(1 week, 4 days ago)
Lords ChamberMy Lords, before beginning my speech, I draw attention to my entry in the register of interests, particularly my involvement with Cambridge University Health Partners, Newmarket Strategy and Health Data Research UK, and in particular as a patron and adviser of the Tessa Jowell Brain Cancer Mission, of which more shortly. I congratulate the noble Baroness, Lady Elliott, on bringing this Bill to this House, and Scott Arthur on introducing it in the other place.
This House has an excellent and long-standing record of promoting innovation in care and research in cancer. The noble Baroness has already talked about and referenced the campaigning of our sadly departed friend Baroness McDonagh; we can think back even further to the Medical Innovation Bill, introduced by the noble Lord, Lord Saatchi, under not dissimilar circumstances.
Today, I pay tribute to, and encourage us to learn from, the example of another dear and sadly departed friend of this House: Baroness Jowell, or Tessa, as everyone knew her. Eight years ago this month, and only months before her own untimely death from glioblastoma—unfortunately, a not so rare cancer—Tessa inspired this House and this country to do more. She wanted us to give the word that both my noble friend Lady Coffey and the noble Lord, Lord Patel, have already mentioned, which is hope—hope to patients and hope to their families. When she finished, it was an extremely emotional event. Those who were there will remember it. The House rose and rightly applauded, in itself a highly unusual response, but one that was absolutely deserved.
It was my privilege to respond on behalf of the Government that day. We were able to make a number of commitments to move forward—of course, in a very typical way, Tessa was talking not just about her cancer but all cancers. Immediately afterwards, therefore, we brought together all the parties in the brain cancer space—charities, NHS England, the NIHR and others—and the Brain Cancer Mission was born, in her name and in tribute to her. Whether or not those are rare cancers—GBM is sadly quite common, while others, such as medulloblastoma, are incredibly rare—they all suffer from the same kinds of problems when it comes to treatment and research.
The aims of the Brain Cancer Mission are to improve the quality and equity of care, to strengthen workforces, and to accelerate research, development and innovation. I am delighted to say that, thanks to the leadership of so many people—the charities that have been involved, the team and others—it is doing, and has done, amazing things. It has supported 32 hospitals to improve the quality of care, 14 centres of excellence in neuro-oncology for adults and 11 for children, a fellows programme that is supporting hundreds of researchers, an academy that has trained over 1,500 neuro-oncology staff of all kinds, and the largest dataset for neuro-oncology ever established. In conjunction with the charity Brain Tumour Research, it has created a novel therapeutic accelerator.
Sadly, though, there is so much more to do. Brain cancer is the biggest cancer cause of death for children, and indeed for adults under 40. Take GBM, for example: late diagnosis, a 12 to 18-month prognosis, and only 5% of people surviving more than five years. Those statistics are repeated over and over for all brain tumours and for all rare cancers, and the standard treatments have been unchanged for decades. That is why this Bill is so important.
I want to speak quickly to the Bill’s three clauses. The first deals with marketing authorisations, which the noble Lord, Lord Patel, has already mentioned. The MHRA has made some progress through what it calls its international recognition procedure, but we need to go further and faster. I look forward to hearing from the Minister about what is happening to make sure we can accelerate those innovative treatments through to patients.
Clause 2 talks about a duty to support research. Eight years ago, at the government Dispatch Box, I made a promise that we would spend £40 million of NIHR money on brain tumour research, but we have not yet. The NIHR has been a willing partner, but we are not yet supporting that research to the degree we should. Again, I look forward to hearing from the Minister how that commitment will be met—and well beyond, and for other cancers, too.
Finally, Clause 3 deals with data. The noble Lord, Lord Freyberg, introduced a debate on this subject some years ago—in itself, it is a whole other subject that we could talk about. However, I strongly commend the clause, as it reflects the recommendations that were made in my own review of clinical trials. We need to go further—patients would be amazed to find out that their data is not being used to find trials for them. That is where the public is, and the law needs to catch up.
I end by again thanking the noble Baroness, Lady Elliott, for introducing the Bill, and reminding the House that Tessa invited us to approach the fight against cancer not with fear but with courage and compassion. That is what this Bill exemplifies.
My Lords, may I take one minute of the House’s time? I commend what was just said by the noble Lord, whom I was pleased to work with many years ago, when he was the Minister. I am very pleased that he recalled the last contribution that my long-standing friend, Baroness Tessa Jowell, made in this House. I had the privilege of being the speaker immediately after her, which was one of the most difficult occasions of my life—
I remind my noble friend that his name is not on the list to speak.
I apologise to the House for my premature and ill-timed intervention earlier. After 10 years in the House, I need to go back and sharply revise my understanding of procedure. I am grateful to the House for the opportunity of being able to intervene.
I am emotionally moved today by two things: first, by two of my most long-standing and closest friends, a married couple, both of whom were diagnosed with different cancers in the autumn and are now supporting and caring for themselves, and, secondly, by the timely intervention from the noble Lord, Lord O’Shaughnessy, and reminder of the very powerful final speech of my long-standing friend, Baroness Tessa Jowell, in this House. I thank the noble Lord for his part in carrying that legacy forward and the important concentration on research.
I only wanted to do two things. The first was to congratulate my noble friend Lady Elliott on taking this forward and to hope that, in the next three months, we can get Royal Assent. The second was to add that rare cancers sometimes morph into being much less rare. The more we can do to examine those so-called rare cancers, the more likely we are to be able to intervene early and prevent developments which would otherwise lead to death. If we can do that, early understanding of their development and the ability to save people in the future will be much more likely.
I am very grateful for the mention of oesophageal cancer this morning. In the past oesophageal cancer was a rare cancer. People were sometimes wrongly diagnosed with stomach cancer, but it was relatively rare. Sadly, it is no longer. I recall my very good friend, Lord Bob Kerslake, who was from and remained in Sheffield. He died from oesophageal cancer not so long ago.
Today, we have the opportunity to turn the spotlight on those rare cancers that affect a very large number of people and, in some cases, will affect greater numbers in years to come as environmental, societal and dietary changes have their impact. I thank your Lordships for the opportunity to intervene.
(2 months, 2 weeks ago)
Lords ChamberI am sure that all this will be clarified—but I will be delighted to change my reference. Indeed, this is extremely important, which is why we have a learning disability improvement standard to support NHS trusts, why each ICB has an executive lead on a learning disability and autism and why, among other things, we are rolling out the Oliver McGowan mandatory training on learning disability and autism.
My Lords, I was not sure who I was giving way to, but I am glad that God is on my side. Does my noble friend agree that, as part of that neighbourhood approach, two things should happen? The first is joined-up services, including good training for support workers where supported housing is concerned. Secondly, the major changes in abolishing NHS England should retain services at place level, rather than have the bureaucrats overseeing them.
I agree with the points that my noble friend raises. Indeed, local provision is the responsibility of local trusts. I assure him that a huge part of our work is about improving care pathways and seeing people as a whole person. Part of the failing previously, I think, has been not to see those with learning disabilities and/or autism as whole people with a range of needs, just like anyone else, with those needs being specific to them. Certainly, moving from hospital to community under the 10-year plan will be a great assistance in that.
(10 months, 1 week ago)
Lords ChamberThe noble Lord puts the case strongly for the process of home adaptations. As I have already mentioned, we have provided an immediate in-year uplift to the disabled facilities grants of some £86 million, which will enable people to adapt their homes exactly in the way that the Centre for Ageing Better describes, and I welcome its work. I should say that it is the responsibility of local authorities to ensure that they are supporting applicants through the process of home adaptations as much as possible. We are always looking at ways to improve the process and share good practice, so I welcome the contribution of the Centre for Ageing Better.
Will my noble friend confirm that very few integrated care boards are either integrated or about care? Much of the work that should be going on is going on with health and well-being boards, which are a combination at place level of the relevant local authority and the health service at the point where delivery takes place.
My noble friend has given me an invitation to agree with him. As he knows, it would be quite inappropriate to suggest that integrated care boards are not integrated or about care—that is their focus—but I appreciate his view on the matter. I do agree with him that much good work is done on the health and well-being boards. This all says to me that local decision-making, and local provision for local populations with their particular dimensions and demands, is the best way forward. My final point on this question is that local systems have to agree plans to achieve more timely and effective discharge from hospital, and to work with local authorities to develop those plans.
(1 year, 4 months ago)
Lords ChamberMy Lords, it is a pleasure to follow the noble Lord, Lord Farmer, and I congratulate him on bringing this Bill forward. Its antecedents were in the previous Parliament, in the House of Commons. I commend the speech that he has just delivered; I did not disagree with a single word of it.
I start by paying tribute to Dame Andrea Leadsom, who is viewing our debate this morning from, I think, the Throne steps. I was not sure whether I should call it the Throne or not—but she was certainly the queen of the review and the Start for Life initiative. I played my part in discussions with Dame Andrea, and I see the initiative as a valuable starting point for rebuilding the Sure Start initiative, for which I was partly responsible. I see the Start for Life initiative, and all the elements spelled out by the noble Lord, Lord Farmer, as the granddaughter of Sure Start—and, as with all granddaughters, we want it to grow into adult life and be able to provide the range of services and comprehensive approach which the noble Lord, Lord Farmer, spelled out.
Information and guidance are a no-brainer; it is obvious that people need that from the time when they become pregnant all the way through those early two years that are so important, as we acknowledge. This is acknowledged and supported by parties of all persuasions. I noticed that the new Liberal Democrat MP for Torbay put a Question down very quickly on this issue. I also noticed that his dog got a lot more publicity than mine, for which my dog is deeply resentful.
The Bill takes a step forward, because it requires co-ordination and mapping of what is available at local level, and it requires thinking about how you reach people, particularly those hard to reach, in that early period. When Tessa Jowell and I, among others, were responsible for developing Sure Start, we discovered that the crucial element, which the noble Lord, Lord Farmer, mentioned at the end of his speech, was the outreach to community and the strength of community. I happen still to be a communitarian and I believe that it is not just about the professional delivery of services, critical as that is—the noble Lord, Lord Farmer, spelled out a whole range of professional services that should be involved—but actually should be seen as growing the strength and social capital of the community to surround and support families of whatever persuasion and size.
It seems to me also that, in providing that information, we highlight the inadequacies of what is already available. My right honourable friend the Secretary of State for Education and her Ministers are deeply committed to developing and building on Start for Life in terms of getting the resources over the years ahead to be able to provide comprehensive support, childcare and nursery education. There is a commitment from the new Government to developing that with primary schools so that continuity and support are available, seeing this on a timeline and a continuum, rather than as a one-off. If we can get the information, guidance and important support immediately available, it will help families to flourish and overcome the gross inequality that we see in this country and elsewhere, in terms of that start for babies.
The problem is, of course, that even with the resource for the limited number of hubs we are covering only part of England. It will be critical that we extend this right across the country and that, in mapping the available resources, public, private and voluntary, in an area, we can highlight what the need is and resource it in due course, despite the miserabilist picture at the moment. I should not say things like that, should I?
I want to put it on record that getting information, advice and support to the most vulnerable and more widely is not easy. Most parents do not access local authority websites; they do not even know about them. From the moment when a mother touches services when she discovers that she is pregnant, and the support services click in, that information and advice should be readily available—and, with consent, overcome data protection problems. Furthermore, we need to use new ways of reaching people as we have not done in the past. I am working with the University of Sheffield on this; it has an action research project using smartphones to reach families—because even the poorest families these days tend to have a smartphone—to provide direct advice by text and WhatsApp to those families, for them to be able to reach advice and support very quickly at the time they need it.
The noble Lord, Lord Farmer, was right to spell out the real challenges and pressures that exist on a new family and the dangers of underestimating the mental health problems. By such immediate access to advice, we can add to the multiplicity of commitments that would be available at local level if we managed to develop the services that this Bill would allow the local authority to highlight.
We have a long way to go and we know that there is a massive shortage of provision and that the workforce challenges are equally enormous in terms of childcare and nursery education provision, but we need to put them all together. If we do that, and the information is readily at hand, it will be possible to intervene and offer that help at the time when it is needed most.
We all know how to develop a child long after we have failed to do it really well—I speak as a father, and it was very important that the issue of fathers was mentioned. It is partly about overcoming child poverty, by the way. People in the debate about child poverty seem to forget that there should be a father as well as a mother available, and it is their duty and responsibility to contribute to the well-being of the child in all kinds of ways, including monetarily. So this is about fathers as well as mothers and it is about grandparents and support from the wider family—but it is also about ensuring that we connect with the community.
I commend this small but important contribution to a wider debate about how we get this right and I commend the noble Lord, Lord Farmer, for his initiative.