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Space has a crucial role to play in our national resilience. Responsibility for it cuts across Government Departments. With that in mind, and given the Cabinet Office’s role in cross-Government co-ordination, can the Minister confirm when the National Space Council will next convene?
T2. Indeed—I am back by popular demand.Will the Minister set out what steps the Cabinet Office is taking to ensure that public appointments are made on merit alone and not based on political patronage or ideological principles?
This brutal conflict has resulted in more than 14 million people being displaced. Around 5 million of those have been displaced over the border, but 9 million are displaced in Sudan itself. Will the Minister set out what practical steps the Government are taking to support those who are displaced internally?
It is a privilege to respond to the debate on behalf of His Majesty’s loyal Opposition. I pay tribute to the hon. Member for North East Fife (Wendy Chamberlain) for securing the debate and for setting out the landscape facing those with PANS/PANDAS in the UK, as well as recognising the lack of knowledge about the conditions and the challenge that presents. I thank her for her sustained work through the APPG on the issue. Many right hon. and hon. Members have contributed to the debate. The hon. Member for Carlisle (Ms Minns) spoke movingly about Joanne and Jake, who have been living with PANS/PANDAS for the past six years, and the challenges of not getting the treatment or the funding that they need. The hon. Member for Henley and Thame (Freddie van Mierlo) made a good point about how those affected do not want sympathy but action. He talked about the excellent campaigning by Albie, who is in the Gallery today, following his brother’s diagnosis—I suspect Albie’s handwriting is somewhat better than my doctor’s scrawl and I commend him on his campaigning. The hon. Member for Harlow (Chris Vince), who is always keen to speak up and champion issues on behalf of his constituents, spoke about the importance of guidance. My right hon. Friend the Member for New Forest East (Sir Julian Lewis) talked about the importance of the early use of antibiotics. Above all, I want to speak directly to the families and children who are following the debate and who live with PANS/PANDAS every day, some of whom are with us in the Gallery today. For them, this is not an abstract discussion about guidance, systems or clinical pathways; it is about the child they love, the moment something changed and the exhaustion of trying to explain that change to people who may never have heard of the condition before. It is about parents who overnight become advocates, researchers, case managers and campaigners, while simultaneously trying to hold their families together, and about the children and young people whose lives can be altered suddenly and terrifyingly. As we have heard, PANS/PANDAS sit at the intersection of neurology, psychiatry, immunology and infectious diseases. That matters because they do not fit neatly into one service, specialty, clinic or budget line. For the children affected, symptoms can be sudden and severe. They include obsessive-compulsive behaviours, restricted eating, tics, anxiety, behavioural change, sleep disturbance, regression, movement difficulties, school refusal and distress that can overwhelm the entire family. For some families, the story is stark. A child who was settled and sociable becomes frightened, withdrawn and unable to eat. A child who was thriving at school begins to struggle. Families find themselves moving from GPs to child and adolescent mental health services, from paediatrics to emergency departments, and from school meetings to safeguarding conversations, often without a clear pathway or a clinician who is able to say, “Do you know what? I recognise this, and this is what we need to do next.” The first task before us is to diagnose the problem honestly. The problem is not that every scientific question has been answered, because clearly it has not. There is uncertainty and professional disagreement, and there is a need for stronger evidence, better data and more research into diagnosis, treatment and long-term outcomes. However, uncertainty has too often translated into inconsistency. It has meant too many families left without a clear answer, too many clinicians left without guidance, too many schools unsure of how to respond and too many children caught between services. Each see part of the picture, but they do not see the child as a whole. At present, there is no official NHS clinical guidance for the diagnosis and treatment of PANS/PANDAS. NICE has previously concluded that the evidence was insufficient to provide useful guidance. The Government have said that data on the number of children affected is not currently collected, because internationally the criteria cannot be agreed. Local integrated care systems are expected to plan services, but they are asked to do so without consistent national direction, which risks variation. As we have heard, in reality variation leads to a postcode lottery. It means that one family may find an informed GP, paediatrician or neurologist, while another family is left scrambling for help. It means that one school may understand the sudden onset and fluctuating need, while another school sees only challenging behaviour. It means that one parent may feel believed, while another parent feels blamed. That is the difficulty at the heart of this debate. PANS/PANDAS cut across the way our systems are organised. The NHS is still too often structured around separate silos, whether it is mental health, neurology, infectious disease, immunology or paediatrics, but children living with these conditions do not arrive in neat administrative categories; their needs are complex, sudden and overlapping. That makes it hard for families to know where to turn, as well as for clinicians who want to help but may not have had the training to do so, and for schools that see a child’s behaviour change dramatically without understanding what is driving it. We must also be candid about the emotional difficulty. Parents can feel dismissed. They can feel treated as difficult or seen as overanxious when they are simply trying to explain what has happened to their child. No child should be left waiting for help because the system is unsure about where they fit. The previous Government did not solve this issue, but foundations were laid through the UK rare diseases framework, annual action plans and engagement with research, including with the APPG and the working group. The current Government have welcomed clinical guidance being developed by PANS PANDAS UK and have said that NICE will consider national guidance as evidence improves. They have also pointed to NIHR research and extended the rare diseases framework into 2027. Where the Government do the right thing, we should welcome it, but the question is whether those actions are sufficient. Do they need to go faster? Are they reaching the families on the ground? Families do not experience this as a framework, action plan or written answer; they experience it as the moment when a child refuses food, compulsions appear, school attendance collapses or a parent is told that a professional has never heard of the condition. If the problem is complexity, inconsistency and a lack of recognition, the solution must be equal in its seriousness. The foundations have been set, and now we must all go further. We need action on guidance. The clinical guidance being developed by PANS PANDAS UK and the PANS guideline development group brings together expertise from general practice, paediatrics, neurology, immunology, infectious diseases, psychiatry, psychology and nursing. I would be grateful if the Minister could set out how the Government will engage with that guidance once it is published. Will she commit to a clear process for assessing emerging evidence? We also need to take action on professional awareness. I recall reading about these conditions in Kumar & Clark when I was a medical student, but I do not recall receiving any formal training on them. It is not enough to ask our clinicians to be responsible for keeping their knowledge up to date; atypical, complex and contested conditions require practical support. As such, I ask the Minister to consider an awareness package for frontline professionals, developed in conjunction with clinicians, families and experts. We also need action on data and research—we need better data, diagnostic clarity, and research into treatment and long-term outcomes. With that in mind, I would appreciate the Minister setting out how the Government intend to support that work and encourage greater patient involvement. There is also a need for greater consistency across local systems. If support is left entirely to local discretion, care will depend on where a family lives or how hard they are able to fight for it. Clearer information on how suspected cases can be supported across specialties should be available to ICBs, and schools also have to be part of the answer. For many families, school is where the change is first noticed; better awareness of sudden onset and fluctuating symptoms could help ensure sensible attendance policies and flexible, rapid and responsive classroom adjustments. This debate should not be one that divides the House, but one that unites it. There will be different views on the evidence, on treatment and on guidance, but there should be no difference between us on the need for children to be seen, for families to be heard, for clinicians to be supported, and for care to be based on evidence, rather than the accident of geography. For families living with PANS/PANDAS, progress will be measured by whether the next family gets an earlier answer, whether the next child is believed sooner, whether the next GP has somewhere to turn, and whether the next school understands. That is a fair and compassionate standard, and it is the one that the Government should now meet.
It is a pleasure to be here in an air-conditioned room while we continue this debate. It is poignant that it is so hot today, because we know how that can impact people with respiratory illnesses; we are probably talking about this issue at a very useful time. I too thank the hon. Member for Wokingham (Clive Jones) for securing this important debate. As has been said, lung cancer remains a leading cause of cancer death in the UK, but it is also one of the cancers where early detection can make the biggest difference. I know that at first hand from my first year as a junior doctor working on a respiratory ward. It was eye-opening and harrowing, but also sometimes successful. I urge anyone who has the chance to visit a respiratory ward to see how important it is—and I believe that would make a difference to smoking rates. It is great that the hon. Member for Wokingham secured the debate, and great to see the hon. Member for Strangford (Jim Shannon) secured the debate, because it is a good debate—it is a good day. This is really a success story. The Liberal Democrat spokesperson, the hon. Member for Didcot and Wantage (Olly Glover), rightly told us John’s story; because of the screening that has been put in place, there will be plenty more Johns in the future, which is exactly what we want to hear. Often we talk about the problems, but this is a really good example of something positive that has come forward, and it all started under the previous Conservative Government. The roll-out of community diagnostic centres has fundamentally changed how we diagnose disease. There are now more than 170 centres across England, expanding capacity and bringing scans closer to where people live. Nationally, they have delivered millions upon millions of additional tests and have helped to ease pressure on acute services, with the clear aim of diagnosing conditions such as cancer faster and improving patient outcomes. Only this month I went to the first year anniversary of the opening of the CDC in Hinckley, a £24 million investment that has seen 59,000 patients through its door and is expanding. That means patients do not have to travel as far into Leicester or Nuneaton, and that they get their diagnoses more quickly and in a modern tech building. That is absolutely fantastic for my community, but I know that is replicated 170 times across the country. That matters because, when it comes to diseases like lung cancer, early diagnosis is everything. The sooner we can identify a problem, the sooner we can act, and crucially, the better the chances of survival. There is a real success story to talk about. The NHS lung cancer screening programme has its roots in work started by the Conservative Government, building on more than a decade of UK research and pilot studies. Following successful trials and local pilots, NHS England launched the targeted lung health check programme in 2019, focusing on high-risk groups in areas with the worst outcomes. That approach, using mobile scanners and proactive interventions, proved effective in detecting cancer earlier and reaching underserved communities. On the back of that success, and with a formal recommendation from the UK National Screening Committee in 2022, the Government announced a national roll-out in June 2023, committing to expand the screening across England and ultimately to reach full coverage by 2030. Since then, the programme has transitioned from pilots to a full national screening service and now forms a central part of efforts to improve cancer survival. I am pleased to see that the Government are continuing on that trajectory. Why does this matter? The NHS lung cancer screening programme is now delivering at scale and showing clear results. About 2.8 million people have been invited, with 1.5 million checks completed and close to 1 million scans carried out. Some 6,000 to 7,000 cancers have been detected, roughly three quarters of which have been identified at stage 1 or 2, the earlier stages, in comparison with fewer than 30% before the programme started. About 1.4% of the scans lead to a diagnosis, demonstrating a targeted and efficient approach, and uptake stands at about 60%. In short, the programme is not only reaching those most at risk, but consistently shifting diagnosis to an earlier, more treatable stage and saving lives at a national level. As I say, we welcome the proposed expansion of the lung cancer screening programme, but it is vital that steps be taken to improve the uptake of screening and lung health checks. The fact that uptake stands at 60% means that 40% of those invited are not coming forward, and they are often the ones at highest risk. The question is why. Can the Minister set out what specific interventions the Government will introduce to increase uptake, particularly among the most deprived and hard-to-reach groups? To that end, can he confirm how the Government plan to deliver targets set in the national cancer plan, including the allocation of resources and funding for the lung cancer screening programme, over the next few years? As my new Scottish Conservative colleague, my hon. Friend the Member for Aberdeen South (Douglas Lumsden), may rightly point out, progress on lung cancer screening is uneven. England is now rolling out a full national programme; Wales has committed to an implementation, with the first invitations expected from 2027; Scotland remains at a pilot stage, with a national roll-out likely to be years away; and Northern Ireland is still in the early planning phases, without a programme in place. Given that variation, will the Minister set out what discussions are taking place across all four nations? Most importantly, what lessons are been learned from the English experience that can be actively shared to support a faster and more consistent delivery and roll-out across the UK? More broadly, this issue speaks to the need for a coherent approach to respiratory disease. Under the last Conservative Government, there was a clear attempt to take a more joined-up approach to the country’s biggest killers through a major condition strategy, which was announced in 2023. It explicitly placed chronic respiratory diseases, alongside cancer and cardiovascular disease, as one of six national priorities, recognising both its scale—it affects millions—and its contribution to avoidable ill health. A detailed framework, setting out a shift towards prevention, early diagnosis and management of those conditions, was published later that year. However, although the direction of travel was established and widely consulted on, the strategy never reached full publication or implementation, because there was a general election. This Government have taken a different route, with modern service frameworks. They have committed to developing modern service frameworks for frailty, dementia, mental health and cardiovascular disease—just a few areas—so I ask the Minister directly: will the Government develop a modern service framework for respiratory disease? If not, how do they intend to drive the same level of improvement for a condition that affects millions and underpins outcomes in lung cancer? We are all serious about improving cancer survival. Across this House, we all have that ambition, but we must match our ambition with delivery. Just like the 10-year plan, the delivery chapter is missing. I worry that the same could be argued for respiratory conditions. I just hope that I am proved wrong.
I appreciate that this is not part of the Minister’s brief. The speed of the programme’s roll-out is fantastic, but there remains a concern that if 60% of people have taken it up, 40% have not done so, despite having had an offer that could have been given to someone else who wanted to go. Can the Department take that point away and work out what is being done to close that gap of more than a third? There is clearly a greater opportunity to get more people in and get them detected sooner.
I beg to move amendment 57, in clause 12, page 10, line 10, at end insert— “(4A) Before making regulations under subsection (1)(b) that would alter the range of services or facilities which the Secretary of State is required to commission nationally, the Secretary of State must— (a) prepare and publish a commissioning transition plan in accordance with subsection (4B), (b) consult in accordance with subsection (4C), and (c) lay the commissioning transition plan before Parliament. (4B) The commissioning transition plan must set out— (a) a description of each service or facility that the Secretary of State proposes to add to, or remove from, national commissioning responsibility under section 3B(1)(b), and the reasons for each proposed change; (b) a description of the body or bodies to which commissioning responsibility for each such service or facility would transfer and the basis on which that body is considered capable of commissioning that service or facility effectively; (c) an assessment of the impact of each proposed change on patients who rely on the affected services or facilities, including— (i) patients with rare diseases or conditions, (ii) patients whose needs cannot be met by a single integrated care board area, and (iii) patients who may face differential impacts on account of a protected characteristic within the meaning of the Equality Act 2010; (d) the transitional arrangements to be put in place to ensure continuity of service for patients during any transfer of commissioning responsibility; (e) the workforce and capacity implications for the bodies to which commissioning responsibility would transfer; (f) the financial arrangements for the transfer of commissioning responsibility, including the funding to be allocated to receiving bodies; and (g) the proposed timetable for implementation of each change. (4C) Consultation under this subsection must include— (a) integrated care boards that would assume commissioning responsibility under the proposed changes; (b) NHS trusts and NHS foundation trusts providing the services or facilities affected by the proposed changes; (c) patient groups and representative organisations for patients likely to be affected by the proposed changes; (d) clinicians with expertise in the services or facilities affected; and (e) such other persons as the Secretary of State considers appropriate. (4D) Consultation under subsection (4C) must— (a) run for a period of not less than twelve weeks, and (b) begin no earlier than the date on which the specialised commissioning transition plan is published under subsection (4A)(a). (4E) Following the consultation period, the Secretary of State must publish a response to the consultation that— (a) summarises the representations received, (b) sets out the Secretary of State's response to the key issues raised, and (c) describes any amendments made to the specialised commissioning transition plan in light of consultation responses. (4F) No regulations under section 3B(1)(b) that alter the range of nationally commissioned services or facilities may be made until at least 60 days have elapsed after the consultation response required by subsection (4E) has been published.” This amendment requires the Secretary of State to publish and consult on a commissioning transition plan before making any regulations under the new section 3B of the National Health Service Act 2006 (inserted by Clause 12) that would alter which services are commissioned nationally.
In essence, the clause confers the commissioning duties of NHS England on to the Secretary of State, because NHS England is being abolished. In that respect, it is quite straightforward. In the existing National Health Service Act 2006, which is to be amended, section 3 sets out the duties of integrated care boards as to commissioning health services, and section 3A similarly. Section 4 is about NHS England’s responsibility for the provision of high-security psychiatric services. In essence, clause 12 replaces the references to “NHS England” in sections 3 and 3A with “the Secretary of State”. The ICBs now must act consistently with the discharge by the Secretary of State of the section 1 duty to promote a comprehensive health service. That is consistent with the aims of the Bill. I have concerns, which I have expressed previously, about how the Government ensure that the Secretary of State can make those decisions fairly, on the basis of clinical need, rather than because of pressure from a lobby group, a celebrity campaign or such like, but again, that seems consistent. The clause also replaces entirely section 3B of the 2006 Act. Under the previous section 3B, the Secretary of State could direct NHS England to commission the service nationally; the proposed new section 3B confers a regulation-making power to require the Secretary of State to arrange nationally services for members of the armed forces and their families specifically, as well as such services or facilities as may be prescribed. Perhaps the Minister will comment on what sort of services or facilities might be prescribed under that proposed new section. In doing that, the Secretary of State must have regard to the number of people needing the service, the cost and the number of possible providers. That reflects a balance. Some services, such as hip replacements, are very common. They occur in all areas of the country, perhaps at different rates, but they are broadly a common service. Accident and emergency is another common service. Some people, however, have the misfortune to have a condition that is rare and requires specialist care, in small numbers. That needs to be commissioned on a more national basis, because of the need for specific expertise among commissioners and health professionals. In subsection (4), proposed new section 3B(5) modifies section 4 of the 2006 Act so that the duty to arrange high-security psychiatric services transfers from NHS England to the Secretary of State, and the Secretary of State gains a new power to direct the providers of those bodies—but only non-public bodies—if he is satisfied that the provider is already licensed under the Health and Social Care Act 2012 and would be required by its licence to obey the direction. In one respect, as I said, it is necessary to transfer powers to Secretary of State, now that NHS England is to be abolished, but I have a couple of questions. NHS England published a direct commissioning update on 2 March, which describes a new commissioning structure. At the moment, NHS England commissions regional NHS England bodies and the ICBs at a more local level. The update suggests that we will have the ICBs commissioning services, and the Secretary of State instead of NHS England, but that each of the seven regions will have an office for pan-ICB commissioning, known as an OPIC, to support ICB commissioning services—both standard commissioning and at-scale commissioning in some instances. How is that more efficient than the old structure? Are we just going to see the people working in the regions of NHS England get made redundant, at a huge cost to the state, only to be re-employed by the OPIC? What is the estimated cost of that? Is that the intention? We are going to either lose the expertise of the regional advisers in NHS England or end up re-employing them having paid them redundancy. Can the Minister explain which she thinks it is? There is a hugely long list of specialist nationally commissioned services. Can the Minister guarantee that those services will not be moved locally? The ICBs only have so much capacity. It will be a challenge for an ICB to deal with conditions that may affect only one or two people in its area in a given year, particularly given the 50% budget cut; obviously, it will prioritise things that affect more of its population. People who have the rare conditions that are currently commissioned nationally may be worried that they will not get the same level of service that they are getting at the moment. The direct commissioning update talks about prisoners and the justice system. At the moment, NHS England works directly with the Ministry of Justice to commission healthcare for those in the justice system. That includes adults in the custodial system, children in secure children’s homes, non-custodial care, sexual assault and abuse centres, and abuse referral centres. There are eight high-security category A prisons in England. Instead of being specially commissioned as one batch, they are going to be commissioned specially by their local ICBs. Where are the ICBs going to get the advice and expertise to do that? Dealing with category A prisoners is about not only managing the prisoner and providing them with healthcare, but keeping the people providing that healthcare safe while they are working. This is a specialist area. I am interested to understand why the Minister thinks it will be managed best locally. If, under her new system, it is to be managed locally and the prisoner’s home address ICB is different from the prison address ICB, where will the funding move from and to? Will the prison’s ICB be reimbursed by the prisoner’s home ICB or will it bear the brunt locally? What will happen to the sexual abuse referral centres? It is perfectly possible, particularly in some areas of the country, that an individual is sexually assaulted in one ICB area, lives in another and reports a crime in a third. Will local commissioning have an impact on where the individual needs to go for their pretty intimate examination and assessment? Has the Minister considered that? What is her view? What happens to healthcare for migrants? That is another area that is dealt with partly by the justice system at the moment. Can the Minister update us on that? There are over 100,000 people in asylum accommodation, including 30,000 in hotels, and many members of her party are keen to welcome even more. Who will be responsible for commissioning their care? The Government are also delegating the child health information services, which are the record of whether children have been vaccinated and such like. Given that they are planning to have a single patient record and the electronic red book, why do they want the services to be commissioned locally rather than nationally? Do they expect commissioning for a uniform service, such as a screening service, to lead to differential outcomes—and if it does not, what is the rationale for it? A particular example is blood spot screening. The Minister will be aware that there was a Westminster Hall debate earlier in the week on spinal muscular atrophy, in which blood spot screening was mentioned. Metachromatic leukodystrophy is another condition for which people want blood spot screening. If blood spot screening is to be commissioned on a local ICB level, will ICBs be required to do it in line with Government guidelines, or will they be able to vary the service they provide to those patients? By delegating more to ICBs, Ministers are creating variation. On one hand, they want local differentiation and variation; on the other hand, they have put in a clause that requires the Secretary of State to limit local variation. Again, there is a tension there. Will the Minister talk about that? Moving to some technical points, I noticed that “hospital premises” is defined in section 4 of the 2006 Act, but I cannot find it defined in the Bill. Under the original section 3B of that Act, the Secretary of State had to obtain appropriate advice before making regulations about commissioning services; when services were commissioned locally or nationally, the Secretary of State had to take expert advice. That seems like a sensible thing that we want the Secretary of State to do. One would hope that if the Secretary of State were doing his job properly, he would do that, but it seems a little odd that that requirement has been taken out, as though there is an intention for the Secretary of State not to do that. I would appreciate the Minister’s comments on that. Proposed new section 3B provides that a direction can be given to a person other than a public authority regarding high-security psychiatric services. The Minister knows that high-security psychiatric services are currently provided at Broadmoor, Ashworth and Rampton, which are still stand-alone units run by NHS providers. Does she plan to ask a private provider—someone other than a public authority—to run those facilities? If not, what is the purpose of the clause? There is a secure children’s unit in Sleaford in my constituency. What will happen to those children if it is commissioned locally, and where will the money flow from? We asked in a previous sitting whether the Minister thought that the new Prime Minister will want to continue with this Bill. When it comes to the OPICs, in essence the Government will be firing staff from one job, paying them redundancy, and rehiring them, potentially on different terms and conditions, to do a similar job in the OPICs. Is the Minister aware that the right hon. Member for Makerfield (Andy Burnham) used to speak out against firing and rehiring staff, and abolishing and recreating organisations? That is essentially what is happening, so will she have to abandon these changes?
I am afraid I do not know the answer to that question. The key point is that it is not logical to abolish a three-tier structure and recreate it with taxpayers’ money to do exactly the same thing. If NHS England is replaced by the Secretary of State, the regional NHS England is replaced by the OPICs and the ICBs are at the bottom—the more local tier—what has changed? The middle tier will be doing the same thing.
But we were not planning to abolish NHS England, so we had no reason to worry about redundancy. We were not planning a large-scale abolition—the largest that has ever happened in this country. Amendment 57 would require the Secretary of State to publish and consult on commissioning transition plans before making regulations under proposed new section 3B that alter which services are commissioned nationally. It is a very reasonable amendment that would just mean that people get answers. It would mean that vulnerable people with unusually rare or highly complex conditions requiring regional or even national treatment could understand any changes the Government planned to make. We know that some services are delivered in only three or four centres in the UK. If a patient lives far from a centre, and suddenly that centre is closed, that can have huge travel and service implications, which can create huge distress and worry and make care worse.
I agree with much of what the hon. Lady has said. Does she therefore support amendment 57, which would ensure that such a consultation takes place?
Unfortunately, the Minister’s reassurances have not convinced me. In relation to change, “significant” means various things to different people. As for “proportionate”, what is “proportionate” to one person is not necessarily “proportionate” to another. Amendment 57 makes reasonable provision for a situation in which there is a change from national to local commissioning, or from local to—mostly, it is from national to local commissioning. Therefore, I would like to push it to a vote. Question put, That the amendment be made.
Clause 14 is very straightforward: it states that schedule 1 “confers functions on integrated care boards in relation to commissioning primary care services…transfers related functions from NHS England to the Secretary of State, and”— perhaps most interestingly— “contains other amendments relating to primary care services.” Schedule 1 essentially makes the following changes to the NHS Act 2006: it makes ICBs responsible for commissioning pharmacy services instead of NHS England; it amends section 99 to make ICBs responsible for commissioning dental services instead of NHS England; it amends section 83 to make ICBs responsible for commissioning primary medical services such as general practice instead of NHS England; and it amends section 115 to make ICBs responsible for commissioning ophthalmic services. Largely, this change is formalising existing delegation and the risk of disruption is therefore relatively low. Local commissioners can tailor decisions to local need, and it is better if decisions are taken closer to users. However, there are a few other things in there as well. Paragraph 12(2) amends section 97 of the 2006 Act containing local medical committees, which are statutory committees. The way it is phrased, “the whole or part of the ICB’s area”, does not allow for overlap. Is that the Government’s intention? The Government, in a broader sense, talk about the strategic authorities and having the mayoral authority level involved in the ICB. But in Lincolnshire, for example, an area that I represent part of, the local medical committee could not work in conjunction with the mayoral authority under this legislation, as far as I read it, because it essentially covers two ICB areas and two regions. The mayoral authority is the Greater Lincolnshire mayoral authority. That includes Lincolnshire’s upper-tier area, the Lincolnshire county council area. It also includes the areas around Scunthorpe, Grimsby and Immingham, which fall into the Yorkshire region as opposed to the midlands region, and therefore not a whole or part of any given ICB area. I wonder whether the Minister has any comment on whether that was the intention, because it is also the case with paragraph 24(2) of schedule 1, which amends section 113 of the 2006 Act on local dental committees. Again, although the ambition stated and discussed in the Health and Social Care Committee yesterday by the Minister for Care, who is responsible for primary care, was that ICBs were to be covered at strategic level, that would not be possible for local medical committees or local dental committees under my reading of paragraph 12(2).
Of course, my hon. Friend is right. One challenge with the Bill is that although not all the measures are a problem individually, the way they are being brought in is a problem. The planning and organisation that has gone into it has not been coherent. A 50% cut has been made to the budgets of ICBs, which has required many of them to merge, but that has been done before the local government reorganisation has been finished, which means that ICBs have been melded together in a way that is not the same as the local government reorganisation. Let me again give the example of Lincolnshire. Lincolnshire had an excellent ICB, run by chief executive John Turner. That has now merged with Nottinghamshire and Derbyshire. Nottinghamshire and Derbyshire form the East Midlands mayoralty, but Lincolnshire ICB, as was, forms part but not all of the Lincolnshire mayoralty—which, as I said, also includes part of what was the Yorkshire region. Because the cuts were done before the local authority reorganisation, and the left hand does not know what the right hand is doing, we have ended up with an incoherent pattern, which does not help, particularly for social care services that are delivered by local authorities. We will come back to that when we talk about who is on the ICB. The risk is that we end up spending money doing this twice—being forced to do it at short notice, because of the 50% cuts brought in overnight by Government, and then doing it again to try to sort out the mess and bring things back into line with the new local authorities as and when it is decided what they will be. Going on to the pharmaceutical arrangements—I should probably declare at this point that my brother is a rural dispensing GP—I share the concerns raised by the hon. Member for Bury St Edmunds and Stowmarket in relation to rural dispensing GPs. Let me give the Minister an example from my constituency. The Cliff Villages medical practice was an excellent medical practice. However, there was a doctor retirement and the illness of a doctor, and as a result the service reduced in quality quite substantially. The ICB was working alongside the surgery and the one remaining practice doctor—not swiftly enough, it must be said. What happened in the end was that the Care Quality Commission came in, found that the service was really not good enough and closed the surgery down overnight, in the middle of the week. It was closed with immediate effect and there were no appointments for any patients in my constituency. Then, because the surgery had been closed, the ICB worked very hard to get a new practice in straightaway, and it got that opened on the Monday, which was pretty quick in the circumstances; but people lost their dispensing GP. Living in a rural area—I have a dispensing GP myself, living in a rural area—people can go to the doctor’s, see the doctor and, if the doctor perhaps says, “You need some antibiotics,” they can go back to the waiting room and sit there for 10 minutes, be given the antibiotics and then leave. That is significantly more helpful to a rural constituent than having to drive eight or nine miles into the centre of town, park the car, find somewhere to get the prescription and then go all the way home again, which would take much longer. People really value that service—I saw how much when I held a public meeting with the ICB and the new provider to talk about what had happened at the surgery, and 250 people turned up to an evening event in the village hall at short notice. It is hugely important to people. Will the changes allow the Secretary of State to step in in such circumstances, where the medical contract has been lost due to that cut-off by the CQC? Will that sudden loss of service be able to be replaced with a new dispensing service? Could Ministers have therefore given dispensing rights to the new provider? At the moment, those rights are not transferable, and it means that the only way that my constituents who live in that area and attend that practice can maintain dispensing rights is either to move house—perhaps to next door and back again, but they have to move house—or to change practice immediately, that same day, to another dispensing practice. To be honest, that seems ridiculous. Could the Minister make any comment on how the provisions in the Bill will help that situation and what her views are? I am confused by new clause 23 and new schedule 1; the Minister has introduced them later than the rest of the Bill, but they seem quite significant. They would move pharmacy appeals from the first-tier tribunal to an NHS body specified by regulations made by the Secretary of State. I presume the regulations are not yet written, so we do not know what form that would take, but the first-tier tribunal is part of an independent judicial system and the appeals will now be under political control, within the Department. Could the Minister explain why they think that is fair? Why do the Government want to do that? Is it just about saving money? How will the judgments made by that new authority be properly enforceable and give people confidence, given the change from the first-tier tribunal in the judicial system to something more politically controlled? I move on to new clause 2, which would require the Secretary of State to establish within six months a scheme to give patients the right to a GP appointment within seven days of seeking one, or 24 hours if urgent. I would be interested to hear the Minister’s comments on that and how she thinks it could be achieved. Modelling by the Health Foundation suggests that 6,500 full-time equivalent GPs—37,800 in total—will be needed by 2030-31 to meet greater clinical need. We have already talked about the doubling of medical school places; I presume the Minister has sought correction since we last spoke on whether the Government have a plan to double those places or not, but the Government are not on track to have that number of GPs. Is it simply that they do not have the resources to deliver it? I would be interested to hear the Minister’s comments.
We Conservatives share the hon. Lady’s desire to ensure that patients get their appointments as soon as they need them to be had, but she is talking about a difference between urgent appointments, within 24 hours, and non-urgent appointments, within a week. Who is going to make the decision about whether the appointment is urgent? Will it be the clinician? Will it be the patient themselves? Has she thought about where that responsibility lies?
One thing that my hon. Friend mentions is the Government’s stated intention to bring things closer to home, as opposed to the reality of the Bill as drafted. Does he agree with me that the document that explains what will happen to the commissioning of specialist services, and that talks about seven regions and how ICBs could collaborate within those regions, might imply that the Government are looking forward to having seven areas in which most commissioning takes place? These are even larger areas than have been described in the mergers so far.
My right hon. Friend the Member for Melton and Syston and my hon. Friend the Member for Farnham and Bordon have covered my points so effectively that I will be very brief indeed. How do we ensure that the consultation is not just well meaning and ticking the legal boxes, but actually listened to, so that people’s voices are incorporated into the plans? Also, I appreciate that amendment 28 is a well-meaning intervention, but how do we ensure that all voices are heard in a co-production, not just those who are the most articulate or the most able to engage with a process that they see online?
I beg to move amendment 51, in clause 16, page 12, line 10, at end insert— “(3) The regulations must ensure that integrated care boards may not impose operational policies requiring patients to wait a minimum number of weeks before they may access treatment.” This amendment would prevent minimum waiting times for NHS treatment.
The Government say they are firmly committed to cutting waiting times and meeting the NHS’ 18-week target. It seems odd that, despite that, it is necessary for me to table an amendment to prevent systems from forcing patients to wait artificially longer for their care through the imposition of minimum waiting times. Last year, The Times reported that at least eight local ICBs had introduced policies to pay healthcare providers for treatments only once patients have waited 12 weeks or more. I cannot think of any clinical reason why someone should wait for 12 weeks before having any treatment. At the time, the Minister said that while there was “no formal national policy supporting minimum waits”, local areas may “choose to include minimum waiting times in Activity Planning Assumptions to ensure delivery of targets within agreed financial allocations…to support commissioners in managing activity to ensure they can sustainably manage within their budgets”. I do not understand why we would want to make people wait longer than necessary. The Royal College of Surgeons has expressed concerns and made clear that minimum waits prolong “pain and anxiety” for those made to wait longer, saying that it is “counterintuitive…to give commissioners the green light to impose 18-week waits, while simultaneously working to ensure patients begin treatment within 18 weeks.” Age UK deemed it a “rationing approach” that is “potentially harmful to the health and wellbeing of older people.” NHS England has made it clear that ICBs cannot introduce minimum waits of more than 18 weeks—that is longer than the target, so that makes sense—but waits between 12 and 18 weeks are permissible. Will the Minister explain why that is a good idea? Amendment 51 seeks to ban ICBs from introducing any operational policies requiring patients to wait a minimum number of weeks before they may access treatment. There are safety risks involved in introducing minimum waiting times. They distort clinical priorities and may make patients wait in unnecessary pain and anxiety. Treatment should be delivered when possible, based on clinical needs. If a patient has a high level of clinical need, they might need to be treated earlier than the minimum waiting time because of the suffering they are experiencing. Minimum waits are not only detrimental to patient experience by forcing people to live in greater pain and discomfort; in some cases, the delay may make the patient’s condition worse, and the treatment they need may be more extensive and even more expensive. Their condition may even become life-limiting or life-threatening as a result of the delay. The introduction of arbitrary minimum waiting times that do not have any relevance to patient clinical need raises worrying issues, clinically, professionally and ethically. Minimum waits will also hinder the NHS’ ability to cut waiting lists and get waits to within 18 weeks. Some providers will have a list of people who can be available at short notice for a procedure, who they can call on if there is a cancellation on the day. If that person has not waited the minimum, that may be left as a gap, and that operation or appointment may not happen. That is wasted NHS resource. Each month that goes by, many people are added to the waiting list, and some are removed from it. We are aware that there seem to be a lot of unexplained removals from the waiting list, and that has spiked recently. Among the people treated by NHS providers in April, around 600,000 were treated within eight weeks of referral, versus 74,000 who were treated between 14 and 18 weeks. The introduction of a minimum waiting time will therefore push back many people’s treatment by as much as 10 weeks. Minimum waits also worsen and entrench postcode lotteries, because patients who have differential waits, based on whether their ICB has decided to implement minimum waiting times, may experience differential levels of care because of where they live. They are also another way of undermining patient choice, because patients may want to be treated in one area or one hospital because of the waiting time. If they all have different minimum waiting times, that distorts patients’ ability to choose. Minimum waits are also completely contrary to the 10-year plan for health, in which choice and productivity were considered central features, along with the Government’s wider commitment to keep people healthy. I hope the Minister will agree with amendment 51, which would ensure that minimum waiting times cannot be instituted. Amendment 52 also concerns waiting times. You will no doubt have seen, Dr Huq, the many newspapers articles about the Government fiddling the figures on waiting times, and there has been a spike in removals from waiting lists. People have found themselves removed from lists or going back on lists, or have suddenly found out that their waiting time started more recently than they thought. Amendment 52 would require the Secretary of State to publish the number of patients who are taken off treatment waiting lists each month and why they were removed. It is important that we are able to explain to our constituents why the Government have decided to remove them.
I should say that I am on a waiting list for treatment myself. The validation process seems to involve phoning people to check if they still need treatment, which after a long period is perhaps not an unreasonable thing to do. However, if they then say yes, they are phoned again a few weeks later; and if they say yes again, they are again phoned a few weeks after that. That puts pressure on people to say, “Okay”. If they are then asked, for example: “Would you be happy to see the consultant so that he can check that you are still listed for the right procedure, given that your condition may have changed and you may want to do something else?” it feels entirely unreasonable to say anything other than “Yes” to that. Would my hon. Friend be surprised to hear that when some people do that they find that they do indeed need the same procedure, but that their waiting time has now gone back down to zero?
Does my hon. Friend agree that when somebody—particularly a vulnerable person—receives a call asking them whether they would be prepared to see a consultant to see whether they still need treatment, they are aware of all the noise in the media? They are aware that other people are waiting. People do not want to waste NHS resources. The first time, they may think it is a routine process but, when they receive the second or third call, they may start to think to themselves, “They are trying to tell me that they want to do something else. Maybe I don’t need it as much as other people.” They feel obliged and pressurised into saying they do not need the procedure when they do.
The hon. Member for Ashford talks about social media and social media comments. I wonder if, where the DHSC or the Government have put that waiting lists are falling, my hon. Friend has read any of the comments that come in from the general public below such proclamations.
If a person has been waiting more than 18 weeks, the trust calls them and asks them to see a consultant to check whether they still need the appointment or whether they need a different treatment. If, after having that appointment, they are told that they still need the treatment, that same day they go back on the waiting list as if it were day one. Therefore, they have not waited less than 18 weeks, even though the Minister’s statistics might suggest they have. Does she accept that?
The clause imposes a duty on ICBs to have regard to the likely impact of their commissioning decisions on areas of Wales and Scotland close to the border. In some respects, this is like other parts of the Bill—a statement of the obvious regarding a person’s job. Are we suggesting that the Secretary of State, and in particular ICBs, would not consider the effect of their decisions? I hope that they would, but, given that the clause is there, what teeth does it have? What if they do not? Is there any consequence in the Bill if they do not? As others have said, will the Minister confirm whether there is a reciprocal agreement with Wales and Scotland? If there is not, what negotiations has she entered into and what progress are they making?
I have one question for the Minister. Which ICBs does she envisage being abolished, or is this just a precaution for the future?
The Government’s explanatory notes state that the clause is intended to give ICBs the ability to provide a broad range of support to those involved in providing or administering the health service. The flexibility there aligns with the Government’s stated vision for more autonomy across the system. I have a couple of questions. If the ICB were to provide support in a way that was out of line with good practice or what is expected by the Department, what would be the recourse? Where will it be possible for right hon. and hon. Members to see the financial expenditure that ICBs make in any such circumstance?
As has been said, the clause replaces the part of the NHS Act that requires NHS England to carry out performance assessments of the ICBs and rewrites it so that the Secretary of State has to carry out those assessments. That makes some sense, but, as the Minister said, it takes out the criteria against which the ICBs will be assessed. I accept what the Minister says—she wants those criteria to be set out more flexibly than can be done in primary legislation—but it is not reasonable or fair to assess people against criteria that they do not know in advance. It will be important, will it not, that ICBs know in advance what those criteria will be? Given what she said to my right hon. Friend the Member for Melton and Syston about writing to him, will she commit to writing to us to say not only what the criteria will be at the moment, but how far in advance ICBs can expect to receive them before they are expected to work to them and then be assessed against them? Will variation be a factor in whether an ICB is deemed to have been performing well or not? We know that there is a tension in the Bill between the Secretary of State’s need to equalise provision and the ICBs’ desire and intention to vary it and innovate. Given that the Secretary of State is a political individual, how will the assessment process be conducted in a way that gives ICBs and their leaders confidence that there will not be political interference in it?
I beg to move amendment 46, in clause 21, page 15, leave out from line 33 to line 6 on page 16 and insert— “(2) The constitution must provide for the ordinary members appointed as mentioned in sub-paragraph (1)(b) to include— (a) at least one person nominated by one or more NHS trusts or NHS foundation trusts which provide services under arrangements made by the integrated care board, in accordance with regulations made under sub-paragraph (2A); (b) at least one person nominated by a body representative of providers of primary medical services whose area falls wholly or mainly within the area of the integrated care board, in accordance with regulations made under sub-paragraph (2A); (c) at least one person appointed by a local authority whose area falls wholly or partly within the area of the integrated care board; and (d) at least one member nominated by the mayor of each mayoral strategic authority whose area coincides with, or includes the whole or any part of, the integrated care board's area (if any). (2A) The Secretary of State may by regulations make provision about the nomination of ordinary members under sub-paragraph (2)(a) and (b), including provision about which NHS trusts, NHS foundation trusts or representative bodies are entitled to make nominations. (3) The constitution must set out the process for making nominations under sub-paragraph (2). (4) A person making a nomination under sub-paragraph (2) must have regard to any guidance published by the Secretary of State as to the selection of candidates.” This amendment modifies Clause 21 so that, rather than replacing the existing mandatory membership requirements in Schedule 1B to the National Health Service Act 2006 with a requirement for mayoral representation alone, the new sub-paragraph (2) reinstates and consolidates the full range of required ordinary members.
At present, integrated care boards will have a chair, a chief executive and at least three further ordinary members. Those three ordinary members will include a representative of the NHS trusts and NHS foundation trusts in the area, someone from the primary medical services in the area and someone nominated by the local authority areas within the ICB area. Under the clause, the requirement for those individuals is replaced with a requirement to have someone from each of the mayoral authorities. Because of the order in which the Government have done this—removing half the budget from the ICBs, which has caused them to merge in a way that is not coherent with the Government’s not-yet-complete local government reorganisation—we have a situation where representation is not even. For example, in my ICB area the Mayor of Greater Lincolnshire and the Mayor of the East Midlands will each be able to choose someone to represent them on the board, but the proportions of the population are not even. Lincolnshire will be over-represented, which is not an issue for my constituents, but it may be for those from Nottinghamshire and Derbyshire. Likewise, the northern part of Greater Lincolnshire, which is in a different region, has a small population relative to its ICB. Some mayors will therefore have representation that is not proportionate to their population size. There is surely a risk that the next step will be for the Government to say they want to make things more even, with ICBs working in relation to mayoral authority areas. Yesterday, the Minister for Care suggested at his appearance before the Health and Social Care Committee that the ICBs should be aligned with strategic authorities, but the only way in which that can happen once the Government have decided where the strategic authorities will be is if things are changed once again. That brings ongoing costs—financial costs, opportunity cost for service development, and cost to the people delivering these services. The people working hard to try to deliver the Government’s plan find themselves and their jobs threatened and chopped and changed all the time. We heard evidence that the concentration on reorganisation rather than service delivery, provision and development is causing distress to those people. We also heard about the effect on social care, which, certainly in Lincolnshire and in other places, is delivered by the upper-tier local authority, but not all mayors have any responsibility for health—our mayor does not. We will therefore have someone who is not responsible for health on the ICB while someone responsible for delivering social care will have their seat on the ICB removed. I am afraid that I simply do not understand that. I watched through several times the Minister for Care’s Select Committee appearance, and I still do not understand the rationale. I will be grateful if the Minister for Secondary Care could explain that.
Where a mayor is from one political party and local authorities are run by different political parties, the mayor, as part of the ICB, will be able to make decisions about spending done by authorities that are run by different parties. That will surely create a political conflict, or at least the potential for one.
I thank the Leader of the House for announcing the business that we have scheduled. In addition to the business he has announced, on Thursday 9 July there will be a debate on a ban on trade with illegal Israeli settlements, followed by a further debate on which we await confirmation from the sponsor. On Thursday 16 July, assuming that we are given that date, there will be the annual Sir David Amess pre-recess Adjournment debate, which is very popular with all colleagues. As we await the implementation of the new Government, it seems that Government business is reasonably light. Early notice of any extra dates that we might get before the recess would be appreciated, as we have only just cleared requests for debates in the Chamber dating back to December. We have a large queue. Let me turn to the debates in Westminster Hall next week. On Tuesday 30 June, there will be a debate on Government support for removing unlawful storefronts and regenerating local high streets. On Thursday 2 July, there will be a debate on reducing premature deaths from heart disease and stroke, followed by a debate on Government plans to tackle air pollution. On Tuesday 7 July, there will be a debate on UK aid policy in the context of global funding trends. On Thursday 9 July, there will be a debate on Government support for the lobular moonshot project, and a further debate to be confirmed. I can announce in advance that on Thursday 16 July in Westminster Hall there will be a debate on the impact of national planning policy framework changes, followed by a debate on capital funding for Changing Places toilets. Given the recent hot weather, I have been inundated with reports of individuals trapped in their flats in high-rise buildings, lifts going out of action and people being trapped in stairwells and collapsing because of the heat. That is particularly prominent in social housing. Given that this is about the design and upkeep of properties, can we have an urgent statement from one of the Housing, Communities and Local Government Ministers on what action the Government will take to protect these very vulnerable people? I have to say that they are often from visible ethnic minorities and often have no recourse to the support that they need. This is an urgent matter. Given that the hot weather is likely to continue for some time to come over the summer, we must take urgent action.
I thank the Minister for advance sight of his statement. We welcome the partial U-turns that have been announced, the engagement there has been and the reflection, even at this very late hour, that the original proposals from the Government would have done great damage to British manufacturing. This decision could, however, have come months ago. If not, it could have come weeks ago, when Members of the House and businesses started raising the alarm and engaging with the Department. It took this Government—if Members can remember—more than a year and three quarters to come up with their original steel strategy, yet the industry is now expected to adjust with less than one week to go. That is not a reasonable way on which to proceed. The Government have left untouched the 50% tariff rate, and that will do great damage to British manufacturing, house builders and those who construct the nation’s infrastructure. It will mean higher inflation, fewer jobs, fewer homes and fewer public projects. The Government have made some welcome concessions on how much steel can be brought in but conceded nothing on the rate that punishes imported steel the very moment that the quota is exceeded. I know, as does the Minister, that he has received significant private representations from industry on this issue, particularly from defence and aerospace, and I imagine that the Minister does understand that this measure will not be enough. Of the 60 codes that we believe are relevant to aerospace and space, just two codes have been removed, and while quota uplifts have been applied, they are not particularly useful to the small-scale, high-value defence manufacturers, as commodity buyers will snap up all those quotas at the start of the year before they get a look-in. As a result, we are, I am sad to say, putting the defence of this country at risk by imposing a shock to defence industry prices, and it will either be the Treasury or the Ministry of Defence that picks up the bill. Projects such as AUKUS, Tempest, drones and much-needed munition rearming will all be vulnerable as a consequence. Finally, let me put some questions to the Minister on behalf of the industry. Will he commit to publishing the impact assessment on downstream steel sectors before Parliament rises for the summer? Does the Minister understand that by not exempting pre-agreed purchase contracts, which may in some cases run for years, he is damaging good, decent British manufacturing firms, even those in Rhondda and Ogmore? His exclusions rest on a test of “no production, or production paused”, but will he explain how he justifies keeping specialist grades in scope when in some industries, such as aerospace, it takes years to certify suppliers? Can he confirm that the EU’s reciprocal quota for exports from the UK will fully protect the 2.4 million tonnes of annual British exports of steel that would otherwise be at risk?
On a point of order, Madam Deputy Speaker. I know that in a former life, the Minister was punctilious about standards in this House, so I seek your advice as to how he may correct the record. He referred to a letter that I believe he said his office had received this morning or yesterday. In fact, the Department will have received copies of two letters, one which was sent a week ago, not on my behalf, but on behalf of hundreds of thousands of small manufacturing businesses that were desperately worried, with one week to go before the tariffs. There was a second letter on Tuesday, jointly from me and the shadow Defence Secretary, my hon. Friend the Member for South Suffolk (James Cartlidge), again, sent on behalf of this vital industry, which keeps us all safe. I have not yet received a reply to either of those. I would not necessarily have expected to, but it would not be right for the record to reflect that he had only received the letter this morning.
I am sure that danger and excitement await the Chief Secretary to the Prime Minister in whatever comes next. The Government have always maintained that they have withheld material from the Mandelson case only at the request of the Metropolitan police, but a fortnight ago, a Daily Mail journalist spoke to the Metropolitan police, who insist that they did not ask for a crucial series of messages to be withheld. Can the Chief Secretary to the Prime Minister explain why the Metropolitan police and the Government are saying different things?
Obviously the House does not want to do anything prejudicial to a case, but it appears that the Metropolitan police are saying that some documents could be released without that being prejudicial to the case. I know that things will soon move on, but the Humble Address will remain in force, even if there is a new Prime Minister. If there is a criminal trial—and even if there is not—it is likely that more information will be released. As this has been a particularly novel way of using and responding to a Humble Address, it is likely that there will be a Select Committee inquiry into how the process ran. Will the right hon. Gentleman give a commitment now, at the Dispatch Box, that there is no material that the Government have withheld that the Metropolitan police have not explicitly asked to be withheld?
This may be the last time I come up against the right hon. Gentleman during parliamentary questions. When we first faced each other nine months ago, I said that he was one of the most able performers in Government, and I still believe that to be the case. I think there will come a time when his party regrets the fact that he did not stand in this leadership contest. I think he would have lost—
I was just trying to be nice, Mr Speaker. We will do it privately. Given that we may have a new Prime Minister on 16 July, does the right hon. Gentleman think that that new Prime Minister should take questions in the House before he goes off for the summer break?
I am very glad to be the one to break the news that the right hon. Gentleman wants to keep his current job and not move to another role. This is a serious question. Does the right hon. Gentleman think it would be appropriate for the new Prime Minister to answer questions before the summer break? If so, will he make representations to the next Prime Minister?
The hon. Member is making an important speech. Climate change is one of those issues that my constituents contact me about all the time, particularly my young constituents. This is something that really bothers them as much as it does us. Does she agree that climate change is something we are experiencing now—we know that when we step outside? Does she also agree that a dead planet with plenty of jobs is no good for any of us, so we need to focus on this and deal with it?
I thank the hon. Member for Bromsgrove (Bradley Thomas) for securing a debate on such an important issue. I put it on record that I am the chair of the APPG on climate change. Frustratingly, the British public once again find themselves at the mercy of the latest chapter of the geopolitical crisis. Our constituents are looking at their energy bills and wincing at yet another increase, as people up and down the country pay the price for an energy market that is exposed to global conflict. The fact remains that the hard-earned money of British taxpayers and bill payers is lining the pockets of fossil fuel giants, which want us to believe that drilling oil is the only way forward. As long as the UK relies heavily on oil and gas, global conflicts and supply disruptions will continue to lead to price hikes. That is why we need to focus on cleaner energy sources. Those hikes are driving fuel poverty in every corner of our country, leaving less money in the pockets of workers and pensioners alike. For too long—we have heard this in the debate—climate action has been pitched as a zero-sum game in which economic activity will somehow be hampered, but it is not at odds with economic security or prosperity. There is a case for moving away from oil and gas and towards clean energy not only for our planet, but for British bill payers. Energy bills cannot and will not be brought down by North sea oil and gas. Our constituents are better protected from energy shocks by investment in renewables than by further exposure to volatile fossil fuel markets. The British taxpayer has been subsidising a hugely polluting industry for too long. Oil and gas companies enjoy an effective tax subsidy of £3 billion every year, when we should instead be investing in the industries of the future, such as renewable energy projects that deliver wealth back into our communities, building global leadership and growing global markets for clean energy technologies. I worked globally on such initiatives with nearly 100 countries in the United Nations. Countries are successfully shifting away from fossil fuel production. That is happening—it is a reality.