Breast Cancer

Debate between Annette Brooke and Jim Shannon

Tuesday 25th November 2014 Commons Chamber

[Annette Brooke]

I thank my hon. Friend, and yes, it is so important. We have the good news that life expectancy is increasing under these circumstances, but that makes it all the more important to think about the quality of those extra years.

There are far fewer clinical nurse specialists for secondary breast cancer. There is no definitive figure, but estimates from Breast Cancer Care suggest that there may be no more than 20 clinical nurse specialists who have expertise or experience of working with secondary breast cancer. This is despite there being approximately 36,000 people living with a secondary breast cancer diagnosis. Given the results of the cancer patient experience survey, and anecdotal evidence from those living with secondary breast cancer, we can assume that many secondary breast cancer patients are not having as positive an experience in their care as those with a primary diagnosis. Unfortunately, we do not know for certain as the cancer patient experience survey does not include a specific stand-alone question on secondary breast cancer. It is essential that the survey continues, so could it not include a question on secondary breast cancer?

Breast Cancer Care ran a taskforce on secondary breast cancer in 2006. Its final report, published in 2008, highlighted a number of issues, other than those already mentioned, that patients with secondary breast cancer face. Those include multi-disciplinary teams not discussing secondary breast cancer routinely, the information needs of patients not being met, and patients not being assessed for their psychological or social needs following a diagnosis—the point that my hon. Friend has just made. Unfortunately, it seems that little progress has been made in the six years since that report was released.

Underpinning the problems with care and treatment for secondary breast cancer—and key to much of this debate—is the lack of data and information about patients diagnosed and living with the disease. As I have already mentioned, we still do not have an accurate figure for the number of people who have been diagnosed with secondary breast cancer, only an estimate. We do not have enough quantitative evidence about the experiences of secondary breast cancer patients.

I had the opportunity to meet some women at a recent Breast Cancer Care event to mark secondary breast cancer awareness day last month, and they told me that the care they received was often inadequate, and certainly not at the same standard as the care that followed their primary breast cancer diagnosis. Some typical comments from patients with secondary breast cancer include:

“A diagnosis of secondary breast cancer changes your life completely—nothing is ever the same again”;

“When you’re diagnosed with secondary breast cancer you can have no idea of just how far and in how many different ways it’s going to change your life. So many people don’t understand what a secondary diagnosis means”;

“So many people tell me how great I look, or tell me that I can beat it with chemo and surgery. They don’t understand that I am in pain and I can’t be cured”;

“The pain I had, from when I was diagnosed, basically it was excruciating. But the pain had started slowly and I’d always had aching pains in my chest area. To the point that it was so bad that I couldn’t hold a glass in my hand or put a handbag on my shoulder. I couldn’t touch my head, I couldn’t dress myself. I couldn’t sleep. I couldn’t turn on my side. And also I couldn’t breathe properly”;

“One thing that does distress me is the lack of continuity in my care and I think that if I had one person who was with me through it all that would help a lot”;

and

“The strange thing about this whole disease is that they don’t really prepare you at all. It’s almost finding out as you go along”.

I think that those comments highlight how much progress we have made on primary breast cancer, with all the advice and support that is given to patients very early on. I want to use this debate to highlight not only that progress, but the need to address those issues for secondary breast cancer, some of which have been faced with primary breast cancer.

Although the comments I have just read out highlight the human story, they are not enough to help us find the solutions. Without firm data and evidence, it is impossible to understand fully the impact of secondary breast cancer. We do not really know enough about the types of treatment that patients are receiving or how the quality of a patient’s life changes over time. That lack of information makes it virtually impossible for commissioners to be able to plan and commission services properly that meet local needs. That, in turn, makes it much harder for clinical nurse specialists with the right knowledge and skills to be recruited, particularly when NHS budgets are under pressure. The result is that patients continue to miss out on the vital support and care they need.

As I mentioned earlier, the Government have committed to improving the collection of data on secondary breast cancer, making it mandatory for the NHS in England. When my colleagues and I met the Prime Minister, he agreed that adequate data collection was required. Following that meeting, in January 2011, the Department of Health published its national cancer strategy, “Improving Outcomes”, which committed to collecting data on secondary breast cancer for the first time, stating:

“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.”

[Jim Shannon (Strangford) (DUP)]

I thank the right hon. Lady for giving way and apologise for not being here for the beginning of her speech; I was at a do down below and could not get here in time. She has just outlined the importance of collecting and then using data to respond to those who have breast cancer. She will also be aware that Breast Cancer Care has campaigned strongly to ensure that data are collected in England. I understand that it hopes to have a similar initiative in Scotland, Wales and, hopefully, Northern Ireland. She refers to the NHS in England. Does she share my opinion that the data should be collected for the whole of the UK so that we can agree a strategy that all four regions of the United Kingdom of Great Britain and Northern Ireland can benefit from?

[Annette Brooke]

I thank the hon. Gentleman for his intervention. I hope that the Minister has taken that point on board, because it is really important. Although data are being collected, they are not being received by various groups, and the purpose of this debate is to address that.

The pilot was run by the National Cancer Intelligence Network 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 being referred to a clinical nurse specialist, palliative care nurse specialist or other key worker at the time of diagnosis. That is despite the NICE quality standards and the evidence in the cancer patient experience survey of the benefit to patients of a named nurse.

Nursery Milk Scheme

Debate between Annette Brooke and Jim Shannon

Monday 5th November 2012 Commons Chamber

[Annette Brooke (Mid Dorset and North Poole) (LD)]

I want to start by saying how important the nursery milk scheme is. All children under five years old in a day-care or early years setting for two or more hours a day are eligible to receive a free daily drink of milk. Milk is full of important nutrients for children. Their free third of a pint portion contains calcium for strong bones and teeth, protein for growth and development, vitamins such as B2, B6, B12 and folate, and the minerals iodine, phosphorus, potassium and zinc.

The Education Act 1944 provided free milk—a third of a pint a day—in schools to all children under the age of 18. I have some personal recollections from the 1950s of the milk in one-third pint bottles left in the sun all day and served in such a way that I am still not very good about drinking my milk, which may be why my bones are a bit fragile. In 1968 Harold Wilson’s Labour Government withdrew free milk from secondary schools, and of course it is well known that in 1971 Margaret Thatcher withdrew free school milk from children over seven.

I saw first-hand the benefits of free school milk for under-fives on my visit to Hayeswood first school in Colehill in my constituency on world school milk day. It was interesting to go to a school, because we have to appreciate that now that children are starting school when they are four, they are accessing the milk at school. I was impressed with the numbers and the uptake at that school, and also with the fact that, through the particular scheme that was operating, older children could have the milk purchased for them at £15 per term.

[Jim Shannon (Strangford) (DUP)]

World school milk day came to my area too. Castle Garden primary school participated and more than 100 young children were present. The important aspect of that visit was that young children who had not taken milk regularly said that they were encouraged by those who were there to participate in taking milk rather than fizzy drinks. Did the same thing happen in the school that the hon. Lady visited?

[Annette Brooke]

Absolutely. Indeed, I was talking to one of my local nurseries—a nursery that is registered for milk. The owner of the nursery had discussed with parents whether they wanted the milk or not. Parents had voiced concerns about participating because their children would not drink milk at home, but they said, “Well, we’ll give it a try,” and to their surprise, every child in the nursery drinks their milk in the group setting.

However, in the past few years the costs of the scheme have been rising. In 2007-08 it cost the Government £27 million, but by 2010-11 the amount had risen to £53 million. Increased costs could be due to greater uptake, growth in the number of under-fives in day care settings or increases in the price of milk. The Department of Health has predicted that costs could rise as high as £76 million by 2016 and so recently set up “Next Steps for Nursery Milk”, a consultation to review the current system and consult on how to make efficiencies.

A significant number of day-care providers are effectively paying over 90p a pint for school milk. I know that we must ensure that the scheme can operate as efficiently as possible while ensuring the greatest access for entitled children. There is clearly also a need to add as little as possible to the burden of bureaucracy on child-care providers and schools. I want to take this opportunity to say how pleased I am that the Department has stated its commitment to this universal benefit for under-fives and that it is fully committed to keeping it as such. The options offered in the consultation are: to leave the scheme as it is; to cap the price that can be claimed for milk; to issue e-voucher cards with economy incentives; or for day-care providers and schools to arrange the direct supply of milk themselves.

There are a number of important aspects to consider when thinking about changing the current scheme. First, it is important that as many eligible children as possible receive their allocation of milk. The Department’s own figures show that roughly 40% of the total number of under-fives currently receive milk at their day-care setting. Whatever system is put in place must be easy to use for day-care providers so that as many as possible take part in the scheme. Given the percentage of children who currently do not receive milk, I ask the Minister to look at how the Government can increase the number of children receiving the milk to which they are entitled. I appreciate that that might be counter to the idea of reducing the costs of the scheme, but I was personally rather disturbed that perhaps only 40% of eligible children access the milk.

Human Rights (Colombia)

Debate between Annette Brooke and Jim Shannon

Tuesday 22nd November 2011 Westminster Hall

[Jim Shannon (Strangford) (DUP)]

I congratulate the hon. Member for Paisley and Renfrewshire North (Jim Sheridan) on securing this debate and on bringing this matter to the House. I want to highlight an issue that perhaps has not been touched upon, which is the human rights of Christians in Colombia.

The Church that I belong to and that I suspect some others in this Chamber belong to, and that many people outside of this Chamber belong to, supports missionaries in many parts of the world and it specifically supports Christians in Colombia. I just want to highlight some of the issues that concern that Church.

We are all very aware of the deadly FARC extremists who are trying to hold sway in Colombia; they are the longest-operating left-wing guerrilla group in Latin America. I want to focus on the human rights abuses and the violence in Colombia that deliberately target churches and their leaders for standing up to the guerrillas and their armed rebellion.

In the time that I have today, I just want to highlight some of those abuses; I am conscious of the issues, but I will not dwell on them too long. There is a catalogue of examples of how the FARC guerrillas have deliberately targeted churches and the work that they do. The guerrillas have tried to close the churches and stop the prayer meetings and gatherings of the people who attend them. By and large, however, the churches have managed to stand up to the guerrillas, and it is good that they have done so.

There is not only human rights abuses against Christians by the FARC extremists, but diminution of human rights and Christian activity by the Colombian state, and I wanted to highlight some examples of that state activity. The Indigenous Municipal Council has suffered a number of violations, including violations against 3,000 indigenous Christians in the province of Cauca. The hon. Member for Ayr, Carrick and Cumnock (Sandra Osborne) said she had some difficulty with some of these Colombian words and so have I. As an Ulster Scot with a very distinct Ulster accent, it is sometimes difficult to get my tongue around some of these words. The governor of Cauca ordered property to be removed from some people in the province. On 17 December last year, a council man was murdered because he was a Christian. On 3 February this year, a Christian family were forced out of their burning home. The leaders of the Indigenous Municipal Council and 20 Christian families were also forcibly moved. A pastor, his nine-year-old daughter and a woman from the pastor’s church were killed because they stood up to the abuse of Christians. Another pastor’s wife was killed, and other people have been imprisoned. Clearly, there has been a catalogue of discrimination and brutal attacks on members of the Christian community.

There have also been political attacks on people. In many villages in Colombia, especially on the western coast, the guerrillas are writing threatening messages on walls and deliberately targeting people in the villages to get them to vote for the candidates that the guerrillas support in elections.

I also want to comment on the issue of religious freedom and on the restrictions that exist in Colombia. In 1991, the Colombian constitution respected religious freedom and practice, and it also mandated the separation of church and state, which is a principle I support. However, the Catholic Church retains a de facto privilege and status in Colombia. Also, the state recognises as legally binding only those religious marriages celebrated by the Catholic Church. Members of the 13 non-Catholic religious organisations, which are not signatories to the constitutional agreement, must marry in a civil ceremony. So I again highlight the fact that there is clear human rights abuse and discrimination against those people. Also, the Treasury Department in Colombia imposes a 4% tax on all tithes, offerings and charitable contributions to certain churches. I contribute to much missionary work—I know that other people do as well—and in Colombia there is also a 17% tax on all financial assistance received from abroad.

Those are the points that I want the Minister to respond to. I am sorry that I do not have time to develop them more, but I look forward to hearing his response.

[Annette Brooke (in the Chair)]

I call Mr Andy Love to speak. I am afraid that you have only three minutes.