Cancer Treatment

Heidi Alexander Excerpts

Thursday 19th April 2018 Commons Chamber

[Heidi Alexander (Lewisham East) (Lab)]

It is a genuine privilege to speak in this debate, and I congratulate my hon. Friend the hon. Member for Croydon Central (Sarah Jones) and the right hon. Member for Old Bexley and Sidcup (James Brokenshire) on securing it. It is entirely appropriate that this debate has been led by two south London MPs. As a fellow south Londoner, may I start by saying what a special place in our heart is occupied by the very noble Baroness Jowell? There are some people we meet in life who radiate positivity, and Tessa is one of them. She has a lightness of step but a firmness of view that is a formidable combination; there was no way those Olympics in 2012 were going anywhere but London! It is right and proper that this House has the chance to debate her latest and perhaps most important campaign: the need to increase research on, and improve outcomes for, individuals diagnosed with brain cancer. The figures on research funding, and the availability of effective drugs and treatment, speak for themselves, and I will not repeat them, as I know time is short.

Last year, I lost two people close to me to cancer. One was my father-in-law, Nigel Ballantyne. I hesitate to say what I am about to say, as I have questioned whether my own grief has skewed my perceptions of the care that he received. I do not think it has. I also hesitate because I wonder whether today is the appropriate time to raise these issues, but I have concluded that Tessa would not want me to pull any punches.

My father-in-law was told that he had lung cancer when he was on his own, in a hospital bed, with only his mobile phone for company. There were complicating circumstances, but there were no excuses. He had struggled to get an appointment to see his own GP and had been passed from pillar to post for months—a situation admittedly not made better by the usual reticence of a 76-year-old man not wanting to cause a fuss, and his understandable desire to go on that holiday that he had been looking forward to. Having said that, the delay in his diagnosis and the way his diagnosis was delivered were unacceptable. He died six days before the general election last year.

Five months later, a good friend died at home after a long struggle. His wife speaks of how she had to fight tooth and nail to get palliative care support in place on the night he died. She described to me a ward that lacked sufficient nursing staff to administer injections without her physical help.

When the national cancer strategy talks about placing patient experience on a par with clinical outcomes and quality of life, it rings a bit hollow to me. I do not want to sound overly bleak, as I know that there are many wonderful examples of good care with positive outcomes, but we do need to be honest. We need to ask ourselves tough questions about how patients are treated on all steps of the care pathway.

Those living with cancer also need more support. Last Friday, my constituent, Amanda Mahoney, whose breast cancer has recurred four times in seven years, came to my advice surgery to ask me to campaign alongside her to change the face of cancer. She said:

“We’re not all bald, we’re not all having chemo. I don’t want to be told ‘sit on a park bench and wait till it gets you.’”

She wants to continue doing the job she loves—she is an outreach worker with autistic children—but her recurring experience has been employer after employer who does not know what to do and a benefits system that seems to make things harder, not easier.

This issue is not going away. This debate is the product of Tessa’s campaigning. She has been able to do what she does best—make her contribution by making those in power sit up and listen. She has been able to continue her working life. Others should be able to do the same, if that is what they want, and employers should be supported to make that happen.

There is so much more that needs to be said, but in the time available it is impossible to do this subject justice, so I will touch on just one other issue, which I know is also close to Tessa’s heart: our impending departure from the EU, which includes our probable departure from the European Medicines Agency and Euratom. Promises were made about extra cash for the NHS after Brexit, but, in stark contrast, Brexit has potentially huge negative implications for cancer research and treatment. We need urgent answers.

The continued ability of British cancer sufferers to participate in pan-European clinical trials is critical, especially for those with rarer cancers. We must ensure that we have a reliable supply of medical isotopes for diagnostics and treatments—that supply is at risk as we leave Euratom. We must not become a second-tier country for access to the newest and the best medicines. The next generation of immunotherapies holds great potential. We cannot willingly put ourselves at the back of the queue.

There are not yet answers to those questions, nor are there answers to the chronic NHS staffing crisis, which is exacerbated by Brexit, yet we are 11 months from leaving. We need a global, cross-border approach to research. We need to be a country that is open to talent and ideas from around the world. We need a properly resourced, adequately staffed NHS that is capable of embracing innovation.

[Wes Streeting (Ilford North) (Lab)]

Will my hon. Friend give way?

[Heidi Alexander]

I am drawing my remarks to a close.

It saddens me that we seem a long way from that aspiration, but if we are to honour the work of people such as Tessa and the memory of people such as my father-in-law, it has to be worth fighting for.

NHS Winter Crisis

Heidi Alexander Excerpts

Monday 5th February 2018 Commons Chamber

[Stephen Barclay]

We are in discussion with Health Education England on workforce planning and ensuring that we address concerns about retention and training, part of which is the fact that the Chancellor has lifted the 1% cap as it applies within the health service, and we are of course in active discussions with the trade unions on that point.

[Heidi Alexander (Lewisham East) (Lab)]

It has been reported to me that out of the 17 cubicles at Lewisham A&E one morning last November, five people were awaiting section with severe mental health problems. One person was there for over 72 hours, another for over 26 hours and another for over 21 hours, and all were there for over four hours. When will the Minister acknowledge that the reason why A&Es cannot cope is that the entire system—from social care and GPs through to mental health—is buckling under the enormous pressure of increasing demand, and when is the NHS going to get the funding it needs?

[Stephen Barclay]

I have already said that I recognise there is increasing demand, and set out many of the measures we are taking through the 111 service and other areas. The hon. Lady’s own trust has received an additional £3.2 million to address many of those pressures, and the key question is how that will be deployed by the trust to address many of the blockages in the pathways at the moment.

Medicines Regulation

Heidi Alexander Excerpts

Tuesday 21st November 2017 Westminster Hall

[Heidi Alexander (Lewisham East) (Lab)]

It is a pleasure to serve under your chairmanship, Mr Davies. I congratulate my hon. Friend the Member for Bishop Auckland (Helen Goodman) on securing the debate and on introducing the topic in such a comprehensive manner.

This debate is both timely and hugely important. It is timely due to the announcement yesterday that Amsterdam is to become the new home of the European Medicines Agency when it leaves London—a relocation that is necessitated by our departure from the EU, and which also symbolises the changing regulatory environment—and it is hugely important because, although the word “medicine” conjures up images of bottles of cough medicine being bought over the counter, it encompasses the whole range of drugs and pharmaceutical products used to treat the many different illnesses, diseases and chronic conditions that could affect each and every one of us over our life course.

If we think the EMA leaving London is bad, the potential implications of the UK leaving the EMA are far worse, and we should be clear—leaving the EMA is precisely what the Government envisage happening. As the Health Secretary said when he appeared before the Select Committee on Health in January this year, he does not expect us to stay in it. The Prime Minister’s ideological red line on European Court of Justice jurisdiction makes it impossible. The loss of 900 jobs and all the associated economic activity brought to our country as a result of the EMA being headquartered in London pales into insignificance when we contemplate the possible consequences of withdrawing ourselves from the EMA’s pan-European drug-licensing processes and its supervisory and compliance mechanisms, which have a key role in ensuring that medicines on the market here are safe and effective.

The Government have given little information about how their desired future close co-operation with the EU might work on medicines regulation. Indeed, as recently as July, the chief executive of the Medicines and Healthcare Products Regulatory Agency, the national regulatory body that works alongside the EMA in the UK, suggested that two options were being considered by the Government. One is a partnership approach, where presumably the UK would seek to mirror future EU authorisations in order to maintain regulatory equivalence going forward; the second is a stand-alone system, whereby the UK could diverge from EU regulations, perhaps aligning itself more closely with American, Australian or Canadian systems.

[Mr Gregory Campbell (East Londonderry) (DUP)]

Would the hon. Lady agree that, whatever route the Government decide to take, one of the things that we must protect—this was alluded to earlier in the debate—is the excellence of the research and development facilities that we have across the United Kingdom? That must be paramount in the considerations by the Government, as we go beyond March 2019.

[Heidi Alexander]

I agree with the hon. Gentleman, but when I speak to scientists at institutions across the UK, they are already seeing the effect of last year’s referendum result in terms of EU-wide partnerships being withdrawn and being harder to secure.

It would be helpful if the Minister could update us on which of the two approaches the chief executive of the MHRA talked about in July the Government now favour. It would also be helpful if he could tell us what discussions he has had with Ministers in the Department for Exiting the European Union or with the EU negotiating team about future co-operation on medicines regulation. Has the Minister or anyone from the Department of Health had contact with Australia and New Zealand about potential alignment with their regulatory systems?

I have a lot of questions for the Minister today. Can he be clear about the Government’s plans for the so-called transition period that the Prime Minister thinks will follow the conclusion of the article 50 negotiations? After all, it is a mere 16 months away. If pharmaceutical businesses will have to deal with only one set of changes, as the Prime Minister promised, presumably the licensing arrangements for new drugs will stay the same for that period.

I see two main problems in setting up some sort of stand-alone replica system to fill the gap vacated by the EMA if we leave the EU. First, will UK patients get the same quick access to new innovative drugs that come on to the market? Secondly, will UK patients benefit from the same high levels of safety and compliance checks that the EMA currently performs for already-authorised medicines in its role in enforcing standards in the pharmaceutical manufacturing process and at clinical trial sites?

I fear that we could see delays in new drugs being launched in the UK. If a small pharmaceutical company has to choose between paying to get a licence in the EU, which accounts for 25% of the global pharmaceutical market, and paying for one in the UK, which accounts for 3% of the global market, which will it choose? The UK is currently a priority location for launching new innovative treatments, but how long before we become a second-tier country?

What guarantees can the Minister give about the next phase of immunotherapies, which are three to four years away from coming to market? They are potentially twice as effective as current immunotherapies and could give cancer sufferers an extra three to four years of life. Will UK patients in a post-Brexit regulatory environment get them as quickly as they would if we were still part of the EMA? Can the Minister guarantee that adverse effects among uncommonly used drugs will be picked up as quickly if the expanded patient pool that would be available for checks across the EU is limited to the UK? Will the UK still have access as quickly to orphan drugs to treat the rarest of diseases, for which pharmaceutical companies have less of an incentive to develop products? What about the participation of UK patients in pan-European clinical trials, which are critically important, full stop, but all the more so for rare diseases and illnesses in children, for which the patient pool is smaller? At the moment, a quarter of cancer research clinical trials involve one or several European countries. Will we comply in the future with the new EU clinical trials regulations, which have been postponed and may not be implemented until March 2019?

The Minister needs to answer many questions if the Government intend to diverge from European processes, but there will be basic problems no matter what new system is put in place. How much will all of this work to reinvent the wheel and beef up our regulatory bodies cost? Will we have to ask UK taxpayers to pay a greater amount for this process, given that we currently share the cost with 27 other member states? What preparatory work has the MHRA done to ascertain what the impact of leaving the EMA will be on both its income and its future staffing requirements? What training of staff will need to be done so they can take on responsibility for tasks they have not previously performed? What impact will the relocation of the EMA have on medicines regulation across the whole of Europe?

I read the EMA’s Brexit preparedness business continuity plan yesterday, and I admit to having a feeling of utter shame about the disruption that our decision to leave the EU has forced on that agency. The huge upheaval will undoubtedly have an impact not just on this country but on others, too. As anyone who has ever moved office knows, projects get put on hold and the basics become harder to deliver.

There are so many questions to ask, and I am sure I have not touched on even half of them. I would like to finish with some more general observations. In 10 years’ time, when we have delayed access to new cancer treatments, compared with, say, France or Germany, will the fact that we have blue passports make up for it? Children with rare diseases will not be able to get new drugs as quickly or easily as they can now, but is that a price worth paying for coming out of the jurisdiction of the ECJ? This is all utter madness. Ministers can bang on about creativity in the negotiations all they like, but we need certainty and clarity. Pharmaceutical companies and patients need certainty and clarity, and the mums and dads of seriously ill children need that, too.

--- Later in debate ---

[Steve Brine]

I thank the hon. Lady; she is always there when we need her.

As I was saying, those skills and expertise have allowed the MHRA heavily to influence global practice and regulations, which is why I say it is a world leader. A majority of medicines available in the UK—around 90%—already receive a national UK licence issued directly by the MHRA. It also leads the assessment of more than 20% of new medicines licensed by the EMA, with particular expertise and specialism in more complex new drugs that come to market. Similarly, on medical devices, five of the EU’s 55 notified bodies are in the UK, and they undertake a disproportionate amount of work. We estimate that they assess between 50% and 60% of the highest-risk devices on the EU market—a big player.

The strengths of our world-leading regulator are similarly reflected in the UK’s life sciences sector. The UK has one of the strongest and most productive life sciences industries in the world, with more than 5,000 companies, more than 233,000 employees, and an eye-watering turnover of more than £63.5 billion each year. It also provides products that the NHS and patients rely on every day—I know that the constituency of the hon. Member for Bishop Auckland has seen the benefits of that productive industry.

GlaxoSmithKline announced this year an investment at its Barnard Castle facility in Teesdale, as part of a wider £140 million investment in the expansion of manufacturing HIV and respiratory medicines. However, we cannot be, and are not, complacent, and we must continue to work hard to support the industry, and we have done just that. The industrial strategy Green Paper was launched in January this year, and it set an “open door” challenge to industry to come up with proposals to transform their sectors through various sector deals.

[Heidi Alexander]

I am grateful to the Minister for his exposition of the current state of life sciences in the UK, all of which we could probably find out if we typed a few words into Google. May I bring him to one of the first questions, which is of pressing importance? What will the regulatory environment be for pharmaceutical companies that wish to get a pan-European licence in April 2019, during the so-called transition period envisaged by the Prime Minister, following the conclusion of negotiations on article 50?

[Steve Brine]

I will come to that.

[Heidi Alexander]

Please, come on. Just get straight to it.

[Steve Brine]

We should always try to be courteous to one another in this House, if we can manage that. To refer to the previous point, DEFRA is responsible for animal medicines policy; EMA covers both human and animal medicines. The Department of Health and DEFRA work incredibly closely together; therefore, DEFRA Ministers answer on applications for animals. I can assist with that at any time.

We are working with Sir John Bell and others in the life sciences sector to consider the industrial strategy in more detail, and specifically what action can be taken by Government and industry in partnership through an ambitious sector deal. At the launch of “Life Sciences: Industrial Strategy”, the Secretary of State for Business, Energy and Industrial Strategy, who has been much spoken of already in this debate, reiterated the Government’s commitment to the sector by announcing the first phase of their investment—£146 million for leading-edge healthcare, which is expected to leverage more than £250 million of private funding from the industry.

Leaving the EU, with all its challenges, allows us to make fresh choices about how we shape our economy and presents an opportunity to deliver a bold industrial strategy that prepares us for the years ahead. Our approach to the EU exit negotiations for medicines regulation is focused on building on the strengths of the MHRA and the UK life sciences sector that I have just set out. As the UK leaves the EU, both parties will have the shared aim to protect the health of patients across Europe and to ensure the safe and timely access to medicines and medical devices that I know concerns hon. Members as it concerns me. It is in the interests of patients and the life sciences industry for us to find a way to continue UK-EU co-operation and to ensure continued sharing of data, even if our precise relationship with the EU will, by necessity, change.

Earlier this year, the Secretary of State for Health and the Secretary of State for Business, Energy and Industrial Strategy published an open letter in the Financial Times setting out Government’s aim to retain a close working partnership in respect of medicines regulation after the UK leaves the EU. Our approach is underpinned by three key principles, which are worth stating. First, patients should not be disadvantaged; secondly, innovators should be able to get their products into the UK market as quickly and simply as possible; and thirdly, the UK should continue to play a leading role in promoting public health.

Yesterday, obviously, the new location of the EMA was announced; in 2019 it will move to Amsterdam. Both the UK and the EU have a collective responsibility to make sure that the process is as seamless as possible, in order to minimise disruption to existing regulatory procedures and public health protection. There are no benefits to UK or EU patients in tearing up the sort of close working relationships that get crucial drugs on the market as fast as possible, share early alerts about problems with medicines or allow patients to benefit from new scientific discoveries earlier. As the Prime Minister has said, there is also no need to impose tariffs where we have none now, which is the case for medicines and medical technologies.

Continued collaboration is in the interests of public health and safety across the continent of Europe, and in the UK for our constituents, because we all know that health is different. Medicines and med tech are different from other consumer products. Patients who need an innovative treatment cannot simply pay more or consume less but otherwise carry on as they were, marginally worse off. We recognise that it could be the difference, as has been said, between life and death. We look forward to discussing these issues as early as possible with our EU counterparts as part of the negotiations.

[Steve Brine]

Yes, of course. I want to come on to the many different questions asked. The hon. Member for Central Ayrshire (Dr Whitford) said that Scotland would have bid for the EMA if it had voted yes a couple of years ago. I do not think that it would have done, because it would not have been a European Union member state.

[Heidi Alexander]

I am grateful to the Minister for giving way. Mr Davies, I hope that it is not out of order to say that the Minister does not quite seem himself. If he is poorly, and my earlier remarks were somewhat curt, I apologise for them.

It would help everyone here to understand the Government’s overriding objective for medicines regulations in a post-Brexit environment. Do we intend to automatically follow EU authorisations in future, or does the Minister foresee divergence from EU regulations?

[Steve Brine]

rose—

--- Later in debate ---

[Steve Brine]

There is a huge body of work going on in the Department about the impact of Brexit on every single area of every single Minister’s responsibility.

[Heidi Alexander]

What assessment has the Minister made of how staying in the European economic area might impact medicines regulation, were we to go down that route instead of the one the Government are currently pursuing?

[Steve Brine]

The hon. Lady asks me to visualise all the different scenarios for the current negotiations. We have been clear that we want a comprehensive deal. A number of Members mentioned that no deal is some sort of ideological obsession for some Government Members. That may be true, but they do not speak for Government policy. We are not looking for no deal; we are looking for a comprehensive deal.

The hon. Member for Barrow and Furness (John Woodcock) asked about meeting my colleague Lord O’Shaughnessy. I cannot speak for my colleague’s diary, but I will speak to him. If he cannot meet the hon. Gentleman and his taskforce, I will. The hon. Gentleman always speaks passionately for his constituency, and I am more than happy to try to sort that out for him.

The hon. Member for Central Ayrshire raised a concern about safety data. That absolutely should always be shared at a global level. The MHRA leads about a third of the EU’s pharmacovigilance work. The EMA already shares data with third countries. It is in all our interests for that to continue. If we are outside EU regulatory procedures, we will ensure that the UK remains an attractive market and that regulation does not delay patient access. A number of Members expressed concern about that, and it is a concern of mine, which is why it is a priority for us.

Oral Answers to Questions

Heidi Alexander Excerpts

Tuesday 10th October 2017 Commons Chamber

[Mr Hunt]

That is something I cannot answer right now, because the latitude that the Chancellor has given me with respect to the negotiation of future pay rises is partly linked to productivity improvements that we will negotiate at the same time. The fact is, though, that we do have that flexibility, and I hope we can get a win-win as a result.

[Heidi Alexander (Lewisham East) (Lab)]

May I take the Secretary of State back to the issue of nursing associates? Given that evidence shows that for every 25 patients for whom a professionally qualified nurse is replaced by a non-nurse, mortality on an average ward rises by 21%, how comfortable is he with reports that hospitals in Lincolnshire and Leicester are using nursing associates to plug gaps in the nursing workforce?

[Mr Hunt]

The hon. Lady should be very careful before talking down nurse associates. They do a fantastic job, they are trained, they are helping our NHS and they are welcomed by their nursing colleagues.

Oral Answers to Questions

Heidi Alexander Excerpts

Tuesday 4th July 2017 Commons Chamber

[Mr Hunt]

My right hon. Friend makes a very important point. That is precisely why last year we increased the number of medical school places with, I think, the second biggest hike in the history of the NHS—a 25% increase. We absolutely do believe that this country should be training all the doctors and nurses that we need.

[Heidi Alexander (Lewisham East) (Lab)]

The truth is that EU staff no longer want to come here. Doctors and nurses are leaving in their droves, and thanks to the abolition of the NHS bursary, our nurses of tomorrow are going to have to pay to train. When will the Secretary of State understand that this staffing crisis has not materialised out of thin air but is directly attributable to his actions and the actions of his Government over the past seven years?

[Mr Hunt]

The hon. Lady may have noticed a little thing called Brexit that happened last year, which is the cause of understandable concern. If she looks at the facts about how many doctors came from the EU to the NHS in the year ending this March, in other words, post-Brexit, she will see that 2,200—[Interruption.] Someone asked about nurses. I happen to have that information here: 4,000 nurses joined the NHS from the EU in the year ending in March.

Health and Social Care

Heidi Alexander Excerpts

Monday 27th February 2017 Commons Chamber

[Heidi Alexander (Lewisham East) (Lab)]

It is a real pleasure to follow the hon. Member for Erewash (Maggie Throup), who has made a characteristically well informed and thoughtful speech.

You do not need to be a brain surgeon, Mr Speaker, to have worked out that the NHS and care system are currently under enormous pressure. Anyone who has recently visited a hospital, sought a GP appointment or tried to arrange support for an elderly relative will tell you that the whole system is struggling. Inadequate funding, a workforce crisis and a failure to reshape services quickly enough to meet the needs of our ageing population mean that the men and women who care for our loved ones are simply running to stand still. This winter, we have seen the front pages of national newspapers covered by images of frail, older people stuck on trolleys in hospital corridors and a poorly toddler led on plastic chairs pushed together to create a make-shift bed.

If you happened to watch BBC2 on a Wednesday night in January or February, Mr Speaker, you would have seen the documentary “Hospital”, which showed the reality of people working on the frontline and taking really difficult decisions about patients, beds and operations in a big and busy hospital. It was captivating viewing, which left me, as a politician, feeling sad and frustrated that we are failing to create the conditions in which the NHS can thrive.

Many of the current problems plaguing our health and care system relate to a lack of money. It is not the only problem, but it is the major one. While the NHS budget has inched up in recent years, it has been outstripped by rocketing demand. Next year, NHS funding per head of the population will fall in real terms. Social care budgets have been slashed, meaning that the support available to the elderly and disabled in the community has been reduced. Even with the changes that the Government have made to the better care fund and the social care precept, the Local Government Association still predicts a shortfall of £2.6 billion by the end of this Parliament.

We cannot escape the fact that our population is growing and we are ageing. There are now more retired people in the United Kingdom than there are children in our schools. As the decades pass, medicine advances. We keep more babies alive when they are born with complicated medical conditions; we successfully treat more and more people who have cancer; we perform ever more complex operations which can give people many happy years of life, but which contribute to the fact that as we age, many more of us have underlying frailties and multiple health needs.

This situation has not come about overnight, and it is one that all recent Governments have had to manage, but the present Government are not managing it, and that is the difference. This Government’s head has been in the sand. Between 1997 and 2010, the Labour Government increased real-terms spending on the NHS by an annual average of 5.7%. The equivalent figure for the coalition Government was 0.8%, the lowest increase under any Government since world war two. Under the present Government, the figure is 1.75%. The Government may talk a good game on NHS spending, but the truth is that we are in the middle of a decade of austerity, and when we add to that a slash-and-burn approach to local government and the social care services for which it is responsible, it is little wonder we find ourselves in our current predicament.

So what now? As we heard from the Chair of the Select Committee on Health, the hon. Member for Totnes (Dr Wollaston), we must be honest about the scale of the challenge. When it comes to NHS spending, this year is meant to be the year of plenty, the one year in the current Parliament when there is a relatively significant increase in available funds, but those funds have already been used to pay off last year’s debts. Money that was meant to be used to repair buildings and buy new equipment is, in effect, being used to pay salaries, and funds that were meant to transform services are being used to deal with the flow of people turning up at A&E. Hospitals are likely to end the year in deficit again, more clinical commissioning groups are overshooting their budgets, and NHS England is struggling to stay within its spending limits for specialised services. So-called efficiency savings really equate to the freezing of staff pay.

People who work in the NHS and social care system need to be honest about their ability to cope. The junior doctors were honest about it last year, and now it is time for others to do the same. NHS managers need to be honest about the time that it will take to transform services, and about the funding that that transformation requires. Hospital beds cannot be closed if services in the community are not already up and running, and have been proved to reduce the demand for in-patient care.

We need to be honest, but we also need action. The Government must provide direct support for local authorities, with funds for social care, in the Budget. How they pay for that is obviously for them to decide, but they cannot continue to shove partial solutions on to local government and wash their hands of the problem. If they do not address the long-term problems in social care, they will be leaving the NHS to pick up the pieces.

However, even if the Government are persuaded of the case for additional funds, we must think carefully about where the money would best be spent. It is tempting to say that it should simply be reinvested in what has been taken away—that there should be more comprehensive care packages and social care for a wider group of people, and the cuts affecting community health nurses and mental health trusts should be reversed—but I think the position is more complicated than that.

The current short-term fix of taking money from the capital budget to prop up revenue is wrong. New scanners are less likely to need repair than old ones, which means cutting waiting times and improving outcomes. Well designed, well maintained buildings can improve productivity and efficiency. Those who compare the new Guy’s cancer centre with the buildings at the Princess Alexandra hospital in Harlow will not believe that the two are in the same country. We should invest in new step-down care facilities for people who are well enough to leave hospital, but for whom care in the home has yet to be arranged.

There is also a massive need to invest in staff and build careers that people aspire to. This will take time as well as money. Perhaps we need to consider new roles in community health services that provide holistic care to older people in the home. Perhaps we need more GPs who are paid to dedicate time to residential homes, spotting problems among the elderly which would otherwise end up in a hospital admission. Perhaps the social care workforce needs a wholesale rethink. I will never forget the conversation I had with a senior A&E nurse who told me that the half-term holidays always result in more older people coming into hospital because the mums who do the part-time, zero-hours jobs in home care were looking after their children instead.

I fundamentally feel that the whole system needs to focus on how we provide care, in the broadest sense, to older people—the one in four people in a hospital bed with dementia, and the three in four people in care homes with dementia. We should focus on the real weekend effect—the one where if we happen to be in hospital on a Friday night, we are unlikely to make it out until Monday lunchtime at the earliest. Why do doctors talk of how it takes three minutes to admit a patient, but three days to discharge them?

I end by saying this: the Government might be absorbed by the complex task of trying to take us out of the European Union, but if they do not do something to address the scale of underfunding in the NHS and care system, the public will not forgive them. We need real answers to the real problems, and we need them quickly.

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[David Mowat]

No. The 2014 figures are the most recent available—and they do not include the comparatively large settlement on healthcare and the front-loaded money in the spending review.

The Government spend 1.2% of GDP on social care—we spend another 0.6% privately. That is more than countries such as Germany—the Chair of the Communities and Local Government Committee talked about Germany—which spends 1.1%, and more than Canada and Italy. Again, it is less than some countries—Holland, an exemplar country in this respect, spends considerably more; I accept that there are choices to be made—but it is wrong to pretend that we are massively out of kilter with the sorts of countries we would regard ourselves as equivalent to.

[Heidi Alexander]

Does the Minister accept that if we continue on current spending rates as a proportion of GDP, by the end of this Parliament we will be spending less than countries such as Costa Rica and Iceland? Is that the sort of health service his constituents aspire to?

[David Mowat]

There are assumptions in that—to do with our GDP growth, their GDP growth and everything else—so it is a difficult question to answer. I would just refer again to the latest OECD figures, for 2014. Those figures are accurate. There is a valid debate to be had about whether they are enough, given the demographics and all the rest of it—that is fair—but it is not fair to imply that there is a massive disparity between us and our EU neighbours.

Oral Answers to Questions

Heidi Alexander Excerpts

Tuesday 7th February 2017 Commons Chamber

[Mr Hunt]

I remember visiting my hon. Friend in Ely last autumn, and I know how much she campaigns and cares for her local health services. The Cambridgeshire and Peterborough CCG knows the importance of Ely’s minor injuries unit. It is setting up some public engagement meetings, but if any changes are deemed necessary, I reassure her that there will be a formal consultation before anything happens.

[Heidi Alexander (Lewisham East) (Lab)]

The Heath Secretary’s self-congratulatory tone is astonishing. In the last year, the number of people waiting longer than four hours in A&E has increased by 63%, the number of people waiting on trolleys has gone up by 55%, and the number of delayed discharges is up by 22%. While all of us want hospitals in special measures to improve, what is the Health Secretary’s answer to those urgent problems that affect the NHS across the board?

[Mr Hunt]

I will tell the hon. Lady what is happening in the NHS compared with when her party was in power: 130 more people are starting cancer treatment every single day; 2,500 more people are being seen in A&Es within four hours every single day; and there are 5,000 more operations every single day. None of that would be possible if we cut the NHS budget, which is what her party wanted to do.

Oral Answers to Questions

Heidi Alexander Excerpts

Tuesday 20th December 2016 Commons Chamber

[Mr Hunt]

I recognise the extent of my hon. Friend’s campaigning on this issue in Telford, and that she expresses the concerns of many of her constituents. As she knows, service changes must be driven locally and must have the support of local GP commissioners. She will also know that the actual situation, very frustratingly, has not led to consensus between clinicians in different parts of Telford and Shropshire. I agree that the process has taken much too long, and I am more than happy to meet her and to try to bring this situation to a close as quickly as possible.

[Heidi Alexander (Lewisham East) (Lab)]

In a year when the Health Secretary has spent quite a lot of time knocking clinicians, it is good to hear him speak so positively about them. After four years in the job, what responsibility does he accept for the lack of suitably qualified individuals—not just clinicians—who are prepared to take on the top jobs in the NHS on a permanent basis?

[Mr Hunt]

I will tell the hon. Lady what I take responsibility for: more doctors, more nurses and more funding than ever before in the history of the NHS. We know that the highest standards are often achieved when there is strong clinical leadership. Only 54% of managers in this country are clinicians, compared with 74% in Canada and 94% in Sweden. That is why it is right that we do everything we can to encourage more clinicians into leadership roles.

Oral Answers to Questions

Heidi Alexander Excerpts

Tuesday 15th November 2016 Commons Chamber

[Mr Hunt]

I can absolutely give that assurance. Through my hon. Friend I congratulate the staff of King’s Lynn hospital who have turned things around there. It was a great privilege for me to visit it and see the work that they have done. My hon. Friend is right—the next step is to integrate the work done in acute hospitals with what happens in the community and the social care system. That is why the open and transparent STP process is so important.

[Heidi Alexander (Lewisham East) (Lab)]

I do listen carefully to the Health Secretary and sometimes I end up wondering what planet he is living on. There are as many trusts in special measures now as there are trusts that have come out of special measures. Just because different people in different places are experiencing poor care does not make the overall picture any better. When will the right hon. Gentleman accept that the overall amount of resource going into the system is simply inadequate if he wishes to provide high quality, timely care for all?

Baby Loss

Heidi Alexander Excerpts

Thursday 13th October 2016 Commons Chamber

[Antoinette Sandbach]

I do agree. I had the pleasure of meeting Annika last year, following on from the speech in Parliament. I know that there are many parents like her who want to see some good come out of the loss. It demonstrates the importance of motivating those parents and allowing them to get involved. Very often, the Snowdrop suite at Scarborough hospital acts as a real reminder in memory of Gypsy.

[Heidi Alexander (Lewisham East) (Lab)]

I congratulate the hon. Lady on securing the debate and on speaking in such a powerful and deeply human way. She is talking about parents’ desire to see some good come from their loss. Does she agree that where failings have occurred, part of that critical process should involve NHS trusts communicating with parents on an ongoing basis about the actions and steps being taken to ensure that these tragedies are not repeated?

[Antoinette Sandbach]

I certainly do. The more open trusts can be and the more they can share information, the more we are likely to achieve reductions in baby death rates. We need that learning to happen in order to tackle what went wrong and why. Without openness, we will not have that.

Freedom of information requests that I submitted to every NHS England trust indicated that approximately 25% of maternity hospitals still do not have bereavement suites. I am aware that, because of the huge difference it makes to parents, the Government have done much to ensure that funding is available and that action can be taken to tackle the problem.