Cass Review

Julie Marson Excerpts

Monday 15th April 2024 Commons Chamber

[Victoria Atkins]

I hope the hon. Lady will forgive me if I have misunderstood her question, but I think she is referring to the decision that NHS England will prevent under-18s from accessing adult gender services. A consultation has just closed and we are looking at the results of that, but I am very sensitive to the needs of young people within that 17-to-25 cohort for whom the “cliff edge”, as it has been described to me, of moving from children’s services to adult services may not be in their best interests. I promise that that is very much the focus of my work on this in the weeks ahead.

[Julie Marson (Hertford and Stortford) (Con)]

My experience of speaking to my constituents on this subject has been characterised by fear—it is often the fear of mothers about their daughters, the fear of what is happening to their children and the fear of speaking out because of the group-think and the toxicity of the debate. Does my right hon. Friend agree that Dr Cass’s extensive, evidence-based report should mark an absolute turning point, in ensuring that we spearhead our approach to this debate by putting children first and being non-ideological in all areas—across Government, in all Departments, not just the NHS, in education and in our public bodies?

[Victoria Atkins]

I thank my hon. Friend sincerely for that. Again, she articulates the concerns of many families where a teenager or young person may be suffering complex needs and are asking questions of themselves and their place in society. We must treat not just the child or young person, but the family with care and respect, trying to support them to get to the right place for the child.

Oral Answers to Questions

Julie Marson Excerpts

Tuesday 5th March 2024 Commons Chamber

[Andrew Stephenson]

I would say that we are sticking to our plan to back the NHS to cut waiting lists and make our NHS fairer, simpler and faster. When there is no strike action, that plan is working. We already eliminated the longest waits, and, in November, we saw the biggest fall in waiting lists outside of the pandemic in more than a decade, alongside record investment in things like women’s health hubs. We are prioritising women’s health.

[Julie Marson (Hertford and Stortford) (Con)]

7. What steps her Department is taking to improve access to primary care.

[Greg Smith (Buckingham) (Con)]

8. What assessment she has made of the adequacy of primary care provision in rural communities.

[The Secretary of State for Health and Social Care (Victoria Atkins)]

We have met our manifesto commitment to deliver a record extra 50 million GP appointments annually. Our primary care recovery plan addresses increased GP access and expands community pharmacy services nationwide with Pharmacy First. Our NHS dentist reform plan also allocates resources for 2.5 million appointments, targeting rural and coastal communities.

[Julie Marson]

I thank the Secretary of State for her response, and I thank the Minister for Health and Secondary Care, my right hon. Friend the Member for Pendle (Andrew Stephenson), for visiting the community diagnostic centre and minor injuries unit at the Herts and Essex Hospital yesterday and all the fantastic staff there.

Frontier Estates committed to building a GP surgery as part of the wider Stortford Fields development. However, citing inflated build costs, it now questions the viability of the plans despite months of negotiations and efforts by the local NHS to find a solution. Will my right hon. Friend work with colleagues in the Department for Levelling Up, Housing and Communities, with whom I have already met on this issue, to ensure that Frontier really engages with the process and builds the surgery it promised my constituents?

[Victoria Atkins]

I congratulate my hon. Friend on the enormous amount of work she has done in her constituency to secure that community diagnostic centre. We have rolled out some 160 or so of those centres across England —we want to do more—and they are supplying some 6 million tests and scans for patients across England.

On the important issue that my hon. Friend raised, my officials and Levelling Up officials are already considering how primary care infrastructure can be better supported in the planning process to ease the pressure on primary care estates, particularly in areas of housing growth. I know that she will continue to be as conscientious in her campaigning on that as she is on other matters.

Cancer Care: Young Adults

Julie Marson Excerpts

Wednesday 8th June 2022 Westminster Hall

[Ian Paisley (in the Chair)]

I will call the Member to move the motion and the Minister to respond. There will not be an opportunity for the Member in charge to wind up, unfortunately, because this is a 30-minute debate and that is the convention. I understand that several Members have indicated to the Member moving the motion that they intend to make an intervention, and she has very kindly agreed to allow that.

[Julie Marson (Hertford and Stortford) (Con)]

I beg to move,

That this House has considered cancer care for young adults.

It is a pleasure to serve under your chairmanship, Mr Paisley. Normally I would say that it is a pleasure to be here in Westminster Hall speaking on a particular issue but, of course, it is not a pleasure today. I wish I was not here raising the issue of cancer in young adults.

It is an issue that is horrible to confront and contemplate, but what I feel is nothing compared with what Simon and Andrea Brady feel. Every day they have to confront the reality of what happened to their daughter Jessica, who tragically passed away on 20 December 2020, aged just 27. They are here today because of Jess. I am here because of Jess. My right hon. and learned Friend the Member for North East Hertfordshire (Sir Oliver Heald) is here because of Jess, and the Minister is here because of Jess—I thank them both for that.

I pay tribute to Simon and Andrea. They are utterly determined in the face of their terrible loss to effect change in Jess’s name. I hope I can do justice to them and to Jess in supporting their call for that meaningful change. We are asking for Jess’s law—a practical change designed to save lives. Jess’s law would be that after the third contact with a GP surgery about a condition or symptom, a case should be elevated for review. After five contacts, it should be red-flagged and set procedures and guidelines should be followed, including a referral to a specialist.

We are clear that this should not be a tokenistic exercise, such as a simple, inconclusive blood test with the patient given an all-clear. The investigations need to be thorough and conclusive to make a real difference and to save lives.

[Jim Shannon (Strangford) (DUP)]

I congratulate the hon. Lady on bringing this debate forward. I am moved by her plea on behalf of her constituents. I thank her for her dedicated efforts and for consistently raising the importance of cancer care for young adults like her constituent Jessica, who she has spoken about on a few occasions.

In Northern Ireland, trusts that run screening tests for certain types of cancer, such as breast, cervical and bowel. Does the hon. Lady agree—indeed I think she is asking for this—that it is time to introduce early intervention blood testing for those with symptoms of cancer to ensure early detection? Doing that would mean catching these cancers earlier.

--- Later in debate ---

[Julie Marson]

The hon. Member is quite right. Early diagnosis saves lives. I will mention some of the figures that prove that using technology and the right processes and procedures during that diagnosis phase is critical to saving lives. These are real people and real lives. I absolutely agree with the hon. Member.

[Mark Tami (Alyn and Deeside) (Lab)]

The hon. Lady has done excellently in getting this debate today. I have done a lot of work with young adults and children, and quite often with children bruising, rashes and tiredness are dismissed. Parents are told, “That is just children” or “That is just the way they are.” The danger is that conditions get picked up far later than they should be. We really need doctors to start thinking outside the box and looking at what these conditions could actually be, rather than just saying, “Oh, it is all fine.”

[Julie Marson]

I thank the right hon. Gentleman for his intervention. I will go on to talk about the danger of not expecting to find symptoms of cancer in children and young adults, and the terrible consequences that delays and misdiagnoses can have, as they did in Jess’s case—it is too often the case.

I want to talk about Jess, because to understand how important this is, and why the Brady family are so committed to this approach, it is important that I tell Jess’s story. In mid-2020, Jess was feeling unwell with abdominal and back discomfort. It was during the pandemic, and Jess was given an online consultation at her GP surgery, and prescribed antibiotics for a suspected kidney infection. Over the ensuing weeks she was prescribed numerous other medications, including more antibiotics and steroids. Jess contacted her surgery on more than 20 occasions in five months. None of the four GPs who provided her with a consultation—17 of which were conducted remotely—took her symptoms seriously. Her requests for blood tests were granted, but a raised D-dimer was dismissed after a preliminary scan, and not investigated further. Blood results showing poor liver function were left for a six-week follow-up review, which proved fatal.

Jess was told for months that she was suffering from long covid, despite two negative coronavirus tests. She was finally diagnosed with cancer following a private referral on 26 November. Her dependency on oxygen from that date meant that she did not leave the hospital or ever return home. Jess discovered that she had stage 4 adenocarcinoma with an unknown primary. It had spread throughout her body to her spine, liver, stomach, lungs and lymph nodes. Jess was a talented satellite engineer for Airbus. She had so much potential and so much life to live. Her loss has shattered her family’s world.

Devastatingly, had someone taken the initiative to closely review Jess’s case and examine the evidence, cancer screening would have been an obvious requirement. A consultant recently said to her parents:

“If a diagnosis cannot be made from initial tests then not enough tests are being carried out”.

In Jess’s case, a request to be referred to an ear, nose and throat specialist was laughed off. Letters written to the surgery listing her symptoms, including dramatic weight loss and vomiting, were ignored. Jess felt powerless and distressed. She tried so hard to be heard and taken seriously. It was heartbreaking for her family to watch her deterioration.

It is obvious really, but when people are desperately ill and at their lowest ebb, they do not possess the stamina to fight the system—nor should they have to. Jess’s age was a key issue. Many people, including GPs, do not expect to see, as the right hon. Member for Alyn and Deeside (Mark Tami) said, a young adult with cancer, and that affects their diagnostic processes and judgment.

[Sir Oliver Heald (North East Hertfordshire) (Con)]

I join my hon. Friend is expressing admiration for the way in which the Brady family have campaigned on this issue. In reality, is it not necessary for each general practice to have at least one doctor who is seriously knowledgeable about cancer diagnosis and able to take a lead, so that if the symptoms are not diagnosed that doctor gets to look at the case and perhaps send it to a rapid diagnosis centre? Otherwise the patient is being let down. The Health and Social Care Committee, in its report on cancer services, said that we need more support for GPs in that area. I commend my hon. Friend for what she is doing and ask if she agrees with me?

[Julie Marson]

I appreciate my right hon. and learned Friend’s intervention. I will come on to talk about some of the things he raised, because he puts his finger on some of the most important aspects of how GPs manage their diagnosis process. The diagnostic centres are fantastic, but they need to have patients referred to them, which goes back to what we are trying to achieve with Jess’s law.

Cancer charity CLIC Sargent found that around half of young people visited their GP at least three times before their cancer was diagnosed. Almost 10% of all new cancers are diagnosed in people aged between 25 and 49, with almost twice as many cases in females as in males in that group.

Simon and Andrea Brady created a petition in Jess’s name. My right hon. and learned Friend the Member for North East Hertfordshire and I joined them to hand it into Downing Street. Its plea was to increase the awareness of diagnosis of cancer in young adults. It currently has an incredible 240,000 signatures, and has highlighted the scale of the problem for young adults. The petition makes for heartbreaking reading. Countless people tell stories of their young family members who have had their lives curtailed by late or non-existent cancer diagnoses. The disproportionate occurrence of females is also deeply troubling.

Being told you are too young for cancer has been happening for years, and it is simply not acceptable. Young people have their symptoms explained away with other diagnoses. As I said, Jess was told she had long covid, despite never having tested positive. The explanations given to other patients for poor health are endless: irritable bowel syndrome, pulled muscles, fatigue, stress, migraine—the list goes on.

I welcome the significant roll-out of rapid diagnostic centre pathways across hospitals in England. I know we have just achieved one million tests and scans via our community diagnostic centres, which is a huge achievement and critical in tackling the covid backlog. Of course, patients still have to be referred by a GP, and that vital link is what we are focusing on here today, particularly the escalation of patients with undiagnosed symptoms within a GP’s surgery or to a specialist, as per Jess’s law.

There are other issues that relate to GPs, including having a dedicated GP lead for a patient. The general practitioners’ contract requires practices to provide a named accountable general practitioner to all registered patients. That GP must take the lead in ensuring that any primary medical services considered necessary to meet the needs of a patient, including appropriate referrals to specialist care and liaison with other health professionals involved in the patient’s care, are co-ordinated and delivered to that patient.

However, Jessica’s case demonstrates that that does not always happen. Jessica was not seen by just one GP at her surgery. In her case, four doctors spoke to her and prescribed medication. Although Jess was told on one occasion that she had been discussed at a practice meeting, it was obvious that there was no one person overseeing her case. She was never seen or contacted by her named GP. It is also vital that GPs are required to maintain their continuing professional development through up-to-date training and awareness of cancer, including in young people.

CLIC Sargent’s Young Lives vs Cancer is a charity dedicated to supporting children and young people with cancer, and ensuring that their voices are heard in the context of cancer care. It has identified several challenges faced by GPs that hamper early diagnosis. Those include limited training and awareness, and time pressures. Of course, the effect of the pandemic is exacerbating existing issues. One third of GPs reported inadequate opportunities to gain experience in the care of children and young people during their initial training as one of the top barriers to identifying cancer in children and young people.

The Health and Social Care Committee’s review into cancer services, published on 5 April, concluded:

“The single most effective way to improve overall survival rates will be to diagnose more cancers earlier. Diagnosing bowel cancer at stage 1 means that 90% of people will live for five years compared to just 10% of people diagnosed at stage 4.”

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

The hon Lady is making a powerful speech. I apologise for missing the start of it. My condolences to Jessica’s parents. That point on early diagnosis is absolutely key. I am chair of the all-party parliamentary group on ovarian cancer and vice chair of the APPG on breast cancer. I have done a lot of work in this area. The number of people—especially women with ovarian cancer —who are diagnosed only in A&E, when it is almost stage 4 or too late, really has to stop, and that all starts with symptom awareness. What is being called for in that petition, therefore, is so necessary. Sometimes people have been back and forward to the GP so many times. Does the hon. Lady agree that that is the one thing that would have made a massive difference in Jessica’s case?

[Julie Marson]

I very much welcome the hon. Lady’s intervention. She is absolutely right. Her work to raise awareness of ovarian and breast cancer is all part of that hugely important process. I lost a dear friend to ovarian cancer, and it is a very difficult and unspecific thing to diagnose, or even for someone to realise that they might have the relevant symptoms. Breast cancer we have made a lot of progress with, and we have to keep that up. There are different cancers, with different symptoms, and awareness of the range of symptoms and how those might impact on different people is key to early diagnosis, to self-diagnosis so that people say, “Let’s go to a GP now”, and to get that GP to take things forward to identify the real underlying issue. I thank the hon. Lady.

The pivotal role that general practice doctors play in diagnosing patients early cannot be overstated. People—our sons, daughters, mothers, fathers, family, friends and neighbours across the board, regardless of age, race, sex or any characteristic—are equally deserving of diagnostic testing and referral. Patients must be accorded the time, space and physical contact to voice their concerns when presenting with recurrent and progressively aggressive symptoms. Listening and acting are key.

I know that the Minister is listening. We have met and discussed the issue, and her own experience in the nursing profession gives her great empathy and insight. I look forward to hearing her response in a moment. I also take this opportunity to thank my right hon. Friend the Secretary of State for Health and Social Care, who is arranging to meet Mr and Mrs Brady to discuss Jessica’s experience, what we can learn from it and how we might be able to implement Jess’s law.

I am also grateful to all those who have contributed today, in particular my right hon. and learned Friend the Member for North East Hertfordshire, who stands shoulder to shoulder with the Brady family. Finally, but most importantly, I reiterate my thanks to and deepest sympathy for Simon and Andrea Brady and their family. We do not want to hear tragic stories such as Jess’s—not because we do not care, but precisely because we do.

To conclude, I will repeat a detail of Jess’s story that I think illustrates the high regard in which she was held. On the day of her funeral, a satellite that she helped to design was launched into space from Cape Canaveral. It was inscribed with the words, “Thank you, Jess!” In honour of Jessica Brady, let us implement Jess’s law, so that other young adults who face the trauma of cancer in future can also say, “Thank you, Jess.”

[Ian Paisley (in the Chair)]

Before I call the Minister, I too want to acknowledge the presence of Simon and Andrea Brady in the Public Gallery.

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

It is a pleasure to serve under your chairmanship, Mr Paisley. I thank my hon. Friend the Member for Hertford and Stortford (Julie Marson) for securing the debate, which as she said is not one we want to have but is one we need to have. I offer my apologies and condolences to Simon and Andrea, who are with us today. Nothing we say in the debate will make things easier for them, but if we can prevent a similar tragedy from happening to another family, we must do absolutely everything we can to make sure we do.

In Jess’s case, it is true that two factors did not help her diagnosis. First, cancer is not as common in children and young people as it is in the rest of the population. It is not unusual for a GP, or even a GP practice, to see only one or two cases across the lifespan of their service. Just under 4,000 young adults between 15 and 29 are diagnosed with cancer in England each year; across the country, those are small numbers, so GPs often do not have experience of dealing with young people who present with symptoms that—as the right hon. Member for Alyn and Deeside (Mark Tami) said—are often non-specific and can be attributed to other causes. The other factor is that if there is an unknown primary, those cases are more difficult to diagnose across the board for all age groups, because there is not an obvious breast lump, an obvious shortness of breath or an obvious mole that has changed. That often makes it difficult for GPs to get to the bottom of what is happening.

Despite that, it is very clear from Jess’s case that there were many opportunities where further investigation could have revealed what was going on. She should not have had to go back so many times with the same symptoms without being investigated further. That is precisely why the Government have put a lot of funding—£2.3 billion—into the roll-out of community diagnostic centres, so that patients with non-specific symptoms that GPs cannot get to the bottom of can be referred straightaway. They do not need a hospital referral to an oncologist or a surgeon to investigate: GPs can refer those patients directly to the community diagnostic centre, where a range of tests is available, including MRI scans, ultrasounds and CT scans, to get that early diagnosis as quickly as possible. If it is not cancer, those patients can then pop back to the GP for further referrals elsewhere, but if it is, they can get started with treatment as quickly as possible. We are also introducing non-specific symptoms pathways, in order to do exactly what my hon. Friend the Member for Hertford and Stortford has said: bring together diagnostic equipment, expertise and support, so that discussions do happen about patients who are coming back on a frequent basis and for whom a diagnosis has not been helpful.

To mention two additional things that the Government are doing, my hon. Friend is absolutely correct that the nub of this issue is getting people diagnosed as early as possible, so we have now set a target that, by 2028, 75% of all cancers should be diagnosed at stages 1 or 2. Doing that means diagnosing people as early as possible. Screening will help, although it would not have helped in Jess’s case. However, the rapid diagnostic and community diagnostic centres definitely will help. This is about enabling pathways through which, if GPs are not able to find the source of a problem, they can get some extra expertise or diagnostic tests that will help them to do so.

Meeting that 75% target means addressing all cancers, not just the ones that are easier to spot, either because they have screening tests in place or because they give rise to more obvious symptoms. It includes the rarer cancers and those that have no known origin, so I hope that that gives some reassurance that we are absolutely focused on trying to diagnose people as early as possible. We are also piloting a nurse specialist route into pathways, so if someone like Jess was meeting their GP regularly and still not feeling that they were getting to the bottom of their problems, they would be able to phone the cancer nurse hotline. If the cancer nurse feels that that person needs to be seen by a cancer specialist or to go into the cancer pathway, they can do so as quickly as possible. Again, this is not about blaming GPs, but it will be another route through which patients can access specialist services.

Turning to Jess’s law, the Secretary of State is currently formulating the 10-year cancer strategy. We are looking at that in detail, and I can reassure my hon. Friend the Member for Hertford and Stortford that the strategy will contain a section on children and young people, because they have specific needs, particularly around diagnosis but also around treatment. I am very happy to discuss a flag-style system with the Secretary of State, as my hon. Friend has. There may be some technical difficulties with that: I am doing work with GPs on a flag system for gun licensing, and the issue we have, from a purely practical point of view, is that most GPs have their own independent IT system—they are not part of a national IT system—so if we introduce one nationally it will be quite difficult for each GP practice to implement it. My hon. Friend has made some suggestions, and it is not beyond the realms of possibility to introduce a system that ensures that, if a young person is seen four times and is still coming back with the same symptoms, that is raised to another level—a red flag level, as my hon. Friend said—to indicate that interventions need to take place.

Many of the points that my hon. Friend made, particularly on named GPs, are very important and I will certainly follow them up with her. In terms of the timing of this debate and the 10-year strategy, including some of work she has done within the cancer strategy would be a real opportunity.

[Julie Marson]

The Minister makes a really important point about the practicalities and technicalities of implementing something such as Jess’s law, and I absolutely appreciate that. The example she gave of IT systems being different across GP practices illustrates how important it is to standardise procedure. Patients should not be reliant on whether a GP has a particularly efficient or good procedure; practice should be standardised across the board.

[Maria Caulfield]

My hon. Friend is absolutely right. We are introducing non-specific pathways so that if someone does not have a specific, clear diagnosis and the GPs are not sure what to do, there is a pathway to follow, consistent across every GP practice throughout the country, and people do not slip through the net. Early cancer diagnosis is one of the priority areas in the Core20PLUS5 approach, which we introduced last year to reduce health inequalities across the country. It is crucial that we use that opportunity to flag some of the issues that my hon. Friend raised.

Crucially, GP training across the board is important. Because many GPs will not have come across a young person with cancer in the course of their practice, Macmillan Cancer Support, CLIC Sargent and Cancer Research UK are doing work to roll out training with regular updates—it is not just one-off training—for GPs and other members of the primary care team. It is much more common now for people to be seen by the practice nurse, the paramedic or the physio if they have back pain or joint problems. It may seem like a physio problem, but there could be an underlying cancer diagnosis. It is important that we educate and keep up to date the whole team, not just the GP.

I am very happy to take away my hon. Friend’s suggestions and to see whether we can put in place some proper measures that will reduce the chances of this happening again. We will not necessarily be able to make sure that no one is missed, but my hon. Friend raises some flags that cause me concern and that suggest we are not where we should be. There are certainly things that we can put in place to stop cancer diagnoses being missed in young people with non-specific symptoms.

Question put and agreed to.

Health and Social Care

Julie Marson Excerpts

Friday 3rd December 2021 Commons Chamber

[Edward Argar]

My right hon. Friend is right to highlight primary care, essentially, as the front door for many people into the NHS system. GPs and general practice have done a fantastic job. They have worked very hard, but it has been very challenging. The Secretary of State announced additional money to support GP practices in returning to face-to-face appointments and in seeing more people—we have seen significant investment in that. The percentage of face-to-face appointments continues to go up, which I know matters to a large number of all our constituents.

[Julie Marson (Hertford and Stortford) (Con)]

Two weeks ago today, my hon. Friend was very generous with his time and in his support for the tragic case of my constituent, Jessica Brady, who passed away aged 27 from cancer. Will he confirm that the funding to support the NHS and the focus on policies such as the community diagnostic hubs, along with some of the other things that we discussed two weeks ago, will help people, including in Hertford and Stortford, to get the referrals that they need?

[Edward Argar]

I remember that Adjournment debate very clearly. My hon. Friend made an incredibly moving and powerful speech, highlighting Jessica’s situation, what happened to her and her circumstances. My hon. Friend made the point about the importance of early diagnosis and a holistic approach to a patient’s symptoms, and then diagnosis and treatment. The investment that we are putting into diagnostic hubs will help to do exactly that and bring those diagnostics to the heart of our communities, allowing more people to be seen more quickly.

Cancer Diagnoses: Young People in Hertfordshire

Julie Marson Excerpts

Friday 19th November 2021 Commons Chamber

[Julie Marson (Hertford and Stortford) (Con)]

I wish to start by pointing out that this debate really does not belong to me. It belongs to Jessica Brady, as it is her tragic story that brings us all here today. The first thing I want to do is pay tribute to Jessica’s parents, Andrea and Simon Brady. They could not be here today, but I know they are watching, even though it is very difficult for them to do so. The pain they have experienced, and the pain they face every day of coping with their daughter’s illness and death, is unimaginable. They have told me that they are utterly broken, yet with dignity and determination they have committed to improving the diagnosis of cancer among young adults. They wish to ensure, in Jess’s name, that others do not have to go through what they have gone through. They have already done much to raise awareness of Jessica’s story. I was honoured, along with Simon and Andrea, and my right hon. and learned Friend the Member for North East Hertfordshire (Sir Oliver Heald), to hand in their petition calling for better awareness and diagnosis of cancer in young people to No. 10 Downing Street. The petition currently has more than 213,000 signatures, which is remarkable and sobering. I am grateful that my right hon. and learned Friend is in the Chamber for this debate and grateful for all of his support.

[Sir Oliver Heald (North East Hertfordshire) (Con)]

I pay tribute to my hon. Friend for securing the debate. My thoughts, as hers, are with Andrea and Simon Brady on the sad loss of their daughter Jess. Does my hon. Friend agree that at least two areas need to be improved in the way that we deal with cancer in young people? First, in general practice, we need to concentrate much more on young people and perhaps have a lead in each practice who looks at it and makes sure that every doctor is up to speed with the latest thinking. Secondly, we need to improve blood tests. There have been recent innovations, so perhaps a blood test could help with diagnosis.

[Julie Marson]

I thank my right hon. and learned Friend for those comments. He has followed the case closely and has supported me. He puts his finger on some of the key lessons that we want to learn from the Brady’s tragic experience to improve the situation for the future. I will expand on the exact points that he has made.

Andrea and Simon first got in touch with me in April. They told me how Jessica, their 27-year-old daughter, had been unwell since mid-2020 suffering with abdominal and back discomfort. We know how difficult it has been to get a face-to-face appointment with a GP during the pandemic, so Jessica had an online consultation and was diagnosed with a kidney infection and prescribed antibiotics.

Over the ensuing weeks, Jessica was prescribed numerous medications, including countless courses of antibiotics and steroids, all without an examination. For months, she was told that she was suffering from long covid, despite the fact that she had never tested positive. Unconvinced by the assessments and desperately worried, Andrea and Simon decided to go down the private healthcare route.

On 26 November 2020, Jessica received the worst news imaginable: she was diagnosed with an extremely aggressive stage 4 adenocarcinoma with an unknown primary. Jessica’s dependency on oxygen from that date meant that she did not leave the hospital or ever return home. By the time the cancer was discovered, it had already spread to her spine, liver, stomach, lungs, bones and lymph nodes. Jessica passed away on 20 December 2020.

I never had the pleasure of meeting Jessica, but by all accounts she was a remarkable young woman. She worked as a satellite engineer for Airbus in Stevenage and on the day of her funeral, a satellite that she helped to design was launched into space from Cape Canaveral inscribed with the words, “Thank you, Jess!”.

[Mr Gagan Mohindra (South West Hertfordshire) (Con)]

I commend my hon. Friend for bringing this Adjournment debate on an important issue for Hertfordshire residents. Does she agree that early diagnosis of cancer would mean that stories such as that of Jess, which she has eloquently put forward, will not necessarily happen again?

[Julie Marson]

My hon. Friend is right: early diagnosis is key. From Jess’s experience, I want to dig into some of the ways that we can get early diagnosis and a diagnosis that speeds up the process to help to stop unnecessary suffering and death from cancer.

Jessica had her whole life in front of her, but because of the restrictions on face-to-face GP appointments and misdiagnoses, she finally received the correct diagnosis just three and a half weeks before she died. I was immeasurably moved by her story and immediately contacted the then Secretary of State for Health and Social Care, my right hon. Friend the Member for West Suffolk (Matt Hancock). I take this opportunity to thank him, because he immediately met me, and Andrea and Simon, and we agreed numerous follow-up points. I thank the current Health Secretary for carrying on that work. Andrea and Simon also shared Jess’s story at the Health and Social Care Committee.

There are four key elements to Jessica’s story: the fragmented nature of the GP care and provision that she received; the misdiagnosis that caused so much pain to her and her family; how her age helped to shape the process; and how we need to use her story to make sure that the same mistakes are not repeated. I will take those elements in turn.

Jessica’s experience of the GP care she received was, at best, fragmented and, at worst, insufficient to deal with the specific needs that she faced. The problem here was not the individuals involved; the problems for Jessica often came from the organisation of the system itself. The GP provision that Jessica experienced was definitely exacerbated by covid. At the Select Committee session, Andrea described how, at Jessica’s lowest ebb, she struggled to navigate receptionists and switchboards while trying to receive any kind of contact from a doctor. In Andrea’s own words, “Nobody listened” and “Nobody took it seriously.” I cannot imagine your child suffering such pain and yet saying, “What's the point? Nobody will do anything.”

We talk so much about how crucial an early cancer diagnosis is, but all parts of the system need to be working for the process to be efficient and, above all, effective. Andrea Brady summed this up perfectly at the Health and Social Care Committee session. She explained:

“No one looked at the big picture and assembled the jigsaw puzzle pieces.”

Jessica really needed one person on her case, looking at all the evidence and looking at things holistically. Whether we see it as an umbrella model, a wheel and spoke model or whatever, they all need a focal point that holds the rest of the process together. Without this, we know just how awful the results can be. In the end, Jessica saw four different doctors, with not one of them taking ultimate responsibility for her care.

The impact of not having that single point of contact was profound. Vital clues were lost or not examined properly. At one point, a blood test revealed high levels of D-dimer in Jessica, which is often indicative of a clotting disorder, but can also be a cancer warning. Jess was fighting two battles: on the one hand, coping with her debilitating symptoms and, on the other, persuading anyone to listen to her. The results can be catastrophic. I would be grateful to the Minister if, when he responds, he detailed what steps are being taken to create a more joined-up strategy in this field. For example, after the third contact with a GP surgery, could that case be elevated for review? Similarly, after perhaps five pieces of correspondence, could the case not be red-flagged and set procedures followed? I remind the House again that Jessica contacted her surgery on 20 occasions in five months. Some kind of escalation procedure could certainly help with cases such as this.

To give proper care, a named GP could handle the case in its entirety—not just in principle, but in practice too. Someone needs to take the time to listen to the case fully to make sure that every facet is assessed. I would be grateful if the Minister also addressed that. Will he detail what steps are being taken to ensure that each GP surgery has access to a designated cancer specialist? Having this available to every surgery would aid the diagnosis of cancers in the young and would come into its own especially when reviewing rare cancers and seemingly inexplicable symptoms.

We absolutely can and should trust our medical professionals. In the vast majority of healthcare situations, they get it right, but we cannot ignore the danger of misdiagnosis, particularly in unusual circumstances. In Jessica’s case, her raised D-dimer levels indicated a significant clot formation and breakdown within her body. It was only later, in their own research, that Andrea and Simon discovered that D-dimer levels are elevated in the plasma of patients with various solid cancers, suggesting a possible link to Jessica’s later diagnosis. However, this possible link was not investigated further at the time, because no medical professional asked further questions when they had the test results. If Jessica’s test results had been coupled with critical thinking from those in medical positions, proper decision-making would have taken place and, in Jessica’s case, it could have led to a different outcome.

I hugely welcome the Government’s commitment to better cancer research. The recent spending review announcement of £5 billion into health research will help us to identify new treatments, but will the Minister explain to what extent research will be carried out that looks specifically into new blood tests that accurately highlight incidence of cancer early. Such a test would have been a game-changer in Jessica’s case, providing a much clearer answer much earlier in the process. Such a test would have been a game-changer in Jessica’s case, providing a much clearer answer much earlier in the process. Will the Minister detail how improvements are being made in respect of misdiagnoses that derive from such a lack of information and questioning?

Jessica’s age, 27, was also a factor. Simon and Andrea have described Jessica and other young adults in a similar situation as

“too old for their diagnosis to be truly shocking and too young to be deemed at serious risk.”

Every diagnosis of this nature is shocking, yet Jessica was seemingly caught between two different age groups. Even her dramatic weight loss and vomiting and the swollen glands on her neck were not taken seriously or linked to possible cancer, because she was not deemed at high risk of cancer, partly because of her age. We really need to think about how this can affect young people.

Cancer Research UK tells us that adults aged 25 to 49 contribute 9% of all new cancer cases, with almost twice as many cases in females as males in that age group. That is far too large a number to ignore. Currently, the 24 to 49 age group is not prioritised, even though many cancers are found to be aggressive and require immediate treatment.

As well as raising awareness among the public of just how serious cancer can be for young adults, Andrea and Simon’s petition and campaign strives to do the same in GP practices, too. I am glad to have the opportunity to get this campaign on the Minister’s radar and hope he will remember this message long after we leave the Chamber today.

One of the biggest tragedies is that Jessica’s story is not an isolated incident: many other people have found themselves in a similar situation, and will continue to unless we can learn the lessons that we need to learn now. The petition has prompted countless people to come forward to tell their own stories of their young family members who have had their lives curtailed by late or undiscovered cancer diagnoses, including some people who were told that they were too young for cancer. We know that cancer can develop in children, elderly people and everyone in between. In 2021, it is just not good enough to tell someone they are too young to have cancer.

In Jessica’s case, it is deeply troubling that her symptoms were explained away with a long-covid diagnosis, despite her not believing she had ever had covid or having even registered a positive test. We need to ask more questions. We need to become better at using data properly. We need to improve cancer diagnosis among young adults.

I welcome the NHS’s introduction of rapid diagnostic centres—their focus on cancers that generate non-specific symptoms that are otherwise harder to diagnose will make a huge difference—but the point remains that a GP still needs to refer a patient to one of the sites. Rapid diagnostic centres are just one of a number of measures that are being introduced to tackle this acute problem; will the Minister outline the other measures?

We cannot help but wonder what would have happened if just one thing had been different about Jessica’s case. What if her case was escalated in the GP surgery? What if the raised D-dimer was investigated further? What if she had seen a doctor sooner? For her family, those are agonising questions.

I stand here and try to do justice for Jessica, and for Andrea and Simon, but I will never be able adequately to describe or encapsulate what they have gone through. Nevertheless, we can try to understand what went wrong in Jessica’s case. We cannot make it right for her, but we can prevent others from going through what she was forced to go through. Andrea and Simon deserve to see the change that will help so many families who find themselves in their shoes.

I am grateful for the support of my right hon. and learned Friend the Member for North East Hertfordshire. I hope that this debate can be a significant moment for cancer diagnosis among young adults, not just in Hertfordshire but right across our country, so that they too can say, like the message launched into space, “Thank you, Jess!”

World Menopause Month

Julie Marson Excerpts

Thursday 21st October 2021 Commons Chamber

[Julie Marson (Hertford and Stortford) (Con)]

It is a pleasure to follow the hon. Member for Newport East (Jessica Morden) and I, too, congratulate the hon. Member for Swansea East (Carolyn Harris) on securing this debate and on her words earlier, because this is an important debate on an important issue. I mean no disrespect to any of the male Members here, because I know they are champions as well, but I have a suspicion that, if this was a male issue, it may have been discussed and medicated out of existence by now.

I had a career in my 20s and 30s, as many of us did. I took a career break for 16 years and when I came back I realised why women in their 50s sometimes do not start new careers—I will leave it at that and not go into any more detail—although I highly recommend that they do.

I wish to make one point about access to HRT for those of us who have a family history of breast cancer, and how difficult—in my case, nigh on impossible—that has been. There is an issue about the training of GPs, misinformation about the issue, and surveys and research that may be out of date. It is so important that diagnosis, treatments and information are based on the latest research and data, and are proportionate. Other issues, including osteoporosis, are important counterbalances to the risk of breast cancer.

One of the biggest things this Government are doing is the women’s health strategy. I pay tribute to my right hon. Friend the Member for Mid Bedfordshire (Ms Dorries), who was previously the Minister responsible, for her work on the strategy, which I know the new Minister will continue. Women’s health, physiology and biology have not always been taken as a central point of reference for medicine, diagnosis and the way we devise and deliver health services in this country. Making sure that that changes is a crucial part of our work in this House.

I wish to make one final point. A few years ago, probably around the time of World Menopause Month, a prominent female parliamentarian with many years of experience used social media to say to women, “Recognise the symptoms and get treatment, help and advice.” The first response was from someone who said that she should not use the term menopause because it was not inclusive enough. If we have a problem, we have to name it and understand it and who it affects. We should be clear that biological sex is a reality and that this affects women, along with lots of other things. To recognise it, treat it and talk about it, we have to be very clear about that biological fact.

Public Health England: Relocation to Harlow

Julie Marson Excerpts

Monday 12th July 2021 Commons Chamber

[Julie Marson (Hertford and Stortford) (Con)]

It is a pleasure to have you in the Chair, Madam Deputy Speaker. It is also a real honour to follow my right hon. Friend the Member for Harlow (Robert Halfon), and I congratulate him on securing this important debate. I commend the argument he has made. The powerful argument does not recognise boundaries; the economic opportunity that he outlines knows no boundaries, including parliamentary boundaries. The economic and strategic benefits of the PHE successor moving to Harlow will also have a powerful benefit in my constituency.

Hertford and Stortford is a beautiful place to live and work, but we too have pockets of deprivation and we too are part of the Government’s levelling-up agenda. We are also building thousands of new homes in the Harlow and Gilston garden town project. The success of that flagship project is so important; as far as I know, it is part of the biggest release of greenbelt land ever. That project is dependent on people and place making—on having skilled jobs for people to do, making it a vibrant new place to live and work.

My constituency is also at the very heart of the Innovation Corridor. As co-chair of the all-party parliamentary group for the Innovation Corridor, I am passionate about the strategic benefits and synergies of siting the public health science campus in this globally renowned cluster for life sciences and healthcare. The corridor is part of an ecosystem and by its very nature every ecosystem is complex; it is not just a case of plonking somewhere down randomly. We need to think about housing, skills and infrastructure. We have all this in the London-Stansted-Cambridge corridor. Harlow is at the heart of that, but so is Hertford and Stortford. We really do want to make the absolute most of the clusters and skills that are at their peak in our part of the Innovation Corridor.

I know that this is part of the Government’s strategic objective to attract investment into our area, particularly foreign direct investment. At the APPG for the Innovation Corridor’s recent annual general meeting, we heard from people in North Carolina and Canada, and asked them, “What are the drivers of success?”. They said that it is about clusters and strategic thinking; that is a crucial part of the success. The campus, with its wider benefits for my constituency, my county and the Innovation Corridor, will be a further step in making the area a scientific global superpower. I commend it to the Minister and again congratulate my right hon. Friend the Member for Harlow on allowing us to have this debate.

Covid-19 Update

Julie Marson Excerpts

Monday 5th July 2021 Commons Chamber

[Sajid Javid]

It is understandable that there has been a difference in approach between Wales and England, and clearly that will continue, but we will continue to co-ordinate. I know that my predecessor, my right hon. Friend the Member for West Suffolk (Matt Hancock), co-ordinated on a regular basis with his Welsh counterpart, and when it comes to transport, my Welsh counterpart and I will work carefully with the Secretary of State for Transport.

[Julie Marson (Hertford and Stortford) (Con)]

It is hugely significant and welcome that the link between cases and hospitalisation seems to have been broken by the vaccine. I would like to echo what my hon. Friend the Member for Harrogate and Knaresborough (Andrew Jones) has just said. Can my right hon. Friend assure me, notwithstanding the risks he has pointed out such as potential variants and increased cases, that the NHS will have the focus and the resources to continue to bear down on the backlog of cases such as cancer, which is scaring my constituents and everyone else?

[Sajid Javid]

Yes, I can give my hon. Friend that assurance. The backlog is already at 5 million, and as I have said today, it is unfortunately going to get a lot worse before it gets better. I think we can all understand why, but today’s announcement will certainly have helped in our march to clear the backlog. My hon. Friend will know that the Government have given significant additional funding, in the billions, to help with that, but there will be a lot more to come in dealing with the priorities, especially cancer.

Women’s Health Strategy

Julie Marson Excerpts

Monday 8th March 2021 Commons Chamber

[Julie Marson (Hertford and Stortford) (Con) [V]]

I really congratulate my hon. Friend on her statement today, particularly on International Women’s Day. Does she agree that the women’s health strategy, including the detailed pillars that she has outlined, is the first of its kind and will mark a real step change in approach in the way that it centres women, their voices, their lived experiences, and their evidence in making real change to the future of health policy in England?

[Ms Dorries]

I thank my hon. Friend for her encouragement. She is absolutely right. We are very excited about this strategy because it is the first of its kind. That is why we have put quite a tight timeframe on this to keep the momentum going. We will be collating all the information and data before the summer and we will be reporting when we come back after the summer recess. We will then be able to announce our women’s health strategy before the end of this year. I hope that everybody is as excited as I am about women getting involved and giving us their information, telling us what they feel, when we know that their voices are not heard. We have, I believe, provided the platform for women to have their voices heard. I thank my hon. Friend for her remarks and I hope that she will follow this process. I hope that she will download the link, provide evidence herself—I hope that every woman in this House does that—and be there when we announce the women’s health strategy later in the year.

Covid Security at UK Borders

Julie Marson Excerpts

Monday 1st February 2021 Commons Chamber

[Julie Marson (Hertford and Stortford) (Con) [V]]

It is right and proper that, at a time when new variants are emerging across the world, we act to shore up our defences and maintain an agile approach that can react to changing circumstances, particularly in the light of the news today on the South African variant, which is affecting part of my constituency.

Suspending all travel corridors two weeks ago was a painful decision to take. We are a truly international nation, a travel hub, but it was the right decision. We are making huge progress through the vaccination programme, and I commend the work of the Minister for vaccine deployment—the Under-Secretary of State for Business, Energy and Industrial Strategy, my hon. Friend the Member for Stratford-on-Avon (Nadhim Zahawi)—particularly today, when the new Avanti Meadows vaccination centre opens in my constituency to add to the fantastic work already under way at Bishop’s Stortford football club.

With herculean efforts and brilliant progress being made each day, we must not on any account become complacent now, but as I said, this decision and others like it come at a cost for the aviation sector in particular. I hold the ambition to safely open the airways as soon as possible. I am particularly keen to support Stansted airport, where a number of my constituents work. To enable that, though, the support that the Government have offered to the aviation sector is crucial: a potential £8 million for every airport, the new global travel taskforce to support the industry, and the many billions of pounds of support through schemes such as the furlough and business interruption loans.

We have a secure strategy in place to mitigate the risk of new variants entering the country, and this has been built from a solid platform that has protected our borders for many months. With the way in which these measures are now described by some Opposition Members, though, I would forgive the public for believing that we have a great big sign on the door saying, “All welcome—no matter what”, but that could not be further from the truth. We are requiring all passengers from abroad to present a negative test before departing for England; we are enforcing mandatory self-isolation periods for arrivals; we have suspended the travel corridors; we are introducing isolation in hotels for British citizens coming from red list countries; and we are increasing police checks, which will be helped by the extra police numbers in my constituency. We will also all continue to act on advice and take all factors into account.

The Opposition’s motion is yet another mix of hindsight and shadow boxing around Government announcements, so I certainly will not be supporting it. I back the Government’s strategy and fully support the agile approach they are taking, which allows us to react quickly in a perpetually changing environment.

[Madam Deputy Speaker (Dame Rosie Winterton)]

I am sorry that we have not been able to get everybody in. The last Back-Bench speaker will be Ben Everitt.