming the NHS workforce, but will the Minister tell us what this Government intend to do to face down groups such as the BMA, which stand in the way of the reforms that we need to provide high-quality care to the British public?

[Several hon. Members rose—]

[Dr Rupa Huq (in the Chair)]

Order. Potentially the final three-minute speech will be Henry Tufnell, and then we might have to drop the time limit to two minutes.

16:57

[Henry Tufnell (Mid and South Pembrokeshire) (Lab)]

It is a pleasure to serve under your chairmanship, Dr Huq. I thank the hon. Member for Mid Bedfordshire (Blake Stephenson) for securing the debate. I am unique in this debate in the sense that I am a Welsh MP, and Wales faces unique challenges in respect of cross-border healthcare. Like many other hon. Members’ constituencies, Pembrokeshire is at a disadvantage because of its rurality. We have a fantastically beautiful coastline and beautiful countryside, but we are disadvantaged in terms of accessing these essential services.

I have conducted a constituency-wide survey, in which 85% of respondents said they found it difficult to secure a GP appointment, and 88% did not have access to NHS dentistry. Time and again, the problem is the distance to essential treatment. They are being required regularly to travel out of county. The recent downgrading of our local hospital in Pembrokeshire by the Hywel Dda University Health Board was a catastrophe for local residents, who are forced to travel further and further afield.

When residents are forced to travel across the border, there are often difficulties in transferring medical records, with real-world implications for my constituents. One constituent, who has been diagnosed with cancer, faces the choice of travelling to Bath or paying thousands of pounds to get treatment privately closer to home. The therapy they need is widely available in England but is not offered anywhere in Wales. Similarly, one constituent was referred to a hospital several hours away, in Bath, for specialist treatment for an autoimmune condition, requiring that individual, who is in their 80s or 90s, to undertake extensive travel and round trips.

I could go on with the examples, but suffice it to say that, while the record settlement that has been put forward by the UK Labour Government to our colleagues in Cardiff Bay is incredibly welcome and much needed, it does not get at the root of the problem of delivering healthcare right across the board. My constituents continue to live with poor access to healthcare.

I therefore ask the Minister to commit to exploring how to ensure better communications and transfer of patient records between practices in England and Wales. Does he agree that the UK Government must work with the Welsh Government to ensure that rural communities, such as mine in Pembrokeshire, do not continue to suffer the consequences of a postcode lottery for healthcare?

[Several hon. Members rose—]

[Dr Rupa Huq (in the Chair)]

We have done the maths; we can allow Members two minutes and 30 seconds.

16:59

[Dr Roz Savage (South Cotswolds) (LD)]

It is a pleasure to serve under your chairship, Dr Huq. I thank the hon. Member for Mid Bedfordshire (Blake Stephenson) for introducing the debate and doing such a great job of painting a picture of the bigger systemic issues—as I do not have very long, I will not repeat those, but will focus instead on two specific issues that I face in my constituency. It is only fair to let the Minister know that I will ask him for a meeting at the end of the debate, because I feel I have just about exhausted all other possible avenues.

Those two examples of the system failing rural constituencies affect Cirencester community hospital and the Tolsey GP surgery in Sherston. Cirencester hospital offers vital community services to a wide rural catchment, but over recent years the hospital has seen a gradual reduction in services. It lost its minor injuries unit in 2016; blood services were removed in 2020, and the day surgical unit is now undergoing a trial closure—I am very concerned that these trial closures have a nasty habit of becoming permanent. Residents are very concerned because they have seen that pattern before.

I do not quite understand how that fits with the NHS 10-year plan, which emphasises care closer to home, when patients will potentially now have to travel considerable distances. By definition, people who need hospitals tend to be elderly, sick or parents of small children, and I do not need to repeat yet again how poor our rural public transport is. There is a great deal of public passion about this. Our petition has gathered getting on for 2,000 signatures in just a matter of days. As new housing developments arrive, the increased population of Cirencester will only increase the demand for services at that hospital.

The second example is Sherston surgery. A developer has offered to build a lovely new custom-built facility to replace the existing one, the lease for which expires at the end of the year. I have lost count of how many meetings I have had with the ICB, which has acknowledged that its toolkit is not well suited to rural areas, yet it still has not agreed to that offer. I am out of time, but I look forward to meeting the Minister in due course.

17:02

[Amanda Hack (North West Leicestershire) (Lab)]

It is a pleasure to serve under your chairship, Dr Huq. I thank the hon. Member for Mid Bedfordshire (Blake Stephenson) for giving us the opportunity to talk about how living in a rural area can impact our access to healthcare.

As time is short, I will focus on two things. When I became an MP, one of the first things I was contacted about was the experience of getting a service on a Sunday. A resident of Ashby was given an appointment at an out-of-hours service in Leicester city. The taxi just one way cost about 40 quid. That is just one example of how the rural penalty is creating real problems in healthcare.

I am glad to see the Minister in his place, because I want to focus specifically on pharmacy and that is his area of responsibility. I have met many of my local pharmacists over the time that I have been a Member of Parliament. Our community pharmacies are often our lifelines, yet access to them is not equal, and certainly not simple, for many of my constituents.

North West Leicestershire is not just a semi-rural constituency, but a proud post-industrial one with a strong coalmining past. However, that means that we have our own unique health issues, particularly respiratory ones. For example, 8% of my constituents are living with asthma—higher than the average for the east midlands and the whole of England. Many residents rely on regular inhalers, medication reviews and preventive advice delivered via their local pharmacy, which is a vital service.

If the local pharmacy is facing a shortage, or a rural pharmacy does not open as frequently, that can have detrimental impacts. In a city, people can pop along the road to the next nearest pharmacy. Castle Donington, which has the highest rate of asthma in my constituency, has just one pharmacy. It does an amazing job for my constituents, but the next nearest pharmacy is more than 5 miles away. With 62% of our bus services cut under the previous Government, it is not easy to just hop on the bus to the nearest town. The isolation of our pharmacies has a detrimental impact in a rural area, because there is simply nowhere else to go.

When patients cannot access their medicines promptly, their conditions can worsen. They will turn to a GP for urgent appointments or to their nearest A&E. Pharmacy provision can provide us with an invaluable capacity for our entire healthcare system, the rural services of which have been hit the hardest.

17:04

[Rachel Gilmour (Tiverton and Minehead) (LD)]

It is a pleasure to serve under your chairmanship, Dr Huq. I thank the hon. Member for Mid Bedfordshire (Blake Stephenson), my colleague on the Public Accounts Committee, for securing this debate. Many hon. Members have today outlined problems in their constituencies that, I am afraid, are all too familiar in mine. I represent a disproportionately elderly population, which brings with it great wisdom as well as greater health challenges, particularly given that parts of my constituency are some of the least densely populated in England.

Shabby transport connectivity hobbles every aspect of my constituents’ lives. Perhaps no more acutely is this reality felt than in access—or the lack of access—to healthcare. For people in the West Somerset corner of my constituency, it can take two hours and two buses to reach Musgrove Park hospital in Taunton. I am told that a return fare would cost my constituents an eye-watering £180 in a taxi, which is simply unaffordable to most local people. These barriers delay diagnoses and treatment.

I am thankful to the Minister for Care for being a responsive member of his Government, but I cannot hide my disappointment at the decision to snub Minehead’s calls for a permanent CT scanner installation. The decision was supposedly reached because such a move was deemed uneconomical. It proved to be a game changer for so many local people, but it is indeed uneconomical because terrible transport links suppress demand.

To conclude, remoteness has not been given the weighting it should in the Government’s local government funding settlement. I implore the Government—and I hope the Minister takes this away—to undertake a real, forensic look at just how important rurality and remoteness is as a factor for the cost of healthcare delivery in rural areas.

17:07

[Jim Shannon (Strangford) (DUP)]

It is a real pleasure to serve under your chairship, Dr Huq. I want to give a special thank you to the hon. Member for Mid Bedfordshire (Blake Stephenson) for securing today’s debate on this matter. It is important that I am here, as a representative of a vastly rural constituency, to highlight the situation faced by my constituents.

I have been fortunate to live in the country all my life; I have now lived on a farm for some 47 years, just outside a small village in my constituency of Strangford on the Ards peninsula. Healthcare is a nationwide issue that impacts every individual, and we want to get it right. Rural populations often live far from hospitals or specialist clinics, making timely care more difficult. The limited public transport and long travel distances can cause delays, especially in emergencies, for the likes of ambulances and so on.

Around one in 10 patients live more than 5 miles from a practice, showing the extensive travel required for a 10-minute GP appointment, in which only one issue can ever be addressed. There are those in my constituency who find it almost impossible to get appointments, and GPs now state that they can take appointments only in the case of emergencies, when we all know that is the purpose of A&Es. GPs are for general issues that may impact someone’s day-to-day life, and there are not enough of them to go round. Everybody has mentioned development, and there is massive development on the Ards peninsula. Every village has grown, and demand is greater than ever it was before.

I shall quickly mention dentists in Northern Ireland. Some 114 dentists in Northern Ireland have handed back their NHS contracts to the Department of Health and Social Care, with many moving to private practice. Those patients then move on to a £25 a month retainer. As a result of these contract returns, more than 53,000 NHS patients were removed from dental practice lists over that period. For a rural constituency, that means there is no choice but to pay in the private sector.

There are continuing issues regarding GP provision and dental care across Northern Ireland, especially in my constituency. The issue is heightened in rural areas, and I will continue to raise these issues for those who have trouble. I understand that health is devolved, but the issue across the board remains the same. I hope we can strive to do better for my constituents and all our constituents, as well as for rural constituencies in general. Location should never dictate the provision of healthcare, be it someone’s GP or dentist, both of which every citizen of this nation has a right to.

17:09

[Richard Foord (Honiton and Sidmouth) (LD)]

It is a pleasure to serve with you in the Chair, Dr Huq. I am grateful to the hon. Member for Mid Bedfordshire (Blake Stephenson) for securing this debate and for talking about the one-size-fits-all solution, which I completely recognise. He is right to say that neighbourhood health hubs need to apply to proper neighbourhoods—things that we would identify with. In rural areas we would identify with towns of 10,000, not 50,000.

There are unique challenges associated with rural healthcare, and all too often it feels like those challenges are invisible from Westminster and Whitehall. Rural and coastal areas are not the same as urban areas. Last month, the Government said that tackling the gap between urban and rural healthcare would be a core focus of their 10-year health plan. That was very welcome, but after years of neglect by the Conservatives, it feels like rural communities, including those in Devon, are increasingly cut off from GPs, ambulances and cancer treatment, and the decline continues.

The south-west already has the fewest GP practices of any region. It also experienced the largest percentage fall in the number of GP practices—2% of practices in the south-west closed between 2024 and 2025. The data for rural healthcare compares poorly with urban areas. Liberal Democrat research found that waiting times for life-threatening ambulance calls are 45% longer in rural areas. Waits of four weeks or more for cancer diagnoses are three times longer in rural areas.

My hon. Friend the Member for Ely and East Cambridgeshire (Charlotte Cane) talked about accessibility in rural areas, and she is quite right to do so. Just getting to the GP takes longer—a third longer by car and twice as long by public transport. That disparity is set to rise if we continue to see bus routes curtailed and rail infrastructure left to crumble.

Honiton and Sidmouth, which I represent, sits in the bottom quarter of constituencies in the country for access to healthcare by public transport, walking or cycling. For those outside the main towns, the situation is worse. The village of Stockland, for example, is in the bottom 0.2% nationally for transport access to healthcare. The hon. Member for Strangford (Jim Shannon) talked about accessibility issues in transport. He is quite right, but that is only part of the challenge.

Rural areas also have older populations, which places a greater strain on already stretched services. My hon. Friend the Member for Tiverton and Minehead (Rachel Gilmour) was spot on about how older populations place so much greater a strain on health services in rural areas. Poor digital connectivity means that the shift to online healthcare and digital access often excludes older residents, many of whom have no desire to acquaint themselves with digital devices. They also suffer from isolation and loneliness, shaped by distance and limited local services.

One example that I think illustrates this issue well is dementia in rural areas. In Honiton and Sidmouth 1.6% of patients have been diagnosed with dementia, whereas the national average is just half that—0.8% across England as a whole. My constituent Heather Penwarden is the chair of Dementia Friendly Honiton. She says that dementia care in Devon

“seems at an all-time low”.

She should know that, because she has been volunteering in this space for 16 years. One carer, through tears, asked Heather:

“How bad does it have to be before I get some genuinely helpful and sustained support in looking after my dear husband through his dementia?”

Heather’s group initially worked alongside community psychiatric nurses from the Devon partnership NHS trust. Dementia Friendly Honiton raised an incredible £350,000 to pay for an Admiral nurse through an embedded scheme. That nurse attended memory cafés, gave regular advice and prevented crises for those with complex cases, but due to a freeze on NHS recruitment and an apparently “outdated” model of fundraising and hosting, there is little chance of the role being filled again by the Royal Devon University hospital.

The Liberal Democrats are calling for a rescue plan: recruiting more GPs and social care workers to provide proactive community support and ease pressure on ambulances, acute hospitals and A&E; creating a national care agency to provide consistent funding for free personal care; and creating a small surgeries fund to protect rural and remote services from underfunding. If we are serious about closing the disparity between urban and rural, we must recognise that rural communities have different health needs.

17:14

[Gregory Stafford (Farnham and Bordon) (Con)]

It is a pleasure to serve under your chairmanship, Dr Huq. I am extraordinarily grateful to my hon. Friend the Member for Mid Bedfordshire (Blake Stephenson), who has campaigned tirelessly for a GP surgery in Wixams in his constituency. I was delighted to hear that his campaigning is beginning to bear fruit, and I wish him well with that.

The challenge that my hon. Friend mentioned resonates strongly in my own constituency. There has been significant housing growth in areas such as Bordon, yet the supporting infrastructure, particularly primary care, has simply not kept pace. Residents move into new homes only to discover that securing a GP appointment is harder than it should be.

Hon. Members across the House have made a consistent and compelling case this afternoon. Rapid housing growth places a real strain on local practices, and patients then struggle to access timely appointments. Infrastructure funding is too often misaligned with development, and co-ordination between local authorities, NHS bodies and developers remains insufficient. Healthcare must arrive with the new homes, not years afterwards.

The Government’s 10-year plan puts having care closer to home at the centre of NHS reform. That ambition is entirely welcome, but as hon. Members have raised, the national neighbourhood health implementation programme begins with pilots in 43 areas, and each designated neighbourhood must serve a population of around 50,000 people. That population threshold presents a fundamental challenge for rural and semi-rural areas, where individual villages and market towns fall well below that figure. Although larger geographical regions might technically meet the requirement, genuinely rural communities cannot qualify as stand-alone neighbourhoods and are therefore excluded from the first phase—and potentially always.

If the 50,000 population threshold is rigidly applied, smaller communities will only ever be served indirectly, folded into large neighbourhoods covering multiple dispersed settlements. That risks diluting the focus on their particular needs, and residents might continue to face long travel times, limited access to primary care and fewer co-ordinated services, as hon. Members have described. That is especially concerning given the demographic trends.

Healthwatch England highlighted in 2023 that the NHS long-term workforce plan projects a 55% increase in the number of people aged over 85 living in rural areas by 2037. Demand is rising most sharply in precisely those areas excluded from the pilot phase. In areas like mine, where hospital access already involves significant travel, the case for strong, well-resourced local primary and community care is self-evident. Excluding rural and semi-rural constituencies from the first wave risks entrenching disparities rather than reducing them.

I also have concerns about cuts and mergers in ICBs. The institutional knowledge and expertise built over many years risk being disrupted during the transition. For example, the Frimley integrated care board, which serves the northern part of my constituency, is being abolished, so the local leadership and co-ordination that previously existed will be lost and responsibilities will be redistributed. Change on such a scale requires clarity of governance, funding and accountability. Without it, delivery will vary and confidence will suffer.

Access to primary care, pharmacy and dentistry remains central to this debate, particularly in rural and underserved communities. Since 2024, more than 200 pharmacies have closed in England. In the first three months of 2025 alone, 31 medium-sized and 24 large pharmacy branches closed. For villages and small towns, the local pharmacy is not a luxury; it is a frontline health service Although schemes such as the pharmacy access scheme and Pharmacy First are supported and welcome, there are significant problems with their roll-out, as highlighted by my hon. Friend the Member for Weald of Kent (Katie Lam), with unions like the BMA trying to undermine that very significant investment.

I have a number of questions for the Minister. For rural and semi-rural constituencies such as mine, the details of the policy matter enormously. First, will the 50,000 population threshold be applied flexibly in rural and semi-rural areas? If so, how will smaller communities be guaranteed equal access to neighbourhood services? Secondly, what is the timetable for expanding the scheme beyond the initial 43 pilot areas? When can constituencies such as mine and that of my hon. Friend the Member for Mid Bedfordshire expect to be included?

Thirdly, how will the continuity of neighbourhood health delivery be safeguarded during the merger and abolition of ICBs, and who will ultimately be held accountable for that if implementation falters? Finally, will the Minister publish clear and measurable criteria for success, particularly in relation to rural access, travel times and coverage of elderly populations so that the House can judge whether care closer to home is being delivered in practice and is not merely a promise?

17:19

[The Minister for Care (Stephen Kinnock)]

It is a pleasure to serve under your chairship, Dr Huq. I congratulate the hon. Member for Mid Bedfordshire (Blake Stephenson) on securing this vital debate. I am also grateful to other hon. Members for making excellent contributions this afternoon.

We know that the NHS faces pressures all over the country, with rural communities experiencing unique health and wellbeing challenges shaped by geography, demography, infrastructure and access to services. Our 10-year health plan is a commitment to rewire our NHS, with the three shifts to improve access to healthcare for everyone—no matter where you live or how much you earn. Those three shifts—from hospital to community, sickness to prevention and analogue to digital—will support neighbourhood and community health services in getting the investment they need, and will greatly expand and improve access to digital services, bringing healthcare closer to everyone’s home.

The hon. Member focused quite a lot of his speech on our emerging neighbourhood health strategy. I will provide some further detail in response to some of his points. He highlighted the important differences between urban and rural. We recognise that neighbourhood services will need to look different across rural and urban areas to best meet the needs of each community. That is why their delivery will be locally led, with local systems determining how neighbourhood health is designed for their area. That work will start in the areas of greatest need, including rural towns and villages.

The hon. Member and others also asked about the definition of neighbourhoods in rural areas. First, neighbourhoods are natural communities that are recognisable by local residents. Secondly, neighbourhoods will typically have a population of around 50,000 people, but coherent geography is more important for defining neighbourhoods than population size. Thirdly, the geography of the neighbourhood will be determined locally by integrated care boards in partnership with their strategic partners, particularly local authorities.

The hon. Member also asked how rural areas will benefit from neighbourhood health. Neighbourhood health provides the unifying framework that will bring together what is already under way across primary care, community services, urgent care, prevention, digital, estates and population health more broadly. The neighbourhood health service will make it easier for people to access care closer to where they live, including in neighbourhood health centres. Delivery will be locally led, with systems determining how neighbourhood health is designed to meet local population need. That will factor in how services may need to look different across rural and urban areas.

The neighbourhood health service will also move us towards a fully digitally enabled health service. We are striving for digital services to improve access, experiences and outcomes for the widest range of people based on their preferences, as any digital healthcare benefit will be limited if people remain digitally excluded. We are working closely with the Department for Science, Innovation and Technology on the issues raised around improving access to broadband.

To deliver neighbourhood health services, the 10-year health plan introduces two new contracts, including one to create multi-neighbourhood providers covering populations of around 250,000 people. That will unlock the advantages and efficiencies possible from greater-scale working across all GP practices and small neighbourhood providers within the footprint. We will start in the areas of greatest need where healthy life expectancy is lowest, which includes rural towns. By targeting places where healthy life expectancy is lowest, we will deliver healthcare closer to home for those who need it most. Neighbourhood health plans will also be drawn up by local government, the NHS and its partners. The integrated care board will bring those together into a population health improvement plan for its footprint and will use that to inform commissioning decisions.

The medium-term planning framework, covering 2026-27 to 2028-29, sets out proposals for the further use of advice and guidance, asking systems to ensure all referrals go through a single point of access. That delivers a robust approach to triage so that patients are cared for closer to home, and there are fewer out-patient appointments in secondary care. That framework will also require a significant reduction in the number of clinically unnecessary follow-ups.

Turning to general practice, which came up a lot in the debate, we absolutely recognise the challenges facing rural communities in accessing GP services. We are expanding capacity across England, including to the areas that need it most. We are investing over £480 million extra into GP services this year, including investment in the primary care workforce, ensuring places like Mid Bedfordshire get the resources and GPs that they need.

Since October 2024, we have invested £160 million into the additional roles reimbursement scheme, which has supported the recruitment of over 2,000 GPs—smashing our manifesto pledge of 1,000 additional GPs. Furthermore, the introduction of a practice-level GP reimbursement scheme, worth £292 million, will enable practices to hire additional GPs or fund extra sessions with existing GPs. We are also seeing the results of those broad efforts. I am absolutely delighted that patient satisfaction has risen by over 15% since July 2024, from 60% to 75%, and an additional 6.8 million GP appointments have been delivered compared with the same period last year.

We know that patients are struggling to access NHS dentistry services, particularly in rural areas. To address that, we are reforming the dental contract to match resources to need and to improve access. As a first step, our 2026 reforms are focused on improving the dental contract to deliver the right care to the right people, including those in rural areas, while incentivising NHS dentists to provide more NHS care, with additional urgent appointments and new pathways for patients with complex needs. We are also continuing to recruit dentists under the golden hello scheme, which offers dentists £20,000 to work in underserved areas.

Urgent and emergency care is also a challenge for rural areas. We are ensuring that the country gets the care it needs, when it needs it. We launched our urgent and emergency care plan for 2025-26, supported by a substantial £450 million of capital investment. That will enable the upgrade of hundreds of ambulances and the expansion of urgent and emergency care capacity, reducing A&E wait times and getting more ambulances back on the road, more quickly.

Rural adult social care services are really important. Local authorities are responsible for shaping their care markets to meet the diverse needs of local people. However, the Government are also committed to ensuring adult social care funding reflects the costs that different communities face, which is why we have updated the formula used to distribute funding for adult social care to local authorities to include a remoteness adjustment. That means that the funding distribution better reflects the cost of providing care in different parts of the country. To give the local picture in the constituency of the hon. Member for Mid Bedfordshire, between 2025-26 and 2028-29, central Bedfordshire is set to see its notional allocation for adult social care services increase by £11.3 million, which is more than a 7% cash increase above budgeted adult social care spend.

I want to say a quick word on finance. To support remote or sparsely populated areas, the ICB target allocations formula includes an emergency ambulance cost adjustment to reflect longer travel times in sparsely populated areas; a travel time adjustment to the community services formula to reflect the additional time it takes patients to travel between appointments in sparsely populated areas; and an adjustment to support hospitals with 24-hour A&E services that are remote from the wider hospital network and have unavoidably higher costs. Those adjustments help to support rural communities in accessing the health services that they need.

I hope that I have managed to touch on some of the issues raised. It is a wide-ranging topic because rural healthcare, by definition, requires many different services. We absolutely recognise the challenges, and we recognise that we still have a mountain to climb before we can get our NHS back on its feet and fit for the future.

We believe that through the three shifts—from hospital to community, treatment to prevention and analogue to digital—and the strategies that we are pushing through on workforce, digital, better support for general practice, and neighbourhood health, we can get our NHS back on its feet and fit for the future. Once again, I thank all hon. Members present and I congratulate the hon. Member for Mid Bedfordshire on securing this debate.

[Dr Rupa Huq (in the Chair)]

I call Blake Stephenson to wind up in 20 seconds.

17:29

[Blake Stephenson]

I shall speed through, Dr Huq. I thank the Minister for summing up and covering an awful lot of ground—I am certainly grateful for that. He gave a lot of additional information, so I am sure he will forgive me if I go back to Hansard to look through it and follow up with a letter if anything is unclear. It has been a wide-ranging debate and there was a lot to cover. I thank all hon. Members for standing up for their communities, putting rural communities on the Government’s agenda and making sure that they get the healthcare services they deserve.

17:30

Motion lapsed, and sitting adjourned without Question put (Standing Order No. 10(14)).