Cancer Strategy

Karen Lee Excerpts

Thursday 22nd February 2018 Commons Chamber

[Karen Lee (Lincoln) (Lab)]

I thank the hon. Member for East Kilbride, Strathaven and Lesmahagow (Dr Cameron) for bringing about this debate, which matters hugely to a lot of people.

Most of the speakers today will talk about the facts, figures and statistics, but I will talk about the impact of cancer on people behind the statistics. A lot of us in the Chamber have been affected by cancer. My daughter died at just 35 of breast cancer, and I will talk about cancer from a patient’s perspective. One in eight women develop breast cancer in their lifetime, and 80% survive for five years or more. About 95% of women will survive for one year, and my daughter survived for 13 months. Recent data show that 11,500 women and 80 men in the UK still die from breast cancer every year.

My Lynsey was diagnosed with triple negative breast cancer in April 2010, and she died just 13 months later. She was a very bright girl, with a degree in politics and a degree in social work, and she worked with underprivileged children. She had a husband and three small children, who were two, four and seven when she died. She was treated at Nottingham City Hospital under Dr Steve Chan—she had chemotherapy, radiotherapy and a mastectomy—and her treatment was just amazing. The staff just could not have been better. She came home for the final three weeks of her life to die, and the unqualified team that came in to support me and her husband, Mike, were just amazing as well. I can never thank them enough.

I want to talk a little about the information that Breast Cancer Now, a charity, has made available to me. I am an ambassador for it, because I decided that one of the things I wanted to do when I got elected was to be an ambassador for a breast cancer charity. It has said that

“it will be challenging to meet the objectives set out in the Cancer Strategy unless corrective action is immediately taken”.

My Lynsey’s cancer was advanced—it was stage 3 when diagnosed, so screening probably would not have helped her. The Breast Cancer Now report states:

“Breast screening is a key initiative to ensure the early detection and diagnosis of breast cancer. Although controversy still exists around over-diagnosis, its benefits are recognised to outweigh its risks in the Cancer Strategy, in detecting 30% of breast cancers and saving 1,300 lives a year from breast cancer.”

The report also talks about a shortage of staff—32% of radiologists are expected to retire between 2015 and 2025.

My daughter developed a brain tumour—a common secondary effect of breast cancer—and she had to go for radiotherapy. It is truly traumatic. She used to see flashing blue and white lights; she had to wear a mask. The really upsetting thing was that because of staff shortages, she often had to lie around on a trolley waiting for things. Imagine what it is like laying on a hospital trolley with cancer in your bone and metastasis—it is just so distressing. That is the effect on patients of short staffing. It is just a phrase in a report, but that is what it really means.

Breast Cancer Now’s report states:

“We are also concerned about the lack of access to Clinical Nurse Specialists for secondary breast cancer patients: only 21% of organisations in England, Scotland and Wales report having one or more CNS dedicated to secondary breast cancer. We know that access to a CNS can make a big difference to the way people with cancer experience their care, providing patients with support and helping them manage their symptoms. This is especially important for patients—

those like my Lynsey—

“with incurable secondary breast cancer who have particularly complex needs.”

Finally, Breast Cancer Now also said:

“We have serious concerns about the future of the National Cancer Patient Experience Survey as a result of the introduction of a new opt-out model scheduled in May 2018. The CPES has been a key driver of the improvements in cancer patient outcomes and experience since 2010.”

It is the aspiration of Breast Cancer Now that by 2050, everybody who develops breast cancer will live. I used to say to my daughter, “I’ve had so much of my life, more than you. I wish it could be me.” She used to say, “Mum, I wish it could be no one.” As parliamentarians we have power to influence things and change them, so perhaps we can join together across the House and make Breast Cancer Now’s vision a reality, so that by 2050, nobody need die of breast cancer.

East Midlands Ambulance Service

Karen Lee Excerpts

Wednesday 21st February 2018 Westminster Hall

[Ruth George]

We can always seek to manage resources better, but East Midlands ambulance service has been seeking to manage resources for a very long time, working with Unison and the unions there.

[Karen Lee (Lincoln) (Lab)]

Does my hon. Friend agree that the closure of Lincoln’s walk-in centre, despite the fact that 94% of the people who responded to the consultation said that they did not want it to close, cannot fail to have a further impact on EMAS and local services? We are told by the clinical commissioning group that it will not have an impact and that there will be other provision, but the local ambulance teams—I will come to this point when I give my speech—told me that it will absolutely have an impact. I wonder what her thoughts are on that.

[Ruth George]

Walk-in centres were established by the last Labour Government to reduce the demand on the ambulance services and to give people the services that they actually needed on their doorstep. Every cut of every walk-in centre is hugely worrying, both for patients and the ambulance service.

--- Later in debate ---

[Ruth George]

The fact is that walk-in centres are open late in the evenings and at weekends, and in most GP practices it is not possible to get an urgent appointment without phoning at 8 am exactly. In my constituency, people have to wait at least two weeks to get an appointment.

[Karen Lee]

When I went out with the ambulance team, one of the people who called and got an ambulance was an elderly gentleman of 91 who had breathing problems. He called an ambulance because he could not get a GP appointment or get to the walk-in centre at that point. It is not always people who are desperately ill who call ambulances; lots of people call ambulances in sheer desperation because they cannot get anything else.

[Ruth George]

That illustrates the point completely. We have seen a lack of primary care services, and doctors’ appointments are far harder to get than the 48 hours it took under a Labour Government. In consequence, we have a hugely overburdened ambulance service.

Now we come to funding. East Midlands ambulance service is already one of the most efficient in all the regions. In spite of the relatively sparse population and demanding geography, EMAS’s costs per face-to-face response are the third-lowest of all the regions—9% lower than the average across England. The costs per call are, again, the third lowest and more than 10% below the average.

By any measure, East Midlands ambulance service is very efficient, with 99% of its staff working on the frontline. Almost all managers take shifts so that they know exactly what is going on. It has cut all that it can, and it has had to make cuts, because EMAS has the second-lowest funding of all the regions—8% lower than the average across England. Only the North East ambulance service, which serves a more densely populated area, has lower funding than the East Midlands ambulance service.

The funding has not kept pace either with inflation or with the increased demand—in fact, it has barely increased at all in the last six years. In 2010-11, EMAS received £160 million for patient care activities. By 2016-17, we had seen over 16% inflation and a 50% increase in activity. Funding should be at least two thirds higher—£105 million extra would be the proportionate cost. Instead, East Midlands ambulance service received less than £5 million extra compared with 2011. That is less than 3% extra funding when it needed 66%.

East Midlands ambulance service has never been well funded—our region has always been the poor relation, as colleagues on both sides of the House often concur—but the cuts over the last seven years have made it impossible for it to meet its targets, and to deliver the right standard of service and care to some of the most sick and injured people, and the most at risk. That is what the Nottinghamshire coroner concluded in May 2016. In an urgent case review, she said:

“Demand is clearly greater than the resources they have most of the time”.

That is not the fault of any of the staff at EMAS. Last summer, the Care Quality Commission found that although the service was in need of improvement, it was caring and responsive—but it could not be safe or effective. The report states that there were

“caring, professional staff delivering compassionate, patient focussed care in circumstances that were challenging due to the continued demand placed on the service.”

The increased demand for primary care, emergency care and ambulance services is not being resourced. Our ambulance service is on the frontline. Our crews do their very best, but it is tough. Yes, staff sickness is slightly higher than average at EMAS, but I am not surprised. It is not just what the crews deal with; it is the constant stress and pressure, and the distress and anger that they sometimes face when they can finally arrive.

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[Matt Warman (Boston and Skegness) (Con)]

It is a pleasure to serve under your chairmanship, Mr Davies. I pay tribute to the workers on the frontline of the East Midlands Ambulance Service NHS Trust. At a constituency event, I met one who had had two teeth knocked out by a patient he was trying to help. He said, literally, “It is all in a day’s work.” Those dedicated people are doing great work. I want everything I say after this to be taken in that context.

EMAS receives a call every 34 seconds. It has been keen to embrace innovations—for example, it has done work in Lincolnshire on sepsis—which complements some of the challenges we face at United Lincolnshire Hospitals NHS Trust. It is telling that six of the seven Lincolnshire Members of Parliament are here in this Chamber. Lincolnshire faces the greatest challenges, although I do not want to diminish the challenges that EMAS faces elsewhere.

Originally, we had a Lincolnshire ambulance service. As my hon. Friend the Member for Gainsborough (Sir Edward Leigh) has said, EMAS was created to fix some of the problems we had in Lincolnshire, but I suggest to the Minister that it has palpably not done that. Some of the problems relate to handover. Only yesterday, a constituent informed me that there were 10 ambulances queuing outside Pilgrim Hospital, and he has informed me that at one point today there were 11. I make that point not to criticise a single member of the ambulance service but to endorse the point made by my hon. Friend the Member for Sleaford and North Hykeham (Dr Johnson). It is clear that we face problems, and we should look at how to solve them.

My right hon. Friend the Member for South Holland and The Deepings (Mr Hayes) made a fair point when he said that there are problems with the management at EMAS. To give but one example, I have raised problems with EMAS every time I have attended health debates in this place, and EMAS has not made a single proactive attempt to reach out to explain even what it is trying to do. I suggest that the waiting times and the service we get from management indicate that the ambulance service is not serving us, as the elected representatives of patients, or patients themselves. This is a serious situation.

I have a number of suggestions to put to the Minister. First, he should support the Lincolnshire County Council manifesto commitment to create, or at least to explore, a Lincolnshire ambulance service. In various parts of Lincolnshire—particularly in my coastal, sparsely populated constituency—there is a huge drain on resources as ambulances inevitably go westwards and do not come back. A Lincolnshire ambulance service, using sensible modern technology, could achieve a great deal more than what was possible under the previous regime, and would address some of the challenges we face simply due to the rather random creation of EMAS—as the hon. Member for Bassetlaw (John Mann) has said, the east midlands is an area that does not really exist in the mind of the public.

To go slightly further, it would be good to see the Minister continuing the work that was done prior to the reshuffle, looking at what we can do sensibly to combine blue-light services. We already do some creative work in Lincolnshire with the fire brigade. We do some really important, sensible things that allow the fire brigade to save lives. Indeed, in some cases, they are saving lives that, under previous, unreformed systems, would not have been saved. There is good work to build on.

[Karen Lee]

Does the hon. Gentleman agree that if we ask firefighters to extend their role, that should be properly resourced and funded and not just given as an extra job on top of what they do already?

[Matt Warman]

I agree, of course, that we need the resources and reform package that will put us where we need to be. As my right hon. Friend the Member for South Holland and The Deepings has said, the issue is not solely about money—though to be fair to everyone present, I do not think that anyone is pretending otherwise —but of course proper resources are a big part of the equation.

Sensible moves on a blue-light combination would be a logical thing to do. I also think that one of the problems we face—this relates both to the issue of handover and to the number of ambulances waiting outside hospitals—is in large part due to the recruitment and retention challenges we have in Lincolnshire. A medical school in Lincolnshire would play a part in solving some of those problems. I say that in part because we need to recognise that this is a system problem, not solely an EMAS problem.

In conclusion, I was all set before the debate to stand up and say that successive Governments have not managed to get a grip on this problem—

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[Karen Lee (Lincoln) (Lab)]

I personally have witnessed how hard EMAS staff work. I pay tribute to their professionalism and dedication.

On 18 January my right hon. Friend the Member for Islington North (Jeremy Corbyn) came to Lincoln and we visited the call centre up at Bracebridge Heath. We saw at first hand what was happening. We were told that the single biggest problem in the increase in response times is when the ambulances get to hospital and cannot hand patients over. The day before I went out with an ambulance crew, there had been a seven-hour wait to hand over and at 7 am the next morning 22 patients were still waiting in A&E for a bed. As I have said, during my right hon. Friend’s visit we talked to ambulance crews and the handover time at hospital is causing the problem and increasing response times.

On 3 January I went out on my own with a crew—I, too, am a healthcare professional: a nurse. Ordinary people were phoning for ambulances. An elderly gentleman called one because he could not breathe and was terrified —he actually had a chest infection, so he was given a nebuliser and did not have to go to hospital, but he had not been able to get a GP appointment. We went to an old lady who had fallen and was on the floor. The paramedics dealt with her and within an hour we left her—she stayed at home and did not need to go to hospital. Our ambulance services deal with all sorts of cases.

A more personal example is my mum, who has mental health problems—she had a breakdown a few years ago. The Friday before Christmas, at half-past 4 in the afternoon, I was called from my office to go to her. I went, called 111 and got her assessed by about 6.30 pm or 7 o’clock. I did not get an ambulance until quarter to 1 in the morning. She just had to wait. There was a bed at Witham Court, but we could not get an ambulance. My mum was getting increasingly distressed—she was in a right state and I had to sit with her. If I had not been there, my stepfather would have had to deal with her, and he has dementia. I was wandering around Tesco at 2 am on the Saturday before Christmas because I had had to stay in to look after my mum—another ambulance wait.

Other examples are personal to me because I am a cardiac nurse. When my right hon. Friend the Member for Islington North came to Lincoln, we went to the heart centre. I am also aware of stuff that has come through my post bag about people with chest pains waiting two and a half hours for an ambulance. The figures for issues such as door-to-balloon time are all going up at Lincoln County Hospital because people who are actually having heart attacks cannot get an ambulance. They are at risk of going into an arrhythmia, whether it be VT or VF—ventricular tachycardia or ventricular fibrillation—because they are having a heart attack. They are not getting the treatment they need, because they are waiting for an ambulance.

Our NHS is in crisis. It is time that the Government acknowledged that. If A&E is so packed that ambulances cannot hand over, the NHS is in crisis—please admit that and let us do something about it. What is happening with EMAS is symptomatic of the situation. NHS workers are underpaid right across the board, with a pay cap, and they are understaffed. All those things work together. I feel sorry for EMAS—at the moment it is set up to fail and there is nothing it can do about that. I am sorry, but this is utterly political: why do we starve public services of resources? It is all right to say that we are giving them money, but we are not giving them enough money. When we do not give them enough money but cut taxes, frankly that is immoral.

[Geraint Davies (in the Chair)]

I call Ben Bradley. Is he here? He has just walked out, has he? He was here. I am sorry about that. I will call the first Front Bencher instead.

NHS Winter Crisis

Karen Lee Excerpts

Wednesday 10th January 2018 Commons Chamber

[Jonathan Ashworth]

My hon. Friend makes a moving contribution to the debate. Those people in Stoke whose relatives have been waiting so long on corridors will see the Prime Minister saying, “Nothing is perfect,” but the truth is that we do not want perfection—we just want a bit of dignity and humanity in our health service.

[Ms Karen Lee (Lincoln) (Lab)]

rose—

[Jonathan Ashworth]

I give way to my hon. Friend, who has been working in her constituency over Christmas.

[Ms Lee]

This time last week, I went out with an East Midlands Ambulance Service crew for a shift, and they told me that over the Christmas period they were waiting two hours and more outside A&E at Lincoln Hospital. They also said that they were not even just sitting in the ambulance—one of them, a paramedic, was going inside and cannulating patients, working in resuscitation, and clerking patients. Will my hon. Friend comment on that and on what we will do about it in government?

[Jonathan Ashworth]

My hon. Friend makes a powerful, and indeed raw, contribution to our proceedings, because she was working over the Christmas holiday on the frontline in Lincoln. I pay tribute to her and all her colleagues there. I hope that the Secretary of State reflects on her contribution and responds to it in his remarks.

Mental Health Units (Use of Force) Bill

Karen Lee Excerpts

2nd reading: House of Commons
Friday 3rd November 2017 Commons Chamber

[Oliver Dowden (Hertsmere) (Con)]

Thank you very much for calling me to speak so early in the debate, Mr Speaker. I should like to begin by paying tribute to the hon. Member for Croydon North (Mr Reed) for bringing forward this legislation, which I very much support. In common with most Members, I am sure, I find that mental health is a rising issue in my constituency. Many of my constituents frequently contact me about it and many have particularly asked me to speak in this debate. I want to talk about two provisions in the Bill that I think are important. First, it is important to have transparency. As someone once said, sunlight is the best form of disinfectant. If people can see what is going on, they are much less likely to behave in an inappropriate fashion. The use of body cameras in many other areas of police work has done a great deal of good, so their introduction in this area, through the Bill, is to be welcomed.

Secondly, I welcome the provisions in the Bill on effective recording. One of the frustrations of my constituents who have mental health problems or whose family members have mental health problems is that the information on their interactions with public bodies—whether the police, local authorities or schools—is not properly collated or shared. Patients and their families therefore feel that they are constantly going round in circles repeating information. The more we can do to retain that information effectively, the better treatment those affected will receive. The root of all this lies in the need for a change in attitudes towards mental health; my constituency is emblematic of the changes that have taken place over the past 30 or 40 years.

[Ms Karen Lee (Lincoln) (Lab)]

Does the hon. Gentleman agree that, no matter what equipment we have, the root of the problem is not having enough staff to deal with these situations? I am a nurse, and I know that we do not have enough nurses. It is as easy as that, and we need to address the problem.

[Oliver Dowden]

I quite agree that we need to have the right levels of staff, and that is why I am so pleased that the Government have protected police funding. I was going to come on to this point, but I will raise it now. In the health service, we are moving towards achieving parity between mental and physical health. Some of the stats on this are very welcome. We are now spending £11.6 billion a year on mental health, for example. I believe that that is more than we have ever spent before. Also, the Health and Social Care Act 2012 is giving parity of esteem.

NHS Pay

Karen Lee Excerpts

Wednesday 13th September 2017 Commons Chamber

[Jonathan Ashworth]

I will make progress, if I may.

MPs on both sides of the House have spoken out against this pay cap. We would hope that they will join us in the Division Lobby, including the hon. Member for North Antrim (Ian Paisley). I pay tribute to my hon. Friend the Member for St Helens North for tabling early-day motion 132, which calls for an end to the NHS pay cap, and which we have picked up and adopted as our motion today.

I know there are many who have sympathy for getting rid of the pay cap. The reason that many in the House have sympathy for getting rid of the pay cap is that in all our constituencies we have met nurses, very directly at our advice surgeries, or indeed in lobbies at Parliament, who have told us that the cap has meant they have seen a 40% real-terms drop in their earnings since 2011.

[Ms Karen Lee (Lincoln) (Lab)]

rose—

[Jonathan Ashworth]

I want to make progress; but I will try to let in as many hon. Members as possible.

We have all read reports of nurses on their way home from a shift stopping off at food banks. The Royal College of Nursing tells us that two-thirds of its members are forced to undertake bank and agency work to help make ends meet. Is that not an example of how self-defeating the pay cap is, because it is driving an agency bill of £3.7 billion in the NHS?

We have all read surveys showing that more and more NHS staff are turning to payday loan companies and pawning their possessions, and we will have heard from the RCN lobby recently of the huge hardship that our nurses are facing. Many nurses have been in touch with us.

Let me give the House the story of Rebecca, who got in touch with my hon. Friend the Member for Oldham East and Saddleworth (Debbie Abrahams). Her story brings into sharp focus the impact of the pay cap, particularly when it is combined with the severe social security cuts that the Government are pushing through. Rebecca is a single parent. She was originally on working tax credit, but she was transferred to universal credit last year, with her payments falling as a result. As a consequence of that reduction and of the ongoing cap on her wages, which have lost their value, she has accrued rent arrears of over £800. Her landlord has now issued her with an eviction notice. There we have it: nurses are turning to food banks, pawning their possessions, and even being issued with eviction notices. Is that not shameful in 21st-century Britain? What a depressing human consequence of Tory economics.

[Ms Karen Lee]

I am a nurse and I believe in fairness. This is not just about paying nurses properly; it is about the porters, the housekeepers, the cooks, the cleaners and the admin staff, because they all do a good job. This is about not just healthcare workers but the whole public sector, because if the Government can find £1 billion for the DUP, they can pay the public sector properly.

[Jonathan Ashworth]

What a pleasure it is to see a Labour MP in Lincoln, Mr Speaker. My hon. Friend is a former nurse—

[Ms Lee]

Still a nurse!

[Jonathan Ashworth]

She is still a nurse—I do beg her pardon—and she makes her case powerfully.

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[Mr Hunt]

Hang on. I think it is important to listen to what the Governor of the Bank of England said. Sir Mervyn King said:

“we came into this crisis with fiscal policy along a path that was not…sustainable and a correction was needed.”

What was he talking about in 2010? The Government borrowed £1 in every £4 that they spent. The deficit was 10.2%, the highest since records began. The reason that, say, Germany did not have to go through austerity is not because a German equivalent of the Leader of the Opposition was throwing prudence to the wind but because Germany did not allow its public finances to get recklessly out of control, which is what happened under the Labour Government.

[Ms Karen Lee]

This is a genuine question. I am a nurse, and I see the situation at first hand. I go to work once a month—I still do bank shifts—and the situation is truly awful. We are so understaffed that it is unbelievable. I looked after 10 patients on my last shift. That is not for the audience; it is the truth. The NHS is in that sort of state. Lincoln’s walk-in centre is threatened with closure. All that is going on. I take the Secretary of State’s point about paying for it, but the Conservative party talks about cutting corporation tax and it is paying the Democratic Unionist party more than £1 billion. While that is happening, he cannot talk to us about austerity and say that we cannot have decent NHS services. I am sorry, but he should listen to what I am saying. The NHS really is in crisis.

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[Dr Whitford]

That was exactly the point I made at the start of my speech. Although the Royal College of Nursing led the campaign and the image has been of nurses, the issue affects everyone. I echo what the hon. Member for Lincoln (Ms Lee) said—[Interruption.] Well, it was the RCN out at the front.

[Ms Lee]

Unison were a part of it.

[Dr Whitford]

Okay—

--- Later in debate ---

[Ms Karen Lee (Lincoln) (Lab)]

I am pleased to speak in this Opposition day debate on the public sector pay cap. I was elected as a Labour MP for Lincoln on a fully costed manifesto, and I am proud to be a member of the shadow Treasury team.

Our NHS is chronically understaffed, and there are not enough nurses, doctors, midwives, healthcare support workers, housekeepers, occupational therapists or physios—I could go on and on. Taking a leaf out of Jeremy’s book, I spoke to some of my colleagues. I spoke to Rachel, a senior occupational therapist. OTs focus on how to support and enable people to live well at home. They empower people to be as independent as possible and to access jobs and education. We simply do not have enough OTs in our hospitals, which might be a clue as to why we have such long waiting lists for social care assessments and why we have delayed discharges.

I also spoke to Sue and Maz, who are both healthcare support workers. They wash our patients, take them to the toilet and give them back their dignity when they feel at their lowest ebb, and much, much more. Nurses cannot deliver holistic patient care without the support of a healthcare support worker. Maz told me that her family have had to cut back considerably because her wages have not gone up with the cost of living. She is on leave in a couple of weeks, and she will be working bank shifts to pay for basic household items that she cannot afford out of her regular wages. Her son is at university, and he gets a grant because the family are on a low income despite both Maz and her husband having jobs. Her son’s grant is not enough, so he is working part time alongside his studies. Next year, Maz and her husband will have to help to support him so that he can cut back on the hours he works so that he is able to study more in his final year at uni.

Another healthcare support worker, Sue, with whom I worked for 12 years, told me that she has had to cut back on her spending every single day. After working for the NHS for 20 years, her hourly rate is £1.75 above the current legal minimum wage. Again, both she and her husband have jobs and cannot make ends meet.

Gail is a housekeeper, and she told me that she has to work extra bank shifts just to make ends meet. She has not had a holiday since 2009 and, after paying her bills, she has £20 left each month. She has to do bank shifts if she wants to buy anything for her grandchildren or take them out. Again, she and her husband both have jobs.

Those women, like me, are in their 50s and will not be able to retire until they are 67. The one thing that they all told me is that they love their job. They love the patients and the people they work with, and they would not do anything else. I used to be part of that team, and I know that nurses feel the same. The trouble is that this Government have taken advantage of that hard work and loyalty for far too long, and some people just cannot afford to stay in the NHS. People cannot afford to train without a bursary, let alone stay in the NHS. To quote Gail:

“You can earn more…at Lidl than I get.”

The Government simply must pay all public sector workers what they are worth and what they deserve. They must reinstate bursaries—

[Mr Deputy Speaker (Mr Lindsay Hoyle)]

Order. It is so unfortunate that time has run out.