Secondary Breast Cancer

Andrew Stephenson Excerpts

Wednesday 21st October 2015 Westminster Hall

[Andrew Stephenson (Pendle) (Con)]

I congratulate my hon. Friend on securing this important debate. He is making a powerful case—a case that has also been made to me by my constituent Jade Braithwaite from Colne, whose mother sadly lost her life to secondary breast cancer. Given that it is already mandatory for hospitals to collect the data on secondary breast cancer, does he agree that it is absolutely shocking how few data we currently have?

[Craig Tracey]

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

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

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

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

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

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

Cancer Drugs

Andrew Stephenson Excerpts

Tuesday 20th October 2015 Westminster Hall

[Jim Shannon]

I am unable to answer that question effectively and honestly. I know that question will be brought to the attention of the Minister back home and the Minister here will have a response to it. Today’s debate highlights the issue and raises awareness. We have concerns about the long waiting list. As the hon. Member for South Down (Ms Ritchie) said, we need diagnoses early—the earlier the better. I find it frustrating when I hear from some of my constituents who might wait 12 weeks for a diagnosis and perhaps longer for treatment. We need to address that.

[Andrew Stephenson (Pendle) (Con)]

I join other hon. Members in congratulating the hon. Gentleman on securing the debate. I agree with the point that he is making about the availability of cancer drugs across the United Kingdom. Does he agree with me that the environment in which patients are treated is also important? Will he join me in congratulating my local hospital trust, East Lancashire Hospitals, on its commitment to build a new cancer unit at Burnley general hospital with the support of the Rosemere Cancer Foundation?

[Jim Shannon]

As the hon. Gentleman says, there are many good examples across the whole United Kingdom of Great Britain and Northern Ireland, where things are done well. We thank the doctors and nurses, who work energetically, and the many charities.

The national target for accessing these life-changing drugs is 19 weeks. The move in Northern Ireland will go a long way towards enabling the health service there to reach that target. My hon. Friend the Member for Belfast East (Gavin Robinson) was correct that we need to focus on that target. Each day in Northern Ireland, 23 people are diagnosed with cancer and 11 people die of it. According to Cancer Research UK, there were 331,487 new cases of cancer in 2011 and 161,823 deaths from cancer in 2012. That tells us a wee bit about the magnitude of cancer and its importance to every person in the whole United Kingdom. More should be done but I can only welcome the recent developments in the Province. I hope that other areas of the country can follow suit by freeing up the funds necessary and introducing legislation to prioritise fighting this awful disease to the best of our ability.

In England and Wales, cancer remains one of the biggest killers, causing 29% of all deaths. Progress has been made and all progress is welcome, but it is opportunities like today when we can really make a difference to the lives of individuals and families from all walks of life. Recent developments across the water—here—are deeply concerning. In September, 16 drugs were removed from the Cancer Drugs Fund list in addition to another 16 drugs that were removed from the list in January.

NHS: Financial Performance

Andrew Stephenson Excerpts

Monday 12th October 2015 Commons Chamber

[Ben Gummer]

My hon. Friend raises an important point. There are trusts that are being managed exceptionally well which hit the budgets they set at the beginning of the year. That is the normal course of business for other organisations. This is why my right hon. Friend the Secretary of State introduced the clawback on new chief executive contracts, which mean that if they do not perform according to plan then a proportion of their salary will be docked at the end of the year. That is an important reform, one not introduced by the previous Administration but by us, the party of the NHS.

[Andrew Stephenson (Pendle) (Con)]

May I echo the comments made by my hon. Friend the Member for Newark (Robert Jenrick)? Parts of the Royal Blackburn hospital and Burnley general hospital were rebuilt by private companies in 2006, under the previous Labour Government, at a combined cost of about £140 million. East Lancashire Hospitals NHS Trust will have to pay back almost £1 billion by 2041 because of the PFI contracts signed at that time. Does the Minister agree that the toxic PFI legacy is one of the biggest challenges facing most of our NHS trusts?

[Ben Gummer]

A considerable number of PFI contracts were poorly negotiated under the previous Labour Administration. They need to be looked at one by one, and the Department is committed to doing that again to see whether we can reduce the burden on trusts. My right hon. Friend the Secretary of State will have more to say about that in the course of the transformational changes that we are helping the NHS to make.

NHS Reform

Andrew Stephenson Excerpts

Thursday 16th July 2015 Commons Chamber

[Mr Hunt]

I know that the hon. Member for Ilford South (Mike Gapes) secured a Westminster Hall debate on this yesterday, during which I hope the hon. Member for Ilford North (Wes Streeting) covered most of the issues he wants to address, but I am happy to arrange to meet him or to get the Under-Secretary of State for Health with responsibility for hospitals, my hon. Friend the Member for Ipswich (Ben Gummer), to meet him to discuss those issues in more detail. The hospital trust that the hon. Gentleman talks about—Queen’s and King George are covered by the same trust—has been through a very challenging period. It is a big trust; it is going through special measures, but I think it has good new management. I think they have really turned things around, and that staff are to be absolutely commended. The link with Virginia Mason in Seattle will be as inspirational for them as it has been for me to see what is possible.

[Andrew Stephenson (Pendle) (Con)]

I welcome today’s statement about transformation of our NHS. Will the Secretary of State join me in welcoming the progress made by East Lancashire Hospitals NHS Trust, which came out of special measures about 12 months ago, and particularly the fact that a Health Service Journal and Nursing Times survey recently ranked the trust among the top 100 places to work, with improved staff engagement and morale, which is a huge transformation from where we were when the trust was put into special measures?

[Mr Hunt]

I thank my hon. Friend for his passionate support for that trust through a very difficult period. I also thank him for giving us perhaps the single biggest insight into how to transform a hospital in difficulty: according to all the measures, the most important single thing is to engage with staff. If staff feel supported and listened to, the result is safer care for patients and better outcomes. That is something they have done in East Lancashire, and it is something that many other hospitals could learn from.

Health and Social Care

Andrew Stephenson Excerpts

Tuesday 2nd June 2015 Commons Chamber

[Mr Hunt]

I will just make some progress.

Prevention also means transforming mental health services. I paid tribute earlier to my former colleague the right hon. Member for North Norfolk (Norman Lamb), who did a terrific job. I welcome in his place my right hon. Friend the Member for North East Bedfordshire (Alistair Burt), the Minister for Community and Social Care, who I know will build on his legacy. It also means a big focus on public health, especially tackling obesity and diabetes. It remains a scandal that so many children are obese. I know that the Under-Secretary of State for Health, my hon. Friend the Member for Battersea (Jane Ellison), is working hard on a plan to tackle those issues.

We must continue to make progress on cancer. We have discussed some of the measures that we need to take, but independent cancer charities say that we are saving about 1,000 more lives every month as a result of the measures that have already been taken. We want to build on that.

We have also talked about technology a number of times today. It will remain a vital priority to achieving the ends that I have described. In the last Parliament, I said that I wanted the NHS to be paperless by 2018. In this Parliament, I would like us to go further and be the first major health economy to have a single electronic health record shared across primary, secondary and social care for every patient. Alongside that, our plans to be the first country to decode 100,000 genomes will keep us at the forefront of scientific endeavour, ably championed by the Minister for Life Sciences, my hon. Friend the Member for Mid Norfolk (George Freeman).

[Andrew Stephenson (Pendle) (Con)]

I welcome what my right hon. Friend is saying about transforming services. He has mentioned Airedale hospital twice. I thank him for visiting Pendle a few weeks ago, and visiting Marsden Grange, one of my local care homes, where he saw the telemedicine service from the care home perspective. Will he say more about how telemedicine and improved technology in the NHS can help improve patient care?

[Mr Hunt]

Yes, I absolutely can. Let me give him one specific example. A couple of years ago, I noted a statistic that showed that 43 people died because they were given the wrong medicine by an NHS doctor or nurse. That problem could be avoided if doctors and nurses had access to people’s medical records so that they could see whether patients had allergies and give them the right medicine. The previous Labour Government had a crack at electronic health records. It was not successful, but they were right to try. We have to get it right if we are to have the best health service in the world. I am committed to that.

Oral Answers to Questions

Andrew Stephenson Excerpts

Tuesday 2nd June 2015 Commons Chamber

[Jane Ellison]

This is a particularly difficult and tragic case. My hon. Friend is right to champion the case of her young constituent. My right hon. Friend the Prime Minister asked NHS England to make further contact with the Longfellow family to fully explain the decision, and I can confirm that the clinical director for specialised services at NHS England North has spoken to the family twice in the past few days. The National Institute for Health and Care Excellence is reviewing, as a priority, the evidence on the use of eculizumab in treating this condition.

[Andrew Stephenson (Pendle) (Con)]

T1. If he will make a statement on his departmental responsibilities.

[The Secretary of State for Health (Mr Jeremy Hunt)]

During the previous Parliament I made it my priority to ensure that NHS hospitals learned from the tragedy of Mid Staffs to transform themselves into the safest hospitals anywhere in the world. That work will continue. Today NHS England has announced measures to ensure that even more funding is available to improve the quality of care. These include restrictions on the use of agency staff and management consultancies, and on senior pay. It is right that the NHS takes every possible measure to direct resources towards improving patient care.

[Andrew Stephenson]

I thank the Secretary of State for supporting the bid by East Lancashire Hospitals NHS Trust for £15.6 million to improve the surgical centre, opthalmology and out-patient services at Burnley General hospital, on which I lobbied him extensively. Thanks to the hard work of the trust’s staff, it has exited special measures. What progress has been made on improving safety in hospitals via the special measures regime?

[Mr Hunt]

I thank my hon. Friend for his campaigning for that hospital. The simple answer is that hospitals put into special measures end up recruiting more doctors and nurses and delivering safer care to patients, and his hospital is a shining example of that.

Local Pharmaceutical Services

Andrew Stephenson Excerpts

Tuesday 3rd March 2015 Westminster Hall

[Caroline Nokes (Romsey and Southampton North) (Con)]

It is, as ever, a pleasure to serve under your chairmanship, Mr Howarth. I appreciate your pointing out the clock to me. I might have thought I had got stuck in some sort of time warp and was forever on 7 minutes 29 seconds.

I want to put on the record my thanks to Mr Speaker for granting this debate on the essential small pharmacy local pharmaceutical services scheme, which has played and continues to play an important role in supporting small community pharmacies up and down the country. Pharmacies are an essential part of our health care system, and pharmacists play a key role in providing quality health care. They are experts in medicines and they use their clinical expertise and practical knowledge to ensure that medicines are safely supplied to and used by the public.

Over the past few years, a much greater emphasis has been placed on the role of the pharmacist. People have been encouraged to use their local pharmacy as the first port of call for the minor ailments—coughs, colds and skin rashes—that afflict us all from time to time. Pharmacists also play a significant role in programmes such as smoking cessation and emergency contraception, and they do great work with medicine reviews and in ensuring that people use their medicines properly and effectively. They play a huge role in the winter by providing flu jabs efficiently and cost effectively. If I recall correctly, my hon. Friend the Minister supported Westminster flu day last year. Your interest in diabetes is well known, Mr Howarth, and you will be aware of the important role that pharmacists play in helping those with long-term conditions to manage their diseases.

[Andrew Stephenson (Pendle) (Con)]

I congratulate my hon. Friend on securing this important debate. I am a huge supporter of the role of local pharmacies, and I am kept regularly updated about developments by a number of Pendle pharmacists, including Mark Collins of the Barkerhouse road pharmacy in Nelson and Matthew Leedam of Leedams’ pharmacy in Colne.

Does my hon. Friend agree that expanding the crucial role of pharmacies to enable them to better care for patients with long-term conditions, help people to get the best from medicines and offer people the support and advice they need to live independently and stay healthy would benefit not only patients but our local communities and our NHS?

[Caroline Nokes]

I absolutely agree with everything that my hon. Friend said. Small community pharmacies often know their patients well, so they are at the forefront of helping people to manage their conditions and know whether they are taking the right amount of medicine. They are often a useful place for people to go for an informal chat about the conditions that affect them.

Community pharmacies are at the heart of our communities. They dispense advice as regularly as medicine, and they help people to make healthier lifestyle choices. Pharmacy Voice, the organisation formed from the three largest community pharmacy associations, strongly advocated the role of the community pharmacy as part of the solution to pressures on accident and emergency and GP services. It has encouraged people to think, “Pharmacy first”, and it has described community pharmacy teams as being perfectly placed to care for patients with common winter ailments. We are coming out of winter and into spring, but pharmaceutical services are there all year round. They are just as adept at dealing with allergies, stings and hay fever as they are at dealing with winter colds.

Last year, Pharmacy Voice identified that up to 8% of A and E visits could have been dealt with by a high street pharmacy, and approximately one fifth of GP visits could have been avoided by visiting the pharmacist. Last year, NHS England reinforced the role of the community pharmacy with the “Feeling under the weather?” campaign. Many Ministers, including my hon. Friend the Minister, have emphasised in responses to written and oral questions that pharmacists have a great role to play in helping people to manage long-term conditions and in helping people with their medication.

None of the pharmacists I spoke to prior to this debate is sure when the role of the essential small pharmacy was first recognised, but I can say with certainty that the essential small pharmacy in the village of Wellow in my constituency has benefited from support, reflecting its small scale and relative remoteness from other pharmacies, since it opened in 1990. The national contract for such pharmacies was first introduced in 2006, and it has been extended a number of times since then. About 100 pharmacies receive support from the essential small pharmacy local pharmaceutical services scheme. Many are located in relatively remote rural areas, but some operate in inner-city communities. Over the years, they have provided services that have been relied upon by residents for their health care as well as their dispensing needs.

The current pharmaceutical needs assessment, published in 2011, supports the continuation of the scheme. It states:

“ESPLPS pharmacies are used to ensure that access to pharmaceutical services is achieved in certain locations in line with the model of access to pharmacy services in ‘Healthy Horizons in Primary Care’.”

Rural bus services are being reduced and it is increasingly difficult to access other pharmacies by public transport, so small pharmacies can easily be described as essential to local communities. Certainly, that is true of Wellow pharmacy.

What is the problem, and why have I requested this debate? These arrangements have existed for many years and have provided modest support for small pharmacies, where they are needed for patients, but where they might not otherwise be economically viable. The national contract was introduced in 2006, and negotiations by the Pharmaceutical Services Negotiating Committee have seen it extended a number of times. But what is an essential small pharmacy? The criteria for eligibility are that the pharmacy must be dispensing fewer than 26,400 items a year and must be more than 1 km from the next nearest pharmacy. Their benefit to communities was deemed to be so great that a minimum level of remuneration was set. It is currently just under £80,000 a year. From the pharmacy global sum, a top-up payment would be permitted to ensure the continued viability of the pharmacy. However, NHS England confirmed last autumn that it is not possible to continue national arrangements, leaving individual pharmacies to negotiate with their own NHS area teams. Support has been available from the PSNC, but many local pharmacists have found those negotiations difficult, time consuming and stressful. Although some have been successful, other area teams have not been able to provide certainty.

Oral Answers to Questions

Andrew Stephenson Excerpts

Tuesday 24th February 2015 Commons Chamber

[Dr Poulter]

The hon. Gentleman will be aware that it was the previous Labour Government who in 2006 set these eye-watering redundancy payments for the NHS, and we have committed to making sure we reform and change that. Therefore, as part of our negotiations and pay offer to NHS staff we want to introduce a redundancy cap of £80,000. Since many Opposition Members are supported by trade unions, I hope they will encourage union members to back that pay and redundancy cap.

[Andrew Stephenson (Pendle) (Con)]

Can the Minister confirm that according to the latest figures there are more nurses working in the NHS now than there were in 2010, including an additional 391 at East Lancashire Hospitals NHS Trust and an additional 59 at Airedale NHS Foundation Trust, the two trusts that serve my constituency?

[Dr Poulter]

I am delighted to confirm that, and we have made a conscious decision to reduce NHS waste and bureaucracy. NHS administration spending is down from 4.27% under the previous Government to only 2.77% now, which has resulted in £5 billion of efficiency savings and meant we can invest in about 6,000 more nurses, midwives and health visitors.

Francis Report: Update and Response

Andrew Stephenson Excerpts

Wednesday 11th February 2015 Commons Chamber

[Mr Hunt]

I can say that we are consulting on making a big change that would mean they would have someone independent in their organisations to whom they could talk and raise their concerns. They could say, “I want to say this, but no one is listening to me”. That is what Sir Robert Francis calls “freedom to speak up” guardians, whom he wants in every organisation. It is what Helene Donnelly is championing in her work. That is the way forward to address those concerns.

[Andrew Stephenson (Pendle) (Con)]

East Lancashire Hospitals NHS Trust was placed in special measures, following the Keogh review, in July 2013, and it successfully exited that regime in July 2014. The trust has employed an additional 201 nurses and nursing support staff and 26 more doctors since June 2013, taking the total increase since May 2010 to 391 additional nurses and 40 additional doctors. In January 2014, the Royal College of Midwives named the maternity services unit the maternity service of the year. Will my right hon. Friend join me in paying tribute to the dedicated staff at East Lancashire hospitals for working with the new tougher regime and turning my local hospital trust around?

[Mr Hunt]

I absolutely will. This is a great example, and I would like to thank my hon. Friend for the interest he has shown in this issue. For one hospital to have 390 more nurses over four years is remarkable. It may interest my hon. Friend to know that those numbers do not include agency staff, so if the hospitals have any such staff, they will be counted on top of those figures. This is a dramatic turnaround for the quality of patient care, which we all welcome. That just shows that if we get the incentives right from the centre, trusts do want to do the right thing. We did not instruct the trust to employ a single extra nurse; rather, we set up a new inspection regime and special measures regime, and what my hon. Friend said shows it has worked.

NHS Major Incidents

Andrew Stephenson Excerpts

Wednesday 28th January 2015 Commons Chamber

[Mr Hunt]

If executives did not declare a major incident because they were worried about the political consequences, they were wrong, but I would have to be persuaded that they would do that, because every NHS executive I speak to wants to put patients first, with patient safety paramount. On the practical things that we are doing, there are 60 more doctors, and 41 more nurses since 2010, and £4.5 million to help them through this winter. We are doing a lot of practical things to help the NHS in the hon. Lady’s area through the winter.

[Andrew Stephenson (Pendle) (Con)]

Many major incidents have their roots in things that happened some time ago. Blackburn’s A and E department has been struggling to cope with demand since Burnley’s A and E department was downgraded under Labour in 2007—a decision that the right hon. Member for Leigh (Andy Burnham) defended several times in the House, including on 19 November 2009, when he said:

“‘This is saving lives; I will stand by it’”.—[Official Report, 19 November 2009; Vol. 501, c. 236.]

On behalf of the residents of Pendle, I urge the Secretary of State to take no lessons from Labour on the management of our NHS.

[Mr Hunt]

That is it, and that is why it is not working for the Opposition politically when they try to put the NHS centre stage. They can see people who downgraded or closed 12 A and E departments across the country during their time in office now coming to Prime Minister’s questions and trying to criticise this Government when similar things have happened. The answer on all these occasions is to put patients first, do the right thing for patients, be honest about the problems and sort them out, and that is what the Government are doing.