The National Health Service

Henry Smith Excerpts

Wednesday 23rd October 2019 Commons Chamber

[Henry Smith (Crawley) (Con)]

It is a pleasure to follow the hon. Member for East Kilbride, Strathaven and Lesmahagow (Dr Cameron). This is indeed a very important debate. I am glad that we have had the opportunity to re-emphasise this Government’s commitment to the national health service, not least through record amounts of investment—an additional £33.9 billion is going in between now and 2024—and to discuss the emphasis on putting mental health on a par with physical health. I am delighted that schools in my constituency are part of a pilot in which mental health professionals are in schools to help young and adolescent pupils to deal with those sorts of issues.

I am glad that my right hon. Friend the Secretary of State for Health reconfirmed today—this cannot be emphasised enough—that the NHS is off the negotiating table when it comes to the post-Brexit international trade deals, and that it will remain free at the point of use, regardless of people’s ability to pay.

Let me re-emphasise that this Government’s record on the NHS is a good one, but sadly it has not always been under previous Labour Governments. The A&E and maternity units at Crawley Hospital in my constituency closed last decade. Services have now started to return, including a 24/7 urgent treatment centre, a new ward, new beds and primary care services. Mention was made of the NHS being a political football, but it is worth stating that all parties in this House can do better when it comes to supporting our health service.

On my right hon. Friend the Prime Minister’s first full day in office I was pleased to seek a commitment for better support for primary care. One challenge in my constituency is that some GP practices are at or even over capacity for a number of reasons, including increased housing in the area and some doctors retiring early. We need to address this issue, particularly as more and more services—such as scans and minor surgery—are provided in GP surgeries, which is better for the patient experience.

I am standing down as chair of the all-party parliamentary group on heart and circulatory diseases, but I am glad that we were able to publish a report on artificial intelligence in the healthcare sector earlier this year. It is a crucial issue that I know the Department of Health takes very seriously, so I was delighted that the Health Secretary attended the launch of the report.

I am pleased to say that I have just been reappointed as chair of the all-party parliamentary group on blood cancer. I very much support the Government’s commitment, in the long-term plan for the NHS, to ensure that 75% of cancers are diagnosed at stages 1 and 2 by 2028. But blood cancer is different from solid tumour cancers, and is much more difficult to detect. I therefore put in a plea and a bid for the diagnosis of blood cancer to be considered. Blood cancer is the country’s fifth most common and it is the third biggest cancer killer in the UK, but because of the vagueness of symptoms it is often very difficult to detect in GP surgeries. Indeed, some 28% of people with a blood cancer are first diagnosed when they present at an accident and emergency department, so it is an area that needs a lot more focus.

In the brief time I have left to speak, let me touch on the importance of developing policy on children’s social care. Regrettably, West Sussex County Council, which covers children’s social care in my constituency, has been judged very poorly in this area and a lot of remedial work needs to be done. As with adult social care, the issue of children’s social care urgently needs to be addressed. It is often treated as the poor relation to healthcare, so it is very important that we place emphasis on the importance of better supporting social care when we talk about the NHS.

I urge the House to reject the amendment because I do not want to see the nationalisation of the production of medicines, which the Health Secretary mentioned earlier. In the context of blood cancer, that would mean that innovative CAR T-cell therapy would not be available.

Artificial Intelligence in Healthcare

Henry Smith Excerpts

Thursday 5th September 2019 Westminster Hall

[Henry Smith (Crawley) (Con)]

I beg to move,

That this House has considered involvement of patients in the use of artificial intelligence in healthcare.

It is a pleasure to serve under your chairmanship once again, Mr Paisley. I am delighted to have been granted this important debate, and I am pleased to see a number—particularly for a Thursday—of Members from all parts of the House present to take part. I declare at the outset that I am the chair of the all-party parliamentary group on heart and circulatory diseases. Earlier this year, the APPG conducted an inquiry, with the support of the British Heart Foundation, to better understand patient perspectives on artificial intelligence. It found huge potential for AI to transform the lives of those living with heart and circulatory diseases and a greater need for those affected to be included in discussions about the development and adoption of new technologies.

Before I go further, I want to speak briefly about what AI is. Put simply, AI is the term given to a set of computer actions that mimic human intelligence. Our report outlines that what separates modern AI, such as machine learning, from other types of computer program is that it can learn and improve at tasks. AI is particularly strong at finding patterns and trends in data that are not obvious through human analysis. I have mentioned machine learning, which is one type of AI. It is where algorithms—a set of rules that a computer uses to make a calculation—are used to look for patterns in data, and the computer then uses those patterns to make decisions. It looks for patterns in many different types of data, from scrutinising images to analysing genomic data.

Every day, we interact with something that uses AI. Whether it is entertainment, online shopping, wearable devices, virtual assistants, chat bots or advertising, the use of AI is ubiquitous. Whether it is through faster or more accurate diagnosis, more personalised treatment, better targeting of demand, improvements in service planning and delivery or better predictions, AI has the potential to touch all aspects of healthcare delivery and management.

Our APPG’s report, “Putting patients at the heart of artificial intelligence”, was launched in May this year. It warns that the spread of misinformation risks undermining public confidence in the use of AI in healthcare. The APPG has therefore recommended that policy makers, parliamentarians, the NHS, charities, healthcare professionals and the health technology industry should seek to engage and involve patients in the design, development and diffusion of AI. If they do not, developments in AI might not reflect the needs of the very people who could benefit from it.

It is important to ensure that fake news and the desire for a quick headline do not undermine the public’s trust and confidence in this important area of research and clinical practice. In a survey conducted for the inquiry, 91% of people with heart and circulatory diseases said that the public should be well-informed about how AI is used in healthcare. Some 90% believe it to be the responsibility of the NHS to inform the public about current and potential uses of AI in healthcare, and 48% of patients surveyed strongly support doctors using artificial intelligence technologies to assist them in diagnosing and treating heart and circulatory diseases.

Heart and circulatory diseases, including coronary heart disease, stroke and vascular dementia, affect millions of families across the UK. The halving of deaths from heart and circulatory diseases since the 1970s has been a major health success for the UK. However, such conditions still cause a quarter of all deaths in the UK and are the largest cause of premature mortality, particularly in deprived areas. Together, they make up the single biggest driver of health inequalities and cost the NHS in England at least £7.4 billion a year. As outlined in the long-term plan, it is the single biggest area where the NHS can save lives over the next 10 years.

In assessing the potential for AI, it is important to note the scale of heart and circulatory diseases in this country. The British Heart Foundation, which provides secretariat support to the APPG, reports that heart and circulatory diseases still cause a quarter of all deaths in the UK, on average killing one person every three minutes. The number of people living with heart and circulatory diseases also remains high, at 5.9 million in England. There are more than 42,000 premature deaths from cardiovascular disease each year in the UK. We must therefore utilise the enormous potential of AI across all areas to transform the way we prevent, diagnose, treat and support those living with or at risk from heart and circulatory diseases.

In my constituency of Crawley, 11,000 people were living with a heart and circulatory condition in 2017-18. Of those, 3,679 had coronary heart disease and 1,865 were living with stroke, 774 were living with heart failure and 1,985 were living with atrial fibrillation. In addition, 16,682 constituents have been diagnosed with high blood pressure, including me, and 7,555 with diabetes. While those numbers may seem high, the British Heart Foundation tells me that according to the quality outcomes framework data, Crawley is ranked 548th out of the 650 UK parliamentary constituencies for the prevalence of cardiovascular disease.

In communities around the country, including Crawley, one of the challenges of introducing AI into everyday practice in healthcare is its potential to exacerbate health inequalities. Age, ethnicity, and socioeconomic demographic factors can influence access to the best technologies. Access to new technologies is relevant because AI is currently being implemented in consumer-facing technologies, such as smartphones, which can help manage adherence to blood pressure medication, smart watches, which can track and analyse heart rates, and voice-activated assistants such as Alexa or Siri, which can act as useful reminders to take medications.

As I mentioned, the APPG on heart and circulatory diseases launched its report on AI earlier this year. Our group was grateful for the involvement and enthusiasm of the Secretary of State for Health and Social Care, who also took the time to speak at the report’s launch. Given the number of people in Crawley who have heart conditions, I wanted to keep local residents updated about my work chairing the group. Shortly after the report’s launch, I wrote in the Crawley & Horley Observer about the importance of tackling such conditions and reiterated the salience of the Department of Health and Social Care ensuring that some of this Government’s increased funding for our NHS is used to address the use of AI and its potential in the health service.

It was very much with that call in mind that, almost a month ago, I welcomed the Secretary of State’s announcement that £250 million is to be spent on the new national artificial intelligence lab to improve the health and lives of patients. The Department of Health and Social Care has said that the AI lab will bring together the industry’s best academics, specialists and technology companies. They will be working on some of the biggest challenges in health and care, identifying the patients most at risk of conditions such as heart disease. That will allow for earlier diagnosis and cheaper, more focused and personalised prevention.

The new national artificial intelligence lab will sit within NHSX, the new organisation that will oversee the digitisation of the health and care system in partnership with the accelerated access collaborative. One of the key recommendations of the APPG report is that NHSX should set up discussions with charities and the public to explore the views and concerns of patients about the use of AI in healthcare, and I would be grateful for the Minister’s assurances that through the development of the new lab, NHSX will be exploring the opinions of patients and thoroughly engaging them throughout that ongoing process.

In the past five years, we have seen AI go from struggling to identify images of cats to being able to identify skin cancer in histological sections of biopsies just as well as a team of specialist doctors with decades of combined experience. In debates on this topic, it is easy to discuss issues in what seem like abstract terms, but when patients go to see their GP, they want to see their GP. In such cases, AI could be used to create automatically the GP’s notes about their patient, reducing the time that the doctor will spend looking at their screen, for example.

There is also the issue of self-management. From dedicated apps that people use while going out for a run to the most basic step counters, more and more people use their own devices, on some level, to keep an eye on their health. AI can be used more and more in this area. Patients could use wearable devices and sensors to manage their condition at home and in the community instead of in hospital. AI systems could then monitor for unusual patient-specific patterns, such as a deterioration in a heart failure patient, and relay that information to a clinical team for further intervention. That also presents an opportunity to put patients in much better control of their care.

Our inquiry heard from experts from the University of Cambridge and the University of Oxford, who told us that NHS health checks could be better at distinguishing the risk of different types of heart condition, to ensure that the most suitable treatment can be received by the patient. On 16 August, the Department of Health and Social Care announced a review of the NHS health check service, which is offered to everyone between the ages of 40 and 74 to spot the early signs of major conditions that cause early death, including stroke, kidney disease, heart disease and type 2 diabetes.

Although the NHS health check programme has identified more than 700,000 people at high risk of cardiovascular disease over the last five years and has saved an estimated 500 lives each year, the Department of Health is right that there is potential for people to benefit even more from an enhanced tailored service. The APPG’s survey of patients with heart and circulatory diseases found that 64% had at least some awareness of the potential future uses of AI to diagnose and treat heart and circulatory diseases. However, only 17% of respondents were aware of any current uses. That represents a huge opportunity to inform patients about the opportunities of AI.

People are becoming more and more wary about the use of their personal data. From cold calls to unsubscribing from mass emails, there is increased caution from people about giving up personal information. When it came to the APPG’s inquiry, however, 86% of respondents were comfortable with their personal health data being used to help better to diagnose medical conditions. Policy makers should feel confident that patients support the use of AI in healthcare if it is done to improve health outcomes.

Trust works both ways of course, and it is important that those implementing policy and programmes are open with the public about how their information will be used. That is why patients, and the wider public, should feel involved with not only the details of what their data will be used for but the wider work of the NHS to use artificial intelligence to improve our health service. In June, when speaking on the use of AI, NHS England chief executive Simon Stevens said that

“from April next year we propose to change the way we fund care so that NHS organisations who invest in this world-leading technology will be properly rewarded for doing so.”

I would be grateful for an update from the Minister on what form that is due to take. I am sure that such an update would be welcome if colleagues are to make representations with their own health authorities and trusts.

Our report raised the issue of what patients need to know. Transparency is welcome, and it is important to specify what type of transparency, as well as its intended outcome, in addition to being clear about for whom the transparency is intended. Transparency can include outlining why an algorithm was developed, what types of data were used, and how the development was funded. Some experts have argued that the black box of AI—the difficulty in understanding how AI models reach their decisions—is not really a problem at all, as humans are equally opaque in how they arrive at decisions.

However, the ability to scrutinise, conduct quality assurance, and undertake due diligence are important parts of regulating the health system and ensuring patient safety. In November 2017, the national data guardian for health and care, Dame Fiona Caldicott, told the House of Lords Artificial Intelligence Committee about the challenges of using patient data in technology, saying:

“What we have not done is take the public with us in these discussions, and we really need their views.”

That needs to be addressed. If patients are to trust the use of AI in healthcare, they need to know they are a vital part of the journey.

Our report also looked at the regulatory framework, and how the development of such technological innovations means that health systems are becoming more complex environments to regulate. At the same time, it is important that the regulatory burden is not added to, so that the spread and adoption of new innovations is not stifled. Our inquiry found that a

“balancing act between managing expectations and encouraging hope and enthusiasm is always challenging but nevertheless important. When we say patients should be informed and clear on what AI can do for the NHS, it is not a tick-box measure. It is to provide the clarity that is needed for better diffusion of AI.”

NHS England and NICE, the National Institute for Health and Care Excellence, should encourage the development and use of reporting standards for AI research, in order to provide best practice for artificial intelligence researchers. That could also lead to greater recognition of quality in AI research, particularly among the media, policy makers, clinicians and the public.

With regard to my constituents, I mentioned the importance of Government, policy makers and NHS staff, all of whom have an important role to play in supporting patients. I am also grateful for the secretariat support provided to the APPG by the British Heart Foundation, and I pay tribute to the charity’s hardworking volunteers, including those whom I have been pleased to meet throughout Crawley, and those at the British Heart Foundation shops located on Queensway and on the Broadway in my constituency.

There is much to welcome in the NHS long-term plan. Indeed, NHS funding will grow on average by 3.4% in real terms each year from 2019-20 to 2023-24, which is of course welcome. The current funding increase will mean that the NHS can lay further foundations for service improvements. Thanks to our NHS staff, millions more people are being treated every year. Although services return to Crawley Hospital—and I continue to call for even greater provision—it remains the case that the worst decision in the history of Crawley as a new town was the removal of A&E in 2005. Our constituents expect to see improved GP provision, reduced waiting times and enhanced frontline services.

The APPG on heart and circulatory diseases welcomes the great strides made in recent years to speed up the development and diffusion of AI in the NHS. The Office for Artificial Intelligence and the AI Council have huge potential to bolster the UK’s position as a world leader in AI as part of the Government’s AI sector deal. The Centre for Data Ethics and Innovation can also cement the UK’s leadership in ethical AI and ensure that society can shape the direction of travel and reap the benefits of AI, and we hope that those initiatives will continue to be taken forward.

The chief executive of NHS England has called for this country to become a world leader in the use of AI and machine learning, stating that exploiting the boom in AI technology can help meet the target in the NHS long-term plan of making up to 30 million outpatient appointments unnecessary, in addition to saving more than £1 billion in what would have been increasing outpatient visits. The money can be reinvested in frontline care and save patients unnecessary journeys to hospitals. That reminds us that patients must be at the heart of today’s debate, and hopefully future debates in Parliament on this issue.

--- Later in debate ---

[Henry Smith]

Thank you very much again for your chairmanship, Mr Paisley.

I sincerely thank the hon. Members for Cambridge (Daniel Zeichner), for Strangford (Jim Shannon), and for East Kilbride, Strathaven and Lesmahagow (Dr Cameron), my hon. Friend the Member for North East Derbyshire (Lee Rowley), and the Opposition spokesman, the hon. Member for Burnley (Julie Cooper), for their contributions to this important debate. I congratulate the Minister, and I welcome her to her well-deserved position.

The key word I heard was “trust”, and as we go forward with AI, we need to instil that for patients.

Motion lapsed (Standing Order No. 10(6)).

Oral Answers to Questions

Henry Smith Excerpts

Tuesday 18th June 2019 Commons Chamber

[Matt Hancock]

Yes, 100%. One of the reasons we have put NHSX in place is to drive exactly this policy agenda, where we can get better treatment for patients and save money.

[Henry Smith (Crawley) (Con)]

Earlier this year, the Secretary of State attended the launch of a report on artificial intelligence by the all-party parliamentary group on heart and circulatory diseases. Can I get a commitment from him that AI is very much part of the future through the NHS long-term plan?

[Matt Hancock]

A most enthusiastic commitment! My hon. Friend has led on this agenda and driven it, because it is all about using technology to save lives. The report that he mentions is optimistic about the power of using data better to ensure that people can live longer.

Interim NHS People Plan

Henry Smith Excerpts

Wednesday 5th June 2019 Commons Chamber

[Stephen Hammond]

The right hon. Lady is right to be angry because her constituents should not be waiting that long. If she wishes to speak to me afterwards, I will take that up directly, with her, on behalf of her constituents.

The right hon. Lady says that we are not taking this seriously and not acting urgently enough. She will know that this interim people plan makes sure we will have not only more people recruited to the NHS, but more people wishing to stay working within the NHS. One of the key issues the NHS has faced is that a lot of people have decided not to work within it, and the key part of the people plan—this being the interim before the final is published later—is actually about ensuring we have more staff there. I reject what the right hon. Lady says. We are taking this seriously, and we are acting on it now.

[Henry Smith (Crawley) (Con)]

I welcome the record amounts of investment going into the NHS, but may I seek assurances from the Minister that we will be using those resources to ensure that specialist clinicians in areas such as blood cancer and heart disease are properly supported so that we have the training for those personnel to tackle those conditions in particular? I say that as the chairman of the all-party groups on both conditions.

[Stephen Hammond]

My hon. Friend will know, because I have been in debates with him before, that I recognise the exceptional work that those two all-party groups do. He will know from the long-term plan that we have set out new commitments on diagnosis for all cancers and for cardiac. He will know that the reason why we have set out an interim people plan and will then set out a final people plan is that a long-term plan cannot work unless we have the people to back it up and are training the right number of people. This plan sets out how to recruit more people, how to train more people, how to give people the skills to deal with what will face the clinicians and the physicians of the 21st century, and that is key to delivering what he has asked for.

Pancreatic Cancer

Henry Smith Excerpts

Tuesday 2nd April 2019 Westminster Hall

[Nic Dakin]

The hon. Gentleman is exactly right; the more we learn about this disease, the more we can try to do things to prevent it and to support people so that they can get early diagnosis and treatment. The chances of survival for Kevin, the husband of my constituent Maggie Watts, were no better than those of his mother, who died of the same disease 40 years earlier. Yet other countries are doing much better; Belgium and the USA have double the survival rates of the UK. We need the Government to work with the fantastic pancreatic cancer charities—Pancreatic Cancer UK, Pancreatic Cancer Action, Pancreatic Cancer Scotland and the Pancreatic Cancer Research Fund—as well as other stakeholders to deliver a step change in outcomes for pancreatic cancer.

[Henry Smith (Crawley) (Con)]

I congratulate the hon. Gentleman on securing this important debate. Sadly, in January my former caseworker died of pancreatic cancer, so I saw the sudden impact of the condition and how quickly it can affect people, as the hon. Gentleman has eloquently set out, as well as the poor survival rates. What particular lessons does he think this country can learn from Belgium, the United States and other countries where outcomes and survival rates are better?

[Nic Dakin]

I pay tribute to the work that the hon. Gentleman has done on blood cancers in particular, and other cancer awareness issues such as this. He is right that we must learn the lessons from elsewhere, and hopefully I can demonstrate that there are things we can do to help us to catch up, once the diagnosis is in place, and get faster treatment.

One of the things that frustrates campaigners such as Maggie is the danger of accepting that little can be done after a diagnosis of pancreatic cancer. There is a sense of nihilism about this disease. Maggie’s optimistic initiative in response to her situation is called “Hope is Contagious”, and it should energise us all to redouble our efforts. No one should be written off.

Paul Kenny is a pancreatic cancer sufferer who has contacted me on Twitter, saying he has a “slim chance” of seeing his next birthday, but adding:

“Hopefully future generations of sufferers will be prevented or given better prognoses.”

Paul is right—we can do so much better, and we must.

Oral Answers to Questions

Henry Smith Excerpts

Tuesday 26th March 2019 Commons Chamber

[Stephen Hammond]

The hon. Gentleman is right: early diagnosis of cancer is vital for successful outcomes. The Government are absolutely committed to a cancer workforce with the skills and expertise to ensure that 75% of all cancers are diagnosed early, not just the top 10. As I have said several times, that is why we asked Baroness Dido Harding to develop a detailed workforce plan to ensure that that can be delivered.

[Henry Smith (Crawley) (Con)]

Blood cancer is the fifth most common and the third biggest killer in the UK. What assurances can I get that the workforce in that area will be increased?

[Stephen Hammond]

My hon. Friend has been a champion of this cause for a long time, raising the matter on the Floor of the House several times. He can be assured that, as I said to the hon. Member for City of Chester (Christian Matheson), Baroness Harding has been asked to bring forward detailed plans for the cancer workforce in her implementation plan.

Exiting the European Union (Medicines)

Henry Smith Excerpts

Tuesday 19th February 2019 Commons Chamber

[Jackie Doyle-Price]

My purpose this afternoon is to ensure that we have business as usual post-exit day, and that we can maintain patient safety at that time. I would not want to encroach on any debate beyond that now.

Questions were raised regarding research funding. I should advise the House that before the Brexit vote the UK was involved in more EU-funded science projects than any other country. The UK secured 14.3% of the total share of the funding to date and is the second-highest recipient of grant funding. We are committed to remaining a world leader in science and research, and that is why, in our modern industrial strategy, we have committed to spending 2.5% of our GDP on research and development by 2027. We have invested an extra £7 billion in research and development as a first step towards that.

[Henry Smith (Crawley) (Con)]

My hon. Friend has said that just over 14% was received by this country from EU funds. Does she have the figures to hand—I would not blame her if she did not—for the percentage of funds that we gave to the EU to be distributed around the bloc?

[Jackie Doyle-Price]

I do not have a detailed knowledge of the accounts in that regard. I can only tell the House how much we have received, and how we are replacing it, which is really the crux of the matter.

Mention was also made of what the Government are doing to prevent the loss of EU nationals working in research. We have been clear that we wish the UK to continue to be an open and tolerant nation, and to continue to attract the brightest and the best. That is equally applicable here. The Prime Minister told the House of Commons on 21 January:

“Having listened to concerns”

about the settled status scheme

“I can confirm today that, when we roll out the scheme…the Government will waive the application fee”.—[Official Report, 21 January 2019; Vol. 653, c. 27.]

We want to give a clear message that we are open for business and open to the brightest and the best.

In bringing these regulations to the House, the central point is that the fundamentals of how clinical trials operate will remain the same and that, wherever possible, we have sought to maintain existing arrangements rather than creating new ones. While it is not the focus of this statutory instrument, the Government are working to ensure that the trials have continuity of supply and will continue as planned. I commend these orders to the House.

Question put and agreed to.

Resolved,

That the draft Medicines for Human Use (Clinical Trials) (Amendment) (EU Exit) Regulations 2019, which were laid before this House on 23 January, be approved.

NHS 10-Year Plan

Henry Smith Excerpts

Tuesday 19th February 2019 Commons Chamber

[Henry Smith (Crawley) (Con)]

Thank you, Madam Deputy Speaker, for calling me to speak in this debate on the NHS long-term plan. I have the privilege of being the chair of the all-party group on heart and circulatory diseases—I took over chairing it last year—and I was very pleased to set up the all-party group on blood cancer in 2016. I would like to speak about both of those in turn.

There are over 130 types of blood cancer, each with its own unique symptoms, treatments and side effects. It is the fifth most common cancer in the UK and, sadly, the third biggest cancer killer, with about 40,000 people diagnosed with each year. The rate at which it affects people is far greater than for breast and prostate cancer combined. Indeed, one in 19 people will be diagnosed with a blood cancer in their lifetimes, and about 240,000 people currently live with blood cancer in the UK.

The NHS long-term plan sets out a number of areas that affect blood cancer. On early diagnosis, the ambition to have 75% of all cancers diagnosed by stage 1 or stage 2 by 2028 is welcome, as many blood cancers are very difficult to diagnose at an early stage. A recent parliamentary answer from the Under-Secretary of State for Health and Social Care, my hon. Friend the Member for Winchester (Steve Brine), to the hon. Member for Scunthorpe (Nic Dakin) stated that there are 17 cancer sites for which no staging system exists and 67 cancer sites that are unstageable. Some blood cancers fall into these categories, and I would be grateful for clarification and assurances that these will be addressed.

I turn briefly to heart disease. Heart and circulatory disease still causes a quarter of all deaths in the UK. On average, it kills one person every three minutes or 420 people each day. The number of people living with heart and circulatory disease also remains high, at 5.9 million people across England, and there are over 42,000 premature deaths from cardiovascular disease each year in the UK.

I am delighted to see that the NHS long-term plan has a renewed focus on the prevention and early detection of the risk factors for heart and circulatory diseases. Four in 10 adults with high blood pressure remain undiagnosed, and it is estimated that one in five of those who have been diagnosed are not being optimally treated. By identifying more people who have these conditions, we can help to manage their risk and save more money and of course, crucially, lives.

I welcome the work that the voluntary sector does in supporting the NHS, and I am grateful to the Government for investing £20.5 billion more each year for the next five years in this very important service.

NHS Long-term Plan

Henry Smith Excerpts

Monday 7th January 2019 Commons Chamber

[Matt Hancock]

I will raise the hon. Lady’s point with NHS Improvement, which considers these things. Local provision of services should, rightly, be decided by local clinical priorities, but she makes a cogent point that I will raise with NHSI, and I will ask its chief executive, Ian Dalton, to write to her.

[Henry Smith (Crawley) (Con)]

I declare an interest, as chair of the all-party parliamentary group on blood cancer and the APPG on heart and circulatory diseases. I very much welcome this plan’s focus on those areas. In tribute to my caseworker, Susan Lester, who sadly passed away last week from pancreatic cancer, can I have an assurance from the Secretary of State that he will continue to work with voluntary sector organisations such as Bloodwise, the British Heart Foundation and Pancreatic Cancer UK?

Blood Cancer

Henry Smith Excerpts

Friday 23rd November 2018 Commons Chamber

[Henry Smith (Crawley) (Con)]

I am grateful for the opportunity to raise the important issue of the NHS long-term plan and blood cancer. In doing so, I congratulate my hon. Friend the Member for Wimbledon (Stephen Hammond) on his appointment to his ministerial position.

We are already nearing December. It is often said that the months seem to fly by, and this is very much the case in terms of the work of the all-party group on blood cancer throughout 2018. As chair of the all-party group, it certainly does not seem like almost a year ago that we launched our first report, which coincided with a Westminster Hall debate on blood cancer care and the NHS. As we come towards the end of the year, we are also approaching the publication of the Government’s long-term plan for the NHS. It is vital that the needs of blood cancer patients are considered and implemented if we are to build on the progress undertaken in recent times for people with blood cancer.

Our all-party group has continued to take evidence from a host of experts and to raise further awareness with health officials and policy makers. Our pursuit of this cause in Parliament is ongoing. September saw Blood Cancer Awareness Month. To mark that occasion it was my pleasure to host Bloodwise, as it invited MPs to meet members of their successful and ever growing patient ambassador programme. Speaking with people such as patient ambassadors really helps to put cancer into a human context. It is important to highlight the fact that some 40,000 people are diagnosed with blood cancer in the UK each year, but listening to just one or perhaps a handful of people who are either living with or have been treated successfully for blood cancer is a powerful reminder that behind every statistic are individual patients, with their own story to tell.

[Mark Tami (Alyn and Deeside) (Lab)]

I add my praise for the work that the hon. Gentleman has been doing with the all-party group. When it comes to patients who need a transplant, around 60% of patients who are white will get the best possible match, but if someone comes from a black, Asian and minority ethnic background, that drops to 20%. Does he agree that we need to do much more work to improve this dreadful situation?

[Henry Smith]

I am grateful for the hon. Gentleman’s intervention, and I pay tribute to him for his contribution to this debate and for raising this matter in this place just yesterday. I absolutely endorse what he says about the importance of transplantation.

Last week, the APPG held its latest meeting on the timely topic of ensuring that patients have access to the best drugs and treatments, ahead of the publication of the NHS plan. In recent months, there have been some significant decisions regarding treatments for blood cancer on the NHS. In September, CAR—chimeric antigen receptor—T-cell therapy was approved for entry into the cancer drugs fund by the National Institute for Health and Care Excellence and NHS England to treat children and young people with relapsed acute lymphoblastic leukaemia. CAR-T therapy is a new type of therapy that modifies a person’s infection-fighting T cells to better spot and kill cancer cells. It could offer people with certain hard-to-treat blood cancers the chance for long-term survival, or even a cure.

I was pleased to question my right hon. Friend the Prime Minister at Prime Minister’s questions about CAR-T therapy following the NHS England announcement. I continue the call I made that day for the Government to ensure that a focus on blood cancer awareness, diagnosis and prevention will continue into the future. With that in mind, will the Minister update the House on when people with blood cancer are likely to benefit from CAR-T treatment and on whether the health system is ready for this type of personalised medicine?

Additionally, NHS England changed its mind recently and allowed ibrutinib to be used for patients with chronic lymphocytic leukaemia after three years’ remission. The development of new drugs is ongoing. Bloodwise estimates that over one third of all indications for which drugs are funded on the cancer drugs fund are for blood cancer, which highlights not only the challenges we face, but the potential to help.

In January, the APPG launched its inaugural report, “The ‘Hidden’ Cancer—The need to improve blood cancer care.” Key to this is the word “hidden”. Blood cancer is known as the hidden cancer because although patients may indeed be receiving or waiting to start treatment, they may not be displaying any obvious or visible signs of ill health.

I am careful to try to refer to patients and their support networks, especially in this context, as the impact of diagnosis on a patient’s family must also be considered, especially when children are involved. This is particularly the case for patients on so-called watch and wait. That is typically an option only for people with few or no worrying symptoms, whose quality of life and prognosis will not be affected by delaying treatment, and it is recommended for those with blood cancers or related conditions that are stable or slow-growing. However, if someone has been told that they have cancer and, at the same time, they know that they will literally watch and wait to see when they are in a position to begin treatment, it is understandably disconcerting, to say the least. Patients on watch and wait told the APPG inquiry that specific emotional support was required to help them to come to terms with what was happening. Approximately 27,000 people with blood cancer are currently on watch and wait in the UK. To put this in context, that is 13% of those living with blood cancer.

Turning to mental health, anyone with experience of living with cancer or supporting a friend or family member who has done so will know of the dedication of NHS staff and health workers in seeking to do all that they can to provide support. However, it is vital that these staff are given the tools to ensure that patients are fully equipped mentally through the psychological support that they receive. Our APPG report recommended:

“Patients should have access to the full range of emotional and psychological support services throughout their treatment, for themselves and their families”.

The Government have put mental health on a par with physical health. As such, I would be grateful for the Minister’s assurances that blood cancer patients will receive the psychological support that they need after diagnosis, during treatment and after it has been completed.

I congratulate the hon. Member for Alyn and Deeside (Mark Tami) again on his Adjournment debate yesterday on psychological support after cancer treatment. By working together on a cross-party basis, it has become powerfully apparent to me that we can make a significant difference. Indeed, I have mentioned that only last week, the blood cancer APPG held its latest meeting on access to drugs and treatments for patients. We were fortunate to be joined by MPs, charity representatives and, of course, patients, one of whom said something that has remained in my mind. She said that patients

“don’t know if they’re living or dying”.

That highlights succinctly and powerfully the importance of this work and the importance of patients, politicians, cancer charities, the Department of Health and Social Care and the wider national health service in ensuring that patients are supported as well as treated.

One of the most striking passages of our APPG report referred to the long-term nature of blood cancer, and how it is different from solid tumour cancers. Respondents to our inquiry found that the term “living beyond” blood cancer was irrelevant. They will probably never live without blood cancer—it will remain part of their life—and very few of those patients have access to the recovery package. Indeed, one respondent even said that they did not know what the recovery package was, which is a point of concern. The recovery package assists patients after their cancer treatment has ended so that they can seek to return to their normal life.

I welcome the fact that the Under-Secretary of State for Health and Social Care, my hon. Friend the Member for Winchester (Steve Brine) recently reiterated that

“the recovery package is being commissioned and delivered in full or in part by many Clinical Commissioning Groups and providers across England”.

He continued:

“NHS England’s aim is to accelerate the process to ensure full implementation by 2020 so the package will be available to all cancer patients across the country regardless of location.”

He also stated that NHS England was

“building up a picture of current provision to help target future work to support rollout.”

I should be grateful for clarification from the Minister for Health on how support for blood cancer patients is included in this analysis.

Turning to data collection, the inclusion of blood cancer in a range of data collection initiatives will help policy makers to gain a greater understanding of the condition and how patients can be supported. For example, clinical commissioning groups and cancer alliances do not group blood cancer into a single disease area, unlike the national cancer patient experience survey, which means that blood cancer currently receives less attention and therefore fewer resources. The inclusion of blood cancer in the cancer dashboard, which only covers breast, colorectal, lung and prostate cancers, would be a step forward for patients.

Earlier this year, the Under-Secretary of State for Health and Social Care, my hon. Friend the Member for Winchester, said in a written answer:

“A second iteration of the dashboard is being considered by the National Cancer Transformation Board with a wider ambition to include rarer cancers and cancers with a lower incidence, such as blood cancers, as the dashboard develops.”

May I ask when we may expect such a development to come into effect?

GP surgeries are a vital part of the NHS. Like all MPs, I receive correspondence from my constituents on the subject of access to GPs. Indeed, in the NHS plan, we need enhanced support for doctors and their capacity to see patients every day, both in Crawley and up and down the country. While the A&E in Crawley Hospital was closed under the previous Government, Crawley Hospital urgent care centre is now open 24 hours a day, seven days a week. I urge the Minister to ensure that hospital services continue to come back to sites such as Crawley Hospital, while at the same time ensuring that the resources are in place to enable our constituents to access their GP, not on the other side of the town or county, but in their own local area.

GPs need more assistance to detect and flag up blood cancer. A GP will see, on average, eight cases of cancer per year, only one of which will be blood cancer. The number of GP visits needed before a cancer diagnosis is significantly higher for blood cancer patients than for people with other forms of cancer. Someone with cancer will of course want to be diagnosed the first time they see their GP with symptoms, but one in six blood cancer patients needed to visit their GP three, four or even more times before diagnosis. Only one in 42 breast cancer patients required such regular visits to be diagnosed with their condition.

In the wider debate, the numbers and the statistics are important. Not far shy of a quarter of a million people are living with blood cancer in the UK, and one in 19 people will develop blood cancer at some point in their lives. In Crawley there were fewer incidents of blood cancer than either breast or prostate cancer, but there were more blood cancer deaths than from either of those other forms of cancer. The challenges are immense. Blood cancer is the UK’s fifth most common cancer, and the third biggest cancer killer. However, there are reasons to be positive. Over a period of almost four decades, from 1971-72 to 2010-11, 10-year survival rates for leukaemia, one of the most common groups of blood cancer, increased from 7% to 46%. Among children, the figure has trebled to 81%.

In all those figures are the individuals who live with blood cancer, who care for family members who are patients, or who are advocates on behalf of those affected by the condition. My constituent Bill Bedford was diagnosed with myeloma in September 2016. He has undergone a stem cell transplant operation and is now fortunately in remission. Bill is one of many patients who are seeking to give something back. He has undertaken a 310-mile cycle ride, from London to Paris, to raise funds for Myeloma UK. Seven-year-old Ebonie Musselwhite, also from Crawley, was diagnosed with acute lymphoblastic leukaemia two years ago. About 650 people are diagnosed with ALL each year in this country, half of them children. Crawley Fire Station and Crawley Lawn Tennis Club are just two of the local organisations that have held fundraising events to help contribute to the cost of support for Ebonie. Angus Rowland, a young man living just outside Crawley, was diagnosed with acute myeloid leukaemia in 2010. Sadly, he died in May 2011, just 14 and a half years old. The Angus Rowland Forget-Me-Not Walk and Run took place in October, just outside Crawley, to raise funds for Bloodwise in Angus’s name.

I said at the APPG report launch that we could not just stand there and be pleased with what we had published in our first report. Rather, it must form the basis of a continued programme of work to effect lasting change. To people living with blood cancer right now, who may be on watch and wait, who may be undergoing treatment, or who may have only just been diagnosed, 1 say this: there are people in Parliament who are on your side, and we will stand up for you. We want to help, and we will keep the pressure on the Government and the NHS. To those who may have undergone treatment, who may be having treatment now, or who simply want to ensure greater support for blood cancer patients, my message is simple: contact your local MP and ask him or her to contact the Department for Health and Social Care, NHS England and local clinical commissioning groups. Let us continue to raise awareness, so that blood cancer is no longer the hidden cancer.

[Madam Deputy Speaker (Dame Eleanor Laing)]

I am delighted to welcome back to the Dispatch Box the Minister, Mr Stephen Hammond.