Public Health Funding: Enfield

Bambos Charalambous Excerpts

Tuesday 16th July 2019 Westminster Hall

[Joan Ryan (Enfield North) (IGC)]

I beg to move,

That this House has considered public health spending in Enfield.

It is a pleasure to serve under your chairmanship, Mr Betts.

I requested this debate to highlight some of the harsh realities stemming from the Government’s decision to slash the public health grant to our community, and to draw attention to the fact that the ongoing uncertainty around long-term funding is prompting a crisis in public health. Our council’s ability to deliver a range of public health services aimed at preventing disease, prolonging life and promoting good health is being seriously affected.

The Government’s national health service long-term plan may have put prevention at the heart of its policy but, to quote David Finch, senior fellow at the Health Foundation:

“The sustained cuts to the public health grant clearly run counter to these aims. The public health grant is not a nice-to-have. Without urgent reinvestment, we will continue to see a direct impact on people’s long-term health”.

Last month, the Health and Social Care Committee said that cuts to public health services were a “false economy”. Cancer Research UK and more than 80 other organisations have come together to call on the Government to provide a sustainable solution for public health. Ministers must take immediate and positive action to increase investment in public health, to reduce health inequalities and to support our health and social care system.

I will take this opportunity to pay tribute to the work of the Enfield Over 50s Forum and its president, Monty Meth, who is sitting in the Public Gallery today with many of the forum’s members. Their typically dogged campaign to highlight the cuts to Enfield’s public health grant and the disparity in per-person funding between our borough and other councils in London has forced this issue to the top of our community’s agenda.

The Minister should be well aware of the forum’s work on this matter, given the number of letters that its members have written to her and her Department in recent weeks and months—although, sadly, their letters have not received a considerate ministerial response. Instead, they have received a reply from the Department’s correspondence unit that, to put it mildly, leaves a lot to be desired.

One constituent with impeccable manners, who forwarded me a copy of the letter he received, described the response as “baloney.” Another resident labelled the reply “meaningless” and “full of Whitehall gobbledygook”, and it is hard to disagree with that analysis when they are treated to phrases such as:

“The formula is designed to generate target allocation shares of a funding envelope”.

[Bambos Charalambous (Enfield, Southgate) (Lab)]

Does my right hon. Friend agree that, because the baseline funding has been set from 2013, it takes no account of changes in the population of Enfield to do with age, poverty and other factors that might hugely affect the funding that Enfield actually deserves right now?

--- Later in debate ---

[Seema Kennedy]

I will move on to the specific issue of the funding formula, how it came into being and how it might change. Of course public health is a question of the investment that national Government put in and how local authorities spend it, but there is a lot of innovation. I applaud Enfield Council and all local authorities for what they have done, because different authorities have used it in different ways. They are adopting innovative approaches. They are renegotiating contracts that perhaps had been untouched for years before the 2013 transfer. I will address funding later in my remarks. Councils are adopting new service models that have the potential to reach communities that have often been left out by traditional service delivery models.

I recognise that in the last spending review, there were difficult decisions to be made to ensure the sustainability of public finances, but over the five-year period, £16 billion has been available to local government for use on public health, including £3 billion for the current financial year.

The right hon. Lady raised a very important issue about the distribution of funding for local authority public health activity. I recognise the pressures that she has referred to specifically in relation to Enfield. When responsibility for local health functions moved from the NHS to local government in 2013, funding for relevant services was transferred to individual local authorities. That was based on historical local spend for the NHS, and the process revealed huge variation across the country. The funding for Enfield is based on what the NHS had been spending there up until 2013.

The Government are now carefully considering how to allocate public health funding in a more needs-based way, rather than continuing to allocate funding based on NHS historical spend. We recognise that Enfield’s per capita funding breakdown is different from that of other London boroughs, but a per capita basis is not actually a meaningful way of comparing allocations or the best way of determining funding. That is precisely because it takes no account of different levels of need and it disregards significant variables that have a major influence on the need for public health interventions. An example is the age profile of a local authority’s population. We will look carefully during the next spending review at future funding arrangements and the best way to allocate funding to each local authority.

On the letters from the Enfield Borough Over 50s Forum, if the right hon. Lady would like to distil those messages into a letter to me, I will happily respond to her and she can make that response available to her constituents.

[Bambos Charalambous]

A future funding formula needs to take account of need. There should not be the current differentiation. Kensington and Chelsea receives £82 per person more in funding than Enfield. It cannot be right that two boroughs that are about 8 miles apart have such a variance in funding. Will a future funding formula take more account of local needs?

[Seema Kennedy]

As I have said, the Department is looking at the funding formula. The hon. Gentleman says that the boroughs are only 8 miles apart, but we know that in areas that are very close together, life expectancy and, importantly, the length of time a person lives in good health can vary hugely. That is why we need to look very carefully at all the factors before the new formula is created. That will be assessed in the next spending review in the light of all the available evidence.

I am committed to working closely with local government, and with other partners and colleagues, to build on the achievements of the last six years. We need to act on a local, national and global level to meet the public health needs of the present and to rise to the public health challenges of the future.

Question put and agreed to.

Medical Cannabis under Prescription

Bambos Charalambous Excerpts

Monday 20th May 2019 Commons Chamber

[Tonia Antoniazzi]

I entirely agree, and I am very concerned about it. We have heard in the House this evening that people are growing their own cannabis, and there is a growing trade. There is an online family of people who are helping each other to obtain the most THC possible from different combinations of different plants. It is a complete industry. Why are the Government not getting a grip, and providing a proper, GMP-standard, pharmaceutical product for people?

I also want to talk about the cost, which is extraordinary. Has the Minister or anybody in her office done a cost-analysis? Alfie Dingley’s case provides a classic example: how much has he saved the NHS by not having emergency medication and not using the ambulance service to go into hospital? It seems nonsensical that we are not going down this road.

I want to talk about a couple of my constituents. Only a few weeks ago I had a visit from the parents of a 14-year-old son. My son is 14 too, so their situation struck a chord with me. Their son has intractable epilepsy. Mum has given up her job to look after him—he has a very efficient system around him. He benefits from a ketogenic diet and the next available medicine is Epidiolex. Epidiolex does not contain THC but she wants her child to be on a trial, and the trial is limited. A mum should not come to me begging for her son to be on a trial, but when I spoke to her about medical cannabis with THC she was reluctant to engage because of a fear of breaking the law and of not following the system properly. All our families are following a system. They are at the end of the road in terms of what medicine they can be given, so I want them to be given medical cannabis with THC as soon as we can.

NHS England is drafting terms of reference, and as co-chair of the APPG I appreciate its efforts. These children must have access, however; they must not be waiting three or four years. I urge NHS England to work collaboratively with the devolved nations because we need our children in Scotland, Wales and Northern Ireland to have the same benefits.

[Bambos Charalambous (Enfield, Southgate) (Lab)]

I congratulate my hon. Friend on her excellent speech and the excellent work she has been doing with the APPG. I also congratulate the End Our Pain campaign, which has done so much to raise this issue. Does my hon. Friend agree that NHS England needs to improve its guidance on intractable epilepsy and fast-track it so that children can get the THC they need?

[Tonia Antoniazzi]

I totally agree that a completely different approach is needed if we are to get the medicine to our families now.

It is very upsetting that families are risking getting criminal records by bringing in medical cannabis and are having to fundraise for prescriptions. I pay tribute to families that are fundraising in the public domain—to the parents and the friends, such as Craig who has cycled many, many miles up Pen y Fan recently to raise money for Bailey. I say to all those families that are raising money, “Don’t give up; there is hope, and hopefully we will be able to get you the medicine you need on prescription from the NHS.”

It would be very remiss of me to stand here and not pay tribute to the late Paul Flynn, former Member for Newport West. Paul was an absolute inspiration. I was a patron of an organisation with him and he was inspirational when I went to Birmingham to speak with him. His knowledge of and passion for medical cannabis was second to none, and I know that, as Madam Deputy Speaker mentioned, he is watching over us now and hoping we will get the breakthrough he was working so hard towards.

My hon. Friend the Member for Manchester, Withington (Jeff Smith) spoke of a bespoke medical response and creative thinking, and I ask the Minister to work with us: pull groups of families out of local trusts and set up an immediate observational trial with the 18 families that we have at End Our Pain; get the NHS to pay for the costs of the medicine when a private prescription has been issued until NHS prescribing is more routinely accepted; and allow the guidance from medical cannabis experts to be used. Some excellent UK experts have come together to form the UK Medical Cannabis Clinicians Society, and they have issued prescribing guidance, too. I say, “Please, work with the NHS to give clear central guidance that medical cannabis is legal and that there is an expectation that it will be prescribed as a normal unlicensed medicine when appropriate.”

Oral Answers to Questions

Bambos Charalambous Excerpts

Tuesday 7th May 2019 Commons Chamber

[Mr Speaker]

Order. We have a lot to get through. I shall take one more question, and then we must move on.

[Bambos Charalambous (Enfield, Southgate) (Lab)]

Today I met representatives of the Teenage Cancer Trust. As we await the publication of the workforce implementation plan following the publication of the NHS long-term plan, what plans does the Minister have to ensure sustainable funding for the teenage and young adult cancer specialist workforce?

[The Parliamentary Under-Secretary of State for Health and Social Care (Seema Kennedy)]

I thank the hon. Gentleman for his question; I had the pleasure of meeting representatives of the Teenage Cancer Trust recently as well. Cancer is an absolute priority for the Government. Our aim is for 75% of all cancers to be detected at an early stage by 2028. As my right hon. Friend the Secretary of State has said, the workforce plan will be reporting imminently.

Age-related Macular Degeneration: NHS Funding

Bambos Charalambous Excerpts

Tuesday 9th April 2019 Westminster Hall

[Bambos Charalambous (Enfield, Southgate) (Lab)]

I beg to move,

That this House has considered NHS funding for age-related macular degeneration.

I begin by welcoming the Minister to her place. I am very pleased that she is now a Minister and I look forward to having many more interactions with her.

Sight is a wonderful gift. Sight allows us to witness and experience the world we live in. It is not surprising that, in survey after survey, the fear of losing one’s sight comes top in comparison with other conditions. It is remarkable that we do not hear more about the leading cause of blindness in adults, which is age-related macular degeneration or AMD for short.

AMD is the breaking down of the macula, which is the sensitive and small tissue at the centre of the retina. It is responsible for processing central vision and allows us to see colour, detail and sharpness in objects. There are two types of AMD: dry and wet. Dry AMD, which affects 90% of people with the condition, is caused by thinning of the under-layer of the macula, which can lead to blurred vision. Thinning of the under-layer of the macula is caused by small white or yellow deposits called drusen. They may at first not affect vision all that much, but as they build up over time, they can lead to blind spots in someone’s central vision and can later become wet AMD.

Wet AMD is usually caused by new blood vessels growing underneath the macula that bleed and leak into the macula, which can cause blindness and distort vision in that eye. The onset of wet AMD is more rapid and can be more damaging, leading to irreversible vision loss. According to the charity Fight for Sight, AMD is the leading cause of sight loss in the UK, predominantly affecting people aged over 65. It accounts for 50% of severe sight impairment and 52% of all Certificate of Vision Impairment registrations in England and Wales.

AMD progressively damages a person’s central vision, which in some cases can leave them unable to read, drive or recognise faces, although they may retain their peripheral vision. It is estimated that 600,000 people in the United Kingdom are living with late-stage AMD. Industry data suggest that by 2026 there will be 9.7 million people in the UK affected by all stages of AMD and 800,000 of them will have late-stage disease that affects their vision. Projections suggest that by 2050 the figure for people with late-stage AMD could rise to 1.3 million unless measures are taken now to address this issue.

[Marsha De Cordova (Battersea) (Lab)]

I congratulate my hon. Friend on securing this very important debate and I, too, welcome the Minister to her place. Significant numbers of people will potentially lose their sight. My hon. Friend has cited some of the figures. By 2050, the number of people living with sight loss will be in excess of 4 million. Does my hon. Friend agree that, given the numbers, it is time that we had a UK-wide vision strategy on eye health and sight loss?

--- Later in debate ---

[Bambos Charalambous]

My hon. Friend makes an excellent point; I will come to that matter later in my speech.

AMD is an ever increasing public health issue, presenting as one of the number of long-term conditions that can lead to an increased risk of morbidity in patients. AMD costs the economy an estimated £1.6 billion a year and hits the productivity of society. There is a strong correlation between AMD and decreased quality of life outcomes, including an increase in depression, impaired ability to do everyday tasks, feeling more socially isolated and being 1.7 times more likely to suffer falls. Twenty-one per cent. of the annual medical cost of falls, which is £56.5 million, is attributed to those with visual impairments. The loss of independence resulting from sight loss can also be incredibly debilitating because systems are not set up to deal with it.

[Jim Shannon (Strangford) (DUP)]

I congratulate the hon. Gentleman on securing this debate, and I offer the Minister all best wishes in her new position. It is well deserved, and we look forward to working with her regularly in Westminster Hall and elsewhere.

My father suffered from AMD, although he did not know he had it until it had reached a late stage. Does the hon. Gentleman agree that early diagnosis is important for all matters of eye care that affect us, as is visiting an optician at least once if not twice a year? That is one positive thing we can do.

[Bambos Charalambous]

The hon. Gentleman makes an excellent point. Early diagnosis is so important, especially for wet AMD. The target requires people to be seen within 18 weeks of diagnosis, but that is unacceptable for people with wet AMD who should be seen within two weeks. Otherwise, their vision could suffer serious damage.

One concern is that the NHS has insufficient eye clinic capacity, due to delays and cancelled appointments that the British Ophthalmic Surveillance Unit has identified could lead to up to 22 patients a month losing their vision. The all-party group on eye health and visual impairment—I am pleased to see two members of the group here today—is supported by the Royal National Institute of Blind People, and in its inquiry, “See the Light”, published in June 2018, it identified 16 recommendations on which the Government should take action.

Three recommendations on which the APPG is still waiting to see progress include: the urgent need to increase the number of trainee ophthalmologists to keep pace with increasing demand; the need to ensure that sustainability and transformation partnerships—STPs—address current and future need; and the need to establish a national target to ensure that patients who require follow-up appointments are seen within a clinically appropriate time to prevent delayed and cancelled appointments.

According to statistics from the Industry Vision Group, last year three out of 44 STPs identified ophthalmology as a priority service, and only seven out of 44 met the 18-week referral target every month between January 2017 and January 2018. Early intervention for wet AMD is crucial to avoid blindness, and even the 18-week target that I mentioned to the hon. Member for Strangford (Jim Shannon) is not suitable for people with wet AMD, which requires treatment within two weeks. There is still a need to collect robust data on ophthalmology at clinical commissioning group level in order to assess performance and learn from best practice. Some of the issues relating to delay or the cancellation of appointments may be due to systems and processes, and not necessarily to funding.

Ophthalmology has the second highest outpatient attendance of any speciality, with 7.6 million appointments in England in 2017-18 accounting for 10% of all outpatient appointments. As we are all living longer, that figure is projected to increase by up to 40% over the next 20 years. The Government could do a number of things to help improve the situation for people with AMD and other sight-threatening conditions. First, we need a national eye health strategy—that point was raised by my hon. Friend the Member for Battersea (Marsha De Cordova). Unlike Scotland and Wales, England does not have a national eye health strategy, but one is needed to address workforce capacity issues and health inequalities, and to enable better care and improvements to the quality of life for those with AMD.

[Tom Tugendhat (Tonbridge and Malling) (Con)]

The hon. Gentleman is making a good point. In my community the Kent Association for the Blind has done a lot of work on this issue, and I was proud to visit it recently. I also congratulate my hon. Friend the Minister on her new appointment, and on her liberation in finding her voice again and being able to express her own views, albeit of course measured through those of the Government.

[Bambos Charalambous]

I am pleased to hear of the excellent work taking place in the hon. Gentleman’s constituency.

Contained within the strategy should be a minimum commitment to research similar to that given in the Government’s dementia 2020 challenge, which committed £60 million a year to dementia research, resulting in significant advances for those suffering with dementia. It is unclear how much funding has been set aside for ophthalmology from the £20 billion announced in the Government’s NHS long-term plan. I would be curious to hear from the Minister whether it is part of the plan or not.

There is also a need for the establishment of a national ophthalmology database to collect and analyse data for the purpose of improving outcomes, better decision making, and allocating resources. At present, there is fragmented data collection, such as that by the health quality improvement partnership, administered by the Royal College of Ophthalmologists, which covers only cataract surgery. A database that routinely collects information on AMD would greatly assist research and the planning of clinical care for those with AMD.

All STPs and integrated care schemes should be held accountable for developing and implanting integrated ophthalmology plans. Three years ago, the Department of Health commissioned a number of “Getting It Right First Time” reports into a series of areas, including ophthalmology. Unfortunately, that report is yet to be published, but hopefully when that happens it could inform the integrated ophthalmology plan, along with other sources such as the Royal College of Ophthalmologists’ “Way Forward” reports.

[Jim Shannon]

The hon. Gentleman is very gracious. As I should have said earlier, I declare an interest as the chair of the APPG for eye health and visual impairment. He is right that it is important to visit an optician to have a test for AMD, but such a visit can have other benefits. Through a person’s eyes, an optician can get an idea of what that person’s body is like, and can diagnose other things that are wrong. There are other benefits to visiting an optician for an early AMD test, in terms of everything that goes with it.

[Bambos Charalambous]

The hon. Gentleman makes an excellent point. We should all visit opticians on a regular basis, because they can detect a whole series of other eye conditions.

My second ask is for the publication of a workforce development plan for ophthalmology. That should also be a priority. There is already a shortage of eye care specialists who can diagnose and treat AMD. The number of ophthalmologists in the UK is the second lowest in Europe. The numbers are expected to reduce further, while the patient population is likely to increase significantly. The Department of Health and Social Care should commit to producing a workforce development plan that addresses the current situation and assesses future demand and provision need.

NHS RightCare should also develop guidance and a workstream for AMD, and data packs that can be shared as a resource and inform improvement in treatment for AMD. An IT platform that allows better integration of services is needed—for example, from primary care to hospital-based ophthalmology—so that a more joined-up approach can lead to better outcomes for patients with AMD.

Finally, it should be remembered that there is a link between sight loss and mental health, depression and frailty. The secondary effects of sight loss should also be considered when making both national and local policies on commissioning services.

[Marsha De Cordova]

My hon. Friend is being very generous. On that point about the impact of sight loss and the link to mental health, does he agree that a clear strategy would enable all services to be more joined up, so that when somebody is diagnosed with losing their sight all the relevant support would fall into place because there is a clear pathway?

[Bambos Charalambous]

My hon. Friend makes an excellent point. The impact of sight loss can lead to depression and other mental health issues, so they should form part of any strategy related to sight loss. I agree with her 100%.

I ask the Minister to recognise the need for more attention to the needs of people with AMD, and to set about taking on board and implementing the suggestions that I have raised.

Services for People with Autism

Bambos Charalambous Excerpts

Thursday 21st March 2019 Commons Chamber

[Huw Merriman]

The hon. Gentleman has referred to adults, but I remember going on a trip with the APPG to a young offenders institution that had tried to establish a wing that was autistic-friendly, and hoped to roll it out across the estate. He is right: a big cohort of the prison population are on the spectrum, and face particular challenges that need to be looked at.

[Bambos Charalambous (Enfield, Southgate) (Lab)]

Will the hon. Gentleman give way?

[Huw Merriman]

I will give way one more time, but I really should make some progress.

[Bambos Charalambous]

The hon. Gentleman mentioned the issue of employment, which is vastly overlooked. Many employers do not know what adjustments they should make to become more autism-friendly, and people with autism are deprived of work as a result. Will the inquiry be looking at that issue?

[Huw Merriman]

A few years ago, Ambitious about Autism produced a big report looking looked at that specifically. I am fortunate to have in my constituency an organisation called Little Gate Farm, which takes people who have finished their education and makes them work-ready. However, it requires employers to give them a chance, and I am always writing to employers urging them to do so.

Let me give some examples. One young lad was obsessed with washing cars. We matched him up with a garage, and that is exactly what he does. Someone else was given a job in a bookkeeping firm. The big challenge there is ensuring that that young person takes time off, because they have become so used to the routine. The initiative has become so successful that people are throwing themselves into work. We must do all that we can, as Members of Parliament, to pair and support people.

My right hon. Friend the Member for Chesham and Amersham says that we in the APPG

“will hold the Government’s feet to the fire to see those recommendations reflected in the new strategy.

Our need to act is clear. Too many people”—

as we have just discussed—

“still have to wait too long for a diagnosis—more than three years in some parts of the country. Getting a diagnosis can be a crucial milestone, helping to unlock vital support. Delays in being diagnosed can result in people developing more significant needs, or mental health problems.

National guidance from the health watchdog NICE state clearly that children or adults suspected of being on the autism spectrum should start their diagnostic assessment within three months of being referred to their local autism team. But we know there is a postcode lottery in waiting times for appointments, with many parts of the country falling far short of the three-month target. Alongside the National Autistic Society, we have been pushing progress on this issue in this very chamber for several years. Valuable research”—

carried out by the right hon. Member for North Norfolk (Norman Lamb)—

“on behalf of the APPGA shone a further spotlight on these long waits and called for a mandatory minimum waiting time standard. I am pleased to have him on board again leading our inquiry on health and mental health, which heard evidence last week.

We also know that autistic people too often don’t get the physical and mental health care they need. They face high levels of health inequality, and evidence suggests that people may die early as a result, which has been highlighted by Autistica. It’s vital that all health and care staff receive autism training to ensure that our health service meets their needs and makes the changes and adjustments that it needs to—a key part of the Autism Act. I welcome the Government’s current proposals on mandatory training in autism and learning disability to all health and care staff following the dogged campaigning of Paula McGowan, a mother who tragically lost her son Oliver. It’s vital that this proposal is taken forward and that its impact is monitored. I hope the Minister will devote some time to make sure that this programme makes a difference.

I also welcome the inclusion of autism, alongside learning disability, as one of the four clinical priorities in the NHS 10-year plan to improve health services. This is a great step towards ensuring that the NHS supports autistic people as well as it supports everyone else. It sets out actions to reduce children’s diagnosis waiting times, reduce the number of autistic people inappropriately under section in mental health hospitals, and making sure that reasonable adjustments are put in place. But we need more details on how these, and other commitments in the Plan will be delivered (and how they will be funded). I would appreciate if the Minister could update the House on when we can expect to see this much-needed detail.

I am pleased to see the Government already thinking ambitiously about the future of the strategy. I warmly welcome the Government’s commitment to extending the autism strategy to include children and young people, as well as adults, for the first time.”

NHS 10-Year Plan

Bambos Charalambous Excerpts

Tuesday 19th February 2019 Commons Chamber

[Bambos Charalambous (Enfield, Southgate) (Lab)]

In May 2018, I introduced my private Member’s Bill on palliative care. Investment in palliative care will help save the NHS billions. While the long-term plan deals with some aspects of end-of- life care, it does not go far enough. There is still a postcode lottery when it comes to hospice funding, with some areas getting up to 50% of their funding from clinical commissioning groups, while other areas get as little as 1%.

We will all be living longer, so it is vital that we put in place proper funding for hospices and end-of-life care. I am very lucky to have North London Hospice’s health and wellbeing centre in my constituency. It provides excellent services for users, but I am still staggered that it has to constantly fundraise to keep them going. These services are vital and should not be dependent on people’s charity. I ask the Minister to commit to making all clinical commissioning groups assess the need for palliative care in their area and provide funds accordingly to meet that need.

Another area where we need additional investment is the NHS workforce. To address the anticipated rise in cancer, with the rise in life expectancy, the Government need to ensure that measures are in place to deal with training, recruitment and retention of staff. Macmillan Cancer Support states that currently 2.5 million people in the UK are living with cancer. That figure is expected to reach 4 million by 2030. That will put huge pressure on the NHS cancer workforce in the foreseeable future.

There is a particular concern about breast cancer specialists. For every three breast radiographers who retire over the next five years, only two are expected to replace them. Breast Cancer Now has called on the Government to invest £39 million in recruitment for the breast imaging and diagnostic workforce, as part of the plan to cover the cost of training to fill clinical radiologist vacancies and to address the current shortfall of radiographers. The problem is being compounded by the delay in the production of phase 2 of the cancer workforce plan, which should be an integral part of the long-term plan. Health Education England must produce phase 2 of the cancer workforce plan, which looks at how many staff are needed to meet growing patient demand. That can then be set out in the 10-year cancer workforce strategy.

Unless the Government get workforce planning right, I have serious concerns that patients will suffer. I urge the Minister to take action to deal with these matters urgently.

Orkambi

Bambos Charalambous Excerpts

Monday 4th February 2019 Commons Chamber

[Bill Wiggin (North Herefordshire) (Con)]

Last week, one of my constituents, whose daughter suffers from cystic fibrosis, came to see me. He explained that every year that access to Orkambi or other such similar drugs is delayed takes 10 years off the life of his daughter.

My constituent explained how the long hours in hospital and in treatment mean that cystic fibrosis defines his daughter’s life. However, clinical trials by Vertex seven years ago marked the start of a new hope. Vertex’s amazing progress suggested that he might not outlive his daughter, that she could have the fullest life now possible, and that he would not have to tell her that she was likely to die when barely into adulthood. The whole House will understand that never in his worst nightmares did he consider the fact that these drugs would succeed yet be unavailable to his daughter.

[Bambos Charalambous (Enfield, Southgate) (Lab)]

Is the hon. Gentleman aware that Orkambi, which is manufactured by Vertex, is licensed and available in Ireland and the Netherlands where there are only 1,000 cystic fibrosis sufferers, but not available in the UK where there are more than 10,000 sufferers? Does he agree that that is a terrible shame?

[Bill Wiggin]

I suggest that the hon. Gentleman hears the rest of the speech before he expects to draw any conclusions.

Cystic fibrosis is a life-limiting genetic disorder. Patients with cystic fibrosis experience a build-up of thick mucus in their lungs. This can have a wide range of effects on their respiratory, digestive and reproductive systems. The disease is widespread in the UK. One person in 25 carries the faulty cystic fibrosis gene. Statistically, that is 26 Members of this House whose future generations could be affected by this cruel disease.

Cancer Workforce and Early Diagnosis

Bambos Charalambous Excerpts

Tuesday 8th January 2019 Westminster Hall

[Bambos Charalambous (Enfield, Southgate) (Lab)]

It is a pleasure to serve under your chairmanship, Mr Howarth. I congratulate my hon. Friend the Member for Poplar and Limehouse (Jim Fitzpatrick) on securing this important and timely debate.

Lives are saved when cancer is diagnosed early. I know we all are united in wanting all cancers to be caught early so that survival rates can be drastically increased. However, to diagnose and detect cancer early, we need a sufficiently skilled workforce and full staffing. NHS staff do amazing work, but they are under extreme pressures. We are one of the richest countries in the world, but lives are being lost because of under-investment in our NHS workforce. If we are to come anywhere near to achieving the Prime Minister’s target of diagnosing three in four cancers at their early stages by 2028, we will need to have a long-term plan that will deal with the staffing shortages, which will no doubt get worse post Brexit.

Cancer Research UK estimates that by 2035 a person will be diagnosed with cancer every minute. At present nine out of 10 people will survive bowel cancer if it is diagnosed at an early stage, but that figure reduces to only one in 10 if it is not diagnosed until stage 4. Currently between 46% and 61% of cancer sufferers are diagnosed at stage 1 or 2, which means that people are slipping through the net and dying needlessly owing to a lack of resources. With 40% more people being referred for diagnostic cancer tests than four years ago, cancer diagnostic services are struggling to keep up with demand. They have already missed their cancer waiting time targets over the past three years.

I am the co-chair of the all-party parliamentary group on breast cancer. The rest of my comments will focus on breast cancer, for which the situation is even worse than I have been outlining. The breast imaging and diagnostic workforce are critical for the early diagnosis of breast cancer, but Breast Cancer Now has discovered that only 18% of breast screening units are adequately resourced with radiography staff to meet demand. Taking into account the ageing workforce of breast imaging radiographers and the increase in demand, we have an exacerbation of pressures that will only get worse. For every three breast radiographers who retire over the next five years, only two are expected to replace them, which means that imaging and diagnostic services will be unable to keep up with demand. That will cause delays, which in turn will cause greater anguish for those waiting to be tested.

Fifty-five thousand people are diagnosed with breast cancer in the UK every year, yet the survival rates lag behind those of Sweden, Portugal, Germany and France. We have a declining workforce and an increase in demand. Unless the Government invest in a fully funded workforce plan, patients will suffer. We need a new approach to workforce planning based on best practice and clinical need. Health Education England must produce phase 2 of the cancer workforce plan, which looks at how many staff are needed to meet growing patient demand, and set out a 10-year cancer workforce strategy. The plan must be backed with appropriate funding. Breast Cancer Now has called for the Government to invest £39 million in recruitment to the breast imaging and diagnostic workforce as part of the plan to cover the cost of training to fill clinical radiologist vacancies and to address the current shortfall in radiographer numbers.

The Government’s decision to scrap bursaries for allied health professionals and nurses is a factor in making it harder to recruit. Someone who wants to become a mammographer must self-fund an MSc following a three-year radiography degree. Prior to the 2017 bursary cuts to allied health professionals courses, including for diagnostic radiographers, the undergraduate degree was covered by a bursary. Following that disastrous cut, there was a 20% decrease in the number of applications to allied health professionals courses and a further 9% cut in 2018. That under-resourcing, directly linked to the Government’s bursary cuts, has undoubtedly cost lives. I urge the Minister to reverse the cut to bursaries to ensure that the financial barriers to becoming a mammographer are removed and that more applicants are encouraged to apply for allied health professionals courses.

Funding for early diagnosis is not just about staffing levels and recruitment. It is also about new technology. There are new improved ways of detecting breast cancer, such as via tomosynthesis, which is far more effective in detecting breast cancer in some women. Artificial intelligence could also be used to assist in analysing the vast data capture involved in screening, but that would require the commitment by the Government of investment in new technologies and training. Risk-stratified breast screening is another way of making better use of technology to assess a woman’s individual level of risk by using algorithms to assess various risk factors. Once an assessment has been done, a more personalised service can be given for women at higher risk, which could again help to save lives.

I will finish by asking the Minister whether he will commit to getting Health Education England to produce phase 2 of the cancer workforce plan, which will be based on need, and confirm that it will be properly funded. Will he reverse the cuts to bursaries for courses for allied health professionals and nurses, and make sure that recruitment levels are up to the levels that are required, especially with Brexit looming? Finally, will he commit to exploring and funding new technologies and training that will help to detect cancer earlier, target those who are at higher risk, and alleviate the pressures on the workforce? If the Government do not get things right in relation to the shortfall in funding for early diagnosis and the cancer workforce, some people will inevitably die an avoidable death from cancer.

Budget Resolutions

Bambos Charalambous Excerpts

Tuesday 30th October 2018 Commons Chamber

[Bambos Charalambous (Enfield, Southgate) (Lab)]

It is a pleasure to follow my hon. Friend the Member for Bristol South (Karin Smyth). Yesterday, the Chancellor made his Budget speech and told us that the era of austerity was nearly over, that schools would be getting money for the “little extras” and that all would be rosy as he increased tax thresholds, but that it would all be off if there was a no-deal Brexit.

The Budget was telling for another reason, though: the areas that it did not mention. There was no mention of funding for policing. We have lost more than 21,000 police officers since 2010. The Home Affairs Committee, in its recent report, “Policing for the Future”, said:

“Without additional funding for policing…there will be dire consequences for public safety, criminal justice, community cohesion and public confidence.”

The report also told of recorded crime having risen by 32% in the past three years and of the number of charges and summons having decreased by 26%. Why are the Government not concerned about public safety and fighting crime?

There was also no mention of extra funding for local authorities. The Chancellor said that austerity was nearly over. Why, then, does my borough of Enfield, which has had to find £161 million of cuts since 2010, still need to find an extra £31 million? Local councils are embedded in their communities and perform many vital roles—they do not just fill in potholes. Why was there no extra money for youth services, social care and local authority CAMHS to meet the needs of children at school? We know what the Government think about local authorities. Rather than supporting councils, they let councils such as Northampton go bust. They should be ashamed of the way they are destroying local councils, which are at breaking point, and slashing their funding. It is death by a billion cuts.

On education, the Chancellor made mention of additional funding for schools to pay for the “little extras”, as he described them. I wonder whether he has spoken to any headteachers, staff, governors or parents. Many schools in my constituency are facing huge cuts in the hundreds of thousands of pounds to teaching assistants, support services for children, school trips and non-curriculum subjects. The Chancellor is delusional if he thinks that £10,000 for “little extras” will go any way towards stemming the tide of cuts to schools. Those cuts are real, and they are having a detrimental effect on children. I have nothing but respect for the headteachers, staff, governors and parents who are trying to keep things together for their schools. What an insult to provide more money for potholes than for schools—the Chancellor could not have been more patronising if he tried.

On universal credit, the £1.7 billion the Chancellor announced to fix the failing system is a fraction of what his predecessor took out of it. What would he say to a local resident I spoke to who is a single mother—not through her own choice—working part time, who will be £50 a week worse off as she migrates from tax credits to universal credit? Why is he not putting money in to make sure that no one is worse off under universal credit? Why are people who are being migrated to universal credit not being protected? The legacy of the Government’s austerity is the prevalence of food banks, homelessness and poverty across the country.

The Ministry of Justice has had its budget cut year on year. The cost of processing women in the criminal justice system is £1.7 billion a year. One of the most successful ways of stopping reoffending is to provide support in women’s centres, yet they have been cut and do not receive the funding they need, leaving many in a precarious situation. Women’s centres have been picking up the pieces from the failing privatised rehabilitation centres, which have been rewarded for their failure.

There is nothing in the Budget for legal aid, which means that people will not get the representation they need and that there will be more injustices. Having proper representation in criminal proceedings is becoming the preserve of the rich. The Government seem totally uninterested in support for the criminal justice system and content to allow injustices to continue.

The Chancellor may think that the era of austerity is over, but it is not over for schools, for councils, for people on universal credit, for the homeless, for those caught up in the criminal justice system or for victims of crime, and certainly not for those who are poor. This Budget is a façade; it does not stand up to scrutiny, and it could all be scrapped by Christmas.

Access to Orkambi

Bambos Charalambous Excerpts

Tuesday 17th July 2018 Commons Chamber

[Mr Lewis]

I entirely agree. It is always very important, when a new Minister begins a role, that they have a very clear sense of a positive agenda on which they want to achieve change. This will be a very appropriate issue for the new Secretary of State to adopt and to drive forward.

[Bambos Charalambous (Enfield, Southgate) (Lab)]

Orkambi would not be suitable for my constituent Holly, who is eight years old, but other drugs that have been manufactured would be more suitable for her. Does my hon. Friend agree that if NICE had more flexibility in looking at pipeline deals, that would help many more people such as my constituent Holly?

[Mr Lewis]

Of course I agree entirely. It must be very frustrating for Holly and her family to find themselves in this situation. There really is no excuse for delaying the beginning of a review. Members know full well how long these reviews can take, so let us get on with it. I think we are united in a belief that this is absolutely essential as part of the lessons that we need to learn from this situation.