Cancer Targets

Debate between Jim Cunningham and John Baron

Tuesday 1st May 2018 Westminster Hall

[Mr Baron]

I thank the hon. Gentleman for his kind words. I am aware of those statistics, and I will come to the 62-day target specifically later in my address. He is right to say that many CCGs and cancer alliances are not close to achieving many of those targets. That is obviously a problem when treating cancer, but it highlights a bigger issue: we should be focusing on outcome indicators rather than process targets as a means of encouraging earlier diagnosis. I will address his point specifically in a moment.

We tried very hard to get the one-year survival rates into the DNA of the NHS. The Government listened, and we now have CCGs being held accountable for their one-year survival rates, which is good news. The logic is simple: earlier diagnosis makes for better survival rates, so by holding CCGs to account for their one-year figures and, in particular, the actual outcomes, we encourage the NHS to promote earlier diagnosis and therefore improve detection.

A key advantage of focusing on outcome measures is that it gives the local NHS the flexibility to design initiatives tailored to their own populations to improve outcomes. CCGs can therefore choose whether to widen screening programmes, promote better awareness of symptoms, establish better diagnostic capabilities in primary care, embrace better technology or perhaps improve GP referral routes—any or all of those, in combination—to try to promote earlier diagnosis, which in turn will improve the one-year cancer survival rate figures.

Rather than the centre imposing a one-size-fits-all policy, the local NHS has been given the freedom to respond to and focus on local priorities, whether that be lung cancer in the case of former mining communities or persuading reticent populations to attend screening appointments. As an all-party group we try to do our bit. Each summer, the group hosts a parliamentary reception to celebrate with the 20 or so CCGs that have most improved their one-year survival rates. Successive cancer Ministers have supported that in the past, including the incumbent.

There is strong evidence, however, that that outcome indicator is being sidelined by hard-pressed CCG managements, who are focused on those process targets that are connected to funding. If the process targets are missed, there is a cost; if the one-year figures are missed, there is not. In recent decades, the NHS has been beset by numerous process targets that, instead of measuring the success of treatment, measure the performance against process benchmarks, such as A&E waiting times.

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

I pay tribute to the hon. Gentleman, because I know he has a strong interest in this issue for a number of reasons—as we all have, because cancer in one form or another touches nearly every family in Britain. I agree with him that it is the outcomes that matter, not the input. I wonder whether the targets are in the wrong place; I may be wrong, and the hon. Gentleman knows more about it than I do, but I think he has made an important point. The problem seems to be how to get the NHS to implement that.

[Mr Baron]

I completely agree. The problem as I understand it is that, according to the House of Commons Library, there are something like nine process targets focused on cancer alone. Briefly, it is an inconvenient truth that, if we look back over the past 20 or 30 years, we will see that the NHS has been beset by process targets from both sides and for the best of reasons. The bottom line is that we have not caught up with international averages in any meaningful way over those 20 to 30 years, so we must start to question the efficacy of those process targets when what we are trying to do is to improve survival rates. If we get the NHS focused on one-year survival rates, it should look at the journey as a whole, not just a small part of it, in trying to promote initiatives to encourage earlier diagnosis, which at the end of the day is what we all have to do if we are to improve survival rates.

Defence Reform Bill

Debate between Jim Cunningham and John Baron

Wednesday 20th November 2013 Commons Chamber

[Mr Baron]

I agree with my hon. Friend. The restructuring of other areas of government, such as the NHS, has been subject to the scrutiny of this place, yet here we are undertaking a major restructuring—the Secretary of State cannot disagree with that—of the Army and we are not prepared to subject it to that scrutiny, apparently for fear that we might not carry the House. It is not a very good reason.

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

Surely, this is a common sense approach, and to say it will cause confusion among the reserves is borderline ridiculous, because they are quite capable of rationalising things for themselves.

[Mr Baron]

I very much agree. I sometimes think in this place, where there is no shortage of former serving soldiers, that Front Benchers can be a little too sensitive about how stoical troops are. Their job is to get on with it, particularly if they are professional soldiers. They know these debates are taking place, but they get on with the job in hand, because that is what they are paid to do.

Nuclear Test Veterans

Debate between Jim Cunningham and John Baron

Tuesday 29th October 2013 Westminster Hall

[Mr Baron]

The benevolent fund that we are discussing would be distributed on the basis of need and not entitlement, which is terribly important to understand. That is what differentiates this fund from other recognition or compensation elsewhere. There is often an automatic entitlement to compensation in other nuclear test countries if veterans can prove that they were there at the tests and have suffered ill health. The US is an example, as is Canada, and even the Isle of Man. I shall come on to the point in a minute that we are near the bottom of what I would call the international table of decency, in terms of how we treat veterans, compared with other countries.

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

I congratulate the hon. Gentleman on securing the debate. He does a lot of good work for veterans, in relation not only to nuclear tests, but to reductions in defence forces in general. I welcome the proposal for the £25 million benevolent fund; I think that the suggestion is a practical one on the basis of need. These veterans made a major contribution to understanding the effects of nuclear war. That is very important, and to do that they often sacrificed their health, and they are still suffering for it today. I find it very strange that, in this country, we always have continual battles to get recognition for veterans. Some years ago, it was about getting recognition for the merchant navy during the war. I do not know what it is about this country, but we seem to be falling behind everybody else in recognising the contribution that people have made on our behalf. I hope that we do not make the same mistakes with the veterans of Afghanistan in future.

[Mr Baron]

Having served myself, I sympathise with what the hon. Gentleman says and I understand the campaigns that he mentions. This is one of the key points that we wish to make about the benevolent fund: if we look at other countries—I shall come on to this very briefly—and compare how they treat their test veterans, we rank very near the bottom. However, I suggest to the Minister—this is where there has been confusion in the MOD before—that the payment should be ex gratia; in other words, there would be no admission of liability. There has been some confusion within the MOD that the BNTVA, as an organisation, has been involved in litigation through the courts, when that has not been the case. If we look at other countries that have made ex gratia payments, we see that the case being made very much stacks up. There would be no admission of guilt or liability, but it would put right an injustice.

It is important to reinforce that point. The campaign organised by the BNTVA, other hon. Members and I has been very much focused on Parliament and not on taking this issue through the courts. Perhaps I should also add that the BNTVA has put in a submission to the medal review led by Sir John Holmes, and it is waiting for the outcome of Sir John’s deliberations. However, that is separate from the campaign that we are discussing today.

I return to both interventions, in a way, and to the point about how other countries treat their test veterans. It is clear, when looking at the comparisons, that we rank towards the bottom of what I would call the international table of decency. Let us take the US for example. Our campaign is about recognition, and all that people have to prove for compensation there is that they were present at a nuclear test—one is sufficient—and there they have a list of more than 100 illnesses. They do not have to provide a causal link between the two. Providing that someone can prove those two things, they will automatically get compensation—£47,000 for the first illness and £47,000 for any secondary attributable illness as a bonus. No causal link between service and illness is required; payment is simply automatic. That is in addition to the fact that veterans in the US have access to free health care.

Commonwealth countries played a great part in our nuclear tests. Canadians were there in large numbers, and Canada pays some £15,000 to each veteran, in addition to war pensions, and enjoys a health care system like the NHS—free at the point of use. Closer to home, the Isle of Man, which has been supportive of our campaign, makes an ex gratia payment of £8,000 to any resident test veteran, and 17 such payments have been made to date.

I stress that our proposals are different from the comparisons that I have just listed, because the £25 million would be distributed on the basis of need, not entitlement. That is why it is important to stress the ex gratia nature of the payment. There is no admission of liability; no admission of guilt. The benevolent fund would be there to help veterans and their descendants who need help with their care and treatment. The fact that someone is a veteran does not necessarily mean that they would gain access to the fund in question.

I urge the Minister, when considering the proposals, to look further afield again. I remind her that in the 1990s this country made an ex gratia payment to Australia that just so happened to be for the exact sum of £25 million, and that payment was made in compensation for having undertaken tests in Australia. It was the equivalent sum of money, and if it is good enough for Australia, I do not see why it is not good enough for our own test veterans. I remind the Minister that Australia already offers a generous pension to its test veterans.

2nd Battalion the Royal Regiment of Fusiliers

Debate between Jim Cunningham and John Baron

Thursday 18th October 2012 Commons Chamber

[Mr Baron]

I completely agree with the hon. Gentleman. The strength of feeling has been illustrated not just by today’s march but by the number of people who have signed the petitions. There can be no dispute but that feelings run high on the issue, and I thank him and all other Members who have supported the campaign.

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

I am sure the hon. Gentleman is aware that Coventry and Warwickshire have been great recruiting grounds for the Fusiliers over the centuries. Does he agree that although we often praise our soldiers in the House, for a change we now have an opportunity to stand by our soldiers’ regiments?

[Mr Baron]

I completely agree. This is a clear opportunity to say that we stand side by side with the Royal Regiment of Fusiliers. At the end of the day, soldiers take orders, which is absolutely right. However, we are having this debate because we contend that 2RRF has been felled by political considerations, to save more poorly recruited Scottish battalions ahead of the 2014 Scottish referendum.

Let me be clear that I, for one, think that the cuts to the Army, and certainly their scale, are a big mistake. In this increasingly uncertain world, when many countries that are not necessarily friendly to the west are increasing their defence spending, I am really concerned about the scale of our cuts and about the ability of the Territorial Army, much as I respect it, to plug the loss of those regular battalions. I believe that no battalions should be cut, Scottish or otherwise, but if there are to be cuts, they must be based on military logic and not political calculation born out of the misguided view that it will somehow help to save the Union if we save more poorly recruited Scottish battalions.