National Health Service Funding

Lord Jackson of Peterborough Excerpts

Tuesday 22nd November 2016 Commons Chamber

[Jonathan Ashworth]

My hon. Friend is running a brilliant campaign on that. I hope that when the Minister responds, he will reply to that point.

[Mr Stewart Jackson (Peterborough) (Con)]

Will the hon. Gentleman give way?

[Jonathan Ashworth]

I shall make a little progress because many other Members want to speak and I want to give them a chance.

The scale of the financial pressures engulfing the NHS are such that the chief executive of NHS Providers, Chris Hopson, said recently:

“The gap between what the NHS is being asked to deliver and the funding it has available is too big and is growing rapidly.”

The King’s Fund said, with respect to the NHS deficit, that

“it signifies a health system buckling under the strain of huge financial and operational pressures.”

In the most damning assessment of the Government’s handling of the NHS, the National Audit Office concluded today that financial problems in the NHS

“are endemic and this is not sustainable.”

Even the former Health Secretary, Andrew Lansley, said that

“in 2010 we knew we had to implement a tight budget squeeze for five years, but we never thought it would last for ten.”

--- Later in debate ---

[Jonathan Ashworth]

The chief executive’s comments to the Select Committee speak for themselves. Talking of repudiation, when are we going to get £350 million a week, or were the Tories typically saying one thing before the people voted and something completely different after they had had their say? That is what the ex-Education Secretary should be telling us.

Let me remind the House what the Health Committee said. I see the hon. Member for Totnes (Dr Wollaston) in her place, and she said:

“The continued use of the figure of £10 billion for the additional health spending up to 2020-21 is not only incorrect but risks giving a false impression that the NHS is awash with cash.”

She is sitting only a little further down from the right hon. Member for Surrey Heath (Michael Gove). Perhaps he can have a word with her if he disagrees.

The Secretary of State hopes we do not notice that he is stretching the timeframe over which he presents this funding allocation. He hopes we do not notice that NHS spending has been redefined by the most recent spending review. He hopes we do not spot that he is cutting billions from public health budgets and other Department of Health funding streams—a £3 billion cut. But we have noticed.

[Mr Jackson]

Will the hon. Gentleman give way?

[Jonathan Ashworth]

In a few moments.

We have spotted the Secretary of State’s conjuring act because we have seen this Tory trick before—robbing Peter to pay Paul. The result of this trick is cuts and underfunding, more pressures flowing through to the frontline, and, as the NAO said,

“Financial stress…harming patient care”.

In all our constituencies we see ever-lengthening queues of the elderly and the sick waiting for treatment. Across the board, we see the worst performance data since records began.

--- Later in debate ---

[Jonathan Ashworth]

I praise the hard-working staff in the NHS every day of the week, but I rather suspect that staff in the NHS will have more sympathy with the position I am outlining than with the right hon. Lady’s position, not least when, according to surveys, 88% of NHS staff think that the NHS is under the most pressure they can remember, and 77% think that there is less access to resources, putting the quality of patient care and clinical standards at risk. That, I say to her, is what NHS staff are saying.

[Mr Jackson]

Will the hon. Gentleman give way?

[Jonathan Ashworth]

Oh, okay.

[Mr Jackson]

Perhaps I can just allow the hon. Gentleman to break off from reading his press release. I think we are moving towards a consensus on this issue, in that we do need to integrate acute clinical care and adult social care, and I understand that. In that vein, why was it that, in 13 years, when there was significant demographic change, the Labour Government failed to bring forward a better care fund or a precept for social care?

[Jonathan Ashworth]

It beggars belief! We tripled investment in the NHS, and the hon. Gentleman and his hon. Friends voted against every penny piece. When we left office, we had the best waiting times and the highest satisfaction levels on record. That is the difference between a Labour Government and a Conservative Government on the NHS.

--- Later in debate ---

[Mr Hunt]

The shadow Health Secretary also did not talk about cancer. In 2010, we had the lowest cancer survival rates in western Europe. Since then, we have referred for cancer tests 2,200 more people every day, and 100 more people are starting cancer treatment every day. The cancer charities say that this is saving 12,000 lives a year. On mental health, he did not mention the fact that we are treating 1,400 more people every day, with record dementia diagnosis rates.

[Mr Jackson]

Would not Opposition Members be a little more straightforward and honest about the wider context if they admitted the demographic challenge that this Government face, as they would have faced? The number of over-60s will increase by 50% in the next 15 years. Should they not also admit that the private finance initiative was an appalling millstone—£64 billion —to bequeath to this Government? That has had an impact on frontline care.

[Mr Hunt]

My hon. Friend is absolutely right to raise that point. People will be astonished to hear Labour Members wasting their time talking about a privatisation of the NHS that is not happening when they were responsible for PFI, the worst possible privatisation that has done such enormous damage.

Another point that the shadow Health Secretary did not mention was the quality and safety of care in our NHS that Labour left behind. The Francis report revealed massive problems—short staffing, a culture of denial and cover-ups—and they were not just at Mid Staffs but, as we now know, at Basildon, Morecambe Bay and many other trusts. Since we have been in office we have changed that. We have put 31 hospitals into special measures, which is more than 10% of hospitals across the entire NHS, and we have recruited record numbers of doctors and nurses.

I want to tell the House about one hospital that was put into special measures. Care was unsafe at Wexham Park in Slough—so much so that fewer than half the hospital staff were prepared to recommend the care provided there to their own friends and family—but it has gone from having six of its eight clinical areas rated as requiring improvement or inadequate, to having all eight of them rated as good or outstanding. It has come out of special measures, as have 15 hospitals in total, and we should all commend the staff who have worked incredibly hard to turn around those hospitals.

Leaving the EU: NHS Funding

Lord Jackson of Peterborough Excerpts

Tuesday 15th November 2016 Commons Chamber

[David Mowat]

Had I been writing something on the side of the bus, and had I been campaigning on that cause in the referendum, I might have been more circumspect. I might have said that £350 million could become available and could be spent on whatever the Government’s priorities were, one of which was very likely to be the NHS. I hope that that satisfies the hon. Gentleman.

[Mr Stewart Jackson (Peterborough) (Con)]

I regret that I seem to have stumbled into a sort of elongated primal scream therapy session involving refighting last June’s referendum. The hon. Member for Streatham (Mr Umunna) would have a more persuasive and cogent argument if he saw the other side of the equation. Yes, EU workers have a massive impact on and are committed to the NHS, but unrestricted EU migration over a number of years has put massive strains on the delivery of our health services. He has never conceded that point.

[Mr Umunna]

That is not what I am talking about.

--- Later in debate ---

[David Mowat]

It is not for me to make that specific guarantee. The Prime Minister clearly said that she hopes and expects them to remain. It is disappointing that a similarly strong statement has not been made by any Head of State in any other European country.

It is also right that we do more to train more of our own nurses and doctors—not because we need to replace people from the EU, but because it is the right thing to do. We should try to become self-sufficient in these matters, and that will happen.

We have knocked around this point quite a lot during the debate and have talked about variables such as the exchange rate, GDP and the EU bonus or payment that we will get, but there is one thing that is not a variable and it is probably the single most important constant: the extent to which this Government give priority to the health service in their spending commitments. That constant is absolutely clear. The previous Prime Minister treated the NHS as his No. 1 commitment, as does the current Prime Minister. Many of the points we have discussed this evening are things that should properly form part of the negotiation that we are going to have after we trigger article 50, as we hope to do by the end of March, and I am certain that that will be the case. What is not negotiable is that our commitments to NHS funding and social care funding are unmoved by any of these things; this is the No. 1 priority for this Government.

[Mr Jackson]

Is it not the case that in the future dispensation after Brexit we might have a fairer system of recruitment and retention of NHS staff? In all our constituencies, we have staff from outside the EU—my constituency has Nigerian, Ghanaian and, in particular, Filipino nursing staff—who have hitherto been discriminated against inadvertently vis-à-vis those from the European Union, and we will have a much fairer system in reaching out and getting the brightest and best to work in our NHS in the future.

[David Mowat]

My hon. Friend uses the word “fairer”, and of course we do have staff from other parts of the world. I will be honest and say that part of me has difficulty with this country taking large numbers of doctors and nurses from places such as Nigeria and others parts of Africa that need them more than we do. So it is right that we try to train more of the people that we need in these vital public services, but it is also right that we make it absolutely clear how important the people who currently work in our NHS and in social care are—those from the EU and from outside it, as my hon. Friend reminded us. That is important.

I make the point again, because I will not go on until 7.30 pm, that the NHS is this Government’s No.1 spending priority and it will continue to be so.

Question put and agreed to.

Oral Answers to Questions

Lord Jackson of Peterborough Excerpts

Tuesday 15th November 2016 Commons Chamber

[Mr Stewart Jackson (Peterborough) (Con)]

I thank the Secretary of State for taking time last week to visit the Peterborough City hospital and to praise the magnificent staff there, who are labouring under a £35 million annual private finance initiative millstone. Is the wider context not that we would have a lot more money to spend on front-line care if we did not have to deal with a poisonous legacy from Labour of £64 billion of appalling PFI contracts in the NHS?

[Mr Hunt]

My hon. Friend is absolutely right. I was incredibly impressed with the staff I met at Peterborough hospital—there was incredible commitment to patients and some fantastic work going on in the oncology and renal departments, which I visited. He is right: PFI was a disastrous mistake, saddling hospitals up and down the country with huge amounts of debt, which cannot now be put into front-line patient care. We are doing everything we can to sort that out and not repeat those mistakes.

Brain Tumours

Lord Jackson of Peterborough Excerpts

Monday 18th April 2016 Westminster Hall

[Nick Smith (Blaenau Gwent) (Lab)]

It is a pleasure to serve under your chairmanship, Sir Edward.

As my hon. Friend the Member for Warrington North (Helen Jones) said, brain tumours are the biggest cause of cancer death among children and adults under 40 in the UK. Surely, research into that disease should be a priority in the UK and around the world.

I will talk today about five-year-old Cian Case. My friend, Huw Irranca-Davies, who has now left this place after being the hon. Member for Ogmore, has been dealing with Cian and his family for some time, and he wanted me to pass on Cian’s story.

At the end of November 2015, Cian was admitted to the Royal Glamorgan hospital with acute stomach pain. A scan identified a tumour on his spine and he was rushed to the University Hospital of Wales in Cardiff, so that as much of the tumour as possible could be removed. The trauma left Cian completely paralysed from the waist down, with the neurologists sceptical about how much mobility he could recover.

Cian was diagnosed with an extremely rare and aggressive cancer that affects the central nervous system and that is mainly diagnosed in very young children. The survival outcomes are not favourable. The “seeds” of this cancer had already begun to spread to Cian’s brain. Fortunately, Cian responded well to that initial dose of chemotherapy and is now receiving intensive chemotherapy to his brain and spine.

[Mr Stewart Jackson (Peterborough) (Con)]

I pay warm tribute to Carole Hughes, the inspirational woman behind Peterborough-based Anna’s Hope. She is in the Gallery today. In view of the fact that cancer affects children in particular, does the hon. Gentleman agree that it is important that specialist neuro-rehabilitation therapy centres are set up to assist children in that position and to try to get them to fulfil their ultimate potential?

[Nick Smith]

I agree with the hon. Gentleman, who makes an important point.

I am pleased to report that Cian continues to make good progress and that his mobility is improving weekly, defying the original prognosis. Cian’s dad, Richard, is one of the more than 120,000 signatories to the petition we are discussing. He understands that cancers such as Cian’s are rare, and that that is why funding may not have been forthcoming enough. He believes, however, that more research can lead to longer and healthier lives for youngsters blighted so early by this disease. I am pleased that Cancer Research UK has committed to increasing spend on research into brain tumours, and we can all welcome that good news.

It is difficult standing here today relaying the story of one family’s brush with tragedy and the long road to recovery ahead, so I do not want our successors, years from now, to face the same questions, wringing their hands and saying, “Something should be done.” The community has rallied around Cian and his family—the school, the rugby club and the community drop-in centre have all organised different activities to raise awareness and funds, for which the family are incredibly grateful. The Noah’s Ark children’s hospital, LATCH and everyone in the health service has been fantastic on every step of Cian’s fight. They are all doing their bit; now it’s our turn.

Mental Health Taskforce

Lord Jackson of Peterborough Excerpts

Tuesday 23rd February 2016 Commons Chamber

[Alistair Burt]

I thank the hon. Lady for her question. It was good to see her in Hull with her constituents and those of the right hon. Member for Kingston upon Hull West and Hessle (Alan Johnson). I do not think that any new money is specifically needed to deliver on the commitment to provide in-patient care for young people in Hull and the surrounding area. It seemed to me that people had already agreed on that; the problem was in the delivery of it. She will recall the frustration that I expressed when I was sitting round a table with representatives from the clinical commissioning group, the NHS and the trust, because for some reason it was impossible for us to reach a decision.

The update is that I have already taken that matter away with me to consider how to resolve it, because I had some concern about it. A national decision has to be made about the allocation of finance and priorities, but there is a clear local need that needs to be addressed. We will make progress on that. On beds generally, we have more beds for young people than ever before, and 50 more since I came into my role, but they are not always in the right places, as we saw in the hon. Lady’s constituency. I do not think that anything in the announcement affects the importance of that matter, which has already been recognised.

[Mr Stewart Jackson (Peterborough) (Con)]

I warmly welcome the Government’s initiative and the taskforce report. I am slightly disappointed by the Opposition’s rather churlish tone, as I thought this was a cross-party matter.

May I make two brief pleas to the Minister? First, we must not lose sight of acute mental health episodes among children and young people at weekends and out of hours, which is a long-standing issue, including in my constituency. Secondly, Tourette’s syndrome falls between the strategies and provision of education and health. One in 100 children are diagnosed with Tourette’s. It is an important neurological condition that we need to address. Will the Minister keep focused on that as part of his wider mental health review?

Health and Social Care

Lord Jackson of Peterborough Excerpts

Tuesday 2nd June 2015 Commons Chamber

[Andy Burnham]

The Conservatives are fond of saying that we did not fix the roof when the sun was shining, but I can tell the hon. Gentleman that we did fix the leaking roofs of hospitals and GP surgeries that they left behind, and we had to invest a significant amount to do so. When we came to office in 1997, more than half the NHS estate predated the NHS itself, and people remember those days. We had to put that right: we had to rebuild substantial portions of the NHS simultaneously by means of the PFI, which, I might add, was inherited from the Major Government.

[Mr Stewart Jackson (Peterborough) (Con)]

The right hon. Gentleman has clearly forgotten the patient records IT project—at £12 billion, it is officially the most disastrous white elephant IT project in British political and Government history—and the £250 million spent on independent sector treatment centres and on higher tariffs to private providers for operations not done, and the £63 billion on the private finance initiative. That is the record of the Government of which he was a part. Has he forgotten that voters made their decision on that record on 7 May?

[Andy Burnham]

I will tell the hon. Gentleman what I remember: I remember NHS waiting lists in 2010 being at their lowest ever level; I remember public satisfaction with the NHS being at its highest ever level; and I also remember leaving behind a financially solvent national health service. Let us look at it today: NHS waiting lists at a six-year high; cancer patients waiting longer for their treatment to start; A&E in crisis; and, as I said, a £1 billion deficit, and rising, at the heart of the NHS. That is the Secretary of State’s record, and a little more humility might not go amiss.

--- Later in debate ---

[Dr Wollaston]

Absolutely, and I recognise and value the work that has been done. We also need to look at the skill mix across the NHS. It is unsustainable to deliver the commitments to primary care and to improve access to primary care unless we look further at the skill mix across the wider NHS. For example, we talked in Health questions about the use of pharmacists. The one area of the NHS where there is not any kind of workforce shortfall is in pharmacy, and that industry has much to offer to primary care. We also need to consider the role of physician associates and nursing assistants, and look at how we can diversify and provide better continuing professional development across the NHS. All those things will be important as we move forward.

[Mr Jackson]

My hon. Friend will know that in the previous Parliament the Public Accounts Committee expressed concerns about the use of clinical excellence awards for senior clinicians and the very high levels of senior management pay. It felt that they were incongruous when compared with the restraint shown towards lower- paid and more junior staff. Does she think that Select Committees such as her own—if she is re-elected to it—and Ministers need to look at that in the future?

[Dr Wollaston]

I thank my hon. Friend for his points. There is an important piece of work that can be done by the next Health Committee in looking at all the wider workforce issues across the NHS, including those to which he refers.

I shall now touch on seven-day access for the NHS. Such a service is vital, but we must focus on safety. The primary focus of seven-day access must be eliminating the unacceptable variation in mortality rates across the NHS on different days of the week. It is important that we address the issue of reducing avoidable and unnecessary hospital admissions. Perhaps the Minister could look at the frailty service in Newton Abbot which considers how GPs can work together to prevent unnecessary hospital admissions. If we broadened access to general practitioners at the weekends, we might be able to reduce unnecessary admissions to hospital, for example of children with asthma. There is much that can be done, but if we are prioritising providing 8 till 8 access in very rural areas there might be unintended consequences in general practice. If we are diverting funding into areas where we are providing a service in which several practices over a large geographical area have to federate, we could inadvertently end up with patients having to travel further than they would to visit a local out-of-hours service.

Will the Minister carefully consider the unintended consequences when we implement seven-day access to ensure that we do not divert essential funds that could be used for safety and avoiding unnecessary admissions into something that is worth while in theory but that might not give the best outcomes for patients? I hope that the Minister will be able to reassure me that the Government will allow local CCGs to look carefully at what is best, while consulting local communities, and to be as flexible as possible.

I also ask the Minister to consider the importance of volunteering across the NHS. In all our constituencies there will be extraordinary organisations that work as partners with the NHS, but I have some concerns, one of which I would like to share with the Minister. In my area, a wonderful charity called Cool Recovery worked with users of mental health services and their families to provide an extraordinary level of support. Sadly, particularly given that I was a patron of this charity, I have to report that it is having to fold for the want of a relatively small amount of stable long-term funding. The voluntary sector—those partner organisations across the NHS—is calling out for access to stable long-term funds. Newly set-up charities gain access to very valuable funding sources, but when they apply for funds once they are established, the response is that it should be provided by commissioners. I ask the Minister to consider carefully how we can sustain some of the extraordinary charities working across the country by giving them access to stable long-term funding so that they can carry on with their work. This issue was raised with the Select Committee by the voluntary sector during our inquiry into children and adolescent mental health services, so it is an issue across the NHS that is causing real problems.

--- Later in debate ---

[Mr Stewart Jackson (Peterborough) (Con)]

It is always a pleasure to follow the hon. Member for Clacton (Mr Carswell), whose contributions are always very thoughtful.

One of the great lessons of the election campaign for the Labour party in the context of its leadership election is that it will have to look at its past and its future in respect of the NHS. The general election tested to destruction the idea that it is possible to repeat the claim, “24 hours to save the NHS,” without a proper, well thought out and coherent policy for our national health service. The irony is that in many respects there is consensus across the parties on the big issues that the national health service will have to face in the next 10 or 20 years, including demographic and societal changes that are above party politics.

That apart, given the very challenging fiscal inheritance of 2010, this Government did an extremely good job on the NHS. We were committed to making those savings while at the same time driving up clinical numbers. My own trust has a 13% increase in the number of nurses and a 9% increase in the number of doctors and carries out 850,000 operations each year. Allowing for inflation, £5.5 billion was put into the NHS under the previous coalition Government. Important issues that had previously been neglected were also addressed, including giving parity to physical and mental health, reducing the stigma and encouraging local clinicians, commissioners and providers to treat people with mental health issues in exactly the same way as they would treat people with physical ailments.

Yes, we had problems with the A&E target, but I am very proud of what we did on, for instance, the cancer drugs fund, an initiative that received cross-party support and which has affected hundreds of thousands of people positively.

We made savings. I accept that very difficult decisions had to be taken on staff salaries, and in my intervention on my hon. Friend the Member for Totnes (Dr Wollaston) I made the point that there is an incongruity between what we are asking people lower down the skill base in the NHS to take and what we are awarding senior managers and, through clinical excellence awards, senior clinicians. We need to sort that out.

A lot of nonsense is spoken about the Health and Social Care Act 2012, but it has set in stone the ability to make incremental savings while protecting front-line clinical services and put into the driving seat local clinicians who are best placed to make commissioning decisions. I welcome the £8 billion funding commitment, and I particularly welcome seven-day-a-week GP access, which the coalition Government pioneered. I know that we will have the support of Her Majesty’s Opposition and other parties on that.

The better care fund is welcome, although the Government should think again about the collaborative work that needs to be done with the Local Government Association—I declare an interest as a vice-president of the LGA—to try to fund the gaps. We will make long-term savings and drive up productivity, which will affect all our constituents, only by properly integrating acute health services and GP and primary care with social care. That is extremely important.

On dementia, prior to this debate we received a very useful and comprehensive briefing from Alzheimer’s Research UK. We need to build on the Prime Minister’s challenge on dementia by making improvements in dementia diagnosis and providing better care. I pay tribute to the work undertaken by Peterborough Dementia Resource Centre in the Millfield area of my constituency. It is important that we also encourage dementia-friendly cities and towns throughout the country.

There are other issues that we must address urgently. My right hon. Friend the Secretary of State made the use and cost of agency staff a central issue that will inform NHS policy under the Conservative Government. That is vital. It is not an easy issue to deal with, but we must grasp the nettle now if we are to protect front-line services.

On private finance initiatives, unfortunately my acute district hospital trust officially has the most indebted PFI settlement in the country—and, I have to say, the worst and most disastrous. Peterborough and Stamford Hospitals NHS Foundation Trust has a £40 million structural deficit. That is unsustainable over the medium and long term. We need the Treasury and the Department of Health to work together to assist such challenging healthcare economies, because they will affect all areas, including social care, primary care and acute hospital care, particularly for older people. Older people account for a disproportionately large number of admissions to acute district hospital trusts. Given that the number of over-85s will double in the next 20 years, we cannot put this issue on the back burner—we need to look at it as a matter of urgency.

We must address senior manager redundancies. When I sat on the Public Accounts Committee in the previous Parliament, we saw some egregious cases of greed, mismanagement and back scratching from senior trust managers who were hiring and rehiring consultants and mates of mates. That is not acceptable when we are asking junior NHS staff to make sacrifices.

Finally, we need to think about an holistic approach to social care. For example, we should give tax breaks for housing and extra care facilities for older people, so that we have a properly co-ordinated system from age 60 all the way through to death. People should have an allocated health service worker, for instance. The health service does not belong to any one party. We have a good and proud record, and I urge the Government to continue their good work.

--- Later in debate ---

[Liz Kendall]

Why is the hon. Lady not talking to her Ministers about the problems created in the NHS? Why do the Conservatives never talk about their reorganisation? I will tell you why: it is because they know it has been a mistake. Far from putting power into the hands of clinicians, let alone patients, it has put power into the hands of bureaucrats.

This Government’s addiction to broken promises goes on. Five years ago, patients were promised that they would be able to see a GP from 8 am to 8 pm, seven days a week. That may sound familiar—well, it should. The Prime Minister has had to make the same promise again in the latest Tory manifesto. It is no wonder that he has had to do that, because, under his watch, it has got harder to see a GP. Two million more patients now say that their surgery is not open at a convenient time, and a quarter say that they cannot get an appointment in a week, if at all, let alone on the same day.

The list of broken promises goes on. The Prime Minister said that, under his leadership, we would never go back to the days when patients waited for hours on trolleys in A&E, or months for vital operations. Yet the number of patients kept on trolleys for more than four hours has quadrupled, and the waiting lists are at a seven-year high. Why is that? It is because the Government wasted three years on reforming backroom structures rather than front-line services. They slashed the very social care and community services that should help to keep elderly people at home, piling further pressure on our hospitals instead.

The Government want us to forget their mistakes. But Labour Members will not let them run away from their record. We will hold them to account for their failures every week, every month, every year. I am talking about their failure on NHS finances and the deficits that have soared to more than £800 million and are set to get worse. Those deficits are predicted to be £2 billion by the end of this year.

[Mr Jackson]

rose—

[Liz Kendall]

What will the hon. Gentleman do about that?

[Mr Jackson]

On the subject of mistakes, apologies and looking back at the past, would the hon. Lady—in her role as a candidate in the Labour leadership election as much as anything else—like to apologise for paying GPs 27% more for doing less work in 2004 through the GPs’ contract, which curtailed out-of-hours services so drastically?

[Liz Kendall]

I will never apologise for Labour’s record on the NHS, for the investment and reforms that saw waiting lists at an all-time low and patient satisfaction at an all-time high, for rebuilding our hospitals and our public health and primary care or for tackling health inequalities. That is more than can be said for the record of Conservative Members. We will hold them to account for their failure on A&E as hospitals miss the four-hour target for the 97th week in a row, and we will hold them to account for their failure on cancer care. The cancer treatment target has now been missed for more than a whole year, and 21,000 cancer patients have waited more than 62 days to start their treatment. Anyone who has a relative or friend with cancer waiting to start treatment knows how desperate that can be, and it is not going to get better anytime soon.

The day before Parliament was dissolved for the election, NHS England snuck out a report saying that the cancer target will not be met again until at least March of next year. Would the Minister like to confirm that? If she will not confirm that, will she tell me how many patients will wait longer as a result so that Members can tell their constituents? Does she think that it is acceptable, and what is she going to do about it? I would be happy to give way to the Minister if she would like to respond. No? Well, that is typical of Conservative Members, who create the problems but refuse to admit to them and do not have a plan to deal with the result.

Five years ago, Government Members made important promises to patients and the public on the NHS. They promised stability, but their reorganisation created chaos. They promised to maintain Labour’s historic low waits for treatment, but waits have risen year on year on year. They promised seven-day access to a GP, but it is getting harder to get an appointment, and they promised to make the NHS more efficient, but they have wasted billions of pounds on their reorganisation, on agency staff, management consultants and soaring delayed discharges because elderly people cannot get the services they need at home. They come to this House today and repeat their promises and claims, but NHS staff do not trust them, patients will not believe them and we will not allow them to get away with five more years of letting patients down.

National Health Service

Lord Jackson of Peterborough Excerpts

Wednesday 21st January 2015 Commons Chamber

[Liz Kendall (Leicester West) (Lab)]

It is a privilege to speak in this debate, which has seen some passionate and thoughtful contributions about the NHS. Many hon. Members spoke about the pressures on their local ambulance services and A and E departments, including the hon. Member for Strangford (Jim Shannon) and my hon. Friends the Members for Barrow and Furness (John Woodcock), for Penistone and Stocksbridge (Angela Smith), for Heywood and Middleton (Liz McInnes), for Hammersmith (Mr Slaughter) and for Bolton South East (Yasmin Qureshi). The hon. Member for Stafford (Jeremy Lefroy) and my hon. Friends the Members for Jarrow (Mr Hepburn) and for Wirral South (Alison McGovern) spoke about the closure of walk-in centres, and difficulties in getting a GP appointment, which are piling pressure on their local hospitals.

My right hon. Friends the Members for Holborn and St Pancras (Frank Dobson) and for Rother Valley (Kevin Barron) described the terrible impact that this Government’s cuts to social care are having on elderly and disabled people, piling further pressure on the NHS, as Age UK’s excellent report showed yet again today. My hon. Friends the Members for York Central (Sir Hugh Bayley) and for Kingston upon Hull West and Hessle (Alan Johnson) spoke about the problems with child and adolescent mental health services, which have seen their constituents, like mine, sent thousands of miles away from family and friends to get treatment, which is terrible for them, terrible for their families and costs the taxpayer far more.

We have heard time and again during the debate how many of the long, hard fought-for gains achieved under the previous Government are being squandered before our eyes. When we left office, 98% of patients were seen within four hours in hospital A and E departments. Now that is down to 84%, with 180,000 patients having waited for more than four hours in the last month alone. In 2010, 80% of people could get a GP appointment within 48 hours; now one in four waits a week or more or cannot get an appointment at all.

The maximum 18-week wait for treatment has been missed for the last six months. Cancelled operations and delayed discharges from hospital have reached record highs in recent months. The vital cancer waiting target has been missed for the last nine months, meaning that 15,000 people have had to wait more than 62 days to start their cancer treatment. Anyone who has had a family member or friend wait for that treatment to start knows just how frightening that can be.

Ministers repeatedly claim that these problems are nothing to do with them and are simply the result of people living longer. But when our population is ageing, when more people are living with long-term chronic conditions and when the NHS faces the tightest financial settlement of its life, we should not cut the very services that help keep people out of hospital and living at home, which is better for them and better for the taxpayer. We should not remove the very incentives that improved GP access and close a quarter of walk-in centres, so that more people end up in A and E.

We should not slash social care budgets by £3.5 billion, so that half a million fewer of the most vulnerable older and disabled people cannot get help to get up, washed, dressed and fed. Forty per cent. fewer people get home adaptations such as grab rails, which prevent falls, and 220,000 fewer people get meals on wheels. We should not cut 2,000 district and community nurses, who are essential to helping elderly people get back home from hospital, and prevent people with long-term conditions ending up in hospital in the first place. We should not cut training places, so that hospitals are now spending £2.5 billion on more expensive agency staff and hospitals such as mine in Leicester have had to recruit 260 nurses from Spain and Portugal.

Moreover, as my hon. Friend the Member for Dudley North (Ian Austin) and my right hon. Friend the Member for Tottenham (Mr Lammy) so powerfully explained, we should not force through the biggest back-room reorganisation in the history of the NHS, wasting £3 billion, distracting the entire system, making thousands of people redundant only to re-employ them elsewhere in the system, and creating even more layers of bureaucracy, so that no one knows who is responsible or accountable for leading the changes that patients need on the ground.

In case the House needs reminding, I should say that the Government have created not only NHS England, alongside Monitor, the Care Quality Commission and the Trust Development Authority, but regional NHS England teams, local area teams and commissioning support units, as well as clinical commissioning groups and health and wellbeing boards. No wonder there is so little leadership in the system.

Labour Members make no apology for holding this Government to account for their record. After all, their Prime Minister promised people that his top priority in government could be summed up in three letters: NHS. I would hate to see what happened in a service he is not so bothered about.

Labour Members know that people want hope—the hope that there is a proper plan to get the NHS back on track. That is exactly what Labour will deliver. We have set out our plans for immediate action to ease the strain on A and Es by making sure that there are enough GPs in emergency departments and enough clinicians on NHS 111; stopping walk-in centres from closing; getting nurses to return to practice; and making sure that councils, the NHS and voluntary organisations identify the older people who are most at risk of going into hospital so that they get the right support to stay at home.

We have also set out a long-term plan for investment and reform so that our care services are fit for the future. We will provide an extra £2.5 billion on top of this Government’s plans to get the GPs, nurses and home care workers we need to transform services in the community and at home.

[Mr Stewart Jackson (Peterborough) (Con)]

Despite the £40 million structural deficit and a dodgy PFI deal that the right hon. Member for Leigh (Andy Burnham) shackled my local hospital to, in the past four years we have increased the number of nurses by 14% and the number of doctors by 9%. On the subject of apologies, would the hon. Lady like to apologise for her party’s dodgy £63 billion encumbrance of PFI off-balance-sheet deals that have been forced on my constituents and others?

[Ian Austin]

On a point of order, Mr Speaker. Is it in order for someone who has not been in the debate at all this afternoon to stand up and make these sorts of points during the wind-ups?

Oral Answers to Questions

Lord Jackson of Peterborough Excerpts

Tuesday 13th January 2015 Commons Chamber

The Secretary of State was asked—

[Mr Stewart Jackson (Peterborough) (Con)]

1. What steps he is taking to improve mental health care for pregnant women and new mothers in (a) Peterborough and (b) England; and if he will make a statement.

[The Parliamentary Under-Secretary of State for Health (Dr Daniel Poulter)]

The Government have prioritised improving mental health care and support for pregnant women and new mothers in its mandate to NHS England, with a clear objective to reduce the incidence and impact of post-natal depression. In order to implement the Government’s priority to improve perinatal mental health services, Cambridgeshire and Peterborough NHS Foundation Trust is working closely with local authority commissioners in Peterborough to develop a joint perinatal mental health strategy to improve care for women.

[Mr Jackson]

The Maternal Mental Health Alliance has estimated that the long-term cost of mental health care for new mothers is £8 billion, which is perhaps not unconnected to the fact that only 3% of clinical commissioning groups have a perinatal mental health strategy. Does the Minister think that this is a very serious issue and needs immediate action?

[Dr Poulter]

My hon. Friend is absolutely right to highlight the challenges posed by perinatal mental illness. The damage it does to women’s lives, and indeed to the wider family, was highlighted in the recent independent inquiry into maternal deaths. It is therefore important for the Government to invest, as we are doing, in improved care for the perinatal mental health of women. That is why we have made it a priority for each and every maternity unit to have staff specially trained in perinatal mental health skills by 2017.

Pancreatic Cancer

Lord Jackson of Peterborough Excerpts

Monday 8th September 2014 Westminster Hall

[Eric Ollerenshaw]

The hon. Lady makes an extremely important point, which the all-party group was trying to weigh up. The hon. Member for Scunthorpe made an important point about CT scans and made the important suggestion that there should be pilots. Also, interestingly, he mentioned that the going backwards and forwards between the GP and the specialists delayed diagnosis. There are certainly things that we could learn from other countries.

One of the basic needs that came up from our research was the need for investment in the basic science and biology of tumours, as well as access to better infrastructure that would allow that, such as access to tissue samples. On the latter point, the Pancreatic Cancer Research Fund told the APPG that it was working in conjunction with Barts on creating a specific pancreatic cancer tissue bank, which would help. That is a massive investment for a small charity and it should be applauded.

As Members know, there is a massive shift throughout all cancer research towards personalised medicine. Pancreatic cancer patients could benefit particularly from such an approach, given the nature of the disease and the fact that so many different tumour types are involved. New treatments need to be developed to attack and destroy the cancer cells. That does not mean new drugs alone, but perfecting the use of advanced radiotherapy techniques, such as NanoKnife or CyberKnife, for the benefit of patients and to the satisfaction of the National Institute for Health and Care Excellence, so that they can be provided on the NHS.

All in all, a lot of research needs funding. A key statistic for this debate, as mentioned in Maggie’s e-petition, is that pancreatic cancer receives only 1% of the National Cancer Research Institute’s site-specific spend of £5.2 million a year. That is despite the fact that pancreatic cancer is the fifth biggest cancer killer in the UK, and predicted to become the fourth biggest by 2030. It is responsible for 5.2% of all cancer deaths in the UK. The National Cancer Research Institute itself acknowledges that research into pancreatic cancer and other cancers deemed to have unmet need, such as brain and oesophageal cancers—forgive me if I do not pronounce that correctly—remains “relatively low”.

By “relatively low”, however, the institute means “low”. I contend that £5.2 million a year from the NCRI partner funders is simply not enough to tackle the extreme intransigence of a disease as tough as pancreatic cancer, a disease that has seen—as has been mentioned before and should be mentioned again and again—little change in survival rates over the past 40 years or by comparison with other countries, as the hon. Member for Belfast East (Naomi Long) said.

Why does funding matter? Is money the be-all and end-all? No—other things need to be done as well if research into pancreatic cancer is to become more effective. However, if we look at other cancer types, we see that sharp increases in survival rates from breast, prostate and bowel cancer, for example, have mirrored sharp increases in research spending into those diseases. As Professor Peter O’Hare, chair of Pancreatic Cancer UK’s scientific advisory board—now there’s a powerful job—told the APPG inquiry:

“I think if you simply looked at the history of science, I don’t think you can, as a scientist, start to make guarantees about research. It’s not like a sausage grinder; you don’t put research in and it comes out and you solve the problem. It just doesn’t work that way”—

we totally understand and agree with that—

“there are convoluted pathways and you can’t make guarantees.

However, I think there is a guarantee you can make: if you don’t carry out research, you are not going to move; nothing is going to happen. That’s the guarantee that you could make.”

Some evidence suggests a critical mass, a level at which research needs to be funded, if advances are to start to gather pace. Pancreatic Cancer UK produced a report in 2012, “A Study for Survival”, which demonstrated a level—around £10 million to £12 million minimum—at which the amount of research starts to become sustainable and from which new research proposals and ideas are generated. Those new ideas in turn lead to more funding coming in, and we get a virtuous circle.

We are some way off that level of funding at the moment. National Cancer Research Institute funding partners contribute just £5.2 million at present. Incidentally, we learned during the all-party parliamentary group’s research inquiry that the Department of Health’s contribution to that sum is just £700,000 a year. Although they are growing, charities for pancreatic cancer are still small and supply probably less than £2 million a year between them for research. Where, then, can that extra funding come from? What needs to be done?

In its new research strategy, published in April this year, Cancer Research UK made a welcome move in the right direction, with a promise to increase funding into pancreatic and other cancers of unmet need—brain, lung and oesophageal—twofold or threefold over the next few years. That is great news.

[Mr Stewart Jackson (Peterborough) (Con)]

My hon. Friend is making a customarily powerful and passionate speech. He is aware that the five-year survival rate in the United States is 6%, as against 3.3% in the UK. Is he also aware that, under the Recalcitrant Cancer Research Act of 2012, the US Congress has given a legal imperative for the director of the US National Cancer Institute to produce a strategy to tackle such cancers? We should do the same in the UK.

[Eric Ollerenshaw]

I am grateful for that intervention, particularly as I will go on to mention the Recalcitrant Cancer Research Act—as usual, my hon. Friend has got in before me. He is on exactly the right lines in terms of what we are all thinking.

I have talked about good news and extra money. However, I am not sure whether that goes quite far enough. There is still no ring-fencing per se of money for research into pancreatic cancer, brain tumours and so on. Instead, applications will still have to be made for funding. They will be peer-reviewed and selected from similar applications for research into other cancer types.

The issue is that the reason given by Cancer Research UK for not awarding more funding for pancreatic cancer in the past has been that not enough quality applications have been received, so the doubling or trebling of funding set out in the strategy will happen only if more applications are made. For that to happen, we need more researchers in the field, whether established and respected researchers coming over from abroad, such as Professor Andrew Biankin from Australia, who has recently relocated to Glasgow—as usual, Scotland sets the trend—to carry on his pioneering work there, or new, young researchers starting out in their careers.

We are currently in a Catch-22 situation, however: new researchers do not generally want to enter the field, partly because it is deemed difficult to make advances in it—that puts them off as they fear it will hold back their careers, as the Department of Health’s written response to the e-petition mentioned—and partly because the funding is not there. But the funding is not there because not enough research applications are being made.

I firmly believe that we need to break that vicious circle and to pump-prime research into pancreatic cancer, making sure that we hit the minimum funding level required to gain critical mass. I also firmly believe that the Government can and should play a role in that.

--- Later in debate ---

[Mr Stewart Jackson (Peterborough) (Con)]

It is a pleasure to serve under your chairmanship, Mr Chope, and to follow the hon. Member for Worsley and Eccles South (Barbara Keeley). I am impressed by the standard of the speeches in the debate. The hon. Member for Scunthorpe (Nic Dakin) made a powerful opening speech, and the remarks of my hon. Friend the Member for Lancaster and Fleetwood (Eric Ollerenshaw) were moving, passionate and heartfelt.

At the moment we feel that pancreatic cancer is an unfashionable issue that is low on the agenda politically and even in the health world, but other causes have been in that position, and have risen up the agenda because of pressure from this place. Pancreatic cancer is an issue that unites people across parties, and it needs attention. I would compare it to dementia and autism, which were once unfashionable, but then were the subject of landmark legislation and rose up the political agenda. That led to some success, and a huge impact on the people affected by the conditions, and their families.

I want to thank the charity Pancreatic Cancer UK for its brilliant work to raise the issue—and particularly David Park, whom I met a few months ago for a briefing—as well as the all-party group on pancreatic cancer. Seldom do all-party groups make an impact, but that one has set an agenda with the report it produced last year. I also thank Maggie Watts, of course, for her fantastic work. Her diligent, committed efforts got the e-petition going. It would have been easy for her to step back and say, “This is not something I want to get involved in. It is Government and politics, and I will leave it to someone else.” However, her sheer passion and commitment to doing what she thought was right, to right a wrong and raise an agenda, have been utterly commendable, and I congratulate her.

As we have heard, the issue is not one that can be tackled by pressing one or two buttons. The dreadful comparisons that can be made between pancreatic cancer survival rates and those for others including breast cancer and prostate cancer have been pointed out. For example, in 1971 the survival rate for prostate cancer was 31% and it is now 81%. My view is that because pancreatic cancer is now so prevalent and such a major killer, it is no longer acceptable, as a matter of NHS governance, that it should be left solely to the discretion of clinical commissioning groups. I am not a born-again centralist, but I believe we need very strong guidance, at least, from the Department of Health and the NHS, to bring the experience of the best, such as the University Hospital Southampton priority jaundice clinic, to the rest of the country. That is enormously important.

Progress has of course been made in the past few years. NICE is improving outcomes for upper gastrointestinal cancers and of course a pancreatic cancer quality standard is in development. Those things, and the cancer outcomes strategy of 2013, are all very welcome. Of course, they are focused on the quality and efficiency of cancer services, improving patients’ experience of care, and the quality of life of patients and cancer survivors. The hon. Member for Scunthorpe made the point that it is vital for the Government to have both quantitative and qualitative data at their disposal, to make value judgments about research.

I came to this subject almost by accident. It is an often overlooked aspect of being a Member of Parliament that we may stumble on issues, and then have the capacity—the honour and privilege, through being elected—to ask awkward questions and make ourselves a bit of a pain in the backside by doing so, sometimes.

[Richard Fuller (Bedford) (Con)]

Or frequently.

[Mr Jackson]

Or frequently, in my case, as my hon. Friend says.

A good friend of mine—a non-political friend in my constituency—was utterly shocked at the premature death of the husband of a very good friend of hers. He was, I think, 48, and the father of two young children. He had visited his general practitioner several times and was told over again that he was suffering from a very bad case of back pain. By the time he had his scan it was too late; the tumour was inoperable and was wrapped round other vital organs. It was not possible to operate and the poor gentleman died, leaving a young family, a matter of weeks later. That account prompted me to think and research more. Of course, I read the moving article that my hon. Friend the Member for Lancaster and Fleetwood wrote for The Daily Telegraph about his experience and the tragic death of his partner such a short time after diagnosis, and that, too, prompted my interest.

Figures have already been given about the comparative spending on different cancers. The current figure of 1% of research spending, representing £5.2 million, is pitiful for a cancer that is so prevalent. If 8,800 people were being knocked down on the roads every year or killed on level crossings or through any other possibly preventable cause, we would demand immediate action; but it seems we are prepared to countenance little if anything being done by central Government on pancreatic cancer. That is not a party political view, obviously. The comparative data show that the USA has a 6% survival rate after five years and Australia has a rate of 5%; but in the UK it is only 3.3%. We must address that. My hon. Friend the Member for Stevenage (Stephen McPartland) made the point that it is shocking that people attend accident and emergency jaundiced and clearly seriously ill before it dawns on anyone that they are in the advanced stages of pancreatic cancer. I just feel that something more can be done, not least because, according to the briefing we have received, one in six people attend a general practitioner or other health care facility more than seven times, yet they do not receive the treatment they need.

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

I congratulate my hon. Friend on his powerful speech. I think we all accept that earlier diagnosis is cancer’s magic key. The problem is that one in four cancers are first diagnosed late in A and E and the figure for pancreatic cancer is double that—nearly half of all pancreatic cancer patients are diagnosed there. In fairness to the Government, and I will speak about this when I make my speech, does my hon. Friend agree that the focus on survival rates as a means of driving forward initiatives for earlier diagnosis at local level, whether better awareness, better screening, better diagnostics or better care pathways, is the secret to unlocking this dreadful disease?

[Mr Jackson]

I thank my hon. Friend for his excellent work as chairman of the all-party group on cancer in raising the issue of cancer generally. He is right in saying that there is no magic bullet and that a multi-faceted strategy is needed to deal with the issue. I will elucidate on that in a few moments without taking up too much further time.

The hon. Member for Worsley and Eccles South is right about public perception. We must remember that 25% of men and women who are diagnosed with this condition are not old, but younger men and women. The public should understand and embrace that fact, and I know from my experience of a much younger man who was diagnosed with the disease and died very quickly. It affects everyone throughout the country irrespective of gender, age, ethnicity, region and so on.

Over and above academic research, we should focus on GP education. This is not an opportunity to have a go at general practitioners, who do a fantastic job and work hard, but reference has been made in the nicest possible way to the ping-pong effect, as was mentioned in the all-party group’s report. We must stop that and make a decision to have clear strategies with a clinical pathway that people can get on to if they exhibit certain symptoms.

There are several reasons for the poor rate of diagnosis, which are not strictly speaking the “fault” of the general practitioner. As I have already said, there are no definitive biomarkers or tests and there is no way to get round that. It may be ameliorated or overcome following future research, but at the moment GPs are unable to decide definitively that someone is suffering from pancreatic cancer. That is clearly linked to more funding over and above the current 1%, to which I will refer later.

Low awareness of symptoms among the general public needs a multi-media approach to try to persuade people that they are not wasting a general practitioner’s time by alerting them to their symptoms, even if they are under 65. There is a lack of obvious referral pathways into secondary care for patients without obvious symptoms. The hon. Member for Worsley and Eccles South gave an excellent anecdote about the way people are pushed around between different clinicians. That is completely different from the treatment of breast cancer where there are prescribed and definitive treatment pathways.

What are the priorities? It is vital to develop local screening tests. People should not have to travel 40 or 50 miles, and there should be such a testing facility locally in an acute district hospital or in primary care facilities. There should be collaboration between clinical commissioning groups, for example, as well as GP training, referral guidelines and diagnostic support.

I am realistic and I understand that not every GP will be an expert on pancreatic cancer, but there should be a general practitioner in the local area who can offer expert advice, training and assistance. GPs should also have direct access to CT scans. The all-party group on pancreatic cancer made all those recommendations. There should be one-stop shops where patients with vague symptoms can have a battery of different diagnostic tests. That would not remove the risk that someone has pancreatic cancer, but it would reduce the risk that they remain undiagnosed. There should be a rapid access clinic for jaundiced patients. It may be too late for some people, but some may be saved.

We need research into the biology of tumours and we must look again at the cancer drugs fund, as my hon. Friend the Member for Lancaster and Fleetwood said. We must move to a personalised-medicine approach. It is wrong that pancreatic cancer is struggling to receive even £10 million a year for research. The Department should aspire to higher funding than the current £700,000. It should aspire to £25 million by 2022. We need a new strategy along the lines of the Recalcitrant Cancer Research Act passed by the US House of Representatives for cancers of unmet need. We must ring-fence grants for such recalcitrant cancers by means of clinical trials.

This has been an excellent debate. I am convinced that the issue will rise up the political agenda and I thank everyone who has made that possible. I have had dealings with the Minister and I know that she is compassionate and diligent. I believe that she and her Department are listening and that we are well on the way to beating pancreatic cancer.

Hospital Car Parking Charges

Lord Jackson of Peterborough Excerpts

Monday 1st September 2014 Commons Chamber

[Mr Stewart Jackson (Peterborough) (Con)]

I join in the congratulations to my hon. Friends the Members for Thurrock (Jackie Doyle-Price) and for Harlow (Robert Halfon). This is precisely the type of issue for which the Backbench Business Committee was established, so that we can try to alleviate the problems of people who feel their voice is rarely heard when set against a big bureaucracy.

Parking charges are an important issue because there are both philosophical and practical problems with them. Philosophically, it was never the intention that patients should be forced into a back-door stealth tax by virtue of the fact that they drive a car and need to park at a hospital. Health care has always been funded through general taxation, not patient charges, and that principle has been established by all parties. Also, surplus income has been ring-fenced for NHS activities. We run the risk of undermining the philosophical underpinning of the NHS. I accept that this is a cross-party matter, because Labour also sought to deal with it when it was in government.

In practical terms, parking charges cause real hardship for the simple reason that they are a regressive type of taxation that hits the elderly, the poorest and the sickest at the most vulnerable times in their lives. We have heard about various cases today. There are bigger issues involved in the debate, too, including our friends the West Lothian question and the Barnett formula. There is a question of fairness and equity, because people in Wales and Scotland do not suffer a similar encumbrance. Effectively, my constituents in England make a capital payment for free parking at health care facilities in Wales and Scotland, which cannot be right.

As my hon. Friend the Member for Hereford and South Herefordshire (Jesse Norman) said, there is a bigger strategic financial issue to consider—the impact of the private finance initiative, particularly schemes such as that in my local trust, the Peterborough and Stamford Hospitals NHS Foundation Trust, which incidentally has a structural annual deficit of £40 million and so finds it difficult to deal with such matters. Both the Treasury and the Department of Health should consider the irreducibility and intractability of the debt encumbrance on such trusts, which forces them to seek finance in that way. I hope that Ministers will think in such wider strategic terms.

[David Wright]

I agree with pretty much everything that the hon. Gentleman has said. One big problem is that many hospital trusts have gone into fairly long-term contractual arrangements with private sector car parking providers. Alongside the broader points that he makes about hospital funding and PFI, the Government should examine the structure of the parking contracts that hospital trusts have put in place. One of the few ways in which they can help in that regard is through national guidance. The Government should take a lead and say to hospital trusts, “You must review this.”

[Mr Jackson]

The hon. Gentleman is absolutely right, and he touches obliquely on another issue—that of transparency, which some of my hon. Friends have mentioned. It should not just be through freedom of information requests by my hon. Friend the Member for Harlow that we get the relevant data before us. Incidentally, my local trust substantially increased its parking revenue from £1.56 million to £1.71 million in one fiscal year. Transparency throws up some perverse practices, such as the fact that at Stamford hospital, in the constituency of my hon. Friend the Member for Grantham and Stamford (Nick Boles), a small community hospital, there is no requirement to pay for parking, but people have to pay at Peterborough hospital, which serves virtually all my constituents. I do not think that is right.

I believe that there is a direct correlation between a wider lack of NHS transparency and high car parking charges. I cannot prove that, but it is my instinct. I say that having found out only a few weeks ago that the interim chief executive of the Peterborough trust was paid more than £400,000 a year for a four-day week. He did a good job, but at some cost to the taxpayer. Parking charges fall within that narrative, because patients should be allowed to know the costs of parking and the income received from it. As my hon. Friends have said, people parking at hospitals are vulnerable, stressed and upset, and things outside their control—bureaucracy, delay, getting the wrong treatment or whatever—can mean that they have to stay at a health care facility, such as a big acute district hospital, for longer than they would otherwise have to.

My hon. Friend the Member for Harrow East (Bob Blackman) made a good point about centres of excellence. In my area, the eastern region, people have to travel 30 or 40 miles. Someone with a child who has a poorly heart might have to travel from south Lincolnshire to Addenbrooke’s hospital or other places, which is difficult.

It would be churlish not to mention the Government’s guidelines. I welcome them, but we need to be tougher and we need a fiscal incentive for trusts to do the right thing—hopefully, abolishing parking charges. We need to punish trusts if they arbitrarily disregard the Government’s guidelines. Hopefully my hon. Friend the Member for Harlow, with his legendary powers of persuasion that we have seen in the past four years, will ask the Chancellor to take the appropriate action. Ultimately, we should work to abolish parking charges completely, because they are an insidious, pernicious tax on the most vulnerable people in our society.