Hospital Parking Charges (Exemption for Carers) Bill

Julian Knight Excerpts

Friday 30th October 2015 Commons Chamber

[Julie Cooper]

I am grateful to my hon. Friend for making that important point.

We all need to understand that carer’s allowance is not dished out willy-nilly. To qualify, a person has to devote at least 35 hours a week to caring for a person with substantial care needs, and many carers provide far more hours than that. To fulfil their caring role, they often have no option but to work reduced hours, and some are forced to give up work altogether. They often face a steep drop in income if they have to leave work or reduce their hours in order to care, and there is sometimes a double loss of salary if they are caring for a partner who also has to give up work as a result of their illness or disability. Some 2.3 million people have given up work to care, and that loss of income is often coupled with a steep rise in expenditure as a result of the additional costs of caring and disability, including travel and parking costs as they support the person they care for to attend medical appointments or continue to provide care during stays in hospital.

One carer, Jackie, shared her story with me. She cares full time for her husband David, who has secondary progressive multiple sclerosis and hairy cell leukaemia. She said:

“As David’s wife and sole carer, I was at the hospital every day from 9.30 am until 7 pm. We live 22 miles from the hospital and rely on benefits as our sole income—so the expense of travelling to and from hospital every day and paying the parking charges was huge. We exhausted the little savings we had. Weekly parking tickets were available and cheaper than daily charges, but I never knew how long my husband would be in hospital for. The last thing I needed was to be worrying about car parking charges when I was anxious about whether my husband was going to make it or not. Carers are at such a disadvantage already, car parking charges are one extra penalty they do not need.”

For carers, fulfilling their caring role often involves parking at hospitals for hours on end day after day, week after week. Hospital parking charges place an unfair financial burden on those caring for disabled, seriously ill or older friends or family members. NHS hospital trusts and foundation trusts are responsible for setting their own charging policies and are not currently required under law to provide any exemptions. Some hospitals in England already provide free car parking, and others offer some concessions, although these are few and far between and invariably poorly advertised.

[Julian Knight (Solihull) (Con)]

I congratulate the hon. Lady on bringing forward this interesting Bill. She has just said that some hospitals in England do not charge for parking; surely that shows that there is discretion in the system.

[Julie Cooper]

The fact is that the current system is very hit and miss. Some hospitals provide small concessions, but that is not widespread.

There are no specific exemptions for carers, and hospital car parking charges are particularly onerous for carers who spend long hours on hospital visits on a regular basis. Research by Carers UK found that 48% of carers are struggling to make ends meet, and 45% said that financial worries were affecting their health. The average cost of parking in England is £39 per week, and in London that rises to £130. For those on low or no incomes—as is the case with many carers—charges at any level are a burden they could do without. Dozens of carers have shared their experiences with me over the past few months, and many have said that their entire carer’s allowance is taken up with the cost of hospital car parking and petrol. Many have been forced to get into debt to meet their day-to-day living costs.

I am grateful for the support of Members from across the House, and I know that the Minister shares many of my concerns. In response to some of the issues I have raised, he intends to publish revised guidelines to hospital trusts on parking charges that

“will explicitly include carers in the groups who are eligible for concessions.”

That is new and I welcome it, but it does not go far enough because most hospitals choose to ignore the guidelines. In the past 12 months, more than 100 hospital trusts have increased their car parking charges—recently, the Medway Maritime hospital increased its charges by a staggering 60%—and the trend is not to support the vulnerable. Indeed, Mid Yorkshire Hospitals NHS Trust has gone a step further and introduced charges for disabled parking. The direction of travel is wrong, and more action is needed if we are to effect real change.

It is also important to consider the emotional pressure facing carers, because when someone who has spent hours at the bedside of a person they care about comes out of a hospital, the last thing they want to do is join a queue to pay for parking. They should not need to worry whether the machine is working or whether they have the right change. They are often distressed, and invariably in a hurry. Often they are on their way to pick up clean clothes and supplies, and they are already planning their return journey, which in many cases is on the same day. Some hospitals require payment on entry, which brings its own pressures. Carers who are on limited budgets need to estimate how long each hospital visit will last, and they often have to leave the ward or treatment room to run out and replenish the ever-hungry parking metre.

In the last few months I have encountered many apparently rational arguments against my proposal, and I shall consider them each in turn. The British Parking Association argues that the removal of charges elsewhere has been unhelpful, and that abuses of that have led to a shortage of parking at medical sites. That is easy to deal with, because my proposal does not ask for free car parking for all, but focuses on a specific group of hospital users, each of whom would display a carer’s charge exemption badge in their car, ensuring that only those genuinely entitled would benefit.

Other critics have pointed out that in many areas carers are able to make use of hospital shuttle buses, which are often provided free of charge. They have said that travelling to hospital in a car is in itself a luxury, but they clearly do not understand the issues. Often, carers cannot access services for a variety of reasons, such as other commitments or dependants, which means that they need their own transport. Sometimes hospital transport requires multiple bus changes, and rural communities often have no bus service at all. Sometimes a patient’s condition means that any form of transport is unsuitable. I have spoken to people who are suffering from cancer and who rely on their carer for transport and for support through the regular chemotherapy and radiotherapy sessions. These patients often have impaired immunity, so exposing them to infection on public transport is surely not an option for them.

The main criticism of the proposals in the Bill relate to the perceived loss of income to the NHS. I would make the following points. It is estimated that the contribution made by carers saves the NHS more than £100 billion each year by virtue of the time they spend supporting people in hospital. Sick children, people suffering with mental illness or Alzheimer’s disease, or those with physical and mental disabilities have special needs. They need special care when they are at home and those special needs do not go away when they are admitted to hospital. In fact, they often need more help to cope in an unfamiliar environment.

If carers and parents did not visit and support each day, hospitals would not be able to cope. I spoke to one lady who gave up work three years ago to look after her husband who had developed Alzheimer’s. Her husband had a fall, broke his hip and was admitted to hospital. For three years she had been feeding, dressing and calming her husband, and she continues to perform this role in hospital. The nursing staff already have enough to do attending to the medical needs of all the patients on the ward. They simply do not have the time to provide such intensive caring. Similarly with stroke patients, I have met many carers who go the hospital each day and sit patiently feeding their loved one, leaving nurses free to perform their duties as qualified medical practitioners. Many families are struggling in poverty because their child has an ongoing medical condition. A parent or carer’s presence at the hospital often provides many hours of valuable support that would otherwise have to be provided by the nursing staff—at what cost?

During the preparation for the Bill, I have met parents who have more than one child with multiple health needs, both of whom are constantly in and out of hospital, necessitating multiple journeys to and from hospital. This means little, if any, time for the parents to go to work as they are performing a big support role on the ward, but suffering significant financial hardship. And we want to charge them to park! Torbay and South Devon NHS Foundation Trust proves the point. It has successfully implemented a free parking scheme for carers. It acknowledges that the financial impact has been minimal by comparison with the benefits received. For example, nurses at the hospital report that the scheme means they have more free time, as carers are able to spend longer visiting their loved ones. Carers who use the scheme say they feel valued, that the scheme saves them money and that it removes one of the many stresses in having to visit hospital.

In addition, there is evidence that patients make a faster recovery when they have the continuous support of a known and trusted carer, and are often discharged from hospital earlier, with obvious financial savings to the NHS. Hospital car park charges are a financial punishment for carers for looking after a friend or family member. Without carers, many people would never be able to access the healthcare they need to help them to manage their illness or disability. Carers have so much to cope with, why do we give them one more financial burden?

As a former member of Lancashire’s health and wellbeing board, I know that one of the ways that the Government seek to make savings in the NHS is by reducing the number of hospital stays. Where carers are willing and able to provide ongoing care at home, many patients can now be discharged at an earlier stage than in the past, thus freeing up much needed beds. They go on to return routinely as out-patients, with transportation invariably provided by their carer. The saving to the hospital in those instances is far more than is ever collected in car parking charges. Carers enable people to continue to live in their own home, saving the expense of care homes.

The Minister rightly recognises that if we want to keep people out of hospital we must improve out-of-hospital care. He has also acknowledged that

“Carers do a magnificent job”

and that

“they do not always get the thanks or support that they need.”

I am singling out carers for special attention because they are vulnerable and going through a difficult time, and because they matter and they need our support.

I ask hon. Members to support the Bill to provide free car parking at hospitals for qualifying carers and in the future to consider supporting eligible carers. It will not solve all their problems by any means, but it will help, and just as importantly, it will send a signal to carers around the country that we value their contribution. The Bill would support carers and send a message that Britain cares about carers. Carers are crucial to the future of Britain’s health and wellbeing. Surely the least we can do is allow them to park for free.

--- Later in debate ---

[Philip Davies]

We are already slightly all over the place with this Bill, and now the hon. Lady has drawn attention—probably not intentionally—to what a dog’s dinner it is. We are already arguing about how many carers there actually are, but in fact the Bill will apply to only a few of them, and the hon. Lady has just suggested that the vast majority will not even benefit from it. The hon. Member for Burnley has said in the past—and I may say more about this later—that the Bill is just a starting point, and that she intends to extend it further and further, so we have no idea where we may end up.

[Julian Knight]

The Bill does not apply only to those who receive carer’s allowance. It also applies to those with an underlying entitlement to carer’s allowance, which brings a great many more people into the net.

[Philip Davies]

My hon. Friend has made a perfectly valid point. How the hospitals are likely to know who has an underlying claim to carer’s allowance is something that we may explore at greater length as the debate continues.

--- Later in debate ---

[Philip Davies]

If I might be able to make some progress, which I am always keen to do on these occasions, I will come later to the situation at Torbay, because it is very interesting and does not make the case for this Bill as the hon. Lady seems to think.

It has also been interesting to learn from these exchanges that whereas not that long ago during the passage of a different Bill the Labour party claimed it very much supported the principle of localism—that it was the champion of localism and devolution and it wanted to jump on that agenda—today, early on in this Parliament, when we actually have localism in action, where local hospitals can make decisions which they think are in the best interests of their local residents and local patients, the Labour party goes back to type and wants to centralise everything.

[Julian Knight]

My hon. Friend is making an important point about how this ties in with the devolution agenda. We are going headlong towards a combined authority in Greater Manchester, which will be in charge of the NHS in the area. Presumably that will mean that it will be in charge of hospital parking charges, and will be able to do many things, including giving discounts to carers, if it deems that necessary.

[Philip Davies]

My hon. Friend is right, and my understanding was that the Labour party in Manchester was in favour of devolution and it had agreed to the devolution package the Chancellor had proposed. I suspect it could not ever have got off the ground if the Labour party in Manchester had not been supportive of it. The whole purpose of devolution is to allow local decision making on things such as the NHS, and presumably as part of that car parking charges within the NHS, yet it seems that at the first step the Labour party wants to take the whole devolution agenda from under the feet of the locally elected people before it has even started.

--- Later in debate ---

[Philip Davies]

I would have more sympathy with the principle of the Bill if it wanted to make the Government’s guidance mandatory, because there would be some logic to that. Clearly, a whole range of people struggle, but just to pick out one group at random seems iniquitous.

[Julian Knight]

My hon. Friend is making an interesting case about other groups and how the Bill picks out carers individually. Many people do not travel to hospital by car but by public transport or by using subsidised bus services. The Bill does not cover them in their time of need, so will my hon. Friend reflect on the fact that the Bill is purely for car owners who are generally in the higher income groups?

[Philip Davies]

My hon. Friend makes a good point. The Bill applies only to car parking charges, and many carers cannot afford a car, let alone car parking charges. They travel faithfully on a probably more tortuous journey to hospital by public transport. If the Bill were to be passed, people who could afford a car would get their parking charges reimbursed but those who cannot afford a car and have to travel by public transport would not get their public transport costs reimbursed. Clearly, there is something not quite right about that. My hon. Friend makes a good point. While we are on that subject—I may come back to this as well—I should have thought that we were trying to deter people from using a car. Some people have to use a car, as he said, and nobody argues with that, but it would be perverse to give people an incentive to use a car rather than using public transport if they could. My hon. Friend has made a good point as to why the Bill would give people a perverse incentive to use a car rather than public transport.

--- Later in debate ---

[Philip Davies]

My hon. Friend makes a very good point. The hon. Member for Worsley and Eccles South made the point that people find it very stressful to have to pay after they have been to visit a relative in hospital, but as my hon. Friend rightly points out, it is probably even more stressful if they cannot find a car parking space at all. We need to bear that in mind.

[Julian Knight]

In my constituency, one of the reasons hospital parking charges were introduced in the first place was that the car park of the hospital, which is very close to the town centre, was being used at weekends by shoppers leaving their cars, and so patients, carers and those with urgent medical needs were unable to get into it. Will my hon. Friend reflect on that point?

[Philip Davies]

I was about to come on to that point, and my hon. Friend makes it very well. One of the essential reasons for hospitals charging is that, particularly near town centres, people use the free parking and then go and spend all day at work. That does not help any carer who is trying to find a parking space. That is why it is so important that hospitals have to be able to use charges in a way that suits their particular local circumstances to ensure that visitor and staff parking is always available when it is needed. Without their being able to make some restrictions on a local basis, there will be nothing to prevent people from using the site as a free car parking area.

I have no idea—perhaps the hon. Member for Burnley could tell me—whether parking would be free for carers only when they are coming to the hospital as a carer or free for them all the time because they are a carer. That is not clear in the Bill. I am looking for assistance from some of my more learned colleagues, but it appears that nobody knows the answer to that question, including the promoter of the Bill, so I will leave it there as something that does not seem to have been thought through.

This issue applies not only to hospitals close to town centres, as mentioned by my hon. Friend the Member for Solihull (Julian Knight), but to those that are close to railway stations, where there is also a large demand for parking. My hon. Friend the Member for Christchurch (Mr Chope) mentioned Scotland earlier. This issue has arisen at hospitals in Wales and Scotland since they scrapped car parking charges. The NHS Confederation said:

“The NHS Confederation represents 99 per cent of NHS trusts in England. On behalf of our members we support the right for NHS trusts to determine their own car parking and transport arrangements within current regulations and good practice”.

That is what is under threat today. A response from the House of Commons Library states:

“There is nothing specifically stopping hospitals from giving concessions or free parking to carers or other groups—although all public bodies need to operate within the framework of the Equalities Act—i.e. avoid discrimination against protected groups. Decisions on hospital car parking charges are a matter for the NHS body running the car park.”

Hospitals clearly have the flexibility to offer a free parking policy for carers—as the hon. Member for Burnley said, some have already done so—but it is not right that we as a House should force them to do so. Hospitals that do not already have a free car parking policy for carers have clearly assessed the situation and chosen not to, for whatever reasons. There may well be good reasons that we are better not second guessing. If she feels so strongly about this issue, perhaps her time would be better spent lobbying her own hospital trust in Burnley to persuade it of the argument for giving carers free parking, as opposed to coming along here and trying to impose it everywhere else when she has not even persuaded her own hospital in Burnley to do it.

Hospital parking charges are a key part of income generation. Hospitals may choose not to give free parking because car parking on healthcare sites is an income- generation scheme under the income-generation powers that enable NHS bodies to raise additional income for their health services. NHS bodies are allowed to charge for car parking, and to raise revenue from it as an income-generating activity, as long as certain rules are followed. Income-generation activities must not interfere to a significant degree with the provision of NHS core services. It is also crucial to note that these income- generation schemes must be profitable, because it would be unacceptable for moneys provided for the benefit of NHS patients to be used to support other commercial activities. It has to be the other way round; the commercial activity has to support the core NHS services. The profit made by income-generation schemes has to be used to improve health services. That is absolutely crucial. The money has to go towards that particular purpose.

The Department of Health’s “National Health Service Income Generation—Best Practice: Revised Guidance on Income Generation in the NHS”, which was published in February 2006, clearly sets out that income generation must be profitable. Paragraph 30.10 states:

“For a scheme to be classed as an Income Generation scheme, the following conditions need to be met: the scheme must be profitable and provide a level of income that exceeds total costs.”

It then goes on at great length, but that is the key part, so I will not bore everybody by reading the whole paragraph. The document goes on to say that

“the profit made from the scheme, which the NHS body would keep, must be used for improving the health services”,

and

“the goods or services must be marketed outside the NHS. Those being provided for statutory or public policy reasons are not income generation.”

Therefore, if exemptions are made for other people, that must be taken into consideration when calculating the estimated annual revenue and whether it will make a profit or a loss.

I fear that if the hon. Lady’s Bill is successful, the consequence will be not just exemptions for carers—worthy sentiment though that may be—but, I suspect, higher car parking charges for everybody else who visits the hospital so that it can protect its revenue stream. The hon. Lady did not mention that and she has not been open about it, but the chances are that that will be the consequence of the Bill. Everyone else will have to pay more in order to meet the NHS’s criteria for income generation. That means that all of the people the Government think should get a concession from car parking charges, including people with disabilities and those who visit hospital regularly, will not be exempt, but will have to pay more as a consequence of this Bill. Does the hon. Lady really want to tell all disabled patients who go to hospital that, in order to pay for her Bill, they are going to have to pay more to park at their local hospital? If that is the message she wants to send, I think she is rather brave. I would not want to tell my disabled constituents that they are going to have to pay more. It seems to me that that would be an inevitable consequence of the Bill. That is why we cannot pass legislation based on a worthy sentiment; we have to think through the consequences. [Interruption.] If the hon. Member for Birmingham, Perry Barr (Mr Mahmood) wants to intervene, I would be very happy to give way to him.

[Philip Davies]

The hon. Gentleman was chuntering—I misinterpreted him. I thought he had something worth while to say, but clearly not.

Given the guidelines, I would be interested to know what information the hon. Member for Burnley has obtained to determine an impact assessment for the scheme in question to be rolled out nationally. Indeed, during my research on the Bill, the House of Commons Library—which, as ever, I praise for its fantastic work—confirmed to me that

“no central data is collected on NHS hospital car parking charges or concessions”.

It therefore seems to me that the hon. Lady could not possibly have done an impact assessment, because no assessment has been made of the current impact.

Where is the money made from car parking charges spent? Obviously, the provision of car parking incurs overheads, including for the running of it and for maintenance costs. If no charges were imposed, the maintenance costs would have to be sourced from elsewhere, at the risk of diverting funds from patient services. There is also the cost of monitoring the car park, to make sure it is being used for its intended purpose. That money has to be recouped, and it is recouped through car parking charges.

[Julian Knight]

The contracts for hospital parking maintenance costs in my constituency are signed by the Heart of England NHS Foundation Trust, and some of those costs, such as those for drawing lines and for preparing machines and barriers, are very high indeed. If this Bill comes to pass, would that not mean that that money would potentially have to come directly from healthcare budgets, because no profit would be being made?

[Philip Davies]

My hon. Friend is right. There is a considerable cost involved in maintaining car parks, including setting them up in the first place and drawing the lines. The Bill would have a number of potential consequences. The maintenance money would have to come from patient care and there would be less provision for car parking spaces. Maintenance would not be carried out and the spaces would not be monitored, so there would be no point in carers being exempt. Everyone may as well be exempt, because no one would be checking whether they had paid to park their car. There would be a number of potential consequences, all of which would be adverse.

Given that foundation trusts are independent bodies, they are not covered by the Department of Health guidance on income generation. Their non-NHS income is governed by a board of governors who are drawn from NHS patients, the public, staff and stakeholders. Non-NHS income streams need to demonstrate concretely how new revenue from sources outside the NHS will support the principle purpose of a foundation trust, which is to provide goods and services for the NHS.

The hon. Member for Great Grimsby (Melanie Onn) has not stayed to hear me talk about my local NHS trusts, despite encouraging me to do so. Back in August, one of my local NHS trusts, Bradford Teaching Hospitals NHS Foundation Trust, said:

“We are determined to keep car parking charges as low as possible, this is the first time in 11 years that rising costs and growing pressure to create extra parking has forced us to increase them.

Our car parks are self-funding, ensuring we do not have to divert money away from frontline services and patient care. Demand for 24 hour parking is low and it is normally used under exceptional circumstances. We will review 24 hour parking if it becomes problematic for our visitors. Reduced parking rates will continue for people frequently attending outpatient clinics and those visiting relatives who are gravely ill or having an extended stay in hospital. Parking for people with disabilities will remain free of charge”.

That strikes me as a perfectly reasonable policy.

The whole point of the governance of foundation trusts is that it is not some NHS baron who decides these things. Foundation trust governors are drawn from NHS patients, the public, staff and local stakeholders. They are the best people to determine their local hospital’s car parking policy. Members of Parliament and Ministers should not dictate to them what is best for them. That is why I am very happy with what my local NHS trusts are doing. I am sure they would like to go further if they could, but there is always a balance to be struck.

During my discussions about this Bill with my local hospital—I did contact my local hospital—it said:

“It must be acknowledged that there is a cost of operating and maintaining the Foundation Trust’s car parks. If car parking income is reduced because of the introduction of the new legislation then the balance would have to be met from elsewhere. Ultimately, this could mean higher charges for other car park users or funding diverted from budgets that could potentially impact on patient services.”

That is a very serious concern. A one-size-fits-all central policy is simply not appropriate for regulating hospital car parking charges and it could have those severe unintended consequences.

I congratulate the hon. Member for Burnley on being a clear champion for the NHS and I praise and support her for it. Time and again she is quoted as being extremely worried about staffing and patient care in the NHS, particularly in her local area, but it is ironic that her Bill could have serious implications for staffing and patient care in local hospitals.

How would the Bill be enforced? That is one of the key practicalities involved. One of the main concerns of many local trusts will be how on earth it will be implemented. I must say that the hon. Lady was quite light on that.

The nearest comparison to a group of individuals being given free parking is the free parking scheme for people with disabilities. The scheme is monitored by ensuring that people using a disabled parking space have a blue badge. That in itself is not as easy as it might seem. I speak as somebody who, in my many years working for Asda, was responsible for our facilities for disabled customers. I also had to ensure we had a system to protect the parking bays for use only by disabled customers. That is one of the biggest problems. I suspect that if hon. Members ask car parks what their biggest problem is, they would all say that it is trying to protect the spaces for disabled blue badge holders to make sure that they can use them when they need them and that the spaces are not abused by other people who want to get nearest to the entrance or whatever. I know that from my own experience.

That scheme uses the blue badge, but it is not all that easy. People go on holiday, break their leg, get themselves crutches and then they are—albeit temporarily—disabled, but do retailers have to tell them, “Actually, you’re not disabled, even though you’re on crutches”? Some discretion must be allowed, otherwise the whole thing becomes a farce and the staff who have to monitor the scheme can be put in very difficult situations, including dealing with conflict. We should always bear in mind that, ultimately, somebody has to enforce such policies. If policies are not very clear, or always have exemptions and shades of grey, somebody somewhere will be in the line of fire. They have to implement the policy, and we must make it as clear and as fair as possible for them, and allow them sufficient discretion. We need discretion in any car parking policy or any policy that involves dealing with customers.

I do not know what the hon. Member for Burnley envisages. Does she expect all carers entitled to free car parking to be issued with a badge for a similar purpose? If so, I am not entirely sure what the cost would be of developing, creating and distributing the new badge, or how everyone to be issued with a badge would be identified. Perhaps she does not envisage having such a system. Perhaps she thinks that car parks could be fitted with automatic number plate recognition technology to ensure that when a car goes into the car park, the number plate is recognised and no charge is therefore allocated. That can of course be successful. We tried such a scheme at Asda to protect disabled parking bays. The problem is that it is extremely expensive to introduce. Another problem is that when a carer goes into a car park for the first time and has not registered, they get clobbered like everybody else. They have be go to the hospital to register, so although it is all right for subsequent visits, they fall foul of the rules on their first visit.

[Julian Knight]

I have discussed with my local hospital trust aspects of free parking and what we can do to help people. One point mentioned to me is that such a scheme might take people off front-line care services, or at least off front-line administration services, when they are asked to step in and help with the parking or to administer a parking scheme such as the one proposed in the Bill.

[Philip Davies]

My hon. Friend is right. There will, as an inevitable consequence of the Bill, be issues about preserving the integrity of the spaces.

I am not sure, but perhaps the hon. Member for Burnley intends to ask hospitals to provide designated spaces for carers to use, in the same way that there are designated spaces in car parks for people with disabilities or for parents with toddlers. If so, how many spaces should the hospital provide? There are rules and guidance on how many spaces there should be for disabled customers. From my memory of working at Asda, I think the rule is that 4% of all the spaces in a car park plus four should be set aside for disabled customers. That was certainly the situation when I was at Asda. Does she envisage a similar system—a number of designated spaces for carers, but when they are full they are full?

Does the hon. Lady expect someone to police the car park at all times to ensure that carers use the right spaces and that no one is charged unfairly? I do not know what system she wants. Perhaps she envisages a system of reimbursement, with carers paying for parking normally, just like everybody else, and then going into the hospital to demonstrate that they are a carer and have their costs reimbursed. That may require 24-hour-a-day, constantly manned reimbursement desks to be open at the hospital. Does she envisage that?

--- Later in debate ---

[Philip Davies]

Whether it is or not, Mr Deputy Speaker, I will move on.

I asked my local hospital how many carers already use its car parking spaces, which very much is our concern today. It replied:

“The Foundation Trust is currently unable to determine how many carers use the designated hospital car parks. It would therefore be difficult to assess the potential impact on car parking revenue”.

That goes some way towards answering the question my hon. Friend the Member for Christchurch asked. The honest answer is that we do not know what the impact will be on any particular hospital. My local hospital certainly does not know.

[Julian Knight]

My hon. Friend is making the important point that his foundation trust does not know how many carers park at the hospital. I have asked similar questions and have not received any answers. That shows that we do not know how much the Bill would cost the country if it were put in statute.

[Mr Deputy Speaker]

In fairness, we have had an hour of explaining that we do not know the cost. I am sure that we do not want to rerun that.

--- Later in debate ---

[Mr Nuttall]

There is always a danger with any scheme, as with the blue badge scheme, that some people will try to use it for their own ends. I hope it would be only a minority, but that danger exists. The assessors would need to be aware of that; they would need to be constantly on the lookout for people who were not genuine cases. That is what I think my hon. Friend is getting at—that some people might “try it on” to their own advantage.

Given that there are no explanatory notes and no impact assessment for the Bill, it is worth considering what has been done in the past. Fortunately, under the last Labour Government, an impact assessment was done—the NHS car parking impact assessment, which was published in December 2009. It estimated that there were 46 million in-patient visitors a day. We do not know how many of them are carers, but as we shall see, car parking charges vary significantly around the country. Regardless of the precise number, it is inevitable that one consequence of the Bill would be to divert part of the healthcare budget that could otherwise be used for front-line national health services—potentially life-saving services—to cover car parking maintenance and all the associated costs ranging from maintenance to administration and dispute management.

The Bill places Members here in the unenviable position of being asked to single out one particular group of people as being more deserving of financial assistance than any other. Without an exact number of those eligible for exemption, it is difficult to know how much money we are talking about in each area that the Bill would take out of the healthcare budget.

At the Bill’s heart is the principle of whether it is right to charge for parking at a hospital or other healthcare facility and, if so, which if any group should be exempt from those charges. I appreciate that some of the public—perhaps virtually all the public—take the view that charging to park a car at a hospital is simply an attempt to make a profit for greedy hospitals or, worse still, for nefarious parking companies. If that were the case, I suspect there would be universal condemnation of such a practice, but of course it is not the case.

Hospital car parking charges in our national health service are what are called “an income-generation scheme”. They are not just an extra-revenue scheme for hospital managers to provide comfier chairs or profit for private parking company executives to fund their jollies to the Seychelles. In 2006, the Department of Health issued guidance called “Income Generation: car parking charges —best practice for implementation”, which was subsequently revised in the same year. This guidance clearly states that to qualify as an income-generation scheme, the scheme

“must be profitable and provide a level of income that exceeds total costs. If the scheme ran at a loss it would mean that commercial activities were being subsidised from NHS funds, thereby diverting funds away from NHS patient care. However, each case will need to be assessed individually. For example, if a scheme is making a substantial loss then it should be stopped immediately.”

If a scheme such as car parking charges at an NHS hospital ran at a loss, it would not be acceptable. The Department of Health’s guidance goes on to state that

“the profit made from the scheme, which the NHS body would keep, must be used for improving the health services”.

The current guidance therefore prevents public money that should be used for patient care from being used to subsidise a loss-making scheme.

Clearly, if the Bill became law, it would inevitably affect the amount of income that a scheme would generate, meaning either that there would be knock-on effects for other users of the car park who are paying for it or that the health authority would be faced with the question of whether to start to subsidise it. It cannot do so because of the guidance, thus raising the question of whether the guidance would need to be revised in the regulations anticipated in the Bill. It is a principle that the Bill could reverse or it could open a door to making such a change.

[Julian Knight]

My hon. Friend is providing a forensic discussion of the Bill and all its parts. Does he agree that we could end up with hospital trusts seeing staff members taken off the front line in order to administer these schemes, or even with administration staff, who would be better deployed in the hospital, being brought in to ensure that the right people get the free hospital parking?

[Mr Deputy Speaker (Mr Lindsay Hoyle)]

Order. I think we have heard this question before. Mr Davies was asked whether staff would be taken from the front line. We are going over ground that has already been covered. This is about a Bill, about car parking, and about the benefit of carers. What I do not want to do is become involved in speculation. We are not here to speculate about the future.

--- Later in debate ---

[Mr Nuttall]

I want to move on to the devolution of healthcare. It was only very briefly touched on earlier, but it is of particular significance to my constituency, because, as Members will be aware, it is proposed to devolve healthcare to Greater Manchester. From April next year, it will be the first English region to get full control of its health spending. The situation in this regard is not at all clear. The Bill states that it will apply to the whole of England, but if healthcare is devolved, will Greater Manchester be exempt on the same basis that Scotland and Wales are exempt? Healthcare spending has been devolved to those countries and they are then excluded from this Bill.

[Julian Knight]

It is very interesting that my hon. Friend mentions devolution in this context. Should there be devolution from next April in the Greater Manchester area and if this legislation were introduced soon afterwards, could the numbers that devolution has been predicated on no longer be correct? Could we have to go back to the drawing-board in terms of Manchester devolution and how the finances are worked out in respect of hospital parking charges?

[Mr Nuttall]

I will not go down that road, Mr Deputy Speaker, although my hon. Friend has made a good point. His area could well be affected by any future devolution.

--- Later in debate ---

[Liz McInnes]

I appreciate that, but it always comes as a surprise to the wider public to hear that staff have to pay to park at their own place of work. I am sure that there would be an uproar if such charges were introduced for our exclusive car park facilities in this place. I know that the staff’s objections to having to pay to park at their place of work have been ignored. We have been protesting about it for many, many years. However, I am not here to talk about staff; I just wanted to make people aware that that practice still goes on. I have always seen it as a tax on coming to work.

We are here to talk about carers. I want to use Pennine Acute as an example. Most recently, it has engaged a private parking company, the income of which comes solely from administering fines to people who have parked incorrectly or who have not paid the right amount of money. The business of this private parking company depends on people contravening parking regulations; it actually wants people to contravene parking regulations, because that is the only way that it gets any income.

When I worked at the hospital, I was a workplace rep for Unite the union. I dealt with a lot of staff who were very, very distressed about the letters they had received from this company, demanding a fine that had to be paid by a certain day, and if they did not pay it by that day, the fine would go up. They were given the opportunity to appeal. If the appeal was not successful, some people found that they had to pay an inflated fine because they had had the temerity to appeal.

With regard to my hon. Friend’s private Member’s Bill, my main concern is about carers. What would happen to them if they were to get one of those bills? At least members of staff, if they are in a trade union, can go to a rep and get some help to deal with the situation. I worry about private parking contractors, because they exist solely to make money out of people. Exempting carers from car parking charges would bring much needed clarity to the matter. It would stop these exploitative companies from making money out of them.

[Julian Knight]

Could the hon. Lady’s local hospital trust not write such a policy into its contract? It would then have discretion over the fines. It would not need to fine carers in a particular situation. That would give them some flexibility, whereas in this scenario, there is no flexibility at all.

[Liz McInnes]

I thank the hon. Gentleman for his intervention, but I am not clear what his point is. He said that the trust could put it into a contract that carers would not be charged—[Interruption.] He means in the contracts of the parking contractor.

[Julian Knight]

indicated assent.

[Liz McInnes]

That would bring us to the issue of how we identify carers, which we have already talked about at length. If we introduce this Bill, it would be clear that carers were exempt. They could approach the hospital trust with evidence that they are in receipt of carer’s allowance. Their registration number would be taken and a badge would be produced with that registration number on, so that there would be no possibility of people transferring permits. They would be valid for only one vehicle. It would take a lot of the stress and worry out of parking at hospital for carers. There has been a lot of talk about how difficult it would be to administer the schemes, but actually it would be fairly simple.

Much is wrong with hospital car parking charges. I applaud the Scottish and Welsh health services for removing the charges. The imposition of car parking charges in England means that staff and others are being treated as a cash cow. While the rate that those charges are put up every single year is way above inflation, hospital staff are suffering from either a pay freeze, or a 1% below-inflation pay rise, which they get only if the Secretary of State deigns to bestow it on them. We really need to look at the whole situation with car parking charges in English hospitals, but at the moment we are considering parking for carers.

At Pennine Acute, there were informal arrangements, to which the hon. Member for Bury North has already referred. Frequent visitors who were in the know could approach the ward manager or departmental manager to ask for help and an exemption from car parking charges if that was available. People need to know that these exemptions exist; that is the problem. This Bill would not cost the NHS a great deal of money, because those in the know are aware that they can ask for exemptions. This Bill is about clarity, so that the exemptions are available to everybody and nobody is kept in the dark about them. That is why we need this Bill.

I fully support the Bill. Points have been made about hospitals introducing car parking fees, but unless a hospital is near a major shopping centre or bang in the middle of a town centre, people will park at a hospital only to visit, attend as a patient or carer or work there, and people should not be penalised for doing any of those things.

I am grateful to my hon. Friend the Member for Burnley for introducing this Bill, and I hope that she is successful in removing charges for carers and bringing much needed clarity to what is a very confused situation. Legislation is long overdue. Hopefully, following the introduction of this Bill, we will look at charges for others—patients, visitors and staff. If it is good enough for Scotland and Wales, it is good enough for England. The policy would be very well received in Heywood and Middleton as well as across the country.

[Julian Knight (Solihull) (Con)]

I also congratulate the hon. Member for Burnley (Julie Cooper) on securing the debate and drawing up the Bill. It seems many hours since you spoke, but I remember that you spoke powerfully and are clearly a strong advocate for carers and for your local NHS. I also think that Government Members will be grateful for the fact that you also paid tribute to the actions of—

[Madam Deputy Speaker (Mrs Eleanor Laing)]

Order. I always let Members get away with this mistake once, and sometimes twice, but the hon. Gentleman has used the word “you” three times. “You” refers to the Chair, and the hon. Lady is the hon. Lady. I am having to say this every day and it is a long time since the general election, so people really ought to be able to take it on board by now. The hon. Gentleman is not the only person making this mistake, so he should not feel bad about it.

[Julian Knight]

Thank you, Madam Deputy Speaker. I will now address only the Chair using that particular word.

I congratulate the hon. Member for Burnley, but unfortunately I cannot support the Bill. However, like my hon. Friend the Member for Shipley (Philip Davies) and many other Members who have spoken, I support the fairer hospital parking that she is trying to achieve. I want to share my experience in Solihull as a campaigner for fairer hospital parking, as it has direct relevance to how we approach the issue as a country and to the Bill.

Many hon. Members have mentioned their hospitals and the experience they had when parking charges were introduced. For my constituents in Solihull, parking charges were introduced not only to bring extra revenue into the NHS and front-line services but to ensure that hospital car parks were free for the use for which they are intended. We have had many difficulties in Solihull because the hospital is located near the town centre and, as that is a popular area, people have used the car park all day while they have been shopping. Many people who needed to use the facility at the hospital were therefore unable to do so and might have parked illegally, receiving fines at a later date. Hospital parking charges, although very unpleasant, are in many cases necessary, particularly at sites close to town centres. As we live in a very densely populated country, there are not many hospitals that are so far from town centres that it would be an easy win not to have any charges whatsoever. The car parks might still be misused in the way that I have explained.

Over time, hospital parking charges have grown exponentially. At the moment, in the three hospitals that make up the Heart of England NHS Foundation Trust—Solihull, Good Hope and the Heartlands—charges can be up to £5.75, but for just one hour they can be £2.75. Again, people have to guess how long they will stay, which is unfortunate. I have looked at the contracts that our local hospitals have signed and in my view there is an excessive charge on the provider from the private companies involved. I am not happy with many aspects of these contracts.

[Mr Nuttall]

My hon. Friend says that he has looked at these contracts. Has he noticed how long they were for? I am rather concerned that if the Bill is introduced, it would affect the viability of those contracts.

[Julian Knight]

My hon. Friend makes a good point. There are often penalty charges which would mean unintended consequences if the Bill came into law and a real hit to the bottom line for our hospitals.

--- Later in debate ---

[Mr Nuttall]

Does my hon. Friend not fear that the Bill might make things worse for members of the group?

[Julian Knight]

My hon. Friend makes a good point. The wording of the Bill and the fact that it covers just one narrow group could mean that charges go up for other groups that are not covered by it. That is an unfortunate and unintended consequence.

I have helped to lead the way with the campaign in Solihull, but it has been about individual engagement with the hospital trust rather than introducing national legislation and a one-size-fits-all policy. As we have explored in our discussions, hospitals have a great deal of discretion in the charges they can put in place. The August 2014 NHS patient, visitor and staff parking principles are much broader than the Bill in allowing people from different groups to have free or reduced hospital parking. As I see it, individual engagement is the way to go.

In Solihull, we have had many achievements through discussion and through highlighting particular issues. For example, earlier in the debate we discussed advertising and websites and it was pointed out that many people did not know what monthly or weekly concessions there are. I have urged my local hospital trust to improve the provision of that information and they have put the concessions up front and centre on their website, so it is now easy to see that information.

[Mr Nuttall]

The hon. Member for Heywood and Middleton (Liz McInnes) made the point that not everybody has access to the internet, particularly many elderly people. Does my hon. Friend agree that we should perhaps consider ensuring that information about car parking charges is included in every letter sent out offering an appointment at a hospital?

[Julian Knight]

My hon. Friend makes a good point and I have urged my hospital trust to make the information available not only online, which always seems to be the catch-all approach of any organisation, but in the hospital, so that patients and visitors do not have to come into the hospital and take up the time of staff and administration staff to clarify something that could easily be set out in a leaflet, a letter or a small poster by a desk.

In Solihull, a reduction in the price of monthly tickets and concessions was the direct response to the lobbying done by me and local councillors. We have also seen a doubling of the free parking time at Solihull hospital from 15 minutes to 30 minutes. At the hospital it can often take up to 15 minutes just to find a space, so I urged the trust to increase this time, and the Heart of England NHS Foundation Trust kindly saw fit to double the time. These are small wins, but they are an example of what can be achieved through individual engagement, by putting our case and understanding that there is not an endless supply of money and that we have to be sensitive to the bottom line—the finances of the NHS—because if we are not careful, we may end up depriving the NHS of vital cash.

My own Heart of England NHS Foundation Trust has a deficit—this is in the public domain—of £29 million for the first five months of the financial year. So seriously is this viewed that the management of the University Hospitals Birmingham has been brought in to help close the black hole in the finances. I welcome that move, but it shows that this is no time to destabilise NHS finances or those of individual hospital trusts in our areas.

[Mr Peter Bone (Wellingborough) (Con)]

My hon. Friend has been generous in giving way. I have listened to the arguments and the one problem I have is this: should we be using car parking charges to fund the NHS? Should we not fund the NHS properly? I am slightly uncomfortable with that.

[Julian Knight]

I understand entirely where my hon. Friend is coming from and in an ideal world I would agree. I would like to see free hospital parking. However, I recognise that there are pressures on our car parks, and that car parking charges at a hospital have to reflect the car parking charges in the local area; otherwise we will have the problem that we encountered in Solihull prior to the introduction of charges, when people were parking at the hospital and then shopping. It is a fine balancing act and it should be dealt with by individual areas on a case-by-case basis.

[Mr Chope]

Does my hon. Friend not think it reasonable that the costs of hospital car parks should be met by the users of those car parks, rather than by eating into money that would otherwise be available for clinical care?

[Julian Knight]

My hon. Friend makes a good point. During my election campaign in the course of canvassing and door-knocking, we mentioned the hospital parking campaign and the response was mainly positive. Obviously, as soon as people are asked whether they want free hospital parking, they say, “Yes, absolutely”, but the other question was what this means for nurses and doctors and for the bottom line of our local hospital’s finances.

[Dr Huq]

Is not the point that the Bill does not propose a free-for-all for everyone, but free hospital parking just for those on carer’s allowance, which is a paltry £62 a week? These are not carers who come through an agency and indirectly through the local authority and who add to the mounting social care bill. These people keep the social care bill down. We pay them carer’s allowance, and if all their money goes on parking charges, they will be deterred from coming into hospital to do the job that they do.

[Julian Knight]

I agree that we must value carers. However, the Bill is very narrow in its focus, whereas a much greater number of people could be covered by the guidelines and the NHS patient, visitor and staff car parking principles. There are opportunities to engage in our localities with our local hospitals and local hospital trusts in order to encourage them to expand existing provision. There is the possibility of working on a case-by-case basis, rather than by means of a rather blunt instrument. I take the hon. Lady’s point, but we should look at hospital car parking charges in the round, not just as they affect carers. [Interruption.] The Bill is about carers. The subject matter, though, is a much greater variety of people who use hospital car parks, including many vulnerable people, as we know.

I suggest that other hon. Members follow what has been done by my right hon. Friend the Member for Harlow (Robert Halfon), the Minister without Portfolio, and my hon. Friend the Member for Wellingborough (Mr Bone) and engage with the local hospital trust, put pressure on the trust and get it to reduce the complexity of charges and to ensure that when it puts charges in place, they reflect the local area. For example, I made a case to my hospital trust that we have three hours’ free parking at council car parks in Solihull, so why do people have to pay £2.75 for just one hour at the local hospital? Why is that not in tune with the local economy and the local environment?

More widely, on the people who are not covered by the Bill, I have mentioned those who may be covered by the NHS patient, visitor and staff car parking principles, but what about people who do not have a car? What about carers who travel by public transport? I was involved in a campaign in Solihull to help save the No. 73 bus service, which was a lifeline to Heartlands hospital. If it had been cancelled, people in Shirley in the west of my constituency would have had to travel by three buses in order to attend hospital appointments. If there is any extra money, surely it would be better for it to be directed at them as they are more likely to be on a lower income and potentially in a more vulnerable position than those driving and using the car park.

In conclusion, I welcome the sentiments of the Bill and I applaud the hon. Member for Burnley for introducing it. We have had a vigorous debate. There is a patchwork of provision and it is up to us as individual Members of Parliament, as well as local councils and bodies such as chambers of commerce, to come together in order to try to get the best possible deal for our area. That, in some instances, may include many more people than are the subject of the Bill.

[Mr Nuttall]

My hon. Friend touches on a key point, which I mentioned briefly—that is, there are competing pressures in different parts of the country, depending on whether a Member represents a rural area or an inner-city area.

[Julian Knight]

My hon. Friend makes a valuable point. In his speech he also touched on devolution. In my area we have the West Midlands combined authority coming to the fore. Although it does not currently have responsibility for NHS provision, that may come down the track towards us, as in the case of Manchester, which takes charge of its NHS in April 2016. The concern is that although these devolution packages are very tightly costed, if we suddenly add an extra expense in the form of NHS provision and take away a valuable income stream, that may damage the devolution project and other services may end up being cut.

I support the intention of the Bill and the heartfelt efforts of the hon. Member for Burnley, but it does not take account of an approach that I prefer—local engagement and following the guidelines, which are much more wide ranging than those in the Bill.

Cardiac Screening: Young People

Julian Knight Excerpts

Tuesday 27th October 2015 Commons Chamber

[Mims Davies]

Absolutely, and I thank my right hon. Friend. There is always a good reason to go the pub and that sounds like an excellent one.

[Julian Knight (Solihull) (Con)]

My hon. Friend is being very generous in giving way as I know this is a short debate. I pay tribute to her for securing the debate and for the passion she is showing in putting her case across.

On defibrillators, will my hon. Friend join me in congratulating Solihull Lions in my constituency, which has just paid for 10 defibrillators in public places, and the cardiac nurses at Solihull hospital who, touched by the tragic case of young Miles Reid, 21, who dropped dead of a heart attack while playing football, paid for a defibrillator in Shirley Park? Will she join me in congratulating those groups and in understanding the importance of public defibrillators?

[Mims Davies]

I absolutely do. My hon. Friend makes a great point about communities coming together—sadly, always off the back of a tragedy. We could be on the front foot on this issue instead.

Secondary Breast Cancer

Julian Knight Excerpts

Wednesday 21st October 2015 Westminster Hall

[Craig Tracey]

I thank my hon. Friend for that intervention. I am coming on to that point now—well anticipated! As I said, it is surprising that we do not have accurate figures and it is therefore difficult to plan and commission effectively. That is acutely demonstrated in the lack of specialist nurses and poor access to palliative care, which both Breast Cancer Care and the secondary breast cancer taskforce first raised in 2008.

In 2010, Breast Cancer Care, along with other breast cancer charities and the APPG, met the Prime Minister to discuss the issue. He agreed that data collection was necessary and committed to achieving that. As a result, in the 2011 cancer strategy, “Improving Outcomes”, there was a commitment to collecting data for the first time. It stated:

“During 2011/12 we will pilot the collection of data on recurrence/metastasis on patients with breast cancer with the aim of undertaking full collection from April 2012.”

The pilot was run by the National Cancer Intelligence Network, the NCIN, in collaboration with Breast Cancer Care, and it involved 15 breast cancer units across England. The pilot report published in March 2012 identified 598 patients with recurrent or metastatic breast cancer. Of those, only 53% were recorded as having been referred to a clinical nurse specialist, palliative care nurse or specialist keyworker at the time of diagnosis. The pilot recommended that all breast cancer units in England submit data on patients with recurrent and metastatic breast cancer using the existing data collection mechanisms, and in January 2013 that was made mandatory in all new diagnoses recorded in England. Unfortunately, the data have yet to be published, and I understand that hospitals are not collecting them consistently. Indeed, a report was due to be published by the NCIN on the topic earlier this year but, disappointingly, it has been repeatedly delayed.

An investigation with health professionals by Breast Cancer Care into why data are not being collected consistently revealed that many of the barriers lie in the practicalities. Time constraints mean that there is often not enough time to input data manually, because patients’ needs, rightly, come first. Structural constraints were cited. Many of the data are expected to be collected through discussion at the multidisciplinary team meeting, but healthcare professionals tell us that most secondary patients are not discussed at MDT level. I welcome the recommendation in the new cancer strategy to review the role and function of the MDT in relation to secondary cancers. IT constraints cause further problems, because online record forms are not set up to collect the data in the cancer outcomes and services dataset, and there is a lack of access to online systems in some hospitals, especially in tertiary centres outside main hospital sites. Finally, there is a lack of awareness about what data are required and confusion about who is responsible for inputting various data items.

Leadership is required to help to drive robust data collection in all hospitals, and we want the Minister, who has responsibility for public health, to make that a priority and lead the way in ensuring that data are collected in every hospital. The new cancer strategy, “Achieving world-class cancer outcomes”, which was published earlier this year, includes a recommendation that data should be collected on all secondary cancer patients. We urgently need the implementation of the plan for how that will happen. In theory, as I have said, breast cancer data should be submitted through the COSD, which replaced the previous national cancer dataset in January 2013 as the new national standard for reporting cancer data in the NHS in England. It has the potential to provide a much broader overview of the treatment, care and outcomes of secondary breast cancer patients. Unless that happens consistently across England, however, we will not see the data that we need to improve care.

[Julian Knight (Solihull) (Con)]

I congratulate my hon. Friend on securing the debate and on the powerful case that he is forensically making. He knows as well as I do that, in our area of the west midlands, we were hit by the Ian Paterson scandal at Spire Parkway hospital. Does he believe that a greater ability to collect and collate statistics would have gone some way to alleviating that problem, because it could have been spotted earlier?

[Craig Tracey]

I agree completely. The lack of data is astounding, and they would help in so many different areas of treatment.

My second objective is access to specialist palliative care. For those living with a diagnosis of secondary breast cancer, such care can make all the difference in enhancing their quality of life, but for too many, support is not available. In many cases when support becomes available, it is too little, too late. Research for Secondary Breast Cancer Awareness Day in 2014 showed that 90% of people living with secondary breast cancer experience regular pain, and 78% find that it affects their ability to undertake everyday activities. For those reasons, palliative care is an absolute essential for secondary breast cancer. Hospices and community-based services can provide symptom management and pain control so that no one has to live with secondary pain. Furthermore, emotional support for both patient and family can help people come to terms with having an incurable disease, as well as ensuring that decisions are taken and adhered to about their choices at the end of life. Palliative care should come at the point of diagnosis, or at a timely point such as when a patient becomes symptomatic. It should provide both symptom control to help them live as well as they can for as long as possible, and emotional support to help them to cope with having an incurable disease and to make informed choices about the end of life.

The third area that I would like to mention is specialist nursing care. We know from the cancer patient experience survey that having a clinical nurse specialist as part of someone’s care is the biggest driver in improving patient experience. The National Institute for Health and Care Excellence quality standard states that everyone with secondary breast cancer should have access to a CNS. A CNS can help to co-ordinate care, provide emotional support and guide a patient through treatment and beyond. However, we know that it is far less common for someone with secondary breast cancer to have a CNS than for someone who has primary breast cancer, mainly because only a handful of CNSs have specific experience of and expertise in secondary breast cancer. A 2010 study found that there were only 19 dedicated secondary breast cancer nurse post-holders across the UK—the current estimate is 25—as opposed to 600 conventional breast cancer care nurse posts. That number must be increased, given that we estimate that there are 36,000 people living with secondary breast cancer—that figure is likely to grow as the population ages and treatments improve.

We need to commit to training more secondary breast cancer CNSs. Anecdotal evidence from existing nurses and from patients who receive care from a CNS suggest that that measure could save money in the long term by keeping patients out of hospital and highlighting problems before they become crises in A&E. We would also expect someone who has a CNS to be more likely than someone who does not to be referred to palliative care when they need it.

My fourth point is about access to drugs and treatments. The cancer drugs fund, which was introduced in 2011, has been an important initiative to improve access to clinically effective drugs that have been deemed by NICE not to be cost-effective enough to be provided routinely on the NHS. Government figures show that, to date, 72,000 people have received life-extending cancer drugs as a result of the CDF. However, it was recently announced that two secondary breast cancer drugs would be removed from the list with effect from November this year. Although NHS England has stressed that any patient who is on a drug when it is de-listed will continue to receive it until it is no longer clinically effective, the change creates anxiety for people living with secondary breast cancer. Cancer charities hear from a lot of people who are concerned that their options for treatment in the future, when their current treatment is no longer effective, are being reduced.

I understand that new cancer drugs can be extremely expensive and it is important to remember that the NHS has finite resources, but there is a clear opportunity to reform the drug appraisal system and bring together pharmaceutical companies with healthcare professionals to ensure that secondary breast cancer patients can access new drugs at a price that is affordable to the NHS. The CDF was only ever meant to be a short-term solution to the problem, and it is vital that we find a long-term solution.

The final key area that I want to see addressed is co-ordinated and joined-up care. The role of a multi-disciplinary team is to bring together all the healthcare professionals involved in a patient’s care to help to co-ordinate the support that that patient receives. For many primary breast cancer patients, it works very well, bringing together oncologists, nurses, radiotherapists and other professionals to ensure that the patient’s care is joined up and integrated. However, the secondary breast cancer taskforce found that that was simply not the case for secondary breast cancer patients, largely because people living with the disease are under the care of only an oncologist rather than a team of professionals. Because of that gap, opportunities—for example, the opportunity to identify when palliative care would be most beneficial—are being missed. The cancer strategy includes a recommendation that MDTs consider new pathways for secondary patients. The implementation of that recommendation would go a long way towards joining up care more consistently and ensuring that patients’ holistic needs are more likely to be met.

To conclude, I ask the Minister to consider five clear steps: better data collection; greater access to palliative care; more specialist nurses; access to better drugs and treatment; and co-ordinated and joined-up care. To achieve the Government’s aim of being the best in Europe for cancer care, we need to ensure that people survive cancer and that those who are living with incurable cancers like Sue, who I met at the event last week, and Dee, who I believe is in the Public Gallery, are getting the care and support they need to ensure that they can live as well as they can for as long as they can.

Oral Answers to Questions

Julian Knight Excerpts

Tuesday 2nd June 2015 Commons Chamber

[The Parliamentary Under-Secretary of State for Health (Jane Ellison)]

The Government is quite clear, as was the coalition Government, that tackling obesity is one of the great challenges of our time for the whole of the developed world, not just this country. We are looking at a comprehensive strategy right across all aspects of Government, including local government and so on. We will address that and rise to the challenge. Everyone has a part to play, including, as has been said during this Question Time, industry and, of course, families themselves.

[Julian Knight (Solihull) (Con)]

T9. My constituent Daniela Tassa has lost her hair while being treated for secondary breast cancer. Sadly, Miss Tassa has been turned down by Solihull clinical commissioning group for a hair replacement treatment called intralace. Is there any guidance that Ministers can offer CCGs when it comes to the sanctioning of such hair replacement treatments?

[Jane Ellison]

I welcome my hon. Friend to his place. I am very sorry to hear of his constituent’s diagnosis of secondary breast cancer. It is of course vital that the NHS supports all patients in the best way possible, but clinical commissioning groups need to make decisions on whether to commission a particular hair-replacement service for patients based on their clinical benefit and cost-effectiveness. I very much hope his CCG will be looking carefully at that.