Barts Health NHS Trust

Debate between Grahame Morris and Jane Ellison

Thursday 19th March 2015 Commons Chamber

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

Absolutely, and not least because we warned of these dangers during the passage of the Health and Social Care Bill, which later became an Act. With all due respect, I should point out to the Minister, on her references to openness and transparency, that this failing has happened as a direct result of mergers introduced by this Government. May I respectfully point out that when this merger was approved by the Secretary of State three years ago, Labour MPs, including my hon. Friend the Member for Leyton and Wanstead (John Cryer), did point out that such a change would be a disaster, and that has come to pass? The Secretary of State pressed ahead. May I point out the bullying issues that the report throws up? The chairman of the Unison branch was sacked on trumped-up charges. Will the Minister issue instructions to have those individuals reinstated?

[Jane Ellison]

The bullying of NHS staff who are trying to draw attention to poor care is never acceptable, and this Government have taken a lot of measures to make sure that NHS staff are protected. The trust’s chief executive has said the following about the report:

“We are very sorry for the failings identified by the CQC in some of our services at Whipps Cross and we know the Trust has a big challenge ahead.”

Part of that big challenge will be in restoring staff morale, and making sure that that culture of openness and support for staff is in place.

NHS (Government Spending)

Debate between Grahame Morris and Jane Ellison

Wednesday 28th January 2015 Commons Chamber

[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.

Late Stage Hepatitis C

Debate between Grahame Morris and Jane Ellison

Tuesday 6th January 2015 Westminster Hall

[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.

Pancreatic Cancer

Debate between Grahame Morris and Jane Ellison

Monday 8th September 2014 Westminster Hall

[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.

Oral Answers to Questions

Debate between Grahame Morris and Jane Ellison

Tuesday 10th June 2014 Commons Chamber

[Jane Ellison]

My hon. Friend highlights that there are a lot of different approaches to reducing the pressures on A and E. The great thing is that we are seeing real innovation from local clinicians, supported by local Members of Parliament. That shows what can be done when we address these problems with an innovative approach, and think about how we can reduce these pressures and ensure that as many people as possible are served in the right way and treated outside A and E, if that is not the place they should be.

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

7. What discussions he has had with NHS England on the future of the cancer drugs fund.

Ambulance Resources and Response Times

Debate between Grahame Morris and Jane Ellison

Wednesday 14th May 2014 Westminster Hall

[Jane Ellison]

No, because I have only just begun and the hon. Gentleman took many interventions.

Emergency services are the first port of call for many of us when serious illness or accident strikes. The total number of emergency calls to ambulance services in England in 2013-14 was 8.4 million, which is a 0.9% drop over the previous year. Unfortunately, a small proportion are unnecessary or frivolous, but the overwhelming majority are from people who feel in need of urgent help.

The growing number of people living with chronic conditions and the ageing population to which the hon. Gentleman referred are placing increasing pressure on urgent care services, something that we all acknowledge. It is important for my Department to work with Public Health England, local commissioners and health care providers to educate and engage the public on measures to prevent chronic health problems from developing. There are a number of people who end up in A and E because they have not taken medication properly or who suffer acute problems as a result of a chronic condition. Hon. Members will be aware of some of the longer-term problems in their region, which result from difficult public health challenges. Tackling those is my own particular portfolio, and is one way in which we can make the emergency services more sustainable in the longer term.

I hope hon. Members recognise that. At times, it seemed that they were merely committing themselves to significant additional future spending rather than also turning their minds to the longer-term challenges.

[Grahame M. Morris]

Will the Minister give way?

[Jane Ellison]

I am going to continue and try to make a few substantive points. If I have time, I will give way.

All 999 calls are triaged into two basic categories, red and green, depending on the seriousness of the call. Those placed in the red category are calls where the patient is in a life-threatening condition; an example would be someone suffering a cardiac arrest. Such calls require assistance on the scene as quickly as possible and the Government have set targets for all ambulance services in England of a response within eight minutes in 75% of cases. The latest figures, for March 2014, show that in north-east England—the area of the hon. Member for Hartlepool—the median average response time for red category calls was 6.4 minutes. Nationally, those figures show that 76.2% of red 1 calls, which are the most critical, received a response within eight minutes. In the north-east the target was also met, with 75.2% of patients receiving a response within eight minutes. That is not to say that there are not significant problems in some cases, but it is important to place on the record the service’s effective work in meeting that target.

Less critical 999 calls placed are in the green category. Those calls are not subject to national targets. Some ambulance services set their own targets for response times, and NEAS uses a one hour standard. It is important that such calls receive a timely and appropriate response, but red calls must be prioritised, as a person’s life may be in immediate danger.

There has been recent media coverage of long waits for ambulances, and hon. Members have alluded to constituents’ experience of such waits during this short debate. Every patient should expect to receive first-class care from the ambulance service, but the nature of emergency response work means there will always be incidents where unfortunate timing leads to a situation in which someone who is assessed as being in a non-life-threatening situation calls 999 at the same time as several other people who are in life-threatening situations. I am sure that hon. Members recognise that that would be the case under any Administration.

[Grahame M. Morris]

Will the Minister give way?

[Jane Ellison]

Briefly.

[Grahame M. Morris]

I am grateful to the Minister for giving way, but I cannot let that pass, because the situation is different now. I have had the honour of representing Easington for four years and it is evident from the cases that are coming to me and to colleagues from the region that the situation is worsening. One case was that of a young man who broke his hip playing football and waited for two and a half hours in the rain. He was in the centre of the constituency, in an area that is readily accessible. Another was of an old lady who waited two and a half hours for an ambulance. She died the following day. Something is sadly wrong with the North East Ambulance Service and the situation is deteriorating. We have all had cases that are really quite shocking, and something needs to be done.

[Jane Ellison]

I am not familiar with the cases that the hon. Gentleman mentioned, but I will draw them to the attention of my ministerial colleagues and of the trust. I spoke to the head of the trust yesterday, and will make sure that the debate is brought to the trust’s attention. However, I gently say to hon. Members that they surely cannot be suggesting that at no previous time, under any previous Government, have there been any cases in which a service did not get this right. It is important to—

Cancer Treatment and Prevention

Debate between Grahame Morris and Jane Ellison

Tuesday 11th March 2014 Westminster Hall

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

It is a pleasure to serve under your chairmanship, Mr Gray. We have certainly had a wide-ranging debate. I think I would need another hour and a half to respond to all the points made, but I hope that hon. Members present know me well enough to realise that if I am not able to respond to their points in detail, I will get back to them after the debate. The shadow Minister and I have many opportunities to debate the wider public health issues, so I will devote most of my response to specific points, particularly those made by my hon. Friend the Member for Mid Derbyshire (Pauline Latham), who called for the debate. I will, however, try to touch on all points made in some way.

I congratulate my hon. Friend the Member for Mid Derbyshire on securing the debate. She always speaks movingly on this subject, not least as a result of her personal experience. She has been a tireless campaigner on behalf of her constituents and others, in particular with regard to melanoma. Before I respond to her specific points, I would like to restate the Government’s ambitions, as those apply across the debate. All Members have referred to this, but improving cancer outcomes is a major priority.

We aim to save an additional 5,000 lives a year by 2014-15 and halve the gap between cancer survival rates in England and the best in Europe. As my hon. Friend the Member for Basildon and Billericay (Mr Baron), who is the chair of the all-party group, said, we are not as good as we could be, so there is great effort and commitment to make us better. Our debate has been on how we do that, not why that is the right ambition. To achieve that, more than £750 million has been committed to deliver our cancer outcomes strategy, which includes £450 million to support earlier diagnosis of cancer by improving public awareness and GP access to key diagnostic tests.

Early diagnosis came up many times during the debate. It is worth making the point that most GPs will see relatively few cancers in a typical year. Because we all know someone affected, whether in our family or our group of friends, we imagine that GPs see cancer all the time, but they do not; certainly, they do not see many of the rare ones. The challenge of early diagnostic testing and training to get those tools into GPs’ hands is serious, because that is also a challenge for GPs, of whom we ask a great deal. That is why it is important that the Government are putting money and effort into those early diagnostic tests. That money also goes towards paying for extra testing and treatment in secondary care.

I want to touch on the architecture of the system. It has been mentioned a few times and hon. Members have expressed concerns about the changes to the system. The first general comment I would make is that the main thrust of the debate is that we can do a lot better on cancer, which would seem to lead to the conclusion that the old system was not necessarily delivering the outcomes we wanted. Although caution is understandable when major change has happened, Members are perhaps being unnecessarily gloomy about the changes that can be delivered under the new architecture for the NHS and the health system. Many of the criticisms that have been made this morning were made under the old structures as well.

Cancer is a priority for NHS England. Clinical expertise is at the heart of commissioning decisions and NHS England has established a range of clinical reference groups, and is leading on delivering clinical strategy. NHS Improving Quality is working with the strategic clinical networks and has played a key role in working with the NHS on early diagnosis, especially on awareness campaigns. NHS England has also created national service specifications for a wide range of cancers to ensure consistent, high-quality service across England.

[Grahame M. Morris]

I know that the Minister is trying systematically to get through all the points that were raised, but I challenge the point that there is no fundamental difference under the new arrangements. There really is a fundamental difference in the commissioning of specialist cancer services. Those were previously commissioned on a local basis, effectively, by primary care trusts coming together in London, but now it is done by NHS England. That has caused a huge hiatus for the patient cohort I identified. Will she agree to look at that and, if necessary, meet me and a group of clinicians to highlight the nature of the problem?

--- Later in debate ---

[Jane Ellison]

The point I was making was not that there has not been change—of course there has—but that it is far too early for hon. Members to be drawing the conclusions they have about the new system. The Government have put a great strategic priority on cancer and NHS England has been charged with delivering against a mandate and against that strategic priority. I take the hon. Gentleman’s point, but NHS England leads on this subject and is quite clear about the priority that the Government and Parliament put on it. I want to make that point. I understand why people have expressed concern.

[Grahame M. Morris]

Will the Minister give way?

[Jane Ellison]

No, I am going to press on, because I will have no chance of getting through all the specific points that were raised if I get into a debate with the hon. Gentleman.

I turn now to skin cancer. I should mention that NHS England has recently published a service specification—I mentioned that it has those across a number of cancers—on adult skin cancer services. That sets out what the NHS must have in place to offer high-quality skin cancer treatment, care and support. I am happy to send that to my hon. Friend the Member for Mid Derbyshire if it would be useful.

My hon. Friend and other hon. Members expressed great interest in what we are doing to ensure earlier diagnosis. It goes without saying that identifying cancers early has a huge benefit in terms of improving outcomes for individuals and for the whole health system. That is why we have committed over £450 million to improve diagnostic services. Later, I will consider in more detail prevention in the context of public health, but it is worth making the point that although diagnosis and treatment are vital, prevention is the biggest prize of all, because we can stop people even having to get to the point of being diagnosed. The more work on awareness and prevention that hon. Members and local councils—particularly given their new public health leadership role—can do, the more we will save the costs in money and in human misery.

Access to early diagnosis is most effective when people visit their GP early. That is why we are running a local Be Clear on Cancer campaign specifically on melanoma in the south-west in April and May, to raise awareness before the summer. We will evaluate the programme as part of our wider programme of Be Clear on Cancer campaigns, which, as the shadow Minister said, has done so much good work in so many areas.

We are also working with GPs to ensure they have the information they need. Cancer Research UK and the British Association of Dermatologists have developed a GP skin cancer toolkit. Evaluation shows that it has reached almost 10,000 GPs and helped to increase confidence in referring suspicious lesions.

My hon. Friend the Member for Mid Derbyshire spoke quite a bit about the NICE approval process, which was also mentioned by my hon. Friend the Member for Lancaster and Fleetwood (Eric Ollerenshaw). I know that my hon. Friend the Member for Mid Derbyshire is concerned about access to NICE’s approval of drugs for late-stage melanoma. As she knows, our priority has to be to get the best possible results for all NHS patients with the resources we have. NICE’s methodology is the best guide we have to the clinical value and cost effectiveness of different treatments.

We have asked NICE to look at the way drugs are assessed so that patients can get the treatments they need at the best value for the NHS, and the price the NHS pays is more closely linked to the value a medicine brings. NICE will carry out a full public consultation before implementing any changes to its methodology. I understand that NICE plans to launch its consultation later this month, and I urge all Members to contribute. I am sure they will, as many Members present take a significant leadership role in Parliament on cancer.

I turn now to the particular concerns my hon. Friend the Member for Mid Derbyshire raised about yervoy or ipilimumab. Although NICE has recommended yervoy as an option for treating advanced melanoma in people who have received prior therapy, I understand her concern that it should be approved as a first-line treatment. I have been advised that NICE is currently considering yervoy as a treatment for previously untreated stage three or stage four malignant melanoma. Although it is not appropriate for me to intervene in an appraisal, I have been advised that NICE’s initial draft guidance, issued on 25 February, recommends yervoy only in the context of clinical trials, as I outlined to my hon. Friend at Health questions recently.

That is not a refusal, however. Instead, it reflects NICE’s view that the technology is promising but there is insufficient clinical evidence for the appraisal committee to recommend its use as a first-line treatment at this stage. However, I hope I can reassure my hon. Friend that the manufacturer is currently conducting a further trial, which, along with other research, is due to complete in 2016. Once that research is available, I am sure NICE will wish to reconsider its guidance. NICE is currently running a consultation on its interim guidance. Again, I would also recommend that hon. Members, and particularly my hon. Friend the Member for Mid Derbyshire, make their views known to NICE. I always make a point of referring Parliament’s views, as expressed through debates such as this, to the relevant people making the decisions. I did so the morning after the debate on pancreatic cancer last week, when I sent a personal letter with a copy of Hansard to the decision makers concerned to make them aware of Parliament’s views. I always undertake to do that where relevant.

In the interim, I understand that NHS England’s national Cancer Drugs Fund panel has considered including yervoy for first-line treatment of advanced melanoma. The panel has decided to refer yervoy to NHS England’s chemotherapy clinical reference group for consideration for inclusion under baseline commissioning. If that is agreed, clinicians would be able to prescribe the drug for use in first-line advanced melanoma according to the commissioning policy that would be developed by NHS England. NHS England will make its decision known in due course.

I also want to reassure my hon. Friend the Member for Mid Derbyshire that NICE is currently developing a clinical guideline on melanoma. It expects to issue final guidance in July 2015. I hope that gives her some sense that a lot is going on this area. We will endeavour to make sure that we keep her updated.

I will have to canter through some of the other points, Mr Gray, but as so many were raised I hope you will be generous and give me a little time to do so. I turn first to the points made about the Cancer Drugs Fund and the concern that no new medicines are being accepted, which my hon. Friend the Member for Lancaster and Fleetwood raised. Just for the record, so far in 2014 the panel has added a number of drugs to the national list—I will probably stumble over pronouncing some of them, but I hope the House will forgive me. They include kadcyla for breast cancer, tafinlar for melanoma and radium-223 dichloride for prostate cancer.

I turn now to the topic of CCG accountability, which I have often discussed with my hon. Friend the Member for Basildon and Billericay, who chairs the all-party group on cancer with such vigour and passion. I entirely share his view that it is a critical point. He has articulated all the wins over the years in making sure that early outcome indicators are part of the CCG outcomes indicator set, and the importance that early outcome indicators have for early diagnosis and more information about survival rates, which we all want to see. It is important to remember that NHS England can intervene where a CCG is found to be failing in its duty to secure high-quality outcomes, although I accept that that is a high-level intervention. I think my hon. Friend is driving at what we will do with the information when we get it. NHS England is considering how it can better respond to the functions in the outcome indicator set and how all permissions and system structures work together to improve outcomes.

This is the first time we have had this indicator set and I know that my hon. Friend has talked to the national clinical director for cancer, Sean Duffy, about this, which is the right thing to do. I will also meet him to talk about it. It is helpful that Parliament returns to the issue regularly because it helps me to emphasise to NHS England how much store hon. Members set by local outcomes and how important it is for us to have a response throughout NHS England to indicators and outcomes that are not as good as they could be. I accept his challenge, which he knows that I am working on. I am having ongoing conversations about it, but it is always good that Parliament returns to the point and challenges the levers of change.

We have introduced GP inspection, and more and more data will be available to the inspectorate to ensure that it is asking questions not just about what GPs do, but about what they do not do and when we expect them to do more. There are all sorts of ways to challenge the system, and it is ongoing work.

I cannot respond to all the points made by the shadow Minister, but I will touch briefly on one. She referred to a report that highlighted the use of out-of-date equipment. To encourage NHS providers to update existing medical technology infrastructure, the Department established a £300 million fund in March 2012, which is operated by NHS Supply Chain to bulk purchase medical equipment to achieve better prices. In August 2013, NHS Supply Chain announced the signing of a deal with Varian Medical Systems to secure 20 new linear accelerators. More detail is available about that innovation fund and the radiotherapy innovation fund, but I do not have time to go into it now.

As ever, the hon. Member for Strangford (Jim Shannon) is present. He often attends debates and makes forceful points about the need for us to work together. The National Institute for Health Research is funded by my Department, so it is focused primarily on England, but I assure him, as I have tried to previously, that the published research is available to anyone. NICE guidance applies formally only to England, but it is available online to all who want to use it. It makes sense for all the Administrations to share that information and expertise, and to ensure that they make use of it when framing their own response.

We have previously discussed human papilloma virus in more detail in this Chamber and during an Adjournment debate on 13 January. My hon. Friend the Member for Mole Valley (Sir Paul Beresford) made many good points about the wider take-up of vaccination to reduce the incidence in females of that and other cancers, and in males. The HPV vaccine was introduced to tackle cervical cancer, which is why the strategy started with girls. He makes a good point about the potential benefits, which are well recognised, of extending that to protection against other cancers, particularly oral cancers.

Since 2008, more than 6 million doses of vaccine have been given in the UK with 87% of the routine cohort of girls completing the three-dose course in the 2011-12 academic year. I was concerned to hear the figure my hon. Friend mentioned from his own area. Hon. Members rightly come here to challenge Ministers about what we are doing, but when there is local information, I urge them also to challenge their local systems and to ask what it being done to bring them up to the national rate. We know that there are challenges about some of hard-to-reach groups, but I am surprised to hear the statistic my hon. Friend mentioned. I urge all hon. Members to recognise that we cannot drive the change solely from Whitehall, and that it is good if they also ask questions about accountability locally.

My hon. Friend referred to the fact that work is continuing through the Joint Committee on Vaccination and Immunisation to look at the matter in more detail. He said that the JCVI is also looking at adolescent boys and men who have sex with men, and highlighted the problem that they do not benefit from herd immunity as HPV vaccination is more widespread among girls. The JCVI is considering whether it is cost-effective to extend the programme to both those groups. The issue is complicated, especially concerning adolescent boys. The evidence base, mathematical modelling and deliberations will take time, but the work is ongoing and it helpful that the House continually expresses its interest.

I recognise that I have not responded specifically to some of the points made by my hon. Friend the Member for Lancaster and Fleetwood about pancreatic cancer, but I responded in the House only last week. I hope he will accept that it is not discourteous to say that my response has not changed substantially since then, but I took the actions I promised last week. He has put on the record his concern about the need to value the additional months of life in a disease that sadly takes people so quickly. Early diagnosis and GP training in that is critical in pancreatic cancer, which is so hard to diagnose. That is well recognised, and I thank my hon. Friend for making his point.

In the remaining few minutes, I cannot respond to all the public health issues raised, but smoking is a factor in so many of the cancers that have been discussed, as the shadow Minister said. Smoking in this country is at an historic low, and has dipped to below 20% of the population for the first time. There is a significant legislative programme and the shadow Minister said she hopes we will keep up the momentum. I assure her that I have no option given the programme that we must deliver in the coming year. I look forward to her co-operation. I also look forward to support from hon. Members in the Chamber when we introduce those measures in the House.

It is always good to remind people why leadership on smoking cessation and legislation is so important. It plays a role in prevention, which is important in many areas that hon. Members have highlighted this morning. There is a big role for leadership at local council level because the figures on smoking cessation are extremely patchy throughout the country. We must drive change at local level.

The hon. Member for Easington (Grahame M. Morris) referred to Gamma Knife, and I will respond to him in more detail after the debate if that is acceptable to him. I am sure he did not mean to say that NHS England is callous and cold. Clinicians must make difficult decisions every day on behalf of all of us in balancing competing health priorities. He used those words, but I know he did not mean them in connection with the people who must make the difficult decisions. Many of our clinicians and health leaders must perform difficult balancing acts. Just the challenges made to me as the Minister in this debate this morning would have an enormous cost. We must make difficult decisions all the time about where we can best spend resources to bring the best results for the population. I know that that is at the heart of hon. Members’ concerns.

I thank hon. Members who are present. Many are long-standing champions of particular issues in Parliament and I urge them to continue their awareness-raising work. NHS England will continue to respond to that, as will Ministers. I thank hon. Members for attending the debate this morning.