Milton Keynes Women’s and Children’s Hospital: New Hospital Programme

Iain Stewart Excerpts

Thursday 25th January 2024 Commons Chamber

[Iain Stewart (Milton Keynes South) (Con)]

My hon. Friend makes an important point that the hospital is there for Milton Keynes, but it is also there for the surrounding areas, including towns such as Buckingham and Winslow and the villages around them. Does he agree that the important partnership between the medical centre at the University of Buckingham and the hospital has driven up clinical standards? When I was first elected in 2010, standards at Milton Keynes University Hospital were not good. They are now among the best in the country. That should be cherished and it bodes well for future investment.

[Ben Everitt]

I agree wholeheartedly; in fact, I remember campaigning with my hon. Friend to get that partnership up and running back in 2015. It really is a virtuous circle: because it is now a teaching hospital, people want to go there to learn, and standards go up. It is one of the best places to work in the region, with fantastic staff and fantastic management.

One of the best measures we have for a healthcare system is its capacity to provide everyone with the specialist care they need. That is why I was very pleased when the construction of a women and children’s hospital, which is the subject of the debate, was agreed in principle. It is part of the new hospital programme, and getting it on to the list of 40 new hospitals and keeping it there has been quite a journey. With covid, build cost inflation, and concrete rot being found in other hospitals, which bumped them up the priority list, it has been hard work to keep our hospital on the list. I sincerely thank my hon. Friend for his hard work, and Professor Joe Harrison at Milton Keynes University Hospital.

On the list we are! The Treasury has confirmed the funding and we are a go. Our new hospital will act as the home for paediatric and maternity care in Milton Keynes, while increasing surgical capacity. Through the new hospital programme, the new hospital and the existing hospital will be able to utilise the latest technological developments to create smarter hospital facilities. That means more up-to-date systems and devices, leading to greater efficiency and better care across the whole hospital estate. Another point, which might be overlooked, is that moving maternity and paediatric care to the new hospital will free up capacity in the existing hospital for other clinical requirements. Often, building new hospitals is not just about new facilities, which are of course important; it is also about improving existing facilities and care. MK University Hospital will be able to move forward with its own expansion plans. In that sense, we can begin to unlock the full potential of our healthcare infrastructure in Milton Keynes.

Having seen the architect’s impressions of the new hospital, I can only be excited. With it, we have a brilliant future ahead of us. It is clear that the hospital will act as a symbol of how far our city has come, but I also feel that it will act as a symbol of the new hospital programme overall, and of the benefits of the Government’s ambitious levelling-up agenda. Of course, having a new hospital focused on women and children is not just about the additional treatment; it is about creating the right environment for that care to take place—an environment in which women feel comfortable talking about their health without distress or worry, and children feel that they are cared for in their own setting.

The integration of maternity and paediatric care is key. Having those services all under one roof will make life easier for nurses and doctors, as well as for families. The health of our women and children is fundamental. We must therefore keep pushing for the new hospital to be built as soon as possible, to ensure that Milton Keynes can provide the best care for our young families and is the best place possible to respond to the challenges of population growth. With funding having been announced last May, I hope that the funds can be released soon, so that we can get the plans finalised and get on with the construction work. I know that many back in MK are itching to get the green light and get on with the project, so I would welcome any updates on the hospital, and where we are on the timeline.

Delivering the 40 new hospitals by 2030 is key to meeting our manifesto commitments from 2019. Getting this hospital up and running as soon as possible will demonstrate in no uncertain terms that the Government are more committed than ever to that target.

New Hospitals

Iain Stewart Excerpts

Thursday 25th May 2023 Commons Chamber

[Steve Barclay]

I very much agree. My hon. Friend is right to draw attention to the £8 million investment in Southend and the wider capital programme, not least the roll-out of diagnostic centres and new surgical hubs, which are all part of us tackling the pandemic backlog and of our commitment to investing in the NHS estate.

[Iain Stewart (Milton Keynes South) (Con)]

With your indulgence, Madam Deputy Speaker, may I place on record my deep sadness at the passing of Karen Lumley today? She was a dear friend, as well as a valued colleague, and she will be very much missed.

I thank my right hon. Friend for the confirmation of funding for the new women and maternity unit at Milton Keynes University Hospital. Can he give me an assurance that he will work with Joe Harrison, the excellent chief executive, and his team to bring forward as many enabling works as possible? The site is ready to be developed almost immediately.

[Steve Barclay]

I am happy to give my hon. Friend that assurance. I have frequent meetings with the chief exec of Milton Keynes University Hospital, not least because he provides national leadership in our development of the NHS app. I know that he champions the Milton Keynes site and its next steps, and I am keen to continue to work constructively with him.

Oral Answers to Questions

Iain Stewart Excerpts

Tuesday 19th December 2017 Commons Chamber

[Mr Dunne]

Bed occupancy rates are high at this time, not least following the recent cold snap, which has put additional pressure on hospital trusts. We have used some of the funding provided in the March Budget to increase the rates of delayed transfers of care to improve patient flow throughout all hospitals, and that has led to a slight reduction in bed occupancy in the run-up to winter.

[Iain Stewart (Milton Keynes South) (Con)]

8. What steps he is taking to increase the size of the mental health workforce.

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

In order to increase the number of mental health patients we treat by 1 million every year by 2020-21, we are increasing the number of mental health posts in the NHS by 21,000.

[Iain Stewart]

I certainly welcome that increase, but does my right hon. Friend agree that there is a particular need to address mental health issues in schools? Could he set out what plans he has to give extra support there?

[Mr Hunt]

My hon. Friend is absolutely right, for the simple reason that prevention is better than cure, and about half of all mental health conditions become established before the age of 14. That is why it was so significant that, following the Budget, we announced the allocation of an extra £300 million through the mental health Green Paper, precisely to improve the service we offer students in schools.

Deafness and Hearing Loss

Iain Stewart Excerpts

Thursday 30th November 2017 Westminster Hall

[Iain Stewart (Milton Keynes South) (Con)]

It is a great pleasure to serve under your chairmanship, Mr McCabe.

I start by congratulating the hon. Member for Poplar and Limehouse (Jim Fitzpatrick) on securing this debate and on setting out his case with his customary courtesy and passion. He has been a champion of these issues for many years, so I pay him heartfelt tribute for that.

As the hon. Gentleman said, this is the first debate in the House to be transmitted via British Sign Language. Unfortunately, news of that came too late for one of my constituents, Christopher Jones, who wanted to attend, but decided not to travel down from Milton Keynes because he did not think that this facility would be available. Mr McCabe, perhaps you could report back to the Speaker and the Panel of Chairs that we should consider providing this interpretation not only during debates on this subject, but during general debates more widely, so that we are as accessible as possible to all our constituents.

I will focus on the introduction of a nationwide telecommunication relay service—something that Mr Jones came to see me about a few weeks ago. In most advanced economies, a nationwide TRS provides functionally equivalent telephone transmission services to deaf and hard-of-hearing individuals. A TRS is a telephone transmission service that allows an individual who is deaf or hard of hearing to have the same telephone availability as someone who is of good hearing. As telephone services and technologies evolve, so does the scope and achievement of functional equivalence. At one time, typed text communication was considered the functional equivalent of voice communication, but in the 21st century, captioning, video and other technologies have changed what equivalency means. The gaps between what is available to hearing individuals and those with hearing deficiency are growing. Sadly, the UK, which was the first to introduce such systems, now lags well behind other countries such as the USA, Australia, Canada and New Zealand.

The issue of functionally equivalent telephone services must be addressed. It includes, but is not limited to: the unrestricted availability of relay services 24 hours a day, seven days a week; emergency preparedness and response, to ensure the delivery of relay services in the event of disruptions to telecommunications services; international capacity; and access to the full array of existing telephone services offered by telecommunications companies. Competition, innovation and choice are important, so that users can access a wide range of services. What works for some people in some circumstances might be different from what others need. There are different facilities available, and it is important that each user can choose the system that works best for them at any one time. That might mean one individual having different things at different times. My constituent said that he would use one means to communicate with his family, and a different one for business conversations. Many other issues need to be considered.

While these may seem like lofty goals, they are being delivered in the countries I mentioned. For example, Australia provides the following relay services: textphone to voice and voice to textphone; textphone voice carry-over; textphone hearing carry-over; speech to speech; video relay services; internet relay; mobile text relay; mobile SMS relay; captioned telephone for phone and web; and captioned telephone to Braille display. In Australia, the system has operated as a national service since 1995 and is available to every Australian at no additional cost, 24 hours a day, seven days a week.

A number of studies since the system’s introduction have looked at its impact. We might think some of the findings are obvious, but it is important to mention them. Access to enhanced relay services is positively associated with reductions in feelings of frustration with telephone use. It gives individuals a much higher quality of life. It not only allows access to work, as the hon. Member for Poplar and Limehouse mentioned, but is proven to reduce the wider health consequences that can arise from isolation, such as mental health issues. The cost saving is likely to exceed the cost of introducing the service. I think I heard him mention that £30 million annually could be saved from the health and social care budget if many of these feelings of social exclusion were dealt with.

Ironically, my constituent was involved in designing and setting up such a system many years ago. It had to close down in 2008 as he could not make it work, and part of the problem was bureaucratic muddle and delay. The issue is often cross-departmental. We have a Minister from the Department of Health here, but the matter is as much for the Department for Digital, Culture, Media and Sport and the Department for Work and Pensions. The potential benefits of the system my constituent introduced could not be realised because there was buck-passing and delays, and the approach was not joined up.

My call today is for the Minister to take away these points and discuss them with his colleagues in DWP and DCMS, and to drive forward the introduction of a nationwide service in this country. It is embarrassing that while we were one of the first to introduce such systems, we have fallen back over a number of decades. Other countries are now way ahead of us. I urge the Minister and his colleagues to look at the evidence, particularly from Australia, on what can be done cost-effectively. This is not just about money; it is about quality of life. We owe it to all our constituents to give them as much access to the world of work and public services as anyone else, and my suggestion is a fairly straightforward way to do that. I urge the Minister to look at the evidence from other countries and discuss it with his colleagues.

Tobacco Control Plan

Iain Stewart Excerpts

Thursday 19th October 2017 Commons Chamber

[Sandy Martin (Ipswich) (Lab)]

I am concerned about the damage that smoking does to my constituents. Almost 15% of the population of Suffolk smoke. More than 7,500 admissions to Suffolk hospitals every year are attributable to smoking. Those who do not quit will have roughly a one in two chance of dying prematurely from smoking-related diseases.

The tobacco industry is deliberately producing products that it knows will kill its customers. While the market for cigarettes is mercifully in decline in the UK and other rich countries around the world, it is still growing in low-income countries, where the industry regularly uses tactics that would be illegal in this country, including the deliberate sale and marketing of cigarettes to young people and children. As a result, more than 7 million people die from the consequences of tobacco use each year. Almost four fifths of the world’s 1 billion smokers now live in low and middle-income countries. Money spent on tobacco is money not spent on other household needs. In Kenya and Bangladesh, tobacco cultivation has replaced food crops, leading to local food insecurity. In Malawi, at least 78,000 children are forced to work in tobacco fields, preventing most of them from attending school. Tobacco growing around the world is responsible for a loss of biodiversity, land pollution due to the use of pesticides, soil degradation, deforestation and water pollution. The result of all that deeply destructive and irresponsible activity is that the four major tobacco manufacturers are some of the most profitable businesses on earth.

It is impossible to hold an ethical investment in a tobacco company. To invest in tobacco is to seek to make money from environmental destruction, social exploitation, disease and premature death. That is increasingly understood by investors, because last year AXA, one of the world’s largest insurers and a major part of the Ipswich economy, divested more than $2 billion of tobacco industry assets. I welcome its decision. Tobacco-free investment policies have also been announced by AP4, one of the most influential pension funds in Sweden; Medibank, the largest health insurer in Australia; Fonds de Réserve pour les Retraites, France’s public pension fund; the Irish sovereign investment fund; and CalPERS, the largest public pension fund in the USA. So far in 2017, tobacco-free investment decisions have been made by AMP Capital, Bank of New Zealand, SCOR, PME, ACTIAM and Aviva, the largest insurer in the UK. In addition, ABN AMRO, the global bank, will cease lending to tobacco manufacturers. Those very welcome individual decisions now constitute a clear trend.

In that context, it is increasingly absurd that large investments in tobacco are still held by local authority pension funds across the United Kingdom. There is a fundamental contradiction between the local authorities’ public health responsibilities and their investments in tobacco, which actively promote the biggest public health problem confronting this country.

I understand that pension fund trustees have a duty to run their funds to secure strong returns for beneficiaries. Local authority workers depend on sound investments for their pensions. Case law has now made it clear that local authority pension fund trustees may consider non-financial factors when setting investment strategies, provided that any restrictions they place on investment as a result of such consideration do not significantly affect financial returns. But how immoral does an investment have to be before the financial returns no longer trump the moral question?

[Iain Stewart (Milton Keynes South) (Con)]

The hon. Gentleman is making a powerful argument, but will he consider the fact that many tobacco manufacturers are actively investing in non-tobacco products, which may change their whole future investment strategy? In the light of that fact, should not investors—pension funds and so on—look at that long-term development of such businesses rather than their current position?

[Sandy Martin]

I thank the hon. Gentleman for his intervention, but I do not agree with him. If a company is producing something that is detrimental to the whole world, the best approach is to disinvest from it.

How bad does an investment have to be before its financial returns no longer trump the moral question? Are there no factors that could lead a pension fund to divest on moral grounds alone? Such factors could—and in my view should—include the UK’s treaty obligations. For example, article 5.3 of the framework convention on tobacco control, to which the UK is of course a party, states:

“In setting and implementing their public health policies with respect to tobacco control, Parties shall act to protect these policies from commercial and other vested interests of the tobacco industry in accordance with national law.”

Guidelines for the implementation of article 5.3 were agreed back in November 2008 at the third conference of the parties to the convention. Recommendation 4.7 states:

“Government institutions and their bodies should not have any financial interest in the tobacco industry, unless they are responsible for managing a Party’s ownership interest in a State-owned tobacco industry.”

I am delighted that the UK has no state-owned tobacco industry, but the level of public investment in private tobacco firms in this country flies in the face of the convention.

As leader of the opposition at Suffolk County Council—before I was elected to this august House—I brought forward a motion proposing that the county’s pension fund should disinvest from tobacco funds. The motion was passed unanimously. The pension fund committee then commissioned legal opinion on how to divest, but the opinion was that the committee could not legally do so.

Does the Minister believe that our local authorities should also invest in, say, pornography—a very profitable business I am led to believe? Profit should not be the only consideration for pension fund investment. We can and must do better, and responsible disinvestment by local authority and public sector pension funds is the right place to start. This is an issue on which the public health Minister could usefully engage, and I hope he will make a commitment to do so when he replies to the debate.

Breast Cancer Drugs

Iain Stewart Excerpts

Thursday 26th January 2017 Commons Chamber

[Iain Stewart (Milton Keynes South) (Con)]

I congratulate the hon. Member for Mitcham and Morden (Siobhain McDonagh) on securing this important debate and setting out her case so powerfully. I agree with pretty much everything she said. I know that several Members wish to speak, so I will not detain the House by simply repeating all those points.

My motivation in speaking today comes from a meeting I had at my constituency surgery just a few weeks ago with my constituent Joanna Mears and her husband. Like many other sufferers, they are watching our proceedings from the Public Gallery. Mrs Mears suffers from secondary breast cancer. Although, sadly, her condition is terminal, she is responding well to her existing medication and has already had more than twice the expected benefit span. When the point comes that the medication no longer has that effect, her only remaining option will be Kadcyla. Naturally, she is very concerned about NICE’s decision.

[Sir Desmond Swayne]

This is essentially the same question I asked earlier. I think that we all accept that a mistake has been made and that the decision was wrong. The key question is this: what is the remedy? Does the remedy lie within NICE’s remit, and therefore it could change its procedures and considerations, or does it lie within the statutory framework that Parliament and Government have set for it to work within? We have to come to an answer on that.

[Iain Stewart]

I am grateful to my right hon. Friend for that question. My answer is pretty much the same as that of the hon. Member for Mitcham and Morden. In this specific case, I hope that there is scope for NICE and Roche, the manufacturer of Kadcyla, to sit down and agree some compromise. I received a briefing note from Roche this morning stating that it was willing to do that, so I hope that NICE will respond in kind. Its consultation ended last week. As the hon. Lady said, and as my right hon. Friend rightly points out, there is a broader issue for other drugs. Perhaps it is time to look again at the appraisal system and the cost mechanisms so that we do not keep returning to this debate every time a new drug is identified and there is a question about its affordability under the cancer drugs fund.

[Mr Jim Cunningham (Coventry South) (Lab)]

I agree, because it is not only about the drugs we are debating today; we have had problems before in relation to NICE. In answer to the question from the right hon. Member for New Forest West (Sir Desmond Swayne), I think that the Minister should look at the procedures and at NICE itself, because otherwise we will keep coming back to this issue time and again. The years I have spent listening to the same issues with different drugs is nobody’s business, to use an expression.

[Iain Stewart]

The hon. Gentleman makes an important point. I do not pretend to be an expert on how NICE works, but I hope to bring to the debate the personal experience of my constituent and underline the human effect of these issues. I do not necessarily have a solution, but I hope that the outcome of the debate will be that we not only consider Kadcyla, but take a fresh look at the whole process.

[Mary Creagh]

The NICE framework works very well for mass drugs for the entire population or where a whole vaccination is going to work, but for very small numbers of people, such as the 1,200 women who really need this drug, I do not think it is as effective a process. There are two organisations in this negotiation, NICE and Roche, and we must not have Roche seeing its new drugs Perjeta and Kadcyla as a new cash cow as Herceptin goes off-patent in 2017-18. Women’s lives should not be treated as cash cows by this drugs company.

[Iain Stewart]

I agree with the hon. Lady. I have not had any personal discussions with Roche; I can only refer to and take at face value the briefing note that it sent me early this morning, which seemed to represent a genuine wish to negotiate with NICE and get the drug down to an acceptable price. I hope the debate is joined in that spirit.

Perhaps it is appropriate to mention now something I was going to bring up later in my speech: one area that needs to be examined is the pharmaceutical price regulation scheme, which is a five-year voluntary contract between the pharmaceutical companies and NICE. If I understand how it is intended to work, the pharmaceutical companies will underwrite any overspend for a particular drug. For various reasons that does not seem to be working in practice. I urge my hon. Friend the Minister to look at that point, which has been made by some in the industry.

In the case of my constituent, Mrs Mears, when her current medication ceases to be effective, Kadcyla is the only option. Although she has responded well to the current treatment, there is every likelihood, and her consultant agrees, that she will respond in a similarly positive way to Kadcyla. There is every chance that she would enjoy the benefits of that drug for a time well in excess of the expected nine months. I would therefore argue that a blanket ban on the drug would be inappropriate. At the very least, there should be some flexibility in the system to make the drug available to people such as my constituent, for whom there is a very high probability that it would have more than the expected benefit. She has responded so well to her existing drug, and if her life could be extended considerably by Kadcyla, that would allow more research to be done on the efficacy of her existing medication, which would be an important body of evidence to add to the appraisal process.

The hon. Member for Mitcham and Morden rightly said that the prescription of drugs should be based solely on clinical need and no other factor, but when I met Mrs Mears, she made one point to me that I could not really answer. Through her life, she worked professionally in the criminal justice system and has done a lot of work saving the public purse money by innovating programmes to reduce youth offending. That value cannot be calculated, but she made the point to me, “At the one point in my life that I need something back from this country, it is being denied to me.” I really could not give an answer to that. I hope that something can be done to make the drug available.

The NICE decision is provisional. I contributed to the consultation and I hope that when NICE meets next—in, I think, early March—it will review the decision.

I know that NHS resources are finite and that there are many competing demands on its budget. The debate on the overall size of the NHS budget must be a matter for another time, but cases such as this illustrate the need to use what resources we have as efficiently as possible. Just before I met Mrs Mears the other week, I happened to see a story in the media that really made my blood boil. I do not pretend to be an expert on the prescription system, but I simply put this on the table. The story reported that the NHS wastes about £80 million per annum by prescribing simple painkillers such as paracetamol, which can be bought in a supermarket for 20p or 30p a packet. Those prescriptions go through the usual prescription system and cost £80 million a year. Surely there is a way of getting around that, perhaps by giving GP practices a stock of basic painkillers. I am not asking for people who get free prescriptions to start paying but, surely, there is a way for doctors to issue them when it is appropriate to do so, and stop this merry-go-round of paperwork that costs many millions of pounds.

[Mrs Sharon Hodgson (Washington and Sunderland West) (Lab)]

The hon. Gentleman is making a very valuable point. Does he agree that one way around this issue would be to have prescribing pharmacists who could give out medications such as those basic painkillers, without the need for the patient even to see their GP, which would also free up valuable GP time?

[Iain Stewart]

That sounds an eminently sensible suggestion. As I say, I do not pretend to be an expert on the system, but, surely, something like that could be done. Then the money saved could be added to the cancer drugs fund and make more drugs such as Kadcyla available to people who need them.

I will end my comments, as I know there are many Members who want to contribute. Please let us try to do everything we can in this House to encourage NICE and Roche to look at the overall system and to look in particular at this drug. It means so much to my constituent and to many others up and down the country. I hope that this debate has that effect. I conclude where I started, by congratulating the hon. Member for Mitcham and Morden on securing it.

--- Later in debate ---

[Mrs Hodgson]

That is a very good point. It may be that more and more people are coming forward and being diagnosed, but, as my hon. Friend says, this will clearly become more of an issue, not less of an issue, in the years to come.

As we have heard today, it is estimated that Kadcyla benefits 1,200 women every year in England alone, and that on average it can increase the length of a woman’s life by six months, although reports suggest that in the case of some women that can stretch into years. Even if it is measured in months, however, the extra time is surely priceless to the women and families involved. I speak from personal experience, as I lost my mother-in-law to secondary breast cancer 20 years ago this year, when my children were very small. I know that she fought for every extra week and day in the end, and that she would have given anything for an extra six months to spend with her grandchildren. We all wanted that little bit longer for her. For all those 1,200 women, that extra time is time with their families. It means seeing their children reach perhaps one more milestone: starting school or university, getting married, or even giving them a grandchild. What is the cost of such moments, such memories, which are so precious and which help families so much with what, ultimately and inevitably, will follow?

[Iain Stewart]

The hon. Lady has made a powerful point. In the case of the most aggressive cancers, the period between diagnosis and death can be very short. As she says, any extension of life enabling women to celebrate family events, or anything else, is incredibly important, and we should not lose sight of that.

[Mrs Hodgson]

I agree. What price can be put on those precious months?

Brain Tumours

Iain Stewart Excerpts

Monday 18th April 2016 Westminster Hall

[Iain Stewart (Milton Keynes South) (Con)]

It is a pleasure to serve under your chairmanship, Ms Buck. I add my congratulations to those that have been offered to the hon. Member for Warrington North (Helen Jones), who spoke to the motion so powerfully.

In addition to the moving personal stories that some of my constituents have told me, one of my motivations for speaking today is that I am proud to have in my constituency the national head office of the charity Brain Tumour Research. I pay tribute to Sue Farrington Smith and her team for the incredible work that they do. Earlier this year, I had the great privilege of attending their launch event and open day in their new Milton Keynes offices. I urge colleagues to visit them if they get the opportunity. Mine was an inspirational visit. I saw the passion and determination that the staff, volunteers, clinicians, family members and supporters put into securing better research funding, better and earlier diagnoses, and support for patients and their families.

The debate shows the value of the petitions system. I was at the office a day or two before the deadline for registering, and signatures were just below the 100,000 level. Great excitement was palpable as the number neared the magic threshold. The system works.

I want to make two brief points about the substance of the debate. First, I echo the Committee’s call with respect to funding priorities being set by research bodies. I agree with its conclusion that research gaps cannot be the sole responsibility of the voluntary sector. The Government have a leadership role too. The National Cancer Research Institute partners have an invaluable role to play, but we cannot over-rely on them. I hope that one of the Minister’s takeaways from the debate will be to have a fresh look at the Government’s role in identifying and addressing funding gaps.

I hope that the other point I want to make is not naive. It is about the diagnostic procedure. I have no medical background, but in the six years I have been a Member I have encountered a range of medical conditions, including some cancers—such as pancreatic cancer and neuroblastoma, which tragically took away the life of my young constituent, Henry Allen, at only four years of age—and other diseases that are not cancers, such as Niemann-Pick type C, that all have symptoms that can be difficult to identify. The research, treatment and cure will be unique to each condition, but I have found that they share a common problem of late diagnosis.

The symptoms are often not readily connected to the condition and may be general, such as nausea, pain and fatigue. GPs may see only a handful of such cases throughout their careers. Often, there is a lengthy process in which a condition is dismissed. It is often A&E, as we have heard, that makes a diagnosis later on. Alternatively, there may be a lengthy ping-pong between the GP and the consultant to find out what the condition is not, but without finding out what it is. Surely we can find a better system of diagnosis. When the obvious causes of a symptom have been ruled out, the patient could be sent for a comprehensive MOT to find out what is wrong more quickly. Funding cannot be the issue. How much money is wasted by that constant back and forth?

Earlier diagnosis is important for treatment, as well as in the search for a cure, through tissue being given for research purposes. There is so much more that could be done. I wish I could expand on that point, but I hope that the Minister responds to what I have said.

Oral Answers to Questions

Iain Stewart Excerpts

Tuesday 2nd June 2015 Commons Chamber

[Jane Ellison]

I think I have some sense of the difficulties my hon. Friend describes from previous meetings, but I am of course happy to talk to her about that. All these things are important, but as I say, the driving principles behind the Keogh review are patient safety and making sure that people get the best and most appropriate urgent and emergency care.

[Iain Stewart (Milton Keynes South) (Con)]

9. What proportion of their funding hospices in England receive from the NHS.

[The Minister for Community and Social Care (Alistair Burt)]

Adult voluntary sector hospices in England receive, on average, about a third of their running costs from the NHS. Although this amount varies for individual hospices and it is a locally commissioned service, the level of funding has remained broadly stable.

[Iain Stewart]

I delighted that my right hon. Friend is back on the Front Bench. He will know that hospices up and down the country, such as Willen hospice in Milton Keynes, do a marvellous job in caring for terminally ill patients and their families, yet they have an annual struggle to raise money from local communities to support their work. Will he assure me that he will do all he can to maximise the direct funding that hospices receive from the NHS?

[Alistair Burt]

I thank my hon. Friend for raising this subject. He is absolutely right: Willen hospice in his constituency, next door to mine, has an excellent reputation, as does St John’s hospice in Moggerhanger in my constituency. We are all indebted to hospices for the invaluable work they do. I am sure that he and the House will be interested to hear that, from April, there will be pilot projects working on a new funding formula for palliative care, with the aim of providing a fair and transparent process and improvements. I expect that there will be a report to the House in due course.

Pancreatic Cancer

Iain Stewart Excerpts

Monday 8th September 2014 Westminster Hall

[Iain Stewart (Milton Keynes South) (Con)]

It is a pleasure to serve under your chairmanship, Mr Davies. I am grateful for the opportunity to take part in this important debate. As my hon. Friend the Member for Pudsey (Stuart Andrew) just said, it is one of the most important and enlightening debates that we have had the privilege to take part in. I pay heartfelt tribute to the hon. Member for Scunthorpe (Nic Dakin) and my hon. Friend the Member for Lancaster and Fleetwood (Eric Ollerenshaw) for the huge amount of work that they have done not just to help secure this debate but across the board to promote the issue of pancreatic cancer.

One of the most important and rewarding parts of being a Member of Parliament is championing and giving voice to issues that often go unsung and ensuring that they get the attention and consideration that they deserve in Government and agencies. I echo what my hon. Friend the Member for Pudsey (Stuart Andrew) said about my hon. Friend the Member for Lancaster and Fleetwood. I know how hard it is for him to speak publicly about matters that are private and personal; the fact that he does so to champion this important issue is entirely to his credit. I am proud to call him my friend as well as my colleague. Like everyone else, I pay tribute to Maggie Watts and everyone who has worked to ensure that the e-petition was successful and that we met here to talk about it.

This debate has covered many important issues, but I will explore an aspect of early diagnosis that has been mentioned: what we can do to improve referral systems. As we have heard, that is particularly important in cases of pancreatic cancer. Some 16% of pancreatic cancer patients must visit their GP or hospital seven times or more before the correct diagnosis is made. By comparison, 75% of all cancer patients combined are referred to hospital after only one or two visits to their GP.

As we have heard, we need to do more to train GPs and give them effective tools to identify possible cases of pancreatic cancer, and for that matter any other type of cancer, more quickly. However, once GPs have identified cancer as a possible cause of a patient’s symptoms, that patient needs to be referred for specialist tests to rule cancer in or out definitively, and such referrals must be made quickly and as effectively as possible. The hon. Member for Scunthorpe and others have mentioned the ping-pong or tennis-ball treatment of sufferers who are referred to specialists to rule something out, then back to their GP, then back and forth until the correct diagnosis is made. As we have heard, it is often too late by then for any effective treatment.

The all-party group report concluded:

“This process of going backwards and forwards between primary and secondary care—with waits between appointments and test results—is frustrating from all perspectives. For those patients who are eventually diagnosed with pancreatic cancer, and find that they have been diagnosed at a stage too advanced for curative treatment, it is simply heartbreaking.”

We must do all that we can to break the cycle and get patients referred for specialist tests, and give them the outcomes of those tests, as soon as possible.

There are several ways in which we could help in that area. One is to ensure that robust and clear referral guidelines for pancreatic cancer are produced, helping GPs to make the right referral in the first place. Effective referral guidelines should highlight for GPs the best diagnostic routes for patients with particular symptoms and help speed up the diagnosis process, as well as making it more accurate. The guidelines need to set a low threshold at which GPs should consider sending patients on for specialist and definitive diagnostic tests if they display the symptoms of pancreatic or other types of cancer. Let us be honest: in most cases, cancer will not be the reason for a patient’s symptoms, but we should move to a system in which we seek to rule out cancer at an earlier stage.

Scotland has been mentioned a couple of times. I want to explore what is happening north of the border, although I know that everyone is preoccupied with a certain vote happening next Thursday. Healthcare Improvement Scotland is doing something potentially instructive for cancer care in the rest of the UK. It has just updated its referral guidelines for the NHS in Scotland to improve the list of symptoms that prompt GPs to consider whether to consider that a patient may have pancreatic cancer. Importantly, it has also set a low threshold at which patients presenting with particular symptoms—for example, non-responsive dyspepsia or late-onset diabetes in a weight-losing patient—should be referred for imaging scans or other diagnostic tests. That approach should be considered for the rest of the country. In her concluding speech, can the Minister tell us when NICE is planning to review its cancer referral guidelines for England and whether draft new guidelines will take note of what has happened recently in Scotland?

Faster access to imaging scans, especially for GPs, will help to make more definitive diagnoses more quickly; the hon. Member for Scunthorpe and others have raised that point. To quote again from the all-party group report, one experienced GP said:

“Presently a (hospital) doctor who has had…two years’ medical experience can request a CT scan for a patient in hospital—where I can’t.”

We should consider introducing systems that will allow GPs more direct access to scans for their patients. I know that there will be concerns in some quarters that radiology departments could become clogged up with needless referrals. However, again, looking north of the border is instructive. Scotland has made a step in that direction, and new guidelines making it easier for GPs to make direct referrals for imaging tests have been introduced. As I understand it, when the approach in Scotland was piloted, it did not lead to a clogging-up of the system, so it was rolled out more widely. Ultimately, I do not think that we should ignore the importance of treating symptoms as cancer until proven otherwise, and CT scans remain an effective way of achieving faster and more definitive diagnoses. Is the Minister prepared to consider that further for England?

The next issue is what I might term “three strikes and you’re referred”. There must, of course, be some sort of investigative threshold in place; not every patient can or should be sent for a scan. One way is to prioritise patients with particular symptoms, based on solid referral guidelines, as I mentioned earlier. However, another approach, or even a tandem approach, would be to send for a scan patients who have repeatedly turned up with the same vague symptoms a particular number of times, in order to get to the bottom of things once and for all.

I understand there have already been discussions in and around the NHS for a “three strikes and you’re referred” policy, under which if a patient visits their GP three times with the same symptom or set of symptoms that have not been resolved, they should be referred to secondary care for further investigation to get to the bottom of the problem. That is vital for pancreatic cancer, but it could also be important for other conditions that often go undetected for long periods. In my constituency this morning, I met representatives from a Huntington’s disease charity. It is an issue with that disease as well: people have the symptoms of all sorts of illness, but they are not diagnosed with Huntington’s until quite far down the line, often when earlier treatment could have been more helpful. The Department should consider such a policy, particularly for pancreatic cancer but more widely as well. Can the Minister say whether her Department is looking at introducing a cut-off point where a patient should be referred for more definitive tests, such as a CT scan?

Perhaps a more radical approach, which again is discussed in the all-party group report, is to create “one-stop shops” where patients with vague symptoms can have multiple tests carried out in one place rather than having to return to their GP after each test by a different specialist. The tests could be carried out in special dedicated centres over the course of one day or, if necessary, over several days. The key point is that this sort of multidisciplinary diagnostic clinic would speed up diagnosis, give peace of mind to patients who do not prove to have cancer and—most importantly—allow earlier treatment for those who are ultimately diagnosed with the disease. As has been said very movingly today, time is everything with pancreatic cancer patients, but too many of them are being diagnosed after emergency admission, which is too late for them to receive any form of curative treatment.

Last year’s all-party group report tells us that this cancer diagnostic centre model is already being used in countries such as Denmark and Canada. I understand that at the all-party group’s meeting last Tuesday members heard from London Cancer and London Cancer Alliance—integrated cancer systems that bring together GPs, hospitals, specialists and academics—that there are plans to test a similar model in the capital. It is hoped that this approach will not only improve patient outcomes but save the NHS money by cutting down the number of GP visits and repeat referrals, and the use of consultants’ time. A testing of this model would be a welcome step in the right direction. Can the Minister say how innovations of this kind, which are designed to improve and speed up referral pathways, can be developed and rolled out across the UK, in order to reduce the time taken to diagnose pancreatic cancer?

I conclude where I began, by saying that we need to speed up the time that it takes to diagnose pancreatic cancer; we need to stop patients being treated like ping-pong balls and being referred from a GP to a specialist, and back again, many times; we need to come up with new methods of referral that are better for clinicians and patients alike, and that will cut diagnosis times and ultimately save lives; and we need to do all this quickly, because too many people are dying far too quickly.

Oral Answers to Questions

Iain Stewart Excerpts

Tuesday 15th July 2014 Commons Chamber

[Norman Lamb]

The hon. Lady raises an important issue and I am very happy to discuss her concerns further with her.

[Iain Stewart (Milton Keynes South) (Con)]

The Secretary of State will be aware of the campaign run by the Milton Keynes Citizen, my hon. Friend the Member for Milton Keynes North (Mark Lancaster) and myself for an expanded A and E department at Milton Keynes hospital. What assurances can he give me that A and E services at the hospital will be able to meet the needs of an expanding population?

[Mr Jeremy Hunt]

No one could have campaigned harder than my hon. Friend and his hon. Friend the Member for Milton Keynes North (Mark Lancaster) for improving the services at their local A and E department. A consultation is currently taking place. There is no question of closing both A and Es in that area, and I understand that a very good capital bid for £2 million for his local A and E has been put in which, subject to the usual value-for-money requirements, looks like it is very strong.