NHS Dentistry

Grahame Morris Excerpts

Tuesday 9th January 2024 Commons Chamber

[Victoria Atkins]

I thank my right hon. Friend for his intervention. I can imagine that the concerns he outlines are very pressing in his constituency, and one important priority behind the dental recovery plan work is addressing health inequalities. Although I have spoken about rural and coastal areas from a constituency perspective, we also understand, of course, that there are differing cost of living pressures in different parts of the country. He makes an important point about the costs for NHS dentists operating in very expensive parts of the country, such as his constituency, and I thank him for doing so.

Our workforce is not just made up of dentists; dental care in England could not function without the vital contribution of dental and orthodontic therapists, dental hygienists, dental nurses and clinical dental technicians. We recognise the importance of harnessing the skills and knowledge of all those professionals. They can support dentists to carry out first-class care, and we must empower them to take on more responsibility and to work at the top of their licences. That is why last year we issued guidance to NHS practices, supporting them to make the most of everyone in the dental team and make a difference to patient care. Since then, NHS England has made it clear that dental therapists and dental hygienists can provide patients with direct care, provided they are appropriately qualified, competent and indemnified. We have also run a consultation to enable dental therapists and hygienists to deliver more treatments. That will boost access to care for patients and support dentists, and we will be setting out our next steps shortly.

[Grahame Morris (Easington) (Lab)]

rose—

[Victoria Atkins]

I am conscious that Opposition Members will want time today, so I am going to bring my remarks to a close. It is my mission, as Health and Social Care Secretary, to build an NHS that is faster, simpler and fairer, and of course I include dentistry in that work. We have taken the long-term decisions that will improve access to dental care. Delivering 6 million more courses of treatment, expanding dentistry training places by 40% and making it easier for patients to find a dentist to deliver the care they need are just some of the ways in which we are going to achieve that. Of course, we must make sure that dentists are properly rewarded for all the work they do. Through our soon-to-be-published dentistry recovery plan, we will go further, to make NHS dentistry accessible and available for everyone who needs it, no matter where they call home in this great country.

--- Later in debate ---

[Grahame Morris (Easington) (Lab)]

It is an honour to follow my good friend my hon. Friend the Member for City of Durham (Mary Kelly Foy). I also raise an issue related to the integrated care board, which may be of interest.

I am sure you are far too young, Madam Deputy Speaker, to remember the school dentistry service but some of us of more senior years will recall the annual visits from the school dentist. Each year, the dentist and dental nurse would attend school assembly, class after class would line up, and every child would have their teeth inspected. At home time, anyone requiring further treatment would receive the dreaded letter asking parents to make a follow-up appointment. This was a simple, efficient, and productive process. The system allowed thousands of children to receive annual dental check-ups. The day was also an opportunity for children to be educated on the importance of dental hygiene—the hon. Member for North Devon (Selaine Saxby) mentioned the special tablets that highlighted plaque on teeth—and how to avoid the dreaded follow-up letter the following year.

I recently asked the integrated care board about reintroducing this scheme, but despite the NHS North East and North Cumbria integrated care board taking over responsibility for commissioning dental services, it passed the buck on this question to the local authority, stating in its reply:

“Commissioning responsibility for dental public health falls under the remit of Public Health, which is hosted by the Local Authority. As such, the ICB is unable to comment on the school dental screening programme and this would need to be raised directly with Durham County Council.”

This silo mentality is a disgrace. I will mention some statistics on opportunity cost in a moment. Although annual school screening would not necessarily be popular with the children, it would ensure they are all seen by a dentist, and it would free up space in dental practices.

Currently, our children are paying the price. Data from NHS Digital shows that 44% of children have not received an annual check-up with an NHS dentist. I looked on the NHS “Find a dentist” website today and there is not a single dentist accepting children aged 17 or under in my Easington constituency. Ministers should be ashamed that after they have been in power for 14 years, NHS dentistry is catastrophically failing our children.

I say to my constituents watching this debate that there are dentists accepting children in neighbouring constituencies—in Wheatley Hill, Easington Lane and Houghton-le-Spring. However, those dependent on public transport will find accessing these services almost impossible due to the appalling state and unreliability of our bus services. That is another story and another catastrophic failure of Tory neglect and mismanagement.

The situation for adult patients in Easington is also dire. There are no dental practices accepting adult patients within a 10-mile radius of my constituency. Within a 15-mile radius, there are only three. Again, that is completely inaccessible for those who are dependent on our unreliable and infrequent local bus services.

The Prime Minister says he is proud of his record on dentistry and has boasted that there are now more NHS dentists across the UK, but he must inhabit a parallel universe. In the real world, data shows that there were 24,151 dentists performing NHS work in 2022-23—more than 500 down on pre-pandemic levels. Moreover, as colleagues have pointed out, the headcount does not show the level of NHS treatment, because a dentist working in the private sector and doing a single NHS check-up in a year counts just the same as a full-time NHS dentist.

There are some scary statistics. One in 10 people have attempted their own dental work, with Healthwatch, the patients’ voice, reporting patients pulling their own teeth out with pliers. That might seem ridiculous but my mother is 87 and very frail, and she did this out of desperation. It is appalling. Here is another terrible statistic—every day is a school day, Minister: tooth decay is the most common reason for hospital admission for children aged between six and 10. Oral cancer is one of the fastest rising types of cancer and kills more people than car accidents in the United Kingdom. Limited access to dental services means that fewer oral cancer cases will be detected early, which will lower the survival rate and further widen health inequalities.

It is time for the Government to get control of this problem and to deliver for the British public, who are being let down time and again by the dysfunction at the heart of the Conservative party.

Radiotherapy: Accessibility

Grahame Morris Excerpts

Tuesday 18th July 2023 Westminster Hall

[Grahame Morris (Easington) (Lab)]

It is a pleasure to serve under your chairmanship, Dame Maria, and I congratulate the hon. Member for North Devon (Selaine Saxby) on securing this important debate. Unusually, I agree with absolutely everything that a Conservative MP said, and I hope the Minister is making copious notes.

I hope you will forgive me if there is a bit of repetition, Dame Maria, because we have been trying hard to address this issue. In effect, this is the radiotherapy lobby. Although we do not have the big guns and finances of the pharmaceutical industry, we are the Members of Parliament who argue for the very small, dedicated and highly skilled radiotherapy workforce to be given the tools and facilities to deliver what they want, which is an improvement in cancer outcomes.

I would like to declare an interest: I am a cancer survivor and have had it twice. I have undergone various treatments, including cancer drugs, chemotherapy, surgery, and radiotherapy on three occasions. I am also privileged to be a long-standing vice-chair of the all-party parliamentary groups for radiotherapy and on cancer. Given the current economic climate, characterised by fiscal conservatism and a reluctance to commit to new spending—that is not a criticism of just the governing party, because it is an issue that my own party is addressing—it is crucial that we optimise the opportunities that present themselves to improve cancer outcomes, and the hon. Member for North Devon raised the issue of IT networks and the use of AI software.

[Margaret Ferrier]

AI technology is proving to be an asset in improving cancer treatment outcomes, and Radiotherapy UK has outlined the fact that a £4 million investment in AI technologies, which equates to £15 to £40 per patient, would immediately enhance NHS workforce capacity and reduce wait times. Does the hon. Member agree that further investment in AI could be vital in increasing access to radiotherapy?

[Grahame Morris]

That is a really important point, and I hope the Minister is taking note. I do not know whether the term is “low-hanging fruit”, but here is an opportunity to get some synergies from the new technologies that are available now but perhaps were not available even a couple of years ago. I will return to that theme, but AI is potentially a force multiplier, if that is the appropriate term: it can improve the productivity of the small radiotherapy workforce. As the hon. Member for North Devon mentioned, AI can save a consultant oncologist two hours in planning a patient’s treatment. As a couple of hon. Members have said, it is wonderful to have centres of excellence—some of the best hospitals not only in the United Kingdom, but in the world—such as the Royal Marsden in London and the Christie Hospital in Manchester. Now we have the opportunity, through IT networks and AI, for doctors and clinicians, even in remote locations, to access highly qualified oncology specialists, who can plan the treatment to be delivered in satellite centres. There is a huge opportunity here.

As we have heard, almost half of individuals experience cancer at some point in their lives, and about a quarter require radiotherapy. It is quite a disturbing statistic that only 27% of cancer patients in the UK access radiotherapy. The international recommendation is that between 50% and 53% should. Only half the people who would benefit from radiotherapy are accessing it at the moment.

[Sir Oliver Heald]

One thing of great concern in my constituency is that people start radiotherapy by travelling to Mount Vernon, which is an excellent hospital, but they cannot keep going, because it is such a terrible journey, so they give up.

[Grahame Morris]

That is a valid point that needs to be addressed. Perhaps part of the solution is the development of more satellite centres. If I have two words for the Minister, if he will forgive me, they are “treatment capacity”; or make that three words: “radiotherapy treatment capacity”. That is what we need—to increase radiotherapy treatment capacity.

Radiotherapy has immense potential for treating various types of cancer. It has been found that a greater number of cancers can be treated effectively using radiotherapy, either exclusively or in combination with other treatments. It has a critical role in four out of 10 cancer cures. As the hon. Member for North Devon said, it is highly accurate, and there is limited damage to healthy cells surrounding the cancerous tumours, particularly with the latest forms and most modern types of radiotherapy, such as stereotactic ablative radiotherapy and so on.

Radiotherapy is particularly useful for treating cancers in vulnerable areas, and requires fewer patient visits compared with other treatments. It does not occupy intensive care capacity, in the way surgery does, nor does it impact the patient’s immune system like chemotherapy. Dame Maria, I am still suffering from the impact of a depressed immune system from the chemotherapy that I had some years ago. That does not happen with radiotherapy. We are not fully utilising the life-saving potential of radiotherapy.

In 2019, Cancer Research UK published a report highlighting inadequate early cancer detection and limited access to the best treatments, resulting in the UK having some of the worst cancer survival rates among western countries. Radiotherapy has been chronically underfunded and under-resourced for a number of years. That is not a political criticism of only this Government, but of previous Governments too, and it needs to be addressed if we are to approach the outcomes and improved survival rates that we all want to see.

As the hon. Member for North Devon said, the UK currently allocates only 5% of its cancer budget to radiotherapy. That is not the whole NHS budget of more than £100 billion; that is just the cancer budget. Most other European countries allocate 10%. That disparity is very telling. It affects patient outcomes, waiting times and the overall NHS budget. Radiotherapy is the most cost-effective of the three main cancer treatments, with a typical cost per cure of £3,000 to £7,000.

However, the lack of investment has left us lagging behind other countries. Our technology is characterised as outdated. As we have heard, within the next year approximately 55 existing radiotherapy machines, which are 10 years old or more, will need replacement. That is about a fifth of the total number of linear accelerators in our NHS. Although the Government talk about record NHS investment, our radiotherapy access falls behind international comparators. As the hon. Member for North Devon said, England has 4.8 radiotherapy treatment machines per million people, while Italy has 6.9 and France has 8.5. The NHS would require another 125 linear accelerators to meet international standards.

It is true that covid-19 had a devastating impact on the NHS and on cancer services, but it is important to note that this problem—the cancer care crisis—predates the pandemic. We had a statement on 3 July from the Health Secretary about the NHS workforce plan. I was rather disappointed, because I raised the issue of the cancer workforce and the 62-day treatment target and he completely avoided giving an answer. The target is that 85% of people should start their first treatment within two months—62 days. However, the latest figures, which have just been published, show that we are hitting that for only 59% of patients. If the Secretary of State does not know that stat, I will be very disappointed. I know a little about Sunderland football club. I know that Jimmy Montgomery, our best ever goalkeeper, made 638 appearances and that we won the FA cup in 1973 and 1937. I would not expect the Health Secretary to know those things, but I would expect him to know the latest key performance indicators in relation to cancer waits, so I hope that the Minister responding today will emphasise the importance of that.

Delays in cancer treatment are not academic. It is not just a question of statistics for our constituents. For every four-week delay—for every month that a treatment is delayed—the chances of survival reduce by 10%, so this is significant. The hon. Member for North Devon mentioned Professor Pat Price. She is a leading authority on cancer, based at the Royal Marsden, and she has warned that up to 45,000 cancer patients could face deadly delays in their treatment by the end of the year. She is consistently reported in the national press, most recently in the Express, and emphasises the need for a cancer-specific plan supported by the requisite investment in improving radiotherapy treatment capacity.

It is great to invest in diagnostics, but this is a hand-in-glove situation: we need to ensure that as the investments in new diagnostic hubs are taking place, we are also making, in parallel, investments in treatment capacity. The Government have access to world-leading cancer specialists such as Professor Price, but we need a greater sense of urgency from Ministers to lift the UK from the bottom of the global cancer outcomes league table to the top. I say to this Minister: that is within our grasp; we have given you the route map for how it can be done.

The NHS has undergone two major reforms in the past 13 years and, although reforming public services is essential, the root causes of the issues sometimes come down to a lack of investment. Investment in cost-effective cancer treatments such as radiotherapy can result in quick gains. Expanding and modernising radiotherapy equipment with a modest—by NHS standards—£200 million investment could update the estimated 76 machines about to become outdated. That would benefit 50,000 patients annually. Then, allocating £45 million for the new surface guided radiotherapy—a fast and accurate British innovative technology—could reduce national waiting times for radiotherapy by almost two weeks. We had a meeting quite recently just along the corridor from this Chamber, and these machines can be installed over a single weekend in a specialist radiotherapy centre. We must utilise new technologies to address the workforce crisis and make access to radiotherapy treatment available across the entire country. Technology is available to the NHS today that was not available 25 years ago, and it is unwise that we are not currently using that technology to its utmost potential. If the NHS made better use of AI software, cancer specialists could plan for radiotherapy treatment two-and-a-half times faster than at present, ensuring that many more patients could be treated sooner. I urge the Minister to reconsider accelerating the roll-out of AI technologies in radiotherapy. There is no shortage of excellent science, technology and innovation in this country, and it is worth noting that most of the advanced radiotherapy machines currently operating all across Europe and in North America are made here in the UK—in Crawley, actually—so we are not making the best use of this British technology.

The Government should be laser-focused on retaining current staff and harnessing the opportunities of AI, up-to-date treatment machines, software and innovation to treat more patients and improve productivity. Some of these technologies could save clinicians up to two hours per patient, which is vital in a health service where we have a workforce crisis and a shortage of specialist oncologists. To bring treatment closer to home, investment is necessary in satellite centres or community cancer treatment centres to complement community diagnostic hubs.

Radiotherapy is a quick and highly effective treatment, and cost-effective radiotherapy services are at the forefront of cancer treatment across the world. It is the first duty of the Government to protect their people. The Minister can demonstrate his commitment to that duty by outlining a workable plan to meet the 62-day cancer treatment target after almost a decade of failure, and ensuring that all patients who will benefit from radiotherapy have access to this lifesaving treatment within 45 minutes of their home.

--- Later in debate ---

[The Minister for Health and Secondary Care (Will Quince)]

It is a pleasure to serve under your chairmanship, Dame Maria. I thank my hon. Friend the Member for North Devon (Selaine Saxby) for securing this important debate on the accessibility of radiotherapy. I agree wholly with the hon. Member for Denton and Reddish (Andrew Gwynne) that there are issues in this place that are not by nature party political. The debate has demonstrated that there is huge consensus on all sides of the House on the need for change, and I thank all right hon. and hon. Members for their contributions today.

Let me turn back to my hon. Friend the Member for North Devon for one moment. Whether it is in the meetings—dare I say it, the many meetings—that I have had with my hon. Friend, or through her public contributions in the House and outside, she has been consistent and powerful in her advocacy on health issues. Her constituents, and patients around the country, are very lucky to have her in their corner.

It is rare for the Front Benchers in a Westminster Hall debate to be allowed so much time to respond. I do not intend to take the entire time available, but I would like to try to answer as many of the questions, points and themes raised as possible. Although Members will know that I am not a new Minister, I am relatively new to this brief, having taken on the cancer portfolio in the last few days. I very much look forward to working with parliamentary colleagues from across the House, including those present today and others who I know have specific interests in cancer, to bring about the changes that we all want to see. I echo the words of the hon. Member for Easington (Grahame Morris) and thank him for sharing his personal experience; I certainly agree with him that we all want to see cancer outcomes improve across the country.

My hon. Friend the Member for North Devon raised the matter of performance levels, which I will touch on briefly before turning to specific points raised in the debate. I echo the hon. Member for Westmorland and Lonsdale (Tim Farron) in paying tribute to the brilliant work of NHS staff in this field. Thanks to them, levels of first treatment following an urgent cancer referral have been consistently above pre-pandemic levels, with activity in May standing at 111% of pre-pandemic levels on a per working day basis. Over 52,000 people had their first or subsequent treatment for cancer in May. In total, over 332,000 people received their first cancer treatment in the 12 months up to May, which is up by more than 18,000 on the same period before the pandemic.

As hon. Members have eloquently pointed out, waiting time performance for radiotherapy is influenced by a range of factors, including workforce and equipment—two subjects that I will come on to address in greater detail. My hon. Friend the Member for North Devon referred to the impact of covid and the recovery of cancer services following the pandemic. In February last year, the Government published the delivery plan for tackling the covid-19 backlog of elective care. We will spend more than £8 billion between now and 2024-25 to drive up elective activity, including cancer diagnosis and treatment. My hon. Friend referred to the community diagnostic centres, which make a huge difference, and the building of surgical hubs.

[Grahame Morris]

I am grateful to the Minister for taking the time to answer the points that have been made. Over the years, we have seen every single cancer Minister and probably every Secretary of State, but it seems that just when the penny is about to drop for the responsible Minister, they get shuffled off and nothing actually happens. I hope the Minister will stay in post long enough to deliver the improvements that we want to see.

The community diagnostic hubs are, of course, a wonderful thing, and we have been calling for them, but they must go hand in glove with increased treatment capacity. Otherwise, all that will happen is that the waiting lists will get longer as we diagnose more patients who require early treatment, but without having the treatment capacity to make the inroads that we all want.

[Will Quince]

I will come on to the hon. Gentleman’s specific point, but he is absolutely right. On remaining in post and Government reshuffles, the Prime Minister giveth and the Prime Minister taketh away, but I thank the hon. Gentleman for his best wishes ahead of any future reshuffle. Having been in the Departments of Health and Social Care, for Education and for Work and Pensions, I know that any Minister understandably ends up taking a considerable interest in their work. I assure the hon. Gentleman that whether or not I maintain my position in the Government, I will maintain my interest in all the areas I have worked on as a Minister. I certainly commit to continuing that work from the Back Benches when one day the Prime Minister chooses to dispense with my services.

[Will Quince]

I will come on to this point in greater depth, but many of the conversations that my hon. Friend and I have had on health issues, and previously on education issues as well, were about rurality and the challenges of rural and coastal communities. Her points are well made—I certainly understand them—and she makes a compelling case. I will address them in greater detail later in my speech.

Not only are we building the community diagnostic centres and surgical hubs—and notwithstanding my hon. Friend’s point about the distance that some have to travel to get to them—but we are creating them deliberately closer to communities; they are not just based in district and general hospitals. In each of the next two years they will be supported by an additional £3.3 billion of funding, which was announced in the autumn statement, and that will enable rapid action to improve emergency, elective and primary care performance towards the pre-pandemic levels.

On cancer specifically, NHS England recently set out the progress made on reducing the number of patients with urgent suspected cancer who wait for longer than 62 days, and announced that the faster diagnosis standard was met for the first time in February this year. It also confirmed the ongoing priorities to improve performance and long waits, prioritise diagnostic capacity for cancer and, of course, focus on the cancer pathway redesign.

The Government and NHS England have pushed to improve the early diagnosis of cancer, which is so important to give patients the best chance of receiving successful treatment and in turn see more people living longer following a cancer diagnosis. However, as my hon. Friend the Member for North Devon eloquently and articulately pointed out—the hon. Member for Easington also made this point—we know that early diagnosis needs to be backed up by high-quality treatment options such as radiotherapy, with its remarkable ability to shrink tumours, as has been set out, and often with minimal side effects.

The hon. Members for Easington and for Denton and Reddish referred to the 62-day cancer target and the changes required to improve cancer outcomes. I hear the strong and compelling arguments that have been made, and I am happy, as I set out at the beginning of my speech, to meet hon. Members to discuss the steps that we are already taking and the further steps that can be taken, alongside NHS England, to improve cancer outcomes.

The hon. Member for Denton and Reddish asked specifically about steps to meet the 62-day target. To target support towards the most challenged trusts in the country, NHS England has developed an intervention model that is designed both to maximise and expand capacity. Challenged trusts have been placed into tiers 1 and 2, and all tiered trusts have weekly or fortnightly oversight calls, and they also have visits with the regional and national teams from NHS England. They receive support on things like the development of a co-ordinated support plan, which is monitored by fortnightly progress meetings. The plans have focused on areas such as pathway improvements, workforce support and targeted capacity increases. That supports the trusts that do not have the resource or bandwidth internally to turn around services.

When my hon. Friend the Member for North Devon made the case for a satellite centre in her constituency, she raised specific challenges in relation to North Devon that are translatable to other parts of the country that have rural and coastal characteristics. I will outline the basis on which provision is reviewed, but before I do let me acknowledge the local efforts that she mentioned. She is rightly proud of her constituents’ initiative in terms of support with travel and other things.

The network oversight group, in conjunction with the relevant specialised commissioning team and cancer alliances, is required to review service provision on a regular basis to ensure that optimal access arrangements are in place. That applies to proposals that relate to the expansion or re-provision of existing services, or to the development of any satellite facilities. The development of any new service location requires the development of a business case, as my hon. Friend pointed out, and business cases must demonstrate, among other criteria, the consideration of the effect on the provision of existing cancer pathways, both within and outside the network geography.

As I have mentioned, that responsibility sits not with the Government but with the integrated care boards, cancer alliances and local specialised commissioning teams. I am happy to meet my hon. Friend, alongside the ICB, to understand the challenges and what can be done in this space. I understand from NHS England that around 450 patients a year travel from my hon. Friend’s constituency to Exeter for treatment, but I am cognisant of the point made by the hon. Member for Westmorland and Lonsdale that many more patients might want to access those services but do not because of the travelling and distances involved. That is why a meeting between me, my hon. Friend and the ICB might be a good starting point.

[Grahame Morris]

The Minister is being generous in giving way. The debate is instructive, and I am glad he has mentioned integrated care boards. As the hon. Member for Westmorland and Lonsdale (Tim Farron) mentioned—sorry, the right hon. Gentleman.

[Tim Farron]

I am merely honourable.

[Grahame Morris]

Well, I am sure it is only a matter of time.

One of the issues has been commissioning. NHS England is responsible for commissioning without having a sensible plan to replace old machines, and there are bizarre disincentives to using the most modern machines, which require fewer visits. Furthermore, the fractionations are smaller, and the radiotherapy could be delivered in a shorter time. Bizarre commissioning arrangements and tariffs apply. Is the advent of the ICBs, with the responsibilities they hold, an important element in deciding where the new treatment centres are going to be? Will the Minister outline their role in the context of access to radiotherapy services?

[Will Quince]

I thank the hon. Gentleman for his question and will jump to the part of my speech that covers equipment, because the issue has been raised by all hon. Members during the debate.

We are absolutely focused on improving cancer treatment and supporting advances in radiotherapy using cutting-edge imagery and technology. As my hon. Friend the Member for North Devon pointed out, since 2016 we have invested £162 million in the most cutting-edge radiotherapy equipment, which is designed to replace or upgrade more than 100 radiotherapy treatment machines so that we can deliver the best possible outcomes for patients. As the hon. Member for Westmorland and Lonsdale said, NHS England is carrying out a stocktake of linear accelerator age, which will be completed in the summer. It is also working with partners to undertake a demand and capacity review, which will complete by the end of the year.

On AI specifically, we want to ensure that we have the best possible cutting-edge, innovative equipment and technologies in the NHS, so we have announced an additional £21 million of funding that will speed up the roll out of AI across the NHS. That will enable us to help to improve diagnosis and to reduce waiting times—one of our top priorities—and clinicians will be freed up to spend more time delivering frontline patient care. The point made by the hon. Member for Easington about AI and the benefits thereof is well made.

The hon. Member for Westmorland and Lonsdale has been campaigning on the issue for around a decade, or perhaps longer, and he has met several Ministers. I am yet to meet with the hon. Gentleman, and I know he was due to meet my hon. Friend the Minister for Social Care, but I am happy to honour that meeting. He recently met his local hospital trust to discuss radiotherapy being part of the new hospital programme. Ultimately, that is a matter for commissioners, but we can certainly have that conversation when we meet and try to find a way forward.

A number of hon. Members raised the issue of the workforce. The hon. Member for Strangford (Jim Shannon) is no longer in his place, but he laboured this point, and rightly so. We have made good progress in growing the cancer workforce. The annual growth rate of the workforce remains steady at between 3% and 4%, but we need to go further. As of February, there were 33,174 full-time equivalent staff in the cancer workforce. In trusts, that is an increase of more than 11,300 since February 2010. Specifically, the number of therapeutic radiography staff grew by 17.4% between 2016 and 2021. As has been referenced, we published our long-term workforce plan, which sets out actions that are backed by £2.4 billion of Government funding up to 2028-29, a couple of weeks ago.

On travel, the travel that a patient needs to undertake is dependent on the type of treatment they need. Decisions about treatment locations are made on a case-by-case basis. As hon. Members have pointed out, specialised services are not available in every local hospital, in part because they have to be delivered by specialist teams of health professionals with the necessary skills and experience and access to the necessary equipment and medicines. Patient-specific requirements are based on what each individual can cope with and are discussed between the patient and clinician.

The Government are, of course, striving wherever possible to reduce any necessity to travel unreasonable distances, which is why our priority continues to be to bolster the specialist workforce and ensure ever-expanding coverage of equipment. That includes by investing in new radiotherapy machines, but the responsibility for investing in that equipment sits with local systems—the ICBs, which I suspect we will discuss in greater detail when we meet. I hear the case that has been made about equality and rurality. We can address some of those issues and work with integrated care boards so that they see the benefits to patients and to outcomes, as well as the cost savings, if we get it right.

We are supporting providers to accelerate the delivery of stereotactic ablative body radiotherapy for targeted cancers, thereby lowering the risk of damage to normal cells. Specialised commissioners have allocated £12 million to support providers to deliver SABR.

NHS Long-term Workforce Plan

Grahame Morris Excerpts

Monday 3rd July 2023 Commons Chamber

[Steve Barclay]

My hon. Friend raises a perfectly valid point. As we expand the primary care workforce, there is a capital consequence. The 50% expansion he talks about builds on the expansion from 2,100 in training in 2014 to 4,000 now, so there has already been an expansion, but we are taking that further by 50%—and on the higher figure. His point about section 106 applications is absolutely valid, and that is part of the primary care recovery plan. I understand that he is discussing the importance of getting that funding in place with the Under-Secretary of State for Health and Social Care, my hon. Friend the Member for Harborough.

[Grahame Morris (Easington) (Lab)]

Given the number of pressures and crises that our NHS faces, it would be a mistake for the Secretary of State to be seen as complacent in how he delivered his workforce plan. Our job as MPs is to speak the truth to power, so I want to raise with him the lack of cancer treatment capacity, particularly in radiotherapy. International comparators suggest that between 55% and 60% of cancer patients should be able to access radiotherapy either directly or in tandem with other treatments. Currently, only 27% do. What is the Secretary of State doing to increase the size of the highly specialised and relatively small radiotherapy workforce? The target is for 85% of patients to start their first treatment within 62 days of an urgent GP referral. What is the current figure?

[Steve Barclay]

To take the hon. Gentleman’s first point, the plan does not get into individual specialties. That was a Health Committee recommendation, which I have discussed with the Committee’s Chair, my hon. Friend the Member for Winchester (Steve Brine). There is a clear reason for that. Within the framework of numbers, the impact of AI and service design will evolve over the 15 years, so it is right that we commit to the number and then the NHS take that work forward with individual specialities and have discussions with the royal colleges.

The hon. Gentleman made a perfectly valid point about boosting capacity. We have already rolled out 108 of the 160 community diagnostic centres that we have committed to deliver. We are also looking to innovate, and I will give two practical examples. Our deal with Moderna, which is looking at individual bespoke vaccines for hard to treat cancers such as pancreatic cancer, will allow us to get ahead on that. We are already seeing a significant reduction in cervical cancer as a result of prevention measures. Likewise, by going into deprived communities with a high preponderance of smoking, the lung cancer screening programme is detecting lung cancer, which often presents late, much earlier, which in turn is having a significant impact on survival rates.

NHS Workforce Expansion

Grahame Morris Excerpts

Tuesday 28th February 2023 Commons Chamber

[Wes Streeting]

My hon. Friend is absolutely right. I very much enjoyed my visit to Leeds with the shadow Chancellor to look at the work the acute trust is doing with Leeds City Council to speed up delayed discharges. He is absolutely right about the impact of the churn of staff on a ward—because they are not regular staff on a contract of employment at a particular hospital or medical facility—and it can be quite distressing for patients to see the faces and names change every day and to constantly be explaining once again what their experience in the hospital has been, if indeed the staff have time to stop and talk.

I am really struck by the fact that one of the biggest issues that staff raise with me is the moral injury. The fact is that they are busting a gut and working their socks off, and they go home at the end of the day deeply demoralised, distressed and depressed because they know that, despite their very best efforts, they are not providing the quality of care that patients deserve, through no fault of their own. That is why, even above the issues of pay and of terms and conditions, which I think many of us would understand in and of themselves, I think the straw that is breaking the camel’s back is the moral injury. Unless we address that, we are going to lose the brilliant staff we have, before we even start to think about recruiting the staff we need.

[Grahame Morris (Easington) (Lab)]

I am very grateful to my hon. Friend for giving way before my knee does. Clearly, he is a man with a plan. Is it not incredible that we do not have a plan for dealing with cancer—the Government have dropped the 10-year cancer plan—particularly at a time when 50,000 patients a month are having to wait more than two weeks between diagnosis and seeing a specialist? We need a plan that incorporates workforce recruitment and retention.

[Wes Streeting]

I apologise for keeping my hon. Friend bobbing—the last thing the NHS needs is another patient, so I hope the exercise has been good for his joints rather than the straw that breaks that camel’s back.

My hon. Friend is absolutely right. I think cancer treatment is in many respects the canary in the coalmine, because it is an area where speed really does matter and where early detection can make a huge difference to the success of the outcomes. It is why, when we were in government, we had a cancer guarantee. By pursuing that cancer guarantee and making sure that patients received timely access to both diagnosis and treatment, the rising tide for cancer patients lifted all ships, and we saw a general improvement in the NHS, so that by the time we left government we had the lowest waiting times in history.

I am deeply anxious that within those waiting lists, which stand at a record in excess of 7 million now, will be a huge amount of undiagnosed cancer. As I know from personal experience of going to accident and emergency with something else, it is often in A&E departments that cancer is detected. I worry how many cancer patients like me will arrive at A&E, see the waiting times and walk away with a cancer undiagnosed. It certainly keeps me awake at night, and it should keep Ministers awake at night too.

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[Grahame Morris]

It is not correct that Labour’s spending plans are unfunded, and I hope that the Minister will put the record right. On the cancer plan, there is information out there that the incidence of cancer is increasing. To get value for money, would it not be sensible for the Government to invest in precision radiotherapy, as a treatment that improves patient outcomes in a cost-effective manner? That would get the best value for money for the taxpayer.

[Helen Whately]

I know that the hon. Gentleman feels very strongly about the issue; we have talked about radiotherapy. He will know that we have invested more than £160 million in improving radiotherapy equipment. This year, we are investing an extra £50 million in the cancer and diagnosis workforce. We are continuing to work hard with the NHS on reducing the backlogs that we have seen since the pandemic, when people did not come forward for cancer treatment as they would have in normal times.

NHS: Long-term Strategy

Grahame Morris Excerpts

Wednesday 11th January 2023 Commons Chamber

[Steve Barclay]

Again, I can understand why the hon. Gentleman does not want to talk about the performance of the Welsh Government, but I was talking about the Scottish, French and German Governments, and about the fact that the pandemic has had a severe impact across the UK and across Europe.

[Grahame Morris (Easington) (Lab)]

rose—

[Steve Barclay]

I know that the hon. Gentleman has been keen to get in, so I will give way, but then I must make some progress.

[Grahame Morris]

I am grateful to the Health Secretary for that. On the point about relative performance, I want to touch on cancer treatment capacity. Our performance as a nation is lamentable on the seven most common forms of cancer. If the buzzword is innovation, surely we have a tremendous opportunity to roll out advanced radiotherapy. About one fifth of the machines we have in our hospitals are more than the recommended limit of 10 years old. Surely that is a perfect example of a cost-effective means by which we could apply artificial intelligence and diagnostics in parallel, and we could treat many more patients and improve outcomes. Is he open to that idea?

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[Grahame Morris (Easington) (Lab)]

In the time available I will focus, laser-like, on the issue I wish to raise, which is the mismanagement of cancer care. I declare my interest as vice-chair of the all-party groups on cancer and for radiotherapy. Covid has undoubtedly compounded the pressures on our NHS, but the problems in areas such as cancer care predate the pandemic—there is no doubt about that. Radiotherapy is a vital treatment option, which already plays a part in the treatment of about four out of every 10 cancers. It is highly cost-effective—a cure typically costs between £3,000 and £7,000—but its potential is being systematically overlooked, and there has been chronic underinvestment.

Ten months ago, the previous Secretary of State for Health and Social Care declared war on cancer, but we are still waiting for the weapons to fight that war effectively. We urgently need to improve treatment capacity in radiotherapy. As I have stated, a fifth of all radiotherapy machines are more than 10 years old and will need replacing before the end of the year.

We need a better approach to funding IT, technology and networking, as that could dramatically speed up treatment processes. New immunotherapy cancer treatments often work far better in combination with radiotherapy. I ask the Minister to commit to engaging with the all-party parliamentary group for radiotherapy and with leading clinicians to develop the potential of advanced radiotherapy treatment capacity and to bring about a step change in cancer outcomes.

Cancer Services

Grahame Morris Excerpts

Thursday 8th December 2022 Commons Chamber

[Steve Brine (Winchester) (Con)]

I beg to move,

That this House has considered the Twelfth Report of the Health and Social Care Committee, Session 2021-22, Cancer services, HC 551, and the Government Response, HC 345.

I am very grateful to the Liaison Committee for selecting this topic for debate in the Chamber today. We know that one in two people in the UK will develop cancer at some point in their lives. It is no exaggeration to say that this is an issue that affects everyone in the House—indeed everyone in the country in one way or another—and it has touched my life for the worse many times, as I will talk about later. That is why the Health and Social Care Committee produced a report on cancer services earlier this year, and I pay tribute to my predecessor as Chair, my right hon. Friend the Member for South West Surrey (Jeremy Hunt), for his leadership in producing that work. That awful statistic is also why I have made cancer a priority as the new Chair of the Committee.

Our report found great strides had indeed been made in improving survival from cancer. Thanks to the tireless work of our scientists, researchers, doctors and nurses and others, including Ministers, over many years, more than half of people diagnosed with cancer now live for five years or more, compared with only one in three people 50 years ago.

We also heard that cancer survival in England, and indeed in the rest of the UK, continues to lag behind comparable countries around the world. The International Cancer Benchmarking Partnership explains that just under 60% of people diagnosed with bowel cancer in England, for instance, will live for five years or more, compared with 66.8% in Canada and almost 71% in Australia. The pattern is seen in many other cancer types, including lung cancer, which, of course, took our great friend James Brokenshire last year; pancreatic cancer, which took my own father, who was diagnosed in September 2019 and was dead three days after the general election that December; and ovarian cancer, which has also touched my family and so many people.

The charity Target Ovarian Cancer came to the House last month—my good friend the hon. Member for Washington and Sunderland West (Mrs Hodgson), who chairs the all-party parliamentary group on ovarian cancer, led the reception downstairs in the Churchill Room—and launched its pathfinder study, “Faster, further, and fairer”. The study notes that 4,000 women a year still lose their lives to ovarian cancer. I highly recommend that excellent report to Members.

We know that one of the biggest reasons for the survival gap—I have just quoted some comparative figures—is that the NHS tends to diagnose fewer cancers at an early stage, when cancer is, of course, much more treatable. Early diagnosis is cancer’s magic key, as has been said so many times from these Benches. NHS England has set a target of diagnosing 75% of cancers at an early stage by 2028, compared with about 54% today. We say that achieving that would make a huge difference to outcomes. I agreed that target when I was the Minister with responsibility for cancer a few years ago, and I firmly believe that it is the right target to give more people the best possible chance of surviving their cancer. But we need to be much more ambitious and get upstream of many cancers—I will return to that point.

Last month, Dame Cally Palmer, the excellent national cancer director who also works at the Royal Marsden, told us in a special topical session of the Select Committee that she remained “cautiously optimistic” that the 75% target would be met, and told us about some great progress being made on programmes such as targeted lung screening—we have all heard about the supermarket checks—which is diagnosing lots of early-stage lung cancers in the pilot studies and is showing great promise. Dame Cally’s optimism was not, I have to say, entirely shared by many of the experts who gave evidence to our inquiry on cancer services. John Butler, a specialist in ovarian cancer, thought it was “extremely unlikely” that the 75% would be reached, and Dr Jeanette Dickson, an oncologist, said the NHS was doing “very badly” against the target. That is a worry. Regrettably, we concluded in our work that the NHS is not on track to meet the 75% target, and that judgment was shared by the Committee’s independent panel of experts, who evaluated Government progress on cancer services.

The Government said in their response to us that it was premature to say that progress towards that target is off-track, but the National Audit Office found that, so far this year, 56% of patients are being diagnosed at stages 1 or 2, which is the same proportion as when I made the target in 2019. Of course, that is below the level of improvement required to reach that three-quarters target of early diagnosis by 2028. I do not agree that it can ever be premature to call for more to be done to make progress on early diagnosis when failing to achieve the target could mean many hundreds of thousands of people missing out on early diagnosis and, of course, on a better chance of surviving their cancer and living for longer.

The Committee heard extremely powerful examples of why it is so important to make more and faster progress on diagnosing cancers earlier. In December 2020, Andrea Brady’s daughter Jess died of stage 4 adenocarcinoma at the age of just 27 years old. Before her diagnosis, Jess had been passed from pillar to post, consulting repeatedly with multiple GPs and other clinicians before her mother was finally forced to pay for a private consultation just to get Jess a diagnosis. By that point, tragically, it was too late. Jess passed away in hospital three and a half weeks after she was diagnosed.

Meeting the target of diagnosing 75% of cancers at an early stage would mean giving thousands of people a better chance of surviving their cancer, and thousands fewer families having to suffer such terrible losses. That is why we called in our report for the then promised 10-year cancer plan to kickstart progress on early diagnosis. We called for it to consider more radical proposals on how to diagnose more cancers at an early stage, and to include an associated workforce plan to reduce diagnostic bottlenecks in the system.

Good work is ongoing, and I know that the Minister will talk about it later. New research, such as the NHS-Galleri blood test trial, could be transformative. Indeed, last month our colleagues at NHS England would not be drawn on whether there is a need for a new 10-year cancer plan, as previous Governments have promised. They seemed to imply that a new plan was not needed given the focus of the long-term plan on early diagnosis. I contest that. The consultation on a new 10-year cancer plan was responded to by the sector, charities, royal colleges and many other organisations, and it has set many hares running and created great expectation about a future cancer plan. We on the Committee—I see other Committee members here—are concerned about that. We are not hung up on plans, but in my experience of being a Minister, the NHS loves a plan, the NHS needs a plan, and critically, that would allow this House to see where we are against the plan.

Achieving early diagnosis is not just about what NHS England can do from the centre. It is also about improving public awareness about the many signs and symptoms of cancer across all communities. It is about making sure that GPs have good systems in place for managing patients with possible cancers and are able, without barriers, to refer them on for tests. It is about the continuous improvement of screening programmes, and hard work—really hard work—in local areas to encourage people to come forward. Of course, one of the great promises of the new integrated care systems is to work with the cancer networks and alliances to deliver on that system of early diagnosis and prevention.

Achieving early diagnosis is also about focusing research and innovation on developing new ways of detecting cancer—especially cancers that are hard to diagnose—and ensuring that the NHS is set up to roll out new tests quickly. I referred to Galleri earlier, and mentioned upstream cancer. Next year, we will do a piece of work that I loosely call “Future cancer”. It is, of course, important that we diagnose cancers early—that is the basis of my remarks. At the moment, however, we largely diagnose cancers and treat them when they are symptomatic, and we hope to catch those symptoms and treat them early. Many cancers, but not all, are preventable, and I am interested in future cancer. Where can we get upstream of this? Where can we use the NHS’s new genomics strategy? Where can we use biomarkers to get ahead of that? That poses big moral and ethical questions to us as a society, but that is no reason not to go there or not to have that ambition.

All this is about making sure that there are enough staff and machines in the system to do even more tests and give many more people the best possible chance of being diagnosed with cancer at an early stage. The 10-year cancer plan should look again to make sure that the Government are truly pulling out all the stops to get to 75% early-stage diagnoses by 2028. I hope the Minister will confirm that the Government are still committed to doing that work.

Early diagnosis means little if there is not sufficient capacity to provide people with the right treatments at the right time. Unfortunately, the latest data suggests that there has been a decline in the NHS’s ability to provide this treatment. While the vast majority of people do still receive timely treatment following a cancer diagnosis, in September nearly 10% of people waited more than a month for their first treatment following their diagnosis, compared with less than 5% in 2019. That is more than 2,400 people having to wait more than an entire month to begin their cancer treatment—more than double the number who were waiting that long two years prior. As the former cancer director, Professor Sir Mike Richards—a giant in this area—often says, when someone is waiting for a cancer diagnosis or treatment, it is not the 31 days that really matter, but the 31 nights. I know that people around the country will understand that.

[Grahame Morris (Easington) (Lab)]

I commend the hon. Member, the Chair of the Select Committee, on an excellent report and an excellent analysis of the problems and the way forward, but he referred to the latest cancer waiting times. It is timely that we are having this debate, because the new cancer stats have been published by NHS England today. They show that the position is worsening. In October this year, 39.7% of cancer patients waited beyond 62 days between urgent referral and cancer treatment. There is an urgency in addressing some of the issues that the Chair raises.

[Steve Brine]

Indeed. The reason why we had Dame Cally and Professor Peter Johnson, who is the national clinical director for cancer, into the Select Committee a couple of weeks ago is that the NHS has set itself a deadline of next spring—it was this spring—to get back to the 62-day wait. I have everything I have crossed that they can get there, but they need to make it happen. I know they are relentlessly focused on that, and the Minister is relentlessly focused on that, but we have got to help them get there.

The Committee also heard about the challenges facing surgery and radiotherapy services, which makes it rather timely that the hon. Gentleman intervened on me at that point, as I suspect he will speak about it later. Professor Pat Price, who he and I are going to meet early in the new year, is a consultant oncologist at Imperial College in London. She told us that radiotherapy services were lacking staff and machines to be able to deliver the best possible care and that services were struggling to deliver the level of activity needed to catch up with the cancer backlog. I will let the hon. Gentleman expand on that a bit later. Professor Mike Griffin, professor of surgery at Newcastle University, also highlighted workforce shortages as a significant barrier to effective cancer surgery, but he also told us about the organisation of services. Because cancer surgery is often co-located within general, acute and emergency care, it can be subject to delay because of capacity shortage, and that was a particular problem during covid in some places, but not everywhere.

My trust, Hampshire Hospitals, did a brilliant job to keep cancer surgery on track at all times by doing it offsite. I pay tribute to Alex Whitfield and her team at Hampshire Hospitals for the way they organised with Sarum Road private hospital in particular to ensure that patients continued to get their cancer treatment. Professor Griffin called for more ringfenced hubs to be developed so that cancer surgery can continue even when there are severe pressures on acute care, and I hope the Minister refers to that when she winds up.

Growing the workforce, investing over the long term in machines and IT and reorganising services to create more cancer surgery hubs are all in the Government’s gift, which is why we recommended that they consider those actions in developing the 10-year plan. Without a wider focus on removing the barriers to the NHS delivering the best possible cancer treatments, the potential gains of earlier diagnosis might not be realised. Given the number of people presenting with suspected cancer at the moment—it is good that they are presenting, and many of them will turn out not to have cancer— if it is found that they do have it, we need to move on that. That is why treatment is the other side of the same coin.

Just as further progress on early diagnosis will depend on research and innovation to develop new tests, improving cancer treatments will require new and more advanced techniques to be developed and implemented by the NHS. We found in the Committee report that the UK is a genuine world leader in research. There are unique aspects to the NHS that make it an effective partner for research organisations. We also heard that there are significant barriers to researchers accessing the data they need for quick and equitable patient recruitment to clinical trials and for staff having the time they need to take part in research. The Government have set out several steps they are taking to improve access to data and improve flexibility for staff wanting to take part in research, and that is welcome, but research by Cancer Research UK has found that the UK’s recovery from the pandemic in clinical trials continues to be outpaced by other comparable countries.

NHS England told us that supporting clinical research into cancer is not its responsibility, so it is clear that a wider effort is needed to make sure that cancer research taking place in the NHS is well supported and aligned with the priorities for cancer services. That is another reason why the plan is important.

Finally, we heard that there is significant variation in outcomes for people diagnosed with cancer, depending in part on the type of cancer they are diagnosed with, but also demographic factors. The Government told us that they would be addressing these differences through the levelling-up White Paper, but also through the health disparities White Paper, by addressing issues such as smoking and obesity, which are more prevalent in our more deprived communities.

On that, there is a story in today’s press which suggests that Britain has the biggest increase in early onset diabetes in the western world. That is a huge concern. I am not suggesting that diabetes is cancer; I am saying that we have many suggested actions to reduce obesity around junk food advertising and stuff that follows on from the sugar tax. Much of that has still not been implemented. Rumours abound—there are always rumours around here—that the Government are seeking to delay junk food advertising restrictions until 2025. I hope that is wrong. I invite the Minister to respond to that when she winds up and, if not, to take that away.

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[Grahame Morris (Easington) (Lab)]

It is a privilege to speak in this debate, and I want to express my appreciation for the work of the Select Committee and for the way its Chair, the hon. Member for Winchester (Steve Brine), presented the report and the way forward. It is very instructive and informative, and I cannot disagree.

I must make some declarations of interest. I am, and have been for some time, vice-chairman of the all-party parliamentary group for radiotherapy. I want to confine my remarks to radiotherapy, although I do have a broader interest as vice-chairman of the all-party parliamentary group on cancer. People might not believe this, but I worked for almost 15 years in an NHS diagnostic laboratory, so I have a little bit of knowledge of the front- line. I served for five years as a member of the Health Committee when I was first elected, under the chairmanship of Stephen Dorrell initially and then Sarah Wollaston. I found that to be one of the most interesting and rewarding things I have done in the House of Commons since being elected.

I also served on the Health and Social Care Public Bill Committee—I must thank you, Madam Deputy Speaker, for putting me on that Committee—which was a marathon. I remind Members who were not around at the time that part of the justification put forward by the then Prime Minister and the coalition Government for those major reforms and restructuring of the national health service, including the commissioning of cancer services, was the poor outcomes on cancer. The system we have now was born out of a recognition that we needed to do better.

I pay tribute to the hon. Member for Westmorland and Lonsdale (Tim Farron), who chairs the APPG for radiotherapy, and the hon. Member for Strangford (Jim Shannon), who is an assiduous advocate for improved cancer services, not just in Northern Ireland but throughout the country.

I am delighted that this report signposts the way to future work. I am very pleased that the hon. Member for Winchester indicated that it is his intention, with the agreement of the Committee, to do further work on how we might achieve the laudable 75% diagnosis target by 2028. I am pleased that the Minister of State, Department of Health and Social Care, the hon. Member for Faversham and Mid Kent (Helen Whately), is responding to the debate. I am sure that, like some of her predecessors, including the hon. Member for Winchester, she will grow tired of me banging the drum for cancer services, and for radiotherapy in particular, but there are some very important points and sound advice that come not from me, although I should say that I am a cancer survivor. I have had lymphatic cancer on three occasions, and I have benefited from surgery, chemotherapy and radiotherapy, so I understand what is involved and I value the vast improvements there have been in all those pillars of cancer treatment.

The sexy thing on cancer services is early diagnosis. It captures a lot of headlines, and the hon. Member for Winchester was right to point that out, but it goes hand in glove with having the requisite treatment capacity. With the best will in the world, the investment in new diagnostic hubs, which I welcome and is laudable, will simply increase the number of patients in the system. If we are to improve outcomes for cancer patients, we simply must address the issues around cancer treatment capacity.

I believe the Minister has a copy of the six-point plan for improving outcomes from the APPG and the charity Radiotherapy UK. We are not saying that radiotherapy is somehow in competition with the other pillars of cancer treatment; rather, it complements them. Advancements in science, technology and skills, with the introduction of artificial intelligence, the ability to map tumours precisely and incredible advancements in MRI scanning facilities, used in parallel with precision radiotherapy machines, gives us an opportunity to make a quantum leap in treatment and to improve productivity.

The cancer workforce is very small; it is only around 6,500 nationally. They are a highly skilled, highly motivated group of individuals who are doing a fantastic job, and I pay tribute to the cancer workforce, particularly those who work in the field of radiotherapy, who are holding the line at the moment and facing growing pressures in the system.

As a country, we spend about 5% of our dedicated cancer budget—not 5% of the entire NHS budget—on radiotherapy. If we look at international comparators, which we must do, we see that the OECD average is about 9%, so we are spending about half as much as other similar developed industrial nations. To put that into context—because sometimes we get lost in the figures—the NHS spends more on a single cancer drug, Herceptin, than on the entire radiotherapy service across the country.

I want to touch on commissioning, which is an issue that can be readily addressed and that came about as a consequence of the 2012 Lansley reforms. We took that up directly with the Minister when she kindly met a delegation earlier this week. Cancer services are currently nationally commissioned by NHS England, but there are things that could be done rapidly to increase treatment capacity by addressing some of the anomalies in the current tariff system.

Perversely, NHS trusts that have the latest advanced precision radiotherapy equipment are financially disadvantaged from using it because of the tariff system. Bizarrely, patients are being treated with 30 fractions of radiotherapy when it is perfectly possible to treat them with four, five or six fractions of precisely delivered radiotherapy if the machines are available and the staff are trained to do it. In many cases, the machines are there but the tariff system works against rolling out that facility. That is completely perverse and it is crazy that we do not do that.

We can learn from examples of what is happening in similar European countries. The Chair of the Select Committee mentioned the rapid improvements that have been made in Denmark as a result of having a well-thought-through, well-developed and well-scrutinised plan to improve cancer services. Rightly, some European countries also have diagnostic hubs, but in many cases they are combined diagnostic and treatment hubs, so it is conceivable that patients go in for diagnosis and rapidly begin their treatment—in some European countries, on the same day. Many patients here wait a month, and far too many wait more than two months—62 days—before their treatment starts.

I have some particular points to make to the Minister, which we also raised with her directly. The Chair of the Select Committee mentioned the new cancer plan. As a House and as a nation, we need some clarity on whether there will be a new 10-year cancer plan and whether the Department and the Ministers are making the case to the Treasury to secure the necessary funding. I hope that, as part of that, the Minister will look at the six-point plan for improved radiotherapy services that she has in her possession. Even without a cancer plan, however, there are things that could be done immediately to address the issues around the tariff system and the bureaucracy that holds back technology, which NHS England could easily resolve.

We are going to move to a new commissioning system with integrated care boards over large areas, but they have no capital budget and their funding is revenue based, so we must address the issue of those centres across the country. It is wonderful if people live near the Royal Marsden, which is one of the finest hospitals not just in the country or in London, but probably in the world, but if people live in the south-west, Cumbria or the north-east, they cannot readily access such a tremendous centre. We must address some of those health inequalities before the new commissioning arrangements come in, so that we have a systematic approach to replacing machines that are more than 10 years old, rather than having to make out a business case and compete against other centres that may already be well provided with the latest technology.

We are on a time limit, so I will wrap up, because I do not want to incur the wrath of Madam Deputy Speaker. I give the Minister credit for her commitment and aspiration to improve cancer outcomes and to have a first-class service. I hope that the Health and Social Care Committee will play its role in scrutinising the cancer plan, or the Minister’s plans to improve cancer services. I am pleased that she recognises the validity of the representations that have been made already and that there is an urgent need to address the tariff issue. I would like an assurance that that will be done quickly, not in a year or two, because there is clear evidence that it could improve outcomes and it is what we call low- hanging fruit.

There is a lot more that I could say and lots of figures that I could quote—for example, I am concerned about the latest cancer waiting times; the Minister attended our presentation where it was shown graphically that there are huge variations across the regions. The Government must address that. I think we could get cross-party support for a sensible cancer plan, so I look forward to seeing the proposals that she comes up with when she has consulted with her colleagues and the Treasury.

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[The Minister of State, Department of Health and Social Care (Helen Whately)]

I very much thank my hon. Friend the Member for Winchester (Steve Brine) for raising the Select Committee’s report on cancer today. I know that he is passionate about this issue both as a former cancer Minister and for the personal reasons that he mentioned, as do I. The Committee’s 12th report makes valuable recommendations, and I am grateful to it for all its hard work. I assure him and hon. Members that we are working night and day, together with our colleagues in the NHS, on three priorities for cancer in particular. They are: to recover from the backlog caused by the pandemic; to get better at early diagnosis and treatment, using the tools and technologies that we have; and to invest in research and innovation, because we know that advances in such things as genomics and artificial intelligence have the potential to transform our experience of cancer as a society.

This is my first opportunity to congratulate my hon. Friend on his election as Chair of the Health and Social Care Select Committee, where I know he will do an excellent job, bringing his expertise as well as his passion on the subject to bear. I also welcome the focus that he will bring to the Committee on cancer and prevention, as he mentioned in his remarks. I am truly sorry that he has lost members of his family to cancer, including, as he said, his father. He rightly said that cancer affects pretty much everyone in our country in one way or another.

My hon. Friend talked about some of the challenges that we and our NHS face in the diagnosis and treatment of cancer. In his time as cancer Minister, he was absolutely right to focus on early diagnosis, because we know that that makes such a difference. As he said, he set the 75% ambition for early diagnosis to be achieved by 2028, and the NHS is indeed working towards that at the moment. He talked about wanting to see the plan for achieving that ambition—I say “ambition” because, as he will know, it was intentionally set as a stretching target—and about the importance of us having the capacity to treat cancer. I think that is currently higher than it was before the pandemic, but I certainly see the need to expand it further.

My hon. Friend talked about the importance of surgical hubs. We have 89 of them, but more are planned, with £1.5 billion of capital funding recently approved for their expansion and future new hubs. He rightly talked about the importance of cancer research and the alignment of that with cancer treatment and cancer services. He also talked about the significance of health disparities and the prevalence of risk factors such as higher smoking and obesity rates in more deprived communities. I will address some of those points during my speech.

The hon. Member for Easington (Grahame Morris) spoke in particular about radiotherapy as well as giving a broader perspective. As he said, we met the other day together with Professor Pryce, and he raised his concerns with me about the use of radiotherapy, the impact of tariffs, the potential for better use of radiotherapy machines, staff, and several other points in the plan. It is too soon to give him the quality of answers that I would like on those points, but I am looking into exactly what he raised and will get back to him and those others we met as well.

My hon. Friend the Member for Erewash (Maggie Throup)—I have huge respect for her, including the work that she did as a Health Minister and the expertise she brings to the debate—is absolutely right about the importance of community diagnostic centres. We are rolling them out around the country, with 19 more just announced, increasing our capacity to diagnose cancers promptly. She also spoke about workforce pressures. I am sure she will know that the 2017 cancer workforce plan was delivered and, in fact, exceeded by over 200 additional staff. Since then, Health Education England has received additional funding of £50 million for the cancer workforce in the last financial year and this one.

I agree with my hon. Friend that we should continue to focus on ensuring that we are training, supporting and retaining the cancer workforce that we need. That is so important to achieving our ambitions in cancer as well as the wider NHS workforce. Indeed, many of those who work in the NHS will be looking after patients with cancer, not just those who might have a specific cancer workforce label. I am sure she will know that we are well on our way to achieving our ambition of 50,000 more nurses in the NHS, with over 29,000 more at the moment.

My hon. Friend also spoke about cancer equipment. For instance, since 2016, £160 million of capital investment has been invested in radiotherapy equipment. I will take away her call for an equipment audit. She also importantly talked about obesity and alcohol as risk factors, although I appreciated that she said we should focus on alcohol reduction after the festive season. I thank her for allowing us to enjoy a drink over Christmas.

[Grahame Morris]

I am amazed that figures are not to hand on how many radiotherapy machines are more than 10 years old. Is it unreasonable to expect that NHS England would have an ongoing audit to identify which machines need replacing on a planned basis? Will that be addressed?

[Helen Whately]

There will be huge numbers of figures on things that NHS England will be monitoring. I said to my hon. Friend the Member for Erewash that I am very happy to look at her specific suggestion, on the extent to which the data already exists or whether we should be collecting it. That is part of what I will be looking into when I follow up on that.

We heard from the hon. Member for Coventry North West (Taiwo Owatemi), who brings really valuable experience to this topic. She said that she is a former oncology pharmacist and, if I heard her right, that she also volunteers as a pharmacist in her local hospital. That is hugely welcome experience to bring to the debate. I am very happy to speak to her more about some of the challenges she raised. I will follow up after the debate to see if we can get that in our diaries.

The hon. Lady pointed out that we are not achieving our targets on treatment rates, which is absolutely true, but she also spoke about cancer referrals. On that point, I want to share some good news. More people than ever before are being referred to hospitals by their GPs to see if they have cancer. The latest data for October this year, published only this morning, shows that almost 250,000 urgent cancer referrals were made by GPs in England, which is up about 109% on the levels in October 2019. It is 10,000 more than in October last year and over 35,000 more than in October 2020. That is thanks to the hard work of GPs, to the 91 community diagnostic centres which have carried out more than 2 million additional scans, tests and checks already, and to all the people who have come forward and got themselves checked. We know it is not always easy if you are worried that you might have something that could be cancer. We are working hard to encourage people to come forward if they are worried, so that we can improve early diagnosis. That is why we are working to raise awareness with campaigns such as “Help us, Help you” alongside targeting case-finding efforts such as targeted lung health checks. Such initiatives are successfully countering the pandemic’s negative impact on cancer referrals.

In further important news, NHS England announced it is expanding direct access to diagnostic scans across all GP practices. That will cut waiting times and speed up diagnosis or the all-clear for patients. Since November, every GP team has been able to directly order CT scans, ultrasounds or brain MRIs for patients with concerning symptoms, but who fall outside the NICE guidance threshold. Non-specific symptom pathways are transforming the way that people with symptoms not specific to one cancer, such as weight loss or fatigue, are either diagnosed or have cancer ruled out. That gives GPs a much-needed referral route, while speeding up and streamlining the process so that, where needed, people can start treatment earlier. Thankfully, with the increased level of referrals, the majority of people referred will be given the all-clear. However, it is crucial to start treatment promptly for those who are diagnosed, while giving peace of mind to those who do not have cancer.

On treatment, my Department has committed an additional £8 billion for the next two years, on top of the £2 billion elective recovery fund, to increase elective activity including for cancer services, because speed of treatment following early diagnosis is of course very important.

I am looking at the time and I know that I need to try to wrap up promptly. I will skip as fast as I can to a conclusion, while answering a couple of points that were raised as we go.

Many hon. Members commented on the pandemic. I recognise that the pandemic severely disrupted health services. The recovery of performance is a multi-year effort. The NHS is working very hard with a delivery plan specifically to tackle the covid elective care backlog. Under the plan, reducing the number of patients waiting over 62 days for treatment is a top priority.

Many hon. Members are interested in the progress of the 10-year cancer plan. We are reviewing the responses we have received on the call for evidence to that plan. In parallel, I am closely scrutinising holding the NHS to account on its elective recovery plan, a major part of which is cancer care, as well as looking to the future and making sure we drive forward research and innovation, including, for example, with our recently announced life sciences cancer mission which will invest over £22 million in a vaccine taskforce approach to cancer research.

I would like once again to thank my hon. Friend the Member for Winchester for securing this debate today. I look forward to working with him and other hon. Members on improving cancer outcomes.

Oral Answers to Questions

Grahame Morris Excerpts

Tuesday 1st November 2022 Commons Chamber

[Will Quince]

My hon. Friend is right to say that we are supporting the NHS to deliver up to 160 community diagnostic centres by March 2025, 89 of which are already operational, as part of £2.3 billion of capital funding, delivering around 2 million additional scans so far. Community diagnostic centres are closer to people’s homes in the hearts of communities, and they will help us not just to reduce and bust the covid backlogs but to tackle health inequalities.

[Grahame Morris (Easington) (Lab)]

As we get older, many of us—individually or our close family and their immediate family—will be touched by cancer. Can the Minister confirm when the 10-year cancer plan will be published in full, and will the Minister agree to meet me and a small delegation from the all-party parliamentary group on radiotherapy to hear more from the experts on the frontline about how we can use this technology to improve cancer outcomes?

[Helen Whately]

Sadly, cancer takes far too many people before their time, and the Government are determined to improve cancer outcomes in the short term and the long term. I am very happy to meet the hon. Gentleman to discuss this further.

Ambulance Services and National Heatwave Emergency

Grahame Morris Excerpts

Wednesday 13th July 2022 Commons Chamber

[Maria Caulfield]

I thank my hon. Friend, who has been campaigning vigorously for better healthcare provision in his local area. I am very happy to meet him to discuss those plans, and I recognise that there is an urgency about that. I can reassure him that six areas of the country account for about a third of the handover delays, and we are specifically focusing our efforts on them. This is about relieving the pressures in the system, whether through more capacity at A&E so that patients can be seen more quickly once they arrive by ambulance, or support for the ambulance service itself. I am very happy to meet him to discuss the problems in his local area.

[Grahame Morris (Easington) (Lab)]

Despite the promises and assurances that the Minister set out in the heatwave plan and in her response, I am very disappointed that previous promises made in the House by the Minister, that she would speak with North East Ambulance Service whistleblower Paul Calvert, my constituent, have not been honoured. If Ministers will not engage with those who identify ongoing problems and learn lessons to fix our failing ambulance service, how can we expect the ambulance service to respond to an acute crisis such as the current heatwave?

[Maria Caulfield]

The North East Ambulance Service is one of three areas of concern in terms of performance. I reassure the hon. Member that I have met the families, and offered other families a meeting, to discuss the matter. In relation to his constituent, there is a tribunal ongoing. It is difficult for me to meet him while that is ongoing. Once that is over, however, I would be happy to meet his constituent to discuss the issues that he raised as a whistleblower.

Health and Social Care Leadership Review

Grahame Morris Excerpts

Wednesday 8th June 2022 Commons Chamber

[Sajid Javid]

I cannot give my right hon. Friend the exact number that he is asking for, but I can answer the latter part of his question. I agree that we want to see a massive improvement in appraisal and performance standards; I am sure that, when he gets to see the report in detail today, he will be pleased by what he reads.

[Grahame Morris (Easington) (Lab)]

The Secretary of State said that we must accept only the highest standards and act where standards fall short. My constituent, Paul Calvert, bravely exposed the management failures of the North East Ambulance Service and, indeed, the criminal negligence of cover-ups of patient deaths.

Mr Calvert, who gave me his permission to raise this case—I met him in person last week—is being bullied, harassed and blackmailed, but he still refuses to sign a non-disclosure agreement. He was offered £41,000 conditional on his silence and on destroying the evidence that he has of wrongdoing. Tomorrow, we anticipate his employment being terminated. Mr Calvert and grieving families want a public inquiry into the North East Ambulance Service. Does the Health and Social Care Secretary agree, and will he outline how the Messenger review will protect NHS whistleblowers such as my constituent, Mr Calvert?

[Sajid Javid]

I thank the hon. Gentleman for bringing Mr Calvert’s case to my attention. The Under-Secretary of State for Health and Social Care, my hon. Friend the Member for Lewes (Maria Caulfield), has listened to that carefully. She is meeting some of the families affected by that case very shortly, and Mr Calvert is someone to whom she can reach out directly.

Like the hon. Gentleman and, I am sure, the whole House, I am very concerned about what I have heard about this ambulance service. I am not satisfied with the review that has already been done. We need a much broader and more powerful review. I will have more to say on the matter very shortly.

North East Ambulance Service

Grahame Morris Excerpts

Monday 23rd May 2022 Commons Chamber

[Maria Caulfield]

As I said to the hon. Member for Stockton North (Alex Cunningham), I am happy, as the Minister for patient safety, to meet to discuss any safety concerns and issues following the review of the cases that we have heard about today. As for wider ambulance reforms, the Minister for Health is here and he has heard that request.

[Grahame Morris (Easington) (Lab)]

Notwithstanding the appalling and heartbreaking cases that were highlighted in The Sunday Times and, indeed, The Northern Echo, including that of my constituent, Quinn Beadle, the Minister implied in her response that processes had been put in place to ensure that these things do not happen again. Does she want to take this opportunity to apologise to my constituents, Mr and Mrs Brocklehurst, for an incident that happened this year? Mrs Brocklehurst fell in her driveway, sustaining severe injuries, including five broken ribs, a collapsed lung, two crushed discs in her spine and other damage. It took the North East Ambulance Service three hours and 15 minutes to arrive. She experienced systemic failures throughout her experience, from a call handler advising her to place a bag of frozen peas on her broken back, to a trainee and two other paramedics wanting to lift her, before administering six syringes of morphine and placing her on a board without a neck brace. At the hospital, Mrs Brocklehurst was queued by the trust, in agony, for six hours before being treated. It is a disgrace, Minister.

[Maria Caulfield]

I am very sorry to hear that and I apologise to Mrs Brocklehurst. That is not an acceptable event to have happened, and I can only imagine the pain that she was going through. I am very happy to meet him and his constituent to discuss that further because, obviously, that wait should not have happened.