Community Pharmacies

Nicholas Dakin Excerpts

Wednesday 2nd October 2019 Westminster Hall

[Nic Dakin (Scunthorpe) (Lab)]

It is a pleasure to serve with you chairing today, Sir David. It is also a pleasure to speak in a debate in which the contributions so far have been full of knowledge and experience of the grassroots. I congratulate my hon. Friend the Member for Halifax (Holly Lynch) on securing it and on setting out at the start, from her own personal experience, the strength and importance of community pharmacies in their communities. They really are at the heart of communities.

My right hon. Friend the Member for Rother Valley (Sir Kevin Barron) spelled out clearly the potential of community pharmacies. I think the Government recognise that potential in their NHS long-term plan, but as my hon. Friend the Member for Halifax pointed out, they do not provide the funding to deliver on that potential.

Every day in this country, 1.6 million people visit a community pharmacy, so it is not surprising that the 2016 petition to save community pharmacies was one of the largest ever seen in this House. It demonstrated the commitment of communities across the country to their community pharmacies.

In visiting local community pharmacies across Scunthorpe, Bottesford and Kirton in Lindsey, I have seen the huge range of work that they do: dispensing medicines, dealing with minor injuries, administering flu jabs, and, as has already been said, being at the sharper end of drug shortages. Making sure that the drugs are there is a massive job and needs a lot of resource to ensure that it is done. As other colleagues have said, community pharmacies are a core part of the public health network, doing important work.

Community pharmacies are at the heart of communities and keep an eye on people, arranging their medicines in trays and delivering them free of charge to people’s doors. However, as my hon. Friends the Members for York Central (Rachael Maskell) and for Heywood and Middleton (Liz McInnes) have said, what is now developing is a drug delivery tax, which threatens the survival of this service. That is because the very people who most need it are the very people who will not use it—that is the nature of the loneliness and other challenges in these communities, as my colleagues have said.

As the hon. Member for Westmorland and Lonsdale (Tim Farron) said, pharmacies are very important in rural areas, but they are also crucial in areas such as Westcliff, which is in the heart of the urban part of my constituency. There, the community pharmacy is the only health service that is close to the local community, which has many health needs.

A local community pharmacist contacted me recently, and I will use his words to describe what it is like at the sharp end. He points to

“Huge shortages and price hikes by suppliers of generic drugs from July 2017 onwards”,

and says that the Department of Health is

“not reimbursing us for even the cost of drugs, let alone giving us a purchase margin”—

something my hon. Friend the Member for York Central talked about in great detail and with great clarity. He says his pharmacy has been losing £10,000 a month since July 2017. He has not been able to afford to replace the two dispensers who have left in the past three months, so local people are losing their jobs as a result of the cuts, and the pressure on those remaining, although they continue to work really hard—I know because I visited them recently—is beginning to take its toll.

He says:

“The government has agreed to a five year funding package with no annual increase to the funding package. I would have at least expected an index linked funding package with index linking to NHS pay rises. The DHSC has given pay rises to all the other sectors of healthcare like GPs and Dentists but has chosen to effectively give a 9% cut over 5 years to community pharmacies.

As you know, community pharmacies are still struggling from the impact of the £250 million cut announced in December 2016. Since then, I have struggled…and…I have had to borrow hugely just to keep afloat. The net result is that my business is in danger of defaulting on the bank loans/overdrafts and might be potentially looking at bankruptcy. I have 20 employees who are mostly Scunthorpe residents and they are unlikely to find any work quickly if we were to go under.”

That pharmacist asks me to ask the new pharmacy Minister, who I congratulate on her appointment—she has shown since she came into this House her commitment to this area of work, and I can see from the way she is listening to the debate that she wants to make a difference—several questions. They are:

“why the Government chose not to give community pharmacy a pay rise given to other primary care health sectors…why the funding was not index linked…how the Government expects us to invest in our staff and premises with what is essentially a cut”

and

“how community pharmacy is expected to be part of Primary Care Networks when our sustainability is in jeopardy.”

That is from the frontline, from a man who is delivering excellent service to my local community and to patients locally and who wants to carry on doing so. The Government recognise the value of community pharmacies. If they want community pharmacists to continue to deliver, they need to give them the ability to do that, and not to speak nice words, without delivering. As well as talking the talk, the Government need to walk the walk on community pharmacies.

--- Later in debate ---

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

It is a pleasure to serve under your chairmanship, Sir David. I thank each and every right hon. and hon. Member who has contributed. Most importantly, I thank the hon. Member for Halifax (Holly Lynch) for securing this debate and allowing us to discuss the challenges and celebrate the opportunities that lie ahead in community pharmacies, as well as how we best deliver to patients. The right hon. Member for Rother Valley (Sir Kevin Barron) and the hon. Members for Scunthorpe (Nic Dakin), for York Central (Rachael Maskell), for Heywood and Middleton (Liz McInnes), for Great Grimsby (Melanie Onn), for Strangford (Jim Shannon), for East Londonderry (Mr Campbell) and for Westmorland and Lonsdale (Tim Farron) all made excellent speeches that gave food for thought, as did the contributions from the hon. Members for Motherwell and Wishaw (Marion Fellows) and for Washington and Sunderland West (Mrs Hodgson). They celebrated exactly what community pharmacies can do if they are embedded in the heart of their communities and what untapped potential there is for moving forward.

I am pleased to have the opportunity to set out the vision for community pharmacy at a pivotal time for the pharmacy sector. As we have discussed, the past three years have been challenging, but there is a new pharmacy sector agreement. I am continually inspired, as everybody has been—we heard about the experience of the hon. Member for Halifax of working in a pharmacy—by the compassion, dedication and commitment of those who work in the NHS family. I saw that myself last week when I met pharmacists and the chief exec of the Pharmaceutical Services Negotiating Committee at the local pharmaceutical committee conference. That underlined to me again what an essential part of the NHS the pharmacy is, working day in and day out on improving outcomes for patients and for the community, which lies at the heart of what they do.

We have heard about the challenges of different communities. The hon. Member for Westmorland and Lonsdale made his point very well, as did other Members who represent rural constituencies. The hon. Members for Strangford and for Motherwell and Wishaw mentioned that the challenges are slightly different in rural, dispersed communities. We hope that the new contract will not be one size fits all but will give additional help to rural pharmacies to help them deliver, because we know that they are an important and integral part of their local community. Ensuring that we maintain a good level of access in England and support pharmacy where there are fewer pharmacies is important and built in.

Community pharmacy always has been an integral part of our communities. We have 11,500 community pharmacies delivering. I pay tribute to the right hon. Member for Rother Valley for his work in chairing the all-party group on pharmacy. He explained clearly how pharmacies are close to 96% of people, who can get to one by foot or on public transport in 20 minutes. The key thing for me was when he said that the majority were in areas of high deprivation. That is hugely important as the contract moves forward, because we are determined to double down on health inequalities, and we know that the pharmacist is a key frontline expert who can help deliver in those communities. Pharmacy can play a greater part in helping people to stay well in their communities.

Today’s debate is timely because the new landmark arrangements for pharmacy—a five-year deal for pharmacies—came into force yesterday. I have heard the deal criticised as flat, but the PSNC said that it wanted certainty; it wants to be able to use its skills better and further, and we have determined the deal in collaboration with it. The deal is the beginning of a programme to transform the sector and to see community pharmacies play a much expanded role in the delivery of health and care across prevention, urgent care and medicine safety. Those new arrangements will support the pharmacy team to utilise all its extensive clinical expertise, further developing new roles and providing the community with the knowledge, skills and support to prevent ill health, manage minor conditions and stay happy and healthy for longer. We have heard from virtually every Member who has spoken about how much that goes on. The hon. Member for Great Grimsby told a moving story of how intimate the relationship is between the community pharmacist and the community that he serves.

The deal sets a programme of work that the Department, NHS England, NHS Improvement and the PSNC have collaboratively developed and agreed—we have worked together to get there. Our direction of travel is clear, and we will continue to work together on the detail, strengthening the role of community pharmacy and the delivery of health and care year on year for the next five years and beyond.

[Nic Dakin]

The Minister is setting out the aspiration well, but does she recognise that having no increase—even by inflation—for five years is a desperately big challenge for community pharmacies?

[Jo Churchill]

On the matter of reimbursement, which was also raised by the hon. Members for York Central and for Westmorland and Lonsdale, we seek to ensure a fairer system of reimbursement for pharmacy contractors and value for money for the NHS. I am sure we would all agree that that is the challenge that we face the whole time. That is why, in July, we launched a consultation on community pharmacy drug reimbursement. We have engaged widely with pharmacy stakeholders and have had an excellent response. We will consider all those responses fully and set out plans for the fairer system in due course. I appreciate that the response will be, “But it’s needed now,” but a pharmacy is a private business, and reimbursement is not pharmacies’ only form of income. What I am talking about will take a shift. There is an acknowledgment that that shift—that transition—will need to be assisted. There is also an independent funding stream from the flu vaccine, for example. I would like to see—and have been discussing with officials—whether a broader vaccine programme could be rolled out through pharmacies as well, and reimbursed. We know we need to do better.

Health Infrastructure Plan

Nicholas Dakin Excerpts

Monday 30th September 2019 Commons Chamber

[Edward Argar]

I pay tribute to my hon. Friend and to my right hon. Friend the Member for Hastings and Rye (Amber Rudd) for their campaigning work on behalf of their local hospital trust, East Sussex Healthcare NHS Trust, and their two local hospitals, the Conquest and Eastbourne. The investment that we envisage flowing from this seed funding will lead to current district general hospital services being provided from a significantly enhanced environment at both Eastbourne and the Conquest—something that my hon. Friend the Member for Bexhill and Battle (Huw Merriman) has campaigned for very actively. I encourage him to continue doing so and to continue working very closely with his local trust to ensure that it continues to develop those services.

[Nic Dakin (Scunthorpe) (Lab)]

I have with me a letter from the chief executive of North Lincolnshire and Goole NHS Foundation Trust, which identifies a capital gap in excess of £247.36 million as of July 2019. Will the Minister meet local MPs to discuss how the Government can work with the trust to address this capital need?

[Edward Argar]

At the risk of being a little brief at this point—yes.

NHS Long-Term Plan: Implementation

Nicholas Dakin Excerpts

Monday 1st July 2019 Commons Chamber

[Matt Hancock]

I thank my right hon. Friend for his question. The shadow Secretary of State is so nice behind the scenes that he sometimes has to get a bit spiky in public, just to prove to his masters in the Leader of the Opposition’s office that he is on their side.

Over the rest of this year, we will deliver the plan to ensure that these targets are put in place. The truth is that we can only manage what we measure, and having a target for access to mental health services and pilots on how we do that for children’s health services is an incredibly important part of ensuring that the system lines up behind the rapid availability of mental health services, which, as I imagine every Member knows from constituency casework, is critical.

[Nic Dakin (Scunthorpe) (Lab)]

I very much welcome the ambition of this plan, the recognition that it will need appropriate resources—it very much needs appropriate staffing, because the human resource is most important—and the emphasis on cancer and early diagnosis. May I ask the Secretary of State how he will ensure that improvements in early diagnosis for less survivable cancers are central to the target to diagnose 75% of cancers at stage 1 and stage 2? There is a concern that the less survivable cancers will get neglected, given the nature of the plan at the moment.

[Matt Hancock]

I am grateful to the hon. Gentleman for the tone that he takes, and he is absolutely right in his analysis. I know he met the cancer Minister, the Under-Secretary of State for Health and Social Care, my hon. Friend the Member for South Ribble (Seema Kennedy), last week on this point. We absolutely will address it, and we will not miss the less survivable cancers. Indeed, the focus on early diagnosis will of course help survivability, but it is also a focus across all cancers equally, rather than just on those where survivability has improved so much.

Oral Answers to Questions

Nicholas Dakin Excerpts

Tuesday 18th June 2019 Commons Chamber

[Caroline Dinenage]

I am really pleased that my hon. Friend has mentioned that it is Children’s Hospice Week. It is a great opportunity to pay tribute to the incredible work that children’s hospices do up and down the country, supporting some of our most poorly children and their families. I thank my hon. Friend for the work that she does on the all-party parliamentary group for children who need palliative care. The short answer to her question is yes; the NHS will match fund CCGs that increase their investment in children’s palliative care, including hospices, by up to £7 million. That is increasing support to a total of £25 million a year by 2023-24.

[Nic Dakin (Scunthorpe) (Lab)]

There are only about 40 Changing Places facilities in the NHS at the moment. I congratulate the Minister on the work she is doing on this, but will she continue to work with campaigners like Lorna Fillingham in my constituency to make sure that it not only happens quickly and on a timely basis but that we build on it in the future?

[Caroline Dinenage]

I am grateful to the hon. Gentleman because it was he who introduced me to Lorna Fillingham and the amazing Changing Places campaigners in the first place. It is really down to their incredible work that we have seen the growth of this very important issue. There are about 38 Changing Places facilities on NHS England estates at the moment, but the £2 million pot will definitely help to improve that number significantly.

Health

Nicholas Dakin Excerpts

Tuesday 14th May 2019 Commons Chamber

[Nic Dakin (Scunthorpe) (Lab)]

On a point of order, Mr Speaker. There has been a lot of speculation today about British Steel, which employs 4,000 people in my constituency and across the country. It is a significant business. In the light of that speculation, while I recognise the sensitivities of the situation, have the Government given any notice of an intention to update the House about what is going on?

[Mr Speaker]

No. I have received no recent indication. If the hon. Gentleman has in mind the Secretary of State for Business, Energy and Industrial Strategy, I should, in fairness, say that that right hon. Gentleman is a most solicitous member of the Government. From time to time, as he judges appropriate, he does come to see me to apprise me of matters of which he thinks I need to be aware, sometimes as a prelude to a ministerial statement. In this case, in recent days—that is to say, this week—I have received no such indication. The hon. Gentleman may wish to conduct his own private discussions or make inquiries about Government intentions. He may thereby be satisfied. If he is not, and on a different subject but, in the same way as the hon. Member for Worsley and Eccles South (Barbara Keeley), he feels the Chamber has improperly been denied a chance to air the issue, he knows there is a recourse open to him.

Pancreatic Cancer

Nicholas Dakin Excerpts

Tuesday 2nd April 2019 Westminster Hall

[Nic Dakin (Scunthorpe) (Lab)]

I beg to move,

That this House has considered treatment for pancreatic cancer.

I pay tribute to the hon. Member for Winchester (Steve Brine), who was an outstanding Health Minister and who I am sure will continue to make significant contributions to the fight against cancer. I thank members of the all-party parliamentary group on pancreatic cancer and associated charities for their work, and people watching on the Parliament channel for their interest and support.

It is time to up our game on the diagnosis and treatment of pancreatic cancer. Full marks to campaigners such as Ali Stunt of Pancreatic Cancer Action, who was inspired after surviving the cancer herself to set up a charity that focuses on improving early diagnosis in particular. We need even more people like Ali, with her determination and passion, to ensure we can make a difference. Once diagnosed, there is an urgent need for access to faster treatment for people who have pancreatic cancer.

[Mr Ivan Lewis (Bury South) (Ind)]

I thank my hon. Friend for ensuring that this issue is brought to the attention of the House. Does he agree that, while there is a great emphasis on early identification of pancreatic cancer and we all share the concern that identification should come as early as possible, the speed of treatment is every bit as important? Does he agree that we have some way to go before we can be satisfied with that speed of treatment for most patients with pancreatic cancer in this country?

[Nic Dakin]

My hon. Friend is right: speed of treatment after diagnosis is an issue, and I will emphasise that in my speech.

Pancreatic cancer is the quickest-killing cancer: only one in four people survive a year and fewer than 7% of those affected in England will survive for five years or more. Those are appalling statistics, and they have not improved in this country in decades.

[Jim Shannon (Strangford) (DUP)]

I commend the hon. Gentleman, who has been a spokesman for pancreatic cancer treatment and many other things in this House. I always look to him personally for his lead in these things. In the background reading I did before the debate, I saw that the latest findings showed that overweight 50-year-olds have a 25% higher chance of having pancreatic cancer. I never knew that before. That not only shows the need for people to be aware of how their weight affects their long-term health, but is a red flag that the number of pancreatic cancer patients could rise. If being overweight can lead to pancreatic cancer, we must ensure that appropriate treatment is available for that rising number,.

[Nic Dakin]

The hon. Gentleman is exactly right; the more we learn about this disease, the more we can try to do things to prevent it and to support people so that they can get early diagnosis and treatment. The chances of survival for Kevin, the husband of my constituent Maggie Watts, were no better than those of his mother, who died of the same disease 40 years earlier. Yet other countries are doing much better; Belgium and the USA have double the survival rates of the UK. We need the Government to work with the fantastic pancreatic cancer charities—Pancreatic Cancer UK, Pancreatic Cancer Action, Pancreatic Cancer Scotland and the Pancreatic Cancer Research Fund—as well as other stakeholders to deliver a step change in outcomes for pancreatic cancer.

[Henry Smith (Crawley) (Con)]

I congratulate the hon. Gentleman on securing this important debate. Sadly, in January my former caseworker died of pancreatic cancer, so I saw the sudden impact of the condition and how quickly it can affect people, as the hon. Gentleman has eloquently set out, as well as the poor survival rates. What particular lessons does he think this country can learn from Belgium, the United States and other countries where outcomes and survival rates are better?

[Nic Dakin]

I pay tribute to the work that the hon. Gentleman has done on blood cancers in particular, and other cancer awareness issues such as this. He is right that we must learn the lessons from elsewhere, and hopefully I can demonstrate that there are things we can do to help us to catch up, once the diagnosis is in place, and get faster treatment.

One of the things that frustrates campaigners such as Maggie is the danger of accepting that little can be done after a diagnosis of pancreatic cancer. There is a sense of nihilism about this disease. Maggie’s optimistic initiative in response to her situation is called “Hope is Contagious”, and it should energise us all to redouble our efforts. No one should be written off.

Paul Kenny is a pancreatic cancer sufferer who has contacted me on Twitter, saying he has a “slim chance” of seeing his next birthday, but adding:

“Hopefully future generations of sufferers will be prevented or given better prognoses.”

Paul is right—we can do so much better, and we must.

[Mrs Emma Lewell-Buck (South Shields) (Lab)]

My hon. Friend is making a powerful speech that will resonate with many people, including my own family. My lovely mother-in-law, Jean Buck, had stomach pains and was misdiagnosed with pancreatitis. She was sent home from hospital on a diet of bread and water. When back in hospital, she suffered a heart attack and slipped into a coma. Only then did the hospital suspect pancreatic cancer, but it was too late to operate, because she needed to breathe unaided and sadly she could not. That left my father-in-law, Maurice, my husband and his brother and sister with the heartbreaking decision of whether to end her life support—a decision that will haunt their grief forever. Does my hon. Friend agree that earlier diagnosis is key not only for those who are suffering, but for those left behind?

[Nic Dakin]

I thank my hon. Friend: in sharing that personal story, she makes a powerful argument about the need for better early diagnosis. Sadly, the story that she tells is the familiar one of undiagnosed general symptoms eventually, in an emergency, being diagnosed as pancreatic cancer. Very often, it is then too late to take action to address the illness. However, I want to focus on the fact that when we do diagnose early, we need to act early to cure people, because that is an area where we can certainly up our game.

At the moment, only one in 10 pancreatic cancer patients receives potentially curative surgery and only two in 10 receive chemotherapy, meaning that a massive seven in 10 people receive no treatment at all. That has to change. Last month, I delivered to the House a petition signed by an incredible 100,600 people supporting Pancreatic Cancer UK’s campaign to “Demand Faster Treatment”. They are asking for pancreatic cancer to be recognised as a cancer emergency and for people to be able to access treatment within 20 days of diagnosis in order to have the best chance of survival.

That ask is based on the latest evidence and best practice from existing fast-track models for operable and inoperable patients. Those models show that treating people with pancreatic cancer within 20 days increases the number accessing surgery by 20% and the number accessing chemotherapy by 25%. Those are significant improvements. Fast-track surgery will allow more people to access life-saving treatment, and we know that the survival rate is 10 times higher for those receiving surgery. The 100,600 people who signed the petition believe that those models should be the basis of a national optimal pathway for the diagnosis and treatment of pancreatic cancer to ensure that people with the disease can be treated within 20 days.

I want to be clear that I am not talking here about early diagnosis, important though that is—hon. Members’ interventions have underlined that—and I welcome the focus of the Government and NHS England on early diagnosis of all cancers. That can only be a good thing and it will help. However, there are currently many people with pancreatic cancer who have been diagnosed early enough to receive treatment but, unacceptably, do not receive it. That is the issue that I am focusing on today.

For example, more than half of people with stage 1 and stage 2 pancreatic cancer die within a year, and almost half of them, 42%, do not receive any active treatment at all—neither surgery nor chemotherapy. The data suggests that those patients are not prioritised and have not been treated as an emergency. Unfortunately, all the evidence shows that the Government’s current and proposed waiting times are not fast enough for people with pancreatic cancer. A one-size-fits-all approach is not improving, and will not improve, survival rates for pancreatic cancer.

It was disappointing that the recently published interim report of the clinically-led review of NHS access standards did not take the opportunity to propose a differentiated target for pancreatic cancer. If we really want to transform outcomes, it is high time that we had differentiated targets, including a 20-day treatment target for pancreatic cancer.

Behind the statistics are real people. We have heard about some of them today, and their stories help us truly understand the missed opportunities and devastating consequences of the current system. No one did more to mobilise people to sign the petition and help make the case for faster treatment than Erika Vincent. In February 2018, Erika was diagnosed with stage 4 pancreatic cancer, yet despite its advanced nature, she was made to wait two months for treatment—something that she described as psychological torture for her and her family. While she waited, her cancer spread, bringing her more pain and complicating the care that she would eventually receive. Erika believed that the delays to her treatment reduced the time she had left with her family. She chose to spend much of that time championing the need to treat pancreatic cancer as an emergency, believing, as I do, that pancreatic cancer patients cannot afford to wait. Sadly, Erika passed away just weeks before the petition calling for faster treatment—a petition that she had done so much to assemble and put together as part of a campaign—was presented to the House.

Erika’s story stands in stark contrast to that of Liz Oakley. When Liz was diagnosed with pancreatic cancer in January last year, it took just 12 days for her to be scheduled for surgery—the only cure for pancreatic cancer. Liz had already survived breast cancer twice. She is both a testimony to the remarkable progress that has been made in the treatment of other cancers and living proof of what is possible for patients with pancreatic cancer.

There is a compelling case for treating pancreatic cancer as a cancer emergency and for creating optimal fast-track pathways. Far too many people have been lost to this disease too early. For far too long, pancreatic cancer has been forgotten, neglected, written off. The Government can commit today to changing that. Will the Government look at developing optimal pancreatic cancer pathways? Will they evaluate rolling out fast-track surgery models across England? Will they commit to the ambition of allowing people with pancreatic cancer to access treatment within 20 days of diagnosis by 2024?

Thankfully, we have seen huge changes for other cancers. Lung cancer is a good example. Back in 2005, the national lung cancer audit showed that patients with operable lung cancer were not referred for surgery, and it was shown that the surgery rate could be tripled in a cancer network within one year. Between 1985 and 2005, there were just 3,000 operations a year; that increased to 7,250 in 2016. That is inspirational. It shows what we can do. It shows what we can achieve when a cancer is treated as a cancer emergency, as pancreatic cancer must be now. Hope is contagious. Let us make it happen.

[Mr Philip Hollobone (in the Chair)]

The debate can last until 4.34 pm.

[The Parliamentary Under-Secretary of State for Health and Social Care (Jackie Doyle-Price)]

It is a pleasure to serve under your chairmanship, Mr Hollobone. I thank the hon. Member for Scunthorpe (Nic Dakin) for the articulate and passionate way in which he made his case. He has a long history of campaigning on this issue, and long may he continue. We know that we need a conscience when it comes to driving improvements throughout the health system, and it is always instructive to hear people’s experiences. I thank the hon. Gentleman for all the work that he does in chairing the all-party parliamentary groups on cancer and on pancreatic cancer.

I am very grateful to the hon. Gentleman for sharing the stories of Ali Stunt, Maggie Watts and Erika Vincent, because we need to remember that we are not talking about some vague disease that happens to other people; it happens to real human beings and their lives are incredibly affected by our failure, or otherwise, to take action in these spheres. They also inspire us. The fact that Erika Vincent dedicated so much of her final days to raising awareness is inspirational, and we would be very poor if we did not take action following that.

I also thank the hon. Member for South Shields (Mrs Lewell-Buck) for sharing her family story. Again, she illustrated that this can happen to any one of us. When we are in a position to do something about it, we must act.

No one will be surprised that tackling cancer is a major priority for the Government. We have presided over year-on-year increases in survival rates, so that today they are at the highest levels recorded. However, we should not rest on our laurels and be complacent. That is good progress, but we must do better—our ambition is to do better.

Last October, the Prime Minister announced a package of measures with the aim of detecting three quarters of all cancers at stages 1 or 2 by 2028. These measures will see improvements to our screening programmes and new investment in state of the art technology, to further improve diagnosis and boost long-term research and innovation.

That represents the cancer element of the NHS long-term plan, published in January, which sets out how we will achieve our ambition of 55,000 more people surviving cancer for five years in each year from 2028. Colleagues will be aware that the Secretary of State is placing considerable emphasis on prevention, so we need to look at what else we are doing, in terms of screening and research, to tackle these issues. All of that is to be commended, but we must not be complacent. We can learn from the examples of Belgium and the USA, where much greater advances have been made.

The hon. Member for Scunthorpe reminds us all that survival rates for certain cancers remain stubbornly low, including for pancreatic cancer, which is the least survivable of all cancers and so merits special attention. As he alluded to, late diagnosis is a key reason for that. We know that less than a quarter of people have their cancer diagnosed at stage 1 or 2, compared to half of people for all other cancers.

The new early diagnosis ambition represents a huge opportunity to change that for three reasons. First, the ambition must apply to all stageable cancers, including pancreatic cancer. NHS England is working with Pancreatic Cancer UK and others on how we can adjust the current national measure of early diagnosis to include pancreatic cancer for the first time.

Secondly, within that headline measure, the Government are committed to publishing regular data on individual cancers. We need to be transparent about how we are performing in this area, so that we can identify which cancers we are tackling in terms of early diagnosis, and which need more attention. That will provide a powerful catalyst for all the charities to come together and work with NHS England to deliver that change.

[Nic Dakin]

I thank the Minister for the serious and thoughtful way in which she is responding to the debate. Does she think that there is an opportunity to look at a 20-day target for moving from diagnosis to treatment, which would make a real difference to this cancer?

[Jackie Doyle-Price]

Indeed. I will come to that point, if the hon. Gentleman bears with me.

I would like to highlight the other unsurvivable cancers that suffer from late diagnosis, which, as well as pancreatic cancer, include cancer of the stomach and oesophagus. We must ensure that we also focus on those cancers.

The focus of the hon. Gentleman’s speech was that pancreatic cancer should be treated as a cancer emergency. Pancreatic Cancer UK’s recent demand for faster treatment set the ambition to treat pancreatic cancer within 20 days from diagnosis by 2024. The hon. Gentleman mentioned Liz Oakley. The fact that she had treatment within 12 days shows that it can be done. We should embrace that level of ambition. While we recognise that great achievement and advance, we should ensure that that is the experience across our national health service.

What I will say does not quite meet the hon. Gentleman’s request, but I think he will welcome the direction of travel. NHS England will shortly be introducing a faster diagnostic standard of 28 days for all cancer patients, including those with pancreatic cancer. That will mean that every patient can expect a definitive diagnosis—yes or no—within 28 days. Taken together with the 62-day referral to treatment standard, all patients should expect to start their treatment within 34 days of diagnosis.

I know that is not quite the target that the hon. Gentleman set me, but if we can ensure the whole system works to that efficiency, we will make great strides in tackling this. I cannot emphasise enough that we should never lack ambition in how far we are prepared to drive improvements. That standard of treatment within 34 days is the maximum, but I expect trusts always to treat patients according to clinical need and to prioritise those needing urgent treatment, such as Liz Oakley, who received treatment within 12 days.

We welcome Pancreatic Cancer UK and all other stakeholders working with the pancreatic cancer clinical community to develop practices to shorten the time before treatment even further. It is important that we continue that dialogue, not just to be reactive, but to build confidence, because poor survival rates are well understood. We do not want people to be diagnosed and automatically think that there is no hope. There is always hope, and our NHS services must ensure that people understand that.

NHS services for pancreatic cancer have improved significantly in recent years. I am grateful that the hon. Gentleman accepted that. In the spirit of demanding more, it is always good to look at how far we have come. I thank him for that. There are now clearer diagnostic pathways. Decision making is done by specialist multi-disciplinary teams.

Oral Answers to Questions

Nicholas Dakin Excerpts

Tuesday 26th March 2019 Commons Chamber

[Caroline Dinenage]

My hon. Friend is absolutely right to raise this: we do need to do more in this space, and that is why we are investing over £1 billion a year in health research through the National Institute of Health Research.

[Nic Dakin (Scunthorpe) (Lab)]

What evaluation is being put in place to see how effective the 2018 NICE guidelines for clinicians on managing Lyme disease are in improving the treatment of this dreadful disease?

[Caroline Dinenage]

All NICE guidelines are permanently kept under review. If the research we are investing in throws new light on any issues, that will always be taken into consideration.

Eurotunnel: Payment

Nicholas Dakin Excerpts

Monday 4th March 2019 Commons Chamber

[Matt Hancock]

The Transport Secretary is working hard on making sure that we can improve the transport system.

[Nic Dakin (Scunthorpe) (Lab)]

And the Secretary of State almost said that with a straight face. What went wrong and who is taking responsibility for it?

[Matt Hancock]

This is a cross-Government decision. The purpose of this settlement was to ensure the unhindered supply of medicines. I am the Health Secretary and it is my job to do everything that I can, in all circumstances, to ensure that there is that availability of medicines. I am sure that, whatever the Brexit scenario, the hon. Gentleman’s constituents who need medicines would rather that we made this settlement to ensure that we have the confidence that we can deliver that.

Cancer Workforce and Early Diagnosis

Nicholas Dakin Excerpts

Tuesday 8th January 2019 Westminster Hall

[Nic Dakin (Scunthorpe) (Lab)]

I congratulate my hon. Friend the Member for Poplar and Limehouse (Jim Fitzpatrick) on securing this important and timely debate.

We very much welcome the NHS long-term plan. It is a once-in-a-generation opportunity to improve cancer care significantly in this country. The plan rightly recognises that one of the biggest actions the NHS can take to improve cancer survival is to diagnose cancers earlier, and sets out welcome commitments to radically improve early diagnosis. I hope that as the plan develops there will be more specific plans for the less survivable cancers—pancreatic, brain, lung, stomach, liver and oesophagus—that account for more than 50% of all cancers.

As chair of the all-party group on cancer I was pleased to chair the Britain Against Cancer conference last month, which focused on future priorities for cancer care. There were many reasons to be cheerful, but one big concern was whether the workforce will be sufficient to deliver the care that will be needed in the future. There is still a lack of clarity about that, despite efforts in the long-term plan, so it is useful to have this opportunity to focus on that.

We know that the number of people diagnosed with cancer in the UK is increasing and that the changing needs of cancer patients present a challenge for professionals working in cancer care, who are dealing with rising case loads, and increasingly complex needs. The plan’s ambition to diagnose three in four cancer cases at an early stage by 2028 is welcome, but unless we have a plan to deal with staffing shortages, backed up by significant investment, the NHS will struggle to maintain today’s standards.

In NHS North Lincolnshire clinical commissioning group, only 71.9% of cancer patients receive their first treatment within 62 days of an urgent GP referral. That is well below the England average and below the national target of 85%. Delays to cancer waiting times are often caused by a diagnostic bottleneck, where there is not enough capacity to carry out the tests needed to confirm a cancer diagnosis so that the patient can begin treatment. I therefore welcome the announcement made just before Christmas of capital investment for Northern Lincolnshire and Goole NHS Foundation Trust, and of diagnostic equipment for Diana, Princess of Wales Hospital in Grimsby and Scunthorpe General Hospital. I hope that will make a significant difference.

To improve early diagnosis and match the best cancer outcomes in Europe, it is crucial to have the workforce in place to support growing patient need. Although the NHS long-term plan sets out ambitions for the future workforce, funding available for additional investment in that workforce in the form of training, education and continuing professional development through the Health Education England budget, has yet to be set out by the Government. Will the Minister—he is an excellent Minister—set out when that budget will be confirmed and say whether the Government intend to set out further funding arrangements as part of the comprehensive spending review?

NHS staff shortages in primary and acute settings have been consistently highlighted by organisations in the sector in recent years, and there is an urgent need to grow the cancer workforce. Cancer Research UK estimates that the cancer workforce needs to double by 2027. Similarly, Macmillan Cancer Support has estimated that the supply of adult cancer nurses must increase by 45% in the next 10 years. Those are big numbers.

Macmillan’s workforce census last year highlighted considerable variation in vacancy rates for cancer nurse specialists across the country. That is also true for specialist chemotherapy nurses, with vacancy rates as high as 15% in some areas. A recent survey of healthcare professionals working in breast care in hospitals by the charity Breast Cancer Care painted a worrying picture, with 87% of respondents stating that job shortages in their hospital could affect breast cancer patients. A freedom of information request from that charity found that two thirds of hospital trusts in England do not provide a dedicated nurse for people living with incurable breast cancer. It is therefore crucial that a fully costed plan is produced to demonstrate how the health and care workforce will be sustained and grown. The long-term plan states that there will be a separate workforce implementation plan in 2019, but more detail is needed about the timeframes. Will the Minister say when the plan will be published? “Soon” is not quite good enough. We would like a date, please.

The 2015 cancer strategy recommended the publication of a cancer workforce plan, yet the sector is still waiting for the publication of phase 2 of that plan by Health Education England. Will the Minister outline how the implementation plan relates to the long-promised phase 2 HEE plan on the cancer workforce? If the ambitions of the long-term plan and the 2015 cancer strategy are to be realised, a comprehensive and fully funded workforce plan must set out how the cancer workforce can be upskilled and developed to meet the needs of the growing number of people living with cancer.

NHS Long-term Plan

Nicholas Dakin Excerpts

Monday 7th January 2019 Commons Chamber

[Matt Hancock]

Yes. I feel strongly about this. Chapter 5 of the plan is all about digitally enabled care. The interoperability of data between systems in different parts of the NHS is mission-critical. Over Christmas we published proposals for the interoperability of primary care systems, and we will roll that out in the hospital sector as well, so that people can access their own patient record and the clinicians who need to see it can access the whole record. Instead of having to phone each other up to find out what is going on with a patient they once had, they should be able to look at the record.

[Nic Dakin (Scunthorpe) (Lab)]

I welcome the Secretary of State’s recognition that the staff are at the heart of the NHS and join him in thanking them for their excellent work, but there are 40,000 nursing vacancies today. How many nursing vacancies will there be at the end of 2019, and how many will there be at the end of 2020?

[Matt Hancock]

I know that the hon. Gentleman takes a close interest in that, as chair of the all-party group. Obviously we need more nurses. The vacancies are, in many cases, filled by temporary staff, but that is not the best way to manage things. We need more nurses and more doctors. I am glad that we have a record number of GPs in training. In the plan, we have made provision for a 50% increase in the number of clinical placements. We have a whole programme, including the Harding review, to take this forward and ensure that it happens, because the NHS is, at its heart, delivered by its people.