Brain Tumours

Baroness Hayman of Ullock Excerpts

Monday 18th April 2016 Westminster Hall

[Mrs Sharon Hodgson (Washington and Sunderland West) (Lab)]

I start by thanking the Petitions Committee for introducing this important debate and commending my hon. Friend the Member for Warrington North (Helen Jones) for her excellent opening speech, in which she eloquently made the case on behalf of the 120,129 citizens who have signed the online petition. I also commend the hon. Member for Castle Point (Rebecca Harris), who is the chair of the all-party group on brain tumours, for her leadership on the issue and her very emotional speech, which I thank her for.

Over the years, I have had to deal with a number of individual cases, as I am sure other hon. Members have. Currently, I have three, and 132 of my constituents have signed the online petition. The response from our constituents on the issue is not surprising when we realise that, as we have just heard, malignant brain tumours are the biggest killer among all types of cancer of people under the age of 40 and of children.

Also, survival rates for brain tumours have not improved in the last 30 years; if anything, on some measures they have got worse. Currently, only 40% of patients will live for more than a year after diagnosis and less than 20% will survive for more than five years. However, as we have heard, despite those shocking figures, cancer research funding into brain tumours amounts to little more than 1% of the spend on cancer research. Due to the chronic and continuous underfunding of brain tumour research, there are clear knock-on effects to the services and treatments that patients access and receive. If we continue to limit the potential progress that properly funded research might make, those outcomes will never improve. That probably explains the 30-year plateau that I have just highlighted.

As with all cancers, early detection is key to boosting survival rates. That is why it is so dismaying to find that brain tumours are not included in the Government’s Be Clear on Cancer campaign. Early diagnosis not only helps to prevent avoidable death, but can relieve the stress on a patient’s life, as one recent case brought to my attention by a constituent exemplifies. After visiting their local GP twice about feeling generally unwell, my constituent was told that they had all the classic signs of stress and they were prescribed antidepressants.

[Sue Hayman (Workington) (Lab)]

My constituent, Rita Magorrian, got in touch with me about her granddaughter, Helen, who collapsed just before Christmas with a brain tumour. Helen had been to see her GP several times and had been told her problems were down to stress, but she had also been to see her optician and was told the same. As well as considering further training for GPs, does my hon. Friend agree that we need to widen the process to include opticians?

[Mrs Hodgson]

That is an excellent point, well made, and I thank my hon. Friend for it.

Two days later, when my constituent lost all strength on the left side of their body, they went straight to A&E, where it was eventually found they had three brain tumours. After receiving brilliant treatment by NHS staff and support from the Bobby Robson centre in Newcastle, thankfully my constituent is now in remission. However, that case clearly shows the need for improved awareness, as the situation would have been better if the GP had been able to spot the signs of a brain tumour sooner. We in the north-east have an excellent research facility in the Bobby Robson centre, but there are always concerns about its future, as it depends greatly on legacy and charitable donations.

It is also important that research considers the needs of patients. According to studies by Brainstrust, patients believe that more research and funding must focus on the quality-of-life issues, such as function and symptom relief, to help to improve life after diagnosis, whether the diagnosis is terminal or not.

That is reflected in the case of another of my constituents, Malcolm, who was given a terminal diagnosis of a glioblastoma multiforme, or GMB, 4 brain tumour. Despite being told by his doctor in the north-east that he was too sick for further treatment, Malcolm, along with his family, sought out specialists in London. He took the difficult and expensive decision to self-fund the life-extending drug, Avastin, which, although licensed for use in the treatment of some other cancers, was not available on the NHS for use in his case.

Malcom is due to receive another dose of Avastin, but he wants it to be administered locally and is unable to find an oncologist in the north-east who is able to do so, even privately, so Malcolm is faced with either travelling up and down to London for that treatment every two weeks, or perhaps up to Scotland, or to Leeds or Manchester. Although Malcolm has responded well to the Avastin treatment, more options need to be available to people in his position, with treatments to improve the quality of life and, where possible, to extend life. However, that is all for nothing when there is a clear postcode lottery on access to specialists and services, as seen by Malcolm and his family.

The chronic underfunding of research into brain tumours is clearly having an impact on the lives of those who are diagnosed with brain tumours, and that cannot and should not go on any longer.

Mid Yorkshire Hospitals NHS Trust

Baroness Hayman of Ullock Excerpts

Monday 21st March 2016 Commons Chamber

[Paula Sherriff]

I thank my hon. Friend for her intervention. I absolutely agree with her. We must also pay tribute to our incredible junior doctors.

Whatever difficulties the trust is facing, there can be no doubt that those working there on the frontline are blameless, and deserve our full backing. As Members of Parliament, we owe it to them to make sure that they are given all the support they need.

The trust and its staff have to work in a challenging environment. In the area covered by the trust, the overall health of the population is below the average for England. Deprivation is higher than average, and nearly 20% of children are living in poverty. Life expectancy is lower than the national average for both men and women.

The Care Quality Commission inspected the trust in July 2014, with a follow-up inspection in June 2015. An unannounced inspection of Pontefract hospital emergency department took place in July 2015. A second unannounced inspection took place in August 2015 at Pinderfields hospital, focusing on staffing levels, with a follow-up visit to Pinderfields in September.

Although there were some improvements between the two main inspections of 2014 and June 2015, there were also areas in which the trust’s performance had worryingly deteriorated, and there were still serious concerns about staffing levels. The CQC noted that there was still a significant shortage of nurses, which was having a knock-on effect on patient care, particularly on the medical care wards, in community inpatient services, in the specialist palliative care team and in end of life services.

Two weeks ago, my hon. Friend and I met the trust’s new interim chief executive. We were both very grateful to him for his candour. He told us that the leadership team has effectively been in crisis mode for the past 14 months. He said that the trust had recently put in an additional 120 beds across the trust to cope with increasing demand, but the 100 extra staff who should have accompanied that expansion are nowhere to be seen. The posts simply have not been filled.

[Sue Hayman (Workington) (Lab)]

Does my hon. Friend agree that the NHS’s problems in recruiting and retaining staff is one of the most critical issues facing our national health industry and our ability to manage our hospitals properly?

[Paula Sherriff]

I thank my hon. Friend for that intervention. I will come to that point later.

To make things more complex on the administrative side, the monthly staffing reports are found to be overly detailed, generally running to over 100 pages, making it difficult to identify the most urgent risks. Likewise, there are concerns that policies and procedures for the escalation of staffing risks were not always followed when they were identified. The trust aims for a ratio of one nurse to every eight patients on adult in-patient wards. The Royal College of Nursing recommends 6.7 patients per nurse on adult wards as a maximum, so one to eight is not too far wide of the mark, though not ideal. However, the CQC found that even the 1:8 ratio was very inconsistently met. During its unannounced visit to Pinderfields hospital in August, of the 17 wards only one was staffed to safe staffing levels. Ten were at minimum level and six were actually below the minimum. Indeed, records show that in August 2015 only 71% of nursing hours were achieved. Staff on the trust’s spinal injuries unit at Pinderfields are constantly reallocated to other wards, in essence robbing Peter to pay Paul. A nurse even told a patient that because they were so short-staffed, if two patients got into respiratory difficulties, which is not uncommon on a spinal injuries ward, the nurses would have to choose which patient they were to save.

The problem is particularly acute at the community in-patient sites at Monument house and Queen Elizabeth house, where between May and June last year 96% of shifts used at least one non-permanent member of staff, either agency staff or staff redeployed from other areas of the trust. Indeed, two shifts had only a single registered nurse on duty. The trust as a whole breached the Department’s cap on charges for agency staff, on average, 132 times a week during December. While it is absolutely right to prioritise patient safety over the Government’s financial targets, that is a clear indication that there has been a failure in long-term workforce planning and that it is struggling to attract and retain appropriately qualified staff.

To give credit where it is due, the trust has been making efforts to address the staffing issue. After the unannounced inspection, a risk summit was held under the leadership of NHS England to look at the actions the trust needs to undertake and the support needed from the wider healthcare community. The high number of registered nurse and care staff vacancies is now noted on the corporate risk register. The trust is looking at a range of different structures for nursing teams to get the best out of the available staff. It has invested in safety guardians to provide support and safeguarding for patients with mental health issues, freeing up time for registered nurses. It is putting extra effort and resources into filling gaps by looking to recruit nurses both locally and from Europe, proactively recruiting rather than waiting for staff to leave.

The CQC rated the safety of services provided by the trust as “inadequate”, largely due to the shortage of staff. For instance, between May 2014 and April 2015, 258 serious incidents were reported, of which 206 were cavity-like grade 3 pressure ulcers. That sort of thing is indicative of nursing staff being rushed off their feet, unable to provide the level of patient care that they would like. Concerns were also raised about patients who required one-to-one care not receiving it, and fluid balance monitoring and nutritional assessments not being properly completed, with charts often not kept fully up to date. In January, 81.4% of accident and emergency admissions were seen within four hours; the target is 95%. More than 2,000 patients waited on A&E trolleys for more than four hours, including six who waited more than 12 hours at Pinderfields.

When looking at such statistics on patient care, we have to be very careful to remember that each number—each percentage point—represents real people. They are people who may be in pain, or vulnerable, worried or nervous. They may be upset or distressed. By any reckoning, the NHS is our nation’s most prized institution, and when people have to make use of it, they rightly expect a certain level of service. NHS staff want to give that level of service, and when they cannot the result is more than just a delay in treatment—the dignity of patients is also compromised.

A few weeks ago I received an email from one of my constituents. Her 84-year-old father had been admitted to Dewsbury hospital with stroke-like symptoms. He was on a trolley in A&E for 14 hours. After he had been admitted to a ward, his daughter came back to visit him. She found that his bed was a complete mess and covered in food, and her father was naked from the waist down. When she asked why he had on only a pyjama top and was sitting on an incontinence pad, she was told that it made it easier when he needed to urinate. When she came back later that afternoon, his bedding had still not been changed, which in the end she did herself. That is a basic outline of one case, but it is by no means the only such correspondence that I have received from concerned constituents. At the moment I receive similar emails more than once a week, which is alarming.

All that, of course, has an inevitable knock-on effect on staff motivation. The results of the 2015 NHS staff survey show just how low morale has sunk. For every key indicator the results are depressing and fall well short of national averages. Only 54% of staff felt that the care of patients was the trust’s top priority, compared with a national average score of 73%, and 55% felt that the trust acts on concerns raised by patients, whereas the national average is 72%. Just 41% of people would recommend the trust as a place to work. Perhaps most damningly of all, only 46% of people would be happy for a friend or relative to receive care at the trust.

The amount of disciplinary action being taken against staff has risen in recent months, which is generally due to staff making minor mistakes or not being able to follow procedures through fully for want of time. That is a symptom of the shorthandedness that has been experienced on the wards, and it contributes to the general air of despondency as staff are effectively penalised for not being able to be in two places at once. I have spoken to a number of past and present members of staff in the trust, who informed me that they have failed to whistleblow for fear of retribution.

The feeling of being worn down is affecting staff at all levels. I was told by the interim chief executive last week that the board has effectively been operating in crisis mode for the past 14 months, which, of course, is now taking its toll. There is a general feeling of chaos, tempers are fraying, and there is severe instability in the personnel in management teams—a sure sign that the trust is struggling to get its problems under control, which is a challenge in itself.

To be fair, there have been some slight improvements recently. The CQC’s follow-up visits noted that staff were more confident than they had been previously, and that senior management were taking some concerns on board and trying to get to grips with the issues. However, that feeling was by no means universal, and that slight improvement from such a low base is hardly a cause for celebration.

On the underlying causes of these problems, the Government must take the lion’s share of the blame. Going right back to slashing nursing training places in 2010, they have failed to ensure that the NHS has the levels of staff it needs to provide a safe and caring service. Thousands of nurses who should have begun training between 2010 and 2012 and would now be qualified—thereby helping to alleviate the difficulties in Mid Yorkshire—are just not there. Applicants for nursing courses outnumber the available places by more than two to one.

The whole ethos of the NHS has been warped from one of service and care to one of financial management. Of course the health service must keep on an even keel, but when a cash-strapped trust feels that it is appropriate to hire city consultants such as Ernst & Young, alarm bells should start ringing. Thankfully, that contract finally came to an end last September, but not before the trust had stumped up more than £15 million. Given that staff are still struggling to keep their heads above water, they could be forgiven for questioning whether that was money well spent.

Junior Doctors’ Contracts

Baroness Hayman of Ullock Excerpts

Wednesday 28th October 2015 Commons Chamber

[Sue Hayman (Workington) (Lab)]

The Scottish Government have said that they will reject this new contract for doctors, and therefore doctors working in Scotland will not be affected by the reforms to pay and conditions. My constituency is in the far north of England, so this issue is of concern to me and my constituents. We already struggle to access decent healthcare in the county—particularly at our acute hospitals and Cumberland infirmary—due in large part to huge problems with the recruitment and retention of doctors.

Many people in my constituency already travel long distances to access the kind of treatment that they ought to be able to get much closer to home. If Scotland opens its doors to junior doctors from England who feel threatened by this new contract, that will have serious implications for my constituency and other constituencies on the Scottish borders. We already know—it has been discussed in this debate—that there is a problem with keeping doctors in the UK and stopping them moving to other countries such as Australia. If a doctor is working in Carlisle at the infirmary, and all they have to do is move to Dumfries, surely that is a lot more attractive and easier than emigrating to Australia.

As MPs we appreciate the sacrifices that come with working long hours, and the stresses of difficult decisions and the impact on our families. Surely, then, we should appreciate the highly skilled work that our doctors do, on top of the kind of work that we have to do, and we should respect and value their huge contribution. It disturbs me that the Government have lost the confidence of so many in the medical professions. While that lack of confidence continues, we will never resolve issues surrounding the recruitment and retention of professionals and junior doctors in our health service, and we will never resolve the problems experienced by my constituents in accessing the quality care to which they are entitled.

If this contract goes ahead, I have a genuine concern that not only will we fail to recruit the junior doctors we need, but we will lose those we have as they go over the border and into Scotland. I urge the Minister to consider that point. Has that impact been taken into account? Have the Government considered the potential loss of doctors to Scotland? I urge the Minister to look at the issue again.

NHS Reform

Baroness Hayman of Ullock Excerpts

Thursday 16th July 2015 Commons Chamber

[Mr Hunt]

We have some fantastic primary care in Torbay. I remember visiting my hon. Friend during the election campaign and going to a hospice run by an absolutely inspirational lady. We need to build on those traditions, and modern technology offers us an opportunity to go even further. In the end, this is about having a less hospital-centric system and prevention rather than cure, and our great tradition of general practice will be our strongest asset in that change.

[Sue Hayman (Workington) (Lab)]

The idea of seven-day working sounds absolutely fantastic for supplying services, but in west Cumbria, where we struggle to deliver services five days a week, it sounds like nothing more than a fantastic pipe dream. I am aware that the Secretary of State understands the specific problems we have in west Cumbria, but I want to ask him about a letter that I recently wrote to him to do with Cockermouth hospital—a beautiful new hospital which sits half empty. Will he meet me and clinicians from that hospital to see how we can deliver and solve the problems in Cockermouth?

[Mr Hunt]

I would be very happy to meet the hon. Lady and clinicians. I am aware of the problems in that health economy and I am aware that they are long-standing. They are a concern to me and I would be delighted to do anything I can to support her in helping to solve them.

Oral Answers to Questions

Baroness Hayman of Ullock Excerpts

Tuesday 7th July 2015 Commons Chamber

[Mr Hunt]

I would expect that all trusts have done so. If they have not, they will not come out of special measures. That is the benefit of a rigorous, independent inspection regime. Seven trusts have come out of special measures. I hope that the others will come out in due course, but that is not a decision for me; rightly, it is a decision for the chief inspector of hospitals.

[Sue Hayman (Workington) (Lab)]

The NHS in my constituency has moved beyond special measures into the success regime. Will the Secretary of State consider innovative models of care, because my constituency is very different from others and the trust will not achieve success without looking at how it can deliver safety in different ways?

[Mr Hunt]

The hon. Lady is absolutely right. The big change that we need in the NHS is to move away from the dependence on hospital care as the only way to deliver safe, effective care. That is why we put £200 million into the vanguard programme last year, which is looking at such models. I hope that the success regime will hasten the innovation in her area.

NHS Success Regime

Baroness Hayman of Ullock Excerpts

Thursday 4th June 2015 Commons Chamber

[Ben Gummer]

It is such a pleasure to see my hon. Friend return to the House. I know that he has been a tireless campaigner for the people of Carlisle. The success regime, as I said in answer to previous questions, will look at every single part of the local health economy, and every single partner in those discussions will be locally based or national regulators and NHS England.

[Sue Hayman (Workington) (Lab)]

I am desperately concerned about the state of our health services in west and north Cumbria, as are many of my constituents. Many people told me during the election that they want their services delivered as close to where they live—as close to home—as is possible. That is challenging in west Cumbria. I hope that the success regime recognises that, and that we stop talking and consulting and actually have action to deliver the services where people live. That is challenging because of recruitment, and those issues need to be taken into account. I would like the Minister’s assurance that that will be part of the success regime, because without it there will be no success.

[Ben Gummer]

I welcome the hon. Lady to her seat. She is right in much of what she says, and the entire purpose of the success regime is to take action, rather than just to keep on publishing PowerPoint presentations. We will be addressing every single part of the failures in her local health economies, and that may well include recruitment.