Cancer Strategy

Rebecca Harris Excerpts

Thursday 8th December 2016 Commons Chamber

[Rebecca Harris (Castle Point) (Con)]

I should like to add my words of thanks to my hon. Friend the Member for Basildon and Billericay (Mr Baron) for securing the debate. I very much regret the circumstances that mean he cannot be here today. It is unusual to be having a debate on cancer without him, as he works diligently on these matters. I send him my best wishes.

As chair of the all-party parliamentary group on brain tumours, I very much welcomed the new cancer strategy that was announced in the Chamber just over a year ago, and I am delighted that we have this opportunity to scrutinise it again now. I congratulate the Government on their focus and their direction of travel, and on the fact that survival times are constantly going up. We are absolutely going in the right direction, but like all hon. Members, I want to push the Government to go further, particularly in relation to brain tumours.

We heard earlier from my hon. Friend the Member for Crawley (Henry Smith) about the difficulty of early diagnosis of blood cancers and from the hon. Member for Scunthorpe (Nic Dakin) about pancreatic cancers. Early diagnosis, about which we hear time and again, is also a problem with brain tumours. People are often turned away by doctors and the cancer is found at the last moment. The hon. Member for Poplar and Limehouse (Jim Fitzpatrick) spoke about prevention, but unfortunately we think that only 1% of brain tumours may be preventable, so it is not really an area of exploration for us.

For patients with brain tumours, the only hope of a cure is through research and innovation into the many types of tumour. While such tumours represent just slightly under 3% of all cancers, they are the biggest killer among cancers of children and people under the age of 40. As for years of life lost, it is a devastating disease. Surprisingly, just 1% of the national cancer spend has gone into research into this area of cancer since 2002, which is clearly an injustice for those suffering from brain tumours and is why survival times have not been improving. Brain tumour research remains perennially underfunded, which was highlighted by the excellent Petitions Committee report—its first ever—into brain tumour research funding and the fine Westminster Hall debate. As a result, the Government set up a “task and finish” working group, for which I am extremely grateful. I look forward to the work that that brings forward, but we are not there yet and more must be done.

From reading the NHS’s “One year on” progress report, it appears that there has been much focus on meeting the clinical service recommendations set out in the original strategy. That should be welcomed, but there has been rather less focus on the research and innovation recommendations. While I recognise the importance of clinical services and their potential to improve outcomes in the diagnosis, treatment and care of people affected by brain tumours, we need equal, if not more, focus on research and innovation into potential cures. To that end, I have a few observations to make about several of the research points in the progress report and how realistic they are for patients with brain tumours and about research into the disease.

The report mentions a focus on modernising radiotherapy services and embedding research in the latest investment. Given the location, brain tumour radiotherapy comes with complex side effects, including increases in cranial pressure for some patients, alongside the more common side effects. More precise stereotactic radiotherapy is welcome, but it still does not represent a cure for many brain tumour patients, only an extension of life. The report states that a key 2020-21 metric is an

“Increase in five and ten year survival, with 57% surviving ten years or more”.

However, Brain Tumour Research’s latest report on national research funding, released in October, shows that five-year survival for brain tumour patients is a mere 19.7% in England, lagging far behind other cancers. With a one year survival rate of 46.5%, which is well below the NHS’s 2020 target of 75%, the NHS looks set not to meet its own key measure on brain tumours. In doing so, it is letting down brain tumour patients.

A key paragraph from the NHS progress report states:

“Although a commitment has been made, NHS England has yet to publish its 2016/17 research plan, leaving the NHS without an up-to-date strategy for research. Now that the Accelerated Access Review has been published, we hope that the NHS England research plan is also delivered without delay.”

That appears to be an admission of prioritising other objectives over research. Clinical services are important in the here and now but without proper planning and investment into medical research, ongoing improvements in health outcomes of many diseases will not be realised, and brain tumour patient outcomes will continue to stagnate when compared with other cancers. I welcome many aspects of the progress report, including the launch of a new integrated cancer dashboard to ensure greater analysis of patient outcomes in local areas. I would be grateful to know whether phase 2 of the dashboard will include data on brain tumours, as they do not appear to have been collected in phase 1.

The launch of the national “Be Clear on Cancer” campaign will also hopefully lead to faster diagnosis of cancer for all patients. However, Brain Tumour Research’s latest report shows that, according to the National Cancer Research Institute, the Government spend on brain tumour research represents just 0.52% of its total spend on cancer. It is clear that brain tumour research continues to be drastically underfunded, even with the cancer strategy in place. Therefore, although the strategy is a major step in the right direction, it will need to be made to work for all types of cancer, including the rarer ones and, in particular, brain tumours. Every week, a family loses a child to brain tumour and, as with many cancers, the incidence of brain tumour is rising. I very much hope that that will be taken on board by the new Minister, and he will hear more from me in future about the need to increase brain tumour research.

[Bob Blackman (Harrow East) (Con)]

Thank you for calling me in this debate, Madam Deputy Speaker. It is always a pleasure to follow my hon. Friend the Member for Castle Point (Rebecca Harris), and one benefit of this type of debate is that we learn something that we did not know before. I, too, congratulate the hon. Member for Scunthorpe (Nic Dakin), who introduced the debate. I know that he has been a doughty campaigner, particularly on behalf of pancreatic cancer sufferers, since we were both elected, and the way he introduced the debate was fitting and appropriate. I also pass on my best wishes to my hon. Friend the Member for Basildon and Billericay (Mr Baron) and his family at this difficult time. It is a surprise not to see him in this Chamber for a debate such as this, but we understand the circumstances.

I want to start by paying tribute to Greg Lake, the rock star who, sadly, died yesterday after a long battle with cancer. To me, he was one of the icons. He founded King Crimson, and one of the first albums I bought was “In the Court of the Crimson King”. He then went on to form the supergroup Emerson, Lake and Palmer, and he also produced the iconic hit “I believe in Father Christmas”, which we hear at this time of year. I want to put that on the record because it is appropriate that we remember that people are suffering and dying as a result of cancer literally every day.

I declare my interest as chair of the all-party group on smoking and health, and I note that the hon. Member for Poplar and Limehouse (Jim Fitzpatrick) raised a number of the issues set out in the briefing that has been circulated quite widely. I want, however, to build on some of the things that have taken place. One of the key recommendations of the UK cancer strategy, which was founded not a year ago, as the title of this debate suggests, but 18 months ago, was that the replacement tobacco control plan should be published within a year. The last tobacco control plan expired a year ago, and we were promised a replacement in the summer. I know that “the summer” can stretch, but stretching it to Christmas is a bit of a long stretch. We recently had an excellent debate in Westminster Hall, where we briefed the new Minister, the Under-Secretary of State for Health, my hon. Friend the Member for Oxford West and Abingdon (Nicola Blackwood), on all the key issues relating to tobacco control. She promised that the new plan would be published soon, and she did so again when I raised it with her at Health questions. It will not surprise today’s Minister to learn that the one thing I have to ask is to be given a date for the new plan—he should not tell me, “Soon”.

I now come to a significant fact. The Prime Minister said in her first major speech, on the steps of Downing Street, that she would be

“fighting against the burning injustice that, if you’re born poor, you will die on average nine years earlier than others.”

Smoking is responsible for half the difference in life expectancy between rich and poor in this country, so if we can cut smoking rates, we will help deliver the Prime Minister’s ambition. I ask the Minister to make sure that we get this tobacco control plan as quickly as possible.

We know that smoking is the greatest preventable cause of cancer worldwide. It accounts for more than one in four cancer deaths in the UK and for a fifth of all cancer cases. Smoking increases the risk of getting 14 other cancers and is responsible for more than 80% of cases of lung cancer—the cancer that is the biggest killer in this country. It also has the worst five-year survival rate. Therefore, from that perspective, if we can cut smoking, we will cut the causes of cancer.

I wish to declare an interest in this matter. As I have said in this place on more than one occasion, both of my parents died, in 1979, of smoking-related diseases. They both died of cancer because they smoked virtually every day of their lives. I heard the hon. Member for Poplar and Limehouse say that he gave up in 1980. I still remember those terrible days when my parents died, and I want us to get to a position where no one has to suffer what my family and I had to suffer.

[Rebecca Harris]

Does my hon. Friend agree that those Members who said that we should not bring in a ban on smoking in cars with children because it was unpoliceable may now regret that? Children are policing that measure very well indeed.

[Bob Blackman]

When the change in law came through, a number of people objected to it, saying that it would not be enforceable. I remember back to my childhood when both of my parents were smoking in the car in front of me. It was difficult then as a child to say, “Please, will you not smoke, because I do not like it?” It was just easier to open the window. I do not want children to go through that. It is right and important that we changed the law in that way, as we know that second-hand smoke is a key killer of young lungs. It was a significant development—and a development that people did not think would happen. People did not think that we could introduce this change and get it through both Chambers, but I am delighted to say that we did it and that it was the right thing to do.

--- Later in debate ---

[Jo Churchill (Bury St Edmunds) (Con)]

I, too, thank the Backbench Business Committee for allowing this debate. I also thank the hon. Member for Scunthorpe (Nic Dakin) for the way he introduced it, which has allowed us to conduct it in the tone that we have.

I came to this place after a journey with this disease, but I have been amazed since I have been here. The hon. Member for Bristol West (Thangam Debbonaire) has fought the disease and now sits back in her place, and very welcome that is. The news about the hon. Member for Blyth Valley (Mr Campbell), too, is welcome. I have heard my hon. Friend the Member for Lichfield (Michael Fabricant) talk about his journey with the disease. My best wishes go to my hon. Friend the Member for Grantham and Stamford (Nick Boles), who is on the journey at the moment. It is unusual not to see my hon. Friend the Member for Basildon and Billericay (Mr Baron) in the Chamber, and my thoughts and prayers go out to him and his wife at this time.

Cancer is interesting: you don’t pick it, it picks you. We have heard from many Members that some cancers are preventable, but there are over 200 cancers. The debate often gets channelled towards rare diseases or prolific diseases such as breast cancer, prostate cancer or lung cancer—one of the big four. However, the debate we have had today is very broad, and I welcome that.

My hon. Friend the Member for Bosworth (David Tredinnick) said we are doing better, which we are, but we could do even better, and I would like to return to the issue of research, which was brought up by my hon. Friend the Member for Castle Point (Rebecca Harris), to see how we might do better there.

I welcome the commitment to the strategy. Implemented, it could be transformational, which is why I hope we will hear about better implementation. The “Five Year Forward View” shows that funding for cancer services will go up by 9%, reaching £13 billion by 2020-21.

As we have heard, one in two of us will suffer from cancer by the end of this Parliament, and 2.5 million people in this country are living with the disease. A question the strategy does not necessarily address properly is how we will care for those people. How will we deal with the survivors affected by it—625,000 people will be, as was mentioned earlier—who will carry forward some form of disability or hardship from having the disease? How will we deal with palliative care? Have the sustainability and transformation plans looked into palliative care and how we can address the needs of people who are looking towards the end of their lives?

I would also like to highlight teenage cancers, although it is usually breast cancer that I talk about in this place. I have a young friend for whom a year on means something different. She wrote to me on Sunday, after I said I was talking in this debate. I thought of her because, on 11 December last year, young Emily was diagnosed with cancer.

She said:

“Last year in December I was diagnosed with ALL Leukaemia. It was a very scary time for me and my family. But something that makes going to hospital that little bit nicer is how lovely the nurses are.

However, there were a lot of horrid bits during the start of treatment, such as hair loss and sickness.

Although, I still have two years to go of treatment to go on treatment, it is a lot less intense now I am in maintenance. The majority of chemo is in tablet form at home, one hospital visit a month and the HORRID, HORRID steroids, also once a month for five days!

I know that the steroids work as one of the main chemo therapy treatment - but they make me put on weight, feel emotional for no reason and sometimes cross and angry at my mum, who is my absolute rock and is always there for me, so that makes me feel very sad!

If I could change anything about the chemo it would definitely be; to not feel sick and not take steroids!”

Emily is a year on in her journey. I am sure I can speak for everybody in wishing her lots of success for a great journey.

One of the best things we can do for young people is to educate them. Education is a theme that has come out of this debate. I will not go over the comments by my hon. Friend the Member for Harrow East (Bob Blackman) and the hon. Member for Poplar and Limehouse (Jim Fitzpatrick) about smoking, which they discussed so well, but merely say that education in that regard is important. Nor will I go over education around food and nutrition, which, as we have heard, is worked on by the Penny Brohn institute and The Haven.

The hon. Member for Strangford (Jim Shannon) mentioned diet. Every oncologist I have ever had through all three of my journeys has spoken about the need to look after oneself through a good diet, keeping fit and exercise. We do our young people a disservice if we do not help them to lead better and healthier lives. I want to understand how the Minister is looking across Departments to make sure that this is addressed in the policies of the Department for Communities and Local Government and the Department for Transport through cycle paths, trim trails, and right across the piece so that we can all lead healthier lives.

I am pleased that the industry is responding by reducing adverts for children and so on, and I would like this to go further, but parents have a huge part to play in their children’s lives. We have a huge part to play in our own lives with regard to what we eat and how we make choices about whether we smoke or have that extra beer or extra pie. There is some self-responsibility involved. If the Minister will do his bit by helping to educate people a little more through public health information, I am sure that we will step up to the mark and do our bit as well.

I welcome the setting up of cancer alliances and the appointment of Cally Palmer, the excellent head of the cancer taskforce. Early diagnosis is fundamental, as the hon. Member for Scunthorpe pointed out, because it gives us better outcomes, but the Government must set out, with NHS England, how funding will be strategically allocated. For example, will we be able to use mobile diagnostics and molecular diagnostics? I note my interest as chair of the all-party parliamentary group on personalised medicine, and vice-chair of the cancer APPG and the breast cancer APPG. If we could see who would benefit from the use of drugs, we would stop waste. For example, only 20% of women with breast cancer would benefit from Herceptin. Will the Minister address the point about the use of innovative technologies raised by my hon. Friend the Member for Castle Point?

How can we utilise the workforce in a more strategic approach? Macmillan, Cancer Research UK and 20 other organisations have developed eight principles on this. We need a workforce that is fit for the future, with people who understand the changing landscape that we are dealing with. I welcome the £130 million put into radiotherapy machines, but I would like to know that we have the radiographers who can work those machines and optimise their use.

More of us survive living with and beyond cancer, but metastatic cancer, in particular, is a type that we need to learn more about. That brings me on to the use of data. The Teenage Cancer Trust would welcome clinical trials with young people. There is a lack of data on metastatic breast cancer.

[Rebecca Harris]

My mother-in-law passed away from secondary metastatic breast cancer after opportunities to diagnose her were missed. It has been brought to my attention that we do not keep very good records or data on metastasized breast cancer. The cancer pathway does not provide a specialist nurse for those with breast cancer, and we do not seem to provide a specialist nurse for those with metastasized breast cancer, either.

[Jo Churchill]

I agree with my hon. Friend. People who are diagnosed with metastatic cancers—not only of the breast, but across the piece—feel like they are dropping through the cracks. They do not necessarily get a clinical nurse specialist, so that is another area for the specialist workforce to address. We need to make sure that we catch people on the journey, because it may be iterative. People may feel fit and well, but then find that they have to use the services again, so our approach needs to be flexible.

My hon. Friend has mentioned the importance of the ecosystem of research, hospitals and patients. My hon. Friend the Member for Crawley works hard with the Bloodwise charity, which is truly emblematic of an empowering organisation that works with the patient, clinician and researcher to help drive understanding. That is one way of giving UK plc a huge advantage. The hon. Member for Strangford has said that we need to look at the ecosystem, which is not just about cancer treatment at the end, but about researchers, universities, those brilliant students and staff whom we welcome from Europe and everyone in the pharmaceutical industry and charities working collaboratively to get the best outcome possible. That is how we will start to rise up the table and be as good as Sweden and other countries whose patients have truly fantastic outcomes.

Timely interventions can help recovery. I want to understand how recovery packages are being rolled out, because the issue of the workforce is critical.

The hon. Member for Bosworth (David Tredinnick) has mentioned alternative therapies, which can be useful, but this is a space in which charities can help people. Only this week, the Countryside Alliance Foundation took women who have received treatment fly-fishing. They find that the experience of being outside, doing something physical and enjoying nature gives them a huge sense of wellbeing. Personally, I do not think that it is a question of either/or; it is a question of joining them together.

Finally, I know that this is not the Minister’s area, but I would like him to take it back with him. I welcome the cancer drugs fund, but I am worried about those who benefit from combined treatments. Melanoma Focus has said that people on combined treatments may be disadvantaged, because not all of them will have access to the cancer drugs fund. I hope that the fund will be flexible and that the matter will be addressed.

Support for Life-shortening Conditions

Rebecca Harris Excerpts

Tuesday 7th June 2016 Westminster Hall

[Rebecca Harris (Castle Point) (Con)]

I congratulate my hon. Friend the Member for Pudsey (Stuart Andrew) on instigating this debate. Life-shortening illness is an issue that many hon. Friends will have experience of from their surgeries; it is invariably moving and humbling.

I felt driven to speak in this debate because of a constituent of mine, a truly inspirational young woman called Lucy Watts. Lucy is 22 and suffers from a rare genetic condition called Ehlers-Danlos syndrome—I hope that I have pronounced it correctly—with life-limiting complications. It has left her disabled and wheelchair-bound since she was 14. She is hooked up to intravenous drips almost 24 hours a day and is largely bed-bound.

Nevertheless, Lucy does not allow her illness to rule her. She is a writer, a speaker, a charity ambassador and trustee, a blogger, a patient-leader and a spokesperson. She has appeared in filmed and recorded work, including on TV and the radio, campaigning for young people with life-limiting disease. Lucy was awarded an MBE by Her Majesty in the new year honours list—all this at 22, and with a life-shortening illness. Those are achievements that many of us could not hope to realise in an entire lifetime. I am immensely proud of Lucy, and I urge hon. Members to take time to visit her amazing website, “Lucy’s Light”.

As chair of the all-party parliamentary group on brain tumours, I know too well the dreadful impact of severe illness on younger people and their loved ones, as brain tumours are the largest cancer killer of children and young people under 40. Only a few weeks ago, we had a debate in this Chamber highlighting the impact of brain tumours and the fact that they receive only about 2% of research spending, despite their effect on reducing lifespans.

Through Lucy, I have also been introduced to the work of the charity Together for Short Lives. As has been said, the charity does incredible work with young people such as Lucy who are diagnosed with life-threatening illnesses. Unfortunately, but understandably, our society often feels uncomfortable discussing sick and dying children. Of course it is uncomfortable; as a mother, I can think of no greater horror. We would like to brush it aside and not focus on it, but we cannot afford to ignore the topic. My parents lost an older brother of mine, so I know some of the impact of being with and losing a sick child. It lasts a lifetime, and it affects the whole family.

Lucy has been keen to make it clear to me that young people desperately need care packages that bring together all three services—health, social care and education—in an age-appropriate way. I am glad to see that we are making some steps towards reforming the health and social care mix in this country, but much more needs to be done, and much faster.

A recent study suggests that the figure of 49,000 children and young people across the UK with life-shortening conditions could be underestimated by as much as 50%. The current population is not being adequately recognised, supported and funded by local authorities and clinical commissioning groups. The research suggests that a further 25,000 children and young people are effectively being ignored. In addition, that is reflected in the policy environment, where too often children’s palliative care needs are inappropriately coupled with those of adults. Children’s needs are much more complex, and must focus on quality of life as well as quality of death.

As we know, two weeks ago it was Hospice Care Week. Hospices are lifelines for families such as the Watts family. The work of hospices, such as Little Havens hospice in Daws Heath in my constituency, is invaluable for those who need support and advice. However, as Lucy has found, a children’s hospice such as Little Havens is not geared up to support a young adult and nor is the local adult hospice, meaning that Lucy is forced to travel from Essex as far as Winchester, despite the complications and difficulties of her illness, to access age-appropriate hospice care. That cannot be right.

I am proud that the Conservative-led Government ensured that there was a £60 million boost for hospice care and I hope that hospice care will continue to receive the vital funding it requires. As I have said, hospices really are a lifeline for families during the most heart-breaking of times. However, we must do more to support hospices such as Little Havens. The cost of palliative care for children is estimated to be £200 million a year, yet the grant for these services is just £11 million a year.

We owe it to Lucy and to thousands of other young people in similar situations to face up to the issue and not only see that that grant is increased, but ensure that research funding is directed more towards the illnesses that impact on the young and that take away the greatest number of years from young people’s lives. Too often we see research funding and care funding being focused on the most common illnesses, which are often less complex and have fewer implications for life expectancy. We have not got our focus right in this area and we need to adjust it.

It is very encouraging to see so many hon. Members here in Westminster Hall today and I look forward to working with the Government to ensure that we provide much more age-appropriate care for young people with complicated illnesses.

Brain Tumours

Rebecca Harris Excerpts

Monday 18th April 2016 Westminster Hall

[Rebecca Harris (Castle Point) (Con)]

I am pleased to have the opportunity to add my voice to this important debate. I thank the Petitions Committee for scheduling it, and its Chair, the hon. Member for Warrington North (Helen Jones), for her superb opening speech, which covered the issue fantastically. It is phenomenal to see so many hon. Members in Westminster Hall. That firmly assures us that the issue is now well and truly in the public eye and on the Government’s agenda.

I chair the all-party parliamentary group on brain tumours, and I am here because I attended the funeral of an 11-year-old boy, Danny Green. No parent should have to bury a child, and no child should have to attend a friend’s funeral, as I saw when Danny’s many school friends made a guard of honour for his coffin, something they will never forget. How on earth can one celebrate the life of someone who died aged only 11?

All hon. Members will have received a copy of Danny’s father’s book, “Danny’s Journey”, detailing Danny’s story from his first dizzy spell in November 2011 to his tragic untimely death just seven months later. It was distributed jointly by the Danny Green Fund and the Brain Tumour Charity. We should all find it shocking that, given that, as we have heard, brain tumours are the main cancer killer of children and young adults and that more life years are lost to them than to any other cancer, this receives as little as 1% of the national cancer research spend.

We have also heard that, over the past 30 years, although cancer survival rates have increased by 50%, brain tumour survival rates have increased by only 7.5%. The people involved are often children and the parents of young children, and those figures do not begin to illustrate the degree of lifelong disability that many of the survivors, of whom there are too few, also face, and the cost and burden added to their lives and those of their families.

Many small charities work tirelessly to make up the funding shortfall. To their immense credit, Danny Green’s parents, Lisa and Chris, and his sister Holly have raised more than £250,000 in the short time since his death, but surely we cannot rely on the hard work of sufferers and their loved ones. Like any parent here, I would give my life in an instant if it could save my nine-year-old’s, and I am certain that my mother, who has enjoyed a very full life for 82 years, would also do so if she could save anyone’s child. We must consider our priorities. Brain tumours may be considered rarer cancers, but their disproportionate effect on the lives of young children and young adults means that we must give them a much higher priority.

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[Caroline Nokes (Romsey and Southampton North) (Con)]

I add my congratulations to the Chair of the Petitions Committee, the hon. Member for Warrington North (Helen Jones), on the Committee’s excellent report, and to every Member on today’s thoughtful debate. I pay particular tribute to colleagues who spoke movingly about their own experiences or those of people close to them.

I will briefly mention one of my own constituents, but first echo the comments of my hon. Friend the Member for North Dorset (Simon Hoare) about Sacha Langton-Gilks. It is clear that someone is a dedicated and doughty campaigner when they not only attend the surgeries of their own Member of Parliament, but pitch up at those of other Members. Sacha came to see me when I was a new MP—bringing with her the legal requirement, one of my constituents, who introduced her—and spoke incredibly movingly about her son, David. She also brought with her the HeadSmart cards and emphasised the importance of early diagnosis and the HeadSmart campaign, which seeks to bring awareness to schools, doctors and, particularly, parents. As a result of that meeting, I was able to introduce her to the leader of Hampshire County Council, who agreed for those cards to be distributed in Hampshire schools. Those cards are incredibly informative, outlining symptoms in an age-specific way and, above all, not provoking alarm; they just educate people. It is important that we increase awareness of brain tumours without instilling fear in people.

[Rebecca Harris]

I, too, commend the HeadSmart cards, but does my hon. Friend agree that unless the medical profession is more aware of brain tumours we will run into the problem, as we have time and again, that it overlooks parents’ instincts in such cases?

[Caroline Nokes]

I pay tribute to my hon. Friend’s work as chair of the APPG, and I will highlight exactly that situation with the case of a constituent. Brain tumours are not as rare as we might think; they are the biggest cancer killer of children. That is why I argue that research and knowledge are critical.

I received an incredibly moving letter from my constituents, Charlotte Swithenbank and James Butler, the parents of Alfie, who is not yet two years old and has been fighting his cancer for more than a year. As in many cases, Alfie was not initially diagnosed. It was not until his seventh trip to the doctor in just two weeks that he was referred to Southampton general hospital. Within 36 hours of admission, he was diagnosed with a grade 3 infant ependymoma, and he has since had more than 24 hours of surgery. He has also had chemotherapy.

Community Pharmacies

Rebecca Harris Excerpts

Tuesday 23rd February 2016 Westminster Hall

[Graham Jones (Hyndburn) (Lab)]

I congratulate the hon. Member for St Ives (Derek Thomas) on securing the debate. It is somewhat of a rerun of the post offices debate mentioned earlier. Post offices provide a commercial service, but the key point is that they also provide a public service. My view is that the UK’s pharmacy network must be protected. They are vital because they are accessible and have good geographical coverage: 95% of the population can currently get to a pharmacy on foot within 20 minutes. For deprived populations, the elderly and young families whose car may be taken to work, such services that can be reached by walking are essential.

Local pharmacies provide advice and reassurance.

[Rebecca Harris (Castle Point) (Con)]

Will the hon. Gentleman give way?

[Graham Jones]

No, I will not; I am sorry, but there is not enough time.

Pharmacies are also vital because they are beginning to be part of a better national health service, providing a first point of contact; 1.8 million people visit a pharmacy each day. They are an essential part of the pyramid of care that has been mentioned. Accident and emergency departments are stretched, and the solutions that will bring about better healthcare must start further upstream, with pharmacies. A pharmacist wrote to me:

“Pharmacies need to evolve and we have always engaged with the governments in the past to deliver the targets, and greater use of pharmacies must be made to reduce the hospital attendances in the AE”.

There are 36,000 patient visits to my local walk-in centre, which is a fraction of the number of visits to GPs. Yet A&E, the walk-in centre and GPs are all stretched. Local pharmacies are vital for access and as part of a model of healthcare delivery in the UK that relieves some of the current pressures and dispenses advice that puts prevention rather than cure at the heart of healthcare.

My local pharmacy in Baxenden is part of an innovative model of care: the healthy living pharmacy framework is a tiered commissioning framework, aimed at achieving consistent delivery of a broad range of high-quality services through community pharmacies to meet local health needs, improving the health and wellbeing of the local population, and helping to reduce health inequalities. What that means in plain English is that those pharmacies are the first point at which healthcare and health advice is delivered. That includes workforce and workplace development—developing a skilled team who can proactively support and promote behaviour change and improve health and wellbeing. Work done by the healthy living pharmacy initiative has shown that 70% of people who visit pharmacies do not regularly access other healthcare services. Those pharmacies are well placed to support the health and wellbeing of people in the community by, as has been mentioned, providing improved choice, and access to early interventions on such issues as optimal use of medicines, obesity, alcohol and smoking. That should improve outcomes in the short and long term, and have an impact on the cost of care in the future.

The Pharmaceutical Services Negotiating Committee evaluations of HLPs to date found that they

“demonstrate an increase in successful smoking quits, extensive delivery of alcohol brief interventions and advice, emergency contraception, targeted seasonal flu vaccinations, common ailments, NHS Health Checks, healthy diet, physical activity, healthy weight and pharmaceutical care services.”

The report also indicates that the HLP model is working in areas with different demography and geography. I cannot vouch for the PSNC evaluations, but I welcome the actions taken by my local pharmacy to be available to local people and offer better health advice.

Across Lancashire, pharmacists such as Linda Bracewell at Baxenden pharmacy are keen to see HLP rolled out across Lancashire. That requires support from the Government and the NHS. All pharmacies, including HLPs, are a vital part of the healthier Lancashire agenda. Yet today pharmacies are under threat from two directions. Those threats are the reductions in Government support—the 6.1% cut by the Department of Health in community pharmacy funding, which comes to a total reduction in funding of £170 million—and market forces. I want to move on to consider that other threat.

My right hon. Friend the Member for Rother Valley (Kevin Barron) mentioned changes in the market, such as the growth of warehouse pharmacies that seek profit—this is the Amazon model—at the expense of both the public service element and geographical access points. That is a cause for concern. Not everyone is online, or comfortable with such remote arrangements. There is no guarantee that such a method of providing pharmacy services has a role in a healthy living environment, or a better healthcare delivery system. Will it engage with hard-to-reach communities?

Over Christmas I was shown a letter by Linda Bracewell that was sent to a constituent by Pharmacy4U, a mail order pharmacist. Worryingly, it was passed off as an official letter. People would feel obliged to fill it in and send it off. It was personalised, and, crucially, it redirected customers with repeat prescriptions to Pharmacy4U. Worse, Pharmacy4U is just one of several emerging online mail order warehouse companies—box shifters. It was not clear that the letter was not official but a marketing ploy. It is a matter of great concern that the letter was part of a mass mailing, sent specifically to people with existing prescriptions. Their GP practice was named on the letter as though it came from that practice. That is a worry for pharmacies.

How did Pharmacy4U get access to patient practice details? Is it right that the letter I saw was allowed to look like an official document and a request for detail, when in fact it was simply permission to transfer existing prescriptions—a huge business for local pharmacies—to a warehouse pharmacy? Even more worrying was the fact that all the patients of GP practices with electronic data systems had been mailed, while patients of GP practices without such electronic patient systems had not been mailed. Does Pharmacy4U have business connections to the data company that provides GPs with electronic patient data systems, and the patients of those practices? The Minister should be aware that those issues are serious, and that such sharp business practices and models threaten existing pharmacies. The presence of warehouse pharmacies operating on an Amazon model is of concern to me and, I am sure, our constituents, because it erodes the public service element of the current pharmacy network—particularly the healthy living pharmacies.

In conclusion, does the Minister recognise the public service element of pharmacies? Does he want to preserve the current pharmacy network? Does he see pharmacies as having an increasing role in healthcare delivery? Does he think that there will be more or fewer pharmacies after his review is implemented?

[Roger Mullin (Kirkcaldy and Cowdenbeath) (SNP)]

It is a great pleasure to serve under your chairmanship, Mr Streeter. As this is a health debate, I hope you will not consider it inappropriate if I start by saying that my thoughts are very much with Pauline Cafferkey. Earlier today she was hospitalised in Glasgow for the third time after contracting the Ebola virus. She is being flown to London for treatment at the Royal Free hospital. I am sure that the whole House will join me in wishing her the very best.

The debate has been extraordinarily good, so I extend my thanks to the hon. Member for St Ives (Derek Thomas) for this timely initiative on his part. I had a standard speech prepared, but such has been the debate that I would like instead to reflect on the contributions we have heard so far. Some might be wondering why a Scot representing a Scottish constituency is here at all. At least some people present have emailed me to say, “Even though this debate is not about Scotland, we would very much appreciate hearing a Scottish voice.” What I bring to the debate is shared by everybody present: a concern to maintain community pharmacies because they are a vital part of all our communities.

When making his compelling case, the hon. Member for St Ives said that patients see pharmacists as the first port of call. They do indeed. My own wife, Barbara, has a condition known as post-polio syndrome, which means that she has to take a wide variety of medicines that often vary. It is essential for her that she is able to go along and talk to a pharmacist as her condition varies over time. If she always had to burden a GP when she needed such advice, that would put an unnecessary strain on local GP services.

[Rebecca Harris]

A lot of people who go to community pharmacies in my constituency such as Bharat Patel’s and Asif’s go there with problems that they would not wish to burden their GP with, but that are a burden to themselves, so it is a great relief for them to be able to talk things through with someone. Does the hon. Gentleman agree that sometimes people go to a pharmacist because they would be uncomfortable or embarrassed to go to their local, perhaps single-handed, GP? They might want to ask for alcohol advice or about something that they find embarrassing, or perhaps a young girl might want to ask for emergency contraceptive but not wish to see the receptionist, who is her mother’s friend whom she has known all her life.

[Roger Mullin]

I agree entirely with the hon. Lady’s point. Moving on a little, the right hon. Member for Rother Valley (Kevin Barron) described very clearly the long-term funding consequences of the Government’s proposals. As he indicated, they are planning to insert £8 billion more into the NHS while at the same time seeking to cut £170 million from pharmacies. The use of market forces to cull pharmacies does not really make any sense. The hon. Member for Bexhill and Battle (Huw Merriman) made a telling point that relates to the intervention that the hon. Member for Castle Point (Rebecca Harris) just made: he said that pharmacists can act as the eyes and ears of the vulnerable in our communities. That is the other side of the coin to the point she made about people who feel under stress or strain in their immediate circumstances very often seeing the pharmacist as their first port of call.

The hon. Member for Ealing North (Stephen Pound), in his typical style, with quiet presentation, pointed out that the proposals will affect every community, whether up in the highlands and islands or down in Ealing North. Indeed, he said that they will affect every community in terms of both the science and the magic that is involved. Everybody here is, I think, as one in our desire to develop pharmacies, yet, as he pointed out, the Treasury is seeking to put on the shackles for the sake of a £170 million saving. As I have previously spoken in Treasury debates, I made a note to point out that that saving would amount to less than half of what the Government could save if they simply closed the so-called Mayfair loophole. Pharmacists provide a service far beyond that supplied by many financial advisers in our society.

The hon. Member for Plymouth, Sutton and Devonport (Oliver Colvile) discussed the need to reduce clusters. When he was talking, I immediately thought of the hon. Member for Ealing North, who would no doubt advise him that perhaps we would do better by going back to some old-fashioned central planning to do things more coherently, rather than using market forces. If we use only market forces, the people who are going to be served least well are those in the large rural communities, whether in Wales or many parts of England. The hon. Member for Ceredigion (Mr Williams) made an excellent case about the importance of such far-flung rural communities and the critical services provided by community pharmacies.

Finally, I was very taken by one of the statistics cited by the hon. Member for Hyndburn (Graham Jones) early in his speech. I have to say I was not aware that 1.8 million people visit pharmacies each day, not merely for the dispensing of drugs but to see someone from whom they can get advice and in whom they can place their trust. Everybody who has contributed to the debate has pointed out that pharmacists supply a service to our communities that goes far beyond that provided by what we used to call in the old days the local chemist. They are highly qualified people who can provide a range of expertise. As the hon. Member for St Ives pointed out, many have masters degrees in specialist areas. In all honesty, in some areas of medicine they can provide advice that goes beyond the expertise of a GP. To lose that in any way, particularly in the most vulnerable communities, would be a sad loss indeed. I am very aware of wanting to leave some time for the hon. Gentleman to say a few words at the end, so I simply congratulate him again on an excellent debate.

Access To Medical Treatments (Innovation) Bill

Rebecca Harris Excerpts

Friday 29th January 2016 Commons Chamber

[Heidi Alexander (Lewisham East) (Lab)]

I congratulate the hon. Member for Daventry (Chris Heaton-Harris) on navigating the Bill to this stage. His pursuit of legislation in this area has sparked an important debate on the Floor of the House about how we can improve access to innovative treatments.

I welcome the opportunity to speak on this group of amendments, and I support the broad thrust of all of them. I commend the hon. Member for Bury St Edmunds (Jo Churchill) for her speech and the contribution that she has made—she spoke with great knowledge and passion.

I am particularly pleased that my hon. Friend the Member for Torfaen (Nick Thomas-Symonds) has tabled new clauses on the important issue of off-patent drugs and off-label uses, which he has championed. I was sorry to see his Bill fall on Second Reading in November and hope we can make more progress with the Government today.

Improving access to off-patent drugs so that people, no matter where they live or by whom they are being treated, are offered well-evidenced treatments that might not be routinely commissioned, is an ambition shared by many in the House, regardless of political persuasion. The Minister shares those objectives. Over the past few weeks and months, he has worked with key stakeholders and discussed the issue with them.

I express my support for new clause 1, which requires the Department of Health to produce an action plan for developing a pathway for off-patent, repurposed drugs, where strong evidence of their effectiveness in a new indication exists, with the aim of securing their routine use in such an indication. I hope the Minister can commit to such an action plan and put forward a clear timetable for progress, which is long overdue. I also hope he can offer the House reassurance on the proposals in new clauses 2 to 6, all of which have merit and deserve proper consideration by the Government.

[Rebecca Harris (Castle Point) (Con)]

rose—

[Mr Speaker]

Order. The hon. Lady had wished to contribute but toddled out of the Chamber at the appropriate moment. I would have called her but did not because she was not here. Does she still wish to speak?

[Rebecca Harris]

Very briefly, Mr Speaker.

I support the Bill and commend all those who have worked towards it in the many iterations it has been through in this House and the other place—I can see that Members of the other place are taking an interest in our proceedings today.

I am chairman of the all-party parliamentary group on brain tumours. Brain tumour research has desperately lagged behind other areas of cancer research, and we desperately need to find new sources of treatment. Sadly, brain tumour is still the biggest cancer killer of the under- 40s—children and young adults. The Bill could be a great step forward in the sharing of information.

I commend the Minister, as all hon. Members have. Without wishing to sound too toadying, we have a Minister who is committed to taking forward progress on research in a way that we have not seen previously.

It should be pointed out that the NHS is a superb innovative organisation that does huge amounts of research. We do not hear that said often enough of the NHS. From my point of view, the most important bit of the Bill is the database, which will mean we can take forward the research we do in the NHS so that people can have access to information—not just patients, but clinicians, who might not know as much as we or they would hope. I very much hope the Bill makes progress.

[The Parliamentary Under-Secretary of State for Life Sciences (George Freeman)]

It is a great pleasure to take part in the debate and to support a package of amendments that have been agreed by Members on a cross-party basis over the past few weeks and months. Very often in private Members’ business, the Government take the view that the intentions are fine but the mechanism is flawed, and that the Government legislate while MPs raise issues. However, with this Bill, we have struck a blow for joined-up thinking and cross-party working in pursuit of patients’ interests—I will say more about that on Third Reading.

With my hon. Friends the Members for Daventry (Chris Heaton-Harris) and for Bury St Edmunds (Jo Churchill), and the hon. Members for Torfaen (Nick Thomas-Symonds) and for Central Ayrshire (Dr Whitford), and with the help of Opposition Front Benchers, we have managed to deal with three Bills with which the House has been preoccupied in recent months—the Bill initiated by Lord Saatchi, which looked to change the culture of innovation; the Bill introduced by the hon. Member for Torfaen, which promoted the use of off-patent repurposed drugs; and this Bill, introduced by my hon. Friend the Member for Daventry, which seeks to promote access to innovative medicines. With the package of amendments we have agreed, we will end up with a Bill that moves forward on those three areas of concern for Members in all parties of the House. Today is a rare and rather wonderful moment because the amendments are supported by every party in the House—I cannot speak for the United Kingdom Independence party because I have not heard anything from it, but all other parties support the Bill.

We have three groups of amendments to get through so I will try to be brief in dealing with the specific points, many of which have previously been raised and discussed. I should take this opportunity to pay tribute to and thank my officials who, over the past three to six months, have tirelessly worked with Members on both sides of the House in an unusual way to help to draft amendments that we can all support. I thank them for their diligence in doing so.

Broadly, the intention of the package of amendments is to introduce off-label repurposed medicines in the Bill, and to put it four square at the heart of the agenda. As the hon. Member for Torfaen said, I wholeheartedly supported the intention of his Bill and its predecessor, but not the mechanism. We now have a mechanism that will work.

I appreciate that the new clauses are probing and that hon. Members are seeking my reassurance on how the Government will take things forward. New clause 1 is a request for an action plan. Nobody seriously thinks that we should put an action plan in the Bill, but let me set out my commitment and that of the Government to pursuing this agenda with time and rigour. As I have said in other places, the truth is that the world of drug discovery is changing profoundly. The transformational power of genomics and informatics create a wholly new opportunity both to discover new medicines and target them at individual patients much more quickly, and to discover repurposed uses of existing drugs in a way that we have not been able to do previously. The 100,000 Genome Project, which the Government have initiated and funded, has already begun to identify existing drugs that have uses in indications that were not hitherto known. The pace at which new drugs are being developed and discovered is increasing, which is a credit to the creativity of the sector.

That sets the backdrop for the creation of my post and the accelerated access review that I have launched. As all hon. Members know, I am committed to putting in place a landscape that accelerates the use of NHS resources to support research. When we launched the strategy, the Prime Minister said that every patient should be a research patient and that every hospital should be a research hospital. We are determined to ensure that the daily footprint of diagnosis and treatment is used more intelligently to support research.

The accelerated access review is looking at that in a lot of detail and is an extensive piece of work. Colleagues have referred to the interim report—the final recommendations are due to arrive on my desk at Easter. I am very happy to give a commitment that, in our response to that report, we will pick up the points made in the debate and in the Bill on ensuring that we look at repurposing and off-label uses of existing drugs as much as we look at innovative medicines.

In new clauses 2 and 3, hon. Members are probing me to give details on how the National Institute for Health Research and the National Institute for Health and Care Excellence can put into practice the mechanism that we have discussed. On new clause 2, there are very open mechanisms currently for applications to the NIHR to research existing medicines. The NIHR—I am delighted that we have reconfirmed our £1 billion a year funding for it—conducts research every year into existing medicines, and there is a clear process for that. It would not be appropriate to legislate in a Bill to tell organisations that are subject to the Haldane principle, which is sacrosanct for the Government, what to do. We want research to be led by that principle, but I am happy—I will say more about this in a moment—to ensure that, through the process, we explore mechanisms for ensuring the NICE can look at evidence and develop evidence-based guidance on off-label medicines, so that doctors are aware of which drugs are being used in an off-label indication.

On new clause 3, I am delighted to confirm that, after discussions, NICE is now looking at ways to collect evidence on repurposed medicines. It is looking at taking evidence and how it could use, through its existing evidence review process, evidence on repurposed medicines specifically. I have asked whether we might be able to put a mechanism in place to find a way to somehow put that into the “British National Formulary”. I would not want to put that mechanism into the Bill, because we need the freedom to evolve the mechanism and to get it right. I hope that is a helpful reassurance.

New Cancer Strategy

Rebecca Harris Excerpts

Thursday 19th November 2015 Commons Chamber

[Rebecca Harris (Castle Point) (Con)]

I, too, begin by thanking the Backbench Business Committee for scheduling this very important debate and my hon. Friend the Member for Basildon and Billericay (Mr Baron) for his endeavours. A great deal has happened since we last had the chance to debate cancer, and I am pleased to be able to discuss the Independent Cancer Taskforce’s report on a cancer strategy for England, which is a major step in the right direction for all those affected by cancer.

As chair of the all-party group on brain tumours, I particularly welcome the focus of the report on early diagnosis. A target for 95% of patients to be diagnosed within four weeks of being referred by a GP by 2020, which has recently been implemented by the Government, is absolutely crucial for improving cancer outcomes for patients, especially those with brain tumours. Currently, 58% of brain tumours are diagnosed in accident and emergency, which unfortunately is far too late for many. That has contributed to brain tumours being the biggest cancer killer of children and adults under 40. Patients diagnosed with brain tumours have a five-year survival rate of just 19.8% compared with cancer as a whole, where 50% of patients can expect to survive for at least 10 years. Cancer survival rates doubled between 1970 and 2010, while, shockingly, brain tumour survival rates increased by a mere 7.5%.

The current poor level of early diagnosis and a general lack of awareness of brain tumours contribute to the stories of far too many people. The Green family from my constituency had a son, Danny, who was a normal, happy, energetic 10-year-old who suddenly suffered a dizzy spell after playing football one afternoon. It was eventually confirmed by his local hospital that he was suffering from a brain tumour. Tragically, despite having an operation to remove the tumour, chemotherapy and radiotherapy, Danny lost his fight for survival in July 2012. He died from pneumonia.

Although the Greens believed that something was really seriously wrong with their child, they found that when they initially took him to hospital, doctors dismissed his symptoms as nothing more than a migraine. It was only when his condition deteriorated and he collapsed in A&E that he was sent for a CAT scan and an MRI scan. Brain tumours are relatively rare, but as Danny’s mother, Lisa, says:

“They are not rare enough when it’s your relative.”

That is why the family would like to see patients with possible brain tumours sent for MRI scans much sooner than they currently are.

I very much welcome the new cancer strategy, but I have a number of concerns, including the lack of a clear, ambitious commitment to improve research. That lack of commitment impacts on the cures and treatments of the future for cancers with low survival rates, such as brain tumours. Those cancers of “unmet need” will not see the boost in survival rates that the more common cancers will, because early diagnosis and prevention alone do not affect the effectiveness of treatment to a significant extent. For example, there are no lifestyle factors that are proven to increase the likelihood of getting a brain tumour, which means that a focus on prevention will do nothing to stop the incidence of the disease, which, for whatever reason, is rising. There should be a stated priority to increase research and to find new curative and palliative treatments for rarer cancers.

The two excellent charities that I work with as part of the all-party group, Brain Tumour Research and the Brain Tumour Charity, have issued their own response to the new strategy. They, along with the two charities in my constituency, the Danny Green Fund and the Indee Rose Trust—the Indee Rose Trust is also tragically named after a little girl who lost her life at the age of three, five months after being diagnosed with a brain tumour—do exceptional work in raising awareness of brain tumours and of the importance of early diagnosis. They also increase the amount of funding for research and improving treatments.

For the strategy to be effective for people with brain tumours and to allay the concerns that I have raised, we need to focus on a few particular areas. First, we need to streamline the process of repurposing drugs. The repurposing of drugs and compounds to tackle brain tumours could open up new treatment options for patients. Repurposing refers to a process whereby a drug or a compound that has previously been used to tackle a certain illness—for example, depression—is examined and studied to see whether it can be used to tackle another illness, such as brain tumours. There is solid evidence that treatments can be developed through repurposing that are safe and effective, and that add years to the lives of patients with terminal cancers. The Government can help to streamline that process by reducing the regulation and red tape on scientists along with incentivising pharmaceutical companies to release compounds for research. The research and trials that will be sparked could result in huge strides being made in the field and in ground-breaking treatments for patients.

Secondly, we need a national register of all site-specific research to track all research work, grants and results. Currently, there is not a great deal of transparency in the research field. There is no clear idea of what research is being funded and what results are being achieved. That leads to confusion, duplication of work and a system that prioritises research in more common cancers rather that in diseases such as brain tumours. A national register will make research more transparent, reduce duplication and allow greater variation in the type and scope of research.

Thirdly, we need an innovation fund for research into rare and rarer cancers. Grant applications to existing research funding bodies require evidence of previous research—pilot work as well as published results. That results in something of a catch-22 situation. Applications must be deemed low risk in nature and as having a high likelihood of success before a grant is awarded. That means that there has to be a pre-existing bank of evidence. Novel research, particularly relating to brain tumours, suffers as a consequence of a lack of existing research. This ring-fenced fund should be set aside for areas of new research on rarer cancers and diseases. There should be a lower threshold for grants to be awarded in new projects, or in existing schemes such as the 100,000 genomes project. This stimulus will create a new wave of research that previously would not have been possible, widening our knowledge of cancer and creating the treatments we need.

Finally, we would like the Government to devote an absolute amount to brain tumour research. Brain tumours represent 1% of cancers diagnosed, yet 3% of cancer death. Within the innovation fund a consistent or growing absolute figure should be devoted by the Government to brain cancer research. Some 16,000 people are diagnosed with a brain tumour every year, and those affected are disproportionately children and young adults, who may have young children themselves. I hope that the Minister will commit to implementing and funding the new cancer strategy so that those 16,000 people, and indeed the tens of thousands more diagnosed with other forms of cancer, get access as quickly as possible to the treatment and the funding for research that they need to give them the best chance of survival.

Improving Cancer Outcomes

Rebecca Harris Excerpts

Thursday 5th February 2015 Commons Chamber

[Mr Baron]

Obviously, I cannot comment on the specific case, but I repeat that putting the one-year figures up in lights will put pressure—the best kind of pressure—on CCGs to look at all the initiatives at their command.

I do not think that the Department of Health or NHS England should be too prescriptive about this. We have CCG managements earning six-figure salaries who should, frankly, be able to make these sorts of decisions by introducing initiatives that best suit their populations. Where there is, say, a black and minority ethnic population, an elderly population, or a mining community population, initiatives have to be skewed accordingly, and that is what CCG managements should be doing. We have to leave an element of local initiative. One cannot just sign a cheque to the NHS for £120 billion and not expect accountability. By putting CCGs’ one-year figures up in lights, we can, over a period of time—there is no quick fix—monitor how they are doing. In the case that the hon. Lady mentioned, I would hope that the CCG would have a look at local initiatives that could perhaps change the situation for the better.

[Rebecca Harris (Castle Point) (Con)]

I, too, welcome the one-year survival rates being put up in lights. Does my hon. Friend agree that there may be a risk of missing rarer cancers such as brain tumours in a drive to catch what might be seen as the low-hanging fruit through screening processes?

[Mr Baron]

That is a very good point, and I will touch on it briefly later; I know that my hon. Friend will do so as well. I agree that there is a danger of that. We need to raise our one-year figures significantly—not by just a few percentage points; if we want to be among the best in Europe, then it has to be by 10 percentage points—and that means that we cannot exclude a lot of the rarer cancers, because there is only so much low-hanging fruit. I hope that this sends out a general message that there must be initiatives across the whole spectrum of all 200 cancers. The rarer cancers are the poor cousin at the moment, and we need to address that specifically. I look forward to hearing what my hon. Friend says later.

Let me explain why it was important to get the one-year figures into the delivery dashboard. We were told that it was all very well to get them into the outcomes indicator set, but they also needed to get into the top tier of NHS accountability—namely, the delivery dashboard. Chief executives of CCGs have told us that they felt they were monitored on that delivery dashboard, or—shall I put it this way—that that was their first port of call.

It is great to be able to inform the House that cancer is now the only disease-specific outcome indicator on the delivery dashboard. I say “great” in the sense that I am delighted that cancer is included, although I wish the delivery dashboard had more outcome indicators, not just process indicators. Processes are fine, but they do not necessarily lead to better outcomes. In my view, if we are serious about improving outcomes, the more outcome indicators we can get on to the delivery dashboard across a range of diseases, the better.

Getting the one-year figures on to the delivery dashboard will be transformational only if we use the tools in the toolbox and ensure that CCGs are held to account effectively. That means not only addressing poor performance, but encouraging those with the highest survival rates in the UK to continue to strive for improvement. There is no point having such figures if we do not use them. Will the Minister clarify how CCGs are being made aware of the upcoming changes to accountability? More importantly, what measures will NHS England take to address underperformance in one-year cancer survival rates by CCGs?

On survival rates, I want to touch on another issue that the all-party group has campaigned on—inequalities. Our recent report, “Cancer across the Domains: A vision for 2020”, particularly highlighted the poorer outcomes for older people. We are not the only ones to have drawn attention to the issue. A recent report from the National Cancer Intelligence Network noted that

“over half of all cancer deaths occur in people aged 75 and over”.

A National Audit Office report on cancer services, published last month, found that

“cancer patients aged 55-64 are 20% more likely to survive for at least 1 year after diagnosis than those aged 75-99.”

Such variation is completely unacceptable. Evidence suggests that the under-treatment of older people happens because some clinicians base their prescriptions on chronological age, not necessarily on their fitness to receive treatment. There is general recognition that older people suffer worse outcomes. The NAO report accepted that

“survival rates for older people are expected to be lower”,

but stated that

“this is unlikely to explain fully the significant variation between age groups.”

I suggest that we need to look at that issue. The all-party group on cancer welcomes the increased focus on it. However, we must ensure that such focus results in action and, as with early diagnosis, that the right accountability levers are in place to deliver real change.

Our recent report highlights our concerns about the fact that all the cancer mortality indicators in the NHS outcomes framework are for under-75s. It is almost as though the NHS has made a decision that the lives of those over 75 are worth just a little bit less than those under 75. That impression has been created in certain quarters, and we need to address that perception. We believe that it sends the wrong message about the importance of older people with cancer. Will the Minister outline what steps the Department is taking to tackle the inequalities faced by older people with cancer?

To move on to patient experience, we tend to think of outcomes simply as survival rates, but it is essential for the NHS to deliver good outcomes for patients at every stage of the cancer pathway. Members will be aware that tomorrow marks two years since the report of the Francis inquiry into the Mid Staffordshire scandal. It therefore feels like an appropriate moment to highlight the importance of the patient experience not as an add-on or a facility that is nice to have, but as an integral part of how we deliver cancer care.

The cancer patient experience survey has given us valuable insight into the experience of cancer patients in the UK. The findings continue to reveal widespread variation in the experience of care that people receive. For example, people with rarer cancers, which were mentioned by my hon. Friend the Member for Castle Point (Rebecca Harris), continue to report poorer experiences than those with more common cancers. The same is true of people with long-term conditions, younger patients, older patients, some ethnic minority patients and patients treated in London hospitals. That widespread variation is unacceptable.

Such an insight is worth very little if we do not ensure that it is used to drive real change. I suggest to the Minister that the mechanisms for doing so simply do not exist at the moment, or if they do, they are disparate and unco-ordinated. The all-party group has real concerns. We know that some trusts develop action plans based on CPES results, but there is no requirement for them to do so. NHS England does not require trusts to report on results. CCGs and NHS England do not seem actively to measure NHS trusts’ progress against their action plans to improve their scores. All that leads to a gap in accountability on the cancer patient experience. There are still concerns about the accessibility of the data from trusts and other local bodies for patients. For example, trust-level reports do not seem to be available on official NHS websites.

The all-party group was pleased that the Minister, in her response to “Cancer across the Domains”, confirmed there were no plans to discontinue the CPES. However, we were concerned to hear that, due to procurement issues, the CPES may not report in 2015. Will she provide an update on whether it will report results in 2015? Perhaps more importantly, will she clarify how NHS England will ensure that the CPES is used to drive improvements in the cancer patient experience, and to hold trusts and CCGs to account?

--- Later in debate ---

[Rebecca Harris (Castle Point) (Con)]

As one of the co-sponsors of the debate and as chair of the all-party group on brain tumours, I thank the Backbench Business Committee for scheduling the debate and the Minister for her presence in the Chamber. This is a timely debate: yesterday was world cancer day. It is also timely for me for another reason, which I will come on to later. I think we all agree on the importance of raising awareness of early diagnosis and I will come on to talk about that, but world cancer day has done an enormous amount of work with the many cancer charities to raise awareness of the risk of cancer. We are much more likely to spot the initial signs of the disease, but I think the consensus is that there is still a way to go.

I would first like to share the story of the Green family in my constituency. Their son Danny, who was a happy, sporty, energetic 10-year-old, suffered a dizzy spell after playing football. After a few days of being unwell his parents, Chris and Lisa, were very concerned about this health and took him to hospital. They were turned away and told that he had a migraine. After trying hard to persuade doctors that this was not how their son was normally and that it was not just a migraine, the family took him back to hospital and asked for a scan, only to be told that a scan could take months to schedule. Only when he collapsed in hospital, was he rushed to have a CAT and MRI scan.

Danny was taken straight to Great Ormond Street hospital, where he received incredibly good care. His brain tumour was removed and he stayed in hospital for many months fighting a little-known unfortunate side effect of brain tumour surgery—something called posterior fossa syndrome—that left him badly disabled and unable to speak. Unfortunately, the cancer came back. After a heavy course of chemotherapy it started to shrink again, but tragically, Danny lost his life after contracting pneumonia and another virus in Great Ormond Street in July 2012.

Like many people, the Greens had taken someone to hospital with balance problems and headaches that were dismissed as a migraine. Far too many people finally get treatment only after having had the symptoms for a long time. Mercifully, brain tumours are rare, but that is the problem, because rare cancers are not sufficiently picked up. The Greens would like to see patients displaying possible symptoms of brain tumours given scans much earlier, and greater awareness of the possibility of brain tumours among clinicians.

From this unbearable tragedy, however, sprang a determination by Chris and Lisa Green and Danny’s sister, Holly, to support families going through a similar ordeal and to tackle the lack of awareness about brain tumours. For that reason, they set up a charity, the Danny Green Fund, of which I am glad to be a patron. It has gone from strength to strength in supporting families of those suffering from brain tumours, and in particular the debilitating condition of posterior fossa syndrome. It has raised an enormous amount of money for research—in the past two years alone, this tiny charity on Canvey Island has raised more than £160,000.

Although awareness of more mainstream cancers, such as breast and prostate cancer, has dramatically increased over recent years, and with it funding for research into cures and treatment to improve patient outcomes, it appears that the same level of awareness of, and funding for, brain tumours is not forthcoming. In fact, brain tumours receive just 1% of the entire national spend on cancer research. I find that shocking, considering that brain tumours are the biggest cancer killer of children and adults under 40. Outcomes remain relatively poor, with patients diagnosed with brain tumours having a five-year survival rate of just 18.8%, compared with cancer as a whole, where 50% of patients can expect to survive for at least 10 years.

Between 1970 and 2010, while cancer survival rates doubled, brain tumour survival rates increased by a mere 7.7%. Rare or not, how can we improve these outcomes for the 16,000 people diagnosed every year with a brain tumour? With more than 120 different types, brain tumours are notoriously difficult to diagnose, and our understanding of other cancers does not readily translate to them. I therefore appreciate that improving outcomes will not be easy, but that does not mean that brain tumours should remain an overlooked cancer.

Having worked with two excellent cancer charities, Brain Tumour Research and the Brain Tumour Charity, along with two charities in my constituency, the Danny Green Fund and the Indee Rose Trust, I know that the charities are doing an exceptional job in raising awareness about brain tumours and increasing the funding and research to improve treatments. However, I believe I speak for all these charities and those affected by brain tumours in saying that we need to focus on at least four key issues if we are to improve outcomes.

The first and most obvious area is funding. Brain Tumour Research estimates that to bring research and treatment of brain tumours into line with other cancers and improve patient outcomes, research funding would need to increase to £35 million a year for a decade. We urgently need earlier diagnosis. About 58% of brain cancers are diagnosed in A and E, which is considerably higher than the figure for cancer overall. We need a far better understanding among GPs of symptoms, and better pathways to secure early treatment. Early diagnosis is essential for starting early treatment. As the cancer proceeds, the brain tumours grow, becoming far harder to treat and manage, and for brain tumours, even benign tumour growth, this is potentially fatal.

New NICE guidelines need to improve the early diagnosis of brain tumours so that more patients are diagnosed by a GP and receive early treatment. We also need a national register of all site-specific cancer research to track the research work, the grants and their results. That is vital, as currently there is not a great deal of transparency in the research field and no clear idea of what research is being funded and results achieved. This leads to confusion, duplication of work and a system that prioritises research into more common cancers, rather than those disease areas of most need, such as brain tumours. A national register would make research more transparent, reduce duplication and allow greater variation in type and scope of research.

Finally, we need better and easier access to available treatments. Research into new treatments and early diagnosis is essential to beating brain cancer, but more can be done with existing treatments through the NHS. One such example that has been in the news in the last year is proton beam therapy. It is similar to traditional radiotherapy, destroying cancerous cells with beams of high-energy radiation, but it is far better suited to the brain as it only affects the cancerous cells. More widespread centres using this technology could be set up and the therapy given to as many brain tumour patients as possible.

I hope that some of the issues that I and others will cover in the debate will raise awareness of how outcomes could improve for all cancer patients, particularly brain tumour patients, and put the spotlight on just how deadly brain cancer is in comparison with other cancers.

[Mr Baron]

Before my hon. Friend moves too far from the subject of proton beam therapy—something I would have raised had time allowed it—may I suggest that she is absolutely right to raise it? A new generation of technology is coming out of CERN and going to British companies, and we must do our best to at least explore the feasibility of embracing that within the NHS. Not only is it cheaper and better technology, it is smaller, which means that we could have more sites around the country. I know the Minister is aware of this, as we have raised it before, but I hope that it will be addressed in the debate.

[Rebecca Harris]

This sort of therapy gives great hope to many sufferers of brain tumours in particular.

The debate is timely for another reason; tomorrow is Danny’s birthday. He should have turned 14, and his family, in his memory, have funded a further day of research with the money they have raised. Mercifully, brain tumours are very rare but, as Lisa Green—Danny’s mum—pointed out, “They are not rare enough when it is your child.” I very much hope that the spotlight can be put on the urgency of improving care.

Dementia Services (Gloucestershire)

Rebecca Harris Excerpts

Tuesday 22nd January 2013 Westminster Hall

[Richard Graham]

I am grateful to the hon. Gentleman for that intervention. I know his constituency well, and I am sure that there are points on which we could exchange information. My hon. Friend the Minister will have heard and noted his comment: it is probably a subject for a separate debate, and we may come back to that issue another day.

Secondly, I want to talk about diagnosis. Currently, less than half of people with dementia in England are formally diagnosed with the disease, even as dementia affects more of us. Gloucestershire is the county with the highest number of people with dementia in the south-west, and it has one of the highest diagnosis rates in the region. However, although the number of people diagnosed with dementia in Gloucestershire rose by 12% last year, to 4,037, another 4,800 people in the county are thought to have the condition but have not yet been diagnosed. Consequently, although the diagnosis rate of our primary care trust is good regionally, at 46%, one can see that we have a long way to go in absolute terms, especially if the county council is right that our population of people over the age of 75 will increase by 30% by 2022.

Where is the best practice currently in the country? Could my hon. Friend the Minister tell us from whom we can learn best how to drive up diagnosis rates within tight budgets? As the Alzheimer’s Society says, low-ish diagnosis rates prevent sufferers from accessing support and medical treatments that can help them to live better with the condition.

The third area is care. In the main debate in the House a fortnight ago, other Members spoke about the link between dementia and care, and about the growing need for a “fair” solution to the problem of caring for an ageing population. Again, it falls to our generation to resolve this situation. Across the country, the number of people over the age of 65 is set to double during the next 20 years, and in counties such as mine the rate of growth will be worse, and faster.

I know that, in the wake of the Dilnot commission’s proposals, the Government will make formal proposals shortly about how they believe this issue can be settled. I wonder if my hon. Friend the Minister can say anything today about whether dementia will have a part in that process, and whether it will perhaps encourage the speed of implementation of the plans that the Government are considering.

At the same time, will my hon. Friend the Minister join me in congratulating Gloucestershire county council for entirely ring-fencing its budget on adult social care during these difficult years of local government spending freezes? In the last debate in the House on dementia, we heard from several Members whose authorities were not doing that, and it would be interesting to know how many other authorities are doing the right thing for the most vulnerable—a group that definitely includes dementia sufferers—as Gloucestershire has been doing.

I have promised to mention two local initiatives on dementia, as I believe they show that Gloucestershire may be leading the way. First, I pay tribute to the development in Gloucestershire of the community dementia nurse, or CDN, service, which was launched in December 2011 by the 2gether NHS Foundation Trust. The CDN service provides specialist and direct dementia support to GPs, with each surgery in the county being allocated such a nurse.

Secondly, we are fortunate to have a local charitable foundation, the Barnwood Trust, and it is working closely with the Gloucestershire clinical commissioning group, which has won £500,000 from the NHS dementia challenge to create dementia-friendly communities. That means having community workers who are trained as dementia link workers—people who are connecting to local communities.

[Rebecca Harris (Castle Point) (Con)]

On that point, does my hon. Friend agree that it is quite often the local voluntary community groups such as the Mickey Payne Memorial Foundation, which was set up by my constituent Caroline Dearson, that are leading the way in spreading best practice, support networks and awareness within their communities?

[Richard Graham]

My hon. Friend is absolutely right. Community groups, such as the one in her constituency that she has mentioned and championed, are exactly the groups of people that are driving forward best practice at the local level. Of course, if they are able to win funds from the NHS dementia challenge then so much the better, because those funds would enable them to spread their good deeds further.

In Gloucestershire, we also benefit from local charities. The Guideposts Trust’s dementia web for Gloucestershire is a web-based support site that provides information for people with Alzheimer’s and other forms of dementia. We also have two very good-value day centres, one run by Age UK Gloucestershire and the other by Gloucester Charities Trust. They enable people to stay in their own homes for longer, while at the same time enabling them to meet friends and access general facilities, and enabling their carers or loved ones to leave them safely for a couple of hours while they go shopping.

Lastly, there is a very helpful purple butterfly recognition scheme for dementia sufferers that the Gloucestershire Hospitals NHS Foundation Trust has introduced in both its hospitals, Gloucestershire royal hospital and Cheltenham general hospital. Therefore my constituents are benefiting all round from an increasing range of services and ways of managing and dealing with dementia better.

However, that is not to say—as my hon. Friend the Minister will understand—that all is perfect, or that we are necessarily doing all the best things that can be done. The important thing is that the barriers are down. All of us can talk openly, in my county and across the country, about dementia. There is no stigma and no shame, just shared sadness and sometimes that surprising strength that I alluded to earlier.

I am sure there are other things being done elsewhere that I would like to know more about and that my constituents would benefit from. So I would be grateful today if my hon. Friend the Minister could do a favour to us all—I mean all parliamentarians—by giving some ideas of the best practice that he has noticed in different ways of handling the disease and managing the suffering that goes with it. Even if he cannot do so comprehensively today, perhaps he can do so later by letter.

Sometimes, too, our own cities and towns need to widen our eyes, stretch out beyond us and allow us to see ideas from further afield that we can bring back, and the Minister can help to steer us. What role, for example, is there for faith groups? Who is doing the best work across different ethnic minorities? Are there particular extra sensitivities, such as elderly immigrants reverting to the languages of their youth, of which we need to be more aware? What more can be done to support GP surgeries in diagnosing dementia? How can people be enabled to stay in their own homes for longer without that feeling of helplessness if something goes wrong?

Finally, like all good pitches must, this speech ends with an invitation for the Minister to visit Gloucestershire to see what is happening; to meet the Barnwood Trust and hear its ambitions and vision for what it might be able to do; and to share with us what he likes, what he has seen across the country and what we can perhaps do more of. I would be delighted if the Minister can accept my invitation, because dementia matters very much to all of us in Gloucestershire, as it does to him, and we want to continue being adventurous by pushing the boat out and actively considering new ways to help people living with this ghastly disease and their families, who are so intimately affected by all elements of it. As I said at the start, we never know what we can do until we have to do it, and we must do it.

--- Later in debate ---

[Norman Lamb]

I think that the hon. Gentleman said in his earlier intervention that the diagnosis rate is quite good in Northern Ireland. I applaud the work that is done there, but the support services might not be as good as in some parts of England, Wales and Scotland. We are learning about these things together, and there must be close collaboration between England, Northern Ireland, Wales and Scotland. Scotland has done good work to achieve high diagnosis rates. It has also introduced the concept of dementia advisers, which my hon. Friend the Member for Gloucester talked about in relation to his county. We need to be willing to learn from anywhere and, critically, not to reinvent the wheel, so I am absolutely up for collaboration with colleagues in Northern Ireland. Just a week ago, the Secretary of State announced a year of dementia awareness to improve understanding of the condition and diagnosis rates nationally.

Let me deal with research. My hon. Friend the Member for Gloucester said that the Government are doubling the amount we spend on research, although it must be said that that is coming from quite a low base, compared with other conditions. One of the difficulties is that we cannot just make a massive increase to the amount that we spend, because building the research community’s capacity to do the work has to happen hand in hand with any increase.

There were several things I was unable to cover in detail during the recent debate granted by Backbench Business Committee because we ran out of time—my hon. Friend was a victim of that. One of them was research, on which we have genuine cause for optimism. A lot of the media narrative has been about high-profile failures of research, but there is positive and encouraging news out there.

Before I give some examples of that, however, I should mention one thing. My hon. Friend talked about the importance of the scientific community and the Government collaborating closely to meet the challenge we face. Last autumn, I spoke at a conference that brought scientists from not just the UK, but around the world, together with the Government and interest groups, such as charities that campaign on this issue. Such a useful gathering is a way of bringing the best brains to bear on this subject, so that collaborative work must continue.

On 21 December, the Government made £22 million available to 21 pioneering research projects to boost dementia diagnosis rates and to trial groundbreaking treatments. The funding was designed to cover all areas of scientific activity that are relevant to dementia across the fields of care, cause and cure, including prevention. For example, we can do a lot to prevent the condition of vascular dementia from ever starting, so if prevention is possible, we must be much smarter. We have also provided £36 million for a new National Institute for Health Research dementia research collaboration to work on better treatments and care for, and understanding of, the condition, as well as £9.6 million to expand the UK Biobank. Last year there were potentially interesting developments in treating early-stage dementia, particularly in Alzheimer’s disease.

As drug companies continue to invest in research, there is now a real prospect of a treatment within the next decade—that seems to be the time frame we are dealing with—that could have an impact on helping to slow or prevent the disorder, if it is caught early enough. For instance, there have been key recent developments from Eli Lilly, which is conducting an additional phase 3 study of a new drug for patients with mild Alzheimer’s disease. I have also heard about promising plans to expand the testing of a drug for patients with pre-dementia.

My hon. Friend rightly emphasised the importance of sharing best practice, of avoiding reinventing the wheel and of encouraging innovation, which is vital for improving dementia care. I am delighted that Gloucestershire benefited from the additional funding of £10 million from NHS South West. It is by learning from the innovative projects that he describes that we will find out what works and how we can improve services.

My hon. Friend asked me to highlight examples of best practice of people taking the lead on dementia. One involves the fire and rescue service, which has made a pledge to take action to increase the safety of people with dementia. That is a critical area, because someone living with dementia can be at risk, and the fire and rescue service can do a lot to help them to remain safe. The service has made a commitment to raising awareness among staff. Already 28 services have signed up, and I applaud them for that work. In addition, Tesco has made a commitment to increase dementia awareness and understanding among its staff and worked with the Alzheimer’s Society to produce a DVD to achieve that. The moment when a customer gets confused about change or forgets their PIN is the one when a caring and understanding approach from the checkout operator who is coping with them is particularly important. It is encouraging that companies such as Tesco are prepared to do such work.

When my hon. Friend mentioned the demographics in his constituency, that rang true for me, because my constituency, similarly, is rural with an elderly population. I am pleased that the diagnosis rate in Gloucester has risen from 40% to more than 45% in the past year but, as in many places, there is still massive room for improvement to match the best performing areas, such as Islington, where the diagnosis rate is 75%. There is an enormous gap between the best and the worst, and a long way to go. We have developed an analytical tool to support the NHS to achieve an increase in local diagnosis rates, and we are working with the Royal College of Psychiatrists to assure and improve the quality of memory services when the actual diagnosis takes place.

I join my hon. Friend in paying tribute to some of the excellent work in his area, which is in many ways mirrored by that of the Norfolk and Suffolk Dementia Alliance, which is led by an inspiring guy called Willie Cruickshank. He demonstrates the difference that can be made by bringing all parts of the system together. In his area, there is now a comprehensive, multidisciplinary memory assessment service that provides support to primary care and outreach to communities. We must ensure that we bring down waiting times, which are far too long in some areas.

Community dementia nurses and advisers are working closely with GPs throughout the country. Last week, I met a group called Uniting Carers, which is part of Dementia UK, which talked about the fantastic work of Admiral nurses in many parts of the country.

[Rebecca Harris]

Sometimes the problem for carers arises when they reach the point at which they admit that they can no longer look after their loved one who has dementia, because it can be difficult to choose the right kind of care home or environment. The gap at such a point might need to be filled by the voluntary sector or Admiral nurses, as the Minister was describing, to help people to ensure that they are putting their loved one into a suitable and dementia-friendly environment.

[Norman Lamb]

I absolutely agree, and that is a role for an Admiral nurse or equivalent, or for dementia advisers, who are now in place in Gloucestershire, my own county of Norfolk, Suffolk and other parts of the country. It is of real value if someone is able to go into the home to provide practical advice to the carer and the person with dementia.

Fantastic work is ongoing to bring district councils, volunteers and community groups together to establish a network of memory cafés. The care home support team supports staff with training, development and management guidance. There is county-wide education for carers and a carer emergency respite scheme, which provides an agreed plan of personal support to the cared-for person.

My hon. Friend the Member for Gloucester raised the important issue of ethnic minorities and faith groups. At last week’s meeting, I met an Indian woman who spoke movingly about how she and her father were cast aside by their local community once he had received a diagnosis of dementia. It is critical that stigma is challenged in all communities. She also explained how her father had reverted to his mother tongue, which further complicated his care arrangements and made a difficult situation more difficult.

I want to consider how we can give specific help to people such as that woman. There is a role for everyone in society to improve the lives of people with dementia, which includes faith, community, and black and minority ethnic groups and charities. My hon. Friend is aware of the plan to sign up 1 million dementia friends by 2015, which will have dramatic effect on spreading awareness throughout the community. All such groups have a role to play in creating the dementia-friendly communities we want to see. Only through all of society—not just government—coming together will we improve the lives of people with dementia and their carers.

Regarding my hon. Friend’s kind invitation to visit, he may be interested to know that the Secretary of State and I are between us embarking on a road show to every region in the country, involving conferences and visits, to bring people together to drive change at a local level. I will certainly pass on my hon. Friend’s suggestions to the team that is planning the visits and the south-west regional event, and I will ensure that he is kept updated.

I am encouraged by the commitment shown in Gloucestershire, as in other parts of the country, to tackle the problems that we face. I was pleased to hear that Gloucestershire county council had ring-fenced funding for social care so that money is prioritised in that most critical of areas. We are expecting an announcement soon on funding for and reform of social care, and that will start to help people to cope with dementia and the costs incurred as a result of it. Although the challenge remains great, the collaborative effort demonstrated by the NHS and its partners in Gloucestershire, including businesses, community groups and volunteers throughout the county, is showing how concrete steps can be taken to improve dementia services and to enhance the day-to-day lives of people with dementia and, crucially, their carers.

EU Working Time Directive (NHS)

Rebecca Harris Excerpts

Thursday 26th April 2012 Westminster Hall

[Dr Poulter]

My hon. Friend makes a very good point and the issue that I was just raising—that of locums and out-of-hours care—ties in very well with it, because those checks and balances very much occur in the sector of locum work. To fill staff vacancies in GP rotas in primary care and in hospital rotas, doctors are often rushed in at short notice from locum firms, even though we have not necessarily got the proper checks that would be in place when doctors are working in hospitals.

As I have said, doctors from overseas make a huge and valuable contribution to the NHS, but they do so when they have been familiarised with the British medical system and they are embedded in our hospitals up and down the country. However, there is a real danger: when we have an over-reliance on locums, which is a direct consequence of the EWTD, the problems that my hon. Friend has highlighted occur, and that has damaging effects for patients.

The key issue for me in this debate is the continuity of care. The point has already been made in interventions that bad things happen to patients at weekends and out of hours, because there are fewer doctors, nurses and members of staff working in the hospital. If we have a system in place whereby doctors are clocking on and clocking off and they are encouraged to do so because hospitals are worried about the dangers of litigation and that encourages the handover of information to another professional because people think, “I’ve finished now; it’s not my job anymore,” that will encourage bad things to happen out of hours.

[Rebecca Harris (Castle Point) (Con)]

On that critical point, is my hon. Friend aware of the effect that that is having on patients and their relatives? They know that something is going on. People are saying, “How is it that highly qualified doctors did not recognise that my relative, who was chatty, friendly and bright eight hours ago, is now distant and uncommunicative?”—something as simple as that. Without years of medical training, they know something is going very wrong.

[Dr Poulter]

My hon. Friend makes a very good point. Continuity of care really matters in terms of what is good medical practice, good for relatives and good for patients. Traditionally, one team took responsibility for looking after a patient and providing holistic care to their family, particularly end-of-life care or when a patient took a turn for the worse. It is not acceptable for a doctor with no previous knowledge of that patient or their family to deal with sensitive circumstances. Indeed, it is very difficult to have any sense of good care when care is continually handed over, in a pass-the-parcel fashion, to the next person who picks up the baton after a shift is timed out—that is not good care. It is bad for patients, bad for families and particularly bad for distressing end-of-life care and the care of the elderly.

For all those reasons, we need to sort out the EU working time directive. It is bad for medicine. It is bad for doctors. It is bad for doctors’ training. It is bad for patients. I know the Minister is on our side and that the Government are working hard. I look forward to hearing the Minister’s comments, and I pay tribute again to my hon. Friend the Member for Bristol North West for securing the debate.