New Cancer Strategy

Nicholas Dakin Excerpts

Thursday 19th November 2015 Commons Chamber

[Nic Dakin (Scunthorpe) (Lab)]

It is a pleasure to follow the hon. Member for Bosworth (David Tredinnick), who painted a very broad canvas of things for us to think carefully about as we take this strategy forward. May I also begin by praising the hon. Member for Basildon and Billericay (Mr Baron) for his leadership in this area and for the way in which Members across the House have worked together in this important field?

It is worth saying from the outset that a large part of the challenges we face are the challenges of success. Success in tackling many cancers has led to a right and proper rise in expectations. It is therefore important to pay tribute to all who work in this field—clinicians, patient groups, charities and a host of other people and organisations—for the outstanding work they do. However, the cost and challenge of treating cancer will continue to rise rapidly during this Parliament. The “Five Year Forward View” projections indicate that expenditure on cancer services will need to grow by about 9% a year, reaching £13 billion by 2020. This growth is between two and three times the rate of other health spend.

The commitment for everyone to have access to the recovery package by 2020 and the development of a quality of life metric by 2017 are welcome, but clear plans need to be put in place for these to happen. It is vital that there are commitments, both in terms of funding and resource, to deliver the full living with and beyond cancer programme, cancer alliances and a workforce review.

A national cancer advisory board, as recommended in the strategy, needs to be set up urgently to hold all the arm’s length bodies to account on delivering the recommendations laid out in the strategy. It is vital that this board is fully independent, with an independent chair. The Government must also fund and implement the recommendations set out in the independent review on choice in end-of-life care to ensure that there is choice and quality in that care.

Such investment in the national choice offer should result in a significant increase in out-of-hospital care, including through district nurses, allied health professionals, pharmacists, social care services and specialist palliative care teams, to ensure that every dying person has access to round-the-clock care seven days a week. That investment should also result in greater co-ordination between services to improve the quality of end-of-life care and to support carers and families; more empowered patients and carers who are able to exercise greater choice in their place of death; a reduction in hospital admissions for people at the very end of their lives; and the use of the latest technologies to support end-of-life care.

As chair of the all-party parliamentary group on pancreatic cancer, I strongly welcome the cancer strategy, and in particular the recommendations relating to improving early diagnosis and improving patient care and end-of-life care. I am concerned, however, that despite recognising the existence of a group of cancers with high incidence but low survival rates—highlighted as group 3 in the strategy—the strategy fails to acknowledge the need for specific actions to tackle the problems unique to that group.

Pancreatic cancer is the fifth most common cause of cancer death in the UK, and it is a clear example of an unmet need in cancer care. On average, one person is diagnosed with pancreatic cancer every hour, yet its five-year survival rate has remained virtually unchanged over the past 20 years and remains shockingly low at around 4%. That is the worst survival rate of the 21 most common cancers.

The hon. Member for Basildon and Billericay rightly welcomed the fact that the strategy recognises the need to improve early diagnosis by reforming the referral system. Improving early diagnosis is the key to improving survival rates. Only 80% of pancreatic cancer patients are currently diagnosed at a stage where surgery—the only real hope of a cure—is still an option, and only 10% go on to receive that life-saving surgery. Ensuring that more patients are diagnosed earlier, while surgery is still a viable option, is therefore essential to improving the appalling survival rates faced by pancreatic cancer patients. That is also an issue for other cancers, such as blood cancers. At present, 50% of acute myeloid leukaemia diagnoses, 37% of myeloma diagnoses and 35% of chronic myeloid leukaemia diagnoses are happening in emergency settings. I echo the comments of the hon. Member for Crawley (Henry Smith) on the excellent work being done by Bloodwise in this area.

The recommendation of a four-week diagnosis target is welcome, and I am pleased that the Department of Health has committed to looking at adopting that recommendation by 2020. I also welcome recommendation 21, which calls on NHS England to pilot the implementation of multi-diagnostic centres as a priority. Such centres would allow patients presenting with vague symptoms, such as abdominal pain, to have multiple tests on the same day, preventing the need for them to present at their GP surgery repeatedly before being diagnosed, thus speeding up their diagnosis. That could be especially significant for pancreatic cancer patients, who report having to visit their GP on multiple occasions before being referred for tests. A UK-wide survey carried out by Pancreatic Cancer UK found that 23% of pancreatic cancer patients had to visit their GP seven or more times before they received a diagnosis. The introduction of multi-diagnostic centres would therefore be a big leap forward.

The call for GPs to have direct access to investigative tests by the end of 2015 is also very welcome. None the less, it is important to ensure that GP surgeries have the imaging capacity—in terms of equipment and of staff training—to carry out investigative tests such as CT scans. Will the Minister tell us what assessment the Department of Health has made of GP practices’ current imaging capacity and the capacity that would be needed to ensure that all GPs were able to carry out investigative tests?

The measures in the strategy to improve patient experience are to be warmly welcomed. National cancer patient experience surveys show that the pancreatic cancer patient experience continues to fall short of expected standards, especially in the lack of appropriate information about their diagnosis, about treatment options and about what to expect following discharge from hospital. Access to a clinical nurse specialist is a key factor in improving the patient experience, but it is also essential to ensure that clinical nurse specialists have the resources needed to provide a good quality service. In a survey of these specialists carried out by Pancreatic Cancer UK in 2015, only 28.36% of respondents said they felt they were able to spend as much time with their patients as necessary and had enough resources to provide a good quality service.

The need for more clinical research into cancer is also highlighted by the new cancer strategy, and I strongly support this recommendation, as the kind of change needed to make any significant impact on survival rates will be achieved only through research: research that will aid earlier diagnosis and screening; research that will result in more and better treatments; and research that, we hope, will offer opportunity for a cure. Despite accounting for 5% of cancer deaths, pancreatic cancer received only 1.4% of the National Cancer Research Institute partners’ research spend in 2014. Although that is an increase on the 2013 research spend, pancreatic cancer research funding continues to lag behind many other areas of cancer research.

The strategy also makes reference to the need for

“a sustainable solution for access to new cancer drugs”.

That has exercised the minds and thoughts of Members from across this House, as well as plenty of people outside it who know a lot more about the matter. It is only a fleeting reference in the strategy, yet access to drugs is one of the most important issues for pancreatic cancer patients. In particular, pancreatic cancer patients face a persistent lack of access to treatments, making access to new drugs especially important. That is demonstrated most starkly by the removal of the life-extending drug Abraxane from the cancer drugs fund list recently. The CDF decision is compounded by the fact that the National Institute for Health and Care Excellence has also reviewed and rejected Abraxane for use on the NHS, on the grounds of it not being cost-effective enough. In a way, that is not surprising, as between 2007 and the end of 2013 NICE recommended only 31% of cancer drugs for use on the NHS. That is why the setting up of the CDF is to be commended, as it is to compensate for this bias by NICE against cancer drugs. The NICE scoring system is even less flexible than the CDF one. Again, it is not fair to judge a new treatment for a disease with such poor survival rates and very few treatment options on the same criteria as other treatments for other cancers and other conditions. We need more imagination and more flexibility if we are to make the strides forward that need to be made.

There is ever such a lot to welcome within the strategy, but it could have gone further, by including measures to deal with group 3 cancers. Despite identifying cancers with high incidence but low survival rates, the strategy has not yet set out any measures aimed at tackling that precise problem. Greater awareness of the symptoms of these cancers, which can be non-specific, alongside more research into diagnosing and treatments, and the creation of a fair and flexible drugs appraisal scheme remain essential. I hope that in taking the work of this strategy forward, the people involved will endeavour to put those things in place.

Cancer Drugs

Nicholas Dakin Excerpts

Tuesday 20th October 2015 Westminster Hall

[Nic Dakin (Scunthorpe) (Lab)]

As ever, it is a real pleasure to serve under your chairmanship, Mr Hollobone. I congratulate the hon. Member for Strangford (Jim Shannon), who is an assiduous campaigner on this and many other issues, on setting out the case very clearly in his opening speech.

I will focus on pancreatic cancer, which, as everyone knows, is an extremely aggressive form of cancer with the worst survival rates of any of the most common cancers. The way in which Abraxane has been dealt with by the cancer drugs fund and the National Institute for Health and Care Excellence is illustrative of the challenges in access to other cancer drugs.

When used in combination with standard chemotherapy, Abraxane can extend the life of eligible patients on average by just over two months compared with using gemcitabine alone. However, it is important to note that, in some cases, patients live for significantly longer than two extra months, with some patients on the trial living for more than two years. The hon. and learned Member for North East Hertfordshire (Sir Oliver Heald) captured very clearly how two months can be significant in allowing patients with such an aggressive disease to settle their affairs and manage their situation as best as they can. There has also been a significant increase in the number of patients surviving for more than one year. For a disease in which there have been no drug improvements for more than 40 years, Abraxane is significant in finding a better answer.

Abraxane represents a middle road for pancreatic cancer patients. It is more effective than gemcitabine alone and, although it has considerable side effects, it is less toxic than FOLFIRINOX, which has been shown to extend life for longer but can only be used for the very fittest of patients. Although not all patients will be fit enough to use Abraxane, more patients will ultimately have access to life-extending treatment.

Abraxane was added to the cancer drugs fund in March 2014. That was a moment of great hope and expectation for the pancreatic cancer community, which for so long has had little about which to be positive. However, as new drugs were added to the cancer drugs fund and costs started to rise, a process began of removing drugs from the CDF’s list of approved drugs so that the fund could keep within budget, as the hon. Member for Strangford has outlined. A further review began in July 2015, and a decision was announced in September that Abraxane, along with several other drugs for other conditions, would be removed as of 4 November. That is happening across cancer treatment. For example, lenalidomide, which is currently being trialled on multiple myeloma patients with positive results, is also being removed from 4 November. This is a big problem out there in the real world.

It seems bizarre that a drug can be added to the cancer drugs fund in March 2014, then be removed just 18 months later. It seems wrong that a drug for which there was such strong demand—more than 550 patients accessed Abraxane via the cancer drugs fund in its first year, and the numbers were rising towards the end of the year—should be removed when few other treatments exist. It seems inequitable that the scoring system used by the CDF does not take into account the extremely poor survival rates for pancreatic cancer. We simply cannot have a one-size-fits-all system in which a drug giving substantial relative gain for a disease that has seen hardly any new treatments or improvements in survival for decades is judged by the same standards as drugs for other cancer types that have much better survival rates and many more treatment options.

Abraxane is not one of the most expensive drugs on the CDF. It costs some £8,000 per patient, not the £90,000 for some other treatments. There is considerable public outcry against the decision. One petition on Change.org created by my constituent, Maggie Watts, who lost her husband to pancreatic cancer 40 years after he lost his mother to pancreatic cancer— there has been no change in survival prospects over those 40 years—has exceeded 88,000 names already. Another petition started by the charity Pancreatic Cancer Action on the parliamentary e-petition site has passed 20,000 signatures.

There is a real problem, and a postcode lottery is emerging across the United Kingdom, with Scotland having approved Abraxane for routine use on the NHS back in January 2015 after the drug was assessed using Scotland’s new patient and clinician engagement system. Perhaps, as the hon. Member for Strangford said, we in England can learn from that. Wales used its own assessment to approve the drug for use back in September 2014. However, because NICE has said no to Abraxane in England, the drug will be reappraised in Wales, which might lead to access being removed. Northern Ireland has never had access to the drug because it generally follows NICE decisions and, as things lie, it does not look as if Northern Ireland will have access to the drug in future.

[Mark Tami (Alyn and Deeside) (Lab)]

My hon. Friend has outlined all the hoops that people have to leap through. If their timing is wrong, they may or more likely may not qualify for the drug. That is happening when patients are at their weakest. They are not experts, and they find themselves victims of what can appear to be a very cruel and harsh system.

[Nic Dakin]

My hon. Friend is right that patients and their families are at a critical point, which is why it is important that, on this difficult issue, we try our best to find a way forward that is sensitive to the need for such exceptional drugs in exceptional circumstances. In many ways, the Government should be praised for introducing the cancer drugs fund, but the CDF is clearly not fit for purpose when dealing with such exceptional situations, which is what is needed.

Other countries across the world are taking a leap forward in approving Abraxane for their health systems. Abraxane has been approved on price grounds for reimbursement in Austria, Denmark, Germany and Greece, and it has been given the go-ahead in the USA, Canada and Australia. There is a real danger that patients in the UK will be left behind unless they happen to be in Scotland. Removing access to Abraxane could mean that fewer patients can access trials. Moreover, we could be setting back research into a disease that for many years has had the worst survival rates of the most common cancers. This is an opportunity for a breakthrough in medical research that needs to be taken

I ask two things of the Minister, who goes about his work in an assiduous and effective way. First, can he take steps to examine the processes that NICE and the CDF use to consider drugs so that they take into account the exceptional circumstances surrounding drugs of this nature in areas where there has been no medical process or medical hope for many years? Secondly, will he meet me and the other officers of the all-party group on pancreatic cancer to explore the specific issues around Abraxane?

Oral Answers to Questions

Nicholas Dakin Excerpts

Tuesday 24th February 2015 Commons Chamber

[Dr Poulter]

The most important thing we have done is support our front-line staff with additional investment in the NHS, which Labour called irresponsible, and there is about £13 billion more going into the NHS during this Parliament. We have also increased transparency to make sure that where there are isolated pockets of poor care, the Care Quality Commission can intervene and make recommendations to improve the quality of care for patients in those hospitals.

[Nic Dakin (Scunthorpe) (Lab)]

20. Given the significant challenges facing the NHS and the fact that this top-down reorganisation has led to this hiring and firing and therefore a distraction of energy and attention at crucial times, do not the Government now regret their top-down reorganisation?

[Dr Poulter]

A reorganisation of NHS services that results in administration spending being reduced from 4.27% under the previous Government to 2.77% under this Government, meaning that there is £5 billion more money for front-line patient care, is a good thing. That is something the Opposition should support, because it means that patients are getting a better service.

Pancreatic Cancer

Nicholas Dakin Excerpts

Thursday 15th January 2015 Commons Chamber

[Nic Dakin (Scunthorpe) (Lab)]

There have been several parliamentary debates on pancreatic cancer over the past year, not least the one in Westminster Hall in September in response to the e-petition launched by my constituent, Maggie Watts, which gained more than 100,000 signatures. The petition called for more to be done to improve public awareness and early diagnosis of, and increased research into, pancreatic cancer. It was a positive, constructive debate, with many Members from across the House showing their passion and commitment to upping our game on tackling pancreatic cancer.

The Minister and hon. Members in the Chamber are well aware of the issues, but it is important to put on the record again the seriousness of this disease. Pancreatic cancer is the fifth largest cause of cancer deaths in the UK today, and is set to overtake breast cancer as the fourth biggest cancer killer by 2030. Some 8,800 people are diagnosed with the disease each year, and 8,700 people die from it each year. Five-year survival rates are less than 4%—the worst rate for any of the 21 most common cancers—and have barely changed during the past 40 years. While mortality rates have fallen for most forms of cancer, sadly, those for pancreatic cancer are rising. That is largely due to late diagnosis, with half of all diagnoses made via emergency admissions, which means that less than 20% of patients are diagnosed at a stage when curative surgery remains an option.

Thankfully, these days a majority of cancer patients survive for 10 years. Sadly, that is not the case for pancreatic cancer patients, of whom fewer than 1% survive 10 years. That is why future medical support for pancreatic cancer—greater awareness, early diagnosis, new treatments and faster access to treatments—is so important.

The debate this week is fortuitous as it follows Monday’s announcement that the cancer drugs fund has removed 25 drugs from its approved list. As the Minister will know, there was real anxiety about the pancreatic cancer drug Abraxane being removed. That drug has been shown to extend patients’ lives by an average of about two months, and in some cases by significantly more. It is routinely used around the world as a basic standard of care for pancreatic cancer patients. If it is removed from the CDF, there is a real danger that English patients will be hugely disadvantaged. It was positive news that Abraxane has not been removed from the CDF list.

However, from reading the small print of the CDF decision, it appears that the drug is still under threat of removal. The CDF panel has merely granted a stay of execution while more evidence on Abraxane is gathered. Do not get me wrong: the extra time is welcome—I hope, once more evidence has been provided, that the CDF panel will agree to keep Abraxane for the longer term—but at the moment we are in a state of limbo.

Will the Minister clarify just how much time will be allowed for the drug manufacturer to provide additional evidence to the CDF panel? What specifically needs to be provided for a positive decision? Importantly, will clinicians dealing with pancreatic cancer day to day and patient organisations be allowed to feed into the process and submit their observable evidence to the CDF? I hope that the Minister will agree that an appropriate period should be allowed for sufficient evidence to be collated, presented and analysed. Ideally, gathering evidence over a period from clinicians, using the drug at the coal face, would be the best way to trial commissioning through evaluation. Does the Minister support that approach?

The truth is that the CDF’s decision not immediately to delist Abraxane on Monday is more important than ever because over the Christmas break NICE announced that it would not fund Abraxane routinely on the NHS. Consequently, if Abraxane were no longer on the CDF list, patients in England would not be able to access the drug for free. Its place on the CDF list is now, literally, the last lifeline for some patients.

NICE rejected the drug on cost grounds, yet it costs only £8,000 per patient—much less than some other specialist drugs, which run to tens of thousands of pounds. The issue is the way that NICE calculates cost benefit through its system of quality adjusted life years, which in reality works against cancer drugs, especially for those cancers with poor prognoses such as pancreatic cancer. In this instance I understand that the drug was not even assessed or considered under NICE’s less prescriptive end-of-life criteria. That seems rather strange when the disease we are talking about has the worst survival rate of any common cancer, with the average survival time for metastatic pancreatic cancer patients just two to six months.

Questions have been raised about the effectiveness of the NICE drug appraisal system, with 60% of cancer drugs rejected by NICE in 2012—an increase on figures for 2010. Despite the excellent work that NICE and the CDF have done, there is a strong argument for reform, and I know that a number of models have been considered in the last few years. I urge the Minister to bring together NICE, the CDF, the NHS, charities, the industry, and others to thrash out as soon as possible a new, workable drug appraisal model that everybody has confidence in.

Important as they are in extending life, chemotherapy drugs are not the be-all and end-all. In fact, for pancreatic cancer survival rates to increase substantially we need earlier diagnosis of the disease, and new types of treatment made available to patients as a matter of priority. Will the Minister prioritise a public awareness campaign? Campaigners such as my constituent, Maggie Watts, and fantastic pancreatic cancer charities such as Pancreatic Cancer Action and Pancreatic Cancer UK would, I am sure, be keen to work with the Department, and others, to promote a public awareness campaign that leads to earlier diagnosis.

Some of the trial measures for early diagnosis announced by NHS England last weekend, including direct GP access to CT scans, direct patient referral to specialists, and multi-disciplinary diagnostic centres, are welcome. Measures that are designed to speed referral pathways and stop patients being “ping-ponged” backwards and forwards between GPs and different specialists were raised in the Westminster Hall e-petition debate.

Self-referral may end the tragic cases of patients who get so fed up with being ignored by their GP or hospital that they end up paying for a private scan to confirm one way or another whether they have cancer, and I am optimistic that progress can be made. Perhaps the Minister can provide us with more details about the trials, which I know are being implemented jointly with Cancer Research UK and Macmillan Cancer Support. How many trial areas will be selected? Where will they be? How can patients take part? Perhaps importantly for this debate, will access to tests for pancreatic cancer, such as CT scans, be included in the pilots?

One issue raised in the September debate was the need to prioritise promising new technologies for treating cancers of unmet need—such as pancreatic cancer—as soon as possible. It was welcome when the Minister said in response to that debate that a new NHS England and Cancer Research UK trial into stereotactic ablative radiotherapy—treatments such as CyberKnife—would include pancreatic cancer. That, and other treatments such as NanoKnife, can precisely target tumours, potentially making them very important in the fight against pancreatic cancer where the location of the tumour sometimes makes curative surgery impossible—for instance, when the tumour has grown very close to an artery. Those new technologies could therefore help to reduce the size of the tumour on so-called borderline resectable patients, subsequently making them eligible for full curative surgery. The confirmation over the weekend that NHS England will be carrying out the SABR trial is most welcome. Will the Minister confirm that the trial will include pancreatic cancer? Will she confirm how many patients will be recruited and which centres will carry out the trial? When will it start recruiting?

One of the ways we might gain more rapid data on the efficacy of technologies such as CyberKnife and NanoKnife and benefit patients at the same time is through the commissioning through evaluation programme. The Minister will be aware that the all-party group on pancreatic cancer produced a report in October that made a number of recommendations about how to boost research into pancreatic cancer. I am grateful to the Minister for copying me in to her response to the hon. Member for Lancaster and Fleetwood (Eric Ollerenshaw), who is in his place. He has done an outstanding job of chairing the all-party group and raising issues both in this House and outside relating to this difficult matter. One recommendation suggested including both NanoKnife and CyberKnife in the NHS England commissioning through evaluation programme as a matter of priority. Will the Minister update us on the current funding status for commissioning through evaluation? What consideration will be given to the all-party group’s recommendation to include those technologies in the scheme as a priority?

On a similar subject, and referring to another recommendation from the recent all-party group’s research report, the Minister will know that Genomics England is funding a huge project to sequence the genomes of people with rare diseases and cancer. As things stand, I believe only six types of cancer are included in that project and that pancreatic cancer is not one of them. I therefore ask the Minister to include pancreatic cancer as a priority area as part of that project. Failing that, will she confirm that, under their service specifications with Genomics England, individual centres have the flexibility to add to the types of disease from which they collect and sequence samples? If individual centres were agreeable, they could themselves decide to add pancreatic cancer to their work areas above and beyond the six cancer types agreed nationally.

I note that a new independent cancer taskforce has been established to produce a new national cancer strategy for the next five years. That is truly welcome news. I understand it will look at areas such as early diagnosis, access to treatment, improvements to care, and, vitally, research and innovation. As part of that development, will the Minister consider making sure that the new strategy has a particular focus on prioritising cancers of unmet need? If we are to make real inroads into improving overall cancer survival rates, we must prioritise building research and innovation to better tackle the most difficult-to-treat cancers—those with the lowest survival rates such as lung cancer, brain tumours, oesophageal cancer and, of course, pancreatic cancer.

In conclusion, hopefully in the coming months we will receive confirmation that Abraxane stays on the cancer drugs fund list for the longer term. This is a short-term, but important, step. I hope we will see new treatments, such as CyberKnife and NanoKnife, made quickly available to pancreatic cancer patients, perhaps through the commissioning through evaluation process. I hope clinical trials and research projects, such as the Genomics England project, will prioritise pancreatic cancer for research, and that a new national cancer strategy might prioritise research and innovation into tackling the cancers with the worst survival outcomes. Lastly, I hope the Government will work with all interested parties to introduce a public awareness campaign to maximise early presentation, followed by early diagnosis, leading to earlier action and transforming outcomes for patients with pancreatic cancer.

--- Later in debate ---

[Nic Dakin]

I thank the Minister for everything she has said to date. On the issue of a public awareness campaign on pancreatic cancer, is there a way in which those with pancreatic cancers could engage with that body to see if there is a way forward?

[Jane Ellison]

If I recall my diary correctly, I have a meeting with Sean Duffy coming up, and I would be happy to raise that issue with him, along with any other points arising from this debate. It will certainly be on my agenda for discussions with him. I have touched on the matter briefly with him before, but I will pick it up again.

The problems with late diagnosis have been explored before, and it is critical that we get people the most appropriate treatment early. We have discussed radiotherapy before. It can be a very helpful treatment for some patients. As part of its recent announcement, NHS England committed a further £15 million over three years to evaluate and treat patients with a modern, more precise type of radiotherapy— stereotactic ablative radiotherapy or SABR, as the hon. Gentleman mentioned. That evaluation programme will mean a significant increase in the number of cancer patients eligible to access this treatment by around 750 a year, and the programme will widen the number of cancers being treated by SABR, including cancer that has spread to another part of the body.

The new investment is in addition to NHS England’s pledge to provide up to £6 million over the next five years to cover NHS treatment costs of SABR clinical trials, most of which are being led by Cancer Research UK and one of which—as the hon. Gentleman knows from our debate last September—relates to pancreatic cancer. As for the hon. Gentleman’s suggestion regarding commissioning through evaluation, I shall raise it with NHS England. I am afraid that we do not yet know which centres or how many patients will take part in the trials to assess the effectiveness of SABR in comparison with conventional radiotherapy or surgery, but I understand that we are likely to have that information in the coming weeks. I will certainly make the decision-makers involved aware of the debate, and of the interest in the outcome of their deliberations.

NHS England’s chemotherapy clinical reference group has set out service specifications defining what NHS England expects to be in place to enable providers to offer evidence-based, safe and effective chemotherapy services. NICE has issued technology appraisal guidance which recommends Gemzar as an option for treating patients with advanced or metastatic adenocarcinoma of the pancreas who meet certain clinical criteria. NICE is also appraising a number of new drugs for pancreatic cancer. NHS commissioners are legally required to fund treatments recommended by NICE in its technology appraisal guidance.

Understandably, the cancer drugs fund has been mentioned this evening. The Government’s reasons for establishing the fund are well documented. At the end of August 2014 it received an additional £160 million, and I welcome the announcement on 12 January by NHS England, which is now responsible for the fund’s operational management, that it too would provide extra money. The CDF panel has decided that further consideration of Abraxane for the treatment of pancreatic cancer is needed, and it will remain on the national CDF list until that has been concluded. I am not yet sure about the timings, but I will undertake to update the all-party group, including the hon. Members for Scunthorpe and my hon. Friend the Member for Lancaster and Fleetwood, in due course.

Let me now say something about NICE appraisals. Representatives of the Department, NICE, 10 key cancer charities and the pharmaceutical industry met in December to discuss the future of cancer drugs commissioning. They committed themselves to establishing a working group to develop a robust process to support the sustainable, long-term commissioning of cancer drugs. The group will meet for the first time, opportunely, on Monday 19 January.

I am glad that the hon. Member for Scunthorpe found the letter about research useful. He and I, along with my hon. Friend the Member for Lancaster and Fleetwood, had a very good meeting with the chief medical officer, and we have followed that up with a response to the all-party group’s excellent report, which was published last October. At our meeting, the chief medical officer said that she would be happy to attend a meeting of the all-party group. I will remind her of that, but I suggest that the hon. Gentleman and my hon. Friend get in touch with her. We would respond positively to that.

The Government are investing a record £800 million over the five years to 2017 in a series of biomedical research centres and units, including £6.5 million of funding for the Liverpool pancreas biomedical research unit. The unit is working in partnership with industry and leading research institutions to develop new treatments and diagnostic strategies for pancreatic cancer. The National Cancer Research Institute brings together clinicians, scientists, statisticians and lay representatives. Its upper gastro-intestinal cancer clinical studies group has a pancreas sub-group, which plays a vital role in the development of trials.

Late in 2012, the Prime Minister launched the 100,000 genomes project, which will sequence 100,000 whole genomes from NHS patients by 2017. It focuses on patients with rare diseases and their families, as well as on patients with some types of cancer. We believe that the six cancers that will be covered will give us knowledge and understanding that can be applied to all cancers. Although pancreatic cancer is not one of the six, we expect the project to make a useful contribution in that regard.

I thank both Members who have spoken this evening, I thank the all-party group, and I thank all those who campaign tirelessly for progress on pancreatic cancer. We know that achieving improved outcomes for people with the disease is a huge challenge, but I believe that the change that we all desperately want to see will come. I welcome the new cancer taskforce, which will be leading the way, and I undertake to write to its independent chairman, drawing his attention to this evening’s important debate and the work of the all-party group.

Question put and agreed to.

National Health Service (Amended Duties and Powers) Bill

Nicholas Dakin Excerpts

Friday 21st November 2014 Commons Chamber

[Clive Efford]

I hope the hon. Gentleman does not mind, but I am going to make some progress.

Never before have we had market tendering of the health service as we have today, and it is breaking down our NHS. The Bill is not a solution to all the mistakes that this Government have made in their top-down restructuring of the NHS, but it is an important block on enforced privatisation. The argument can be simplified into two distinct sides. If people believe the NHS should be a pure market, open to competition regulations, where the interests of competition are put before those of patients, they belong on the side of the Government. If people believe the NHS is a public service that should be free of competition rules, where the interests of patients are put first, they should vote for the Bill today.

We know that No. 10 did not understand what was going on in 2012. The Chancellor was asleep at the wheel, and the Liberal Democrats, suffering from some form of terminal Stockholm syndrome, were led by the nose to turn the NHS from a public service into a free market. My Bill takes a scalpel to cut the heart out of the hated 2012 Act and put right the worst of the Government’s mistakes. It will remove the sections that require the tendering of NHS services for competition with the private sector, the result of which has been millions of pounds being diverted from patient care into the pockets of lawyers and accountants through the tendering process. NHS bodies are spending millions either bidding or managing bidding processes, and that is all money being diverted from patient care. That must stop, and this Bill will end it.

[Nic Dakin (Scunthorpe) (Lab)]

I congratulate my hon. Friend on securing the Bill’s progress today. Does he agree with my constituent Julian Corlett, who expresses real concern that further privatisation would mean the NHS may be reduced simply to a brand and nothing more?

Five Year Forward View

Nicholas Dakin Excerpts

Thursday 23rd October 2014 Commons Chamber

[Mr Hunt]

Exactly—that is precisely the point. This report has example after example of how the new structures—clinical commissioning groups—are integrating care. That is why it makes it so clear that it would be wrong to do what Labour wants to do, which is to repeal the Health and Social Care Act 2012 and to strip CCGs of their powers when they are providing precisely the integrated care that we all think is important.

[Nic Dakin (Scunthorpe) (Lab)]

Northern Lincolnshire and Goole Hospitals NHS Trust has made significant progress over the past two years, but it remains financially very challenged and in significant deficit. What, if anything, in these plans will help to remedy that challenging situation?

[Mr Hunt]

Two things. I have had a very interesting visit to Goole hospital. It was very impressive to see how it has responded to the special measures programme and how, as a result of the new inspection regime, which Labour Front Benchers tried to vote down, it has made real improvements in care on the front line for the hon. Gentleman’s constituents. Those at the hospital will be pleased to see that this report endorses the new transparent approach to dealing with variations in care. It also says that we need to continue with increases in real-terms funding for the NHS, which we only get with a strong economy.

Pancreatic Cancer

Nicholas Dakin Excerpts

Monday 8th September 2014 Westminster Hall

[Nic Dakin (Scunthorpe) (Lab)]

I beg to move,

That this House has considered the e-petition relating to research funding for and awareness of pancreatic cancer.

It is a pleasure to serve under your chairmanship, Mr Chope. I thank the Backbench Business Committee for granting this important debate. That citizens of the United Kingdom can, through their petitioning, move issues up the national agenda shows the strength of our democracy. Pancreatic cancer has not had the strong public spotlight of concern that some other diseases have had, so it is fantastic that the public’s voice has led directly to this debate, which I am proud to initiate. I thank every one of the 106,398 people who signed the petition by 8 April, and all those who have signed it since.

I pay particular tribute to my constituent, Maggie Watts, who started the petition with a determination to push pancreatic cancer further into the public’s conscience and higher up the political agenda. That we are here today in a packed Westminster Hall debate is tribute to her efforts and to those of everyone in the pancreatic cancer community—the charities, clinicians, patients, survivors and family members and friends of patients—who energised the nation to say through the petition that the time is right for us to up our collective game on pancreatic cancer.

It is worth pausing to consider the powerful testimony of the petition text, which asks the Government to:

“Provide more Funding & Awareness for Pancreatic Cancer to aid long overdue progress in earlier detection and, ultimately, improved survival rates”.

It reminds us that pancreatic cancer is the

“5th leading cause of UK cancer death with the worst survival rate of all cancers yet it receives only c1% of research spend. 5 year survival of 3% hasn’t improved in over 40 years, whilst survival rates for other cancers have… More funding/more public awareness is vital so that progress can be made in earlier detection and, ultimately, better survival rates. Often termed the “silent killer”, many of PC’s symptoms mirror other less critical illnesses. Sometimes GPs may not recognise these early enough, looking first at other possible causes resulting in lost time before diagnosis. By this time, in many cases, the prognosis is terminal.”

The petition calls for action:

“Another 40 years can’t pass without change. The requirement is for significantly increased research funding and inclusion in the National Awareness & Early Diagnosis Initiative (NAEDI) Public Symptoms Awareness Campaign”.

Pancreatic cancer is the fifth most common cause of cancer death in the UK. It has the worst five-year survival rate of the 21 most common cancers, and that has not changed in 40 years. Maggie Watts’s husband Kevin died of pancreatic cancer exactly 20 months from diagnosis, aged 48. His mum died 40 years earlier of the same disease, aged 27. Maggie said:

“What shocked me the most when I started to research pancreatic cancer is that, actually, Kevin stood no better chance of survival in 2009 than his mum did in 1969. Their deaths were 40 years apart yet there was no change in survival rates in all of that time. I found that hard to understand—there is not a lot in this world that hasn’t changed or improved over a 40 year period, including most other cancers but, for pancreatic cancer, survival rates are still shockingly low.”

She concluded that

“there must be a direct correlation between the lack of funding allocated to pancreatic cancer and the lack of progress in the disease.”

The lack of funding has meant that there has been no progress in 40 years. It has not been a public or political priority, and that has to change. As Dr Andrew Millar of London Cancer told the all-party group on pancreatic cancer last week, the very fact that people have only a one in 90 chance of getting this cancer, but a 95% chance of dying once it is diagnosed means that it is less likely to attract commercial funding than the more treatable forms of cancer. As he said, that is exactly when the Government need to step up to the mark and step in, yet site-specific funding for pancreatic cancer research is very low in real terms when compared to other forms of cancer. Only £5.2 million, or just 1% of the National Cancer Research Institute’s 2013 budget, was spent on pancreatic cancer research—that equates to just £625 per death per year on pancreatic cancer, compared with £3,426 per death per year on breast cancer—despite pancreatic cancer being responsible for 5.2% of all cancer deaths in the UK and deaths from pancreatic cancer increasing between 2002 and 2013, while deaths from most other cancers declined.

[John Hemming (Birmingham, Yardley) (LD)]

I congratulate the hon. Gentleman on taking up this issue in Parliament and the campaigners on raising the petition. Constituents have come to me to explain their concerns about pancreatic cancer. Does he agree that it is important that the campaign continues to do excellent work in raising awareness of the difficulties with pancreatic cancer?

[Nic Dakin]

The hon. Gentleman is absolutely right. The campaign must go on, beyond today and into the future. Campaigners are here today in strong heart and with a strong determination to ensure that that is the case.

Breaking down the NCRI spend into contributions from individual partner members is difficult, but we know from evidence given to the all-party group that in 2013, Cancer Research UK provided £2.3 million and the Medical Research Council provided £750,000. The contribution from the Department of Health was therefore just £700,000. In its 2012 policy briefing, “Study for Survival”, Pancreatic Cancer UK calculated that at least £10 million of investment is needed by 2015 and that £12 million is needed by 2017. The target is £25 million by 2022. The minimum figure of £10 million to £12 million has not been plucked out of the air; it comes from a high-level analysis of other cancers, such as prostate and bowel, which suggests that there is a point where funding starts to grow in a more rapid and, importantly, more sustainable manner. A critical mass is needed to generate a solid research infrastructure—for example, through the establishment of centres of research excellence. A critical mass of researchers generating competitive research proposals needs to accrue, and those investment targets are a key starting point for such progress.

Maggie told me that she considers herself in a way to be lucky. She said that she and Kevin had 20 months post-diagnosis and that he was an incredibly positive man, who refused to give in to the disease. Maggie said:

“When I say we were ‘lucky’ I mean because we got 20 months to do and say everything we wanted to. People that I have met whilst I’ve been working on the e-petition lost their loved ones weeks or even days from diagnosis. They were only just getting their heads around a terminal cancer diagnosis when they were having to deal with death. I’ve heard some incredibly sad stories around pancreatic cancer and I’ve heard lots of them.”

Stories of such shattering losses are not rare. One quick look at the tributes left online for victims is testament to that.

[Mr Andrew Smith (Oxford East) (Lab)]

I congratulate my hon. Friend and the others who have raised this debate, as well as those who have petitioned on this vital matter. Does he agree that, as well as the general need for more research funding, screening tools, which are not presently available, need to be developed to make early diagnosis possible? Such developments have been responsible for so much progress with other cancers.

[Nic Dakin]

My right hon. Friend is absolutely right that the nub of the issue is how to get early diagnosis—the difficult-to-achieve holy grail.

In evidence to the all-party group a week after celebrating six years of survival, pancreatic cancer survivor Ali Stunt said:

“We need to focus on early diagnosis… Those of us who are diagnosed in time for surgery, which is what we want to achieve, have a tenfold increase in the chance of surviving five years… I was lucky. I was told that surgery was an option and that my operation would be booked in for a week’s time. I was told I needed chemotherapy and a week later was in my consultant oncologist’s office. I told him that I wanted to live to see my boys graduate. Following combination chemotherapy for 6 months and then chemo-radiotherapy, my scans were clear. Regular check-ups followed with scans and blood tests—all of which revealed ‘no evidence of disease’. My oncologist finally ‘signed me off’ in April 2013.

This is a story not often heard when pancreatic cancer is involved. These past 4 years since I founded Pancreatic Cancer Action I have met and got to know some fabulous people who have bravely fought and helped me raise awareness of this cruel disease. Not many of them are still alive, but all will have a special place in my heart. It is and always will be my mission to get more people diagnosed sooner—so more can have the same outcome as me.”

I first became aware of pancreatic cancer many years ago when my friend and colleague Martin Newbould became ill with it. Martin was an inspirational individual, a wonderful family man and an outstanding head of maths. More recently, my witty local newsagent Mick Emerson retired only to be diagnosed with pancreatic cancer soon after and then pass away. My friend Sir John Mason passed away just before the summer after a dignified battle against the disease, leaving a massive legacy of good work in the community. Having been ill for some time with an undiagnosed condition, John’s pancreatic cancer was, I understand, finally diagnosed after an emergency admission at Scunthorpe hospital’s A and E.

Currently, a staggering 48% of pancreatic cancer diagnoses are made by emergency admission, which is more than twice the total for other forms of cancer. That is important, as presentation via emergency admission is normally when the disease is more advanced and associated with much poorer survival rates than other routes to diagnosis. For example, one-year survival for patients presenting via emergency admission is just 9%, as opposed to 26% for those diagnosed as a result of GP referral. Over 40% of pancreatic cancer patients visit their GPs three times or more before even being referred to hospital. Some 16% have to visit their GP or hospital seven times or more before the correct diagnosis is made. By comparison, figures show that 75% of all cancer patients combined are referred to hospital after only one or two visits to their GPs.

Such data are only recently known as a result of the National Cancer Intelligence Network’s impressive work. It shows the power of data in helping us to tackle this disease. Further improvements in the collection and application of real-time data have the potential to transform medical practice in this area. Evidence given to the all-party group last week suggests that establishing a tool to collect patient data online would not be difficult to achieve. Such a robust IT system would radically improve data collection. Patients support their data being used for analysis and expect their data to be used to improve care for everyone else. London Cancer’s Dr Millar recommended that patient data be made freely available for use, within the law, for research in return for the free health care received under the NHS. Linking more GP data with that already received through secondary care and the research lab will help to improve early diagnosis in terms of the amount of data that can be analysed.

One issue highlighted throughout the all-party group’s inquiry was the disconnect between primary and secondary specialist care in achieving timely, effective treatment. Pancreatic cancer patients are not transferred quickly enough from primary to secondary care when time is of the essence if better outcomes are to be achieved. Most European countries do not have the same GP gateway as the UK; patients can see a specialist more quickly and clinical outcomes are better. One consultant surgeon and surgical oncologist told us:

“The patient turns up and the chap says, ‘Well it’s not reflux and I’m a reflux doctor. Back to your GP.’ So he goes back to the GP—more delay is coming. The GP says, ‘Well it isn’t reflux. Maybe now he has some back pain or something. We’ll try the spine doctor.’ So he goes to the spine surgeon. The spine surgeon says, ‘Well, it’s not spine pain. Back to your GP.’ This is the common scenario. The patient becomes a tennis ball.”

To get around this investigative ping-pong, it is worth seriously considering whether to allow GPs direct, easier access to CT scans, which would be much more likely to rule cancer in or out at an earlier stage than other investigative measures. One experienced GP told us:

“I think it’s about getting the right test, for the right patient, at the right time. Presently a hospital doctor who has had—no disrespect to my colleagues—two years’ medical experience can request a CT scan for a patient in hospital where I can’t.”

There is recognition that allowing GPs to refer patients directly for CT scans could accelerate diagnosis, but there is understandable concern about how it might work in practice.

[Dr Phillip Lee (Bracknell) (Con)]

Mr and Mrs Stella, constituents of mine who tragically lost their son Robert aged just 26, are sitting in the Public Gallery. I am a working doctor and fully understand how difficult it is to diagnose pancreatic cancer early because of the non-specificity of the symptoms. However, the solution might be in research. GPs require a test and to be able press a button and diagnose something from within the primary care setting. As the hon. Gentleman rightly points out, obtaining tests from primary care is difficult. Does he agree that once we have found such tests, which will come with time, primary care is where funding should be placed, so that earlier diagnosis is more achievable? Pancreatic cancer can be beaten, but to beat it we must diagnose it early.

[Nic Dakin]

I absolutely agree that the need is to find the tests and to have the wherewithal to allow them to take place.

I want to ask the Minister a few specific questions that she may pick up on in her response. Will the Government put in place pilots across the UK to experiment with direct GP referrals for CT scans to see how that might work and what impact it has on what actually happens—the positives and the negatives—so that we can learn from the experience? What actions can she take to boost awareness of pancreatic cancer signs and symptoms among GPs, to which the hon. Member for Birmingham, Yardley (John Hemming) referred earlier? Will the Department of Health consider pump-priming research into more recalcitrant cancers, such as pancreatic cancer, with ring-fenced grants where sustainable research has yet to be reached? As pancreatic cancer survival rates remain stubbornly low, will the Minister consider running specific awareness campaigns for the public through appropriate media?

The petition and this debate will have helped to raise pancreatic cancer up everyone’s agenda. I pay tribute to how Julie Hesmondhalgh—Hayley Cropper in “Coronation Street”—has helped to raise awareness of pancreatic cancer. I understand that she has been nominated for the best soap actress award at the TV Choice awards tonight. We wish her luck with that, because it will move pancreatic cancer yet further up the agenda. It is good to have her here today as part of the campaign. Julie points out:

“What the Coronation Street storyline did for pancreatic cancer awareness is phenomenal, but much more attention and funding is required. I worked with Maggie, along with many motivated people affected by pancreatic cancer and the charities Pancreatic Cancer Action and Pancreatic Cancer UK, to push the petition to the 100,000 signature milestone. This cancer desperately needs to be in the spotlight.”

She is absolutely right. The spotlight shines on it today. We need to seize this opportunity, this moment, this petition, this debate to up our game. Another 40 years cannot pass by without change. We need to set our stall out to make the same progress that we have made in prostate, breast and bowel cancer in the past 40 years for pancreatic cancer in the next 40 years. Nothing less is satisfactory. It is, as our parliamentary inquiry says, time to change the story.

[Mr Christopher Chope (in the Chair)]

I call—[Applause.] Order. It is not customary for us to applaud. We keep quiet and listen. I am sure that the mere presence of so many people in the Public Gallery is an indication of the strength of feeling on this important issue. I call Eric Ollerenshaw.

--- Later in debate ---

[Nic Dakin]

It is a pleasure to see you in the Chair, Mr Davies. It is important that the House of Commons takes seriously issues that are of concern to the general public. As the Minister recognised, that an e-petition can get a subject on our agenda is a big plus for UK democracy and is something of which we should all be proud. Those who worked with Maggie Watts to get the e-petition over the 100,000 mark should be congratulated on helping to secure today’s quality debate and to shine a spotlight on pancreatic cancer.

What a debate we have had! Twenty-five Members of Parliament have been in the room during the sitting and the Public Gallery has been full throughout. As the hon. Member for Pudsey (Stuart Andrew) said, the debate has been varied. As the hon. Member for Peterborough (Mr Jackson) said, it has been Parliament at its best. We had a contribution from the hon. Member for Lancaster and Fleetwood (Eric Ollerenshaw), whom I congratulate on the leadership that he has shown on the issue over the past few years in this Parliament. It is my pleasure to have worked with him. We also heard contributions from my hon. Friends the Members for Worsley and Eccles South (Barbara Keeley), for Stalybridge and Hyde (Jonathan Reynolds) and for Easington (Grahame M. Morris), the hon. Members for Basildon and Billericay (Mr Baron) and for Milton Keynes South (Iain Stewart) and then the shadow Minister and the Minister. Each and every contribution was of the highest quality.

The issues that we constantly returned to were cracking the challenge of early diagnosis, getting faster referrals from primary care to specialist secondary care to improve outcomes, the nature of research and the amount of funding, GP training and awareness, GP access to CT scans and the use of international and intra-national comparisons to help drive our performance. The Minister’s response engaged with the points made in the debate and was full and positive. As she said, the issue is fundamentally hard, but we need to do better. Listening to her, I thought that she shares our determination to ensure that we do better and that, following 40 years of no change, the next 40 years will be transformational in how the disease is dealt with. I welcome her willingness to continue to meet the all-party group and campaigners from outside Parliament to help to improve our performance on pancreatic cancer.

The title of the all-party group’s report is worth repeating as we conclude the debate: “Time to Change the Story”. It is time for action. This is the beginning of the rest of the campaign.

Question put and agreed to.

Resolved

That this House has considered the e-petition relating to research funding for and awareness of pancreatic cancer.

Hospital Car Parking Charges

Nicholas Dakin Excerpts

Monday 1st September 2014 Commons Chamber

[Nic Dakin (Scunthorpe) (Lab)]

I rise to make a brief contribution to the debate. I congratulate the hon. Members who secured the debate. Already, we can see the value of it, not least from the way in which the last speaker drew attention to the sort of best practice that should be considered by trusts up and down the land.

In my patch, I have been very concerned about the rise in car park charges at Scunthorpe general hospital. I presented a petition to the House on behalf of local residents and patients in September 2013, which argued that the rises in car parking charges should not go ahead. At the time, the Secretary of State advised me that every trust has the autonomy to make decisions locally and that the provision of car parking for patients, visitors and staff should reflect the local situation. I am pleased that he has now gone further in the guidance that he has issued, which I hope will help people such as my constituents, who are taxed for being ill or for visiting the hospital. As the hon. Member for Eastbourne (Stephen Lloyd) pointed out, the impact on parking in the local area is also a problem for local residents. For those two strong reasons, it is important that the movement on this issue is welcomed and that it goes even further.

[David Wright (Telford) (Lab)]

I believe that hospital parking charges should be abolished. The car parks in Telford and Shrewsbury could easily be managed without charges. Some people have expressed the concern that people will overflow-park in hospital parking areas. Tickets could still be issued to ensure that parking spaces are controlled, but it could be made free. The House should push the Government and the Opposition to make a commitment to abolish parking charges at hospitals in the medium to long term.

[Nic Dakin]

I very much agree with my hon. Friend’s point. That has been the thrust of the contributions to the debate. I hope the Minister and the shadow Minister are listening to the voice of the House, which reflects the voice of our constituents as patients and residents who live close to hospitals. Hospital car parking charges should be got rid of in the interests of better, more open and fairer access to health care. The hon. Member for Thurrock (Jackie Doyle-Price) made the point well that increasing the number of visitors increases the speed of recovery. It should therefore be welcomed and facilitated as part of the healing process.

[Martin Vickers (Cleethorpes) (Con)]

As the hon. Gentleman knows, we share the same hospital trust. Patients are prepared to accept that more services are being shared between our two hospitals at Scunthorpe and Grimsby, but does he agree that patients face the double whammy of increased travelling costs and car parking charges at the other end?

[Nic Dakin]

The hon. Gentleman and I work well together on local issues such as health care. He makes the sound point that as we rationalise the way in which hospitals perform to maximise health outcomes, there will be more travelling by patients. Why should there be an added barrier to that travelling and to access? People should not have to focus on things like that, rather than on better health care, when there have to be discussions about where services will be delivered, as there have to be in north Lincolnshire. That is a sound and positive point that supports the point that was made by my hon. Friends the Members for Bolton South East (Yasmin Qureshi) and for Telford (David Wright), which is that the best way forward would be to have free car parking at every hospital as standard.

[David Wright]

My hon. Friend makes a sound point about rural areas, but it is often difficult for people in urban areas to use public transport as well. Sometimes, people have to change buses several times to get to a hospital. If people in Telford want to go to Shrewsbury, they have to change buses multiple times.

--- Later in debate ---

[Nic Dakin]

My hon. Friend makes a sound point. The hon. Member for Cleethorpes (Martin Vickers) and I represent rural areas as well, so the point is well made and well received.

[Rosie Cooper (West Lancashire) (Lab)]

Everybody in the House wants free car parking at hospitals now, but what does my hon. Friend think we can do in the interim to ensure that hospitals stop private car parking companies targeting the disabled and those who arrive in emergency situations? None of that will stop now without proper enforcement.

[Nic Dakin]

I very much agree with my hon. Friend. I am sure that the Minister and the shadow Minister will take that point on board and listen to the other points that have been made in the debate. That will put pressure on hospital trusts to respond positively to the point that she has made.

Special Measures Regime

Nicholas Dakin Excerpts

Wednesday 16th July 2014 Commons Chamber

[Mr Hunt]

That is certainly something we keep under constant review, because it is a particular issue in some trusts. I would like to pay tribute to the progress made in Sherwood Forest trust—and in Newark hospital, which I know my hon. Friend has campaigned for—and to mention that it has an excellent chief executive, who has done a very good job in challenging circumstances.

[Nic Dakin (Scunthorpe) (Lab)]

I would like to pay tribute to the staff team at Northern Lincolnshire and Goole Hospitals Trust for the progress they have made, which has resulted in the trust moving out of special measures, but there is still much more to do. How will the Secretary of State ensure that the funding challenges faced by the local health service do not get in the way of making the further progress that is necessary?

[Mr Hunt]

Good progress has indeed been there, including centralising stroke services in Scunthorpe. There are funding pressures everywhere. What I would say about funding is that I do not want to run away from the fact that money is tight throughout the NHS, but lots of places are delivering safe, compassionate care even with those funding constraints. In fact, when we look in detail, we see that less safe care is the most expensive, so what we are doing should help trusts such as the hon. Gentleman’s to deliver safer care.

Patient Safety

Nicholas Dakin Excerpts

Tuesday 24th June 2014 Commons Chamber

[Mr Hunt]

My hon. Friend speaks wisely, and I commend her for her work in championing whistleblowers. In her relatively brief time here, she has made a big difference on that issue. Personally, I do not like to use the term “naming and shaming” because I think identifying problems should always be the first step to sorting them out. What we are doing today by identifying trusts that do not have a proper open and honest reporting culture is also helping them to change that reporting culture while at the same time identifying trusts that have a good culture. It is all about changing the culture, so this is a positive move, and I think that NHS staff will really welcome it.

[Nic Dakin (Scunthorpe) (Lab)]

Does the Secretary of State agree that the best way to deal with concerns about patient safety, such as those raised last week about Scunthorpe general hospital, is to have a proper independent investigation that respects patient confidentiality and reports objectively, clearly and transparently so that appropriate action can be taken when all the facts are known?

[Mr Hunt]

There are definitely times when an independent investigation is needed, and a number of them are going on in the NHS at the moment. The first thing, however, is to talk to the trust and get it to deal with the particular issues being raised and to create a culture in which trusts are willing, enthusiastic and keen to do that. Today is an attempt to deal not only with what happens when things go wrong with whistleblowers, but with how to create the right culture in the first place.