Health and Care Bill

Craig Tracey Excerpts

Consideration of Lords amendments
Wednesday 30th March 2022 Commons Chamber

[Edward Argar]

The reason for that is that an amendment was brought forward on Report, and the matter was settled at that stage; things have not changed since. In lieu of what had been tabled, we tabled our own amendment on Report, which—even though in our view it was unnecessary—we felt further clarified how to avoid conflicts of interest. In the previous group of amendments, we tabled an amendment to extend that conflict of interest policy and approach to the sub-committees of the boards, in order to ensure that it is explicit that the policy applies to both. It is essentially the same principle, but widened out to the sub-committees to avoid them being inadvertently left out of the legislation.

[Craig Tracey (North Warwickshire) (Con)]

I really welcome Lords amendment 12 on palliative care. Can the Minister give us any more information about whether statutory guidance will be given to the ICBs? It is important that they get proper guidance on what is expected of them. Can he also reassure us that palliative care will be a priority objective for the trusts?

[Edward Argar]

I can give my hon. Friend an assurance that we expect that to be the case. I will turn to palliative care in the context of other amendments shortly, and I might address some of his points then.

We are also committed to tackling climate change. Lords amendments 9, 18, 33 and 40 place duties on NHS trusts, foundation trusts, ICBs and NHS England to have regard to the Government’s key ambitions on climate change and the natural environment in everything they do. The amendments include a guidance-making power for NHS England that will assist in the discharge of these duties by different bodies.

There are also a number of amendments relating to how integrated care boards should operate as statutory bodies. Amendments 19 to 21 and 23 require an ICB to consider the skills, knowledge and experience it needs to discharge its functions and, where there are gaps, to consider what steps it can take to mitigate them. The amendments also require the forward plan to include detail on how the ICB intends to arrange for the provision of health services, as well as its duties under sections 14Z34 to 14Z45. The annual report must also include an explanation of how it has discharged these duties.

The hon. Member for Oldham East and Saddleworth (Debbie Abrahams) mentioned conflicts of interest. We amended the Bill in this place, and the Lords amended it further with Lords amendment 11. We understand the motivation, but the drafting does not fulfil the stated aim, which is why we tabled an alternative amendment in lieu of that amendment.

Oral Answers to Questions

Craig Tracey Excerpts

Tuesday 18th January 2022 Commons Chamber

[Maggie Throup]

I thank the hon. Gentleman for raising this important issue, because fortifying non-wholemeal wheat flour with folic acid will help to prevent hundreds of neural tube defects in foetuses every year. I regret that I cannot commit to a specific timetable, but we need to consult on the draft legislation and will look to give industry appropriate notice. All four nations are working together on the timetable and hope to deliver this important policy as soon as possible.

[Craig Tracey (North Warwickshire) (Con)]

9. What steps his Department is taking to help (a) maximise NHS capacity and (b) increase the NHS’s resilience during the covid-19 outbreak.

[The Minister for Health (Edward Argar)]

Alongside measures to reduce demand and admissions, such as the vaccine roll-out and new therapeutics for covid, the NHS is creating the maximum possible capacity and investing in improved discharge arrangements, the use of independent sector beds, virtual wards and Nightingales to provide surge capacity, alongside our investment in delivering more than 20,000 more clinical staff this year compared with August 2020.

[Craig Tracey]

I thank the Minister for that answer. As he knows, one of the main challenges facing hospitals is delays in the transfer of patients back to care homes due to historic restrictions, particularly where there has been an outbreak, although there may have been only one case. As we move to treating covid as more of an endemic condition, what steps can be taken to stop restricting admissions to these care homes, which would undoubtedly relieve pressure on hospitals?

[Edward Argar]

There is local flexibility to allow residents to be safely admitted to a care home during outbreak restrictions, following a risk-based approach that takes into account the size of outbreaks, who is affected, care home size and layout, rates of booster vaccination and current Care Quality Commission rating. The CQC supports risk-based decisions made on admissions to support the discharge of people with a negative covid test result, but, of course, we must continue to ensure the safety of those in care homes.

Breast Cancer Diagnosis and Services: Covid-19

Craig Tracey Excerpts

Thursday 12th November 2020 Westminster Hall

[Craig Tracey (North Warwickshire) (Con)]

I beg to move,

That this House has considered the effect of the covid-19 outbreak on breast cancer diagnosis and the future of breast cancer services.

It is a pleasure to serve under your chairmanship, Ms McVey. As co-chair of the all-party parliamentary group on breast cancer, I am delighted to raise these hugely important issues. It is great to see the Minister in her place; she brings great expertise and knowledge to this topic. This has all the hallmarks of an excellent debate.

To set the scene, as hon. Members will know, the pandemic has had a major impact on breast cancer services, with Breast Cancer Now estimating that almost 1 million women in the UK missed out on their screening appointment as a result of a pause in the programme. There was a worrying drop at the peak of the pandemic in referrals of suspected breast cancer and breast-related symptoms.

We also know that some breast cancer patients had their treatments changed or temporarily paused to protect their immune system, or had their surgery delayed. That caused, understandably, huge anxiety, particularly for patients with incurable cancers, such as secondary breast cancer, and that was passed on to their families. Recruitment to many clinical trials was paused. The sustained pressure on staff as a result of dealing with the covid-19 pandemic alongside the existing challenges for the breast cancer workforce, has the potential to overwhelm the system for the foreseeable future.

There is some good news. Despite a dip in August, referrals have been steadily recovering. Although there is some way to go before they reach pre-pandemic levels, breast screenings are restarting and the number of people beginning treatment is rising. I am sure hon. Members across the House will join me in thanking the NHS for its effort in treating people and finding ways to deal with cancer patients during the pandemic. I would particularly like to thank my local hospital, the George Eliot Hospital, and Kristy and her team in palliative care. They do such amazing work, in difficult circumstances.

The recovery plan set out how we will restore breast cancer services to pre-pandemic levels, but we also need to look to the future, to ensure that the progress we made in treating cancer is not allowed to stall or be forgotten. As I mentioned, the pandemic has raised several urgent issues in relation to cancer. It is fair to say that many of those needed tackling prior to the pandemic, and they still need addressing.

In 2018, a report by the APPG on breast cancer showed that while breast cancer outcomes were good and outperforming those of other cancers, inequalities in diagnosis, treatment and care across the country were being masked, impacting the experience and outcomes of patients. Our inquiry also found significant variations across England in the support that women with secondary breast cancer received, particularly in access to a clinical nurse specialist, patchy provision of information, psychosocial needs not being met, and a lack of prompt and timely access to specialist palliative care services.

I know that hon. Members will all have their own angles that they want to address in today’s debate, and I take the opportunity to thank the many organisations that have been in touch with their views on what we could discuss. However, I want to focus my remaining remarks on secondary breast cancer, which is an issue that the APPG has had a particular focus on. For hon. Members who are not aware, secondary breast cancer occurs when breast cancer has spread to other parts of the body. Critically, it cannot be cured, but it can still be treated. To put that in context, about 1,000 women still die every month from breast cancer in this country, and pretty much all those deaths are from secondary breast cancer, so it is a considerable issue that we need to address.

Five years ago, in October 2015, I hosted my first ever Westminster Hall debate, which was on the subject of secondary breast cancer. I spoke about the inequalities in the system, and the fact that secondary breast cancer patients were often overlooked. It was in that debate that the present Minister, my hon. Friend the Member for Bury St Edmunds (Jo Churchill)—then a Back Bencher—spoke so powerfully about her experiences and battles with cancer. I know this is an issue that she is really passionate about getting right, but sadly, for various different reasons, since my 2015 speech nothing much has changed. I know that that frustrates the Minister as much as it does me.

The research continues to show that although many secondary breast cancer patients receive inadequate care, it is all too often even worse than that which they received when they had their primary diagnosis. That cannot be right in this day and age. The 2015 debate noted how much of the current discussion and debate on cancer focuses on promoting early diagnosis of primary breast cancer and improving survival outcomes, which is absolutely right; we should be dealing with that, but a crucial part of any strategy has to be that we do not forget about people who are living with incurable cancers. They should be given parity of care in our system.

There are many things that we could do, including focusing on earlier diagnosis of secondary breast cancer and increasing knowledge and understanding of the signs and symptoms of it. However, I want to focus on two areas; if we addressed them, it would make such a difference to patients who have secondary breast cancer. The first is around data, which is one of the key issues. One of our problems that is that we have a real lack of understanding of the data on secondary breast cancer. At the moment, we do not know how many people are diagnosed with it each year, how long they are living for, how the disease spreads or what kind of treatment and support they are receiving.

Where data on secondary breast cancer is collected, there is variation in what is recorded and how that is done. That is despite its being mandatory since 2013 for hospitals to collect data on their new diagnoses of metastatic cancer. Research by Breast Cancer Now in 2016, repeated in 2018, showed that that is still routinely not happening. In the 2018 study, a staggering 40% of hospital trusts and health boards across the UK were still unable to tell Breast Cancer Now how many secondary breast cancer patients were under their care.

I brought up that issue in the 2015 debate on secondary breast cancer. I highlighted some of the practical barriers to data collection, which often include IT constraints, constraints of time within hospitals, their structures, a lack of awareness about what data is required, and confusion in the trusts and hospitals about who was responsible for inputting the various data items.

[Grahame Morris (Easington) (Lab)]

The hon. Gentleman is making an important and powerful point, and I hope the Minister is taking note. As he rightly says, many older people—particularly older women—with breast cancer were not prioritised to receive breast radiotherapy over the past six months. Data is available in the radiotherapy datasets that are held by Public Health England, but they have not been published so far. Does he agree that the Minister should seek to persuade NHS England to publish that data?

[Craig Tracey]

The hon. Gentleman raises an interesting point, which I am sure the Minister will address. It makes perfect sense that we are seeing the lack of cohesion in data. We know that data is power in everything—without the data, how can we plan a strategy? Wherever we get it from, it should be imported into the system. In the 2015 debate, I asked the Minister to lead the way on ensuring that the data was collected uniformly in every hospital, and not just collected, but collected in a format that enables us to interpret it. We need that now more than ever.

I felt that we were making some headway at the start of the year. I had a productive meeting with my right hon. Friend the Secretary of State for Health and Social Care, where we brought in some secondary breast cancer patients and had a really good discussion on a number of topics. Data was one of the key things that we addressed. The Secretary of State made very positive noises about the potential for a national secondary breast cancer audit. Unfortunately, shortly after that, we ended up in the grip of the pandemic and I appreciate that the Department’s focus has been pulled into different areas.

To return to the point that I have made, without accurate figures for the number of people living with secondary breast cancer, it is nigh-on impossible for the NHS to plan and commission services effectively to meet patients’ needs. Equally, without understanding the level of service and care that patients were accessing before the pandemic, it will be challenging to know how to improve outcomes when we get back to pre-pandemic levels. How can we hope to do that without knowing where we started?

Inadequate collection and sharing of data acts as a barrier to service improvement. We are missing out on an incredibly powerful tool that we should be using to spot variation and hold services to account, and to better understand the secondary breast cancer population and the service it requires. At a time when long-term local and national plans are being drawn up, we want to ensure that the NHS can fully deliver on its commitments, and that we have a clear understanding of the experiences of people with secondary breast cancer.

I ask the Minister to follow up on the delivery of a national secondary breast cancer audit, which would cover things such as diagnosis, treatment and access to support. That could transform our insight into this key area and provide the missing information that is desperately needed to ensure that the NHS can meet the needs of those living with secondary breast cancer.

The second point that I will touch on is the importance of increasing access to clinical nurse specialists. In the 2015 debate, I said that the cancer patient experience survey showed that when a clinical nurse specialist contributes to a patient’s care, it is the biggest driver in improving their experience. That measure could save money in the long term, by keeping patients out of hospital and highlighting problems before they become crises in A&E. That is particularly true for secondary breast cancer patients, because they are on a lifelong treatment pathway and often have complex emotional and supportive care needs. A recent survey found that less than a third of secondary breast cancer patients had seen a CNS regularly. With the number of men and women developing breast cancer increasing, and people with secondary breast cancer living longer with the disease, there was already a high demand for CNSs. With covid-19 resulting in changes to people’s treatment and care, however, while also having an impact on their emotional wellbeing, access to CNSs for secondary breast cancer patients has never been more urgent.

Yet Breast Cancer Now’s most recent report said that 41% of breast cancer patients felt they had had less contact with their CNS during the lockdown period. That was partly down to the fact that, in common with other parts of the workforce, many CNSs were moved elsewhere in the NHS during the peak of the pandemic. As an example, 400 Macmillan NHS professionals, including Macmillan-funded CNSs, were among those redeployed.

I am sure all hon. Members agree that it is encouraging that the NHS long-term plan commits that everyone, including those with secondary cancers, should have access to a CNS. There was also an additional commitment in the recent people plan 2020-21 to offer grants for 250 nurses to become cancer nurse specialists. That is another step in the right direction, which we really applaud, but the commitments made by the Government require investment in training and expanding of the CNS workforce to meet both the current and future challenges. I am sure we all want that to be addressed when the full NHS people plan is published, and I am sure we all want it to be matched in its intent by receiving the necessary funding in the upcoming spending review.

I realise many people want to speak. There is much more that I could talk about, but I will conclude and recap the asks, which are pretty straightforward. We need a secondary breast cancer audit and a fully funded long-term workforce plan to ensure that the Department of Health has the appropriate tools and structures to honour its commitments to deliver the best possible outcomes for all cancer patients, and to build back breast cancer services better following the pandemic.

[Esther McVey (in the Chair)]

It might be helpful for colleagues to know that I intend to get to the Front-Bench speakers no later than 2.30 pm, so, to enable everybody to get in and speak, speeches will be limited to four minutes. Also, will the Front-Bench speakers be mindful of the time, because we want to hear Craig Tracey again?

--- Later in debate ---

[Craig Tracey]

I thank the Minister. It is far better that we heard from her than from me. She has tackled this issue in the forthright way we have come to expect. Coming into this debate, I knew that we were in the right hands and I am even more sure of that now. I also thank other colleagues who participated in the debate, not just for their contributions but for the way the debate has been conducted. That is the message—

[Steve McCabe (in the Chair)]

Order.

Motion lapsed (Standing Order No. 10(6)).

Covid-19 Update

Craig Tracey Excerpts

Thursday 17th September 2020 Commons Chamber

[Matt Hancock]

The hon. Lady, earlier in the week in a statement that was all about testing, raised an issue that turned out to be wrong. I think it is really important and incumbent on all of us as public servants to explain things fairly, straight and properly to our constituents, and that is what she should start to do.

[Craig Tracey (North Warwickshire) (Con)]

I thank the Secretary of State for that statement. I was actually due to head to the north-east myself this weekend to celebrate my parents’ golden wedding anniversary, which obviously I cannot do now, but I take this opportunity to wish them a happy anniversary anyway.

On the subject of testing, I have been contacted by constituents who are struggling to get tested. I know that is something the Secretary of State really does grasp and appreciate, but I wonder what further reassurances he can give them that those who genuinely do need testing will be able to access that as soon as possible.

[Matt Hancock]

I am sure that my hon. Friend’s family will be disappointed he will not be there, but at least a mention in Hansard is something to make up for it. He rightly raises the challenges in getting tests. I assure him that we are working as hard as we possibly can to fix the problem, that tests are available, even though it is a challenge to get hold of them, and that those who do have symptoms should come forward and get a test.

Coronavirus

Craig Tracey Excerpts

Wednesday 26th February 2020 Commons Chamber

[Matt Hancock]

I am very happy, subject to consent, to look at that. I would also say that the way that contact tracing works is that, once the positive case is identified, you trace out from the positive case, rather than starting from the wider population—including attendees at the bus conference—and focusing in. Contact tracing was undertaken in the correct way. Indeed, the majority of cases that we have found in the UK have been found through the proactive contact tracing undertaken by Public Health England; that commends its approach.

[Craig Tracey (North Warwickshire) (Con)]

I thank the Secretary of State for the statement. Obviously, this issue affects all our constituencies, so can he confirm that he will continue to provide further information to the House as the situation develops and as more information becomes available to us, so that we can keep our constituents’ minds at rest that everything that can be done is being done?

[Matt Hancock]

Yes, absolutely; of course I will keep the House and the wider public updated. That is an incredibly important part of our work. Of course, for any colleague, my door, and that of the Minister for Public Health, my hon. Friend the Member for Bury St Edmunds (Jo Churchill), is always open to answer any questions.