Improving Cancer Outcomes

Grahame Morris Excerpts

Thursday 5th February 2015 Commons Chamber

[Grahame M. Morris (Easington) (Lab)]

I place on record my thanks to the Backbench Business Committee for allocating time for this timely debate on cancer services. I also thank the hon. Member for Basildon and Billericay (Mr Baron) and the various co-sponsors who made the case for this debate. I pay tribute to the various all-party groups covering the issues. Many Members are dedicated to particular groups and play an important role in compiling research, getting information to Ministers and raising specific issues in Adjournment debates. We should pay tribute to all of those people for all the work they do, irrespective of which party they represent.

I wish to raise two specific issues; one that, I hope, is not terribly controversial but another—an issue I have raised previously—that I suspect might be. The hon. Member for Castle Point (Rebecca Harris) touched on it as well. I echo the comments of the hon. Member for Basildon and Billericay that we have made excellent progress within the NHS on tackling cancer and bringing forward new treatments and on promoting early diagnosis. But there is still an awful lot we need to do. I get angry when I see reports indicating how badly we are doing in this country at treating cancer patients when looking at international comparators. I know it is difficult because like has to be compared with like and there are issues about centres of excellence. I understand all that, but I think the NHS should be the best in the world. We argue about resources, but the funding should be there to deliver an excellent service.

The most recent Concord report on the use of advanced therapeutic radiotherapy puts the UK behind in Europe for certain cancers, but also behind Malaysia, Indonesia and Puerto Rico. It says there are a range of reasons why we are falling behind, and one of them is the lack of access to advanced radiotherapy.

Today, cancer treatment in England is an area of health care where the most money is spent on the least efficient method of treatment. I do not want this to become an argument between the cancer drugs fund and alternative cancer treatments, because they are, in essence, complementary. My concern is that we have taken our collective eye off the ball and have not made sufficient investment in what could, as the hon. Member for Castle Point mentioned, save many thousands or tens of thousands of lives, particularly outside the regions where there is limited access.

According to the Department of Health commissioning guidelines, radiotherapy cures 16% of all cancers on its own. When combined with surgery, that figure becomes over 40%. I know that my hon. Friend the Member for Denton and Reddish (Andrew Gwynne), on the Opposition Front Bench, has heard all these figures from the Society of Radiographers before, but they are important statistics. In comparison, cancer drugs, which are incredibly expensive—there is a huge outcry if the National Institute for Health and Care Excellence does not approve a cancer drug or if resources are not put into the cancer drugs fund—are statistically very different. If we look at the statistics in a cold and objective way, we find that cancer drugs by themselves cure only 2% of all cancers. The drugs are effective only in combination with other therapies such as surgery and radiotherapy.

Modern technology has made radiotherapy more effective and much safer for cancer patients. Yet the cancer drugs budget consumes a far larger proportion of the NHS budget in comparison with the radiotherapy budget, which I believe is in the order of £400 million. The disparity is huge because of the requirement to invest in the infrastructure, staff, training, evaluation of techniques and so forth. I personally do not understand how we can make a moral or economic case for not putting greater emphasis on advanced radiotherapy.

There is, in my view, no better example of unbalanced spending than in this country’s appalling record in delivering SABR—stereotactic ablative body radiotherapy—to cancer patients. This is one of the most precise ways of delivering radiotherapy. It is so accurate that it allows tumours to be targeted in a way that was almost impossible 10 years ago, and it can do so without causing harm to healthy tissues.

I went to see one of these machines in operation. I managed to get one of my constituents referred to a unit in St Bartholomew’s hospital. I saw that the machine focuses a beam—in fact, 200 beams—of intense radiation precisely on to the tumour. This is an incredible development in medical technology. It has the added benefit, because of its accuracy, of reducing the number of radiation doses a cancer patient needs from 30 to five. I recall undergoing two courses of radiotherapy like that myself some years ago. That was the standard procedure then; now it is potentially condensed through this advanced form of treatment to five doses. That will be invaluable for older patients. Members have talked about inequalities and how patients over 75 are often unable to access surgery. Perhaps the medical opinion is that they might not stand up to surgery or that conventional radiotherapy might not be an option for them.

SABR is now used to treat 18 different cancers in the United States. Closer to home, in Europe, it is used routinely in countries such as Italy, Belgium and Switzerland. Its use in France is so well developed that in one centre in Lille the SABR machine is treating 500 patients a year, whereas an identical machine in our country treats fewer than 100. It is all to do with the number of staff who are trained to deal with extended operations. I met a member of the Lille team at a conference in London, and he explained to me how they were able to achieve such a tremendous throughput.

A recent international survey of more than 1,000 clinicians in 43 countries revealed that 83% of them were using SABR. Only 34% of our radiotherapy centres in the United Kingdom—and it should be borne in mind that we have 28 cancer networks—have the capability to deliver SABR, and nearly all of them use it only for treating lung cancer.

Five years ago the National Radiotherapy Implementation Group, which consists of some of the best cancer doctors in our country, produced a plan which received extensive support, and which I have raised—not with this Minister, but with her predecessors—during Health questions and Adjournment debates. The plan would allow a wider range of cancer patients in England to be treated with SABR. More importantly, the group recommended that patients should be treated closer to their homes, in centres of excellence. My region, in the north-east, has two cancer centres. Why should your constituents, Madam Deputy Speaker, have to travel from Bristol to London in order to have access to advanced radiotherapy?

Sadly, that report was ignored—before the present Minister took office, I should add. However, the hon. Member for Wells (Tessa Munt), to whom I pay tribute, has been tenacious in raising the issue since I entered the House in 2010, and, following a campaign by the former England rugby captain Lawrence Dallaglio, which lasted for about two years, NHS England was finally persuaded to start putting it right. The “Dallaglio agreement” will allow our country to start treating cancer patients with SABR and to increase the number of cancers that are treated. It will facilitate the development of centres of excellence in the English regions. I certainly hope that we shall have some in the north-east. Those of us who represent constituencies outside London should pay attention to the agreement. We need to ensure that those centres of excellence are created, because they will be able to treat hundreds of cancer patients each year closer to their homes and families, and will have the right technology and staff who are trained to use it.

However, the Dallaglio agreement is just the beginning. We have a long way to go before we can catch up with our European neighbours. In particular, we need to adapt more skilfully to new technologies as they become available. Quicker adaptation does not mean cutting corners with patient safety; other countries appear to be able to use new technology safely, and to be adapting to it much faster than we are. New technology does not have all the answers, but it cannot be a coincidence that countries that adapt speedily to technological advances seem to have much higher cancer survival rates than we do.

This week, Cancer Research UK said that half of us living today will get cancer. The NHS needs to work out how to deal with that. Cancer is one of the biggest health challenges we face in the 21st century and we need to know that in tackling it we are utilising our valuable resources most effectively. The Government should conduct a full and independent review into the matter, particularly if they are going to spend many billions of pounds on cancer drugs as the best way forward, at the expense of adopting rapid advances in technology, especially robotic technology that is making radiotherapy safer, more efficient and better for patients.

I would like to address another important matter: end-of-life care and the need to make improvements for people with cancer. Seventy-three per cent. of cancer patients want to die at home but less than a third are able to do so. The palliative care funding review has pointed to the fact that providing free social care is key to supporting people to die at home. Evidence from Macmillan suggests that savings of £345 million could be made. The right hon. Member for Sutton and Cheam (Paul Burstow) will remember the debates that we had. I think we won the argument, although we lost the vote. I sensed that there was a lot of support for free end-of-life care across all parties. I press the Minister to consider that. The Government previously stated that they saw much merit in such a policy. Does the Minister still see merit in the principle of free social care for people at the end of their lives?

Two further policies are fundamental to improving end-of-life care. The first is the provision of 24/7 community care to ensure that, regardless of what time of day it is, if someone is at the end of their life, they do not have to contact the emergency services to be admitted to A and E. Secondly, there should be better recording of patient preferences at the end of life and better sharing of information between all the services that come into contact with that patient. I support the motion.

NHS Major Incidents

Grahame Morris Excerpts

Wednesday 28th January 2015 Commons Chamber

[Mr Hunt]

My hon. Friend is absolutely right. I have spoken to the chief executive of Northamptonshire county council and I have heard about the excellent integration of services that is now starting to happen between the local authority and the local hospital. That is the way forward. The guidance simply says that trusts must pay attention to the impact on the local health economy before they make a local decision. It is time that Labour stopped playing politics with something that they know is a disgrace.

[Grahame M. Morris (Easington) (Lab)]

Is the Secretary of State satisfied that the new guidance with its 17 criteria, to which my right hon. Friend referred, will not have the effect of making it less likely that NHS hospital trusts in the west midlands or in my region declare an emergency plan?

[Mr Hunt]

Declaring a major incident is the decision of the local hospital trusts, and that is right. But it is important that, before they make that decision, they should take proper account of the impact on the rest of the local health economy. That is what every responsible hospital wants to happen, and that applies to the hon. Gentleman’s area as well as everywhere else.

NHS (Government Spending)

Grahame Morris Excerpts

Wednesday 28th January 2015 Commons Chamber

[Chris Leslie]

I think we got the gist of the intervention. The hon. Member for East Worthing and Shoreham (Tim Loughton) opposed such competition, but I think he voted for it in the Health and Social Care Bill. He has his own demons to worry about on that.

[Grahame M. Morris (Easington) (Lab)]

I, too, served on the Health and Social Care Bill Committee. Does my hon. Friend agree that one of the great problems we face with work force planning, as Government Members have highlighted, is that private sector providers by and large are not training the doctors and the range of staff we need to deliver an integrated health service?

[Chris Leslie]

My hon. Friend is right. That is the crucial difference between those on the two sides of the Chamber: Government Members are not interested in having private or voluntary sector supplements where there is need in the NHS; their agenda is to replace provision across the NHS and to contract out across the board.

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[The Parliamentary Under-Secretary of State for Health (Dr Daniel Poulter)]

I welcome this opportunity to discuss the NHS. In answer to the question from the hon. Member for Nottingham East (Chris Leslie), I reconfirm the Government’s commitment to an NHS free at the point of need and free at the point of delivery. Only with a strong economy can we afford to pay for our NHS.

It would be wrong to open my remarks without commenting on the Labour party’s increasingly regrettable approach of weaponising the NHS. I still work as an NHS hospital doctor. There are a lot of professional politicians on the Opposition Front Bench. In my capacity as a local MP, I have been out on the front line with the East of England ambulance service during night shifts over this busy winter period. Front-line NHS staff do not appreciate the way in which the Labour party is trying to run down our NHS. There are a lot of staff working incredibly hard over this busy winter period and they should be congratulated on the effort and dedication that they put into front-line patient care. I hope that the hon. Member for Nottingham East and the Leader of the Opposition will reflect on that.

As this is an economic motion, it is appropriate in my opening remarks to address the economic situation our country was in when we came into government. We inherited the worst economic record of any new Government since the 1930s. Labour’s record of economic incompetence and profligate spending meant that the annual deficit was £134 billion and that we were paying back £367 million each and every day in debt interest alone. I believe that the hon. Member for Nottingham East was a special adviser who advised on that profligacy and incompetence. Labour left Britain with its largest deficit since the second world war. One pound in every four that was spent by the Government came from borrowing. Labour’s outgoing Chief Secretary to the Treasury, the right hon. Member for Birmingham, Hodge Hill (Mr Byrne), summed it up in his note to his successor with the words, “Good luck. There’s no money left.” There we have it—Labour’s record of economic incompetence. Britain was bankrupted by the last Labour Government, but thanks to our long-term economic plan things have changed for the better and Britain is back on track. There are now 2.16 million more private sector jobs since the coalition came to power, and 2 million more people have started an apprenticeship. The Government are giving more young people a chance in life and the opportunity to take home a pay packet.

[Grahame M. Morris]

May I just point out one of the lessons from history? When the NHS was established after the second world war, the country was tasked with rebuilding and its debt and deficit were considerable. But the Labour politicians of the day had the strength of character and the will to make that investment in the interests of the health of the nation. Should we not do that now?

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[Mr Mark Spencer (Sherwood) (Con)]

It is a pleasure to follow the hon. Member for Islington South and Finsbury (Emily Thornberry).

It is a little sad, to be honest, to be having this debate today, because we could approach this issue in a much more mature way as politicians. Clearly there are enormous challenges facing our health service and our adult social care services, not only for this Government or the next, but for the two Governments after them. As politicians, we owe it to our constituents to have a mature debate about how we are going to avert the demographic time bomb that is heading our way. Frankly, we all have an interest in that. Just like the hon. Member for Nottingham East (Chris Leslie), we are probably going to need those services at some point. I hope I will not find myself in a bed next to him, but we could end up on the same ward.

It is worth saying that every Labour party election leaflet for the last 50 years has said, “You can’t trust the Tories with the NHS.” Yet we have had countless Conservative Governments over that period, and the NHS continues to thrive, to look after people and to offer its services.

[Grahame M. Morris]

The hon. Gentleman is saying that the NHS is safe in Conservative hands, but let me remind him that in 1997, when Labour came to power, there had been 18 years—a considerable length of time—of under-investment. Expenditure on the NHS was increased 300% by the Labour Government: from £30 billion to over £100 billion. Every accident and emergency unit was rebuilt and many hospitals were rebuilt, too.

[Mr Spencer]

That is where the hon. Gentleman’s party falls down. Labour Members obsess about cash and forget about clinical operation. That is why we ended up with crises such as that at Mid Staffs hospital, with people dying in their beds because of bureaucracy, target setting and obsession with process rather than the care of patients.

The Opposition also have an obsession with the private sector. My father had to have a new knee, unfortunately. He went to the local hospital, which happens to be the one that the constituents of the hon. Member for Nottingham East attend. Rather than being treated in the NHS Queen’s medical centre, he was sent to a hospital in Sherwood in his constituency, which looked after him very well. It was a private hospital and this was in 2008—under the previous Government. The NHS was making use of private services back then. It was very efficient and well delivered. I do not understand this obsession with the private sector. We need to remember that private companies make the drugs that the NHS uses; private companies make all the crutches and the ambulances; and GPs are, in effect, private companies. It works very well. As long as we can deliver a service that is free at the point of use and run in the most efficient way but with the highest levels of care and consideration, I think that is the right place to be.

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[Grahame M. Morris]

I am sorry to interrupt the hon. Lady’s flow, but I want to defend the land of my fathers, Wales. I do not know whether the hon. Lady was present for the urgent question. We often measure the stress on the system according to the declaration of emergency and major incident plans. There have been 15 in England but, as far as I am aware, none in Wales.

[Margot James]

I do not want to cast aspersions relating to cover-ups and the like on some of the NHS management in Wales, but I think that some members of the hon. Gentleman’s own party have some salutary tales to tell on that front.

However, as was pointed out by my hon. Friend the Member for Sherwood (Mr Spencer), this is not just about spending; it is about how we control the budget and what we get for the money that we spend. I appeal to those who rate the Labour party on the basis of its health policies to reflect on its record. They should remember how much Labour was borrowing when it was running the NHS, and that it was spending money as though it were going out of fashion.

Under the last Government, the number of managers increased three times as fast as the number of nurses, and managers’ pay increased far faster than nurses’ pay. The management pay bill more than doubled under the last Government, but we have reduced it by nearly a fifth. There was absolutely no integration of health and social care under the last Government, although they had 13 years in which to put that right. Despite severe financial constraints, our record has been so much better than theirs, and that is the position I will put to my electorate when the time comes. We have produced 13,000 more doctors and nurses, and 21,000 fewer administrators and managers. That is what the public want to see. They know that this Government have the right priorities. In my area, that has translated to 353 more nurses and 84 more doctors in my hospital since this Government came to power. I congratulate our health ministerial team on not caving in all the time to producer interests—another facet of the last Government, with their command and control culture.

I want to mention a few of the things I am proud this Government have achieved within severe spending constraints. We have ended the indignity of mixed sex-wards. We have reduced infection rates dramatically. C. difficile infection rates have come down by a staggering 63%. The last Government grappled with this issue for 13 years, leaving a disaster when they left office. They had an appalling record. Another great innovation—one of many; I have not got time to mention them all—is the Cancer Drugs Fund, which has helped many of my constituents to get the treatment they were denied under the last Government, with all their spending largesse. That has also flowed through to the hospital sector—imaging and radiodiagnostic tests have increased by 34%. All these benefits have been achieved with very small real-terms increases in spend. That is what this Government have been able to do: deliver more with less.

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[Grahame M. Morris (Easington) (Lab)]

I am pleased to follow the hon. Member for Dover (Charlie Elphicke). I wish to make it clear that I have chosen to be here in the Chamber today to participate in this important debate rather than attend the Health Committee, which is also considering important matters, because I feel that we need to set out our view of the direction of the health service.

I was very interested in some of the hon. Gentleman’s views about fair funding. Having experienced NHS funding under the Conservatives and Liberal Democrats, I must say that my view is rather different. After the general election in 2010, the funding for a brand-new hospital that would have served my constituency—it was to be funded not through the private finance initiative scheme but by NHS capital—was cancelled by the present Government. It is an absolute disgrace that we still do not have modern facilities to serve my constituents and those of neighbouring constituencies. It prompts us to ask whether fair funding or some kind of gerrymandering is being applied.

The hon. Gentleman was talking about opening urgent treatment centres. That is a revelation to me because the two centres that opened in my constituency under the previous Labour Government are now threatened with closure. We have neither a modern hospital nor modern facilities.

I am proud to say that, although I am not a doctor, I did work in the health service. Like my hon. Friend the Member for Heywood and Middleton (Liz McInnes), I worked in a pathology laboratory, doing some important diagnostic work. I am proud of the people who deliver that service; I think they deserve enormous credit.

The creation of the NHS is Labour’s proudest achievement. More than anything else—more than football or cricket—it is what binds us together as a nation. The principle of a free national health service, which is free at the point of use, has huge popular support among the general public.

When the Prime Minister said that his priorities could be summarised in three letters—NHS—we might have been forgiven for thinking that the Conservatives had been transformed and had come to cherish the NHS as much as the British people do. But, with fewer than 100 days to the general election, it is apparent that his words were nothing more than a smokescreen. It is clear that the Government knew that they could never go into a general election stating their true intentions. Now, we have been accused of weaponising the NHS.

[Charlie Elphicke]

Yes, you have.

[Grahame M. Morris]

I would rather weaponise it than privatise it, which is what I accuse the Government of doing. That would not have been possible without the active support of the Liberal Democrat party—talking of which, the hon. Member for Redcar (Ian Swales) has just taken his place in the Chamber. I feel bitter about what has happened. The hon. Gentleman and I both served on the Health and Social Care Bill, which has now been enacted. The lead advocates were the right hon. Members for Chelmsford (Mr Burns) and for Sutton and Cheam (Paul Burstow). That Act was a really dangerous move, because part 3 opened up our national health service to the full force of competition. Conservatives may say that the difference is only marginal, but the truth is that that Act allows hospital trusts to have up to 49% of their income come from private patients.

I know that we are desperately short of time, but I want to set out some political dividing lines. Labour and the Conservatives are making very different offerings for the NHS. Labour’s offering is that it will provide more nurses and GPs, and I think it will find favour. In the next general election—

[Mr Deputy Speaker (Mr Lindsay Hoyle)]

Order.

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[The Parliamentary Under-Secretary of State for Health (Jane Ellison)]

It is a pleasure to follow the hon. Member for Leicester West (Liz Kendall). In truth, I think we have heard a great deal more consensus about the future of our health services than the Opposition sometimes like to pretend. It has been obvious that Members in all parts of the House care passionately about their local services. They have spoken up clearly on behalf of local staff who are working so hard through this winter. I thank all hon. Members for their contributions.

All Members speaking up for their constituencies are doing so because they care about their local health services. They also accept the challenge that the NHS and the whole health service in England is facing but is collectively rising to meet. Hard-working NHS staff do not need to hear the endless politically driven scaremongering that we hear all too often from Opposition Members. That was highlighted by my hon. Friend the Member for Daventry (Chris Heaton-Harris) and by many colleagues who have come here with scaremongering leaflets from their constituencies saying the very opposite of what is true. Far too much of that is going on. It must be absolutely demoralising for staff who are working hard in the face of winter pressures.

Despite the huge financial pressures we were faced with when we came to office, such as the need to reduce the deficit we inherited, which was, as Members have said, the worst peacetime—

[Grahame M. Morris]

Will the Minister give way?

[Jane Ellison]

I will make some progress; the hon. Gentleman has made a contribution.

Not only has NHS funding in England been protected; it has risen in every year of this Parliament. That is an indisputable fact that flies in the face of the Opposition’s financial scaremongering. As a result of the additional £2 billion funding for 2015-16 the Chancellor announced in the autumn statement, funding in 2015-16 will be £16 billion higher in cash terms than in 2010-11. Those are the facts. That equates to an increase of £6.8 billion in real terms. That additional investment is a down-payment on the NHS’s own plan, which was set out in the “Five Year Forward View”. The chief executive of NHS England, Simon Stevens, has said that the autumn statement gives the NHS what it needs for next year.

Winter is always challenging for the NHS. This year, it comes on top of a significant increase in A and E attendances, which have been higher than in any year since 2010. On average, 3,000 more patients each day are being seen and treated in under four hours than under Labour. As my hon. Friend the Member for Stourbridge (Margot James) set out clearly in going back over the past few years, the additional funding the Government have put in emphasises the priority we place on the NHS. That makes utter nonsense of the claim that we are going back to 1930s levels of funding. That is ludicrous, and Opposition Members parroting that because they have been told to insults the intelligence of every Member of the House. It is nonsense.

A and E (Major Incidents)

Grahame Morris Excerpts

Wednesday 7th January 2015 Commons Chamber

[Mr Hunt]

When we did the autumn statement last year, we asked Simon Stevens and NHS England how much they needed for their plan next year and they told us it was about £2 billion, so we made that commitment. We also said that that was a down payment on delivering the entire plan, not a one-off payment. I agree about the importance of long-term certainty over funding, but the most important thing in that regard is to have a strong economy that can deliver the money that will support our NHS. It is only Government Members who have shown that they are capable of delivering that strong economy rather than the instability that would come from disastrous economic policies.

[Grahame M. Morris (Easington) (Lab)]

The Secretary of State and Prime Minister accuse the Labour party of using the NHS as a political football and as a weapon. May I advise the Secretary of State that the NHS is a weapon—a very powerful one—for the treatment of illness and the relief of disease and suffering, and that it is being blunted by this Government and his Department under his stewardship? I met the chief executive of City Hospitals Sunderland NHS Foundation Trust about the NHS crisis and the A and E crisis, and one of the problems he identified was the lack of sufficient staff and the need to recruit locums. What is the Secretary of State doing about recruiting more staff and how many vacancies are being carried?

[Mr Hunt]

I agree that we need more staff, but the hon. Gentleman should welcome the fact that under this Government there are 9,000 more doctors and 3,000 more nurses. Such an increase was made possible by a reorganisation that took money away from bureaucracy and management and put it on to the front line. What is wrong is for the Leader of the Opposition to say that he wants to weaponise the NHS—turn it into a political weapon. The NHS is not a political weapon; it is there for patients. Labour should be ashamed of trying to turn it into a political football.

Late Stage Hepatitis C

Grahame Morris Excerpts

Tuesday 6th January 2015 Westminster Hall

[Stephen Pound]

I profoundly endorse my hon. Friend’s comments and I very much hope that what he refers to will be the outcome. It is a cruel irony if one presents at a hospital in search of good health, and ends up iller than when one went in. I certainly will refer to that later.

One of the highest levels of hepatitis C infection in this country is from injecting drugs. That is part of the stereotype, and it is the case that 49% of identified hepatitis C cases in England, 34% in Northern Ireland and 33% in Wales are from that source. There are significant public health risks of further transmission if hepatitis C is left untreated. This is the astonishing and terrifying aspect of hepatitis C, and if we achieve nothing else today, we can at least ventilate the issue and, I hope, bring it to the attention of a few more people in the country. Hepatitis C is one of the most sinister blood-borne diseases, in that it in effect lies dormant for 20 to 30 years in the blood. A person who lived a fairly rackety life in the 1960s may have no idea that they have been infected with hepatitis C. It may present itself 30 years later, when the symptoms of lassitude, fatigue, inexplicable tiredness lead the individual to go and see their medical practitioner; and it is a simple blood test—it does not require anything other than a spot of blood on a piece of paper—that reveals it. The sinister, long-standing, dormant nature of hepatitis C is something to which I wish to refer.

[Grahame M. Morris (Easington) (Lab)]

I congratulate my hon. Friend on securing an important debate. Does he agree that one problem that we face in tackling hepatitis C—he has outlined the scale of the problem; more than 200,000 people suffer from it—is the mixed messages coming from the Department of Health and, in particular, the information provided in an earlier debate in this Chamber by the Under-Secretary of State for Health, the hon. Member for Central Suffolk and North Ipswich (Dr Poulter), who said that hepatitis C is not curable when in fact, with appropriate treatments, the cure rates are between 80% and 95%?

[Mr James Gray (in the Chair)]

Order. One must be brief in a half-hour debate.

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[Stephen Pound]

I enthusiastically endorse the approach of the Welsh Assembly Government on the matter, and their efforts have been widely respected and appreciated. One of the things that I seek today is precisely such an overarching, UK-wide strategy. It is important to note that the United Kingdom is the only country in Europe that is showing an increase in liver disease. All the statistics indicate that cases of liver disease, particularly hepatitis C, will continue to increase until they peak in about 2030. It is hoped that in 2030 they will tail off, partly because if we backtrack 20 or 30 years to the turn of the century, people had a bit more knowledge and understanding. One hopes that debates such as this will extend that knowledge and information outwards.

[Grahame M. Morris]

On that point, I completely agree that we need an overarching national plan and strategy as in Wales and Scotland, but is there not an obligation on the health and wellbeing boards, as part of their joint strategic needs assessment? In my region, my constituency has the highest incidence of hepatitis C, which is often associated with high levels of poverty and deprivation, but less than half of the health and wellbeing boards in our region identify it as any sort of priority.

[Stephen Pound]

I knew my hon. Friend’s predecessor very well, and we discussed the matter at the time of my Bill on presumed consent. I entirely endorse my hon. Friend’s comments about the health issues that affect his constituency, and I will come to precisely that point later when I refer to clinical commissioning groups.

On the question of how lethal hepatitis C is, there are a range of brand new therapies, many of which are moving rapidly through the health system. Treatments such as daclatasvir and sofosbuvir provide shorter courses of orally administered treatment with fewer side effects than previous treatments. Traditionally, people with hepatitis C have tended to be given treatments such as interferon or ribavarin, which are partly injected intramuscularly and partly oral, and which have some pretty horrific side effects. I made it my business to go and speak to the practice nurse at the hospital across the river who deals with such cases and supervises the courses of treatment. I heard the rather chilling comment that the side effects of interferon included not only nausea, dizziness, sickness and fatigue but nightmares, depression and occasionally suicide.

We have moved on a great deal, and we are no longer talking about purely an interferon or ribavarin treatment. Modern treatments do not cause the awful problems of anaemia and skin reactions that the older treatments did. I give credit to companies such as Bristol-Myers Squibb and others that have undertaken groundbreaking work in the area. Treatment used to take 48 weeks, and it is incredibly difficult to work or even simply to endure while receiving the treatment. The treatment cycle for the new treatments lasts 12 to 14 weeks, which is quite incredible and much more attainable. We reckon that 10% of people who are HIV-positive also have hepatitis C, and the new course of treatment is particularly effective in those cases. Patients will almost certainly continue their course of treatment if it is shorter and less painful. I do not have time to go fully into the economic benefits of somebody being able to remain economically active while they have hepatitis C, but under the new treatments, there is absolutely no reason why a person should not continue in employment, providing a useful function and benefiting the state.

The real difficulty is late diagnosis. The benefits of early diagnosis to the NHS and to the patient are self-evident. If patients do not receive early treatment, we can see the occurrence of cirrhosis, liver cancer and even the need for transplants. If we could only address the issue of early diagnosis, it would be not only cost-effective but good for the humanity of the individual. That is one of the reasons why I am particularly pressing for early diagnosis.

I have mentioned hepatitis A, B and C, and within each of those are genotypes that have different characteristics. There tend to be four different genotypes within hepatitis C, which are known as 1, 2, 3 and 4. Genotype 1 is typically associated with intravenous drug users, and my hon. Friend the Member for Ealing, Southall referred at great length and with considerable knowledge to genotype 3 at the recent launch of the programme of treatment for the south Asian community. Bizarrely, genotype 1, which was supposed to be the hardest to treat, has turned out to be one of the easier to treat. However, genotype 3, of which the opposite was the impression, is becoming extremely hard to treat. That is one of the reasons why “The Challenge of Hepatitis C for the South Asian Community” is all the more important. One way to deal with hepatitis C is to wait until the symptoms present, but the symptoms are very difficult, because there is no typical symptom of someone who has liver disease. Most commonly, the symptoms will be things such as lassitude and fatigue, but there can be numerous other factors.

I have mentioned the hepatitis strategy in Scotland. The effect of that strategy has been to improve access to treatment from 10% to 20% through better integration among health care providers. Of course, I understand that there is a smaller population in Scotland. People often talk about the situation in the Republic of Ireland, which has a very good identification programme. The reason for that is that there is only one place in the entire Republic of Ireland where someone can get the test, which happens to be in the Dublin health district, so all the data are gathered in one place. In GB, the United Kingdom and England there are a multiplicity of areas, so it is harder to get hold of and keep such data.

That brings us to the hepatitis framework document. I am reluctant to criticise the Minister, even tangentially, because she is a good person. However, the document is a little bit overdue. I think we were promised it at the beginning of the year. I blame no one for that; the Government have other matters to deal with, and I know the Minister has been working extremely hard. I do not think anyone would disagree, however, that we are due that document.

There are a number of questions that I would like to raise as we flesh out the shape of that document. What exactly is the timetable for its presentation and implementation? Will there be targets in it? The previous documents have not contained targets. What about the role of the clinical commissioning groups? When the document was first mooted, CCGs were not the powerful agency they are now. There will be no point in having some sort of strategy if we do not address the questions of funding streams and co-commissioning. That will almost certainly happen, and we need to know where we are. We cannot revert to a situation whereby a particular area provides a particular course of treatment that is denied to someone in another area.

Who will be involved with the document? Perhaps it is an illness of politicians that we often take refuge in strategy when implementation becomes too difficult, but a working party can be a useful thing. As part of the Government’s strategy, will they consider the establishment of a working party, which might include the Association of the British Pharmaceutical Industry, Professor Graham Foster from Queen Mary, university of London—the pre-eminent diagnostician in the area—patients’ groups and the Hepatitis C Trust? I mentioned Bristol-Myers Squibb earlier, and I have no financial or other interests in the company, but I admire people who can produce good, life-saving products and I think that such people should be involved.

We need to have a strategy. I would like to suggest that, first of all, the strategy should improve outcomes for people with hepatitis C. That may seem obvious, but let us get it down on the record. We should improve the prevention strategy. We need to tell people that if they get a tattoo in Thailand, it is not enough that the needle and the syringe are clean if the bowl of ink is not. That happens to people. I will keep my shirt and jacket on, but if I did not, Members would see a large number of tattoos up and down my arms that were mostly inflicted on me in Hong Kong in the ’60s. At that time we did not consider the sterile nature of tattoos. People nowadays should be savvier, wiser and more aware, but we need to tell them.

Above all, we need early diagnosis and prompt treatment, which will not only save lives and money but improve the health of the nation. It will improve on an individual, collective and community basis. We have an opportunity, because there is a coming together of a whole range of different streams: advances in medical science, the recognition of the scale of the problem and the possibility of a solution. We are also in a fortunate position because the Minister is extremely sympathetic to this issue.

--- Later in debate ---

[Jane Ellison]

I cannot take an intervention on that point because I must deal with the rest of the debate.

On presumed consent, within the past year we have had two good, thorough debates in this Chamber on issues of organ donation and consent. It is a very interesting area of discussion. I am watching the Welsh experience with interest; I do not dismiss it, but it is very complex. I would be happy to debate it at any time with any Member because it is a topic to which I have given quite a lot of thought and consideration.

I pay tribute to the Hepatitis C Trust for its work. More recently, I have met the Hepatitis C Coalition, which has impressed on me with great force some of the issues that it wishes to see addressed—issues that were picked up by the hon. Member for Ealing North.

The NICE appraisal of the first of the new hep C therapies is due very soon, so this debate is timely. Understandably a lot of the focus is on the new therapies, but focus on prevention runs right through the NHS long-term strategy. That is highly relevant because if people are to be treated with good, new and expensive therapies, it is important to address issues such as re-infection rates and good public health prevention. Members should be in no doubt about the Government’s commitment, which I suspect would be shared by any Government, to reducing the big killers—the main reasons for premature mortality in our country—one of which is liver disease. We cannot tackle the big killers if we are not tackling hepatitis C. We are clear that the contribution that tackling hepatitis C can make to reducing current rates of end-stage liver disease is an important part of any premature mortality strategy.

[Grahame M. Morris]

Will the Minister take this opportunity to put on record the fact that hepatitis C is indeed curable and clear up any misunderstandings inadvertently created by her predecessor?

[Jane Ellison]

I have read the transcript of the previous debate and dealt with some of the issues subsequently raised in correspondence, so there is no need to go over that again. I am well aware of the issue.

The single biggest risk group for hepatitis C is people who inject drugs, or have done so in the past. Public Health England estimates that such people comprise about 90% of all those infected in England. There are also high rates of hepatitis C among the prison population, which presents significant challenges for the NHS, particularly in terms of re-infection and changing risky behaviours. We obviously need to prioritise making the best possible treatment available to people who are suffering the worst ill health. From a public health perspective, the starting point must be prevention. Some of the new treatments will clearly be focused on people who are the most ill. Although it is right to focus on the exciting opportunities offered by new drugs and treatments, we must not lose sight of the fact that we have to make sustained progress on reducing infection in the first place. I therefore welcome the emphasis on prevention in NHS England’s five-year forward view.

Public Health England has been working with drug treatment services to improve health promotion resources for injecting drug users and those sharing needles, and to increase coverage of opiate substitution therapies and needle syringe exchange programmes. Joined-up drug treatment services commissioned by local authorities are important. We are very conscious of the need to raise the priority of hep C in local authorities and their joint strategic needs assessments—I note that it is mentioned in Ealing’s, but it is not mentioned by some authorities that face a significant challenge. That is one reason why, early this year, I will host a joint hepatitis C and tuberculosis summit with elected members from those local authorities with the highest rates of both diseases in England. The aim of the summit will be to explore how we can bring together different parts of local health systems with local authorities to control TB and hepatitis C rates in particular communities. Distinctly different communities are affected and need distinctly different approaches to tackling the problem.

As the hon. Member for Ealing North said, NHS England and Public Health England are working together on a framework. I apologise that it has been delayed, but it is due to be published this year and I will use this debate as an opportunity for another discussion about the timetable. Nevertheless, those bodies are working together very carefully on the framework, which will set high-level aims for the public health system towards the elimination of hepatitis C-related liver disease as a public health issue, with specific, time-bound objectives that feed into the overarching plan. I think that that deals with one of the issues raised earlier.

Clearly, the framework must have key targets, involve clinical commissioning groups and address co-commissioning. PHE has been working with a range of local partners—such as GPs, CCGs and NHS commissioning—to look at the rates of testing, diagnosis and treatment for people at risk of hepatitis C. That will be a core part of the framework. I will pick up the issue and write to Members when I have more detail on when we are going to publish the framework, but it will be very thorough, which is why it is taking a little longer to finalise.

In recent years, the Hepatitis C Trust has played an important role in piloting innovative ways of increasing testing rates through the use of a mobile testing van and pharmacy-based testing. We always underestimate what can be done in pharmacies, but I am very keen to make far more of what we can deliver through them. It is important that people can access early diagnosis. Those accessing drug treatment services should routinely be tested for hepatitis C, as recommended in NICE guidance. I welcome data from PHE that show increasing rates of testing. Nevertheless, we clearly must do more to ensure high levels of professional awareness about that.

PHE has also been working with NHS England and other commissioners to look more generally at how best to commission to meet the needs of patients with hepatitis C. For example, its work has included issuing extremely informative liver profiles to each local authority area, including information about hepatitis C. Every single local authority in England was sent the liver profile for its area, in the hope that that would provide the basis on which services could be planned. I urge Members to look at those profiles, and if any Member has not seen the one for their area, I would be happy to supply it.

Time is very much against me and I have not really had the chance to discuss the new therapies. We are very conscious of the potential that they offer, but I must also put on record the fact that there are existing therapies. They come with great challenges, as the hon. Member for Ealing North outlined, and they are also more difficult for people who struggle to access health care and keep to regular therapy programmes. We see great potential in some of the new therapies, but careful thought must be given to how they are delivered to patients. More than 700 patients have already been treated through the policy on access to new therapies for patients with liver failure, which has cost about £38 million, with specialist centres established to deliver early access around the country.

I am afraid that time has beaten me, as I thought it might given the interest in this subject, but I hope that I have given hon. Members the sense that we have real momentum, with the summit and the plan to come. I will write to them with further detail.

Oral Answers to Questions

Grahame Morris Excerpts

Tuesday 25th November 2014 Commons Chamber

[Grahame M. Morris (Easington) (Lab)]

3. What representations he has received on exemption of the NHS from the provisions of the transatlantic trade and investment partnership.

[The Secretary of State for Health (Mr Jeremy Hunt)]

The Government will not allow TTIP negotiations to harm the NHS. Any suggestion to the contrary is both irresponsible and false. I am grateful to the former Labour shadow Health Secretary for confirming that.

[Grahame M. Morris]

That is an interesting answer but, without specific exemption from TTIP, how can the Secretary of State give any reassurance that predatory organisations such as the Hospital Corporation of America, which was prosecuted for fraud in the US, will not use the TTIP provisions to seek contracts in our NHS?

[Mr Hunt]

The best assurance I can give the hon. Gentleman is not what I have said, but what the EU Trade Commissioner, Karel De Gucht—I challenge colleagues in Hansard to spell that correctly without looking at my notes—has said. In an interview in September, he said:

“Public services are always exempted—”

from TTIP—

“there is no problem about exemption. The argument is abused in your country for political reasons but it has no grounds.”

National Health Service (Amended Duties and Powers) Bill

Grahame Morris Excerpts

Friday 21st November 2014 Commons Chamber

[Grahame M. Morris (Easington) (Lab)]

I congratulate my hon. Friend on introducing this Bill. Does he agree that the Liberal Democrats have got a brass neck in making criticisms, given that not only did they sit on their hands during that Bill Committee, but the right hon. Member for Sutton and Cheam (Paul Burstow) was the prime advocate who led the Bill during its passage through Parliament?

[Clive Efford]

And then led a campaign to stop his local accident and emergency department closing, having done that for the Government.

--- Later in debate ---

[Sir Tony Baldry]

My hon. and learned Friend makes a very good point. There is confusion about whether we have got new Labour or old Labour. The Labour party has to set out how it would undo the market it created without further top-down reorganisation. It could not do it simply by removing the health rules that manage it. There has been no change on when to tender competitively; the rules on procurement are the same as those used by the previous Government. The Act makes it clear that the Secretary of State remains politically accountable to the NHS. The changes in the Bill would restrict the greater autonomy given to the NHS and inhibit staff from making the innovative changes needed to secure sustainable, high-quality care for patients. In particular, it would tie the hands of clinical leaders on CCGs, which the NHS England five-year forward view says should have more powers, not fewer.

[Grahame M. Morris]

The right hon. Gentleman is engaging in a lengthy filibuster, in my opinion. I served on the Committee for the 2012 Act, and a plethora of organisations pointed out during the passage of that Bill the folly of what the Government were doing. They introduced a lengthy Bill; we spent 40 sittings in Committee; they tabled more than 1,000 amendments to their own Bill; it had 20 different sections; part 3 introduced Monitor. To suggest to the House that that Act introduced no change to the system operated under Labour is—well, it is not disingenuous, but it is not correct. I am not sure what term is best to use.

[Sir Tony Baldry]

During the passage of that Bill, the Labour party and certain organisations, including some trade unions, sought to rewrite history. Interestingly, when Labour introduced things such as the independent treatment centres, the Darzi centres and the 2002 concordat, the trade unions that rallied to support the hon. Gentleman in Committee were totally silent. I do not think it lies in the mouth of those organisations, which did not complain when the Labour party introduced a partnership and a concordat with the independent and voluntary sector when it was in government, now to complain, simply because it is the Conservative party in a coalition Government, that we are somehow “privatising” the NHS. It is simply not true.

--- Later in debate ---

[John Healey]

We on the Labour Benches cannot wait for the debate on the NHS to be put right at the heart of the next five months of policy and political debate, and my right hon. Friend the shadow Secretary of State will make sure that happens.

Let me return to my point about the way that we in this House were misled about the reorganisation and the legislation. I am disappointed to see that the man who led it, the right hon. Member for South Cambridgeshire (Mr Lansley), is not in the Chamber today to explain himself. He argued—it was completely wrong, but he argued it—in the debate on Second Reading in January 2011:

“It is about gearing the entire system towards supporting the relationship between doctor and patient”.—[Official Report, 31 January 2011; Vol. 522, c. 617.]

Of course, it was not and it is not. As I argued, at the time from the Opposition Front Bench:

“The reorganisation and legislation is designed to break up the NHS, to open up all areas of the NHS to private health companies, to remove requirements for proper openness, scrutiny and accountability to the public and to Parliament, and make the NHS subject to both UK and European competition law.”—[Official Report, 16 March 2011; Vol. 525, c. 378.]

The Government were and are driving free market political ideology through the heart of our NHS.

The arguments that those of us on the Opposition Benches made then are those that we make now, and that my right hon. Friend the Member for Leigh (Andy Burnham) makes especially strongly from our Front Bench. That is why the Bill that my hon. Friend the Member for Eltham (Clive Efford) has introduced is so essential and why I am so pleased and proud to be one of his sponsors.

[Grahame M. Morris]

My right hon. Friend made some powerful points when the Health and Social Care Act 2012 was going through Parliament, when Tory Members were denying the purpose of the legislation. He quoted the last Health Secretary, but the current Health Secretary, the right hon. Member for South West Surrey (Mr Hunt), said in a book:

“Our ambition should be to break down the barriers between private and public health provision, in effect denationalising the provision of healthcare in Britain”.

What could be a more succinct and clear expression of their intentions?

[John Healey]

My hon. Friend has been a strong champion of the NHS and followed this issue from day one of this Parliament. To answer directly his question of what could be more succinct and clear, I suspect that when we hear from the new Member for UKIP, the hon. Member for Rochester and Strood (Mark Reckless) or his colleague, the hon. Member for Clacton (Douglas Carswell)—given some of the things that they have argued should be the basis of the NHS in future—they will make the vision of the right hon. Member for South West Surrey look positively UKIP-lite.

This Bill is essential because it starts to correct the three fundamental flaws, brought about by the reorganisation legislation, that are now driving the NHS. We could call them the three Cs—cost, complexity and competition.

On cost, the scale of the reorganisation was simply huge. As the chief executive of the NHS said at the time, it was

“beyond anything that anybody from the public or private sector has witnessed”.

The cost of the waste has been huge. We reckoned beforehand that it was about £2 billion; we now reckon £3 billion. What is clear is that getting on for £1 billion has been paid out in redundancies, much of which was to staff who were paid off and then re-hired by our NHS.

--- Later in debate ---

[Mark Reckless]

Indeed, I am proud, and many people in my constituency have moved down from Eltham and the surrounding areas, and I am delighted that they returned me to the House in the early hours of this morning.

I found the hon. Gentleman’s speech compelling. At half-past 4 this morning or thereabouts, I was extolling the virtues of the Levellers and the Chartists. I can only think that I had a premonition of the speech that the hon. Gentleman was to make in the House this morning.

The other reason for my presence here is that, in the by-election I have just fought, we had in Naushabah Khan a Labour candidate who made—quite eloquently, I thought —the case against fragmentation and privatisation of the NHS, and she and others in Medway Labour commended the Bill to me.

[Grahame M. Morris]

I was not in Rochester last night. I joined a vigil outside Parliament by groups who are campaigning to save our NHS, and I had a conversation with a consultant oncologist on that very issue of fragmentation. He said that the only competition we should have in the NHS is the competition to defeat disease. Does the hon. Gentleman agree with that?

[Mark Reckless]

That sounds a good statement. I myself feel a certain degree of scepticism, as the hon. Member for Southport (John Pugh) said, about internal markets in the NHS and other public services. Much depends on the circumstances of the service provided, and an ideological predisposition either against or in favour of internal markets is probably not wise.

The Labour candidate in the by-election opposed fragmentation and privatisation of the NHS, and the Bill appears to do so as well. I have discovered that this is now the Labour party’s position. I had assumed that the Labour party was in favour of fragmentation and privatisation in the NHS, because that was my understanding of what the record had been.

--- Later in debate ---

[Dr Poulter]

I will come on later to the costs that the hon. Gentleman’s Bill would directly create. The point is that we should be proud—the Labour party should be supporting the Government—that we are reducing administration and bureaucratic costs, because that money is now being spent on patients. Why cannot Labour for once accept that a good thing has happened and that more money is now going into front-line patient care?

The second effect of the 2012 Act is that it empowered local doctors and nurses, as those closest to and most able to determine the needs of their patients, to design and lead the delivery of services around the needs of those patients. Thirdly, the Act placed great importance on and sought to drive increased integration across our NHS, a point clearly articulated by my hon. Friend the Member for Bosworth (David Tredinnick). Commissioners had duties placed on them by the Act to consider how services could be provided in a more integrated way, and we have since built on the Act by supporting a number of integration pioneer sites, which will trail-blaze new ideas to bring care closer together, particularly for frail elderly people and people with complex care needs. They will be leaders of change—a change we have to see in the health system, if we want to offer the very best quality of care to patients.

We are also supporting the health and care system through the £5.3 billion better care fund, with commissioners working in partnership with local authorities to deliver more integrated person-centred care. Offering seven-day services and delivering care that is centred on patients’ needs will encourage organisations to act earlier to prevent people from reaching crisis point. That is the sort of clinical leadership that the Act has fostered. It will refocus the point of care towards more proactive community-based care, for the benefit of so many patients.

[Grahame M. Morris]

The Minister is defending fragmentation, but may I, as a former member of the Health Committee, remind him that Sir David Nicholson, the former chief exec of the NHS, summed up the situation last year by saying:

“You’ve got competition lawyers all over the place, causing enormous difficulty. We are getting, in my view, bogged down in a morass of competition law which is causing significant cost in the system”.

Is the Minister saying that the chief exec is wrong in his assessment?

Physical Inactivity (Public Health)

Grahame Morris Excerpts

Tuesday 18th November 2014 Westminster Hall

[Grahame M. Morris (Easington) (Lab)]

I also congratulate my hon. Friend the Member for Blaenau Gwent (Nick Smith) on securing this debate, and I congratulate the Backbench Business Committee on allocating time for a subject whose importance is increasingly being recognised. The Select Committee on Health, of which my good and hon. Friend the Member for Worsley and Eccles South (Barbara Keeley) and I are members, will be holding an inquiry on the impact of physical activity and diet on health, so this is a timely debate. I am sure that the evidence compiled by the Select Committee will be brought to the Minister’s attention, and that appropriate action will be taken.

Many hon. Members who have contributed to the debate have covered the general subject areas, so in the interests of brevity I do not intend to repeat the statistics, but I will mention some specific issues that affect my constituency of Easington, County Durham in the north-east of England. The figures on physical inactivity quoted by hon. Members earlier in the debate are even higher in my region. Some 32% of people in County Durham are classed as physically inactive, and all the projections indicate that the problem will get worse. Higher degrees of inactivity are predicted by 2030.

International comparisons show that our levels of inactivity are twice those in Germany and France. I thought we would be rather more active than the United States, but our levels of inactivity are 20% higher. It is generally recognised that physical inactivity is a considerable public health problem. The numbers of people who are likely to suffer as a consequence of physical inactivity were identified earlier in the debate. It has been suggested that physical activity can help to combat, or at least delay the onset of, conditions such as heart disease, type 2 diabetes, obesity and even dementia.

The costs are not just for the individual; there are also costs for communities and our economy. There are various estimates of the cost to the UK economy, and I have seen a figure of £20 billion a year, so there are direct costs associated with the health issues. My hon. Friend said that £9 billion a year is spent on costs associated with treating type 2 diabetes, but many other health issues are also caused by inactivity. There are also indirect costs such as, for example, lost days of work and low productivity. Employers need to take note. Some 16 million working days are lost every year due to obesity-related illnesses, so improving workplace health could have an immense impact on individual businesses and the economy. It is in everyone’s interests to address physical inactivity.

There have been some welcome improvements, and hon. Members have mentioned local authorities that are trying to prioritise physical activity, but local authorities are facing considerable pressures as a consequence of cuts in central Government funding, which have inevitably had an impact on their ability to deliver activities and opportunities to engage in physical activity. My local authority, Durham county council, is one of the hardest hit, and such authorities face some of the greatest challenges in relation to physical inactivity. Such authorities have seen the deepest cuts to their overall budgets. Indeed, 13 of the 15 local authorities with the most inactive populations are located in areas that are considered most deprived or more deprived. Despite facing huge challenges, particularly public health challenges, Durham county council has had to implement £135 million of cuts in three years, with another £44 million of cuts in the pipeline.

[Mr Mike Weir (in the Chair)]

Order. Time is up, I am afraid.

--- Later in debate ---

[Luciana Berger (Liverpool, Wavertree) (Lab/Co-op)]

It is a pleasure to serve under your chairmanship again, Mr Weir. I congratulate my hon. Friend the Member for Blaenau Gwent (Nick Smith) on securing this debate and all colleagues across the House who supported the application for it. We have heard some important contributions by hon. Members from all parties.

I should like to take this opportunity to thank the many organisations that are doing an important job to get Britain moving—hon. Members mentioned many of them—including ukactive, Sustrans and StreetGames. I had the pleasure of joining Living Streets on a walk to work back in May, to celebrate national walking month and the benefits of walking to work, so I have seen first hand the fantastic work that it does. I also thank my hon. Friend for mentioning pedometers. Many hon. Members measure their steps on a daily basis. I am just on 2,000 already today and on my way to securing my 10,000 a day.

I share hon. Members’ concerns about the place of physical activity in our society. Just a few generations ago, physical activity was an integral part of daily life, yet today it is becoming ever less a part of our daily routines. The opportunity to move and be active in modern life has declined dramatically: advances in technology mentioned by hon. Members, the rise in passive entertainment options, community safety concerns, roads that are not safe for pedestrians and cyclists, and limited playgrounds and green spaces are just a few of the reasons why.

We have heard the statistics, but they are worth reiterating. In some parts of the UK, more than 40% of the adult population is classed as inactive and a quarter of all adults in England are failing to do enough physical activity to benefit their health. Nearly half of all 11 to 25-year-olds in England—more than 4.5 million individuals —fail to achieve the chief medical officer’s recommended levels of physical activity. This is deeply concerning. Our nation’s children and young people are not getting the activity that they need to stay strong, fit, healthy and happy, which is something that will inevitably affect them in later life.

As we heard, insufficient levels of physical activity are estimated to cost more than £7.5 billion nationally. Other figures have also been mentioned. That sum is broken down to just over £1 billion in the NHS, £5.5 billion in lost productivity and £1 billion in premature mortality among the working-age population. My hon. Friend the Member for Easington (Grahame M. Morris) also mentioned the staggering 16 million days lost in the workplace, which we must be concerned about and take action on.

More than 1 million children are classed as obese and a third of children leaving primary school are classed as obese or overweight. We know that the status quo is not working. If we are to make the NHS financially sustainable in the 21st century, it follows that we need to have the most ambitious plans for physical activity, to contend with those lifestyle diseases that the NHS is increasingly responding to.

We know that physical activity is the simplest and cheapest route to good health and staying well. Moving from inactivity to activity is one of the easiest first lifestyle changes to make. This has been looked at academically and found to be easier than altering diet, stopping smoking or reducing drinking—and it can cost next to nothing, too. However, the issue is about more than health; it is also about people fulfilling their potential and making the maximum contribution. We know that children who are more active are more likely to achieve better exam results and earn more throughout their lives. I echo the concerns of my hon. Friend the Member for Blaenau Gwent about lower levels of physical activity in more deprived communities. I should be keen to hear the Minister respond to that issue.

Put simply, physical activity and sport builds strong people and strong communities. Yet for an activity that brings such universal health benefits, there seems to be very little centrally driven support for its promotion. We have neither a way of accurately measuring the physical activity people take, nor consistent messages about what level of physical activity people should be taking. Until recently, the guideline for adults was for them to take 30 minutes or more of physical activity of moderate intensity on at least five days a week. That is a minimum of two and a half hours of physical activity per week.

In 2008, the health survey for England measured physical activity among adults by means of a questionnaire. Some 39% of men and 29% of women reported that they met the recommended minimum level of physical activity. However, when accelerometers were used on a group to measure their physical activity objectively, the real percentages were actually 6% and 4%. That was complex enough, but to make things more challenging, in 2011 new guidelines were produced by the UK’s four chief medical officers that are particularly complex—I shall not read them out; I struggle to understand exactly what the recommendations are.

There are other issues to consider, too. The active people survey does not actually measure activity and does not include recreational walking or recreational cycling. We no longer even have a way of measuring children’s participation in school sport, because the school sports survey, which measured the proportion of pupils receiving two hours of curriculum PE and the proportion participating in at least three hours of “high quality” PE a week, was scrapped in 2010. So, too, were the regulations that previously tracked schools’ travel patterns. Will the Minister share with us any plans to clarify this confusing picture and introduce a more consistent way of measuring physical activity? Are there any plans to reintroduce the school sports survey and school travel survey?

Again I share concerns raised by hon. Members about the Olympic legacy in our country, despite the huge progress made under the previous Labour Government. In 2002, just 25% of children undertook two hours of PE and sport in school, but by the end of the previous Labour’s Government time in office this had been raised to 93%. The previous Labour Government also created 422 school sports partnerships and 2,300 school sport co-ordinators, covering every school. It was my right hon. Friend the Member for Kirkcaldy and Cowdenbeath (Mr Brown) who promised a “golden decade of sport”, kicked off by the Olympics and Paralympics in 2012. Yet a series of decisions has meant that these ambitions have not quite been realised under this Government.

The school sport partnerships—the local networks of schools and PE teachers—which had quietly been achieving notable success in getting students across England to be more physically active during school hours, have been abandoned; playing fields in some areas have been sold off; and school sport targets have been removed. We heard earlier this month that the borough that hosted the Olympic games is the least physically active in England.

[Grahame M. Morris]

Will my hon. Friend acknowledge the impact that cuts in local government have had, particularly on youth services? In national youth week last week, a number of youth clubs, including in Peterlee in my area, were reporting that they may have to close because of funding cuts.

[Luciana Berger]

I will move on to that point in a second. I was interested in the remarks made by the hon. Member for North Swindon (Justin Tomlinson). I have seen first hand some young people in my constituency who have taken part in the national citizen service, but that is just a few young people. At the same time, throughout the country, we have seen devastating cuts to our youth services. I want all young people to have access to good services. In a moment, I will mention my concerns about local authority cuts.

I should be interested in hearing from the Minister what work the Government are doing to mobilise all the different sectors, industries and organisations that have a role in getting Britain moving. My hon. Friend the Member for Easington mentioned people with dementia. We need particularly to pay more attention to and focus more on older people.

I am keen to hear what the Government are doing to encourage councils, which have the delivery system, to open up their parks, improve access to leisure centres and swimming pools, and make walking, running and cycling a key consideration of developments. However, I echo the concerns of my hon. Friend the Member for Easington about cuts sustained by local authorities throughout the country. My own area in Liverpool has had its budget cut by 56% and it is struggling to do all those things well.

We know that small adjustments to workplaces can make active travel or exercise before or after work a much more realistic option. What work are the Government doing with employers so that workplaces can become more physical activity-friendly? I have asked a number of questions about the health at work programme, and I was disappointed to learn from a parliamentary question that no records are being kept of the number of businesses that are becoming good health at work employers. That is a key issue, which needs more attention and resource directed towards it.

What work are the Government doing with sport governing bodies to ensure that the great success we have enjoyed at the elite level is matched with the same success at grass-roots level? I, for one, enjoyed taking part earlier this year in the “Back to Netball” programme, and I would like to hear about more projects like that that the Government are encouraging across the country—not only for young people, but for adults.

There is a particular concern and challenge around young people at college or university and the differing costs of accessing physical activity and organised sport in places of higher and tertiary education. In the absence of school sport partnerships and compulsory minimum numbers of hours of physical education in schools, how will the Government ensure that sport and activity are a feature of every school, with quality sports coaching and provision in all schools?

I echo the concerns raised by my hon. Friend the Member for Worsley and Eccles South (Barbara Keeley) and the hon. Member for Romsey and Southampton North (Caroline Nokes) about female participation in sport and physical activity. We know that there is a gap between the number of men and the number of women who take part, and I would be keen to hear from the Minister what the Government are doing in that area. Finally, what action are the Government taking to promote active travel and create environments where people are more likely to walk or cycle for short journeys?

With the right support and direction from Government, getting Britain moving is a single, simple, positive goal that the whole country can get behind—a goal that has the potential to shift our national culture. The issue is not about finger-wagging or telling people they cannot do something they enjoy; it is about promoting a positive activity that people can feel good about and an affordable route to good health and well-being for the whole population. It is the most cost-effective way of making our public services and our NHS sustainable now and in the future.

Care Workers

Grahame Morris Excerpts

Wednesday 5th November 2014 Westminster Hall

[Mr Smith]

Yes, indeed. The hon. Gentleman makes a good point, and I will say more about that later. Of course, there will be massive increased need for these workers in the future. One reason recruitment and retention are so difficult is that terms and conditions are often so poor.

Let me develop my argument further. Only 21% of councils have ever asked to see documentary evidence relating to the pay of care workers employed by their contractors. In the face of that and the other evidence I have cited, it is appalling that the Government are doing so little to uphold the legal rights of home care workers. It is indefensible that HMRC has stopped carrying out proactive investigations of national minimum wage compliance in home care, despite having revealed the extent of the breaches itself.

[Grahame M. Morris (Easington) (Lab)]

I congratulate my right hon. Friend on bringing this debate to the Commons at such an important time. In my area, Durham county council has had to implement £135 million of cuts over three years, with another £44 million in the pipeline. It is commissioning home care at £11 an hour, whereas the commissioning rate in some more affluent areas is £15 an hour. Does my right hon. Friend agree that the Government’s cuts in support for local government are compounding the problem?

[Mr Smith]

Most certainly they are, and I will say more about that later. I support, and the House ought to support, the key action that Unison and others are calling for. First, the Government should make ending illegally low pay for care workers a key priority. Secondly, HMRC should be instructed and resourced to do a proper job in ending the widespread breaches of the national minimum wage. Thirdly, care providers and the councils that commission them should be named and shamed when they do not pay the minimum wage.

It is not just trade unionists, local councillors and those whose loved ones use care services who are concerned about all this. In preparation for the debate, I spoke to local private care providers, and I will share with Members some of the points they made. They told me that care workers’ salaries do not reflect the responsibility they have; that luck and money are all too likely to decide people’s quality of care; that too many staff are on poor contracts, but that often reflects poor profit margins; that zero-hours contracts can be a barrier to recruitment, but that some employees want them; that staff turnover is high because of the high cost of living and shortage of affordable housing, which is an issue in my constituency; and that pressure on council budgets—the point made by my hon. Friend the Member for Easington (Grahame M. Morris)—means that restricted funding is available for front-line care.

Local providers also drew my attention to the fact that in six out of 14 areas in Oxfordshire, the county council is offering rates of funding for front-line care that are below the living wage, even though it has rightly pledged to pay its own staff above the living wage. Providers also told me that upper-tier councils such as Oxfordshire, which are responsible for home care, have their hands tied by the local government squeeze. Members should remember that all these points have been put to me by providers.

Pancreatic Cancer

Grahame Morris Excerpts

Monday 8th September 2014 Westminster Hall

[Grahame M. Morris (Easington) (Lab)]

Thank you for calling me, Mr Chope. I apologise for not being present for the whole debate; I meant no discourtesy to colleagues. I wanted very much to speak in the debate. I begin by congratulating my good and hon. Friend the Member for Scunthorpe (Nic Dakin) and the hon. Member for Lancaster and Fleetwood (Eric Ollerenshaw), who made a very moving contribution. I also thank the Backbench Business Committee and, indeed, all the volunteers. I had the pleasure of meeting Maggie Watts, but there are also many hundreds of others working in charities and as volunteers who have campaigned so effectively on this issue; they have helped secure the signatures to get this debate on what is very often a forgotten and neglected form of cancer.

I know that there are time constraints, but there are some specific issues that I want to raise with the Minister. I will just make some general points and then move straight to my questions. We know from earlier contributions that pancreatic cancer is not an uncommon cancer. My understanding is that by the time this debate has concluded, three more people will have lost their lives to the disease.

We heard in the contribution from the hon. Member for Basildon and Billericay (Mr Baron) that the UK still lags behind most other European countries when it comes to cancer survival rates. To be fair, there have been significant improvements in cancer treatments across the board in recent decades, but as we are aware the rates for pancreatic cancer, at 5.2%, have virtually stood still in the past four decades, so this is not a criticism of the current Minister or the present regime—the present Government.

The very nature of pancreatic cancer contributes towards poor survival rates. I do not intend to go over the arguments put so eloquently earlier about the difficulty of getting a proper diagnosis and the lack of an effective pathway to make the necessary early referrals. However, one thing that I am concerned about—I want to put this point to the Minister—is this. Yes, it is very important to have awareness campaigns, and I pay tribute to the campaigners who have brought this subject to Parliament today, but if we are to have real progress, there need to be improved treatments as well. Pancreatic cancer receives just 1% of the National Cancer Research Institute partners’ research spend. That equates to £625 per death.

[Philip Davies in the Chair]

I fully understand that we one cannot equate such things in financial terms, but that compares with almost £3,500 per death on breast cancer, the campaign against which receives much more public attention. If we as politicians—I am talking about all politicians; this is not a criticism of the Minister or the Government—are serious about improving survival rates for pancreatic cancer, our rhetoric must be backed up with firm action on the allocation of resources.

We have heard that relatively few treatment options are available for patients with pancreatic cancer, and research into the development of new drugs and treatments is key if we are to bring survival rates for pancreatic cancer down towards those of other common cancers. Over the past week or so, the case of the little boy Ashya has been in the news, and we have heard about the terrible circumstances and trauma that his parents went through in being unable to access the advanced radiotherapy that they felt was an appropriate form of treatment for their son. The hon. Member for Lancaster and Fleetwood has already referred to the potential of advanced radiotherapy. Forms of the treatment such as NanoKnife and CyberKnife, which can target tumours very precisely with intense bursts of radiation, may be particularly effective for some, although not all, pancreatic cancer patients.

I know that the Minister is sick of me going on about advanced radiotherapy, but we are not doing as much as we should to develop the evidence base for the treatment. I fully understand that it is not suitable for all types of cancer, or even for all types of pancreatic cancer; there are a number of different forms. The National Institute for Health and Care Excellence insists that before it allows routine use of the treatment, particularly in the NHS, there must be an evidence base.

Many of the cancer charities that I have spoken to have argued that, as a matter of urgency, the technology for advanced radiotherapy must be verified. I make an appeal to the Minister on that. Patients already receive advanced radiotherapy for other cancer types, and the treatment is available for private patients. I fully understand that we need to have an evidence base and see what is effective in different circumstances. Until research into advanced forms of radiotherapy for the treatment of pancreatic cancer is increased and the viability of the technology can be properly verified—until we actually grasp the nettle and fund the research and the trials—NHS patients will continue to miss out.

[Stephen McPartland]

The hon. Gentleman and I have debated radiotherapy and chemotherapy several times. I am proud that my NHS hospital trust was given the first CyberKnife by a wealthy donor, so it has the evidence required for advanced techniques and advanced radiotherapy. I sound a note of caution, however. My constituents have to make a 60-mile round trip to access that treatment. We have just opened a chemotherapy unit that can be used by someone who has cancer in Stevenage, but if they receive radiotherapy they often have to make a 4,000-mile journey over the course of their treatment. Although patients can have advanced radiotherapy, the difficulty is accessing that treatment.

--- Later in debate ---

[Grahame M. Morris]

That is a sensible point, which I have made to the Minister and several of her predecessors on a number of occasions. My view is that each of the 28 cancer networks should have access to advanced radiotherapy and that we should carry out a series of trials to evaluate the effectiveness of that treatment.

I would be interested to hear the Minister’s response, particularly on research into advanced radiotherapy. I hope that when our successors debate the matter in 40 years’ time, they will be talking about survival rates significantly higher than the current 3%. For that to happen, I respectfully say that the Government, or a Government, must act.

--- Later in debate ---

[The Parliamentary Under-Secretary of State for Health (Jane Ellison)]

It is a pleasure to serve under your chairmanship, Mr Davies. It has been an excellent debate, with excellent contributions from all hon. Members. I will try to do justice to all questions that I have been asked, but inevitably there will be some that I cannot pick up in my speech. I may stick more broadly to pancreatic cancer and research and perhaps pick up points on other matters outside this debate with the shadow Minister; we are happy to update him on all those.

I, too, congratulate the hon. Member for Scunthorpe (Nic Dakin) and my hon. Friend the Member for Lancaster and Fleetwood (Eric Ollerenshaw) on securing this debate and thank the public for their role in it. I served for more than two years on the Backbench Business Committee and was present when the e-petition system first came in. As others have said, it illustrates how swiftly we can bring an issue of great concern to the public to the Floor of the House and, I hope, do justice to the subject in a way that they feel justifies their faith in us and their efforts to get it here. I believed in the e-petitions system then, and now, on the receiving end, as Minister responding to the debate, I am equally happy that we have it.

I reassure the public—both those who have taken care to come here today and those listening or reading afterwards—that they are very well served by the all-party group on pancreatic cancer. It is fair to say that one or two all-party groups in our Parliament do not put in much of an appearance from one year to the next, but this is an excellent all-party group that genuinely takes its mission and its role within Parliament seriously. Its members have achieved much in highlighting the needs associated with this dreadful disease, not least through their report, “Time to Change the Story” and through their current inquiry on research, which is where I will focus most of my remarks in a fair bit of detail.

Hon. Members have spoken of the impact of pancreatic cancer on those who get the disease, their friends and their families and of the need for improvement in research and services. Obviously, I will look at as many points as I can. I reassure Members that it is certainly not a low priority for me. Of all the debates on cancer that I have responded to in my time as a Health Minister, I have responded to debates on pancreatic cancer more than any other, so this subject is certainly not low on my radar and—I reassure hon. Members again—not the Government’s.

I understand why people feel frustrated. Hon. Members have mentioned awareness levels, neglect or fashion and some of those things play a part, but fundamentally this is hard: it is a hard disease that is hard to diagnose and research. The scientific opportunity is not as readily there as it is in some other areas of human medicine. This is not easy territory, but we need to do better; we all know that and that is acknowledged.

As many hon. Members and the petitioners have said, investment in research is crucial. The Government are investing a record £800 million over five years to 2017 in a series of biomedical research centres and units—my hon. Friend the Member for Pudsey (Stuart Andrew), among others, mentioned this—including £6.5 million of funding for the Liverpool pancreas biomedical research unit. So that advancements in science can lead to benefits for patients, that unit is working in partnership with industry and leading research institutions to develop new treatments for, and ways of diagnosing, pancreatic cancer. This includes research on biological markers, which might be one way to help achieve earlier diagnosis.

[Grahame M. Morris]

The Minister’s knowledge is far superior to mine in relation to advanced radiotherapy and the funding of trials—the hon. Member for Lancaster and Fleetwood mentioned the NanoKnife and the CyberKnife—so will she clarify whether there are any such trials in relation to its efficacy for pancreatic cancer?

[Jane Ellison]

The hon. Gentleman will like my next page. I move on.

The unit that I mentioned is involved in a major European collaboration. I want to put that on the record because a lot of hon. Members have asked, rightly, whether we are learning from international examples, collaborating and learning what we can from those who are best in Europe—and that happens in that unit. It is also involved in the European Registry of Hereditary Pancreatitis and Familial Pancreatic Cancer, looking at hereditary factors as well.

As a number of hon. Members have eloquently described, the challenges of a stubbornly low survival rate are great, so it is also important that we consider new treatments for pancreatic cancer. For example, due to the limited evidence currently available, stereotactic ablative body radiotherapy—SABR—is available only for certain patients with lung cancer. To address this, NHS England has agreed to make up to £6 million available over the next five years to fund the treatment costs of new clinical trials for SABR. I am pleased to inform the hon. Member for Easington (Grahame M. Morris) and other hon. Members that one of these trials will be in pancreatic cancer.

I join hon. Members in welcoming the commitment made by Cancer Research UK to increase spending on pancreatic cancer research. That will in turn drive further investment by the National Institute for Health Research. I want to explain how that happens in two principal ways. First, scientific breakthroughs are translated into interventions benefiting patients, through infrastructure for experimental medicine, for example, with the Liverpool pancreas biomedical research unit. To talk to the point made about pancreatic cancer losing out and being the poor relation, Members might be interested to know that this is the only biomedical research unit that is organ-specific, with a focus on cancer.

Secondly, new investment, including NIHR investment, is driven by support from Government spend, as emerging interventions are investigated in studies and trials through the NIHR clinical research network. I was talking to the chief medical officer earlier this afternoon, ahead of this debate, to understand how this comes about. This is essentially known as NHS research support costs. For example, there might be, in a trial considering a specific treatment for people with pancreatic cancer, a lot of wrap-around care needed for the patients in that trial that might be beyond pure treatment for that cancer. That is where NHS research support costs come in and support the work going on in a specific trial.

The National Cancer Research Institute is a UK-wide partnership—it has been mentioned in this debate—between the Government, charity and industry, which promotes co-operation in cancer research among the 22 member organisations. In turn, NCRI is a member of the International Cancer Research Partnership, which includes cancer research funders from all over Europe, the United States, Canada and Japan.

The NCRI clinical studies groups—I apologise for the number of acronyms that crop up in health debates; I am afraid that it is just one of those things—bring together clinicians, scientists, statisticians and lay representatives to co-ordinate development of a strategic portfolio of trials within their field. The upper gastrointestinal cancer clinical studies group has a pancreas sub-group that plays a vital role in developing pancreatic cancer trials. It is effectively doing the same job as the US Recalcitrant Cancer Research Act—looking strategically at what is needed and where the gaps are.

My hon. Friend the Member for Pudsey made the point about looking at inter-regional and international comparisons and variation. We would expect the NCRI to look at that area, but I will make a point of making it aware of the strength of feeling in this debate on a number of issues, although I am sure they will be following it closely.

More broadly, improving cancer outcomes is a major priority of this Government. Our ambition is, as has been said, to save an additional 5,000 lives a year by 2014-15 and, crucially, to halve the gap between cancer survival rates in England and the best in Europe. Tackling late diagnosis, as many Members have said, is vital, as is raising public awareness and encouraging earlier presentation. Significant money has been put into that, and to put a cost in human lives on that, we know that we could save an additional 75 lives a year from pancreatic cancer if we matched the best in Europe. As many Members have illustrated, with so many examples from their constituencies, that does not begin to tell the story of the human suffering that could be averted if we did that.

To touch on Be Clear on Cancer, symptom awareness campaigns are a difficult area. Since 2011, the Department of Health has undertaken a series of local, regional and national Be Clear on Cancer campaigns, some of which have had excellent results. Public Health England now leads on that work in partnership with the Department, NHS England, charities and others. New campaigns are tested locally and then regionally to ensure that messages are correct for the target audience and to assess the impact on NHS services. That is important, because in some cases the balance has to be found when sending a lot of people in for diagnostics that might not be there or might stretch capacity. We ask experts to strike a careful balance and, if appropriate, we run the campaigns nationally.

The focus of those campaigns so far has been on cancers with the largest number of avoidable deaths, but the campaigns are under constant review and we work with relevant experts to see what more can be done to tackle the cancers, including pancreatic cancer. The group that makes decisions on the campaigns is called the public awareness and primary care steering group. It is chaired by the national clinical director for cancer, the excellent Sean Duffy, who I am sure a number of Members have met. Those who have met him will know what an important and serious clinician he is and how dedicated he is to making progress in this area. The group has considered pancreatic cancer for a possible campaign. Although it could not recommend that at this time, because symptoms are not always clear, it will keep that under review and would be happy to look at it again in the light of new evidence. Again, that group will note this debate and the interest in it.

During the debate, Members have raised the issue of how we support GPs to recognise signs and symptoms, particularly for such a difficult to recognise and difficult to diagnose cancer. Pancreatic cancer is often symptomless. When symptoms do develop, however, diagnosis can be complicated because, as Members have said, those symptoms are often similar to a range of benign conditions. We therefore have terrible rates of presentation through emergency routes, and that is clearly unacceptable. NICE is updating its guidelines on the referral of suspected cancer to ensure that they reflect the latest evidence. A number of Members raised that issue, and we anticipate a publication date of May 2015.

In early 2013, the Department of Health part-funded a six-month pilot, run by Macmillan Cancer Support, of an electronic cancer decision support tool for GPs. It is designed to recognise the symptoms of five cancer types, including hard-to-detect cancers such as pancreatic. Some 500 GP practices across England participated in the pilot, and I am aware that the all-party group is keen to see that tool being widely used by GPs, if evaluation shows that it can help to identify patients with symptoms. Initial indications were that the cancer decision support tool influenced a GP’s decision on around half the occasions that it was used. A full formal evaluation of the pilot has been undertaken by Cancer Research UK and one of the Department’s policy research units, and we hope to publish the results in an academic journal. I want to see that happen as quickly as possible, if the tool can do good, and I have made that clear. Macmillan has already begun to address many of the issues, which were highlighted by the draft evaluation that was shared with it, through changes made to the diagnostic software. It will continue to make further changes as it rolls the system out across the country.

In introducing the debate, the hon. Member for Scunthorpe spoke about allowing GPs to refer patients directly for MRI scans, as did my hon. Friend the Member for Milton Keynes South (Iain Stewart). I thank the hon. Member for Scunthorpe for giving me advance notice of that point. We have promoted direct referrals through the cancer outcomes strategy and have increased funding for GPs to access a range of diagnostic tests. NHS England is now working with providers to identify innovative ways of diagnosing cancer earlier, which could include extending direct referrals by GPs. Again, I will make sure that the strength of feeling expressed today, which I share, about looking seriously at whether that work can be accelerated is brought to the attention of NHS England.

Recently, the Secretary of State for Health announced a joint piece of work with Cancer Research UK and Macmillan to look at a number of innovative ways in which we can support GPs to ensure that cancers are diagnosed as quickly as possible. It is worth saying that last year GPs referred nearly half a million more patients to cancer specialists than were referred in the last year of the previous Parliament. A number of Members have said that this is not an easy one for GPs, because they see this cancer very rarely. The average GP actually sees some of the more common cancers surprisingly rarely, and this cancer is particularly rare, so anything we can do to support GPs is important.

Further policies have been unveiled that will improve the quality of life of cancer survivors. NHS England is rolling out additional support, in co-operation with Macmillan, so that cancer survivors will have their needs fully assessed and plans agreed for meeting those needs. In that regard, we are drawing heavily on the cancer patient experience survey, which has been mentioned.

The work going on to help to support cancer survivors to take regular physical activity will help. Physical activity is important in recovery and might help prevent recurrence. We have not touched a lot on lifestyle factors, but they are definitely an issue in some instances of pancreatic cancer. I undertake to talk to Public Health England about what more can be done. A major piece of work will be announced this autumn on physical activity, and I will have that conversation with Public Health England in that context. That new package of measures adds to the extra £750 million that the Government invested at the beginning of the Parliament.

At the end of August, the Health Secretary announced that thousands more cancer patients in England will be offered vital treatment through the £160 million boost to the cancer drugs fund in 2014-15 and 2015-16. I note the concerns of my hon. Friend the Member for Lancaster and Fleetwood about the interactions between NICE and the cancer drugs fund. I am happy to talk to him further about that, but NICE, for lots of good reasons, is an independent expert body, free from ministerial intervention. I do, however, note his concern. We discussed and explored that in a bit more detail in the Adjournment debate that he so ably led earlier in the year, when we looked specifically at NICE and new drugs.

In conclusion, I thank all those who have contributed to the debate. There is a huge challenge for us all, and we need to make a significant improvement to outcomes for people with pancreatic cancer. I do not underestimate the nature of that challenge—I know that Members do not—and I hope that my response has illustrated to the Chamber and to the many thousands who have signed the e-petition that pancreatic cancer is a priority and that more money is going into research, and not only what is directly invested. I have tried to illustrate what the wrap-around research support is.

As I said, I spoke today with the chief medical officer. She heads up the Government’s research policy, and some of the bodies that I have referred to report to her. Given the strength of feeling in this excellent debate, which has had thoughtful contributions, I will ask the chief medical officer if she is happy to meet with me and the debate’s co-sponsors to look in a bit more detail at the research package and to understand the research journey and where it might go. I will get back to my hon. Friend and the hon. Member for Scunthorpe after the debate about that.

We all know that change needs to come, and that it will not be easy, but we can make change. We have seen it in other hard areas of medicine, so it is not impossible; it is just difficult. Through the Government working in partnership with patients, charities, the nation’s excellent research teams, the pharmaceutical industry and the NHS, as well as by drawing on international data, we can make progress, and we all know that we must.