Oral Answers to Questions

Henry Smith Excerpts

Tuesday 9th February 2016 Commons Chamber

[Ben Gummer]

I am aware of The Lancet review, which makes some important points. We are not doing well enough yet in England, and it is of note that progress has been made in Scotland, Wales and Northern Ireland that we should be able to copy in England. I know that the Under-Secretary of State for Health, my hon. Friend the Member for Battersea (Jane Ellison), who has responsibility for public health, will want to hold such a meeting to discuss that. We have made considerable progress, but there is still a differential between rich and poor that we need to fix.

[Henry Smith (Crawley) (Con)]

I am pleased to support the National Society for the Prevention of Cruelty to Children’s “It’s Time” campaign, which is an initiative to ensure that children who have been the victims of abuse receive ongoing support. May I seek assurances from the Government that they will actively help with this initiative?

[Alistair Burt]

Yes, indeed. We strongly support the initiative. Our work to look after children who need extra care, particularly in relation to their health and emotional needs, has been helped by the transforming care package, which is going through local authorities at the moment. Their vulnerabilities are certainly a matter of great concern, and that will be followed up by the Government.

NHS Trusts: Finances

Henry Smith Excerpts

Monday 1st February 2016 Commons Chamber

[Ben Gummer]

During the course of the last Parliament and the beginning of this one, we have moved from being one of the worst performers on cancer outcomes in Europe to a position roughly midway in the table. We have done that through making rapid improvements in the work we do with people suffering from cancer. There is a lot more to do, but the money is flowing in and improvements to outcomes are being made. However, if there are individual cases, I will of course look at them, as I know will the Under-Secretary of State for Health, my hon. Friend the Member for Battersea (Jane Ellison), who has responsibility for cancer services. I am happy to take this on as a personal case.

[Henry Smith (Crawley) (Con)]

During the past decade, under the previous Labour Government, the healthcare trusts that serve Crawley constituency had chronic deficits, and services such as A&E and maternity were closed at Crawley hospital. Services are now returning to that location. Will the Minister confirm that this Government will invest £10 billion in our NHS over the course of this Parliament, and will he say by how much the NHS is being cut in Wales, where Labour is in control?

[Ben Gummer]

I can confirm that the amount of money available to the NHS will increase by £10 billion over the course of this Parliament. However, this is not just about an infusion of money; it is about concentrating on quality and efficiency across the service. In Wales, not only has money been cut, but there has not been such a concentration on quality and efficiency, which is why outcomes are so much worse in Wales than they are in England.

New Cancer Strategy

Henry Smith Excerpts

Thursday 19th November 2015 Commons Chamber

[Mr John Baron (Basildon and Billericay) (Con)]

I beg to move,

That this House notes the findings of the independent cancer taskforce published in July 2015; and calls on the Government to publish an action plan on implementing the new cancer strategy.

I want to begin by thanking the Backbench Business Committee for granting this timely debate. I also thank fellow officers of the all-party group on cancer, some of whom are going to participate in this debate, and the officers of the other cancer-specific all-party groups, who joined me in applying for this debate. This therefore represents a coming together of all the cancer-related APPGs. Although we want to raise specific issues, we are all agreed on the importance of debating the new cancer strategy delivered by the cancer taskforce.

I hope you will not mind, Mr Deputy Speaker, if I mention the fact that on 8 December the all-party group on cancer will hold our annual Britain Against Cancer conference in Central hall. It is the largest gathering in the country of the cancer community, and I warmly invite all Members to join us on the day. My thanks would not be complete if I did not also thank the Under-Secretary of State for Health, my hon. Friend the Member for Ipswich (Ben Gummer), who is sitting on the Front Bench, having stepped into the shoes of the Under-Secretary of State for Health, my hon. Friend the Member for Battersea (Jane Ellison), who has responsibility for cancer. Unfortunately, she cannot be with us today, but she is a good friend of the cancer community. To help my hon. Friend on the Front Bench, I sent him an advance copy of my speech. He may not be able to answer all of my questions from the Dispatch Box, but I look forward to receiving his written responses to those that he cannot answer today.

Perhaps we need to remind ourselves of the challenge. There are currently 2.5 million people living with cancer in the UK, and by the end of next year it is expected that 1,000 people will be diagnosed with cancer every day. Macmillan Cancer Support has suggested that in a few years’ time, one in two people will have been affected by cancer.

The challenge of delivering world-class cancer outcomes for all patients is growing ever greater. Hospital admissions for cancer in England have gone up by 100,000 a year compared with five years ago. For 17 months, the NHS has missed the target for cancer patients to receive their first treatment within 62 days of an urgent referral. Our outcomes continue to lag behind our European counterparts. Research has shown that the one-year cancer survival rate in the UK is about 13 percentage points behind the best in Europe, which is about 81%. That may not sound like a big figure, but it means that in the region of 10,000 lives a year are lost needlessly, in large part because the cancer was diagnosed too late.

That is the backdrop against which the cancer taskforce delivered its recommendations for a new five-year cancer strategy in July—something that the whole cancer community welcomed. Like others who are campaigning for improvements in cancer services, I was disappointed that the cancer taskforce report ended up being a report to the NHS and its arm’s length bodies, rather than a report of the NHS and its arm’s length bodies. That was not the original intention. However, that should not detract from the excellent work that went into it. Our congratulations should go to Mr Harpal Kumar for his efforts and hard work in preparing the strategy.

The recommendations of the strategy are based on evidence and advice from organisations across the cancer community, including the all-party parliamentary group on cancer. It covers the whole cancer pathway from early diagnosis to care after treatment and at the end of life. It aims to deliver a radical improvement in cancer outcomes by 2020.

Since its publication, the strategy has been welcomed by the Government, the health sector, the charities and the cancer-related all-party groups in this place. Attention must now turn to the implementation of the taskforce’s report. I congratulate Ministers on pre-empting the spending review in at least two ways by committing the Government to two of the key recommendations in the strategy. First, there is a commitment to ensure that all patients receive a definitive diagnosis within four weeks of their referral from a GP. Secondly, there is a commitment to ensure that all patients are offered a recovery package by 2020 and to develop a new metric on quality of life.

However, the taskforce has been clear that the recommendations set out in the strategy will deliver a step change in outcomes only if implemented as a whole. It is therefore important that there is urgency in implementing the remainder of the strategy. If he can, will the Minister outline today when he expects to publish the implementation plan and what degree of consultation he envisages before its publication? What assurances can he give that Ministers will ensure that the implementation plan contains clear deadlines and earmarked resources for implementing the strategy’s recommendations?

May I touch briefly on the importance of earlier diagnosis, which is one of the key priorities identified in the strategy? That point is of particular interest to the all-party parliamentary group on cancer and the other cancer-related all-party groups. As some Members will be aware, the all-party parliamentary group on cancer campaigned tirelessly on improving early diagnosis—what we call “cancer’s magic key”. The logic behind our campaign is exceedingly simple: the evidence shows that people who are diagnosed earlier are more likely to survive for over one year and, therefore, to survive cancer generally.

[Henry Smith (Crawley) (Con)]

I warmly congratulate my hon. Friend and all the cancer APPGs on securing this important debate. Early diagnosis is absolutely key, as he rightly points out. Regrettably, my mother died of acute myeloid leukaemia in 2012. She was diagnosed on the day before her death. We really do need to bear down on this issue. Will my hon. Friend pay tribute to charities such as Bloodwise that do such important work in highlighting this area of cancer?

[Mr Baron]

I will do so by all means. Let me express my heartfelt sympathies to my hon. Friend as regards his mother. He is absolutely right that charities such as Bloodwise, as well as many others across the charitable sector, realise the importance of earlier diagnosis. I will give him one statistic that directly answers his question. I spoke at an event about bowel cancer yesterday. The statistics quite clearly show that 90% of people diagnosed in the early stages of bowel cancer survive for more than 10 years, but that figure drops to just 5% if they are diagnosed at a later stage. That is the difference that earlier diagnosis can make.

The logic behind focusing on earlier diagnosis is very simple. We have found over a number of years that the NHS is as good as any other healthcare system at getting patients from the one-year point after diagnosis to the five-year point, but is poor at getting them to the one-year point in the first place. That suggests that it is not good at detecting cancer. We lose the vast majority of those 10,000 lives in the early phase—up to one year—and then it is simply not possible to catch up. We therefore need to do more on earlier diagnosis.

Getting the NHS to focus on the one-year figures will encourage initiatives on the frontline to promote earlier diagnosis. By putting the one-year figures up in lights, we can ensure that the local NHS realises that it is being monitored. It will therefore be up to the local NHS to introduce and adapt a range of initiatives that suit the local population best, whether they are elderly people, black and minority ethnic populations or whatever. The initiatives range from everything from encouraging better screening uptakes to encouraging better awareness campaigns when it comes to education, better diagnostics in primary care and better GP referral rates, all or any of which could be approved locally to drive up earlier diagnosis.

I suggest that earlier diagnosis, as well as being better for patients, can also save the NHS money. Incisive Health and Cancer Research UK published a report last year that set out the cost savings of diagnosing a patient early. One example is in colon cancer. Stage 1 treatment costs about £3,300, while stage 4 treatment costs £12,500, which is a notable difference. If we look at the range of cancers and the number of cancer patients involved, we can see that we could save hundreds of millions of pounds if we raised our game and diagnosed cancer early.

The all-party group on cancer and the wider cancer community, including the Cancer Campaigning Group, have worked collaboratively with the Government and NHS England—I congratulate the Government most heartily on listening to our concerns—and have campaigned together to get the one-year figures into the DNA of the NHS. We have managed to get them into the NHS outcomes framework and the commissioning outcomes framework.

Last year, our efforts culminated in a successful campaign to ensure that a one-year cancer survival rate indicator is included in the delivery dashboard of the clinical commissioning group assurance framework from this April. For the moment, that is the primary mechanism by which CCGs are held to account. Many CCGs have told us that it is the primary tool they use for determining priorities at local level. With the one-year figures now up in lights in the top tier of NHS accountability, commissioners will be encouraged to take action in their local area to improve earlier diagnosis and ultimately to improve cancer survival rates.

Many people may think, “Job done. We’ve managed to get the one-year rate into the DNA of the NHS. We’ve managed to get it on the radar screen of CCGs. Is there anything else we should be doing except following through on those initiatives?” However, many of us are concerned that the recently proposed changes to the accountability system in place for CCGs may undermine this work. A few weeks ago, the Secretary of State announced a new scorecard for measuring the performance of CCGs, which will involve each CCG being awarded an Ofsted-style rating with effect from next April. Although the all-party group on cancer approves in principle the improvement of accountability, we strongly advocate, on behalf of the cancer community as a whole, that the use of the one-year figures to drive earlier diagnosis at local level is not lost throughout this process. Will the Minister outline in further detail the Government’s plan to implement a CCG scorecard and the process by which the metrics relating to cancer will be determined? Will he confirm that the focus on one-year survival rates will not be diluted?

Let me mention the reforms suggested in the cancer strategy for the patient pathway. With a growing number of people surviving cancer, it is particularly important that we make improvements throughout the whole cancer pathway, and there are two key parts to that. First, all too often patients report being treated as a set of symptoms rather than as a person, and certain groups of patients—namely older people, ethnic minorities and those with rarer cancers—report a poor patient experience. Secondly, many cancer patients lack the necessary support to get on with their lives once treatment has ended.

The all-party group on cancer welcomes the increased focus on patient experience across the NHS, but we must do more to ensure that we have the right data to drive improvement at local level. Although the cancer patient experience survey is a useful tool, too often the data are difficult to access and not widely used. The cancer strategy recommends the creation of a new metric to measure the patient experience across the whole pathway. Will the Minister set out how the Government plan to implement the strategy’s recommendation on a new patient experience metric, and say how they will ensure that data are used effectively to drive improvement at local level? Will he confirm that there will be sufficient resources for the new metric and the cancer patient experience survey?

We welcome the Government’s commitment to ensuring that all patients have access to a recovery package following their treatment, but if we are fully to address that challenge it is vital that the NHS understands where it is working well and where improvements are needed. As such, it is vital that the strategy for the development of a new quality of life metric is taken forward as a priority. Will the Minister ensure that the Government’s commitment to take forward that recommendation for the cancer strategy to develop a quality of life metric is backed up with clear plans for funding and implementation?

In the few minutes that remain, let me address a couple of key issues including rarer cancers and the cancer drugs fund. It is an interesting fact that the combined number of rarer cancers—those less common than breast, lung, prostate and bowel cancer—outnumber the sum total of those more common cancers. Services for people with rarer cancers are no less important, and we must ensure that people with rarer cancers get access to the right level of specialist expertise, irrespective of where they live. The taskforce recommendation for the creation of highly specialised multi-disciplinary teams for rarer cancers is particularly welcome. Will the Minister assure the House that that will happen, and that MDTs will be supported by technology so that they can deliver specialist care without inconveniencing patients?

Research efforts into rarer cancers must be redoubled. The Government are leading the world in their investment in genomics, most notably through their 100,000 genomes project, which is sequencing the genomes of those with cancer and rare diseases in general. It is good that the project has so far fully sequenced the genomes of 5,000 patients, but will the Minister update the House on progress with cancer patients? May I suggest that, once complete, Genomics England should independently carry that research forward for the benefit of the NHS and patients, given its excellent track record?

NHS: Financial Performance

Henry Smith Excerpts

Monday 12th October 2015 Commons Chamber

[Henry Smith (Crawley) (Con)]

I note with interest that the new Leader of the Opposition has said that the Welsh model for the NHS should be expanded to encompass the whole of Great Britain. I am interested to hear my hon. Friend’s views on that, seeing as Labour has significantly cut funding to the NHS in Wales.

[Ben Gummer]

My hon. Friend is entirely right that the new Leader of Her Majesty’s Opposition made that point. It is surprising because, as a representative, I would not like our A&E targets to be missed for seven years in a row, as has happened in Wales. If we replicate what has happened in Wales here in England, we will see worse care for patients. I am sure that Members from all parts of the House would not wish to see that happen.

Oral Answers to Questions

Henry Smith Excerpts

Tuesday 7th July 2015 Commons Chamber

[Jane Ellison]

The message is actually very clear, as we have labelling on over 90% of bottles. As the hon. Gentleman knows from the debates we have had on the subject, it is a difficult area and there is no consistent evidence of adverse effects from low to moderate pre-natal alcohol consumption. I have talked this through with the chief medical officer: we have to get the balance right between warning women and responding to the important stats the hon. Gentleman has mentioned, without causing unnecessary worry for the around 50% of women who do not plan their pregnancy and might have drunk alcohol before they realised they were pregnant.

[Henry Smith (Crawley) (Con)]

14. What steps the Government are taking to improve support for children and young people with mental health problems.

[The Minister for Community and Social Care (Alistair Burt)]

Improving children’s mental health services is one of my highest priorities. We want to achieve this by integrating mental health services for children and young people through a major transformation programme backed by additional funding; by expanding the children and young people’s access to psychological therapies; and by working with the Department for Education to develop single points of contact for mental health in schools.

[Henry Smith]

I pay tribute to the West Sussex youth cabinet that is looking into the issue of mental health provision for young people. Why does the Minister believe this area has been chronically underfunded for so long, and will he give me an assurance that this will not be the case in the future?

[Alistair Burt]

I agree with my hon. Friend when he commends the involvement of young people in discussing their services. Only last week, the Under-Secretary of State for Education, my hon. Friend the Member for East Surrey (Mr Gyimah) and I attended a youth select committee organised by the British Youth Council to do something very similar.

There are two reasons why I think these services have not been so good in the past. First, there is the difficulty of collecting information and data; and, secondly, there is the complexity of financing for services. I hope that we will address both of those, and we will ensure that people know about this so that things do not slide back by being more transparent about both.

A&E Services

Henry Smith Excerpts

Wednesday 24th June 2015 Commons Chamber

[Mr Reed]

My hon. Friend makes an excellent point. He is right to mention those issues, which I will come to later. I pay tribute to him for doing so.

The reason for those pressures on A&E, in addition to the issues that my hon. Friend raises, is the sharp increase in people attending A&E since 2010. In the past the Secretary of State has tried to claim that the increase is the fault of the previous Labour Government, but that is patently nonsense. Annual attendances at hospital accident and emergency units increased by 60,000 in the four years before 2010, whereas in the four years after they increased by nearly 600,000—10 times faster. The reality is that A&E dramatically improved between 2004 and 2010, when 98% of patients were seen within four hours. This is a crisis that only started on the Tories’ watch—after they made it harder to see a GP, after they started stripping back social care services and after they launched their damaging top-down reorganisation.

[Henry Smith (Crawley) (Con)]

Does the hon. Gentleman not think that the closure of A&E at Crawley hospital in 2005, under a Labour Government, was distinctly unhelpful to A&E waiting times?

[Mr Reed]

The hon. Gentleman has made that point on the Floor of the House on many occasions, and he has been a constant voice with regard to the hospital services used by his constituents. That was a decision made by clinicians in the area, and he will recognise that. He will recognise also how much the framework has changed and how much more difficult the Government have made it for communities such as his to have their say on health reconfiguration.

--- Later in debate ---

[Mr Reed]

My hon. Friend makes the case. What is happening in Stoke, I regret to say, appears to be something of a canary in a coal mine for the NHS around the country, and its issues will increasingly be seen in areas all over the country.

It is clear that the GP workforce crisis is a major driver of the problems. The number of full-time equivalent GPs per head has fallen over the past five years, even as demand has increased.

[Henry Smith]

rose—

[Mr Reed]

I have been generous with time, so I must press on.

In 2013, the Government announced a call to action to improve general practice access and experience for patients. They set out six key indicators to rate the quality of access and experience for patients. One year later, every single indicator had shown a deterioration in performance. Fewer people described the overall experience of their surgery as good and fewer people were able to get an appointment. The Government must address that finding. Only by addressing the crisis in general practice in addition to social care can the Government begin to relieve the pressures on A&E departments.

When the Secretary of State and the Prime Minister discuss the NHS in this House, they like to use words such as “openness” and “transparency”. Sadly, their actions betray that sentiment on a routine basis. I refer again to Professor Keogh’s seminal letter to the Secretary of State two years ago in which he refers to the use and principle of transparency in the NHS as representing

“a turning point for our health service from which there is no return.”

Except that, for this Government, it seems that there is a return.

Currently, NHS England publishes the performance measures for each A&E in England every week. Those figures contain a wealth of information for each trust and it makes that data available to the public. The data show how each A&E department is performing across a range of measures, and it can be used to target specific interventions at trusts that are struggling. This reporting time period also means that issues can be identified quickly and resolved promptly. Rather than taking action to ensure that hospitals in England meet this target, the Government are seeking to hide the performance data. We will not be able to see how A&Es are performing each week; we will have to wait until the end of each month. By publishing a significant number of performance measures from across the NHS on the same day, the Government appear to have found an innovative way of burying bad news—publishing even worse news at the same time. Patients deserve better than that. Clearly, Ministers find it more palatable to be reminded of their failings just once a month, rather than at the end of each week. This move is designed to make the red box lighter and the scathing headlines kinder. Will people not conclude that the monthly publication of A&E data—unlike other monthly data sets—has nothing to do with patient care and everything to do with political and media management?

--- Later in debate ---

[Henry Smith (Crawley) (Con)]

Thank you for giving me the opportunity to speak in this important debate, Madam Deputy Speaker. May I join other hon. Members in welcoming you to the Chair? This is the first time I have spoken with you in your place, and it is very good to see you there. May I also extend my congratulations to the hon. Member for Dewsbury (Paula Sherriff) on her maiden speech? Like other hon. Members, I thank sincerely the people who work in our NHS and perform such an important task on behalf of the nation’s health.

When the shadow Minister, the hon. Member for Copeland (Mr Reed), introduced the debate, I intervened and mentioned the fact that, in 2005, under a Labour Government—the decision was made in the then Labour Department of Health—Crawley hospital lost its accident and emergency unit. In the six decades of Crawley new town’s history, that will prove to be the worst possible mistake. The people of Crawley, which is the natural population centre of the Surrey and Sussex Healthcare NHS Trust area, had to travel up to 10 miles up the road, on single carriageway highways, to access East Surrey hospital. The result has been at best inconvenience and at worst dangerous situations for many patients trying to reach the hospital. The South East Coast Ambulance Service does sterling work, but it has been a great challenge.

I am pleased that, in the past five years, hospital services have returned to Crawley hospital. We have an urgent treatment centre that is open seven days a week, 24 hours a day. We are about to have new GP primary access at the Crawley hospital site in West Green, and I was delighted a few years ago to open the new digital mammography unit. We have increased beds and staff at Crawley hospital, and I was pleased to open a new MRI scanner earlier this year.

None of that would have been possible without the previous Government’s commitment to increase funding on the NHS. Through the Health and Social Care Act 2012, they ensured that many more decisions are made locally by the Crawley clinical commissioning group, which means that local doctors and clinicians have far greater influence to meet the needs of my population and my constituents in Crawley. It was a very welcome development.

I support the Government’s commitment to invest further in the NHS and to increase its funding, and their commitment to ensure that GP services are extended, not only for patients’ convenience, but to ensure that, as far as possible, we divert those unnecessary attendances at the urgent treatment centre at Crawley hospital and A&E at East Surrey hospital. That initiative will have a significant impact on reducing the pressure on A&E.

In addition, I support and welcome the Government’s commitment to ensure that social care plays an important part, so that people who should not be detained in hospital any longer, not only for their own health needs but for the health of the healthcare system, are moved into appropriate care settings. That will mean more capacity for A&E.

Finally, on the future of healthcare in the Crawley area, my constituency contains Gatwick airport. Next week, we will hear the results of the Airports Commission into runway expansion. If Gatwick is the commission’s choice, an awful lot of infrastructure investment will need to be placed into the area, not only for transport such as rail and roads but for healthcare. Should Gatwick airport be the Government’s final decision—for the reasons of infrastructure pressure, I do not believe Gatwick is the appropriate location—an absolute necessity would be a new acute hospital with full A&E.

I welcome what the Government have done to support our national health service and their commitment in this Parliament, and I look forward to playing my part in ensuring that the needs of our patients and the needs of our NHS remain a central priority.