Healthcare Provision: East of England

George Freeman Excerpts

Tuesday 3rd September 2024 Westminster Hall

[Clive Lewis (Norwich South) (Lab)]

I beg to move,

That this House has considered healthcare provision in the East of England.

It is an honour to conduct this debate with you in the Chair, Sir Christopher. Before getting into the meat of the debate, I will give a brief overview of the broad context. The beating heart of healthcare provision in this country is of course the national healthcare system, arguably the closest thing to socialism that this country has ever seen, based as it is on the provision of healthcare by need, not the size of someone’s wallet. That is pretty unique, not just in this country but around the world. One could argue that this far-sighted policy has changed the very nature of our everyday reality.

Our health is everything. Without it, we are more insecure, less productive and less happy. The security of good health and of access to care free at the point of use has revolutionised our society, helping us to live longer, more secure lives, and arguably creating social stability that affects economic productivity and perhaps even the strength of our democracy itself. Or at least it did so until about 60 years ago, when it began to be picked apart.

[George Freeman (Mid Norfolk) (Con)]

I am grateful to the hon. Gentleman, who is my friend as well, for giving way. How wonderful it is to see so many people present for this debate at the beginning of term.

I point out gently that the NHS has also thrived under successive Conservative Governments and that, although it may be a great socialist idea, I believe it has come to be part of the fabric of our whole country and I think all parties present want to improve and support it. Does the hon. Gentleman agree that the NHS also underpins our enterprise economy? In America and other places, it is difficult to start a company when the healthcare costs of the staff have to be thought about; here, by underwriting the cost, we help entrepreneurs to start businesses. That point is often overlooked.

[Clive Lewis]

On the hon. Gentleman’s first point, yes, successive Governments have presided over the NHS, but with differing intentions. Until the mid-1970s, say, there was a broad consensus—I will come on to this—on what the welfare state was and how it operated. That has changed substantially in the past 60 years. The implementation of different policies by different Governments, including Conservative ones, has not always been in the best interests of the NHS. On enterprise, yes, a secure welfare state, good social security and the ability to give people good health—the NHS has been integral to that—have implications for our economy, as I have already pointed out.

I am sure I am not the first or the last to suspect a direct connection between the rise of angry and anti-democratic right-wing politics and the demise of the NHS’s ability to look after us all effectively. The sheer far-reaching impact of the NHS and its crisis cannot be underestimated. One needs only to look at the US, where free universal healthcare does not exist, as the hon. Member for Mid Norfolk (George Freeman) just mentioned, to see the state of politics, crime, drug addiction and social breakdown there. The free market in healthcare provision and medicines has led to a country with one of the least efficient and most high-cost healthcare systems in the western world, and where millions are hooked on drugs that are as heavily advertised as if they were cans of coke. Let us not indulge too much in English exceptionalism, though. We need only to look at dentistry and adult social care in this country to see what happens to healthcare provision that is, to all intents and purposes, privatised or well on its way to being so—the consequences of which I hope colleagues will discuss later in the debate.

The foresight of the 1945 Labour Government cannot be underestimated. When the NHS was launched in 1948, it was done in tandem with the advent of the welfare state, because Beveridge, Keynes and Bevan understood the three pillars necessary for a healthy nation. The first pillar—the NHS—would be there for people if they became sick, but it was the second and third pillars that meant the NHS would not be overburdened. They would work in tandem with it to prevent sickness.

The second pillar was, of course, the welfare state, providing a network of social institutions that would protect citizens from the market risks associated with unemployment, accidents and old age. The third pillar was an economic system that prioritised full employment in secure, well-paid, unionised jobs—a system that sought to reduce all forms of inequality, from wealth to health.

Over the last 60 years, the three pillars have been systematically smashed. The second and third pillars are in tatters, while the first—the NHS—is wobbling precariously. It is testament to the enduring nature of the national healthcare system that it has managed to survive as an almost solitary pillar for as long as it has. If a Labour Government are truly to fix the foundations of our broken healthcare system, they must acknowledge the nature of the three-pillar foundation, and acknowledge that the NHS cannot be fixed if we do not rebuild and replace the other two pillars as well.

The situation in the east of England—from dentistry deserts to sky-rocketing rates of mental health referrals and some of the worst ambulance waiting times in the country—is beyond one malfunctioning organisation. Norwich and the wider region are experiencing a systemic crisis that is institutional, social and economic. Healthcare reforms such as devolution to the integrated care boards have become about devolving who gets to wield the axe to make savings—known to many people as cuts. I will give an example. Our ICB in the east of England, part of NHS Norfolk and Waveney, has been told by national health bosses to cut its running costs by 30% by 2026. My first question to the Minister is: how will our Government deliver improved healthcare outcomes while simultaneously implementing the previous Government’s frankly destructive cuts?

We know that vast areas such as dentistry and social care are largely privatised, with spiralling costs, and that undermines the NHS’s central commitment to care being free at the point of use. Tendrils of the crisis extend into social care. It is often said that if social care is cut, the NHS bleeds too. Norfolk county council acknowledges a crisis in social care. With soaring demand and struggles to recruit staff, there is a backlog of hundreds of vulnerable people waiting to get their care needs assessed, and care providers fold on a regular basis. My second question to the Minister, then, is: what news can she give us on the last Government’s unimplemented cap on care costs? Is it being implemented, as the Secretary of State implied during the general election campaign, or being dropped? If it is dropped, what plans are there to help those facing ruin given their complex care needs?

One consequence of the situation in Norfolk is that there are regularly hundreds of hospital patients who are medically fit to leave but unable to be discharged. It is clear that our healthcare system is struggling to respond to today’s crisis, but it is also unprepared for the challenges of the future. East Anglia is the UK region most at risk from early climate impacts, and there is clear evidence of the link between climate breakdown and ill health. For example, from 2022 to 2023 the number of flood reports in Norfolk doubled, and stretches of Norwich are predicted to flood year after year. Victims of flooding in the UK are nine times more likely to experience long-term mental health issues, and flooding is linked to a greater instance of respiratory diseases because of dampness.

Prevention is better than cure—it is about treating the causes, not just symptom alleviation. We know that the Prime Minister is keen on the so-called preventive state and we have seen some early policy announcements, so my third question is: will the Minister elaborate on what that will look like? What does healthcare provision that prioritises prevention look like in the east of England?

[Clive Lewis]

I thank the hon. Gentleman for his input, and his points were well made. When researching this debate, I probably spent more time working out what I did not have time to say than what I could actually put into the debate, so I have tried to do a broad overview. Many of the issues the hon. Gentleman raised are also of concern in my Norwich South constituency and across the eastern region. I am sure that during the debate many of those issues will be raised and dealt with in more detail.

Our Government have said they are a Government of service, but a legitimate fourth question that I ask the Minister is: in service of whom and to what end? It is clear to many that the interests of big business, of big tech and data companies and of private finance do not always sit well with the public interest, particularly when it comes to health. There are areas where they do, but there are also areas where they do not. We know with whom the last Government sided; whom will ours back when push comes to shove—big business, big tech, the finance industry or Joe public?

I want to briefly provide a snapshot of the scale of the crisis in the eastern region. Ambulance response times in the east of England are significantly worse than those in the rest of England. In 2023, response times for category 1 cases—that is, severe cases—were nearly 12 minutes in East Anglia, while the national target is seven minutes. They were nearly the worst on record. The Care Quality Commission, now under inquiry and investigation itself for its capability to do its job, has described Norwich university hospital as the

“worst in the East of England”

for ambulance handover times.

Referrals to mental health services increased by 18% between 2018 and 2020. Compared with the rest of England, Norwich and Norfolk have higher rates of self-harm, death by suicide and mental health issues among young people, as well as more self-diagnosed mental health issues generally. Our mental health trust—Norfolk and Suffolk NHS foundation trust—is notorious for being the worst in the country, and I do not think that can be said enough.

Norwich is a dental desert. In July, the Secretary of State branded Norwich North the “Sahara of dental deserts”. That is a rather romantic notion, but it is a desert where people pull their own teeth out in this burgeoning phenomenon of a do-it-yourself dentistry industry. Indeed, some of my Ukrainian constituents have told me that they find it preferable to dodge Russian missiles and artillery to use Ukrainian dentists. Ukraine arguably has a better dental system in the middle of a prolonged war. That is unsurprising given that in the east we have one NHS dentist—no, it is not even one NHS dentist; it is one dentist—per 2,600 people. Just picture that in your head: one dentist with their tools with 2,600 people queued up. That is what it feels like to many of my constituents.

For the second year running, no dental practices are accepting NHS patients. Norfolk children under five have some of the worst tooth decay in the entire country. Thousands of people have had to go to hospitals in Norwich and Norfolk for abscesses that should have been prevented. The list goes on and on. I am sure that many of my colleagues from the eastern region will also outline some of the issues and stories that they know are taking place on a daily basis, and that have been for many years now.

[George Freeman]

I am grateful to the hon. Gentleman for making the point about dentistry that I think we all understand, particularly in the east. Does he agree that the real cause is threefold—the tariff did not keep up with costs and inflation, we have not been training enough dentists and we have been losing too many—and that the previous Government’s dental plan was a big step in the right direction? Does he support that plan? I am interested to know whether the Opposition intend to continue to implement it.

[Clive Lewis]

I thank the hon. Gentleman for his intervention but will leave the response to the Minister, because it is a question that she would be better able to answer. Frankly, given that the last Government had 14 years to sort out that mess and have handed it over, pretty much complete, to the new Labour Administration, I will not be singing their praises when it comes to dentistry. That will not be going on the record.

I will conclude by looking at the social and economic roots of the healthcare crisis, which are the elephant in the room. As I have outlined, many of the causes of ill health are socially determined. Waiting lists, ill health and mental health issues are signs that our healthcare system is breaking down, but also that we have an economy with a degrading social fabric—one need only look at the race riots this summer to understand that. But do not take my word for it; listen to civil society organisations in my constituency that are at the coalface of this crisis. The Norfolk Care Association says:

“Around 10% of health outcomes result directly from healthcare delivery, with a more significant proportion derived from the physical, social, and economic factors that people experience day to day. The government must do more to tackle poverty, ensure quality housing, and create safe communities, as these are fundamental to improving health outcomes.”

Age UK Norwich says that the key healthcare issue older people face is

“chronic health conditions and limited spend/focus on prevention: around 55% of Norfolk’s older population have one or more long-term health conditions; however, most are treated independently”.

That organisation points to the need for

“Rebalancing healthcare focus and investment to underlying causal factors”—

the “wider determinants” that make up 80% of a person’s overall health status.

Let us have a quick look at some more drivers of ill health. Take, for example, fuel poverty: 10% of people in the east of England live in fuel poverty, and it is almost 12% in Norwich South. Fuel costs in the UK are on average 30% higher than the EU average.

--- Later in debate ---

[Jerome Mayhew (Broadland and Fakenham) (Con)]

I congratulate my constituency neighbour, the hon. Member for Norwich South (Clive Lewis), on securing this important debate about the health service in the east of England.

We have just recovered from a general election, and I hope we have all had time off—a bit of a break—to recharge our batteries so that we can start thinking about how we should lead this country in the years and months ahead. Health and the health service was a key election issue on the doorsteps of Broadland and Fakenham. As the Conservative candidate, I was armed with a whole series of data about how we had 20,000 more doctors and had, I think, recruited 50,000 more nurses. We had paid for and secured 50 million more GP appointments each year—an increase to 350 million per year. We had provided a lot more funding for the NHS, increasing it by £28 billion, or 17%, since 2019. I would have the conversation on the doorstep and read off all these facts about how we had funded the health service, but that was not how things felt to our constituents, and that was a key negative impact for Conservative candidates such as myself. As a Government, we felt we had done what we could—we had increased the funding—but the outcomes our constituents experienced did not tally with that.

I have come up with a number of factors to explain that. One was the covid backlog for elective surgery. Back in early 2020, covid was thrown at the Government, who were caught unaware, and it created a huge backlog. Steps were taken to address it in Norfolk. We had two new operating theatres for elective surgery at the Norfolk and Norwich university hospital, and we got the diagnostic centres at the James Paget university hospital and the Queen Elizabeth hospital, as well as a new one at Cromer. However, these things take time to work through, and the election came before our constituents felt the benefits of that enormous local investment.

However, there was a bigger problem, which the Conservative Government failed to address. A key, proper criticism of our Government is that productivity in the health service went down between 2019 and 2024 by about 5.8%. We were putting much more money in and we had more staff, but what they achieved decreased. If there is one thing the Minister should address—I would be grateful if she could do so in her summing-up—it is what plans the Government have to improve productivity, rather than just funding and staffing, in the NHS, because that is the absolute key. My starter for 10 is that productivity will not improve if we have pay deals like that awarded to ASLEF, where money was provided and productivity improvements were removed from the deal.

[George Freeman]

My hon. Friend makes a really important point about productivity in the health system. I have been a Health Minister and I have observed that—not because of ministerial diktat, but just because of the way the health system works—if you deliver more for less, the Treasury and the Department of Health give you less, but if you struggle to deliver more for less, we give you more. If we ran a business like that, we would go bust. Does my hon. Friend agree that, ultimately, the east needs a much more decentralised, empowered system? In Norfolk, we have an ambulance trust, a mental health trust, three hospital trusts and five clinical commissioning groups. That is bonkers. We need one Norfolk healthcare system that provides what patients need: an integrated patient pathway.

[Jerome Mayhew]

We have made progress in that direction with the integrated care board, which is a very good step in the right direction because it allows the whole care system in Norfolk to come under one remit. We were beginning to see some of the benefits of that with the mental health trust. Although it has a long and pretty disgraceful history of underperformance, there have been tentative signs of improvement since the ICB came in.

The next issue, particularly in Norfolk, is the physical state of our hospitals. We have the Queen Elizabeth hospital at King’s Lynn, which is a RAAC—reinforced autoclaved aerated concrete—hospital, the James Paget in Yarmouth, and the pretty modern Norfolk and Norwich in Norwich. The last Government fully funded and agreed full rebuilds of the QEH and the James Paget, which are long overdue. Those hospitals should be rebuilt by 2030, and I am very concerned to hear that that funding commitment is now under review. The Minister might be constrained in what she can say at the Dispatch Box, but whatever reassurance she can give the residents of Norfolk about the Government’s intention to continue those rebuilds would be much appreciated, because they are enormously important to my constituents.

Then there is dentistry. The hon. Member for Norwich South talked about our dental desert in Norfolk. We have 39 dentists per 100,000 of population, compared with a national average of 52. If someone who grows up in Norfolk wants to be a dentist, the nearest place they can train is Birmingham or London, so it is no surprise that we do not have domestic, home-grown talent becoming dentists in Norfolk. What incentive is there for a just-qualified 26 or 27-year-old who is not from the eastern region to move to a largely rural area? For those reasons, we desperately need an undergraduate dental training school at the UEA in Norwich, perhaps in partnership with other academic establishments in the east of England. I am not squeamish about what it might look like, but we need to have undergraduates being trained in the east of England and in Norwich, because 40% of UEA medical school graduates become “sticky”—they stay in the area because they fall in love, get married and develop commercial relationships with GP surgeries and the like.

The dental Minister in the last Government came to the UEA in about May for a lecture and a series of meetings. The impression given was that we were on the cusp of an announcement of a dental training school but that the election got in the way. All eastern region Members of Parliament, irrespective of their political colour, are wholly in support of that, and we would be very grateful, as the hon. Member for Norwich South said, if we could have some indication that it is still on track.

There is a huge amount to be done in the east of England and in Norwich in particular. We have great staff and good structures, but we need to get the productivity working and the expectation of early GP appointments back on schedule. One recurrent complaint I get from constituents is about how difficult it is to see a GP. I note that 43% of all GP appointments are now same-day appointments, and that record needs to be built on. I have listed a number of areas on which I would be grateful if the Minister could give an indication of the Government’s thinking, and I look forward to hearing her response.

Oral Answers to Questions

George Freeman Excerpts

Tuesday 23rd July 2024 Commons Chamber

[Karin Smyth]

Again, across the country we see the damage done over the last 14 years, and the hon. Gentleman is absolutely right to highlight that the situation in one part of the system knocks on to other parts. That is why we want a 10-year plan to look at this, an immediate look with Lord Darzi, and, critically, to understand which community and primary care services can be supported to support the rest of the system. I am very happy to meet with colleagues across Cornwall, where we now have many Labour MPs.

[George Freeman (Mid Norfolk) (Con)]

8. If he will make an assessment of the potential merits of requiring newly-qualified dentists to work for the NHS for a set period of time.

[The Minister for Care (Stephen Kinnock)]

I thank the hon. Gentleman and congratulate him on his survival instincts in getting re-elected to this place.

NHS dentistry needs urgent action thanks to 14 years of chaos, failure and neglect. Our rescue plan will get NHS dentistry back on its feet, followed by contract reform to make NHS dentistry more attractive. A consultation for a tie-in to NHS dentistry for graduate dentists closed on 18 July and we are now considering the responses. The Government position on this proposal will be set out in due course and I will keep the House updated on this matter.

[George Freeman]

I thank the hon. Gentleman for that answer and congratulate him and his colleague the Secretary of State on their appointments. All of us who are serious about the health service and the need for reform, about which the Secretary of State has spoken, have their back in pushing for reform. The hon. Gentleman has his moment of triumph, but may I gently encourage him to reach out and build a cross-party coalition of support for serious reform? The NHS is broken not by Tory cuts but by years—[Interruption.] For years we have been pouring money in; it needs to modernise for the 21st-century.

In the spirit of which, on dentistry, may I encourage the Front-Bench team to reach out and have a meeting—a rainbow coalition meeting including the new hon. Members for Norwich North (Alice Macdonald) and for North Norfolk (Steff Aquarone)—of all MPs in Norfolk, which has suffered more than most counties? We desperately need that University of East Anglia dental school.

[Stephen Kinnock]

The hon. Gentleman was doing so well at the start, and then he kind of blew it a bit towards the end. It is absolutely right that we put country before party, and we will work with whoever has the best interests of rebuilding our public services at heart. The issue that he raises specifically sounds interesting. What I would say is that unless we get the bigger picture sorted, and unless we make NHS work pay for dentists, we will not be able to rebuild the NHS dentistry system that we should be cherishing and seeking to reform. I am of course always open to conversations with him.

Oral Answers to Questions

George Freeman Excerpts

Tuesday 5th March 2024 Commons Chamber

[Andrew Stephenson]

The hon. Gentleman sounds like a broken record, as usual. The Department has no evidence to suggest that EU exit is leading to sustained medicine shortages. Shortages occur for a wide range of reasons and are affecting countries all over the world.

[George Freeman (Mid Norfolk) (Con)]

Rural Norfolk is experiencing a dental crisis and a generation of children are in danger of going without dental care. I welcome the dental recovery plan, but I notice that it will be four or five years before we get more dentists. Last week, NHS Norfolk and Waveney integrated care board announced a £17 million underspend on dentistry. Will the Minister agree to meet with me and the ICB to work out how we get more money out now to help dentistry in Norfolk today?

[Victoria Atkins]

One of the many ways we have tackled access to dental care is to ensure that those dentists who have a contract to conduct NHS work are using them to the top of their licence. We are encouraging dentists to do that through the new patient premium and a higher rate paid for units of dental activity. There is so much more to the plan. Labour keeps trying to claim credit for our plan, but the truth is that our plan promises 2.5 million appointments while its plan promises a miserly 700,000.

Oral Answers to Questions

George Freeman Excerpts

Tuesday 23rd January 2024 Commons Chamber

[Maria Caulfield]

Through the investment we are putting in, particularly in the hon. Lady’s local area, there are a number of initiatives to help support children and young people with their mental health. The Sandbox scheme, which is a funded NHS service, supports those in the south Staffordshire area; Malachi provides family support across Tamworth and east Staffordshire; and Combined Wellbeing, which is an online resource, covers north Staffordshire. There is also the Family Wellbeing Service, Action for Children for those aged five to 18 with mild to moderate mental health needs, and the Staffordshire Emotional Health and Wellbeing Service for those aged five to 18. I would recommend that the hon. Lady’s constituents look up those services, because we are funding them to improve mental health care for children in her local area.

[George Freeman (Mid Norfolk) (Con)]

The agony and damage of undiagnosed and untreated mental health conditions is nowhere more acute than in rural areas, where we see an epidemic of silent suffering. The Norfolk and Suffolk NHS Foundation Trust has long struggled with a series of management problems. I am sure the Minister has seen the recent report highlighting that between 2019 and 2022, we saw over 8,500 avoidable deaths—that is nearly 45 a week. Will she agree to meet me, other Norfolk and Suffolk MPs, and those affected to look at what is really going on here and make sure that we turn that trust into a beacon of the best mental health services, rather than the worst?

[Maria Caulfield]

I thank my hon. Friend for raising this issue. We were holding regular meetings with Norfolk and Suffolk MPs, the trust, the Care Quality Commission and NHS England, and with the new management team, that trust did appear to finally be turning things around. However, I am concerned to hear the points that my hon. Friend has raised. I am very happy to restart those meetings and will ask my office to arrange them as quickly as possible.

Dental Training College: East Anglia

George Freeman Excerpts

Tuesday 11th October 2022 Commons Chamber

[Jerome Mayhew]

I am grateful to my hon. Friend. The only phrase that I would pick him up on is that he has “a foot in both camps”. I do not think there should be two camps. This is an East Anglian solution, whereby the proposals are complementary and, in time, they should both be implemented.

[George Freeman (Mid Norfolk) (Con)]

I commend my hon. Friend and constituency neighbour for raising this issue and highlighting the huge pressures that the dental service in his area and mine is experiencing on the ground. Many of our constituents are struggling and this proposal would not only make our region a leader in the science and technology of dentistry, but help to meet that demand and need on the ground. With new housing, the pressure will only get more acute in the next few years.

[Jerome Mayhew]

My hon. Friend is entirely right. There is a further point to be made about the collaboration between the University of East Anglia and the Norfolk and Norwich University Hospital, because they also have the Norwich research park co-located. I am thinking particularly of the Quadram Institute, the sole focus of which is world-leading research on the gut microbiota. I cannot pretend to know exactly what the gut microbiota are, but I know that they start with the mouth. There is huge capacity for proper, hard research in the area, and it could be assisted by a dental training school in Norwich. That is the first solution.

The second solution, which is also needed, is for the dental school in Norwich to complement the University of Suffolk’s plans to build a centre for dental development in Ipswich to support further career development in the region, attracting and retaining newly qualified dentists. My hon. Friends the Members for Bury St Edmunds (Jo Churchill), for Waveney (Peter Aldous) and for Ipswich (Tom Hunt) and others have all pushed for that.

The truth is that we need both to attract qualified dentists in the short term and to find a long-term solution to the wider training problem. It may be that an assessment is made nationally that there is no need for additional dental training seats, but people are human. We have to look beyond the empirical analysis and recognise that training needs to be offered in a location of real shortage. That location is East Anglia, and Norfolk in particular.

As a Conservative, I believe that people should have power over their own lives and that communities should not be dictated to by national Government. Rather, they should be empowered to come up with their own solutions to their local needs. We know what the problem is, and we have a solution to fix it locally; we just need the Government to trust the people to let us get on and do it.

We simply need more dentists and dental technicians in East Anglia. We recognise that budgets are tight and that timings may have to be stretched. We accept that short-term fixes are sometimes more powerful arguments in politics than long-term solutions. We simply ask the Minister to agree to meet the University of East Anglia team to learn at first hand how we can make East Anglian dentistry better, and to be inspired by their practical vision.

--- Later in debate ---

[George Freeman (Mid Norfolk) (Con)]

As a former Minister for life science and for science and research, I rise very briefly to highlight the point that my hon. Friend the Member for Broadland (Jerome Mayhew) made about the microbiome and the mouth—the buccal cavity—as a primary diagnostic for our understanding of the role of the biome and of gut flora and fauna, not only in good health but in diseases such as cancer. As a diagnostic tool, it could make our region a leader in the diagnostics of the digestive system and the gut biome, which would have a whole bunch of other important secondary health benefits. For that reason, I commend my hon. Friend’s case to Ministers on the Front Bench.

Oral Answers to Questions

George Freeman Excerpts

Tuesday 7th May 2019 Commons Chamber

[Stephen Hammond]

My hon. Friend is a diligent and consistent representative of his constituents on this matter. He will know that I have heard his request and that, as I have said to him before, the spending review will take place later in the year. Priorities will be decided at that stage.

[George Freeman (Mid Norfolk) (Con)]

7. What steps he is taking to improve the patient experience through the use of digital technology.

[The Secretary of State for Health and Social Care (Matt Hancock)]

Providing patients with modern digital services that are safe, effective, convenient and personalised is central to our NHS long-term plan.

[George Freeman]

I thank the Secretary of State for that answer and for the energy that he brings to this brief. Does he agree that digital health not only improves healthcare systems but also provides a platform for place-based and population-based prevention, better diagnosis, patient empowerment, novel mental health therapies and accelerated access to the innovative treatments that I introduced as a Minister? This is now being pioneered in some parts of the country. Will he meet me and the Birmingham health partners to look at an interesting idea for digital place-based health impact bonds?

[Matt Hancock]

Yes, I am always happy to meet my hon. Friend to talk about interesting new policy innovations like that. It sounds right up my street. In fact, I met the Mayor of the West Midlands combined authority to discuss this subject only last week. There is a huge amount of enthusiasm and energy in this policy area, which will enable us to improve patients’ lives across Birmingham and, indeed, the whole country.

NHS Long-term Plan

George Freeman Excerpts

Monday 7th January 2019 Commons Chamber

[Matt Hancock]

I strongly agree with the hon. Gentleman. For those who have rare diseases, diagnosis takes seven years, on average, and genomics can bring that down to a matter of seven days, in the best cases. We are the world leaders in genomics and we are going to stay that way. We have reached the 100,000 genome sequence and we are going to take it to 1 million, with 500,000 from the NHS and 500,000 from the UK Biobank. He is absolutely right. This is one of the bright shining stars of the future of healthcare, and Britain is going to lead the way.

[George Freeman (Mid Norfolk) (Con)]

As a former Health Minister, I congratulate the Secretary of State and the Government on this statement. I particularly pay tribute to his work on mental health—I am proud that under this Government it looks as though we are finally beginning to close the gap and stop mental health being the Cinderella service—and on early diagnosis of cancer. I also welcome his espousal of the work on genomics, which I, as a former Minister for life sciences and health technology, and others were involved in setting up. Does he agree that if we are really going to drive the revolution of accountability, productivity and local engagement, the accountable care pilots offer us the chance to really measure and drive digital communities of healthcare where we reward communities that promote health and wellbeing?

[Matt Hancock]

Yes, I do. I pay tribute to the work that my hon. Friend did in putting together the areas of the NHS where this is already working. We want to spread that success more broadly across the NHS to make sure that we seize these very exciting opportunities as well as deal with the important day-to-day challenges that the NHS faces.

Budget Resolutions

George Freeman Excerpts

Tuesday 30th October 2018 Commons Chamber

[John McDonnell]

No.

We have a record number of children coming into care. I know what coming into care means for a child: they are scarred for life. Why are they coming into care? Because there has been a 40% cut in funding to councils for early intervention to support families. Let the Government justify that.

On young people, the YMCA reports that spending on youth services has fallen by 62% since 2010. The average graduate comes out of university with a £50,000 debt. The IFS describes home ownership among young people as having collapsed completely. Tragically, with the mounting pressure, a decades-long decline in suicide among men has been reversed since 2010.

[George Freeman (Mid Norfolk) (Con)]

I am grateful to the right hon. Gentleman for mentioning suicide. I wonder whether there is anything in this Budget that he can welcome, even though I appreciate that we may differ. Does he not welcome the announcement on mental health or the announcement of a £21 million centre of excellence for public sector leaders?

[John McDonnell]

Of course we welcome more money for mental health, but what was required was £4 billion, not £2 billion; and that £2 billion was contained within the £20 billion that had already been announced, so it is not additional money. There are some things that we can work on on a cross-party basis in this House, but we have to be honest about the needs and the requirements, and we have to be straightforward in saying how they can be funded.

--- Later in debate ---

[George Freeman (Mid Norfolk) (Con)]

Last year, after the disappointment of the general election manifesto process, I left the Government in order to make the case that we needed to make this a moment of much bolder national renewal, that we needed to move on from the first phase of reducing the deficit through a programme of austerity and that we needed to set a trajectory of higher growth, more public sector enterprise and innovation, and wage increases and tax cuts focused on the poorest—those on the lowest incomes—in our society. Let me start by saying that I strongly welcome the Chancellor’s Budget for all those reasons. He managed to square an almost impossible circle in a clever Budget that has done something important for some of the most vulnerable in our society.

As a constituency MP, I wish to mention in particular the measures to support the high street. In Mid Norfolk, as in many other rural constituencies, we have seen our high streets hit hard by a big transfer to online retail without the digital giants paying tax in return, and I welcome the measures that the Government have taken to support our high streets. In particular, in health and care day of the Budget debate, I want to highlight the £10 billion put aside for social care; the extraordinary announcement, which I strongly welcome, of the launch of the first mental health emergency service; the £10,000 for every primary school and £50,000 for every secondary school; the £400 million a year for our schools; and the £2 billion to make sure that universal credit is properly funded. These, I suggest, are compassionate steps taken by a Government still paying off the legacy of the appalling inheritance from the Labour party, but doing so in a way that tries to put the needs of the most vulnerable in society first.

All of that is made possible because of the extraordinary economic success over which we have managed to preside. It pains Opposition Members, which is why they are all looking away, that the rate of real income growth has been rising. In the next five years, the OBR forecasts that there will be a bigger real-terms rise in real incomes for the lowest paid than for anybody else, and 3 million new jobs. This is a success story, and nothing tells us how important it is more than the howls of derision from the Opposition, so upset are they that more and more people in this country are not in need of Labour party support. People are coming to us because they know that ours is the party that supports growth.

I want to acknowledge that after eight very painful years, there is a weariness afoot among both those on the frontline of public services, who have tightened their belts, and the lowest-paid people in work. Those two groups have tightened their belts far more than those in plum jobs in government, in Whitehall, or even in local government. We need, as a House, to say to them that they have earned it and to send a very sincere thank you. The British people have tightened their belts far harder than the Government have in the past eight years.

Talking of public sector workers and the need for public sector leadership, I want to thank the Chancellor for announcing the new public sector leadership academy—an academy to support those on the frontline of public services, who have one of the hardest jobs in our society. [Interruption.] The hon. Member for Dewsbury (Paula Sherriff) might say that is rubbish, but that is because she has never had to run anything. The people on the frontline of our public services are actually running very complex public services. They, alongside the lowest-paid people in work, are the people to we need to support in the next five years in tightening the belt and delivering the innovation and efficiency that the public want to see.

[Paula Sherriff (Dewsbury) (Lab)]

I note that the hon. Gentleman said that I have never had to run anything. I wonder whether he would like to change his mind given that I ran a crime management centre in a police station and two incredibly busy departments in a busy hospital. Perhaps he would like to correct the record.

[George Freeman]

I will happily correct that bit of the record, as long as the hon. Lady welcomes the public sector leadership academy, because, given her experience, she will know how important it is.

If we are really to tackle the structural legacy of the 13 years of a Labour Government that led to the biggest economic crisis in this country’s peacetime history—[Interruption.] That is a reality that Labour Members now shout down because it is inconvenient. The crisis that a new generation of voters needs to be consistently reminded of was the legacy of 13 years of a Labour Government. If we are to tackle that, we will have to do two important things: yes, we must continue to drive the modernisation of public service, but we must also increase the rate of growth and revenue generation in the economy by the Government. Even more powerfully, over the next five years we need somehow to make those two ambitions work together. I would like to share some thoughts on how we might do that.

The truth is that our growth rate has dropped since the EU referendum, from 3% to 1.5%. Therefore the first thing that we need to do is to get a good Brexit deal for business confidence. I hope that the Opposition will take the opportunity of the forthcoming Brexit votes to put the needs of business, prosperity and the economy ahead of ideology or party politics. We also need to create an environment in which we can unlock business investment in this country. There is £600 billion tied up on businesses’ balance sheets, and we need to trigger the confidence needed to unlock that money in the post-Brexit dividend. We will not get it unless the Brexit deal gives business the certainty that it needs in the years ahead.

We also need to go much faster on infrastructure. I am delighted that, at this point, the Chief Secretary to the Treasury has entered the Chamber, because for eight years she and I have been holding meetings to try to accelerate funding for the Ely rail junction. I want the Treasury now to recognise that, across the country, there are infrastructure schemes that could be funded by private finance. I am talking not about PFI, but about giving local authorities and mayors powers to set up infrastructure bonds to create more innovative ways of driving investment into our public services. If we regenerated rail links and rail lines, gave planning permission for stations and developed innovative schemes for capturing the value increase around those lines, we could harness that growth to fund new models of infrastructure.

I particularly welcome the Government’s continued emphasis, through the industrial strategy, on fields such as life sciences, robotics and artificial intelligence so that we can create in this country the research platform needed to support the creation of the jobs and businesses of tomorrow. But if we are to be more than just a research economy—if we are to be a genuine innovation nation that pulls innovation through into practice—we need an economy that uses innovation in the private and public sectors. The great trick is to harness the power of innovation in our public services, and nowhere more than in the NHS. If we are really to lead the world in digital health and digital medicine, and the extraordinary revolution that that offers, we will not do it with an NHS running on paper and cardboard. We need to make the NHS a genuine catalyst for UK leadership in digital health. It is the same in genomics. When I set up the UK genomics programme, the idea was not only that we would launch the world’s first genomic medicines service in the NHS, which we have, but crucially that, in so doing, we would make this country a leader in genomic research and life science investment.

This, in the end, is the key to getting out of the debt that we inherited from the Labour party—the high-debt, low-growth model that yesterday’s Budget acknowledged. We have to somehow unlock innovation in our public services and drive much higher rates of growth in the private sector. With Brexit coming to its resolution here in this House in the next few weeks, we have to make it a catalyst for the renaissance of innovation and enterprise, and the moment at which we set out a vision for public services in the 21st century.

Cancer Treatment

George Freeman Excerpts

Thursday 19th April 2018 Commons Chamber

[George Freeman (Mid Norfolk) (Con)]

May I say what a pleasure it is to follow the hon. Member for Dulwich and West Norwood (Helen Hayes)? She spoke with great passion and authority.

Thirty years ago this month, my father developed a cough and two months later he was dead from throat cancer. Being a man of that generation and age, he had never taken his health too seriously. He had never been for a check-up and had never received the care and treatment that would now follow, so what I say today is partly for dad. Eighteen months ago, I heard from a childhood friend of mine, Charlie Williams, that he had been diagnosed with the same form of brain tumour that Tessa has. Last week, Charlie posted on Facebook that he did not expect to see the next year out, so this is for Charlie.

I want to start by paying tribute to you, Tessa, for what you said in that remarkable speech. You spoke for us all, and to us all, and you spoke to the patients of this country not only with your condition, but with every other form of cancer—the patients I had a career working with who want us to make a difference for them. They want warm words, yes, and there were no words warmer than yours, Tessa, but they want us to turn the warm words into action. I believe that is the spirit in which we gather in this Chamber today, so this speech, Tessa, is for you.

Having come to this House after a career in medical research, it was my great privilege to be asked to lead, on behalf of the Government, a brain tumour research debate in Westminster Hall two years ago. I say this without a shred of criticism of my officials, who were simply doing their job, but the speech that I was given to read out said, as diligent speeches written by officials so often do, “There is no problem here. Move along. Everything is in good shape. Money is limited.” I read it with great respect, but I also listened to my colleagues with great respect, because unlike officials, we are sent to represent the people who put us here. As Tessa spoke for us all, I think it is our duty to speak always for the people who send us here.

I surprised my officials that day by announcing, as Under-Secretary of State for Life Sciences, that we would indeed create a taskforce to look into brain tumour research, never thinking that 18 months later my great friend the Secretary of State would announce £45 million of extra funding, in addition to the extra funding that he has recently announced on prostate cancer. That is a sign that, if we listen and speak on behalf of the people who put us here, we can make a difference, which is what Tessa wants us to do on her behalf and on behalf of all those people who send us here and the many patients around the country who are more impatient than anybody.

As you and patient colleagues know, Mr Speaker, I had a career in medical research. I want to highlight three important parts of this debate, the first of which is the new models of research that are coming—I was involved in my professional career in developing them. Secondly, I want to highlight the importance of patient voice in that model, and thirdly the importance of bold reforms to accelerate access to new treatments for our NHS patients.

My right hon. Friend the Member for Old Bexley and Sidcup (James Brokenshire) referred to precision medicine. The truth is that the life sciences sector that I joined 25 years ago is undergoing a profound transformation. The sector that I learned about was basically in the business of making blockbuster medicines that work for everybody. It would start with a theoretical drug target and, after 15 years, $2 billion on average and an 80% failure rate, drugs would be developed and eventually brought through regulation to the all-too-patient patients who were waiting for the approval.

In the new model, based on the genomic information that we have and phenotypic hospital records, we are able to look at a population and know which are likely to respond to the drug and which are not. We can start with the patients that we know are likely either to respond or to receive the disease, which means that we can start with the patient. With patient consent, we are able to start with their tissues, their genetics and their hospital records, and we are able not to end with a patient waiting patiently for the system to authorise a medicine, but with patients volunteering up-front to be part of that research.

It has been my privilege in my professional as well as my political career to work with inspired NHS clinicians around the country who have been leading this model. I pay tribute to the work of Cancer Research UK as an organisation, but also to Harpal Kumar, whose leadership of that organisation has been transformational.

We should be inspired by the fact that breast cancer is now 95% curable. We are within living, touching distance of cancer being a preventable disease or a treatable disease. More than 800,000 people are now living and working with cancer: it is not the death sentence that is used to be. We are in the midst of the most phenomenal revolution led by cancer. We should applaud those involved and learn the lessons of how they have managed to do it, largely through genomics and informatics.

I will share with the House a story that illustrates where the value in the new model lies. During my last project before I came to Parliament, I was working with an NHS clinician who, at the end of the meeting, pointed to a shelf in his office and asked me, “Do you think there is any value in that?” I said, “What is it?” He said, “It is all the data from a £25 million study of 250,000 women at risk of gynaecological cancer, funded by the Medical Research Council and Cancer Research UK.” I said, “What have you got?” He said, “All the blood samples, all the genetic samples, and their patient records.” “That should be the Ageing Biomarker company,” I said. “We should form a company around that asset, because it will help us to identify ageing biomarkers.”

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

May I place on record at this point the work that my hon. Friend has done to get us to this point? He is very modest in not saying too much about it himself—although he mentioned the Westminster Hall debate and the way in which he went out on a limb in response to it—but his understanding of the business and this fight has taken us a long way towards where we are today. I hope he can now conclude his speech as he needs to.

[George Freeman]

That is very kind. I take the hint from my hon. Friend.

The assets that we have in our health system are phenomenal assets to drive this research model, and I think it is our challenge to release them, but in order to do so, we need patient consent. However interventionist we are as Ministers, we as a system will not and cannot release data on tissues and genetics without patient voice. This research model requires us to empower patients and the charities that speak to and for them. I would like us to think about setting up disease portals in which patients can slide the consent bar on their phones, share their records, and help the charities to drive research.

Finally, we need to accelerate the uptake of innovative medicines in the system, which is what the accelerated access reform that I put together with my right hon. Friend the Secretary of State was all about. I dream of—I think we are within touching distance—a model in this country enabling the NHS to use its genomics and data to drive research. If we reform NICE to drive accelerated access, we give Tessa and the people for whom she spoke the legacy that they really want. We will make this country the leader not just of research, but of accelerated uptake of new treatments.

Cancer Strategy

George Freeman Excerpts

Thursday 22nd February 2018 Commons Chamber

[George Freeman (Mid Norfolk) (Con)]

I know, having been a Health Minister, of my hon. Friend’s assiduous commitment to this cause. He mentioned the noble Baroness Jowell. Does he agree that, with the sight of her and the Prime Minister together embracing, the Prime Minister’s announcement of £40 million for brain cancer is good news and that that is being done in the spirit of cross-party commitment to tackling disease? It will give a lot of hope to that community.

On the point about alternative therapies, does my hon. Friend agree that it is very important that the medical community and, through the Government, the National Institute for Health Research do the research to examine those therapies? Although they might not be rooted in a tradition of empirical science, if there is data that shows that they help patients’ recovery time, that is worthy of consideration.

[David Tredinnick]

My hon. Friend has helped me on my path. Various trials have taken place: randomised control trials, observational studies and quality-of-life studies. The person who came up with the notion of evidence-based medicine, Professor Sackett, said:

“The practice of evidence-based medicine means integrating individual clinical expertise with the best available external clinical evidence”.

In plain language, that means, “You have to look at the patient and see what the patient thinks and what the patient’s experience is.” We are often told by Ministers and others that we need more evidence—that there must be evidence. The trouble is that when evidence is produced on the basis of proper trials, it is often ignored.

The subject on which I have chosen to focus this afternoon is healing—therapeutic touch; call it what you like. There is very good evidence that people are able to use their hands to transfer some kind of energy. I have studied reiki myself—I have done it twice—as well as another Japanese tradition. I once ended up speaking to 5,000 therapists at a conference in Japan, believe it or not, many years ago.

According to Cancer Research UK, a study conducted in 2007 found that up to 40% of people in America used some kind of what they termed spiritual healing. In this country, there is good evidence to suggest that seeing a healer helps people. In the UK, long-term hormone therapy for women with breast cancer can be enhanced and patients can be helped if they are given healing therapy for the side-effects of their treatment. A study showed that a number of women who were given the therapy for 10 weeks experienced fewer side-effects.

In the national health service, there was a two-year trial involving 200 hospital patients with long-standing illnesses. It was the largest clinical trial of its kind, and was funded by the national lottery and supervised by the University of Birmingham, a Russell Group university known for its first-rate research. The methodology was used to assess the effectiveness of healing in dealing with irritable bowel system and inflammatory bowel disease in 200 patients. After the assessment, the Measure Yourself Medical Outcome Profile showed a significant improvement after six, 12 and 24 weeks.

That trial was scientific and properly carried out, and I think that if healing worked for those problems, it would almost certainly work for cancer. I suggest to my hon. Friend the Minister that if a drug showed the same results, especially at such minimal costs, it would be recommended by the National Institute for Health and Care Excellence. More research and trials are needed.

Some of the Government’s efforts to bring about more rigorous assessments of therapies have involved the Professional Standards Authority, which was set up to oversee the UK’s nine health and care professional regulatory bodies. It was previously known as the Council for Healthcare Regulatory Excellence. In February 2013, it launched a Government-backed accredited register scheme. There are now 24 accredited registers covering 31 occupations and 80,000 practitioners. They include the Association of Child Psychotherapists, the British Acupuncture Council, the British Association of Sport Rehabilitators and Trainers, the Federation of Holistic Therapists, the National Hypnotherapy Society, and many others. In its summary, Harry Clayton, chief executive of the Professional Standards Authority, said that

“a key recommendation is for practitioners”

whom the PSA is regulating

“to have the authority to make direct NHS referrals—in appropriate cases—thereby reducing the administrative burden on GP surgeries.”

I ask the Minister to take note of that: it is saying that practitioners on that PSA register should have the authority to make direct NHS referrals. If that were possible, we would bring into the service 30,000 practitioners.

Madam Deputy Speaker, I am trying to figure out how long I have been speaking for; perhaps you can guide me.

--- Later in debate ---

[Nic Dakin (Scunthorpe) (Lab)]

It is a pleasure to follow the hon. Member for North Warwickshire (Craig Tracey), who reminds us of the importance of using the expertise and knowledge we have in the system to accelerate improvements in outcomes.

I thank the hon. Member for Basildon and Billericay (Mr Baron), who I know is disappointed not to be here, for securing the debate and for his time and dedication in chairing the all-party parliamentary group on cancer so well and so impressively over the past nine years.

This debate focuses on the cancer strategy and the current challenges it faces. It is important to reflect on the positives, too. In the space of my lifetime, the progress on understanding, diagnosing and treating cancer has been remarkable. In the 1950s, there was limited knowledge of cancer and of the associated risk factors, the NHS had only recently emerged and there was no co-ordinated plan to treat cancer. We have come a very long way since those early days.

Cancer survival rates have doubled in the UK since the 1970s, which is a real credit to the countless health professionals, researchers, volunteers, charities and, of course, patients who have pioneered progress and who continue to do so every day. It is because of them that we are where we are today, where a person in the UK is more likely to survive cancer than to die from it.

However, massive challenges remain. My constituent Maggie Watts came to see me after losing her husband, Kevin, to pancreatic cancer in 2009. It is her fault that I have ended up as chair of the all-party parliamentary group on pancreatic cancer—thank you, Maggie. Kevin’s mother died of pancreatic cancer 40 years earlier, and the shocking thing is that Kevin’s chances of survival were no better than his mother’s. In most parts of life, the world has moved on rapidly in 40 years, but it has not done so in that part. In fact, at less than 7% in the UK, pancreatic cancer has the worst five-year survival rate of the 20 most common cancers, with the UK ranked 26th out of the 27 EU countries, according to the Association of the British Pharmaceutical Industry. Sadly, pancreatic cancer is on course to become the fourth biggest cancer killer by 2026, so action is needed now.

[George Freeman]

Does the hon. Gentleman agree that, if we are to tackle such cancer outliers, it is vital that, as well as the great research we do in the UK, we make sure that the NHS is better at adopting and taking up innovative medicines? A large part of the accelerated access review, the genomics programme and the informatics programme is about making sure that the NHS is capable not just of doing the research but of enlightened procurement to take up more quickly the drugs that work.

[Nic Dakin]

Absolutely, and I will come on to that later.

As the hon. Member for East Kilbride, Strathaven and Lesmahagow (Dr Cameron), who introduced the debate so well, pointed out, we are now almost halfway into the five-year implementation plan of the Government’s cancer strategy for England. At this mid-point, there are concerns about the rate of progress being made, and the workforce plan is not yet as effective as we would wish.

For example, as the Royal College of Pathologists has said, it can take up to 15 years to train a pathologist. Pathology services are unable to recruit to vacant posts today, and it is anticipated that a third of consultant histopathologists will retire in the next five years, which is just one example of the challenges we face.

The lack of workforce capacity must be addressed to change survival outcomes for pancreatic cancer patients. It would be good if the Minister were able to update us on what his Department is doing to prioritise workforce planning and to provide the funding needed, based on England’s cancer workforce plan.

Fast access to quick and accurate diagnostic tests is also crucial. Many pancreatic cancer patients are diagnosed too late, when surgery—the only curative option—is no longer available. The early diagnosis inquiry by the all-party parliamentary group on pancreatic cancer, “Time to Change the Story,” heard anecdotal evidence from a healthcare professional that a CT scan can be done quite quickly but that the report can sometimes take 10 weeks. It would be helpful if the Department were able to respond to the recommendations of the all-party group’s report and to update us on the progress being made in that area.

The diagnosis of not only pancreatic cancer but other cancers, such as blood cancer, can be complex because symptoms such as back pain or tiredness are often misunderstood or misdiagnosed. Delays in blood cancer diagnosis can have a major impact on a patient’s quality of life and overall outcome, and earlier diagnosis would make a difference for many, but not all, blood cancers. To change this, recommendations for early diagnosis in the cancer strategy should be reviewed to ensure that all people with blood cancer are benefiting from early, accurate diagnosis. GPs could be encouraged to ask for a simple blood test for people displaying one or more blood cancer symptoms.

Diagnostic techniques also have the potential to guide what treatment options are likely to be effective. Last month, NICE provisionally rejected the use of five tumour profiling tests to guide treatment decisions on whether patients with a particular type of early breast cancer should also receive chemotherapy following surgery, reversing its previous guidance recommending Oncotype DX as an option. This goes to the heart of the point made by the hon. Member for Mid Norfolk (George Freeman) about using genomics effectively and precisely. Breast Cancer Now is concerned that this could be a backwards step for some breast cancer patients, especially in the context of the current cancer strategy’s welcome ambition to enable more personalised treatment.

[George Freeman]

Does the hon. Gentleman agree that on this subject of accelerated, earlier diagnosis and treatment, the work of the Institute of Translational Medicine in Birmingham, led by Professor Charlie Craddock, and the Cure Leukaemia team, working on blood cancers, has written the playbook on how we do early diagnosis? They have pulled in £200 million of free drugs for NHS patients by doing accelerated access.

[Nic Dakin]

There is some wonderful work going on, and this goes back to what the hon. Member for North Warwickshire said about the need to grab this wonderful work and move it forward, and not be held back by frameworks that are not quick enough to move with the times.

The ability to personalise treatment based on tumour profiling, which would allow many women to avoid the gruelling side effects of chemotherapy, is an essential part of improving patient care and has the potential to reduce costs associated with chemotherapy—that is a win-win. It can also give both clinicians and patients invaluable reassurance that they may safely not have chemotherapy, thus reducing overtreatment. NICE has not communicated clearly enough the reasons behind provisionally rejecting the future use of the Oncotype DX tumour profiling test, as it is unclear whether this is a result of additional clinical evidence, the cost or a combination of both. Will the Minister ask NICE to clarify the clinical and economic drivers behind the recent provisional rejection of tumour profiling tests to guide treatment decisions in a specific group of breast cancer patients?

The cancer strategy calls on Public Health England to continue to invest in “Be Clear on Cancer” campaigns to raise awareness of possible symptoms of cancer. Symptom awareness is a big challenge in terms of pancreatic cancer, as well as other cancers. A ComRes poll carried out by Pancreatic Cancer UK in 2017 found that 35% of adults in the UK would not be worried if they had a few of the potential symptoms of pancreatic cancer. Last year, Public Health England launched an exciting regional pilot on vague abdominal symptoms, including persistent diarrhoea, bloating and discomfort. Although the results for the campaign were positive, it has not yet been rolled out nationally. I would be keen to know when the Minister plans a national roll-out of the vague abdominal symptoms “Be Clear on Cancer” campaign.

In conclusion, much has been done and much is happening, but there is much more to do. Cancer alliances have a significant role to play in delivering effective change, and many are clearly making a difference. Workforce planning, early diagnosis and greater symptom awareness are key areas where we need to up our game as we move into the second half of this five-year cancer strategy.

--- Later in debate ---

[Michelle Donelan (Chippenham) (Con)]

I thank the hon. Member for East Kilbride, Strathaven and Lesmahagow (Dr Cameron) for securing this debate. It is an honour to follow the hon. Member for Bristol West (Thangam Debbonaire) in her passionate and very well-informed speech.

We all have loved ones who have been affected by cancer. I lost my maternal grandparents to breast cancer and oesophageal cancer. Many in my family have suffered from melanoma, including my mother, and one of my friends is currently battling cancer. We have all heard harrowing stories from constituents. Cancer is indiscriminate: it does not care whether you are young or old, or someone’s mother or brother. Yes, we can make dietary and lifestyle changes to try to avoid it, and be aware of the symptoms, but advances in medicine mean that we can fight it more effectively and detect it earlier to increase the odds of survival, although there are still no guarantees.

Cancer survival rates are at a record high, with about 7,000 people alive today who would have not have been had mortality rates been the same as in 2010. This is a fantastic step in the right direction, but we are not at our destination. That is the point that I want to labour. For all those who lose their mother or child or friend today and hear of this debate, I want them to know that the Government, and all MPs, do “get it”. We get that we are on the right track, but equally that there is a long way to go, because cancer is still the most dangerous serial killer that remains at large in our communities. That is why we must continue to prioritise this area.

The formation of the £1.2 billion cancer drugs fund in 2010 was a massive step forward and has helped more than 95,000 people to access the life-extending drugs that they need, as was the implementation of the independent cancer taskforce’s strategy, seeking to save a further 30,000 lives by 2020. As I said, we are on the right track. In 2010, we had some of the worst survival rates in Europe, but we are now closing that gap. Last year, there were 7 million more diagnostic tests than in 2010, and 57,000 more patients started cancer treatment.

When it comes to cancer, prevention is key. I welcome the increased investment in cancer research by the National Institute for Health Research since 2010 and the work that the Government have done with Cancer Research UK, including a jointly funded network of 18 experimental cancer medicine centres aimed at driving the development and testing of new anti-cancer treatments.

I would like to draw attention to the high uptake of the HPV vaccination among teenage girls, which can prevent around 600 cancers per year and 99% of cervical cancer cases. I have spoken before in the Chamber on Public Health England’s tobacco control plan, which aims to usher in the first smoke-free generation by 2022.

Improving diagnosis is equally essential. Public health campaigns such as “Be Clear on Cancer” are vital to raise awareness of early symptoms, especially of less common cancers. Crucially, the £200 million that has been invested to ensure that patients receive a diagnosis or the all-clear within 28 days by 2020 will make a huge difference.

That would have benefited my constituent, whose symptoms were initially dismissed as irritable bowel syndrome. She then waited a long time for testing. She is now terminally ill with bowel cancer, but inspiringly, she is trying to work hard every day to raise awareness and help others to get diagnosed quickly. Nearly everyone will survive bowel cancer if diagnosed early—in fact, nine in 10 people—yet shockingly and sadly, only 15% of people are diagnosed at that stage.

[George Freeman]

I thank my hon. Friend for giving way; she is making a powerful point. On early diagnosis, prevention and screening, the 100,000 Genomes Project that we launched here in the UK, focused on cancer and rare diseases, is seeking volunteers for genome sequencing to combine with patient data, to identify people at risk. That is a brilliant way for people to get involved, and if anyone is concerned, they should contact the NHS and enrol. We still need another 50,000 patients, and that is a marvellous way of getting access to early diagnosis. Does she agree?

[Michelle Donelan]

I thank my hon. Friend for making that point. Unfortunately, time does not permit me to cover that, so I am delighted that he has.

I welcome the new bowel cancer test, the faecal immunochemical test, known as FIT, which will be rolled out in April. It is more sensitive and accurate and can detect twice as many cancers as the current test. Currently only half of those invited to take part in bowel cancer testing do, but FIT is proven scientifically to increase the number participating in the programme, especially as it is easier and more hygienic to post than the current test.

However, new awareness of symptoms, coupled with the new test and the ageing population, is leading charities within the sector to voice concerns of a looming endoscopy workforce crisis. Bowel Cancer UK and Beating Bowel Cancer question the realism of getting 400 non-medical clinical staff by 2020 to carry out the 450,000 procedures, especially as only 48 have been trained so far. I would like to hear more from the Minister in response to that, so that my constituent can be assured that others may be diagnosed earlier than she was.

A key issue when it comes to beating cancer and preventing cancer is getting screened regularly when applicable. That is especially the case with cervical cancer. The NHS cervical screening programme in England offers screening to women aged 25 to 49 every three years and women aged 50 to 64 every five years. Every year in the UK, around 3,000 women are diagnosed with cervical cancer, but research shows that the number of women using the service has dropped to a 20-year low, with more than 1.2 million not attending their screening in the last year. A recent report by Jo’s Cervical Cancer Trust showed that embarrassment is a key barrier to attendance for between a third and a half of all women, as is the desire not to miss work. There is also a severe lack of understanding about the importance of screening. Shockingly, one in three women aged between 25 and 29 miss their smear, yet cervical cancer is the most common cancer for women under 35. We must address this.

I note that Imperial College has conducted a trial to assess the effectiveness of texting non-responders to improve coverage, but I think that we should just do this—it can only help. I also welcome the fact that the Department of Health and Social Care’s behavioural insight team has undertaken a trial to investigate the use of behavioural insights to optimise the content of the invitation letter for cervical screenings.

I must admit that I was one of these women: I put off my screening for years. I left it at the bottom of my to-do list until I could fit it in around my job, and it just kept slipping year on year. I must admit, if I am honest, that I really did not realise that cervical cancer is most common in women under the age of 35. When I did have my screening, I had to go through the processes necessary after abnormal cells show up. As my results showed high-grade abnormalities, I am extremely thankful that I went when I did. I want to take this opportunity to praise the work of Jo’s Cervical Cancer Trust, which provides women with information and support, which I found extremely helpful.

We seem to be very British about cervical smear tests. We do not really like to talk much about them, and that does not promote women going for them. Yes, it is not nice—it hurts a little, it is awkward and a bit embarrassing —but it could save your life. That is the message we need to get out. We need to promote cervical screening from school age, so that women recognise all the risks and the importance of going from the age of 25.

In September and October 2017, Jo’s Cervical Cancer Trust sent freedom of information requests to all upper-tier and unitary local authorities and clinical commissioning groups in England to ask what activities they had undertaken to increase cervical screening coverage from August 2016 to August 2017, along with the outcomes of those activities. Of the 149 local authorities that responded, 32% had not undertaken any activities at all. I ask the Minister to commission a review—and to adopt a strategy to increase the falling rate of cervical screenings—looking at availability and the challenges of reaching all women and at the need for awareness of cervical cancer.

To conclude, Macmillan claims that, by 2020, 47% of people will get cancer at some point in their life, which is almost one in two. That is the scale of the problem we face. While we have come so far since 2010 in terms of diagnosis and treatment, there is still so far to go.