Oral Answers to Questions

Jo Churchill Excerpts

Tuesday 21st March 2017 Commons Chamber

[David Mowat]

One of the criteria by which STPs are being judged is the extent to which they are making this tilt from secondary into primary care, exactly as the hon. Lady suggests. That is precisely why the extra funding for primary care that I have set out is so important and why it is happening.

[Jo Churchill (Bury St Edmunds) (Con)]

“General Practice Forward View” talks about supporting general practice to improve digital technology for patients. Given the recent data challenges, does the Minister agree that putting a national data guardian on a statutory footing to protect patients and professionals is becoming an imperative?

[David Mowat]

I know that my hon. Friend has introduced a private Member’s Bill in this area, and the Government intend to support it.

Health and Social Care

Jo Churchill Excerpts

Monday 27th February 2017 Commons Chamber

[Anne Marie Morris (Newton Abbot) (Con)]

Let us be clear: estimates are a serious business; they must be realistic. Every year, Parliament votes on how much can be spent. If excess is needed, Departments have to go back to the House, so getting estimates right is mission-critical.

The challenge I have with these estimates is that I have little faith that the assumptions they are based on are realistic. As my hon. Friend the Member for Totnes (Dr Wollaston) said, there is an assumption that demand will go down. As the population increases, and as immigration increases, that seems a very unrealistic view to take. The Government need to look long and hard at the assumptions they have made, because I for one am not convinced that they have got them right.

We also need to look at what these estimates assume in terms of the negatives. They assume we can keep on course if we reduce public health spending. If we start reducing that spending, which prevents the need for NHS intervention—the most expensive form of intervention—will we really save money? It seems to me that we will not. The other assumption made in these estimates is that central administration will be cut. We should bear in mind the complexity of what is going on at the moment, with 44 STPs coming on board, as we all hope they will, and I agree with my hon. Friend that they are a good concept, although I have some real concerns about delivery. Overall, I am concerned that these estimates are not based on realistic assumptions, and Ministers will need to seriously address that.

As the hon. Member for Hackney South and Shoreditch (Meg Hillier), who leads the Public Accounts Committee, and my hon. Friend have said, the estimates must take into account what we need for health and social care. If we cut spending on social care, or do not adequately fund it, we will increase spending in the NHS.

However, underpinning all of that is the need to have measurements in place across the whole system, as my hon. Friend indicated, so that we know what the full scope of the demand is. We must measure the results achieved by the resource we put in and the outcomes for the population as a whole. We all talk about measures around A&E and the NHS. We all talk about waiting times, and the targets that are set are all around waiting times. However, nobody is looking at what impact that has on primary care—on our GPs—or on social care. If an estimate is to be right, therefore, we need to look at the whole system of measurement.

[Jo Churchill (Bury St Edmunds) (Con)]

My hon. Friend is making powerful points. At my local district general hospital, West Suffolk, winter preparedness plans included a 5% uplift in demand—this is exactly the point she is making—but there was a 20% increase. I have exactly the same thing in social care, where my social care providers tell me people are older and more poorly. We have increased demand across the piece for that reason.

[Anne Marie Morris]

I thank my hon. Friend for that helpful example. She is absolutely right.

If we look at the whole measurement system—this was acknowledged in one of our Public Accounts Committee sessions by the Department of Health—we see that there is limited measurement, and that there probably should be more. When I challenged the individual concerned on whether the Government would be looking at that, he stood from one foot to the other and could not give us much of an answer. These estimates have to be based on proper measurement of need, on what is operationally put into practice, and on the outcome for patients, but that simply is not the case.

We need to look at the differences between the NHS and social care as regards how the money is allocated. In the NHS, we have some ring-fencing, while in social care we do not, but because the two are inextricably linked, unless we look at the way in which each of those pots is managed, never mind how much is in them, we give rise to problems for the future. Social care is not ring-fenced. I am sure we are all grateful for the additional moneys that have been provided, but frankly they do not go far enough. The first chunk of money might cover the living wage, and the ability of local authorities to increase the precept by 3% is welcome, but as the Chair of the Public Accounts Committee said, that is taxpayers’ money.

Oral Answers to Questions

Jo Churchill Excerpts

Tuesday 7th February 2017 Commons Chamber

[Nicola Blackwood]

We have continual discussions with the Welsh Government to make sure that these issues are kept under review. I shall definitely write to my hon. Friend about this. I shall also be happy to meet him if he would like to discuss it in further detail.

[Jo Churchill (Bury St Edmunds) (Con)]

Does the Minister agree that not one subject that we have discussed today would not be improved by the better transfer of patient data? How is the Department working towards linking social care with the acute sector, with GPs, with mental health services, with innovation and with cancer drugs in order to understand where we can best target patient outcomes and spend our resources?

[Nicola Blackwood]

My hon. Friend has a leading role with her private Member’s Bill so she is well aware that we are working very hard to improve the connection of patient data, particularly through the role of the national data guardian and her 10 safeguarding rules, which will make sure that we not only protect patient data more effectively but are able to share it in an effective way that improves patient care.

Pharmacies and Integrated Healthcare: England

Jo Churchill Excerpts

Wednesday 11th January 2017 Westminster Hall

[Mrs Main]

My hon. Friend is absolutely right and completely backs up the point I was making. There is evidence of good practice but other areas could do much better. Without bringing pharmacies to the table and into the ongoing dialogue about this issue, we risk not having the new model that we would all like to see—one that operates consistently wherever people go.

There must be a consistent model in the drop-in pharmacy service that we are envisaging. Of course, people often use pharmacies away from where they live, such as where they work or when they are on holiday or visiting friends. If the model is patchy, as my hon. Friend says, the system will not improve and we will end up with a situation like the one that is found in many holiday towns. A few years ago, the Select Committee on Communities and Local Government looked into the fact that many seaside and holiday towns have enormous pressures on their frontline services. If something goes wrong when people are on holiday, although what happens is not necessarily catastrophic, they all end up at the local A&E services in hospitals. That huge problem was recognised, I think, in the 2006 seaside towns report by the CLG Committee. This is all part of evening out the stresses and strains on the system, which for many seaside holiday and tourist destinations are often huge.

[Jo Churchill (Bury St Edmunds) (Con)]

Does my hon. Friend agree that that was largely the point of the Murray review, which she alluded to earlier? Integration throughout the whole of the NHS is vital, so that everybody knows what everybody else is doing and so that there are seamless pathways that everybody knows how to follow. That will ultimately give us benefits not only in pharmacies, but right across the NHS.

[Mrs Main]

Absolutely. Rachel Solanki and her colleagues are not necessarily critical of change—that is important. Pharmacies are nervous about some of the things that may be coming along, but they are not critical of change. Indeed, they would welcome a debate on the innovative services that other pharmacies are operating around the country. The fact that we do not all know about these services in other places shows that there is not an integrated approach. The services include anticoagulation monitoring in Knowsley; medicines optimisation work for respiratory diseases in South Central; sexual health screening, including for hepatitis, syphilis and HIV, on the Isle of Wight; oral contraceptive supply in Manchester and other contraceptive provision in Newcastle; alcohol screening and brief intervention on the Wirral; healthy lung screening in Essex; pneumococcal immunisation in Sheffield; a reablement service on the Isle of Wight; and phlebotomy services in Coventry and Manchester. That is a long, diverse list of services that are provided by pharmacies in those areas.

--- Later in debate ---

[Jo Churchill (Bury St Edmunds) (Con)]

It is a pleasure to serve under your chairmanship, Mr Bailey. I add my congratulations to my hon. Friend the Member for St Albans (Mrs Main) on securing not only a timely debate, given the current circumstances, but one that is important because we need to look at the whole system and integration, rather than at each specific service.

Interestingly, on 6 December, Lord Prior said:

“The Government recognise the vital importance of community pharmacy.”—[Official Report, House of Lords, 6 December 2016; Vol. 777, c. 593.]

It is from that positive stance that I wish to make my points. Pharmacists have been identified as one of the professions that are highly qualified and not in short supply. Some very advanced GPs are bringing pharmacists into their surgeries to help to alleviate some of the pressure. Some clever thinking is going on out there. I hope the Minister can tell us how we are capturing that innovative thinking and how it is being spread throughout the system.

The “Five Year Forward View” identified that the British public need to be made more aware of what pharmacies can do and how they can help people keep healthy. However, the Government need to give a steer and ensure that people with minor ailments understand that the pharmacist should be their first port of call.

When I visited my pharmacist there was concern about the 111 service, which was my hon. Friend the Member for St Albans mentioned. We need to keep an eye on that so that we do not unintentionally put pressure on different parts of the service. We need to look at it in the round and incorporate all key roles into pharmacies in order to provide additional services. I had my flu jab at a pharmacy this year, which is a useful use of resources within the system and within the community. We could make that more available and perhaps incentivise individual pharmacists to go out into care homes, which have a proliferation of need because of age and comorbidities, and give flu jabs and so on. Moving our workforce around, rather than driving ever-greater demand into smaller places such as hospitals, must be a consideration.

The Murray review, which has been mentioned, found that poor integration with other parts of the NHS was a significant barrier, and the Royal Pharmaceutical Society agreed. I like to think that the Government are taking a good look at what was said in the review and taking the issues on board.

I love the term “pharmacy-first culture”, which is a good motto for everybody to live by. I want to concentrate on my Bury St Edmunds constituency for a couple of minutes. We have 21 pharmacies and a cluster of Superdrug and Boots shops, which are volume providers that have other things such as make-up and lunches; they have optical services and Boots has audiology services. They provide everything needed from the cradle to the grave and they have considerably greater footfall than my excellent independent pharmacist, who puts more prescriptions through than any other pharmacist in the town. The 100-hours rule meant that I got local surgeries with pharmacies dispensing in them. We need to take a little bit of care, step back and get the right things in the right place. The last thing my local community wants is my independent pharmacy not being able to survive through these important transitions.

An ageing population is a challenge in rural areas such as Bury St Edmunds. Within the next decade, 40% of Suffolk’s population will be over 85. We know that that age group lives with comorbidities that need a degree of monitoring. That can be done most effectively in the pharmacy and in the GP’s surgery, but out of the big NHS pie the GPs get only about 8% and the acute sector gets about 92%. We need to show that we are spreading the money throughout the system, because a lot of the pressure will be coming down on the pharmacies, the GPs and the care sector.

Pharmacists are often not used to their full value. Delayed discharge from hospital often comes about because people do not get their meds, and pharmacies in some hospitals are not available throughout the weekends. There could be more joined-up thinking.

[Bill Esterson]

I do not think I disagree with anything the hon. Lady has said. She is making a very good case for the excellent practice in her constituency and for pharmacists more generally. Does she agree that the logic of her argument is that money is saved by investing in pharmacies? That is a strong argument. She is arguing that cuts should not be made and that the Government should invest in pharmacies to support the whole health system, which is what this debate is about.

[Jo Churchill]

I thank the hon. Gentleman for his intervention and agree with his final point. This is about the whole system and making efficiencies. We are talking about evolution. We are no longer looking at the service as it was perceived in 1948. There was a private element to it even back then, because that is what GPs wanted. We need a 2017 solution to the challenges of a larger population, an ageing population and so on. Pharmacists must play their part in that. They are really keen to step up and deliver more for the Government and more for the patients and people in their communities.

There are issues in the town, but there is an interesting rural situation, where there are rural payments for Elmswell and Thurston, but the GP surgery in Woolpit, which dispenses more scripts, does not get one. There seems to be a bit of discrepancy. I echo the point made by my hon. Friend the Member for St Austell and Newquay (Steve Double): looking at rural constituencies is a very different thing from looking at the whole ecosystem.

There is a Day Lewis pharmacy in my town. An exceptional local resident, Ernie Broom, is keen to note that that pharmacy, because of its location, cannot offer a lot of peripheral things. The local residents are largely mature or on lower incomes, which means that the pharmacy is vital to the community. We also have really poor bus services into town—it would take a young mum or an elderly person nearly an hour and a half to cross town. I want the Government to look at a weighting system, which takes into account what local pharmacies can deliver. They would get points for being in certain areas, or incentives for delivering more. I know that is something that is being looked at.

My questions are similar to those posed by my hon. Friend the Member for St Albans. What more can pharmacies be incentivised to do? How much more capacity can they provide? With people living longer and with comorbidities, how can we remunerate for services? How can we ensure that that is included as part of sustainable transformation plans? It is not something that should be added at the end as an afterthought, but is a hugely integral part of how we make our NHS better and more able to look after the health of us all.

--- Later in debate ---

[David Mowat]

That is of course a valid concern. We are trying to make progress on having GP services open for much longer than they have been historically, including weekend opening. Several colleagues have made the point—the Murray review also addressed this—that there is occasionally a barrier between the attitudes of some GPs and what can be done by pharmacists. That is true. We must be conscious that it behoves us to try to encourage the breaking down of that barrier, and misplaced professional pride must not prevent us from doing things to the best extent. Putting some pharmacists in GP practices—particularly with new models of working in which more disciplines tend to work together and a GP does not just work on his own—is an important part of that.

[Jo Churchill]

There is a barrier, but again, those services are used in different ways. My independent community pharmacist in Bury St Edmunds dispenses around 18,000 or 19,000 prescriptions in the town and provides all these ancillary services. He also has a dispensing practice in a GP surgery, which he is looking to automate, to make it more streamlined and cost-effective. Those services are two slightly different things, and I would worry if there were too much of an idea that they service the same thing.

[David Mowat]

They are different, but my point was somewhat different: optimising the use of the pharmacist profession could facilitate the breaking down of barriers and some of the care home activities that have to happen.

I will leave a couple of minutes for my hon. Friend the Member for St Albans to respond, so I will not talk in detail about the value for money aspect, other than to repeat the point—Opposition Members made a couple of interventions about this—that overpaying for a dispensing service is not the way to facilitate a much more clinically-based and service-based approach. The way to facilitate that is to get the appropriate remuneration models and revenue streams in place, and that is what we are determined to do. In the end, that is what we expect to be judged on, and I hope that we will be judged on it. With that, I will let my hon. Friend summarise.

NHS and Social Care Funding

Jo Churchill Excerpts

Wednesday 11th January 2017 Commons Chamber

[Dr Whitford]

Public consultation is important, and not just in the way it has often been done in the past—“We’ve made a decision, it’s a fait accompli, and we’re coming and telling you about it.” Unfortunately, that is very much what we have heard about the STP process, partly because it has been so short and partly, I am afraid, because it is about budget-centred care, not patient-centred care. Areas have been given a number and told, “If you’re not reaching this number, don’t bother submitting your plan,” and they are working back from that. That will not achieve an efficient, integrated service, so the public must be involved.

Frontline clinicians must also be involved. They work in a service and know exactly what the bottlenecks are and exactly what horseshoe nail is missing and holding a service back. If we have clinician-led redesign, such as I was involved in for breast cancer in my health board 17 years ago, we can track a patient’s path. We can quickly imagine ourselves as a patient, see the bottlenecks and focus investment on them.

I read an article yesterday stating that three hospitals in Manchester have spent £6 million on management consultants to say, “Shut a ward, sack hundreds of people and jack up the parking charges.” I am sorry, but that was not good value for £2 million each.

[Jo Churchill (Bury St Edmunds) (Con)]

I thank the hon. Lady for, as ever, eloquently expressing issues that face us all, no matter where we come from and who we are. Does she agree that having good healthcare data for clinicians enables patients to be put through the system seamlessly? Many individuals do not realise that their data do not go from their GP into acute care and then back into social care. If we could improve that—I make a plug for my private Member’s Bill on Friday—it would help patients.

--- Later in debate ---

[Jo Churchill (Bury St Edmunds) (Con)]

I pay tribute to all who work in our national health service and welcome this important debate. I hear the Secretary of State not blaming, but looking for solutions; that is more what we should be about. I have called for an honest debate about the NHS since I came to this place. The NHS is 70 years old next year, and if it is going to reach 100 we need to look after it.

But I want to start with the positive. My own hospital, West Suffolk, saw a 20% increase between Christmas and new year in the number of patients admitted. Those patients were poorly—very poorly; that point was made earlier. The hospital had prepared a resilience plan for a 5% uplift in patient numbers, but it has coped spectacularly well. To refer to a point made by the hon. Member for Tooting (Dr Allin-Khan), who is no longer present, people come into A&E with ingrowing toenails and dry skin, and it is important that we make sure we see the most poorly people in the most appropriate way and use resources most effectively.

My constituency has the second oldest population in the country. There is an ageing population with comorbidities, and in the next 10 years the number of those aged 85-plus will rise by 45%, so the allocation of resources as we go forward is important.

But my hospital has been one of the most resilient in the east, at 85%, and its resilience is in most part due to its fantastic staff. West Suffolk hospital has been innovative. It pays for 20 beds in Glastonbury court, a facility owned by Care UK to provide a step-down facility. In January, it will be doing a bridging care service with the councils. Improvement will come through prevention and integration, and not always by shouting for more money.

My hon. Friend the Member for Faversham and Mid Kent (Helen Whately) said that what we need is good integration. Good working in Suffolk needs to be copied. As my hon. Friend the Member for Wells (James Heappey) and the hon. Member for Central Ayrshire (Dr Whitford) said, STPs need to be looked at as a force for good, and I urge Labour not to knock them, but to work with them. They are clinician-led, which is what everybody was asking for.

We cannot have everything we want in life—we never can—and we cannot have everything we want out of the NHS. That is why we need an honest conversation. With rising expectations and an ageing population, the private sector has been in use in the NHS since 1948. If we are going to get more bang for our buck, we should perhaps look at parts of the private sector, to be able to enhance what we give patients through these critical periods.

[Simon Hoare (North Dorset) (Con)]

My hon. Friend is absolutely right about the need for a grown-up debate about integration and about learning from best practice. Does she share my concern that as Labour Members fan the flames of their artificial indignation, all they are doing is proving yet again that they are either unwilling, ill-equipped or ideologically—

[Madam Deputy Speaker (Mrs Eleanor Laing)]

Thank you. Jo Churchill.

[Jo Churchill]

I agree in that since we last debated this with the Opposition on 23 November, apart from asking for £700 million to be brought forward, they have put forward very little in the way of tangible plans. We are talking about everybody here, and just slinging bows and arrows across the Chamber will not get us to the solution we need.

If this is about money, why do some areas do better than others? It is actually about the allocation of resources and good leadership. I have received three letters about good healthcare. A resident in my constituency saw the GP on 28 October, the consultant on 8 November, and had their operation on the 29th. That was at my district general hospital that used the private facility locally to enhance the patient experience.

We need a long-term solution. I am pleased that the Prime Minister has spoken about tackling the difficulties of mental health. The right hon. Member for North Norfolk (Norman Lamb) has championed that and shares a mental health trust with me. I am pleased to see that another 49,000 people are being treated for cancer—that is something that I came to this place to champion—and another 822,000 people are receiving specialist cancer treatment. We have seen huge increases in demand, and we need to admit that we cannot just carry on. There have been advances in drugs, but we need to take into account comorbidities and an ageing population.

We need to understand what is wrong, and we will do that by having better data throughout the system. The Richmond Group wrote in support of my private Member’s Bill that information held in healthcare records has a huge potential to provide better care and improve health service delivery within the service. Paramedics have asked me for better access to data so that, when they find someone on the floor, they will know what meds they are on and what the most beneficial treatment would be. GPs want their information to flow through the system to help social care and the hospital sector. Pharmacies need to be able to read and write, and those working in social care need to be able to look at someone’s pathway. Patient outcomes should be the thing that we are all talking about, but we have to make decisions. At the centre of all this, we need to support those colleagues who are working above and beyond at this time. We need to behave in a grown-up, responsible way, just as they are, in caring for our NHS.

Children’s Wellbeing and Mental Health: Schools

Jo Churchill Excerpts

Tuesday 10th January 2017 Westminster Hall

[Jo Churchill (Bury St Edmunds) (Con)]

It is a pleasure to serve under you chairmanship, Mr Nuttall. I thank the right hon. Member for North Norfolk (Norman Lamb), with whom I share a mental health trust, which we are both glad to see is out of special measures. I congratulate the staff on that, but there is much more work to do. I concur with other Members who have said that prevention is better than cure. There could be no more opportune time for this debate, which comes a day after the Prime Minister highlighted mental health, and particularly children’s mental health, as a problem. We have been talking the talk, not walking the walk, for quite long enough.

Why have I chosen to speak today? Mental health is one of my top three surgery priorities. Week after week, in surgery after surgery, I see families whose lives are breaking down because of waiting times. Very often, it is not only the child at the centre. Often Mum has given up work, so there is an economic impact; Dad has stopped doing overtime, so there is a further economic impact; and the siblings do not quite get the activities that they used to, because everybody is focused on the child who has the problem at that time.

I have four children; the last left school last year. Like my hon. Friend the Member for Taunton Deane (Rebecca Pow), I have been somewhat horrified over the past 10 years, as they have travelled through their teenage years, to see how their contemporaries have struggled with mental health and to see the help that has been available for them. As a governor some 10 years ago, the fact that some of my children would be sent hundreds of miles away, when we know that closeness to the family gives better outcomes in the long term, filled me with horror. We really need to drill down into the issue of tier 4 beds and the local availability of child and adolescent mental health services.

As governors and teachers, we instigated sessions with parents on eating disorders and resilience. The World Health Organisation’s whole-school approach is the right one, but we actually need a whole-system approach of teacher training, actual connectivity and knowing where the services are. School-based counselling is excellent, but as the right hon. Member for North Norfolk said, we need to ensure that the funds are there at the right time. Like my hon. Friend the Member for Taunton Deane, I welcome fairer funding, but the fairer funding formula for Suffolk still leaves us short of the national average, so for us it will make a slight difference but not enough. Suffolk’s population is rural, and delivering issues rurally causes problems. It is much harder for us, with a sparse population in which more than 40% are scattered around, to deliver those scattered services.

Why do only 25% to 40% of children and young people currently receive input? Some 50% of lifelong mental health illnesses develop before the age of 14, and 75% before the age of 25. Young people with mental health problems use other coping strategies: self-harm is one that is familiar to me, unfortunately, and they are four times more likely to turn to alcohol. All these are destructive. They are 20 times more likely to go to prison, as we have heard. Tragically, they are six times more likely to die before the age of 30.

One in seven adults has a common mental disorder. If we capture these problems earlier on, we will be doing ourselves and the country a great service, saving people’s lives and building resilience within their families. I was glad to hear the Prime Minister placing importance on mental health, but at the schools and colleges I go to, particularly my sixth-form college, the pastoral care teams reckon they spend up to 70% of their time on mental health issues. I have talked to teachers in the primary sector, who are seeing issues earlier and earlier. We need that teacher training and we need that funding.

How do we improve? We must build resilience, both personally and emotionally. We must focus on young women, who are three times more likely to experience common mental disorders than young men. However, our young men have less ability to express themselves and we see greater suicide numbers in young men, so we need a comprehensive approach. I encourage schools to reach out. Like my hon. Friend the Member for Taunton Deane, I support volunteering and using green spaces. The Green Light Trust does a great deal locally; Westgate Community Primary School does the daily mile. Exercise and sport improve outcomes, because children are within a team—research backs that up. Reducing the hours children spend in front of a screen, ensuring they eat together—all these things are part of resilience building.

When things go wrong, we do not want to medicalise, but we do not want to wait. People need services locally, and we need our children not to be sent all over the country. We have to look at the provision of funding and the allocation of resources. The lack of the family unit locally undermines short and long-term recovery.

I pay tribute to the fantastic work of the Prince’s Trust, of the Duke and Duchess of Cambridge and of Heads Together, which aims to destigmatise and shine a light on the area. That is to be welcomed. I will not give the statistics about body image and coping with work for young people, because we have already heard them, but we need to understand where the money goes. When I spoke to my local mental health trust recently, I discovered that some £363,000 went to eating disorders, but that there was no more money for any additional services. That worries me.

I ask the Minister the following questions. Young people’s mental health needs prioritising. How do we scrutinise those who commission those services? I welcome the £67 million investment in digital connectivity, but many of my constituents do not have access, and there is a broader issue with telecare and prescriptions. How are we locking into the Department for Culture, Media and Sport and the Department for Communities and Local Government to ensure that the fourth utility is there? Will she assure me that rural areas will be fairly treated? As in everything, we sit in the lower quartile both for education and for health, and that is not a good combination. How can we ensure that cuts in community care and local government support, which often give support services the money they are looking for, are considered effectively? Many trained professionals have moved out from children’s services into adult services. We need to capture that skill and bring it back.

It was my birthday when “Future in mind” was announced. I want to understand how we will properly evaluate whether the money that was announced yesterday—most welcomely—and the money announced in “Future in mind” is being spent where we need it to be spent, so that we can understand what is working. I was also glad to hear the Secretary of State for Health announce that sustainability and transformation plans will not be passed without mental health being high on the agenda.

Many have said that the journey to better mental health starts with a conversation, so I hope that this is our conversation and that by 2020 there will be shorter waiting times and talking therapies in every region, and particularly for my young people.

Accelerated Access Review

Jo Churchill Excerpts

Tuesday 13th December 2016 Westminster Hall

[Ian Austin]

The hon. Gentleman is completely right to say that Orkambi could reduce hospital admissions, and could shorten the amount of time people spend in hospital when they have been admitted.

In its statement, NICE referred directly to the trust’s proposal as a potential solution to the shortage of long-term data. With the NICE process exhausted and seven months wasted, we hoped that the way would be clear for direct negotiations between the drug manufacturer Vertex and NHS England, which would allow for a speedy resolution to the situation. However, Department of Health officials then demanded that the drug be put through a rapid review process, which, at 16 weeks, is anything but.That process is based on exactly the same criteria that had just seen Orkambi denied to those who need it. Vertex has declined to enter the process, because of the certainty that it will come to nothing.

New data published in October at the North American cystic fibrosis conference, which my right hon. Friend the Member for Leigh (Andy Burnham) mentioned, are based on 96 weeks of trials and show that Orkambi slows the decline in lung health by up to 42%. That is comparable with the 47% slow in decline caused by the transformational treatment Kalydeco, which is widely available in the UK for a less common mutation of cystic fibrosis. Those data were unavailable to NICE but clearly illustrate that drugs such as Orkambi need the chance to prove their worth in the long term. That also underlines the fact that we now have a situation where people with cystic fibrosis face discrimination by genotype, because they are being denied the same level of treatment that people with a different genetic mutation of cystic fibrosis receive.

Twelve months after licensing, negotiations are at a standstill. I understand that Vertex is keen to offer a substantial discount, but for commercial reasons would need to do so confidentially. It would like to take up the trust’s offer of monitoring the effectiveness of Orkambi for a trial period. That could build on the American data and allow NHS England to conduct final negotiations based on an accurate reflection of the drug’s effectiveness.

[Jo Churchill (Bury St Edmunds) (Con)]

I would like to thank the hon. Gentleman for securing such an important debate. One of the beauties of cystic fibrosis data is that they capture 99% of all people with the disease, so could truly be used as an exemplar. The accelerated access review calls for accurate monitoring via data, and this offers an ideal chance to do that.

[Ian Austin]

The hon. Lady is completely correct. It is good that she is here in the Chamber, making these important points.

Vertex is also keen to explore flexible reimbursement schemes, which would allow the NHS to manage the overall budget impact of the treatment. However, the inflexible current system insists that any offer has to be made public, rejects the trust’s solutions and offers no scope for flexible reimbursement schemes. That brings me to the accelerated access review, which was commissioned to speed up access to innovative new drugs and treatments such as Orkambi. The review was finally published in October, after a long delay, and recommends that NICE reviews its processes. It calls directly for the current system to change, to include more emphasis on the confidential commercial arrangements, flexible reimbursement arrangements and collection of real-world data that I and other Members have referred to. Those recommendations could be the key to reaching a deal that delivers Orkambi to those desperate to receive it.

When the review was commissioned last year by the Minister’s predecessor, the hon. Member for Mid Norfolk (George Freeman), he spoke of how accelerating the uptake of transformational technologies in the 21st century would attract investment in research and innovation to help us earn the prosperity we need as an advanced economy. When the review was published in October, NHS England’s chief executive, Simon Stevens, said that creating headroom for faster and wider uptake of important new patient treatments would create opportunities for the UK’s globally successful life sciences sector. The failure to deliver Orkambi undermines that vision.

We have a rigid and inflexible system, and warnings that it is not fit for purpose have been ignored throughout the process. Instead of embracing the opportunity for an innovative solution, we have been offered further negotiations based on criteria that have already failed once. That is a waste of time and taxpayers’ money and sends completely the wrong signal to a global life sciences industry currently questioning future investments here in the UK. Hugh Taylor, the review’s chair, set out the need for commitment and collaboration across Government, the NHS and the life sciences industry to make the review’s proposals a reality.

The review sets out criteria for transformational treatments that should be fast-tracked for access. Orkambi meets those criteria. It presents the perfect opportunity to put many of the review’s proposals to the test, to illustrate the commitment and collaboration needed and to demonstrate how we can come together and adapt in the light of new information. It is predicted that 95% of people with cystic fibrosis could benefit from a personalised medicine within five years. Coming up with a solution for Orkambi—one that makes sense to the NHS as well as reflecting the investment that goes into these treatments—will give us a genuine opportunity to beat this condition.

I am sure people will benefit from the review’s proposals in the years to come, but that must not be at the cost of Orkambi, which is available now. Many people with cystic fibrosis, as well as their families and carers, such as my constituents Carly Jeavons and Samantha Carrier, are watching this debate. Many of them are forced to spend weeks and months of each year in hospital, and most of all they want a chance to be able to do the everyday things we all take for granted, such as raising a family, planning a holiday or breathing without struggling. They have already endured needless delays, and as time goes on those delays present an obstacle to investment in future treatments to beat cystic fibrosis. That is not the vision set out by the accelerated access review.

Social Care Funding

Jo Churchill Excerpts

Monday 12th December 2016 Commons Chamber

[David Mowat]

The hon. Lady made two points, both of which I agree with. The first was that in Scotland there has been a 9% reduction in delayed transfers of care. It is also true that in England many parts of our system, particularly those that have integrated most quickly, have achieved reductions of that size and more. She is right that the STPs are part of the process of re-engineering the system. Adult social care and the integration of adult social care are a big part of that and we need to ensure that we deliver.

[Jo Churchill (Bury St Edmunds) (Con)]

Does the Minister agree that better integration could be driven by better patient data, which could help to show us where quality practices exist and how to spread best practice?

[David Mowat]

I do agree. I had a discussion with the Care Quality Commission on the dataset that is reported, and I hope that over the next months and years we can improve how we do that.

Cancer Strategy

Jo Churchill Excerpts

Thursday 8th December 2016 Commons Chamber

[David Tredinnick (Bosworth) (Con)]

I am most grateful to you, Mr Deputy Speaker, for calling me to speak in this important debate.

I listened with great interest to the hon. Member for Poplar and Limehouse (Jim Fitzpatrick) talking about his experiences of smoking. I gave up smoking before a flight with a parliamentary delegation coming back from Bahrain nearly 15 years ago, and I have never looked back. One of the drivers that made me give up smoking was a conversation with the then Member for Manchester, Withington—I would call him an hon. Friend, but he was an Opposition Member—who is now Lord Bradley. Like the hon. Member for Poplar and Limehouse, I remember smoking in the House. I remember lighting up in a Standing Committee and being reprimanded, but we could smoke in the Library Room C then. I offered the then Member for Manchester, Withington a cigarette in the Tea Room—we could smoke anywhere then, as well as in the Smoking Room—and he said, “David, no thanks. I’ve got an emphysema hospital in my constituency.” That really hit home.

The hon. Member for Scunthorpe (Nic Dakin) is nodding. May I pay tribute to him? He was at the Britain against Cancer conference on Tuesday, which I attended as an officer of the all-party group on cancer. He has served on that group for much longer than I have, and he chaired the meeting in the absence of my hon. Friend the Member for Basildon and Billericay (Mr Baron). Other hon. Members have paid tribute to my hon. Friend, and of course to his wife, who is undergoing treatment at the moment. I want to say what a great job my hon. Friend has done to drive this agenda on the Conservative Benches. It just shows that if you follow something you believe in in this House, you can get dramatic results.

As a politician, I often think that we should be able to sum up something, such as a very wordy report, in just a phrase or a sentence. That may be because of my background in advertising many years ago. Those dramatic results were clearly illustrated by Simons Stevens, when he said that in 1999, 60% of cancer patients survived, but in 2014, the figure was 70%. We went over some of those figures, which I thought were truly remarkable and really very encouraging.

I want to focus on something else that Simon Stevens said, which the hon. Member for Scunthorpe has mentioned. He announced £200 million of funding at the conference:

“The £200m fund has been set up to encourage local areas to find new and innovative ways to diagnose cancer earlier, improve the care for those living with cancer and ensure each cancer patient gets the right care for them.”

That includes aftercare treatment. What do we do when a patient has had chemotherapy and then there is nothing else—they have not been given any other options, so they feel depressed and unhappy?

That is where my main experience in this House comes in, as I have worked on integrated healthcare—holistic medicine, I suppose—with the all-party parliamentary group on integrated healthcare for nearly 30 years. I have been an officer of the group for nearly 25 years, and have chaired it for quite a while. It feels almost as if our time has come. It has now been clearly recognised that part of the cancer package should be a wide range of support. We can see that all over the country. I was at LOROS last week, which is where very ill people in Leicestershire go for their last few days. A range of different therapies were being offered there. That is happening not just in my constituency but in many others.

I return to the conference mentioned by the hon. Member for Scunthorpe—[Interruption.] I see he has now been promoted to the Front Bench. That is the great thing about the Opposition—the Front-Bench team changes so quickly that we can never be sure where any hon. Members are. I remember that when I was a young Member the advice I was given was always to sit in the same place in the House so that the Speaker knew where you were. In that case, it is a wonder that any Opposition Members get called at all, because they are always moving around the Benches. The hon. Member for Scunthorpe has clearly been promoted this afternoon, so congratulations.

One battle I have had over the years has been with the medical establishment about what should be included in treatments on the health service. It has been an ongoing battle against vested interests in the medical establishment who do not want to see money leaking from their own particular silos. That is down to scarce resources. One of the most interesting stalls at the Britain against Cancer conference on Tuesday was about cancer detection dogs. Even I gasped when I saw it—my hon. Friend the Member for Bury St Edmunds (Jo Churchill), who has also had experience of cancer and has contributed so much in her short time in this House to addressing cancer problems, is nodding and smiling. Just as we have dogs in this House—I will not say when or where they go—to detect things that may have been placed here by people who do not particularly agree with what we do, so it is possible to use dogs to detect cancer. If that is possible, I suspect that the authorities in the health service have not run double-blind placebo-controlled trials to establish whether it works. It works on the basis of experience, because the dogs are trained to detect by smell when people have developed cancer.

On the great battleground with the orthodox proponents of orthodox medicine, the battle line has in recent years been drawn on something called evidence-based medicine. We are told that in the health service medicine should always be evidence-based, and nothing should be used unless it meets that criterion. I had a look at that, and got the Library to look the papers up. It goes back to 1992 and a statement by Professor Sackett that various other academics then ran with—there was a Professor Guyatt also. But when saying how important evidence-based medicine was, Professor Sackett also said:

“Good doctors use both individual clinical expertise and the best available external evidence, and neither alone is enough. Without clinical expertise, practice risks becoming tyrannized by external evidence, for even excellent external evidence may be inapplicable to or inappropriate for an individual patient. Without current best external evidence, practice risks becoming rapidly out of date, to the detriment of patients.”

It is hardly a secret that we were discussing Brexit in the House yesterday and that we have been very much involved in the whole debate since the summer—and for many of us, a long time before that. One problem in healthcare in relation to the EU has been the imposition of directives on the UK that have negatively impacted support services in healthcare. The traditional herbal medicines directive requires Chinese medical practitioners to show 30 years’ usage of a particular medicine in the UK, or 15 years under other circumstances, and bans a whole range of complex preparations freely available, and produced to very high standards in modern factories, in the People’s Republic of China.

Before I came to the Chamber this afternoon, I was at a Chinese medical clinic. I practise what I preach and have acupuncture once a month. I take Chinese herbal medicine and I think it has kept me away from antibiotics, steroids and other drugs for a good few years. I talked to practitioners about what they are able to do for cancer patients. There is a very long list of types of cancer that can be treated using traditional Chinese herbal medicine: cervical cancer, Non-Hodgkin lymphoma, HIV, colon cancer, head and neck cancer, breast cancer and prostate cancer. The list goes on.

I believe that several of my constituents are alive today because they have used Chinese medicine. It strengthens one’s immune system and is very effective after cancer treatment. It deals with particular symptoms. I asked the practitioner this afternoon what conditions she would expect to be able to alleviate using Chinese herbal medicine and acupuncture. She said: tiredness, lack of energy, fevers, headaches, hypertension, dry skin, seizures and involuntary muscular twitching.

We have to broaden the scope of services available on the health service to help to meet patient demand. I hope the £200 million fund will mean a further widening of the scope of services available. My hon. Friend the Minister, who is new to his post, could do a lot worse than contact the head of the Professional Standards Authority, Harry Cayton. Harry Cayton’s organisation oversees the regulation of 23 different health organisations, including about 20,000 providers. If we go to the trouble of regulating different therapies, or having oversight of that regulation, why on earth do we not use it? What is the point of having a statutory regulator that checks the oversight when we do not actually use its services? That is a great mistake.

My hon. Friend the Minister could do a lot worse than go around the country and look at some of the practices that help cancer patients in remission. One of the best is the award-winning Velindre cancer centre in south Wales. Each year, it sees over 5,000 new referrals and about 50,000 new out-patient appointments. It employs over 670 staff and has an annual budget of over £49 million. The money for that service, which is widely used by doctors, comes not from the Department but from charitable donations. At that centre, they use reflexology, reiki healing, which I have studied over the years, aromatherapy, and breathing and relaxation techniques, and they have spectacular results.

Another wonderful clinic that my hon. Friend would do well to visit—it is a few stops on the District line from here, in Fulham—is the Breast Cancer Haven. It offers a range of therapies to combat stress, and I have attended its sessions. It is wonderful to see people suffering from breast and other cancers being given hope that chemotherapy is not the end of the road and that there is something out there to support them.

Another wonderful organisation of which my hon. Friend should be aware, and which was at the cancer conference on Tuesday, is Penny Brohn UK, the living well with cancer organisation. It has worked hard to produce a report on the long-term impact of its living well course, and the results from the five-year follow-up show a high approval rating among patients. The figures are staggering: 97% of patients reported making positive lifestyle changes after the course; 75% said they had maintained the positive changes for four to five years or were still maintaining them; and 85% said the living well course had enabled them to self-manage their health more effectively.

My hon. Friend, being well aware of Government policy, will know that patient choice is, according to the Health Secretary in the last Parliament, at the heart of the health service. If we are to give patients choice, we have to give them the provision to choose from. I was a member of the Health Committee for the whole of the last Parliament—I chaired it for a while when Stephen Dorrell stood down, before my hon. Friend the Member for Totnes (Dr Wollaston) took over—as well as a member of the Science and Technology Committee, both of which looked at the complex problems of polypharmacy and polymorbidity, which is jargon for too many people taking too many drugs and nobody really knowing what those drugs do. We need to reduce that.

There is a crisis in this country with antimicrobial and antibiotic resistance—we are not getting new antibiotics into the pipeline—and part of the problem is that we are trying to create new drugs while also trying to reduce antibiotic use. There is a range of other therapies that can help patients stay away from antibiotics. I will not get called to order, Madam Deputy Speaker; I know that this is a cancer debate, but a lot of alternative therapies—I will get to the H word, homeopathy, in a minute—offer options at a time when mainstream medicine is running out of solutions.

I have always championed the cause of homeopathy in this House, and I want to relate that strictly to cancer this afternoon. Homeopaths do not claim to cure cancer, but my goodness they can assist people who have had cancer and who are in remission by helping them to adjust their moods and to deal with anxiety and sleeplessness. It is a great tragedy that a tiny number of people, whom I regard at best as foolish and at worst as wicked, are trying to erase the tiny sum of money—£500 million—spent on homeopathy in the health service. Without looking at the benefits, they argue that it is a waste of money.

We have seen the pressure on institutions at Liverpool and elsewhere. What could be more stupid than to attack a medical system that is widely used in France, that voters went for in Switzerland, and that is used across the world, including in India and Brazil? What is the problem here?

I was in Toulouse to look at British Aerospace work recently, and I found a homeopathic chemist right in the middle of the main square there. Some 90% of pregnant women in France use homeopathy. The Minister must not be bludgeoned by the tiny number of people who use legal threats and resist it. Simon Stevens is now coming up with new money for aftercare for cancer, so we need to look out of the box and consider new possibilities. We are not even looking at some possibilities that are orthodox.

As I said, I am an officer of the cancer group, and I chaired a meeting the other day to hear anxious and anguished professors of medicine from this country talking about a new mainstream treatment called Target for breast cancer. Target is about putting a small device the size of a tangerine on the end of a cricket stump into an incision in the chest. The chemotherapy treats the tumour and not all the other organs in the chest. The professors saw this as a great breakthrough. It was invented in Britain, and it is widely available in Europe. How come NICE has only given it draft clearance? What is going on? Professors of medicine are saying that this is hugely important, yet we are not actually dealing with it.

[Jo Churchill (Bury St Edmunds) (Con)]

On that particular point about targeted interoperable radiotherapy, I too have spoken to these professors, and I understand where they are in the clearance process. I find it a little bit concerning when there is a lack of money in the system. Is my hon. Friend aware that there are half a dozen machines around the country that could deliver that targeted therapy? Perhaps we need to look at what we should do first—whether it is purchasing the machines or giving the clearance in full.

[David Tredinnick]

My hon. Friend makes her point very well. In his excellent presentation, Simon Stevens talked about bringing new equipment onstream for radiography, I believe. [Interruption.] Yes, my hon. Friend was there, and she confirms this. I certainly agree with what she said, and we need to wake up to what is being invented in Britain and used across the world.

I shall conclude shortly, in case anyone else is hoping to catch your eye, Madam Deputy Speaker. I want to finish with a couple of other points. There are other treatments out there, to which people turn in desperation when they reach the end of their conventional treatments. One of them is called oxygen therapy, and broadly speaking it means getting more oxygen than is normally received, from a container. It is not a very expensive treatment, and the information I am getting is that it produces spectacular results when it comes to energising people and improving their sense of self-worth and wellbeing.

My final point is one that I find amazing. In the great cancer hospitals and clinics of this country, diet is seen as a sideline. In some of these institutions, the diet is, frankly, appalling, but I am not going to name of any of them this afternoon. Like most colleagues, I have a big enough postbag already and I do not want to hear the defence. Anyone attending a big clinic in America, such as the Mayo Clinic, can say goodbye to dairy and sugar, and hello to more juices. The Haven in Fulham certainly uses a lot of raw juices and raw vegetables. Diet is absolutely fundamental. When I worked in the computer industry, we used to say “Garbage in; garbage out”—and the same applies to humans. Our outputs as a being—[Interruption.] The hon. Member for Scunthorpe (Nic Dakin) does me the honour of laughing, but it is true. Diet is such a soft ball to hit, is it not? We are spending millions of pounds on all these expensive treatments, but what about telling people to cut back on sugar? Well, there we are.

I have tried to address some of the issues following the landmark speech at a landmark conference on Tuesday. For the first time, we have seen a lot of money set aside for developing aftercare for patients and improving services around mainstream medicine.

My hon. Friend the Minister has a great opportunity to make his mark in the House. His Department is, I believe, the fourth largest employer in the world. I think the Red Army comes top and McDonald’s second; I expect another burger provider comes third; and my hon. Friend is presiding over part of an organisation that comes fourth. His brief gives him enormous opportunities to improve the quality of life of cancer patients in this country, and by the time he has finished, there should not be just an increase in the cancer survival rate from 60% to70%—his target should be 80%.

Madam Deputy Speaker, I rest my case.

--- Later in debate ---

[Bob Blackman]

When the change in law came through, a number of people objected to it, saying that it would not be enforceable. I remember back to my childhood when both of my parents were smoking in the car in front of me. It was difficult then as a child to say, “Please, will you not smoke, because I do not like it?” It was just easier to open the window. I do not want children to go through that. It is right and important that we changed the law in that way, as we know that second-hand smoke is a key killer of young lungs. It was a significant development—and a development that people did not think would happen. People did not think that we could introduce this change and get it through both Chambers, but I am delighted to say that we did it and that it was the right thing to do.

[Jo Churchill]

I thank my hon. Friend for providing such a powerful case. I could not agree with him more. To my way of thinking, banning smoking would do me, but we probably cannot go that far. Does he agree that the broader point of health economics is also important? Lung cancer is not the only issue. There is also emphysema, pulmonary disease and so on. If we sort out the tobacco issue, we could make much broader savings across the health service.

[Bob Blackman]

There are aspects of that with which I agree. The reality is that tobacco is the only product in the world, which, if used in the way that was intended, will kill us. Therefore, controlling it is vital.

We know as well that those with complex medical needs have the highest smoking rates. I am talking about people who are unemployed, who have mental health conditions, and who are in prison. I am also talking about the people whom I am championing at the moment—the homeless. All of them are much more likely to smoke than others, and they are also more likely to have the most health problems as a direct result. It is quite clear that the most disadvantaged members of society are more likely to smoke and therefore suffer cancer and other health-related problems as a result. Clearly, we need to take action. Quitting smoking reduces the likelihood of having cancer. It is also key that lungs can recover if one gives up smoking. We must encourage people to give up smoking and, more importantly, to try to prevent young people from ever starting. The hon. Member for Strangford (Jim Shannon) told us what happened to him as a five-year-old. I would not advocate that as a shock treatment. None the less, it is quite clear that stopping people starting to smoke is the best way forward, rather than trying to get them to give up later in life.

The recent report “Smoking Still Kills”, which was endorsed by no fewer than 129 organisations, recommended that, as a target, we should reduce adult smoking to less than 13% by 2020 and to 5% by 2035. I take the point made by my hon. Friend the Member for Bury St Edmunds (Jo Churchill): that is not ambitious enough. We should be going for a smoke-free Britain, or, rather, a smoke-free United Kingdom. I must get my phraseology correct.

To achieve that target, we need mass media campaigns, which the Department of Health has ceased. We need stop-smoking services to be encouraged, promoted and funded across the UK, and local authorities should enforce the necessary activities and to do their job. We know that mass media campaigns are extremely effective and cost- effective in prompting people to stop smoking and in discouraging young people from starting. In 2009 we had funding of just under £25 million for anti-smoking campaigns, but by 2015—last year—that had been reduced to £5.3 million. That is a false economy.

If we had much better funding for mass media campaigns, I am sure we could reduce the incidence of smoking far more. Equally, we know that stop-smoking services across the UK have been highly effective in reducing smoking rates. Smokers are up to four times more likely to quit if they have support from specialist groups and smoking services, compared to quitting cold. The hon. Member for Poplar and Limehouse referred to when he gave up smoking, and he can remember the time and the date when he did so. Most people who have smoked in their adult lives have difficulty giving up and they need help and support. We should ensure that that is available.

The sad fact is that right across the UK smoking cessation services are either having their funding reduced or being closed altogether. That is extremely regrettable. I suggested to the Chancellor that by putting just 5p on a packet of 20 cigarettes and using that money to fund smoking cessation services we could provide all the money that is needed to continue smoking cessation services across the United Kingdom. That, to me, would be a very sensible investment indeed.

Funding for trading standards has fallen from £213 million in 2010 to £124 million now; the teams have been cut to the bone and the number of staff working in trading standards has been reduced radically. That means fewer local controls to target illicit tobacco in the way we should, to prevent some very nasty products from being used by people across the United Kingdom. That is a retrograde step. We need to invest in those services to make sure that we deliver better health outcomes.

We desperately need a new tobacco control plan and programme so that we can see the radical targets that are needed and the investment required across the United Kingdom. We should be setting out our stall—we want a smoke-free United Kingdom not by 2035 or beyond, but by 2020 or 2025. We can achieve it with the right programme. The key point is that if we deliver this plan, we will cut the rate of cancer deaths and the number of people suffering from cancer, which will reduce the burden on the national health service and allow us to take that money from the health service to use on the more difficult cancers that colleagues have mentioned. Those cancers are difficult to spot, difficult to treat and need specialist drugs and specialist treatments.

--- Later in debate ---

[Jo Churchill (Bury St Edmunds) (Con)]

I, too, thank the Backbench Business Committee for allowing this debate. I also thank the hon. Member for Scunthorpe (Nic Dakin) for the way he introduced it, which has allowed us to conduct it in the tone that we have.

I came to this place after a journey with this disease, but I have been amazed since I have been here. The hon. Member for Bristol West (Thangam Debbonaire) has fought the disease and now sits back in her place, and very welcome that is. The news about the hon. Member for Blyth Valley (Mr Campbell), too, is welcome. I have heard my hon. Friend the Member for Lichfield (Michael Fabricant) talk about his journey with the disease. My best wishes go to my hon. Friend the Member for Grantham and Stamford (Nick Boles), who is on the journey at the moment. It is unusual not to see my hon. Friend the Member for Basildon and Billericay (Mr Baron) in the Chamber, and my thoughts and prayers go out to him and his wife at this time.

Cancer is interesting: you don’t pick it, it picks you. We have heard from many Members that some cancers are preventable, but there are over 200 cancers. The debate often gets channelled towards rare diseases or prolific diseases such as breast cancer, prostate cancer or lung cancer—one of the big four. However, the debate we have had today is very broad, and I welcome that.

My hon. Friend the Member for Bosworth (David Tredinnick) said we are doing better, which we are, but we could do even better, and I would like to return to the issue of research, which was brought up by my hon. Friend the Member for Castle Point (Rebecca Harris), to see how we might do better there.

I welcome the commitment to the strategy. Implemented, it could be transformational, which is why I hope we will hear about better implementation. The “Five Year Forward View” shows that funding for cancer services will go up by 9%, reaching £13 billion by 2020-21.

As we have heard, one in two of us will suffer from cancer by the end of this Parliament, and 2.5 million people in this country are living with the disease. A question the strategy does not necessarily address properly is how we will care for those people. How will we deal with the survivors affected by it—625,000 people will be, as was mentioned earlier—who will carry forward some form of disability or hardship from having the disease? How will we deal with palliative care? Have the sustainability and transformation plans looked into palliative care and how we can address the needs of people who are looking towards the end of their lives?

I would also like to highlight teenage cancers, although it is usually breast cancer that I talk about in this place. I have a young friend for whom a year on means something different. She wrote to me on Sunday, after I said I was talking in this debate. I thought of her because, on 11 December last year, young Emily was diagnosed with cancer.

She said:

“Last year in December I was diagnosed with ALL Leukaemia. It was a very scary time for me and my family. But something that makes going to hospital that little bit nicer is how lovely the nurses are.

However, there were a lot of horrid bits during the start of treatment, such as hair loss and sickness.

Although, I still have two years to go of treatment to go on treatment, it is a lot less intense now I am in maintenance. The majority of chemo is in tablet form at home, one hospital visit a month and the HORRID, HORRID steroids, also once a month for five days!

I know that the steroids work as one of the main chemo therapy treatment - but they make me put on weight, feel emotional for no reason and sometimes cross and angry at my mum, who is my absolute rock and is always there for me, so that makes me feel very sad!

If I could change anything about the chemo it would definitely be; to not feel sick and not take steroids!”

Emily is a year on in her journey. I am sure I can speak for everybody in wishing her lots of success for a great journey.

One of the best things we can do for young people is to educate them. Education is a theme that has come out of this debate. I will not go over the comments by my hon. Friend the Member for Harrow East (Bob Blackman) and the hon. Member for Poplar and Limehouse (Jim Fitzpatrick) about smoking, which they discussed so well, but merely say that education in that regard is important. Nor will I go over education around food and nutrition, which, as we have heard, is worked on by the Penny Brohn institute and The Haven.

The hon. Member for Strangford (Jim Shannon) mentioned diet. Every oncologist I have ever had through all three of my journeys has spoken about the need to look after oneself through a good diet, keeping fit and exercise. We do our young people a disservice if we do not help them to lead better and healthier lives. I want to understand how the Minister is looking across Departments to make sure that this is addressed in the policies of the Department for Communities and Local Government and the Department for Transport through cycle paths, trim trails, and right across the piece so that we can all lead healthier lives.

I am pleased that the industry is responding by reducing adverts for children and so on, and I would like this to go further, but parents have a huge part to play in their children’s lives. We have a huge part to play in our own lives with regard to what we eat and how we make choices about whether we smoke or have that extra beer or extra pie. There is some self-responsibility involved. If the Minister will do his bit by helping to educate people a little more through public health information, I am sure that we will step up to the mark and do our bit as well.

I welcome the setting up of cancer alliances and the appointment of Cally Palmer, the excellent head of the cancer taskforce. Early diagnosis is fundamental, as the hon. Member for Scunthorpe pointed out, because it gives us better outcomes, but the Government must set out, with NHS England, how funding will be strategically allocated. For example, will we be able to use mobile diagnostics and molecular diagnostics? I note my interest as chair of the all-party parliamentary group on personalised medicine, and vice-chair of the cancer APPG and the breast cancer APPG. If we could see who would benefit from the use of drugs, we would stop waste. For example, only 20% of women with breast cancer would benefit from Herceptin. Will the Minister address the point about the use of innovative technologies raised by my hon. Friend the Member for Castle Point?

How can we utilise the workforce in a more strategic approach? Macmillan, Cancer Research UK and 20 other organisations have developed eight principles on this. We need a workforce that is fit for the future, with people who understand the changing landscape that we are dealing with. I welcome the £130 million put into radiotherapy machines, but I would like to know that we have the radiographers who can work those machines and optimise their use.

More of us survive living with and beyond cancer, but metastatic cancer, in particular, is a type that we need to learn more about. That brings me on to the use of data. The Teenage Cancer Trust would welcome clinical trials with young people. There is a lack of data on metastatic breast cancer.

[Rebecca Harris]

My mother-in-law passed away from secondary metastatic breast cancer after opportunities to diagnose her were missed. It has been brought to my attention that we do not keep very good records or data on metastasized breast cancer. The cancer pathway does not provide a specialist nurse for those with breast cancer, and we do not seem to provide a specialist nurse for those with metastasized breast cancer, either.

[Jo Churchill]

I agree with my hon. Friend. People who are diagnosed with metastatic cancers—not only of the breast, but across the piece—feel like they are dropping through the cracks. They do not necessarily get a clinical nurse specialist, so that is another area for the specialist workforce to address. We need to make sure that we catch people on the journey, because it may be iterative. People may feel fit and well, but then find that they have to use the services again, so our approach needs to be flexible.

My hon. Friend has mentioned the importance of the ecosystem of research, hospitals and patients. My hon. Friend the Member for Crawley works hard with the Bloodwise charity, which is truly emblematic of an empowering organisation that works with the patient, clinician and researcher to help drive understanding. That is one way of giving UK plc a huge advantage. The hon. Member for Strangford has said that we need to look at the ecosystem, which is not just about cancer treatment at the end, but about researchers, universities, those brilliant students and staff whom we welcome from Europe and everyone in the pharmaceutical industry and charities working collaboratively to get the best outcome possible. That is how we will start to rise up the table and be as good as Sweden and other countries whose patients have truly fantastic outcomes.

Timely interventions can help recovery. I want to understand how recovery packages are being rolled out, because the issue of the workforce is critical.

The hon. Member for Bosworth (David Tredinnick) has mentioned alternative therapies, which can be useful, but this is a space in which charities can help people. Only this week, the Countryside Alliance Foundation took women who have received treatment fly-fishing. They find that the experience of being outside, doing something physical and enjoying nature gives them a huge sense of wellbeing. Personally, I do not think that it is a question of either/or; it is a question of joining them together.

Finally, I know that this is not the Minister’s area, but I would like him to take it back with him. I welcome the cancer drugs fund, but I am worried about those who benefit from combined treatments. Melanoma Focus has said that people on combined treatments may be disadvantaged, because not all of them will have access to the cancer drugs fund. I hope that the fund will be flexible and that the matter will be addressed.

National Health Service Funding

Jo Churchill Excerpts

Tuesday 22nd November 2016 Commons Chamber

[Jo Churchill (Bury St Edmunds) (Con)]

I want to start by saying a huge thank you to everybody in our hospitals, our GP surgeries and our care homes. Listening to the debate, one might be under the impression that brilliant things are not going on, but nine out of 10 people in A&E benefit from being seen within four-hours. This discussion therefore needs to be balanced. I have heard that there are problems up and down the country, but the West Suffolk hospital in my constituency has just been rated as outstanding not for its buildings or anything peripheral, but for its care. That is the most important thing we can ask anyone to give.

The hon. Member for Tooting (Dr Allin-Khan) said that things were better under Labour. I was diagnosed with my second and third cancers when Labour was in government. The radiotherapy machines were under a sheet and not working because of a lack of staff. This problem has been coming down the track for ages. We do not do anybody a service if we deny that it is a problem and that it is looming.

GPs in Suffolk are under pressure. I talk to them regularly. I engage with social care, which is struggling. It is about the service, as my hon. Friend the Member for Calder Valley (Craig Whittaker) said, but we should remember that every patient is a person—a daughter, a mum, a dad. For the five year forward view, we listened and we came to the table with the money. Demand has outstripped us, and we need to look at streamlining services. Having one pot of money will help us to understand the blockages in the system to which so many people, including my hon. Friend the Member for Henley (John Howell), alluded. We can then look to unblock the system. It is ridiculous to have people on delayed discharge because we cannot get them into the community, and then for GPs to send to A&E people who cannot get into the hospital to be treated. We all know the problem; let us look at the solutions.

Prevention is also an issue. The motion today is about far more than cash. The year 1948 is a long time ago and the system has always been a mix of private and public. It is stronger today, but there are 1.4 million in its workforce.

I said thank you earlier. I would especially like to thank junior doctors, many of whom speak to me on a regular basis. They tell me that just a little thank you from people for the hard work they do would make a difference in their daily lives, so I ask for that. Some 92% of the pot of money goes to the acute sector. Our GPs, who we are expecting to do more, receive 8%. Working together would help us to look at what funds are needed for social care.

Moving people through the system is tricky. With an ageing population and comorbidity, 70% of the health budget is spent on long-term conditions. Some 22.4 million people visited A&E last year—up 600,000. I applaud the doctors who are beginning to say, “Do you know what? You can do the odd thing at home. You don’t always have to come and see us.” We need to be more responsible for our own health.

It is important that we look at new ideas. My hon. Friend the Member for South West Wiltshire (Dr Murrison) mentioned in The Telegraph the other day that we should perhaps look at the triple lock. Today, Stephen Dalton, interim chief executive of the NHS, talked about using the private sector more slickly. The provision of care relief for patients could be moved around so that home services are sorted. We need to consider community diagnostics. We need to be able to talk about these new ideas. Let us think about the future.

A young medic told me on Friday how much a 10-hour operation involving nine professionals cost. People need to understand what things cost. A young clinician said to me only yesterday that when somebody does not attend they should be asked to pay. They are sent a text, and there has to be more responsibility.

In this country, where a diabetes crisis is looming, 66% of people are obese; one third drink too much; and 20% smoke too much. We have to decide what we want out of this overburdened system and what we want to put in. As the hon. Member for Strangford (Jim Shannon) mentioned, the NHS spends around £85 million on paracetamol, yet it can be bought for just 16p. Should we be investing money in different places? If we treasure the NHS, we should treasure ourselves and its resources. The rise in cancer diagnoses is linked to obesity. Some £3.5 billion is spent on treating alcohol-related illnesses. The system is in crisis, but we have ways of addressing it. I do not want this to be a blame game. We have recruited more doctors and nurses, but now we need to step up, talk about the problems and develop a streamlined system.