Brain Tumours in Children

James Duddridge Excerpts

Tuesday 3rd September 2013 Westminster Hall

[Mr Raab]

I thank the hon. Gentleman for his intervention, and he is absolutely bang on. I will come on to discuss the three specific measures that are key as part of that co-ordination.

Many of these tragedies could be averted. Whether it is preventing avoidable deaths or limiting the permanent damage inflicted by brain tumours, early diagnosis is the key, as has already been said; I suspect that there will be consensus on that.

[James Duddridge (Rochford and Southend East) (Con)]

As well as early diagnosis, early treatment is vital; in many cases, that involves immediate surgery. Will my hon. Friend press the Minister to make some statement as to how long it takes from diagnosis to treatment, and about how things are progressing on that front?

[Mr Raab]

I thank my hon. Friend for his intervention; I know that he feels very strongly about that point. It is an excellent point and the Minister will have heard it. I have a range of points that we can certainly follow up with the Minister if they are not addressed in her speech, but that is an important point on top of the critical importance of early diagnosis.

There is a wealth of clinical and scientific evidence to back up the argument that early diagnosis is key. Research up until 2006 showed that the median delay in diagnosing a brain tumour in a child in Britain was 12 to 13 weeks. In other words, half the affected youngsters took more than three months to reach diagnosis and then treatment. That was up to three times longer than the diagnosis delay in other countries, including the US and Canada. Let us just think about what that means. It means child after child walking around—in their home, around their school and even through their own GP’s surgery—with identifiable symptoms of brain tumours that could have been picked up but sadly were not.

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[Anna Soubry]

I am more than happy to add my grateful thanks for the work of Neil and Angela Dickson, and the work of all those who support them. There are many such examples, and funds are often raised for research and to support families or other bits of work.

As my hon. Friend the Member for South West Bedfordshire (Andrew Selous) said, money that goes into research often has the most powerful results. I pay tribute to Headcase cancer trust in my constituency, as I am very much aware of the great work that continues to be needed on brain cancer, which is a pernicious and horrible disease that affects people of all ages, but it seems somehow to be particularly cruel and wicked when it is inflicted on children.

There are a few things that I want to mention before moving on to some of the substantive points raised by my hon. Friend the Member for Esher and Walton. We recognise that we need to do more to bring cancer survival rates up to the level of the best in the world—survival rates have been languishing in the wrong place for too long—so we have an outcome strategy that sets out our ambition to halve the gap between England’s survival rates and those of the best in Europe through saving an additional 5,000 lives every year by 2014-15. We know that the earlier a cancer is diagnosed, the greater the scope for curative treatment, and our strategy therefore prioritises addressing late diagnosis. To support that, we have £450 million over four years going into early diagnosis, which is part of the £750 million of additional funding from the Government for addressing cancer over the spending period. That funding will do much great work that I am happy to identify in a letter to my hon. Friend.

On direct GP access to diagnostic tests, my hon. Friend the Member for Hexham (Guy Opperman) made a good point about having someone within each clinical commissioning group who knows about not only brain cancers and brain tumours but other similar afflictions. As he rightly identifies, when a child has a headache, or when an adult has some other complaint and they are not sure what it is, there could be a more specialist GP who can say, “Maybe this is the sort of case that we need to scan swiftly,” or, “Maybe it needs some other treatment.” That is a very good point, but we need GPs to recognise symptoms that could be indicative of cancer and, where appropriate, to refer patients to more specialist care.

The National Institute for Health and Clinical Excellence has published referral guidelines for suspected cancers, including a section on children, to help GPs and primary care professionals identify children with suspected cancer. The Department of Health published guidance in April 2012 on the best practice for what we call “referral pathways” for GPs.

When GPs suspect a brain tumour, they are able urgently to refer patients for special care using the two-week urgent referral pathway, and I have been helpfully supplied with some figures that I hope will give comfort and encouragement. Some 95.5% of patients were seen by a specialist within two weeks of an urgent GP referral for suspected cancer—that is for all cancers—in the first quarter of 2013-14, and 96.4% of patients urgently referred by their GP for suspected brain or central nervous system tumours were seen by a specialist within the two-week period. In the first quarter of 2013-14, 96.4% of patients in England urgently referred by their GP for a suspected children’s cancer were seen by a specialist within the two-week period. I think those are good figures, but of course we can always do better.

[James Duddridge]

Will the Minister give way?

[Anna Soubry]

Briefly, yes.

[James Duddridge]

Those are the figures for being seen by a consultant, but are there figures for when surgery actually takes place? Will the Minister provide us with those figures after the debate?

[Anna Soubry]

I do not believe I have those figures in front of me, but I am more than happy to provide them to everyone who has taken part in the debate. My official is indicating that we have the figures, and it is not a problem for me to give them to my hon. Friend.

NHS England now monitors the use of key diagnostic tests through the diagnostic imaging dataset, and the latest available provisional data for the period from April 2012 to March 2013 show that 28,995 tests—which is about a quarter of all tests—that may have been used to diagnose or discount cancer were requested by GPs under direct access arrangements.

I pay huge tribute to HeadSmart, and of course I welcome its “Be brain tumour aware” campaign and the collaboration between the Brain Tumour Charity, the children’s brain tumour research centre at the university of Nottingham—to which I admit I have a bias, being a Nottinghamshire MP—and the Royal College of Paediatrics and Child Health. I have written to HeadSmart offering encouragement and advising that it could apply to the voluntary sector investment programme for funds to raise awareness of HeadSmart cards in schools. I will continue to work with those great and wonderful charities, and I look forward to seeing them inform the development of our nationally led campaigns.

My hon. Friend the Member for Esher and Walton directly challenges me to take action, and I shall tell him what I will do. I might not completely agree with all that he proposes, but I am more than happy to speak to my colleagues at Public Health England—cancer screening is an obvious priority for Public Health England—about how we can best advance HeadSmart cards in schools. As he knows, of course, public health is now devolved to local authority level. And as he also knows, we are a Government who believe in localism, and therefore it is not for Ministers to tell people what to do, however much we might want to at times.

The idea advanced by my hon. Friend the Member for Brentford and Isleworth is very good. A great deal of work can be done by local MPs. Of course, hon. Members might not know about this, but we can talk afterwards about how we can alert our colleagues throughout the House to what can be done. A letter from a local Member of Parliament to their director of public health, or to the chair of their health and wellbeing board, will frankly have more weight than any letter from me.

Health and Social Care

James Duddridge Excerpts

Monday 13th May 2013 Commons Chamber

[Andy Burnham (Leigh) (Lab)]

Like you, Mr Speaker, I am tempted to say, “Is that it?” I suggest to the Secretary of State that he starts reading the weekend newspapers. He began with complacent statements about how everything is marvellous and it is all going so well, but it will not feel like that to staff working in A and E. The Secretary of State’s statement will just confirm to them that he is completely out of touch.

Every day brings new signs of an NHS in distress: more ambulance queues outside A and E; more patients left waiting for a call-back by a 111 service ill-equipped to deal with their needs; more older people seeing social care support withdrawn, or struggling to pay spiralling care charges and ending up in A and E; more patients waiting hours in A and E on trolleys in corridors; and more hospitals running way beyond safe occupancy levels. This is the fragile state of the NHS today: battered and bruised by a reorganisation that nobody wanted and nobody voted for; an entire health and care system on the brink, facing huge challenges that require urgent answers. However, we will not find them in this Queen’s Speech. There is no answer to the collapse of social care, and no answer to the understaffing of hospitals or the growing chaos in A and E. On the preventable deaths and health harm caused by smoking and alcohol, there is silence.

This Queen’s Speech is the product of a dysfunctional Government who have lost any ability they once had to face up to the big challenges the country faces. It cements the impression of a failed coalition project now preparing the ground for the next election rather than governing in the national interest. What else could explain the pathetic spectacle this weekend of Government Members, spooked by UKIP, falling over themselves to say that they will be voting against their own legislative programme? Has this place ever seen something so ridiculous?

[James Duddridge (Rochford and Southend East) (Con)]

Will Labour give us a referendum?

[Andy Burnham]

I thought the new compassionate Conservative party was meant to have stopped “banging on about Europe”—that was the phrase, was it not?—but now its Members are all dancing to UKIP’s tune and reading out what Mr Crosby gives them. It will not wash. The country can see that this is a shambles of a Government who look ridiculous to the country they purport to govern. When Britain needed leadership, it got the farce of this coalition. There is no need to send in the clowns; they are already here.

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[Sir Gerald Howarth (Aldershot) (Con)]

I must say at the outset that I am disappointed that no day has been set aside for us specifically to discuss defence and foreign affairs, because we face some pretty severe challenges around the world and, of course, our armed forces are undergoing major change. Such a debate would have provided me with a further opportunity to argue that we should not spend another £2.5 billion on overseas aid this year and that we should divert that money to our armed forces, which are very hard-pressed.

[James Duddridge]

I understand my hon. Friend’s argument, but I disagree with it. I respectfully ask him: what is the right amount to spend on international aid?

[Sir Gerald Howarth]

It is a question of priorities. Our level of aid is such that the Prime Minister can say, with great justification, that Britain has given a lead in the world, but the figure of 0.7% is entirely arbitrary. I would submit that there is no natural level for the amount of aid to be given. I am not an opponent of overseas aid; I just believe that there should be other priorities at the moment.

I do not wish my speech to be a negative one, and it was written not by Mr Lynton Crosby but by myself. I welcome some aspects of the Gracious Speech. The first is the continuing priority to cut the budget deficit. It was pretty nauseating to listen to the shadow Health Secretary, the right hon. Member for Leigh (Andy Burnham), and to hear him demand more money here, there and everywhere. He was part of a Government who destroyed the public finances of this country. That is why we have to make cuts. These cuts are Labour’s cuts across the country, because Labour destroyed the public finances by running up an impossible debt.

Secondly, I welcome the confirmation that we are going to pursue further reforms of the benefits system. It has been most encouraging to see how warmly the country has received our changes, particularly the £26,000 limit on families receiving benefits. The Philpott case was an eye-opener to many, highlighting that far too many people in this country are living a wholly immoral lifestyle on public finance, and we need to crack down on that.

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[John Woodcock (Barrow and Furness) (Lab/Co-op)]

It is a pleasure to follow the hon. Member for Stafford (Jeremy Lefroy), who made a thoughtful and considered speech on an issue of great importance nationally, as well as to his constituents.

It was a pleasure to be in the Chamber to hear such a powerful speech on plain packaging for cigarettes from my hon. Friend the Member for Barnsley Central (Dan Jarvis). Frankly, if Ministers are not convinced after hearing his arguments, they should probably not be in their place. I think that they are convinced and I hope to see them make progress.

I want to start on a note of consensus. I welcome the inclusion in the Gracious Speech of the Bill on mesothelioma compensation. This dreadful disease is a time bomb that, once detonated, often goes on to kill within months. With its shipbuilding heritage, more individuals in Barrow and Furness suffer from mesothelioma than in any other constituency in England. We owe a duty of care to all those who are suffering: they made an honest living and what is happening to them is not right. We should applaud all those who have pushed for further progress, including former Labour Ministers and the hon. Member for Chatham and Aylesford (Tracey Crouch), who I understand wanted to be here but is on her sick bed.

There are early concerns about the Government’s paucity of ambition. It is vital that the Government mandate a scheme that will build fittingly on the work of my predecessor, Lord Hutton, who expanded and speeded up compensation in the previous Parliament. However, many will see the thin programme last week as a missed opportunity to address increasing alarm about the Government’s poor stewardship of the NHS. It would be too optimistic to hope that Ministers have had an early change of heart on the costly and ill-conceived reforms they have just bulldozed through Parliament. In addition to the lamentable absence of plain packaging legislation, they could have introduced measures that sought to bridge the yawning gap between their rhetoric on listening to local people and the reality that is seeing the clear wishes of residents on NHS services ignored up and down the country.

In Barrow and Furness, we hope that health professionals in charge of provision across Morecambe bay will heed the passion and powerful arguments from local people on oncology, maternity, and accident and emergency provision. While residents understand that it can make sense to travel to get the best that 21st century health care can offer, like so many across the country they love their local hospital, they think it should have its fair share of the very best, and they think local provision, that is accessible to them and visiting loved ones, is a basic part of a quality service, not something to be dismissed as an unnecessary luxury.

I have some hope that the new management team at Morecambe Bay NHS Foundation Trust will listen to local concerns. An early test will be the publication of revised plans for Furness General hospital’s oncology unit this month. However, we see what is happening in other areas where the Government’s local engagement test is proving to mean little more than holding a meeting and nodding in an understanding manner, and ignoring everything people say and downgrading services anyway. When my constituents see the scale of the upheaval and cuts to front-line nursing staff involved in reducing the budget of Morecambe Bay Trust by £25 million within two years, they are, understandably, very wary of trusting Government promises that no efficiency savings will be allowed to affect the quality of patient care. I hope the Minister will tell me whether the Government will heed calls, including from the trust itself, for a rethink on the speed and scale of the cuts they are imposing.

Will the Government not take heed of the dismay felt about recent NHS reorganisations and enact measures to strengthen the power of local opinion in determining the future of our hospitals? We live in times of strained resources, but faith in the future of the NHS may continue to be eroded until we learn genuinely to trust local communities. When we come to look back at the history of the NHS over the current decade, I think we will see this as the time when we were bound overly tightly to the idea that the clinician always knows best. We will come to see the Government’s blind faith in the clinical stamp for taking services away as an early 21st century equivalent of the “Whitehall knows best” mentality that gripped reforming Governments after the second world war. Just like the “Whitehall knows best” ethos of the 1940s and 1950s, the clinician knows best mantra has the best of intentions but is insufficiently responsive to challenge from the patients who rely on the services that are being shaped by those at the centre.

Let me be clear. It is essential that health professionals make their case when decisions are made. Their expertise is immense and people should not deviate lightly from their plans. However, it is by no means certain that any one group, even one bursting with medical experience, will always call it right first time. Their views must be subject to scrutiny. Often the clinical push to concentrate a specialism at a single site takes less account of local geography and community links to health facilities than is demanded by local people, who ultimately pay the clinicians’ wages.

This is not an argument for sentimentality. The views of local people will sometimes be irreconcilably different in a single area, but if, for example, Barrow families suddenly face the prospect of a 100-mile round trip to visit a relative—because a unit at Furness General hospital has moved to Lancaster—their views on the move will be important. Many communities across England are fighting for their local health services. Some are threatened by cuts, but others are at risk from this clinically led decision-making model.

[James Duddridge]

The hon. Gentleman is making some valid points, several of which I am deeply sympathetic to, but on clinicians, is he referring to GPs or specialists? Does he think that the clinical commissioning groups of GPs who are more fixed in the community could have an impact on, for example, oncology and other specialisms in local hospitals?

[John Woodcock]

That is a good point, and it remains to be seen. We hope so, but the system has yet to be put to the test.

I am disappointed that no move towards genuine localism was outlined in the Gracious Speech. It is time for a people’s NHS Bill to end the toothless sham that too often passes for local consultation. When local people say no, the default should be that they have exercised a veto that ought to be heeded. That would require a step change in our NHS away from a model that, yes, might have helped deliver improvements in health outcomes of which the country should be proud, but which has done so—

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[James Duddridge (Rochford and Southend East) (Con)]

It is a privilege to be called to speak in the debate, and it is good to follow the hon. Member for Bridgend (Mrs Moon). Some of her comments about rare kidney diseases resonated with me, as I have recently visited the very good renal centre in Southend. I have also looked into the issue of rare diseases. Individually, they might be rare, but collectively they are quite common as a group, and the funding for the relevant drugs and for more general treatment can be tricky.

I have a quite carefully drafted speech here, but I was blown away by my hon. Friend the Member for Blackpool North and Cleveleys (Paul Maynard), who spoke without notes and whose speech was a fantastic tour de force. I am tempted, perhaps unwisely, to pick up on a number of issues that have been mentioned in the debate, some of which have been quite controversial. I did not listen to every single speech today; I missed half an hour. While I nipped out for a cup of tea, I heard colleagues on this side of the House speaking out against equal marriage—perhaps some Opposition Members did so as well—but I for one am glad that that legislation will be dealt with in this Session. The carry-over motion will ensure that we have ample time to debate it and to work through some of the issues. In 20 or 30 years, we will look back in confusion as to what the problem was. We are perhaps introducing the legislation faster than the public has an appetite for, but politicians sometimes need to lead rather than follow.

At lunchtime today, I had the privilege of having lunch with my mum and dad, who were in very good form. They said that they had been looking for me during the Queen’s Speech but had been unable to see me, and I told them that the debate was carrying on today. I asked them what they had thought of the speech, and they told me they thought it was very funny. I am not sure that either Her Majesty or the Prime Minister wanted to create that impression. I asked my mum why she found it funny, and she described how Black Rod had got stuck halfway down and been held up by the Speaker.

There has been a debate today about whether the Queen’s Speech was too narrow. The right hon. Member for Rother Valley (Mr Barron) criticised Conservative Members for talking more about what was not in the speech, but the general public do not think in terms of Bills and Acts; they think in themes, as my hon. Friend the Member for Blackpool North and Cleveleys said. One theme of today’s debate has been immigration seen through the prism of the NHS, although the general public probably also look at it through other prisms, including housing and Europe. Looking at the Queen’s Speech in a thematic way is perhaps slightly more useful.

I am tempted to make some comments on Europe. It is constructive that we should vote on the matter. If the coalition is to survive, it will need to be more comfortable about having open debates rather than simply private ones. We will need to have more open debates, rather than fewer, if the coalition is to be healthy all the way through to 2015. It is a strength of democracy to have open debate rather than narrowly commit ourselves to certain lines.

On immigration, the right hon. Member for Rother Valley talked about the use of extremist language. Actually, far from its use being negative in this context, the use of immoderate language can sometimes be essential if we are to have an open discussion. Otherwise, the debate gets overtaken by the Daily Mail and the Daily Express. We should have a full and frank debate on immigration, and on other issues.

When we consider health—the main focus of today’s debate—I think politicians are sometimes too scared to ask questions about a merger or a closure, for example, and to query whether those are the right things to do. We should be more open minded. The hon. Member for Barrow and Furness (John Woodcock) said that more local people should be involved in the process. I am sure he is right, but I am not sure that that is a totally new thing, as the Minister intervened to say in the latter part of his speech. I was certainly very close to the position the hon. Gentleman stated. I am not sure which of us should worry more about that, but it is a statement of fact about how I felt.

The commitment to spending 0.7% of gross national income on international aid was not in the Queen’s Speech. That is a totally arbitrary figure, but it is a promise that all the main political parties made and one that I fully support. To be frank, I cannot get het up about whether or not the commitment is built into a piece of legislation. If my family was starving in Ethiopia, or in the northern badlands as Bob Geldof would describe them, I would not care whether the money was coming because it had been mandated or because it had been promised. It makes little difference. I certainly congratulate the Government on actually spending that money, which is far and away the most important thing.

Let me deal with the deregulation Bill—legislation announced in the Queen’s Speech to reduce the body of existing legislation. I feel that an awful lot more can be done. The Bill has not been published, but I think that the Government have been too modest in their ambitions when it comes to deregulation. The Better Regulation Task Force is producing some really strong ideas.

[John Woodcock]

I am fascinated by what the hon. Gentleman is saying. Perhaps he was about to mention this, but what does he want to deregulate?

[James Duddridge]

At the moment, we have piecemeal deregulation, whereby we look at specific issues and then deregulate. I was elected as chair of the Regulatory Reform Committee, which as a body deals with pieces of legislative reform that the Government think can be fast-tracked for regulation or deregulation in order to avoid burdensome regulation. That is very much a piecemeal process—we looked, for example, at veterinary legislation—but it would be much better to have a big thematic review of issues surrounding care homes, for example. Rather than look at health and safety, the medical issues or equipment separately, it would be better to have a thematic review, cutting across Departments in the same way this debate cuts across the division between the health service and social services, local councils and different funding streams. I think it is our responsibility to do that here in the House of Commons.

The deregulation Bill will be good and tidy up bits of the statute book, but I would like to see a lot more detail about how that is going to happen. A Joint Committee will be set up between the Lords and the Commons, and I would very much like to serve on it, but as much as possible we should open out the number of Bills that we are looking at. Setting aside the issue of whether we should be in or out of Europe, the increase in European legislation demands that we face up to a two-for-one deregulatory challenge, just to stay standing. We need to go further.

The economy is another key theme in the Queen’s Speech. Given our current economic position, if we had had a Conservative Government from the outset, I believe such a Government would have tested every single Bill by asking, “Will this Bill help the economy? If not, it is marginal, and we should push it to one side—certainly when it comes to parliamentary time and impact.” I think that the Budget is much more important. When we highlight the themes in the Queen’s Speech, we should not judge ourselves by the amount of paperwork we sign off. The Budget is, in many ways, more important. Corporation tax, the national insurance deal and so forth will get Britain booming. I have seen it in my local area, where, for example, Southend airport has boomed, generating over 500 jobs in the few years that it has been motoring in a serious way, as opposed to when it was a rather hobbyist airport. There is much still to be done, but we should not judge ourselves by the volume of legislation. In fact, through the deregulation Bill, we should be able to reduce that volume.

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[John Glen]

I am grateful to the hon. Gentleman for that intervention, but I think we have had quite enough amendments this week.

Nevertheless, the point remains that we cannot rely on a debate about the issues of the illegal production of illicit cigarettes or in the packaging industry; those issues need to be tackled head-on. The core point is this: why does the tobacco industry spend so much money on elaborate packaging? It does so because such packaging works and because it encourages young people to take up the habit of smoking.

In this Chamber, the hon. Member for Shipley (Philip Davies) would usually sit next to me. Fortunately he is not here today, because if he were I am sure he would have intervened. He would have said it should be about freedom to choose. I am sorry, but I do not believe that 16-year-olds faced with massive peer pressure in certain communities genuinely have freedom to choose. It is not enough to say that the Government gain lots of tax revenues. For those individuals and their families, the health implications of smoking are dire. The situation is disappointing and I hope that a private Member’s Bill or another mechanism will be found to address the issue before the end of this Parliament.

[James Duddridge]

I am persuaded to a degree by my hon. Friend’s argument, and if plain packaging were the solution to eliminate the problem, I would be inclined to vote for it. However, I cannot help but think that there will be something else around the corner, such as a ban on smoking in films or a ban on role models being seen to smoke, and ultimately an absolute ban on smoking. That might well be the right answer, but I am not quite sure where the debate is going.