Non-invasive Precision Cancer Therapies

Debate between Jeff Smith and Grahame Morris

Thursday 18th July 2019 Commons Chamber

[Grahame Morris (Easington) (Lab)]

I beg to move,

That this House recognises the vital role that radiotherapy plays in cancer treatment across the UK with an estimated one in four people needing that treatment at some stage of their life; notes that there is a significant body of expert opinion that up to 24,000 people may be missing out on the radiotherapy they need, resulting in many hundreds of unnecessary or premature deaths; further notes that the UK spend on radiotherapy as a percentage of the overall cancer budget is approximately five per cent which compares badly with most other advanced economies where the percentage varies from nine per cent to 11 per cent; notes that the current commissioning system for radiotherapy is sub-optimal as exemplified by a tariff regime which discourages NHS Trusts from implementing advanced modern effective radiotherapy; calls on the Government to provide an immediate up-front £250 million investment in the service, an ongoing extra £100 million per annum investment in personnel and skills and IT, and to introduce a sustainably, centrally and fully funded rolling programme for Linac machine replacements; and further calls on the Government to appoint a single person to oversee the commissioning and implementation of radiotherapy services.

I thank the Backbench Business Committee and its Chair, my hon. Friend the Member for Gateshead (Ian Mearns), for granting this debate, and all the Members on both sides of the House who supported the application. I must declare an interest as one of the vice-chairs of the all-party group on radiotherapy, and also as a cancer survivor—[Hon. Members: “Hear, hear.”] Thank you. Thanks to early diagnosis, I was successfully treated with both chemotherapy and, crucially, precision radiotherapy.

I want to point out to the Minister that there is currently a crisis—there is no other word for it—in the management and funding of radiotherapy in the United Kingdom. Indeed, the charity Action Radiotherapy estimates that as many as 20,000 people across the UK may be missing out on the radiotherapy they need. Many of these patients will die prematurely or unnecessarily as a result of this shortfall. Given that one in four people receives some form of radiotherapy during their lives, and that almost half of us in the United Kingdom will be diagnosed with cancer at some point in our lifetimes, I hope the Government will realise just how important it is that we invest in modern and, importantly, accessible cancer diagnosis—and not just in diagnosis, but in cancer treatments.

[Jeff Smith (Manchester, Withington) (Lab)]

I am very proud to have the Christie Hospital in my constituency of Manchester, Withington. It has a fantastic proton beam therapy unit, which is going to be the future of cancer treatment. However, when I speak to the staff at the Christie, their biggest worry is the workforce. Does my hon. Friend agree with me that the challenge is not just funding for treatment, but actually investing in our cancer workforce as well?

[Grahame Morris]

Absolutely, and I am grateful to my hon. Friend for pointing that out. Indeed, that is one of the four basic requirements, as the all-party group, the charity Radiotherapy4Life and Action Radiotherapy have pointed out. That is clearly demonstrated in the “Manifesto for Radiotherapy”, which I commend to the Minister and to all hon. Members.

I appreciate that the Minister will want to refer to chapter 3 of “The NHS Long Term Plan”, particularly paragraph 3.62 on more precise treatments using advanced radiotherapy techniques. In anticipation of that, I would like to say, on investment, that the Government have promised to complete the £130 million investment in radiotherapy machines and, as my hon. Friend has just mentioned, to commission the proton beam machines at University College Hospital in London and the Christie Hospital in Manchester. However, I respectfully point out to the Minister that that is not a new announcement of additional resources, but the recycling of previous announcements. The money has already been spent or committed, so it is not part of the comprehensive 10-year plan for radiotherapy that we advocated for in the “Manifesto for Radiotherapy”.

The £250 million for proton beam facilities, while welcome, will only treat 1,500 patients a year. I accept that many of them will be children with brain cancers, but the number represents only 1% of patients needing radiotherapy. As indicated in the manifesto, we recommend that the same sum that was spent on proton beam facilities—a relatively modest sum given the size of the budget as a whole—is all that is needed to renew radiotherapy centres and to ensure that all patients, not just those who live in London or near to major conurbations, can receive treatment within the recommended 45-minute travel time. I know that other hon. Members will say a little more about that.

We are also asking for an additional £100 million a year, increasing the cancer funding for radiotherapy from the current 5% a year to 6.5% a year, to ensure sufficient funding for workforce planning, including ensuring that there is suitable training, and ensuring that there is an effective IT network, equipment upgrades and a rolling programme to ensure that all radiotherapy machines across the UK are up to date. According to analysis of freedom of information requests made by Action Radiotherapy, more than 40% of NHS trusts in England—all bar six responded to the requests—that provide radiotherapy have machines that are past their recommended lifespan, leading to less efficient and effective care.

The current system of commissioning for radiotherapy often incentivises trusts not to use their most modern precision radiotherapy machines to their full capability. That means that some patients are treated more often and less effectively, even though there are modern stereotactic ablative radiotherapy machines that could treat them more effectively. Precision radiotherapy is needed to cure 40% of cancers, and all that we want is to ensure that all patients can get to a radiotherapy machine and that the professionals are allowed to switch on the machines and provide the appropriate treatment. However, chronic underfunding and the complications of radiotherapy commissioning and delivery are preventing that from happening.

Radiotherapy receives only 5% of the cancer treatment budget. At £383 million a year, that represents 0.025% of the total NHS budget, and I want to compare that with the cost of just two cancer drugs. The NHS budget for Herceptin—an effective drug that is used to treat about 15% to 20% of breast cancer patients—is £160 million. A recent UK trial showed that only six months, not 12 months, of adjuvant Herceptin may be needed for adjacent therapy, which is when the drug is used in combination with radiotherapy. In financial terms, the NHS could therefore save up to £80 million a year, offsetting much of the additional radiotherapy costs.

It is time to put radiotherapy back at the top of the NHS agenda, and we need someone to advocate for that. We are urging the Department to appoint a radiotherapy tsar who will ensure that the NHS has a world-class radiotherapy service. Many other MPs want to speak in the debate, so I will keep my remarks short. I am pleased that the Government have accepted that advanced precision radiotherapy is more effective and has fewer side-effects.

In summary, I want to see a modest increase in the budget for advanced radiotherapy, rising from 5% to 6.5% of the cancer budget. That would enable large numbers of cancer patients to live longer and more fulfilling lives and would achieve better outcomes and more positive economic benefits. I am keen to ensure that Members have an opportunity to participate in the debate. There are many issues that we need to highlight, including in relation to commissioning, workforce planning and IT networks, so I will leave it at that to allow others to participate.

Police, Fire and Rescue Services: Funding Reductions

Debate between Jeff Smith and Grahame Morris

Wednesday 20th February 2019 Westminster Hall

[Grahame Morris (Easington) (Lab)]

I beg to move,

That this House has considered the effect of reductions in funding of police, fire and rescue services.

It is a pleasure to serve under your chairmanship, Mr Hosie. I declare an interest as a member of a number of trade union groups, including the Fire Brigades Union parliamentary group. I start by placing on the record my appreciation for and gratitude to our police officers, firefighters and, indeed, NHS staff. I am sure that those sentiments will be shared by all Members.

The focus of the debate relates to the funding of the police and fire services, as pressures affecting those services in my constituency have been more acute in recent months. However, I in no way seek to downplay the funding challenges facing our health service and, in particular, the ambulance service. In many respects, they face similar pressures.

The last Labour Government had a well-known policy; it was a kind of catchphrase: “Tough on crime, tough on the causes of crime”. And they had a proud record. Indeed, finance, resources and police numbers were all increased. Being tough on crime was not just a slogan. It meant more visible policing, a priority being placed on community policing, intelligence gathering and the detection of crime. I well recall attending PACT—Police and Communities Together—meetings at which there were consultations with community safety partnerships and local priorities were determined. There was a real sense of partnership.

In 2010, when Labour left office, there was a record number of police officers; it was in excess of 143,000. However, in the last decade, we have seen a systematic reduction in funding and what amounts to a downgrading of the police service. In every community, we can see the effects of the missing police officers who once patrolled our streets.

[Jeff Smith (Manchester, Withington) (Lab)]

I congratulate my hon. Friend on securing the debate. He is absolutely right. Greater Manchester police have lost nearly 2,000 police officers since 2010, and across south Manchester the problem is that the police are so stretched that they struggle to fulfil their duties, including proper investigation of the crimes that are happening. Does my hon. Friend agree that one of the biggest effects of the reduction is a loss of confidence among the local community that crimes will be properly investigated, and that that is not the fault of the police?

[Grahame Morris]

Trust and relationships are built over many years. Sadly, the impact of sustained funding cuts over nine or 10 years has been that much of the good work from the partnership arrangements, and often valuable intelligence, have been lost. It will take a colossal effort to regain that.

There are many implications from having fewer police officers. I am thinking of the reassurance that comes from seeing a police officer talking to residents in Peterlee town centre in my constituency, seeing officers walking down Church Street—a rare occurrence in the current climate—or community police officers gathering intelligence to combat drug dealing or engaging young people to tackle antisocial behaviour.

It is the view of many that the Conservative Government have abandoned their support for law and order by cutting more than 20,000 police officers, taking us back to numbers that we have not seen since the 1980s. Crime is now rising as a result. In my own policing area, Durham, the number of police officers is down by 25% since 2010; we have lost 360 police officers. The National Audit Office report on the financial sustainability of police forces identifies Durham as having lost more resources than any other provincial force between 2010 and 2018-19, with its funding from central Government cut by one third.

I hope that the Minister will join me in acknowledging that, despite every funding challenge being placed before Durham constabulary, credit must go to Chief Constable Mike Barton, Police and Crime Commissioner Ron Hogg and all the officers, staff and support staff of Durham constabulary. It has been rated as the only outstanding force in the country for the past three years, and has the highest crime detection rate in England and Wales. It has endeavoured to overcome its difficulties. Nevertheless, the fact that we have fewer police officers is manifest, and the consequences are there for everyone to see.

I want to say something about Grenfell. The County Durham and Darlington fire and rescue service is experiencing the same financial pressures as the police in my constituency. Before I move on to the circumstances that apply in my constituency, I want to comment on the Channel 4 “Dispatches” episode that aired on Monday night. It was called “Grenfell: Did the Fire Brigade Fail?” Unfortunately, the episode had the same flaw as some of the questioning in the Grenfell inquiry, and was blinkered from the wider context of the incident that led to the dreadful loss of 73 lives because it focused solely on the night of the tragedy.

On 14 June 2017, the London fire brigade was confronted with a fire spreading at an unprecedented rate. The crews’ experience and training would have taught them that, in a high-rise building, a fire would be contained within a flat in an individual concrete unit built to contain the fire. In such cases, it is clear why a policy of “stay put” would work. On that night, as the fire developed, the crews on the ground had to make decisions in that moment of pressure, panic and uncertainty. I ask everyone to consider what they would do in that moment, with a fire spreading rapidly in an unexpected manner, with lives being lost in front of them, watching colleagues and friends entering a building in the belief that they might not return. Are we to expect a fire chief on the ground instinctively to change established policy and procedures that had been ingrained into the service through training, and to develop new strategies on the spot?

To scapegoat the firefighters—the men and women who bravely risk their lives in a service whose purpose is to preserve life—is nothing short of a scandal. It will not get us any nearer finding those responsible for the tragedy. In the opinion of many people, including me, the fire service and the firefighters did not fail. The building and the policy failed. Policy fails when faulty and unsafe electrical appliances are not tested, when building regulations fail and when substandard windows do not contain the fire. A local authority fails when the cheap cladding that was used to wrap the high-rise building is actually made of flammable materials. Business fails when the companies that installed the cladding and produced it do not act when their product fails to meet safety standards.

It is easy to attack the fire service for decisions made in a moment of extreme pressure, but at some point those who made the decisions with time and forethought that placed residents in a dangerous building will have to be held to account. Perhaps that is not for this debate, but that programme raised such questions that I felt that I had to put something on the record.

I am offended when the fire service and firefighters are unfairly attacked. I have seen that in my constituency. County Durham and Darlington fire and rescue service is currently consulting on changes, as it is trying to manage excessive Government cuts. It has set out a number of options and is asking the public for their views. I have never met a fire chief or a firefighter who does not want to recruit more firefighters. The barrier to recruiting more firefighters is finance, which is determined by central Government, combined with the local authority precept. Our problem is that we are being systematically underfunded, and as a result, the fire service in our area is being downgraded. The Minister may disagree, but how can the loss of 11,000 firefighter posts nationally—one in five posts—be described as anything other than a downgrade of the service?

The scale of cuts to the fire service is nothing less than a national scandal. County Durham and Darlington fire and rescue service has lost 58% of its Government funding since 2012. In the current four-year settlement, its Government funding will reduce from £10.9 million to £8.9 million, and Government support for new fire appliances and other vital equipment has been almost totally axed. Hon. Members may recall that, some years ago, we were actually encouraged to develop resilience and to acquire equipment, particularly pumping equipment and boats, which might not be used so much in our area but could support neighbouring brigades during flooding incidents.

Our own chief fire officer in Durham, Stuart Errington, described a £1.3 million stealth cut, stressing:

“I’m not worried about PFI, I’m worried about capital spending.”

I place on the record my thanks to Stuart and to our firefighters for the work they do under the most difficult circumstances. I know from my conversations with the chief fire officer that he has raised concerns with the Minister about cuts and their implications for public safety. He said to me:

“I think everyone thought the cuts would stop after four years.”

He added:

“I’m still lobbying with the Home Office really hard to stop the cuts, because we’re getting to the point where we’re going to see some really big cuts, which will increase the risk to the public.”

I ask Ministers to look at the cuts to the police and to the fire and rescue service and to recognise that they have gone too far and are now endangering the public. The idea that fire services covering Seaham and Peterlee in my constituency could be reduced, at a time when they are actually dealing with more incidents, defies all logic and common sense. It makes the likelihood of death and injury greater, which cannot be acceptable.

I ask the Minister to address funding cuts. One issue in Durham is that the precept is not an effective means of raising finance. As a relatively deprived area, we have a low council tax base. Some 55% of households in County Durham and Darlington—it is more in my constituency—are classed as band A, whereas nationally a typical property is classed as band D. That limits the capacity to increase funding for the fire and rescue authority via the precept, compared with more affluent areas.

An example used by my own police and crime commissioner is that, if Thames Valley police increased its precept by the same amount as Durham, it would raise £17 million a year more. At some point we will have to question the sustainability of the precept as a means of financing both the police service and the fire and rescue service, particularly in the current climate, where the principle of resource equalisation—that more affluent areas should provide support to less affluent areas—which has stood since the second world war, seems to have been abandoned. We increasingly see a postcode lottery in resources and funding.

I point out to the Minister that the demands on policing and fire and rescue services—particularly in areas of high deprivation, such as mine—are complex and need to be funded appropriately. That will require the Government to recognise the needs of communities like mine and the limited ability of local areas to raise the necessary funding via the precept.