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Westminster Hall

Tuesday 11 March 2014

[Mr James Gray in the Chair]

Cancer Treatment and Prevention

9.30 am

Motion made, and Question proposed, That the sitting be now adjourned.—(Mark Lancaster.)

Pauline Latham (Mid Derbyshire) (Con): It is a delight to serve under your chairmanship today, Mr Gray.

During the past few months, cancer has been something of a hot topic in this House, and the Government have committed themselves to reducing the number of people who die from cancer every year. That is an admirable goal and the provision of services to cancer patients has undoubtedly improved. However, the complicated licensing procedure for cancer drugs and the lack of knowledgeable doctors are preventing patients from receiving the life-saving treatment they need.

During my tenure as an MP, I have had the privilege of working with a cancer charity called Melanoma UK. Melanoma is a cancer that is particularly close to my heart, as my brother died from a malignant melanoma when he was only 54. What is most insidious about this cancer is that it is impossible to treat in its late stages, and it often results in a drawn-out and painful death for the sufferer.

Last week, I sat in on a meeting of the Melanoma Taskforce, which is attended by experts in skin cancer, patients and their families. The consistent theme of the complaints from these experts was that initial diagnosis and referrals of potential melanoma sufferers were taking too long, which often results in sufferers receiving treatment that comes too late to save their lives. In the case of my brother, he went to the doctor three times, but the doctor said, “There is absolutely nothing wrong with you.” Eventually, he told my brother, “All right, I will refer you to Addenbrooke’s and you can go and see somebody, but I’m sure it’s fine”, by which time more than a year had passed and it was far too late.

As I say, the consistent theme of the experts’ complaints was that initial diagnosis and referrals of potential melanoma sufferers take too long, which often results in sufferers receiving treatment that comes too late to save their lives. At that meeting, I learned that medical students receive only a week or less of teaching on dermatology, and that is on the whole of dermatology, not just melanomas. Even less time was spent on teaching them how to spot the signs and symptoms of melanoma. All that is shocking, given that malignant melanoma is the fifth most common cancer in the UK.

Another piece of feedback that I received from the dermatologists who were present at that meeting is that there are simply not enough consultants in this field and the few dermatologists that there are end up being completely inundated with patients. Sadly, the figures fully support that opinion: there are only 650 dermatology consultants practising nationwide. How can so few consultants effectively deal with the influx of potential

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melanoma referrals? Given this state of affairs, it is imperative that the Department of Health and the UK’s teaching hospitals encourage medical students to pursue a career in dermatology.

The other bar to the survival of late-stage melanoma patients is the difficulty in accessing effective cancer drugs. As some Members may know, about two weeks ago the National Institute for Health and Care Excellence published its response to the consultation on the use of the drug ipilimumab as the first-line treatment for late-stage melanoma. Currently, the drug that is prescribed in the first instance is dacarbazine, which is generally acknowledged to be ineffective in fighting the progression of the disease. On the other hand, ipilimumab has been proven to extend people’s lives and give them a better quality of life during treatment.

One case study to recommend ipilimumab as a first-line treatment is the story of Richard Jackson, who was told that he had only weeks to live when he was diagnosed with late-stage melanoma and was prescribed the drug straight away. As a consequence of the early prescription of ipilimumab, Richard is still alive seven years after being diagnosed with melanoma. When one considers that, when he was given the diagnosis, he was planning his funeral, because he was told that he had only weeks or months to live, that is remarkable.

Dacarbazine, which is a type of chemotherapy, often leaves patients sicker than before they began using it, and they are generally progressed on to ipilimumab anyway. NICE’s decision was based on a number of factors, including cost. If the majority of patients do not benefit from dacarbazine as a first-line treatment, NICE’s decision not to use ipilimumab initially both fails to provide value in the long term for the British taxpayer and shortens people’s lives.

With that in mind, I call upon the Department of Health to make melanoma a real priority. I know that everybody wants everything to be a “real priority”, so I understand the Department’s difficulties in that respect, but melanoma can be cured if it is detected early. The Department needs to start by motivating young doctors to study dermatology, and by working with universities so that the time devoted to teaching this important subject can be extended. Most urgent, however, is the need for the Department to put pressure on NICE to offer ipilimumab as a first-line treatment to extend the life expectancy of melanoma sufferers and—perhaps vitally—improve their quality of life, so that they can continue to contribute to society for longer as well as having a better quality of life.

Ongoing changes to the UK cancer infrastructure, such as downsizing and dismantling the cancer networks in April 2013 and the National Cancer Action Team being merged into NHS Improving Quality, risk creating a gap in the cancer expertise that is used to advise and shape the NHS and the Department of Health. NHS England is looking to broaden its work in other disease areas beyond cancer. The cancer policy team at the Department has been all but abolished, with just a handful of its staff remaining. This inevitably dilutes the cancer expertise in the Department.

The overall reduction in expertise and resource in oncology will limit the ability to identify and spread best practice and drive innovation in treatment and care. Although the diversion of resources and expertise away from cancer is worrying, it is positive to see a

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strong policy focus on preventing people from dying prematurely, through domain 1 of the NHS outcomes framework.

Each clinical commissioning group should have at least one member with an interest in cancer. Previously, GPs benefited from better liaison with specialists via the cancer networks, and they could use the lessons learned from that approach and build on them further to create informal communities of primary and secondary care colleagues interested in cancer, to influence what is happening in CCGs.

Multidisciplinary teams for cancer should work to feed into strategic clinical networks, in the way that they previously worked with the cancer networks, to promote collaboration, consistency and quality of care. National clinical advisory groups for the common cancers should be re-established to bolster the work of strategic clinical networks in sharing best practice, supporting intelligent commissioning and driving up standards of care.

The extension of the Cancer Drugs Fund is welcome, but there is now a need for long-term clarity that, after 2016, the new pricing and reimbursement scheme will offer patients an appropriate level of access to cancer drugs that have been proven to be effective. Furthermore, we must collect better data on what medicines cancer patients across the UK need. It is also essential that NICE offers flexibility in its appraisal of cancer medicines. It should consider looking at cancer treatments under its own separate criteria, in particular measures beyond overall survival.

The Government have done a lot of good work on cancer, but there is still more to do. I am particularly interested in melanomas and bowel cancer; they are the two cancers that I tend to specialise in. There is more work to do on those cancers, and success is about early diagnosis. If we can get early diagnosis and appropriate treatment, the Government will succeed in achieving the aim of giving people longer life and better quality of life.

9.39 am

Eric Ollerenshaw (Lancaster and Fleetwood) (Con): I congratulate my hon. Friend the Member for Mid Derbyshire (Pauline Latham) on securing this debate.

I apologise in advance because there will be some repetition as I had an Adjournment debate last week on pancreatic cancer and a new drug, which is fundamentally what I will speak about this morning. I think hon. Members will understand that there is a need for repetition, because we are right in the middle of the Cancer Drugs Fund’s making a decision about this drug, so anything extra we can add is useful. I am sure the Minister has heard this before, because she attended that Adjournment debate on Tuesday 4 March.

The Cancer Drugs Fund met on Thursday 6 March and I understand that the process is that it will take a week to consider, then it will inform the applicants and then, in two weeks’ time, its decision about Abraxane will be made public and we will know. Abraxane has been licensed for use in patients in the UK and Ireland with metastatic pancreatic cancer; it has been described as the biggest advance in pancreatic cancer treatment in almost two decades, for a disease where survival rates have barely changed in 40 years.

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As Abraxane has not been approved by NICE, it is not yet available on the NHS as a standard treatment. Pancreatic Cancer UK, the biggest charity in this field, together with Pancreatic Cancer Action are both keen to ensure that patients are able to access Abraxane through the Cancer Drugs Fund. We should like to see the drug approved by the CDF then eventually by NICE, so that access to it is more readily available. We know that Abraxane is due to be reviewed by NICE soon, but this process takes a great deal of time, and time is something that most pancreatic cancer patients do not always have.

My comments relate to the treatment of cancer. As I have said, I hope that hon. Members will put up with some repetition, given the importance of these few weeks to the sufferers, survivors and friends and relatives connected to this cancer, because it is a highly charged moment.

Nic Dakin (Scunthorpe) (Lab): I congratulate the hon. Member for Mid Derbyshire (Pauline Latham) on securing this debate. Does the hon. Gentleman agree with her that the key is early intervention and effective treatment? That is the key to getting it right with regard to melanoma, bowel cancer, pancreatic cancer and ovarian cancer, for example. The hon. Gentleman is making powerful points in this respect.

Eric Ollerenshaw: As per usual, I agree with the hon. Member for Scunthorpe (Nic Dakin). I pay tribute to his work on the all-party group on pancreatic cancer. He and my hon. Friend the Member for Mid Derbyshire hit the nail on the head. At the moment I am just talking about treatment, but early diagnosis is the key to all of this, particularly pancreatic cancer. More than 50% of people who are diagnosed with pancreatic cancer are diagnosed after emergency admission to hospital: it is that late and, too often, too late to be able to do much in terms of survival beyond a year. Only 4% of people diagnosed with pancreatic cancer survive for up to five years, so it is clear how dramatic an improvement in early diagnosis would be.

It is estimated, on average, that Abraxane will allow a further two months’ survival, which, in the great scheme of things, does not seem massive, but it could double the lifetime chances of the average pancreatic cancer sufferer. Pancreatic Cancer UK launched its campaign, “Two More Months”, to highlight that. I quoted examples in my other Adjournment debate, which hon. Members may read, of survivors describing what two more months could have done for them, in their situation. Survivors talk about the possibility of getting married, which was not available because the person died early. There are other heart-rending examples of what that time would have enabled them to do. To underline the point, in terms of pancreatic cancer, as I have said, two more months is a massive improvement on what is available, unfortunately, to far too many.

In my Adjournment debate, I expressed our fears—the all-party group’s, Pancreatic Cancer UK’s and Pancreatic Cancer Action’s—that the call for the drug to be made available would be dismissed by the Cancer Drugs Fund because it gives only two more months. It is interesting that there are no pancreatic specialists in the Cancer Drugs Fund. Our key concern last week was that the two months would not be considered sufficient, because in comparison with other cancers it does not seem a

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great deal of time. Yet more than 60 specialists treating patients with pancreatic cancer shared their names, via Dr Seb Cummins, supporting this submission and therefore hoping that they would be listened to.

Although I did not attend the meeting, apparently the panel did not acknowledge the unmet need in this disease area and did not allocate points to represent this, given its criteria. Individual panel members did not appear to accept, as we feared, the benefits of an additional two months, although I am told that there was some acceptance that, yes, the drug did prolong life. Obviously, the panel has to take into account—I am not a specialist in medicine, Mr Gray, as you well know—the quality of life in those two months.

I understand that the decision will have been made, but it will not be public until two weeks’ time. So where do we go from here? I have already expressed concern about the Cancer Drugs Fund, because, to my knowledge, last year not one new cancer drug was agreed, plus none, if I understand the system correctly—I admit that my understanding of it is a bit basic—has been passed down to standard NHS clinical use. Nothing has left its funding stream. I am told that it has overspent a certain amount of money, but again I do not know whether it is anecdotal or exactly correct; I hope that the Minister comments on that.

The Cancer Drugs Fund process has had enormous success, which I acknowledge. Thousands of people have benefited from this innovation. There is anecdotal evidence that, because this does not exist in Wales, people there are moving across into England to take advantage of it, and why would they not, if they or somebody in their family is in this situation? The hon. Member for Strangford (Jim Shannon), who is present, has commented previously on the situation in Northern Ireland. However, although I acknowledge its massive success, it seems to me, from the outside, that somehow we are stuck in respect of where we go with the Cancer Drugs Fund and its funding in future.

It almost appears as though the Cancer Drugs Fund has become a victim of its own success. We must not let that success become failure now, simply because we are going to get a blockage of applications for new drugs; I thought that dealing with those was the whole purpose of the Cancer Drugs Fund in the long run.

In terms of pancreatic cancer, too many hopes have been raised too many times and for too long it has remained the poor relation in all this. So when hope, such as this new drug, comes along, we want that hope tested, not against other cancers but against a past history of neglect. Pancreatic cancer already has the lowest survival rate of the 21 most common cancers. As I mentioned, five-year survival rates are less than 4%. This figure has barely changed in nearly 40 years. Pancreatic cancer five-year survival rates lag behind many other European Union countries and are almost half of what they are in the United States, Canada and Australia.

Hon. Members might now understand why we want the hope given by this new drug extended to the 7,900 of the soon-to-be diagnosed 8,500 patients this year, because these 7,900 will be diagnosed with cancer too late and will die within the year. They deserve that extra time that so many others were denied in the past because there was nothing like Abraxane available. They deserve some extra consideration, given our past neglect of this, the fifth biggest cancer killer in our country.

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9.48 am

Jim Shannon (Strangford) (DUP): It is a pleasure to follow the hon. Member for Lancaster and Fleetwood (Eric Ollerenshaw). His Adjournment debate last week is still fresh in the minds of all hon. Members here. I also thank the hon. Member for Mid Derbyshire (Pauline Latham) for bringing this matter to the Chamber for consideration. Many learned hon. Members will speak today and make a massive contribution to this debate. I look forward to their contributions.

By 2020, one in two people who hon. Members meet in the street will be affected by cancer. That is the magnitude of the issue. The hon. Gentleman passionately advanced the appeal on behalf of those with pancreatic cancer. I will not repeat what he said, but I will speak about pancreatic cancer because I know a number of people who have been affected. The hon. Lady referred to her brother, and my father had cancer on three occasions. The skill of the surgeon’s knife, the care of the GP and nurses, and the prayer of God’s people all contributed to his reaching 84 years of age, which is marvellous given that he had his first experience of cancer at the age of just over 60.

The shocking statistic of one in every two people hits home to each of us and gives us the impetus to contribute today and to plead for the cancer drugs and the help that we need. If we cannot see those changes today, when will we see them? Last Friday night I held a public meeting in my constituency on cancer services at the Ulster hospital in Dundonald, which is the closest hospital to me. We are seeking a modern cancer care centre. As an elected representative, I know so many people in my area who have passed away due to cancer, but I know so many more people who are being diagnosed with cancer. I am sure that the situation in Strangford is no different from the situation in any other constituency. Every day in Northern Ireland 25 new people are diagnosed with cancer, which equates to 1.3 people a day in my constituency of Strangford and 1.3 people in the neighbouring constituency of the hon. Member for North Down (Lady Hermon). The figures also reveal that in Northern Ireland the overall rate of cancer diagnosis climbed by a 10th between 1993 and 2011, which is a clear statistical indication of the problem. In 1993, some 370 people per 100,000 were diagnosed with the disease, which increased to almost 405 per 100,000 in 2011. Overall UK figures show that 331,487 people were diagnosed with cancer in 2011, rising from 329,547 in 2010.

The most common form of cancer in Northern Ireland is breast cancer, with some 1,300 cases in women and 340 deaths a year. There are 1,200 cases of bowel cancer and 410 deaths each year. The figures for lung cancer are horrific: 1,100 cases and 910 deaths each year. Lung cancer is almost a death sentence. There are 1,000 cases of prostate cancer and 230 deaths each year. Men are probably worse affected by cancer because we do not acknowledge that we are ill, so prostate cancer needs to be advertised to make men more conscious of it. There are 340 cases of non-Hodgkin’s lymphoma and 130 deaths each year. Those are the statistics only for Northern Ireland, which has a population of just under 1.84 million. That is not even a quarter of the population of London, which gives an idea of the magnitude of the cancer problem. I look forward to the contribution of the

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hon. Member for Basildon and Billericay (Mr Baron) as we have previously discussed the problem, which we both understand.

I recently attended an ovarian cancer awareness event at Stormont. The hon. Member for Scunthorpe referred to ovarian cancer in his intervention, and I am personally aware of the terrible statistics in Northern Ireland. Una Crudden, a wonderful, courageous lady from west Belfast, talked about her experiences at the debate in Stormont last Monday. She was one of five people diagnosed in her area. The other four are dead, and she is the last one to survive. We were all touched and shocked by the figures and by her presentation, which knocked it home to all of us that there is a desperate need to lift the profile of ovarian cancer.

As we all know, early detection saves lives. The fact is that, if there is an early diagnosis, up to 90% of women with ovarian cancer could survive for five years or more. The survival rate for ladies diagnosed with ovarian cancer in my Strangford constituency, and in the local Ards borough council area, is no more than 36%. Again, those figures are horrific and horrendous. Many women would never dream that if they had a swollen stomach or pain, or if they always felt full, it could be ovarian cancer. Each year, more than 7,000 women are diagnosed. If detected early, the survival rate can be as high as 70%, but sadly many people simply put the symptoms down to irritable bowel syndrome. Early detection makes a difference, and I stated at Stormont that we need an awareness scheme not unlike the scheme that I supported in a Westminster Hall debate in 2011. I cannot recall who the Minister was, but that debate led to an initiative in England to raise awareness of ovarian cancer. That scheme has undoubtedly saved lives, for which the then Minister and the Government should take credit. A lady with ovarian cancer was over at Stormont last week, and she was very grateful for what the Government have done.

As the hon. Member for Lancaster and Fleetwood (Eric Ollerenshaw) said, it is important to re-emphasise the treatment and drugs that are available for pancreatic cancer. I was contacted by Pancreatic Cancer UK about its “Two More Months” campaign. Would we not all love to have another two months of life to interact with our family and put our affairs in order? Pancreatic cancer has the lowest survival rate of the 21 most common cancers. Five-year survival rates are less than 4%, and the figure has barely changed in nearly 40 years. Pancreatic cancer five-year survival rates lag behind those in many other EU countries and are almost half of the five-year survival rates in the US, Canada and Australia.

As the hon. Gentleman said, most pancreatic cancer drugs are expensive, but they are vital to those with pancreatic cancer. Will the Minister talk about ongoing drug trials and the drugs that are available? What steps have been taken to reduce the price of those drugs? The drugs range in price from £21,000 to £100,000 per year per person. I am the first to say that we should make those drugs available, and I am sure everyone here is of the same mind. At the same time, there have to be discussions with the pharmaceutical industry to see what it can do to reduce those prices, too.

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Only 1% of the total research spend of National Cancer Research Institute partners is directed at pancreatic cancer, which underlines the dire need in that sector. Some £3,613 per death per year is spent on breast cancer—I am not saying that that money should not be spent on breast cancer—compared with £553 per death per year on pancreatic cancer. Some 50% of pancreatic cancer patients are diagnosed as a result of emergency admission, which is nearly twice the rate for all other cancers combined. Patients diagnosed as a result of emergency admission, compared with other routes to diagnosis such as routine GP referral, have significantly lower rates of survival.

Earlier this year, as the hon. Member for Lancaster and Fleetwood said, Abraxane, in combination with standard chemotherapy and Gemcitabine—my pronunciation is probably wrong, but I have a Northern Ireland accent, so I hope Members will excuse me—was licensed for use in patients in the UK and Ireland with metastatic pancreatic cancer. Abraxane has been described as the biggest advance in pancreatic cancer treatment in almost two decades, which is good news, given that survival rates have barely changed in 40 years. As Abraxane has not yet been approved by NICE, however, it is not yet available on the NHS. I repeat the hon. Gentleman’s question: when will Abraxane be available? If the tests show that the drug is effective, it should be made available as a standard treatment. Pancreatic Cancer UK is keen to ensure that patients are able to access Abraxane through the Cancer Drugs Fund, and I understand that a decision is due within the next couple of weeks. Will the Minister outline her thoughts on the drug?

I could mention many other cancer drugs, but in my last brief moments I ask the Minister to consider a UK-wide strategy. I suggested such a strategy in the Adjournment debate last week, and it is important that we do not consider such drugs regionally. We have expertise in the different regions of the United Kingdom of Great Britain and Northern Ireland, which includes Scotland, Wales, Northern Ireland and England, but it is time that we had a strategy that brings everything together across the whole UK on an equal basis so that we can make the drugs and treatment available. The strategy should include regional assemblies promoting awareness among the general public.

I suggest that we have refresher courses for GPs. One of the issues that has emerged recently—it is not a criticism, because I am not a person who likes to criticise; it is simply an idea for how we can make things better—is that GPs are not always totally aware of issues. The hon. Member for Mid Derbyshire said that her brother went to the GP three times, and we can all give similar examples from our own constituencies. The refresher courses would ensure that the latest criteria and pro forma for testing were entrenched in GP minds, so that they were clearly thinking about what the patient’s problem could be at its worst. Many cancers that are curable, such as melanoma, must be detected early. If they are not detected early, they are no longer curable but deadly. That is the reality. It is scary to think that in six years, half of the people in this room will get a form of cancer during their lifetime. Something must be done and today must be the first day of a new strategy and new moves to beat cancer.

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10 am

Mr John Baron (Basildon and Billericay) (Con): I, too, congratulate my hon. Friend the Member for Mid Derbyshire (Pauline Latham) on securing this important debate.

I will focus my remarks on the importance of early diagnosis, but in many respects we have already won that debate. In recent years, there has been a general awareness of that issue’s importance, so I will also focus on the importance of accountability within the NHS in ensuring that the measures introduced to encourage early diagnosis are followed through by NHS England. I speak as chairman of the all-party group on cancer, which has long recognised the importance of early diagnosis—we call it cancer’s magic key. There are very few magic keys in life that open doors to untold riches, but that key exists for cancer with early diagnosis.

Initially, we may need to be reminded of the scale of the problem. Members have already alluded to some of the statistics. The Government’s figures and many independent studies suggest that if we matched European averages on survival rates, we could save 5,000 lives a year in this country. Only a month ago, the OECD published a further study, which showed that we could save up to 10,000 lives a year if we matched international averages. That is the scale of the issue.

My hon. Friend the Member for Strangford (Jim Shannon) rightly suggested that the figures, which I think are from Macmillan Cancer Support, show that within 10 years, one in two people will be diagnosed with cancer during their lifetime. Another shocking statistic that illustrates the scale of the problem is that one in four cancers in this country is first diagnosed as late as at A and E, when it is, in far too many cases, far too late to treat. Rarely can we define the scale of a problem as precisely as that. We are only talking about averages here, but thousands of lives depend on our ability to come together—not just Parliament, but the cancer community as a whole and the NHS—to drive forward initiatives to promote earlier diagnosis and thereby raise survival rates.

One or two colleagues will remember that the all-party group first looked at the issue back in 2009, when we produced a report looking into cancer inequalities. We found that the NHS stood as much chance as any other health care system of getting patients who made it to the one-year point to the five-year point. Where the system failed, however, was in getting them to the one-year point. That suggested that the NHS was as good at treating cancer patients as anyone else, but was poor at detecting and diagnosing cancer in the first instance, and that accounted for why we were behind on cancer survival rates and averages.

All the evidence clearly showed that the NHS treated patients as well as any other system after the one-year point, but we fell down in getting them to it, and we never made up that gap. There are always dangers and pitfalls with comparisons—in France, for example, we are comparing with four or five cancer centres of excellence—but by and large the figures are robust in suggesting that we have a major problem with our survival rates.

What is the remedy? It could have been to bombard the NHS with even more targets on this, that and the other, such as better training for GPs or other initiatives,

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but we thought that there were enough targets in the system. We came up with the idea of putting one-year and five-year survival rates up in lights, broken down by clinical commissioning group—or primary care trust, as they were then. That is important, because we all know that late diagnosis makes for poor survival. Showing those survival rates at a local level would clearly show which CCGs were failing on early diagnosis. As the report and all the evidence shows, early diagnosis makes for better survival rates, particularly at the one- year level.

We have campaigned long and hard on the issue, and I am pleased to say that the Government have listened. There have been two big reforms of the health care system. One was the reorganisation, which I will not go into, because not all of us were as supportive of that as some might have liked. The second was the focus on outcomes, which will have the longer lasting effect, to the benefit of patients. That focus put the one and five-year survival rates in the NHS outcomes framework, which sets the parameters at a national level.

The one-year survival rates are in at the local level in the CCG outcomes indicator set. That is good news, because if the managements of CCGs at the bottom of that list are worth their salt—their salaries run into six figures—they will introduce a range of initiatives to boost their one-year figures. That can mean everything from better uptake of screening, to better prevention and awareness, to more diagnostics and primary care, to better GP training. It can be a whole host of initiatives—not in isolation, but taken together.

The bottom line is that it is incumbent on the management of a CCG with one-year figures at the bottom of the pile to get their act together and to introduce initiatives to encourage early diagnosis. If those initiatives are right and that early diagnosis is pushed forward, the one-year figures will rise. The mathematicians in the room will appreciate that if the low-hanging fruit on averages—the low figures at the bottom of the table—is picked off and those managements raise their game, that will have a disproportionate effect when it comes to averages for the group as a whole.

If we as a country are seriously going to set ourselves the target of saving an extra 5,000 lives by 2015, which would bring us only up to the average, and of perhaps exceeding that thereafter, we have to focus on how we can drive forward early diagnosis at a local level. One hopes that it all then becomes self-fulfilling, in that once the poorer CCGs start raising their game, others will do likewise, because no one will want to be at the bottom of the pack. That is why we as an all-party group have been delighted with the Government’s putting the one and five-year survival rates in at the national level, and the one-year survival rates in at the local level.

I will not muddy the waters by reminding everyone that because the population sizes of CCGs are smaller than those of PCTs, we have had to introduce some proxy measures, such as staging and emergency presentations, to complement the one-year figure and add to the overall picture. The bottom line is that we are focusing on early diagnosis through those figures, particularly the one-year figure going in at the local level.

I want to ask the Minister one question about something that she knows we have focused on in the past. The all-party group, the wider cancer community and other

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all-party groups have worked together as a team and should be congratulated, but despite the one-year figures in the CCG outcomes indicator set, the lines of accountability are still unclear. Who will actually ensure that CCGs will be held accountable for the figures? We have the tools, but if we do not use them, there is no point in having them.

Will the Minister provide clarity on what will happen if CCGs are at the bottom of the table year after year? There is no point in having one-year figures that show poor one-year survival rates, and therefore late diagnoses, if nothing happens as a result. Where are the levers of change? Where are the mechanisms to ensure that local managers are brought to account for their poor performance? We need to focus on that. Early diagnosis is important not only because it raises survival rates, but because it, along with the figures, will reduce disparities between CCGs when it comes to cancer. Poorly performing CCGs will have to raise their game, which will also serve to reduce inequalities across the system. It is unfortunately still a fact, at least to a certain extent, that cancer care in this country comes down to a postcode lottery.

Will the Minister please address the central issue of the levers of change—if not in this debate, then subsequently? I appreciate that many such functions are now the responsibility of NHS England and that the Department of Health has taken a step back, but the Government still have a responsibility to the taxpayer to ask questions and to ensure that improvements are followed through. The Minister has been gracious in that she will be formally responding to the all-party group’s report, “Cancer across the Domains”, and a meeting will follow, but we cannot leave such a great opportunity as this debate without raising the issue. I hope she will forgive me for pursuing the matter again, but it helps to keep the focus on the issue in hand.

10.12 am

Sir Paul Beresford (Mole Valley) (Con): I am delighted to be in a position to receive your advice once again, Mr Gray. I congratulate my hon. Friend the Member for Mid Derbyshire (Pauline Latham). She is pushing a subject that I would normally push myself as chairman of the all-party parliamentary group on skin, but I will not repeat what she said. I am delighted to see the Minister here, along with all the usual suspects, including me, who try to persuade her of various things. I am also chairman of the all-party parliamentary group for dentistry and a very part-time dentist. I will refer to and slightly repeat what I said in my Adjournment debate on oral cancer of 13 January and question the Minister’s response.

As I said during the January debate, some 6,000 new cases of oral cancer are reported annually in the UK, with 1,800 deaths each year. It is an appalling, disfiguring disease that affects sufferers’ quality of life. Early diagnosis, which everyone is pushing, can solve many cases, but it must be early. The total number of cases has been rising steadily over the past three decades, with 35% more new cases a year now than 30 years ago. The problem has become so acute that oropharyngeal cancer is the fastest growing cancer in Scotland—the only place for which I could find figures—but it is also a huge problem in the rest of the UK. The British Dental Association said:

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“No other cancers have shown such a significant increase in their incidence. Furthermore, treatment of many cancers is showing impressive improvement in survival, but oral cancer continues to have high death rates.”

There are four factors that would help to restrict or perhaps even to defeat the disease. The first is early diagnosis through education of clinicians and increasing patient awareness, which greatly improves the opportunity for effective and positive treatment. The other three are purely preventative. Carcinogenic substances such as betel nut and, much more commonly, tobacco are major factors in oral and other cancers. Excessive alcohol, particularly combined with tobacco smoking, is a huge causative factor. We are all well-versed in and applaud the actions of various Governments to persuade people to reduce alcohol intake and to secure, hopefully and eventually, a collapse in tobacco usage.

I will concentrate on the human papillomavirus, which I touched on during the debate on 13 January. I want to refer to the two main ones—there is a huge family—that cause particularly unpleasant cancers throughout the body. We know about cervical cancer and the related penile cancer, but there is also oral cancer. The latest figures that I quickly managed to find on cases of HPV-related cancers for the UK are from 2009, when 7,538 females and 6,484 males were affected. It is not quite 50:50, but it is getting there.

In 2010, 2,016 males and 2,253 females died in the UK as a result of HPV-associated cancers, including cervical, penile, vaginal, vulval, laryngeal and oral. For males in the UK, the greatest proportion of new cases and deaths were as a result of oral cancer. In females, oral cancer is a relatively close second to cervical cancer. The number of annual cases of HPV-related cancers in men is rising significantly and it is not just oral cancer. Indeed, if recent trends continue, annual cases of HPV-positive oropharyngeal cancers may surpass annual cases of cervical cancers by 2020.

This country, along with several others, has an inoculation programme for HPV. A full inoculation programme would, in a manner not too dissimilar to that of polio, effectively reduce and then cut out transmission of the HPV virus. It would produce what is known as herd immunity, as has happened in Australia. Here, however, HPV inoculation is available only for girls and not for boys. The Minister correctly pointed out on 13 January that the Joint Committee on Vaccination and Immunisation, after considering the matter at two meetings in February, will be reporting later this month, hence my pre-emptive strike. She also stated that the JCVI agreed in October last year to set up a sub-committee on HPV vaccination to assess, among other things, extending the programme, as a priority, to men who have sex with men—I do not quite see the relevance of that—to adolescent boys or to both. Obviously, I hope that an inoculation programme for boys and girls should be made available and promoted.

In my area of Surrey, where parents take health and health protection seriously, only 60% of the girls who could and should be receiving the HPV vaccine do so. Assuming a 50:50 split of boys and girls at inoculation age, only 30% of the Surrey population that could and should be inoculated are being inoculated. A full spread of inoculation would, as with polio, bring herd immunity over time. It is irrelevant whether these kids grow up to pass on the HPV virus by heterosexual or homosexual sex. What is important is that, whether the JCVI agrees

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or not, the Government take early action, as Australia has done. I put it to the Minister that it is not fair, ethical or socially responsible to have a public health programme that leaves 50% of the population vulnerable to infection just because the vaccine is not made available to boys.

As I said, my speech is a pre-emptive strike, and I wait to hear what the JCVI and the Minister have to say.

10.19 am

Grahame M. Morris (Easington) (Lab): It is a pleasure to serve under your chairmanship, Mr Gray. I congratulate the hon. Member for Mid Derbyshire (Pauline Latham) and apologise for the discourtesy of my being late for the start of the debate.

It is an important subject and I am grateful for a few moments to raise with the Minister an anomaly that affects sufferers of brain cancer and to highlight the dislocation caused by the reorganisation of the commissioning of cancer services. The hon. Member for Basildon and Billericay (Mr Baron) highlighted the tension between organisation and outcomes. That is relevant to the issue I am raising, because of the hiatus that resulted from the reorganisation of the commissioning of cancer services, which came out of the Health and Social Care Act 2012; and it follows the theme of the importance of early diagnosis and treatment set out by the hon. Members for Strangford (Jim Shannon) and for Lancaster and Fleetwood (Eric Ollerenshaw).

University college London’s national hospital for neurology and neurosurgery, in Queen square, is the UK’s largest dedicated neurosurgical hospital. It is not only a UK centre of excellence, but a centre of excellence within Europe. For more than 150 years it has provided treatment and care for conditions including cancer affecting the brain. It is globally recognised. In October 2012, the hospital enhanced its services to cancer patients by the acquisition of one of the new advanced radiotherapy systems that we know as the Gamma Knife radiosurgery machine. I have been to see one of them at St Bartholomew’s hospital, and if the Minister—or any other hon. Member—has not seen one, I recommend making such a visit. It is an incredible piece of kit.

Before April 2013, when the new NHS England took over responsibility for commissioning radiosurgery, the national hospital was using its Gamma Knife to treat NHS patients with brain cancer. On 1 April, however, NHS England informed the hospital that it could no longer treat NHS patients with its Gamma Knife and that all patients waiting for treatment should be transferred to other hospitals. The other hospitals that were identified were run by private health care companies—BUPA and the Hospital Corporation of America. Not surprisingly, the patients concerned—about 60 in total—refused to transfer to other centres, because they would have to engage with new conditions and go through pre-operative checks and scrutiny, and rejoin the waiting list.

That situation makes a mockery of the Health and Social Care Act 2012. When the Government pressed the Act through Parliament, they relied principally on the argument that it would return control of patient care to clinicians and reinforce and enshrine patient choice in the NHS. NHS England has poured scorn on that idea and is exercising control over where patients

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can be treated. There is no choice for patients and certainly no choice for brain cancer patients who need immediate treatment.

Fortunately for the patients I have mentioned, there is good news. The national hospital is not as callous and cold hearted as NHS England, and it decided to treat them anyway. Some 60 patients have been treated since April. However, that has not dealt with the basic problem. They were treated there because it was their choice, and their clinicians’ choice, and despite NHS England’s refusal to pay for them. I should be interested in the Minister’s response. Will she give me a guarantee in good faith that she will look into that appalling situation as a matter of urgency?

10.23 am

Luciana Berger (Liverpool, Wavertree) (Lab/Co-op): It is a pleasure to serve under your chairmanship again this morning, Mr Gray. I congratulate the hon. Member for Mid Derbyshire (Pauline Latham) on securing the debate, and thank her for sharing her personal connection with its subject.

Every two minutes someone in the UK is diagnosed with cancer, and more than one in three people in the UK will at some time develop some form of cancer. One in four of them, sadly, will die of it. Cancer touches every community, without exception. Its reach is wide and its impact devastating. We have won many important victories in our battle against cancer, but there is a long way to go to ensure we are diagnosing it earlier, treating it more effectively, and preventing it in the first place. Many hon. Members have focused on those things in the debate, and I want to discuss them.

Detecting cancer early can make a real difference. When cancer is diagnosed at an early stage, the treatment is often simpler and the outcome is more likely to be positive. The hon. Member for Strangford (Jim Shannon) shared some startling statistics about the impact of early detection on ovarian cancer survival. Developments in cancer screening and increasing efforts to promote public awareness, such as the Be Clear on Cancer campaigns, are welcome. On Saturday, I saw the great work being done by those campaigns when I joined a team at a shopping centre in Liverpool to raise awareness of ovarian cancer in women.

Encouraging people to visit their GP sooner rather than later if they have any symptoms of concern is a simple message that can make a big difference. However, we have further to go to ensure that GPs are getting the training and support that they need to help them identify cancer signs and symptoms. Several hon. Members have raised concerns this morning about the amount of training of that kind that GPs receive. I hope that the Minister will respond on that issue in particular. I share the alarm expressed by the hon. Member for Basildon and Billericay (Mr Baron) about the fact that too many cancers are detected in accident and emergency.

Improvements at the first point of contact are not enough if, once cancer is suspected, people are not seen quickly enough by a specialist. Before Christmas there was concern at the news that in as many as half of cases the Government are missing their target for 95% of people with suspected cancer to be seen by a specialist within two weeks. It was right that Labour introduced the two-week cancer guarantee. We also left plans in place to speed up diagnosis, but unfortunately it appears

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that focus has drifted a bit from that important part of the fight against cancer. I am keen to hear the Minister’s comments on what further steps the Government are taking to improve early diagnosis.

If cancer is diagnosed, people need to feel safe in the knowledge that they are going to receive the most effective treatment possible, as quickly as possible. Many hon. Members expressed concern about that this morning. The hon. Member for Basildon and Billericay said that if we reached the average European survival rates we would save an additional 5,000 lives. I think that we can do better than that. Despite improvements in survival and mortality in recent decades, cancer outcomes in England remain poor when compared with the best outcomes across Europe. The hon. Members for Mid Derbyshire and for Lancaster and Fleetwood (Eric Ollerenshaw) mentioned the Cancer Drugs Fund and raised the question of its future, and I share their concern.

In more than 90% of cases when cancers are cured, it is as a result of surgery or radiotherapy. That is where our focus and resources should be directed. I welcome the Government’s recent focus on radiotherapy, and, in particular, on access to intensity-modulated radiation therapy. Last week I visited the Clatterbridge cancer centre in Merseyside, which treats 26,000 new patients every year, and saw how cutting-edge treatments are positively affecting patients’ lives.

Last week, however, we heard that the Prime Minister’s pledge that, from April 2013, all cancer patients would receive the advanced radiotherapy treatment they need, where it is clinically appropriate and cost-effective, has not been met. A less than glowing report published by Cancer Research and NHS England last week said that

“more needs to be done”

to achieve the Prime Minister’s guarantee. The report describes how momentum has been lost during the transition resulting from the NHS reorganisation in England, and it identifies a number of challenges on which I hope the Minister will comment.

One concern is that ageing equipment is preventing centres from keeping pace with innovation and providing advanced techniques. Another key concern is about deficiencies in the numbers of staff in crucial positions such as physicists, therapeutic radiographers and clinical oncologists. When I visited Clatterbridge last week, I heard first hand from the management how they are struggling to get physicists in the hospital.

There is also concern about the shortfall in radiotherapy work force capacity across the services, which impinges on the ability to deliver advanced techniques and innovate. On the number of radiotherapy treatments administered per 1,000 patients, we are well off the pace compared with other parts of Europe. While advances are being made, the pace at which innovations have been adopted across the NHS has been inconsistent. In Liverpool, cancer mortality rates are twice that of parts of London. Clearly, we still need to do much more about inequalities in access and outcomes for cancer patents. I hope that the Minister, in her response, will share with the House the Government’s plans in that regard.

Our battle against cancer will not be won with treatment alone. As the title of the debate suggests, we also need to look at prevention. More than half of all cancers

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could be prevented if people adopted healthy lifestyle choices such as stopping smoking, eating a healthy diet and exercising. I will focus on each of those in turn.

On smoking, great progress has been made in the past decade, but a quarter of cancer deaths are still linked to tobacco and smoking is by some margin the largest single cause of cancer in the UK. About 20% of our population smoke. That is down from 27% in 2000, but that figure is still too high. For every 1% decline in smoking prevalence, we could prevent about 3,000 deaths. Last month, Parliament voted in favour of an amendment to make Labour’s proposal of a ban on smoking in cars with children in them a reality. That great step forward will protect children and, ultimately, create a shift in smokers’ behaviour.

We are glad that the Government have agreed to standardised packaging; we look forward to Sir Cyril Chantler’s review. We are also pleased that the Government adopted our proposal to ban proxy purchasing of cigarettes. However, we must maintain momentum and ensure that those three victories are not pursued in isolation, but are part of a much bigger ambition. I hope that the Minister will share what more her Department is doing to reduce the number of smokers and smoking-related deaths, specifically in relation to the cancers that we are discussing.

Obesity is the second area for prevention and some of my biggest concerns are about the Government’s approach to tackling that. The voluntary responsibility deal stands little chance of delivering the fundamental change needed to improve our national diet. We need action that will impact on the whole population rather than the current piecemeal scheme that works on a product-by-product basis.

I was concerned to hear in the press reports relating to the World Health Organisation’s position on reducing our consumption of sugar, which leads to obesity. If what we read was correct, the view was that the Government might ignore that expert guidance. I hope that the Minister will respond to that and outline specifically what her Department is doing to tackle the obesity crisis in order to reduce cancer prevalence, because so many cancers are connected to obesity. On physical activity, to secure significant improvements in tackling the main causes of cancer, we need to see a fundamental shift in our nation’s behaviour.

Jim Shannon: To step back one sentence to the hon. Lady’s comments on better diet, and the need to have that at an early stage, many education authorities across the United Kingdom—they are doing this in Northern Ireland—are trying in schools to address children’s diets and the relationship of that to their parents and their family budget. Does she feel that education and health can play a joint role to help get the diet right at an early stage, which would prepare children for adult life?

Luciana Berger: The hon. Gentleman makes an important point about the role of education. A real intergenerational role can be played in education. If we educate our students and young people, they can play a role in informing and educating their parents and grandparents too. Some work has been done on that, but more can be done. I am concerned that when children start school, about 10% are obese or overweight,

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yet when they get to year 6, about a third are obese or overweight. That is a shocking statistic that we need to address urgently. I am working with my colleagues who shadow education on that and I hope that the Government are looking at what more can be done to affect the lifestyle and food choices of our young people to give them the best chances in life. A child with obesity will live on average nine or 10 years less than a child who is not obese, which is of serious concern and I thank the hon. Gentleman for making his point.

Labour is putting physical activity at the core of its public health policy. The easiest lifestyle change to make is moving from inactivity to activity and, once achieved, people can begin to feel better about themselves and more in control, and can then make better choices on smoking, drinking and eating, yet more than two thirds of our population fail to meet the minimum recommended levels of physical activity a week. I am concerned about the Government’s cuts, which have led to a reduction in local leisure services, which I have seen locally. The end of free swimming, for example, serves only to create further barriers to participation in physical activity. I would be interested to hear from the Minister on what the Government plan to do about that.

On prevention, the hon. Member for Mole Valley (Sir Paul Beresford) raised some important questions on vaccinations, specifically the HPV vaccination. I hope that the Minister will respond to those points.

Undoubtedly our national fight against cancer is going in the right direction, but is that enough? I do not think that it is. We have had a thorough debate this morning, with interesting and varied contributions. Collectively, we have touched on what needs to happen. We need earlier diagnosis, swifter access to the most effective treatment and an even stronger focus on prevention. We need bold, ambitious and concerted action on all three counts to ensure that we win not just the battle, but the war. I look forward to the Minister’s reply.

10.36 am

The Parliamentary Under-Secretary of State for Health (Jane Ellison): It is a pleasure to serve under your chairmanship, Mr Gray. We have certainly had a wide-ranging debate. I think I would need another hour and a half to respond to all the points made, but I hope that hon. Members present know me well enough to realise that if I am not able to respond to their points in detail, I will get back to them after the debate. The shadow Minister and I have many opportunities to debate the wider public health issues, so I will devote most of my response to specific points, particularly those made by my hon. Friend the Member for Mid Derbyshire (Pauline Latham), who called for the debate. I will, however, try to touch on all points made in some way.

I congratulate my hon. Friend the Member for Mid Derbyshire on securing the debate. She always speaks movingly on this subject, not least as a result of her personal experience. She has been a tireless campaigner on behalf of her constituents and others, in particular with regard to melanoma. Before I respond to her specific points, I would like to restate the Government’s ambitions, as those apply across the debate. All Members have referred to this, but improving cancer outcomes is a major priority.

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We aim to save an additional 5,000 lives a year by 2014-15 and halve the gap between cancer survival rates in England and the best in Europe. As my hon. Friend the Member for Basildon and Billericay (Mr Baron), who is the chair of the all-party group, said, we are not as good as we could be, so there is great effort and commitment to make us better. Our debate has been on how we do that, not why that is the right ambition. To achieve that, more than £750 million has been committed to deliver our cancer outcomes strategy, which includes £450 million to support earlier diagnosis of cancer by improving public awareness and GP access to key diagnostic tests.

Early diagnosis came up many times during the debate. It is worth making the point that most GPs will see relatively few cancers in a typical year. Because we all know someone affected, whether in our family or our group of friends, we imagine that GPs see cancer all the time, but they do not; certainly, they do not see many of the rare ones. The challenge of early diagnostic testing and training to get those tools into GPs’ hands is serious, because that is also a challenge for GPs, of whom we ask a great deal. That is why it is important that the Government are putting money and effort into those early diagnostic tests. That money also goes towards paying for extra testing and treatment in secondary care.

I want to touch on the architecture of the system. It has been mentioned a few times and hon. Members have expressed concerns about the changes to the system. The first general comment I would make is that the main thrust of the debate is that we can do a lot better on cancer, which would seem to lead to the conclusion that the old system was not necessarily delivering the outcomes we wanted. Although caution is understandable when major change has happened, Members are perhaps being unnecessarily gloomy about the changes that can be delivered under the new architecture for the NHS and the health system. Many of the criticisms that have been made this morning were made under the old structures as well.

Cancer is a priority for NHS England. Clinical expertise is at the heart of commissioning decisions and NHS England has established a range of clinical reference groups, and is leading on delivering clinical strategy. NHS Improving Quality is working with the strategic clinical networks and has played a key role in working with the NHS on early diagnosis, especially on awareness campaigns. NHS England has also created national service specifications for a wide range of cancers to ensure consistent, high-quality service across England.

Grahame M. Morris: I know that the Minister is trying systematically to get through all the points that were raised, but I challenge the point that there is no fundamental difference under the new arrangements. There really is a fundamental difference in the commissioning of specialist cancer services. Those were previously commissioned on a local basis, effectively, by primary care trusts coming together in London, but now it is done by NHS England. That has caused a huge hiatus for the patient cohort I identified. Will she agree to look at that and, if necessary, meet me and a group of clinicians to highlight the nature of the problem?

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Jane Ellison: The point I was making was not that there has not been change—of course there has—but that it is far too early for hon. Members to be drawing the conclusions they have about the new system. The Government have put a great strategic priority on cancer and NHS England has been charged with delivering against a mandate and against that strategic priority. I take the hon. Gentleman’s point, but NHS England leads on this subject and is quite clear about the priority that the Government and Parliament put on it. I want to make that point. I understand why people have expressed concern.

Grahame M. Morris: Will the Minister give way?

Jane Ellison: No, I am going to press on, because I will have no chance of getting through all the specific points that were raised if I get into a debate with the hon. Gentleman.

I turn now to skin cancer. I should mention that NHS England has recently published a service specification—I mentioned that it has those across a number of cancers—on adult skin cancer services. That sets out what the NHS must have in place to offer high-quality skin cancer treatment, care and support. I am happy to send that to my hon. Friend the Member for Mid Derbyshire if it would be useful.

My hon. Friend and other hon. Members expressed great interest in what we are doing to ensure earlier diagnosis. It goes without saying that identifying cancers early has a huge benefit in terms of improving outcomes for individuals and for the whole health system. That is why we have committed over £450 million to improve diagnostic services. Later, I will consider in more detail prevention in the context of public health, but it is worth making the point that although diagnosis and treatment are vital, prevention is the biggest prize of all, because we can stop people even having to get to the point of being diagnosed. The more work on awareness and prevention that hon. Members and local councils—particularly given their new public health leadership role—can do, the more we will save the costs in money and in human misery.

Access to early diagnosis is most effective when people visit their GP early. That is why we are running a local Be Clear on Cancer campaign specifically on melanoma in the south-west in April and May, to raise awareness before the summer. We will evaluate the programme as part of our wider programme of Be Clear on Cancer campaigns, which, as the shadow Minister said, has done so much good work in so many areas.

We are also working with GPs to ensure they have the information they need. Cancer Research UK and the British Association of Dermatologists have developed a GP skin cancer toolkit. Evaluation shows that it has reached almost 10,000 GPs and helped to increase confidence in referring suspicious lesions.

My hon. Friend the Member for Mid Derbyshire spoke quite a bit about the NICE approval process, which was also mentioned by my hon. Friend the Member for Lancaster and Fleetwood (Eric Ollerenshaw). I know that my hon. Friend the Member for Mid Derbyshire is concerned about access to NICE’s approval of drugs for late-stage melanoma. As she knows, our priority has to be to get the best possible results for all NHS patients

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with the resources we have. NICE’s methodology is the best guide we have to the clinical value and cost effectiveness of different treatments.

We have asked NICE to look at the way drugs are assessed so that patients can get the treatments they need at the best value for the NHS, and the price the NHS pays is more closely linked to the value a medicine brings. NICE will carry out a full public consultation before implementing any changes to its methodology. I understand that NICE plans to launch its consultation later this month, and I urge all Members to contribute. I am sure they will, as many Members present take a significant leadership role in Parliament on cancer.

I turn now to the particular concerns my hon. Friend the Member for Mid Derbyshire raised about yervoy or ipilimumab. Although NICE has recommended yervoy as an option for treating advanced melanoma in people who have received prior therapy, I understand her concern that it should be approved as a first-line treatment. I have been advised that NICE is currently considering yervoy as a treatment for previously untreated stage three or stage four malignant melanoma. Although it is not appropriate for me to intervene in an appraisal, I have been advised that NICE’s initial draft guidance, issued on 25 February, recommends yervoy only in the context of clinical trials, as I outlined to my hon. Friend at Health questions recently.

That is not a refusal, however. Instead, it reflects NICE’s view that the technology is promising but there is insufficient clinical evidence for the appraisal committee to recommend its use as a first-line treatment at this stage. However, I hope I can reassure my hon. Friend that the manufacturer is currently conducting a further trial, which, along with other research, is due to complete in 2016. Once that research is available, I am sure NICE will wish to reconsider its guidance. NICE is currently running a consultation on its interim guidance. Again, I would also recommend that hon. Members, and particularly my hon. Friend the Member for Mid Derbyshire, make their views known to NICE. I always make a point of referring Parliament’s views, as expressed through debates such as this, to the relevant people making the decisions. I did so the morning after the debate on pancreatic cancer last week, when I sent a personal letter with a copy of Hansard to the decision makers concerned to make them aware of Parliament’s views. I always undertake to do that where relevant.

In the interim, I understand that NHS England’s national Cancer Drugs Fund panel has considered including yervoy for first-line treatment of advanced melanoma. The panel has decided to refer yervoy to NHS England’s chemotherapy clinical reference group for consideration for inclusion under baseline commissioning. If that is agreed, clinicians would be able to prescribe the drug for use in first-line advanced melanoma according to the commissioning policy that would be developed by NHS England. NHS England will make its decision known in due course.

I also want to reassure my hon. Friend the Member for Mid Derbyshire that NICE is currently developing a clinical guideline on melanoma. It expects to issue final guidance in July 2015. I hope that gives her some sense that a lot is going on this area. We will endeavour to make sure that we keep her updated.

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I will have to canter through some of the other points, Mr Gray, but as so many were raised I hope you will be generous and give me a little time to do so. I turn first to the points made about the Cancer Drugs Fund and the concern that no new medicines are being accepted, which my hon. Friend the Member for Lancaster and Fleetwood raised. Just for the record, so far in 2014 the panel has added a number of drugs to the national list—I will probably stumble over pronouncing some of them, but I hope the House will forgive me. They include kadcyla for breast cancer, tafinlar for melanoma and radium-223 dichloride for prostate cancer.

I turn now to the topic of CCG accountability, which I have often discussed with my hon. Friend the Member for Basildon and Billericay, who chairs the all-party group on cancer with such vigour and passion. I entirely share his view that it is a critical point. He has articulated all the wins over the years in making sure that early outcome indicators are part of the CCG outcomes indicator set, and the importance that early outcome indicators have for early diagnosis and more information about survival rates, which we all want to see. It is important to remember that NHS England can intervene where a CCG is found to be failing in its duty to secure high-quality outcomes, although I accept that that is a high-level intervention. I think my hon. Friend is driving at what we will do with the information when we get it. NHS England is considering how it can better respond to the functions in the outcome indicator set and how all permissions and system structures work together to improve outcomes.

This is the first time we have had this indicator set and I know that my hon. Friend has talked to the national clinical director for cancer, Sean Duffy, about this, which is the right thing to do. I will also meet him to talk about it. It is helpful that Parliament returns to the issue regularly because it helps me to emphasise to NHS England how much store hon. Members set by local outcomes and how important it is for us to have a response throughout NHS England to indicators and outcomes that are not as good as they could be. I accept his challenge, which he knows that I am working on. I am having ongoing conversations about it, but it is always good that Parliament returns to the point and challenges the levers of change.

We have introduced GP inspection, and more and more data will be available to the inspectorate to ensure that it is asking questions not just about what GPs do, but about what they do not do and when we expect them to do more. There are all sorts of ways to challenge the system, and it is ongoing work.

I cannot respond to all the points made by the shadow Minister, but I will touch briefly on one. She referred to a report that highlighted the use of out-of-date equipment. To encourage NHS providers to update existing medical technology infrastructure, the Department established a £300 million fund in March 2012, which is operated by NHS Supply Chain to bulk purchase medical equipment to achieve better prices. In August 2013, NHS Supply Chain announced the signing of a deal with Varian Medical Systems to secure 20 new linear accelerators. More detail is available about that innovation fund and the radiotherapy innovation fund, but I do not have time to go into it now.

As ever, the hon. Member for Strangford (Jim Shannon) is present. He often attends debates and makes forceful points about the need for us to work together. The

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National Institute for Health Research is funded by my Department, so it is focused primarily on England, but I assure him, as I have tried to previously, that the published research is available to anyone. NICE guidance applies formally only to England, but it is available online to all who want to use it. It makes sense for all the Administrations to share that information and expertise, and to ensure that they make use of it when framing their own response.

We have previously discussed human papilloma virus in more detail in this Chamber and during an Adjournment debate on 13 January. My hon. Friend the Member for Mole Valley (Sir Paul Beresford) made many good points about the wider take-up of vaccination to reduce the incidence in females of that and other cancers, and in males. The HPV vaccine was introduced to tackle cervical cancer, which is why the strategy started with girls. He makes a good point about the potential benefits, which are well recognised, of extending that to protection against other cancers, particularly oral cancers.

Since 2008, more than 6 million doses of vaccine have been given in the UK with 87% of the routine cohort of girls completing the three-dose course in the 2011-12 academic year. I was concerned to hear the figure my hon. Friend mentioned from his own area. Hon. Members rightly come here to challenge Ministers about what we are doing, but when there is local information, I urge them also to challenge their local systems and to ask what it being done to bring them up to the national rate. We know that there are challenges about some of hard-to-reach groups, but I am surprised to hear the statistic my hon. Friend mentioned. I urge all hon. Members to recognise that we cannot drive the change solely from Whitehall, and that it is good if they also ask questions about accountability locally.

My hon. Friend referred to the fact that work is continuing through the Joint Committee on Vaccination and Immunisation to look at the matter in more detail. He said that the JCVI is also looking at adolescent boys and men who have sex with men, and highlighted the problem that they do not benefit from herd immunity as HPV vaccination is more widespread among girls. The JCVI is considering whether it is cost-effective to extend the programme to both those groups. The issue is complicated, especially concerning adolescent boys. The evidence base, mathematical modelling and deliberations will take time, but the work is ongoing and it helpful that the House continually expresses its interest.

I recognise that I have not responded specifically to some of the points made by my hon. Friend the Member for Lancaster and Fleetwood about pancreatic cancer, but I responded in the House only last week. I hope he will accept that it is not discourteous to say that my response has not changed substantially since then, but I took the actions I promised last week. He has put on the record his concern about the need to value the additional months of life in a disease that sadly takes people so quickly. Early diagnosis and GP training in that is critical in pancreatic cancer, which is so hard to diagnose. That is well recognised, and I thank my hon. Friend for making his point.

In the remaining few minutes, I cannot respond to all the public health issues raised, but smoking is a factor in so many of the cancers that have been discussed, as the shadow Minister said. Smoking in this country is at an historic low, and has dipped to below 20% of the

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population for the first time. There is a significant legislative programme and the shadow Minister said she hopes we will keep up the momentum. I assure her that I have no option given the programme that we must deliver in the coming year. I look forward to her co-operation. I also look forward to support from hon. Members in the Chamber when we introduce those measures in the House.

It is always good to remind people why leadership on smoking cessation and legislation is so important. It plays a role in prevention, which is important in many areas that hon. Members have highlighted this morning. There is a big role for leadership at local council level because the figures on smoking cessation are extremely patchy throughout the country. We must drive change at local level.

The hon. Member for Easington (Grahame M. Morris) referred to Gamma Knife, and I will respond to him in more detail after the debate if that is acceptable to him. I am sure he did not mean to say that NHS England is callous and cold. Clinicians must make difficult decisions every day on behalf of all of us in balancing competing health priorities. He used those words, but I know he did not mean them in connection with the people who must make the difficult decisions. Many of our clinicians and health leaders must perform difficult balancing acts. Just the challenges made to me as the Minister in this debate this morning would have an enormous cost. We must make difficult decisions all the time about where we can best spend resources to bring the best results for the population. I know that that is at the heart of hon. Members’ concerns.

I thank hon. Members who are present. Many are long-standing champions of particular issues in Parliament and I urge them to continue their awareness-raising work. NHS England will continue to respond to that, as will Ministers. I thank hon. Members for attending the debate this morning.

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Transport Infrastructure (Wellington, Somerset)

10.58 am

Mr Jeremy Browne (Taunton Deane) (LD): Thank you, Mr Gray, for presiding over our debate this morning. It is narrowly focused and not necessarily of interest to many Members of Parliament, but is certainly of interest to the residents of Wellington, Somerset, which is in my constituency, and people in the surrounding communities. To put the matter into context for hon. Members who are less familiar with Somerset, I should say that the principal town in my constituency is Taunton, which has a population of around 60,000. It is the largest town in Somerset and the county town, and there have been some substantial infrastructure development projects there during the last decade or so.

A bridge was built on Silk Mills road—the Silk Mills bridge, which opened in 2005 and replaced a level crossing. That was important in allowing the traffic to flow around the edge of that side of Taunton and was introduced at the same time as a park and ride. More recently, a few years ago, the so-called Third Way bridge opened in Taunton. That alleviated some congestion in one part of town and provided a more direct route across the river.

As we speak, the northern inner distributor road is being built in Taunton, with a substantial contribution from the Department for Transport—central Government are spending in the region of £15 million, supplementing money that has been made available locally as well—to alleviate congestion in the northern part of Taunton. However, perhaps more importantly, the road will allow for the development of an extensive brownfield site near Taunton train station and provide an obvious opportunity for new jobs, new housing and new retail sites in Taunton. All that is conditional on the road that is currently being built and due to be finished next year.

There are always people who would like even more projects to be initiated and funded, but we recognise in Taunton that although the traffic congestion is a serious problem, there has been transport infrastructure investment. It is fair to recognise, of course, that central Government have limited funds and that demand always outstrips the money available.

During this short debate, I want to turn to the second town in Taunton Deane constituency, or borough. About two thirds of people in Taunton Deane live in Taunton, but if the Minister or any other Members were to travel further down the south-west peninsula on the M5, going one more junction beyond junction 25—the principal Taunton junction—and turning off at junction 26, they would come to the second town in Taunton Deane, which is called Wellington. It is well known for the Wellington monument, which overlooks the M5, and it has a population of approximately 10,000, depending on how one calculates some of the outlying parts of the town. It is a substantial community in its own right and has a very strong and proud identity.

The purpose of securing this morning’s debate is to talk about the infrastructure requirements of Wellington. There is a danger, because the town is smaller and is only six or seven miles away from Taunton, that Wellington’s transport infrastructure needs will otherwise be overlooked. I want to discuss two aspects of the transport infrastructure

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that I hope could be improved, if we think in terms of a five-year or 10-year project. We have a vision for improving the quality of life of Wellington residents by upgrading their transport infrastructure. The two elements are, in my view, the two core components of a transport infrastructure vision for Wellington.

The first one is the problem of traffic congestion in the town. I recognise that every Member of Parliament could stand up and identify a town in their constituency where traffic congestion was a problem, but it is becoming more of a problem in Wellington, in part because extra house building is going on in the town. The Cades Farm development has brought forward several hundred houses, which are now occupied, and the Longforth Farm development will have the space for about 500 houses when it is completed. It is only in its first phase at the moment. Obviously, that is adding a substantial percentage population increase to the town of Wellington.

If you were to come a mile or two into Wellington from junction 26 on the M5, Mr Gray—it is a very underused junction, so there is a lot of opportunity for development and it is attractive to people who can access the motorway quickly at that junction—and you were trying to get across to either the northern part of the town, coming in from approximately the east, or to places north of Wellington from the motorway, such as Milverton or Wiveliscombe, you would be hugely frustrated. You would have to go pretty much into the centre of the town, into the high street, and then turn right into a road called Longforth road.

That junction and the junction right in the centre of the town become hopelessly congested at peak times. You would almost certainly be stuck, Mr Gray, possibly for one or two phases of the traffic lights, and it would be even worse coming back, if you were coming back from Longforth road and looking to turn left and exit Wellington at that same junction. At peak times, the congestion is becoming intolerable and with the extra house building, the situation will become much worse.

What Wellington residents and I had hoped is that the Longforth Farm development would allow for a northern relief road for Wellington. At the moment, the traffic can flow round the southern part of the town without coming into it, but to get to the northern part of the town or north of it, traffic has to come into the town and out again, so Wellington needs a northern relief road. The Longforth Farm development, which is just getting under way, and will have, as I say, about 500 houses when it is complete, was widely thought to provide the opportunity for a northern relief road as part of the project. That seemed a very sensible trade-off, which would allow people to get around Wellington. I think that Wellington residents, even those who are perhaps uncomfortable with the scale of that development, would have seen that there was a quid pro quo and that there would be benefits for them in having the northern relief road.

Instead, I regret to say, the development of up to 500 houses has a road accessing the development, but it is a dead end—it is a road to nowhere. It means that if the people living in those 500 houses, when they are built, want to go to the northern part of Wellington, only 100 or 200 yards from their homes, they will have to drive out of their extended cul-de-sac into the middle of Wellington, exactly to the junction or junctions that, as I described, are already hopelessly congested at peak

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times. They will then have to drive back out to the north again. There is no northern relief road, just more scope for congestion.

The only beneficial caveat relates to Relyon, which is a major employer in Wellington that makes mattresses. Next time you are going along the motorway, Mr Gray, you may see a lorry with Relyon written on the side. When you are thinking of buying a mattress yourself, you may consider buying a Relyon mattress, and you would be very well advised to do so. It makes very high-quality mattresses and is one of the two big employers in Wellington, along with a company called Swallowfield, which makes aerosols and other cosmetics. We want to keep both those in Wellington. The one advantage of this new cul-de-sac is that it allows Relyon lorries to get out of Wellington without coming into the town centre, because it goes up to their factory. However, it does not allow any residents—any normal traffic—to bypass the town centre.

The first task of all is a northern relief road in Wellington, which we would very much benefit from. There are, essentially, two options—a modest option and an ambitious option. The modest option would be a road that goes into the new Longforth Farm development, but would then exit at Brendon road. It would not, in other words, try and cross the railway line, because as soon as a bridge is put over the railway line, it becomes more expensive and more complicated. It would not bypass as much of the town, but it would bypass the junction of the high street and Longforth road that I discussed a moment ago, which causes difficulties by Waitrose.

The more ambitious option would be a northern relief road that made a slightly broader sweep—there are different options as to where it could go on the map—crossed the main railway and came in at the end of either Wardleworth way, on the other side of the railway line, or possibly further along Station road, towards Milverton.

Either of those options would be an improvement on the current situation. The latter would be a sizeable improvement on the current situation and would set up Wellington for the next generation, because there would then be a southern relief road and a northern relief road. The northern relief road would not go all the way round to the north, but it would take out a substantial proportion of the traffic, and I think that it would allow Wellington’s extra development to be absorbed. It would be a long-term solution, not a sticking-plaster solution. It would stand Wellington in good stead for a considerable time.

The second big infrastructure project in the vision for Wellington’s infrastructure is a train station, and this links to the first point that I was just making about the northern relief road. Wellington is on the main line from Paddington to Penzance—or the line that normally runs from Paddington to Penzance; it is not running there at the moment. It is the main line that comes through Reading and then through Wiltshire, Somerset, Exeter and Plymouth and goes through to Penzance. Wellington did have a station; historically, it was a town with a station, but it has not had a station for many decades. There has been a debate for an extended period—longer than I have been the MP, which is almost nine years—about the feasibility and desirability of Wellington’s having its own train station.

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I recognise that Wellington could not be expected to have a train service that was as frequent as Taunton’s, because Taunton is a much bigger town and virtually all the inter-city trains stop at Taunton, but there are other stops on the line between London and Penzance that are comparable to or smaller places than Wellington. I travel frequently on that line—almost every week—and shall give some examples. The fast service from Taunton to Paddington stops only at Reading, but some of the slower services stop at Castle Cary in Somerset or at Pewsey in Wiltshire, and in Cornwall the service stops at many places that are much smaller still.

It would be possible for there to be a stopping inter-city train—the slower service—stopping at towns such as Wellington. That would not require a diversion—Wellington is on the line; the line runs through the northern part of Wellington. It would require a new station, and the expectation would be that some of the trains in-between the inter-city trains, perhaps those running between Bristol and Exeter or Bristol and Plymouth, would stop in a number of places, including Wellington, and a few—not many, but one or two—of the inter-city trains would also stop at Wellington.

Such a new station would be hugely advantageous, because at the moment people who live by the train line in Wellington have to drive—even though they see the trains going past their front door—either to Tiverton Parkway or to Taunton. If they do not have a car, it is hugely inconvenient for them to get to either of those locations. They would probably need to get a bus into the centre of Wellington. Then they would need to get another bus, from the centre of Wellington to the centre of Taunton, which is 6 or 7 miles away. Then they would either have to walk from the centre of Taunton to the train station in Taunton, which is not at the same place in Taunton as the bus depot, annoyingly, or have to get a third bus, from the bus depot in Taunton to the train station in Taunton. If they allow enough time for those three bus journeys—enough time for contingencies—it is possible that getting the 6, 7 or 8 miles from their home in Wellington to the train station in Taunton would not take much less time than getting the train 150 miles from Taunton to London. That is how much extra time and inconvenience is built in.

To have a few inter-city services a day—I would not expect it to be a service every hour or so—stopping at Wellington, as they do at Castle Cary or Pewsey, would be of transformational benefit to people in Wellington and surrounding areas such as Milverton and Wiveliscombe, which I have mentioned. What would potentially work so well and make this a coherent vision would be building that station as part of the same project that came with a bridge, which made the superior version of the northern relief road possible. In other words, when I was talking about the traffic congestion and northern relief road and about the station, I was talking about not two unrelated projects, but potentially related elements of a project that would transform Wellington.

The project would provide opportunities for some more development in the town. That development would obviously need to be proportional to the size of the town, but the project would allow some reasonable development to take place. It would be hugely beneficial to the residents of the town by alleviating congestion in

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the centre of town. It would be beneficial to the major employers in the town, who would be able to access the motorway better. It would be beneficial to people from nearby communities, who would be able to get through Wellington and out the other side; at the moment, they get stuck in Wellington when they do not even want to be in the town. It would also be beneficial to the people who were able to use the services from that train station.

I conclude by saying that I appreciate that money is a finite resource and we live in straitened times. I am very grateful to the Minister for being willing to respond to what I appreciate is a very limited debate about a very specific project, or two potentially related projects. I hope that the message that I am leaving him is that if we can put in place a vision for this Wellington development that includes those two projects and that is supported by the borough council, the county council, Wellington town council and me as the Member of Parliament, the Department of Transport could look at putting those projects in some sort of future funding plan.

We could look at moving from just talking about the projects in a broad, generic, hypothetical sense to hoping that in one, two, three, five or 10 years we will have a plan that we can put in place, with some funding—not all the funding, but perhaps some—from a central Government pot. That could be used to turn the current situation in Wellington, which is pretty intolerable and in need of improvement, into the vision for the town that would serve its residents so well.

11.17 am

The Parliamentary Under-Secretary of State for Transport (Stephen Hammond): It is a pleasure to see you in the Chair, Mr Gray. I congratulate my hon. Friend the Member for Taunton Deane (Mr Browne) on securing the debate, but it would be wrong of me not to start by saying how saddened I was to hear the news that Bob Crow died in the early hours of this morning. My thoughts are with his family, friends and colleagues. Like many, I will obviously remember him as a passionate advocate of safety on the railways and the well-being of people who work on the railways. Although it is probably clear to everyone that we may have had different opinions on how to run the railways, he was a man who led his organisation from the front and made an important contribution to the debate about how railway services are run in this country. My thoughts and, I am sure, the thoughts of everyone in the Chamber are with his family, friends and colleagues.

I commend my hon. Friend the Member for Taunton Deane for his eloquent and passionate speech. I listened to his opening remarks about the improvements in Taunton and clearly I welcome his support for the improvements that have been undertaken there. Of course, I also commend his realism in recognising that money is tight. That is a helpful prefacing remark.

The economic benefits of good transport are well understood and, in challenging times, transport investment is even more important. As my hon. Friend has pointed out, transport helps to support local communities by enabling businesses to move people and goods more quickly, easily and reliably, which helps them to grow and be competitive; by enabling people to get to work and creating more job opportunities; by supporting local projects and products such as Relyon mattresses,

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for which we heard an admirable advertisement; and by attracting inward investment to towns and cities to make them great places in which to live and do business.

It is useful to remind ourselves—this was implicit in my hon. Friend’s remarks—that the Government inherited not only a fiscal deficit but an infrastructure deficit. In the years leading up to 2010, there was a huge increase in demand on our transport network, but investment failed to keep up with that demand. As a result, nearly half of the respondents to a CBI survey at the time rated the UK’s transport network as well below average. It is to the Government’s credit that, at a time when we are trying to put the public finances in a sound place, we are investing record amounts in maintaining, upgrading and expanding the road and rail infrastructure in this country, investment that will, according to the International Monetary Fund, improve the long-run growth potential and boost demand.

Between 2011 and 2014, we invested £32 billion in roads, rail and local infrastructure, and between 2015 and 2021 we are committed to funding of £56 billion. We ensure that that money goes throughout the country. In the current two fiscal years, the Somerset block funding for road maintenance and highways maintenance will consist of more than £40 million. It is clear that the Government are committed to investing in reliable networks and providing the capacity that towns and cities across the country need.

The severe winter weather that we have suffered has made some parts of the network extremely vulnerable. As my hon. Friend knows, Somerset has had particular difficulties, so it is right that my right hon. Friend the Secretary of State for Environment, Food and Rural Affairs announced last week the publication of an action plan, which contains several transport recommendations. In addition to £10.5 million of funding from the Department for Environment, Food and Rural Affairs and the Department for Communities and Local Government, the Department for Transport is making £10 million of support available immediately to Somerset to enable it to start work on several short-term actions to help secure a sustainable future. As a result, I hope that Somerset will be able to begin to clear the roads of silt and debris, to deep clean the drainage system—that will help the road system—and to repair bridges and other structures. In addition, my right hon. Friend the Secretary of State for Transport has commissioned a review of the resilience of our transport networks. The challenge of the coming months is to get the network back to business as usual, to learn the lessons and to give the right support to the transport infrastructure in counties such as Somerset.

The Government clearly have a role to play in supporting communities through such extreme events and, as my hon. Friend the Member for Taunton Deane identified, in supporting communities with their priorities for transport. However, the days when Westminster decided and dictated to local communities what those priorities should be are over. Local priorities should be identified, and local decisions made, by local communities, local highways authorities and local enterprise partnerships. That is why the Government have committed £2 billion a year over the six years from 2015-16 to the local growth fund, which will be available to LEPs. Those growth deals can provide the resources required to facilitate local communities’ priorities, and such deals may well

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be appropriate for some of the targeted growth priorities that my hon. Friend described. The funding is not ring-fenced, but it will be available to support long-term planning infrastructure, including the transport priorities.

Many hon. Members will be aware that the growth deals are a competitive process, and moneys will be made available to the places that demonstrate the clearest-cut and most convincing arguments for delivering growth. It is important for local communities to engage with their local economic partnerships, and for local authorities and LEPs to work together to shape local priorities. I know that my hon. Friend has been involved in discussions with his LEP, Heart of the South West. I stress how important it is for the ambitions that he has described that the LEP is intimately involved in the discussions and that it recognises and supports his priorities.

I turn to the two interrelated schemes that my hon. Friend has described. He spoke about the congestion in Wellington and the need for a northern relief road to bypass the town centre by connecting roads to the east and the north, which has long been sought. The development that he mentioned will provide much of the road. It will provide access to some of the new residential development and to the factory, and it should reduce HGV traffic in the town centre. As he pointed out in an article last November, however, it will not be a

“proper northern relief road…we have the road to nowhere.”

I understand his concerns about the continuing congestion, delay and air pollution that are caused by the fact that the road is unconnected. He set out two aspirations for a northern relief road: one modest and one—a broader sweep that would cross the railway line—more ambitious. Both those ambitions are excellent examples of the solutions that the local growth fund has been established to support. As far as I am aware, and he may wish to correct me, they have not yet featured in the draft of the LEP’s strategic economic plan. I urge him to engage with the LEP and ensure that it recognises that ambition as a strategic priority. That is a route through which the scheme might be pursued.

Mr Browne: If we were able to bring forward a joint vision for those two projects, would there be any national impediment to Wellington having a railway station? Would the Department for Transport object to that on the basis that it might have implications for other traffic on that line? That might not be an entirely local point, but it would be beneficial to local people if there was not a national impediment.

Stephen Hammond: I will come on to discuss the railway station in a moment, so I will tackle that point shortly. Local pinch point funds, of which there have been two tranches under this Government, have helped with schemes such as the rail route that my hon. Friend mentions. Such problems are likely to be a priority for a future Government, and if such a scheme is re-established in future I hope that he might look at it as a potential way forward.

My hon. Friend is right to say that people in Wellington see the train services going past, but the station was closed in 1964. Wellington is thought to be the largest town on the Penzance to London line that does not have an operational station. I am aware that Mid Devon district council and Devon county council have spoken about how they might work together to re-establish

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local rail links between Exeter and Taunton. I understand that Somerset council has a long-term aspiration to reopen the rail line, but it has yet to identify a suitable service or adequate funding.

To come to my hon. Friend’s essential point, if Wellington station were to be re-established, the issue would be to ensure that a stopping service that called at Wellington did not interfere with the timings for some of the faster services, or with the ambition to provide accelerated services to some of the key markets such as Plymouth, Exeter and further into Cornwall. He is right to say that whatever happened, not all services would call at Wellington. The best way to achieve a semi-fast service that called at Wellington, fitted in with the timetable and allowed faster trains to pass would clearly be a discussion point. I do not see it as an impediment, but it would be a discussion point. I suggest that the next stage is to consider the proposal and to work up a business case, so that that work can be developed in partnership with the local transport body and the LEP. My officials will be happy to provide advice and guidance on how a viable case might be made.

As I have tried to convey in my short speech, I strongly believe that local priorities and local decisions should be made locally. My hon. Friend has made an eloquent case for his local priorities, and one of the main routes through which those priorities might be pursued is the local growth fund.

11.30 am

Sitting suspended.

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Energy Company Obligation

[Nadine Dorries in the Chair]

2.30 pm

Lilian Greenwood (Nottingham South) (Lab): It is a pleasure to serve under your chairmanship for the first time, Ms Dorries.

I am pleased to have secured this debate on an issue that is affecting literally thousands of my constituents and, I know, many more thousands of people in constituencies up and down the country. The debate is timely because last week the Government finally published their consultation document on the future of the energy company obligation.

I do not intend to focus on the Government’s impact assessment, because I want to speak about the effect that changes to the energy company obligation are having on my constituents in Nottingham South right now—constituents such as Ilona, one of the people in fuel poverty that the energy company obligation was designed to help.

2.31 pm

Sitting suspended for Divisions in the House.

2.56 pm

On resuming—

Nadine Dorries (in the Chair): The debate will now finish at 4.26 pm. That means that we will start the wind-ups at 4.5 pm, if that is okay, which gives everyone else an indication of how long they have to speak.

I call Lilian Greenwood to speak.

Lilian Greenwood: Thank you, Ms Dorries for calling me to speak.

I was speaking about my constituent, Ilona. She lives on the Wollaton Park estate in one of the 500 “white bungalows”, or Crane Composite houses, that were built in the 1920s by the Nottingham Corporation as part of a bold experiment in new building techniques. The bungalows are specially constructed, with steel frames and pre-cast concrete walls. They are really distinctive and are now part of a conservation area. However, they are cold and hard to heat.

Ilona suffers from fibromyalgia and chronic sinusitis, and she desperately needs a warm house; what she has is a cold and damp house with terrible mould problems. Her landlord, Nottingham City Homes, says that the only way to make her house really warm is solid wall insulation. Since the changes to the energy company obligation, that possibility has become more distant.

Kate lives about a mile away from Ilona on the Lenton Abbey estate, which was built by the council in the late 1920s. The 900 houses on the estate are of conventional brick construction. However, as was normal practice at that time, they were built with solid walls, so there are no cavities that can be insulated. About 500 of the houses are now privately owned, with about one fifth rented out. Kate says that since NCH fitted new doors—front and back—to her house, it has been noticeably warmer. However, her house is still cold and difficult to heat, and she worries about her bills. Lenton Abbey is

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one of the neighbourhoods that NCH had prioritised for energy efficiency measures under its greener housing scheme. However, the changes to the ECO mean that acting on those plans may now be years away.

Ennis is in his 80s. He lives across the River Trent in Clifton. The local claim that the Clifton estate was once the largest council estate in the country may be open to question, but there is no doubt that Clifton is a large example of the post-war drive to build. It is said that the Wimpey “no-fines” construction method of concrete walls allowed for a construction rate of 30 homes per week. Unfortunately, despite the fact this design type was popular across the country, the resulting homes are poorly insulated. NCH manages more than 1,200 of these properties in Clifton, but there are more than 3,500 similar privately owned former council homes whose residents exercised their right to buy but now face the same problems as Ennis—cold, damp homes and high fuel bills.

Ennis has seen his neighbours on the Clifton estate benefit from solid wall insulation, thanks to Nottingham’s pilot greener housing scheme, which was launched in the north of the estate last September. He has heard what a difference insulation has made to his neighbours’ bills, and how warm and cosy their houses now feel. He has also seen how good the insulation looks, as hundreds of tenants and owner-occupiers alike have taken up the offer of solid wall insulation provided by the scheme during the past six months.

Sadly, for Ennis the future is uncertain, because he lives in the first street in the southern half of the Clifton estate. The scheme was due to launch there in January, until the changes to the ECO that were announced in December allowed the funder—British Gas—to pull out, leaving Ennis and thousands more Clifton South residents to look enviously at their neighbours’ homes when they walk down the street.

Chris Leslie (Nottingham East) (Lab/Co-op): I commend my hon. Friend’s campaigning on this issue, which has clearly affected her constituents. My constituents in the Candle Meadow area have encountered similar stories, with some residents getting this insulation for free, but because of the Government’s changes, all of a sudden, other neighbours not getting it. This is incredible unfairness, which can be seen from house to house—those who have and have not benefited. I fully support my hon. Friend’s argument.

Lilian Greenwood: My hon. Friend is right. Clifton is the largest scheme in Nottingham, but Candle Meadow is equally important, albeit of a different property type.

Ilona, Kate and Ennis are just three of my constituents whose homes need to be made more energy efficient, but there are more than 20,000 solid wall, hard-to-treat properties in Nottingham and our city is not untypical of the position throughout the UK, which has more than 7.6 million uninsulated solid wall homes.

Nottingham council is committed to improving the quality of its housing stock and tackling the fuel poverty that affects more than one in seven households in our city. It has long understood that improving council homes has wider positive social impacts. I have spoken before in this Chamber about the council’s decent homes programme, known locally as Secure Warm Modern, which began in 2008 and which, when complete, will

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have delivered double-glazed windows, loft and cavity wall insulation and new boilers to more than 20,000 council properties.

A joint impact study by Nottingham City Homes and Nottingham Trent university’s business school found that improvements to the physical condition of properties led to improved outcomes for tenants and better security, health and comfort, and that it also impacted on the wider community, by reducing carbon emissions, providing employment opportunities and improving neighbourhoods. It was as a result of working with Nottingham City Homes to secure funding for the completion of decent homes that I began to understand the challenges involved in tackling our city’s hard-to-treat solid wall houses.

I first raised these issues with the Minister in July 2012, explaining that Nottingham City Homes could use the decent homes funding to lever in additional benefits from the green deal’s energy company obligation, if there was more certainty about funding.

Graham Stringer (Blackley and Broughton) (Lab): My hon. Friend is making a cogent, coherent case for her constituents. Is she aware that only 4% of the money spent until October last year, for the country as a whole, had gone on solid wall insulation and that the worst cases of fuel poverty and coldness often exist in homes with solid walls?

Lilian Greenwood: My hon. Friend is right. Solid wall homes are associated with fuel poverty. Of course, they are more difficult to deal with, which is specifically why measures were needed to help tackle those hard-to-treat homes, when many councils, my own included, had done the easier work on lofts and cavity walls.

Huw Irranca-Davies (Ogmore) (Lab): I compliment my hon. Friend on the case that she is making on behalf of her constituents, but will she acknowledge that, although solid wall external insulation is critical for some of the older housing stock in our urban and peri-urban areas, it is also critically important for our rural areas, where there is a predominance of solid wall homes, and that often elderly and vulnerable individuals feel now that it is much more difficult to obtain solid wall external insulation?

Lilian Greenwood: My hon. Friend has probably, like me, received a briefing from Calor, which has expressed particular concern about the impact in rural, off-grid locations.

In the Minister’s reply in July 2012, he praised Nottingham for its “progressive agenda” and looked forward to visiting the city in the near future to drive that agenda forward. In the event he did not visit, but he did meet me, along with representatives from Nottingham City Homes, to discuss our ideas and experiences to date. Following those positive and challenging discussions, a joint approach was developed between the city council, Nottingham City Homes and local energy efficiency charity, Nottingham Energy Partnership. They drew up the Nottingham energy saving neighbourhoods proposal, a detailed plan to maximise the insulation work on hard-to-treat homes, promote the green deal and spread benefits to private homes as well as social housing, beginning on the Clifton estate, but with the aim of

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transforming energy efficiency across more than 20 Nottingham neighbourhoods with hard-to-treat houses.

We were delighted to welcome the Energy Secretary to Nottingham last spring to see how the neighbourhood model had been developed and the potential for future works. He visited the Bulwell Hall super warm zone, where solid wall insulation had been rolled out to 350 council and 352 private homes. That project helped identify the factors for success that were incorporated into the energy saving neighbourhoods proposal: a large-scale project attracting funding from an energy company; the role of NCH as a trusted intermediary for council tenants, overseeing resident liaison and ensuring quality; the key role of Nottingham Energy Partnership, a local trusted and independent organisation, in contacting every private owner and facilitating private resident engagement; and support from the city council’s planning department in developing an attractive insulation solution to suit the area. It also demonstrated the potential to support Nottingham’s local jobs plan, employing more than 200 people and supporting local employment and the development of the solid wall insulation industry.

Responding to Nottingham’s energy saving neighbourhoods proposal, the Minister wrote:

“I was delighted to see the ambitious proposals you have developed to deliver the Green Deal across Nottingham, in particular your plans for a neighbourhood wide approach fits our vision for the delivery of the Green Deal.”

Although we were unable to persuade the Minister to provide financial support for the energy saving neighbourhoods proposal, when the Department launched its green deal communities fund the following July, we were delighted to see the similarities to our plan. It seemed clear that in Nottingham we were already pursuing precisely the sort of innovative, cross-tenure, area-based approach Ministers were looking for.

The scheme was launched in Clifton in September last year under the branding, Nottingham Greener HousiNG, and was an immediate success. As I explained in last Monday’s estimates day debate, the scheme offered external wall insulation at an affordable fixed price based on property type, so private residents paid a contribution of between £1,000 and £1,300 depending on whether they lived in a bungalow, mid-terrace, end-terrace or semi-detached house. Most residents chose to fund their contribution using savings or via informal help from family and 10% took up the option of a loan from Nottingham Credit Union, which was low cost and could be repaid early without incurring a penalty. None chose to utilise green deal finance, even though the option was set out alongside others available.

The remainder of the cost—around 85%—was funded by British Gas as part of its energy company obligation. The insulation works were rolled out street by street across the Clifton housing estate, to council properties and privately owned homes alike. As residents saw their estate being transformed and heard neighbours describe their warm homes and lower bills, demand continued to grow. Within weeks, hundreds of residents had signed up and by the end of November more than 90% of council tenants had agreed to have the work done and there was 65% take-up in the private sector, with more than 1,000 private residents or landlords having signed up and paid their contribution towards getting the work done.

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The feedback from residents was overwhelming. People told me that their homes were warm for the first time ever and that they were saving money and were excited about the improved appearance of the estate. Those signed up were impatient for work to start on their homes.

The Energy Secretary’s statement on 2 December prompted high anxiety in Clifton, and that anxiety turned to despair when British Gas used the opportunity of the Government’s policy change to pull out of the Clifton scheme. Last week, the other Energy Minister, the right hon. Member for Sevenoaks (Michael Fallon), responding to the debate, said that I had “suggested” that our Clifton scheme was

“a victim of the changes taking place in the ECO arrangements.”—[Official Report, 3 March 2014; Vol. 576, c. 722.]

I did not suggest it, I quoted the statement from British Gas in which it said,

“In light of the Government’s proposed changes to the ECO, it was necessary for us to review our current ECO contracts. These changes mean we can no longer fund some projects and unfortunately this is the case with our planned programme with VolkerLaser and Nottingham City Homes”.

It could not be clearer. The Minister’s Government’s ECO changes have led to the collapse of our energy efficiency scheme. As a direct result of his policy shift, hundreds of my constituents in Clifton who have paid for solid wall insulation do not know whether they will get it.

The Minister of State, Department of Energy and Climate Change (Gregory Barker): I will respond fully in my closing remarks, but I do not want the hon. Lady to scare or alarm her constituents unnecessarily. I spoke yesterday to the chief executive of Nottingham city council, and we are working closely with Nottingham on a new bid for our green deal communities. Although I cannot announce the result of that bid for our green deal communities fund, Nottingham has made a robust proposal that aims to deliver hundreds of measures, if not more than 1,000 measures, of the type the hon. Lady describes in south Clifton. Far from being dead and over, the south Clifton scheme has every reason to be optimistic.

Lilian Greenwood: I thank the Minister for his intervention. Unfortunately, my constituents are both scared and alarmed. They will, however, welcome his indication that there is hope for the scheme in south Clifton. There are many more people across Nottingham South who do not know if or when they will get the help they need with their fuel bills. They continue to live in cold homes that affect their health and the health of their children.

Huw Irranca-Davies: My hon. Friend is being generous in giving way. In answer to the Minister’s intervention, it is not only householders who are concerned. I have met companies in the midlands and elsewhere that have said that, because of the changes, they are rethinking where they invest and what they prioritise. Although the Minister’s announcement might be very welcome, there is now a hiatus, which is a classic symptom of the Government’s policies—they are having to rejig their thinking to catch up with a misfortune of their own making.

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Lilian Greenwood: My hon. Friend is right. I will address the impact on employment and on businesses in due course. Nottingham will, unfortunately, continue to experience excess winter deaths and excess winter admissions to hospital as a result of cold housing. As he says, hundreds of people employed in our greener housing project are at risk of redundancy, and some have already lost their jobs. New apprentices who are looking forward to long careers installing insulation face, at best, uncertainty about their future. The young people who had completed their initial training and were due to start year-long apprenticeships leading to national vocational qualifications are now back in the dole queue.

Mark Lazarowicz (Edinburgh North and Leith) (Lab/Co-op): My hon. Friend is making an important point. We all accept that programmes need to be fine-tuned from time to time, which is inevitable with any Government programme, but we have been told that more than 600,000 fewer properties will be dealt with under the hard-to-treat cavity wall insulation scheme. Apart from the impact on the people living in the houses concerned, taking away 609,000 properties will obviously have a major impact on businesses.

Lilian Greenwood: My hon. Friend is right. It gives me no pleasure to tell the Minister that those are the effects of his changes to the energy company obligation. Right now in Clifton, the contractor VolkerLaser is working at an incredible pace to try to complete work for all those residents who have signed up and paid their contribution, but the 9 April deadline, when British Gas funding ends, is fast approaching. The Minister knows that. He met me and colleagues from Nottingham on 22 January to discuss the crisis we face. He promised to raise the matter with the chairman of Centrica, British Gas’s parent company. Can he tell us today whether he has held those discussions? If so, what was the outcome?

I also wrote to British Gas following our meeting to ask it to consider a grace period for private customers who have suffered financially, thereby allowing their properties to be completed beyond the 90-day notice period. In his reply, Chris Weston, the managing director of British Gas, said

“we cannot commit to an extension of the termination period”.

Does the Minister agree that those residents who have signed up and paid should have their contracts honoured? If British Gas will not provide that funding, is he prepared to step in to honour that commitment and ensure that my constituents receive the work for which they have paid at the price they expected?

The Minister also said in our meeting that Nottingham city council should amend its bid to the green deal communities fund, which has been increased to £80 million, and we followed his advice. As I anticipated, we have not yet had success, but I remain hopeful after his earlier comments. Can he say when the next tranche of green deal communities funding is expected to be announced?

When the Minister met us, he also suggested that the Government’s announced increase in green deal cashback might help to fill the gap left by the reduction in ECO funding. A few weeks later we learned that green deal cashback could no longer be used alongside ECO. I simply ask the Minister how we can plan for the future and work with him to deliver the energy efficiency

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measures that our constituents need, and that we all want to see, without some certainty on the policy and funding framework within which we are operating.

The Clifton scheme, which we believe is the largest area-based approach so far, has enabled Nottingham city council to learn valuable lessons about what works. Councillor Alan Clark, the portfolio holder for energy and sustainability, has led the city’s work, and he concludes that, to be successful, a scheme needs to: address the issue on an area-by-area basis; apply to all tenures equally; pay for green deal assessments, avoiding risk and up-front costs for households; identify a fixed price for works to bring certainty to residents; engage specialist contractors of the highest quality; and engage local councils as a trusted broker. Above all, there must be a stable national policy and funding regime.

Phil Angus, the manager of Nottingham Energy Partnership, puts it more bluntly,

“the Government’s stop start approach to funding policy is sending businesses to the wall along with hard working families left in the lurch”.

He illustrates the point with reference to a typical Clifton property for which the funding support available has changed, or is due to change, every few months as a result of policy changes since last December.

Ahead of the green deal’s launch last year, the Minister described it as

“the most transformational energy efficiency programme that this country has ever seen—a programme that is built for the long term.”—[Official Report, 16 January 2013; Vol. 556, c. 983.]

Clearly, as my hon. Friend the Member for Edinburgh North and Leith (Mark Lazarowicz) said, any scheme has to be reviewed and revised in light of experience but, as Phil Angus says:

“How is any small business connected to domestic energy efficiency services supposed to plan ahead and maintain consistency with customers, supplier and workforce…is this Government on the side of business?”

VolkerLaser, the contractor that has been delivering the solid wall insulation in Clifton, surely has to conclude that the answer to that question is no. Here is what managing director Mike Weaver had to say about the effect of changes to the energy company obligation:

“The recent events…and the uncertainty in the market have had, and will continue to have a devastating effect on the VolkerLaser business. We have had to suspend our forward apprenticeship scheme and staff recruitment programme, denying up to 50 young people the chance to get ‘a start’ in this industry.

The whole business has a cloud of insecurity hanging over it and for a Managing Director who started this business over 20 years ago this is particularly distressing. VolkerLaser prides itself on retaining good staff, with a large number of long serving employees enjoying their 20th year alongside me. It is now impossible to map out our employees’ future and it is inevitable that if current conditions persist, there will have to be redundancies.

Due to the collapse of the funding market it is now extremely difficult to plan a future order book. The proposed changes to ECO have swung the market so much in the favour of the energy retailers that even if funding becomes available, it will come with onerous conditions which will place enormous risk on contractors and clients alike.

No one in this industry believes they are owed a living, but it would be good for once to operate on a level playing field. Our staff and the residents of Clifton need some security and some reassurance that ECO is not just another flash in the pan. Or, to put it bluntly, yet another initiative the government asks thousands of people to spend millions of pounds gearing up for, only to see it decimated in one fell swoop.

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The impact of the proposed changes to ECO, and in particular the 100,000 solid wall minima, will be significant and will undo all of the good work the partnership has achieved to date. 42% of the staff on the Clifton Greener HousiNG initiative are residents of Nottingham; ten apprentices have been inducted so far and are now working towards a nationally recognised qualification; and countless sustainable job opportunities have been created with local SMEs.

With a doubling of the minima to 200,000 measures (or 8 million tonnes equivalent) thousands more residents will be guaranteed a reduction in their fuel bills and be afforded the opportunity to live in warm and energy efficient homes. With the certainty of funding going forward, more and more employment opportunities and apprenticeships would be generated for the benefit of Clifton residents and the local economy.”

I do not doubt that the Minister wishes to see more energy efficient homes; what I doubt are the policies and funding support he has put in place to deliver on that aspiration. He says that the ECO will lead to insulation of at least 25,000 solid wall properties a year, but at that rate it will take 304 years to complete the task. Although he ramps up green deal cashback to persuade people that they want to take up energy efficiency measures, his funding changes are denying energy efficiency measures to my constituents who desperately want them. That simply is not good enough.

As Sally Longford, one of Ilona’s local councillors in Nottingham, says:

“Many of my elderly residents living in the Wollaton Park estate cannot keep warm without paying ridiculous amounts to the energy companies. Even then cold patches on the walls attract condensation and mould, they deserve better.”

She is right. What hope can the Minister give me that they will get it?

Nadine Dorries (in the Chair): Order. At the moment there are about eight minutes each for those who want to speak.

3.20 pm

John Pugh (Southport) (LD): Thank you, Ms Dorries; that will be ample.

I congratulate the hon. Member for Nottingham South (Lilian Greenwood) on her timely and effective presentation of the problems with the energy company obligation. I am increasingly in despair, and not just because of being a Liberal Democrat. I should like to be able to say that the green deal is great, and the ECO scheme is perfect, and that I support every detail of it without criticism or quibble; but I cannot. I should like to be able to say that the Government correctly understand the problems being experienced by people in the ECO scheme and that they are thoroughly engaged and are ironing out possible difficulties; but I cannot quite do that. I am grateful that the Minister responding to the debate is the right hon. Member for Bexhill and Battle (Gregory Barker), because if anyone can solve the problem he can.

I should love to be able to say that everything that is involved in managing a market composed of myriad private suppliers and big corporate giants, to environmental effect, is easy, but it is not. It is difficult, and I sympathise with the Minister. However, like him, I have lived through the solar panel trauma, when schemes hit the buffers and businesses crashed, projects were caught and there

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was boom and bust—white van man trying to cash in and good schemes being trashed or abandoned. I think that we all learned a lesson from that: in the green business, predictability helps an awful lot. We seem to have a similar problem now, although it is not necessarily the one that the hon. Member for Nottingham South touched on. I want to talk about the problem that the ECO scheme is creating for boiler suppliers—a topic that I have become familiar with simply because suppliers have brought it to my attention.

The phenomenon is similar to what happened with solar panels. There has been an increase in the number of suppliers and installers—I have looked at the Government stats—followed by what currently appears to be the sound of businesses collapsing and the stalling of installation.

Gregory Barker: If we could replicate for insulation what happened in the solar industry I should be extremely delighted. The fact is that since we took those difficult decisions in 2011 we have reached the point where nearly 3 GW of solar are installed; almost 500,000 roofs have solar, compared with 15,000 in 2010; and we have the highest growth prospects for solar, with the cheapest installations, anywhere in Europe. Solar in the UK is a huge success, because we cut costs, bore down on the expense to the consumer, and as a result are getting genuine commercial deployment.

John Pugh: I am delighted that the Minister can tell me that. I am a great enthusiast for solar panelling. If he can solve the problems with boilers I shall be even more in his debt.

It seems to me that the Government are not quite to blame for the problem I have outlined. It is almost an unintended consequence of the Labour fuel pledge, which led to a bit of a media panic about the green levy, which led to discussions between the energy companies and the Government. There may be some tacit agreements between the Government and the big six. I know not—it is above my pay grade. However, it is true at the moment that the big energy companies are substantially reducing their funding for boilers, from 25p per pound lifetime savings to something like 8p. The drop is sudden and dramatic.

There is some evidence that those companies do not want referrals, particularly in connection with fuel poverty. I am in possession of a letter from British Gas to Sefton, my local authority, which basically says “Don’t send us any more work at the moment. We are simply not going to commission it or progress it.” There is some evidence that some big companies have stopped commissioning altogether, and there is no doubt that the price has crashed. How should a small boiler supplier react to that? If he is severely exposed he goes bust; if he is very canny or unscrupulous he can start to fit boilers of substandard quality, which will not last, and will eventually need to be repaired and replaced. Another thing that he could do is target carbon savings rather than fuel poverty.

A large part of my constituency consists of Edwardian housing, with solid walls. We also have many old houses of the maisonette type, with old or no boilers. In those houses are many elderly people, including widows living alone, and the like. Companies in my constituency once did the jobs needed in such houses, but they no longer

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do them because they cannot be done without some financial support being offered; and customers in fuel poverty are precisely the ones who cannot do a deal of that kind. In rare cases that I know of, the company exercises a degree of charity and takes a hit on the job. I also have evidence that in some hard-to-treat large houses—we might call them mansions—where there is someone who meets the qualifying criteria in some way, the job will pay; obviously, putting a boiler into those places gives a substantial carbon saving and brings a better reward from the energy companies. A genuine case that was featured on “File on 4”—or it may have been “You and Yours”; I forget—involved a premier footballer profiting directly from the ECO scheme.

Clearly, something is wrong. I am not an expert—I know that there are experts present for the debate—but I know people who are. People in the trade tell me things and I am inclined to believe them. Deborah Judd, who runs a firm in Darlington, writes:

“It is so disheartening having to turn clients down who are exactly the sorts of people who need it. We’ve been going 20 years in June and now we just don’t see a future…In some cases, you can get paid £12,000 for fitting a boiler in a large house because the energy efficiency saving is so large. Realistically, that person can afford to replace their boiler themselves. We could fit 5 boilers in homes where people are in real need for that amount.”

I have similar evidence from a supplier in Blackpool, and from assessors and so on. People who appear to know tell me that there is a problem, and that it is analogous to the one that the Minister solved à propos of solar panelling.

Perhaps I can offer the Minister a solution rather than a problem. He needs to talk not to me, a relative ignoramus on the subject, but to the people who bring the problem to me, who are in earnest and have a genuine problem. Importantly—and this issue has come up previously—during the spring we must monitor how fuel poverty is addressed. Clearly, the targets might slip a long way before anyone notices. I suggest that because of the reduction applied by the gas and energy companies there is a perverse incentive to target big houses and big carbon savings, rather than people in fuel poverty.

My final point, and the point that will haunt the debate, was made by the hon. Member for Nottingham South when she summed up: we need stability in the market. If we are to get many small businesses working regularly to good effect with large corporates and funders—in this case the energy companies—and if we are to solve the problems of greenhouse emissions and fuel poverty, we shall need a strong element of stability and predictability in the market. I am concerned because at the moment the suppliers I know and talk to do not think we have that.

3.28 pm

Dr Alan Whitehead (Southampton, Test) (Lab): The starting point for the debate must be the notorious Prime Minister’s Question Time at the end of November, half way through which he announced that there would be a green levy review. Sure enough, there was one; only, because it appeared that the review was thought of about two minutes before Prime Minister’s Question Time, the green levies were not reviewed but stayed roughly as they were. ECO was reviewed instead, and the result is that we are where we are now.

The document put out by the Department said:

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“One of the major challenges for the ECO and Green Deal is the changing nature of the types of measures that need to be delivered. CERT, by focusing on delivering low-cost measures, has been very successful at installing simple loft and cavity wall insulation. From 2012 Green Deal finance will offer a route to deliver the remaining low cost loft and cavity wall opportunities at no upfront cost and without need for subsidy. However to meet our carbon budgets cost effectively, we will need to go far beyond just lofts and cavity walls, and move towards the next most cost effective measures.

However, some 7 million of the most difficult to treat homes require some form of solid wall insulation. The Committee on Climate Change recommended in their 2009 Report, ‘Meeting Carbon Budgets – the need for a step change’ that 2.3 million solid wall homes will need to have taken up solid wall insulation by 2022 in order for the UK to be on track to achieve carbon budgets. ECO support for these properties will help drive this market, and the supply chain to fulfil it, enabling us to unlock the resulting carbon savings more cost effectively.”

That was the prospectus that people bought into when they started doing work on ECO. In that context, the process of the review has been interesting, because it effectively boiled down to ECO having to take the bullet. In quick order, it was announced on 2 December that there would be substantial changes in how ECO would work, without an impact assessment. Only now has a consultation paper been released. It says that a number of the proposals have already been announced or foreshadowed in the Government’s announcement on 2 December. I am reminded a little of the referendum in Crimea, where first the outcome is announced, then a consultation is held on what the announcement should be. The measures in the 2 December announcement, which essentially stretch out like a lump of pizza dough the annual overall commitment of some £1.3 billion from two years to four years—however it may be wrapped up in decisions to borrow from some parts of the ECO programme to maintain others—starve elements of ECO of resources, particularly the carbon emissions reduction obligation.

That announcement, however, was wrapped up in something of a complication, because ECO finances are predicated on the achievement by obligated energy companies of a carbon obligation—that is, the obligation is discharged by the amount of carbon saved by the measures undertaken—and the estimated overall finances relate essentially to what it will cost, collectively, for that overall obligation to be discharged. Treatment costs for each hard-to-treat property, for example, add up to a cost per tonne of carbon saved, and if the companies have to discharge that obligation within a set period—initially for ECO, that is 2015—the price paid for each tonne saved will logically be higher than if the same level of obligation was over a more extended period.

Another issue is the extent to which the programme admits of access to measures, which, by their nature, allow for savings to be made at a lower cost per tonne of carbon dioxide saved. Those measures, however are supposed by and large to be covered by the green deal, whereby the cost of loans for measures is recovered from bills. As the original Department of Energy and Climate Change document says, ECO should be concerned only about the measures that go beyond those treatments. However, if such measures are allowed to count for ECO’s purposes instead of green deal purposes, inevitably a carbon obligation can be discharged by concentrating on those measures, rather than on the hard-to-treat homes specified in the original DECC document on ECO.

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Indeed, the consultative document published last week recognises that. On page 28, it states: