Childhood Cancers

Baroness Blackwood of North Oxford Excerpts

Wednesday 25th February 2015 Commons Chamber

[Nicola Blackwood (Oxford West and Abingdon) (Con)]

Skye was born on 5 November 2008. He was a happy, healthy young boy with a wonderful sense of humour who loved his younger brother, Jesse. In July 2013, he became unwell with nausea and vomiting and after many visits to the GP and the failure of medication to help, he was referred to the John Radcliffe in Oxford where he had a CT scan and was diagnosed with a brain tumour. That was 27 August 2013.

Skye was operated on less than a week later and tissue analysis identified the tumour as a grade IV metastatic medulloblastoma, the most commonly occurring paediatric brain tumour. It is an aggressive form of primitive neuroectodermal tumour, which originates in the cerebellum, the part of the brain which controls movement and co-ordination. Although Skye’s tumour had been caught early, it had already metastasised throughout the brain and spinal cord. Surgery was quickly followed by what is known as the Milan protocol: four cycles of chemotherapy over 11 weeks, and a further five weeks of hyper-fractionated radiotherapy. After a four-week period of recovery, Skye had high-dose chemotherapy that confined him to hospital for seven and a half weeks.

He then had four weeks rest at home, and was due to head back to hospital on 14 May 2014 for another round of high-dose thiotepa, but a urinary tract infection delayed the treatment until 28 May, which in hindsight was fortunate. Instead of getting stronger, it became apparent that Skye was getting weaker and an emergency MRI scan on 20 May revealed widespread white matter lesions within his brain and spinal cord, which caused a flurry of correspondence between consultants across the UK and abroad. He was quickly started on high-dose steroids to combat the inflammation.

It was initially diagnosed as radionecrosis, which had been brought on by the combination of therapies that he had had to endure. It was later confirmed as radio-chemo neurotoxicity. His parents were told that that was highly unusual and very rare. We now know that a number of other children have also developed severe neurological side effects and the Milan protocol was quickly withdrawn from use in the UK. He was in a state of paraplegia, with double incontinence, and very poor use of his upper limbs and hands. Skye sadly died at home on 29 August 2014.

I did not meet Skye and I only met his parents some time after his death. They are in the Gallery tonight and have demonstrated to me the most extraordinary bravery in the face of losing their child in this most distressing of ways. They have set up Blue Skye Thinking, a charity that supports research so that all children diagnosed with brain tumours will have a better chance of survival and a better quality of life post-treatment. They continue to support many other parents whose children are suffering from cancer today.

I have taken some time to explain Skye’s story in detail this evening because it illustrates only too well some of the things that are working in childhood cancer treatment at the moment and some of the things that need improvement. The overall story of childhood cancer treatment over the past 30 years is a positive one. Eight in 10 children with cancer survive five years or more, compared with just three in 10 in the 1960s. Short-term survival is also high: fewer than 10% of children die within a year of diagnosis and only 2% die within 30 days.

I congratulate the Government on that. Ministers have demonstrated a clear commitment to fighting cancer and the work and money that has been put into the system to improve cancer survival rates are bearing fruit and proving that the money is being well spent. However, we should not allow these headline statistics, encouraging though they are, to blind us to the fact that, rare though childhood cancer is, it remains the leading cause of death in children and teenagers in the United Kingdom. Childhood cancers account for just 1% of cancer diagnoses in the UK. For research purposes that is a small cohort, but 700 children and young people are diagnosed with a brain tumour every year.

[Jim Shannon (Strangford) (DUP)]

I thank the hon. Lady for bringing this matter to the House today, and for allowing me to intervene. Cancer Research UK has given me some figures today showing that 60 people are diagnosed with cancer each day in Northern Ireland. When Josh Martin, a young boy at secondary school, went into hospital to have his appendix removed, he was found to have progressive cancer. His family started the Pray for Josh campaign, which is being supported by his family and by the Churches. It has not only given great comfort to the family but helped to highlight the scourge of cancer and the fact that funding for drugs and help for families are very important. One of the organisations that can help is Macmillan Cancer Support. Does the hon. Lady agree that the support of such organisations can be important for families at times like these?

[Nicola Blackwood]

The hon. Gentleman is absolutely right to say that this is about not just Government funding but the way in which funds are given, and charities in particular play an important part. The fundraising that they do through individuals is vital.

As I was saying, 700 children and young people are diagnosed with a brain tumour every year, and that makes it the most common form of cancer affecting children and young people. It is also the most lethal. Brain tumours kill more children and young people than any other cancer—around 160 children a year—but despite being responsible for more than a third of childhood cancer deaths, brain tumours receive only 6% of childhood cancer funding. That funding matters because children’s cancers are biologically very different from adult cancers and treating them effectively requires specifically tailored research and targeted treatment regimes. At the moment, only about 50% of childhood cancers are part of a clinical trial; the remainder are treated using standard treatment guidelines. As Sally and Andrew Hall discovered, that can have serious consequences.

Cancer treatment is harsh at the best of times, and recent studies show that while many survivors of children’s cancers go on to live healthy lives, others face long-term disability and reduced immunity. Radiotherapy, the gold standard in terms of its efficacy in treating cancer, can also have damaging long-term consequences for the developing child. This is particularly true of childhood brain tumour survivors, 60% of whom are left with a life-altering disability. In a few cases, the side effects can be so severe as to be fatal. That is what happened in Skye’s case.

The Milan protocol, under which Skye was treated, was a standard treatment guideline, because as with about 50% of other childhood cancers there is no clinical trial available. It has become clear that there is currently no formal infrastructure in place to collect, record and share data, particularly on adverse effects of treatment, about standard treatment guidelines. I understand that before 2008 the responsibility for collecting and sharing data for clinical trials and for standard treatments fell under the remit of the Children’s Cancer and Leukaemia Group. Subsequently, clinical trials monitoring was tightened, and the CCLG’s “Guide to Clinical Trials” states:

“Clinical trials are very closely monitored by a number of different individuals and organisations. This will include the Chief Investigator…the working group…and relevant staff within the clinical trials unit. An Independent Data Monitoring Committee may also be established to oversee the conduct of the trial. At a national level, there will be an ethics committee and the national regulatory body. If there are any concerns about the conduct of the trial or the results, a trial may be stopped early.”

By contrast, in a letter responding to my concerns about the issue, the National Cancer Intelligence Network, told me that

“all of us in the field accept that (adverse effects in Standard Treatments) is something that should, under ideal circumstances, be a part of the data that we routinely collect. Such data are, however very much more difficult to collect than might be imagined and adverse effects were never part of what the CCRG (Childhood Cancer Research Group) or the CCLG themselves collected outside of a clinical trial. There are no nationally agreed datasets relating to adverse effects and few clinicians systematically collect and collate data of this sort...but it is clearly something that we in the NCIN should be considering.”

I am grateful that the NCIN has recognised that these data should be collected and collated, but I do not think that considering doing it is a sufficiently robust or urgent response to the problem, given the gravity of the consequences if a standard treatment goes wrong.

Clearly, in an ideal world all childhood cancers would be the subject of a full clinical trial and new targeted therapies being developed to reduce the long-term risks, but all of us know the challenges associated with research into childhood cancers, where cohorts of rarer cancers can be incredibly small and the ethical issues are more complex, making recruiting participants more difficult. Obviously, I am going to urge the Government to do whatever they can to fund and encourage more research into childhood cancers. I am going to ask the Minister to consider whether having only 6% of childhood cancer funding going to the biggest killer in childhood cancer represents getting the balance right, and I am going to ask her to maintain investment in the Health Research Authority programme to streamline the regulation and governance processes for clinical research in the NHS.

[Mr Brian Binley (Northampton South) (Con)]

May I say that, as a cancer sufferer, I welcome my hon. Friend’s courage in bringing this debate? May I pay tribute and offer my sorrow to these parents? May I also say that our Front-Bench team need to take on board the problems? I have seen parents, week in, week out in Northampton general hospital, and I know the case she is making is a real and heartfelt one. I hope that we will get good words from the Minister.

--- Later in debate ---

[Nicola Blackwood]

I thank my hon. Friend for his intervention and his support. I wish to emphasise the need for investment in the HRA streamlining programme, because I believe it will have a significant impact on reducing the resource and time required to set up trials across multiple sites in the UK, and that can only be good for research into childhood cancers, as it will be for research into all cancers.

I particularly want to focus today on the complete absence of data collection, recording and sharing on standard treatments of childhood cancers in the UK. I am very disappointed that having written to the life sciences Minister about this issue in early December I have yet to receive a substantive response. This issue could not be more serious for the treatment and long-term outcomes of children with cancers, especially brain tumours. Consultants around the country who work with incredible dedication to save the lives of their young patients struggle with their inability to quickly access information about the potential adverse effects of very tough treatment regimes, and it is a problem that we must try to fix. The architecture for collecting the information—the NCIN and the CCRG—is in place, but the lack of a formal data collection requirement and of a single responsible body can have devastating consequences for families.

When Skye’s consultant noticed there was an unexpected problem with Skye—the severe white matter damage shown on the MRI scan—she immediately tried to see whether any other clinicians had experienced similar issues. This was important in order to ascertain what other symptoms to look out for, what other treatments could be tried and what other outcomes they had had. Despite the fact that we now know that other children had been suffering in a similar way and that different treatments had been tried, she could not easily obtain this information; it was a matter of phoning around individual colleagues in an ad-hoc way to ask them one by one, and all this took place while Skye deteriorated. Time in such situations is of the essence so this is an unacceptable situation and it cannot be allowed to continue. Had there been a system in place to monitor adverse effects, things might have been different.

In so many ways, we are making tremendous strides in tackling cancer in the UK, including childhood cancer, but the complete absence of monitoring for adverse effects of standard treatments of childhood cancers can lead to life-long disability and death. I hope the Minister will take this away and take urgent action to rectify the situation. I also hope she will arrange for myself and Sally and Andrew Hall to meet the appropriate representatives from her Department to address this issue, once and for all. If details of those adverse effects are properly collected, recorded and shared, we might be able to avoid those consequences in more cases, increase childhood cancer survival rates and improve the quality of life for survivors even more.

Oral Answers to Questions

Baroness Blackwood of North Oxford Excerpts

Tuesday 13th January 2015 Commons Chamber

[Dr Poulter]

The hon. Lady makes very important points. I have certainly seen in my clinical practice that some women present when there are domestic violence issues or other issues in the home, and such issues can be heightened and exacerbated during pregnancy. A lot of work is now going on to improve the awareness of all NHS staff of domestic violence and, more broadly across training, of mental health issues.

[Nicola Blackwood (Oxford West and Abingdon) (Con)]

For many people with mental health problems, the first emergency service with which they come into contact at a point of crisis is the police. What steps are the Government taking to ensure that such a crisis is treated as a health crisis, not a criminal incident, and will the Minister undertake to do whatever he can to ensure that no children end up in a police cell as a place of safety?

[Dr Poulter]

My hon. Friend makes an important point. It is absolutely right that we do not want people with mental health problems to be looked after in police cells. A lot of work has been going on. The Government have set up the crisis care concordat to look at exactly that issue, and as a result the number of people with mental illness going to police cells is now falling rapidly.

NHS Services (Access)

Baroness Blackwood of North Oxford Excerpts

Wednesday 15th October 2014 Commons Chamber

[Andy Burnham]

That is inaccurate, because it was not a private-only shortlist—there was an NHS bidder in the frame at the time. The hon. Gentleman needs to keep his facts straight. As I said earlier, I introduced the NHS preferred provider principle, and that is my policy. [Interruption.] If he wants to dispute that, then the facts will speak for themselves. The shortlist had public and private on it.

[Nicola Blackwood (Oxford West and Abingdon) (Con)]

rose—

[Andy Burnham]

I will give way one last time and then finish.

[Nicola Blackwood]

The shadow Secretary of State is being very generous, and I hope that he will respond to me in a non-partisan way. I speak as the daughter of two NHS workers and as somebody who has recently had a very close family member survive an emergency operation for a life-threatening illness. Will he clarify Labour’s position on what it would do in government about a reorganisation, because the difference between a restructuring and a reorganisation is not clear to me? The British Medical Association and GP leaders have been very concerned about exactly what the policy is and what it would mean, so will he make that clear? He has been criticising certain policies, and I would like to understand what his policy would be.

[Andy Burnham]

I am glad that the hon. Lady asked that—it is a very fair question. I imagine that a reorganisation is the last thing that people in the NHS would want right now. My definition of a structural reorganisation is where we stand down a whole set of organisations and then create a whole set of new ones. I have been very clear that I will not do what the right hon. Member for South Cambridgeshire (Mr Lansley) did. I will work with the organisations that I inherit. I will work with CCGs, and with health and wellbeing boards, in particular. Health and wellbeing boards were one of the few good things that came out of the Act, because they are a partnership between local government and the NHS, and that is something I can work with. She asked a fair question and I hope I have given her a fair answer. A structural reorganisation where we make everybody redundant again and recreate organisations will not help anybody. In fact, if the Government wanted GP-led commissioning, they should simply have put doctors in charge of the old primary care trusts. If they had done that, they would have saved a lot of money and a lot of heartache in the process.

I am going to finish on NHS funding. The letter I mentioned at the beginning called for a long-term spending plan for the NHS. The NHS Confederation has put that at £2 billion a year. At the Conservative party conference, the Prime Minister committed to maintaining the ring fence for health in the next Parliament, but experts are clear that that will not be enough to prevent the NHS from tipping into a full-blown crisis. Indeed, the Chair of the Health Committee, the hon. Member for Totnes (Dr Wollaston), has said:

“Maintaining the ring-fence on health spending is not enough.”

I am sure the hon. Lady is right, but her problem—and the problem for everyone on the Conservative Benches—is that they have chosen a different spending priority. They have given a commitment to tax cuts for higher earners, which will cost an unfunded £7 billion. What that means in reality is that if the Tories get back in, any spare money will go towards filling that black hole and there will be nothing left for the NHS, so the outlook for the NHS under the Tories in the next Parliament is very bleak indeed. Given current policy direction on competition and the funding plans they have announced, the NHS is looking at a toxic combination of cuts and privatisation under a re-elected Tory Government.

By contrast, Labour’s priority is not tax cuts for some, but a strong NHS for all. We have found an extra £2.5 billion a year—that is not spin; it is money we have committed to—to build the NHS of the future, and the question before the House tonight is whether it should call on the Government to match it.

Labour’s plan is for a national health and care service—full integration of health and social care, starting in the home and building one team around the person. We will do that by recruiting 20,000 more nurses, 3,000 more midwives, 8,000 more GPs and 5,000 extra home care workers by the end of the next Parliament—a new generation work force in the NHS, working from home to hospital, transforming the delivery of care. Social care is prevention, and by uniting it with the NHS we can turn the financial tide around and place the system on a path towards financial sustainability.

Labour has a credible plan for the NHS and the money to back it up. This House needs to decide tonight whether it agrees and whether it is prepared to match the money needed to turn the NHS around. The decision we make tonight will clarify the decision before the country next May. Will our top priority be, as the PM used to say, those three letters: NHS? Or will it be tax cuts for some, but an NHS crisis for all? That is the choice. We have made ours and our choice is the NHS.

Care Bill [Lords]

Baroness Blackwood of North Oxford Excerpts

Tuesday 11th March 2014 Commons Chamber

[Mr Dorrell]

The right hon. Gentleman is 100% right. That is precisely what the care.data programme is designed to address.

[Nicola Blackwood (Oxford West and Abingdon) (Con)]

My right hon. Friend is rightly concentrating on the benefits of the programme. Sharing large datasets clearly has big research and integration benefits, but we now have a huge confidence problem with the programme. It will be beneficial only if it gets widespread buy-in from patients. What does he believe is the answer if we are to regain the public’s confidence?

[Mr Dorrell]

First, we must concentrate the rationale for the programme on to patients. Looking back at how NHS England has got itself into this position over the past few weeks and months, I have lost count of the number of times I have been told how important the programme is for research. I absolutely agree that it is important for research, but the health and care system does not exist to support research; it exists to treat and care for patients. The logic of allowing commissioners to develop joined-up services that respond to individual people’s needs—and the pattern of need based on multi-morbidity to which the right hon. Member for Sutton and Cheam (Paul Burstow) has referred—must be placed centre stage in the justification for the improved handling of data in the health and care system.

I go back to the point that this must be about treating people, not conditions. We cannot achieve that if we do not have the information to allow us to connect up the experience of the patient between one part of the system and another. In regard to the logic behind NHS England’s plans, yes there is a research argument, but—with apologies to the research scientists—it is a secondary argument. The primary argument is that we must improve the services delivered to patients and service users.

Children’s Heart Surgery

Baroness Blackwood of North Oxford Excerpts

Wednesday 12th June 2013 Commons Chamber

[Mr Hunt]

That is what I absolutely want to do. One huge frustration for those on both sides of the House has been how the process has dragged on. If I could have come to the House today with a detailed timetable, I would have. Although we had internal access to the report before today while I considered its findings and reached a judgment, we believed that it was necessary for external stakeholders to see the report and give their view of how the timetable should proceed. That is why I have given NHS England until the end of July to come back with that timetable.

[Nicola Blackwood (Oxford West and Abingdon) (Con)]

The Health Secretary is absolutely right that parents in my constituency have found this process deeply destabilising. Although they also want to see quality, they felt that their concerns about building up a good relationship with their medical teams and about accessibility and co-located services were simply dismissed. Will the Health Secretary assure me that that will not be the case in the future, and will he look more closely at the networking solution we have in Oxford and Southampton, which strikes a good balance between having a quality site further away and providing aftercare in an accessible site with trusted medical teams?

[Mr Hunt]

That is a very interesting thought. My hon. Friend will be pleased to note that the IRP report states that the whole care pathway, not just the surgery on its own, needs to be considered when we make this very difficult decision. I agree with her that this has been a very distressing process for every family involved and although we are suspending the process today, we have a responsibility to be honest with people. At the end of the process, there will be a difficult decision to take and we will honestly do our duty as Members of this House.

Community Hospitals

Baroness Blackwood of North Oxford Excerpts

Thursday 6th September 2012 Commons Chamber

[Dr Sarah Wollaston (Totnes) (Con)]

I beg to move.

That this House recognises and supports the contribution of community hospitals to the care of patients within the National Health Service; requests the Secretary of State for Health to commission a comprehensive database of community hospitals, their ownership and current roles; and believes that the assets of community hospitals should remain for the benefit of their community while allowing them greater freedom to explore different ownership models.

I warmly welcome my hon. Friend the Minister to her new role. She will know that there are more than 300 community hospitals in England. I used to work at one of the very smallest at Moretonhampstead in the heart of Dartmoor, so I know just how important community hospitals are, especially to isolated rural communities. I may have lost one, but I fortunately gained four, and I am happy to represent Brixham, South Hams, Dartmouth and Totnes.

Community hospitals vary in size and function—some are urban, some are rural, for instance—but they share a common theme: they are deeply rooted in their communities and provide an extraordinary level of support with volunteering and charitable giving through leagues of friends. The reason for that support is clear: people value their personalised approach and want to be treated closer to home. Community hospitals score well on things such as dignity, respect and nutrition. We should be treasuring and enhancing their role because although small is beautiful, unfortunately it can make them a tempting target for cuts.

The need for efficiencies in the health service is nothing new. I remember reading in 2009—before the general election—about the Nicholson challenge. We have known for some time that we have to make £20 billion of efficiency savings over the next four years—that is 4% efficiency gains year on year—but there is a misunderstanding about what this means. It is not about doing less of the same; it is about spending what we spend more efficiently and looking at the needs of our population. Over the next 20 years, the number of over-85s in our country will double.

[Nicola Blackwood (Oxford West and Abingdon) (Con)]

In my constituency, Abingdon community hospital has played a fascinating role in supporting the wider NHS in Oxfordshire. It has assisted with the problem of bed blocking by supporting early and late-stage rehab and preventing patients from needing acute beds. I do not think that community hospitals should face cuts, given the role they can play in easing pressures on acute hospitals. Does my hon. Friend agree?

[Dr Wollaston]

I agree absolutely. Their role in so-called step-down care and rehabilitation is vital, and I am glad to hear that it is happening well in Abingdon.

Seventy per cent. of the total spend on health and social care goes on people with long-term conditions. We should all understand that the burden of disease in England has completely changed—from tackling life-threatening emergencies to managing people with long-term, complex conditions.

Health and Social Care (Re-committed) Bill

Baroness Blackwood of North Oxford Excerpts

Wednesday 7th September 2011 Commons Chamber

[Mr Lansley]

I beg to move, That the Bill be now read the Third time.

The national health service is among our most valued and loved institutions. Indeed, it is often described as the closest thing we have to a national religion. I am not sure that that was always intended to be complimentary, but I think it should be. People in this country believe in the NHS wholeheartedly, share in its values and the social solidarity it brings, and admire the doctors, nurses and staff who work in it.

It is because I share that belief that I am here. Over eight years, I have supported, challenged and defended the NHS. As a party, and now as a Government, we have pledged unwavering support for the NHS, both in principle, because we believe in the values of the NHS, and in a practical way because we are reforming the NHS to secure its future alongside the additional £12.5 billion of taxpayer funding over the next four years that we have pledged for the NHS in England.

[Nicola Blackwood (Oxford West and Abingdon) (Con)]

Will my right hon. Friend give way?

Congenital Cardiac Services for Children

Baroness Blackwood of North Oxford Excerpts

Thursday 23rd June 2011 Commons Chamber

[Nicola Blackwood (Oxford West and Abingdon) (Con)]

I, too, congratulate my hon. Friend the Member for Pudsey (Stuart Andrew) on his leadership in securing the debate. I open my remarks by paying tribute to Oxford’s paediatric cardiac team, including Professor Steve Westaby. The team have saved countless lives and have the complete confidence of the patients and families who have asked me to speak up for them today. I also pay tribute to the Young Hearts charity, which has stood up for children with congenital heart disease and their families in Oxfordshire and presented a petition, which I am holding in my hands, with thousands of signatures to the Prime Minister in his constituency this month. They have done much to assure services in Oxfordshire.

Few would take issue with the basic aims of the Safe and Sustainable review; who does not want to improve outcomes for children with congenital heart disease? That is not where the concerns lie. The review works on a simple premise: more surgeons doing more surgeries will achieve better outcomes for more patients. That makes perfect sense, but in this instance, as the motion states, size is not everything. Although the simple centralisation of specialist services is backed by clinical evidence, some clinicians in Oxford, Southampton and elsewhere are of the opinion that it draws on too narrow an evidentiary base and that matters such as the co-location of services, assessed travel and population projections must also be considered.

On co-location, for example, a 2008 Department of Health report states that cardiac surgery requires the absolute co-location of paediatric cardiology, paediatric critical care, specialist paediatric anaesthetics, specialist paediatric surgery and specialist paediatric ear, nose and throat services. Even though Safe and Sustainable states that the co-location of those services should be mandatory, it is not clear how the four proposed options meet the standards of the framework of critical interdependencies or, for that matter, the standards of Safe and Sustainable itself. I hope that the Minister will note those grave concerns, which patient groups, families and clinicians have expressed, and will ensure that the joint committee of primary care trusts takes the process forward, clarifying the issue of the co-location of service and properly and transparently communicating that clarification to those groups.

A child with congenital heart disease does not exist in isolation. He or she is cared for tirelessly by family members who have to make terrifying treatment decisions, and by siblings who have to accept that home life is on hold while parents go to and from hospital and everyone concentrates only on keeping that child alive. That is what parents do for their children. It is what they sacrifice and do without hesitation, because nothing matters more than bringing that child home again, happy and healthy, so that everything can get back to normal. No matter how freely they give that care, however, caring for a child with congenital heart disease puts massive stresses on parents and siblings, and the outcome of the review should also try to relieve that pressure, if at all possible.

That is not just a moral argument; paediatric patient outcomes improve when carers cope better. I know that Ministers believe that the best possible surgical outcome is the best way to help families, but families who come to see me are worried that they will not be able to get to the hospital for the surgery in the first place; that there will be longer waiting lists; that they will not have continuous care under surgeons whom they can trust with their child’s life; that staff at units that close will not be able to move to those that scale up; that we will lose dedicated people from the NHS; and that there will be a shortfall in service while new staff are trained up. All those concerns are just as valid and significant as ensuring that the surgeon has the necessary skill once he gets the patient on to the operating table.

The irony is that, while the Safe and Sustainable options are causing that concern, Oxford and Southampton already have an option that is working as we speak. The south of England congenital heart network offers the quality guarantees of an increase in clinical team size and patient base that Safe and Sustainable seeks, while creating and retaining the continuity of care and patient access that local clinicians and patients fear losing. That network was developed and is led by clinical teams at Oxford and Southampton; it has five congenital heart surgeons and nine consultant paediatric cardiologists; and it is the first time that two teaching hospitals have collaborated to provide joint tertiary clinical service.

That is exactly the kind of networking arrangement that Safe and Sustainable aspires to create, but the network puts the patient first, not the surgeon. It makes the best use of existing services but does not require extensive restructuring of human or physical resources; it addresses the problems of waiting times, travel times and co-location which Safe and Sustainable has failed to address; and, most importantly, it has been tried and tested for more than a year.

There is a risk that Safe and Sustainable will be seen as a top-down, inherited review, so a locally innovative system such as that network, which is supported by local heart groups, supported by local clinicians and clinically driven, is something that the Government should seek to support.

Medical Students

Baroness Blackwood of North Oxford Excerpts

Tuesday 3rd May 2011 Westminster Hall

[Mr Andrew Smith (Oxford East) (Lab)]

It is a pleasure to have this debate under your chairmanship, Ms Dorries. I am very pleased to have the opportunity to raise some key issues about the funding of medical students. Aspects of the upheaval in higher education funding are, of course, important both for the recruitment of doctors and the availability of opportunities to study for the medical profession. They are of particular concern in my constituency, which is home to 1,000 undergraduates and 1,300 postgraduates in medical sciences. I am grateful for the briefing that I have received on the matter from the British Medical Association and the Oxford university medical sciences division, as well as for the concerns that constituents have raised with me on these issues.

At a time when higher education as a whole faces the challenges and dangers of the 80% cut in university teaching support and the trebling of fees, concerns about the costs of and access to medical education are all the greater. The length and intensity of medical courses both add to the cost to students and limit their opportunity to supplement their income through paid work.

The BMA estimates that, under the present system, medical students graduate with some £37,000 of student debt. With all universities charging or set to charge £9,000 for medical studies under the new regime, the BMA estimates that that figure will go up to around £70,000. That does not count overdrafts, credit cards, professional loans or family borrowing. We do not need to exaggerate the impact of prospective debt on students’ choices to be concerned that debts of £70,000 or more might be a barrier to able people from poor—or, indeed, middling—backgrounds who are considering entering the medical profession.

My concern is about the funding position facing all medical students. However, on the challenge facing us on widening participation, there is likely to be a triple impact on entry to medical studies. The A-level admission grades are understandably particularly demanding and poorer students from schools serving poorer areas are less likely to achieve them, which clearly demands further action within the school system. The requirement of medical work experience is also likely to be harder to fulfil for school students from financially hard-pressed families or, indeed, from families with no connections to the medical profession. At the same time, the prospective length and costs of study are considerably higher and it seems plausible that those are also having an impact on the relatively low rates of admission to medical studies from poorer socio-economic groups.

Statistics on admissions show that the wider challenge of opening up access to higher education is certainly compounded in the case of medical studies. The BMA equal opportunities committee report published in October 2009 includes a review of UCAS data. It states:

“The proportion of acceptances to medical school coming from socio-economic class I (31%) was almost twice that of acceptances to all other degrees from class I (16 %). Just 15% of students accepted into medical school came from the four poorer socio-economic classes (grades IV to VII) compared with 24% of students accepted to all degrees.”

The BMA has also said:

“The percentage of students from lower income families is slowly improving across the higher education sector but the rate remains stagnant in medicine.”



In the light of all that and the Government’s stated commitment to widen access to higher education, I would like to ask the Minister what the Government’s specific proposals are to widen the pool of talent entering medicine and whether the Government, in bringing forward the higher education White Paper, will look at the likely special factors at work in relation to medicine? I have listed some of those.

Will the Government also consider the advice and support given to able students in school, the necessity and operation of the work experience requirement and the £75 cost of the UK clinical aptitude test used as part of the selection process? That test gives an early signal to students from poor backgrounds that studying medicine is an expensive undertaking.

An important part of overall support for medical students is the provision of bursaries. As the Minister will be aware, the future shape of those has been uncertain for some time. The previous Government consulted on options for change in 2009, and last month the present Government set out new options for reforming the system.

[Nicola Blackwood (Oxford West and Abingdon) (Con)]

As I represent the other half of the Oxford university seat, the right hon. Gentleman will know that I share many of his concerns. In the light of his valid concerns about equal representation among medical students, does he agree that now is the crucial time to decide about the NHS bursary scheme, given that many students are deciding which courses to apply for?

[Mr Smith]

I am grateful to have the support of my colleague. I might describe her constituency as covering the other third of Oxford university. Her support on that point is very welcome. I was about to say that people are already asking what the situation will be, and obviously the sooner they can have certainty, the better.

The BMA has joined other bodies in consulting on the issue, and I understand there is some expectation that agreement will be reached. However, one big outstanding question is whether the new proposed bursary arrangements will cover tuition fees in the same way as they are covered now, with the Department of Health paying the fees for years 5 and 6 of an undergraduate course. If the bursary does not cover fees—it seems extraordinary that Ministers have not yet made the Government’s position on that clear—medical students would obviously face still higher costs and debt.

As my colleague and friend the hon. Member for Oxford West and Abingdon (Nicola Blackwood), whose constituency represents the other third of Oxford university, says, mounting urgency on that matter arises because would-be applicants worry about how the arrangements will work for 2012-13. I press the Minister to give an undertaking that tuition fees for medical students will be covered at least as well as they are now.