NHS: Cancer Treatments

Baroness Jowell Excerpts

Thursday 25th January 2018 Lords Chamber

Asked by

[Baroness Jowell]

To ask Her Majesty’s Government what action they are taking to evaluate innovative cancer treatments and make them available through the National Health Service, and to raise life expectancy for cancer patients.

[Baroness Jowell (Lab)]

I begin by extending my deepest gratitude to everybody who is giving their time to attend the debate this afternoon, and to contribute to something that will begin to reshape the way we think about the treatment of cancer for people all over the world. In doing so, I thank the noble Lords, friends and colleagues who have shown me such support since I learned that I had a brain tumour. Today, though, is not about politics but about patients and the community of carers who love and support them. It is of course about the NHS but it is not just about money. It is about the power of kindness, support for carers, better-informed judgments by patients and doctors, and sharing access across more and better data to develop better treatments.

I shall briefly tell your Lordships what happened to me. On 24 May last year I was on my way to east London to talk, not for the first time, about new Sure Start projects. I got into a taxi but I could not speak. I had two powerful seizures. I was taken to hospital. Two days later I was told that I had a brain tumour—a glioblastoma multiforme, or GBM. A week later the tumour was removed by an outstanding surgeon at the National Hospital in Queen Square. I then had the standard treatment of radiotherapy and chemotherapy. To put it in context, across the country GBM strikes fewer than 3,000 people every year. It generally has a very poor prognosis.

Less than 2% of cancer research funding is spent on brain tumours, and no new vital drugs have been developed in the last 50 years. A major factor in survival is successful surgery. The gold standard is to use a dye to enable the surgeon to identify the tumour precisely, but it is available in only about half the brain surgery centres in the UK, and it must of course be extended to all of them.

Cancer is a tough challenge to all health systems, particularly to our cherished health service. We have the worst survival rate in western Europe, partly because diagnosis in cancer is too slow. Brain tumours, in particular, grow very quickly, and they are very hard to spot.

However, there is a good reason for hope. It is called the Eliminate Cancer Initiative. Its director, along with his great colleague who is travelling with him, is here with us today, one of the greatest men in the cancer field: Professor Ronald DePinho from the MD Centre in Houston. ECI is a global mix of programme and campaign, already under way in Australia. It is designed to be rolled out next in the UK, the USA and China. It recognises that no one nation can solve the problem of GBM on its own. It is an opportunity that belongs to the world.

ECI aims to do three main things: first, link patients and doctors across the world through a clinical trial network; secondly, speed up the use of adaptive trials; and thirdly, build a global database to improve research and patient care. Usually, drug trials test only one drug at a time. They take years and cost a fortune to deliver. New adaptive trials test many treatments at the same time. They speed up the process and save a lot of money. We can see approaches to the delivery of cancer treatment transformed.

ECI also has a secure cloud platform—it sounds rather technical, but you will very soon understand its importance—where doctors can share insight and data. Too much data is held in silos with highly limited access. That reduces its value. This is quite a new approach. Already, collaborative discussions are under way in England. ECI will focus on GBM because it is so tough to beat. It is all about sharing knowledge at every level between everyone involved. If we achieve this, we will go a long way to crack GBM and other cancers.

For what would every cancer patient want? First, to know that the best, the latest science was being used and available for them, wherever in the world it was developed, whoever began it. What else would they want? They need to know that they have a community around them, supporting and caring, being practical and kind. While doctors look at the big picture, we can all be a part of the human-sized picture.

Seamus Heaney’s last words were, “noli timere”—do not be afraid. I am not afraid. I am fearful that this new and important approach may be put into the “too difficult” box, but I also have such great hope. So many cancer patients collaborate and support each other every day. They create that community of love and determination wherever they find each other, every day. All we now ask is that doctors and health systems learn to do the same, and for us to work together, to learn from each other.

In the end, what gives a life meaning is not only how it is lived, but how it draws to a close. I hope that this debate will give hope to other cancer patients like me, so that we can live well together with cancer—not just dying of it—all of us, for longer. Thank you.

[Applause.]

--- Later in debate ---

[Baroness Jowell]

I thank the Minister very much indeed for a really inspiring and excellent summary of our discussion. Obviously, I would like to thank everybody else who has considered, and taken part in, the discussion today. I feel that we have made real progress forward. It happens very rarely in this sort of way and I am absolutely delighted and grateful to everybody for their contributions and for the support that the Minister will continue to have. I thank my very dear, long-standing friend, the Secretary of State. He will keep his own—I always have a problem talking about this but he will know exactly what I am talking about. Everything will be done as we hope it will, so thank you very much indeed. Now we look forward to the progress.

[Applause.]

Early Childhood Development

Baroness Jowell Excerpts

Thursday 30th January 2014 Westminster Hall

[Luciana Berger]

I listened to the hon. Lady’s point about the speed of introduction, but reflecting on the experience in my area of Liverpool, the work load on our health visitors is such that they cannot provide the best service possible, because they are so swamped by the amount of visits that they have to do. I contend that there is a challenge in the work load on health visitors. Will the Minister share with us what steps her Department is taking to meet the target?

On maternal support, in particular during the months of pregnancy, with births in the UK at a 40-year high, prioritising maternity services has never been more urgent. Around 10 stillbirths happen in Britain every day, and we have one of the highest stillbirth rates: according to The Lancet, Britain is ranked 33rd out of 35 countries with similar income levels. The charity Sands has linked that to maternity care, issues to do with inappropriate risk assessments for potential mothers and low uptake of perinatal services. Given that neonatal mortality and stillbirth have been indicated as areas for improvement in the NHS mandate to 2015, will the Minister please share with us what activities her Department will undertake to lower the stillbirth rate in England?

The findings of a National Audit Office review late last year are also of concern. It found that more than half of birthing units are not meeting staffing guidelines; that more than one in 10 had to close for a fortnight or more last year; and that 28%, or nearly a third, were forced to turn away mums-to-be at the door between last April and September because of a lack of space or a shortage of midwives. We can all understand how stressful that must be for women towards the end of their pregnancy.

[Mr David Amess in the Chair]

I thank my hon. Friend the Member for East Lothian (Fiona O'Donnell) for raising the important issue of premature babies and for sharing her personal experience of having premature twins and of the importance of the neonatal care received by her sons. A parent in a similar position who had to work might struggle to balance that with visiting the hospital and developing a bond with the babies.

We all have friends or family, or know people who have been expectant mums—some people in the room have been expectant mums—so we know that a skilled midwife can make all the difference between a smooth pregnancy and a stressful one. It is deeply concerning, therefore, that the NAO has highlighted that there is a shortfall of 2,300 midwives. The hon. Member for South Northamptonshire highlighted the increase in midwives’ work loads. The Royal College of Midwives has also calculated that the gap between the number of midwives we have and the number that the NHS in England needs will not be closed until 2026.

Before the previous election, the Prime Minister promised that there would be 3,000 new midwives during this Parliament. Again, regretfully, that target is some way short of being delivered. I am aware that there are many midwives in training, but the high drop-out rate and impending retirements could mean that we face significant shortages for some time to come. We would appreciate any reassurance that the Minister can provide on that matter.

Will the Minister also comment on the training that midwives receive? We have heard from a number of Members about the importance of maternal mental health. Mental ill health is one the biggest risks to a pregnancy, with one in 10 mothers suffering a mental illness before or after birth. Last November, I asked the Under-Secretary of State for Health, the hon. Member for Central Suffolk and North Ipswich (Dr Poulter), what proportion of midwives were trained to provide expectant mothers with mental health support. Unfortunately, he was not able to provide a figure, but I am sure that both he and the Minister agree that we need more midwives who are confident in providing that kind of support.

We also need more specialist mother and baby mental health units. It has been estimated that as much as 50% of the UK lacks any kind of specialist perinatal mental health service. There are only 17 mother and baby mental health units across England, and they are geographically disparate. There are just two in Scotland and one in Wales, and none in Northern Ireland. As both the hon. Member for South Northamptonshire and my hon. Friend the Member for East Lothian said, it is a postcode lottery.

The hon. Member for South Northamptonshire talked about the 1% of mothers who might experience a psychotic episode. That could lead to mothers being hospitalised two or three hours’ drive away from their loved ones. It could also mean that they are separated from their babies. That is good for neither the mother’s well-being nor her newborn child’s development.

I thank all those Members who have raised the importance of support for parenting. A number of Members thanked Home-Start for the work that it has done and the way in which it so helpfully supports parents. We have also heard about specific challenges on early intervention, maternal support and maternity care. However, we know that the challenge of improving early years development reaches far beyond those specific issues. The hon. Member for East Hampshire raised the issue of social mobility, for example; many social determinants extend well beyond the reach of the Department of Health. The hon. Member for South Northamptonshire suggested that the issue could be looked into more widely, perhaps at Cabinet level, and I take that point on board.

Both my hon. Friend the Member for East Lothian and the hon. Member for East Hampshire raised the issue of the importance of digital networks and social networks. They are indeed important, and I welcome the work done by Mumsnet and Netmums, but I would like to put on record the challenges there are for many mums who do not have access to the internet, or perhaps do not know how to use computers. Although digital networks are important and can help to support parents—both mums and dads—one issue that we need to look at further, which is far beyond the reach of the Department of Health, is access to the internet and to broadband, particularly for people living in rural areas. There is also the issue of being able to afford that internet access: people might not want to have to go to a public library to connect and reach out about specific personal issues. We should be thinking about those matters.

There are other issues that we should address, which again reach far wider than the remit of the Department of Health. For example, there is the problem of parents who are struggling with the cost of living, and those who are working all hours and do not have the time to be with their children because they are working all day. We must establish genuine parity of esteem between mental and physical health, across the board. We have to protect babies and children from specific dangers—just yesterday in the House of Lords, for example, there was a debate about protecting children and babies from smoke in cars. There is no better investment that we can make as a society than in our children.

[Dame Tessa Jowell (Dulwich and West Norwood) (Lab)]

I pay tribute to the hon. Member for South Northamptonshire (Andrea Leadsom), with whom I have had the pleasure of collaborating on the all-party group on conception to age two—the first 1,001 days. Does my hon. Friend the Member for Liverpool, Wavertree (Luciana Berger) agree that there is an increasing amount of scientific evidence on early childhood that shows the value of intervention in the first 1,000 days? Will she join me in commending the campaign to see early childhood represented in the new millennium development goals in 2015, which will benefit tiny children and their mothers, not only in this country but around the world?

[Luciana Berger]

I thank my right hon. Friend for her important contribution to this debate. She has summed up many of the earlier speeches on the importance of this issue and how vital early intervention is. Right at the start of the debate, we heard about the science relating to the difference in brain development of children who get that care, love and affection in early life, and those who do not. As we heard, that care is vital to the development of a child over their entire lifetime. I echo her remarks on the millennium development goals. This issue is important not only for us in the UK but further afield, right across the world. I support her call for early intervention to be included in the 2015 goals.

South London Healthcare NHS Trust

Baroness Jowell Excerpts

Thursday 31st January 2013 Commons Chamber

[Mr Hunt]

Let me take those two points in reverse order. First, on GP commissioners, all six local commissioning groups support the principles upon which these proposals were developed. To meet the London-wide clinical quality standards, which are not being met in south-east London at present, it is necessary to centralise the provision of more complex services in the same way that we have already successfully done for heart attacks and strokes. That principle applies as much to complex births and complex pregnancies as it does to strokes and heart attacks, and it will now apply for the people of Lewisham to conditions including pneumonia, meningitis and if someone breaks a hip. People will get better clinical care as a result of these changes. That is the most difficult project in all the work of the trust special administrator. The project has been to try to resolve an unsustainable financial situation while improving clinical care for the people of south-east London, and I think that, in the end, we have got a set of proposals that does that.

[Dame Tessa Jowell (Dulwich and West Norwood) (Lab)]

The Secretary of State will be aware of the dismay with which this statement will be heard across south London. Whatever eloquent argument he advances, the people of south London will take from what he said that the maternity and A and E services at Lewisham have been downgraded.

I have had the opportunity to look briefly at the wording of his statement, and I am alarmed by the degree of risk that Sir Bruce Keogh identifies, particularly in relation to the relocation of the paediatric service. The clinical outcomes to which he refers are dependent on extremely difficult interconnections among ambulance services, receiving staff and inpatient beds, and rely on them all working effectively. He rightly recognises the knock-on effect for other hospitals, and my right hon. and learned Friend the Member for Camberwell and Peckham (Ms Harman), my hon. Friend the Member for Streatham (Mr Umunna) and I, together with all south London MPs, also recognise those knock-on effects. Given that King’s college hospital has seen a fourfold increase in cancelled operations since 2009-10, we are therefore very concerned about the consequences for the care of the constituents whom we represent. We are also concerned that the responsibility for the PRU, which King’s is prepared to welcome, will be properly and adequately financed.

[Mr Hunt]

The right hon. Lady talks about the risks that Sir Bruce alludes to in his analysis of the trust special administrator’s proposals. Those risks are precisely why I have not accepted the proposals in their entirety and have put in place a series of additional safeguards.

Not resolving this issue, which is effectively what the Labour party is calling for because it has put forward no alternative proposals, would carry a high degree of risk. It would mean that south London would not meet the London-wide clinical quality standards. It would mean that £1 million a week would continue to be diverted from front-line patient care into funding an unsustainable deficit. That would be bad for her constituents and those in neighbouring constituencies.

We must look at the south-east London health care economy as a whole, but the objective must be to improve the services that people receive. That is a difficult balance to get right, but I think that we have the right balance in the proposals that I have outlined this morning.

South London Healthcare NHS Trust

Baroness Jowell Excerpts

Tuesday 8th January 2013 Commons Chamber

[Mr Hunt]

I want to meet colleagues from the House but, as I am sure the hon. Lady will understand, I want to be careful not to restart the whole consultation process that has been happening in what I believe is a very thorough way in the past few months. However, one of the things that I will be considering very carefully—and I will listen to any points that the hon. Lady makes when I meet her—is whether the consultation has been done properly, as it needs to be done and as was intended by the legislation. I will not accept any changes unless I am satisfied on that point.

[Dame Tessa Jowell (Dulwich and West Norwood) (Lab)]

I welcome the Secretary of State’s apparently open-minded approach to the proposals, which have caused enormous clinical alarm in our hospitals as well as local concern.

Two particular issues affect my constituents and those of my right hon. and learned Friend the Member for Camberwell and Peckham (Ms Harman) in relation to King’s College hospital. I ask the Secretary of State to take them seriously. First, should the proposed closures at Lewisham hospital go ahead, that will impact on the King’s College hospital paediatric A and E, which is already overstretched; the staff have enormous concern about their ability to meet any additional demand.

Secondly, will the Secretary of State agree that discussions currently under way to merge the managements of King’s College hospital with those of Guy’s and St Thomas’s should be suspended while the extensive reorganisation threatens the stability of a number of hospitals? If they were to go ahead in parallel, that would risk engulfing our hospitals with preoccupations about reorganisation rather than there being a focus from our world-class hospital staff in south London on treating the patients that we represent.

[Mr Hunt]

The right hon. Lady makes two important points. As she knows, I visited King’s College hospital just before Christmas and was incredibly impressed by what I saw. I visited the geriatric ward and was really impressed, and I am sure that the paediatric service is outstanding as well. It came across to me as an extremely well run hospital. I will, of course, make sure that I consider the impact of the changes proposed by the trust special administrator on King’s, just as I will consider the impact on all surrounding hospitals.

With respect to the merger proposals, because the legislation requires me to come to a decision within 20 working days, the right hon. Lady will find that I have to make and publish my decision quickly enough to ensure that any impact from the changes is properly considered by the people pursuing the possibility of a merger between King’s, Guy’s and Tommy’s.