Oral Answers to Questions

David Mowat Excerpts

Tuesday 15th November 2016 Commons Chamber

[Fiona Mactaggart (Slough) (Lab)]

4. What the average time taken is between referral and treatment for patients with (a) ovarian and (b) bowel cancer; and if he will make a statement.

[The Parliamentary Under-Secretary of State for Health (David Mowat)]

The figures for times between referral and treatment are published against the standard whereby 85% of patients should begin treatment within 62 days of GP referral. The September 2016 figures were 69% for bowel cancer and 75% for ovarian cancer.

[Fiona Mactaggart]

Is it not the case that only skin cancer and breast cancer referrals are meeting that 62-day target? Is it not unsurprising that the survival rate over 10 years is 78% for breast cancer and 89% for skin cancer, whereas it is 35% for ovarian cancer and 57% for bowel cancer? How does the Minister feel about these excess deaths, and what is he going to do to ensure that people with these cancers are treated in time?

[David Mowat]

There are eight cancer standards for waiting times and we are consistently meeting seven of them, as we did in September. The right hon. Lady is right to say that the 62-day waiting time has been challenging, and that has an impact on bowel cancer and ovarian cancer. It is also true, though, that one-year, five-year and 10-year survival rates for bowel and ovarian cancer are improving significantly. However, we do need to go further. That is why all 96 recommendations of the Cancer Taskforce have been accepted—we are investing up to £300 million to make that happen—and there is going to be a new test whereby all patients will be either diagnosed or given the all-clear within 28 days.

[Simon Hoare (North Dorset) (Con)]

I refer to my entry in the register. Does my hon. Friend agree that research will defeat bowel and gastrointestinal tract cancer, and may I invite him to congratulate Bowel and Cancer Research on its fundraising and support for the cancer research community?

[David Mowat]

My hon. Friend is quite right: research, in the end, is the way we will beat cancer. This country is ahead of all countries in the world in terms of the number of trials going on, including the US. The voluntary sector, including the charity to which he refers, makes a big impact and I congratulate it.

[Tim Farron (Westmorland and Lonsdale) (LD)]

I lost my mum to ovarian cancer just a few years ago. She received outstanding treatment at the Rosemere centre in Preston. That is the centre that my constituents need to travel to for radiotherapy for all forms of cancer, but an average round trip to receive treatment takes about two hours. Does the Minister agree that that is not acceptable, and will he support the Rosemere centre in setting up a satellite unit at Kendal hospital, so that people in south Cumbria can get treatment quickly?

[David Mowat]

I certainly agree with the hon. Gentleman that two hours is a long time. His is a large constituency and I am very happy to look at his specific point and to revert to the House.

[Mr Peter Bone (Wellingborough) (Con)]

Like the hon. Member for Westmorland and Lonsdale (Tim Farron), I lost my mother to ovarian cancer. One of the reasons is late diagnosis and it has been suggested that cervical smear results should state that it is not a test for ovarian cancer. Will the excellent Minister update the House on his research on that proposal?

[David Mowat]

My hon. Friend is right to say that one of the big issues with ovarian cancer—we talked about this earlier—is that early diagnosis does not happen as quickly as it should. It is true that the cervical cancer test could raise awareness of ovarian cancer. We are looking at the issue and will revert to the House.

[Jim Shannon (Strangford) (DUP)]

Ovarian cancer accounts for some 12% of all new cases, and early diagnosis is critical. What discussions has the Minister had with the devolved Assemblies to co-ordinate and make available better treatment options, to provide a truly UK-wide NHS?

[David Mowat]

This is a reserved matter, but the hon. Gentleman is right to say that early diagnosis is the single most important thing that we need to do better in order to improve our cancer out-turn rates, and that dialogue continues.

[Michael Fabricant (Lichfield) (Con)]

Is it not rather unfair to compare outcome rates for skin cancer, with which I was diagnosed, with those for other types of cancer, because it is easier to diagnose skin cancer at an early stage, which means that the outcomes are usually very good?

[Michael Fabricant]

Yes, because it is easier to diagnose at an early stage—that is the point I am making. Compared with 2010, are we not seeing more than 26,000 extra outpatients a day?

[David Mowat]

Compared with 2010, we are referring an average of 800,000 more people urgently for cancer treatment. My hon. Friend is also right to say that both skin and lung cancer have more straightforward pathways than ovarian and bowel cancer, but that is not to say that we should not focus on continually improving in relation to the points made by the right hon. Member for Slough (Fiona Mactaggart).

[Stuart C. McDonald (Cumbernauld, Kilsyth and Kirkintilloch East) (SNP)]

5. What steps he is taking to implement his Department’s childhood obesity strategy.

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[The Parliamentary Under-Secretary of State for Health (David Mowat)]

The STPs are a collaborative local effort, involving providers and commissioners coming together with other stakeholders to produce place-based plans. The vast majority of plans have been developed jointly between the health sector and local authorities. Several plans have been led by local government.

[Ms Eagle]

Yesterday, the King’s Fund rightly characterised what is euphemistically called the sustainability and transformation project as being planned in secret, behind the backs of patients and the public. In Merseyside and Wirral, we know from leaks that the Government are going to cut £1 billion from our local national health service, which, despite rising demand, will close hospitals, downgrade many accident and emergency departments and possibly leave the whole of Wirral without an acute hospital. Will the Minister now come clean and publish these plans in full, and will he undertake to visit Wirral so that my constituents in Wallasey can come and have a word with him about his plans for their NHS?

[David Mowat]

To be clear, every single STP will be published by Christmas. About 12 have been published so far, and the Cheshire and Merseyside STP will be published tomorrow. When the hon. Lady has access to it, she will see that some of the statements she is making are just scaremongering. She mentioned the King’s Fund, so let me quote it:

“The King’s Fund continues to believe that STPs offer the best hope of delivering long term improvements to health and care services.”

That is what the King’s Fund says.

[Peter Heaton-Jones (North Devon) (Con)]

20. Will the Minister ensure that NHS managers undertaking the STP process affecting North Devon are fully aware of my constituents’ concerns, especially in relation to our geographical isolation? In particular, will he ensure that they are aware of their concerns in Ilfracombe, which has suffered from decades of health inequality because of its location?

[David Mowat]

It is vital that every STP engages with all stakeholders, and that includes North Devon. The public and, indeed, MPs should engage in the process as critical friends to try to make these plans better.

[Norman Lamb (North Norfolk) (LD)]

Despite reassurances, there are still concerns that mental health remains peripheral to STPs in many areas. Will the Minister provide some further reassurance, because unless the Government absolutely insist that mental health is central and that resources are focused on prevention in mental health, these plans will simply fail?

[David Mowat]

I give the right hon. Gentleman the categorical assurance that better mental health is a fundamental part of what the STPs are trying to achieve, as are better cancer outcomes and better integration of adult social care. If an STP does not include those things, it will have to continue to evolve until it does.

[Richard Fuller (Bedford) (Con)]

The Mayor of Bedford, Dave Hodgson, and I have a common approach to the STP in Bedford—it is ably led by Pauline Philip, the chief executive officer of Luton and Dunstable hospital—but he is frustrated that he is not being involved and that his voice is not being heard in the process. Will my hon. Friend ensure, when he reviews all the STPs, that he gets a guarantee in every single case that the local authorities have bought into the plan, and, if not, that they will not proceed?

[David Mowat]

I give my hon. Friend the categorical assurance that if local authorities and the NHS managers doing the planning work have not engaged properly, the plan will not be considered to be complete. That does not mean that every local authority has a veto on its STP.

[Justin Madders (Ellesmere Port and Neston) (Lab)]

Following on from that point, the Minister has previously said that STPs will

“not go ahead if councils believe they have been marginalised.”

Given that seven councils in London and west Yorkshire have already rejected their STPs and, as we have heard, that council leaders from both main parties have expressed concerns about the Cheshire and Merseyside proposals, does the Minister have a plan B when it comes to rejected STPs?

[David Mowat]

In a previous answer, I made the point that every local authority should be engaging with its STP, and the NHS must ensure that that happens. That is not the same as saying that every local authority has a veto on the STP, which was the implication of the hon. Gentleman’s point.

[Tom Blenkinsop (Middlesbrough South and East Cleveland) (Lab)]

7. What assessment he has made of the effect of changes to local authority social care budgets on the level of delayed discharges from hospital.

[The Parliamentary Under-Secretary of State for Health (David Mowat)]

The Government are giving councils access to a further £3.5 billion for social care by 2019, which will mean a real-terms increase over the lifetime of this Parliament. The causes of delayed transfers of care are complex and, frankly, vary considerably by local council.

[Tom Blenkinsop]

The Care Quality Commission has commented that social care is on the verge of collapse. The Government have had six years of warnings in relation to this matter, yet they have cut £4 billion from the social care budget. Will the Secretary of State for Health be talking to his colleague the Chancellor of the Exchequer to ensure that the £4 billion is replaced in the autumn statement?

[David Mowat]

The system is under pressure but we also know that the best way to achieve the best results is faster integration, and not just money. I will give the hon. Gentleman an example. There is a massive disparity between councils. The best 10% of councils have 20 times fewer delayed transfers of care than the worst 10%. It is not just about money, as the budgets are not 20 times different. Indeed, many councils have been able to increase their budgets, including Middlesbrough.

[Dr Sarah Wollaston (Totnes) (Con)]

The Minister is aware of the Health Committee’s concerns about the effect of underfunding of social care on the NHS. He may also be aware that there are particular concerns in my area and in the constituency of my hon. Friend the Member for Torbay (Kevin Foster) because of the recent Care Quality Commission rating of Mears Care as inadequate. Coming on the back of community hospital closures in Paignton, that gives grave concern to all our constituents. Will the Minister meet me and my hon. Friend the Member for Torbay to discuss this further?

[David Mowat]

My hon. Friend is right that there was an inadequate CQC rating for that care home. It is therefore right that the care home must either improve or go out of business. That is what the CQC regulatory environment will ensure. She makes a point about the issue with the hospital in Paignton; that is out for consultation at the moment, and I would expect the local care situation to be part of that consultation.

[Barbara Keeley (Worsley and Eccles South) (Lab)]

The National Audit Office report “Discharging older patients from hospital” said that

“there are…far too many older people in hospitals who do not need to be there”.

Delayed discharges reached a record level in September. The Minister says that this is complex, but I can tell him that the main drivers for that increase were patients waiting for home care or for a nursing home place; those issues are both related to the underfunding of social care. Does he agree with NHS England chief executive Simon Stevens that any extra funding from Government should go into social care?

[David Mowat]

As I said earlier, we accept that the system is under pressure, but we also make the point that there is a massive disparity between different councils. Some 13% of local authorities cause 50% of the delayed transfers of care—DTOCs. The real point is that those local authorities that go furthest and fastest in integration, with trusted assessors, early discharge planning and discharge to assess, have the most success.

[Sir Hugo Swire (East Devon) (Con)]

Northern, Eastern and Western Devon clinical commissioning group is already consulting on the possible closure of community beds across Devon. The social care budget in East Devon, an area of elderly people, and the rest of the county is already under severe pressure. That pressure will inevitably increase if community beds are closed. Will the Secretary of State therefore commit to putting those points to the Chancellor of the Exchequer in the run-up to the autumn statement?

[David Mowat]

The Secretary of State has already made the point that we do not give a running commentary on the status of discussions with the Treasury, but I accept my right hon. Friend’s point about his local issue.

[Alan Brown (Kilmarnock and Loudoun) (SNP)]

9. What assessment he has made of the performance of NHS England in meeting A&E waiting time targets in the last 12 months.

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[Jeff Smith (Manchester, Withington) (Lab)]

11. What assessment he has made of the effect of changes to local authority social care budgets on the demand for health services.

[The Parliamentary Under-Secretary of State for Health (David Mowat)]

Social care plays a vital role in keeping people healthy and independent, which is why the Government are making a further £3.5 billion available by 2020—a real-terms increase over the lifetime of this Parliament. There is an overlap between care and health, which is why faster integration is our major priority.

[Jeff Smith]

The Secretary of State’s Conservative predecessor, Stephen Dorrell, has said this month that we are increasingly using our acute hospitals as “unbelievably expensive care homes”, and he described this as a “grotesque waste of resources”. Is it not the case that the Government have simply outsourced the hardest decisions on social care cuts to the hardest-pressed local authorities to ensure that councils get the blame, not the Government, and that ultimately it is the NHS that suffers?

[David Mowat]

As I said earlier, we agree that the social care system is under pressure, but we also make the point that there is a massive disparity between the performance of different parts of that system. For example, Manchester, the hon. Gentleman’s own patch, has a DTOC performance seven to eight times worse, per 10,000 patients, than Salford, in spite of the 15% increase in its budget this year.

[Caroline Ansell (Eastbourne) (Con)]

A small-scale study by Professor Peter Fleming has recently made the press. It links cardiorespiratory compromise in new-borns with sleeping in car seats for prolonged periods—over 30 minutes. Given that for many Eastbourne babies, one of their first life experiences is the journey home from Hastings hospital, which is longer than 30 minutes, will the Department look at these findings, consider whether further study is required and offer reassurance to parents rightly concerned by the research?

[David Mowat]

This is a very difficult case. The Department will look at the evidence and revert to the House.

[Mr Speaker]

That was very dextrous handling of a very broad interpretation of the question on the Order Paper, but I hope that honour has been served.

[Helen Jones (Warrington North) (Lab)]

14. The Cheshire and Merseyside sustainability and transformation plan relies heavily on more care in the community. Does the hon. Gentleman accept that this will not work while local authority social care is being cut to the bone, because it will merely send people back to their own homes, where their health will deteriorate?

[David Mowat]

The Cheshire and Merseyside STP will be published tomorrow, and we will all know better then what it says. The hon. Lady is right that there is an interaction between social care and health, but she and I, as Warrington MPs, must both be pleased that Warrington is one of the top performers in terms of delayed transfers of care, and on that we should congratulate our local authorities.

[Jason McCartney (Colne Valley) (Con)]

12. What discussions he has had with NHS England on the reconfiguration of A&E units.

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[Henry Smith (Crawley) (Con)]

T7. The anti-coagulation service at the Furnace Green general practice was recently moved to Crawley hospital, which has caused concern to some local patients. Will a member of the health ministerial team agree to meet me to discuss that further?

[The Parliamentary Under-Secretary of State for Health (David Mowat)]

I understand that the clinical commissioning group has provided an alternative which is no more than two miles away, but I should be happy to meet my hon. Friend to discuss the matter.

[Stuart Blair Donaldson (West Aberdeenshire and Kincardine) (SNP)]

Climbing obesity rates are expected to lead to increases in type 2 diabetes, cardiovascular disease and the need for joint replacements, which will put even greater pressure on the NHS. Given such threats to health, does the Secretary of State really think that now is the time for timidity and sucking up to business?

[Antoinette Sandbach (Eddisbury) (Con)]

T8. General practices in Winsford are being underfunded by 3.6% in terms of the formula that should apply to them because of the slow rate of change, while nearby Merseyside practices are being overfunded by 5%. That is resulting in a £30 million loss to my local surgeries. Will the Minister commit himself to looking into it and introducing a quicker rate of change, so that local residents can benefit from the funds that they should be receiving?

[David Mowat]

In 2016, the Government implemented a new formula for allocation, which means a better deal for underfunded areas such as Winsford. As my hon. Friend has noted, however, the extra money is being phased in over a few years to prevent distortions. This year her local CCG received an increase of more than 3%, and the funding will continue to catch up as a result of the new mechanism.

[Mr George Howarth (Knowsley) (Lab)]

The Minister rightly said that greater integration between health and social care was a prize worth striving for. Why do local government leaders on Merseyside feel that they have been excluded from discussions about the STP process? If we are to make progress, they need to be part of the solution.

[David Mowat]

As I said earlier, local engagement with all stakeholders is necessary. The STP for Cheshire and Merseyside will be published tomorrow. It is essential for local authorities to engage in it as it evolves, and it is essential for MPs to engage in it—as critical friends—to make the plans better.

[Andrew Bridgen (North West Leicestershire) (Con)]

T9. According to a report published recently by the British Lung Foundation, 1.2 million people are suffering from and have been diagnosed with chronic obstructive pulmonary disease, while many more sufferers have not been diagnosed. Will the Minister support the establishment of an independent respiratory taskforce to help diagnosis and improve lung health for everyone?

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[Matt Warman (Boston and Skegness) (Con)]

Shared care allows GPs to provide complex prescriptions for drugs such as methotrexate, but in my constituency the Beacon surgery recently withdrew from those arrangements. Can the Secretary of State assure me that the Department will support not only patients who now face potentially longer round trips, but GPs themselves, so that they can continue to provide those vital services?

[David Mowat]

The arrangement my hon. Friend describes is a special relationship whereby a GP agrees with a hospital consultant to prescribe complex drugs which are normally only hospital-prescribed. This is not part of the standard GP contract and they cannot be required to provide this service. On the specific issue raised, we have asked NHS England to determine whether there are alternatives and I will revert to my hon. Friend on that.

[John Cryer (Leyton and Wanstead) (Lab)]

Is the Minister satisfied that the National Institute for Health and Care Excellence procedures for the approval of anti-cancer drugs are sufficiently speedy, because the waiting times for approvals can be months or even years, and there is a widespread feeling that that is too slow?