Elective Surgical Operations: Waiting Lists

Esther McVey Excerpts

Tuesday 20th April 2021 Westminster Hall

[Esther McVey (in the Chair)]

I remind hon. Members participating physically and virtually that they must arrive for the start of debates in Westminster Hall. Members are expected to remain for the entire debate. I also remind Members participating virtually that they are visible at all times to each other and to us in the Boothroyd Room. If Members attending virtually have any technical problems, they should email the Westminster Hall Clerks’ email address. Members attending physically should clean their spaces before they use them and as they leave the room, and take the wipes with them and bin them. I also remind Members that Mr Speaker has stated that masks should be worn in Westminster Hall. Members attending physically who are in the later stages of the call list should also use the seats in the Public Gallery and move to the horseshoe when seats become available.

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[Peter Dowd]

That is a fair point, and I will touch on it later. I know that the Minister is well aware of the situation and has his own challenges in getting the point home to his colleagues in the Treasury, among others. We will give him the support that he needs when he has those conversations.

In terms of support to weather this crisis, the Government cannot put the brakes on this vital area of public expenditure. Given the figures I have outlined, it is better to pre-empt this tsunami, because once it comes, it will be all the more damaging. Putting it right after the fact will be more expensive, more difficult and lives will be in danger, not to mention the ongoing economic impacts for the nation. If we have learnt anything from the covid-19 crisis, it is the point made by my hon. Friend the Member for Bristol South (Karin Smyth) that assessment and planning, followed by focused, comprehensive action, are required.

I have set out the issues as many in the health field have them set out. They are not my figures, they are not made up, they are in the public domain. The Minister knows the organisations concerned, as do hon. Members, so I will not list them.

I have attempted to be as concise and factual as possible and to set the scene, but there is a second element: how the issue can be tackled. The rest of my time will be spent on that. Again, this is not me making this up—is is not the hon. Member for Bootle’s version. It is, in a sense, the health organisations’ view. In this respect, the Royal College of Surgeons has set out a clear way in a comprehensive fashion. Other royal colleges and health organisations have expressed their views too. I have no doubt that the Minister will listen to those voices, which will be helpful and constructive. However, they are also unambiguous in their view of the need for the Government to act now with specific proposals that go beyond a balance-sheet approach. I believe the time for details and proposals is fast approaching.

I want to highlight four recommendations. The first is increasing NHS bed capacity. For many years in the run-up to the pandemic, the NHS was far too close to capacity. It was running hot, to use that phrase. International comparisons, which I acknowledge do not tell the full story, but do give a partial story, show that the UK has 2.5 hospital beds per 1,000 people, which is well below the OECD average of 4.7, and behind countries such as Turkey, Slovenia and Estonia. Remember, beds have been reduced from 108,000 in 2010-11 to 95,000 in 2021.

Secondly, during the pandemic the Royal College of Surgeons of England called for the setting up of green or covid-light sites with a separation of elective surgery from emergency admissions. As the college says, there is, “evidence of the risks to patients if covid-19 is contracted during or after surgery, including a greater risk of mortality and pulmonary complications”. In this regard, covid-light sites are critical to process ongoing planned surgery, given that patients and staff are segregated from situations where those who have the virus are treated. In addition, there is a regime whereby patients self-isolate and test negative before any surgical intervention is in operation. Meanwhile, staff without symptoms are regularly tested.

The third recommendation is for surgical hubs. During the pandemic, professionals have worked in partnership to provide mutual aid during periods of intense pressure, thereby enabling a seamless process of surgical intervention. Because of the multi-agency, multidisciplinary co-operation, trusts have also been able to designate certain hospitals as surgical hubs. As such, a capacity for particular types of elective procedures has been facilitated through skills and resources coming together in one place in covid-secure environments. While this hub model, as it is called, is not a total solution, it is none the less a practical way to enable many geographies and surgical specialities such as orthopaedics and cancer to work together.

The fourth recommendation is support for patients, and I touched on that earlier. Again, the Royal College of Surgeons has welcomed the prioritisation of patients in NHS England’s 2021-22 priorities and operational planning guidance. None the less, I agree that we need to go further and provide more guidance about how to develop and expand the options to address those waiting longest, and to ensure that health inequalities are tackled throughout the plan.

In my view, there should also be cross-departmental work on more comprehensive support for those directly affected by covid isolation requirements and people whose livelihood is threatened by longer waiting lists. Before I go on to summarise the four recommendations I have just put to Members, I emphasise that I am aware, and appreciate, that NHS England and NHS Improvement have been working on an elective recovery frame- work covering workforce logistics, clinical prioritisation, patient focus reviews, waiting list validation and patient communication. I welcome that, as will other hon. Members. I acknowledge that the NHS has completed almost 2 million operations and other elective care in January and February this year, and non-urgent surgery times have begun to recover.

In summary, there are four recommendations arising out of the narrative. Recommendation one: the Government should urgently invest in increasing bed and critical care bed capacity across England. Recommendation two: the Government should consolidate covid-light sites in every integrated care system region, and ensure that at least one NHS hospital acts as a covid-light site in each integrated care system in England. Recommendation three: the Government should widen adoption of the surgical hub model across all English regions for appropriate specialities, such as orthopaedics and cancer. Recommendation four: all integrated care systems should urgently consider what measures can be put in place as soon as it is practical to support patients facing long waits for surgery. I would like to put on record my thanks to the Royal College of Surgeons for its advice, information and support in relation to this matter.

Finally, the whole question of workforce-related issues—numbers, pay, conditions at work—needs a comprehensive, fair, equitable and inclusive review. The Secretary of State can initiate a wholesale review of organisational structures in the NHS in the middle of this crisis, which is causing angst and concern across the NHS—we cannot pretend that is not happening. He can therefore initiate a review of the terms that I have suggested.

Many lessons need to be learned from this crisis. I stress the value, commitment and professionalism of all staff in the NHS. Staff across all professions, disciplines and sectors are feeling drained after a year of hard, unrelenting work and we need to thank them for that. Without them, in particular, this country would be in an even worse social and economic predicament than it already is. We owe it to them to ensure that they get all the support they need to support the rest of us. Who could disagree with that?

[Esther McVey (in the Chair)]

Before I call Back Benchers to speak, I remind Members that in this 90-minute debate we will be calling the Front Benchers no later than 3.40 pm, and obviously Peter Dowd will be winding up again after the Minister.

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

As a fellow Cheshire MP, it is a pleasure to see you in the Chair, Ms McVey.

Every Member who has contributed to the debate has spoken with great knowledge and sincerity about the challenge we face as a society. I pay particular tribute to my hon. Friend the Member for Bootle (Peter Dowd) for securing the debate and for his excellent introduction. As every Member has pointed out, he was right to say that we have record waiting lists. We should never forget that we had already seen a huge rise of over 40% in the decade before the pandemic. As some Members mentioned, it is possible that covid is masking an even worse situation. We know that the number of referrals plummeted around this time last year, as the NHS rightly focused all its intention on the pandemic.

As Members have said, we know that the NHS aims to ensure that no more than 8% of patients wait more than 18 weeks for treatment. That is a target that has not been met for five years, so this situation cannot be laid entirely at covid’s door. Indeed, just over a year ago, in February 2020, 17% of people on waiting lists had been waiting longer than 18 weeks. It is clear that the past year has had an impact, because the figure has now doubled to 35%.

Sadly, it is now the case that over a million people have waited longer than six months for hospital treatment. There are now 388,000 people waiting more than a year. Again, that is the highest number on record. That is nearly 400,000 people waiting for things such as knee and hip replacements. As Versus Arthritis points out, they

“are in extreme distress, with many struggling to cope with pain which is impossible to ignore, worsening mental health and reduced quality of life.”

My hon. Friend the Member for Bootle set out clearly some of the implications not just for physical pain, but for mental health and uncertainty about job prospects. My hon. Friend the Member for York Central (Rachael Maskell) eloquently set out the reduced outcomes and difficulties we will face if the process is not followed as well as we would like and patients enter the system at a later date.

As my hon. Friend the Member for Bootle said, this is an issue that cannot and should not be ignored. He described the challenges as possibly overwhelming—an apposite description, given that the Government’s strategy for the last year has been to avoid the NHS being overwhelmed. As that challenge was met, we hope that this challenge will be met as well. He also made the important point that, if we do not get this right, it will cost us more in the long run and will have economic and as well as physical and social impacts. The lessons learned from the pandemic ring true in that respect as well.

When we look very closely at the figures, we see that around 18,000 people are now waiting longer than 18 months. The figures we have relate to people waiting more than a year. Obviously, I have discussed this with the Minister on previous occasions and we hope that we will get the official figures shortly. We must remember that at the moment, we only have details for people waiting over a year, but the information I have suggests that more than 175 people have been waiting for more than two years. Those figures are slightly out of date, as they are from January, but that is a horrendous situation and I hope it has got better in the last few months. If it has got worse, I hope and expect that the Minister will be on the phone to those trusts inquiring exactly why people are waiting over two years to receive their treatment.

The importance of dealing with the backlog quickly cannot be overstated, because of the likely pressure that will manifest itself over the coming months. As my hon. Friend the Member for Bootle said, the Health Foundation has estimated that there could be as many as 4.7 million missing patients. If only three quarters of those are referred to treatment, that would lead to a waiting list of 9.7 million people by 2023-24. Obviously, that is an estimate, but if the Minister has done his own calculation, can he tell us what it is?

Over the last year, the NHS has adapted fantastically to the challenges of covid in a way that has rightly won the respect of everyone in this place and in the country. That has meant decisions have been taken about how treatments should be prioritised. We have seen appointments cancelled, operations postponed and staff redeployed, but even with those challenges, the NHS managed to carry out 1.9 million operations in January and February this year, which Stephen Powis, NHS England’s medical director, said is

“a testament to the hard work and dedication of staff”.

I join him in paying tribute to those staff for delivering that. However, even with that fantastic effort—to put into context the challenge that we face—the number of routine operations in January was down 54% on last year and in February it was down 47%.

Thankfully, I think we are past the peak of the third wave and there are only just over 2,000 patients with covid in hospital, which is the lowest since last September. However, the NHS is still under enormous pressure, with so many people now waiting for treatment, stricter infection control measures and, as many Members have referred to, an exhausted healthcare workforce. We have to be realistic: this could take years to address unless there is a credible and costed plan in place at the earliest opportunity.

Modelling by the NHS Confederation suggests that the sustained impact of the pandemic will leave a backlog of care in excess of anything seen over the last 12 years and that to maintain any sense of control over its waiting list, the NHS will need to increase capacity considerably above levels that have previously been sustained. My hon. Friend the Member for Bristol South (Karin Smyth) referred to the huge efforts that were made by the previous Labour Government to get waiting lists down. It seems that a strategy at least on a par with that will be needed.

The NHS Confederation has said:

“Without a comprehensive new plan, the government faces the…legacy of hundreds of thousands of patients left with deteriorating conditions”.

It warns that the additional £1 billion agreed in the spending review will not be enough to clear the backlog. The chief executive of the NHS Confederation Danny Mortimer said:

“health leaders are clear that the NHS will be recovering for years to come, and this must be appropriately resourced in the long-term.”

He called for

“investment in growing and maintaining the workforce”.

NHS Providers has said that the situation could take three to five years to resolve. Its chief executive, Chris Hopson, said:

“Trusts believe they can clear the backlog within a reasonable period of time”,

but that treating this like another waiting list initiative, relying on overtime and private sector use, will be insufficient. He said that the NHS will need to transform “how it provides care” and that the Government will need to provide

“the extra funding required to enable that transformation.”

As my hon. Friend the Member for Bootle set out, a number of practical steps can be taken to deliver transformation, but they come with a price tag. The Prime Minister was quick to pledge that the Government will ensure that the NHS has the funds it needs to beat the backlog, but how can we have confidence in him when he has already gone back on a promised pay rise for NHS staff? NHS England said that although the £1 billion fund will help, it will not be enough. Of course it will help and it is welcome, but helping is not the same as solving. Nobody, probably not even the Minister, believes that what is on the table represents a solution.

There is no doubt that the NHS has a monumental task ahead of it to restore services, meet demand and reduce the care backlogs, but it also must support staff and take steps to reduce inequality in access, experience and outcomes. Now is the time for the Government to deliver on their promise to deliver to the NHS whatever it needs. It certainly is not the time for another expensive reorganisation, as my hon. Friend the Member for Bristol South said. If that is the road we go down, it is important that patients’ voices are put front and centre of those new bodies, particularly if they are forced to deal with some of those extremely tricky issues.

As many Members said, 10 years of underfunding have left us in this precarious position. The challenge is there for the Minister. The experts say that we can tackle the backlog, but it will need funding. If the Minister can confirm any specific figures, that would be wonderful. I suspect we will not get that today, but at the very least will he confirm on the record that he agrees that the £1 billion that has been allocated so far is insufficient?

To pick up on what Chris Hopson, chief executive of NHS Providers, said about relying on the private sector, we know that huge sums were provided last year. As my hon. Friend the Member for York Central said, we have never had transparency about what that money was spent on. Can the Minister tell us how many NHS patients were seen in the private sector last year, and how many procedures were carried out using taxpayers’ money? I am sure that he is as keen as all of us to ensure that the best value has been achieved.

Many Members said that none of the backlog will be tackled if we do not have the staff to do it. A recent Institute for Public Policy Research report based on a YouGov poll of 1,000 healthcare professionals said that a third more nurses and midwives are leaving the NHS than a year ago. Those figures are scaled up across the workforce—that means 100,000 nurses and 8,000 midwives leaving. With 40,000-plus vacancies already, we cannot afford to lose one more, never mind 100,000 more.

Dame Donna Kinnair of the Royal College of Nursing said that that is

“The reality of a failure to properly invest in the nursing workforce”

and must be a

“wake-up call to the Government.”

It should indeed, especially when we are still waiting for the publication of the substantive long-term workforce plans to deliver a lasting solution to recruiting and retaining the workforce and ensuring there are enough skilled staff to provide safe and effective care now and in the future. That is why it is vital that Ministers bring forward a fully funded plan to tackle the backlog—we have been calling for that for a long time: an NHS rescue plan that will bring down waiting lists and ensure that patients can receive the quality of care that they deserve. As my hon. Friend the Member for York Central put it, we cannot carry on with business as usual.

Let me end with the important comments from Dr Rob Harwood, the chair of the British Medical Association’s consultants committee:

“Without further financial support and investment in increasing staffing numbers, patients will be waiting even longer for care, and there is a risk that patient care becomes unsafe the more exhausted staff become. The future of our NHS, already walking wounded, must not be put in jeopardy.”

The NHS is the jewel in our crown, but it needs protecting, sometimes as much as the patients it treats. We need financial support, a detailed people policy and a credible plan to deal with the backlog if we are to avoid coming back in 12 months to talk about an even worse situation.

[Esther McVey (in the Chair)]

I call the Minister, mindful that we will have a winding-up speech from Peter Dowd at the end.

Covid-19: Access to Cancer Diagnosis and Treatment

Esther McVey Excerpts

Wednesday 2nd December 2020 Westminster Hall

[Esther McVey (in the Chair)]

I remind hon. Members that there have been some changes to the normal practice in order to support the new call list system. Members should sanitise their microphones and then remove and dispose of the material used for that when they leave the room. Members are asked to observe the one-way system and should speak only from the horseshoe. Members may speak only if they are on the call list. That applies even if the debate is undersubscribed. Members may not join the debate if they are not on the call list. This is a slight change, but I want to remind Members that they must arrive for the start of the debates in Westminster Hall, although they are not expected to remain for the winding-up speeches. Members may wish to stay beyond their speech, but they should be aware that doing so may prevent other Members from speaking if it is a full debate.

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[Tim Farron]

I am extremely grateful to the hon. Gentleman for making a very important point. I have heard the same reports from the frontline that treatment would normally be 70:30 curative to palliative and that now it is 50:50. That is a blindingly obvious consequence of the fact that when we catch cancer, we catch it too late.

I have a request of the Department, which we have made before, including in face-to-face meetings with the Secretary of State. I want the Department of Health and Social Care team responsible to sit down with the frontline experts—we can provide them this afternoon—and go through the evidence of the backlog. There is no way of tackling the problem if the NHS management and the Department are not cognisant of it and prepared to listen to the people working their socks off in cancer units all over the United Kingdom.

I want to make another important point. Whoever was in power during this time would have been handed the same challenge and would have made many mistakes. The Government have rightly sought to control the virus so that we can protect the NHS and save lives. The lives that we seek to save are those at risk from not just covid but other illnesses, including, of course, cancer.

We as a country have stood together and defended our NHS so that it has the ability to fight cancer in the midst of a pandemic, which is what every clinician is desperate to do. The great success of this year, for which Ministers should rightly be proud, is that our NHS has not collapsed and did not fall over. Our doctors, nurses, paramedics and clinicians of every sort have saved lives, defeated the odds and kept our NHS on its feet so that it can fight cancer, and yet a failure at senior levels of NHS England and in Government to recognise the scale and nature of the cancer backlog means that people are dying today who did not need to die.

We have terminal diagnoses for cancers that could have been treatable among my constituents and yours, Ms McVey—among all our constituents. Their lives have been cut short when earlier, more urgent and more ambitious action from our leaders could have saved them. What troubles me so much is that we hear statements from some in senior management in the NHS, and from within the Department, that suggest they do not quite get the scale of the backlog problem. They freely admit that they do not know how big the backlog is. On more than one occasion, I have heard the Secretary of State seek to reassure us by saying that progress has been made on recovering the 62-day wait. If people understand what is happening, however, that does not reassure them. It does the exact opposite: it sends a shiver down their spine—it confirms the problem.

Surely Ministers know that the 62-day waiting time target for treatment does not give a complete snapshot of the situation, because it captures only patients who are already in the system. I am sorry to be brutal, but as more people die, there are fewer people in the system. The target does not take into account the tens of thousands of undiagnosed patients who may be going about their daily life completely unaware that they are living with cancer.

I fear that the Government hugely underestimate the cancer backlog, and the consequence will be thousands of unnecessary deaths and lost life years. An article last month in The BMJ estimated that there will be 60,000 lost years of life as a result. Does the Minister recognise the significant fall in people receiving cancer treatment this year compared with 2019? Like me, is she worried that this will mean there are thousands of people out there with undiagnosed cancer who have yet to come forward?

I move on now to my second point, which relates to the Chancellor’s recent comprehensive spending review, which was a pivotal opportunity to signal that the Government, the Department of Health and Social Care, the Chancellor and NHS leaders understood the need for investment in the techniques and treatment required to quickly build capacity in order to clear the cancer backlog and ensure a resilient service going forward—to build the capacity that is vitally needed if we are to make sure cancer patients are not the collateral damage of covid. Far from seizing that pivotal opportunity, the Government appear to have turned it into a missed opportunity. As far as we can tell, there is no boost to cancer treatments in the comprehensive spending review. There is no increase in capacity to catch up with cancer, and there is no plan to do what is needed to save thousands of cancer patients’ lives.

The Action Radiotherapy charity estimates that the true cancer backlog could be as high as 100,000 patients. It supports the estimate of the Chair of the Health and Social Care Committee that it would take cancer services working at over 120% pre-covid capacity two years just to catch up. Members of all political persuasions, working with clinicians and experts who are desperate to make a difference, are clear about how the Government could provide the boost required to catch up with cancer and to save thousands of lives. The answer is not to exhort our heroic frontline staff to work harder—they continue to be inspirational, straining every sinew. It is not to carry on doing what we have always done, but just doing it a little better. It requires some new thinking. It requires taking an axe to some of the internal bureaucracy that has held back some treatments, such as radiotherapy. Crucially, it requires investment, but that critical investment seems to be missing from the comprehensive spending review. That is a missed opportunity on a massive scale, and I hope it is not too late to make a change.

I have to say that there has been a collective gasp of disbelief across the oncology and radiotherapy sector, as it appears—unless we are all mistaken—that there is not even an explicit mention of radiotherapy in the spending review, never mind of the investment in it. Radiotherapy is covid-safe and is required by over 50% of cancer patients. It already plays a significant role in 40% of cancer cures and is able, where clinically appropriate, to substitute for chemotherapy and surgery at times when they are deemed not to be appropriate because of the fact that we are in a pandemic. It is hugely cost-effective: it cures patients for as little as £5,000 to £7,000 apiece.

The reality is that radiotherapy has huge untapped potential to do even more to clear the backlog. For many reasons, however, it has been actively restricted and held back for years. Although radiotherapy treats 50% of cancer patients, it receives just 5% of the annual cancer budget—something for which recent Governments of all parties must share the blame. That is why the UK is massively behind on technology that could empower the workforce to do more. Pre-pandemic it was estimated that as many as 24,000 patients were missing access to radiotherapy treatment each year. It is worse now.

Faced with the current crisis, the radiotherapy community came together to put together a transformation plan for consideration at the comprehensive spending review. The six-point plan would deliver a super-boost to cancer services to clear the backlog, with innovative technology and digital solutions to deploy linear accelerators at the many covid-clean hospital sites in England, such as the Westmorland General Hospital in my constituency, that are perfectly suited to adding satellite capacity to their main cancer units while protecting patients and clinicians from covid infection risk. The plan would also see an immediate boost in precision radiotherapy at existing cancer units, upgrading linear accelerators to perform curative treatment over shorter periods. However, on our reading of the spending review, that appears to have been totally ignored. In fact, as far as we can tell, there is no clear plan of investment in cancer treatment capacity at all.

While the investment in diagnostic machines over 10 years is truly welcomed by all of us here, it is not enough. According to Freedom of Information Act requests carried out by the Radiotherapy4Life campaign, more than half of NHS trusts are using radiotherapy machines that are more than 10 years old. To replace only the machines that deliver diagnostics, or radiology, and not those that actually cure people—the radiotherapy machines—is a baffling decision, to me and, more importantly, the experts. Patients and the public will be shocked to learn that immediate solutions presented by expert professionals to the covid-induced cancer crisis are being overlooked.

Every week that we delay giving an immediate boost to cancer services—capacity, diagnostics and treatments —we increase the risk of losing cancer patients needlessly. Recent data shows that for every four weeks of delay in starting treatment there is as much as a 10% increase in deaths. Some departments report a 20% drop in the number of patients classified as curable, leading to downgrading to palliative treatment instead. Patients—our constituents, families and friends—are being told that their cancer now cannot be cured and that their treatment will be palliative instead. Yet the decision to catch up urgently with cancer has been either delayed or ignored. We will pay a huge cost for missing out on the chance to correct things at the spending review. That is why I hope it is not too late to do so. The public inquiry, when it happens, will reveal the situation. The cost of the understandable litigation by patients and families who have been failed will be needlessly huge.

We first wrote to the Secretary of State about the growing crisis in April, and we have not stopped warning of the devastating impact that there will be on the lives of cancer patients. Three hundred and seventy-five thousand people have signed the Catch Up With Cancer petition and have hundreds of patients shared their heartbreaking stories. Experts are saying that there will be as many as 35,000 unnecessary deaths and, as I have said, 60,000 life years lost to cancer because of the impact of the covid crisis. Cancer survival rates have been pushed back to where they were more than a decade ago.

I know that the Minister cares. She is a good person seeking to do a good job. I hope that she will forgive me for being direct today, but thousands of people could have their lives lengthened or saved, and their families could be spared unspeakable grief, if we acted urgently to catch up with cancer. I conclude by repeating my plea in the strongest possible terms. Will the Minister meet me and, most importantly, the expert clinicians who advise the Catch Up With Cancer campaign, in the next few days so that we can turn the tide on the crisis?

[Esther McVey (in the Chair)]

Just for the ease of colleagues, I will say that I am looking to call the Front-Bench speakers at 10.30 am, so divide the time among yourselves.

[Andy Carter (Warrington South) (Con)]

Thank you, Ms McVey. I will do a quick calculation.

[Esther McVey (in the Chair)]

You have quite a few minutes.

[Andy Carter]

It is a pleasure to serve under your chairmanship, and I am delighted to follow the hon. Member for Westmorland and Lonsdale (Tim Farron). I congratulate him on securing this important debate, and pay tribute to his excellent opening speech. I agree with many of the points that he made. The issue is incredibly important for families up and down the UK, and I am delighted to be able to join him in speaking in the debate.

I want to thank those who work in oncology in Warrington—the consultants, nurses, radiographers and, of course, GPs who are right at the frontline as the primary gateway into cancer services. Their work, and that of those in their sector across the UK, has continued through the pandemic.

Early on, I spoke to the chief executive of Warrington hospital, Professor Simon Constable, who outlined the steps his team were taking to try to maintain cancer care services in as near normal fashion as possible. Their ability to operate across two campuses, with a covid-free site in Halton, has meant that procedures such as breast cancer could operate very close to normal. The partnership formed with Spire hospital in Stretton, where the NHS has contracted bed space and use of operating theatres to give capacity for critical operations, has meant that referrals for urgent treatment in Warrington have continued.

I think that talking to real people is when we hear the true stories. Last Friday, I spoke to a constituent called Helen who lives in Lymm. It was one of the more pleasant conversations that I have had with her over the last few weeks. She very sadly discovered that her breast cancer had returned in April, which was the same week we hit the peak of the first wave. Understandably, she was incredibly concerned when she contacted her GP. Helen was referred back to a consultant and, after tests, was told that she needed a double mastectomy. I remember talking to her earlier in the year, when she told me the news, and she explained in detail her fears of catching covid when she went into hospital to undergo radiotherapy and tests. She was asked to isolate and follow detailed guidance, and she was superbly cared for by her son at home, who went out of his way to make sure she had everything that she needed. She went into hospital in Halton for treatment and last week, some eight weeks after the operation, told me that she was looking forward to going back to work as a supply teacher in one of our local schools. Her description of the care that she received from the NHS was incredible, and she said that they could not have done more for her. I highlight this story because I think we have not heard enough about the work that has continued over the last few months—but that does not mean we do not have a problem with cancer care services.

The local hospital in Warrington was treating 170 patients for covid at the start of November. It was one of the most under pressure hospitals in the entire country. The team has only been able to operate about 80% of normal services. I say only but I actually think that is pretty good, given that we are in a global pandemic and that is roughly in line with services across the north-west of England. I suspect though that the 80% headline masks many true and worrying statistics that we will discover over the next five years.

Last week I also spoke to executives at Macmillan Cancer about the local situation in Warrington, as well as the national picture. I pay tribute to the Macmillan nurses who have continued to work with patients in their homes through lockdown, particularly those who have supported families of loved ones who are near their end of life. Macmillan estimates that across the UK there are currently 50,000 missing diagnoses, meaning that, around 33,000 fewer people started treatment compared to a similar timeframe last year. That backlog of undiagnosed cancer could take 18 months to tackle in England alone. Most worryingly, if cancer referrals and screenings do not return to pre-pandemic levels, the backlog could grow by 4,000 missing diagnoses, reaching over 100,000 by October next year.

During much of the pandemic, the NHS has been open for business, and we should be proud of that. Anyone who needs care and treatment can continue to access it. When they need it, they can go to their GP and be seen, especially where delays could impose an immediate and long-term risk. I think the most worrying statistics are on urgent GP referrals in July and August. They were 72,000 lower than last year. In some ways, that highlights the most stark problem that the pandemic is storing up for us.

We have seen a significant reduction in people starting their cancer treatment in 2020. Between March and September, around 31,000 fewer people started their first cancer treatment, which is a drop of 17% compared to 2019. More than 650,000 people with cancer in the UK have also experienced disruption to their cancer treatment or care because of covid-19. For about 150,000 people, that included delayed or rescheduled cancer treatment.

I welcome the announcement of £3 billion of extra funding to support NHS recovery from covid-19 and to help tackle and ease some of the pressures in all our hospitals, allowing them to carry out more checks, scans, operations and procedures. That will help to ensure that cancer patients can access the care they need as quickly as possible, but we need to tackle the backlog, and we cannot afford to undo the great work and investment that has gone into cancer treatments in recent years. I am delighted to speak in a health debate today because of the news we have heard that a vaccine has been approved and is on the way. That is incredibly welcome, but we must put that alongside the challenges that exist in every single branch of medicine, and particularly in cancer care, where the patient backlog is extending.

One of the biggest challenges we face is caused not by money or pressure on NHS services but by putting things off. We all do it—mainly due to a fear of going into hospital. I mentioned Helen earlier, who talked about her greatest fear being to go into hospital. Lumps and bumps are not treated because we think it does not really matter at the moment. I am afraid that is particularly true for us men, and the pandemic has highlighted that. We really do need a public information campaign that says, “If you spot a problem, don’t leave it for a later date.”

As the hon. Member for Westmorland and Lonsdale said, since 2010, survival rates from cancer have increased year on year. We have a really good story to tell in this country—about 7,000 people are alive today who would not have been here if mortality rates had stayed the same—but to sustain that drop, the NHS and Government will have to take action like they have never done before. It is critical that the cancer workforce is ring-fenced against any further redeployment to ensure that cancer care continues and further avoidable cancer deaths are averted.

Before the pandemic, there were about 3,000 specialist cancer nurses, which Macmillan modelling indicates is around 2,500 below the level required to deliver basic cancer care—and given the backlogs, that figure is probably closer to 3,500. Patient feedback to Macmillan was that, though its nurses work incredibly hard, they are not getting the support that they need. I really welcome the 14,000 additional nurses we have recruited in the last 12 months as I do the additional £260 million fund allocated for Health Education England in the one-year spending review, which will go towards the Government’s commitment to train 50,000 more nurses. However, my hon. Friend the Minister will know that that alone will not address the significant shortfalls in specialist cancer care nurses. I am therefore really keen to hear from her how the Government can commit to further long-term funding support for the next iteration of the NHS people plan to eliminate the gap in the cancer workforce.

It is hugely important that the Government back the national cancer recovery plan and the additional resource needed to build capacity and help beat the backlog now and in the long-term, getting the right skills and resources in the right places to make sure we have the biggest impact possible and, most importantly, encourage people to get the treatment that they need. Getting all of us to feel comfortable with reaching out to our GPs early on, so that we can get treatment, must be our No. 1 priority.

--- Later in debate ---

[Jim Shannon (Strangford) (DUP)]

I congratulate the hon. Member for Westmorland and Lonsdale (Tim Farron) on securing the debate and setting the scene, and all hon. Members on their incredible contributions. I look forward—I said this yesterday and need to get away from saying it again—to the Minister’s response and the contributions of the shadow Minister and the Scots Nats spokesperson.

I have been contacted by many constituents asking me to attend and speak in this debate, and as my party’s health spokesperson I am very happy to do so. One of the heartbreaking stories I have heard in the past couple of difficult days is a widow saying:

“my husband only died of cancer—he isn’t important”.

I honestly could have cried when I heard those words, because I believe that she genuinely felt that no one cared, and that is what she told me. I felt that hardness; I had a compassionate understanding of what she was saying.

We are in unknown territory and undoubtedly we are distracted. How can we save people from contracting covid? How do we treat those who have it? How do we keep people in contact with others for their mental health? How do we ensure economic viability to pay for the future health needs of this nation? We are distracted, but when we have widows and cancer patients telling us how left behind and unimportant they feel, we know that in our distraction we have got this wrong. It pains me to say that.

Throughout this pandemic, I and others have lost loved ones. Two of the girls in my office have lost loved ones: one lost a sister and the other lost two uncles. We know the devastation, but we have all lost loved ones to cancer too. It is not that one is less important than the other, so that is why this debate is so important. I am thankful for this debate, which allow me to come alongside my colleagues and friends—that is what they are—to discuss how better we can do this together.

I was contacted by a radiotherapist who highlighted the massive problems they are dealing with daily. There are two main radiotherapy centres in Northern Ireland. I know this is not the Minister’s responsibility, but I am saying this to give some context to the debate. One is in Belfast, and the other is the newer, smaller North West Cancer Centre at Altnagelvin. I am told that the main issues in radiotherapy are the result of the lack of investment and funding. There are major problems as a result of staffing—doctors, therapy radiographers and physics—including recruitment, training and retention. That has a knock-on effect on service delivery, development and research. Investment is needed to replace old radiotherapy treatment machines.

Northern Ireland would like to feel more connected to mainland UK radiotherapy, through sharing best practice, training support, data sharing, peer review and so on, and that is what we are asking for. It is important that we take an holistic approach to this across the whole of the United Kingdom of Great Britain and Northern Ireland.

The covid problems found also included more patients having their treatments disrupted in many centres in the United Kingdom and a higher proportion than average reporting a poor or very poor experience. That also worries me greatly. We have members of the all-party parliamentary group for radiotherapy in the Chamber today, and I know that every one of us understands these issues, including the hon. Member for Westmorland and Lonsdale, who set the scene. One hundred per cent of responders said they were treating patients who would usually be having chemotherapy or surgery. The additional referrals were for a range of cancers, including oesophagus, lung, breast, head and neck, upper gastro- intestinal and bladder, and also included palliative cases.

I want to speak about one specific cancer, pancreatic cancer. It has been highlighted that there was already an emergency before covid-19. This was a critical issue back in March and it is even more critical today, in December. Surgery is the only potential cure for pancreatic cancer. Before the pandemic, only one in 10 people received surgery. With pancreatic cancer, a six-month delay to surgery means a 30% reduction in survival and a three-month delay a reduction of over 17%. Unfortunately, that sets the scene, with pancreatic cancer progressing from a curative to a non-curative disease while treatment is delayed. Surgery, for some, is no longer an option. That is greatly disturbing.

Reports of service restoration are encouraging. We hear from clinicians that, in most parts of the UK, surgery and treatment are now back up and running at near normal levels, but for so many people with pancreatic cancer and their families the damage has already been done. For those diagnosed in the future, the continued delays to the restoration of clinical trials are stunting crucial improvements in treatments and outcomes.

People with pancreatic cancer have also experienced an information gap, with 40% of patients who were impacted by the pandemic reporting having received insufficient information and support about treatment, symptom management or palliative care. We have had multiple reports of people being sent home from hospital with a new diagnosis without any further information on the disease, their prognosis or treatment options. Anyone facing something incredibly dark such as pancreatic cancer at an advanced stage will want the person opposite them to tell them what is wrong and give them some light on a way forward. All of us in this Chamber today, and all of us outside it, have been touched by cancer. For every two people we meet, one of them, or someone in their family, will have had it. Unfortunately we are continually confronted by this, each and every day.

Calls and emails to Pancreatic Cancer UK’s support line nurses have been up 58% on the normal weekly average, and there has been a 34% increase in the number of people being supported each week. Again, I think those figures are the critical factor in where we are on this. Pancreatic Cancer UK has also been contacted by a larger proportion of palliative patients than normal, because that is unfortunately what pancreatic cancer often leads to. If people do not get an early diagnosis and early surgery, they are confronted with end-of-life care. For families, that is incredibly difficult and complex, and a very difficult time in their lives. People with pancreatic cancer have reported feeling forgotten and isolated, at a time when they are also unable to see friends and family due to the risk of covid-19 transmission.

We are all heartened by the tremendous news today that we are going to roll out the covid-19 vaccine late this year and into next, given the time it will take to get to everyone. That is good news, but we have to address the issues for those with cancer now. I believe we need to do better, and the changes must be implemented from here at Westminster and across the whole of the United Kingdom of Great Britain of Northern Ireland. On behalf of all those cancer patients—all the ones who have contacted us, and all those facing an incredibly difficult time—I look, as I often do, to the Minister for a response. I know we will get that, but we really do need to be reassured. We need early diagnosis and extra care, and we need to show compassion in this place for those outside.

[Esther McVey (in the Chair)]

We now move to the Front Benchers.

--- Later in debate ---

[Alex Norris]

Those points are very well made and get to the heart of what we as an Opposition want, what all Back Benchers want—and in fact, everyone. We do not want to beat cancer on paper and in statistics; we want to beat it in reality. We are not making this an issue of politics. It has to be an issue of coming together, as the hon. Member for Westmorland and Lonsdale said in opening the debate, with new and challenging things. Critically, at the heart of this, there is an indication of a plan, so I hope that today the Minister will commit to publishing it, give us greater detail on what is in it, update us on its progress in recent months and tell us whether it works through the full pathway, from symptoms to treatment, or whether it is just a diagnostics plan. To what extent is it being maintained in the second wave, and, with the national cancer recovery plan expiring next March, will there be a longer-term successor? I know that is a peppering of questions, but this is our best opportunity to ask, so I hope the Minister will take that in the spirit intended.

On resources, there was £1 billion in the spending review to tackle backlogs. Will the Minister clarify how much of that will go to cancers? Although the money is welcome, it is less than all the health experts have called for. The Chancellor has promised to give the NHS what it needs, and this is a “what it needs” issue, so resources are important.

On innovation, I am lucky enough to have lots of innovative companies contact me to talk about their treatments. It cheers the spirit to hear about developments in chemotherapy that will make it possible for drugs to be tailored to individuals. That is remarkable. However, I will make a point about radiotherapy because of the hon. Members between me and the door; I will not get out unless I do. Radiotherapy is safe to deliver in a pandemic, is significant in 40% of cures and is cost-effective. That is an area where we can make a real impact. Will the Minister commit to follow what my hon. Friend the Member for Easington said and publish the delayed radiotherapy dataset? That would be a nice step forward.

Macmillan has raised concerns that the long-term plan for the NHS will not be matched by the workforce available. It thinks we need a further 2,500 specialist cancer nurses. Where are we up to with that?

The most important message that any of us can send today is to a person listening to this, watching this or following the coverage who has a hacking cough, a lump or bump or blood in the stool, and has previously used the pandemic—as perhaps many of us would—as a reason not to access care. I ask them to please not do that. The NHS is there for them. We need them to access it. It will be there.

[Esther McVey (in the Chair)]

I am about to call the Minister, but am mindful that Tim Farron needs time to wind up.

--- Later in debate ---

[Tim Farron]

The hon. Members for Warrington South (Andy Carter), for Gower (Tonia Antoniazzi), for Easington (Grahame Morris), for Strangford (Jim Shannon), for Angus (Dave Doogan) and for Nottingham South (Alex Norris), and indeed the Minister, all made excellent points, and I am extremely grateful. I thank the Minister for what she said and for agreeing to meet us this side of the recess. To be specific, we are after a meeting with her, of course, and departmental finance officials so that we can revisit the investment decision—that decision is problematic—and have our experts meet hers to get to the bottom of the data. We need to see the datasets so that we can explore the extent to which there is an urgent crisis—we are certain that there is one.

Finally, the Minister talked about the importance of diagnosis. The Government are making progress on diagnostics. Of course, in the NHS long-term plan, we see the desire to find more cancers earlier so that we can treat them. If we find more cancers early, however, we will have more people to treat. That is why the radiotherapy investment that we have called for is essential, not just now but in the long term.

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

[Esther McVey (in the Chair)]

I will suspend the sitting for two minutes so that hon. Members can exit safely and the next lot can come in safely.

Dementia: Covid-19

Esther McVey Excerpts

Thursday 12th November 2020 Westminster Hall

[Esther McVey (Tatton) (Con)]

I am pleased to follow the hon. Member for Oldham East and Saddleworth (Debbie Abrahams).

At the end of September, more than 812 patients over the age of 65 were recorded as having dementia across GP practices in Tatton. Many of those patients’ family and friends, and people who work with them, have asked me to speak, including Lorraine Albiston, Simon Brazendale and Suzanne Jeans from Knutsford, and Victoria Caruana and Sue Kisloff from Wilmslow.

Like others, I have heard truly harrowing stories about how those with dementia have not been able to see family members. They feel abandoned, at a loss and confused, not having contact, conversation or physical affection. The Alzheimer’s Society says that for people with dementia, lack of social contact is not only bad for their mental health, but has a significantly negative effect on the progression of their dementia.

That was the case for Sue Jeans’ mum, Jackie. Sue has only been able to see her mum three times since February, when the home stopped all visits, meaning she has seen her mum for 50 minutes since February. While she supported the decision to stop visits in February, she does not now. Nine months later, there must be better ways of doing things. Sadly, this lack of contact has led many people to die sooner than they would have been expected to. Between January and July this year, 5,000 more people than usual died of dementia—that is 52% higher than normal.

Sue is not alone. Lorraine Albiston lives in Knutsford, but her mother lives two hours away in a care home in Worcestershire. The home allows a 20-minute visit once a week, in a gazebo with no heating, meaning that visits are often cancelled due to bad weather and only one or two people can visit at a time. As Lorraine has four siblings, that means she cannot see her mother as regularly as she would like to.

I know that in Tatton and across the country care workers, family members and helpers have worked tirelessly, and I put on record my thanks and appreciation to all those people. Oliver Stirk, director of Carefound Home Care in Wilmslow, told me that their carers have adapted to the situation. Their patients are no longer now allowed to go to the pub to have a Sunday lunch, so his carers are cooking for them at home, so they can have some kind of enjoyment. They have also done much to support the families to get online.

Lisa Burrows, the general manager of Sunrise of Mobberley, told me how her team have implemented an enhanced infection control programme. Furthermore, they are doing their best to do numerous social distanced garden visits and are in the process of introducing dedicated visiting rooms. I also want to mention the members of Knutsford Methodist Church, who provide valuable support for carers through their Friendship Café, run by volunteers led by Paula Lambe and Eve James. However, that has not been able to happen, as it usually does every Friday.

There are grave concerns about the Government’s decision to ban almost all visits and about the lack of input from Public Health England to guide care homes’ approach to this pandemic. I have these questions for the Minister: first, what are the Government doing to address the needs of people affected by dementia and of their family and friends? Secondly, someone’s experience may differ greatly depending on the home they are in, so what are the Government doing to facilitate and encourage a common approach between care homes and to ensure that lessons learned at one care home are shared among others? Thirdly, what is being done by the Government to rebuild trust in the vital social care sector?

Finally, I commend the Daily Mail on its Christmas campaign. I will conclude with the words of an elderly constituent who said to me, “I want to live before I die, and at the moment, with all these confusing lockdown rules, I can’t.”

Breast Cancer Diagnosis and Services: Covid-19

Esther McVey Excerpts

Thursday 12th November 2020 Westminster Hall

[Esther McVey (in the Chair)]

I remind hon. Members that there have been some changes to normal practice in order to support the new call list system and ensure that social distancing can be respected. Members should sanitise their microphones using the cleaning materials provided before they use them and then dispose of those materials and respect the one-way system around the room.

Members should only speak from the horseshoe and Members can only speak if they are on the call lists. That applies even if debates are undersubscribed. Members cannot join the debate if they are not on the call list. Members are not expected to remain for wind-ups. I remind hon. Members that there is less of an expectation that Members stay for the next two speeches once they have spoken. This is to help manage attendance in the room. Members may wish to stay beyond their speech, but they should be aware that doing so may prevent Members in the seats in the Public Gallery from moving forward to the seats on the horseshoe.

--- Later in debate ---

[Craig Tracey]

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

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

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

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

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

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

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

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

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

[Esther McVey (in the Chair)]

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

Family Visits in Health and Social Care Settings: Covid-19

Esther McVey Excerpts

Wednesday 11th November 2020 Westminster Hall

[Esther McVey (in the Chair)]

I remind hon. Members that there have been some changes to normal practice in order to support the new call list system and to ensure that social distancing can be respected. Members should sanitise their microphones using the cleaning materials provided before they use them, and then place those materials in the bin. They should also respect the one-way system around the room. Members should speak only from the horseshoe, and they can speak only if they are on the call list—that applies even if debates are undersubscribed.

Members cannot join the debate if they are not on the list. Members are not expected to remain for the wind-up speeches. I remind hon. Members that there is less of an expectation that they stay for the next two speeches once they have spoken—that is to help manage attendance in the room. Members may wish to stay beyond their speech, but they should be aware that if there are lots of speakers, doing so might prevent Members in the seats in the Public Gallery from moving to the horseshoe.

[Joy Morrissey (Beaconsfield) (Con)]

I beg to move,

That this House has considered family visit access in health and social care settings during the covid-19 outbreak.

It is an honour to serve under your chairmanship, Ms McVey. My main focus in speaking today is to highlight the need for improved patient advocacy and adult safeguarding via visitation rights for family members of working-age disabled adults in full-time residential care, including those admitted to hospital. Such patients often cannot speak for themselves and need additional access to family members who are able to advocate and communicate on their behalf.

I applied for the debate because of an awful situation of a mother in my constituency—a mother, much like me or any hon. Member present, who has had to endure a situation that I hope no mother has to face in the future. She is a teacher, a local community advocate, a single mother and someone who has tirelessly fought for her child’s care needs. She was prevented from caring for her son, Jamie, and forced to abandon him to a care home that did not live up to its name. At 21 years old and with no visitors, he was left isolated, bewildered and depressed, often calling out in anguish, “I want my mum. I want my mum.”

Jamie was a warm and affectionate young man who loved touch, kinaesthetic learning and being with people. His mother was denied access to her child, and I cannot begin to imagine what it must have felt like, knowing that her son was denied the care of his family for months—denied a hug, denied the comfort of a warm hand holding his, and denied dignity in his suffering. As a mother, my constituent felt powerless but sure that, had she been able to see him, she would have identified his decline and been able to intervene.

Underfed, Jamie wasted away, getting thinner and thinner in his confusion and isolation. Separated from those he loved and trusted, with multiple bedsores and open wounds left untreated, he began to withdraw within himself and into a catatonic state of unresponsiveness—a young adult with complex disabilities and care needs, left to suffer in silence. By the time his mother was able to see him, it was too late. She reflected on the lack of status that she felt as a mother, which she felt was shared by many family members. It felt to her as though families are often seen as a nuisance or even a threat, and they are sidelined and ignored by some in adult care homes. This mother also felt strongly that some adult care homes do not embrace the care of the whole person.

Jamie entered full-time care at age 13. As a child in a care setting, it was wonderful. The care was holistic and helped support Jamie in every aspect of his daily life and learning. He thrived in that environment, but the change came when he moved into adult social care. Many adult care homes are excellent and highly skilled in supporting adults with complex disabilities, but others—it might be a very small minority—seem reluctant to work with families or to provide adequate levels of transparency and care. It is an ongoing problem, which existed well before the covid pandemic; that has only highlighted these issues.

Disallowing visits or video links that allow families to see and interact with patients takes away a level of scrutiny that makes those already vulnerable chronically so. Depriving vulnerable working-age disabled adults who have complex disabilities and needs, especially those who already struggle with communication, of the love and support of their families is inhumane and cruel. As a society, we lessen our dignity and humanity when we allow our loved ones to perish alone and to wither away and give up on life. Jamie had no voice, so I am here today to speak on his behalf, and on behalf of his mother and grandmother, to make sure that his story is remembered and that other deaths can be prevented this winter.

I welcome the Government’s support for care homes and adult social care during the pandemic and I thank the Minister for reaching out to me the moment that I applied for this debate. She has been incredibly helpful and I thank her for her active participation in finding a solution and justice in Jamie’s case. I thank the Government for their care home support package in March that announced £1.6 billion funding for local government and £1.3 billion to go to the NHS and social care. In April, a further £1.6 billion was announced for local government and for the adult social care action plan and, in September 2020, the Government published “Adult social care: our COVID-19 winter plan 2020 to 2021”, which was shaped and recommended by the adult social care taskforce. The plan set out key elements of national support available for the social care sector for winter 2020; I welcome everything that was outlined in it.

Finally, I welcome the Government’s announcement on visiting guidelines from 5 November. Allowing visitation is so important for patient care, advocacy, safeguarding and mental wellbeing, particularly for disabled vulnerable patients who may not be able to advocate for their own care needs. Allowing family members to visit could save many lives during the winter months and prevent other vulnerable disabled patients from being neglected, abused and left to suffer and die in silence, while restoring a level of compassion, empathy and humanity to patient care both in hospital and in the care home setting.

Now that we are in the second lockdown I ask the Minister and others to consider what lessons we have learned from the excess deaths in care homes and from the adult safeguarding issues raised during the first lockdown. I understand that the main goal of the Department of Health and Social Care is to protect the NHS, particularly during the winter months, but we also need to save the lives of the vulnerable disabled by allowing each patient to have a family member with them as their advocate and carer. That would be aided by the improvement in mass testing in the coming months and the availability of personal protective equipment. This cohort needs a special exemption. A carer would allow for lives to be saved and, with mass testing and the arrival of a vaccine, that could help safeguard many other lives in the future.

If the NHS reaches capacity, as it often does in the peak winter months of January and February, another alternative would be for a family member or carer of the vulnerable patient to care for them directly in a home, a hospital or care home setting. A family member or loved one can also help with caring for the vulnerable person at home, further reducing the burden of care to the NHS. Many of these family members are able-bodied adults who are at a lower risk of developing serious health problems from covid-19 transmission. We also have to allow people to care for those they love.

I welcome the Government’s announcement in the winter care plan that local authorities should work with social care services to reopen safely, especially day services and respite services. Reopening such day centres would allow families to manage a disabled loved one’s care more effectively, while perhaps reducing the need for full-time residential care and lightening the burden on full-time carers who do not have access to vital daycare facilities. The Relatives and Residents Association, which is an advocacy group, reported that helpline callers had been concerned about the standard of care falling as already stretched services face staff shortages and burn-out. Stopping visits from family and friends restricts the ability for oversight and advocacy.

One of the callers to the association’s helpline said that his wife

“starved herself to death. Her death was due to the pandemic but she did not die from the virus itself. It wasn’t coronavirus—it was death due to a refusal to eat. She was isolated and alone.”

Perhaps the Minister could provide clarity as to whether families are now permitted to remove their loved ones from residential care home settings, and what the protocol for that would be, moving forward.

Jamie’s care home was in a neighbouring county, but his mother and grandmother lived in my constituency. Buckinghamshire County Council and the NHS are excellent and I worked extremely closely with them during the pandemic and the first lockdown to protect care homes and elderly residents, and to reduce the rate of transmission and death in care homes. I was proud of the work that we all did to protect the elderly in South Bucks.

However, the issue of working-age adults with complex disabilities in residential care facilities completely passed me by in the first lockdown, because many of my residents had additional needs and were at home. They were reliant on day centres and respite care. That was the issue I was seeing, not the issue of the long-term residential care crisis.

I did not learn about Jamie’s treatment during lockdown until the week before his death, when it was too late for me to help. That is why I am raising the matter now. This patient cohort cannot speak or advocate for their own care. They require extensive care and support from care home and hospital staff, and could run the greatest risk of being sidelined during a spike in hospital admissions, when staff resources are spread more thinly and they have to prioritise patient care.

Because these patients require the most care it is important that they have a family member who can be with them as their patient advocate and carer, to help ensure that they make it through these winter months. I welcome the Government’s announcement of a vaccine and I know that, with the highlighting of safeguarding, we can get through these winter months, and that Jamie’s memory will not be forgotten.

[Esther McVey (in the Chair)]

It might be helpful to colleagues to know that I intend to call the Front Benchers by 3.30 pm at the very latest. I would like to ensure that all colleagues get to speak today.

Contaminated Blood

Esther McVey Excerpts

Tuesday 11th July 2017 Commons Chamber

[Ms Esther McVey (Tatton) (Con)]

Trust is the key word—trust and faith, if people have that, in the inquiry. Every story is different. My constituent Barry Flynn is a twin. His twin is not here, but on his behalf he wants to be able to trust the inquiry. He wants the victims to be heard and to decide the remit, and he wants their evidence to be taken. Does my hon. Friend agree that that is the way to get trust?

[Dr Johnson]

Absolutely; the victims and their families have the right and deserve to know what happened. They deserve answers to their questions. They need to know when people knew that these blood products could be causing harm and, if those people did know, why the products were still given.

The House should be under no illusions—I am sure it will not be, after listening to many eloquent Members describe their constituents’ cases—about the suffering people have been through, losing their family members. There is a stigma that still exists today around many of these medical conditions, particularly HIV. Other people, such as victims’ wives and children, have been put at risk, and many others still suffer today from poor health.

I very much welcome the announcement of the public inquiry, which I hope will get to the bottom of all the issues. I hope that the victims receive the compensation they deserve.

Care (Older People)

Esther McVey Excerpts

Tuesday 6th September 2011 Westminster Hall

[Gareth Johnson]

The two issues are separate. When Southern Cross went bankrupt, for example, it blamed in part the increase in health and safety legislation, some of which was sensible and some completely unnecessary. Ensuring that people who reside at care homes have some rights over the land that they are living on is a separate matter. I do not see that as placing increased burdens on those running the care homes; it simply gives the individual residents the same rights that we would have if we leased a flat. Those living in residential care homes, who are perhaps among the most vulnerable in society, should surely have that extra protection. The challenge for the Government is to find a solution that is both affordable and fair—affordable, so that the Government can cope with the ageing population and the increasing demand on care homes, and fair, so that the elderly are not forced to sell their homes and lose out because of their earlier, sensible financial decisions.

[Esther McVey (Wirral West) (Con)]

I am delighted to take part in the debate, which echoes the conversation I had earlier in the week with the residents of Hoylebank in West Kirby about the diverse and huge issues involved. Those residents believe that they are part of an invisible generation. They would like to be visible and, like my hon. Friend the Member for Chatham and Aylesford, they are calling for a Minister for the elderly to go through everything thoroughly.

[Gareth Johnson]

I am sure that the residents in Hoylebank have similar difficulties to many residents all around the country: they are often screaming loudly and not being heard by anyone. It is incumbent on Government to listen to the messages we hear from care homes and to see where we can make improvements to their rights to ensure that their homes are protected as well as possible. We need to find a more sensible balance than is currently in place. Care homes provide a vital link in the health chain. The hon. Member for Birmingham, Erdington (Jack Dromey), who is not now in the Chamber, made the important point that if we reduce the availability of care home provision, the amount of so-called bed blocking in hospitals will inevitably increase, with all the extra difficulties and costs arising.

We all want to facilitate elderly people remaining in their homes as much as possible, but the ideal should be about choice and not about forcing people who want to go into a care home to stay at home, or forcing people who want to remain in their own homes to go into care. Their individual choice should be paramount, and their opinion should count for a great deal. I therefore look forward to the spring, when the Government intend to announce their intentions regarding the Dilnot report and what happens thereafter. I look forward to finding a balance that works for the whole of the older generation.

Patient Confidentiality (Mentally Ill)

Esther McVey Excerpts

Thursday 9th December 2010 Commons Chamber

[Dr Julian Lewis (New Forest East) (Con)]

I am delighted to have secured this debate. This is the second time I have addressed the House today and I hope that the consensus that was lacking in the earlier debate will be restored for this one, because hon. Members in all parties have the welfare of the mentally ill very much at heart. We are all constituency Members and we all have to deal with sad cases. Sometimes, we can do something to help people and sometimes it is too late to do anything to help those whom we have lost, but we can still try to achieve something in their memory to help other sufferers in future.

By way of background, I want to make it clear that I have no expertise or practical qualifications in mental health and that my doctorate is not a medical degree. I do, however, have a certain amount of experience stemming from when I first set foot in the House, in 1997, and came second in the private Member’s Bill ballot. The individual who came first in the ballot promoted a Bill to ban hunting and the Chamber was packed on that Friday. I am sorry to say that when we came to debate my private Member’s Bill, which was on improving conditions for people who suffer catastrophic breakdowns and need in-patient treatment, the House was back to its normal sparse attendance. Nevertheless, despite that somewhat cockeyed sense of priorities, the issue of mental health is an enduring one that requires great sensitivity.

Since those days, I have from time to time raised issues that affect my constituency. Most recently, I have been concerned about the closure of the psychiatric intensive care unit at Woodhaven hospital, which was constructed on the site of a former mental institution. I was delighted when that great facility was opened in my constituency a few years ago, and I worry about its future now that it has lost the intensive care unit. I recently set up a small group of people from different parts of the spectrum of mental health concern in the New Forest area. I asked members of that group, which is called “Support our Mental Health Services”, to drop me a note about why they had joined it. One lady, Mary Stephenson, is particularly concerned about the loss of the PICU at Woodhaven, even though we are left with an acute ward. She wrote:

“On any acute psychiatric ward, there should be an opportunity to remove very disturbed, noisy and possibly violent patients, to have private peace and ‘cooling-off’ facilities.”

That is also for the benefit of other people on the acute ward who do not require intensive psychiatric care. Unfortunately, that facility has now been lost.

We are also concerned about the future of Crowlin House, which is a sort of halfway house. People have joined our group because they are concerned that if that residential facility were to close, those currently housed there might find themselves put into care homes for the elderly or for those with dementia. That would not be suitable for people who are, in a sense, halfway between being in-patients and being in the community.

Other people have joined us from Solent Mind, which supplies various important services. It has drawn to my attention the fact that the community mental health team is coming under pressure, as it faces losing 20% of its budget because of the introduction of improving access to psychological therapies—IAPT. In itself, IAPT is a good idea, but it is fairly low level and not a specialist service. It was supposed to be in addition to the services available to my constituents. As I have said before in this House, the danger can be seen in what happened to the specialist student service in Southampton—I cite that example in view of today’s earlier debate. That service is no more because its functions were supposedly moved in the direction of IAPT, but in fact IAPT was not able to take them up. In addition, one of the beneficiaries of a scheme called supported permitted work, David Hayward, has written to me expressing his worry that that is under threat, and I understand that there are concerns about the position of the vocational advice service—my constituent, Lorraine Miller, has written to me about that.

I have painted a general picture about the state of mental health services, which is mixed. We have lost some good services, but we retain quite a lot of valuable assets, although we are worried that they might go. That is why we are setting up a campaign group to try to ensure their future.

My specific concern tonight is the problem that arises when somebody is mentally ill and the people treating that person feel unable to share information about that person’s treatment with their carers or their next of kin. For once, I can say that some excellent work has been done on the theory, but I am a little worried about the practice.

I have with me a briefing paper prepared under the imprint of the Department of Health, King’s college London, the Institute of Psychiatry at the Maudsley, Rethink and the NHS service delivery and organisation research and development programme. The paper goes right to the heart of the issue. It is entitled “Sharing mental health information with carers: pointers to good practice for service providers”, and it seeks to tread a delicate line between preserving patient confidentiality and letting people who care about these patients have vital information about them when they are not in their right mind.

[Esther McVey (Wirral West) (Con)]

I congratulate my hon. Friend on securing this debate and beating me to it. I wish to raise the issues faced by a constituent who looked after her husband 24/7 until he passed away in 2006. He suffered from hallucinations, paranoia and depression. He also had falls, lost consciousness and regularly became violent towards her, all of which put a lot of pressure on their relationship and left her upset. Her health deteriorated and she felt that she could not look after him properly. It was not until he passed away that she learned that he had dementia. I have a question for the Minister: should the safety of the carer be put ahead of the patient’s right to confidentiality? Should we consider the severity of the patient’s mental health problem in determining whether they are fit to keep their condition a secret?

[Dr Lewis]

I am so grateful to my hon. Friend for staying after this somewhat trying and long day to make that important contribution, because it shows that I am not talking about some quirky, one-off situation. It is a very real dilemma, which requires great thoughtfulness and sensitivity.

I do not have time to go into the contents of that briefing paper in great detail, but I shall select just a couple of quotations that show how good it is. It says:

“Carers play an important role in many service users’ lives. Their knowledge and expertise represent an enormous resource for statutory and voluntary mental health services. These are reasons why it is so important to include them through sharing information. Providing carers with information to support them in their role can improve outcomes for both service users and carers…Carers fear being denied access to important information to help them in their role. They are also concerned that their own confidences may be broken.”

I came to the topic through the case of Mr and Mrs Edgell—my constituents David and Kay—whose lovely daughter Larissa, aged 34, hanged herself in 2006. They have obviously done everything that they can to come to terms with that, but I have a detailed file, which I have shared, because I knew they would want me to, with the Department and the Minister. I shall not go into the detail, because I do not have the time to do so, but it shows that from the earliest stages, back in about 2000, they warned of their fears that Larissa, or Lara as she was known, was seriously at risk.

Subsequently, in about 2004, Lara made a serious suicide attempt, but between then and 2006, when sadly—tragically—she succeeded, her parents were unable to know what was going on between her, the people who advised her in the NHS and, indeed, the people whom she saw privately, the private therapists.

I made it clear to Mr and Mrs Edgell that I felt that little could be done to improve on the excellent briefing document that I have only briefly quoted. It is an admirable piece of work and—unlike so much jargon produced in-house and, dare I say it, within the NHS—admirably clear. It is a first-class piece of work, and I would not alter a dot or comma in it.

When Mr and Mrs Edgell first came to see me in 2007, I wrote to the then Under-Secretary at the Department of Health—the hon. Member whose constituency I should have looked up. Is somebody going to tell me Ivan Lewis’s constituency? I am not the only who is stumped. That is the first time I have known Mr Speaker’s encyclopaedic memory to let him down. Sorry about that, Mr Speaker.

Anyway, I wrote to the hon. Gentleman and said that my main reason for doing so was to focus on two main issues relating to what had happened—[Interruption.] A voice off tells me that he is the hon. Member for Bury South (Mr Lewis). I am glad that we have sorted that out.

I said that I was writing on two main issues:

“The first is the frequent invocation by doctors who were seeing Larissa of the concept of ‘patient confidentiality’ when her desperate parents were trying to look after her interests at a time when she was too unwell to be the best judge of them herself.”

I went on to say that, after Larissa took her own life, Mr and Mrs Edgell investigated that matter and discovered that the Department of Health had an extremely good policy, set out in the paper that I have described, which it issued in January 2006. The paper seemed to show, as I said in my letter,

“a clear understanding of the importance of sharing vital information with those nearest to the mentally ill person”,

but, I pointed out,

“the best policy in the world is worthless if the doctors concerned fail to apply it either out of ignorance or obstinacy.”

Mr and Mrs Edgell discovered only when it was too late how many times—it said how many in the notes of their daughter’s various visits to medical professionals—she had had suicidal thoughts.

The response from the hon. Member for Bury South was rather disappointing. I see that I did write the name of his constituency on the reply, so I apologise for having embarrassed Mr Speaker for no good purpose.

In the reply, the then Minister states:

“As you state in your letter, the Department of Health had issued excellent guidance regarding confidentiality and people with mental illnesses. However, as you may be aware, the Government’s task is to set the national agenda, to put in place national standards and provide overall health service funding. The responsibility for deciding how the national agenda is delivered locally and determining how best to allocate these resources to meet the needs to their local populations rests with local health communities.”

I did not think that that was an adequate response. What is the point of producing excellent guidelines on highly sensitive, critically important, life and death matters, in that way and then relying on individual trusts to bestir themselves to the extent that they decide to apply or not to apply them? For once, it was the Conservative Opposition Member who was asking for a bit more central direction because, in this case, central direction was necessary.

The second main concern of Mr and Mrs Edgell was the lack of regulation of the private therapists whom Larissa had been seeing. Larissa was 34 when she died, and was well and truly an adult. However, it is a matter of concern that, even after her death, the people treating her outside the NHS have refused to give up any notes or information about what they were doing during the period she was desperately in need of help. Again, the reply basically said that Mr and Mrs Edgell might wish to contact the British Association for Counselling and Psychotherapy, which is a voluntary professional organisation that currently helps the psychotherapy and counselling profession to self-regulate. Frankly, that is no proper method of ensuring compliance when private therapists have been taking part in the treatment of someone who has ended their life under these circumstances.

My time is pretty much exhausted, so I will confine myself to saying that I hope I have done justice to my constituents and to the memory of their daughter. They have not failed to understand the delicacy of the issues involved and they hope that their daughter’s death will mean that, in the future, people recognise that the next of kin and/or the carer must be taken into confidence when people talk about doing away with themselves, even if those people are adults.

Adults do not have quite the same rights when they are not operating within their normal mental framework. We talk about people being “out of their mind,” which is perhaps an old way of saying something unpleasant about someone, but there is a literal truth in that phrase. I do not come from a Christian background, but I feel a particular sense of sadness when I hear people singing the famous hymn, “Dear Lord and Father of Mankind.” The third line states:

“Re-clothe us in our rightful mind”.

When people are not in their rightful mind, they need professional help. The professionals need to talk to each other and the mentally ill need the help of the people who have their interests most closely at heart. Those people are the next of kin and the carers. I would be most grateful if the Minister could give some reassurance for the future.