Radiotherapy: Accessibility

Oliver Heald Excerpts

Tuesday 18th July 2023 Westminster Hall

[Selaine Saxby]

I thank the hon. Gentleman for his intervention. We do not talk enough about the lack of specialist staff in this area, and I am indeed going to talk about the need for a proper plan for radiotherapy. Obviously, that involves resources of all types moving forward.

I think we all ask why a treatment as effective as radiotherapy is not used more often. Funding for radiotherapy falls between the cracks, and radiotherapy receives only 5% of the cancer budget. While there has been specific investment in radiotherapy, such as the £162 million in 2016 to replace 64 out-of-date machines, and the additional £32 million in 2019, there will be approximately 74 machines in need of replacement by the end of 2024.

We all know the NHS budget is under strain, but radiotherapy is the closest thing we have to a silver bullet for improving cancer care. An investment of £200 million would update all the machines due to be out of date by the end of next year, benefiting an estimated 50,000 people a year. An investment of £45 million in an innovative British technology—surface guided radiotherapy—could reduce waiting times by 1.8 weeks nationwide, and the use of artificial intelligence tools in radiotherapy could save clinicians two hours per patient.

If radiotherapy received between 10% and 12% of the cancer budget, instead of 5%, we could invest in more machines to bring ourselves up to international standards. In England, we have 4.8 treatment machines per 1 million people, while France has 8.5. and Italy 6.9. New machines and techniques would treat patients more quickly and help to clear the backlog. We need to reap the benefits of successful investment in early diagnosis and increased screening programmes so that early diagnosis leads to timely treatment and improved patients outcomes, rather than long and stressful waits for treatment.

We also need to focus investment in the right areas. Treatments such as proton therapy do not help patients outside Manchester and London. Proton therapy assists only 1% of patients, and my constituents in North Devon do not benefit from more investment in urban centres.

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

Does my hon. Friend agree that satellite radiotherapy centres have an important role to play? People from my area have to travel down to Hillingdon from north Hertfordshire. The journey is supposed to take 40 minutes, but it is actually an hour and a half each way. If we had a satellite radiotherapy centre in north Hertfordshire it would make all the difference.

[Selaine Saxby]

I thank my right hon. and learned Friend for his intervention, and I agree entirely. Indeed, I believe the Government should look at bringing radiotherapy treatments closer to patients such as those in my constituency of North Devon. I ask the Minister to consider bringing radiotherapy to satellite centres or community cancer treatment centres to complement diagnostic tools such as radiology in community diagnostic hubs.

Furthermore, may I recommend a trial in North Devon? We have a proud history of raising funds locally for cancer care provision, and I would dearly love to work with the Minister to deliver a new radiotherapy machine—on a partnership basis, if necessary—to begin to tackle some of our challenges head on. Indeed, that sounds significantly more achievable than tackling some of the other health inequalities from which my constituents suffer. Not a single NHS dentist across Devon is taking patients, and the last orthodontist has just left Barnstaple. I recognise that dentists are hard to come by but, for anyone listening, the surf is fantastic and you will be the most welcome blow-in we have ever seen in Devon.

Sorting out radiotherapy could be easier with a community-driven fundraising scheme and some assistance from the Minister to facilitate such as trial. I have former community hospitals waiting, and space on the main hospital site that could accommodate the machine and bunker. As we look to 2040, when an estimated 500,000 people will be diagnosed with cancer each year, we need to invest in cost-effective and efficient treatment.

Half of us will get cancer in our lifetime, so one in four of us will require radiotherapy treatment. Access to such treatment should not be limited by someone’s postcode. I ask the Minister not just to look at modernising and supporting radiotherapy, but to ensure that planning for cancer care accounts for rurality and that everyone has access to all available treatments.

--- Later in debate ---

[Grahame Morris]

That is a really important point, and I hope the Minister is taking note. I do not know whether the term is “low-hanging fruit”, but here is an opportunity to get some synergies from the new technologies that are available now but perhaps were not available even a couple of years ago. I will return to that theme, but AI is potentially a force multiplier, if that is the appropriate term: it can improve the productivity of the small radiotherapy workforce. As the hon. Member for North Devon mentioned, AI can save a consultant oncologist two hours in planning a patient’s treatment. As a couple of hon. Members have said, it is wonderful to have centres of excellence—some of the best hospitals not only in the United Kingdom, but in the world—such as the Royal Marsden in London and the Christie Hospital in Manchester. Now we have the opportunity, through IT networks and AI, for doctors and clinicians, even in remote locations, to access highly qualified oncology specialists, who can plan the treatment to be delivered in satellite centres. There is a huge opportunity here.

As we have heard, almost half of individuals experience cancer at some point in their lives, and about a quarter require radiotherapy. It is quite a disturbing statistic that only 27% of cancer patients in the UK access radiotherapy. The international recommendation is that between 50% and 53% should. Only half the people who would benefit from radiotherapy are accessing it at the moment.

[Sir Oliver Heald]

One thing of great concern in my constituency is that people start radiotherapy by travelling to Mount Vernon, which is an excellent hospital, but they cannot keep going, because it is such a terrible journey, so they give up.

[Grahame Morris]

That is a valid point that needs to be addressed. Perhaps part of the solution is the development of more satellite centres. If I have two words for the Minister, if he will forgive me, they are “treatment capacity”; or make that three words: “radiotherapy treatment capacity”. That is what we need—to increase radiotherapy treatment capacity.

Radiotherapy has immense potential for treating various types of cancer. It has been found that a greater number of cancers can be treated effectively using radiotherapy, either exclusively or in combination with other treatments. It has a critical role in four out of 10 cancer cures. As the hon. Member for North Devon said, it is highly accurate, and there is limited damage to healthy cells surrounding the cancerous tumours, particularly with the latest forms and most modern types of radiotherapy, such as stereotactic ablative radiotherapy and so on.

Radiotherapy is particularly useful for treating cancers in vulnerable areas, and requires fewer patient visits compared with other treatments. It does not occupy intensive care capacity, in the way surgery does, nor does it impact the patient’s immune system like chemotherapy. Dame Maria, I am still suffering from the impact of a depressed immune system from the chemotherapy that I had some years ago. That does not happen with radiotherapy. We are not fully utilising the life-saving potential of radiotherapy.

In 2019, Cancer Research UK published a report highlighting inadequate early cancer detection and limited access to the best treatments, resulting in the UK having some of the worst cancer survival rates among western countries. Radiotherapy has been chronically underfunded and under-resourced for a number of years. That is not a political criticism of only this Government, but of previous Governments too, and it needs to be addressed if we are to approach the outcomes and improved survival rates that we all want to see.

As the hon. Member for North Devon said, the UK currently allocates only 5% of its cancer budget to radiotherapy. That is not the whole NHS budget of more than £100 billion; that is just the cancer budget. Most other European countries allocate 10%. That disparity is very telling. It affects patient outcomes, waiting times and the overall NHS budget. Radiotherapy is the most cost-effective of the three main cancer treatments, with a typical cost per cure of £3,000 to £7,000.

However, the lack of investment has left us lagging behind other countries. Our technology is characterised as outdated. As we have heard, within the next year approximately 55 existing radiotherapy machines, which are 10 years old or more, will need replacement. That is about a fifth of the total number of linear accelerators in our NHS. Although the Government talk about record NHS investment, our radiotherapy access falls behind international comparators. As the hon. Member for North Devon said, England has 4.8 radiotherapy treatment machines per million people, while Italy has 6.9 and France has 8.5. The NHS would require another 125 linear accelerators to meet international standards.

It is true that covid-19 had a devastating impact on the NHS and on cancer services, but it is important to note that this problem—the cancer care crisis—predates the pandemic. We had a statement on 3 July from the Health Secretary about the NHS workforce plan. I was rather disappointed, because I raised the issue of the cancer workforce and the 62-day treatment target and he completely avoided giving an answer. The target is that 85% of people should start their first treatment within two months—62 days. However, the latest figures, which have just been published, show that we are hitting that for only 59% of patients. If the Secretary of State does not know that stat, I will be very disappointed. I know a little about Sunderland football club. I know that Jimmy Montgomery, our best ever goalkeeper, made 638 appearances and that we won the FA cup in 1973 and 1937. I would not expect the Health Secretary to know those things, but I would expect him to know the latest key performance indicators in relation to cancer waits, so I hope that the Minister responding today will emphasise the importance of that.

Delays in cancer treatment are not academic. It is not just a question of statistics for our constituents. For every four-week delay—for every month that a treatment is delayed—the chances of survival reduce by 10%, so this is significant. The hon. Member for North Devon mentioned Professor Pat Price. She is a leading authority on cancer, based at the Royal Marsden, and she has warned that up to 45,000 cancer patients could face deadly delays in their treatment by the end of the year. She is consistently reported in the national press, most recently in the Express, and emphasises the need for a cancer-specific plan supported by the requisite investment in improving radiotherapy treatment capacity.

It is great to invest in diagnostics, but this is a hand-in-glove situation: we need to ensure that as the investments in new diagnostic hubs are taking place, we are also making, in parallel, investments in treatment capacity. The Government have access to world-leading cancer specialists such as Professor Price, but we need a greater sense of urgency from Ministers to lift the UK from the bottom of the global cancer outcomes league table to the top. I say to this Minister: that is within our grasp; we have given you the route map for how it can be done.

The NHS has undergone two major reforms in the past 13 years and, although reforming public services is essential, the root causes of the issues sometimes come down to a lack of investment. Investment in cost-effective cancer treatments such as radiotherapy can result in quick gains. Expanding and modernising radiotherapy equipment with a modest—by NHS standards—£200 million investment could update the estimated 76 machines about to become outdated. That would benefit 50,000 patients annually. Then, allocating £45 million for the new surface guided radiotherapy—a fast and accurate British innovative technology—could reduce national waiting times for radiotherapy by almost two weeks. We had a meeting quite recently just along the corridor from this Chamber, and these machines can be installed over a single weekend in a specialist radiotherapy centre. We must utilise new technologies to address the workforce crisis and make access to radiotherapy treatment available across the entire country. Technology is available to the NHS today that was not available 25 years ago, and it is unwise that we are not currently using that technology to its utmost potential. If the NHS made better use of AI software, cancer specialists could plan for radiotherapy treatment two-and-a-half times faster than at present, ensuring that many more patients could be treated sooner. I urge the Minister to reconsider accelerating the roll-out of AI technologies in radiotherapy. There is no shortage of excellent science, technology and innovation in this country, and it is worth noting that most of the advanced radiotherapy machines currently operating all across Europe and in North America are made here in the UK—in Crawley, actually—so we are not making the best use of this British technology.

The Government should be laser-focused on retaining current staff and harnessing the opportunities of AI, up-to-date treatment machines, software and innovation to treat more patients and improve productivity. Some of these technologies could save clinicians up to two hours per patient, which is vital in a health service where we have a workforce crisis and a shortage of specialist oncologists. To bring treatment closer to home, investment is necessary in satellite centres or community cancer treatment centres to complement community diagnostic hubs.

Radiotherapy is a quick and highly effective treatment, and cost-effective radiotherapy services are at the forefront of cancer treatment across the world. It is the first duty of the Government to protect their people. The Minister can demonstrate his commitment to that duty by outlining a workable plan to meet the 62-day cancer treatment target after almost a decade of failure, and ensuring that all patients who will benefit from radiotherapy have access to this lifesaving treatment within 45 minutes of their home.

Healthcare Facilities: Royston

Oliver Heald Excerpts

Monday 5th June 2023 Commons Chamber

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

I am very glad that I have been able to secure this debate about healthcare facilities in Royston in my constituency. I have been concerned for some time that there is a danger of Royston not receiving the recognition that it needs from the national health service and the health facilities fit for such a fast expanding town.

Royston has almost 17,500 residents. That is rising in the near future to about 20,000, given the local plan and approved developments. It has a catchment area of villages in Cambridgeshire, Hertfordshire and Essex, covering at least another 24,000 residents. The area is expanding fast—not just Royston, but the villages around it. I will mention Melbourn and some of the other villages in a moment.

Royston is recognised as an important town by retailers; it houses one of the largest Tesco Extras in the region, as well as Marks & Spencer and Lidl. It is home to the major FTSE 100 company Johnson Matthey, which has its headquarters there. The area is full of innovative businesses, including successful science and engineering companies, and the same is true of the area around it. For example, Melbourn Science Park is part of the corridor that is recognised as being part of Cambridge, the A1 corridor and so on. It is clear that Royston is widely recognised as an important hub in this part of the east of England.

Earlier this year, the two main GP practices merged to become part of Granta Medical Practices, which is one of the largest and most innovative organisations when it comes to bringing together a range of local services, while retaining the close link between patient and clinician. Its inspirational leader—the managing partner, Dr James Morrow—has pioneered this approach over many years from his base in Sawston, Cambridgeshire, and he believes that to make the most of this new merger, Royston needs a state-of-the-art health centre and community diagnostic centre. But Royston appears to be a forgotten part of the region by NHS decision makers.

In January, via a reply to a written question to the Secretary of State for Health, I was told that it was for the Hertfordshire and West Essex Integrated Care Board to determine whether such a centre is needed in Royston. Now, the Herts and West Essex ICB covers much of my constituency and has some relevance to Royston, but it is not the lead ICB for Royston. When I queried this with the Department, I was told that I was right and that the Cambridge and Peterborough ICB would be making these decisions. That makes a lot more sense, because it includes Royston within the list of areas that it covers. Cambridge is very close and has good transport links with Royston, and many local residents have always used and continue to use Addenbrooke’s Hospital as “our hospital”. These examples show that Royston is falling between two stools; for a town of such significance, that is not good enough.

One of the four aims on the Cambridge and Peterborough ICB website is to “Think Local”. We want it to “Think Royston” and help our GPs to realise their vision for the future. Investigations show that the NHS may be doing anything but that: the Cambridge and Peterborough ICB estates plan proposes transferring clinical services from the current Royston Hospital site into the Royston health centre, and then disposing of the hospital site. Royston Hospital—a site of six acres—currently offers a number of clinics and treatments, including in obstetrics and gynaecology, and physiotherapy. It also houses our community transport, is the base for our district nurses and is Hertfordshire Community NHS Trust’s depot for its medical devices.

Royston’s growth as a town and its close relationship with its villages nearby is reflected in the fact that the two practices that have merged have patients not only in Royston but in nearby villages in Cambridgeshire, Essex and Hertfordshire; it is a wide catchment area, not just for retail and industry but for health. The opportunity to merge the two practices provides the opportunity for modern facilities and for the secondary sector to follow Government policy and delegate services such as diagnostics to the primary community setting by way of a community diagnostic centre. I understand that Addenbrooke’s Hospital is a keen advocate for that approach and believes that Royston could be a good centre for the CDC.

In Royston, local people have seen the idea of a refurbishment of Royston Hospital co-located with modern community services as the way ahead. There have been campaigns over time to save the hospital site, but that is not out of sentiment or dogmatism; it is simply because it is a six-acre site close to the town centre and already in the NHS fold. If another site were identified and its benefits outlined, I am sure that Royston people would give it a fair hearing, but we do not want to lose our hospital site and be left struggling in the existing GP practice buildings, which come from a time when the town was half its current size. Where would the advantages of the sort of modern state-of-the-art health centre that we want be? They would be absent. There would be no room for our diagnostics unit. A new modern building would mean that the patients reliant on Royston would have guaranteed long-term primary care services provided in a locally based setting, satisfying the ICB mission to think local. It would also be future-proofed.

Local primary care services are suffering from recruitment problems in our area. I am sure that both Government and the NHS want to show professionals a modern vision for the future. What local doctors are proposing satisfies the current national programme seeking to improve access to common diagnostic tests using community diagnostic centres. The combining of services from the two Granta practices plus utilising the opportunity to cascade services from Addenbrooke’s into primary care and diagnostics at Royston is both opportune and efficient, and it would help with solving the problem of staff shortages. This issue is addressed in Dr Morrow’s recent BMJ article with Dr Sinsky about how to retain GPs, the importance of the patient-doctor relationship and how CDCs can help with that by doing the diagnostics locally and enabling that relationship to flourish.

I would like to see constructive discussions between Granta Medical, the Cambridgeshire and Peterborough ICB and Addenbrooke’s Hospital, hopefully supported by the Hertfordshire authorities, to see how this vision can be realised. The Minister has kindly already had one meeting with me and the various stakeholders, and he has played a part in helping this to happen. I note that last week I received a letter from the Cambridgeshire and Peterborough ICB—I wonder if it was aware this debate was to take place—asking me to work with it on a programme of engagement with local people and communities about health and care services around Royston. It also made it clear that no decision has been made about the future of Royston Hospital. I welcome that, and I will be happy to take part, but I hope that the Minister will continue to help us by backing the vision of our local doctors and ensuring that Royston does not fall off the map again.

If we take the map of the ICB area for Cambridgeshire and Peterborough and place it next to the map for Hertfordshire and West Essex ICB, the significance of Royston emerges clearly. It is in the middle, it is one of the fastest growing towns, it is surrounded by burgeoning villages, and it is at the heart of the innovation and engineering corridors that are the future of the UK economy. I am certain that, if meaningful discussions were held between all the interested parties, a long-term solution could be found for Royston. I am hoping that today’s debate, with the support of the Department, will go a long way to persuading Cambridgeshire and Peterborough ICB to re-evaluate its options and to accept that a health centre and CDC in Royston is an eminently sensible way forward.

[The Parliamentary Under-Secretary of State for Health and Social Care (Neil O’Brien)]

I congratulate my right hon. and learned Friend the Member for North East Hertfordshire (Sir Oliver Heald) on securing this important debate and I thank him for his work advocating for health services for his constituents. If there were any danger of Royston being forgotten, my right hon. and learned Friend and his activities are ensuring that that does not happen. It was genuinely a huge pleasure to meet him, his local ICB, Addenbrooke’s and in particular his local GPs, who I thought were a particularly impressive and thoughtful bunch with many interesting ideas that he is helping to catalyse. I also congratulate him on his imaginative and thoughtful advocacy on behalf of Royston Hospital and the opportunities presented by that site, which he has explained further in this debate.

We absolutely recognise the importance of suitable and well-functioning premises for healthcare facilities, expanding our NHS workforce further, and accommodating and enabling good-quality healthcare services for growing populations, particularly in areas such as Royston that are expanding so rapidly. We are taking action to support ICBs in that aim, and we are aware that many areas, including Royston, are set to experience further increases in population, which of course puts pressure on local health services.

We announced in the delivery plan for recovering access to primary care, which is part of the wider review going on of the national planning policy framework—the subject of the most recent debate, in fact—that we would be better considering how primary care infrastructure can be supported and how we can get more of the profits of development flowing into our primary care facilities. So we will be updating guidance to encourage our local planning authorities to engage with ICBs, particularly on large sites where there is opportunity and the need for extra primary care capacity.

NHS England is currently undertaking a formal assessment of all general practice premises through a primary care data collection programme, and this will provide an overview of the current capacity, suitability and ownership of all premises, with the information made available to local commissioners to inform their planning. But the activity of my right hon. and learned Friend in pointing out the opportunities and the challenges will be very clearly in the minds of his local ICB as it thinks about its future plans.

From 2023, a substantial proportion of primary care business-as-usual estates and GP capital is included within overall integrated care system capital funding envelopes. That allows local systems to take a more cohesive and coherent approach to how they spend capital across that system, and to prioritise the primary care investment needs in their own local strategies.

As well as funding from specific national programmes, Cambridgeshire and Peterborough ICB—as we now know, it is responsible for commissioning health services in Royston; my right hon. and learned Friend was quite right about that—received £77 million in operational capital funding in 2022-23, totalling over £205 million during this spending review period. Cambridgeshire and Peterborough integrated care system has worked in partnership with NHS Property Services to develop the first estates strategy for the region. This was consulted on earlier in 2023 and approved by the ICB on 10 March.

The ICB has been working closely with primary care providers to try to stabilise primary care provision locally, and is now reviewing estates and local health care provision to make sure that they are also fit for the future. I know that the ICB is in conversation with the Hertfordshire Community NHS Trust, Granta Medical Services, and NHS Property Services—my right hon. and learned Friend has mentioned some of this—to review all the sites and consider options for a potential healthcare centre, co-located with primary care and diagnostic facilities.

In its decision-making capacity for estates and healthcare service commissioning, it is essential that the ICB is able to fully assesses capital and revenue costs, and service implications, that would arise from any decision. The ICB has noted that, while it recognises the community hospital is not currently functioning as it should, it is important that any future decisions on its use are not taken until it has fully considered and appraised all options, as my right hon. and learned Friend has quite rightly insisted on. That is why the ICB is about to begin a comprehensive listening and engagement exercise for an initial six weeks, encouraging local communities to take part in that conversation through a range of routes. The ICB will share more details in the coming weeks, on its website, on social media channels and through updates to key stakeholders, as well as via the printed materials in the community so that everyone knows that this conversation is ongoing.

Another approach and consideration that integrated care boards may take when they are shaping healthcare estates locally is the reconfiguration of services. This is a clinically-led local decision following appropriate engagement with patients and stakeholders. Responsibility for the delivery, implementation and funding decisions for services ultimately rests with the appropriate NHS commissioner. All substantial planned service change is subject to a full public consultation, and must meet Government and NHS England’s tests to ensure good decision making. As my right hon. and learned Friend has sometimes pointed out, community diagnostic centres are an important development to allow patients to access planned diagnostic care nearer to home, without the need to attend acute sites. That is only one of the ways we are doing that, including through virtual wards and a closer tie-up between primary and secondary care. Funding for community diagnostic centres has been allocated so that areas with unmet need receive more funding. That will help to tackle health inequalities.

My right hon. and learned Friend rightly raised the Priors Field surgery closure at Sutton. NHS Cambridgeshire and Peterborough ICB is pleased to conform that from 1 April, Malling Health took on an interim contract to provide primary care services to the patients of Priors Field surgery. While that interim solution is being secured, the ICB continues to work with key stakeholders in the local community to ensure that communities in Sutton and the surrounding areas continue to have access to primary care services that meet their needs, both now and in the future. Knowing my right hon. and learned Friend well, I know that he will not be backward in coming forward to make the case strongly for investment in his local community and constituency, and we will continue the useful and helpful conversation that we have been having.

[Sir Oliver Heald]

I am grateful to the Minister for the help he has given us. Would he be prepared to continue to take an interest in Royston and its future plans, because I think that has been very helpful so far?

[Neil O’Brien]

I am happy to conclude as I started, by saying that I would love to continue that conversation with my right hon. and learned Friend, his constituents and local clinicians. I thought it was extremely interesting, and they had some powerful ideas. I look forward to continuing that with my right hon. and learned Friend and local clinicians.

Question put and agreed to.

Covid Pandemic: Testing of Care Home Residents

Oliver Heald Excerpts

Wednesday 1st March 2023 Commons Chamber

[Helen Whately]

It is relatively easy for the hon. Member to come to the House today and make these highly political points. Knowing how she and I worked together in the pandemic, and that she and I talked about all that we were doing to look after people in care homes, I am shocked and disappointed by the tone she has taken today, when we are dealing with extremely serious questions.

I will turn first to some of the difficult prioritisation decisions that were made, given the limited quantity of testing we had at the beginning of the pandemic. The Government followed the expert public health advice available at the time. We had the capacity to test just 3,000 cases a day in mid-March, and I am sure colleagues will understand why the health advice at the time was to prioritise those working on our NHS frontline and, for instance, the testing of people in hospitals and care homes who had symptoms. In fact, the courts have already agreed that our prioritisation decisions on testing were completely rational.

As we dramatically ramped up testing capacity, we also adjusted that prioritisation in line with the public health advice and the capacity, so by mid-April—just a month later—with testing capacity exceeding 38,000, we were in a position to test more widely. In fact, that is reflected in our adult social care plan published on 15 April, which made it clear that everyone discharged from a hospital to a care home should be tested even if asymptomatic, and that all discharged patients, regardless of the result of their test, should be isolated for 14 days. It is worth reflecting just what a dramatic increase in testing the Government oversaw, from just 3,000 in March 2020 to over 38,000 in mid-April, to over 100,000 by mid-May, to the point where we could test many millions in a single week. We established the largest testing network in Europe from a standing start, and the science proves that it saved lives.

The hon. Lady asked about the content of the WhatsApp messages that have been published. I say to her that it is a selection from a larger quantity of messages. Clearly, while there were discussions and debates between Ministers and colleagues, partly on WhatsApp, there were also meetings and conversations and other forums in which advice was given and decisions made. A huge quantity of that is with the public inquiry, but I can say to her that, for instance, a meeting to discuss the implementation of the advice on testing was not referenced in the WhatsApp messages she is talking about. There is an email following the exchange to which she is referring that says, “We can press ahead straightaway with hospitals testing patients who are going into care homes. And we should aspire, as soon as capacity allows and when we have worked out an operational way of delivering this, that everyone going into a care home from the community could be tested.” As I say, she is basing her comments on very selective information.

As I said, the hon. Lady knows how the Government, and me personally, strained every sinew, worked day and night, and did everything in our power to help people, and specifically the most vulnerable, during the pandemic. She and I spoke about it regularly during our frequent calls. In fact, at the time I appreciated her perspective, questions and insights from her own area of Leicester. I say to her that we should go about this discussion in the right way for the country. This is not the time to play political games. We should look to save lives. That is the purpose of the public inquiry: to learn lessons in the right way in case this should ever happen again.

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

My hon. Friend will agree that it was Labour that called for a public inquiry, and the Government agreed to it. It is a full public inquiry and we could not have a better judge than Dame Heather Hallett, one of our most experienced and distinguished judges. She will do a very thorough job. Does my hon. Friend agree that what we are seeing today is a bit of trial by media and party politics?

[Helen Whately]

My right hon. and learned Friend is exactly right; we are having a public inquiry and the Government are fully co-operating with it so that it has all the information required to look through all that happened, to investigate it and, rather than trying to score political points, to truly learn lessons for the benefit of the country.

Draft Water Fluoridation (Consultation) (England) Regulations 2022 Draft Health and Care Act 2022 (Further Consequential Amendments) Regulations 2022

Oliver Heald Excerpts

Monday 24th October 2022 General Committees

[Will Quince]

My hon. Friend is right to push us on those issues. I will touch on them all, because it is about not just local authorities, metro Mayors and others having a say, but all those who live, work and study in an area. No doubt they will have strong views, notwithstanding me as a Health Minister having a view when it comes to tooth decay and the difference that fluoridation will have in that respect.

We launched a public consultation on 8 April that ran until 3 June. We sought views on whether future water fluoridation consultations should be restricted only to people affected locally and bodies with an interest, such as those referenced by my hon. Friend the Member for Bolton West—incidentally, that had been the case under legislation—or whether we should move to a model in which consultation would open to all, especially given the shift of responsibility from local authorities to central Government. Some people with strong views on water fluoridation may not live in a particular area but may have certain expertise or a particular interest.

We received 1,228 responses to the consultation; of those, 94% came from individuals and 6% came from organisations. The majority of respondents favoured a consultation open to all. The draft regulations will not restrict who can respond to any future consultation on water fluoridation, which I hope my right hon. Friend the Member for East Yorkshire and my hon. Friend the Member for Bolton West agree is the right approach.

To come to the crux of my hon. Friend the Member for Bolton West’s points, we understand that the views of those who are directly affected and living, working and studying in an area in question are incredibly important. For that reason, the regulations also provide for consideration to be given, as part of the decision-making process, to whether additional weight should be given to consultation responses from those who may be particularly affected by any future proposals.

Public opinion and the extent of support for a water fluoridation proposal will continue to be important but, as my right hon. Friend the Member for East Yorkshire rightly pointed out, consultations are not referendums. It is right that regulations provide for a range of other factors to be taken into account when considering a water fluoridation proposal.

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

In the consultation, were any of the representations made about the European convention on human rights, particularly articles 5 and 8?

[Will Quince]

The honest answer is that I am not aware of any, but no doubt my officials will look that up and I will be able to respond in my closing remarks.

The wider factors that have to be taken into account in the consultation include but are not limited to the strength of evidence underpinning an argument made by the respondents. It is absolutely right that due regard is given to those arguments and that they are properly supported by sound evidence.

On evidence, a point that my right hon. Friend the Member for East Yorkshire alluded to, we are committed to scientific evidence on water fluoridation. It has to underpin any proposal that we put forward. The Department continues to review scientific papers published both in this country and internationally as part of the continuous monitoring of the evidence. That includes papers on the epidemiology and toxicology of water fluoridation. Every four years, the Department will continue to publish a summary report on our knowledge, in line with the Secretary of State’s responsibility for monitoring the effects of the water fluoridation arrangements on the health of the populations that are served by existing schemes.

--- Later in debate ---

[Will Quince]

I thank colleagues for their contributions, and the Opposition for their constructive response and the tone of their questions. I will focus on water fluoridation and then come to dental access, which is not entirely related, but is important and a priority for me.

Consultations seem to be the key issue, so let me focus on them. I am happy to meet my right hon. Friend the Member for East Yorkshire and my hon. Friend the Member for Bolton West to discuss this issue at greater length as we progress toward consultations. On the additional weighting that will be given to local views, which is important, the regulations require the Secretary of State to take into consideration a range of factors when making a decision on water fluoridation. That includes giving consideration to whether the views are of individuals directly affected and constitute bodies with an interest. If they are, they should be given additional weight. There are clearly established public law principles that require public bodies to act lawfully, rationally, fairly and compatibly with the human rights of those affected by their actions. We would quite rightly have to justify any decisions taken on a future scheme as part of the decision-making process.

One of the questions asked was on the methodology of the extra weight given to local people as per the regulations. Under the Water Industry Act 1991, as amended, Parliament granted the Secretary of State the power and discretion to make decisions on future fluoridation steps in England, including establishing, varying and terminating fluoridation agreements. To give those powers additional weight, the Secretary of State will be bound by the regulations to do that in an appropriate manner, in accordance with the public law principles of rationality that I have just set out.

I remind the Committee that implied in the Secretary of State’s existing direction is the power to grant additional weight to any person or persons whom she deems fit. In effect, all this provision does is to compel the Secretary of State to give due consideration to doing so. As I say, I would be very happy to pick that point up in more detail with my right hon. Friend the Member for East Yorkshire and my hon. Friend the Member for Bolton West.

Questions were raised about the duty of sampling water to ensure that a dosage is not too high. Clear regulations on water supply were laid in 2018. They allow up to 1.5 mg of fluoride per litre in public water supplies. I would be happy to write to my right hon. Friend the Member for East Yorkshire about how water authorities are held to account to ensure that water is monitored and that limit adhered to.

Finally, I hear what the hon. Member for Enfield North says about dental access. Access to dentistry is difficult in too many parts of the country, especially when people do not have ongoing relationships with a dentist. In July, we announced a package of improvements to the NHS dental system, which was detailed in our plan for patients. The Committee will have noted that the Secretary of State has her A, B, C and D priorities, and D stands for doctors and, importantly, dentists. As the Minister with responsibility for primary care, I can tell the hon. Lady that dentistry is a priority for me. I know that the delivery of dental care suffered considerably during the pandemic, but it continues to improve as we recover. Many dentists are already delivering at or above 100% of their contracted activity, but I recognise that we need to go further, and I am meeting stakeholders in the profession to see what further steps we need to take.

[Sir Oliver Heald]

Were any consultees concerned about human rights issues, and would that impact on consulting and on the way in which the measures on sampling and so on are implemented?

[Will Quince]

I was not avoiding my right hon. and learned Friend’s question, but I do not have an answer for him as my officials have not been able to find one in the short time that they have had. I will certainly commit to writing to him and to any other Committee member who is interested. Of course, if people made challenges or raised concerns on those grounds, they would be given weight as part of any consultation.

I understand that this is an emotive subject and that there are strong views on either side of the debate. That debate has already been had as part of the passage of the Act, but I trust that my answers—notwithstanding the one that I have failed to deliver for my right hon. and learned Friend the Member for North East Hertfordshire—have provided some reassurance on the benefits of water fluoridation and, in particular, on the importance of the consultation regulations. The regulations reflect the consultation responses from the public, and will not restrict those who want to respond to future public consultations on water fluoridation schemes.

I hope that my answers have also provided some reassurance on removing the requirement of the CQC to issue statutory guidance on mandatory learning disability and autism training. Let me be clear: that will not leave service providers without clear information. It will not be removed until it has been replaced with the code of practice.

Cancer Care: Young Adults

Oliver Heald Excerpts

Wednesday 8th June 2022 Westminster Hall

[Julie Marson]

I thank the right hon. Gentleman for his intervention. I will go on to talk about the danger of not expecting to find symptoms of cancer in children and young adults, and the terrible consequences that delays and misdiagnoses can have, as they did in Jess’s case—it is too often the case.

I want to talk about Jess, because to understand how important this is, and why the Brady family are so committed to this approach, it is important that I tell Jess’s story. In mid-2020, Jess was feeling unwell with abdominal and back discomfort. It was during the pandemic, and Jess was given an online consultation at her GP surgery, and prescribed antibiotics for a suspected kidney infection. Over the ensuing weeks she was prescribed numerous other medications, including more antibiotics and steroids. Jess contacted her surgery on more than 20 occasions in five months. None of the four GPs who provided her with a consultation—17 of which were conducted remotely—took her symptoms seriously. Her requests for blood tests were granted, but a raised D-dimer was dismissed after a preliminary scan, and not investigated further. Blood results showing poor liver function were left for a six-week follow-up review, which proved fatal.

Jess was told for months that she was suffering from long covid, despite two negative coronavirus tests. She was finally diagnosed with cancer following a private referral on 26 November. Her dependency on oxygen from that date meant that she did not leave the hospital or ever return home. Jess discovered that she had stage 4 adenocarcinoma with an unknown primary. It had spread throughout her body to her spine, liver, stomach, lungs and lymph nodes. Jess was a talented satellite engineer for Airbus. She had so much potential and so much life to live. Her loss has shattered her family’s world.

Devastatingly, had someone taken the initiative to closely review Jess’s case and examine the evidence, cancer screening would have been an obvious requirement. A consultant recently said to her parents:

“If a diagnosis cannot be made from initial tests then not enough tests are being carried out”.

In Jess’s case, a request to be referred to an ear, nose and throat specialist was laughed off. Letters written to the surgery listing her symptoms, including dramatic weight loss and vomiting, were ignored. Jess felt powerless and distressed. She tried so hard to be heard and taken seriously. It was heartbreaking for her family to watch her deterioration.

It is obvious really, but when people are desperately ill and at their lowest ebb, they do not possess the stamina to fight the system—nor should they have to. Jess’s age was a key issue. Many people, including GPs, do not expect to see, as the right hon. Member for Alyn and Deeside (Mark Tami) said, a young adult with cancer, and that affects their diagnostic processes and judgment.

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

I join my hon. Friend is expressing admiration for the way in which the Brady family have campaigned on this issue. In reality, is it not necessary for each general practice to have at least one doctor who is seriously knowledgeable about cancer diagnosis and able to take a lead, so that if the symptoms are not diagnosed that doctor gets to look at the case and perhaps send it to a rapid diagnosis centre? Otherwise the patient is being let down. The Health and Social Care Committee, in its report on cancer services, said that we need more support for GPs in that area. I commend my hon. Friend for what she is doing and ask if she agrees with me?

[Julie Marson]

I appreciate my right hon. and learned Friend’s intervention. I will come on to talk about some of the things he raised, because he puts his finger on some of the most important aspects of how GPs manage their diagnosis process. The diagnostic centres are fantastic, but they need to have patients referred to them, which goes back to what we are trying to achieve with Jess’s law.

Cancer charity CLIC Sargent found that around half of young people visited their GP at least three times before their cancer was diagnosed. Almost 10% of all new cancers are diagnosed in people aged between 25 and 49, with almost twice as many cases in females as in males in that group.

Simon and Andrea Brady created a petition in Jess’s name. My right hon. and learned Friend the Member for North East Hertfordshire and I joined them to hand it into Downing Street. Its plea was to increase the awareness of diagnosis of cancer in young adults. It currently has an incredible 240,000 signatures, and has highlighted the scale of the problem for young adults. The petition makes for heartbreaking reading. Countless people tell stories of their young family members who have had their lives curtailed by late or non-existent cancer diagnoses. The disproportionate occurrence of females is also deeply troubling.

Being told you are too young for cancer has been happening for years, and it is simply not acceptable. Young people have their symptoms explained away with other diagnoses. As I said, Jess was told she had long covid, despite never having tested positive. The explanations given to other patients for poor health are endless: irritable bowel syndrome, pulled muscles, fatigue, stress, migraine—the list goes on.

I welcome the significant roll-out of rapid diagnostic centre pathways across hospitals in England. I know we have just achieved one million tests and scans via our community diagnostic centres, which is a huge achievement and critical in tackling the covid backlog. Of course, patients still have to be referred by a GP, and that vital link is what we are focusing on here today, particularly the escalation of patients with undiagnosed symptoms within a GP’s surgery or to a specialist, as per Jess’s law.

There are other issues that relate to GPs, including having a dedicated GP lead for a patient. The general practitioners’ contract requires practices to provide a named accountable general practitioner to all registered patients. That GP must take the lead in ensuring that any primary medical services considered necessary to meet the needs of a patient, including appropriate referrals to specialist care and liaison with other health professionals involved in the patient’s care, are co-ordinated and delivered to that patient.

However, Jessica’s case demonstrates that that does not always happen. Jessica was not seen by just one GP at her surgery. In her case, four doctors spoke to her and prescribed medication. Although Jess was told on one occasion that she had been discussed at a practice meeting, it was obvious that there was no one person overseeing her case. She was never seen or contacted by her named GP. It is also vital that GPs are required to maintain their continuing professional development through up-to-date training and awareness of cancer, including in young people.

CLIC Sargent’s Young Lives vs Cancer is a charity dedicated to supporting children and young people with cancer, and ensuring that their voices are heard in the context of cancer care. It has identified several challenges faced by GPs that hamper early diagnosis. Those include limited training and awareness, and time pressures. Of course, the effect of the pandemic is exacerbating existing issues. One third of GPs reported inadequate opportunities to gain experience in the care of children and young people during their initial training as one of the top barriers to identifying cancer in children and young people.

The Health and Social Care Committee’s review into cancer services, published on 5 April, concluded:

“The single most effective way to improve overall survival rates will be to diagnose more cancers earlier. Diagnosing bowel cancer at stage 1 means that 90% of people will live for five years compared to just 10% of people diagnosed at stage 4.”

Draft Health and Social Care Act 2008 (Regulated Activities) (Amendment) Regulations 2022

Oliver Heald Excerpts

Wednesday 26th January 2022 General Committees

[Karin Smyth]

I will just finish the point about our concerns about coroners’ assessments of the conditions in which people are dying early, perhaps because they could not access care. The CQC’s report, which it did manage to do, outlined ongoing concerns.

To be clear, we will support the Government today, but with grave concerns, because the CQC has itself said that it has ongoing concerns about patient safety. In relation to high-risk mental health services, it is concerned that people are at risk where there are warning signs of closed cultures. Improvements in maternity care are far too slow, with staff not having the right skills or knowledge, or poor working relationships. Other concerns include lack of engagement with women in maternity services and limited action being taken to improve equitable access. Its final area of concern is about the really important issue of deprivation of liberty safeguards during 2020-21. Those are really grave concerns about the most vulnerable people in our society. This is important to all our constituents across the country.

I am really concerned that the Government’s proposals to simply extend the 2014 regulations by three years indicates a disregard for the importance of timely reviews. The CQC and providers need clarity, which is why we will support the Government today. This is not a technical a piece of legislation. We are being asked to extend the regulations without any indication of what the review that the Government have undertaken might be saying, and I am disappointed that the Minister did not say more about that in her opening remarks, so I trust that she will do so when she concludes. If not, perhaps she could write to us—I will write to her formally if she is unable to say more today.

We are being asked simply to extend these regulations, which should have been completed by April 2020. Although the pandemic might have had an impact on the review, I would have expected the review to be ready for the printer in March. Certainly, when I conducted reviews of such a serious nature when I worked in the health and care system, I would be expected to have my draft well and truly ready for publication before the final deadline in April. Perhaps the Minister can say why that was not done before.

The Minister did not mention that the consultation received only 32 responses from health and care provider organisations. They are busy and have other things to do. Of those responses, 19 were in favour of the Department’s proposal, and 13 were against. It was noted that the 2014 regulations should not be extended without also making amendments to reflect the changes in the health and care sector since 2014, which are considerable.

When we are reflecting on those changes since 2014, we should bear in mind, for example, the fitness to hold a licence by some providers, particularly in adult health and social care. It is well documented that we are deeply concerned about some of those providers—they are essentially owned and run by hedge funds located in countries far from here, and are not perhaps paying their due level of taxation. If they did, it might provide the social care sector with a bit more stability.

We have had many years of senior Government Ministers talking about patient safety. Hon. Members recently spent six weeks on the Health and Care Bill Committee trying to improve the oversight of the CQC of whole systems and adult social care. None of this is joined up. If we are pushing this down the road for another three years, how does that align with the current legislative programme, legislation in the other place and anticipated legislation in the adult health and social care sector that is due at any moment? We need to line up some of these things, so that we parliamentarians can provide due process and scrutiny. Ultimately—the Minister knows it well—this is about patient safety.

The Government were unprepared going into the pandemic and I am concerned that this legislation is also tardy, and reflects the fact that they are not taking the timeliness of reviews seriously. Perhaps they are distracted by other matters. The Government have had two years to consider the matter. Why are systems not in place to ensure that such legislation is not left to the last minute? I hope the Minister can address my concern about why these measures were not ready in April 2020. It is not the first example. I do not want to detain the Committee, and I might go out of scope, but there are many examples of tardiness in timeliness and appointments and bringing forward regulations; that really does affect people. Members of Parliament across the House are really getting quite fed up of it.

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

Surely the hon. Lady would recognise that we have been through a pandemic that has caused great uncertainty for the social care sector. Is it not more prudent while we are still in the pandemic to extend the regulations rather than changing the whole system overnight?

[Karin Smyth]

The measures were due to come in in April 2020. As I said, if I was writing the review, I would have had it ready at the printer’s in March 2020 as the pandemic started. I do not really understand—I am very happy for the Minister to clarify—why, if it was ready for April 2020, which I suspect it perhaps was not, that it has taken this length of time, and why we need another three years. There are clear concerns in the sector as to why we need three years.

We support these measures today—that is the responsible thing to do, because we cannot have the sector unregulated, but we impress upon the Government the requirement that full regulations and good governance are important. We do not expect matters to be left in such a state.

Can the Minister explain why the review was not completed in April 2020? What stage was it at? How much of it was completed by then? What steps is the Department now taking to make sure that this review is completed in a timely manner? Can she provide information on the conversations the Government have had with the CQC regarding further areas of activity that need to be brought within the scope of the Act? We hear rumours, but we would like some certainty.

The consultation received 32 responses from health and care provider organisations. As I said, 19 were in favour and 13 were against. Does the Minister consider that to be a sufficient level of review and engagement? What steps will she be taking to ensure further stakeholder engagement?

Health and Care Bill

Oliver Heald Excerpts

Report stage
Monday 22nd November 2021 Commons Chamber

[Bob Blackman]

Clearly, if we invest in public health and smoking cessation, we prevent costs in the health service later. It is estimated that most of the cost of people’s healthcare arises in the last two years of their life. Individuals who suffer from cancer or other respiratory diseases caused by smoking will cost the health service dramatic sums of money, so through cessation, we are helping the nation to be healthier and, indeed, saving money for the health service in the long run.

To quote the chief medical officer, the great majority of people who die from lung cancer

“die so that a small number of companies can make profits from the people who they have addicted in young ages, and then keep addicted to something which they know will kill them.”

The time has come to make the tobacco manufacturers pay for the damage that they do, not only to older people but to young people in particular. We need to bring forward the day when smoking is finally obsolete in this country, and I regret to say that if we do not take measures, the time before that day arrives will be lengthened quite considerably.

However, funding alone is not enough; we have to consider tough regulation. The hon. Member for Central Ayrshire mentioned that since lockdown, we have seen the smoking rate among young adults surge by 25%. In the United States, raising the age of sale from 18 to 21 reduced the smoking rate among 18 to 20-year-olds by 30%. We could do the same thing here. We talk about complementary measures; giving tobacco products away is not illegal at the moment. Just imagine—tobacco manufacturers may say, “If we give tobacco products away for free, we can encourage people to become addicted, and then they will buy them, and that will lead them on to a lifetime of smoking.” We have to break that chain of events and make sure that people do not do that.

I have a passion for ensuring that women do not smoke in pregnancy. That is one of the most stubborn measures, and we have to overcome it. Some 11% of women still smoke in pregnancy. We must give them every incentive and introduce every measure to ensure that they give up smoking, and that their partners give up smoking at the same time. That is something that I passionately support.

Our revised amendment, new clause 11, addresses the concerns that the Government raised in Committee about a review of the evidence. I hope that the Government will adopt the new clause at this stage, and then look at the evidence and consult.

People start smoking at certain key points in their life. They may take it up when they are at school and their friends are smokers and they want to be part of the team or the gang. They may take it up when they go to college or university or start a new job, when they are in a new social environment, or at a dreadful time of stress in their life. We have to make sure that they understand that if they take up smoking, they will shorten their life and cause damage to their health—and, indeed, to the health of the people around them.

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

I am following my hon. Friend’s argument closely. Does he agree that there is an interrelationship between the issues to do with alcohol dependency that the hon. Member for Central Ayrshire (Dr Whitford) mentioned and the issue of smoking? One of the things that comes out from the book “Alcohol Reconsidered” by Lesley Miller and Catheryn Kell-Clarke is that the science shows that alcohol reduces people’s inhibitions, and it is therefore more likely that they will smoke. If we had a culture of moderation in alcohol, we would probably do better on smoking.

[Bob Blackman]

I thank my right hon. and learned Friend for raising that point. Clearly, the fact that people can no longer smoke in public houses or restaurants has dramatically reduced the incidence of smoking. Someone has to make a deliberate decision to go outside and inflict their smoke on the outside world rather than on the people in the public house or restaurant.

We who support these amendments tabled them in Committee—we sought Government support and we debated them in Committee—and now we are debating them on Report. I understand that we may not be successful tonight, but I give fair warning that these amendments, in another form, will be tabled in the other place, and we will see what happens. We know that there is very strong support in the other place for anti-tobacco legislation. In July 2021, the Lords passed by 254 votes to 224 a motion to regret that the Government had failed to make it a requirement that smoke-free pavement licences must be 100% smoke free. That is smoking in the open air; we are talking about measures to combat smoking overall.

Finally, if we look back over the years, the measures on smoking in public places, on smoking in vehicles, on smoking when children are present and on standardised packaging of tobacco products were all led from the Back Benches. Governments of all persuasions resisted them, for various reasons. I suspect that my hon. Friend the Minister, whom I know well, may resist these measures tonight, but we on the Back Benches who are determined to improve the health of this country will continue to press on with them, and we will win eventually. It may not be tonight, but those measures will come soon. I support the measures that are proposed.

Cancer Diagnoses: Young People in Hertfordshire

Oliver Heald Excerpts

Friday 19th November 2021 Commons Chamber

[Julie Marson (Hertford and Stortford) (Con)]

I wish to start by pointing out that this debate really does not belong to me. It belongs to Jessica Brady, as it is her tragic story that brings us all here today. The first thing I want to do is pay tribute to Jessica’s parents, Andrea and Simon Brady. They could not be here today, but I know they are watching, even though it is very difficult for them to do so. The pain they have experienced, and the pain they face every day of coping with their daughter’s illness and death, is unimaginable. They have told me that they are utterly broken, yet with dignity and determination they have committed to improving the diagnosis of cancer among young adults. They wish to ensure, in Jess’s name, that others do not have to go through what they have gone through. They have already done much to raise awareness of Jessica’s story. I was honoured, along with Simon and Andrea, and my right hon. and learned Friend the Member for North East Hertfordshire (Sir Oliver Heald), to hand in their petition calling for better awareness and diagnosis of cancer in young people to No. 10 Downing Street. The petition currently has more than 213,000 signatures, which is remarkable and sobering. I am grateful that my right hon. and learned Friend is in the Chamber for this debate and grateful for all of his support.

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

I pay tribute to my hon. Friend for securing the debate. My thoughts, as hers, are with Andrea and Simon Brady on the sad loss of their daughter Jess. Does my hon. Friend agree that at least two areas need to be improved in the way that we deal with cancer in young people? First, in general practice, we need to concentrate much more on young people and perhaps have a lead in each practice who looks at it and makes sure that every doctor is up to speed with the latest thinking. Secondly, we need to improve blood tests. There have been recent innovations, so perhaps a blood test could help with diagnosis.

[Julie Marson]

I thank my right hon. and learned Friend for those comments. He has followed the case closely and has supported me. He puts his finger on some of the key lessons that we want to learn from the Brady’s tragic experience to improve the situation for the future. I will expand on the exact points that he has made.

Andrea and Simon first got in touch with me in April. They told me how Jessica, their 27-year-old daughter, had been unwell since mid-2020 suffering with abdominal and back discomfort. We know how difficult it has been to get a face-to-face appointment with a GP during the pandemic, so Jessica had an online consultation and was diagnosed with a kidney infection and prescribed antibiotics.

Over the ensuing weeks, Jessica was prescribed numerous medications, including countless courses of antibiotics and steroids, all without an examination. For months, she was told that she was suffering from long covid, despite the fact that she had never tested positive. Unconvinced by the assessments and desperately worried, Andrea and Simon decided to go down the private healthcare route.

On 26 November 2020, Jessica received the worst news imaginable: she was diagnosed with an extremely aggressive stage 4 adenocarcinoma with an unknown primary. Jessica’s dependency on oxygen from that date meant that she did not leave the hospital or ever return home. By the time the cancer was discovered, it had already spread to her spine, liver, stomach, lungs, bones and lymph nodes. Jessica passed away on 20 December 2020.

I never had the pleasure of meeting Jessica, but by all accounts she was a remarkable young woman. She worked as a satellite engineer for Airbus in Stevenage and on the day of her funeral, a satellite that she helped to design was launched into space from Cape Canaveral inscribed with the words, “Thank you, Jess!”.

--- Later in debate ---

[The Minister for Health (Edward Argar)]

I thank and pay tribute to my hon. Friend the Member for Hertford and Stortford (Julie Marson) for bringing this debate before us, and for raising this difficult issue in a typically dignified and sensitive way. She has done justice to Jessica and her family.

I join my right hon. and learned Friend the Member for North East Hertfordshire (Sir Oliver Heald) and my hon. Friend the Member for South West Hertfordshire (Mr Mohindra), who intervened, in sending my condolences to Andrea and Simon, and to Jessica’s family and friends, following her death. We know that the passage of time can help, but it can never totally remove that sense of loss. I pay tribute to them for the work that they are doing to highlight the issue. It must be very difficult for them and it is humbling that they—through their excellent Member of Parliament, but also in person—have been willing to share this deeply upsetting experience to seek to build a better future for others. I put on record my tribute and gratitude to them.

As my hon. Friend the Member for Hertford and Stortford has set out, Jessica sadly had a very rare form of cancer. I am advised that the timescale and complexity of diagnosis in this case was due to the rarity of the cancer, especially in younger people, but we are always willing to look more broadly and holistically at other factors that we may have some control over that could help to improve diagnosis in the future. It is absolutely right that we do so because, as my hon. Friend said, sadly no one is too young to fall victim to cancer, so it behoves all of us in this House and beyond to do all we can to improve diagnosis.

As my hon. Friend alluded to, we are working nationally on achieving the long-term plan commitment towards early diagnosis of cancer, including rarer cancers or those that are harder to diagnose, in order hopefully to avoid situations such as Jessica’s being repeated in the future. Hertfordshire’s hospital trusts are working extremely hard to that aim. In delivering the long-term plan for cancer, we have the aim of diagnosing three quarters of cancers at stage 1 or 2, and increasing cancer survival rates so that an additional 55,000 people survive their cancer for five years or more. Delivering those ambitions through earlier and faster diagnosis, rapid adoption of innovation and, crucially, the roll-out of personalised care—looking at someone as an individual—will benefit children and young adults across the country.

Alongside this, as my hon. Friend set out, all cancer systems continue to roll out rapid diagnostic centres or rapid diagnostics services, which are an important part of the clinical commissioning groups’ broader strategy to deliver faster and earlier diagnosis, and an improved patient experience. By summer 2021, there were 102 live rapid diagnostic centre pathways across hospitals in England and a further 98 in development, compared to just 12 in March 2020.

To make the discussion rather more local, in East and North Hertfordshire NHS Trust, the services to support and assist patients whose cancer is of unknown primary origin and those who have what are clinically known as “vague symptoms” are being brought together to make best use of clinical resource. Multi-disciplinary team co-ordinators will track patients on their pathways and ensure that the new 28-day faster diagnosis standard is met. Funding has also been put in place to provide psychological support to support patients earlier, at a time when they may be worried about receiving a potentially life-changing—or, tragically in some cases, life-ending—diagnosis.

Herts Valleys CCG is developing services for patients with non-specific symptoms that could indicate cancer—for example, a 12-month pilot of a primary care-led vague symptoms pathway, with direct access to CT scanning. This began in February and is reported to be working well, and the CCG is looking further to develop this work and integrate it more with the acute trust. There is also a significant amount of work on the site-specific pathways through more efficient diagnostic pathways. This goes to what my hon. Friend was saying, as it supports earlier and faster cancer diagnosis by assessing patients’ symptoms holistically—bringing all the symptoms together when considering them, rather than looking at them in isolation, when it would be understandable if a misdiagnosis were made.

[Sir Oliver Heald]

I want to follow up on the point that I made when intervening on my hon. Friend the Member for Hertford and Stortford (Julie Marson). The project that the Minister is talking about is very good, but I just wonder about disseminating best practice more widely in GP surgeries. Does he think that the idea of having one GP in a practice who takes a lead on cancer—ensuring that the practice is up to date with the latest diagnostics, treatment and so on—is worth pursuing?

[Edward Argar]

My right hon. and learned Friend is also an old friend, so I suspect that he has a slight insight into where I was to be going in a few minutes. I hope to be able to answer that point specifically.

On education in cancer diagnosis within Hertfordshire and on GPs having the necessary skills and keeping them up to date, GPs in the region are encouraged to maintain their knowledge and skills in the field and are supported by Macmillan GPs, who are specialists in cancer care. Cancer education programmes such as Gateway C are available online, and face-to-face education sessions have now resumed, including monthly seminars offered by providers and by Cancer Research UK. A primary care network cancer clinical leads group has also been established to share the latest local issues and best practice.

I turn to specific points highlighted by my hon. Friend the Member for Hertford and Stortford. On face-to-face appointments and the ability to diagnose in that context, £20 million of elective recovery funding has been distributed to cancer alliances in this financial year to help accelerate the implementation of service models that streamline the front end of the pathway and support the management of high referral volumes. Throughout the pandemic, NHS England and Improvement has provided guidance to general practice and continually updated standard operating procedures to ensure that changing services could operate safely. NHS England and Improvement set out clear expectations that general practices offer face-to-face appointments alongside remote appointments—telephone or online—and that clinical necessity and patient preference should be taken into account to determine the most appropriate method.

My hon. Friend raised research and how it could help save lives in the future. NHS England and Improvement is supporting GRAIL’s Galleri trial, where studies have shown the ability to detect more than 50 types of cancers through a single blood test. The Galleri test can, as she said, detect chemical changes in blood as cancer can release small particles of DNA into the blood—known as circulating tumour DNA—which leak from tumours into the bloodstream, to give a vital early warning. The Cancer Research UK and King’s College London cancer prevention trials unit is conducting a randomised control trial along with the NHS and GRAIL. The blood samples from the first subjects in the trial are being obtained at mobile testing clinics in retail parks as well as at various convenient community locations. The trial’s participants must not have had a cancer diagnosis in the last three years. The main trial has now started. As hon. Members will know, I am always cautious about such things, but I am cautiously optimistic and genuinely hope that the trial will yield innovation that will make a huge difference in the ways mentioned by my hon. Friend.

My hon. Friend also raised the central point of GPs handling cases in their entirety or of having a point of contact who can look at a case holistically from the individual’s point of view, with knowledge of all their symptoms, medical history and so on. The general practice contract requires practices to provide a named accountable general practitioner to all registered patients. That GP must take the lead in ensuring that any primary medical services considered necessary to meet the needs of a patient, including appropriate referrals to specialist care and liaison with other health professionals involved in the patient’s care, are co-ordinated and delivered to that patient.

As of 1 April last year, we introduced the supporting early cancer diagnosis service specification for primary care networks to support improvements in rates of early cancer diagnosis. The 2021-22 quality and outcomes framework, which is a reward and incentive scheme for general practices, includes five indicators related to cancer care, including a quality improvement module on early cancer diagnosis. That improvement module was designed specifically to improve referral and safety net practices.

I hope that that answers some of my hon. Friend’s questions. She rightly highlights that there is always more to do in this space, and as we think of Jessica and her family it behoves all of us to continue to work to improve the quality of care provided, improve research, improve early diagnosis and look at each person who comes forward with symptoms or concerns as an individual, bringing all those factors together.

One of the privileges for the Minister responding to the Adjournment debate on a Friday is to speak on a subject outside of their usual portfolio, and this is one such opportunity. It has been a humbling experience, and one that I hope will inspire us all to renewed efforts, thinking of Jessica, to improve services as we go forward.

Question put and agreed to.

Oral Answers to Questions

Oliver Heald Excerpts

Tuesday 23rd June 2020 Commons Chamber

[Jane Stevenson (Wolverhampton North East) (Con)]

What steps his Department is taking to support the mental health of NHS workers during the covid-19 outbreak.

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

What steps his Department is taking to support the mental health of NHS workers during the covid-19 outbreak.

[The Minister for Care (Helen Whately)]

Our NHS workers—from the doctors, nurses and allied health professionals to the healthcare assistants, porters and all those who work behind the scenes—are truly heroes. I wish to say a special thank you to students: thank you to the medical students and nursing students who courageously stepped up to work at the frontline in a global pandemic. I am determined to do all that we can for our NHS workers. We have set up a round-the-clock mental health support line, which includes a freephone helpline run by the Samaritans and an out-of-hours text support service provided by Shout.

--- Later in debate ---

[Helen Whately]

I would be delighted to join my hon. Friend in thanking the staff at New Cross Hospital for all that they have been doing in these incredibly difficult times. Mental health support absolutely should be, and is, there. There is the mental health support helpline and the text messaging service. It is also really important that NHS trusts take steps locally to ensure that their staff have the support that they need.

[Sir Oliver Heald]

When we stood with our neighbours and clapped for the carers, we showed solidarity across the nation with them and recognised the strain, stress and anxiety under which many of them were working. Can the Minister assure me—and say what practical steps can be taken to ensure—that, as they work through the experiences they have had, they will get the care and support necessary for them, and that we care for our carers?

[Helen Whately]

The clap for carers initiative was fantastic because it was a moment when we showed, as a nation, our support for our health and social care workers, but my right hon. and learned Friend is right that clapping is not enough. One thing that I want to do in the months ahead is bring forward the people plan—work that had to be paused because of covid—and to ensure that it includes all possible support for the NHS workforce, so that the NHS can be the best place to work in the world.

Coronavirus and Care Homes

Oliver Heald Excerpts

Tuesday 19th May 2020 Commons Chamber

[Matt Hancock]

I welcome the hon. Lady to her post and to her first question in this new role. I know that she enjoys a good working relationship with the Minister for Care, my hon. Friend the Member for Faversham and Mid Kent (Helen Whately), and that cross-party working during this crisis has gone on throughout. I thank her for that and for the approach that she is taking. She is right and perfectly reasonable to ask questions about how we can further improve the support that we are giving to the care sector, and, as I have said from this Dispatch Box before, and before her appointment, we have made social care a priority from the start. The first guidance went out to social care in February. She referred to the 13 March guidance. That was only a matter of days immediately after the risk to the public was raised on medical advice. The guidance that was in place until then, as she probably knows, explicitly stated that that guidance was in place while community transmission was low and that it would be updated as soon as community transmission went broader. That is exactly what we did.

More importantly, the hon. Lady raised the question of discharges, and I understand the questions that have been asked about discharges into care. It is important to remember that hospital can be a dangerous place for people. As well as saving lives, it can also carry risks, and does so, so it is an appropriate clinical decision in many cases for people to be discharged from hospital, and safer for them to go to a care home. What is important is that infection control procedures are in place in that care home, and those infection control procedures were put in place at the start of this crisis and have been strengthened, exactly as she says, as we have learned more and more about the virus all the way along. As the clinical understanding of coronavirus has strengthened, so too have we updated and strengthened our guidance.

The hon. Lady asked about PPE. As she and every Member of the House knows, there has been an enormous global challenge with the global shortage of PPE and the need to get PPE distribution out to tens of thousands of settings. The guidance that we have put out again, which is guided by clinical expertise, states the level of PPE that is required, and we are now delivering against those standards. We have processes in place so that all care homes that have shortages—the numbers are coming down, I am glad to say—can get in contact with their local resilience forum and make sure that they can get that PPE. Those processes are in place. It has been a huge challenge. It was called the biggest logistical exercise of the last 40 years by the head of the Army, and I think he was right.

The hon. Lady also asked about resources. Of course, if more resources are needed, we are open to those discussions. The fact that we put through £600 million more that will go directly to social care—it will not be able to be held by councils; rather, it will go directly into social care—is right, but we have also learned some really big things about social care, confirming some of the things many of us thought before. For instance, it is true that we need to have a more co-ordinated policy between health and social care. These social care reforms, which are long overdue and have not been put in place by Governments of all colours, absolutely must happen.

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

Clearly, tackling this virus in care homes is a very difficult thing, but the chief executive of Hertfordshire Care Providers Association is on record as saying that care providers in the county feel well supported during the pandemic. Does the Secretary of State agree that what is required to achieve this, as in Hertfordshire, is a very close working relationship—a partnership—between care homes, the councils, the Care Quality Commission and, of course, the clinical commissioning groups?

[Matt Hancock]

I entirely agree. We have seen much better partnership working in most parts of the country during this crisis. The partnerships between local authorities, with their statutory responsibilities, and, as my right hon. and learned Friend mentioned, all parts of the NHS, with its statutory responsibilities—clinical commissioning groups, trusts and the integrated care systems—is very important. They have worked much better over the last few months than they had hitherto. We need to make sure that that coming together—in a very difficult circumstance, which has broken down boundaries—continues. I look forward to working with him and others in making sure that the boundaries that exist in social care can be brought to the ground.