NHS Staff Pay

Craig Tracey Excerpts

Wednesday 21st March 2018 Commons Chamber

[Mr Hunt]

What the hon. Lady chose not to tell the House was that since the time of the last Labour Government, we now have 5,500 more nurses and 15,000 more doctors in the NHS, and there has been a 9% rise in NHS funding. [Interruption.] I hear the shadow Secretary of State talking about vacancies from a sedentary position. I hope that he will also welcome the 25% increase in the number of doctors and nurses whom we are training precisely so that we can fill those vacancies.

[Craig Tracey (North Warwickshire) (Con)]

I welcome the announcement, and it was great to see the Secretary of State meeting staff at my excellent local hospital, the George Eliot, recently. What will be particularly welcomed is the hugely progressive nature of this deal, with its focus on the lowest paid. What exactly does it mean for those at the very bottom of the pay scale?

[Mr Hunt]

For people starting off in nursing, there will be a rise of about £2,000, which will make a very big difference, and we are increasing the minimum starting salary for anyone working in the NHS by about £2,500. This is completely in line with the Government’s policies over a whole range of areas. We have prioritised increasing the amount people can earn tax-free before paying any income tax at all. We have taken millions of people out of income tax. That is because this Government are committed to helping the lowest paid.

Oral Answers to Questions

Craig Tracey Excerpts

Tuesday 20th March 2018 Commons Chamber

[Steve Double (St Austell and Newquay) (Con)]

16. What steps he is taking to increase the capacity and availability of GP services.

[Craig Tracey (North Warwickshire) (Con)]

21. What steps he is taking to increase the capacity and availability of GP services.

[The Parliamentary Under-Secretary of State for Health (Steve Brine)]

We of course recognise the shortages in general practice, which is why we remain committed to delivering an additional 5,000 doctors working in general practice by 2020 compared with 2015.

--- Later in debate ---

[Craig Tracey]

It is great to see that record numbers of medical students are going into general practice this year, but far too many GPs are choosing to retire and leave the NHS when they are in their 50s because of tax penalties on their pension scheme. Does the Minister agree that we need to address that situation so that experienced GPs are not penalised for staying in the NHS?

[Steve Brine]

Along with concerns about workload and, for example, indemnities, pensions are an issue that older GPs often bring up with me. Ultimately, it is a matter for Her Majesty’s Treasury. My hon. Friend the Member for South West Bedfordshire (Andrew Selous) raised a similar issue at Prime Minister’s Question Time last week, and the Chancellor was on the Bench to hear it. I am sure he will read the report of these exchanges, too.

Cancer Strategy

Craig Tracey Excerpts

Thursday 22nd February 2018 Commons Chamber

[Craig Tracey (North Warwickshire) (Con)]

I am delighted to be taking part in today’s debate. I know that this is an important area for the Government. I congratulate the members of the all-party parliamentary group on cancer on securing time for the debate today. Since 2010, the Government have recognised the need to improve cancer services offered by the NHS and to make the UK a world leader in cancer research, diagnosis, treatment and care. Many innovations have been introduced, including the cancer drugs fund and the implementation of the independent cancer taskforce’s strategy. Cancer survival rates are at a record high, and access to the world’s leading cancer drugs continues to improve. It is clear that a lot of great work is already being done.

I would like to focus specifically on breast cancer. It has been a real honour for me to be co-chair of the all-party parliamentary group on breast cancer for the past three years. This has given me the chance to meet and work with a range of really inspirational people, from patients through to clinicians. It is great to see two former chairs of the group representing both Front Benches here today. During his time as chair, the Minister in particular did some really good work on age-related risk, and it is good to see that he is carrying that on. I hope that we will be able to tempt him to talk about some of the work he is doing when he speaks later.

As we know, breast cancer is the UK’s most common cancer, with 11,500 women and 80 men dying from the disease every year. That said, great strides are being made in diagnosis and treatment, leading to survival rates doubling in the past 40 years. One of the key recommendations in the cancer strategy is on early diagnosis, with a target that, by 2020, 95% of patients will be diagnosed and receive results within four weeks. I want to concentrate my remarks on an area that is critical to achieving that ambition and that is often referred to as the biggest breast cancer risk that women are not aware of—namely, breast density.

During my work with the APPG, issues surrounding breast density have become clear, particularly the increased risk and the masking of cancers in mammography. Mammograms are obviously the main method of national screening and, while considered the gold standard, evidence shows that they are not as effective for women with dense breasts. Before I move on, it is important to understand the implications of breast density. It is not uncommon, with 40% of women aged over 40 having dense breast tissue. Although it is completely normal to have, it is also a well-established predictor of developing breast cancer. Women with the highest density are between four and six times more likely to develop the disease than those with less dense breasts.

The challenge is that tumours show up as white on a mammogram, but so does the dense tissue, meaning that the cancer is missed in more than 50% of cases. To illustrate the significance of that, it is useful to recount a couple of examples given to me by patients that highlight the importance of the issue and the differences in approach by country. One lady living in the UK underwent mammogram screening from 2004 to 2012, receiving a clean bill of health each time. Shortly after her fourth mammogram, she found a lump, which was later found to be 7 cm in size and had been missed for over 10 years due to her breast tissue being 75% dense. She underwent a mastectomy and, as a result of her illness, was forced to give up her business. Six years later, she continues to undergo breast construction surgery. Compare that experience with that of another patient I met who lives in France. In 2016, her first ever mammogram was clear. However, as she was also diagnosed as having dense tissue, she was immediately referred for an ultrasound scan, which revealed an 8 mm invasive tumour. As a result of the early detection, she received minimal treatment and an extremely positive outcome. Sadly, the first experience is not unusual, with 3,500 breast cancers going undetected each year in the UK alone.

I am aware that there is a global movement to educate not only women, but also health professionals about the implications of density, with a view to ultimately saving lives by promoting earlier diagnosis, so that tumours can be found when they are small. In the USA, 30 states have passed legislation to provide women with some level of information on breast density, detailing the increased risk they face and how effective mammograms are likely to be for them. Having raised it with the Minister previously, I know that he has a great deal of interest in this area, and it is pleasing that some action is already being taken in the UK, with the Government commissioning research from the University of Warwick. However, clear evidence shows that high breast density eclipses family history as a risk factor for actually developing breast cancer.

What are the solutions? In an ideal world, the answer would be to change screening guidelines and offer further screening to those women at risk. For changes on this scale, I appreciate that we need to await the outcome of the research so that long-term decisions can be reached, but a relatively straightforward solution can be achieved right now. We should not ignore the breast cancer experts in the UK, who are already educating about breast density, as there is a definite need to promote awareness not only to women, but health professionals, including GPs, who are the usual first port of call for women concerned about their health. The simple task of educating about breast density can potentially promote more positive health outcomes, lead to less harsh treatments, reduce mastectomies, avoid secondary cancers and, ultimately, save lives.

In conclusion, I have learned an awful lot about breast density over the past two years, and I would like to think that more people will be informed about its potential impact as a result of today’s debate. However, the following questions remain. Do the women in your family or among your friends know the risk from breast density? Does your mother, wife, sister or daughter know that a clear mammogram may not actually be clear? Those potentially life-saving pieces of information should be available to every single woman to ensure that the Government’s excellent ambition to deliver world class cancer outcomes and even better cancer survival rates can be achieved.

Oral Answers to Questions

Craig Tracey Excerpts

Tuesday 6th February 2018 Commons Chamber

[Mr Hunt]

The hon. Lady always speaks powerfully about the social care system. One of the key parts of the social care Green Paper that we are currently working through is on market stabilisation. We have seen a number of care homes go under, although the number of beds overall has remained broadly stable, but our particular concern is, as she rightly points out, people in the advanced stages of dementia who might not be able to get the care that they want. This is a key focus of our work.

[Craig Tracey (North Warwickshire) (Con)]

T7. I have had concerns highlighted to me over the national cancer patient experience survey in the light of the introduction of a new national opt-out model. Can the Minister confirm that the survey will continue to deliver the same high-quality data annually and can he tell me when a final decision on its format is likely to be made?

[The Parliamentary Under-Secretary of State for Health (Steve Brine)]

I have listened carefully to cancer charities, clinicians and patients on the importance of the cancer patient experience survey. I have been clear that, whatever form the CPES takes as a result of the changes to how confidential data is shared, we want the survey to continue with a methodology as close to that of the current survey as possible.

Oral Answers to Questions

Craig Tracey Excerpts

Tuesday 19th December 2017 Commons Chamber

[Mr Hunt]

If we decide that we want more nurses following Mid Staffs, that creates vacancies. If we want to transform mental health provision, that creates vacancies. That is why we announced a workforce plan, which I notice the Welsh Government have not had time to do yet. But I will finish by wishing the hon. Gentleman a merry Christmas. If he wants to take a bit longer off and stay away for January, we are happy to hold the fort.

[Craig Tracey (North Warwickshire) (Con)]

T2. Research shows that breast density is a strong predictor of developing breast cancer, yet many women remain unaware of the risk. Will the Minister confirm what steps are being taken to educate women with this potentially life-saving information?

[The Parliamentary Under-Secretary of State for Health (Steve Brine)]

My hon. Friend asks an important question. We have just commissioned Warwick University to investigate the links between breast density and breast cancer. If the findings suggest that there should be any changes to the national breast screening programme, the UK national screening committee will of course consider that, as it does with any new evidence that helps it to target screening appropriately and make women aware of any increased risk of breast cancer. I will be watching this like a hawk.

Oral Answers to Questions

Craig Tracey Excerpts

Tuesday 10th October 2017 Commons Chamber

[Mr Hunt]

Accountable care systems are supported by such rabid right wingers as Polly Toynbee, writing in The Guardian, because they are about health systems coming together to co-operate to give the best care for patients. That is what is happening across the NHS, and it is already delivering great results.

[Craig Tracey (North Warwickshire) (Con)]

This Friday marks Secondary Breast Cancer Awareness Day. In 2015, the Government recognised that data collection for this type of cancer was not good enough. However, research by Breast Cancer Care shows that less than a third of trusts collect the number of people diagnosed with secondary breast cancer. Will the Minister confirm what actions the Government are taking to ensure that all trusts are collecting this information, given its importance to improving outcomes?

[Steve Brine]

I thank the co-chair of the all-party group on breast cancer in what is BCAM—Breast Cancer Awareness Month. We must never forget the treatment and support we give to those living with and beyond the cancer diagnosis. We must always remember those living with secondary breast cancer and the work of the third sector—brilliant charities such as Breast Cancer Haven and Breast Cancer Care—so that we can focus on access to a specialist nurse. As my hon. Friend says, the collection of data is critical, and I will be discussing that at my roundtable with some of the main players in the cancer community later this week.

Secondary Breast Cancer

Craig Tracey Excerpts

Wednesday 21st October 2015 Westminster Hall

[Craig Tracey (North Warwickshire) (Con)]

I beg to move,

That this House has considered secondary breast cancer.

It is a pleasure to serve under your chairmanship, Ms Dorries, in the first Westminster Hall debate that I have secured. As a co-chair of the all-party group on breast cancer, I am delighted to be able to raise the extremely important issue of secondary breast cancer. I thank all the people and organisations that have provided me with valuable information for today’s debate, not least Breast Cancer Care and Breast Cancer Now, both of which provide vital support to the all-party group. I particularly welcome the volunteers from those charities who are in the Public Gallery, representing the approximately 36,000 people living with secondary breast cancer in the UK today.

Last Tuesday was Secondary Breast Cancer Awareness Day. It underlines the importance of the issue that, at an event held in Parliament, nearly 90 MPs from both sides of the House turned up to support. Cancer is a disease that will sadly affect us all in one way or another during our lifetime, but the subject of today’s debate, secondary breast cancer, is often overlooked. Before making progress, I apologise to everyone for the number of acronyms that I will use, but given the number of hon. Members who want to speak, if I used the full names each time, we would never get through everyone.

Secondary breast cancer, also known as metastatic, advanced or stage 4 breast cancer, is where breast cancer cells have spread from the breast to other parts of the body—most commonly to the bones, lungs, liver and brain. It is incurable, but treatable. On average, people live with the disease for two or three years after diagnosis. However, that can vary considerably from person to person, with some living only months after diagnosis and others living many years longer. Unfortunately, research has shown that many secondary breast cancer patients receive inadequate care. All too often, it is much poorer than that which they received following their primary diagnosis. They do not always have access to palliative care, specialist nursing or the treatments that could extend their lives. Much of the current discussion and debate on cancer focuses on promoting early diagnosis and improving survival outcomes. That is extremely important and should be at the forefront of any cancer strategy. However, it is vital that it does not mean that people living with incurable secondary breast cancer are forgotten about. For them, efforts to improve early diagnosis rates will have no effect.

However, there are many things we can do, and for the purposes of today, I would like to focus on five key areas. First, one of the key issues underpinning many of the problems in care is the lack of data about the disease. At present, we have no idea how many people are being diagnosed with secondary breast cancer or how the disease progressively affects life over time. It is surprising that we still do not have an accurate figure for the number of people living with secondary breast cancer. Without that number, it is extremely difficult for the NHS to plan and commission services effectively to meet the needs of patients.

[Andrew Stephenson (Pendle) (Con)]

I congratulate my hon. Friend on securing this important debate. He is making a powerful case—a case that has also been made to me by my constituent Jade Braithwaite from Colne, whose mother sadly lost her life to secondary breast cancer. Given that it is already mandatory for hospitals to collect the data on secondary breast cancer, does he agree that it is absolutely shocking how few data we currently have?

[Craig Tracey]

I thank my hon. Friend for that intervention. I am coming on to that point now—well anticipated! As I said, it is surprising that we do not have accurate figures and it is therefore difficult to plan and commission effectively. That is acutely demonstrated in the lack of specialist nurses and poor access to palliative care, which both Breast Cancer Care and the secondary breast cancer taskforce first raised in 2008.

In 2010, Breast Cancer Care, along with other breast cancer charities and the APPG, met the Prime Minister to discuss the issue. He agreed that data collection was necessary and committed to achieving that. As a result, in the 2011 cancer strategy, “Improving Outcomes”, there was a commitment to collecting data for the first time. It stated:

“During 2011/12 we will pilot the collection of data on recurrence/metastasis on patients with breast cancer with the aim of undertaking full collection from April 2012.”

The pilot was run by the National Cancer Intelligence Network, the NCIN, in collaboration with Breast Cancer Care, and it involved 15 breast cancer units across England. The pilot report published in March 2012 identified 598 patients with recurrent or metastatic breast cancer. Of those, only 53% were recorded as having been referred to a clinical nurse specialist, palliative care nurse or specialist keyworker at the time of diagnosis. The pilot recommended that all breast cancer units in England submit data on patients with recurrent and metastatic breast cancer using the existing data collection mechanisms, and in January 2013 that was made mandatory in all new diagnoses recorded in England. Unfortunately, the data have yet to be published, and I understand that hospitals are not collecting them consistently. Indeed, a report was due to be published by the NCIN on the topic earlier this year but, disappointingly, it has been repeatedly delayed.

An investigation with health professionals by Breast Cancer Care into why data are not being collected consistently revealed that many of the barriers lie in the practicalities. Time constraints mean that there is often not enough time to input data manually, because patients’ needs, rightly, come first. Structural constraints were cited. Many of the data are expected to be collected through discussion at the multidisciplinary team meeting, but healthcare professionals tell us that most secondary patients are not discussed at MDT level. I welcome the recommendation in the new cancer strategy to review the role and function of the MDT in relation to secondary cancers. IT constraints cause further problems, because online record forms are not set up to collect the data in the cancer outcomes and services dataset, and there is a lack of access to online systems in some hospitals, especially in tertiary centres outside main hospital sites. Finally, there is a lack of awareness about what data are required and confusion about who is responsible for inputting various data items.

Leadership is required to help to drive robust data collection in all hospitals, and we want the Minister, who has responsibility for public health, to make that a priority and lead the way in ensuring that data are collected in every hospital. The new cancer strategy, “Achieving world-class cancer outcomes”, which was published earlier this year, includes a recommendation that data should be collected on all secondary cancer patients. We urgently need the implementation of the plan for how that will happen. In theory, as I have said, breast cancer data should be submitted through the COSD, which replaced the previous national cancer dataset in January 2013 as the new national standard for reporting cancer data in the NHS in England. It has the potential to provide a much broader overview of the treatment, care and outcomes of secondary breast cancer patients. Unless that happens consistently across England, however, we will not see the data that we need to improve care.

[Julian Knight (Solihull) (Con)]

I congratulate my hon. Friend on securing the debate and on the powerful case that he is forensically making. He knows as well as I do that, in our area of the west midlands, we were hit by the Ian Paterson scandal at Spire Parkway hospital. Does he believe that a greater ability to collect and collate statistics would have gone some way to alleviating that problem, because it could have been spotted earlier?

[Craig Tracey]

I agree completely. The lack of data is astounding, and they would help in so many different areas of treatment.

My second objective is access to specialist palliative care. For those living with a diagnosis of secondary breast cancer, such care can make all the difference in enhancing their quality of life, but for too many, support is not available. In many cases when support becomes available, it is too little, too late. Research for Secondary Breast Cancer Awareness Day in 2014 showed that 90% of people living with secondary breast cancer experience regular pain, and 78% find that it affects their ability to undertake everyday activities. For those reasons, palliative care is an absolute essential for secondary breast cancer. Hospices and community-based services can provide symptom management and pain control so that no one has to live with secondary pain. Furthermore, emotional support for both patient and family can help people come to terms with having an incurable disease, as well as ensuring that decisions are taken and adhered to about their choices at the end of life. Palliative care should come at the point of diagnosis, or at a timely point such as when a patient becomes symptomatic. It should provide both symptom control to help them live as well as they can for as long as possible, and emotional support to help them to cope with having an incurable disease and to make informed choices about the end of life.

The third area that I would like to mention is specialist nursing care. We know from the cancer patient experience survey that having a clinical nurse specialist as part of someone’s care is the biggest driver in improving patient experience. The National Institute for Health and Care Excellence quality standard states that everyone with secondary breast cancer should have access to a CNS. A CNS can help to co-ordinate care, provide emotional support and guide a patient through treatment and beyond. However, we know that it is far less common for someone with secondary breast cancer to have a CNS than for someone who has primary breast cancer, mainly because only a handful of CNSs have specific experience of and expertise in secondary breast cancer. A 2010 study found that there were only 19 dedicated secondary breast cancer nurse post-holders across the UK—the current estimate is 25—as opposed to 600 conventional breast cancer care nurse posts. That number must be increased, given that we estimate that there are 36,000 people living with secondary breast cancer—that figure is likely to grow as the population ages and treatments improve.

We need to commit to training more secondary breast cancer CNSs. Anecdotal evidence from existing nurses and from patients who receive care from a CNS suggest that 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. We would also expect someone who has a CNS to be more likely than someone who does not to be referred to palliative care when they need it.

My fourth point is about access to drugs and treatments. The cancer drugs fund, which was introduced in 2011, has been an important initiative to improve access to clinically effective drugs that have been deemed by NICE not to be cost-effective enough to be provided routinely on the NHS. Government figures show that, to date, 72,000 people have received life-extending cancer drugs as a result of the CDF. However, it was recently announced that two secondary breast cancer drugs would be removed from the list with effect from November this year. Although NHS England has stressed that any patient who is on a drug when it is de-listed will continue to receive it until it is no longer clinically effective, the change creates anxiety for people living with secondary breast cancer. Cancer charities hear from a lot of people who are concerned that their options for treatment in the future, when their current treatment is no longer effective, are being reduced.

I understand that new cancer drugs can be extremely expensive and it is important to remember that the NHS has finite resources, but there is a clear opportunity to reform the drug appraisal system and bring together pharmaceutical companies with healthcare professionals to ensure that secondary breast cancer patients can access new drugs at a price that is affordable to the NHS. The CDF was only ever meant to be a short-term solution to the problem, and it is vital that we find a long-term solution.

The final key area that I want to see addressed is co-ordinated and joined-up care. The role of a multi-disciplinary team is to bring together all the healthcare professionals involved in a patient’s care to help to co-ordinate the support that that patient receives. For many primary breast cancer patients, it works very well, bringing together oncologists, nurses, radiotherapists and other professionals to ensure that the patient’s care is joined up and integrated. However, the secondary breast cancer taskforce found that that was simply not the case for secondary breast cancer patients, largely because people living with the disease are under the care of only an oncologist rather than a team of professionals. Because of that gap, opportunities—for example, the opportunity to identify when palliative care would be most beneficial—are being missed. The cancer strategy includes a recommendation that MDTs consider new pathways for secondary patients. The implementation of that recommendation would go a long way towards joining up care more consistently and ensuring that patients’ holistic needs are more likely to be met.

To conclude, I ask the Minister to consider five clear steps: better data collection; greater access to palliative care; more specialist nurses; access to better drugs and treatment; and co-ordinated and joined-up care. To achieve the Government’s aim of being the best in Europe for cancer care, we need to ensure that people survive cancer and that those who are living with incurable cancers like Sue, who I met at the event last week, and Dee, who I believe is in the Public Gallery, are getting the care and support they need to ensure that they can live as well as they can for as long as they can.

--- Later in debate ---

[Craig Tracey]

I will be very quick.

I thank the Minister for her response. I also thank the other Front-Bench spokesmen, especially the hon. Member for Central Ayrshire (Dr Whitford) who obviously brings a great deal of expertise to the debate. I thank all colleagues who have taken part in this debate, particularly my hon. Friend the Member for Bury St Edmunds (Jo Churchill) for sharing her experience.

It is clear from the debate that we all have the same objectives; we all want to get the same thing and there are many common arguments. However, the fact remains that 11,700 people still die from secondary breast cancer every year, so there is more that we can do. I ask the Minister to ensure that more is considered in relation to secondary breast cancer.