Ockenden Review

Jim Shannon Excerpts

Thursday 10th December 2020 Commons Chamber

[Ms Dorries]

I thank my hon. Friend for her pursuance, her persistence and her dedication, both to her constituents and the hospital as a trust. I would also like to mention, as my right hon. Friend the Member for South West Surrey (Jeremy Hunt) did, the parents of Kate Stanton-Davies and Pippa Griffiths, who have been instrumental in getting us along the pathway to where we are today. Yes, my right hon. Friend commissioned the report, I pushed for it to happen now, and my hon. Friend has been pushing also, but it is down to those parents and their commitment. It should not have to be like this. Parents should not have to go through what they have gone through to get to where we are today.

As my hon. Friend is aware, I have visited the trust myself and have been round the midwifery unit and the consultant-led unit, and I think there is an anomaly there. Should we have a midwifery unit and a consultants’ unit? Is that not where the problem is, with two separate disciplines not working together? Should there not be just one delivery unit? Does the culture not start there, and should we not look at how it works?

However, my hon. Friend has my absolute 100% assurance that, for as long as I am in this post, I will be driving forward the recommendations and findings of this report.

[Jim Shannon (Strangford) (DUP)]

I thank the Minister for her understanding and compassion on the findings of the Ockenden report. With other right hon. and hon. Members, I wish to express my deepest sympathy to those families who have been grievously damaged by the failings of the Shrewsbury and Telford Hospital NHS Trust.

But will the Minister underline that sympathy alone is not necessarily what is required? What is required is action, and an undertaking to review procedures not only in this trust, but UK-wide, to ensure that the Ockenden report recommendations are implemented in all maternity wards. Will she give a guarantee that that will be done?

[Ms Dorries]

I thank the hon. Gentleman for his question; he is absolutely right, of course. The findings will be put in place, and in many trusts they already are. I was just looking for my data on the Morecambe Bay investigation, which I believe my right hon. Friend the Member for South West Surrey (Jeremy Hunt) also commissioned. If we look at the Morecambe Bay trust investigation, the predecessor to this, it is quite commonplace to say—I hear it all the time—“Well, we had Morecambe Bay and nothing has happened: the recommendations haven’t been implemented there.”

Actually, the Morecambe Bay investigation made 44 recommendations, 18 of which have been completed within the Morecambe Bay trust. There were 26 wider NHS learnings and recommendations, of which 14 were accepted nationally and 11 are being worked on now in the Department, to be rolled out nationally. I use that as evidence that reports such as this have consequences: actions that are implemented and make a difference in maternity units.

Covid-19 Vaccine Roll-out

Jim Shannon Excerpts

Tuesday 8th December 2020 Commons Chamber

[Matt Hancock]

Well, I very much hope so, but there is some time between now and then, so we have got to temper our joy and enthusiasm at today’s announcement with the need to keep on keeping each other safe between now and then. Let us not blow it, since we can see that the answer is on the horizon.

I reiterate the point that my hon. Friend made about the team in the Department, because my civil servants and special advisers have been amazing during this year. They have worked so hard—seven days a week, often 18 hours a day—and they deserve enormous praise, because this is a team effort and nobody can do this sort of thing on their own.

[Jim Shannon (Strangford) (DUP)]

First, could I say what a positive news story it was this morning when Margaret Keegan got her jab, followed by a fellow called William Shakespeare, which I thought was quite interesting? I thank the Secretary of State and all those who have made this happen, because it is really good news. Will the Secretary of State outline whether he has liaised with the Treasury to secure the funding needed to roll out this vaccine in the devolved nations, bearing in mind that we are behind on our flu vaccine roll-out and both cannot be carried out at the same time? Further, what discussions have taken place with the Secretary of State for Defence to provide trained military assistance in the devolved regions to make it happen?

[Matt Hancock]

This year, I have sometimes turned for inspiration to the bard:

“If you prick us, do we not bleed?”

So it was a delight and a coincidence to find that Mr William Shakespeare of Stratford-on-Avon, a constituent of the vaccine roll-out Minister, the Under-Secretary of State for Health and Social Care, my hon. Friend the Member for Stratford-on-Avon (Nadhim Zahawi)—by coincidence; Members should not get any ideas—was called forward to be the second person to be vaccinated by the NHS. It is absolutely terrific to see that people right across this United Kingdom are being vaccinated right now according to need, and I hope it can bring us all together.

Covid-19: Access to Cancer Diagnosis and Treatment

Jim Shannon Excerpts

Wednesday 2nd December 2020 Westminster Hall

[Jim Shannon (Strangford) (DUP)]

I congratulate the hon. Member for Westmorland and Lonsdale (Tim Farron) on securing the debate and setting the scene, and all hon. Members on their incredible contributions. I look forward—I said this yesterday and need to get away from saying it again—to the Minister’s response and the contributions of the shadow Minister and the Scots Nats spokesperson.

I have been contacted by many constituents asking me to attend and speak in this debate, and as my party’s health spokesperson I am very happy to do so. One of the heartbreaking stories I have heard in the past couple of difficult days is a widow saying:

“my husband only died of cancer—he isn’t important”.

I honestly could have cried when I heard those words, because I believe that she genuinely felt that no one cared, and that is what she told me. I felt that hardness; I had a compassionate understanding of what she was saying.

We are in unknown territory and undoubtedly we are distracted. How can we save people from contracting covid? How do we treat those who have it? How do we keep people in contact with others for their mental health? How do we ensure economic viability to pay for the future health needs of this nation? We are distracted, but when we have widows and cancer patients telling us how left behind and unimportant they feel, we know that in our distraction we have got this wrong. It pains me to say that.

Throughout this pandemic, I and others have lost loved ones. Two of the girls in my office have lost loved ones: one lost a sister and the other lost two uncles. We know the devastation, but we have all lost loved ones to cancer too. It is not that one is less important than the other, so that is why this debate is so important. I am thankful for this debate, which allow me to come alongside my colleagues and friends—that is what they are—to discuss how better we can do this together.

I was contacted by a radiotherapist who highlighted the massive problems they are dealing with daily. There are two main radiotherapy centres in Northern Ireland. I know this is not the Minister’s responsibility, but I am saying this to give some context to the debate. One is in Belfast, and the other is the newer, smaller North West Cancer Centre at Altnagelvin. I am told that the main issues in radiotherapy are the result of the lack of investment and funding. There are major problems as a result of staffing—doctors, therapy radiographers and physics—including recruitment, training and retention. That has a knock-on effect on service delivery, development and research. Investment is needed to replace old radiotherapy treatment machines.

Northern Ireland would like to feel more connected to mainland UK radiotherapy, through sharing best practice, training support, data sharing, peer review and so on, and that is what we are asking for. It is important that we take an holistic approach to this across the whole of the United Kingdom of Great Britain and Northern Ireland.

The covid problems found also included more patients having their treatments disrupted in many centres in the United Kingdom and a higher proportion than average reporting a poor or very poor experience. That also worries me greatly. We have members of the all-party parliamentary group for radiotherapy in the Chamber today, and I know that every one of us understands these issues, including the hon. Member for Westmorland and Lonsdale, who set the scene. One hundred per cent of responders said they were treating patients who would usually be having chemotherapy or surgery. The additional referrals were for a range of cancers, including oesophagus, lung, breast, head and neck, upper gastro- intestinal and bladder, and also included palliative cases.

I want to speak about one specific cancer, pancreatic cancer. It has been highlighted that there was already an emergency before covid-19. This was a critical issue back in March and it is even more critical today, in December. Surgery is the only potential cure for pancreatic cancer. Before the pandemic, only one in 10 people received surgery. With pancreatic cancer, a six-month delay to surgery means a 30% reduction in survival and a three-month delay a reduction of over 17%. Unfortunately, that sets the scene, with pancreatic cancer progressing from a curative to a non-curative disease while treatment is delayed. Surgery, for some, is no longer an option. That is greatly disturbing.

Reports of service restoration are encouraging. We hear from clinicians that, in most parts of the UK, surgery and treatment are now back up and running at near normal levels, but for so many people with pancreatic cancer and their families the damage has already been done. For those diagnosed in the future, the continued delays to the restoration of clinical trials are stunting crucial improvements in treatments and outcomes.

People with pancreatic cancer have also experienced an information gap, with 40% of patients who were impacted by the pandemic reporting having received insufficient information and support about treatment, symptom management or palliative care. We have had multiple reports of people being sent home from hospital with a new diagnosis without any further information on the disease, their prognosis or treatment options. Anyone facing something incredibly dark such as pancreatic cancer at an advanced stage will want the person opposite them to tell them what is wrong and give them some light on a way forward. All of us in this Chamber today, and all of us outside it, have been touched by cancer. For every two people we meet, one of them, or someone in their family, will have had it. Unfortunately we are continually confronted by this, each and every day.

Calls and emails to Pancreatic Cancer UK’s support line nurses have been up 58% on the normal weekly average, and there has been a 34% increase in the number of people being supported each week. Again, I think those figures are the critical factor in where we are on this. Pancreatic Cancer UK has also been contacted by a larger proportion of palliative patients than normal, because that is unfortunately what pancreatic cancer often leads to. If people do not get an early diagnosis and early surgery, they are confronted with end-of-life care. For families, that is incredibly difficult and complex, and a very difficult time in their lives. People with pancreatic cancer have reported feeling forgotten and isolated, at a time when they are also unable to see friends and family due to the risk of covid-19 transmission.

We are all heartened by the tremendous news today that we are going to roll out the covid-19 vaccine late this year and into next, given the time it will take to get to everyone. That is good news, but we have to address the issues for those with cancer now. I believe we need to do better, and the changes must be implemented from here at Westminster and across the whole of the United Kingdom of Great Britain of Northern Ireland. On behalf of all those cancer patients—all the ones who have contacted us, and all those facing an incredibly difficult time—I look, as I often do, to the Minister for a response. I know we will get that, but we really do need to be reassured. We need early diagnosis and extra care, and we need to show compassion in this place for those outside.

[Esther McVey (in the Chair)]

We now move to the Front Benchers.

Coronavirus Vaccine

Jim Shannon Excerpts

Wednesday 2nd December 2020 Commons Chamber

[Matt Hancock]

Yes, I am very happy from this Dispatch Box to remind the supermarkets of their responsibilities to follow covid-secure guidelines and ensure that they are in place for their customers and staff. I pay tribute to my hon. Friend for standing up for the small businesses of Ashfield. It is tough in Ashfield at the moment—I get that. We have the restrictions in place only because they are absolutely necessary. I know that he understands that. He is a strong voice in this Chamber for all the small businesses and residents of Ashfield.

[Jim Shannon (Strangford) (DUP)]

What a joy it was at 7 o’clock this morning to see this news being broken, and to see the Secretary of State as well. I put on the record my thanks to the Secretary of State and all his team for making this happen.

Is the Secretary of State aware that there are still those who are unable to access their flu vaccine? What steps have been taken to ensure that the flu vaccine roll-out is completed before the corona programme begins? What discussions has the Secretary of State had with the Northern Ireland Assembly on providing vaccines and, more importantly, on the roll-out for our vulnerable and our frontline key workers?

[Matt Hancock]

I am grateful to the hon. Gentleman for his kind words. It has been a big team effort. I echo his thanks to the whole team.

We have a further tranche of flu vaccines ready to go; that is just about to be rolled out. Making sure that flu vaccines are available right across the UK is very important. It is an issue that Robin Swann—my opposite number in the Northern Ireland Administration—and I have worked on extensively. He is incredibly diligent in ensuring that we get the flu vaccines rolled out to Northern Ireland. There is an interaction between the massive flu vaccine roll-out programme, which the NHS does every year but which this year is bigger than ever, and at the same time having to do a covid vaccine roll-out. We have taken that into account in the plans. In fact, before the announcement at 6.30 this morning, I was talking to Robin Swann on the phone, which shows how hard-working he is.

Covid-19: Hospital Parking Charges for NHS Staff

Jim Shannon Excerpts

Tuesday 1st December 2020 Westminster Hall

[Zarah Sultana (Coventry South) (Lab)]

I beg to move,

That this House has considered parking charges for NHS staff at hospitals during the covid-19 outbreak.

It is a pleasure to serve under your chairmanship, Mr Walker. The pandemic has made many things clear: it has exposed the deep inequalities in our society and highlighted that it is the labour of working people that keeps society going. Perhaps more than anything else, it has shown the value of our NHS and its staff. NHS doctors, nurses, cleaners and porters have been incredible throughout the pandemic, working tirelessly on behalf of us all to defeat the virus. They deserve huge thanks and recognition for their courage and determination, so I begin by paying tribute to NHS staff at University Hospital Coventry and Warwickshire and across the country. I thank them for all that they do.

Thanks alone are not enough; NHS staff deserve much more than that. In the spring, in response to the public outpouring of support for the NHS, the Government announced that parking would be made free for staff during the pandemic. The Government said that NHS staff should be able to

“carry out their vital work without worrying about paying for car parking”

and that they would provide

“the financial backing NHS Trusts need to make this a reality”.

That pledge was, of course, welcomed by NHS staff across the country. So far, so good.

The pledge has been regularly repeated by the Government since. On 8 July, the Prime Minister told the House of Commons that

“hospital car parks are free for NHS staff for this pandemic”.—[Official Report, 8 July 2020; Vol. 678, c. 966.]

Last month, the Secretary of State for Health and Social Care repeated that, telling “Good Morning Britain” viewers that

“We don’t have parking charges in English hospitals and we’re not going to for the course of this pandemic.”

That all sounds well and good. The only problem is that it is not true, and has not been for many months.

As far back as June, parking charges were reintroduced for NHS staff at University Hospital Coventry and Warwickshire. Ever since, staff have been made to pay for parking. Similar things have happened at NHS trusts across the country. Charges were brought back at the nearby University Hospitals Birmingham and at the South Warwickshire NHS Trust, as well as in places as far afield as the Harrogate District Hospital and Wye Valley NHS Trust. Even now, as the second wave puts renewed pressure on NHS staff, charges are being reintroduced.

[Jim Shannon (Strangford) (DUP)]

As I said to the hon. Lady and the Minister outside, during the first wave of coronavirus, trusts and the health board in Northern Ireland did away with the charges, but restarted them after the covid wave had passed. Now that the second wave has come, they are considering stopping the charges again. Does she feel that the example from Northern Ireland and elsewhere indicate a need to subsidise staff during the covid-19 outbreak? Clearly, their work, which saves us all, is a priority.

HIV Commission

Jim Shannon Excerpts

Tuesday 1st December 2020 Commons Chamber

[Steve Brine]

I most certainly would. As a Health Minister I travelled around the world to G7 and G20 meetings. The NHS and what we do within it, as the Health Secretary has said many times, is so well respected around the world that we often set the tone and the lead. Yes, this is a plan for England, but I hope it will work across the devolved nations of the UK. I hope that we will set the standard around the world, as we have in so many areas of public health policy, so that others will then follow. I take the hon. Gentleman’s point exactly.

[Jim Shannon (Strangford) (DUP)]

First, I congratulate the hon. Gentleman on securing the debate. I just want to add my support for the HIV Commission project. I spoke to him beforehand. It is important that we put on record the hard work that has been done by so many people, including by those in my constituency. The Elim Church’s missions have helped to address HIV in Swaziland. Over the years I have known them and what they have done, they have been instrumental—it is a wonderful thing—in assisting the Swazi Government to reduce the number of adults who have HIV from 50% to 27%. A programme of education and medical support has helped. Does he agree that what they have done in Swaziland could enable us, through the House of Commons, to deliver that to the rest of the world as well?

[Steve Brine]

Yes. The faith element is very important. We have done very well on driving down the numbers, but we have to do even better, and it will get harder as we get closer to the goal. Reverend Steve Chalke, a Baptist minister and the founder of the Oasis Charitable Trust, was one of our commissioners. He provided a very important element and the hon. Gentleman’s point is very valid.

Why do I say that this is scientifically possible? A HIV diagnosis is a notification of a serious condition, but these days, thank goodness, it is not the death sentence it once was and many understand it to be. An end is therefore in sight. Treatment has come such a long way. People on the right treatment have their viral load suppressed, meaning that they cannot pass on HIV. That, frankly, was a game changer. Overwhelmingly, people in England and the UK now know their HIV status. Of the 106,000 people with HIV in our country today, 94% know they are HIV positive, 98% are on treatment, and nearly all are virally suppressed and therefore cannot pass it on.

In addition, we have a wonder drug, PrEP— pre-exposure prophylaxis—which is taken by people who are HIV negative. It stops transmission during sexual intercourse. The PrEP impact trial data comes out in the new year, but we know already that it is a massive success—I hope I am proved right in that assertion. The Secretary of State made the drug readily available, free on the NHS—that was important. That took a little longer than it might have done but, legal challenges notwithstanding, let us not dwell on old ground. Let us ensure that all communities that can benefit from it know about its virtues and its availability.

If we are to get the benefits of PrEP to all who need it, HIV testing is needed in GP surgeries, pharmacies—I refer the House to my entry in the Register of Members’ Financial Interests—termination clinics, gender clinics and much more besides. Then, PrEP prescribing powers need to be given to each of those bodies. Again, it can be done—we need the will to do it. I commend the PrEP Protects campaign, focusing on black African women and men. If we can get take-up in other communities as there has been with gay and bisexual men, we will be changing lives and saving money. So thank you to the Terrence Higgins Trust, the National AIDS Trust, I Want PrEP Now, who lobbied me heavily as a Minister, and PrEPster for their amazing campaigns on the issue.

--- Later in debate ---

[Matt Hancock]

The cross-party nature of the support for this work could not be better demonstrated than by the fact that when our colleague from the Scottish National party, the hon. Member for Glasgow Central (Alison Thewliss) intervened, she anticipated my very next sentence, and so has the hon. Gentleman. I wanted immediately to turn to the global matters, because no one is safe until everyone is safe. If we have learned anything this year, we have learned that. We also need to work on shared solutions together and across the world, and we as a country will lean into the global efforts to tackle HIV and AIDS, as we have done under Governments of all persuasions over the past three and a half decades.

[Jim Shannon]

In my intervention on the hon. Member for Winchester (Steve Brine), I referred to the good work that has been done in Swaziland. From a global point of view, I just wonder whether the Secretary of State will be able to make contact with Swaziland and see how it has reduced the numbers.

[Matt Hancock]

I would be very happy to ensure that that happens and to work with the hon. Gentleman on a subject that I know is close to his heart. I reiterate that over the past three and a half decades, here in the UK we have played our part in supporting efforts right around the world. I am proud that we are the world’s second-largest donor to the Global Fund, which is reallocating up to $1 billion to support the prevention and treatment of HIV and other threats to global public health during the pandemic. We have to make sure that work goes on, even in the clutches of another public health emergency. It is absolutely critical that we do not let up, because we cannot let one virus undo the progress we are making in fighting another.

Today is a day to look back and remember those we have lost to HIV. It is a day to look back and acknowledge the progress we have made, but it is also a day to look forward and together reaffirm our resolve to keep working towards that goal of no new infections in 2030, because HIV is a virus that has taken too many people before their time. We should all redouble our efforts to make it a thing of the past.

Question put and agreed to.

Cancer in Teenagers and Young Adults

Jim Shannon Excerpts

Tuesday 1st December 2020 Westminster Hall

[Jim Shannon (Strangford) (DUP)]

I beg to move,

That this House has considered the matter of raising awareness of signs and symptoms of cancer in teenagers and young adults.

It is a pleasure to have this debate, and I thank the Backbench Business Committee for making it possible. I have a number of debates lined up with the Committee, and it asked me the week before last which debated I wanted to do. That is a very difficult question, because there are others that have been lined up since April or May, so I said, “I can’t make my mind up. I will leave it to you.” The Committee chose this subject, and I am very happy to speak on it.

I am my party’s health spokesperson, and this issue is very close to my heart. That is perhaps because, over the years, as an elected representative, I have had the opportunity to speak to constituents who are very clear about what the issues are for them. Cancer in teenagers and young adults is very important because sometimes children have been healed, and sometimes they have not.

Far too often, young people are forgotten when it comes to the conversation around cancer. Today’s debate offers a great opportunity to highlight the issues young cancer patients face, helping us all to explore how we can increase the understanding of signs and symptoms of cancer in their age group, and how to support their specific needs, experience, survival and recovery from cancer.

The importance of the debate was made clear to me the Teenage Cancer Trust, a charity that is very close to my heart and that I have supported frequently over the years. The Teenage Cancer Trust is the only UK charity dedicated entirely to improving the quality of life for 13 to 24-year-olds with cancer. It helps the seven young people who are diagnosed with cancer every day of the year, supporting them through treatment and beyond. The Teenage Cancer Trust has specialist units in NHS hospitals and provides dedicated staff, including specialist nurses and youth support co-ordinators. It is important to have specialist nurses and youth support co-ordinators in place to offer that umbrella of support when it is needed. The charity has 28 units across the United Kingdom of Great Britain and Northern Ireland, and uses the charitable funds it raises to provide over 90 specialist staff posts.

This year, after noticing the worrying drop in cancer referrals across the first lockdown, the Teenage Cancer Trust ran the “best to check” campaign, which was supported by a large number of MPs, on social media. Many MPs in this House and many Members of the devolved Administrations were involved in that social media campaign. The aim of the campaign was to highlight the specific signs and symptoms of cancer in young people and, importantly, to encourage young people to speak to their GPs or other healthcare professionals if they were concerned, with the message that, if in doubt, it is best to check. It is a good campaign, because it highlights the issues well.

An important point to raise today is that young people with cancer are different from children and older adults. While, fortunately, cancer in teenagers and young adults is rare, compared with cancer in older adults, it is still the biggest killer of young people by disease. This week in Westminster Hall and in the Chamber, we will have a number of debates about cancer, which is something we have highlighted over the last period.

It is always a pleasure to see the Minister in her place, because she has personal experience, but also a knowledge of the subject matter, and I look forward to her response. I also look forward to hearing from the shadow Ministers and from other hon. Members today.

It is always important to remember that cancer is still the biggest killer of young people by disease, because we focus very much on older people in our constituencies who come to see us. My father had cancer on three occasions; the first time, the specialist told my mother, “Go home and get your affairs in order,” yet he survived that. I have a similar outlook in life, both spiritually and in understanding, to my hon. Friend from the Scottish National party, the hon. Member for Glasgow East (David Linden). We believe in prayer. At that time, prayer was a big thing, and I believe it changed the outcome for my father. It was the skill of the surgeon and the care of nurses along with the prayers of God’s people and others that brought him through. He lived 34 years after he was first diagnosed. For a man who was told that his life was over, it is clear what happened. He had two more bouts of cancer and survived them too.

Young people experience a pattern of cancer types distinct from those faced by children and older adults. Typically they are the types of cancer that are considered rarer than those we are most used to hearing about in older adults. It is important that we focus on that. These cancers include the lipomas, the leukaemias, the sarcomas and the germ-cell tumours that are often harder to diagnose than the cancers faced by those in older age groups. We regularly see on television adverts from Great Ormond Street children’s hospital, and when I see young children suffering from cancer at a very early age, it always make me focus on the young people who have to deal with the disease. For example, a couple on television this morning told a very personal story. The case of children who have not had the chance to see all of life resonates very much with us and is close to our hearts.

Alongside that, it is important to recognise that young people with cancer have a distinct and highly significant set of social and emotional needs. Perhaps they do not always understand what has happened to them. They depend on the love of their parents and their families, and the skill of the nurses and their love as well. The normal challenges facing all adolescents and emerging adults still have to be faced by a young person with cancer. Along with the changes that they face, they have to deal with some of the bigger issues.

Young people are at a stage when their brain is still developing. That means that they will interpret and manage their diagnosis and the treatment of cancer differently. Experiencing cancer at the same time as puberty can have an effect on the physical transformations that are taking place. Cancer can have a number of unique physical and social impacts on a young person, and that can affect their identity, sense of self and body image. As the father of three young boys growing up, I was very aware of the difficulties and changes in children. Now I have the pleasure of having grandchildren and watching them growing up. All the things that I did not do right for the children I can perhaps get right for the grandchildren. My wife might say, “That’ll be a big thing for you,” so we will see how it goes.

Cancer can disrupt young people’s attendance at school, their romantic relationships and their interactions with peers at a crucial time in their development. The Teenage Cancer Trust funds youth support co-ordinators who are specialists, who help young people through all aspects of their care.

Young people with cancer face many barriers when needing a swift and accurate diagnosis. An issue both before and during the coronavirus pandemic is the challenge of getting age-specific data on cancer referrals. That is one of the things that we perhaps have not been able to do accurately. I understand the pressures that Ministers and Departments face, but data are not just figures. Data enable us to look at trends and to focus on them. It is important that we have age-specific data.

Statistics on cancer waiting times are broken down by trust and cancer type, but not by age, which is rather unfortunate. When the Minister replies, perhaps she will give us an indication of how improvements can take place. If we had such improvements for age data, we could focus our efforts on how best to address the issue. It is difficult to understand the full impact of coronavirus on access to the system for young people with cancer, but there is no benchmark for comparison in the first place. We cannot even compare with what happened before because the statistics are not in place. It is important that we get them.

Data from the national cancer patient experience survey in 2018 showed that young people were the group most likely to sit on concerns about their body for more than 12 months before presenting to a doctor. We have to address that. If young people are not sure what is wrong and what the changes in their bodies are, they need to be encouraged to speak to their parents and their GP and to feel free to do that, just to check and be sure. I will shortly give one example or perhaps a couple of examples of where doing things that way probably saved people’s lives.

Data from the national cancer patient experience survey and surveys conducted by the Teenage Cancer Trust also show that, compared with older adults, young people with cancer are the group most likely to have to present to GPs or healthcare professionals three or more times before they end up getting a referral and a diagnosis. How many times have we heard that people have gone to see their GP and presented their case, but the GP—I am not being critical—has never been able to indicate exactly what is wrong at an early stage, when the symptoms are perhaps clearly saying it? That is why people go back perhaps two or three times.

As I said, I will give an example of one young person, and I will give just her first name. The Teenage Cancer Trust hears these stories frequently. In June 2019, a young person named Alex was diagnosed with acute lymphoblastic leukaemia. She was 13 years old. Her symptoms started as back pain. When she presented her symptoms to the GP, she was told to take paracetamol and ibuprofen and to keep an eye on it. A week later, she was still having persistent severe back pain, but she had also developed a rash and unusual bruising. Luckily, her GP told her to go to the A&E department for a test, and that was probably what saved her life. Following that, Alex was told that she had cancer.

Alex is now on maintenance treatment and wants to share with other young people the message that if they go to their doctor once and something still feels wrong afterwards, it is important to keep going and asking for help. It might seem silly to do that, but it is essential. If someone has a persistent pain or problem, they must go back to their doctor. What made young Alex persevere was knowing that she would be able to stop guessing once she found out what was wrong. Alex’s story is one of many with a similar message.

Studies such as that by Herbert et al in 2018 have shown that GPs are often not familiar with cancer in teenagers and young adults because of its relative rareness, so their suspicion is low. I know that GPs are confronted every day with different issues, and I understand that, sometimes, with the rapidity of issues, it might not always be possible to know exactly what the problem is. It is often thought that young people are too young to get cancer. No, they are not. It is important that that is said today.

Interestingly, the BRIGHTLIGHT cohort study has highlighted that sociodemographic factors and tumour type significantly influenced primary care referral rates and time to diagnosis. BRIGHTLIGHT has done excellent work, and it is good to have that on the record.

Following on from that, it is timely to raise the issues that coronavirus has caused for teenagers and young adults with cancer. At the height of the coronavirus pandemic, around the time of the first national lockdown, cancer referrals from GPs dramatically reduced for all age groups. It would be great to think that that was just because cancer problems and the need for diagnosis had dropped, but that was not the reason. Cancer referrals were down by as much as 75% across all age groups—adults, young adults and children—as people stayed at home to prevent the spread of coronavirus. People were obviously afraid. They would think, “If I have a chronic disease and I go to the hospital or my GP, I might find that I have coronavirus as a result of that.”

There are potentially thousands of undiagnosed people who otherwise would have been diagnosed, and I think that other debates this week will indicate that as well. There is concern, too, about the particular challenges from the increased demand during the winter period. We cannot ignore that, because the winter period will bring its own problems as it always does. As one who had the flu jab back in September, I understand how important that is. I was never convinced at the beginning that it was really important, but as a type 2 diabetic, I now understand that there is a purpose to it. I have no doubt at all that the flu jab has helped me and many others.

As I said, there is concern about the particular challenges from the increased demand during the winter period. We also have to look at wider access to services for young people with cancer and at how that can work and how we can do it better, because it is important that we do so. Much of the support for young people with cancer has had to move online during the pandemic. That suits some people, but not everyone. While there has been some excellent adaptation and innovation, it cannot fully replace one-to-one support. While online is important, it is not the answer to it all.

It is encouraging to see the pick-up in referral rates across age groups in the latter part of the year. The NHS Help Us, Help You public awareness campaign is welcome. Some of these campaigns are really important, and we have to thank the Minister and the Health Department for campaigns that raise awareness. It is important that that happens.

During the first lockdown, the Teenage Cancer Trust found that young people with cancer found that accessing members of their treatment team much more challenging, particularly for rehabilitation and emotional support. We often say this—there are not many debates when we do not—but the issue is not always the physical part; it is also the mental and emotional wellbeing, the social interaction and the help of families. My goodness, how much we depend on our families for support as well. The trust’s findings show that 69% of young people were seeing their physiotherapist less frequently than usual, and 53% of young people were seeing their psychologist less often than normal. Those figures tell their own story of the fall-downs.

For many of these young people, the impacts of covid-19 and cancer are a massive double whammy. For those in treatment, coronavirus has exacerbated what is already a horrible situation and made it even more isolating and scary. Those young people who do not have the support of family and friends find it a very lonely road to chart a way down. I hope the Minister will give us some ideas in her response about how we can help these young people with their emotional and wellbeing.

For those at the end of treatment, coronavirus has extended some of the most difficult pressures of cancer treatment, which they thought they were finally breaking clear from, such as missing friends, family work and education. I support the Government’s campaign here and in Northern Ireland, where the issue is devolved, to have children at school. It is really important to do that where possible. We can probably do education at home and online by Zoom, but there is not the contact. I watched a TV programme last week where four children from a school back home were asked how important interaction in class was to them. They all said the same thing: they need that social contact. That is very important to have a normal life.

Another young person, Darcy, was diagnosed with skin cancer in February this year, at the age of 21. Her diagnosis came after her mum noticed a mole on her collar bone that was growing and getting darker. Like Alex, Darcy was originally turned away by her GP, who thought the changes were nothing to worry about. That is not a criticism; it is a reality. Luckily, because Darcy knew that something was not right, she decided to go back. She was persistent, and her mother was persistent as well. Her mole was removed and tested, and Darcy was diagnosed with skin cancer.

Coronavirus changed Darcy’s experience of cancer, as the UK entered lockdown soon after her diagnosis. She was one of the fortunate ones who had a diagnosis early and was treated before coronavirus came in. Coronavirus has amplified the issue of young people being forgotten in the conversation about cancer. Due to infection control restrictions as a result of coronavirus, many young people with cancer have to face treatment without someone there with them.

We have had many such debates in Westminster Hall and in the main Chamber. We had a Westminster Hall debate about month ago about miscarriages and losing young babies and children. It was a very emotional debate, full of raw emotion from all those who participated with personal stories. One person in particular—I do not think I will ever forget her contribution—told her story for the first time. Her story was that she had lost her child during the coronavirus pandemic, and it had happened only three months previously. She told the story, from that chair, not so long ago. It told me how important it is to have someone there. Because of the coronavirus, she had not seen her mother since she lost the baby. The special contact that mothers have with daughters was lost for a period of time, so it is important to have that in place. The restrictions are there, of course, in the interests of safety and stopping the spread of virus, but young people with cancer report that they are increasingly struggling with the impact of having to face some of that treatment alone. I underline that again, as it is really important.

It is important to raise several other issues faced by young people with cancer, one of which is access to clinical trials. Perhaps the Minister will agree that we should be trying to address that. Access to clinical trials can improve survival rates, outcomes and quality of life. Teenagers and young adults are, however, significantly under-represented in cancer research. We do need to do something in that department, and it is important that we do that. If young people are involved in clinical trials, we can improve cancer research, thereby improving the results. Recruitment rates in the UK among 15 to 24-year-olds are between 14% and 30%, compared with a rate of 50% to 70% in paediatrics. That tells me something. Those facts are stark, and we need to address that.

Another key issue is the impact that cancer can have on the mental health of a young person. I said it earlier on and I say it again. CLIC Sargent’s 2017 “Hidden Costs” report on young cancer patients showed that 70% had experienced depression, 90% had experienced anxiety and 42% had experienced panic attacks during treatment. Despite that, many young people with cancer cannot access the psychological support that they need. Research by the Teenage Cancer Trust in 2018 showed that only 61% of young people said they had access to a psychologist or a counsellor throughout their cancer treatment. That figure fell to 44% after the treatment had finished. We really need to do something with that sector. It is crucial that every young person with cancer who needs it gets support from a mental health professional, from diagnosis through treatment to aftercare: from the beginning of the process to its end.

Cancer in young people may be rare when compared to cancer in adulthood, but it is still the biggest killer of young people by disease. Cancer awareness now forms part of the health education curriculum in schools in England. That is welcome, but education about lifestyle choices to prevent cancer in adulthood does not go far enough to help young people to understand the signs and symptoms of cancer in their own age group that are not down to lifestyle. It is important that we realise that. Cancer can come and strike hard when it is least expected. Young people with cancer need to be equipped with knowledge about the signs and symptoms of cancer in their age group, and empowered to visit a doctor when they think that something is wrong. Perhaps the Minister can give a follow-up in her response on how that education programme is going. It is a good idea, by the way. It is fantastic, and I highly welcome it, but I think, ever more mindful of the difficulties in education due to coronavirus, that the follow-on is important. Hopefully life will change in the new year, when the vaccine is more available and we have a better opportunity to take advantage of it. I am not quite sure what the new normal will be, but we do look for some sort of normality for the future. More widely, young people with cancer are consistently forgotten in the cancer conversation, so it is important that awareness of the issues faced by young people with cancer is raised. If data on referrals and diagnosis risks by age is not publicly available, however, difficulties in knowing where to effectively target interventions will continue. The specific needs of young people with cancer must be considered. Public awareness activity on cancer needs to include reference to the specific types of cancer that are more prevalent in young people. If we can focus on cancers that are more prevalent, we can give advice, raise awareness and encourage young people to act at an early stage.

Finally, general practitioners and healthcare professionals should be encouraged to refer young people who present possible cancer symptoms for tests, even if the suspicion is on the lower side. If they are in any doubt whatsoever, it is always better to check this to just sit on it. Thank you for this opportunity, Sir Christopher. I look forward to hearing contributions from right hon. and hon. Members, who have plenty of time to do so.

--- Later in debate ---

[Wendy Chamberlain (North East Fife) (LD)]

It is a pleasure to serve under your chairmanship, Sir Christopher, and I congratulate the hon. Member for Strangford (Jim Shannon) on securing this very important debate.

I will use my time today to highlight the work of a charity in my constituency, based in Cupar, that is focused on childhood and teenage cancers, called Toby’s Magical Journey. The “Toby” in Toby’s Magical Journey is Toby Etheridge, who was diagnosed with acute lymphoblastic leukaemia as a child, back in 2014. Together with his parents, Richie and Alison, he raised over £50,000 for charity during the two years of his treatment: £50,000 that would help provide toys, games, gifts and experiences to children and young people who were being treated for cancer and their families, both at the Royal Hospital for Sick Children in Edinburgh—which is where 90% of child and teenage cancer sufferers are treated in Scotland—and to families across Fife.

After Toby’s treatment was, thankfully, successfully completed in 2018, which was fantastic news, Toby, Richie and Alison decided to keep going with that amazing work, and set up Toby’s Magical Journey as a result. I have seen first hand the support that Toby’s Magical Journey provides, both to those being treated and to their siblings and parents. It is doing absolutely amazing work, helping people at what is an incredibly difficult time. When restrictions were eased earlier this year, I spent a morning sorting toys and craft gifts for Halloween, and saw the consideration and co-ordination that goes into the purchases it makes. I am looking forward to hopefully joining its team again in the run-up to Christmas.

One of the key issues that Alison, Richie and Toby have raised again and again—indeed, all Members so far have highlighted this—is the challenges that children and young people face in getting a diagnosis in the first place. This was not actually the case with Toby, but for many parents of children and young people with cancer, achieving diagnosis is often an arduous first step. The pandemic has created added difficulties: coronavirus is now a complicating factor, and that is why debates such as this are so important. Thirteen children and young people are diagnosed with cancer in the UK every single day, and of those 13, three will sadly die. That is a huge number of families every year, and it is therefore so important that we as a society do all we can to raise awareness of the symptoms of cancer, and to support those families who have children and young people being treated for cancer.

We have had Breast Cancer Awareness Month, and we have just finished Movember. These campaigns do a great job of raising awareness of the symptoms of breast cancer and testicular cancer. We need to better promote Childhood Cancer Awareness Month each September, in order to raise similar awareness of the symptoms of childhood cancer—symptoms that are not well known, which means that diagnosis can sometimes come too late. That means for many children, the chance of survival is greatly reduced, and as the hon. Member for Strangford has said, cancers in young adults and their symptoms are even less understood.

As I touched on earlier, this problem has definitely been exacerbated by coronavirus. In Scotland, general practitioners’ surgeries are still not seeing patients, which means diagnosis over the phone. As we have heard, that is a real problem when it comes to the often obscure symptoms of childhood and teenage cancer. It is important that these young people can have a face-to-face session with a doctor. I hope the UK, Welsh and Scottish Governments will commit to this as an absolute priority, especially given the mass expansion of testing we are seeing and the prospect of future vaccinations. Thankfully, at the Royal Hospital for Sick Children in Edinburgh, those crucial treatments are still going ahead. Children are being covid tested, and one parent is allowed in—usually, that would be two. I pay tribute to the team there, who do such important, life-saving work.

I also pay tribute to Alison, Richie, Toby and their wider family, because childhood and young people cancer impacts the whole family, and to all at Toby’s Magical Journey—volunteers, etc.—for the support they provide to children and families, but also for the way they have adapted the support they provide during the period of restrictions. Where they would be holding craft activities for family groups, they are now buying the same supplies and posting them to families, and doing sessions remotely. They are still sending gifts to children in the ward at the Royal Hospital, and I am pleased to say that Father Christmas will be doing socially distanced visits and meetings.

It is a very challenging time and as with many other charities, fundraising has been limited by covid. There are a number of factors, but one that I want to highlight is that people are using cash far less than they were at the beginning of 2020—I know that certainly I am. We need to think about how we can enable charities to continue to best collect donations in an increasingly cashless society.

Without child and teenage cancer charities such as Toby’s Magical Journey, the experiences of families being treated for cancer would be far worse than it is. They provide vital support, but equally important is the voice that they provide to families and parents. Without parents like Alison and Richie, who have direct lived experience, child and teenage cancer services would be much the poorer.

Like the hon. Member for Strangford, I commend the work of the Teenage Cancer Trust. In Scotland, it contacts all children weekly by text, and young people can respond via coloured love heart emoji, depending on how they are currently feeling.

We should be aspiring for a system far better than the one we have: one in which parents not have to fight for their child or young person to receive a diagnosis or treatment. We can do much better than this. The work that people such as Toby, Alison and Richie are doing has hugely improved services and will continue to improve those services in the future. They are amazing, but they should not have to be amazing in some respects. They should not have to step in to advocate; we should be getting the system right in the first place. I am sure all Members here aspire to that.

[Jim Shannon]

On the issue of charitable giving, the Government have made it possible through gift aid that for every pound given, they will give an extra 25%. Does the hon. Lady agree that this could be raised better, to ensure charities receive that extra bit of money? Sometimes when giving money, if a person knows they will get more for it, it is a bit like investing money for the future as one pound is actually worth £1.25.

[Wendy Chamberlain]

I agree that is arguably one of the opportunities of a more cashless society. If people are making a payment, the gift aid opportunities are potentially easier to access than with putting money in a box.

I appreciate that healthcare is a devolved matter, but I am still looking forward to hearing the Minister’s response because I am sure these challenges exist throughout the UK. Indeed, that is why the hon. Member for Strangford is the person who has secured this debate. We can also achieve much by pooling our healthcare expertise across the four nations. We should be making sure that in Scotland, Wales, Northern Ireland and England that we are following the best possible practice, which means raising awareness of symptoms, enabling swift diagnosis and ensuring that children, young people and their families are properly supported.

--- Later in debate ---

[Alex Norris (Nottingham North) (Lab/Co-op)]

It is a pleasure to serve under your chairmanship, Sir Christopher. I thank the hon. Member for Strangford (Jim Shannon) for securing this important debate. He works hard through the Backbench Business process to get important debates either on the Floor of the main Chamber or here in Westminster Hall. I think he has chosen very wisely in this one.

I know that all Members in the room have a personal commitment to this issue. My childhood experience of cancer was the death of my father just before my third birthday, and that stays with me and my family, 33 years on. I am here to speak up for my community, but also to fight on this issue so that across the country, there might be fewer families like mine. We are well served in that regard with the Minister, and her personal commitment to this issue is something that we all look to.

Similarly, when it comes to the Scottish National party, it always great to see the hon. Member for Glasgow East (David Linden) in his place. We always learn from his contributions, and also from those of his colleagues, such as the hon. Member for Central Ayrshire (Dr Whitford); with her enormous professional experience, she always adds to the debate. The hon. Gentleman mentioned his colleague and friend the hon Member for East Dunbartonshire (Amy Callaghan). I am sure she is watching, and I know the hon. Member for Glasgow East will pass our best wishes on to her. We can see that across this Chamber, there is a high level of commonality in our views about what must be done for young people. Between us, I am sure we can move forward on this important issue and make an impact.

I agree with so much of what the hon. Member for Strangford has said that throughout my speech, I will be reiterating the points that he made. Unlike him, I did not have a point to make on schooling, which is very important. Whatever challenges our children face in their lives—because of their socioeconomic background, their health, or whatever makes them different from their peers; everything makes a child different in some way—we must ensure that we are no less ambitious about their educational outcomes. We must meet their health needs in the short term, and then be ambitious about their futures so they can reach their potential. That is a cross-party theme; no one has ownership of it. It is important that we remain ambitious about the broader outcomes of children and young people who are suffering from cancer, so that—fingers crossed, and all that wonderful support willing—we can help them to resolve their health challenges and they can go on to live really full lives.

I refer to the poignant personal experiences described by the hon. Member for Wakefield (Imran Ahmad Khan). If he is still in touch with Daniel’s family, I hope that they can take comfort from the fact that Daniel’s story has been heard and his life recognised. The hon. Gentleman’s moving contribution will stand as a testament to Daniel in Hansard for centuries, and I hope that the family get to see it. I agree with what the hon. Gentleman said about early diagnosis, and I will refer to that theme shortly.

On covid-19, the hon. Gentleman said that the cure must not be worse than the disease. I understand that, but if we do not put restrictions in place and we do not control the virus to the degree to which we are able, our NHS will not be able to do anything else because it will be overwhelmed. I do not think that treating cancer and treating covid are in tension, and I hope we do not lose sight of that in the debate that we will have later today.

The hon. Member for North East Fife (Wendy Chamberlain) made points about cashlessness. We are all looking at how covid will change British life and our own lives. I was thinking about cashlessness only this morning as I beeped on to the tube. I have had the same £10 note in my wallet for months, and it is hard to think when we will use cash again. I have to say that such change makes me a little anxious—that might just be something in me—especially when I think about my constituents. For me, beeping in is great and doing stuff on apps on my phone while watching the telly is brilliant, but for lots of people in my community, cashlessness would be their worst nightmare. We tend to think about it in those terms, but the hon. Lady talked about how we might embrace the opportunity to get better outcomes, and how we might all take into these new times the spirit of putting money into charities’ collection boxes. Those points were well made. Importantly, I am sure that those whom she works with at Toby’s Magical Journey will have seen that their contributions and their wonderful work have been recognised today. I will come back shortly to the point about getting an early diagnosis.

I have spent eight months as shadow public health Minister, and it has has been a non-stop procession of virtual calls. The fact that it has been eight months may remind you that it feels simultaneously as though this pandemic has been going on forever, and as though it only started yesterday. The sense of time and space is strange. Sometimes, the virtual meetings can blend in together—I think I can say that without that sounding rude—but one really stood out, and that was when I was lucky enough to meet the Teenage Cancer Trust youth advisory group. I heard from four incredible people who had all experienced cancer at a young age, and they shared with me their unique and personal experience of this horrific disease. What they said was eye-opening and quite hard to hear at times. It was so inspiring that those four young people, who have fought or are fighting cancer, have chosen to use their experiences to fight the greater fight for others like them. That has had a great effect on me and informed my work.

Those young people talked about the scale of the problem that we are dealing with. We know that every year, 2,200 15 to 24-year-olds will be diagnosed with cancer. Lymphoma will be the most common—about a third—the next most common will be carcinoma of the thyroid, cervix, ovary, bowel or breast, at a little bit less than that. Survival rates are improving. That is something we should recognise, and we should be pleased and optimistic about it. We know that 82% to 85% of teens or young adults diagnosed with cancer will now survive for at least five years, but that is still in the context of the fact that nearly once a day a young person will pass away from cancer. That is the level of seriousness of this debate. Cancer in young people is rare, thankfully, but it is the biggest killer by disease, and the 2,200 15 to 24-year-olds diagnosed each year face mammoth challenges. We in this place cannot make that go away, although we wish that we could, but we have a responsibility to make sure that the best services are in place to meet their health needs directly and to provide support. I know that we are all committed to that.

The hon. Member for Strangford talked about the wide variety of challenges our young people face; everyone goes through them, even if they do not have to deal with this disease. I am just about young enough to remember some of them, whether social, emotional or physical. The idea of combining them with the physical and mental burdens of dealing with cancer is quite unimaginable. As we know, the normal challenges faced by young people are not sidelined in that situation; dealing with cancer just adds to and compounds them.

The experience that the TCT youth advisory group shared with me highlighted one of the biggest issues that young people with cancer face, and that is diagnosis. As multiple hon. Members have said, that is something that those young people face before they even know they have cancer. Cancer is often not the first, second or even third suggestion for what their healthcare challenges might be, and we know that young people are the most likely age group to present three or more times before they are diagnosed. That is backed up by studies that show that rarity can lead to doctors being unfamiliar with some of the symptoms that are presenting. A compounding factor is that, as the hon. Member for Strangford said, this age group is the least likely to take to a doctor concerns about their bodies. That can often go on for more than a year. Although the challenges that we face are understandable, we should not accept them. Rarity is not an excuse for us to not be really focused on the issue, and to want to do something about it.

I know the Minister will want to do that, and I look forward to hearing her contribution. I hope she can address a couple of issues. I am particularly keen to understand what steps the Government can take differently to increase awareness of cancer, not just among young people, but also among healthcare professionals, doctors and the wider healthcare system. We know those people are doing their best, so what can we do better to make sure they have the right information and awareness to recognise it more quickly? The hon. Member for North East Fife mentioned Childhood Cancer Awareness Month, and I think we could all do more during that month.

I am keen to hear the response to the question asked by the hon. Member for Strangford about what can be done to get waiting time statistics broken down by age, and I will explain in a second why that is particularly personal. The current situation masks the true extend of the problem and restricts our ability to understand it.

That leads on to my point about the impact of the coronavirus. I have raised this at three of the last four Health questions. Dealing with the cancer bubble of delayed diagnosis and delayed care is critical to improving our health services and making sure we do not add to the terrible loss of life from covid a series of other lives lost to cancer. Young people are particularly at risk in that regard.

In the short term, I cannot even imagine how scary it must be to deal with cancer at a young age during this period of time, because all the support systems that would normally be there are more difficult to access, and they must be accessed virtually rather than person to person. That is really challenging. The long-term issue is around waiting times. In the first lockdown, referrals dropped dramatically, as people stayed home to protect themselves and others. That means that lots of undiagnosed cases of cancer are out there, many of which will be among young people, who were already less likely to seek medical attention or be diagnosed quickly. That is a potential added factor that may make outcomes for young people worse. As cancer services are restored, we really need a sense of what we are doing differently to deal with the bubble for young people in relation to those extra factors.

[Jim Shannon]

The hon. Gentleman is making some important points. There is a build-up of young people, children and young adults who have not had a diagnosis or the chance to get treatment because of covid-19. Does he think that in the Government’s policy and strategy decisions, resources must to be set aside to address the long list of people who need diagnosis and treatment, and that resources must be in place for staffing as well?

[Alex Norris]

I agree with the hon. Gentleman. We will have to do something differently to catch up. When we talk about restoring cancer services, that does not mean restoring them to how they were in January. I know there will be a debate tomorrow morning on ways in which we can make those treatment pathways better. I think the wise thing to do is to focus on those groups on whom the impact is worse, and young people are one of those groups. Before I finish, I ask the Minister for her assessment of what the second lockdown has done to referrals and waiting times. When that was discussed at Health questions the week before last she was relatively optimistic about it, but I would be keen to know more. Particularly, we had a period between lockdowns where services will have been getting back to normal. Do the Government feel that we have learned any lessons from that about restoration of services, particularly for young people?

I want to conclude by saying, as have all Members who have taken part: if any young person, or indeed anyone at all, who is watching this is worried about possible symptoms, such as hacking cough, blood in the stool, or a lump or bump that they do not recognise—whatever it is—they should please not think that we are distracted by fighting the coronavirus and that they should therefore not present in the normal way to the health services. Do it—ideally this morning, or, if not, this afternoon or tomorrow morning. Whatever the earliest opportunity is, please do it, because the services will be there for you.

[The Parliamentary Under-Secretary of State for Health and Social Care (Jo Churchill)]

It is a pleasure to serve under your chairmanship, Sir Christopher. I thank the hon. Member for Strangford (Jim Shannon). I congratulate him on securing the debate and on the sensitive way in which he always approaches these subjects.

Someone once said to me, “You don’t choose it. It chooses you.” That is the challenge with cancer. People have very little control over when or if they have to make that journey. However, it is a matter of making sure that we have the services in place and can have early diagnosis, and that we never take our foot off the pedal in getting the right workforce and making the pathways simple. People are understandably discombobulated when they are told; it is a tsunami of emotions. I would gently say that in the case of someone’s child, the wave is even higher. I could not imagine the pain of being told that.

On that point, I thank the hon. Member for Strangford for talking about Alex. I thank my hon. Friend the Member for Wakefield (Imran Ahmad Khan) for his tribute to Daniel and to Ellis Price. I thank the hon. Member for North East Fife (Wendy Chamberlain) for giving us a little hope and showing us that Toby’s Magical Journey was a way those parents, through the most appalling circumstances, could turn their love of their child into something incredibly productive that is now helping parents who are going through the same thing.

As many hon. Members have said, the issue is a cross-party one. I was so pleased that the title of the debate was about raising awareness, because that is something that we can do in this place no matter what divides us about our other politics. We can raise awareness, and the issue of health is very much one that joins us, although the delivery of it is separate in the devolved nations that we belong to.

I thank those who have made contributions and want to add my good wishes to the hon. Member for East Dunbartonshire (Amy Callaghan). When I noticed that she had become the chair of the all-party parliamentary group on children, teenagers and young adults with cancer, I looked forward to perhaps being able to discuss things with her. As hon. Members have said, the ability to bring personal experience to this place—in the sphere of health, business or anything else—gives debates a power that is sometimes otherwise lacking. In these covid-tinged times, debates in this place have changed, but our ability to do things together—to raise awareness and make sure that people’s voices are heard—is still very much in our control.

We have discussed the fact that cancer is no respecter of anyone. I have two young friends who have been through the challenge of teenage cancer—and it is challenging. One was just a teenager and the other was just exiting that period of life, which, as everyone has said, is one with an awful lot going on, emotionally and in a person’s maturity. We have not talked about ensuring we get the transition right, but speaking to people from the Teenage Cancer Trust or young people who have had cancer, we know that ensuring we get them in the right place in the system is important, so that as they move into adulthood they are not on a ward with very young children and vice-versa.

We have talked about the challenges posed by covid-19. In phase one of the pandemic we stopped services, but as soon as we could push the recovery button, we did. I have focused, along with those leading the drive in the NHS—Cally Palmer and Peter Johnson—to ensure we do not do that again. It is important that people can access other treatments. As the hon. Member for Nottingham North (Alex Norris) said, if covid-19 overwhelms the system, all the other areas we so passionately debate will become secondary and access to those services will become more difficult. We should all be aware, however, of the ambition to be tough on this disease.

We will get into calmer waters. When we do, we need that long-term plan and personalised care interventions, including a holistic needs assessment, health and wellbeing information and support, and end-of-treatment summaries. We need to identify and address the more psychological, psycho-social and emotional needs from diagnosis onwards, and to inform GPs about what is happening to a patient and their ongoing needs. A patient’s journey in hospital is often quite short, so those other medical professionals need help and assistance to access the information they need in their training.

As several hon. Members pointed out, childhood cancer is thankfully rare. That offers professional challenges in ensuring the diagnosis is as early as we would like. We heard from my hon. Friend the Member for Wakefield about the short window between Ellis’s exhibiting symptoms and being in hospital. We often find that in young children; it feels as if the change happens in a week or so. That is a challenge for the profession, but one it is up for. It is incumbent on me to outline to everyone that, thankfully, these cases are rare, but that makes it challenging for doctors when they are looking at a set of symptoms.

In the light of phase one, we have set up the cancer recovery taskforce, which includes children and young people’s cancer charities, to ensure that their voice is heard. It is important that, as we are recovering, we ensure that individuals from across the cancer family have their voice heard, because no two journeys and no two individuals’ needs are the same. That is a challenge. We are focusing on early diagnosis, workforce, treatment pathways, data and support. We are addressing system recovery, urgent referrals and screening, and ensuring the right communication is in place.

I know personally—like all of us—of the devastation this disease causes and the pain it brings to individuals and their families, but the impact on a young person is particularly heartbreaking. We know that cancer is rare among teenagers and young adults, who account for less than 1% of all diagnoses. Approximately 2,200 cancers are currently diagnosed for patients between 15 and 24. However, today’s debate has provided an important opportunity to raise awareness and shine a light on young people’s specific needs, experiences and recovery from cancer.

One of the positives of covid is that many more cancer treatments have become more patient-friendly and less impactful on the individual; that relates to the point made by my hon. Friend the Member for Wakefield about the treatment not being worse than the disease. Therefore, as treatments progress and with genomic testing coming along, it is important to make sure that we target the disease and not the healthy part of the body, so that we get the most positive outcomes for individuals that we can.

[Jim Shannon]

In my speech, I referred to clinical trials and the need for young people to be part of them. That will improve the data and the end results. Perhaps the Minister is about to come to that point and I apologise if she is, but has she any thoughts on how we can do that?

[Jo Churchill]

I thank the hon. Gentleman; if he will give me a second, I will come to that. Like him, I believe that research is the way to unlocking some the problems.

Awareness of teenage cancers in schools is important. Education from an early age on the causes and symptoms of cancer has been mentioned. I was pleased to see that this year’s curriculum for religious, sex and health education means that children are being taught about some of the signs and symptoms of cancer. In particular, that includes skin cancer, the link between smoking and lung cancer and ensuring that people keep a healthy weight. All these things help young people to become more aware of themselves, their bodies and their health outcomes. I hope that will encourage someone to pick up the phone and take steps towards discussing their health if they are worried about it.

As the mum of four daughters and, like my hon. Friend the Member for Wakefield, as the friend of parents who have been in this situation, raising awareness in a sensitive manner especially when the risks are low is something that we should all work on. Cancer is a frightening subject at any age and I pay tribute to the cancer charities that specifically deal with young people. As many Members have said, they do an amazing job not only to support people but to promote cancer awareness. For example, the charity HeadSmart helps to improve the understanding and awareness of the symptoms of brain cancer. The Teenage Cancer Trust, CLIC Sargent and Teenage and Young Adults with Cancer are also in this space, and the hon. Member for North East Fife pointed out that many local charities, such as Toby’s Magical Journey, do good work right across the country.

There is another debate in the conversation about moving to a cashless society and understanding how charities will probably have to reframe their work. In my constituency only last month, a small team of three raised more than £400,000 in an online auction. Things will have to move in a different direction when traditional collections cannot take place. We saw that with the Royal British Legion’s poppy collection, which was severely impacted. Like the hon. Member for Nottingham North, I am aware that if we are not careful, we will create a two-tier society because many people in all our constituencies still want to use cash. We could probably be smarter, but that is an issue for another day.

On the learning in school guidelines, we will keep an eye on how the research develops and feed that in. I will have further conversations with my colleagues at the Department for Education to understand how we look at the curriculum and what more we can do.

I turn to research. Only by understanding the data can we understand the treatment pathways and cohorts. I want to make a point about those carrying the BRCA gene, who tend to be much more at risk. A young friend with BRCA in their family recently had a double mastectomy. She wrote to me about the support that she had had from a charity and she mentioned raising awareness.

Understanding the data is really important. The National Institute for Health Research is leading a multi-stakeholder strategy with NHS England and NHS Improvement, cancer charities, teenage and young adult cancer patients and clinicians, focused on increasing the participation of teenage and young adult patients in research, as set out in the recommendations of the independent cancer taskforce in 2015 to improve outcomes. I regularly meet Cally Palmer. Our focus last week was on teenage cancers, because it is a challenging area where we know we have to do better. The collection of data is very important, as is the participation in clinical trials.

The NIHR clinical research network has funded specific teenage and young adult research and also nurse posts in its 15 local clinical networks, and has instituted measures to identify all teenage and young adult cancer patients participating in the NIHR portfolio research. It is also taking a lead role in an international initiative to remove artificial age barriers that prevent adolescents and young patients from accessing clinical trials.

There are some challenges around data protection and various other things that make the collection of age data a little problematic, but my offer to the hon. Member for Strangford is to take that away and further discuss with colleagues how we can do it. Although things often seem simple, they sometimes are not, and we have to consider the unintended consequences of collecting vast amounts of data. For example, who do we allow the data to be shared with? We can depersonalise it for research purposes, but very often people want it personalised because they think that perhaps the school should know or whatever. All these things are very sensitive and need handling in the correct way.

The long-term plans states that we will

“actively support children and young people to take part in clinical trials, so that participation among children remains high”

and rises to the 50% that the hon. Gentleman mentioned by 2025. However, it is a challenge. Clinical trials need to be more representative across the board. We often find that they are particularly skewed towards males, but that is for another debate. Pharmacology and treatments act differently across genders and age boundaries, so making sure we have the right participants is important.

More effective consent processes for using data and tissue samples will contribute to improving survival outcomes. We will seek the views of patients aged under 16 to ensure that the NHS continues to offer the very best services for young people, which is where the cancer patient survey is most important. That will be used alongside other data to inform service design and transformation.

It is a given that we all want to do more, but making sure that the ambition for the future of cancer diagnosis and care is foremost is something that I am particularly focused on.

I am pleased that we have delivered on our commitment of September 2019 and that all boys aged 12 and 13 are being offered the vaccination against human papillomavirus-related diseases such as oral, throat and anal cancer. That builds on the success of the girls’ programme, which has already reduced the prevalence of the main cancer-causing types of HPV, 16 and 18, by more than 80%. There is also prevention here, which is very important. Ultimately, that will reduce cervical cancers and other cancers as people go through their lives.

Our aim is to drive more personalised treatments for patients, but particularly children. From last year, we have targeted the use of whole genome sequencing, which will enable more comprehensive and precise diagnosis and access to personalised and less invasive treatment. Cancer treatment is often challenging, and the personal approach reduces medications and interventions that may be harmful to healthy parts of the body.

We also support increased access to clinical trials, making sure we have diverse participation across age, genders and ethnicities. Following from that commitment, we made available treatments targeting neurotrophic tyrosine receptor kinase gene fusion solid tumours earlier this year, following the National Institute for Health and Care Excellence appraisal. Further guidance that has been issued by NHS England and NHS Improvement prioritises the delivery of the long-term plan commitments that support the recovery of services.

The ambitions include improving survival rates and early diagnosis. In March, we had 17 live rapid diagnostic centres. However, since October we now have 45, and I hope the fact that, even during the pandemic, the cancer workforce have stood up a further—I will do my maths very quickly—28 rapid diagnostic centres shows that commitment. Continuing the accelerated roll-out of places where people can be swiftly diagnosed is vital to getting on top of this disease.

I know hon. Members have raised concerns about the impacts on services through the second wave. As I said at the start, we must protect NHS capacity for non-covid services such as cancer. We expect cancer services to be maintained, with the redeployment of staff or blanket decisions to postpone services made only as a last resort and only at the behest of the clinicians involved in the treatment of others in their local area.

I have been meeting regularly with the national cancer director, Cally Palmer, and this week NHS England issued its latest guidance on maintaining cancer recovery throughout the second wave. It is important to continue to advise children and young people and their parents, as several hon. Members have done, to contact their GPs if they are worried about any sign of cancer. It is far better to pick up the phone and ask and to have their worries allayed than to think that maybe they could have rung before.

Referrals in September were running at 102% against referrals last year, but we do have a backlog to make up, and we still have some challenges in some of the pathways, which I know the workforce are addressing as swiftly as they can. We saw 199,801 urgent referrals, which, as I say, was 102% of the normal rate year on year; in April it was at 40%. That gives hon. Members some idea of the differential that we have to drive forward. We intend to ensure that we get education right for professionals and that we maintain a patient-centred approach.

I would like to conclude by wishing all those young people the best for their treatment and a fervent hope that they get to ring the bell. At the end of treatment, in most wards, there is a bell that young people get to toll, which marks out that they have finished what is a pretty gruelling episode of their life. I would like to hear that bell ring out for every family. While I know in reality that that is not possible, with good attention to research, by ensuring that we collect the data appropriately, and with all of us focused on raising awareness, I hope we will hear those bells ring out much more regularly.

[Jim Shannon]

I thank the Minister for the wee reminder of that TV programme. We have seen the adverts for Great Ormond Street Hospital—and other hospitals as well—where, when the child has finished their treatment, they ring the bell. That is an incredible finale. It is a wee salient reminder to us all that we have a wonderful NHS—a wonderful health service—and that it can make changes in the lives of young people.

I thank all hon. Members for their contributions and personal stories. Everyone has a personal story and everyone has shared their story with us today. It reminds us all of the heartache that others go through, even though we, personally, are fortunate not to have travelled that road. I believe that we, as elected representatives, have a responsibility and a duty to deliver on behalf of those people. I thank each and every Member for sharing their wonderful stories—what a reminder for us all.

I also thank Members for raising awareness, which we will continue to do. The Minister and every hon. Member is right to continue to do that. The hon. Member for North East Fife (Wendy Chamberlain) is absolutely on the ball on the issue of charities and how we can help them.

I welcome the Minister’s commitment to the review of clinical tests. I understand the reasons in relation to personal data. I also welcome her other comment on being able to pick up the phone and get reassurance—it is so important that people do that.

I look forward to working together. I have said often, and I think we all agree, that the House always shines better when we agree on the subject matter. This morning, we have all agreed on the matter and are all very pleased at the Minister’s response. I am not just saying that; I really think that her response was excellent.

Question put and agreed to.

Resolved,

That this House has considered the matter of raising awareness of signs and symptoms of cancer in teenagers and young adults.

Deaths in Mental Health Care

Jim Shannon Excerpts

Monday 30th November 2020 Westminster Hall

[Barbara Keeley (Worsley and Eccles South) (Lab)]

It is a pleasure to speak in this debate with you in the Chair, Mr Stringer. I thank the Petitions Committee for granting this important debate and my hon. Friend the Member for Hartlepool (Mike Hill) for opening it, and I congratulate Melanie Leahy on the strength of her campaigning to get us to this debate.

As we have heard, Matthew’s case is a tragic one, with a catalogue of failures that culminated in his death. I know that nobody here can fail to be moved by what Matthew and his family went through—the hon. Member for South Suffolk (James Cartlidge), who has just spoken, certainly was. Melanie has been fighting for answers and justice for her son for eight years now; I pay tribute to the work she has done, but I also say it should not have been necessary.

Matthew was in the Linden Centre for only a few days. In that time, he reported a sexual assault to the police, but they took no follow-up action on his report. Staff claimed that he lacked mental capacity, despite no assessment being carried out. He was heavily medicated with anti-psychotics and tranquillisers, despite him telling staff that he would attempt to kill himself if he was given injections. As we have heard, only a week after being admitted, he was found hanging in his room and he died.

That catalogue of failures would be shocking in itself, but it ended with a young man dying. In cases such as Matthew’s, we have a duty to learn the lessons and ensure that others in mental health care do not end up dying preventable deaths.

[Jim Shannon (Strangford) (DUP)]

I sympathise greatly with the hon. Lady and the story that she is telling and that other hon. Members have told. Does she agree that when it comes to helping people who have mental and psychiatric issues, who need help more than anyone, it is important that facilities are modern? They need in-patient care and they need the staff to be trained and able to respond. If those things were improved, does she think that would be a step in the right direction to try to help people and prevent such tragedies from happening?

[Barbara Keeley]

There is much that needs to change, but the hon. Member is right that that is one aspect of it. The mental health estate is known for being run down and out of date.

The learning of lessons has not happened in the Linden Centre or in mental health services in Essex. The charity INQUEST has worked on more than 28 cases involving deaths in mental health settings in Essex since 2013, yet despite the many investigations, reports and inquests that have highlighted failures, preventable deaths have continued. At the Linden Centre, INQUEST is aware of six in-patients found hanging between 2004 and 2019. Despite repeated inspections and visits by the Care Quality Commission, people have continued to die in those services.

The ombudsman’s report found clear signs of a cover-up at the Linden Centre. As Melanie told me:

“Matthew had no key worker. Records of observation levels and when he had been observed were changed. His care plan was falsified after he died. His claims of rape were ignored. Lots of documents were missing and a whole catalogue of policy failings were uncovered.”

That speaks of a culture that is less interested in learning from failings than in avoiding the blame for Matthew’s death.

The only way to restore trust in our mental health services is to publicly demonstrate that all those issues, including the one that the hon. Member for Strangford (Jim Shannon) mentioned, are considered and addressed. Melanie Leahy has suggested that the only way to do that is through a full public inquiry. At the inquest into Matthew’s death, the coroner asked the NHS trust to consider commissioning an independent inquiry.

The ombudsman, in his recommendation, said that the review due to be held by NHS Improvement,

“should consider whether the broader evidence it sees suggests that a public inquiry is necessary.”

In an interview on ITV, the ombudsman went further on the failings, including about Matthew’s care plan being altered after he died and his claim of rape not being investigated. He described them as

“a catalogue of failings which are entirely unacceptable.”

He also said that he would fully support a public inquiry if one was recommended, and that he would like to have investigated further if he had had the powers.

Both public officials who have investigated Matthew’s death, the coroner and the ombudsman, have said that they would support a public inquiry. I ask the Minister, on behalf of Melanie Leahy, to set up a public inquiry. Only a public inquiry will have the transparency and broad participation needed to rebuild trust in the services. The Minister will know that that is the only way that witnesses can be compelled to give evidence without seeking to apportion blame, and evidence must be given on oath.

As Melanie has said,

“Since Matthew’s death I have been on a mission to get to the truth of what happened to Matthew and to get justice for him. On my journey I have not only found that many other families are in the same position as me, but also individuals who have the survived the quotes ‘care’ that they received.”

In this most tragic case, inadequate and neglectful care led to the death of a young man like Matthew. His mother has had to take on a fight over many years to get to the truth. I thank all the families and parents such as Melanie Leahy who have put so much of themselves into their campaign. I return to what she said to me:

“To say the current situation is not good enough is a massive understatement. We know what has to change and we have known for decades. What will make the Government take real action? How many times do we need to hear the same information and recommendations? How many more Matthews have to die?”

--- Later in debate ---

[Jim Shannon (Strangford) (DUP)]

I thank all those who set the scene and the Petitions Committee for what it did.

Our hearts go out to our constituents. Hon. Members have spoken on behalf of them, and I thank them for that. I admire the determination that each and every one of them has shown. A breakdown in care took place, and we must not see another family in that situation.

I want to take a slightly different approach to the issue of mental health and talk about how we can help within the system. Ultimately, that is what the Minister will set out in her response. I have seen too many of my constituents broken, in need of support and let down by the system. I remember one young man, Michael, who came to my office when he was on the edge. He was a young fellow and was homeless and distraught, and the girls in my office were able to reach out and tell him in a helpful, compassionate way, “Your life is important and we will help you.” He broke down in tears.

We were able to help that young fellow get accommodation through the Northern Ireland Housing Executive. We also got him some help from the local food bank, which is always there to help, and were able to sort out his benefits. What happened was that that young fellow had just disappeared off the grid. He clearly had mental health issues and was not able to cope. He got the psychological help that he needed and he got his benefits renewed, so the pressure on him became less of a difficulty because of those who helped—the Northern Ireland Housing Executive, the local benefits office, the food bank, the local churches. All those people came together.

It is my sincere belief—I believe this in my heart—that if Michael had not come to my office, he may not have survived. We all believe that, including the girls in the office and those we spoke to. Every Government body was exceptionally helpful, and we thank them for that.

That is the foundation for mental health. Ours is not to question how or why people have got to the stage that they find themselves it; we must only see how we can help them where they are. The overhaul of the facilities that I spoke about when I intervened on the hon. Member for Worsley and Eccles South (Barbara Keeley) is about updating them, so that the in-patient help gives people hope to reach out. We are desperate to see an upgrade of facilities that are sometimes not fit for purpose.

Sometimes there is no privacy. Sometimes people need a wee bit of privacy where they are, but they also need to be able to reach out and have someone help them at the times when they need that. Some of the wards that I am aware of are mixed-gender wards, where a lack of privacy is obviously even more of a problem. When it comes to people being allowed to visit, they get one hour each, once a week. I do not feel that that is enough; more time should be allocated for visitors.

I am always very aware of the great work that occupational therapists do. They have a brilliant team, with fantastic ideas. They have allocated some rooms for activities. I think that it is important to have some sort of organised activities, so that those who are under pressure psychologically, mentally and socially have somewhere where they can look outwards. The OTs in the area that I represent have come up with a therapy garden. These things can be done in-house and in a way that can really help. There are gardening classes. Again, it is a question of designating an area for people and ensuring that they have it.

To conclude, it is little wonder that patients and those who are in homes remain uninspired and unhopeful if that is how they view a place designed to provide the help and support that they are crying out for. It is clear that we must make massive changes, and if the first step to doing that is an inquiry, that is where we must begin. My heart goes out to all the families who grieve and feel let down. I believe that we can do better, but not only that—we should do better and must do better.

DHSC Answers to Written Questions

Jim Shannon Excerpts

Thursday 19th November 2020 Commons Chamber

[Edward Argar]

My hon. Friend highlights that the workload from constituents has increased for all Members. I recognise that. It is important that we do our bit in trying to answer questions in as timely a fashion as possible, to assist colleagues in the House with responses to constituents. In response to his second point, he is absolutely right. As I alluded to, it is not only through attending the House and through its mechanisms that Ministers have been accountable; as a Department, we have sought to use multiple channels—briefings to colleagues, WhatsApp and a whole range of newsletters and other mechanisms—to get messages out and to communicate with colleagues and answer their questions.

[Jim Shannon (Strangford) (DUP)]

I thank the Minister for his departmental response to covid-19 and many issues. As one of the Department’s most prolific questioners, I am aware of the pressure on the Minister’s Department to respond to a vast array of complex medical and social issues. Perhaps to assist the Minister, his team could work closely with the health trusts to provide up-to-date data in a timely manner.

[Edward Argar]

The hon. Gentleman is indeed a prolific questioner, but his questions are always welcome and to the point. He highlights an important aspect that affects the response of the Department, which is that a significant number of questions, and the information required to answer them, is not held within the Department but by various health trusts, NHS England or other external bodies, which can occasionally introduce additional slight delays in the system. We are working closely with them to minimise that and get answers as quickly as we can to hon. Members.

Independent Reconfiguration Panel

Jim Shannon Excerpts

Thursday 19th November 2020 Commons Chamber

[Siobhain McDonagh (Mitcham and Morden) (Lab)]

I have lost count of the number of times that I have spoken in this House about the future of St Helier Hospital. Time and again, the hospital has been hurled head first into turbulence, with countless consultations coated in fancy branding repeatedly asking my constituents whether they want their hospital to keep its A&E, critical care and maternity services. The latest plan—almost laughably named “Improving Healthcare Together” proposes to downgrade both Epsom Hospital and St Helier Hospital, moving all acute services south to leafy, wealthy Belmont. The purpose of this debate is to look at whether the Independent Reconfiguration Panel was actually independent when it came to a decision not to look into these proposals.

The panel is a little known but hugely important body that provides checks and balances to the plans of one of the most powerful institutions in our country: the NHS. The NHS employs as many people as the red army, and some would argue that it is built around the same command and control principles—that is, decisions are made and everyone is expected to row in behind them. Communities are hugely affected by proposed NHS changes. As such, their representatives in local government have the power to consider whether they agree with a hospital reorganisation. If they do not, they can refer it to the Secretary of State, who has the power to refer it to an independent panel of experts.

In the case of the “Improving Healthcare Together” programme, my argument is not that the chair of the panel, Professor Sir Norman Williams, is not a man with a hugely important and successful medical career who has brought benefits to thousands, or that he has not made a huge contribution to the NHS. My argument is simply that he could not be regarded as independent, and that through his involvement as a member of the board of St George’s Hospital—which will be profoundly affected by these changes—he should have recused himself. We know that in public life not only do we have to do the right thing; we have to be seen to do the right thing. I will argue that Sir Norman could not be regarded as independent because his connection is far from “tangential”.

Let me turn first to the plans themselves. The programme proposes to turn St Helier Hospital into a glorified walk-in centre, removing its A&E, maternity services, children’s beds and critical care. Some 62% of beds would be lost from the area where health is poorest and life expectancy shortest. The programme’s own analysis unsurprisingly reveals the indisputable link between deprivation and the need for acute services, but ignores the fact that 42 of the 51 deprived areas in the catchment are nearest to St Helier. It is a slap in the face for expectant mums in my community.

[Jim Shannon (Strangford) (DUP)]

I congratulate the hon. Lady on securing this debate. Does she agree that although moving beds to a nearby hospital may make sense on paper, to ask expectant mothers to add a lump of time to their journey makes no sense, and that community-led care is essential and should be kept in the community?

[Siobhain McDonagh]

I agree with the hon. Member.

In the plan, it is assumed that mothers in my area want home births. That is a discriminatory assumption that is completely against their right to choose. It takes maternity services away from the mothers who are most likely to deliver a low-weight baby and mothers who are less likely to want a home birth. It also breaks up the continuity of care, with pre and post-natal services being delivered at one hospital and the birth at another.

The programme ignores the intrinsic link between old age and life expectancy in pointing to the higher number of elderly people in Belmont when deciding where need is greatest. The sobering reality is that Mitcham has a far lower life expectancy than Belmont—nine years lower, in fact. There are more elderly residents in Belmont because, quite simply, its residents live longer. To experts, it is yet another example of the Tudor Hart law, or the inverse care law as it is also known: the understanding in health academia that the areas in greatest health receive the most health investment. Or as my mum, herself a nurse, would say, “Much gets more.”

The reality is that the Minister and his Department are being asked to commit £500 million of scarce NHS resources to move acute services to one of the richest and healthiest areas in London, at the expense of one of the most deprived. Surely the Minister can see that that is wrong, if not from a health perspective, then from a financial one. The plans require 22% more capital than the option of rebuilding where health needs are greatest. Improving St Helier would have a higher return on investment, posing far less risk with a significantly lower capital requirement. Our economy is being decimated by the virus. Can the Minister not see that this proposal goes completely against Treasury guidance and value for money?

This was a devastating decision before the pandemic, but have we learned nothing from coronavirus? How can it possibly make sense for south-west London to come out with fewer acute beds and fewer intensive care units than before? Surely the decision to place the only intensive care unit on the same site as a cancer hub now has to be questioned. I do not dispute the extraordinary work of the Royal Marsden or challenge whether it requires an intensive care unit, but these plans were formed long before the pandemic was known about and have to be reassessed in the light of it.

The programme’s own impact assessment in January warned that any unplanned event such as a pandemic could challenge the resilience of the proposed reconfiguration. It described this situation as “unlikely” and yet, astonishingly, just five pages of analysis have been produced on the pandemic’s impact on the plans. It is the wild west, where everything proceeds full steam ahead, no matter the evidence presented—evidence that cannot be dismissed.

We now know that people from black and ethnic groups are most likely to be diagnosed with coronavirus, more likely to require admission to an intensive care unit once in hospital, and up to twice as likely to die than those from white British backgrounds. We know that black women are five times more likely to die in childbirth than white women, and more likely to require neonatal or specialist care baby units. We also know that 64 of the 66 areas with the highest proportion of BAME residents are nearest to St Helier, and that half of those are in the bottom two quintiles of deprivation, increasing their likely reliance on acute services.

It is indisputable: these proposals would negatively and disproportionately impact BAME residents, deprived communities and expectant mums in my constituency. It is no wonder that when they were put out to public consultation, tens of thousands of residents voiced their disapproval, with overwhelming opposition to the downgrading of St Helier. It was also clear from the public response that if these plans went ahead, many residents would not travel to inaccessible Belmont, but would head instead to St George’s—a hospital that is already under immense pressure, with an A&E in the bottom quartile for safe standards.

Why does Sir Norman have a conflict of interest? Because this is a reorganisation of a neighbouring trust that will have a profound impact on St George’s. That is a case that the board of St George’s has rightly and successfully fought, very publicly, so much so that in a letter in March this year, the chief executive of St George’s made it clear that support for the plans was contingent on her hospital receiving capital investment for a new emergency floor to take account of the increased number of emergency care patients that it would receive. That is the kind of change that requires the full consideration, scrutiny and involvement of the board and the most senior staff. I can think of a number of words to describe that relationship: conditional, connected and dependent, but certainly not “tangential”.

In July this year, Merton Council saw these plans for what they are and used its power to call them in for review by the Department of Health and Social Care Independent Reconfiguration Panel. By its name and nature, it is an independent panel of health experts who can cast a fresh, impartial eye for the Secretary of State. The chair of the panel is Professor Sir Norman Williams, who until 30 September 2019 was a long-standing board member at St George’s Hospital. Naturally, I presumed that that conflict of interest would be recognised and he would step aside from judging this proposal. Unfortunately, he did not, with his connection to the plans described as “tangential” and

“not relevant to his role in independently formulating a response”.

This evening, I ask the Minister to consider just how tangential that connection is. In April 2016, Sir Norman became a board member at St George’s, and board meeting minutes and papers reveal that the reorganisation was debated time and time again. The papers from one of his first board meetings in June highlighted the requirement for service change and reconfiguration in south-west London. In March 2017, the chair discussed the upcoming board-to-board meeting with Epsom and St Helier, which would provide an opportunity to discuss the development of joint renal services. Fast forward to October, and the board’s attention was on a joint letter signed by the CEO of St George’s about the importance of considering the future of their hospitals with any reconfiguration at St Helier.

The issue came to the board again in December, following Epsom and St Helier’s indication that it needed to change its clinical model. By the following November, the impact of the proposals on St George’s was so clear that the chair of the board, Gillian Norton, wrote to the programme directly on behalf of her board, including Sir Norman:

“Senior staff within St George’s have spent significant amounts of time over the last 3 months engaging with both the programme team and colleagues in other providers to work through the impact on providers of the shortlisted options…The board agreed that I need to write to you now, formally, to set out these concerns…I understand that a key principle of how programme process has been agreed is that there is no formal requirement to take account of the impact on other providers. I find this difficult to understand in any event given we are a health system but particularly so in the context of the SWL Health and Care Partnership and the expectation that we will work collaboratively.”

I found this letter so extraordinary, after fighting this reorganisation for 23 years, that I wrote back to the board and the chair. Naturally, this issue rightly remained high on the board’s agenda. The papers for the board meeting of December 2018 show concerns from St George’s finance and investment committee about the lack of options explored by Epsom and St Helier, and agreement that the trust should feed this back to the programme. By January 2019, the chief executive spelled out to Sir Norman and the board:

“Any changes to the current configuration of services at Epsom and St Helier are likely to impact St George’s, and it is important these are factored into any future proposals.”

She again used her notes at the February board meeting to state:

“While the location of the new facility is yet to be decided, it’s clear that there are significant estate issues at both Trusts that need to be addressed through capital investment.”

Time and again, the programme was brought to Sir Norman and the board’s attention—in April, in May and in June. This would be a landmark decision for St George’s Hospital. It is completely understandable that it had their full attention.

In July 2019, the programme released the impact assessment on St George’s. It is utterly inconceivable that someone as diligent and respected as Sir Norman would not have been aware of this, particularly as senior staff at his trust had helped produce it—a document released just months before he became chair of the Independent Reconfiguration Panel. That Sir Norman was so heavily involved in these proposals is no criticism. He was rightly fulfilling his responsibility as board member of a hospital that would be heavily impacted by these proposals. He declared his role to the other Independent Reconfiguration Panel members, explaining that he had even had recent discussions with senior consultants at Epsom and St Helier through his role as chair of the national clinical improvement programme. All public office holders are subject to the seven principles of public life, one of which is objectivity. But how could Sir Norman be objective? How could he even appear to be so? In public life, it is important not only to be objective, but to be seen to be objective.

My community has fought tirelessly for St Helier, and the least we expect is transparency, honesty and objectivity from the top. Astonishingly, the panel instead considered that there was nothing more than tangential connections, irrelevant to Sir Norman’s role in independently formulating a response for the Secretary of State. Tangential! If there is any doubt over how interconnected the hospitals are, then be aware that the chair of St George’s also became chair of Epsom and St Helier in 2019. Conveniently, it was on the very same day that Sir Norman became chair of the Independent Reconfiguration Panel. Surely the Minister can see that there is nothing tangential in the evidence that I have laid out today. Not only did Sir Norman already know about the proposals before he was asked independently to judge them, he must have known them inside out, having faced them repeatedly at board level and in conjunction with a whole host of the key personnel involved. It was tangential to the tune of millions of pounds of investment on which his former hospital’s support is contingent.

We must not underestimate the importance of a fresh eye. One of the leaders of these plans, Daniel Elkeles, formerly led the infamous “Shaping a Healthier Future” plan, which proposed similar hospital downgrades in north-west London, wasting £76 million over eight years before the Treasury finally put a stop to it.

I draw to a close now. I must say that I respect the Minister. He found time to meet me in the summer when his time must have been so scarce. I explained my reasoning for calling this debate to his office last week so that he could come prepared. I am not trying to catch him off guard. I am asking that he steps away from party politics and recognises that this connection is indisputable rather than tangential. If an independent panel was asked to review the plans, the panel must be independent. I am asking that he consults his Treasury colleagues on why the most expensive option is being chosen at a time of such economic turmoil. I am asking that he reflects on the powerful shoes he is in and the unique opportunity he has to help to close health inequalities in an area where they are so stark. Surely that would make any Health Minister proud of his work, and maybe then we really could improve health together.