Nursing: Higher Education Investment

Karen Lee Excerpts

Wednesday 21st November 2018 Westminster Hall

[Eleanor Smith]

I thank the hon. Lady for her intervention, but unfortunately, as someone who has worked on the wards, I have to say that we do not see it; it does not feel like that.

Simply put, there is no long-term plan without a registered nursing workforce. Whatever ambition the Secretary of State and Simon Stevens have must be matched by credible growth in the number of registered nurses.

[Karen Lee (Lincoln) (Lab)]

Will my hon. Friend give way?

[Eleanor Smith]

Yes.

[Karen Lee]

Does my hon. Friend—

[Philip Davies (in the Chair)]

Order. It is not for me to rule on whether people should or should not give way, but I should say that it is not really on for people just to wander into the Chamber and seek to intervene within two minutes of doing so. I say that gently, but it is not for me to decide who should be given way to; that is a matter for the speaker.

[Karen Lee]

Sorry, I have been at another meeting.

[Philip Davies (in the Chair)]

That is not the point, if I may say so to the hon. Lady. Would the hon. Member for Wolverhampton South West (Eleanor Smith) like to give way?

[Eleanor Smith]

I will take this intervention and then I would like to make some progress.

[Karen Lee]

I will be brief. There was mention of how many nurses there were on the wards. I was a nurse on a ward, and I am getting older. The drop by one third in the number of applications means that, even with the new nurses, we do not have the number of people to fill the vacancies. The Prime Minister makes great play of how much money there will be for all these nursing vacancies. If nurses are not trained and people are retiring and those places are not being filled by new nurses, how do we do it?

[Eleanor Smith]

I will address that in my speech. I thank my hon. Friend very much for that intervention.

I welcome the public commitment made by the Secretary of State at the Royal College of Nursing on 31 October to invest in growing the number of nurses through higher education, including through the long-term plan, because I feel that finally someone is paying attention. The Secretary of State has said that he will look into the possibility of introducing safe nurse staffing legislation. He has said that he will explore anything that might help to address the problem we face. I sincerely hope that the Secretary of State means it, because he and Simon Stevens have the power to fix this mess with proper funding and intervention.

That brings me to the crux of the debate. We have to grow our nursing workforce, so the only question that we need to answer is this: how do we fund what we know is the fastest and safest way to do that at scale, in the light of our crisis? Higher education is the best and most cost-effective way to ensure that we have the right number of registered nursing staff, with the right skills and experience, which patients need and deserve. New routes into nursing, which are welcome if done right, still cannot educate anywhere near enough nurses to an appropriate skill level to meet the current need, let alone the future one. It is time to fix the supply pipeline and for the Secretary of State and Simon Stevens to stand up and be counted.

In 2016, the Government removed the NHS bursary and replaced it with a student loan. The £1.2 billion that was taken out of healthcare higher education was framed as a saving, but where did it go? What did it save? Was it used to grow the number of nurses? The stated purpose of the Government’s reform was to increase the number of nursing students. It is against that goal that the impact of the Government’s reforms must be judged.

Let me bust a few myths. I expect the Minister to say, “The old bursary model placed an artificial cap on the number of nurse training places that universities could offer students.” That is factually untrue. Funding of nursing student numbers has always been a political choice. It has always been up to the Government to choose what they want to fund. I expect the Minister to say, “The loan model has not made it less attractive to apply.” In each year since the reform, applications to nursing courses have fallen. In September 2018, nearly 1,800 fewer nurses were due to start at university, compared with September 2016.

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[Karen Lee (Lincoln) (Lab)]

I was a mature student aged 41 when I started my nurse training, and I was a single parent. I could not have completed my training without a bursary, and could not have done a part-time job because it was a full-time course and I had a child to care for. My younger single friends also needed their bursaries, because everyone had bills to pay. I was a nurse for 14 years and my colleagues are still nurses. None of us could have trained without the bursaries, and none of my friends would have gone on to be nurses as they are to this very day.

There are currently 41,000 nursing vacancies in NHS England. For the second year in a row, more nurses are leaving the profession than joining it, and one in three is expected to retire in the next 10 years. The NHS has spent £527 million plugging staffing gaps with expensive agency staff. I do not know how that makes any kind of economic sense. Added to that, the reality is that patient safety is compromised. Agency staff are not experts in their field. I have been in an arrest situation in which, out of seven trained, only three were regular nurses. It compromises patient safety. In addition, the number of European nurses registered in Britain dropped by 87% compared with 2016-17 figures. That means that there will be even fewer nurses.

The Government must stop putting lives at risk by understaffing and underfunding the NHS. People just are not signing up to be apprentice nurses. It sounds all right in theory, but does not work in practice. There is not the take-up. If we genuinely aim to train sufficient nurses the Government must join the Labour party in committing to reinstate nursing bursaries. Until that happens, no matter how many nursing jobs the Government fund, as nurses of my generation retire and numbers of the newly trained gradually decrease, we will simply not have the trained nurses to fill the places.

Budget Resolutions

Karen Lee Excerpts

Tuesday 30th October 2018 Commons Chamber

[John McDonnell]

I respect the right hon. Gentleman’s views on Brexit because I campaigned for remain as well, but it behoves any Liberal Democrat to come to this House with a bit of humility after serving with a Tory Administration that savaged our public services.

Let me look at some of the elements of human suffering. Health workers are having to cope with the biggest financial squeeze in the NHS’s history.

[Karen Lee (Lincoln) (Lab)]

Does my right hon. Friend agree that we must reinstate nursing bursaries if we are to see the number of nurses we need in our NHS?

[John McDonnell]

That is an essential element of the reconstruction that Labour will have to do when we come to power.

The Institute for Fiscal Studies said that a rise in health spending of 3.3% was needed just to maintain the current stretched service, and that at least 4% was needed to improve it. Instead, according to the Nuffield Trust, what we got amounts to just a 2.7% increase in overall health spending in real terms next year.

Police officers have seen 21,000 of their colleagues’ jobs cut since 2010. As a result, violent crime is on the rise. The independent police watchdog is warning that

“the lives of vulnerable people could be at risk.”

What did the police get yesterday? Some £160 million for counter-terrorism—far less than is needed—and not a penny more for neighbourhood policing. And that despite the head of counter-terrorism warning that counter-terrorism work relies on regular policing being properly funded.

Teachers’ pay has fallen by 4% since 2011 and the schools budget has been cut by £3 billion in real terms. Some 36,000 teachers have left the profession in a year —the highest since records began.

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[Karen Lee (Lincoln) (Lab)]

Austerity has been inflicted on the UK for the past eight years. Austerity was, and still is, an ideological and political choice. The absolute truth that we cannot get away from is that true austerity would not have allowed for further tax cuts for the wealthy, while the rest of us bear the burden. We do not hear a lot about those tax cuts from Government Members.

The Government were lying to us when they said that austerity was a necessity, and they are lying to us now when they say that it is over. Tax cuts costing £2.8 billion will benefit high-income households at the same time as we see a cash freeze on working-age benefits. The idea that this Government are strong and stable on the economy is ridiculous. The economy they have presided over for eight years is one of low investment, low growth and low pay. After eight years, economic productivity is on its knees, local government is at breaking point and the cuts are not forecast to end any time soon. Calling this Budget the end of austerity is a mockery of those who have taken the brunt of the cuts over the past eight years.

I am very concerned that no extra funding has been provided for regular policing, because the cuts to policing budgets have hit Lincolnshire hard. I am also worried that three quarters of the £12 billion of welfare cuts announced after the 2015 election remain in place. It is not tinkering around the edges of income thresholds that will address the callous and chaotic roll-out of universal credit in my constituency of Lincoln. Proper funding and a route out of poverty are needed. I hope that the links between poverty and ill health need no explanation. It is a national disgrace that, thanks to this Budget, food banks will remain a feature of our society.

Under this Government, the NHS has experienced the slowest spending growth in its history. After eight years in which NHS budget increases have averaged just 1.4%, the Government’s 3.4% increase is, to quote the Health Foundation, “simply not enough”. This Budget will barely keep our NHS afloat, let alone reverse eight years of neglect. As a nurse, I saw at first hand the appalling damage the Government have done to our health services. I get fed up with hearing people say how good our health workers are and, “Let’s give them a pat on the back.” Actually, let’s pay them properly, because they cannot spend a patronising pat on the back; they cannot pay their rent with it or buy food with it.

An estimated 4.3 million people are on NHS waiting lists and last year 2.5 million people waited four hours or longer in A&E. With 41,000 nursing vacancies in the NHS in England and more nurses leaving the profession than joining it—some of them are my friends—the Government must reinstate nursing bursaries to reverse the 32% drop in applications since they were scrapped in 2016. I support nursing apprenticeships, but they are not delivering the numbers. We have to reinstate bursaries if we want the numbers. It is all right saying that we will fund however many places, but we have to train those nurses and we have to give them the money to be able to afford to train. I know; I have been there. I remind the House how expensive the current reliance on agency nurses is. That expense is coming out of the public purse. It just makes no sense not to have bursaries and trained nurses.

The insufficient funding increase for the NHS is further undermined by the Government’s disregard for public health services. Public health budgets have decreased by 5.2% since 2014. Those cuts have consequences for our local communities; 85% of councils are planning to reduce their public health budgets this financial year.

The Government have been similarly short-sighted in slashing funding for social care, which has been cut by an estimated £7 billion since the Tories came to power. While the Chancellor allocated an increase to social care grants, that will not close the social care funding gap, which could be over £2 billion by 2020. Age UK estimates that 1.4 million older people do not have access to the care and support they need.

In conclusion, I welcome the Government’s commitment to increase mental health funding by £2 billion, but the Institute for Public Policy Research estimates that double this amount is needed to achieve true parity of esteem between mental and physical health. That sum is meaningless; it is simply not enough. With one in four of us experiencing a mental health problem each year, there is no excuse for the Government’s half-hearted approach. The Government’s cuts to mental health, social care and public health also drive demand for NHS use, creating a bleak cycle in which underfunding places further strain on staff and service delivery. I know that; I have been there first hand.

This Budget shows that austerity is part of the Conservatives’ political ideology and make-up; it is central to their small state, low public investment approach to managing the economy. We should not expect anything other than austerity while we have this Government. To truly end austerity, we need a general election and a Labour Government, and we on this side of the House say, “Bring it on.”

Breast Cancer

Karen Lee Excerpts

Thursday 18th October 2018 Westminster Hall

[Karen Lee (Lincoln) (Lab)]

It is a pleasure to serve under your chairmanship, Mr McCabe.

I thank my hon. Friend the Member for Crewe and Nantwich (Laura Smith), my good friend, for introducing this debate. It is vital for us to have the opportunity to discuss the future of breast cancer care and treatment. I also place on the record my thanks to Breast Cancer Now, a fantastic organisation without which this debate would not be possible. I am an ambassador for Breast Cancer Now.

As people probably know by now, in 2010 my daughter, aged 35, was diagnosed with triple negative breast cancer. She was dead within 13 months. When I first came to Parliament, one of my aims was to do anything I could to ensure that that did not happen to other people and whatever I could to make things better.

This month is Wear it Pink Month. The timing of the debate could not be better—in Breast Cancer Awareness Month, with a new cancer strategy announced by the Prime Minister at her recent party conference and while the long-term economic plan for the NHS is being decided. This is an unprecedented opportunity to ensure that the way in which we prevent, diagnose and treat breast cancer, and care for those who have it, truly benefits all patients in every part of the country.

Every year about 55,000 people in the UK are diagnosed with breast cancer, making it the most common cancer in the country. One in eight women in the UK will develop breast cancer in their lifetime, and nearly 11,500 women and 80 men in the UK still lose their lives to breast cancer each year. Progress has been made, but survival outcomes vary significantly between regions across the country, and Britain continues to trail other European countries on breast cancer survival. As Members can imagine, that sort of statistic hits home with me.

Debates such as this one, along with the necessary commitments from the Government, are crucial if we are to work towards a future in which everyone with breast cancer can live, and live well. After three decades of progress in the UK, however, within four years the number of women dying from breast cancer each year is projected to rise, according to recent analysis. We have to address that—an increase simply cannot be allowed to happen.

What we need is action; we do not need platitudes or promises, because neither of those leads to improvements in care. We need some real action. I appreciate that the hon. Member for Bexhill and Battle (Huw Merriman) means well, and it is all very well to praise NHS staff, but at the end of the day we cannot spend a pat on the back. Someone needs to go back to the Prime Minister to tell her that we actually need to pay NHS staff properly.

Incidence rates are projected to increase in the next decade, but waiting times still vary widely, screening attendance is at a record low, secondary patient needs are still too often unmet, and the quality of care still depends far too much on where someone happens to live. My daughter did not have a cancer clinical nurse specialist, a CNS, and when her cancer metastasised—she was diagnosed at the end of April, and it metastasised by the following February—she tried to get her GP to visit her. The GP lived quite a distance away and would not come out; even after I made a number of phone calls, she still would not come out.

My daughter lay in that bedroom with a cancer metastasising to her brain, but only had paracetamol and ibuprofen to take because she could not get a doctor out to her. Had she had a CNS, that would not have happened. For women to get nursing from a cancer specialist is crucial. Again, I know that the hon. Member for Bexhill and Battle means well, but seeing that and having to care for someone in that position did not give me inner strength—it broke my heart, and I hope that it never happens to anyone ever again.

It is not too late to prevent the projected decline in breast cancer survival rates. For example, were 10% of breast cancers diagnosed a stage earlier, an estimated 290 lives could be saved in just one year. My daughter could have been one of those. It is therefore vital that we raise awareness. A couple of weeks ago, I went out to our local shopping centre, the Waterside. My office manager and I had loads of leaflets from Breast Cancer Now—the little ones, which tell people how to check their breasts—and a stack of chocolate brownies that my younger daughter had made. I have to say that the leaflets went faster than the chocolate brownies, but we gave it all out in the end.

We could also prevent more than 1,200 breast cancer deaths by increasing breast screening uptake from the current low of 71% to the 80% standard set for breast screening units. Those figures show that if the Government act now, and act decisively, progress can continue to be made, more lives can be saved and quality of life can be improved.

The progress made on breast cancer over the years masks stark regional inequalities in diagnosis, treatment and care across the country. Having worked in our NHS, I am so proud of the values of universality, equality and fairness that are hardwired into the delivery of life-saving care. Under our national health service, your postcode should have no bearing on the care you receive.

Last Friday, I visited Lincoln’s breast unit and saw the brilliant staff doing an amazing job. To do such a fantastic job, they often leave late at night. They have an answerphone, so people can ring up and leave a message if they are worried about anything. Those girls do not go home at night until they have emptied all the messages on that machine—it does not matter what time it is, or if they were meant to have gone home an hour ago: they stay. I do not think they get paid for staying.

In Lincoln, the average incidence rate for breast cancer is slightly above the English average. Most worrying, however, is that Lincoln’s premature mortality rate was higher than the English average, and significantly higher than that of the neighbouring area of North Lincolnshire.

Having worked at first hand on hospital wards—I am an ex-nurse—I know how essential it is for patients, staff and quality of care that teams are appropriately staffed, and that regular, trained nurses are working—not agency staff. Staff should be in an area all the time, so they know what they are looking for, and to do that we need the reinstatement of nursing bursaries. That does not only go for nurses; we need them for radiographers as well, because the people who do the mammograms need three years of training in radiography and then an extra year on top of that. I was told that only last week, and there is a real shortage of them. The Government talk about their apprenticeships, but it takes four years to train an apprentice nurse, and people are just not taking up the training.

Only 21% of trusts in England have a dedicated clinical nurse specialist for secondary breast cancer patients. As I said just now, having a CNS is vital, so that is a shockingly bad statistic. Our dedicated NHS staff work around the clock to provide expert care. The minimum that they deserve is not to have to worry about filling the gaps in understaffed departments. I do not know whether people realise, but when nurses go to work in a hospital that is understaffed—that is, most of them—and another ward is short, they can be moved from one ward to another. They are still nurses, but they might not know quite as much about exactly what they are doing. That is really bad. Bursaries need to be reinstated so that we have enough nurses.

The Government must invest £39 million in recruitment to the breast imaging and diagnostic workforce, and they must provide funding for the 120 hospital trusts without a dedicated CNS post. To the first person who asks, “How do we do that in a time of austerity?”, I will say how—fair taxation is how. Every year, 23% of breast cancer cases could be avoided by simple lifestyle changes but, owing to austerity, public health budgets in 2017-18 were 5% less in real terms than they were in 2013-14. Over the same period, this Government have reduced corporation tax and taxes for the very rich.

The cut in public health budgets drastically reduces the capacity of local public health services to deliver life-saving preventive action. Not only is underfunding local public health services putting people’s lives at risk, but cost-cutting measures fail on their own terms. Investing in public health locally would not only save lives but result in long-term savings for our NHS. It is therefore essential that the NHS long-term plan secures the future of cancer alliances through a continued commitment of at least £200 million per year, in line with inflation. I hope that the Minister will make a real commitment to that. I do not want to hear how we all have to live within our means: we can do that and we ought to do it.

To conclude, it is fantastic to see this crucial debate receive the participation and thoughtful consideration that it deserves. I hope that the Government take on board the excellent range of proposals from Members in all parts of the House. Breast cancer is, after all, an issue that affects all of us. It would be a travesty if we allowed decades of progress to be undone, especially when the pathway to continued improvement is already laid out.

I urge the Government to support fully the delivery of breast cancer diagnosis, treatment and care. Ever since I was elected, I have wanted to work towards a future in which everyone with breast cancer can live, and live well. Breast Cancer Now has a pledge: that by 2050 no one should be dying of breast cancer. I hope that everyone across the House can join in that aim and that, in future years, we will look back on debates such as this as a crucial step in the eradication of breast cancer as a fatal disease.

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[Mrs Hodgson]

The challenge to the Minister is whether improvements to the breast cancer workforce will include recruiting and training additional secondary breast cancer nurses, clinical nurse specialists—whatever we may decide to call them—so that patients have the vital support they need and no one has to witness their loved ones suffering in agony, with only over-the-counter painkillers to ease the pain, as my hon. Friend the Member for Lincoln so bravely testified to earlier.

[Karen Lee]

Does my hon. Friend agree that the withdrawal of nursing bursaries cannot fail to have impacted on the numbers of nurses training? There are figures out today—I have been on the radio this morning. I think there has been more than a 30% drop in the number of people training to be nurses since the nursing bursary was withdrawn. That cannot fail to have had an impact. It impacts on radiographers as well, because they train for three years, then for another year after that to do mammograms. Does she agree that those bursaries absolutely must be reinstated?

[Mrs Hodgson]

Yes, I agree. Obviously, that is why it is in our manifesto that we would reinstate those nursing bursaries. I would urge the Government to look at this closely, especially in light of Brexit, and what might happen post Brexit, with regard to the EU workforce, as I already mentioned.

Finally, I will move on to prevention. It is a challenge to us all to live healthier lives. I do not stand here saying I am doing a very good job, but we know that regularly drinking alcohol, as the hon. Member for Central Ayrshire mentioned earlier, and being overweight or obese, can increase the risk of developing breast cancer—and most cancers—as can smoking and lack of exercise. Regular physical exercise and reducing all the above can reduce the risk. Researchers estimated that 23% of breast cancers are preventable through lifestyle changes. That means there were approximately 10,600 preventable cases in 2016. Turning that into money, approximately £102 million in treatment costs could have been saved in 2016 if all those cases had been prevented. I know that may not be completely achievable, but since 2015, public health budgets have been cut by 3.9% a year until 2020-21. Has the Minister made any assessment of the effect that cuts to public health budgets have had on the incidence of breast cancer, and will he commit, as much as he can, to an increase in public health funding to help to prevent more cases of breast cancer? I know that might be above his pay grade; he is not the Chancellor—yet.

In closing, I will touch on secondary breast cancer. More than half of women are given no information about the signs and symptoms of breast cancer returning. Will the Minister look into ensuring that all patients are advised at the end of their primary breast cancer treatment about lifestyle and symptoms, so that where possible all cases of incurable secondary breast cancer can be prevented? I know that, like me, the Minister is incredibly passionate about breast cancer and that he will take much if not all of what he has heard today back to his Department to work on, so that he can achieve the best future for breast cancer.

On the day of Dame Tessa Jowell’s memorial, I will end by quoting from her magnificent last speech in the House of Lords in January this year, when she said:

“In the end, what gives a life meaning is not only how it is lived, but how it draws to a close.”

She said that she hoped the debate would give hope to other cancer patients,

“so that we can live well together with cancer—not just dying of it”.—[Official Report, House of Lords, 25 January 2018; Vol. 788, c. 1170.]

Perhaps her most precious legacy will be not only Sure Start and the Olympics, as wonderful as they are, but a better future for everyone with any form of cancer.

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[Steve Brine]

I always keep an open mind. The truth is—the hon. Member for Central Ayrshire knows exactly what I will say—that although the screening review will no doubt make recommendations on that, there is a very heated and divided debate within the breast cancer community around screening, and not just about the age at which to begin it. We had the AgeX age extension trial, which broadened the range of ages at which we screen, but there is absolutely no consensus within the breast cancer community on the benefit of screening. That debate continues and rages strongly, and it is for policy makers to listen to all the different views, as the screening review will do.

Several Members, including the shadow Minister, rightly mentioned clinical nurse specialists and the cancer workforce. Last December, Health Education England published its first ever cancer workforce plan, which committed to the expansion of capacity and skills in fighting the big C.

[Karen Lee]

Will the Minister give way?

[Steve Brine]

Let me make this point. That plan includes an ambition to attract qualified people back to the NHS through domestic and international recruitment. HEE also plans to expand the number of clinical nurse specialists and to develop clear CNS competencies and routes into training. This will see every breast cancer patient having access to a CNS or other support worker by 2021.

We are committed to ensuring that all that happens. I saw a lot of news coverage last weekend on access to CNSs, and I completely accept that we have more to do. However, I have been very interested in listening. These debates are not only about me sitting here and waiting to read out my speech; they inform me, as much as anything. I was very interested in the discussion between the Labour and Scottish National party Front Benchers about what CNSs are called and the multidisciplinary team that they could be part of to offer support to women as they are going on this journey. I will definitely take that away.

[Karen Lee]

May I ask the Minister to respond directly to my comment that according to the figures out this morning—I know, because I was given them and asked to comment on them—the numbers of people training to be a nurse have dropped by just over 30% since the bursaries were withdrawn? The Government talk and talk about associate nurses and apprentice nurses, but there is not the take-up for those posts, and an apprentice nurse takes four years to train, so will he respond directly to my comments? Of course, the issue affects not just nurses but radiographers, as I said.

[Steve Brine]

The general point I would make is this. The hon. Lady said that people cannot live on good will; they have to have pay rises, and that is why I am very pleased that we have lifted the public sector cap pay. The significant pay rise that will be coming is welcome. Also, as well as expanding the number of nurse training places by 5,170, we are expanding the skills of specialist cancer nurses. There are 52,000 nurses training in the NHS, with more to come, thanks to our 25% increase in training places. The debate on bursaries is very live. That is discussed every single time we have Health questions—I dare say it will be again on Tuesday—but the Government have been very clear about our vision for the health education workforce and where we see nurse training places and the nurse apprenticeship scheme sitting in that. That is probably all I can add at the moment on that issue.

I want to touch on so many other different things. The hon. Member for Central Ayrshire, the shadow Minister and everyone else who spoke in the debate talked about prevention, and of course the title of the debate on the Order Paper is “Future of breast cancer”, so yes, we need to do a lot more to prevent people from developing cancer—not just breast cancer, but cancer—in the first place. As the Minister responsible for public health and dealing with cancer, I know that encouraging people to live healthier lifestyles can be one of the most effective ways to prevent cancer. Yes, there have been challenging budgets since we took office in 2010, but I refuse to bring politics into the cancer debate. All I will say is that Governments do have to live within their means. Governments do not have any money of their own; they have only our constituents’ money. We are spending £16 billion on the public health budget in England during this spending review period, but difficult decisions have been made. Clearly, I cannot pre-empt the spending review next year. I know what the NHS is getting, because we have pre-empted that ourselves, but we will make our announcements around the future of the public health grant, which obviously comes through a different Department, in due course.

I want to talk about the prevention point. Better prevention is not a silver bullet. I wish it were, but the truth is that cancer is indiscriminately cruel. We have had statistics today on the number of cancers that are preventable. Some two thirds of cancers are just down to bad luck. That is a horrid fact of life, and a horrid fact of life that every Member in this Chamber lives with every day. Cancer can have devastating effects on children, and on people who have lived the healthiest of lives, but we can have a huge impact and ensure that more people live their lives free of cancer if we focus on the prevention message.

Obesity is relevant. We talk a lot about childhood obesity. That is obviously because big children become big adults. Cancer Research UK has been very good in this space in making the connection between obesity and cancer. When we made the connection between smoking and lung cancer, it was a game changer. CRUK makes the connection between obesity and cancer. I am not fat shaming in saying that; it is just a matter of fact that obesity is a contributing factor to cancers. I am told that 8% of breast cancer cases in 2015 were the result of being too heavy. We need to do better on obesity, and we could talk for hours about the childhood obesity strategy alone. There are of course the issues of diet and physical activity. Earlier this month I was at the G20, talking about strengthening health systems, obesity and physical activity, and everyone around the world concurs on that.

I shall close on prevention by talking about alcohol, which the hon. Member for Central Ayrshire mentioned. It is a big breast cancer risk. That is the truth. Women who drink more alcohol have higher rates of breast cancer; women who do not drink have a lower risk of breast cancer compared with those who do. Risk rises with alcohol consumption, and no particular level of intake is risk free. That is the truth.

I want to return to the screening failure, because screening was referred to by the hon. Member for Strangford. He is in his place as always—God bless him. However well we are doing, we cannot be complacent. I constantly look at and worry about the screening figures. With regard to the failing in the national breast screening programme in England, many things come across our desk as Ministers that we wish did not come across our desk, and there are many things that we lie awake at night and worry about. Some things kick you where you do not want to be kicked as a man, and the breast screening programme failure in England kicked me very hard there when it happened. It resulted in thousands of women between the ages of 68 and 71 not being invited to their final screening. That is a stark reminder that however well we think we are doing, we have to do better. The former Secretary of State apologised unreservedly for it. He said that all we can do is put it right, and we are putting it right in terms of inviting people back for screening. We are determined; the independent review was set up to investigate and report on the circumstances of breast screening failure. That is expected to report shortly. It will challenge us and make very challenging recommendations. I look forward to discussing that with hon. Members.

The five-year survival rate for breast cancer is already 86%, as has been said. Some in the breast cancer community worry that the long-term plan and the Prime Minister’s new 75% early-stage detection ambition for cancer mean that we have no ambition left for breast cancer. Earlier this week the national cancer director and I discussed the long-term plan. I was absolutely clear with her, and she agrees, that our long-term ambitions cover all cancers, including breast cancer. The 75% five-year survival aim is ambitious—we would love many cancers to be even remotely there—but it is not the limit of our ambition.

As I said, I want a future in which there is no breast cancer. The NHS does well at diagnosing breast cancer, but it must do a lot better at preventing it. We must continue until the five-year survival figure is 100%, and I do not say that as a naive ambition. I want to make that point clear, because I know that some in the breast cancer community are concerned about that.

I pay tribute to the selfless work done by the people who will deliver the vision in the cancer strategy and the wider long-term plan. Obviously, doctors and nurses are at the sharp end, and I visit them when I go out and about. They, not Ministers, are the people behind the highest ever survival rates. I also want to add my thanks to the charities, which I have enjoyed working with. Breakthrough Breast Cancer joined with the Breast Cancer Campaign to become Breast Cancer Now. I enjoy working with Delyth, Baroness Morgan, of Breast Cancer Now and with Breast Cancer Care and Breast Cancer Haven. I have a lot of time for Breast Cancer Haven, which creates havens to help women to feel human and normal again after treatment. It does a lot of good work.

NHS England and I, with the support of what I always call Team Cancer, are utterly committed to making the ambitions that we set out in our long-term plan and our new cancer strategy a reality. That will ensure that we take a huge leap forward, over the next 10 years, to a future in which cancer has no future.

NHS Long-Term Plan

Karen Lee Excerpts

Monday 18th June 2018 Commons Chamber

[Mr Hunt]

Absolutely. The most important way of spending to save is to invest in prevention, and a lot of that work comes from strong local hospitals. Before my hon. Friend finally leaves this place, I have no doubt at all that her local hospital will be called not the Horton General Hospital, but the Great Horton General Hospital.

[Karen Lee (Lincoln) (Lab)]

Does the Secretary of State agree with me that without the reinstatement of the nursing bursary, we cannot even hope to train enough nurses. The figures show that the numbers training have fallen—this is a serious inquiry—and until we can train enough nurses, we can talk about extra nurses, but we will always need agency nurses. Does he agree that we need to reinstate the nursing bursary so that people can afford to train?

[Mr Hunt]

The reason why we took what I fully accept was a very difficult decision was that we wanted to fund the training of an additional 5,000 nurses every year. When there is a reform of higher education funding, there is always an initial dip in applications. In this case, record numbers of 18 to 19-year-olds applied, but there was a dip among mature students. That is why we have introduced the apprenticeship route. We need to make sure that that works if that dip is to be reversed.

NHS Outsourcing and Privatisation

Karen Lee Excerpts

Wednesday 23rd May 2018 Commons Chamber

[Jonathan Ashworth]

My hon. Friend makes the point well. I believe about 50 walk-in centres have closed and there are another 50 whose future has been reviewed.

[Karen Lee (Lincoln) (Lab)]

Lincoln’s walk-in centre was closed. A consultation was undertaken by the clinical commissioning group and 94% of those who responded did not want the centre to close. So what did the CCG do? It closed it.

[Jonathan Ashworth]

I thank my hon. Friend for her contribution. I know that she, as the relatively new Member for Lincoln, will be campaigning for the future of health provision in her constituency.

The response of the Prime Minister to those cancelled operations this winter was to shrug her shoulders and say, “Nothing is perfect,” but by the end of the winter reporting 185,000 patients, often elderly, vulnerable and in distress, had been left waiting in the back of an ambulance or treated in a corridor for more than 40 minutes. We do not have a crisis in our NHS just in winter; we have a crisis all year round. Since 2010, we have seen a reduction of about 16,000 beds, including more than 5,000 acute beds and nearly 6,000 mental health beds—that is almost 20% of them. Among equivalent wealthy countries, only Canada and Poland have fewer doctors per head, and only two countries have fewer beds per head.

A report today in The Guardian details how old and out of date the equipment is in hospitals because infrastructure budgets have been raided. According to the OECD, we are bottom of the league for the provision of CT and MRI scanners. Meanwhile, as my hon. Friend the Member for Worsley and Eccles South (Barbara Keeley) has pointed out, eight years of multi-billion cuts to social care provision have decimated the sector and have denied 400,000 people, often the elderly and the vulnerable, the support they would otherwise get.

Years of pay freeze, and failure to invest in and plan properly for the workforce, have meant vacancies for 100,000 staff, including vacancies for 40,000 nurses, 3,500 midwives and 11,000 doctors. In the past two years, we have lost more than 1,000 GPs. In our communities, we have seen district nurses cut by 45%. We have lost more than 2,000 health visitors in two years. We have lost nearly 700 school nurses. There are 5,862 fewer psychiatric nurses and 4,803 fewer community health nurses than in 2010, and the Prime Minister’s hostile environment has meant the Home Office has turned down visas for at least 400 staff.

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[Mr Hunt]

The hon. Gentleman makes a fair point, which would be echoed by many Government Members who represent rural constituencies. There is a balance to be struck between the benefits of specialist surgery, where greater volumes of a particular procedure are done, leading to better outcomes for patients, and the trade-off that we make with travel times. I know that that is something that the local NHS, in all parts of the UK, thinks through very carefully.

There is another myth we always get from the Labour party that I think it is very important to dispel: the narrative about the NHS being in total decline. Let us be clear about the pressures facing the NHS. We had to deal with the financial crisis of 2008, which left this country’s coffers empty. We have had to deal with the fact that over the last seven years, we have had half a million more over-75s. We had to deal with a crisis of care at Mid Staffs, which turned out to be a problem affecting many other parts of the NHS.

Yes, it is true that we are missing some important targets at the moment, but let us not forget the extraordinary things that have been achieved despite that pressure, such as for cancer. We inherited some of the lowest cancer survival rates in western Europe. In 2010, only 10% of patients got intensity-modulated radiotherapy; that figure is now 44%. We have two new proton beam therapy machines—at the Christie and University College London Hospitals—and there are 7,000 people alive today who would not be had we stayed with the cancer survival rates of 2010. Every day, 168 more people start cancer treatment than did in 2010. This is a huge step forward.

On mental health, previously we had no national talking therapy service for people with anxiety and depression; today, 1,500 more people are starting or benefiting from talking therapy services every single day, and we have huge plans to extend mental health provision to 1 million more people.

[Karen Lee]

Does the Secretary of State think it acceptable that ambulances were waiting outside Lincoln A&E for up to seven hours over the winter? Is that a mark of progress?

[Mr Hunt]

No, I do not think it acceptable at all, but I would ask the hon. Lady to bear it in mind that we have 2,000 more paramedics than we did in 2010 and that we have invested in a huge amount of capital equipment for the ambulance services. Of course we need to do more, but, when she talks about A&E, she should recognise the achievements of many hospitals, including her own. Every day across the NHS—even over this difficult winter—2,500 more people are seen within four hours than were in 2010.

Labour seems to think that quality problems in the NHS started in 2010. I should point out that because of what we have done to deal with the problems of Mid Staffs, which happened on Labour’s watch, including through the new Care Quality Commission regime, 2.1 million more patients every year benefit from good or outstanding hospitals than did five years ago. A couple of weeks ago for the first time the majority of hospitals in the NHS were good or outstanding, which is a huge step forward and a huge tribute to NHS staff. That might be just one reason the Commonwealth Fund last year said that the NHS was the best healthcare system in the world. When Labour was in office, it was not even the best in Europe.

There is another reason to oppose the motion. It has nothing to do with health policy, but is a much bigger point of principle. After more than five years in this role, the one thing I have learned is that good policy can be made only through frank and open discussion between Ministers and officials. It will not surprise the House to know that Ministers are human, we make multiple mistakes—not me of course—and it is critical that the Secretary of State in charge of the largest health system in the world can get honest, high-quality advice, but the motion would fundamentally undermine that.

This is not a party political point. Many Labour Members have benefitted from such advice, and all of us would want Ministers of any party in power to benefit from such advice, regardless of whether we support the Government, yet the motion asks us to release not just that written advice from officials, which would have an enormous chilling effect, but notes of confidential discussions between Ministers and officials. In short, as my right hon. Friend the Member for Aylesbury (Mr Lidington) said only last week, it would undermine the safe space within which Ministers and civil servants consider all the options and weigh up the best approach. Officials must be able to give advice to Ministers in confidence. The candour of all involved would be seriously affected if there were any fear of those discussions being disclosed.

No Government of any party have ever operated in an environment where advice is sought one week and made public the next. Let us look back to what Andy Burnham said in 2007 when he as a Minister was asked to release information. His words were:

“Putting the risk register in the public domain would be likely to reduce the detail and utility of its contents. This would inhibit the free and frank exchange of views about significant risks and their management, and inhibit the provision of advice to Ministers.”—[Official Report, 23 March 2007; Vol. 458, c. 1191.]

Far from increasing the accountability of the Executive to the legislature, releasing such information would risk weakening it, as more and more discussions would end up taking place informally with no minutes taken at all.

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[Karen Lee (Lincoln) (Lab)]

After eight years of the Government’s austerity agenda, the NHS is on its knees. People in Lincoln commonly wait hours for an ambulance, including those having a heart attack. If a Health Minister happens to be in Lincoln any time soon, they might want to ask about that, because call-to-balloon times for PCI have increased. I am not scaremongering—that is the truth. I am sorry, but I will not pretend that—pardon the pun—everything is rosy.

Although the austerity experiment has been discredited by various economists, we have not seen a halt or a reversal of the underfunding and privatisation of our NHS. With the NHS approaching its 70th birthday, the Government are not providing it with the funding and resourcing it desperately needs. Despite the Government telling us that they are putting record amounts of money into the NHS, compared with countries such as Germany and France, we spend a considerably smaller percentage of our GDP on healthcare.

The latest King’s Fund research confirmed the bleak picture of the policies of the past eight years. The NHS has among the lowest levels of doctors, nurses and beds in the western world. This is not scaremongering; it is the reality of the past eight years’ effect on the health service. I am sorry if people do not like hearing it, but it is the truth. The question should not be why the NHS does not perform better compared with other countries, but rather how the NHS copes under immense pressure when it is so under-resourced. Remember, this is at a time when the Government are prioritising tax cuts for the wealthy and for large corporations.

Deregulation under the Health and Social Care Act 2012 is a stain on this country’s long respect and support for our NHS. There is no role for the private sector if the NHS is fully resourced. Outsourcing has led to nearly two thirds of clinical contracts being won by non-NHS providers. The NHS should not be a cash cow available to the highest bidder. The financial pressures on the NHS have forced some firms to leave the market, while others search for short-term cheap fixes to deliver contracts, which ultimately impacts on patient care.

It is clear that the Government have a not very well hidden agenda: slash, trash and privatise. Underfunding, with little sign of change over the past eight years, only raises the question: do the Government actually want a nationally run service that provides free healthcare to all, free at the point of service? My constituents, after the closure of our walk-in centre—against the wishes of 94% of people who said they wanted it to stay open—are not convinced. The sustainability and transformation partnerships, wholly owned subsidiaries and accountable care organisations are all a ploy for their ideological goal: the backdoor privatisation of our service.

I have seen that at first hand from the hospital floor as a nurse. Instead of just words of praise for those working in the health service—praising nurses sounds really cheap, you know, as if Conservative Members can take some sort of credit for it; it is their hard work, not yours—why not provide them with the resources to do their job properly? Rewards come with actions, not just words.

Education (Student Support)

Karen Lee Excerpts

Wednesday 9th May 2018 Commons Chamber

[Angela Rayner]

Forced debt for students and nurses of whatever gender is a really important issue, which I will come on to. My hon. Friend is absolutely right to highlight that we need to encourage both genders to see nursing as a legitimate career.

I mentioned that there are 700 fewer students training to be nurses. That is the first fall in close to a decade.

[Karen Lee (Lincoln) (Lab)]

Does my hon. Friend agree that the bottom line is that without applications we cannot train nurses? That is just all there is to it.

[Angela Rayner]

My hon. Friend is absolutely right and I congratulate her on her outstanding dedication to nursing.

The Government said that they can fill the gap with nursing apprentices. They promised 1,000 of them, yet it has now been revealed that just 30 apprentice nurses have started the course. To miss a target may be unfortunate, but to miss it by 97% and carry on regardless just seems reckless. The shortfall is not the only problem with relying entirely on apprenticeships. A nursing apprentice will take four years to become a registered nurse. Even if there is a miraculous surge in apprentices starting this summer, we would not see any new qualified nurses on our wards until 2022.

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[Angela Rayner]

I am not sure it is my words that are putting people off; I would say the thought of having £50,000 of debt hanging over them for a very long time is putting people off going into education.

[Karen Lee]

I started my nurse training in 2000 as a single mum. When I finished, I had £15,000 of debt—and that was with a bursary. It took me five years to pay it off. People say we should not talk about debt, but we have to talk about it—debt is debt. Students come out with debate. I came out with debt. I sit here listening to people who know nothing about this talking as if they do. It simply is not true.

[Angela Rayner]

The passion from my hon. Friend reflects how people feel up and down the country. It is funny because we all know what happened at the general election—and the verdict was clear on the Government’s position on education and student debt and tuition. [Hon. Members: “You lost!”] And of course the Government lost their majority at the same time, and the weak and wobbly Prime Minister has done nothing to make anyone in the country feel more confident about her future—but I digress.

How many postgraduate students affected by this policy repay any of, let alone all, their additional loan? Will the Minister explain how this is sustainable? How much will really be saved in the long run? Or is this another example of what the Treasury Select Committee has called the fiscal illusion—in this case, of a student finance system that allows the Government to pretend they have made a saving when they are simply passing the bill down to the next generation? It is no wonder that all the devolved nations have maintained their own NHS bursaries.

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[Stephen Barclay]

My right hon. Friend will not be surprised to learn that that is a selective picking of the facts because it does not include direct entrants, to cite just one example that was not included. I could go on, but I know the—[Hon. Members: “Go on”.] It does not take account of direct entrants; that is one population that was not included. It also—

[Karen Lee]

rose—

[Stephen Barclay]

Would the hon. Lady like me to go on or to give way?

[Karen Lee]

Would the Minister confirm the number?

[Stephen Barclay]

I am happy to confirm that. We now have 13,100 more nurses on wards since 2010 and we have a commitment to expand the numbers—[Interruption.] It is a new programme and we are expanding the number of apprenticeships. We have committed to 5,000 this year, expanding to 7,500.

It is interesting, is it not? Having routes that give people opportunities to progress—having different choices for people and empowering individuals, not all of whom want to go to university—so that people from different backgrounds can go into the profession is the very essence of what our party stands for. It is shame—

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[Karen Lee (Lincoln) (Lab)]

As Members probably know, I was a nurse until last June. I did 12 years in cardiology and almost three in out-patient gynaecology clinics. As an ex-nurse, I could not be any more in opposition to this amendment to nursing bursaries, as I am concerned that it will fail to address the problems with nursing recruitment and will intensify the fall in applications to nursing courses. Overall, applications have fallen by 33% since March 2016, when bursaries were withdrawn. At that time, the Royal College of Nursing, a much respected and non-political body, said the changes were unfair and risky, and the Royal College of Midwives argued that the move threatened the future of maternity services in England.

I hope that all of us in this Chamber acknowledge that there is a workforce crisis across the whole NHS. As the RCN has said,

“plans by the government to remove the NHS bursary for pre-registration students in England must be stopped immediately”.

It goes on to say that

“nurses need bespoke financial support if the government is to meet its commitment to grow the nursing workforce and meet the future population demand for health and care services”.

The National Audit Office has reported that the impact of the EU referendum appears to be driving EU nurses away, and both the Care Quality Commission and the NAO have raised safety concerns relating to nursing shortages—it is not just Opposition Members who are saying that.

[Alex Sobel (Leeds North West) (Lab/Co-op)]

My hon. Friend gave many years’ service as a nurse and I am sure she worked with many nurses who came here from abroad. The Migration Advisory Committee has placed nursing back on the shortage occupation list. In the light of that, is not this statutory instrument wrongheaded, as we need nurses to come through all routes if we have a nursing shortage?

[Karen Lee]

I completely agree with that.

There are 40,000 nursing vacancies across the NHS and, for the second year in a row, more nurses are leaving the profession than joining, with one in three expected to retire in the next 10 years. The Government have made much of the nursing associate role and apprenticeships for nurses. Nursing associates provide a support role for nurses, and the RCN feels that diluting and substituting registered nurses with associate nurses has potentially life-threatening consequences for patients. That is the RCN saying that, not me.

This Government also speak in glowing terms about the apprentice nurse role. I do take the points made by the right hon. Member for Harlow (Robert Halfon)—he means well—but it takes four years to train as an apprentice nurse and our health service is, as the RCN says, in crisis right now. Furthermore, this route is not currently providing the 1,000 new nurses per year that the Government planned for, with RCN figures suggesting that there are just 30 apprentice nurses at present—I will give that answer.

I was a mature student. I was 41 when I started my training, and a single parent. We have heard a lot tonight about how we will encourage people who do not want to go down the university route. I worked in Tesco on a checkout. I had been to grammar school and it had failed me, so I had to go to night school to get my A-levels to become a nurse. That took me a year, three nights a week, on top of working. I then worked for three years as a nursing student to become a nurse. I could not have completed my training without a bursary. I also borrowed £5,000 a year from the Royal Bank of Scotland, so I came out hugely in debt, even though I had a bursary, and it took me five years to clear that debt.

[James Cartlidge (South Suffolk) (Con)]

You shouldn’t have.

[Karen Lee]

That is what I had to do to become a nurse. I think I got around £500 of bursary at that time, and I had myself and my 10-year-old daughter to keep.

My friend Ali was a wife and a mum, and she needed her bursary, and my friends Clare, Haley, Adele and Lisa were younger and single, but they still needed their bursaries, because everybody has bills to pay. None of us could have trained without our bursaries and none of those friends would have gone on to be the nurses they are today without them. Please, will no one on the Government Benches talk about encouraging disadvantaged people to train as nurses? When we had bursaries, we did—I did.

The bottom line is that more nurses equals better healthcare provision. We cannot go on with an NHS in the state it is currently in. The Government continue to ignore completely the wise words of those who are experts in their field—like the Royal College of Nursing—when it comes to the support available for future healthcare professionals. They seem to think that they know best, but the reality does not bear out that fantasy. The regulations must be scrapped and the Government should reinstate nursing bursaries immediately.

I stand in this Chamber time and again defending our NHS, and I hear people who have no idea what it is like on the ground. Sometimes they sit looking at their phones when people like me are talking. I despair. If the Government will not listen to me, I hope they will heed the wise words of the RCN, because it is right on this. Please listen to the RCN and please reinstate nursing bursaries.

[Maria Caulfield (Lewes) (Con)]

May I start by declaring that I still work as a nurse on the bank shift, mainly at the Royal Marsden Hospital in London? It is a pleasure to do so.

I have previously been very outspoken against the removal of bursaries and the move to a tuition fee-based system, for practical reasons: student nurses are different from most students. The course requires them to do a set number of practical hours, and the fact that those are often unsocial and irregular means that it is almost impossible for student nurses to get other part-time work to supplement their time on their courses. We have heard today that student nurses are often mature students who have come from other professions and so already have financial commitments, such as mortgages and loans, that they have to bear in mind when they start a nursing course. Postgraduates who have existing debt are often reluctant to take on more to become a student nurse.

However, since the changes were introduced a couple of years ago, the background has changed. We have seen the rise of the apprenticeship route for nursing and of the associate nurse. My difference with Opposition Members is that I have actually worked with some associate nurses who are in training, and with apprenticeship nurses in training, and the difference is phenomenal. They are enjoying their courses a huge amount more because they are working in a practical setting. It is not just about what they are learning on their nursing course; they are back to being part of the team. They are not students who just come to their placement from university; they are learning about being part of a hospital team and a clinical community.

Associate nurses and apprentice nurses are more than just students; they bring experience with them. Many have backgrounds as healthcare assistants. The experience that they bring from a variety of settings is phenomenal. I know about the support that they have given me on shifts as a bank nurse, and that would not have been available with student nurses previously. We are underestimating their power.

I echo some of the comments in the debate: we do need to ramp up the apprentice and associate routes, because that is the way forward. The bursary system was far from ideal. I lived on a bursary of £400 a month for the three years that it took me to train as a nurse, with little or no additional income. As the hon. Member for Lincoln (Karen Lee) said, student nurses rack up significant debt during those three years. That shows that the bursary system was far from ideal. The statutory instrument took some of those points into account, establishing a hardship fund for struggling students and grants for childcare, travel and accommodation—none of which were available under the bursary system. They are there to support students who have financial pressures.

The bursary system has failed to achieve the number of students that we need. There was a cap on the number of places. Each and every year there were more applicants, but there were not more students coming through the system, because the cap did not allow those applying to secure the places. We need to embrace change, and use this as an opportunity to increase the number of nurses. We should also make student nurses feel valued, and give them a variety of routes into nursing. They have the associate nurse role, which means that they are healthcare assistants who want to do their associate training. They can then top up their training in the future to become registered nurses, or they can go down the apprenticeship route to qualify.

I see Opposition Members laughing. They seem to find it difficult to understand how a Conservative Member of Parliament can be a nurse—I am talking about someone who came from a deprived background and who took the route into nursing because she could not get into university. I will not apologise. I am not afraid to speak out for student nurses and for nurses. I worked with the RCN in the “Scrap the cap” campaign. I spoke out when there was a move away from the bursary system, but, with my hand on my heart, I can say that the associate and apprenticeship routes into nursing are the way forward. It is misleading to pretend that the bursary system was a panacea, that student nurses were happy and that we were fulfilling the numbers that we needed.

I am a member of the RCN and I fully respect everything that it does to support nurses, but its briefing has been slightly misleading. It lists only two routes into nursing: the two-year postgraduate route, and the three-year route into nursing. It does not even mention the associate route or the apprenticeship route, which we need to take into account. It also highlights the fact that applications into nursing have fallen, but it has not mentioned that 2017 saw the second-highest number of students ever accepted on to nursing courses—26,620 students—and that was despite an overall fall in the total number of applications.

[Karen Lee]

I have the briefing here, and it does mention it.

[Maria Caulfield]

I thank the hon. Lady for her intervention. As a member of the RCN, I, too, have had the briefing, and it does not mention the associate and apprenticeship routes into nursing.

The bursary system was not the panacea that Opposition Members claim it to be. I am happy to stand up to fight for nurses when I think that Labour Members may have a point, but I think they are now moving into the realm of scoring political points, which is their usual tactic. There is a better way to get nurses into training, and I urge Ministers to continue both the associate route and the apprenticeship route, to give student nurses alternative routes into nursing, to boost nursing numbers and to develop nursing into a degree-entry healthcare profession.

Oral Answers to Questions

Karen Lee Excerpts

Tuesday 8th May 2018 Commons Chamber

[Mr Speaker]

I call Karen Lee. No? The hon. Lady is a most confusing individual.

[Karen Lee (Lincoln) (Lab)]

I wanted to ask a supplementary to the question about Boston.

[Mr Speaker]

Oh, well, blurt it out.

[Karen Lee (Lincoln) (Lab)]

23. Lincoln’s walk-in centre closed a few weeks ago and Boston’s paediatric department is threatened with closure. Does the Minister agree that cuts and privatisation in our NHS are damaging staff recruitment, retention and morale? [Interruption.] Ministers can shake their heads, but it is true: there are not enough doctors at Boston, which affects A&E and wider care delivery.

Cancer Targets

Karen Lee Excerpts

Tuesday 1st May 2018 Westminster Hall

[Mr Baron]

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

[Karen Lee (Lincoln) (Lab)]

I am the mother of somebody who died of breast cancer and I would argue that this is about the lived experience. It is not just about survival; it is also about the journey—getting there. If care is not adequate or good enough along the way, whether somebody survives or not—well, it is better to survive, of course, but I would argue that this is absolutely about the journey. Targets are meaningless if they are not about people and their lived experience.

[Mr Baron]

I completely agree. My worry about targets is that they focus on a very small, specific part of the journey when we should be talking about the journey as a whole. What I have not mentioned so far is that it was not just the one-year figures but the five-year figures that we were arguing for. We have to take a longer view of the journey in order to ensure that we take into account all aspects of it, including the support, the surround sound—the way of living—and so on. We have to ensure that those who survive receive enough support, but my central point is that if we really are intent on encouraging earlier diagnosis, the process targets have been too blunt a weapon. We all love them. Politicians love them. Both sides love them, and the Opposition can hit the Government with them if they are missed. It is a short-term approach. In reality, they have not improved survival rates to the point where we are catching up with international averages, and that is the key problem.

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[Mr Baron]

I broadly agree. Although a system as big as the NHS must always be able to respond to short-term emergencies, such as the winter crisis, longer-term thinking is needed to address key issues such as cancer survival. At the moment we have an absence of long-term thinking, let alone long-term funding, which is harming patients to the extent that we are not focusing on outcomes. In 2009 the then Department of Health’s own figures showed that 10,000 lives were needlessly lost because we were not meeting European averages for survival rates. I agree that we need longer-term thinking, and that is where outcome indicators, such as one-year and five-year cancer survival rates, would encourage not just long-term thinking, but long-term funding.

[Karen Lee]

That is a problem right across the NHS. We need to take the NHS out of the political arena. The absolute bottom line is that we need a proper, long-term strategy.

[Mr Baron]

I thank the hon. Lady for her support. I have been non-partisan on this matter, as I have been as chairman of the all-party group. Both sides have been guilty of trying to score political points on the back of process targets, because no Government have met them all in their entirety; we play this short-term political game when in reality what we need to do is, as best as possible, take the NHS out of politics and encourage long-term thinking. The best approach, at least with regard to cancer, would be to get the NHS to focus on those one-year and five-year survival rates. We could then stand back and say, “You are the medical experts and we are the politicians. We will hold you accountable, but use your expertise now to come up with the best plans to improve your one-year and five-year figures.” That would certainly encourage longer-term thinking and funding.

I am conscious that other hon. Members want to contribute, so I will not bore everyone with the ins and outs of the all-party group’s efforts to encourage the Government to break the link between the 62 days and the transformation funding, because discussions are still ongoing. However, I will share with the House the fact that I raised the issue at Prime Minister’s questions back in December. During a positive subsequent meeting in March, the Prime Minister agreed that all transformation funding should be released immediately, provided that relevant cancer alliances promised to produce a 62-day plan—the promise is the important thing; they did not have to produce them.

I am now in discussions with officials from No. 10 and the DHSC, because the system has been slow in following through what was agreed at that meeting. Following my further question at Prime Minister’s questions last Wednesday, the Prime Minister has agreed to meet me again, should we continue to make insufficient progress. Negotiations are now in train and I hope that we can get the funding released as quickly as possible, without waiting for the alliances to actually hit the 62-day target. The Prime Minister clearly said that she wants the transformation funding released on the promise that they will produce a plan to hit the 62-day target.

In the long term, the NHS needs to rebalance its focus away from process targets in favour of outcome indicators, such as the one-year cancer survival rates, that best help patients. If outcome measures are good and being hit, it follows that the processes will also be good; one cannot have good outcomes if there are not good processes. Patients will be seen and diagnosed in a timely fashion appropriate to their illness. These outcome measures will also have the benefit of allowing the NHS to design services and pathways flexibly, and without the straitjacket imposed by blunt process targets. That is the key issue here: focusing on the outcomes encourages the NHS at the frontline to devise ways of encouraging earlier diagnosis, including better awareness campaigns, wider screening uptake, better GP referral routes and better diagnostics. The NHS is encouraged to make those decisions at the frontline in order to drive forward earlier diagnosis.

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[Karen Lee (Lincoln) (Lab)]

I do not want to repeat a lot of what the hon. Member for Basildon and Billericay (Mr Baron) has said because he has already said some of what I was going to say. I am here because when I was elected I was asked by Breast Cancer Now to be an ambassador and I readily agreed. I will highlight a few things on its behalf.

Breast Cancer Now says that although some CCGs meet diagnosis and detection targets, there are national geographical inequalities in the provision of care, and diagnosis and detection are taking priority over treatment for secondary breast cancer, which is an issue. Transformation funding has been mentioned, and Breast Cancer Now feels that such funding must be decoupled from waiting time targets immediately.

My CCG is failing to hit the targets, which means it does not get the funding. If it is failing to meet the targets, how will withholding the money make things any better? I want the Government to tell us how that makes things any better. I understand about targets and measures, but how does not giving CCGs money to treat people properly make things any better?

NHS cancer targets have tended to focus on early detection and diagnosis, which means there is less focus and resource allocated to supporting people after they have finished treatment and are living with secondary cancers. One in four people find that the end of their treatment is the hardest part and they do not always have access to a clinical nurse specialist. My daughter did not. Things moved fast for my daughter. She was diagnosed and died within 13 months. She was just 35 and she left a husband and three children behind. To get her back into hospital was an absolute nightmare. I knew all the right things to say to get her into hospital and I finally managed it, but the support was not there. People try and do their best, but the support was not right and it was not good enough. The treatment for secondary breast cancer is not good enough and that really needs to be looked at.

Every cancer patient coming to the end of their treatment should have a recovery package. A clearer picture of progress on the availability of health and wellbeing events for people living with and beyond breast cancer across England is urgently needed. The Government, as the agency that ultimately decides how our NHS is run, must deliver on that and answer for that.

I was asked to mention the collection of data and access to clinical nurse specialists, because there has been no progress. Breast Cancer Care’s 2015 research showed that only a third of NHS trusts were collecting full data on secondary breast cancer, and three quarters of NHS trusts and health boards say there is not enough specialist nursing care available. People with secondary breast cancer feel they are second rate. Lynsey used to say that. She said, “It was all right, Mum, when I was having chemo and radiotherapy and everybody was buzzing round me, but now there is nothing. There is no support at all.”

I spoke on Breast Cancer Now’s 2050 vision in Parliament a couple of months ago. If we all act now, by 2050 everybody who develops breast cancer will live, and I really hope that that happens.

[Mr Baron]

The first point that the hon. Lady made about the iniquitous position that many CCGs now find themselves in is a strong one. The Government have given transformation funding of £200 million to NHS England, but a lot of it is sitting there when it is desperately needed, particularly by those that need to do a lot of catching up. It was not meant to be withheld in such a fashion. It is iniquitous also that the 62 days was retrospectively applied.

--- Later in debate ---

[Karen Lee]

This is not meant to be a political point, but if we want people to train as medical staff, we need to look at the funding for that, such as the nursing bursary, which has now gone. It has been noted that the number of people applying for training has fallen since the bursaries were withdrawn.

[Justin Madders]

I thank my hon. Friend for that intervention. We have touched on the impact of the nursing bursary on a number of occasions, and Labour has a commitment to restore it. There are also implications for the ongoing training and continuing professional development for nurses and other health professionals who wish to specialise. The budgets available for those kinds of initiatives are being continually squeezed.

Turning back to the issue of overseas recruitment, it is worrying to hear that there is a block on recruiting trained and “ready to go” staff from other parts of the world, because it is evident from the numbers we have talked about today, and not only in this area but in other areas across the NHS, that there is a funding crisis and a recruitment crisis. Actually, staff in some of the disciplines that we have talked about do the essential behind-the-scenes work that helps us to reach patients that bit quicker and makes the targets easier to meet.

Only yesterday, Macmillan Cancer Support released research showing that hospitals in England have more than 400 specialist vacancies for cancer nurses, chemotherapy nurses, palliative care nurses and cancer support workers. Macmillan said that cancer patients were losing out, with delays in their receiving chemotherapy, and that cancer nurses were being “run ragged”, as they were forced to take on heavier workloads because of rota gaps. It also reported that vacancy rates for some specialist nurses are as high as 15% in some areas. Clearly, those kinds of gaps will have an impact on our efforts to achieve the outcomes that we all want to deliver.

There is little doubt that we would enjoy much more success in meeting some of our aims, particularly in the cancer strategy, if the workforce had the resources they need. We welcomed the publication of the cancer workforce plan in December, although we would have liked to have seen it much earlier. I shall be grateful if the Minister will update us on the progress of that plan, if he has time to do so when he responds to the debate.

More generally, the “two years on” progress report on the cancer strategy was published last October, and it set out some of the progress that has been made, but we are now six months on from that. Again, if the Minister has an opportunity, I shall be grateful if he will provide us with an update. If he is unable to do so today, could he indicate when the next formal update will be available?

In conclusion, it is wholly unacceptable that we continue to lag behind many of our neighbours with regard to outcomes, but I believe that, with the right funding, the right strategy and support from the Government, the situation can change. I hope that the Minister, when he responds to the debate, will confirm that there are plans to put in place the world-class services that our patients truly deserve.

Points of Order

Karen Lee Excerpts

Wednesday 7th March 2018 Commons Chamber

[Mr Speaker]

I will say two things in response to the hon. Gentleman. First, he seeks and perhaps over-generously expects from me a degree of reassurance and even of wisdom that it is not within the capacity of the Chair to provide. Secondly, in asking how we—meaning the House as a whole—can be sure, I simply say that the hon. Gentleman, who is no stranger to these matters, raises something of a philosophical question. Whether, when and to what degree Members can be confident of certainty are not matters that can be broached now from the Chair. However, in so far as he was seeking—as the puckish grin on his face suggests—to register his own concerns, he has found his own salvation.

[Karen Lee (Lincoln) (Lab)]

On a point of order, Mr Speaker. At Prime Minister’s Question Time on 31 January, I asked for a meeting with a Minister and was promised that I could have one. I received a letter two or three weeks ago saying that the matter had been passed to the Department of Health and Social Care. I seek your guidance—or anyone’s guidance, really—on how I can progress that, because I have had no meeting and no date so far. That was five weeks ago, so I think I have been fairly patient.

[Mr Speaker]

The hon. Lady has certainly been patient. Sometimes, raising a point of order in the Chamber and reminding those on the Treasury Bench of a promised meeting that has not yet been delivered can be a remarkably effective way of bringing about said meeting. The other device that I recommend to the hon. Lady, who is a new Member of the House, is the tabling of a written question. If she is interested in exploring historic copies of the Official Report, she will know that the former Member for Manchester, Gorton, our late and dear friend Sir Gerald Kaufman, was fond of highlighting unanswered correspondence to which he demanded a reply, unanswered questions to which he demanded a reply, or undelivered meetings that he had been promised and on which he still insisted by tabling written questions to remind Ministers of those matters and inquire when the promised reply or meeting would take place. In my experience, Sir Gerald was remarkably effective at obtaining such responses, as indeed was the former Member for Walsall North, Mr David Winnick. The hon. Lady may usefully learn from their and many other examples.

Organ Donation (Deemed Consent) Bill

Karen Lee Excerpts

2nd reading: House of Commons
Friday 23rd February 2018 Commons Chamber

[Karen Lee (Lincoln) (Lab)]

I thank my hon. Friend the Member for Coventry North West (Mr Robinson) for introducing this important private Member’s Bill.

The NHS has just reached the historic milestone of 70 years. As a country and as a society, we are proud of the landmark advances we have made within that time. Because of advances in organ donation and transplantation, 50,000 people are alive today. Most people are willing to donate their organs after they die, but only 36% of the population are on the organ donation register. Organ donation is increasing gradually, but sadly it is not keeping pace with the number of people on the transplant waiting list.

The British Heart Foundation highlights the fact that an average of three people per day die in need of an organ. As someone who was a cardiac nurse in a previous job, I am only too aware of how desperate a patient can become when waiting for an organ to become available. I saw at first hand the distress that people suffered while waiting for a heart transplant or for another organ.

In Spain and Belgium, a softer opt-out approach has facilitated a cultural change that has generated higher donor rates. That is why I am here today supporting my hon. Friend’s Bill, which will address this bleak statistic and bring the discussion of organ donation back to the dinner tables of families across the UK. I also express my sincere thanks to the Daily Mirror for its campaign in support of the Bill, which has shown the public the gift of life that is given by those who donate organs.

One organ donor can transform as many as nine people’s lives. As has been mentioned, the UK has one of the lowest family consent rates in Europe. In Wales, the Welsh Government bravely introduced deemed consent. The rate at which Welsh families are approving rather than refusing the donation of their loved ones’ organs is showing a marked increase compared with the rest of the UK. The latest Welsh organ donation and transplantation statistics display a 72% consent rate, putting Wales above other UK countries.

[Mr Paul Sweeney (Glasgow North East) (Lab/Co-op)]

My hon. Friend gives the excellent example of how Wales is leading the way in changing the emphasis on organ donation. Does she share my dismay that no one from the Scottish National party has joined the debate today? This is a cross-border issue, and the SNP blocked a private Member’s Bill by Anne McTaggart MSP in the Scottish Parliament. Why has the SNP not led the way on this issue?

[Karen Lee]

I share that concern, and I had hoped that today we could have cross-party consensus. This issue is something on which we can all come together.

I represent Lincoln in the east midlands, where organ donation is the lowest in the UK. In a year, there were just 74 organ donors in the whole of the east midlands. In my constituency, there are around 40,000 registered organ donors. I am one of them—my card is in my bag. I am proud of the people of Lincoln, but even though that number represents a pool of opportunity, only a small number of people on the register pass away in such a way that allows their organs to be donated. In the last five years, only 10 deceased donors in Lincoln have been able to donate their organs.

Passing this Bill could save 500 lives a year. We need sensitive dialogue with those suffering from serious illnesses about the possible lifesaving capacity that their donation could have, should the worst occur. Conversations with grieving families can often be crucial in that process.

Yesterday, I spoke about the loss of my daughter, and when any family member is lost it is a terrible, terrible thing that stays with you forever. However, if someone can donate an organ and turn a negative into a positive, how much better is that? How much better would it be to salvage some positivity out of the situation? The Government have announced a consultation on opt-out consent on organ donation, which closes on 6 March, and the success of this private Member’s Bill might be the vehicle for that change. I hope that the Bill achieves cross-party support and makes progress today.