Cancer Strategy

Debate between Lisa Cameron and Jim Cunningham

Thursday 22nd February 2018 Commons Chamber

[Dr Lisa Cameron (East Kilbride, Strathaven and Lesmahagow) (SNP)]

I beg to move,

That this House has considered the Cancer Strategy.

Thank you, Madam Deputy Speaker, for your guidance. I will try to behave much better timewise in this debate, which it is an honour and a privilege to introduce. I pay tribute to the Backbench Business Committee for enabling the debate, to the all-party parliamentary group on cancer for its timely and extremely important report and, in particular, to the hon. Member for Basildon and Billericay (Mr Baron), who could not be with us today but deserves our thanks for the extraordinary amount of work he has done on this issue.

We in the House are all on the same side against cancer and in our ambition to achieve world-class cancer outcomes. My speech will address—briefly, according to your instructions, Madam Deputy Speaker—the recommendations of the all-party group’s recent report, “Progress of the England Cancer Strategy”. The report received more than 80 contributions from charities and bodies and truly reflects the passion in the sector, but it is also a cry for help, progress and a positive way forward. My speech will address the report’s four main areas of concern: workforce strategy, data, transparency and funding. It is open to colleagues to raise all aspects of cancer care and treatment, but, on behalf of the all-party group and the hon. Gentleman, I will stick to the recommendations in the report.

The report considers progress as we reach the halfway point of the NHS cancer strategy 2015-20 and is the result of an inquiry that the all-party group held last summer and autumn. The inquiry was formally launched at a summer reception last July and the number of written submissions was far larger than anticipated, showing the dedication of those working in the field. Many submissions came from cancer alliances and others on the frontline of the services being provided and identified many pressures and challenges. The evidence from frontline services in particular seemed to amount to a call for help. In its report, the all-party group concluded that although progress had been made since the launch of the strategy, the NHS

“will struggle to achieve the objectives set out in the Cancer Strategy unless corrective action is immediately taken.”

To this end, the all-party group has listed recommendations, a copy of which will shortly be sent to all MPs. The lack of workforce planning emerged as a key concern. The cancer workforce is constantly recognised as the biggest barrier to implementing our strategy. We are all pleased that Health Education England published its report into the cancer workforce in December 2017, but it was originally promised for December 2016. According to written evidence from Breast Cancer Now, the workforce is the greatest challenge in delivering the cancer strategy. The all-party group also heard that transformation funding is being withheld from cancer alliances because of their performance against the 62-day waiting-time target—a new conditionality of funding that emerged only after the bidding process had closed.

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

I appreciate the hon. Lady acknowledging the cancer organisations, such as Macmillan, which often rely on subscriptions. Does she agree—I am sure she does—that the public should be encouraged to give more subscriptions where possible?

[Dr Cameron]

Absolutely. The hon. Gentleman makes an excellent point. These agencies are working on the frontline with people and families at their most vulnerable and deserve all our encouragement, praise and, of course, funding.

In addition to setting out how cancer alliances are to be funded and supported for the duration of the strategy and into the future, the all-party group strongly recommends that the 62-day waiting-time target be immediately decoupled from any release of funding to the alliances. The previously mentioned issues prevent progress in improving cancer care and treatment, which is not our collective vision. The all-party group also heard that improving transparency in priorities and accountability would help to support the delivery of the strategy. At the moment, a lack of clarity and lines of communication are delaying its implementation. Publishing a detailed progress update on each of the strategy’s 96 recommendations would be a positive step forward.

It is generally accepted that the 62-day waiting-time target has been treated as a higher priority among clinical commissioning groups and cancer alliance leaders than survival or stage at diagnosis, as shown by the linkage between funding and performance against the measure. Decoupling funding from process and target performance in favour of a greater focus on outcomes would strongly be in the interests of patients, not least because, if outcomes are good and survival rates increasing, processes will also be functioning efficiently and correctly.

Autism Community: Mental Health and Suicide

Debate between Lisa Cameron and Jim Cunningham

Thursday 30th November 2017 Commons Chamber

[Dr Cameron]

I thank the hon. Lady for her important words. The bedrock of much of the work undertaken across the UK is such small charities, often run by those who have personal experience and know what works and what needs to be done.

The level of interest in the debate shows the importance of the issue. It is important to so many across the UK, including charities such as those already mentioned. Many charities have contacted me with important recommendations, including Autistica, the National Autistic Society, the Royal College of Psychiatrists and the British Psychological Society.

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

I congratulate the hon. Lady on securing this debate. Will she join me in congratulating women’s organisations in Coventry that are very much involved in mental health issues among younger people and older people in particular? What help can they get? Often, women act as carers and the Government should do something about that and give proper grants to those organisations.

[Dr Cameron]

That is an extremely important point. We must bear it in mind that for young people with autistic spectrum disorder, there is often a family-systemic approach, with carers are at the forefront of providing support, and they need the best resources possible.

I also thank the many citizens from across these isles who have contacted me to give their own poignant personal accounts. These accounts have been harrowing to read—and more harrowing for them to experience—and make us realise just how absolutely vital this debate is.

I also want to extend a personal warm welcome to the youth patrons up in the Gallery today representing Ambitious About Autism. Their recent campaign and research project, “Know your normal”, has been helping many people and raising important awareness. I pay specific thanks to the hon. Member for South Cambridgeshire (Heidi Allen) and the right hon. Member for Chesham and Amersham (Mrs Gillan), who have worked tremendously hard on this debate, on behalf of people with autistic spectrum disorder, through the all-party group over many years.

As a psychologist, I know that progress has been made on autism and mental health over the many years since I started in 1990, when waiting lists were extremely long—possibly a year and more—and services were very limited. However, much more must be done across the United Kingdom.

--- Later in debate ---

[Dr Cameron]

Yes, I wholeheartedly agree with that point. I have personal clinical experience of that through working across a variety of secure hospitals and prisons in my practice with the NHS. People with autistic spectrum disorder often find themselves caught up in the criminal justice system, which has little awareness of their needs or of the support that they require. When they get caught up in the system, it is difficult for them to move on and rehabilitate because the provision simply is not there.

[Mr Jim Cunningham]

Following on from the point made by my hon. Friend the Member for Cardiff West (Kevin Brennan), there is an argument that the police lack the training to handle some of these young people because they do not understand the nature of their mental illness. Does the hon. Lady agree that something needs to be done to provide the police with the necessary training?

[Dr Cameron]

I agree. Our police are on the frontline and they deserve the utmost respect for the work they do, but yes, it is correct to say that they require further training and also further support. There requires to be a clearer pathway when people exhibit challenging behaviours in the community, from the point at which the police are put into contact with them right through to the provision of adequate support in the health system, without their being caught up in the criminal justice system in between.

--- Later in debate ---

[Dr Cameron]

I agree. That is an extremely valid point. If people arrive at A&E for crisis intervention and are admitted for a period of time, it is important that they are discharged with some follow-up. People often return to the same circumstances that led to the difficulties in the first place, and if they do not have some support to deal with those difficult circumstances, they may be in a vulnerable situation and may try to self-harm or take their own life once again.

If a person with autistic spectrum disorder feels unable to go to the GP or to reach out to services in their local community, they might try to ring a suicide helpline. However, that can be extremely difficult in itself for a person with autistic spectrum disorder who finds communication and social interaction difficult. They might be able to verbalise only some of their difficulties, and they may then find there is no follow up from that service, either. Early access points and early intervention are crucial to preventing suicide and preventing mental health problems being exacerbated. Much more has to be done at that critical early intervention stage to ensure access to services.

If a person with autistic spectrum disorder reaches a health professional, they often find that their mental health problems are overlooked or misdiagnosed, which might be because they present an extremely complex case. They might also have concomitant learning difficulties, and they might not present the symptomatology that would usually be expected for anxiety or depression per se because their symptoms are complicated by their autistic spectrum disorder. It is extremely important that mental health practitioners have training in autistic spectrum disorder, in the types of presentation that they might need to identify and, particularly, in risk issues.

Diagnosis is still a postcode lottery. I hope to continue working with the Minister on that issue, because we need an understanding of who is appropriately trained in diagnosis of autistic spectrum disorder and what level of specialty we have in different professions. What is the workforce plan to ensure that this very great need is addressed across our society? This is so important. People with autistic spectrum disorder say they do not know where to go locally. As a member of the Select Committee on Health, I have asked services about that, and they say, “We don’t really have a map of who can diagnose and who can provide specialist intervention in a given area of NHS England.” Streamlined services would make it so much easier for people to gain that initial access.

I do not want to take up the whole debate, so I will provide a brief overview before letting others speak. Many Members want to contribute to this important debate, but I wish to touch on a few other important issues.

I request that the Minister look at what mental health therapies work specifically for people with autistic spectrum disorder who have concomitant mental health difficulties. There is no adequate research base yet, but we know it is critical—it is lifesaving—so we need to prioritise funding. Traditional mental health therapies might not work in the same way for people with autistic spectrum disorder. If one of us presented at a GP surgery, we might be offered cognitive behavioural therapy, but we do not know whether that is the best option for a person with autistic spectrum disorder, or whether some kind of adapted therapy would be more appropriate. That important work should be undertaken, and undertaken quickly, to engage people in appropriate therapies and save lives.

I have been contacted by a couple of individuals whose poignant accounts have struck me. One is an individual from my constituency who says that she has continually tried to access CAMHS for her daughter, who has been repeatedly self-harming. It has placed the family in such a stressful situation over a lengthy period that the family, including the mother and carers, now feel that their own mental health is under stress.

It is extremely important that we ensure not just that individuals can access the system but that we preserve family life, that we support carers and families, and that we do not place an additional burden on the NHS and other services. Families and parents may go on to develop their own depression and anxiety when dealing with an intractable situation because they do not know how to cope. If we do not address the problem at its root, we will multiply the problem for services across the UK.

[Mr Jim Cunningham]

I met a number of carers some months ago, and one thing that struck me was that from time to time they were extremely distressed. Some of them could not afford a holiday and they do not get very much help, to say the least,—they are not even paid as carers—so there is an effect on the mental health of the carers sometimes as well.