Hospice Funding

Colleen Fletcher Excerpts

Monday 22nd April 2024 Commons Chamber

[Colleen Fletcher (Coventry North East) (Lab)]

I thank the hon. Members for Hastings and Rye (Sally-Ann Hart) and for Darlington (Peter Gibson), as well as the APPG, for securing this hugely important debate on the Floor of the House.

In Coventry, we are extremely lucky to have Myton hospice. Like other hospices across the country, Myton is a critical part of the healthcare system and plays a vital role in providing care for people from the point at which their illness is diagnosed as terminal to the end of their life, while also supporting the needs of their families. The services that Myton provides are a crucial part of palliative and end of life care in Coventry. The work it does and the services it provides not only ease pressure on the wider health and care system in our city, but ensure that patients receive exactly the care they need when and where they need it. Without Myton, patients might find themselves unnecessarily relying on A&E or other hospital departments, which would massively increase the burden on, and costs for, the NHS.

I know at first hand how important Myton is to our city and local communities, because my husband, Ian, received end of life care there. Diagnosed with leukaemia in 2014, he had a stem cell transplant and was fighting his way back to reasonably good health when, three years later, he became ill with an aggressive secondary cancer and was diagnosed as terminally ill in 2018. He wanted to die at home, but we were advised that domiciliary end of life care was “clunky”. Those are not my words, but the words of the NHS care team who were advising and talking to us. That meant that we could not be sure of a timely home visit if my husband needed more pain relief—and he was on a lot of pain relief. He was on a pain driver and I could give him liquid morphine, but that shot, which only a district nurse could give him, might not have been there immediately and he might have had to wait an hour or two hours for the nurse to come. He decided to go into Myton hospice, which is only a stone’s throw away from where we lived, so it was very local to us. He went into Myton hospice, and I stayed with him until he passed peacefully away just one week later. It was a tranquil, respectful place, where all his needs were met, and ours. We were grateful for that real quality time together.

Just before Christmas, I went to an event at Myton hospice where I met staff, the loved ones of those who had received palliative and end of life care there, and the people who fundraise to help ensure that Myton can continue to provide its vital services. It takes just moments when speaking with people at such an event not only to understand the importance of the hospice sector, but also to recognise the huge funding challenges it faces. We know that the hospice sector’s reliance on fundraising for much of its income brings with it significant risks, and those risks have been compounded in recent years, first by the pandemic and now by the cost of living crisis. As a result, the hospice sector is facing a perfect storm, with the cost of delivering services increasing, while charitable donations are volatile and NHS funding is falling in real terms.

Take Myton Hospices as an example: just 20% percent of its funding comes from the NHS, and in real terms that is decreasing every year. That comes at a time when its costs are consistently increasing year on year. For the financial year 2024-25, its running costs will be £14.3 million, and it will need to raise £11 million of that in voluntary income. That is compared with running costs of £13.25 million and raised voluntary income of £10.5 million last year. Those funding challenges inevitably increase pressure on and access to services. I know that more people need a hospice bed than ever before, and demand for beds at Myton has increased by 25% over the last year. As a result, over 70% of people accepted for a bed at Myton will not be able to access one straightaway and will have to join a waiting list. Sadly, three out of four people waiting for a Myton bed will die before they can access one.

Although I understand the funding pressures that Coventry and Warwickshire integrated care board is operating under, that certainly raises questions about whether it is meeting the requirement to commission palliative and end of life care to meet the population’s needs. Indeed, I know that with funding for just four more nurses, Myton could open eight more beds and eliminate its waiting list completely, ensuring that everyone in Coventry and Warwickshire gets the palliative and end of life care that they need and deserve. Those funding challenges are certainly not unique to Myton, and most—if not all—hospices are facing similar problems. This needs to change. If we are to ensure that demand for hospice care is met, both in in-patient units and in the community, and eliminate the inequality and postcode lottery of services, we need hospice funding to be sufficient, resilient and sustainable.

I asked those at Myton hospice what steps they believe need to be taken to ensure we have a thriving hospice sector, with long-term sustainability at its heart. They told me they believe there needs to be a tariff-based approach to funding that reflects the core services provided, so that funding is based on what each hospice provides against clear criteria. They also felt that essential hospice services, including doctors and nurses, should be funded by the NHS. We must ensure that all patients with a terminal illness receive the right care to meet their needs, that that care is delivered with dignity, respect and compassion, and that the end of their life is valued as much as the beginning. To achieve this, hospices must be funded fairly and sustainably.

Stem Cell Transplant Patients

Colleen Fletcher Excerpts

Monday 12th June 2023 Commons Chamber

[Mark Tami (Alyn and Deeside) (Lab)]

I am very grateful to have been granted today’s debate on the impact of the cost of living crisis on stem cell transplant patients and their families. I thank all the Members who have stayed for this evening’s debate, and I should put on record that I am chair of the all-party group on stem cell transplantation and advanced cellular therapies.

Many Members will be aware that a stem cell transplant is an extremely intensive treatment for blood cancer and blood disorders. Receiving a stem cell transplant is a long and difficult journey, and not without considerable risk to the patient. Despite this, stem cell transplantation is an absolutely vital treatment option. For many patients, it may be the last chance to cure their disease.

Overall, an average of fewer than 5,000 people receive a stem cell transplant every year. As many in the House will know, in 2008 my son Max was one of the children to receive a transplant, and I am pleased to be able to tell the House that, following the completion of his MA at the University of Manchester, he will be starting the first day of his job tomorrow. Max responded well to treatment, after a very bumpy road, but I cannot overstate the sheer terror and mental anguish of that experience for me and my family.

[Colleen Fletcher (Coventry North East) (Lab)]

I congratulate my right hon. Friend on securing this debate on a subject which, as he knows, is very close to my heart as my husband also had a stem cell transplant in 2014. It is often a last chance, and I know from personal experience with my late husband that it is essential for stem cell transplant patients to attend every single one of the many hospital appointments they have each week. Missing just one appointment can have serious, even life-threatening, consequences, which we experienced ourselves. So it is extremely concerning that due to the impact of the cost of living crisis, many patients are struggling to pay for travel to and from their hospital. Often these specialist centres are many miles away and they cannot use public transport because of the threat to their compromised immune system. So does my right hon. Friend agree that a dedicated travel fund is vital to ensure that stem cell transplant patients can attend every single appointment?

[Mark Tami]

My hon. Friend must have read my speech, because I will develop precisely that theme, as it is very important. When we went through that very difficult time, we were fortunate financially in that I had a well-paid job, being a Member of this House. I also had a very flexible and understanding employer; I was allowed the time off to be at the hospital. We had a car. We could afford to stay in a hotel if necessary and to eat out. Saying that, we still managed to build up debts, but we were in the hospital off and on for about two years and we saw many people who were not in that fortunate position—single mothers, people without a car who had to rely on public transport, people without a family network to support them, and people without that financial back-up to get through what is not only a traumatic process but a costly process for the family of the person being treated.

Oral Answers to Questions

Colleen Fletcher Excerpts

Tuesday 19th July 2022 Commons Chamber

[James Morris]

Given the size of England and the diversity of the health needs of different communities, we believe that commissioning should be locally led, so there are no current plans for a national eye health strategy. However, I am delighted that NHS England has appointed the first-ever national clinical director for eye care, Louisa Wickham, who will want to set priorities in this area. It is also worth mentioning that we continue to be committed to the national eye care recovery and transformation programme, which is looking to transform secondary care ophthalmology services in order to use existing funding to improve service quality and patient outcomes. That remains a top priority for us.

[Colleen Fletcher (Coventry North East) (Lab)]

10. What steps his Department is taking to support innovation in the treatment and care of NHS patients.

[The Minister of State, Department for Health and Social Care (Maria Caulfield)]

The NHS has made significant progress in recent years in embracing innovations, from the NHS app where patients can now access their medical records, to the expansion of electronic patient records making it easier for healthcare professionals to share information for better, safer care for patients.

[Colleen Fletcher]

I recently visited Coventry and Warwickshire Partnership NHS Trust’s wound healing service and saw the ground-breaking work being undertaken there, which is changing the lives of people who were thought to be living with unhealable wounds. By adopting innovative methods of healing, the service has not only healed the unhealable, giving patients back the quality of life they deserve, but reduced the average cost of healing at the trust. Will the Minister look at how this approach could be adopted more broadly to improve patient care, save money, and reduce on-costs incurred through unhealed wounds?

[Maria Caulfield]

I thank the hon. Lady, because it is the first I have heard of that and it sounds very exciting. I know how difficult it is with chronic wound management to get wounds to heal. Often these are patients with multiple co-morbidities such as diabetes that make the wounds very difficult to treat. I am keen to visit her constituency and her trust to learn more about it.

Covid-19

Colleen Fletcher Excerpts

Tuesday 12th January 2021 Commons Chamber

[Colleen Fletcher (Coventry North East) (Lab)]

Since 2010 the unfair and regressive economic and social policies implemented by this Government have perpetuated and, indeed, exacerbated the deep-rooted structural inequalities in our society. As a result, the past decade was marked by widening health inequalities, deteriorating health and stagnating and even declining life expectancy. This means that, even without the coronavirus pandemic, we started this new decade as a more inequitable, unequal and imbalanced society, which faced enormous challenges to help alleviate health inequalities, improve life chances and increase life expectancy. What the covid-19 outbreak has done is expose those health and wider societal inequalities and demonstrate quite starkly that the circumstances that a person is born into, that they grow up in and that they live their life in can have tangible consequences for their health. We know that coronavirus has had a disproportionate impact on many people who already face disadvantage and discrimination, and, sadly, it is becoming increasingly clear that the covid-19 outbreak has widened and will continue to widen existing health inequalities.

Similarly, we know that people who live in deprived areas have higher diagnosis, rates and death rates than those living in more affluent areas. Indeed, national and regional evidence shows that patterns of death from covid-19 correspond with patterns of deprivation. Most worryingly, the covid-19 pandemic has had a hugely disproportionate impact on people from black, Asian and minority ethnic groups. As somebody who represents a constituency where poverty and deprivation are entrenched in some communities and where residents from BAME groups make up a large proportion of the population, I can say that these statistics are extremely concerning.

In Coventry, men in the most deprived areas can expect to live an average of almost 11 years fewer than men from the most affluent areas, with the gap for women being more than eight years. These health inequalities are reinforced by high unemployment, poor quality housing, falling incomes, declining living standards, fuel poverty, air pollution, food bank reliance, and poorer educational opportunities. This means that many young people in my constituency are held back from birth when compared with peers in different areas of the country, all of which is a consequence of this Government’s policy choices over the past 10 years.

We need the Government to commit to properly funding public health, the NHS, local authorities and others, so that we can tackle the deeply entrenched health inequalities that exist in our communities and mitigate the impact of the covid-19 pandemic. We also need the Government to take additional steps to tackle the root causes of the hugely disproportionate impact that coronavirus has had on our BAME communities. The Government cannot delay any longer. We need urgent action on health inequalities now.

Covid-19

Colleen Fletcher Excerpts

Thursday 22nd October 2020 Commons Chamber

[Colleen Fletcher (Coventry North East) (Lab)]

There is an increasing weight of evidence showing that covid-19 and the response to the pandemic—however necessary to contain and slow the spread of the virus—is having a significant impact on and leading to a growing epidemic in mental ill health. As we are forced to contend with the fear, stress and worry of contagion for ourselves and our loved ones, these feelings are compounded by anxieties about the monumental changes to everyday life.

Working from home, shielding, furlough, self-isolation, home schooling, face coverings, and a lack of physical contact with family and friends have become the new normal. Faced with these new realities and a growing sense of uncertainty, we are already beginning to see the impact of the pandemic on people’s mental health. Social isolation, loneliness, bereavement, health anxieties, loss of income and jobs, poor or unaffordable housing, a lack of access to outdoor space, and working in frontline services are triggering mental health conditions or exacerbating existing ones.

Covid-19 has undoubtedly increased the drivers of worsening mental health, but at the same time it has reduced access to and interrupted the provision of essential mental health services, just when they are needed most. To compound the problem further, the pandemic has diminished many of the coping mechanisms that people typically use to deal with stress, worry and anxiety, such as meeting up with family and friends, exercising or going out to work. As a result, there is a real fear that we are building up considerable mental health problems for the future, and could see a wave of acute and untreated mental illness after the pandemic.

To avert a mental health crisis, we must ensure that mental health needs are treated as a central component of our response to and recovery from the covid-19 outbreak. We need to increase significantly investment and capacity in services during the pandemic and beyond, to ensure that all people living with mental ill health have continued access to treatment to prevent their conditions from worsening and becoming more acute. In Coventry, there are some excellent community groups delivering tailored local support to tackle these growing problems. I recently visited one such group, the Mote House Community Trust. I saw the fantastic work that it is doing in conjunction with our health services to combat loneliness, and deliver positive health and wellbeing outcomes.

From tomorrow, at just past midnight, Coventry is due to move to tier 2 of the local covid alert system. Although there was a sad inevitability about this decision, given the rising number of coronavirus cases in the city, the new tighter restrictions such as those imposed on other towns and cities in tiers 2 and 3 will simply add fuel to the fire of the mental health epidemic, unless we can ensure that the right support is in place. I sincerely hope that Ministers will confirm that mental health services and social prescribing schemes will be given the requisite support to tackle the growing mental health epidemic before we reach crisis point. After all, failing to recognise the importance of good mental health and invest appropriately in services now risks storing up significant mental health and physical wellbeing problems for the future. That would come at an unacceptable human, social and economic cost.

Oral Answers to Questions

Colleen Fletcher Excerpts

Tuesday 6th October 2020 Commons Chamber

[Matt Hancock]

Yes, I wholeheartedly agree with my hon. Friend, who speaks well for her constituent. I am very sorry that her constituent had that experience, and of course GPs should be sensitive, as the large majority are.

[Colleen Fletcher (Coventry North East) (Lab)]

The implications of coronavirus include rising levels of loneliness, which can impact on mental health and physical wellbeing while increasing pressure on the NHS. Last Friday, I visited Henley Green community centre in my constituency of Coventry North East and saw the work it is doing with health services to combat loneliness and deliver positive health and wellbeing outcomes. What resources can the Government provide to accelerate the spread of such social prescribing schemes so that community groups can deliver tailored local support to tackle this growing problem?

[Matt Hancock]

I pay tribute to the group that the hon. Lady mentions. I have put a huge amount of effort into supporting social prescribing, including with funding, and I encourage her CCG to engage with such bodies to make sure that we can get funding to support them on the frontline.

Health Inequalities

Colleen Fletcher Excerpts

Wednesday 4th March 2020 Commons Chamber

[Colleen Fletcher (Coventry North East) (Lab)]

It is a pleasure to follow the hon. Member for Ashfield (Lee Anderson), whose area I know extremely well, and the fabulous maiden speeches on the Labour Benches, including from my hon. Friend the Member for Coventry North West (Taiwo Owatemi), who spoke most warmly about my city and about her predecessor; I concur with her comments.

Since 2010, the Government have chosen to implement unfair, regressive economic and social policies that have widened the gap between rich and poor, holding individuals back and leaving entire communities behind. Those policy choices have ensured that the last decade has been marked by widening health inequalities and deteriorating health. In Coventry, where poverty and deprivation are entrenched in some communities, the progress made in the years up to 2010 in terms of improving people’s life chances, quality of life and life expectancy have been derailed by this Government.

Over the last decade, people in our most deprived communities have experienced rising levels of in-work poverty, food insecurity and food bank reliance. They have found it more difficult to access good-quality housing and secure, well-paid employment, while their incomes and living standards have declined significantly. Public services and welfare spending, which would once have alleviated some of those pressures, have been slashed, removing a crucial safety net. That has an impact on not only people’s health but their ability to make positive healthy choices, which ultimately increases their chances of premature mortality and morbidity.

The evidence shows that there is now a life expectancy gap of 11 years between men living in the most deprived areas of Coventry and men in the least deprived areas, and the gap is 10 years for women. That gap has increased by nearly one and a half years over a five-year period. Those living in the most deprived areas not only die much earlier than those in more affluent areas; they also live much longer in poor health. Data shows that poorer men in the city will experience 17 years fewer in good health than their more affluent counterparts, while poorer women can expect 18 fewer years in good health.

Sadly, that is not altogether surprising when we consider the fact that some of the most deprived areas in the city experience higher rates of economic inactivity, fuel poverty and air pollution, while having fewer green spaces, all of which impact people’s mental and physical health and wellbeing. Moreover, Coventry’s statistics on smoking, drinking and obesity show that 33% of adults who smoke live in the most deprived 10% of neighbourhoods; hospital admissions for alcohol-related illnesses and deaths are much higher than national rates; and overweight and obesity rates for children are higher than average.

We all know that tackling health inequalities is not a job that belongs exclusively to the NHS or to public health. To make a tangible difference, we have to improve our health and our health services, but we also have to look at our society as a whole and the conditions that determine our health. This is happening in Coventry, and we have had some notable successes, despite the poor hand we have been dealt by Government. For example, we have seen an increase in the proportion of children with good development by the end of reception year, and a reduction in the proportion of 16 to 18-year-olds not in education, employment or training. We have also achieved great results through employability support programmes, such as the Job Shop or Ambition Coventry, which work with people to help them secure employment.

However, if we hope to build on these successes, we need the support of Government. I hope the Minister will commit to funding public health, the NHS, local authorities and others properly, so that we can tackle the deep and entrenched health inequalities that exist in our communities and reduce the huge life expectancy gap between the richest and the poorest.

BAME Blood, Stem Cell and Organ Donation

Colleen Fletcher Excerpts

Wednesday 27th June 2018 Westminster Hall

[Tulip Siddiq (Hampstead and Kilburn) (Lab)]

It is a pleasure to serve under your chairmanship, Sir Henry. I thank my hon. Friend the Member for Bedford (Mohammad Yasin) for securing this debate on an issue that is so important to my constituents in Hampstead and Kilburn. I will speak briefly.

More than 2,000 incredible people from Hampstead and Kilburn are on the Anthony Nolan stem cell register, a large proportion of whom are from BAME backgrounds. I mention that fact because, as Members from across the House have said, only 20% of patients from BAME backgrounds will get a perfect match, compared with 69% of people from white northern European backgrounds.

[Colleen Fletcher (Coventry North East) (Lab)]

I declare an interest: my husband had a stem cell transplant three years ago. His donor came from this country. Does my hon. Friend agree that, if we are to meet the needs of BAME patients who require a stem cell transplant, we must work with international registers? Increasing BAME donation in the UK alone is not enough. Some 60% of UK patients already receive stem cell transplants from international donors. That is made possible by Anthony Nolan’s incredible volunteer couriers, who collect donated stem cells around the world and transport them to patients. I hope the Minister will explain what steps the Government will take to support international registers.

[Tulip Siddiq]

My hon. Friend has stolen one of the questions I was going to ask the Minister, but I will forgive her.

In 2016, a young woman in my constituency called Lara, who was 27 years old and from a BAME background, needed a stem cell donor. The constituency snapped into action and organised the Match4Lara campaign. Elana Wall and Jacob Haddad, the volunteer co-ordinators for Anthony Nolan, co-ordinated 40 volunteers who spent their evenings packing spit kits and organising spit drives and spit drive socials. I went to a spit drive in the O2 Centre on Finchley Road, and I was impressed by the enthusiasm of the youngsters—especially those from a BAME background—who realised that if they took the spit test on the spot, there was a chance they could save a life. My younger sister, Azmina, participated and said that she found the science very accessible. She understood that she needed to raise awareness of the issue among young people. She has recently had a call to say that she could be a potential match for a patient.

Will the Minister address the request to integrate awareness-raising into the school curriculum? Will she talk about how the Department of Health and Social Care can work with international donor banks? That issue has been raised a few times already. How does she intend to spread the word about stem cell donation among young people, especially those from BAME backgrounds?

[The Parliamentary Under-Secretary of State for Health and Social Care (Jackie Doyle-Price)]

It is a pleasure to serve under your chairmanship, Sir Henry. I thank the hon. Member for Bedford (Mohammad Yasin) for securing this important debate on an issue that has been exercising me for the past year. Since I became Minister with responsibility for this area, the disparity in access for people from black and minority ethnic communities to blood, organs and stem cells has been of great concern to me. I have been working with NHSBT on this theme for the past year, and I hope I can give the hon. Gentleman some comfort. We are making some progress, but I want to assure all hon. Members that I am under no illusions about how big this challenge is, for a host of reasons that I will come on to.

I thank the hon. Member for Wolverhampton South West (Eleanor Smith) for being here. I read her report with interest and agreed with every word. The principles she articulated are key to increasing donation. If I were to highlight one particular issue, it would be the culture of normalising donation in those communities. The hon. Member for Hampstead and Kilburn (Tulip Siddiq) has just given a beautiful example of how local leadership can do that, and that is something we can all take away.

Whenever we debate a subject like organ and blood donation, everyone brings their own personal story, because we have all been touched by people who have needed a transplant. That is what brings the issue alive for us; it is about saving lives.

My overall objective is to increase the rate of donation across the board. Although it is true that a person is more likely to die waiting for a transplant if they are from a black and minority ethnic community, the fact is that we are losing too many people who are waiting for a transplant. We need a concerted effort to improve the rate of donation from all parts of our society. There is much we can do to achieve that. Hon. Members will be aware of the private Member’s Bill from the hon. Member for Coventry North West (Mr Robinson), which seeks to change the opt-out system. It will be a big help, but it will not solve the problem by itself. There is a lot more we need to do to educate the public about the importance of donation and to dispel the fears and myths about it.

[Colleen Fletcher]

The Minister mentioned the private Member’s Bill of my hon. Friend the Member for Coventry North West (Mr Robinson). I hope she is aware that stem cell transplantation is very much done when the person is alive, which is what makes it so easy. People do not have to die to donate. I just want to make sure people listening to this debate know that.

[Jackie Doyle-Price]

That is a point well made. It is the same for blood, of course—donors do not have to die to give blood. People who give blood do so regularly because they get into the habit and it has become normal. Perhaps we need to do a lot more about stem cell transplants.

I am particularly moved to be having this debate today because only this weekend I lost a very good friend of mine to lymphoma at the age of 47. That brings home how cancer and illness can kill people at a very young age. It will be in honour of my dear friend David Furze that I will do something to reboot stem cell donation.

On the barriers to more donation, some have serious concerns about faith and religious beliefs. Tackling those concerns is a big challenge for us in Government, because of the element of trust. The hon. Member for Bedford mentioned that quite often people do not trust medical professionals, but they trust Government even less. We must find innovative ways of getting that message out. We need the right messengers. Dare I say, the people in this Chamber are among the right messengers? Most of us have respect in our communities and are able to show leadership in our communities. We can go out, speak, raise awareness and encourage donation. I have given NHSBT the challenge to do exactly that.

Cancer Strategy

Colleen Fletcher Excerpts

Thursday 22nd February 2018 Commons Chamber

[Colleen Fletcher (Coventry North East) (Lab)]

It is a pleasure to follow the hon. Member for Bosworth (David Tredinnick), who made an interesting speech. I also thank the hon. Member for East Kilbride, Strathaven and Lesmahagow (Dr Cameron) for securing this important debate.

We all know someone who has had, or has been affected by, cancer. My family is no exception: both my parents had cancer and my husband lives with cancer every day of his life, and I could talk about cancer forever—but, Madam Deputy Speaker, I will try to limit myself to the recommended time.

The cancer strategy sets out strategic priorities and recommendations that aim to improve radically the outcomes that the NHS delivers for people affected by cancer, yet we also know that the specific needs of blood cancer patients are not being fully met by the cancer strategy. That is primarily because the experience of blood cancer patients is different from that of solid tumour cancer patients, so general cancer services are not always effective in meeting their needs.

These unmet needs occur in a number of priority areas identified in the cancer strategy, including awareness and early diagnosis, patient experience, living with and beyond cancer, access to new treatments and research, and NHS commissioning. Today, I want to focus on one particular issue: the need to improve post stem cell transplant care for blood cancer patients. This issue overlaps with a number of the aforementioned priority areas: patient experience, living with and beyond cancer, and NHS commissioning.

It is estimated that by 2020 there will be more than 16,000 people in the UK living post transplant, many of whom will be experiencing both physical and psychological side-effects from their treatment which can last for months or even years. The side-effects can include graft versus host disease, second cancers, infertility, depression, isolation and post-traumatic stress disorder.

Unfortunately, we know that there are worrying gaps in the care and support available to stem cell transplant patients after treatment. It is particularly concerning that only half of those who need psychological support actually receive it. The same is true for practical support: one in five are not offered any specialist care to help with elements of their physical recovery. These statistics are reflected in the experiences of many blood cancer patients, who feel that the level of support available to them falls away when they are sent home after their transplant. They feel that they have no one to talk to about the effects of the transplant, the challenges of late complications, the psychological burden of living with and beyond cancer and its treatment, their dietary needs, their infertility problems or practical issues such as when they can start to resume the everyday activities that they enjoyed before their treatment started.

This is happening because the commissioning of post transplant services is simply not working for every patient. After 100 days, responsibility transfers from NHS England to the clinical commissioning groups, but evidence suggests that this arbitrary cut-off can lead to fragmentation and gaps in the care and support offered to patients. To remedy this situation, there must be a review of the 100-day cut-off, as well as of the care currently provided to patients after a stem cell transplant, to ensure that all patients can access the support they need. This includes ensuring that all patients have access to appropriate emotional and psychological support services and to a clinical nurse specialist or the equivalent model of support, both of which are pledges in the cancer strategy.

This issue very much ties into what the cancer strategy says about the commissioning of cancer services being “highly fragmented”. The strategy recommended

“setting clearer expectations, by the end of 2015, for how cancer services should be commissioned”,

and as we head rapidly towards 2020, it is important that we continue to work hard to resolve the confusion that still exists. I hope that the Minister will be able to update us on how work in that area is progressing. I have outlined just a few of the priority areas where much more needs to be done to ensure that blood cancers and the needs of blood cancer patients are appropriately addressed by the cancer strategy. I believe that thorough and robust action in these and a number of other key areas will have a significant impact on outcomes for blood cancer patients, improving care on their journey from diagnosis to treatment and through to recovery.

NHS Blood Cancer Care

Colleen Fletcher Excerpts

Wednesday 17th January 2018 Westminster Hall

[Colleen Fletcher (Coventry North East) (Lab)]

Thank you, Mr Wilson. It is a pleasure to serve under your chairmanship. I commend the hon. Member for Crawley (Henry Smith) on securing the debate, which, as we have heard, is particularly timely, given today’s launch of the report by the APPG on blood cancer, “The ‘Hidden’ Cancer: The need to improve blood cancer care”. I was happy to be a small part of that. The report makes significant recommendations, all of which I, as a member of the APPG, fully endorse, about improving care for blood cancer patients on their journey from diagnosis to treatment and through to recovery.

I shall focus my comments today on the commissioning of stem cell transplantation and the inconsistencies in post-transplant care. There is a common misconception that if a blood cancer patient finds a matching donor and undergoes a stem cell transplant, they are out of danger—that that is the beginning of the end of their journey, the point from which they get better. In reality, nothing could be further from the truth. Although a stem cell transplant is a potentially curative treatment for blood cancer patients, recovery can be a long and difficult journey. Many of those living post transplant will experience severe and debilitating physiological and psychological side effects from their treatment, not only in the first few days, weeks and months after the transplant, but many years down the line. Indeed, a transplant patient is often described as “a patient for life”.

The side effects include physiological problems, such as graft versus host disease and a higher risk of second cancers, infections, infertility, premature menopause and fatigue, as well as psychological effects, including isolation, depression, anxiety and post-traumatic stress disorder. Patients dealing with the impact of a stem cell transplant, and particularly those receiving an allogeneic transplant, therefore require ongoing support from appropriately qualified health professionals.

The problem is that the provision of high-quality post-transplant care varies significantly across the country, leaving vulnerable patients at the mercy of the often fragmented and inequitable postcode lottery NHS, in which some get very good support but others get very little.

Recent research by the charity Anthony Nolan reveals that many patients are struggling to access the services that they need post transplant. It is particularly concerning that only half those who need psychological support, such as counselling or group therapy, receive it. The same is true for practical support, such as help at home or with getting back to work; and one in five is not offered any specialist care to help with elements of their physiological recovery, which includes access to physio- therapists, dieticians and fertility experts.

To address the areas of unmet need, we must reform the commissioning of post-transplant care. Currently, responsibility for commissioning services transfers from NHS England to CCGs after only 100 days. There is evidence that that arbitrary cut-off leads to gaps and variation in the care and support that hospitals are able to provide, despite their best efforts. That increases the burden on patients and their families, making their recovery much more difficult. As recommended by both the APPG report and Anthony Nolan, it is essential that NHS England reviews the 100-day cut-off in order to eliminate the inconsistencies and fragmentation in post-transplant care across the country. I hope that the Minister addresses that point in winding up the debate.

As part of the process, we should consider the creation of a national care pathway for patients for at least five years post transplant. That pathway should ensure that patients have access not only to the full range of physiological, psychological and practical support services after their transplant as well as before and during, but to a clinical nurse specialist—or equivalent model of support—who can help them through their recovery journey, managing their care and plugging some of the gaps that would otherwise exist.

[Mr Gregory Campbell (East Londonderry) (DUP)]

The hon. Lady is talking about the system required in a post-transplant period. Does she agree that every individual is obviously significantly different and there may well be a significant difference in the amount of time required immediately after the transplant and subsequently for a period of years, and that that needs to be taken into account as we go forward?

[Colleen Fletcher]

I thank the hon. Gentleman for that intervention. Yes, I agree. People are totally different. Some, I know, have sailed through with few problems, and others have had many problems occur after the 100 days.

People may know that my husband, Ian, had a stem cell transplant more than three years ago, just after being diagnosed with acute myeloid leukaemia. What I have said today reflects his journey. He has been a beneficiary of cutting-edge research, which has allowed his cure, but we have also experienced some of the inconsistencies along a journey that has been too long to narrate today. It is from that experience, and from my heart, that I ask the Minister to look at a fully funded care pathway for at least five years post transplant, with the specialist care needed to allow people the chance to live their lives again as fully as they can.