Radiotherapy Services (North East Hertfordshire)

Oliver Heald Excerpts

Wednesday 4th February 2015 Westminster Hall

[Sir Oliver Heald (North East Hertfordshire) (Con)]

This debate could not be better timed, because today is world cancer day, and the day on which we heard from the charity, Cancer Research UK, that although we are seeing better outcomes with cancer, more people are at risk. This is also an opportunity for me to ask for help for my constituents, who have to travel day after day, for many hours, to get their radiotherapy, which is tiring, dangerous, onerous and needs changing.

The situation that I am about to describe affects people not only in my constituency, but in Stevenage, North East Bedfordshire and Hitchin and Harpenden. I am glad to see my right hon. Friend the Member for North East Bedfordshire (Alistair Burt) and my hon. Friend the Member for Stevenage (Stephen McPartland) in the Chamber to support the campaign. I am also receiving great support from the public, patients and their families in seeking to ensure that radiotherapy treatment is available to cancer patients at the Lister in Stevenage, in my hon. Friend’s constituency. I pay tribute to his work in raising the issue so strongly.

I have asked questions in Parliament and have secured today’s debate. The Minister will, I know, listen to our case, and I hope that she will intercede for us with NHS England to break the logjam, so that we finally get the Lister hospital this facility, which it needs. The hospital recently opened a new cancer centre in conjunction with Macmillan Cancer Support, and radiotherapy would be an important addition. Furthermore, our local newspaper, The Comet, has long supported the cause.

Radiotherapy for people living in the Stevenage, Letchworth, Baldock and Hitchin area, and just over the border in Bedfordshire, at the moment takes place in Mount Vernon hospital in north London, in Hillingdon. It is a great hospital and the treatment is excellent but it is a difficult journey there, either by car or by the hospital bus service. That service takes all day—it collects patients at 7.30 am, delivering them back at 4 pm. Those long daily journeys are often needed for a three-week period, which is gruelling for patients and their families.

My constituents have described the visits as tiring and stressful. One young woman who is about to start treatment says:

“I am having to go for a three week stint at Mount Vernon, after my breast cancer op at Lister. I’ve been told by people in the same boat that it’s quite a stressful journey and the parking! Lister also has a small bus service pickup from your home at 7.30 back at 4ish! Daily. This is great but after all the patients go through it would be another stressful stage of getting well and to fight cancer.”

Another said:

“I had 39 Radiotherapy sessions for prostate cancer treatment at Mount Vernon Hospital. The treatment was excellent and was given by wonderful staff. Fortunately the transport was provided but this would have been saved if Lister had the appropriate facilities.”

One of the constituents of my right hon. Friend the Member for North East Bedfordshire told me:

“I am pleased to see you raising the question of installing a radiotherapy unit in the Lister Hospital. This treatment is sorely needed in N. Herts as the travel and journey is particularly onerous for what can be very repetitive and tiring treatment to Mount Vernon in Middlesex…from Stotfold where I live. Myself and two neighbours have had need of this treatment in the past 12 months…the requirement generated from a single road so the need is certainly there.”

[Alistair Burt (North East Bedfordshire) (Con)]

I have already apologised to both my hon. and learned Friend and the Minister that I am not able to stay to hear the Minister’s speech. I very much want to support my hon. and learned Friend. My constituent’s point is very pertinent. The A1 runs directly down from where that constituent was talking about to the Lister. Does my hon. and learned Friend agree that that is a perfect example of how a facility closer to north-east Bedfordshire would make all the difference to relieving our constituents’ suffering?

[Sir Oliver Heald]

I totally agree with my right hon. Friend. There are many arguments for the change. One patient from east Hertfordshire, who is a constituent of mine, said:

“Being diagnosed with cancer is devastating for the person and the family and to discover that part of the treatment involves regular journeys to north London just adds to the stress that family is undergoing.”

Another aspect to consider is patients with children. One constituent wrote to me about her daughter, who is in her 30s and has three children. She needs radiotherapy at Mount Vernon and will have to find someone to travel with her and someone to look after her children on a daily basis for three weeks. Her mother says:

“This all adds to the stress of having to deal with cancer, especially at such a young age.”

She ends her letter to me:

“Here’s hoping we are successful in making someone see sense.”

[Stephen McPartland (Stevenage) (Con)]

I congratulate my hon. and learned Friend on securing this debate, which is important to my constituents in Stevenage. He and I have secured the support of the local newspaper, The Comet, and have run a petition over a number of years to improve radiotherapy access. We have dealt with thousands of people. There is no public transport available for them to get from Stevenage in north-east Hertfordshire to Hillingdon in London, so they are very much stuck with having to have private vehicles and people to support them.

[Sir Oliver Heald]

That is very much the nub of the issue: there is no alternative to the car or the bus, and the bus takes a day to take patients and bring them back.

The NHS is currently mapping the country to find areas where it takes more than 45 minutes by car to reach radiotherapy, in order to assess pressing need for new and satellite centres. My hon. Friend and I have been in contact with Kim Fell of NHS England about this issue. We have arranged to meet her, Ruth Derrett, who is the head of specialised services, Dr Adrian Crellin, who is the radiotherapy clinical reference group chair, and Pam Evans of the specialised commissioning team, because they think that the journey from our area takes less than 45 minutes.

We have been told that, as part of the review, the National Clinical Analysis and Specialised Applications Team has produced a map that shows the 45-minute position across our area. Apparently, the map shows that only a small proportion of the population of Stevenage travels more than 45 minutes for treatment, and questions have been asked about whether that would generate sufficient activity for the satellite service that we are asking for.

The methodology used is clearly flawed, so we are pressing on the 45 minute figure. Even if one ignores the heavy traffic congestion in our area—my hon. Friend the Member for Stevenage and I have been campaigning for some years to widen the A1(M) between Stevenage and Welwyn because it is so congested, and we have recently got about £100 million for it—the AA, the RAC and everyone who does that journey all say that it takes longer than 45 minutes. The senior management at the trust that runs both hospitals, East and North Hertfordshire NHS Trust, allows one hour 15 minutes each way for the journey. I have done the journey only once, and it took me two hours in the rush hour. I have offered to do the drive seven times at different times of the day using the three possible routes and to report the findings to NHS England. I am waiting to hear whether it considers that to be a satisfactory methodology. My hon. Friend the Member for Stevenage and I have suggested that the key officials might like to come with us on the journey one morning at the same time as the bus, so that they can see the challenge to the 45 minute figure.

I am arguing that Mount Vernon hospital should put a satellite radiotherapy centre at the Lister hospital. We like the Mount Vernon hospital—the treatment there is excellent—so we would like it to use its staff and machines at the Lister. The machines that they use do need to be replaced from time to time, and there are currently eight of them. I am told that fairly soon an opportunity will arise when two need to be replaced. The new machines should be sited at the Lister hospital. That would leave six at Hillingdon and allow Mount Vernon to offer its expertise to an even wider area, thereby securing its position as a cancer centre. It would be able to offer services to a larger group in Bedfordshire, for example, than it currently can. That would benefit the status of Mount Vernon hospital as well as helping the patients.

The Lister hospital has recently benefited from the opening of the wonderful Macmillan cancer care centre on its site. Radiotherapy would greatly improve the support and care available to people in our area. Patients and their relatives strongly support the idea of the move, which has been described to me as “wonderful”. Another person wrote to me to say:

“It would be fabulous to have the device at Lister. It makes sense as we have just opened a great cancer chemotherapy unit”.

I hope that the Minister might intercede on our behalf with NHS England so that our case can be properly considered. The idea that it takes 45 minutes or less from our area to Mount Vernon must be reconsidered. It is time for a satellite radiotherapy centre at the Lister, but we need help to make it happen. I intend to present a petition to Parliament in March. We already have hundreds of signatures, and it can be downloaded from my website: www.oliverheald.com. I will present it on the Floor of the House. My right hon. and hon. Friends, our constituents and I feel strongly that it is time for the change to be made. It is time that those endless journeys, hour after hour, day after day, ended.

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[Jane Ellison]

I will certainly draw NHS England’s attention to the force with which the invitation was put in this debate.

Let me say a few words about the bigger picture on cancer before we go into the detail in the contribution by my hon. and learned Friend the Member for North East Hertfordshire. The Government are committed to improving cancer outcomes and matching the best in Europe. As Members are aware, we do not match the best in Europe; we were certainly lagging behind some important countries when the Government came to office in 2010.

The 2011 strategy, which was backed by £750 million, set the ambition of saving an additional 5,000 lives a year. We believe that we are on track to save an additional 12,000 lives a year, far exceeding that ambition. Much of the focus has been on early diagnosis and awareness. Given the clear interest in cancer that Members have expressed by being here, I hope that they will join me in welcoming the announcement of NHS England’s cancer taskforce, which is charged with designing a new cancer strategy for the NHS to take us through to 2020.

I thought Members might be interested in the statistics for East and North Hertfordshire NHS Trust over the last 12 months. Some 2,881 more patients with suspected cancers were seen than in 2010—a 49% increase. In addition, 239 more patients were treated for cancer than in 2009-10—an 11% increase. Local NHS staff, to whom I pay tribute, are therefore doing a good job of seeing more people.

[Sir Oliver Heald]

I am grateful to the Minister for giving way on that important point. About half of the patients require radiotherapy, so the numbers on that journey are getting higher and higher, and there surely comes a point when we can have our satellite.

[Jane Ellison]

Indeed, and I will address some of the issues my hon. and learned Friend raised, but let me say a quick word on radiotherapy more generally. The Government have set about improving these services. NHS England will be investing an additional £15 million in stereotactic ablative radiotherapy on top of the £6 million already committed. That will benefit about 750 patients a year. There is also a £23 million radiotherapy innovation fund, which has resulted in the doubling of intensity-modulated radiotherapy activity. In addition, we are investing £250 million in building two new proton beam therapy centres. A lot of investment is therefore being made in some very up-to-date and important technology.

Let me turn to local health matters. First, I congratulate my hon. and learned Friend the Member for North East Hertfordshire, my right hon. Friend the Member for North East Bedfordshire and my hon. Friend the Member for Stevenage, who are all known as doughty champions of their local health services. It is particularly good to see the latter, who champions health matters with great vigour in this place.

I am aware of the issues that have been raised. Regardless of the part of the country we live in, we would all expect patients to have ready access to radiotherapy services as part of patient care. Obviously, radiotherapy is a specialised service. It is commissioned directly by NHS England. Fortunately, it is not needed by the majority of NHS patients, but it is vital to those who do need it. The smaller number of patients involved means that the health service needs to think carefully about access—locating units to provide the maximum benefit closest to the highest possible number of people. I will go on to talk about the implications for expertise.

Such decisions are made locally, and are best made locally, by clinical leaders who have the full benefit of local knowledge. However, it is right, of course, to bring concerns to Parliament and to give Ministers a chance to understand what is happening in the local health economy, so that we are aware of the issues and can discuss them, where necessary. Decisions on where to locate specialist services need careful consideration. The issue is of particular note to those who represent more rural constituencies. Patients who live some distance from treatment centres—not only those providing radiotherapy—can, unfortunately, face repeated, long and tiring journeys. I realise that the seats of my hon. Friend the Member for Stevenage and my hon. and learned Friend the Member for North East Hertfordshire are not necessarily rural, but those are factors in parts of our country. My hon. and learned Friend gave us examples of the anxieties that long, tiring journeys bring, alongside the already stressful situation of being treated for cancer.

Interest in where radiotherapy services are located is understandably heightened by the NHS England review of stereotactic radiotherapy and stereotactic radio surgery services, which is being undertaken at a national level. For the benefit of Members, let me explain that those services involve a type of external beam radiotherapy treatment currently commissioned by NHS England for the treatment of patients with a wide range of cranial cancers. That consultation closed recently, on 26 January, and as part of the review, NHS England found

“an unmet need in the provision of treatment, with services distributed unevenly across the country.”

The proposed changes to the way in which stereotactic radio surgery and radiotherapy services are commissioned in England was looked at in the public consultation. Proposals include consideration of the location of services provided in the interests of ensuring equity of access, and the results are being reviewed by NHS England.

My hon. and learned Friend will be aware that NHS England has also carried out a separate, high-level exercise to assess capacity and demand for external beam radiotherapy more generally at a national level to give it a sense of the national picture. A further phase of work is proposed to take place locally, as there will be some specific local issues of which commissioners and providers will need to take account. That process is due to begin in late March.

Accessibility is characterised by an assurance that all patients are offered the most appropriate and effective treatment for their cancer. The latest research suggests that about 40% of all cancer patients should receive radiotherapy, complementing earlier recommendations made by the National Radiotherapy Advisory Group that aim to boost cancer survival through increasing access to that therapy, delivered as part of a treatment with curative intent. The England average access rate was 33% in 2007, and 38.8% in the most recent figures, which demonstrates real progress. I know, however, that there is further to go, as my hon. and learned Friend made clear in his speech.

NHS England has told me that the radiotherapy clinical reference group, which supports it in commissioning radiotherapy, is of the view that all patients should be offered equitable access to specialist radiotherapy care and treatment. The clinical reference group plans to build on the assessment of radiotherapy demand and capacity for England by considering aspects such as innovative treatments, the stock of equipment and how needs differ across areas. That national overview will enable commissioners to ensure that the right services are in the right places to meet future demand, including innovative forms of radiotherapy. Such improvements might well mean that, in future, patients need fewer episodes of treatment, so the problem of repeated tiring journeys would at least be reduced. I think we would all welcome that.

Access to radiotherapy treatment locally is a matter for NHS England to lead on. The decisions on the introduction of satellite radiotherapy centres will need to involve the local providers—in this case, East and North Hertfordshire NHS Trust—and NHS England as commissioners. As my hon. and learned Friend said, his closest radiotherapy services are the excellent services at the Mount Vernon hospital, and there are also services at Addenbrooke’s hospital in Cambridge. NHS England will continue to review the need for additional radiotherapy facilities outside those centres, if such facilities would benefit sufficient numbers of patients, be economically viable and enhance the existing care pathways.

It is possible that, as a result of those discussions, it will be found that more radiotherapy services are needed, but the optimum location will be determined by a number of criteria, including the impact on nearby trusts and existing cancer pathways—in other words, in trying to balance out one lack of access, we would not want to cause a problem elsewhere. Such decisions need to be looked at in the round in the local health economy. However, my hon. and learned Friend made good points about access, and I will ensure that those are underlined.

I understand that in 2009-10 there was a capacity review of radiotherapy provision for the Mount Vernon cancer network. That concluded that although the capacity to meet future demand up to 2016 could be met by the current providers, increasing access to the north of the network was an objective that needed looking at. My hon. and learned Friend underlined that point.

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[Sir Oliver Heald]

It is remarkable that the county of Hertfordshire, which has 1.2 million people, does not have radiotherapy facilities at all. Does my hon. Friend agree that the urgency of the matter is changed by the fact that the whole county—or at least most of it—has to go all the way down to London? That is a rather old-fashioned approach. I do not know whether she is prepared to ensure that my remarks, and the support of my right hon. Friend the Member for North East Bedfordshire (Alistair Burt) and my hon. Friend the Member for Stevenage (Stephen McPartland), are relayed to NHS England.

[Jane Ellison]

I will certainly do that. I make a point of drawing the attention of the relevant clinical leaders to our debates, and to the strength of feeling expressed by Members on behalf of their constituents. I am of course happy to do that.

The siting of a satellite unit at either the Luton and Dunstable hospital or the Lister hospital in Stevenage was considered in the previous review, but given that the system already had sufficient capacity to meet future requirements, the report acknowledged that any satellite development would need to be planned as part of existing capacity, not additional capacity. In other words, services would have to transfer.

Any review should include an assessment of the best fit, to ensure that if a radiotherapy satellite service is a preferred solution, it is located in the right place. I understand all the points made about location and the county not having such a facility, but equally, looking purely at the geography and the county boundaries might not always lead one to completely the right conclusion. That point was, however, important and has been well underlined today. The unit has to be located in the right place, so that there is capacity, and so that the preferred location offers cost-effective treatment to a sufficiently large number of patients. That is the important point: the number of patients.

I understand, too, that my hon. and learned Friend is not talking about using old equipment, but looking at the location of new equipment. Furthermore, sometimes there is concern about involving what might be called the “penny packet” approach, scattering specialist services thinly to achieve better access. One of the challenges with that approach, however, is that while it can often make sense to people on the face of things—“Of course we want those services there”—there is always the caution about staff not getting the benefit of mutual support, and expertise in particular can become diluted. That approach might also make it sometimes more difficult to manage demand, as one unit might become overwhelmed while others are underworked.

Those factors need to be taken into account, and I underline the expertise one in particular. We all want our constituents to be seen by people who treat sufficient specialist health problems to be really expert in them. We want those experts to see enough patients to know what they are doing when they see something. Concentration of expertise is important in many areas of health and has been much focused on.

[Sir Oliver Heald]

I am suggesting a Mount Vernon operation—that it provides the service in the Lister. Mount Vernon would have two fewer machines, which we would have in the Lister. In that way, we hope that the expertise would be as good as it always has been, but people would not have to do the long journeys.

[Jane Ellison]

I completely understand that point. I expect local clinical leadership to understand the expertise and staffing available. All those factors will be taken in the round and looked at, because the work is specialist. I would expect the NHS to look at things such as his suggestion about the new machines at Mount Vernon. I will of course write, drawing attention to the particular concerns of my hon. and learned Friend and of my hon. Friend the Member for Stevenage about access and the travel distances. They, however, would in turn expect the local NHS to look at issues such as the distribution of expertise to ensure that the continuity of expertise was available.