National Health Service

Pat Glass Excerpts

Wednesday 26th October 2011 Commons Chamber

[Stephen Pound]

I am grateful to my hon. Friend, and may I place it on record that, as I am sure virtually everybody in the House would agree, she has brought enormous expertise in this area to the House, for which we are extremely grateful?

The NHS cannot be disaggregated. It has to be a national health service, not a notional health service, a postcode health service, a better-in-some-parts-than-others health service or a good-for-Kensington-bad-for-Kidderminster health service. It has to be for the nation, and why? Because Beveridge did not just produce a one-point proposal for the NHS. There were actually five evils that he wished to slay. It was an integrated proposal that addressed want, hunger, ambition and other issues.

The NHS is not just an agency to patch people up; it is part of providing a healthy, productive nation and increasing the good and the good life within this country. At so many levels, we have to look beyond the bottom line and beyond, as the hon. Member for Southport said, the bean-counting philosophy. The NHS should not be about the click of the abacus in some cobwebbed recess, or about constantly seeking whether things can be bought cheaper here or commissioned for a lower price there. It should not be about container-loads of cheap goods being shipped in from Shanghai because some GP commissioning group somewhere has discovered it can get a discount on Tubigrip. It should be about the recognition that the health of a nation is utterly crucial, basic and intrinsic to that nation’s hope and future. Without health, we have no future.

[Pat Glass (North West Durham) (Lab)]

I am sorry to break my hon. Friend’s flow, but is it not the underlying principle of this country that we take care of one another? That is the principle behind the NHS and what the NHS stands for.

[Stephen Pound]

It has been said—not by me, but by some—that the NHS has almost become the national religion. They say that as Christianity has faded, as it has in some places—not in my constituency, and certainly not in my home—the NHS has become more important. The NHS is the perfect example of what Galbraith called the “gift relationship”, when we look out for one another. We should not constantly look for the bottom line, but instead look to be our brothers’ keepers. That is the principle—

Health and Social Care (Re-committed) Bill

Pat Glass Excerpts

Tuesday 6th September 2011 Commons Chamber

[Grahame M. Morris]

I am grateful to my hon. Friend for raising that issue, which I will return to later. There were assurances that there would be no top-down reorganisations, but we should note the scale and complexity of this huge, top-down reorganisation. The Government alluded in Committee to the costs of administration, as did other members of the Committee. During Health questions and in Committee, I raised the question of the huge costs of administering Monitor, which have grown exponentially. We have had various estimates from the Government about the true cost, but over the lifetime of a Parliament it could be as much as £500 million, once we know the full extent of the legal challenges that Monitor will be expected to defend. That is a colossal sum.

I wanted to intervene when the Secretary of State referred to clause 60 of the original Bill and the intention to extend the duties of Monitor into the social care element of health and social care, but he would not allow me to do so. I wanted to ask whether any estimate has been made of the cost of such an extension of Monitor’s remit, which I suspect will be considerable.

[Pat Glass (North West Durham) (Lab)]

The Secretary of State mentioned 38 Degrees, which clearly has touched a raw nerve. Quite apart from the people from 38 Degrees who have contacted me, huge numbers of my constituents have contacted me to express real worries about this issue. Given the concerns of the Opposition, the press and, most importantly, the voting public, how does my hon. Friend think that we all got so out of step with the Prime Minister and the Secretary of State?

[Grahame M. Morris]

I am grateful to my hon. Friend for expressing that concern, which many people share—even among the Government, although perhaps they conceal it. Such concerns are not restricted just to 38 Degrees and Opposition politicians. Lord Tebbit of Chingford, an outspoken man who could hardly be described as a left-wing agitator, raised real concerns about what he described as these privatising reforms. He said that there is something seriously wrong, and that

“What worries me about the reforms…is the difficulty of organising fair competition between the state-owned hospitals and those in the private sector. In my time I have seen many efforts to create competition between state-owned airlines, car factories and steel makers. They all came unstuck. The unfairnesses were not all one way and they spring from the fact that state-owned and financed businesses and private sector ones are different animals”.

I have rarely found myself in agreement with Lord Tebbit, but on this occasion his analysis is extraordinarily insightful. His comments underline many of the basic contradictions in the Bill and in the subsequent amendments, which number more than 1,000.

Oral Answers to Questions

Pat Glass Excerpts

Tuesday 12th July 2011 Commons Chamber

[Paul Burstow]

I am absolutely determined to make sure that the additional resources that the NHS is transferring to social care deliver real benefits for people who need social care services, protect services, and allow local authorities to make the right decisions about how they continue to support not just investment in prevention, but those most in need.

[Pat Glass (North West Durham) (Lab)]

It is disappointing that we will now not see the Government’s White Paper until the spring, but will the Government agree to take forward the commission’s recommendations on national eligibility criteria and portable care assessments? The Minister will understand that that is now urgent, given the Southern Cross crisis.

[Paul Burstow]

The hon. Lady raises a question about eligibility; of course, we know from the latest figures in an ADASS survey that the majority of local authorities moved, under Labour, to “substantial” needs being the test for access to social care; that happened on her watch, not this Government’s watch. When it comes to portability, the Law Commission has made recommendations that the Government have to consider, and yes, we need to look to legislate on that.

Congenital Cardiac Services for Children

Pat Glass Excerpts

Thursday 23rd June 2011 Commons Chamber

[Pat Glass (North West Durham) (Lab)]

I do not have a children’s heart unit in my constituency. I do not even have one close by. There are parents in my constituency who are 50 miles from the nearest unit, but they tell me that they do not care about that. They would travel to the ends of the earth to get access to the best provision. That is what matters to them, not having somewhere on their doorstep.

[Stuart Andrew]

I have to take issue with that. The parents I have spoken to are very concerned that they might have to travel. Of course they will travel as far as they have to, but if we can provide a service closer to their homes, should we not strive for that?

[Pat Glass]

They are saying that because they have a unit on their doorstep now. We do not all live in big cities, and some people have to travel a long way. Parents tell me that what they want is the best services, and even if they have to travel to get them, that is what comes first. Travel and access are issues to consider, but every parent who has contacted me has confirmed that the most important thing for them is that their child gets access to the best provision available, and to surgeons who carry out these complex operations a couple of times a week, not a couple of times a year. They tell me that they will go anywhere to ensure that their child gets the best chance of surviving and that their condition improves.

[Mr Kevan Jones]

Does my hon. Friend agree that in County Durham, the concentration of adult cardiac surgery and emergency care at the Freeman hospital and the James Cook university hospital, which was controversial when it happened, has improved not only care but the survival rates of individuals from County Durham? Even though there are hospitals in the county closer to some people, survival rates have gone up because of that concentration.

[Pat Glass]

Absolutely, and we need to appreciate why such moves are necessary. None of us wants another Bristol baby tragedy, and I think there is general agreement that we need changes in the organisation of services to drive up the quality of treatment and bring together specialist surgeons to work in larger teams.

[Andrew Percy (Brigg and Goole) (Con)]

Will the hon. Lady give way?

[Pat Glass]

Practically everyone remains in agreement that those changes need to be made.

[Andrew Percy]

Will the hon. Lady give way?

[Pat Glass]

The argument is simply about which units will specialise in surgery, even though all existing units will continue to offer ongoing cardiology care.

[Andrew Percy]

Will the hon. Lady give way?

[Pat Glass]

I am not going to give way, no matter how much the hon. Gentleman hassles me. I can see that that is what he plans to do.

Many local campaigns have been mounted, and they have been supported by local MPs fighting for their own units or fighting to delay decisions. I absolutely understand that, but the decisions have been put off before for many reasons, which I believe is to the detriment of patients.

The decision should not be made on a political basis. Few of us in the House are qualified to judge the quality, sustainability and deliverability of clinical outcomes in children’s heart provision. On 7 June, when I questioned the Minister of State, Department of Health, the right hon. Member for Chelmsford (Mr Burns), on the matter, he gave me a categorical assurance that decisions would be

“based on clinical outcomes, not political considerations.”—[Official Report, 7 June 2011; Vol. 529, c. 12.]

I hope that he will keep his nerve in the face of sustained political lobbying.

[The Minister of State, Department of Health (Mr Simon Burns)]

If it encourages or reassures the hon. Lady, I will give her that commitment again today.

[Pat Glass]

I thank the Minister.

The Children’s Heart Foundation has advised me that the closer we get to a decision, the more difficult the political battle will become. In a bid to save surgery facilities in their areas, some parents and clinicians are asking MPs to stall progress towards a decision. Parents have been told that some units will close, when in fact even if surgery is centred elsewhere, local units will continue to provide specialist medical treatment on a “hubs and spokes” model. I believe that parents have been misled on some matters.

These decisions are crucial to the future clinical outcomes and life chances of our children. The Minister has again today categorically assured me that they will be based on clinical outcomes only, and I thank him for that.

Oral Answers to Questions

Pat Glass Excerpts

Tuesday 7th June 2011 Commons Chamber

[Mr Lansley]

The hon. Lady seems to have forgotten that we were very clear at the time of the election that we would establish the cancer drugs fund not least on the basis that under this Government, the NHS would not have to pay the additional employer’s national insurance contributions that it otherwise would. The money available for the NHS is being used for the benefit of patients, and it represents additional resources.

I might also remind the hon. Lady that before the election, her party was not committed to protecting the NHS budget. The Leader of the Opposition was completely wrong today when he said that Labour was going to protect NHS spending, as we did. That is not true. Actually, it was committed to only 95% of NHS funding, which was that for the PCTs. It was going to cut the rest, and centrally funded budgets such as the cancer drugs fund are precisely what would have disappeared.

The hon. Lady asked about diagnostic tests. The figures show that a year ago, the average waiting time was 1.7 weeks, whereas the latest figure is 1.8 weeks.

[Pat Glass (North West Durham) (Lab)]

12. What recent assessment he has made of the ability of all NHS hospital trusts to become foundation trusts by 2014.

[The Minister of State, Department of Health (Mr Simon Burns)]

The Department is currently in the process of working with strategic health authorities to establish timetables for every NHS trust to achieve foundation trust status by April 2014, and to agree the actions that are required to achieve that. That work is ongoing, and once plans are finalised, they will be published locally.

[Pat Glass]

The Minister will have to make some difficult decisions very soon about specialist children’s heart provision. In my part of the world, the choice will be between the NHS trusts in Newcastle and Leeds. Can he confirm that those decisions will be based on clinical outcomes, not political expediency?

[Mr Burns]

I can give the hon. Lady a categorical assurance that they will be based on clinical outcomes, not political considerations. I hope she will accept that it would be inappropriate for me to say anything further at this point in the proceedings, because we are in the middle of a consultation process at arm’s length from Ministers.

Health and Social Care Bill

Pat Glass Excerpts

Monday 31st January 2011 Commons Chamber

[Grahame M. Morris]

I agree completely with my hon. Friend’s point. According to evidence given to the Select Committee on Health, specialists in secondary care and the nursing and other professions could add their expertise to the commissioning process.

The shake-up of the NHS goes far beyond simply involving clinicians in spending decisions. GP commissioning is a red herring. We were told by the Secretary of State that these reforms are needed because productivity has fallen since Labour’s increased investment. However, after 18 years of mismanagement and under-investment under the Conservative party, it was obvious that on a crude measurement of productivity—inputs versus outputs—there was going to be a decline in supposed productivity, because obviously money had to be directed towards clearing up the mess left by the previous Tory government, to building new hospitals, accident and emergency units and maternity units, and to reducing waiting lists, which in many areas of the country were 18 months and longer.

The Secretary of State raised the satisfaction survey. Indeed, in December 2010, the National Centre for Social Research released its most recent report on British social attitudes. It found that public satisfaction with the NHS was at an all-time high, whereas in 1997, when Labour came to power, only 34% of people surveyed were satisfied with the NHS—the lowest level since the survey began in 1983. By 2009, satisfaction had nearly doubled to two thirds—to 64%. Given that most health unions, professional bodies, think tanks and the public did not call for such reforms, where did the Secretary of State’s motivation come from? These are not patient-led reforms; they are private health care-led reforms.

[Pat Glass (North West Durham) (Lab)]

Does my hon. Friend share my concerns that these plans will lead to high and low-tariff services, and cherry-picking, and that services such as child and adolescent mental health services, children’s health services and adult mental health services will lose out?

Oral Answers to Questions

Pat Glass Excerpts

Tuesday 7th December 2010 Commons Chamber

[Mr Lansley]

I understand exactly my hon. Friend’s point. The increase in liabilities was, in part, an expression of the change in the discount rate rather than necessarily an increase in the number of cases coming through. It is a worrying figure and costs the NHS not far short of £1 billion a year through contributions to the clinical negligence scheme for trusts. My noble Friend Lord Young, in the course of his review of health and safety and other issues, made recommendations on dealing with conditional fee arrangements and clinical negligence. It set out that we would consider, for example, how we implement NHS redress arrangements, including whether there should be a fact-finding phase before any question of legal intervention. We will do that and report back to the House.

[Pat Glass (North West Durham) (Lab)]

T7. My local hospital, Shotley Bridge hospital in Consett, has faced a degree of certainty over its future in recent years. However, with the demise of the local PCT, which owns the hospital and the land, uncertainty has returned. Is the Minister prepared to meet me and a delegation from the hospital to consider the future?

[Mr Lansley]

I am sure that I or one of my hon. Friends will be happy to meet the hon. Lady. I do not know why she thinks that the abolition of the PCT will make that change. We have yet to set out how PCT assets will be dealt with when they are abolished. She must talk to her local GPs as I know that GPs in Durham have come together in a consortium and they will be well placed to give precisely the kind of assurance about the security of services in the future that she is looking for.

Public Health White Paper

Pat Glass Excerpts

Tuesday 30th November 2010 Commons Chamber

[Mr Lansley]

My hon. Friend will not have to wait long for announcements from hon. Friends of mine in the Government.

[Pat Glass (North West Durham) (Lab)]

Is not part of the problem the way in which Departments continue to operate in silos, so the Secretary of State for Education can cut the school sports initiatives with no impact on educational outcomes, but massive impacts on health? The Department of Health can consistently underfund children’s health services such as speech therapy and mental health, with very little impact on the Minister’s Department but massive impact on education outcomes. Is the statement not just evidence of more silo working?

[Mr Lansley]

That is all complete nonsense. On sport and activity in schools, my right hon. Friend the Secretary of State for Education is supporting schools and mainstreaming funding for sport and physical activity into school budgets; my right hon. Friend the Secretary of State for Culture, Olympics, Media and Sport is working to support competitive sport and the sport Olympics; and I am working to stimulate physical activity through Change4Life school sports clubs, increasingly in the primary sector as well as in the secondary sector. We are working on all that together and it is entirely complementary.

Breast Cancer Screening (Young Women)

Pat Glass Excerpts

Tuesday 30th November 2010 Westminster Hall

[Pat Glass (North West Durham) (Lab)]

Breast Cancer is the UK’s most common cancer. It affects thousands of families every year. Almost 48,000 people were diagnosed with breast cancer last year: 47,000 women and 277 men, and 125 women will be diagnosed with breast cancer today. Breast cancer incidence rates among women have increased by 50% over the past 25 years—5% in the past 10 years—and, because of lifestyles changes such as increased obesity and drinking in young women, those incidence rates will continue to rise, particularly for those under 50. Eight in 10 breast cancers diagnosed are in women aged 50 or over, but that means that two in every 10 are diagnosed in younger women, who may have young families. For young women the disease can be particularly virulent and aggressive, and the chances of survival are less good as a result.

[Ian Lavery (Wansbeck) (Lab)]

Does my hon. Friend agree that the time between the mammogram and the results is critical, and that the length of that period depends on the area and district a person lives in and the hospital they attend? It could be between a week and up to four weeks, depending on the hospital, which could mean the difference between life and death. At the same time, those with money have the opportunity to have a mammogram in the morning and receive the results in the afternoon.

[Pat Glass]

That is incredibly true. I am particularly concerned about young women, and in many cases the younger they are, the more virulent the disease is and the chances of survival are less good as a result, so that is particularly crucial. Every family in this country will be touched by this awful disease. Within my family, four close relatives have died of breast cancer in recent years, all aged well under 50; and a cousin, also under 50, is currently battling the disease for a second time.

However, it was an inspirational woman, Trish Greensmith, who runs the Chyrelle Addams breast cancer appeal trust in my constituency, who first brought home to me the number of young women who are being diagnosed with, and having to fight, breast cancer today. She told me that when she first visited an oncology clinic she was struck by the number of young women in the waiting room—young women who were trying to deal with virulent and aggressive cancers while bringing up young families. Under the current system, they would never be offered the opportunity for routine screening, which might have detected their cancers early and saved their lives. More women are surviving breast cancer than ever before, and the survival rates have steadily improved over the past 30 years, but 12,000 women and 70 men in the UK died from breast cancer last year.

[Alex Cunningham (Stockton North) (Lab)]

I congratulate my hon. Friend on securing this important debate. Few people will not have a friend or relative who will suffer from breast cancer and who would benefit from earlier diagnosis and improved information. I understand that Cambridge university has developed a computer programme called “Predict”, which allows any patient—or doctor—to go online and enter their symptoms and the kind of cancer they have, and it will predict their life expectancy and the likelihood of survival. Does my hon. Friend agree that that would be another useful tool to help inform and reassure women and men who are diagnosed with breast cancer?

[Pat Glass]

I am aware of the “Predict” computer system, which is an incredibly useful tool in the hands of clinicians, but I do not think it should be generally available for people to use in their own homes to calculate, using their symptoms, how long they have to live. I think they would find that very worrying. However, it would be incredibly useful for their doctor.

Of the women who died last year from breast cancer, 1,300 were under 50 years old. We know that women with a mother, sister or daughter who have been diagnosed with breast cancer have almost double the risk of being diagnosed themselves. We know that the risk increases with the number of first-degree relatives diagnosed, but even so, eight out of nine breast cancers occur in women with no family history of cancer whatsoever.

[Natascha Engel (North East Derbyshire) (Lab)]

A woman in Derbyshire, Wendy Watson, runs the national hereditary breast cancer helpline. What is my hon. Friend’s view on getting national funding for that helpline, which is a lifeline for many women suffering from hereditary breast cancer?

[Pat Glass]

I am aware of Wendy and the fantastic work she does; I also know that she is struggling to secure funding. Perhaps the Minister might look at that as a result of today’s debate. I thank my hon. Friend for making that point.

We know that obesity presents a risk, as do hormone replacement therapy and the use of oral contraceptives. In the binge capital of Europe, we are now told that as little as one alcoholic drink per day increases the risk of breast cancer by about 12%.

[Neil Carmichael (Stroud) (Con)]

Breakthrough Breast Cancer, which is an excellent organisation, has rammed home the point that awareness is important and that we should all do all we can to remind women of that. We should make women aware that they need to be aware.

[Pat Glass]

I absolutely agree.

Going back to the risk factors—obesity, HRT, oral contraceptives and alcohol—all of them are likely to affect women under 50 more than women over 50, and yet women under 50 are not routinely offered screening of any kind. About 1.5 million women in the UK are screened for breast cancer each year, and we must congratulate those involved in the routine screening programme on the many lives they save. The previous Government extended the screening programme so that from 2012, all women aged 47 to 73 will be invited for routine screening. That extension will save many more lives, but it will do nothing to help identify breast cancer in younger women.

Concerns have been expressed that wider screening could lead to over-diagnosis, but recent research is showing that the benefits of mammographic screening in terms of lives saved are greater than the harm caused by over-diagnosis. Those same arguments about over-diagnosis were used in the past to argue against extending screening for womb cancer and cervical cancer, but the response to those arguments has always been that it is better to be safe than sorry, and that, in the case of breast cancer screening, between two and two and a half lives are saved for every over-diagnosed case. Despite that, however, women under 50 are not currently offered routine screening.

It is also argued that film mammograms are not as effective for pre-menopausal women as for post-menopausal, as the greater density of breast tissue in pre-menopausal women makes it more difficult to detect problems. That is absolutely right. Screening of women under 50 may not be as effective as screening of women over 50, but it can still be effective, certainly in the absence of any other screening programme.

It is also argued that routine screening of women under 50 is not necessary, because the incidence of breast cancer is lower in that age group. I would say, “Tell that to the hundreds or thousands of young women battling this disease”, who say that any arguments about numbers are outweighed by the increased virulence of the disease in the young.

We are told that, because breast cancer is less common in women under 50, research trials have shown that regular screening of young women does not help to save lives. It is even argued that in other trials, regular mammogram screening is more of a risk than not screening. However, I say to the Minister, “Tell that to the young women currently undergoing chemotherapy”.

It is absolutely clear that mammogram screening is most effective among women who have gone through the menopause, but recent research shows that it can also be effective among those aged 35 to 50 and that, despite all the counter-arguments, there is now increasing evidence that there are significant gains to be made by routine screening of women from the age of 35 upwards.

[Grahame M. Morris (Easington) (Lab)]

I compliment my hon. Friend on securing time for this important debate. On routine screening and the value of targeting a particular age group, I, too, have received information from Breakthrough Breast Cancer—an excellent organisation—pointing out that 1,400 lives a year are saved by routine breast screening. However, Breakthrough Breast Cancer also says that any woman aged 70 or over is not routinely invited to attend for breast screening. It may well be advantageous, in terms of improving the health outcomes of those women, if a screening programme targeted them, too, in view of the high incidence of breast cancer among post-menopausal women.

[Pat Glass]

I thank my hon. Friend for that intervention.

I ask the Minister to consider the arguments that have been put forward and the increasing weight of medical evidence calling for routine screening from the age of 35 onwards. In his response, I ask him not to pull out the one argument that the coalition Government seem to have for everything: that there is no money. If we could set aside £9 billion last week to build more trains to make commuting more comfortable, surely we can consider routine screening. If we can find £9 billion to lend to the Irish in their hour of need, surely we can find the money to save young lives.

I understand that the Minister is unable to announce that routine screening for breast cancer will start tomorrow, but he could consider a long-term plan—over five years, for example—to reduce the age of screening to 45 in year one, 42 in year two, 40 in year three, 38 in year four, and to 35 within five years. Such a policy would be universally welcomed and could save precious lives.

I am aware of the Breakthrough Breast Cancer campaign. In particular, it seeks early breast screening for women from the age of 35 where there is a history of breast cancer. We must learn lessons from the highly successful cervical cancer screening programme. Early intervention is cost-effective—it saves the country money in the longer term, and it saves lives.

[The Minister of State, Department of Health (Paul Burstow)]

It is a delight to serve under your chairmanship, Mr Betts, and I congratulate the hon. Member for North West Durham (Pat Glass) on securing this important debate. As others have said, it is important that we do everything possible to increase awareness of breast cancer so that people are more aware of signs and symptoms and are able to present themselves at an earlier time and thus make the chances of survival much greater. I also congratulate the hon. Lady on the work that she does in raising funds and increasing awareness of the issue, as she has done today. I note the personal experience that she draws on.

Around 40,000 women a year are diagnosed with the disease—that is a third of all cancer diagnoses in women. The hon. Lady made a good speech setting out a powerful case that needs proper consideration. It is a shame that she made the point about Ministers trotting out certain lines about coalition funding and so on, as that added nothing to the debate. I was certainly not intending to go down that line because I want to try to give a substantive response to her remarks.

Breast cancer can strike women of all ages, although a person’s risk of developing it rises dramatically after middle age, with cases peaking among women in their early 60s. The prognosis for a person with breast cancer has transformed over the last 40 years. It has gone from a consistently lethal killer, to the second-least deadly form of the disease, if judged by five-year survival rates.

The NHS breast screening programme has played a major part in that success. Since it began in 1988, the programme has made a huge difference to a woman’s chances of surviving breast cancer. Around 83% of all women with breast cancer are still alive five years after diagnosis, and among those whose cancer is detected through screening, that survival rate increases to over 96%. That is a striking demonstration of the power of detecting cancer early on—that point has rightly been made in the debate—and that is why we will make earlier detection a key part of our forthcoming cancer reform strategy.

Experts believe that the current breast screening programme saves 1,400 lives a year among the 50 to 70-year-old age group on which it focuses. That point was made by the hon. Member for Easington (Grahame M. Morris). Therefore, the hon. Lady asks a fair question about whether there is scope to widen the net and whether that would be appropriate. Should we be looking to extend the programme to cover other age groups?

Under the current programme, women aged between 50 and 70 are routinely invited for screening, and women over 70 can request to be screened every three years. The hon. Lady suggested that women as young as 30 should be invited for screening. When it comes to health care, our priority is simple—to have outcomes that compare with the very best in the world. We will achieve that by handing power to front-line professionals and basing decisions on the best available evidence. That is where there is a debate. I am interested and I listened carefully to what the hon. Lady said about the emerging evidence. However, when it comes to extending screening to all women older than 30, as far as I can see, the evidence is not there.

[Pat Glass]

May I just clarify that I am talking about women between the ages of 35 and 47 rather than 30? That is the point at which screening would be most helpful.

[Paul Burstow]

I am grateful to the hon. Lady for that clarification. In 2006, the Institute of Cancer Research published the results of a 15-year study of the benefits of screening women from the age of 40. The study invited about 53,000 women to receive annual breast cancer screening over nine years and then compared them to a control group of women who received standard NHS treatment. The study found that the reduction in deaths due to screening was not statistically significant. I understand that, for the individual, it is 100%; I understand the hon. Lady’s powerful point. She might say that, if such measures save a single life, they are worth doing. However, the study pointed out, as she seemed to guess, that early screening had significant disadvantages. Almost one in four women in the study had at least one false positive, with all the resulting distress, anxiety and unnecessary follow-up, including invasive biopsies. Currently, there are about 7 million women aged between 30 and 49 in England. I accept that she wants to screen from 35 onwards, but if the take-up rate among that population were 75%, we would be screening about 5 million more women a year. Even if the minimum age were 35, it would create the issue of false positives.

--- Later in debate ---

[Paul Burstow]

I understand fully. Today, the Secretary of State will make a statement in the House setting out this Government’s new commitments on public health and the clear lines that we are drawing on tackling health inequalities. Some of the issues clearly involve a social gradient that we must address, and we will address them in our new cancer reform strategy and public health White Paper.

[Pat Glass]

I appreciate what the Minister says about considering new evidence. Will he also take into account—this relates to the remarks by my hon. Friend the Member for Easington (Grahame M. Morris)—the issues that affect younger women and the cohort that those younger women are likely to come from? It is about obesity, hormone replacement therapy and alcohol. It is younger women from low socio-economic backgrounds who are likely to be hit hardest by those things.

[Paul Burstow]

I am grateful for those points, and I am coming to them, which is why I was smiling—it was not because of the subject, which is very serious.

Let me talk briefly about partial age extensions, which is another issue worth airing. The last cancer reform strategy committed the Government to extending the NHS breast screening programme to women between the ages of 47 and 73. Beyond 73 years of age, patients would still be able to self-refer. That extension will ensure that all women are invited for screening before their 50th birthday. The June revision to the NHS operating framework confirmed that the extension will begin this year—in 2010-11. By the end of March next year, we expect 60% of screening programmes to be screening that wider age group, and we obviously want to go as far and as fast as we can.

Our updated cancer reform strategy will focus on outcomes and on improving cancer survival rates. Although the one-year and five-year survival rates have improved in recent years, we still lag behind other European nations. If we could match the five-year survival rates of the best countries in Europe, we could save up to 10,000 lives every year in England. As has been said, therefore, early diagnosis is essential. In September, I announced funding for a new £9 million campaign to get people to recognise and, importantly, to act earlier on the signs and symptoms of cancer. We are talking not so much about a campaign as a series of 59 local campaigns, which will focus on the three big killers: breast cancer, bowel cancer and lung cancer. The campaigns will raise public awareness of symptoms and encourage people to talk to their GP at the earliest possible opportunity. We will target those populations that the hon. Member for Easington talked about, which are often harder to reach.

Our approach will also encourage GPs and others in primary care to act appropriately. The tragedy of these cancers is that they are preventable. As has been said, lifestyle—eating too much, drinking too much and not getting enough exercise—plays a big part. That is why the coalition is determined that public health will become a far more important part of overall public policy and practice nationally and locally. We will make sure that we treat and prevent cancer in that context. That is why we will, as I said, publish a White Paper later today to set out how we will provide the right leadership and the strategy to improve people’s lifestyles and to reduce their risk of getting cancer in the first place.

Child and Adolescent Mental Health Services

Pat Glass Excerpts

Wednesday 7th July 2010 Westminster Hall

[Jonathan Reynolds]

Speaking as a parent, we must recognise that this is a spectrum disorder. Therefore, children with autism are in different situations and have different symptoms, and each requires a response particular to them. Generalisations of the kind that the hon. Gentleman asks about cannot be made. Each parent and professional would, in respect of the support that they had, have to make the decision based on what was best for that particular child.

The professionals who spoke to the NAS stressed the importance of specialist autism expertise when dealing with a child with autism and mental health problems. They explained how in many cases a specific skill-set is required to treat these children and that without that specialist knowledge it can be very difficult to effect any real improvement. They felt that specialist expertise was often required to get a real understanding of how the child’s mental health problems related to their autism, and how they would need to adapt the interventions they provided to take account of the child’s autism.

Although basic autism knowledge will help a professional to communicate better with the child and understand better why the child displays certain behaviours or symptoms, greater expertise is often needed to make a positive difference to the child’s mental health. That is because many therapies and interventions rely on thought processes and communication techniques that do not make sense to children with autism, and only skilful adaptation from a specialist can make them relevant and useful. Children with autism often will not gain any benefit from treatment that is applied in the standard way. Indeed, such treatment can make things worse.

Again, we should recognise good practice where it exists. West Berkshire has a social communication team that provides home and community-based assessment and intervention for young people with complex diagnostic issues or needs that cannot be met by local services. That team works with children with autism and a co-occurring mental health disorder. It takes a multidisciplinary approach, incorporating speech and language therapists, two clinical psychologists and a psychiatrist. The team is also part of a wider multidisciplinary group that provides services for children with autism in west Berkshire. The team recognises the need to adapt therapies to account for autism. Psychologists divide their time between diagnosis and follow-up appointments, and provide behavioural and mental health interventions.

[Pat Glass (North West Durham) (Lab)]

I have worked in this area for many years, with many children and CAMHS services. I have found across the country that there is massive inconsistency in the quality of CAMHS services, but there is absolute consistency in the lack of those services for children. Quality is variable throughout the country. Although the services that my hon. Friend is talking about are at the upper end of the scale, for many children they simply do not exist.

[Jonathan Reynolds]

I am tremendously grateful to my hon. Friend for her intervention. She has great expertise in this and other matters, and in another capacity was responsible for the education system that I went through. I hope that I am not letting her down.

Following on from that, as so many children who access CAMHS have autism, what action will the Government take to ensure that specialist autism support is available to all children with autism and mental health problems? To take up what my hon. Friend has said, I think we would all agree that one matter that always arises when we talk to parents and campaigners is the inconsistency in service delivery across the country. For every example of innovative or positive practice, there are often many examples of children with autism and mental health problems facing inadequate or non-existent provision.

Local commissioners are supposed to plan services based on the needs of the local population, but it seems that in many instances commissioners are unaware of either the number of children with autism and mental health problems in their area, or that those children need specific support from people who understand autism, or both. When commissioners fail to recognise and address the needs of children with autism and mental health problems, those extremely vulnerable children and their families do not receive the support that they need. Commissioning is a local exercise, but there is no doubt that direction from the Government at national level can make a huge difference to what is commissioned.

Previous Government directives—for example, the national indicators, Care Quality Commission inspections and the national service framework for children—have instructed commissioners to prioritise specific areas of CAMHS, such as age-appropriate in-patient wards for teenagers, early intervention services, and services for children with a learning disability. Those directives drive commissioning in those areas, and lead to greater availability of services and greater consistency across the country.

The National Autistic Society has provided strong evidence that CAMHS are failing children with autism, and that results for such children can be greatly improved by improving autism understanding and specialisms within CAMHS. We know that only 10% of CAMHS provide targeted support to children with autism. Surely, there is a strong argument for the Government to prioritise the commissioning of services for children with autism.

Ten thousand children with autism access CAMHS each year. Given that the mental health of two thirds of children with autism is not improved by the support that they receive, that is a huge waste of NHS resources when we can ill afford such a waste. Furthermore, when children with autism receive services that do not work for them, or receive no support because none is available, their problems escalate and become more complex. Not only does that mean that it is much harder for families to cope; it means that, ultimately, those children are much more expensive for the NHS to treat. A relatively short period of appropriate therapy from an autism specialist at an early stage could prevent a child from needing a long stretch in an expensive in-patient unit.

If commissioners were given more guidance and direction to help them to commission the right services for children with autism in the first instance, we could stop wasting money and stop wasting lives. What action will the Government take at national level to ensure that the right services for children with autism are commissioned locally across the country?

--- Later in debate ---

[Pat Glass (North West Durham) (Lab)]

I thank my hon. Friend the Member for Stalybridge and Hyde (Jonathan Reynolds) for securing the debate, which has been excellent. I do not disagree with anything that I have heard, nor do I intend to repeat any of it. I shall concentrate on the areas that I have the most concerns about.

We have come a long way in recent years and there have been improvements, particularly in education, but we must not be complacent and there is still a long way to go. The two areas that I have the greatest concern about are transition, which I shall come on to, and diagnosis. This refers back to the issues of child and adolescent mental health services. In my experience, far too many children still receive a diagnosis that is less related to their symptoms and difficulties than to who they are and where they live. I still see too many cases in which clinicians go down the route of attention deficit hyperactivity disorder or EBD—emotional and behavioural difficulties—first, because of the family and where they live. That means that those children and their families do not gain access to the diagnosis, services and provision that they need. That is one concern, and it relates to what I said in an intervention about the quality and consistency of CAMHS across the country. If people look at the issue geographically—on a map, as I have done—they will see hot spots of certain diagnoses, and sometimes around certain clinicians. Those issues need to be addressed.

Everything that I have heard today about transition, particularly transition in the early years, is absolutely correct. If we get that right and provide access to the right services—good, well co-ordinated provision—the mental health of those children and their families will be much improved, outcomes will be much improved and we will save money in the long run. Transition in the early years is crucial and will save us money in a time of austerity.

The transition at the other end is also an issue. A lot of emphasis has been placed on that in recent years, but in my experience that has been about the process—the right forms filled in by the right people, and the right people being at the right meetings at the right time. For the families, the process can be fabulous, but if there is nothing to transition on to, it is a disaster for them.

When I was in my former role in education, we recognised that there was almost a time bomb here. Children are going through the education services and coming up to the adult services, but those services are not there for them. Will the Minister consider the issues of diagnosis and quality of provision across the country to ensure that a child’s diagnosis is right and not based on the family’s circumstances or socio-economic grouping? Will she also consider transition in relation to the quality of provision, not just the processes, forms and meetings?