UKPOL.CO.UK

Category: Health

  • Emma Hardy – 2022 Speech on the NHS Workforce

    Emma Hardy – 2022 Speech on the NHS Workforce

    The speech made by Emma Hardy, the Labour MP for Kingston upon Hull West and Hessle, in the House of Commons on 6 December 2022.

    In Hull West and Hessle, 1,730 people are waiting more than 28 days to see a GP and 6,225 are waiting more than 14 days. The ratio of GPs to patients in Hull is one of the lowest in the country, which is fuelling some of the many problems that we are seeing in accident and emergency. That is combined with the concerns that I raised with the Secretary of State about the delay to discharge; the 30% vacancies in our adult healthcare sector; and the delay in money that the Government promised to adult healthcare services, which means that delays are only increasing. I am incredibly concerned about what will happen over the winter.

    I will focus my remarks on my concerns about radiotherapy, about which I have written to the Minister of State, Department of Health and Social Care, the hon. Member for Faversham and Mid Kent (Helen Whately). With respect, I wrote to her on 3 September and received a reply on 28 November, which is disappointing on such a serious matter. I raise that issue today because, in August, I received an update from the Humber and North Yorkshire cancer alliance about the state of radiotherapy. For those who are unfamiliar, radiotherapy is used to treat and kill cancer cells and to shrink tumours. It is often used in the early stages of cancer.

    In the briefing note that the Humber and North Yorkshire cancer alliance sent me, which I can only assume it sent to other Members of Parliament, it says:

    “It is expected that the radiotherapy position at HUTH will worsen through the year. The reduced capacity obviously could pose a risk to patients (from a health and wellbeing perspective, as well as from a patient experience perspective).”

    The reason it wrote to me to tell me of its concerns about radiotherapy is the shortages we have in the area. It says that the percentage of Hull University Teaching Hospitals NHS Trust patients who began radiotherapy as their first definitive treatment for cancer and who did so within 62 days of an urgent referral for suspected cancer—within 62 days of an urgent referral—was 22% in July, 50% in June and 29% in May, compared with over 50% previously. The percentage of HUTH patients who received radiotherapy following their first definitive treatment within the 31-day target was 44%. So the majority of people are not being seen for their cancer treatment within the 31-day target, and only 22% of people sent for urgent referrals for suspected cancer are being seen.

    The reason for this is given in the briefing note, which says:

    “Many of HUTH’s therapeutic radiographers have left the profession to pursue a better work-life balance, while those who have remained in their roles have also sought improved work-life balance by seeking roles closer to where they live to reduce commute times.”

    That is the reason people are leaving—to seek a better work-life balance. It is not because they do not care or they do not wish to continue to treat people, but because they simply cannot maintain it at this level. The note says that

    “staffing shortages is an issue experienced across the country.”

    It also says—this is a key point because the Government’s defence is often that the pandemic has caused all these problems:

    “Therapeutic radiography has been considered a vulnerable profession for years.”

    Pre-pandemic we were having problems with radiographers, but no action was taken, and this is still considered a problem right now.

    I wrote to the Minister and the Secretary of State about this, quoting from the briefing note. I sent the letter on 3 September, and I said:

    “I am sure you will agree that the evidently increased waiting time for potential life-saving or life-prolonging treatment is extremely concerning.”

    I understand that Hull University Teaching Hospitals NHS Trust is doing everything it possibly can. It has taken on two apprentices to be trained up as radiographers, but we all understand that we cannot instantly produce the radiographers we need. As I say, I sent the letter on 3 September, and it was also signed by my right hon. Friend the Member for Kingston upon Hull North (Dame Diana Johnson) and my hon. Friend the Member for Kingston upon Hull East (Karl Turner). It took the Minister until 28 November to reply, even though I started the letter by saying:

    “I am writing having received a very worrying update from the Humber and North Yorkshire Cancer Alliance regarding a reduction in services”

    in my constituency.

    In her reply, the Minister admitted:

    “HUTH advises that, to protect existing staff and maintain the service, it was necessary to reduce capacity to sustainable levels, which has in turn led to the inability to reach specific targets and a growing waiting list.”

    So this is a problem that the Government are well aware of, despite their delay in responding to it. It is a problem that has been around for years, and it is a problem that is literally a matter of life and death. If people do not get the cancer treatment they need when they need it, we know the consequences. The failure to deal with and address the NHS workforce is not just a mild inconvenience; it is an incredibly serious matter that has been a long time coming and a damning indictment of 12 years of Conservative mismanagement of our NHS.

  • Sam Tarry – 2022 Speech on the NHS Workforce

    Sam Tarry – 2022 Speech on the NHS Workforce

    The speech made by Sam Tarry, the Labour MP for Ilford South, in the House of Commons on 6 December 2022.

    For the first time in its 106-year history, the Royal College of Nursing has taken the monumental decision to take strike action. They have not taken that decision lightly, because no worker does, but this Government have pushed them to the brink. Ministers have had weeks to find a resolution, but they have rejected all offers of formal negotiations. As the RCN said, all meetings with the Government have seen Ministers sidestep the serious issues of NHS pay and patient safety. Do not be mistaken: they have the power and the responsibility to address this dispute, but they choose not to for self-serving political gains. They have seen that workers in rail, the Royal Mail, BT, universities and across the public and private sectors are now prepared to fight back because they are so sick of what this Government have been doing. They know full well that these disputes will have to end in pay rises for the workers of this country.

    These are not the days of the miners’ strikes when the mines could just be closed because they were not needed any more. We are always going to need hospitals, we are always going to need railways, we are always going to need schools and we are always going to need universities. People are beginning to fight back and stand up, and it is time that the Government listened very carefully, especially in their so-called red wall seats.

    At the height of the pandemic, every Thursday night the Prime Minister, the Health Secretary and Members across the House clapped for our NHS heroes and praised their immense effort on the frontline of the pandemic, but clapping does not pay a single bill. This dispute has highlighted the total hypocrisy at the heart of this Government. Once praised as heroes, nurses are now treated dreadfully. Ministers have sought to ratchet up the rhetoric, with the right hon. Member for Stratford-on-Avon (Nadhim Zahawi) seemingly seeking to present NHS workers as hostile agents of a foreign power, ludicrously and disgracefully dismissing industrial action as “helping Putin.” Get real! These are nurses, not agents of a foreign power. The Health Secretary has said that pay demands are “neither reasonable nor affordable”, while utterly refusing to engage with nurses’ unions over their demands, only offering a paltry 3% pay rise when inflation is well above 11%. According to The Times, instead of looking for a resolution to this dispute,

    “Ministers plan to wait for public sentiment to turn against striking nurses as the toll of disruption mounts over the winter”.

    Anthony Browne (South Cambridgeshire) (Con)

    The hon. Gentleman talked about the difference between the pay offer and inflation. If all public sector workers were given a pay rise in line with inflation, it would cost the equivalent of a 4.5p rise in the basic rate of income tax. Does he support that, or would he pay for such big pay rises in other ways?

    Sam Tarry

    Our Front-Bench team have clearly set out a number of proposals, including taxing non-doms, which would seek to address the lack of funding in our NHS. I will not get into the specifics, but putting money into the pockets of ordinary people will clearly bring more revenue into the Treasury. The truth is that nurses have not had a real pay rise for more than a decade. The most experienced frontline nurses are now £10,000 a year worse off in real terms than in 2008, effectively meaning that they are working one day a week free of charge—how many days does the hon. Gentleman work free of charge?

    Carla Lockhart (Upper Bann) (DUP)

    The hon. Gentleman is making a powerful point about nurses. He will be aware that their role has evolved significantly and they are often now asked to do more training and more work on the same pay. Does he agree that it is unfair to demand more while paying the same?

    Sam Tarry

    Absolutely. My little sister is a nurse who works in palliative care in Southend, Essex. During the pandemic, her job was to help lots of people to experience the least suffering as they met the end of their life. The mental health of nurses has been broken, there is increased stress, and bank staff are being used—all as a result of nurses being so devalued that the Government have taken away their bursaries. We have a huge crisis, but one obvious fix would be to sort that out. Of course I agree that we have to listen and value our nurses.

    Paul Bristow

    Will the hon. Gentleman give way?

    Sam Tarry

    I will make some headway, because plenty of other hon. Members want to speak.

    It is not just about pay: workforce shortages are at unprecedented levels across the NHS. The latest figures reveal that there are now more than 133,000 vacancies in England alone—more than a third of which are in nursing—which is an all-time high and a record for this country under the Government. The vacancy rate in registered nursing is running at nearly 12%, which is an increase from 10.5% in the same period of the previous year. A key factor in the failure to attract and retain enough staff is the Government’s inability to provide workers with a decent pay rise. Some 68% of trusts report that staff are leaving for better terms and conditions elsewhere.

    Paul Bristow

    The hon. Gentleman spoke about nurses’ pay and how they deserve more. We would all like to give nurses more money, but how does he account for the fact that the Welsh Labour Government are giving exactly the same pay award as proposed by this Government?

    Sam Tarry

    I cannot speak for the Welsh Government, but if we look at their record—the times that they have been returned to office with a stonking majority, and the fact that there are no strikes on their railways, which they had the guts to take into public ownership; they called it what it was—I would much rather be living under them than the appalling Government we have.

    The impact of those shortages on existing staff is enormous. Reports by Unison have repeatedly highlighted the acute strain that understaffing has put on the workforce, with stress and burnout rife among NHS staff. That predates covid, which demonstrates the immense damage done by a decade or more of Conservative Governments and the failure of successive Governments and Prime Ministers to invest in the workforce or take workforce planning seriously. As the RCN has said, the dispute is about not just pay, but patient safety, which is key for all of us. Staffing levels are so low that patient care is being compromised; only paying nursing staff fairly will bring the NHS to a point where it can recruit and retain people to address those issues.

    I have visited my local hospital, King George Hospital, on many occasions and I have heard about the impact of staff shortages and pay cuts on staff and patients alike. Recently, for once, I went to open some new services in paediatric emergency and radiology—something positive after 20 years of campaigning for our local NHS in Ilford—yet the staff were still overstretched, run ragged and demoralised. They just want the support that they need to care for their patients, which means pay recognition and ensuring fair practices at work without undermining their working conditions.

    I spoke to staff who, during the worst of the pandemic, received food donations from the local community just to get by. That should never, ever be allowed to happen and makes it even more sickening to hear about the outright corruption on the other side of this House and the despicable corrupt PPE deals with people like Baroness Mone. People in Ilford are sick and tired of that because of the attacks on our local services. We even had to stand up and campaign for our local ambulance station not to be shut down under the Government’s measures.

    Conservative Members seek to present nurses’ demands as unreasonable and undeliverable, and have asked nurses to tighten their belts even further, while they have allowed the pay of the wealthy to explode. This year, FTSE 100 CEOs collected an average of 109 times the pay of ordinary workers—that is part of the answer to where we get the money to pay the people who actually keep our country off its knees. Where is the Government’s commitment to pay restraint when it comes to high pay and those sorts of people? How many Conservative Members have fat cat salaries and executive directorships, and coin it in left, right and centre?

    Anthony Mangnall (Totnes) (Con)

    You all have second jobs!

    Sam Tarry

    I do not think a single person sitting on the Opposition Benches has a second job.

    The truth is that NHS staff pay demands are reasonable and fair. Nurses’ pay is down by £4,300 and paramedics’ pay is down by £5,600. One in three nurses cannot afford to heat their homes or feed their families. NHS staff are at breaking point. When I met NHS Unite members from Guy’s and St Thomas’s Hospitals—I welcome any hon. Member to come with me and speak to them, because they are just across the river from this House—they were justifiably furious about the way that for too long, they and their colleagues have been exploited and abused by the Government, as they see it.

    Staff are the backbone of the NHS, and if they break, so does the NHS. As the RCN general secretary said:

    “Nursing staff have had enough of being taken for granted, enough of low pay and unsafe staffing levels, enough of not being able to give our patients the care they deserve.”

    Allowing the NHS to collapse will cost the country considerably more, financially and in national wellbeing—as we are already seeing on the Government’s watch—than the rightful pay demands of NHS staff. If our NHS is not providing the care that we need, the costs are far greater, as is economically demonstrable.

    Many hon. Members on both sides of the House believe that the NHS is our greatest institution. We cannot take it for granted and it is well worth fighting for. Conservative Members have the power to stop this dispute; to sit down with the trade unions; to face the nurses and NHS staff; and to negotiate a fair deal to prevent misery, ensure patient safety and save the NHS. If the Government will not do it, they should resign now, because a Labour Government will save the NHS and support NHS staff.

  • Taiwo Owatemi – 2022 Speech on the NHS Workforce

    Taiwo Owatemi – 2022 Speech on the NHS Workforce

    The speech made by Taiwo Owatemi, the Labour MP for Coventry North West, in the House of Commons on 6 December 2022.

    Many Members will remember that the Health and Social Care Committee recently published a report on the NHS workforce—a report that the Government frustratingly chose to ignore. As workforce shortages stand at unprecedented levels right across the NHS, with the latest figures revealing that there are more than 133,000 vacancies in England alone, I thought it might be useful to remind the Government of some of the report’s key recommendations.

    First, the Government are failing to provide our NHS nurses with the essentials that anyone would need to do their job properly. In short, they are serving up poor working conditions, year in, year out. At the bare minimum, all nurses across the NHS should have easy access to hot food and drink, free parking or easy access to work and spaces to rest, shower and change, but the Government cannot even get that right.

    I have repeatedly raised with the Department of Health and Social Care and the Prime Minister the fact that NHS staff at Coventry’s University Hospital are paying an astronomical £600 per year simply to park at work. In the middle of a cost of living crisis, it is outrageous that Coventry’s NHS heroes are out of pocket because the Government choose to do vanishingly little to improve their situation. I again call upon the Department of Health and Social Care to look closely at this situation and scrap these unfair parking charges for good.

    Is it really any surprise that the Government’s current target of recruiting 50,000 nurses has been woefully missed when they are treated so poorly? It is unacceptable that many NHS nurses are struggling to feed their families, pay their rent and heat their homes. Some nurses are even resorting to using food banks this winter. I urge the Government to look closely at how they can better pay and treat NHS staff this year and next, so that we can finally reverse this worrying trend.

    Our beloved NHS, which I had the honour of working for as a senior cancer pharmacist before being elected, is on its knees as a result of 12 years of Conservative neglect and mismanagement. Many services are crumbling. Pay has failed to keep up for years, and morale among nurses is in a truly terrible place. That is exactly why the Royal College of Nursing has been pushed into taking industrial action this month and why the Government must stop the mud-slinging and instead work with nurses to resolve this crisis.

    Secondly, the Government must take urgent action to improve maternity care. For over a decade, the Conservatives have failed midwives across my community, and now we are all paying the price. We need a robust, fully funded maternity workforce plan, and the Government must commit to recruiting and retaining the workforce at the level set out in the forthcoming report by the Royal College of Obstetricians and Gynaecologists. Labour has made it crystal clear that we would train at least 10,000 additional nurses and midwives each year to tackle the crisis that currently exists in maternity care. Labour has also committed to a historic expansion of the NHS workforce, to plug the gaps created by this Government.

    The Government must also improve diversity in the recruitment of midwives, to improve the standard of care that black, Asian, mixed-race and minority ethnic women receive throughout pregnancy, birth and the post-natal period. By increasing diversity across the NHS, we can guarantee better standards of care for everyone, regardless of their background or ethnicity. Labour’s women and equalities team has routinely pushed for reforms that would improve how everyone experiences healthcare in this country, so when will the Government catch up?

    Lastly, as the newly elected chair of the all-party parliamentary pharmacy group, I want to highlight an opportunity that the Government have failed to grasp: better use of community pharmacists. As a trained pharmacist, I know that the sector is crying out for more responsibilities to become the first port of call for patients who need advice and treatment. That would help to rebalance the workload across primary care, bring healthcare back into the community, reduce the pressures on GPs and hospitals and deliver healthcare that is much more prevention focused.

    Any plan for the future of pharmacy must ensure that all pharmacists have adequate access to supervision and training, along with clear structures for professional career development into advanced and consultant-level practice to help to deliver this. That way, community pharmacists can play a much larger and more effective role in delivering healthcare. Until this Government properly mobilise pharmacies, we will struggle to reduce waiting times, clear NHS backlogs or improve patient access to GPs, so I desperately want to see action here. Every Member here today understands that our NHS workforce faces a range of big challenges. Whether it is nurses, midwives or pharmacists, our NHS workforce are at breaking point.

    Paul Bristow

    I completely share the hon. Lady’s sentiments about making better use of community pharmacists. She talked about better support and resources being available for pharmacists to do just that, but what specific things does she think need to happen to get the ball rolling?

    Taiwo Owatemi

    That is an excellent question. I could be here for hours explaining what I would like to see, but essentially, what I and many in the profession would like to see is an understanding and full use of the various skills that pharmacists have. We talked about this in the Health and Social Care Committee today: I would like pharmacists to be involved in providing clinical care—for example, a diabetes workshop or a cardio blood pressure workshop. We have seen other countries do that. In Alberta, Canada, community pharmacists are involved in the whole of the hypertension management; it is taken away from GPs and brought into the community, because it is more accessible in a community pharmacy.

    Whether it is nurses, midwives or pharmacists, our NHS workforce are at breaking point, but the Government are seemingly ignoring that. I hope that the Government urgently sit up, take note and look at how they plan to address our workforce needs, to ensure that our beloved NHS staff are no longer ignored.

  • Paul Bristow – 2022 Speech on the NHS Workforce

    Paul Bristow – 2022 Speech on the NHS Workforce

    The speech made by Paul Bristow, the Conservative MP for Peterborough, in the House of Commons on 6 December 2022.

    I refer Members to my entry in the Register of Members’ Financial Interests. It is a great honour to follow the hon. Member for West Ham (Ms Brown), who I thought spoke very movingly about the challenges faced by communities in her constituency. West Ham is not a million miles away from Peterborough, and I recognise some of the challenges that she identified, especially the horrible disparity between black women giving birth and their white counterparts—that is a stark statistic. She spoke passionately about that, and I think we would all recognise it—especially me, as a father of two young daughters.

    In one of my first speeches as a Member of this House, I stood here and spoke about our NHS as someone who had worked in healthcare and public policy on and off for 20 years. I said that every two or three years, politicians stand up and say that the NHS needs more money, more capacity and a plan. When I made that speech—about three years ago now—I said that we cannot have another situation whereby we stand in the House asking again for more money, more capacity and a plan. Ultimately, that is exactly what we are doing. And so it goes on.

    I understand that we have had a covid pandemic in the meantime; I understand that we have to recover from something that was extraordinary. But we have to make sure that the NHS is able to make the most of the budgets that it has. We have listened to quite a few contributions from the Labour party, including that of the shadow Secretary of State, the hon. Member for Ilford North (Wes Streeting). I cannot quite be sure whether he was asking for more money or saying that the investment in our NHS was not enough. As a result of the covid pandemic, the Government are putting an extra £45.6 billion of investment into healthcare. That is an extraordinary amount of money.

    Indeed, the Institute for Fiscal Studies says that by 2024, healthcare will account for 44% of day-to-day Government spending. I understand that that does not include capital funding, but that 44% of day-to-day Government spending leaves just 56% for everything else—that is an extraordinary statistic. We have to make sure that we get value for money out of the money going in. Yes, we have the £44.6 billion that is going in, but another £3.7 billion is also being spent on capacity. What does that say to us? It says that we need to increase productivity in our NHS and get the most out of the money that we are putting in.

    The King’s Fund has found relatively recently that the annual average growth in productivity in our NHS increased from 0.7% in the 1980s to only 1.2% by 2012-13, and we need to do much better. When I say “we”, I am talking not about the individuals working for our NHS—doctors, nurses, allied health professionals; people on the ground—I am talking about the system as a whole. We need to do much better, and I want to suggest a few things that may help.

    The first is ensuring that clinicians and those working in our NHS operate and practise at the top of their licences, and that we make better use of other healthcare professionals, such as nurse practitioners, and of things that have been around for a long time, such as nurse-led prescribing. Why does my wife, if she does not want another child and she wants to take contraception seriously and go back on the pill, need to have that prescribed by a GP? That does not need to be done by a doctor; it could easily be done by a pharmacist or at least a nurse in a practice. That does not require a face-to-face GP appointment, especially when we have shortages of GP appointments.

    Some GP practices are doing fantastic work. I refer to the Thistlemoor surgery, which I have mentioned in this House on a number of occasions. I think that Dr Neil Modha and everyone who works there would be embarrassed by the number of occasions I talk about them in this place. That GP surgery serves up to 35,000 people in my constituency, of whom 80% do not have English as a first language. Those there pride themselves that if someone turns up who was unable to get a face-to-face appointment by ringing up, they will do everything they can to see that person on the day, and in the vast majority of cases that happens. How do they do it, with such a huge demographic challenge with the number of people who do not have English as a first language? They do it through effective use of admin staff. They have a number of people who work in the admin department in triaging who speak a variety of different languages from the communities that the surgery represents. By the time the patient is with the GP or relevant healthcare professional, they already know pretty much everything about the patient, what symptoms they are presenting with and what might be done to help them. It is an excellent surgery doing excellent things in my city.

    I also want to talk about surgical and cath lab capacity. Perhaps I am naive, but we seem to spend lots of money to create that capacity in our NHS, yet for a significant period of time, it is just not being used. We are increasing the productivity of those places by making sure that they operate throughout the day, and in certain cases throughout the night, but a consultant I spoke to relatively recently said that it was still very common for consultants to operate only one day a week in cath labs. I understand that they have lots of important things they need to be doing with their time, including training the people of tomorrow, and that being a surgical consultant is not just about surgery time, but goodness me we need to be doing a lot better than one day a week. We need them to be treating patients, powering through lists and doing what they need to do.

    A lot of this is about investing in innovation, too. Lots of procedures, such as nurse-led endoscopy, do not necessarily need to be done by a consultant at the top of their game. We need to be investing in systems and technologies that allow us to have more day cases, rather than more expensive in-patient services. This all seems like common sense, but the same debate about increasing productivity has been going on for about 20 years in the NHS, and these are some of the arguments I have been making for a number of years, not just inside this House, but outside it.

    I also want to talk about pharmacy. During the pandemic, pharmacy was often the only visible sign of the NHS on our high street. It is right that we make more effective use of pharmacy and pharmacists. I speak to pharmacists in my constituency, and they want to do more. They did so much during the pandemic, particularly with vaccinations, and they can do so much more. My plea is to use our pharmacies as much as we possibly can.

    Another issue I want to raise while I have the House’s attention is that we spend a lot of money on organisations such as the National Institute for Health and Care Excellence and Getting It Right First Time. We put a lot of responsibility in the hands of doctors, clinicians, patient organisations and all those involved in creating policies, commissioning policies, service specification and all the rest of it, but often we then go away and ignore them. I do not understand why we do that. GIRFT identifies sensible ways that the NHS can save money and get better outcomes for patients, but most of the time that is not replicated across the system, and I just do not understand why. Of course local decision making is important, but if something works in Peterborough, it will work in Torquay. We can certainly increase productivity, patient outcomes and save money by doing the things that those organisations tell us to do.

    Similarly, we do not quite have the 24/7, seven days a week NHS system that many of us would want. There are far too many elements of our NHS that only seem to operate between 9 and 5 on weekdays. Unfortunately, when someone presents with a serious episode, such as myocardial infarction, stroke or whatever, they will not wait until 9 o’clock on a Monday morning to get the most appropriate treatment. We need a system that is truly 24/7, 365 days a year.

    I pay tribute to what my hon. Friend the Member for Winchester (Steve Brine) said about prevention, which was spot on. A lot of the things I have talked about on increasing productivity relate to treatment within the NHS itself, whether in an acute or primary care setting, but if we are to make significant productivity or value for money savings in the NHS, we need to stop people presenting at hospital when they do not need to. A lot of that will be achieved by people looking after themselves and having the information available to them, through investment in public health. I asked today in the Health and Social Care Committee whether these integrated care systems looked like a true partnership among public health, primary care, acute care and social care. The jury is still out on that one, but we definitely need significant investment in prevention, and I am looking forward to taking part in that inquiry.

    I end with this. I have talked a little about what I think needs to happen, and I have done it rather constructively, I hope Members from all parts of the House agree. Despite the fact that there are probably severe differences between both sides of this House, all of us want a national health service and systems in place that are working as they should be, and all of us want to see a fully funded, appropriately funded and appropriately staffed national health service. Significant progress has been made: the Chancellor of the Exchequer, my right hon. Friend the Member for South West Surrey (Jeremy Hunt), who was previously Chair of the Health and Social Care Committee, has said that he will accept the idea of an official workforce target being put in place. That is a huge step forward.

    Some significant gains, and investment, have been made in our NHS. The number of people working in our NHS is going up. With a little consensus about the solutions we need for our national health service, such as those that I have suggested, we can ensure that it goes on and prospers.

  • Helen Whately – 2022 Speech on Cancer Services

    Helen Whately – 2022 Speech on Cancer Services

    The speech made by Helen Whately, the Minister of State at the Department of Health and Social Care, in the House of Commons on 8 December 2022.

    I very much thank my hon. Friend the Member for Winchester (Steve Brine) for raising the Select Committee’s report on cancer today. I know that he is passionate about this issue both as a former cancer Minister and for the personal reasons that he mentioned, as do I. The Committee’s 12th report makes valuable recommendations, and I am grateful to it for all its hard work. I assure him and hon. Members that we are working night and day, together with our colleagues in the NHS, on three priorities for cancer in particular. They are: to recover from the backlog caused by the pandemic; to get better at early diagnosis and treatment, using the tools and technologies that we have; and to invest in research and innovation, because we know that advances in such things as genomics and artificial intelligence have the potential to transform our experience of cancer as a society.

    This is my first opportunity to congratulate my hon. Friend on his election as Chair of the Health and Social Care Select Committee, where I know he will do an excellent job, bringing his expertise as well as his passion on the subject to bear. I also welcome the focus that he will bring to the Committee on cancer and prevention, as he mentioned in his remarks. I am truly sorry that he has lost members of his family to cancer, including, as he said, his father. He rightly said that cancer affects pretty much everyone in our country in one way or another.

    My hon. Friend talked about some of the challenges that we and our NHS face in the diagnosis and treatment of cancer. In his time as cancer Minister, he was absolutely right to focus on early diagnosis, because we know that that makes such a difference. As he said, he set the 75% ambition for early diagnosis to be achieved by 2028, and the NHS is indeed working towards that at the moment. He talked about wanting to see the plan for achieving that ambition—I say “ambition” because, as he will know, it was intentionally set as a stretching target—and about the importance of us having the capacity to treat cancer. I think that is currently higher than it was before the pandemic, but I certainly see the need to expand it further.

    My hon. Friend talked about the importance of surgical hubs. We have 89 of them, but more are planned, with £1.5 billion of capital funding recently approved for their expansion and future new hubs. He rightly talked about the importance of cancer research and the alignment of that with cancer treatment and cancer services. He also talked about the significance of health disparities and the prevalence of risk factors such as higher smoking and obesity rates in more deprived communities. I will address some of those points during my speech.

    The hon. Member for Easington (Grahame Morris) spoke in particular about radiotherapy as well as giving a broader perspective. As he said, we met the other day together with Professor Pryce, and he raised his concerns with me about the use of radiotherapy, the impact of tariffs, the potential for better use of radiotherapy machines, staff, and several other points in the plan. It is too soon to give him the quality of answers that I would like on those points, but I am looking into exactly what he raised and will get back to him and those others we met as well.

    My hon. Friend the Member for Erewash (Maggie Throup)—I have huge respect for her, including the work that she did as a Health Minister and the expertise she brings to the debate—is absolutely right about the importance of community diagnostic centres. We are rolling them out around the country, with 19 more just announced, increasing our capacity to diagnose cancers promptly. She also spoke about workforce pressures. I am sure she will know that the 2017 cancer workforce plan was delivered and, in fact, exceeded by over 200 additional staff. Since then, Health Education England has received additional funding of £50 million for the cancer workforce in the last financial year and this one.

    I agree with my hon. Friend that we should continue to focus on ensuring that we are training, supporting and retaining the cancer workforce that we need. That is so important to achieving our ambitions in cancer as well as the wider NHS workforce. Indeed, many of those who work in the NHS will be looking after patients with cancer, not just those who might have a specific cancer workforce label. I am sure she will know that we are well on our way to achieving our ambition of 50,000 more nurses in the NHS, with over 29,000 more at the moment.

    My hon. Friend also spoke about cancer equipment. For instance, since 2016, £160 million of capital investment has been invested in radiotherapy equipment. I will take away her call for an equipment audit. She also importantly talked about obesity and alcohol as risk factors, although I appreciated that she said we should focus on alcohol reduction after the festive season. I thank her for allowing us to enjoy a drink over Christmas.

    Grahame Morris

    I am amazed that figures are not to hand on how many radiotherapy machines are more than 10 years old. Is it unreasonable to expect that NHS England would have an ongoing audit to identify which machines need replacing on a planned basis? Will that be addressed?

    Helen Whately

    There will be huge numbers of figures on things that NHS England will be monitoring. I said to my hon. Friend the Member for Erewash that I am very happy to look at her specific suggestion, on the extent to which the data already exists or whether we should be collecting it. That is part of what I will be looking into when I follow up on that.

    We heard from the hon. Member for Coventry North West (Taiwo Owatemi), who brings really valuable experience to this topic. She said that she is a former oncology pharmacist and, if I heard her right, that she also volunteers as a pharmacist in her local hospital. That is hugely welcome experience to bring to the debate. I am very happy to speak to her more about some of the challenges she raised. I will follow up after the debate to see if we can get that in our diaries.

    The hon. Lady pointed out that we are not achieving our targets on treatment rates, which is absolutely true, but she also spoke about cancer referrals. On that point, I want to share some good news. More people than ever before are being referred to hospitals by their GPs to see if they have cancer. The latest data for October this year, published only this morning, shows that almost 250,000 urgent cancer referrals were made by GPs in England, which is up about 109% on the levels in October 2019. It is 10,000 more than in October last year and over 35,000 more than in October 2020. That is thanks to the hard work of GPs, to the 91 community diagnostic centres which have carried out more than 2 million additional scans, tests and checks already, and to all the people who have come forward and got themselves checked. We know it is not always easy if you are worried that you might have something that could be cancer. We are working hard to encourage people to come forward if they are worried, so that we can improve early diagnosis. That is why we are working to raise awareness with campaigns such as “Help us, Help you” alongside targeting case-finding efforts such as targeted lung health checks. Such initiatives are successfully countering the pandemic’s negative impact on cancer referrals.

    In further important news, NHS England announced it is expanding direct access to diagnostic scans across all GP practices. That will cut waiting times and speed up diagnosis or the all-clear for patients. Since November, every GP team has been able to directly order CT scans, ultrasounds or brain MRIs for patients with concerning symptoms, but who fall outside the NICE guidance threshold. Non-specific symptom pathways are transforming the way that people with symptoms not specific to one cancer, such as weight loss or fatigue, are either diagnosed or have cancer ruled out. That gives GPs a much-needed referral route, while speeding up and streamlining the process so that, where needed, people can start treatment earlier. Thankfully, with the increased level of referrals, the majority of people referred will be given the all-clear. However, it is crucial to start treatment promptly for those who are diagnosed, while giving peace of mind to those who do not have cancer.

    On treatment, my Department has committed an additional £8 billion for the next two years, on top of the £2 billion elective recovery fund, to increase elective activity including for cancer services, because speed of treatment following early diagnosis is of course very important.

    I am looking at the time and I know that I need to try to wrap up promptly. I will skip as fast as I can to a conclusion, while answering a couple of points that were raised as we go.

    Many hon. Members commented on the pandemic. I recognise that the pandemic severely disrupted health services. The recovery of performance is a multi-year effort. The NHS is working very hard with a delivery plan specifically to tackle the covid elective care backlog. Under the plan, reducing the number of patients waiting over 62 days for treatment is a top priority.

    Many hon. Members are interested in the progress of the 10-year cancer plan. We are reviewing the responses we have received on the call for evidence to that plan. In parallel, I am closely scrutinising holding the NHS to account on its elective recovery plan, a major part of which is cancer care, as well as looking to the future and making sure we drive forward research and innovation, including, for example, with our recently announced life sciences cancer mission which will invest over £22 million in a vaccine taskforce approach to cancer research.

    I would like once again to thank my hon. Friend the Member for Winchester for securing this debate today. I look forward to working with him and other hon. Members on improving cancer outcomes.

  • Liz Kendall – 2022 Speech on Cancer Services

    Liz Kendall – 2022 Speech on Cancer Services

    The speech made by Liz Kendall, the Labour MP for Leicester West, in the House of Commons on 8 December 2022.

    I thank the Backbench Business Committee for granting this hugely important debate and the hon. Member for Winchester (Steve Brine) for securing it. Ever since he was elected in 2010—the same year as me—he has championed health issues. We have sat on several Bill Committees together and I know that he will continue to champion health issues in his new role as Chair of the Health and Social Care Committee. I was particularly pleased to hear him say he is determined to continue focusing on cancer care as that issue touches so many of our lives personally and professionally. I wish him well in his role.

    The central point made in the Select Committee report is that early diagnosis and prompt treatment of cancer is critical to improving survival chances and to bringing the UK up to the standards of other countries. The grim reality is that patients are having to wait longer at every stage of the process and the fundamental reason for that is a shortage of staff. The report says:

    “Neither earlier diagnosis nor additional prompt cancer treatment will be possible without addressing gaps in the cancer workforce and we found little evidence of a serious effort to do this.”

    I am afraid this is a terrible indictment of the Government’s record on cancer care, and that is despite repeated warnings not only from Members on this side of the House but from cancer charities, NHS staff and a range of other organisations.

    Members may know that the former Chair of the Select Committee and now Chancellor used to rightly say that the Government needed to do far more in terms of the workforce and that they did not have a proper workforce strategy; indeed, I think he may have joined Labour Members in the Lobby in voting to try to make that happen. Since becoming Chancellor he has been more silent on the issue. Labour, on the other hand, does have a clear workforce plan that would help make serious improvements in cancer care alongside many other parts of NHS treatment. I will say more about that later.

    I want to start, however, by setting out some of the current situation on waiting times for cancer care, and there are problems every step of the way. More than 60% of cancers are diagnosed following a GP referral, yet the report rightly says pressures on general practice mean there is a big increased risk of cancer being missed in primary care. The report says:

    “The NHS has lost 1,704 fully-qualified full-time GPs since 2015 despite repeated commitments to recruit more”.

    The impact of these GP shortages is clear.

    The standard is supposed to be that 93% of patients should wait two weeks between initial referral from a GP to cancer treatment. As of October this year only 77.8% of patients were seen within two weeks. That means 53,128 patients waited longer than they should. That is in contrast to when Labour last left Government, when over 95% of patients were seen within two weeks. The Government will no doubt say that that is entirely down to the covid pandemic. I am absolutely clear that covid has had a huge impact on cancer care, but let me remind the House that the Government were failing to hit the two-week referral target even before the pandemic. There are many problems in many other steps along the way. The Government have never hit their diagnosis target of at least 75% of patients being told whether they have cancer within 28 days of an urgent referral from either their GP or a cancer screening programme.

    As hon. Members have said, patients are waiting longer and longer for treatment. If we look at the two-month target, we see that in the East Kent Hospitals University NHS Foundation Trust, which serves the Minister’s constituents, 27% of patients are waiting longer than two months to have their treatment. That is two months when people will be terrified and anxious about what will happen to them. Will their cancer be getting worse? Their family members will be worried, too. In Leicester, the city that I represent, more than half of patients are waiting longer than two months for their treatment. I am afraid that the human cost of that has yet to be fully recognised by the Government.

    The key reason for that is a lack of staff. Alongside the shortages of GPs that I mentioned, the report says that

    “the NHS is estimated, on a full-time equivalent basis, to be short of 189 clinical oncologists, 390 consultant pathologists and 1,939 radiologists, and will be short of 3,371 specialist cancer nurses by 2030.”

    It adds that there is “no detailed plan” to address that. When the Minister rises, I hope that she will set out what she intends to do about that. The Labour Party has set out its long-term workforce plan, which will have independent workforce projections, new career paths in the NHS and new types of health and care professionals to help solve those problems. That includes doubling the number of medical school places to 15,000 a year, doubling the number of district nurses who qualify each year and creating 10,000 more nursing clinical placements, paid for by scrapping the non-dom tax status, because we believe that people who come and live in this great country should pay their fair share of tax.

    I could say far more about transforming cancer care and the need to fundamentally shift the focus of support towards prevention and early intervention, with more action on tobacco, on obesity, on exercise, and on alcohol —all the things that we know make such a difference. I could say far more about end-of-life care, which the hon. Member for Erewash (Maggie Throup) spoke about, and the need to join NHS services with social care and support so that people have choice about how and where they die. Within these time constraints, I want to say that I am optimistic about the future facing cancer patients in this country. There have been huge advances in science, medicine and technology, and Britain has been leading the way in much of that. It gives us hope for the future, but cancer patients and their families need the Government to act to solve the huge problems in the NHS, starting with the workforce, to get those waits down, get early diagnosis up and transform survival rates for cancer treatment.

  • Taiwo Owatemi – 2022 Speech on Cancer Services

    Taiwo Owatemi – 2022 Speech on Cancer Services

    The speech made by Taiwo Owatemi, the Labour MP for Coventry North West, in the House of Commons on 8 December 2022.

    It is a pleasure to follow the hon. Member for Erewash (Maggie Throup), a former Health Minister, who spoke with so much authority about the current workforce challenges, but also the need to improve and invest in better diagnostic equipment. I also commend the Select Committee Chair, the hon. Member for Winchester (Steve Brine), for perfectly outlining the Committee’s report.

    As somebody who worked in our NHS as a cancer pharmacist before entering this House and has worked as a regular volunteer pharmacist at my local hospital in Coventry, I know just how overwhelmed and over- stretched NHS cancer services are. The recently published report from the Health and Social Care Committee on cancer services uncovered that, in September, only 60.5% of patients started treatment within 62 days of urgent referral. In Coventry this year, only 57.2% of patients at University Hospitals Coventry and Warwickshire NHS Trust began their treatment within two months of being referred to the hospital by their GP. That is against a national target of 85%, so in Coventry and across the country cancer patients are being failed, making the Government’s declaration earlier this year of a war on cancer look more like a retreat than a tactical advance.

    The reality is that waiting lists are up, referrals are slower than ever, screening is in crisis, patient satisfaction has plummeted, medical professionals are leaving the sector in droves and the sector faces major structural challenges. If the Government are serious about making inroads into improving cancer care over the long term, it is crucial that they build a cancer workforce that is fit for the future. I welcome the Government’s commitment to publish a workforce plan next year, but they must commit to publishing the plan in full and deliver the much-needed funding for any workforce growth to succeed.

    Just to take clinical directors as an example, 99% have said that they are concerned about morale and burnout across the clinical radiology workforce. If we continue to treat our medical professionals with contempt, no one should be surprised if they decide to look for pastures new. If allowed to worsen, I fear that this workforce crisis will lead to expensive outsourcing and it will inevitably place greater strains on the public finances. Equally, I am deeply concerned that the Government have so far failed to recommit to a long-term cancer strategy.

    Under the last Labour Government, there was a long-term strategy and by and large we delivered it. That was reflected in record high patient satisfaction, record low waiting times, speedy referrals and improving survival rates across the board, so that is exactly what cancer services deserve.

    We know that one in two of us will get cancer in our lifetime, yet cancer outcomes in the UK continue to lag behind those of comparable European countries, as many Members have mentioned. This is disappointing to hear and highlights why we need a 10-year cancer plan. I am concerned that there are rumours that the plan may have been scrapped; given how many resources and how much energy have been put into developing the plan, I hope the Minister will confirm whether that is the case.

    Many Members have spoken about prevention, which is at the heart of the Committee’s latest cancer report. Four in 10 cancers in the UK are preventable, yet only through taking action to prevent cancer developing in the first place will we save lives and reduce pressure on our NHS. I welcome the successful public health campaigns on smoking and obesity in recent years, but much more needs to be done to ensure patients are made aware of the risk factors in developing cancer and can recognise its early signs and symptoms.

    Shockingly, smoking is still the biggest cause of cancer and death in the UK, causing around 150 cancer cases every day and 125,000 deaths each year. Recent Cancer Research UK modelling suggests that England will miss its smoke-free 2030 target by seven years for the population as a whole and by almost double that for the most deprived communities, who will not meet this target until the mid-2040s. So I urge the Government to invest in the resources and services that encourage and support people to quit smoking for good. Only through this long-term investment are we going to see the preventive results we urgently need.

    As the recently elected chair of the all-party pharmacy group and a former oncology pharmacist, I will briefly focus on drugs. As Health and Social Care Committee Chair the hon. Member for Winchester said earlier, drug research and development is not within the remit of the NHS. However, much investment is needed on research and development for new drug treatments, particularly for rare cancers such as liver cancer.

    I also want to speak briefly about aseptic services. I still work in aseptic pharmacy and understand the challenges and difficulties facing pharmacy aseptic services. The failure of the firms who make the cancer drugs to meet demand and the subsequent delays in patient treatment mean many treatments are repeatedly rescheduled. Frustratingly, this also means more work for NHS staff, who are already under enormous pressure. Also, increasing vacancy rates in aseptic services mean that services are working at, or above, capacity. These posts are hard to fill due to the fact that only a small group of healthcare professionals have the specific skills required, and given the small number of new staff entering aseptic services the filling of a vacancy at one hospital often results in a vacancy at a neighbouring hospital. I urge the Minister to take this challenge seriously, and to recognise that delays to treatment and referrals and cancellations must be addressed as they impact the ability of hospital pharmacy teams to supply these vital treatments.

    The Government must also take note and understand that the relationship with the firms supplying these drugs and NHS units is of fundamental importance. Hospitals must work in partnership with these companies to ensure that all parties do all they can to make sure the treatment is available on time and when patients need it; at the moment this is not happening. Pharmacy teams must be part of all capacity planning discussions; they are the ones on the frontline and they know what patients need. Aseptic units with capacity must also have the power to support other hospitals within their integrated care system areas. There will always be a small number of products that have to be prepared locally on a patient-specific basis; however, currently no mechanism exists for these products to be made without relying upon the manufacturers. I would welcome the opportunity to discuss these issues with the Minister further, and I hope she recognises the serious challenges aseptic pharmacies currently face.

    I have covered a lot of ground in my remarks today, but that is because of the scale of the challenge facing cancer care across the NHS. Whether driving down waiting times and eliminating needless delays, growing the workforce to treat cancer patients, boosting cancer prevention services, or facing down the challenges facing aseptic services, the Government certainly have a lot to do to improve cancer services and patient outcomes. I know the Minister is committed to improving those services and outcomes, and as a member of the Health and Social Care Committee I look forward to seeing, I hope, the much-awaited cancer plan and scrutinising it. I sincerely hope that this time next year the situation has improved for my constituents and all cancer patients nationally.

  • Maggie Throup – 2022 Speech on Cancer Services

    Maggie Throup – 2022 Speech on Cancer Services

    The speech made by Maggie Throup, the Conservative MP for Erewash, in the House of Commons on 8 December 2022.

    It is a pleasure to follow the hon. Member for Easington (Grahame Morris), who speaks with much knowledge and personal experience, which makes a huge difference. I welcome the report of the Health and Social Care Committee on cancer services, and the subsequent response from the Government. I commend all Select Committee members involved in producing that excellent report and I have every confidence that more quality reports will be produced on this subject and many others under the leadership of my hon. Friend the Member for Winchester (Steve Brine).

    I am grateful for the opportunity to discuss the report further. I will focus on community diagnostic centres and the role of diagnostics more generally in supporting cancer services. With 91 community diagnostic centres already open, a further 19 announced yesterday and 40 more to come before March 2025, this is definitely a good news story. I am delighted to have a community diagnostic centre in my constituency at Ilkeston Community Hospital. It opened a year ago. In its first eight months, it delivered more than 6,500 tests, checks and scans. To date, across all the community diagnostic centres that have opened, 2.4 million tests, checks and scans have been carried out. That is excellent news, but not the full story.

    The success of the upcoming 10-year cancer plan—we hope that it is upcoming and has not been shelved—as well as tackling the backlog, elective recovery plans and levelling up, depends heavily on diagnostics. Diagnostics, whether in vivo or in vitro, are crucial to the overwhelming majority of patient pathways and are central to health outcomes. I know that the royal colleges, specifically the Royal College of Radiologists, and many other organisations support investment in improving cancer services across England and, at the same time, addressing historic postcode lotteries created over recent decades.

    Community diagnostic centres have an important role to play in this, but they bring their own problems. There are already existing chronic workforce shortages and ageing equipment that prevent cancer diagnosis and improvements in cancer care. There is a shortfall of 30%—1,453—full-time equivalent clinical radiologists and a 17%—148—shortfall of clinical oncologists. Those shortfalls vary in severity for each region, but I take a particular interest in the east midlands, where my constituency is. The east midlands has the same shortfall of clinical radiologists as the national average, which is 30%, but the shortfall in clinical oncologists is above the national average, at 28%, while 19% of clinical radiologists and 18% of clinical oncologists are forecast to retire in the next five years, adding even further pressure on a workforce already struggling to meet demand.

    A global study has found that a treatment delay of four weeks, which could be caused by a workforce shortage, is associated with a 6% to 13% increase in the risk of death, and that worries me as it could have a detrimental impact on the outcomes for cancer patients across Erewash, however hard those in post work. If we are to improve cancer services in England, we must invest in clinical radiology and clinical oncology training places to ensure that there are enough clinicians throughout a cancer patient’s pathway. I know there is competition for clinicians across all disciplines, but, if we are to improve outcomes for our cancer patients, we need to attract radiologists and oncologists.

    I pay tribute to everyone involved in this aspect of medicine, whatever their role, and of course our NHS workforce across all disciplines. I include all the amazing people, whether healthcare professionals or volunteers, at my local hospice, Treetops Hospice Care, who each day make the end of life a better experience for so many of my constituents—a huge thank you to everybody.

    I have mentioned that one of the other barriers to community diagnostic centres reaching their full potential is the lack of investment in equipment in the existing system. The UK has fewer scanners than most comparable countries in the OECD: it has 8.8 CT scanners per million of the population while France has 18.2 and Germany has 35.1; it has 7.4 MRI scanners per million of the population, while France has 15.4 and Germany has 34.7. Industry surveys have shown that one in 10 CT scanners and nearly a third of MRI scanners in UK hospitals are over 10 years old, and 10 years is usually the age at which this equipment can be considered obsolete and must be replaced.

    In June, the Royal College of Radiologists surveyed a representative sample of its members in England about equipment needs, revealing that 49% of clinical radiologists and 21% of clinical oncologists said they do not have the equipment they need to deliver a safe and effective service for patients in their department or cancer centre. Only 32% of clinical radiologists and 54% of clinical oncologists said their equipment is fit for purpose, with the rest saying it is substandard or only acceptable to some extent. There must be a comprehensive audit of all diagnostic equipment across England so that investment is made in the right equipment where it is needed most.

    I have some questions for the Minister, for whom I have great respect. I know just how much she cares about getting it right for patients. First, are clinical radiology and clinical oncology training places being invested in to ensure there are enough clinicians throughout a cancer patient’s pathway and, if so, will that investment include both the 50% of trainee costs covered by Health Education England and the other expenses incurred by trusts? When it comes to equipment, are community diagnostic centres taking the investment preference over and above the replacement of obsolete diagnostic equipment in hospitals, and will an audit of all diagnostic equipment be carried out? Of course, as has been mentioned, one of the elephants in the room—or, more correctly, in the Chamber—is: how do we help to prevent people from getting cancer in the first place?

    Across the UK, there are huge health disparities. When heat map after heat map is laid over the UK —whether for high smoking rates, high levels of obesity, high rates of cardiovascular disease, high rates of cancer, excess alcohol consumption or poorer health outcomes—they all show that the same areas are affected detrimentally. Therefore, we need to consider how we are going to achieve the Government’s targets to become smoke-free by 2030 and to halve childhood obesity by 2030. Perhaps, after the festive season, there can be a fresh look at measures to tackle excess alcohol, because alcohol, smoking and obesity are all markers of and can all cause cancer. If we are serious about tackling cancer, we need to be serious about preventing it as well, and it is never too late. We are always excited to hear about new therapies that have been proved to be effective, but surely we need to get as excited about preventing cancer in the first place, so my final question for the Minister is: when can we expect the health disparities White Paper to be published?

    There are many innovations to harness across all diagnostics, while community diagnostic centres, genomics and AI have a role to play, as do many more innovations, but until the unprecedented challenges—including the huge workforce pressures, out-of-date equipment and preventive measures continuing to be watered down—are addressed, cancer diagnosis and treatment will never reach their true potential. The Government state in their response to the Select Committee’s report that

    “the Government’s forthcoming 10 Year Cancer Plan will set a new vision for how we will lead the world in cancer care, including ensuring we have the right workforce in place.”

    That is an admirable ambition, and we all want the Government to succeed. Indeed, they must succeed, as this will be transformational for the life chances of my constituents in Erewash and those of the whole nation. As my hon. Friend the Member for Winchester has said, I look forward to reading the Government’s 10-year cancer plan very soon.

  • Grahame Morris – 2022 Speech on Cancer Services

    Grahame Morris – 2022 Speech on Cancer Services

    The speech made by Grahame Morris, the Labour MP for Easington, in the House of Commons on 8 December 2022.

    It is a privilege to speak in this debate, and I want to express my appreciation for the work of the Select Committee and for the way its Chair, the hon. Member for Winchester (Steve Brine), presented the report and the way forward. It is very instructive and informative, and I cannot disagree.

    I must make some declarations of interest. I am, and have been for some time, vice-chairman of the all-party parliamentary group for radiotherapy. I want to confine my remarks to radiotherapy, although I do have a broader interest as vice-chairman of the all-party parliamentary group on cancer. People might not believe this, but I worked for almost 15 years in an NHS diagnostic laboratory, so I have a little bit of knowledge of the front- line. I served for five years as a member of the Health Committee when I was first elected, under the chairmanship of Stephen Dorrell initially and then Sarah Wollaston. I found that to be one of the most interesting and rewarding things I have done in the House of Commons since being elected.

    I also served on the Health and Social Care Public Bill Committee—I must thank you, Madam Deputy Speaker, for putting me on that Committee—which was a marathon. I remind Members who were not around at the time that part of the justification put forward by the then Prime Minister and the coalition Government for those major reforms and restructuring of the national health service, including the commissioning of cancer services, was the poor outcomes on cancer. The system we have now was born out of a recognition that we needed to do better.

    I pay tribute to the hon. Member for Westmorland and Lonsdale (Tim Farron), who chairs the APPG for radiotherapy, and the hon. Member for Strangford (Jim Shannon), who is an assiduous advocate for improved cancer services, not just in Northern Ireland but throughout the country.

    I am delighted that this report signposts the way to future work. I am very pleased that the hon. Member for Winchester indicated that it is his intention, with the agreement of the Committee, to do further work on how we might achieve the laudable 75% diagnosis target by 2028. I am pleased that the Minister of State, Department of Health and Social Care, the hon. Member for Faversham and Mid Kent (Helen Whately), is responding to the debate. I am sure that, like some of her predecessors, including the hon. Member for Winchester, she will grow tired of me banging the drum for cancer services, and for radiotherapy in particular, but there are some very important points and sound advice that come not from me, although I should say that I am a cancer survivor. I have had lymphatic cancer on three occasions, and I have benefited from surgery, chemotherapy and radiotherapy, so I understand what is involved and I value the vast improvements there have been in all those pillars of cancer treatment.

    The sexy thing on cancer services is early diagnosis. It captures a lot of headlines, and the hon. Member for Winchester was right to point that out, but it goes hand in glove with having the requisite treatment capacity. With the best will in the world, the investment in new diagnostic hubs, which I welcome and is laudable, will simply increase the number of patients in the system. If we are to improve outcomes for cancer patients, we simply must address the issues around cancer treatment capacity.

    I believe the Minister has a copy of the six-point plan for improving outcomes from the APPG and the charity Radiotherapy UK. We are not saying that radiotherapy is somehow in competition with the other pillars of cancer treatment; rather, it complements them. Advancements in science, technology and skills, with the introduction of artificial intelligence, the ability to map tumours precisely and incredible advancements in MRI scanning facilities, used in parallel with precision radiotherapy machines, gives us an opportunity to make a quantum leap in treatment and to improve productivity.

    The cancer workforce is very small; it is only around 6,500 nationally. They are a highly skilled, highly motivated group of individuals who are doing a fantastic job, and I pay tribute to the cancer workforce, particularly those who work in the field of radiotherapy, who are holding the line at the moment and facing growing pressures in the system.

    As a country, we spend about 5% of our dedicated cancer budget—not 5% of the entire NHS budget—on radiotherapy. If we look at international comparators, which we must do, we see that the OECD average is about 9%, so we are spending about half as much as other similar developed industrial nations. To put that into context—because sometimes we get lost in the figures—the NHS spends more on a single cancer drug, Herceptin, than on the entire radiotherapy service across the country.

    I want to touch on commissioning, which is an issue that can be readily addressed and that came about as a consequence of the 2012 Lansley reforms. We took that up directly with the Minister when she kindly met a delegation earlier this week. Cancer services are currently nationally commissioned by NHS England, but there are things that could be done rapidly to increase treatment capacity by addressing some of the anomalies in the current tariff system.

    Perversely, NHS trusts that have the latest advanced precision radiotherapy equipment are financially disadvantaged from using it because of the tariff system. Bizarrely, patients are being treated with 30 fractions of radiotherapy when it is perfectly possible to treat them with four, five or six fractions of precisely delivered radiotherapy if the machines are available and the staff are trained to do it. In many cases, the machines are there but the tariff system works against rolling out that facility. That is completely perverse and it is crazy that we do not do that.

    We can learn from examples of what is happening in similar European countries. The Chair of the Select Committee mentioned the rapid improvements that have been made in Denmark as a result of having a well-thought-through, well-developed and well-scrutinised plan to improve cancer services. Rightly, some European countries also have diagnostic hubs, but in many cases they are combined diagnostic and treatment hubs, so it is conceivable that patients go in for diagnosis and rapidly begin their treatment—in some European countries, on the same day. Many patients here wait a month, and far too many wait more than two months—62 days—before their treatment starts.

    I have some particular points to make to the Minister, which we also raised with her directly. The Chair of the Select Committee mentioned the new cancer plan. As a House and as a nation, we need some clarity on whether there will be a new 10-year cancer plan and whether the Department and the Ministers are making the case to the Treasury to secure the necessary funding. I hope that, as part of that, the Minister will look at the six-point plan for improved radiotherapy services that she has in her possession. Even without a cancer plan, however, there are things that could be done immediately to address the issues around the tariff system and the bureaucracy that holds back technology, which NHS England could easily resolve.

    We are going to move to a new commissioning system with integrated care boards over large areas, but they have no capital budget and their funding is revenue based, so we must address the issue of those centres across the country. It is wonderful if people live near the Royal Marsden, which is one of the finest hospitals not just in the country or in London, but probably in the world, but if people live in the south-west, Cumbria or the north-east, they cannot readily access such a tremendous centre. We must address some of those health inequalities before the new commissioning arrangements come in, so that we have a systematic approach to replacing machines that are more than 10 years old, rather than having to make out a business case and compete against other centres that may already be well provided with the latest technology.

    We are on a time limit, so I will wrap up, because I do not want to incur the wrath of Madam Deputy Speaker. I give the Minister credit for her commitment and aspiration to improve cancer outcomes and to have a first-class service. I hope that the Health and Social Care Committee will play its role in scrutinising the cancer plan, or the Minister’s plans to improve cancer services. I am pleased that she recognises the validity of the representations that have been made already and that there is an urgent need to address the tariff issue. I would like an assurance that that will be done quickly, not in a year or two, because there is clear evidence that it could improve outcomes and it is what we call low- hanging fruit.

    There is a lot more that I could say and lots of figures that I could quote—for example, I am concerned about the latest cancer waiting times; the Minister attended our presentation where it was shown graphically that there are huge variations across the regions. The Government must address that. I think we could get cross-party support for a sensible cancer plan, so I look forward to seeing the proposals that she comes up with when she has consulted with her colleagues and the Treasury.

  • Steve Brine – 2022 Speech on Cancer Services

    Steve Brine – 2022 Speech on Cancer Services

    The speech made by Steve Brine, the Conservative MP for Winchester, in the House of Commons on 8 December 2022.

    I beg to move,

    That this House has considered the Twelfth Report of the Health and Social Care Committee, Session 2021-22, Cancer services, HC 551, and the Government Response, HC 345.

    I am very grateful to the Liaison Committee for selecting this topic for debate in the Chamber today. We know that one in two people in the UK will develop cancer at some point in their lives. It is no exaggeration to say that this is an issue that affects everyone in the House—indeed everyone in the country in one way or another—and it has touched my life for the worse many times, as I will talk about later. That is why the Health and Social Care Committee produced a report on cancer services earlier this year, and I pay tribute to my predecessor as Chair, my right hon. Friend the Member for South West Surrey (Jeremy Hunt), for his leadership in producing that work. That awful statistic is also why I have made cancer a priority as the new Chair of the Committee.

    Our report found great strides had indeed been made in improving survival from cancer. Thanks to the tireless work of our scientists, researchers, doctors and nurses and others, including Ministers, over many years, more than half of people diagnosed with cancer now live for five years or more, compared with only one in three people 50 years ago.

    We also heard that cancer survival in England, and indeed in the rest of the UK, continues to lag behind comparable countries around the world. The International Cancer Benchmarking Partnership explains that just under 60% of people diagnosed with bowel cancer in England, for instance, will live for five years or more, compared with 66.8% in Canada and almost 71% in Australia. The pattern is seen in many other cancer types, including lung cancer, which, of course, took our great friend James Brokenshire last year; pancreatic cancer, which took my own father, who was diagnosed in September 2019 and was dead three days after the general election that December; and ovarian cancer, which has also touched my family and so many people.

    The charity Target Ovarian Cancer came to the House last month—my good friend the hon. Member for Washington and Sunderland West (Mrs Hodgson), who chairs the all-party parliamentary group on ovarian cancer, led the reception downstairs in the Churchill Room—and launched its pathfinder study, “Faster, further, and fairer”. The study notes that 4,000 women a year still lose their lives to ovarian cancer. I highly recommend that excellent report to Members.

    We know that one of the biggest reasons for the survival gap—I have just quoted some comparative figures—is that the NHS tends to diagnose fewer cancers at an early stage, when cancer is, of course, much more treatable. Early diagnosis is cancer’s magic key, as has been said so many times from these Benches. NHS England has set a target of diagnosing 75% of cancers at an early stage by 2028, compared with about 54% today. We say that achieving that would make a huge difference to outcomes. I agreed that target when I was the Minister with responsibility for cancer a few years ago, and I firmly believe that it is the right target to give more people the best possible chance of surviving their cancer. But we need to be much more ambitious and get upstream of many cancers—I will return to that point.

    Last month, Dame Cally Palmer, the excellent national cancer director who also works at the Royal Marsden, told us in a special topical session of the Select Committee that she remained “cautiously optimistic” that the 75% target would be met, and told us about some great progress being made on programmes such as targeted lung screening—we have all heard about the supermarket checks—which is diagnosing lots of early-stage lung cancers in the pilot studies and is showing great promise. Dame Cally’s optimism was not, I have to say, entirely shared by many of the experts who gave evidence to our inquiry on cancer services. John Butler, a specialist in ovarian cancer, thought it was “extremely unlikely” that the 75% would be reached, and Dr Jeanette Dickson, an oncologist, said the NHS was doing “very badly” against the target. That is a worry. Regrettably, we concluded in our work that the NHS is not on track to meet the 75% target, and that judgment was shared by the Committee’s independent panel of experts, who evaluated Government progress on cancer services.

    The Government said in their response to us that it was premature to say that progress towards that target is off-track, but the National Audit Office found that, so far this year, 56% of patients are being diagnosed at stages 1 or 2, which is the same proportion as when I made the target in 2019. Of course, that is below the level of improvement required to reach that three-quarters target of early diagnosis by 2028. I do not agree that it can ever be premature to call for more to be done to make progress on early diagnosis when failing to achieve the target could mean many hundreds of thousands of people missing out on early diagnosis and, of course, on a better chance of surviving their cancer and living for longer.

    The Committee heard extremely powerful examples of why it is so important to make more and faster progress on diagnosing cancers earlier. In December 2020, Andrea Brady’s daughter Jess died of stage 4 adenocarcinoma at the age of just 27 years old. Before her diagnosis, Jess had been passed from pillar to post, consulting repeatedly with multiple GPs and other clinicians before her mother was finally forced to pay for a private consultation just to get Jess a diagnosis. By that point, tragically, it was too late. Jess passed away in hospital three and a half weeks after she was diagnosed.

    Meeting the target of diagnosing 75% of cancers at an early stage would mean giving thousands of people a better chance of surviving their cancer, and thousands fewer families having to suffer such terrible losses. That is why we called in our report for the then promised 10-year cancer plan to kickstart progress on early diagnosis. We called for it to consider more radical proposals on how to diagnose more cancers at an early stage, and to include an associated workforce plan to reduce diagnostic bottlenecks in the system.

    Good work is ongoing, and I know that the Minister will talk about it later. New research, such as the NHS-Galleri blood test trial, could be transformative. Indeed, last month our colleagues at NHS England would not be drawn on whether there is a need for a new 10-year cancer plan, as previous Governments have promised. They seemed to imply that a new plan was not needed given the focus of the long-term plan on early diagnosis. I contest that. The consultation on a new 10-year cancer plan was responded to by the sector, charities, royal colleges and many other organisations, and it has set many hares running and created great expectation about a future cancer plan. We on the Committee—I see other Committee members here—are concerned about that. We are not hung up on plans, but in my experience of being a Minister, the NHS loves a plan, the NHS needs a plan, and critically, that would allow this House to see where we are against the plan.

    Achieving early diagnosis is not just about what NHS England can do from the centre. It is also about improving public awareness about the many signs and symptoms of cancer across all communities. It is about making sure that GPs have good systems in place for managing patients with possible cancers and are able, without barriers, to refer them on for tests. It is about the continuous improvement of screening programmes, and hard work—really hard work—in local areas to encourage people to come forward. Of course, one of the great promises of the new integrated care systems is to work with the cancer networks and alliances to deliver on that system of early diagnosis and prevention.

    Achieving early diagnosis is also about focusing research and innovation on developing new ways of detecting cancer—especially cancers that are hard to diagnose—and ensuring that the NHS is set up to roll out new tests quickly. I referred to Galleri earlier, and mentioned upstream cancer. Next year, we will do a piece of work that I loosely call “Future cancer”. It is, of course, important that we diagnose cancers early—that is the basis of my remarks. At the moment, however, we largely diagnose cancers and treat them when they are symptomatic, and we hope to catch those symptoms and treat them early. Many cancers, but not all, are preventable, and I am interested in future cancer. Where can we get upstream of this? Where can we use the NHS’s new genomics strategy? Where can we use biomarkers to get ahead of that? That poses big moral and ethical questions to us as a society, but that is no reason not to go there or not to have that ambition.

    All this is about making sure that there are enough staff and machines in the system to do even more tests and give many more people the best possible chance of being diagnosed with cancer at an early stage. The 10-year cancer plan should look again to make sure that the Government are truly pulling out all the stops to get to 75% early-stage diagnoses by 2028. I hope the Minister will confirm that the Government are still committed to doing that work.

    Early diagnosis means little if there is not sufficient capacity to provide people with the right treatments at the right time. Unfortunately, the latest data suggests that there has been a decline in the NHS’s ability to provide this treatment. While the vast majority of people do still receive timely treatment following a cancer diagnosis, in September nearly 10% of people waited more than a month for their first treatment following their diagnosis, compared with less than 5% in 2019. That is more than 2,400 people having to wait more than an entire month to begin their cancer treatment—more than double the number who were waiting that long two years prior. As the former cancer director, Professor Sir Mike Richards—a giant in this area—often says, when someone is waiting for a cancer diagnosis or treatment, it is not the 31 days that really matter, but the 31 nights. I know that people around the country will understand that.

    Grahame Morris (Easington) (Lab)

    I commend the hon. Member, the Chair of the Select Committee, on an excellent report and an excellent analysis of the problems and the way forward, but he referred to the latest cancer waiting times. It is timely that we are having this debate, because the new cancer stats have been published by NHS England today. They show that the position is worsening. In October this year, 39.7% of cancer patients waited beyond 62 days between urgent referral and cancer treatment. There is an urgency in addressing some of the issues that the Chair raises.

    Steve Brine

    Indeed. The reason why we had Dame Cally and Professor Peter Johnson, who is the national clinical director for cancer, into the Select Committee a couple of weeks ago is that the NHS has set itself a deadline of next spring—it was this spring—to get back to the 62-day wait. I have everything I have crossed that they can get there, but they need to make it happen. I know they are relentlessly focused on that, and the Minister is relentlessly focused on that, but we have got to help them get there.

    The Committee also heard about the challenges facing surgery and radiotherapy services, which makes it rather timely that the hon. Gentleman intervened on me at that point, as I suspect he will speak about it later. Professor Pat Price, who he and I are going to meet early in the new year, is a consultant oncologist at Imperial College in London. She told us that radiotherapy services were lacking staff and machines to be able to deliver the best possible care and that services were struggling to deliver the level of activity needed to catch up with the cancer backlog. I will let the hon. Gentleman expand on that a bit later. Professor Mike Griffin, professor of surgery at Newcastle University, also highlighted workforce shortages as a significant barrier to effective cancer surgery, but he also told us about the organisation of services. Because cancer surgery is often co-located within general, acute and emergency care, it can be subject to delay because of capacity shortage, and that was a particular problem during covid in some places, but not everywhere.

    My trust, Hampshire Hospitals, did a brilliant job to keep cancer surgery on track at all times by doing it offsite. I pay tribute to Alex Whitfield and her team at Hampshire Hospitals for the way they organised with Sarum Road private hospital in particular to ensure that patients continued to get their cancer treatment. Professor Griffin called for more ringfenced hubs to be developed so that cancer surgery can continue even when there are severe pressures on acute care, and I hope the Minister refers to that when she winds up.

    Growing the workforce, investing over the long term in machines and IT and reorganising services to create more cancer surgery hubs are all in the Government’s gift, which is why we recommended that they consider those actions in developing the 10-year plan. Without a wider focus on removing the barriers to the NHS delivering the best possible cancer treatments, the potential gains of earlier diagnosis might not be realised. Given the number of people presenting with suspected cancer at the moment—it is good that they are presenting, and many of them will turn out not to have cancer— if it is found that they do have it, we need to move on that. That is why treatment is the other side of the same coin.

    Just as further progress on early diagnosis will depend on research and innovation to develop new tests, improving cancer treatments will require new and more advanced techniques to be developed and implemented by the NHS. We found in the Committee report that the UK is a genuine world leader in research. There are unique aspects to the NHS that make it an effective partner for research organisations. We also heard that there are significant barriers to researchers accessing the data they need for quick and equitable patient recruitment to clinical trials and for staff having the time they need to take part in research. The Government have set out several steps they are taking to improve access to data and improve flexibility for staff wanting to take part in research, and that is welcome, but research by Cancer Research UK has found that the UK’s recovery from the pandemic in clinical trials continues to be outpaced by other comparable countries.

    NHS England told us that supporting clinical research into cancer is not its responsibility, so it is clear that a wider effort is needed to make sure that cancer research taking place in the NHS is well supported and aligned with the priorities for cancer services. That is another reason why the plan is important.

    Finally, we heard that there is significant variation in outcomes for people diagnosed with cancer, depending in part on the type of cancer they are diagnosed with, but also demographic factors. The Government told us that they would be addressing these differences through the levelling-up White Paper, but also through the health disparities White Paper, by addressing issues such as smoking and obesity, which are more prevalent in our more deprived communities.

    On that, there is a story in today’s press which suggests that Britain has the biggest increase in early onset diabetes in the western world. That is a huge concern. I am not suggesting that diabetes is cancer; I am saying that we have many suggested actions to reduce obesity around junk food advertising and stuff that follows on from the sugar tax. Much of that has still not been implemented. Rumours abound—there are always rumours around here—that the Government are seeking to delay junk food advertising restrictions until 2025. I hope that is wrong. I invite the Minister to respond to that when she winds up and, if not, to take that away.

    Maggie Throup (Erewash) (Con)

    Will my hon. Friend give way?

    Steve Brine

    I give way to somebody who possibly shares that view.

    Maggie Throup

    I agree 100% with his concerns about the potential watering down of the much-needed anti-obesity measures. Does he agree that it is important that we reflect what the public want? The public are in agreement with banning advertising on TV for particular foods that cause obesity. If we want to keep the public on our side, surely we have to follow their wishes, as well.

    Steve Brine

    I think that is right. The public are clear on this. I get that there are different views across this House and that there are those who disagree with much of the work that my hon. Friend and I did in government to push some of those measures on preventing obesity. I could agree with them, but then we would both be wrong. At the end of the day, obesity is a driver of diabetes, and obesity is a driver of certain cancers. We must take that seriously. Next year, the Select Committee will be doing a huge piece of work on prevention, and we will be returning to that. I hope that Ministers are aware of that.

    The recognition of the importance of health in the levelling-up White Paper is welcome, but without specific actions to address health disparities, this agenda will be at risk, so it is vital that the Government take up the prevention agenda again to stop people developing cancer in the first place. I hope the Minister will have some good news for us on that front, and I recommend that she returns to the prevention Green Paper that we published back in 2019, which contains lots of helpful ideas in that respect.

    Richard Foord (Tiverton and Honiton) (LD)

    On that point about health disparities and levelling up, I want to draw attention to the Royal Devon University Healthcare NHS Foundation Trust, which serves my constituency. The staff who work there do a fantastic job of cancer diagnosis but, given that the target for the number of people seeing a cancer specialist within two weeks is 93%, it is tragic that only fewer than 60% of people who are served by that trust see a cancer specialist within two weeks of a referral. Does the hon. Member agree that we need to level across, as well as level up, and think about health disparities across the country?

    Steve Brine

    Yes, of course. I hate the term, but this should not be a postcode lottery. We do have integrated care systems and cancer networks, and good, strong, experienced MPs should be driving those local health economies to ensure that they level themselves up and make use of what is there in the system to deliver as well for their population as other parts of the country do. There could be a lot more sharing among us of how we use that ability as Members of Parliament to drive our systems. I do it in my area, and I am sure the hon. Member does it in his. I thank him for his intervention.

    There are issues of variation affecting cancer specifically, such as proper screening uptake among certain groups, lower referral rates for some cancers and in certain areas, and higher rates of less survivable cancers among more deprived groups. We called for NHS England and the Office for Health Improvement and Disparities to produce an action plan for addressing disparities in cancer and for the much talked about 10-year cancer plan to include a specific action schedule for rarer and less survivable cancers. That remains, for us, a vital aspect of improving cancer services, and we hope that the long-term cancer plan—should one arrive—makes that part of its work.

    Last month, NHS England made it clear to us that it was focusing on delivering the NHS long-term plan for cancer. In many ways, that emphasis on delivery is welcome. The programmes being implemented as part of that work are positive, and I have covered some of them today, but recent research from the International Cancer Benchmarking Partnership has shown that national cancer plans are worth far more than the paper they are written on. The ICBP found that the countries that have made the biggest improvements in cancer since 1995 are those that have ambitious, detailed and costed plans for improving cancer services that are open to scrutiny by those whose job it is to do that—namely, us. Denmark and England used to be at the bottom of the league table for cancer, but thanks to consistent national cancer plans with associated long-term investment, the Danes have made rapid improvements, and they now leave us lagging behind.

    In conclusion, the Health and Social Care Committee’s report on cancer services found that there are many areas where the Government and the NHS are doing really good work and using the unique benefits of our national health service, but there are too many other areas where we can go further and faster to improve cancer services and outcomes. I hope the Minister will confirm that the Government intend to do so through the promised 10-year cancer plan.