Oral Answers to Questions

Fiona Mactaggart Excerpts

Tuesday 21st March 2017 Commons Chamber

[Mr Speaker]

Order. We are out of time, but I want to get in two more questions.

[Fiona Mactaggart (Slough) (Lab)]

The Secretary of State will be aware that many migrants in the UK are not registered with GPs, yet now when they come to Britain they have to pay an NHS fine. What is he doing, with the Home Office, to ensure that migrants are registered with a GP and are aware of community health facilities?

[Mr Hunt]

I am not quite sure whether I understand the right hon. Lady’s question, but there is not a fining system for migrants; what we say is that people who come to the UK as visitors should pay for their healthcare, or pay the visa surcharge if they are coming for a longer period. There is an exemption for public health, because it is important for everyone that we make sure that we treat people for things like tuberculosis.

Health and Social Care

Fiona Mactaggart Excerpts

Monday 27th February 2017 Commons Chamber

[Maggie Throup]

I thank my hon. Friend for his pertinent comments. I did my training as a biomedical scientist at Halifax general hospital and the royal infirmary in Halifax, so I know the area very well. Yes, we must not go down the route of more disastrous PFI agreements.

[Fiona Mactaggart (Slough) (Lab)]

On the hon. Lady’s point about tests that are not being deployed, but which could save money, I have long been concerned that many areas do not issue women at risk of ovarian cancer with the CA 125 test. It is not a definitive test, but it can help identify the cancer early, which can save money. Does she agree that we need leadership from the top of the NHS on such clinical issues to ensure that short-term savings decided by an individual CCG are not putting patients’ health at risk?

[Maggie Throup]

The right hon. Lady makes a very good point, and we could have an entire debate on the topic of prevention and screening.

The spending of the NHS budget affects social care, and the spending of the social care budget affects the NHS. As we have heard from other hon. Members, the two are linked, but are funded in different ways. All too often, these budgets are costed only in silos.

Taking the treatment of stroke patients as another example, there is a new technique available called mechanical thrombectomy. I recently met a young man who was fortunate enough when he had a massive stroke to be near one of the few centres in the UK that carries out that procedure—if a young man in such a situation can be viewed as fortunate at all. As a result of the procedure, the young man can lead a full life rather than being disabled for the rest of his life and possibly dependent on social care, too. However, the procedure cannot yet be rolled out across the country due to the limited funding available to train specialists to carry it out and to fund the procedure itself. What are the lifetime costs, mainly imposed on social care, for those patients who do not get that procedure or other such procedures, irrespective of the personal costs to the individuals?

There are great examples of integrated working between the NHS and social care, but it is far too slow to spread new and best practice. Locally in my constituency, Erewash CCG is a Vanguard site. One of its actions is to carry out what are classed as “ward rounds” in residential and nursing homes. There is already strong evidence to show that that is reducing hospital admissions for elderly people. However, it is not being rolled out quickly enough to other areas.

I do not believe that continually throwing more money at the NHS and social care is the answer. If we want different results, we need to do things differently. That is what the sustainability and transformation plans aim to do. I have read the Derbyshire STP in depth, and while I applaud the aims of the plan, there appears to be very little indication of how it will be implemented. My concerns are around workforce balance, transitional costs to implement the STP, capacity in the community and stakeholder buy-in.

I hope I am wrong with my analysis, because better integration and bold action are what are really needed. It is important for us not to shy away from the hard and difficult decisions that lie ahead.

Oral Answers to Questions

Fiona Mactaggart Excerpts

Tuesday 20th December 2016 Commons Chamber

[Mr Jeremy Hunt]

My hon. Friend speaks wisely. Christmas can be a very lonely time for a number of people, so we all commend the work of voluntary organisations that do so well. I would be delighted to meet her.

[Fiona Mactaggart (Slough) (Lab)]

More than a third of my male constituents live until they are over 80, and yet next door in Windsor and Maidenhead the same is true of well over half of the residents. In the 10 years before 2010, that gap narrowed. What is the Secretary of State doing to narrow the gap in future?

[Mr Hunt]

The best thing we can do to narrow the gap is make sure that we continue to invest properly in the NHS and social care system, and make good progress on public health, which often has the biggest effect on health inequalities. That is why it is good news that we have record low smoking rates.

CQC: NHS Deaths Review

Fiona Mactaggart Excerpts

Tuesday 13th December 2016 Commons Chamber

[Mr Hunt]

My hon. Friend is absolutely right. Boards now have a legal duty of candour, and are obliged to tell patients the truth about what has happened when something goes wrong, but how can they possibly do so if they do not properly record deaths or avoidable deaths? That is why this is a very significant moment. From next year, on a quarterly basis, all trusts will be publishing how many avoidable deaths there are in the trust. Those figures will be compared with national benchmarks. That is how we will start to make boards feel that they have a critical responsibility on this.

[Fiona Mactaggart (Slough) (Lab)]

I welcome the learning disability mortality review that the Secretary of State has announced, but I am keen to ensure that it includes unexpected deaths in care settings other than the NHS. When I was first elected, Longcroft, which purported to be a care home for people with learning disabilities, was actually a torture chamber for people with learning disabilities. We have ended that kind of thing, but we need to ensure that unexplained deaths of people with learning disabilities in other care settings are fully investigated, and that those investigations feed into this review.

[Mr Hunt]

The right hon. Lady is absolutely right. I will take away with me the question of what the legal responsibilities will be for people in adult social care settings. One thing the report highlights, which I had not particularly anticipated, was the problem that a number of people with learning disabilities are cared for in multiple settings, so if there is a tragedy, the place where the tragedy happens may not be the place responsible for what went wrong. Often, the person’s previous care provider never even finds out that that person has died. One thing that Sir Mike Richards talks about is making sure that all care providers are informed promptly when something happens, so that there can be a multi-institution examination of what went wrong.

Accelerated Access Review

Fiona Mactaggart Excerpts

Tuesday 13th December 2016 Westminster Hall

[Fiona Mactaggart (Slough) (Lab)]

The hon. Gentleman is right to focus on the development of these drugs. My concern is not just that patients are denied access to life-changing drugs, but that our pharmaceutical industry finds this a frustrating country in which to develop new drugs and to ensure that they are available to people such as the constituents of my hon. Friend the Member for Dudley North (Ian Austin).

[Ben Howlett]

The right hon. Lady is quite right that pharmaceutical companies, in the rare diseases space in particular, find this country a very frustrating place to come to. The message that we are going to support the industry to bring drugs to market here is not loud and clear, and there have been a range of delays and process errors. I know that the Minister and previous Ministers have tried to address this issue, but it has been a very slow, difficult and arduous process, because the message has not been heard loudly and clearly enough.

The difficulty that Orkambi is currently facing in getting funded perfectly displays the problems faced by many other innovative drugs that aim to treat rare or genetic diseases. As chair of the APPG, I get contacted by many people across the country who are desperate to see potentially life-changing drugs approved by NICE. There is a clear deficiency in the process for this type of drug, so I hope that the Minister can today announce a pilot process to show that the UK is committed to leading in this field and providing hope for all those sufferers of rare and genetic diseases.

Cancer Strategy

Fiona Mactaggart Excerpts

Thursday 8th December 2016 Commons Chamber

[Nic Dakin (Scunthorpe) (Lab)]

I beg to move,

That this House has considered the Cancer Strategy one year on.

In moving this motion, which stands in my name and that of the hon. Member for Basildon and Billericay (Mr Baron), I wish to recognise all those in the cancer community for all their work, day in, day out, fighting this disease, and the huge number of Members of this House who, through a wide range of cancer-related all-party groups, carry out work in this very important area.

The hon. Member for Basildon and Billericay, who is chairman of the all-party group on cancer, is unable to be here today, but he wanted me to say how much he appreciates the Backbench Business Committee’s granting this debate. As Members may know, the hon. Gentleman’s wife is undergoing treatment, and I am sure that everyone in the House would want to send their best wishes to him and his family at this difficult time.

It is estimated that there are more than 2.4 million people living with cancer in the UK, and that number continues to grow. Cancer is becoming more complex, with many more treatments available. Many patients are living with co-morbidities and with the consequences of a cancer diagnosis many years after treatment has finished.

The all-party group on cancer has a proud record of successfully campaigning on a number of issues. Just two days ago, we held our annual Britain against Cancer conference in Central Hall—it is one of the largest cancer conferences in the UK. On behalf of the group, I wish to pass on thanks to all the contributors, including the Under-Secretary of State for Health, the hon. Member for Warrington South (David Mowat), and the shadow Secretary of State for Health, my hon. Friend the Member for Leicester South (Jonathan Ashworth), for their contributions. Delegates very much appreciated everybody’s input.

The last two years have seen significant developments in cancer policy. In July 2015, the independent cancer taskforce published the England cancer strategy. Since we last debated this issue in November last year, NHS England has published its England cancer strategy implementation plan, setting out how it will roll out the 96 recommendations.

More recently, we have seen the publication of the National Cancer Transformation Board’s progress report, outlining what steps NHS England has taken over the past year in implementing these recommendations across the country. Only last Friday, the Office for National Statistics published the latest one-year cancer survival rate figures for those patients diagnosed in 2014 and followed up to 2015. As NHS England chief executive Simon Stevens pointed out at the Britain against Cancer conference, that showed the dramatic improvement in patient outcomes that has been achieved over the past 20 years. That is something to be celebrated, but there is still much more to do.

The all-party group has been active in monitoring progress on the England cancer strategy, holding a short inquiry early in the year to assess progress. We concluded that positive progress is being made, but that there is still much more to do to realise the ambition of the England cancer strategy. Having taken evidence from a wide range of people, we made a number of recommendations, which I will use to highlight some of the key themes that emerged from the inquiry.

The first key recommendation focused on the need for greater clarity on funding for all the 96 recommendations of the England cancer strategy. It was positive, therefore, to see more detail in the National Cancer Transformation Board’s progress report, which set out the funding available per year for the next four years. I very much welcome the announcement by Simon Stevens at our Britain against Cancer conference that Cancer Alliances will be able to bid for £200 million of funding to invest in early diagnosis, care for people living with cancer, and cancer after treatment. That is very good news, and I look forward to getting further clarity on how the full funding package, set out in the progress report, will be allocated across the cancer strategy’s recommendations. This is particularly important given the lack of clarity around cancer funding to date. The estimates for the total amount spent on cancer care in the NHS per newly diagnosed patient have not been published beyond 2012-13, which has been described as a significant data gap when it comes to evaluating the cost and efficiency of cancer care. Will the Minister today commit to publish an update on those figures in the House of Commons Library at the earliest opportunity?

Alongside funding, another recommendation and concern that was raised by stakeholders in our inquiry was around the need for further transparency on how the cancer strategy is being delivered, what the priorities are, and who is responsible for delivering key recommendations. Again, the progress report from the National Cancer Transformation Board went some way to address that concern. However, further detail around how the strategy is being delivered, particularly the membership and terms of reference for the six oversight groups tasked with overseeing delivery, is vital to ensure that the wider cancer community is properly engaged.

We also heard from many organisations that were unclear on how the delivery of recommendations will be monitored at a local level.

[Fiona Mactaggart (Slough) (Lab)]

One of the things that shocked me in a debate on ovarian cancer was to find that there are parts of the country where CA125 is not routinely available to women who are suspected of having ovarian cancer. I have also had letters from a number of constituents who say that they are unable to get access to bisphosphonates, a drug that helps to prevent breast cancer. Did the all-party group come up with recommendations to try to ensure that wherever people live, they get the best possible cancer prevention and care? At present there clearly is not universal provision of these important diagnostic tests and drugs.

[Nic Dakin]

My right hon. Friend makes an important point about equal access across the country. We are all concerned about that and focused on it.

It is positive news that the 16 cancer alliances have been established and that NHS England will publish further guidance for alliances to help them develop their plans to deliver the cancer strategy locally, but if they are to monitor the delivery of the strategy, it is vital that they are given the right resource to do so effectively.

A particular issue which was raised in relation to both transparency and accountability was workforce. Most people, I believe, will agree with me when I say that our NHS workforce is under great strain. The cancer workforce is experiencing significant gaps in key areas, including radiography and clinical nurse specialists. For example, Anthony Nolan highlights the fact that access to post-transplant clinical nurse specialists is inconsistent across the country. At the same time, demand is growing, and cancer is becoming more complex, as patients often have multiple co-morbidities. Unless they are addressed, these workforce pressures will undoubtedly have a severe effect on cancer services.

Another area of growing need for cancer patients is access to timely and appropriate mental health support which, if achieved, can reduce pressures on other parts of the health service.

The all-party group welcomes the recommendation in the strategy that Health Education England would deliver a strategic review of the cancer workforce by March 2017, and we were grateful to Professor Ian Cumming for meeting us earlier this year. However, we have strong concerns about progress on this crucial piece of work. Although we are aware that a baseline report of the current cancer workforce has been produced, it has not been published, and there is currently little detail on how Health Education England is planning to conduct the strategic review. We are not aware of any plans from HEE to engage with the sector on the strategic review, and we continue to be concerned by the lack of transparency and involvement of the wider sector. We were pleased to see a reference to the strategic review of workforce in the Department of Health’s mandate to HEE. Will the Minister outline how he is holding HEE to account on that recommendation?

Diagnosing cancer earlier improves survival rates, and the all-party group believes that focusing on outcome indicators such as the one-year survival rate is crucial to driving progress in this area. The inclusion of the one-year cancer survival indicator in the clinical commissioning group improvement and assessment framework—formerly the delivery dashboard—is very much welcomed by the all-party group, which has long campaigned for that. Since then, the all-party group has continued to champion this cause, and earlier this year at our annual summer reception we were the first to congratulate and recognise clinical commissioning groups that had improved their one-year cancer survival figures.

So it was music to our ears to hear Simon Stevens at this week’s Britain against Cancer conference further commit NHS England to increasing its efforts on diagnosing cancer early. Last week the latest one-year cancer survival rates were published, and we were pleased to see an improvement, with the average one-year cancer survival rate in England standing at 70.4%. However, incremental improvements are not enough to match our neighbours in Europe and across the world, as our figures are below the standard set in countries such as Sweden, which has a one-year survival rate of 82%.

As chair of the all-party parliamentary group on pancreatic cancer, I am acutely aware of the difficulty of diagnosing some cancers early. My constituent Maggie Watts lost her husband to pancreatic cancer. Kevin’s mother had died from pancreatic cancer 40 years earlier. Difficulty in early diagnosis is one of the reasons why the outcomes for pancreatic cancer had not improved over those 40 years. Some 74% of patients across the UK cannot name a single symptom of pancreatic cancer, so there is a need for further cancer awareness campaigns to improve the outcomes for these “stuck” cancers, as well as further research into better diagnostic tools in these areas.

Be Clear on Cancer campaigns have been very effective but, as Bloodwise points out, we need further thought on how the NHS can work closely with cancer charities and patient organisations to increase awareness of cancers with non-specific symptoms, such as blood cancers.

I recently met representatives of the Roy Castle Lung Cancer Foundation, who were clear that early diagnosis of lung cancer dramatically improves patient outcomes for this, the biggest cancer killer. In some countries, screening for lung cancer is being introduced, with positive outcomes. Should we actively consider that here?

It is worth pausing to recognise the excellent work that public health campaigns have played in fighting cancer. Since the smoking ban was introduced nearly 10 years ago, the number of adult smokers in the UK has dropped by 1 million. Smoking cessation is still the most effective cancer preventive strategy, and all of us need to ensure that, when local government budgets are under pressure, that does not lead to reductions in public health budgets for short-term fiscal gain, with long-term negative health consequences and associated costs. As Cancer Research has made clear, the Government must publish the tobacco control strategy without delay.

The final recommendation I want to highlight from our inquiry is on a similar theme: the involvement of patients and organisations in the cancer community in the implementation of the cancer strategy across England. This recommendation has been supported by other groups, such as the Cancer Campaigning Group, which noted in its recent report that the National Cancer Transformation Board and the Independent National Cancer Advisory Group should collaborate with organisations with an expertise in cancer and involve patients in delivery.

The issue is particularly pertinent to people with rarer or less common cancers, many of which are childhood and teenage cancers. The all-party group was concerned when the cancer transformation board’s implementation plan did not highlight rarer cancers specifically. Rarer cancers—particularly those with vague symptoms—tend to be diagnosed later than most common cancers, with many diagnosed through emergency presentation. That not only impacts on survival but leads to poor patient experience. In addition, many patients with rarer cancers, and particularly those with blood cancers, can live with their conditions for many years, and it is vital that provision to support people living with and beyond cancer, such as the Recovery Package, consider the needs of these patients. While many of the recommendations in the cancer strategy will go some way to address that issue, it is vital that NHS England retain a strong focus on this group. What discussions has the Minister had with NHS England about how it is ensuring that organisations across the cancer community are involved in the delivery of the cancer strategy?

Currently, cancer medicines, including those for rare cancers, are appraised by the National Institute for Health and Care Excellence on a timetable designed to ensure that a recommendation can be issued at the time of licence. However, there is growing recognition in the cancer community that current NICE methodology and process are not suitable for assessing treatments for rarer cancers, and that the one-size-fits-all model adopted by NICE could result in patients with rarer cancers losing out on access to treatments that patients in other developed countries are able to access.

There is an ongoing joint consultation by NICE and NHS England, which incorporates changes to highly specialised technology appraisal thresholds, introduces an affordability assessment and creates a fast-track route for highly cost-effective drugs. However, the consultation does not address or acknowledge any specific recommendations for the assessment of treatments for rarer cancers. Concern has been raised by the cancer community that this makes these available treatments vulnerable to always falling through the net. What is the plan to ensure that the NICE process and methodology applied to rarer cancers incorporate the limited patient numbers and data collection, rather than applying the same process irrespective of the rarity of the cancer? What additional flexibility will be applied to NICE criteria when assessing rare cancers, to account for inevitable uncertainties in clinical data?

In summary, it is important to recognise the progress that is being made in implementing the cancer strategy one year on, but there is much more to do. Together, properly supported by Government, those in the cancer community are willing and eager to deliver the better outcomes that would mean we were not just closing the gap on better-performing nations but beginning to lead the way.

Oral Answers to Questions

Fiona Mactaggart Excerpts

Tuesday 15th November 2016 Commons Chamber

[Fiona Mactaggart (Slough) (Lab)]

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

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

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

[Fiona Mactaggart]

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

[David Mowat]

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

--- Later in debate ---

[Michael Fabricant (Lichfield) (Con)]

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

[Fiona Mactaggart]

If it is treated in time.

[Michael Fabricant]

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

Oral Answers to Questions

Fiona Mactaggart Excerpts

Tuesday 11th October 2016 Commons Chamber

[David Mowat]

This is a very difficult area, but decisions on priority are clinically driven and must continue to be based on peer-reviewed data. The most recent review determined that less than one third of second transplants would result in survival after five years; that is why they were not funded. There will, however, be a further review next April, and to the extent that the data have changed there will be a new evaluation at that time.

[Fiona Mactaggart (Slough) (Lab)]

T5. Deer Park medical centre in Witney faces closure, and patients will be dispersed a long way into other practices in an area where one in four already waits more than a week to see their GP. Duncan Enright, who is Labour’s candidate in the Witney by-election, is campaigning to save the centre. Will the Secretary of State reward his campaign by saving it today?

[Mr Jeremy Hunt]

The Conservative candidate in the Witney by-election will be saying very clearly that because of the extra funding from this Government we are aiming to have 5,000 more doctors working in general practice by the end of this Parliament, something that would not have been possible with the increase of less than half that amount promised by the Labour party.

Oral Answers to Questions

Fiona Mactaggart Excerpts

Tuesday 5th July 2016 Commons Chamber

[Mr Hunt]

We already commit huge resources to that, but we can do more. As I just said, we hope to announce something to the House before the break.

[Fiona Mactaggart (Slough) (Lab)]

8. How many staff working in the NHS have been recruited from other European countries in the last 12 months; and if he will make a statement.

[The Parliamentary Under-Secretary of State for Health (Ben Gummer)]

There are no centrally held data on the countries from which NHS staff are recruited, but self-reported nationality data suggest that 15,723 non-UK European nationals joined the NHS in England and that 7,900 left, leaving a net increase of 7,800. As the Minister responsible for the NHS workforce, may I say that every single one of them is very welcome in, and provides an invaluable contribution to, our NHS?

[Fiona Mactaggart]

The problem is that the Immigration Minister’s waffle yesterday and Ministers’ warm words today are not giving confidence to these vital NHS employees. Has the Minister spoken to the Immigration Minister to request that he guarantee permanent residence to every EU national working in the NHS so that they can have the security that they—and we, their patients—need?

[Ben Gummer]

The Home Secretary is well aware of the enormous contribution that EU nationals make to the NHS. We all have a duty to undo the damage done during the referendum campaign and the poisonous atmosphere that exists in some parts of our communities and to thank personally—I will be doing so myself—EU nationals working in the NHS for their hard work and dedication so that they feel valued by each and every one of us.

NHS Commissioning (Pre-Exposure Prophylaxis)

Fiona Mactaggart Excerpts

Tuesday 7th June 2016 Commons Chamber

[Jane Ellison]

The NHS is seeking clarity through the courts on its own position. No decision has been made about who will be the final commissioner for PrEP, so what the hon. Gentleman said is not quite right. The £2 million that has been committed to the pilot is important and will inform our understanding of this important intervention.

[Fiona Mactaggart (Slough) (Lab)]

Slough has an extraordinarily high incidence of HIV and AIDS, much of it undiagnosed. Our local authority is the smallest unitary authority in the country and has faced cuts to its central Government funding of 50%. It has no prospect of being able to fund a challenge of this size. Does the Minister understand that this delay in sorting out who will pay for PrEP will lead to the deaths of hundreds of people in Britain?

[Jane Ellison]

As I have mentioned, Truvada is not yet licensed for use as PrEP in this country. We have set out a process by which we can understand far more about how PrEP might fit into the landscape. The right hon. Lady mentioned undetected HIV. The Government have invested significant effort and funding into detecting HIV. We have the world’s first home testing service and last year we launched the major HIV innovation fund, which has come up with some new and extremely cutting-edge ideas on how to improve HIV detection and diagnosis. I fully accept that this is a major challenge in her area, but PrEP is only one part of a wider programme of work. [Interruption.]