Maternity Services (Morecambe Bay)

Eric Ollerenshaw Excerpts

Tuesday 3rd March 2015 Commons Chamber

[Eric Ollerenshaw (Lancaster and Fleetwood) (Con)]

As a Member of Parliament for an area covered by the trust, I assure the Secretary of State that many thousands of workers in the NHS in my area do a really good job in very difficult geographical circumstances.

I was newly elected to Parliament in 2010. My experience, alongside that of colleagues whom I see in the House, as a constituency MP dealing with the huge institution that is the NHS has been that it is difficult to find out who is responsible, where and for what. Like everybody else, my heart goes out to the parents. I do not know how they have struggled on, with their loss and with being confronted with what almost seems like a professional or administrative closing of ranks and doors to their pleas for some information on what happened. It is just unbelievable.

My constituents do not understand why—this is mentioned in the report—a major incident in 2004 was not looked at. There were five more major incidents in 2006-07 and another five in 2008, yet still nothing was done. What will the Secretary of State do to reassure my constituents that when a major incident happens again—as presumably it could in any NHS hospital across the country—it will be acted on?

[Mr Hunt]

I am happy to do that. In fact, I can not only tell my hon. Friend what we are going to do, I can tell him what we have done. The main purpose of the new CQC inspection regime, with a chief inspector of hospitals and a special measures regime, is to make sure that these issues come to light much more quickly. The new regime has been very active: 20 trusts—more than 10% of all trusts in the NHS—have gone into special measures. We have seen dramatic improvements.

I would like to make a broader point to my hon. Friend’s constituents. He speaks very wisely when he says that this is not about the dedication and commitment of front-line staff. He is absolutely right. The Royal Lancaster infirmary is not the main focus of the Kirkup report, but of course as part of the same trust it suffered from the same management failings. There are Members of this House who have had problems at the Royal Lancaster infirmary and found that they were not listened to when they made complaints, because proper management was not in place. That will have affected his constituents. I hope they will take encouragement from the changes that have happened recently in that regard.

Francis Report: Update and Response

Eric Ollerenshaw Excerpts

Wednesday 11th February 2015 Commons Chamber

[Eric Ollerenshaw (Lancaster and Fleetwood) (Con)]

Following on from the question of the hon. Member for Barrow and Furness (John Woodcock) about Morecambe Bay trust, has the Secretary of State had a chance to look at yesterday’s “Better Care Together” future plans report by the trust, which finally puts to bed the wild allegations locally of hospital and A and E closures and also sets a road map for eliminating the pre-2010 deficit, provided we get some recognition of the difficult geography of our area?

[Mr Hunt]

I know geography is a big issue, and the driving distance between Morecambe bay and Lancaster is a big challenge for the trust. I will look closely at that report, and I think Members in all parts of this House would welcome a commitment to avoiding scaremongering about local hospital services in the run-up to the election.

Pancreatic Cancer

Eric Ollerenshaw Excerpts

Thursday 15th January 2015 Commons Chamber

[Eric Ollerenshaw (Lancaster and Fleetwood) (Con)]

I am grateful for the opportunity to speak in this Adjournment debate and to my friend the hon. Member for Scunthorpe (Nic Dakin), the deputy chair of the all-party group, for his constant work. He introduced the Westminster Hall debate and it seems that we merry three—the Minister, the hon. Member for Scunthorpe and myself—meet frequently in these debates. But we make no excuses for that.

With the permission of the hon. Member for Scunthorpe, I will let the Minister into a secret; we deliberately went for this debate not knowing the outcome of the cancer drugs fund decision. We must thank everyone involved in the decision to keep Abraxane. Those include the people who signed the petition, and my hon. Friends the Members for Romford (Andrew Rosindell) and for Milton Keynes South (Iain Stewart), the right hon. Member for Hazel Grove (Sir Andrew Stunell) and my hon. Friend the Member for Mid Derbyshire (Pauline Latham), who accompanied me to No. 10 to hand in the petition. I thank also Pancreatic Cancer UK, Pancreatic Cancer Action—as mentioned by the hon. Member for Scunthorpe—Pancreatic Research UK and Maggie Blanks. I thank everybody who put so much effort into this. But as the hon. Gentleman said, it is temporary and we expect something more.

Reference has been made to the period of two months but in terms of the average, that could double the survival rates of most people with pancreatic cancer. I will not repeat the figures but, on average, 24 people today will be diagnosed with pancreatic cancer. Of those 24, 23 will die within a year. That is the situation.

I also thank the Minister and, as the hon. Member for Scunthorpe mentioned—he seemed to mention everything—there is the five-year action plan. We talked about unmet need and the Americans have talked about recalcitrant cancer strategy, but I add my support to the hon. Gentleman that that becomes part of the responsibilities of the taskforce.

I welcome the announcement last month by NHS England that one-year survival rates from cancer would become a measurement for the new clinical commissioning groups from 2015. I believe that that will make a huge difference; not just with pancreatic cancer but with every cancer. Given that that is the only disease that will be measured in those terms, I thank the Minister and her colleagues for getting that through. I also commend the work of the all-party group on cancer led by my hon. Friend the Member for Basildon and Billericay (Mr Baron), which has worked constantly on early diagnosis. That will be a fundamental key in the revolution that is happening in cancer, and we would like to see it happen for pancreatic cancer.

I also thank the Minister for her detailed reply to the all-party group’s report on pancreatic research, “A Roadmap to Change.” We are grateful for that and the group will try to come back on it. But I have one last request; when I met the Minister, we were promised that the chief medical officer would at some point come to the all-party group and discuss the findings. I would be grateful if she used her good offices to ensure that that happens.

Oral Answers to Questions

Eric Ollerenshaw Excerpts

Tuesday 25th November 2014 Commons Chamber

[Dr Poulter]

It is important to outline that for the first time this Government have put in place, via section 42 financial agreements with trusts where there is a requirement for interim financial support, measures that will ensure that trusts are held to account for delivering efficiencies—for example, reducing agency staffing costs, improving procurement practice, more efficient estate use and land disposal, and pay restraint of very senior managers. I am therefore confident that the local NHS can continue to deliver efficiencies to direct money to front-line care.

[Eric Ollerenshaw (Lancaster and Fleetwood) (Con)]

11. Whether it remains the policy of the cancer drugs fund to provide drugs which NICE has rejected for general use in the NHS.

[The Parliamentary Under-Secretary of State for Health (George Freeman)]

I pay tribute to my hon. Friend for his tireless campaigning on the issue of cancer drugs. I can assure him that the cancer drugs fund now administered by NHS England continues to fund effective cancer drugs which have been not been recommended by the National Institute for Health and Care Excellence. Over 60,000 patients in England have benefited from the fund since October 2010. That is why we announced a £160 million boost to the fund earlier this year.

[Eric Ollerenshaw]

Will my hon. Friend look again at the CDF’s proposal to delist 42 cancer drugs, including Abraxane, which was put on the list only nine months ago and is the first new drug in nearly 40 years to produce an extension of life for pancreatic cancer patients?

[George Freeman]

I am grateful to my hon. Friend for his notice. I have spoken to NICE. It is appraising the use of Abraxane for pancreatic cancer and has not yet published its final guidance. It would not be appropriate for me to intervene at this point. Obviously, we respect NICE’s clinical independence. Abraxane is available through the CDF for patients meeting specific clinical criteria. I understand that the NHS England’s CDF panel plans to reassess the inclusion of Abraxane in the national list, but no decisions have yet been made.

--- Later in debate ---

[Mr Hunt]

There are huge pressures in the NHS. That is why we have put a record £700 million into the NHS to help it to get through this winter. May I gently suggest to the right hon. Gentleman that he should not try to politicise every single operational problem? When the NHS is all about politics, patients get forgotten—as he should know, because that is what happened when he was Health Secretary. Whether in Medway, Colchester, Burton or George Eliot, patients were forgotten because for Labour it was politics before patients every time.

[Eric Ollerenshaw (Lancaster and Fleetwood) (Con)]

T6. Will the Secretary of State look again at the funding formula for hospital trusts so that some adjustment can be included to recognise the issues in trusts such as University Hospitals of Morecambe Bay NHS Foundation Trust which cover large and difficult geographical areas?

[Mr Hunt]

I recognise those issues, and I am very happy to take that suggestion away. I particularly want to put on the record that the scare stories put out by Labour in Lancaster about the potential closure of Royal Lancashire Infirmary are false. It is totally irresponsible to scare people in Lancaster in that way.

Pancreatic Cancer

Eric Ollerenshaw Excerpts

Monday 8th September 2014 Westminster Hall

[Eric Ollerenshaw (Lancaster and Fleetwood) (Con)]

Thank you, Mr Chope. It is good to serve under you, and we did hear the applause.

I congratulate my colleague the hon. Member for Scunthorpe (Nic Dakin) on such a brilliant start to the debate and I thank him for the support that he has given the all-party group on pancreatic cancer month after month. May I also put on the record that my interest in the subject comes from having lost my partner to pancreatic cancer in 2009, only six weeks after diagnosis? I am grateful for the support that I received, and continue to receive, as a result of my loss from my hon. Friends the Members for Pudsey (Stuart Andrew), for Milton Keynes South (Iain Stewart) and for Redditch (Karen Lumley). They are sat close to me to keep me going in the debate, and I am always grateful for their support.

I decided to campaign on pancreatic cancer and helped to set up the all-party group, which I now chair. As the hon. Member for Scunthorpe pointed out, that has meant starting to meet others campaigning on the same issue. I have met representatives from charities such as Pancreatic Cancer UK, which acts as a secretariat for the all-party group and is ably led by Alex Ford, its chief executive; from Pancreatic Cancer Action, founded and led by pancreatic cancer survivor Ali Stunt; and from the Pancreatic Cancer Research Fund, founded and led by Maggie Blanks, who lost her husband to the disease.

I have also met Maggie Watts, whose petition ultimately led to today’s debate. As it happens, she lost her husband, Kevin, only two months after I lost my partner, so we have shared and similar frustrations. That shared sense of loss, the sense of injustice and the shocking survival rates for pancreatic cancer, along with the small amount of time that can generally be spent with people following diagnosis, drive us all—whether MPs, chief executives, charity workers or volunteers—to raise awareness and, I hope, to bring about change so that others do not have to go through what we did.

I thank Maggie Watts and the hundreds of people who campaigned so hard to get more than 100,000 signatures on their petition. I know it was touch and go, but they have managed it in only the past few days. The effort that they have put in to change the status quo, in honour and memory of their loved ones, should be applauded. I really thank them.

As the hon. Member for Scunthorpe mentioned, the all-party group on pancreatic cancer produced a report last year, which made a number of recommendations on how to improve awareness, diagnosis, treatment and care for pancreatic cancer patients. We did not even broach the subject of research in that report; to have done so would have complicated things unnecessarily. This year, therefore, the all-party group is carrying out an inquiry into how to increase the quantity and quality of research into pancreatic cancer in the UK. We held the last of the four evidence sessions last week and will be producing a report in late October. I want to spend some time talking about issues that emerged from the inquiry.

[Dr Julian Huppert (Cambridge) (LD)]

I thank the hon. Gentleman and the hon. Member for Scunthorpe (Nic Dakin) for securing this important debate. Before I was elected, I used to do research into cancer targets. Pancreatic cancer was one of them, and I was looking for new targets. I support the call for research. An oncologist who worked on the issue and with whom I was collaborating said, “All my patients will die very quickly from this unless they are hit by a car in the meantime. We have to change that situation.”

[Eric Ollerenshaw]

I thank the hon. Gentleman for underlining that critical point about survival rates and their impact on the ability of researchers to get that much-needed research.

The consensus we found was that more work is needed and that one of the reasons why survival rates for other cancers are increasing is that effective screening and markers have been developed to allow early diagnosis, thus giving more time for curative treatments to be given to patients. The other side of the argument, which we will go into, is that what we are looking for is support and treatment to allow survival rates after diagnosis to increase. In this day and age, having only six weeks left in which to make life-shattering decisions is unbelievably difficult for people.

[Naomi Long (Belfast East) (Alliance)]

I am glad that we are able to have this important debate. Does the hon. Gentleman agree that, in addition to the need for primary research, there is a disparity between the UK one-year survival rates and the best survival rates in Europe—it is often as much as 11%? Things are known about pancreatic cancer that we can perhaps learn from to treat and diagnose the condition.

[Eric Ollerenshaw]

The hon. Lady makes an extremely important point, which the all-party group was trying to weigh up. The hon. Member for Scunthorpe made an important point about CT scans and made the important suggestion that there should be pilots. Also, interestingly, he mentioned that the going backwards and forwards between the GP and the specialists delayed diagnosis. There are certainly things that we could learn from other countries.

One of the basic needs that came up from our research was the need for investment in the basic science and biology of tumours, as well as access to better infrastructure that would allow that, such as access to tissue samples. On the latter point, the Pancreatic Cancer Research Fund told the APPG that it was working in conjunction with Barts on creating a specific pancreatic cancer tissue bank, which would help. That is a massive investment for a small charity and it should be applauded.

As Members know, there is a massive shift throughout all cancer research towards personalised medicine. Pancreatic cancer patients could benefit particularly from such an approach, given the nature of the disease and the fact that so many different tumour types are involved. New treatments need to be developed to attack and destroy the cancer cells. That does not mean new drugs alone, but perfecting the use of advanced radiotherapy techniques, such as NanoKnife or CyberKnife, for the benefit of patients and to the satisfaction of the National Institute for Health and Care Excellence, so that they can be provided on the NHS.

All in all, a lot of research needs funding. A key statistic for this debate, as mentioned in Maggie’s e-petition, is that pancreatic cancer receives only 1% of the National Cancer Research Institute’s site-specific spend of £5.2 million a year. That is despite the fact that pancreatic cancer is the fifth biggest cancer killer in the UK, and predicted to become the fourth biggest by 2030. It is responsible for 5.2% of all cancer deaths in the UK. The National Cancer Research Institute itself acknowledges that research into pancreatic cancer and other cancers deemed to have unmet need, such as brain and oesophageal cancers—forgive me if I do not pronounce that correctly—remains “relatively low”.

By “relatively low”, however, the institute means “low”. I contend that £5.2 million a year from the NCRI partner funders is simply not enough to tackle the extreme intransigence of a disease as tough as pancreatic cancer, a disease that has seen—as has been mentioned before and should be mentioned again and again—little change in survival rates over the past 40 years or by comparison with other countries, as the hon. Member for Belfast East (Naomi Long) said.

Why does funding matter? Is money the be-all and end-all? No—other things need to be done as well if research into pancreatic cancer is to become more effective. However, if we look at other cancer types, we see that sharp increases in survival rates from breast, prostate and bowel cancer, for example, have mirrored sharp increases in research spending into those diseases. As Professor Peter O’Hare, chair of Pancreatic Cancer UK’s scientific advisory board—now there’s a powerful job—told the APPG inquiry:

“I think if you simply looked at the history of science, I don’t think you can, as a scientist, start to make guarantees about research. It’s not like a sausage grinder; you don’t put research in and it comes out and you solve the problem. It just doesn’t work that way”—

we totally understand and agree with that—

“there are convoluted pathways and you can’t make guarantees.

However, I think there is a guarantee you can make: if you don’t carry out research, you are not going to move; nothing is going to happen. That’s the guarantee that you could make.”

Some evidence suggests a critical mass, a level at which research needs to be funded, if advances are to start to gather pace. Pancreatic Cancer UK produced a report in 2012, “A Study for Survival”, which demonstrated a level—around £10 million to £12 million minimum—at which the amount of research starts to become sustainable and from which new research proposals and ideas are generated. Those new ideas in turn lead to more funding coming in, and we get a virtuous circle.

We are some way off that level of funding at the moment. National Cancer Research Institute funding partners contribute just £5.2 million at present. Incidentally, we learned during the all-party parliamentary group’s research inquiry that the Department of Health’s contribution to that sum is just £700,000 a year. Although they are growing, charities for pancreatic cancer are still small and supply probably less than £2 million a year between them for research. Where, then, can that extra funding come from? What needs to be done?

In its new research strategy, published in April this year, Cancer Research UK made a welcome move in the right direction, with a promise to increase funding into pancreatic and other cancers of unmet need—brain, lung and oesophageal—twofold or threefold over the next few years. That is great news.

[Mr Stewart Jackson (Peterborough) (Con)]

My hon. Friend is making a customarily powerful and passionate speech. He is aware that the five-year survival rate in the United States is 6%, as against 3.3% in the UK. Is he also aware that, under the Recalcitrant Cancer Research Act of 2012, the US Congress has given a legal imperative for the director of the US National Cancer Institute to produce a strategy to tackle such cancers? We should do the same in the UK.

[Eric Ollerenshaw]

I am grateful for that intervention, particularly as I will go on to mention the Recalcitrant Cancer Research Act—as usual, my hon. Friend has got in before me. He is on exactly the right lines in terms of what we are all thinking.

I have talked about good news and extra money. However, I am not sure whether that goes quite far enough. There is still no ring-fencing per se of money for research into pancreatic cancer, brain tumours and so on. Instead, applications will still have to be made for funding. They will be peer-reviewed and selected from similar applications for research into other cancer types.

The issue is that the reason given by Cancer Research UK for not awarding more funding for pancreatic cancer in the past has been that not enough quality applications have been received, so the doubling or trebling of funding set out in the strategy will happen only if more applications are made. For that to happen, we need more researchers in the field, whether established and respected researchers coming over from abroad, such as Professor Andrew Biankin from Australia, who has recently relocated to Glasgow—as usual, Scotland sets the trend—to carry on his pioneering work there, or new, young researchers starting out in their careers.

We are currently in a Catch-22 situation, however: new researchers do not generally want to enter the field, partly because it is deemed difficult to make advances in it—that puts them off as they fear it will hold back their careers, as the Department of Health’s written response to the e-petition mentioned—and partly because the funding is not there. But the funding is not there because not enough research applications are being made.

I firmly believe that we need to break that vicious circle and to pump-prime research into pancreatic cancer, making sure that we hit the minimum funding level required to gain critical mass. I also firmly believe that the Government can and should play a role in that.

[Dr Phillip Lee]

I have long lamented the fact that celebrity endorsements seem to increase the funding of research into particular illnesses and conditions disproportionately in terms of the impact that those conditions and illnesses are having on broader society. Does my hon. Friend agree that the Government might want to take into account the funding that certain conditions receive from private sources because they are deemed fashionable, so that greater Government funding can be given to those conditions that are seemingly less fashionable?

[Eric Ollerenshaw]

My hon. Friend makes an important point. It is difficult for Ministers and boards to make decisions about what is or is not fashionable. Nothing we are trying to do, in getting pancreatic cancer higher up the agenda, is aimed at taking away from the advances being made for other cancers. We all welcome those. We simply want fairer funding ourselves, and some recognition of the impact of this particular cancer. We are not asking to take away from anything else, but unfortunately we are asking the Minister for something extra.

I come now to the Recalcitrant Cancer Research Act, which my hon. Friend the Member for Peterborough (Mr Jackson) mentioned. It was passed in 2012 in the United States, and requires the director of the US National Cancer Institute to prepare a special strategy for recalcitrant cancers in the US. A recalcitrant cancer is defined as a cancer type with a five-year survival rate of less than 20% that kills more than 30,000 US citizens a year.

The result of the Act has been more focus on pancreatic and lung cancer research in the US, as well as a welcome increased focus on and awareness of those cancer types more generally. I would like the Minister to consider whether the British Government need to produce their own recalcitrant cancer research strategy, commissioned and produced either by the Department of Health or the National Institute for Health Research. Such a strategy should focus not just on pancreatic cancer but on other cancers of unmet need—those with low survival rates.

If a British strategy were to use the US definition of “recalcitrant”, it would cover pancreatic cancer, which has a survival rate of just under 4%; lung cancer, for which it is 10%; oesophageal cancer, for which it is 15%; brain tumours, for which it is 19%; and stomach cancer, for which it is 19%. That would help to give a focus.

[Sir Andrew Stunell (Hazel Grove) (LD)]

I apologise to my hon. Friend for arriving late—I was at a Statutory Instrument Committee. My brother-in-law died of pancreatic cancer in July in the United States. I draw my hon. Friend’s attention to the fact that research has then to go on to produce outcomes, and we are still a long way from that. I hope he will agree that it will be a long-term project.

[Eric Ollerenshaw]

I thank the hon. Gentleman for that. I think everybody here—all the people who signed the e-petition and the hon. Members who are here to support the debate—realises that it will be a fairly long journey. We are trying to say that we want a quicker start to that journey, please, given what has happened.

I will not detain hon. Members for too much longer, but I want to finish by mentioning a hobby-horse that I have mentioned in previous debates: the need for more and more effective treatments for pancreatic cancer to be made available on the NHS. The treatments do not need to be discovered; they already exist. Last week, I spoke in the House about the need for the National Institute for Health and Care Excellence to reform if it is ever to be fit for purpose, at least when it comes to ensuring that patients have access to cancer drugs. That is evidenced by the fact that in 2011-12, NICE, as it is called, rejected 60% of the cancer medicines it assessed—an increase since 2010. Simply put, that means that drugs licensed for use in the UK are not being made routinely available on the NHS to all who need them.

The cancer drugs fund for England was introduced in 2010 to clear up the mess—we welcome the fund—and because of it 55,000 patients have been able to access drugs they would not otherwise have managed to access. Those drugs have extended patients’ lives, giving them more time to spend with their loved ones. Unfortunately, the CDF is funded only until 2016. Doctors have to apply for drugs from the fund, which are not routinely available, and any drug on the list could in theory be removed by the CDF panel at any time.

The drug Abraxane, for metastatic pancreatic cancer patients, was added to the CDF list in March this year, following a public campaign and a debate held in the main Chamber. Sadly, however, things have moved on. The Health Secretary recently announced that the CDF will get more money, but the accompanying announcement said that the CDF will be reformed. The precise wording was that it would be more closely “aligned with NICE” and that a new cost-benefit analysis will be introduced when new drugs are considered. Imagine the alarm, Mr Chope, when Sir Andrew Dillon, the chief executive of NICE, said to the Health Committee last week:

“We would like to move away from a situation where…the Cancer Drugs Fund then says yes to the treatments we have said no to…I don’t think that makes any sense. It’s not a criticism of the decision to allocate more money to cancer. It’s about an alignment of processes and methodologies that we need to get sorted out…There is no reason at all why we can’t provide the basis for NHS England’s decisions on cancer treatments just as we do for all other treatments.”

I say to Sir Andrew that there is a reason why: as I have already said, NICE does not work for cancer patients. To treat cancer as if it were like other diseases when it causes so many deaths and when the population is ageing—we know the likelihood of cancer increases with age—is to take a step backwards.

I would be grateful if the Minister commented on the cancer drugs fund. We are worried at the moment. Abraxane has been considered by the fund. We are grateful that it has received ministerial sign-off in Wales. The cancer drugs fund agreed to list it, but now that is with NICE. I hope I am wrong on this, but I suspect that in the near future it will be rejected by NICE for routine use in the NHS in England. It is the first advance in some kind of pancreatic cancer treatment for 40 years, and it looks likely that NICE will reject it. That is a disgrace.

I have held up the Committee for too long, but I do not mind because of the importance of the issue. Just to finish, next year 8,800 people will be diagnosed with pancreatic cancer, of whom 80% to 90% will probably not survive beyond six months. Thousands of relatives and friends will then enter a parallel world: the cancer world.

[Karen Lumley (Redditch) (Con)]

I congratulate my hon. Friend on securing the debate. Does he think that we need to follow the example given to us by the e-petition to educate our constituents? Should we not take part in pancreatic cancer awareness month in November to help raise awareness of this killer disease in all our constituencies?

[Eric Ollerenshaw]

I thank my hon. Friend. If raising awareness was the one thing to come from this petition, all of us who have been affected would say that was positive.

Thousands have signed the e-petition that we are debating because they believe the purpose of government is to make improvements in people’s lives. For the sake of the thousands of cases to come, and for those of us left behind, I urge the Minister to help us to prove that our partners, relatives and friends did not die totally in vain.

Clinical Technology Appraisals (NICE)

Eric Ollerenshaw Excerpts

Monday 1st September 2014 Commons Chamber

[Eric Ollerenshaw (Lancaster and Fleetwood) (Con)]

I welcome the Minister to his place. I hope that he does not feel that he has drawn the short straw by having the 10 o’clock slot. I am pleased to be here to have the opportunity to raise an issue of growing concern to NHS patients throughout the country, particularly those suffering from cancer. It will be a debate about how new drugs and treatments are approved, or not, by the National Institute for Health and Care Excellence. That organisation’s acronym is NICE, but, sadly, for many patients, the decisions it makes often seem anything but that.

Tonight’s debate is particularly timely given the announcement last week about the expansion of the cancer drugs fund. That is of course welcome, but it does serve to highlight the ongoing problem. That announcement comes on the back of a number of recent decisions by NICE not to fund important new cancer drugs. Both Kadcyla for metastatic breast cancer and Abiraterone for routine use in prostate cancer are high- profile examples, so the whole issue of the affordability of the drugs bill is back in the news, and especially how NICE carries out its cost-benefit analysis and comes to its decisions.

My original reason for raising this issue was the current review of NICE’s technical appraisals, the consultation on which closed earlier in the summer. I will make some specific points on that, but first I want to set out the problem as I see it and give some wider context. Put simply, I do not believe that the appraisal system is fit for purpose, at least not for cancer drugs. In 2011-12, NICE rejected 60% of the cancer medicines that it assessed. What makes it worse is that the rate at which they have been turned down has actually increased since 2010. That is largely because the methods used to work out the cost-benefits of each drug are too restrictive. The use of what are called “quality of adjusted life years” does not take into account many potential benefits for patients and their families. The appraisal process is also far too long—it can take a year to conclude that a new drug priced by a company at X is not cost-effective. Subsequent resubmissions by a company, based on a new price or new clinical data, can then take just as long.

Most of these drugs are already licensed for use in the UK but can be obtained only through private health care. It was that repeated failure to give patients on the NHS the same access to cancer drugs that led to the creation of the cancer drugs fund. That was a hugely welcome move, and I commend the Government for it. Because of the fund, 55,000 patients have since 2010 been able to access drugs that they would not otherwise have had. But we have to admit that the CDF is, in a sense, a sticking plaster. It was only ever envisaged as an interim measure until NICE got its act together and became more user-friendly. Even with the welcome new boost to its total funds, the CDF is scheduled to expire in 2016. That expiry date is fast approaching and many, particularly among the charities, are worried about what will happen after that date.

There is another level of uncertainty. Drugs on the CDF can be de-listed at any time. The failure of NICE to approve treatments means that the fund has been working at or above its planned financial capacity. Again, I am grateful that the Government have recognised that with the announcement last week, but the chair of the fund seemed to hint last week that time may be called on some of the drugs on the list very soon. That would be a disaster for possibly thousands of patients and their families around the country. I understand that these things need to be considered in detail, but I would be very grateful if the Minister could address this specific issue in his response. In particular, will he clarify the process and likely time scale for any de-listing of drugs?

What does this mean in practice? The Minister knows that I have a particular concern for improved treatments for pancreatic cancer patients. He may remember an Adjournment debate back in March when we discussed the new drug Abraxane. When used in combination with standard chemotherapy, it has been shown in trials to extend eligible patients’ lives by an average of just over two months, although in some cases it is significantly more.

At the time of the debate in March, I expressed my support for Pancreatic Cancer UK’s “Two More Months” campaign, which gave a number of examples of what two more months in life would have achieved for various people, and asked Ministers for the drug to be added to the CDF. Imagine my delight when that happened. As I understand it, between the end of March and the end of June this year, 118 patients have accessed Abraxane on the NHS. That would not be happening if the CDF did not exist.

Abraxane is currently under consideration by NICE for routine use for eligible metastatic pancreatic cancer patients on the NHS—a move that would make it easier for patients to access the drug. I believe that a decision on whether to approve Abraxane for use will be made in the next few weeks. However, if we use the quality-adjusted life-year system, the price of an additional two months of life looks set to be deemed too costly. Most drugs are capped at £30,000 a year, and Abraxane is estimated at slightly above £50,000.

Although NICE allows a higher cost threshold of about £50,000, that is only for drugs that meet its current end-of-life criteria, which demand that a new drug provide at least three months’ extra survival on average. The evidence so far does not show that Abraxane does that. However, if we consider that the average survival time for a pancreatic cancer patient from diagnosis is just two to six months, we can imagine that an extra two months’ survival is massively significant. Instead of having arbitrary targets in terms of months, why do we not look at percentages of the average survival rate as a means of dealing with these more difficult cancers and diagnoses?

If Abraxane is rejected by NICE, as I fear it might be, we will be back to relying on the cancer drugs fund to provide it. It will end up like other treatments that are available for pancreatic cancers, only one of which has been approved by NICE. Non-drug alternatives such as NanoKnife and CyberKnife, which have been discussed in this Chamber, are in use in private practice but have not been approved by NICE for clinical use on the NHS. Patients are forced to spend tens of thousands of pounds of their savings to access those treatments privately.

We are in a position where new treatments might start to make a small difference in survival rates for pancreatic cancer—there have been no improvements in those rates over the past 40 years—but such improvements will have been despite, not because of, NICE. That must change.

Indeed, change is now in prospect. NICE is currently looking at introducing a new way of assessing drugs, called value-based assessment. The consultation on it closed in June and I understand that some next steps are due to be announced very soon.

I have looked at the proposals, but I must say to the Minister that there are worries that the new system will not improve the current situation. Briefly, my concerns are these. First, the proposals maintain a quality-adjusted life-years system as the basis of an appraisal. That will still mean that many benefits to patients and their loved ones highlighted by patient groups might not be taken into account. Secondly, it is proposed that specific end-of-life criteria be removed and incorporated in a wider “burden of illness” measure. There is no guarantee that this measure will capture the unique requirements of end-of-life drugs. Thirdly, the way the proposals are framed could well mean that the age of patients with a particular condition could count against the drugs, which is a particular concern given, as everybody knows, that the likelihood of getting cancer increases with age. Perhaps more importantly, I see nothing in the proposals that suggests that the new appraisal process will be any quicker than the current one, and time is one thing that many cancer patients do not have.

I have serious reservations about the proposals. The crucial question is this: will the new system make more cancer treatments available or fewer? If there were confidence that the new set of criteria would solve the problem, we might not be facing the need for extra funds, but as things stand, the extra CDF money remains the lifeline. If the new system does not solve the problem and the CDF ends in 2016, we will be back to square one, with thousands of patients not getting the drugs they need and deserve—drugs which over the past four years have been proved to make an immense difference to patients’ and their families’ and friends’ lives.

These fears are shared by many cancer charities and patients groups. I hope that their responses to the consultation will be given the consideration they deserve. If they are, it should be possible to devise a system that genuinely works. That means a system that works faster. The NICE process is extensive, but it takes too long. Why on earth when a drug is rejected at one price does the whole elongated process that I have mentioned have to start again when it is resubmitted at a new price? There is an argument that that simply encourages companies to pitch a high price to begin with, and therefore creates further delays as the argument goes on to get the price down. Why can we not have a system where there are sensible negotiations between NICE and the drug companies immediately after a drug is licensed, along the lines of systems used in many continental countries?

The system should also give more weight to patients’ and carers’ needs and experiences. At the moment, the process is almost exclusively focused around clinical effectiveness—that is understandable—and value for money. Patient engagement is ostensibly taken into account, but it needs to be given a higher priority. The Scottish Medicines Consortium has just changed its system along those lines, and that might be a good model to consider.

Lastly, a specific end-of-life weighting really must be maintained in the new system. It cannot, however, be so prescriptive that it excludes new treatments for cancers with extremely poor prognoses, such as pancreatic cancer. NICE’s current three-month rule makes that a specific problem that the new system must tackle.

To sum up, of course the NHS does not have an unlimited budget—we all understand that—and it is right to seek value for money for taxpayers. Drug companies must also be realistic when pricing their drugs, but as I have said, the current system provides incentives for them to pitch high. This review of appraisals gives us an opportunity to make them work better. We urgently need reform because for too many cancer sufferers NICE simply is not working.

Until that improved system is in place, the cancer drugs fund will remain vital, and the extra money will be well spent. I hope that it will be extended beyond 2016 to make sure there is at least one fast and effective route for cancer drug approvals. However, that can only ever be a temporary fix. There must be a more reliable long-term system to get cancer patients the treatments that they so desperately need. Such decisions can literally be life-and-death ones, and too often we are not getting them right. Cancer need not be a death sentence, but the rejection of a drug based on a flawed assessment might be one.

For many patients, extra days and months are not just numbers in a cost-benefit equation, but precious moments with loved ones. NICE must recognise that the timeline is arbitrary, and it must start to build on the success of the cancer drugs fund.

Special Measures Regime

Eric Ollerenshaw Excerpts

Wednesday 16th July 2014 Commons Chamber

[Mr Hunt]

Absolutely, and I think we have legislated to make that the case.

[Eric Ollerenshaw (Lancaster and Fleetwood) (Con)]

With reference to University Hospitals of Morecambe Bay NHS Foundation Trust, which has just gone into special measures, may I reassure the Secretary of State that the CQC has seen some improvements there delivered by front-line staff, particularly at Royal Lancaster infirmary? However, I want to underline what the hon. Member for Barrow and Furness (John Woodcock) said about the unique geographical problems facing a trust with four hospitals separated by hundreds of miles of sea, mountains and valleys.

[Mr Hunt]

I absolutely recognise that issue, which is something we will have to think about in terms of the long-term sustainability of the trust. Let me reassure my hon. Friend and the hon. Member for Barrow and Furness that the CQC chief inspector will not say that a trust can come out of special measures unless he can see a long-term sustainable future for that trust, so part of the purpose of the regime is to force everyone in the system to confront those issues so that we bite the bullet quickly.

Cancer Treatment and Prevention

Eric Ollerenshaw Excerpts

Tuesday 11th March 2014 Westminster Hall

[Eric Ollerenshaw (Lancaster and Fleetwood) (Con)]

I congratulate my hon. Friend the Member for Mid Derbyshire (Pauline Latham) on securing this debate.

I apologise in advance because there will be some repetition as I had an Adjournment debate last week on pancreatic cancer and a new drug, which is fundamentally what I will speak about this morning. I think hon. Members will understand that there is a need for repetition, because we are right in the middle of the Cancer Drugs Fund’s making a decision about this drug, so anything extra we can add is useful. I am sure the Minister has heard this before, because she attended that Adjournment debate on Tuesday 4 March.

The Cancer Drugs Fund met on Thursday 6 March and I understand that the process is that it will take a week to consider, then it will inform the applicants and then, in two weeks’ time, its decision about Abraxane will be made public and we will know. Abraxane has been licensed for use in patients in the UK and Ireland with metastatic pancreatic cancer; it has been described as the biggest advance in pancreatic cancer treatment in almost two decades, for a disease where survival rates have barely changed in 40 years.

As Abraxane has not been approved by NICE, it is not yet available on the NHS as a standard treatment. Pancreatic Cancer UK, the biggest charity in this field, together with Pancreatic Cancer Action are both keen to ensure that patients are able to access Abraxane through the Cancer Drugs Fund. We should like to see the drug approved by the CDF then eventually by NICE, so that access to it is more readily available. We know that Abraxane is due to be reviewed by NICE soon, but this process takes a great deal of time, and time is something that most pancreatic cancer patients do not always have.

My comments relate to the treatment of cancer. As I have said, I hope that hon. Members will put up with some repetition, given the importance of these few weeks to the sufferers, survivors and friends and relatives connected to this cancer, because it is a highly charged moment.

[Nic Dakin (Scunthorpe) (Lab)]

I congratulate the hon. Member for Mid Derbyshire (Pauline Latham) on securing this debate. Does the hon. Gentleman agree with her that the key is early intervention and effective treatment? That is the key to getting it right with regard to melanoma, bowel cancer, pancreatic cancer and ovarian cancer, for example. The hon. Gentleman is making powerful points in this respect.

[Eric Ollerenshaw]

As per usual, I agree with the hon. Member for Scunthorpe (Nic Dakin). I pay tribute to his work on the all-party group on pancreatic cancer. He and my hon. Friend the Member for Mid Derbyshire hit the nail on the head. At the moment I am just talking about treatment, but early diagnosis is the key to all of this, particularly pancreatic cancer. More than 50% of people who are diagnosed with pancreatic cancer are diagnosed after emergency admission to hospital: it is that late and, too often, too late to be able to do much in terms of survival beyond a year. Only 4% of people diagnosed with pancreatic cancer survive for up to five years, so it is clear how dramatic an improvement in early diagnosis would be.

It is estimated, on average, that Abraxane will allow a further two months’ survival, which, in the great scheme of things, does not seem massive, but it could double the lifetime chances of the average pancreatic cancer sufferer. Pancreatic Cancer UK launched its campaign, “Two More Months”, to highlight that. I quoted examples in my other Adjournment debate, which hon. Members may read, of survivors describing what two more months could have done for them, in their situation. Survivors talk about the possibility of getting married, which was not available because the person died early. There are other heart-rending examples of what that time would have enabled them to do. To underline the point, in terms of pancreatic cancer, as I have said, two more months is a massive improvement on what is available, unfortunately, to far too many.

In my Adjournment debate, I expressed our fears—the all-party group’s, Pancreatic Cancer UK’s and Pancreatic Cancer Action’s—that the call for the drug to be made available would be dismissed by the Cancer Drugs Fund because it gives only two more months. It is interesting that there are no pancreatic specialists in the Cancer Drugs Fund. Our key concern last week was that the two months would not be considered sufficient, because in comparison with other cancers it does not seem a great deal of time. Yet more than 60 specialists treating patients with pancreatic cancer shared their names, via Dr Seb Cummins, supporting this submission and therefore hoping that they would be listened to.

Although I did not attend the meeting, apparently the panel did not acknowledge the unmet need in this disease area and did not allocate points to represent this, given its criteria. Individual panel members did not appear to accept, as we feared, the benefits of an additional two months, although I am told that there was some acceptance that, yes, the drug did prolong life. Obviously, the panel has to take into account—I am not a specialist in medicine, Mr Gray, as you well know—the quality of life in those two months.

I understand that the decision will have been made, but it will not be public until two weeks’ time. So where do we go from here? I have already expressed concern about the Cancer Drugs Fund, because, to my knowledge, last year not one new cancer drug was agreed, plus none, if I understand the system correctly—I admit that my understanding of it is a bit basic—has been passed down to standard NHS clinical use. Nothing has left its funding stream. I am told that it has overspent a certain amount of money, but again I do not know whether it is anecdotal or exactly correct; I hope that the Minister comments on that.

The Cancer Drugs Fund process has had enormous success, which I acknowledge. Thousands of people have benefited from this innovation. There is anecdotal evidence that, because this does not exist in Wales, people there are moving across into England to take advantage of it, and why would they not, if they or somebody in their family is in this situation? The hon. Member for Strangford (Jim Shannon), who is present, has commented previously on the situation in Northern Ireland. However, although I acknowledge its massive success, it seems to me, from the outside, that somehow we are stuck in respect of where we go with the Cancer Drugs Fund and its funding in future.

It almost appears as though the Cancer Drugs Fund has become a victim of its own success. We must not let that success become failure now, simply because we are going to get a blockage of applications for new drugs; I thought that dealing with those was the whole purpose of the Cancer Drugs Fund in the long run.

In terms of pancreatic cancer, too many hopes have been raised too many times and for too long it has remained the poor relation in all this. So when hope, such as this new drug, comes along, we want that hope tested, not against other cancers but against a past history of neglect. Pancreatic cancer already has the lowest survival rate of the 21 most common cancers. As I mentioned, five-year survival rates are less than 4%. This figure has barely changed in nearly 40 years. Pancreatic cancer five-year survival rates lag behind many other European Union countries and are almost half of what they are in the United States, Canada and Australia.

Hon. Members might now understand why we want the hope given by this new drug extended to the 7,900 of the soon-to-be diagnosed 8,500 patients this year, because these 7,900 will be diagnosed with cancer too late and will die within the year. They deserve that extra time that so many others were denied in the past because there was nothing like Abraxane available. They deserve some extra consideration, given our past neglect of this, the fifth biggest cancer killer in our country.

Pancreatic Cancer

Eric Ollerenshaw Excerpts

Tuesday 4th March 2014 Commons Chamber

[Eric Ollerenshaw (Lancaster and Fleetwood) (Con)]

Thank you, Mr Deputy Speaker. As one Lancastrian to another, let me say that I am pleased to introduce this debate on access to new treatments for pancreatic cancer. It will become apparent why we are so pleased to get this debate at this time.

I want to start by reiterating some points I made about this dreadful disease in a debate in Westminster Hall last May that might help to set the context for this further debate today. Before I do, may I put on record my thanks to Pancreatic Cancer UK, Pancreatic Action, the all-party group on pancreatic cancer and others who have highlighted the impact of this disease? These include that great Lancastrian actress Julie Hesmondhalgh, who recently gave the disease some publicity in “Coronation Street”. More sadly there is the example of Kerry Harvey, who died at the age of 24 on 22 February and did so much in her last months to highlight the impact of this disease with the assistance of Pancreatic Action.

Pancreatic cancer is the fifth most common cause of cancer death in the UK. Approximately 8,500 people will be newly diagnosed with pancreatic cancer this year with around 7,900 people dying from the disease annually. Pancreatic cancer has the lowest survival rate of the 21 most common cancers. Five-year survival rates are less than 4%; a figure that has barely changed in nearly 40 years. Pancreatic cancer five-year survival rates lag behind many other EU countries and are almost half of what they are in the US, Canada and Australia. Only 1% of the National Cancer Research Institute Partners' total research spend is directed towards pancreatic cancer. By way of comparison, £3,613 per death per year is spent on breast cancer research compared to £553 per death per year on pancreatic cancer.

Some 50% of pancreatic cancer patients are diagnosed as a result of emergency admission—nearly twice that of all other cancers combined. Patients diagnosed as a result of emergency admission, compared to other routes to diagnosis such as routine GP referral, have significantly lower rates of survival. Pancreatic cancer patients have one of the least satisfactory NHS experiences of all cancer patients, evidenced by National Cancer Patient experience surveys.

If it is not too presumptuous, I would like to quote myself from the debate on 23 May 2012:

“Effective cures for pancreatic cancer remain stubbornly elusive, but we need to try to find ways to prolong patients' lives and to ease their pain and sufferings while always remembering that, with cancer, it is not only the patient who is affected but the people around them, including their family.”—[Official Report, 23 May 2012; Vol. 545, c. 93WH.]

The all-party group then found out that a new drug, Abraxane, in combination with standard chemotherapy was licensed for use in patients in the UK and Ireland with metastatic pancreatic cancer. Abraxane has been described as the biggest advance in pancreatic cancer treatment in almost two decades—for a disease, as I have already said, where survival rates have barely changed in 40 years.

As the drug has not yet been approved by the National Institute for Health and Clinical Excellence, it is not yet available on the NHS as a standard treatment. Pancreatic Cancer UK is very keen to ensure that patients are able to access Abraxane through the cancer drugs fund. The House will now see the importance of the debate tonight: the decision will be taken on Thursday 6 March—that is this week. Along with others in the Chamber, I would like to see the drug approved by the CDF this week and then eventually by NICE so that access to it is more readily available. We know that Abraxane is due to be reviewed by NICE very soon but this process takes a great deal of time, and it is time that pancreatic cancer patients do not always have.

One of my fears is based on my understanding of the way these new drugs are measured. This is based partly on what is called quality-adjusted life years which, so far as I understand it, is a measurement of the state of health and how long life is prolonged running from optimum health to death.

[Jim Shannon (Strangford) (DUP)]

I thank the hon. Gentleman for giving way and for bringing this important matter to the House’s attention. It is surprising how many of us know people, both personally and from our constituencies, who have been affected by pancreatic cancer. I have some figures from Northern Ireland that might help his argument. Only 14.2% of males and 10.3% of females live longer than a year after diagnosis. When we get to five years, those figures drop to 2.8% and 2.9% respectively. Early diagnosis is key, along with new treatments. That would increase the survival rate by 30%. Does he agree that a strategy covering all the regions of the United Kingdom of Great Britain and Northern Ireland would be better for addressing the issue?

[Eric Ollerenshaw]

The hon. Gentleman hits the nail on the head. It is of course a UK issue, and one of the concerns is the regional variation in performance on early diagnosis and the impact that is having. We want to get rid of that.

I want to talk today about the new drug Abraxane. The vast majority of pancreatic cancer patients are diagnosed so late that the benefit of any new drug can be measured only in months, rather than years. Our worry is that, compared with other cancers, that benefit might be deemed insufficient simply because it is measured in months and might not register highly on the quality-adjusted life years measurement scale.

That is why Pancreatic Cancer UK launched its Two More Months campaign, which highlights what patients would have been able to do with two more months, which is the average additional survival time provided by Abraxane. I have a few quotes from relatives of those who have died from pancreatic cancer:

“Two more months would have been a significant amount of time for Nicola, only 25 years old herself, to spend with her four year old daughter”.

That was from Chris, Nicola’s brother.

“Two more months would have meant my daughter Gemma might have got to wear her wedding dress and walk down the aisle with Adam”.

That was from Debbie, Gemma’s mum.

“Two more months would have seen my wife Jill finish her Open University Modern Languages degree and attend an international social work conference in Buenos Aires, both of which she would have been very proud of”.

That was from Dave, Jill’s husband.

“Two more months would have seen Andy and I celebrate our second wedding anniversary, and given us more time to prepare for what was to come”.

That was from Lynne.

For me, two more months would have meant one last Christmas with my partner—

[Stuart Andrew (Pudsey) (Con)]

May I pay tribute to my hon. Friend, who has done tremendous work on this issue and been a great advocate for all those affected by pancreatic cancer? I know from my experience of working in the hospice movement that time is the thing that all patients want. If that drug can provide just a little more time, surely it is something that all those families should be given.

[Eric Ollerenshaw]

rose—

[Guy Opperman (Hexham) (Con)]

I congratulate my hon. Friend on securing the debate and endorse what he says entirely. Does he agree that perhaps we should also consider going commando this Friday to raise male cancer awareness and show our general support for all cancers that people are struggling with today?

[Eric Ollerenshaw]

I am grateful for those well-timed interventions from my colleagues across the frontier.

What I am trying to get on the record is the fact that those two more months are critical in this particular cancer. Our worry is that two more months might not look good enough when the judgment is made, but for pancreatic cancer it is a massive improvement.

I also want to put on the record two other emerging possibilities. A useful and emerging new technology is NanoKnife. It carries out a process called irreversible electroporation, which destroys parts of the tumour while avoiding damage to vital tissue nearby, such as blood vessels. The process shrinks the tumour to a more manageable size, which might then allow more permanent surgical solutions. NanoKnife is currently available only through the private sector at one hospital in London.

A company called Novartis, has a treatment for neuroendocrine pancreatic cancer that is currently funded via the CDF in England. Although it is welcome that patients can access treatment via that route, we continue to argue for a long-term solution. In that context, we are worried about Andrew Dillon’s statement that, under the new system of value assessments that NICE is due to introduce in the autumn, only six out of 20 treatments assessed by NICE in the past year would be approved. A 30% approval rate is clearly not the long-term solution expected from the original concept of value-based pricing. In 2013, I understand, not one new cancer drug was approved by NICE. That issue, perhaps, is for a wider debate, but I hope the Minister understands that those arguing on behalf of pancreatic cancer patients are extremely worried about ever getting the new drugs on to the system and available for wider use across, hopefully, the whole United Kingdom.

Minister, this debate has been an unashamed appeal for support—from the charities concerned, the all-party group, the survivors and all those who have been affected by pancreatic cancer through the loved ones they have lost. We do not want others to go through our tragic experiences.

[Tessa Munt (Wells) (LD)]

I congratulate the hon. Gentleman on securing this debate. I should like to pick up on what he said about NanoKnife—there is also CyberKnife and Gamma Knife. Those are all modern, stereotactic treatments for cancer. I hope that he agrees that we need to concentrate not just on the drugs but on those particular types of radiosurgery, which can make sure that people live longer if they are given the trials that they need.

[Eric Ollerenshaw]

The hon. Lady makes an important point. Our point is that because of the poor pancreatic cancer survival rates and its late diagnosis, which is the key, it always seems that the pancreatic cancer patient is last in the queue. The quality of life assessments do not look long enough to justify a new drug or new radiotherapy, as has been pointed out.

Again, I pay tribute to Pancreatic Cancer Action, which got a great deal of press from an advert, not used at the time, saying, “I wish I had breast cancer”. That was effective in raising publicity about the impact of pancreatic cancer.

I am trying to put whatever pressure the Chamber is capable of exerting on the cancer drugs fund when it makes its decision on Thursday and on NICE for what it does to follow. Providing Abraxane and an extra two months could help ease this year’s 8,500 tragedies and start the process of making up for 40 years of lost hope.

Accident and Emergency

Eric Ollerenshaw Excerpts

Wednesday 18th December 2013 Commons Chamber

[Eric Ollerenshaw (Lancaster and Fleetwood) (Con)]

It is a pleasure to follow the hon. Member for Stretford and Urmston (Kate Green), who attempted to make solid, practical suggestions in a debate that has too often become too politicised, as the debate on A and E did in June. I will refer to that later.

I represent a large constituency with a large rural population. Some people are 10, 15 or 20 miles away from the one A and E. To me, it sounds a little bit rich when hon. Members from urban areas talk about the A and Es in their part of town when no account of that distance or rurality was included in any grant formula by the previous Government. I wanted to put that on the record.

From my perspective and, I am sure, from that of all hon. Members, the majority of our constituents get a damn good service from hard-working professionals, who will work at Christmas time when the rest of us are on holiday. Having said that, hon. Members recognise that there has been a big growth in the number of people attending A and E. Those facts are clear. Opposition Members suggest that that happened last year or a few years ago. According to the Opposition motion, the increase has been

“three times faster since 2009-10”.

However, the College of Emergency Medicine report “The drive for quality” shows a sharp upward trend in new attendances at A and E, but its figures start from 2003.

That ties in with local information. I asked my A and E doctors at the Lancaster royal infirmary to give me figures for the past few years. They say that the number of new patients attending A and E decreased between 1989 and 1993 and steadied at about 35,000 admissions a year until 1999, when the number increased rapidly. The figures are clear. There were 35,000 A and E admissions in 1999; 36,000 in 2000; and 37,000 in 2001. There was an increase of 1,000 in every single year to 2007. Funnily enough, there was a 3,000 increase in A and E attendances from 2006 to 2007. The latest figures I have are for 2011, when there were 52,500 attendances. The increase did not happen yesterday but continually over that period, for all the reasons hon. Members have mentioned.

The other side of the problem is the training and retention of A and E specialists. We have all heard stories of vacancies in A and E departments. I understand that it was announced today that Wales is 15% down on A and E specialists. One reason for that is that working in A and E is hard, and there is evening and weekend work, so people move to other specialisms. To increase retention, we need to recognise the work of A and E specialists, which might include through salaries. We need to give A and E specialists the recognition they deserve to keep them in those posts.

The Labour motion mentions the 48-hour appointment guarantee. It is no use having an appointment within 48 hours if it lasts for only five minutes before the doctor moves the patient out just to meet the target, which is what happened in the past.