Oral Answers to Questions

Nicholas Dakin Excerpts

Tuesday 7th February 2017 Commons Chamber

[Nicola Blackwood]

I completely agree with my hon. Friend. Medicines are the second highest area of spending in the NHS after staff, and it is vital that the NHS gets best value from that investment. That is why I am pleased that the House supported our recent Bill on the cost of medicines and medicine supplies, which will enable us to tackle unjustified price rises for unbranded generic medicines. We are also working closely with NHS England to promote the use of the new wave of biosimilar medicines and to ensure cost-effective prescribing behaviour.

[Nic Dakin (Scunthorpe) (Lab)]

When will the Government publish their response to the accelerated access review, and will that include a consideration of how to improve patient access to molecular diagnostics?

[Nicola Blackwood]

We are working hard on that exact point.

Social Care Funding

Nicholas Dakin Excerpts

Monday 12th December 2016 Commons Chamber

[David Mowat]

This year, 42% of councils are increasing their adult social care funding in real terms. The discrepancy caused by the precept is addressed by the way in which we allocate the additional better care fund component and the formula that is used for that.

[Nic Dakin (Scunthorpe) (Lab)]

I think the Minister recognises that there is a crisis and that the precept alone will not address it, so does he agree with the former Health Secretary, Stephen Dorrell, who said this morning that it was a missed opportunity in the autumn statement not to invest in social care?

Cancer Strategy

Nicholas Dakin Excerpts

Thursday 8th December 2016 Commons Chamber

[Nic Dakin (Scunthorpe) (Lab)]

I beg to move,

That this House has considered the Cancer Strategy one year on.

In moving this motion, which stands in my name and that of the hon. Member for Basildon and Billericay (Mr Baron), I wish to recognise all those in the cancer community for all their work, day in, day out, fighting this disease, and the huge number of Members of this House who, through a wide range of cancer-related all-party groups, carry out work in this very important area.

The hon. Member for Basildon and Billericay, who is chairman of the all-party group on cancer, is unable to be here today, but he wanted me to say how much he appreciates the Backbench Business Committee’s granting this debate. As Members may know, the hon. Gentleman’s wife is undergoing treatment, and I am sure that everyone in the House would want to send their best wishes to him and his family at this difficult time.

It is estimated that there are more than 2.4 million people living with cancer in the UK, and that number continues to grow. Cancer is becoming more complex, with many more treatments available. Many patients are living with co-morbidities and with the consequences of a cancer diagnosis many years after treatment has finished.

The all-party group on cancer has a proud record of successfully campaigning on a number of issues. Just two days ago, we held our annual Britain against Cancer conference in Central Hall—it is one of the largest cancer conferences in the UK. On behalf of the group, I wish to pass on thanks to all the contributors, including the Under-Secretary of State for Health, the hon. Member for Warrington South (David Mowat), and the shadow Secretary of State for Health, my hon. Friend the Member for Leicester South (Jonathan Ashworth), for their contributions. Delegates very much appreciated everybody’s input.

The last two years have seen significant developments in cancer policy. In July 2015, the independent cancer taskforce published the England cancer strategy. Since we last debated this issue in November last year, NHS England has published its England cancer strategy implementation plan, setting out how it will roll out the 96 recommendations.

More recently, we have seen the publication of the National Cancer Transformation Board’s progress report, outlining what steps NHS England has taken over the past year in implementing these recommendations across the country. Only last Friday, the Office for National Statistics published the latest one-year cancer survival rate figures for those patients diagnosed in 2014 and followed up to 2015. As NHS England chief executive Simon Stevens pointed out at the Britain against Cancer conference, that showed the dramatic improvement in patient outcomes that has been achieved over the past 20 years. That is something to be celebrated, but there is still much more to do.

The all-party group has been active in monitoring progress on the England cancer strategy, holding a short inquiry early in the year to assess progress. We concluded that positive progress is being made, but that there is still much more to do to realise the ambition of the England cancer strategy. Having taken evidence from a wide range of people, we made a number of recommendations, which I will use to highlight some of the key themes that emerged from the inquiry.

The first key recommendation focused on the need for greater clarity on funding for all the 96 recommendations of the England cancer strategy. It was positive, therefore, to see more detail in the National Cancer Transformation Board’s progress report, which set out the funding available per year for the next four years. I very much welcome the announcement by Simon Stevens at our Britain against Cancer conference that Cancer Alliances will be able to bid for £200 million of funding to invest in early diagnosis, care for people living with cancer, and cancer after treatment. That is very good news, and I look forward to getting further clarity on how the full funding package, set out in the progress report, will be allocated across the cancer strategy’s recommendations. This is particularly important given the lack of clarity around cancer funding to date. The estimates for the total amount spent on cancer care in the NHS per newly diagnosed patient have not been published beyond 2012-13, which has been described as a significant data gap when it comes to evaluating the cost and efficiency of cancer care. Will the Minister today commit to publish an update on those figures in the House of Commons Library at the earliest opportunity?

Alongside funding, another recommendation and concern that was raised by stakeholders in our inquiry was around the need for further transparency on how the cancer strategy is being delivered, what the priorities are, and who is responsible for delivering key recommendations. Again, the progress report from the National Cancer Transformation Board went some way to address that concern. However, further detail around how the strategy is being delivered, particularly the membership and terms of reference for the six oversight groups tasked with overseeing delivery, is vital to ensure that the wider cancer community is properly engaged.

We also heard from many organisations that were unclear on how the delivery of recommendations will be monitored at a local level.

[Fiona Mactaggart (Slough) (Lab)]

One of the things that shocked me in a debate on ovarian cancer was to find that there are parts of the country where CA125 is not routinely available to women who are suspected of having ovarian cancer. I have also had letters from a number of constituents who say that they are unable to get access to bisphosphonates, a drug that helps to prevent breast cancer. Did the all-party group come up with recommendations to try to ensure that wherever people live, they get the best possible cancer prevention and care? At present there clearly is not universal provision of these important diagnostic tests and drugs.

[Nic Dakin]

My right hon. Friend makes an important point about equal access across the country. We are all concerned about that and focused on it.

It is positive news that the 16 cancer alliances have been established and that NHS England will publish further guidance for alliances to help them develop their plans to deliver the cancer strategy locally, but if they are to monitor the delivery of the strategy, it is vital that they are given the right resource to do so effectively.

A particular issue which was raised in relation to both transparency and accountability was workforce. Most people, I believe, will agree with me when I say that our NHS workforce is under great strain. The cancer workforce is experiencing significant gaps in key areas, including radiography and clinical nurse specialists. For example, Anthony Nolan highlights the fact that access to post-transplant clinical nurse specialists is inconsistent across the country. At the same time, demand is growing, and cancer is becoming more complex, as patients often have multiple co-morbidities. Unless they are addressed, these workforce pressures will undoubtedly have a severe effect on cancer services.

Another area of growing need for cancer patients is access to timely and appropriate mental health support which, if achieved, can reduce pressures on other parts of the health service.

The all-party group welcomes the recommendation in the strategy that Health Education England would deliver a strategic review of the cancer workforce by March 2017, and we were grateful to Professor Ian Cumming for meeting us earlier this year. However, we have strong concerns about progress on this crucial piece of work. Although we are aware that a baseline report of the current cancer workforce has been produced, it has not been published, and there is currently little detail on how Health Education England is planning to conduct the strategic review. We are not aware of any plans from HEE to engage with the sector on the strategic review, and we continue to be concerned by the lack of transparency and involvement of the wider sector. We were pleased to see a reference to the strategic review of workforce in the Department of Health’s mandate to HEE. Will the Minister outline how he is holding HEE to account on that recommendation?

Diagnosing cancer earlier improves survival rates, and the all-party group believes that focusing on outcome indicators such as the one-year survival rate is crucial to driving progress in this area. The inclusion of the one-year cancer survival indicator in the clinical commissioning group improvement and assessment framework—formerly the delivery dashboard—is very much welcomed by the all-party group, which has long campaigned for that. Since then, the all-party group has continued to champion this cause, and earlier this year at our annual summer reception we were the first to congratulate and recognise clinical commissioning groups that had improved their one-year cancer survival figures.

So it was music to our ears to hear Simon Stevens at this week’s Britain against Cancer conference further commit NHS England to increasing its efforts on diagnosing cancer early. Last week the latest one-year cancer survival rates were published, and we were pleased to see an improvement, with the average one-year cancer survival rate in England standing at 70.4%. However, incremental improvements are not enough to match our neighbours in Europe and across the world, as our figures are below the standard set in countries such as Sweden, which has a one-year survival rate of 82%.

As chair of the all-party parliamentary group on pancreatic cancer, I am acutely aware of the difficulty of diagnosing some cancers early. My constituent Maggie Watts lost her husband to pancreatic cancer. Kevin’s mother had died from pancreatic cancer 40 years earlier. Difficulty in early diagnosis is one of the reasons why the outcomes for pancreatic cancer had not improved over those 40 years. Some 74% of patients across the UK cannot name a single symptom of pancreatic cancer, so there is a need for further cancer awareness campaigns to improve the outcomes for these “stuck” cancers, as well as further research into better diagnostic tools in these areas.

Be Clear on Cancer campaigns have been very effective but, as Bloodwise points out, we need further thought on how the NHS can work closely with cancer charities and patient organisations to increase awareness of cancers with non-specific symptoms, such as blood cancers.

I recently met representatives of the Roy Castle Lung Cancer Foundation, who were clear that early diagnosis of lung cancer dramatically improves patient outcomes for this, the biggest cancer killer. In some countries, screening for lung cancer is being introduced, with positive outcomes. Should we actively consider that here?

It is worth pausing to recognise the excellent work that public health campaigns have played in fighting cancer. Since the smoking ban was introduced nearly 10 years ago, the number of adult smokers in the UK has dropped by 1 million. Smoking cessation is still the most effective cancer preventive strategy, and all of us need to ensure that, when local government budgets are under pressure, that does not lead to reductions in public health budgets for short-term fiscal gain, with long-term negative health consequences and associated costs. As Cancer Research has made clear, the Government must publish the tobacco control strategy without delay.

The final recommendation I want to highlight from our inquiry is on a similar theme: the involvement of patients and organisations in the cancer community in the implementation of the cancer strategy across England. This recommendation has been supported by other groups, such as the Cancer Campaigning Group, which noted in its recent report that the National Cancer Transformation Board and the Independent National Cancer Advisory Group should collaborate with organisations with an expertise in cancer and involve patients in delivery.

The issue is particularly pertinent to people with rarer or less common cancers, many of which are childhood and teenage cancers. The all-party group was concerned when the cancer transformation board’s implementation plan did not highlight rarer cancers specifically. Rarer cancers—particularly those with vague symptoms—tend to be diagnosed later than most common cancers, with many diagnosed through emergency presentation. That not only impacts on survival but leads to poor patient experience. In addition, many patients with rarer cancers, and particularly those with blood cancers, can live with their conditions for many years, and it is vital that provision to support people living with and beyond cancer, such as the Recovery Package, consider the needs of these patients. While many of the recommendations in the cancer strategy will go some way to address that issue, it is vital that NHS England retain a strong focus on this group. What discussions has the Minister had with NHS England about how it is ensuring that organisations across the cancer community are involved in the delivery of the cancer strategy?

Currently, cancer medicines, including those for rare cancers, are appraised by the National Institute for Health and Care Excellence on a timetable designed to ensure that a recommendation can be issued at the time of licence. However, there is growing recognition in the cancer community that current NICE methodology and process are not suitable for assessing treatments for rarer cancers, and that the one-size-fits-all model adopted by NICE could result in patients with rarer cancers losing out on access to treatments that patients in other developed countries are able to access.

There is an ongoing joint consultation by NICE and NHS England, which incorporates changes to highly specialised technology appraisal thresholds, introduces an affordability assessment and creates a fast-track route for highly cost-effective drugs. However, the consultation does not address or acknowledge any specific recommendations for the assessment of treatments for rarer cancers. Concern has been raised by the cancer community that this makes these available treatments vulnerable to always falling through the net. What is the plan to ensure that the NICE process and methodology applied to rarer cancers incorporate the limited patient numbers and data collection, rather than applying the same process irrespective of the rarity of the cancer? What additional flexibility will be applied to NICE criteria when assessing rare cancers, to account for inevitable uncertainties in clinical data?

In summary, it is important to recognise the progress that is being made in implementing the cancer strategy one year on, but there is much more to do. Together, properly supported by Government, those in the cancer community are willing and eager to deliver the better outcomes that would mean we were not just closing the gap on better-performing nations but beginning to lead the way.

--- Later in debate ---

[Nic Dakin]

I thank the Minister for his response to what he was right to say has been a very good debate among critical friends, to steal the excellent point made by my hon. Friend the Member for Washington and Sunderland West (Mrs Hodgson). My hon. Friend the Member for Poplar and Limehouse (Jim Fitzpatrick) and the hon. Members for Bosworth (David Tredinnick) and for Harrow East (Bob Blackman) all highlighted the importance of public health measures, and particularly smoking cessation campaigns, in preventing cancer. We are reassured that we will have the plan “soon”.

The hon. Member for Crawley (Henry Smith), who is the chair of the all-party group on blood cancer, spoke movingly from personal experience about how blood cancers thunder into people’s lives unexpectedly. The hon. Member for Castle Point (Rebecca Harris), who is chair of the all-party group on brain tumours, echoed that in much that she said about the need to do something about these cancers that are stuck. She reminded us that brain cancer is the biggest killer of young people, and she was right to say that although the cancer strategy is a strong step in the right direction, we need to do more. The hon. Member for Strangford (Jim Shannon) echoed the point that we need to do even better. As the hon. Member for Bosworth said, if we have moved from 60% to 70%, why not to 80%? The hon. Member for Bury St Edmunds (Jo Churchill), a cancer survivor herself, posed a series of very challenging questions—exactly the sort of questions that should drive better performance as we move forward.

We are at a pivotal moment for the cancer services. I know that many people will be heartened by the Minister’s comments both today and on Tuesday, at the Britain against Cancer event. He was right to say that it is easy to write strategies, but now is the time to deliver.

Question put and agreed to.

Resolved,

That this House has considered the Cancer Strategy one year on.

Community Pharmacies

Nicholas Dakin Excerpts

Wednesday 2nd November 2016 Commons Chamber

[Kevin Barron]

It is very important, and the mechanism that has been put in place will not solve everything. We may get Boots in Gatwick airport supporting it, but there is the potential that others may drop off the line because they are just outside the geographical area. We need to look at that.

Let me turn to population health. This cannot be done by central distribution centres or a pharmacy based miles away, as they have no link with the locality. I am pleased that the idea of major companies getting involved in prescribing has been dropped. Pharmacists know their customers well and are familiar with their medications and, consequently, the customers feel confident in asking them for their advice.

The Government’s figures show that the £170 million cut could force up to 3,000 community pharmacies—one in four across the country—to close their doors to the public, so people would have to travel a lot further to their pharmacist and not have the local connection that I mentioned previously. Community pharmacy is the gateway to health for some 1.6 million patients each day. If anything, that is something we need to get a grip on.

A core component of current pharmacy services supports the public to stay well, live healthier lives and self-care. Pharmacists play a central role in the management of long-term conditions. They carry out medicines use reviews, for example. We must remember that more than 70% of expenditure on our national health service at both primary and acute level is spent on people with long-term conditions. There could not be a better gateway for those people to get the assistance they need to manage those conditions than through local pharmacies.

[Nic Dakin (Scunthorpe) (Lab)]

My right hon. Friend is right. Community pharmacies are at the heart of the gateway. Does he agree that there is a danger that the proposed cuts might end up costing more money than they save?

Coeliac Disease and Prescriptions

Nicholas Dakin Excerpts

Tuesday 1st November 2016 Westminster Hall

[Mr Jones]

That is the main point. What some CCGs are doing is a false economy, because one hospital admission will cost more than the annual cost of prescriptions for an individual who adheres to a gluten-free diet.

Another person living with coeliac disease, Janice, who is a constituent of mine, wrote to me saying:

“I strongly believe that these plans will cause more expense to the government when coeliac patients can’t afford shop priced gluten-free foods and don’t stick to their diet and end up with cancer of the bowels”,

as well as other conditions. She went on:

“I am a pensioner and find it increasingly hard to afford luxuries like biscuits and cakes. If I have to add gluten free bread, pasta and cereals to my shopping list this will cause more stress. I cannot have any form of gluten, even in small doses, as I am violently ill.”

As well as a failure to consider the evidence before making decisions to withdraw gluten-free prescriptions, there is also evidence of a lack of public consultation by CCGs. Coeliac UK has been doing a good job of holding CCGs to account. One example it provided is of Trevor, who told Coeliac UK that he has never received confirmation in writing that the policy had changed; he was informed only when Coeliac UK told him. He was diagnosed 10 years ago and has only ever had bread on prescription. He is unable to work and has ongoing medical problems. His nearest shop is a Co-op, which does not stock gluten-free products, and the nearest shop that does is some six miles away. That creates problems for people such as him.

The CCGs that have already removed access to prescriptions for gluten-free products have not outlined or implemented policies that offer alternatives to safeguard patients, such as access to specialist dietary or nutritional advice. When a coeliac patient is taken out of a CCG’s responsibility because their gluten-free food prescription has been withdrawn, that CCG can no longer monitor them or determine the changed policy’s impact on that patient’s health. This is an important factor, and I am concerned that it has not been taken into account by a number of CCGs.

In areas where gluten-free products are not prescribed, there is now no opportunity to encourage dietary adherence nor a prevention strategy for long-term management of people with coeliac disease. Effectively, patients who suffer the condition in these areas will be offered no support by the NHS. Although CCGs are engaged with local authorities and wellbeing boards to explore alternatives, none has yet been put in place.

The NHS has a good track record of involving the public in consultation, but the lack of consultation on the decision to withdraw prescriptions for gluten-free products is a disgrace, added to the fact that charities such as Coeliac UK are not consulted before such decisions are made.

[Nic Dakin (Scunthorpe) (Lab)]

I congratulate my hon. Friend on securing this debate. The point he is making is direct and correct. The nine-year-old daughter of my constituent, Helen Frost, has coeliac disease and Helen is worried that prescriptions for gluten-free products may be taken away. The uncertainty is adding stress to a situation that is already difficult to manage.

[Mr Jones]

That is not even taken into consideration, as my hon. Friend says.

My concern is that cutting prescriptions for gluten-free products is a simple and easy target for CCGs under financial pressure. The entire prescription cost to the NHS in 2014 was £26.8 million or 0.27% of the total prescription budget—£194 per patient. The procurement system that the NHS has in place is not working. The market for gluten-free products in the UK in 2014 was some £211 million, but the annual NHS budget was around £27 million or 13% of that total market. I do not know why the NHS cannot negotiate contracts with some commercial companies. Failure in procurement will clearly have an impact.

I turn to the issue of pharmacists. Back when we had primary care trusts, some pharmacy-led supply pilot schemes were set up in a handful of regions in England. When a patient was diagnosed with coeliac disease, the pharmacy-led scheme allowed patients to access gluten-free food and to manage their coeliac disease. However, with the establishment of CCGs, that seems to have gone out of the window—except in Scotland, which has a national gluten-free food service: a pharmacy-led scheme based on pilots in the UK.

Will the Minister seriously consider introducing such a scheme in England? It would save time and money and be a better way of managing people with coeliac disease. It is worth noting that the annual cost of gluten-free food is lower than the annual cost of items that the NHS provides that cost less over the counter—for example, paracetamol and so on. I beg the Minister to consider that, if properly done, what I suggest would save money.

I know the Minister has been in post for only a few months and I am sure he receives many demands for things to be provided by the NHS, but I am also sure his officials have briefed him on the principles of the NHS: that it is a comprehensive service available to all with access to NHS services based on clinical need, not individual ability to pay, and that it aspires to put patients at the heart of everything it does. This issue is about limiting choice because of cost.

In conclusion, the issue needs urgent intervention. It is not fair to individuals and there is a postcode lottery. A pharmacy-led system could be delivered better and more effectively. At the of the day, the people affected have no choice but to have a gluten-free diet. We should not ration care for some of the most vulnerable in our society.

Community Pharmacies

Nicholas Dakin Excerpts

Monday 17th October 2016 Commons Chamber

[David Mowat]

We have been talking to the Pharmaceutical Services Negotiating Committee for 10 months. We have tried to incorporate, in the proposals that we are going to make, some of the points it has put to us. I can only again tell hon. Members, as I have already said to many others, that we value the contribution that the pharmacy sector can make. We wish to see that move over and above what it is now, in terms of dispensing, into more value-added services dealing with minor ailments, repeat prescriptions and long-term conditions. We want to do all those things, and we will.

[Nic Dakin (Scunthorpe) (Lab)]

The Minister should tread with great care. I have visited many community pharmacies in my constituency, and in each and every one I saw lots of value-added activity—preparing medicine trays, delivering medicines or whatever—and a keenness to be involved in wider activities. There is a real danger that the Minister, in seeking savings, will cost the health service and communities more.

[David Mowat]

That would be a danger, had we not spent time over the past 10 months to try to get this right. We are confident and believe that we have done so.

Blood Cancers

Nicholas Dakin Excerpts

Thursday 7th July 2016 Westminster Hall

[Jim Shannon (Strangford) (DUP)]

I beg to move,

That this House has considered blood cancers and the Cancer Drugs Fund.

It is always a pleasure to come to this Chamber and have the opportunity to expound on the subjects that we bring here for consideration. I am pleased that so many hon. Members have made the effort to attend on a Thursday afternoon—often referred to as the graveyard shift. I am not sure that is entirely accurate or fair, but we thank very much those who have made the effort to be here. It is also a pleasure to see in her place the shadow Minister, the hon. Member for Hackney North and Stoke Newington (Ms Abbott), and I look forward to hearing the Minister. He and I always seem to be in these debates—if he is here I am here, and if I am here so is he—but it is always a pleasure to see him. We look forward to his response to the points that we make during the debate.

Cancer is a massive issue. It will affect one in every two people we meet, and many of us here have a personal interest in the subject. More and more people are surviving cancer because of the incredible work that has been done by the pharmaceutical industry and private enterprise, and also because of the work done in partnership with universities. Queen’s University Belfast is involved in finding new drugs and working with private enterprise, the Government and the education system to find ways of doing more.

The fact that more people are surviving and living longer is to be celebrated, but unfortunately not everyone is living well, which is what this debate is about. That is especially true for people with blood cancers, many of whom will live with the disease and the consequences of its treatment for many years. Some of them are fortunate to do so, but for many that will be time limited. About one in four people living with or beyond cancer face disability or poor health following their treatment. Evidence from Macmillan shows that by 2020 nearly one in every two people will receive a cancer diagnosis in their lifetime. Just look round this Chamber: half the people here today will receive a cancer diagnosis at some time during their life; or, if they are not affected directly, their families certainly will be.

I place on the record my thanks to the cancer charities, Marie Curie Cancer Care, Macmillan Cancer Support and the many others, which do such marvellous work with those who have cancer. Right now, routine follow-up care for people with cancer costs about £250 million a year. It is usually delivered via a one-size-fits-all medical model that is based on repeat out-patient consultations despite a lack of evidence to show that that is effective, so we must also look at that.

I was therefore pleased to see the commissioning guidance released recently to promote the roll-out of a recovery package for everyone with a cancer diagnosis. The recovery package will be especially important for patients with blood cancers, because it will mean that they get the physical, emotional and social support they need to lead as healthy and active a life as possible for as long as possible. Every one of us in this Chamber would wish that to happen. Many people with blood cancers live for a number of years with the consequences of their disease and treatment, so there needs to be a commitment from the Department of Health that everyone with a blood cancer will be offered tailored support.

Let me talk from a personal point of view. My father had cancer on three occasions. He passed away last year. He did not die because of cancer, but he was diagnosed 39 years ago—38 years before he passed away—and my mother was told to go home and prepare and get the estate sorted out. In other words, there was next to no hope, but my dad survived, and he survived for three reasons. He survived, first, because of his faith and the prayers of God’s people; secondly, because of the skill of the surgeon’s knife; and thirdly, because of the care of the nurses. Those three things are vital for all of us. That is an example of how far we have come in those 39 years.

Patients with blood cancers can face significant problems in accessing vital treatment because of the difficulties and complexities of appraising medicines in this area. I thank the charities and others who have given us background information. I will not do this of course, but I could probably speak for three hours on this subject. I am sure that people are thinking, “Well, I hope he doesn’t.” I am not going to, because clearly I want to give everyone an opportunity to participate in the debate.

The appraisal system used by the National Institute for Health and Care Excellence is not suitable for assessing medicines that treat conditions with small patient populations—in other words, cancers that affect a small number of people. Perhaps in the greater scheme of things, they are numerically small, but it is vital that the drugs are available and in place.

At this point, I pay special tribute to the hon. Member for Crawley (Henry Smith), the chair of the newly brought together all-party group. I thank him for going with me to the Backbench Business Committee to ask for this debate. We are both pleased to be able to have the debate so early after the launch of the APPG. The hon. Gentleman will speak himself, but it is a pleasure to work alongside him.

[Nic Dakin (Scunthorpe) (Lab)]

I congratulate the hon. Gentleman on securing this very important debate. The issue of small populations and finding the right treatments is crucial as the cancer drugs fund goes forward within the NICE context. That is an opportunity as well as a threat. I hope that the hon. Gentleman will reflect that in the rest of his speech.

[Jim Shannon]

It is always a pleasure to have the hon. Gentleman come along to a debate in support. He always does so, and his valuable contributions are always appreciated by us all. I wholeheartedly agree with him.

The way the system fails blood cancer patients can be illustrated via the case of ponatinib, a drug designed to treat chronic myeloid leukaemia patients who are resistant to or intolerant of other treatments. I will elaborate on this point later, for it is very important. I think that the hon. Gentleman has grasped that it is a vital issue as well. The drug is fully available to all CML patients in Scotland and Wales, but in the remainder of the United Kingdom it is provided on the NHS only to a small subset of patients who can benefit from it after NICE refused to appraise it because of the small patient population. One of the questions that we would like answered in this debate if possible—I am not sure whether the Minister is the right person to answer it, but I know that if he is not, he will certainly direct it to the right Department—is how we ensure that there is not a postcode lottery when it comes to the allocation and availability of cancer drugs.

Defending Public Services

Nicholas Dakin Excerpts

Monday 23rd May 2016 Commons Chamber

[Mr Hunt]

We need extra legislation to expedite the process. I point out to my right hon. Friend that that is another policy which has been opposed by the Labour party. All the time it says we should be doing more to get a grip on NHS finances and yet it opposes every policy we put forward in order to do precisely that. The answer to his question is that the issue with the NHS is primarily that we are not very good at collecting the money to which we are entitled from other European countries, because we are not very good at measuring when European citizens are using the NHS. This legislation will help us to put those measurement systems in place so that we can get back what we hope will be about half a billion pounds a year by the end of this Parliament.

We will no doubt hear later this afternoon the charge that the Government have lost control of NHS finances, but we strongly reject that charge. The House may want to ask about the credibility of that accusation from a party that is at the same time proposing a funding cut for the NHS and criticising the difficult decisions we need to take to sort out NHS finances.

[Nic Dakin (Scunthorpe) (Lab)]

Two months into this financial year, can the Secretary of State say whether or not the Department of Health broke its budget for last year?

[Mr Hunt]

We will find out those figures when the full audit is complete. I just say to the hon. Gentleman that efficiency savings are never easy, but a party with the true interests of NHS patients at heart should support those efficiency savings, because every pound saved by avoiding waste is one we can spend improving patient care.

Let me therefore outline to the House what we are doing to deliver those efficiencies, as well as to support NHS trusts to return to financial balance. First, we are taking tough measures to reduce the cost of agency staff, including putting caps on total agency spend and limits on the rates paid to those working for agencies. So far, that has saved £290 million, with the market rate for agency nurses down 10% since October and with two thirds of trusts saying that they have benefited. Our plan is to reduce agency spend by £1.2 billion during this financial year. Secondly, we are introducing centralised procurement under the Carter reforms. Already 92 trusts are sharing, for the first time, information on the top 100 products they purchase in real time, and we expect savings of more than £700 million a year during this Parliament as a result. Thirdly, given that the pay bill is about two thirds of a typical hospital’s costs base, we are supporting trusts to improve on the gross inefficiency of the largely paper-based rostering systems used at present. This should also significantly increase flexibility and the work-life balance for staff, as we announced last week. Finally, and perhaps most critically, we will reduce demand for hospital services by a dramatic transformation of out-of-hospital care, as outlined in the five-year forward view. If we meet our ambitions, we will reduce demand by more than £4 billion a year through prevention, improved GP provision, mental health access and integrated health and social care.

--- Later in debate ---

[Nic Dakin (Scunthorpe) (Lab)]

It is a real pleasure to follow the hon. Member for Bexhill and Battle (Huw Merriman), who came to the debate from the viewpoint of people on the frontline. That is to be commended, because what they do on behalf of us and our constituents is most important. We should never move far away from focusing on that.

I want to speak about what the Queen’s Speech offered my constituents on the two biggest issues of concern to them: local health services and the future of our steel industry. Local health services are severely challenged. We were told last week that NHS trusts nationally had reported a deficit of £2.5 billion in 2015-16. When I asked the Secretary of State earlier whether he could rule out the books not being balanced at the end of the year, he was unable to do so. Some 121 of 138 acute trusts ended 2015-16 in deficit, so there is a real problem with the finances. Members on both sides of the House have echoed that today.

In the Scunthorpe area, our whole health economy is severely challenged financially. Balancing the books is a long-running problem for the clinical commissioning group and the local hospital. That raises the question, which hon. Members have asked today, of whether there is enough cash in the system to allow local health services to do the job we expect. There are wonderful people working in the system in the Scunthorpe area and elsewhere in the country—nurses, care workers, porters, doctors, paramedics, administrators and many others. They go to work every day determined to do a good job, but as my hon. Friend the Member for Southampton, Test (Dr Whitehead) said, they are being asked to do more for less, day in, day out, which produces a strain. As the hon. Member for South West Wiltshire (Dr Murrison) said, the system is at full tilt —or we might say at full stretch.

There have been challenging evaluations of our local health services during the past six months, and we have received poor Care Quality Commission reports for mental health, hospital and some care services, and most recently for ambulance services. People are not going to work to do a bad job, but there is strain in the system and that is reflected in issues of quality and delivery. Disproportionate cuts to social care are adding to the strain on the system.

Locally, there has been an ongoing review of health provision, “Healthy Lives, Healthy Futures”, and there is a general recognition that the way forward is to move resources into the community and closer to patients. That is the theory, but managing to deliver it is challenging because the acute demand at the secondary care end of hospitals, and people turning up at accident and emergency, does not get any less. How do we turn off the tap at that end so as to invest where we know it is needed?

As many Members have said, the real challenge is the ageing population. The Secretary of State said that there will be 1 million more people over the age of 70 by the end of this Parliament, which illustrates the challenge to the system. My hon. Friend the Member for Oldham East and Saddleworth (Debbie Abrahams), many other Members and I are wearing badges from Dementia Friends, which is a reminder of the growth in demands on mental health services, particularly with an ageing population. Despite the excellent work done by the Alzheimer’s Society and others, much more is needed to deliver what needs to be done.

There are massive challenges, and it would be good if it were easier for local services to develop their local workforce, so that healthcare assistants can be translated into nurses, and other innovative things can be done to meet local needs. Given the importance of community services, pharmacies are being challenged by the Government’s desire to take away £170 million of pharmacy funding. That is not a huge figure, but it seems to run counter to the desire to recognise pharmacies as deliverers of community services, particularly for older people who are close to the community, or those who suffer from mental health problems. Why challenge pharmacies in that way? The other week I was proud to present in this Chamber a petition signed by more than 800 local people that said, “Look after our local pharmacies.” As we consider the challenges to health services, we will see that much can be done intelligently to work with the situation and make it better.

I was disappointed that there was nothing in the Queen’s Speech—just as there was nothing in the Budget—to support the steel industry at its time of great challenge. A real industrial policy would make a difference to setting a strategic path, and give confidence to all players, be they employers, trade unions or other stakeholders in our manufacturing industry, especially our steel industry. The Government have been slow to respond to the challenges facing our steel industry, and I hope that in a week Tata long products will move into new ownership, and there will be a new and positive chapter for the future. Today is the closing date for expressions of interest in the ownership of the other part of the Tata empire from across the steel industry in the UK.

The fact that such things are happening does not mean that the Government can go to sleep. They must wake up and do more, including on business rates. When Tata invests in a new blast furnace at Port Talbot, or a reconditioned blast furnace at Scunthorpe, it is ridiculous that that capital investment should mean an increase in its business rates. That is the economics of madness. We should have a system to encourage investment in further production, not penalise it.

We must do more on procurement. The Government’s procurement policy has positive aspects, but when businesses such as DONG Energy develop the North sea wind farm, the test is whether they use UK steel or not. We need action against Chinese dumping, to address the lesser duty rule, and we must stop dragging our feet and stopping the European Union carrying out measures that would support our steel industry.

In those two big challenging areas—the local health economy and the steel industry—the Queen’s Speech does not offer a great deal at the moment. However, this debate, and contributions from across the House, can allow it to be developed into something much better.

Junior Doctors Contract

Nicholas Dakin Excerpts

Thursday 19th May 2016 Commons Chamber

[Mr Hunt]

Yes, I am happy to do that, and I thank my hon. Friend for a lot of his correspondence. The principle here is that junior doctors want to know that there is someone independent they can appeal to if they think they are being asked to work hours that are unsafe and which mean that they cannot look after patients in the way that they would want to because they are physically or mentally too exhausted. We would all want to make that possible, but it means that they need to have someone who is not their line manager. They will go to their line manager in the first instance, but they need to have someone independent and separate. One area where we have made the most progress during the past few months, even before the past 10 days of talks, is on establishing how these guardians can work in a way that has the trust of both the hospitals and the doctors working in them.

[Nic Dakin (Scunthorpe) (Lab)]

The Secretary of State is absolutely right that we can always get further if we get round the table, so why, in response to the cross-party initiative back in February to get everybody around the table, did he not do exactly that and save us all this trouble, rather than trying to impose the contract?

[Mr Hunt]

The cross-party initiative was not to have a new contract, but to abandon plans for a new contract and to have pilots in a few limited places. If we had followed that advice, we would not now have agreed with the BMA the biggest changes in the junior doctors contract for 17 years. Our goal was to get the agreement that we secured yesterday—safer care for the NHS and a better deal for doctors. That was what we achieved, and we would not have got there if we had listened to that advice.

NHS Bursaries

Nicholas Dakin Excerpts

Wednesday 4th May 2016 Commons Chamber

[Heidi Alexander]

I am grateful to the hon. Gentleman for his intervention. The key question we need answered with regard to nursing associates is whether the Government intend them to replace registered nurses. If that is the case, I fear the proposals would be bad for patient care.

Madam Deputy Speaker, you might think a sensible approach to trying to resolve this problem would be to sit down with the Royal College of Nursing, other trade unions, universities and healthcare providers to work out a way forward. But no, this Government seem incapable of that. Instead, in just two lines in the Chancellor’s autumn statement, they announced that they would be scrapping NHS bursaries and asking student nurses to pay tuition fees. The Minister will argue that this will allow universities to train more students, but his problem is this.

[Nic Dakin (Scunthorpe) (Lab)]

Does my hon. Friend agree that the Government should listen to the Royal College, which said that these proposals were “high risk”, potentially

“deterring prospective students from entering the nursing profession”,

and that they risked “worsening the nursing shortage”?

[Heidi Alexander]

I entirely agree with my hon. Friend. I think the Government’s problem is this: they have failed to back up their claim with any evidence and they are now faced with a breadth of opposition to this proposal, not just from Members but from the Royal College of Nursing, the Royal College of Midwives and Unison, while organisations such as MillionPlus, the association for modern universities, are also questioning the assumptions on which the Government base this policy.

--- Later in debate ---

[Ben Gummer]

By reforming the system so that this becomes a loan rather than a grant, we are able to produce 25% extra support for these students while they are training, much as with the rest of the student population.

The results relating to newly qualified nurses are not as the hon. Member for Lewisham East suggests. She should be very clear in the way she addresses this question, because all of us, whatever our views on this subject, have a duty to inform the public properly. It would be remiss of all of us, even those who disagree with the policy as she does, to mislead potential students into thinking that they will have to pay more than they would otherwise. She said that students would have to pay hundreds of pounds more in repayments once they had qualified. That is just not the case. We anticipate that a newly qualified nurse will pay roughly £90 a year more; that will be about the same as they are currently paying, because of the way in which student payment finance is gradated. The impact on newly qualified nurses will therefore not be anywhere near the impact that she has suggested. She should be very careful about how she addresses her points; otherwise, people could receive an impression about these loans that is not actually a fact.

[Nic Dakin]

What calculation has the Minister made of how much of the loan will not be paid back over a period of time? Can we have that information in the public domain as well?

[Ben Gummer]

The economic impact assessment is part of the consultation, and the hon. Gentleman should consult that. It will obviously depend on the way in which the student workforce develops over the next 20 or 30 years, but this has been fully costed within the Treasury’s assumptions, and we anticipate that people working beneath the current limits will not be paying back more than they are doing at the moment. That is in the nature of the way in which student finance repayments are calculated. These measures will not land newly qualified nurses with new payments that they might otherwise not have expected.

--- Later in debate ---

[Nic Dakin (Scunthorpe) (Lab)]

It is a pleasure to follow the thoughtful contribution by the hon. Member for South West Wiltshire (Dr Murrison), who draws attention to the whole issue of workforce planning, which is clearly very challenging for those who are doing it—or not doing it.

The recent inspection of North Lincolnshire and Goole Hospitals NHS Foundation Trust exposed issues of real concern about staffing levels at Scunthorpe general hospital. The challenge of attracting, securing and retaining sufficient nurses and other medical staff has been a constant theme in my conversations with the trust since 2010. In that respect, Scunthorpe hospital is no different from many others around the country. The more I have got involved, the more I have thought that locally designed solutions have a role to play. Having talked to Health Education England, it is disappointing that it cannot do more to support healthcare assistants, for instance, in growing into nurses on the local patch, because they are clearly a potential resource.

There are lots of issues about recruitment, training and retention, as the right hon. Member for Hitchin and Harpenden (Mr Lilley) said, and about how, if we lose 3,000 nurses a year, as the hon. Member for Morecambe and Lunesdale (David Morris) said, we try to keep them. That is a big issue, as well as how we recruit and retain them.

[David Morris]

Just to clarify that, we are not losing 3,000 nurses a year—we are losing 3,000 applicants to be nurses a year.

[Nic Dakin]

I thank the hon. Gentleman, but many nurses are being lost to the system as well, as his comments clearly highlighted.

In Scunthorpe, as in other areas, we are having to recruit from Spain, Portugal and elsewhere in the world. Although that is helping and supporting us, it has impacts, as we have heard, on those areas of the globe from where those nurses are being recruited.

I would like to quote the words of a young student nurse—a constituent—because in some ways they capture the comments that people from around the country are making to us. Katie-May Taylor says:

“I’m a first year student nurse and when I start placement (for 3 months), I will just about be able to cover my travel on top of my rent and food. When you see the hours we have to complete and having a fraction of the summer holidays other students get, you have to understand why the proposed cuts to the bursary and overall funding to the NHS isn’t beneficial.

I appreciate that to other students, getting a monthly bursary must seem like a luxury, however every penny I get goes towards my rent—it’s not just pocket money.

We’re seeing reports that parents are already telling their children not to go into the nursing profession and future nurses are being scared out of applying for university. This is deeply saddening; it’s such a wonderful course to be a part of and our nurses are absolutely vital in the care of society’s health and the maintenance of OUR NHS.

If the bursary is scrapped, a lot of student nurses will end up working 70 plus hours a week (placement, study time, job/s). Is a student nurse working that many hours a week safe patient care?”

Those words capture very effectively the concerns that we have.

The Government are taking a huge gamble with the future of the NHS workforce and patient safety. There is already a shortage of nurses in the NHS, and scrapping bursaries risks making the recruitment and retention of staff even harder. Student nurses are not like other students: they are required to work in clinical practice throughout their degrees, and they deserve to be treated differently. The hon. Member for South West Wiltshire was right to say that it is worth looking at how much they are an intrinsic part of the NHS, and if they are, that must be recognised within the consultation so that they are given credit and remunerated effectively for it. My hon. Friend the Member for Ilford North (Wes Streeting) rightly emphasised the unique position of student nurses.

The longer courses and clinical placements make it harder for NHS students to get part-time jobs to supplement their income. NHS students are much more likely to be women, more likely to come from black and minority ethnic backgrounds, and more likely to be mature students. Many nursing students have already completed one degree and turned to nursing in their late 20s or early 30s. The average age of a student nurse is 28. Many student nurses have family or caring commitments. MillionPlus has pointed out that the changes to the higher education funding system in 2012 have been much less favourably received by mature students and part-time students. Those two groups make up a much greater proportion of the nursing, midwifery and allied health student body, so it is worth looking at that part of the evidence as well.

Analysis by London Economics estimates that the switch to loans will have a significant negative impact of minus 5% on participation, at least initially, especially if one bears in mind the composition of the student health cohort. The Government’s insistence that undergraduate and postgraduate loans will be repaid at the same time will require a repayment rate of 15% above the earnings threshold for those students accessing both undergraduate and postgraduate loans. That will be in addition to any tax, national insurance and pension contributions that will be due.

The savings to the taxpayer are questionable. The Minister was not clear about that when I pressed him on it during his opening remarks. The Department of Health estimate that taxpayers will be better off as a result of the switch is very much a short-term calculation. In fact, it is much less likely that these students will repay their loans as graduates in the 30-year repayment period than the general higher education cohort. Essentially this is a switch in responsibility for the funding of the education of the health workforce from the state to the workforce itself, and it is primarily designed to reduce the departmental budget of the Department of Health.

We need to know more about what estimate the Government have made of the percentage of second degree student loans that will be written off after a 30-year period. We need the Department of Health to provide an estimate of by how much the taxpayer will be better off. We need those figures.

All the key stakeholders have expressed concern, including the Royal College of Midwives, the Royal College of Nursing, the College of Podiatry and the Royal College of Speech and Language Therapists. Even the NHS Pay Review Body has said that

“the removal of the incentive of the bursary could have an unsettling effect on the number and quality of applications for nursing training places in the early years.”

Those who are closest to what is going on are all concerned.

The Minister for Community and Social Care is a very good and thoughtful Minister, and I am sure that he is concerned about the issue. I hope that he will listen to and engage with all those bodies, which know what they are talking about. They are not making it up—their concerns are real and genuine. The Royal College of Nursing is calling on the Government to work with all stakeholders to create a model of student funding that encourages people to join the profession and that recognises the unique aspects of nursing degree courses.

I hope that the Government will take this opportunity to engage with the strong initiative proposed by the shadow Health Secretary and work together to come up with a solution that will allow us not only to recruit professionals, but to retain them into the future. As the son of a nurse and the father of a speech and language therapist, I hope that the Government are listening.

--- Later in debate ---

[Alistair Burt]

If the hon. Lady had been here for the entire debate, she would have heard people speak about the problems of hardship following bursaries; that was referred to by the hon. Member for Ilford North (Wes Streeting) and by Government Members. People want access to more funds, which might help those whom the hon. Lady just mentioned, but the assumption is that, because it will be a student loan and because it is a change, people just will not want to do the courses. There is no evidence to suggest that that is correct. Using it as a scare story is unhelpful for the recruitment that we want.

[Nic Dakin]

Does the Minister accept that the royal colleges and others are genuinely anxious about the proposals? If he does, will he commit to engaging with them as fully as possible?

[Alistair Burt]

That is a good question. Yes, of course. At a time of change, there is a degree of uncertainty. My main point is about how the matter has been blown up yet again, as it was for student loans originally. The idea that people would be deterred from ever going to university, and that no one would go from disadvantaged backgrounds, has been proved false. Of course, the concerns are very much being addressed by the consultation that the Under-Secretary of State for Health, my hon. Friend the Member for Ipswich, is undertaking, and he is listening extremely carefully. The consultation process is very wide and genuine, and he is listening particularly to ideas on alterations and proposals. The consultations are not complete and the scheme is not complete, and he is keeping a close ear on those consultations.

There is recognition that there are different characteristics for those who go into nursing, midwifery and allied health professions, which is why we want to make sure that appropriate support is available. Department for Business, Innovation and Skills student support regulations give more support than the bursary; the Secretary of State retains the power to give discretionary funding in exceptional cases; and in the consultation, respondents can give examples of unique characteristics, so that the reforms can reflect that. Our position recognises that, as my hon. Friend the Member for Faversham and Mid Kent (Helen Whately) said, more of the same will not do the job. The need for change is there. We need more nurses, and we need more nurses domestically trained. We are going to do something different, recognising what changes there might be. That is why we have the consultation. Unique characteristics will be reflected in it; that is what the consultation is about. Keeping the current system is not working and will not work in the future. That is why we need change.