Government PPE Contracts

Simon Hoare Excerpts

Tuesday 6th December 2022 Commons Chamber

[Will Quince]

The hon. Member for Kingston upon Hull East (Karl Turner) will know that civil servants had to take decisions about speed, pace and quantity. They were looking at contracts that would get the most amount of PPE for the best value for money as quickly as possible.

[Simon Hoare (North Dorset) (Con)]

Was everything that was done, done perfectly? No, and no doubt all the lessons will be learned but, as the Minister says, we would all be well advised to remember, because it was a long time ago now, the absolute panic and fear. The whole world was trying to buy any of this stuff they could get hold of at any price. If we neglect to remember the doctors, nurses and care home operators in our constituencies who were knocking on our doors asking for emergency help, we cannot have a proper debate about this issue.

[Will Quince]

My hon. Friend is absolutely right. Under those circumstances, in those conditions, we had to be quick and decisive to protect colleagues on the frontline so that they could continue providing life-saving care. With lives on the line, of course we had to change our approach to procurement and adjust our appetite for risk. I do not believe the British people would have forgiven us if we had stuck to the same old processes. We had to balance the risk of contracts not performing and supplies being sold at a premium against the real risk of harm to the health of frontline workers, the NHS and the public if we failed.

Public Health

Simon Hoare Excerpts

Tuesday 14th December 2021 Commons Chamber

[Wes Streeting]

My hon. Friend is absolutely right.

We have heard the arguments in outline: this is about protecting staff and patients; it is not a new precedent; and there is a professional obligation, which makes it slightly different from the experience in the social care workforce. I will come on to talk about what the Government need to do. Those are broadly the arguments—

[Simon Hoare (North Dorset) (Con)]

Will the hon. Gentleman give way?

[Wes Streeting]

If the hon. Gentleman just lets me make this point, I will certainly give way.

Those are broadly the arguments, but I would ask Members on both sides of the House to think about those NHS staff who go to work every day feeling unsafe because their colleagues are not vaccinated. If that is not persuasive enough, I ask them to think about how they would feel if a loved one were treated in a clinical setting or care home by an unvaccinated member of staff through whom they contracted covid and, with it, serious illness or worse. If I lost a loved one through serious illness in those circumstances, I am not sure that I would be very forgiving about the decisions made by Members of this House.

--- Later in debate ---

[Wes Streeting]

I will say more about that in a just a moment, because the hon. Member for North Dorset (Simon Hoare), at the back, has been very patient.

[Simon Hoare]

I am grateful to the shadow Secretary of State for giving way. May I endorse and welcome what he said at the start of his speech with regard to comments about the Nazis? I called that out yesterday and he was right to do so at the Dispatch Box. I was looking through my inbox from the start of the pandemic and lockdown, and almost every person working in the care sector or the NHS in my constituency was saying, perfectly legitimately, “When the vaccine is available, we must be at the front of the queue, because we are dealing with the vulnerable and it is our duty to get vaccinated.” I do not think that has changed, and I think he is absolutely right, as is the Secretary of State, to say that those caring for the most vulnerable in society should, to try to reduce the risk that they face, be vaccinated.

[Wes Streeting]

I agree with the hon. Gentleman. We have a big effort to boost the booster this month and we have to boost the workforce as well, and make sure that people are supported.

Public Health

Simon Hoare Excerpts

Tuesday 30th November 2021 Commons Chamber

[Daisy Cooper]

Something appears to have been lost in translation here. I am not entirely sure whether the right hon. Member is referring to students or to the academics who teach them. I am talking about encouraging people to work from home where they can. There are of course examples where people will need to go into work, and they can change the ways in which they work, but working from home has been proven to reduce levels of transmission.

I am concerned that we are talking solely about the new variant, and that the mantra around putting in place restrictions to protect the NHS appears to have stopped. I worry that the Government appear to have lost their tongue. Ambulance services across the whole of England are at their highest alert level: level 4, or code black. That means that there are people in the back of ambulances who cannot get into hospitals. The NHS 111 line has had more than 1 million calls abandoned after 30 seconds this year, when they should be answered within 20 seconds. We have GPs who are reducing their hours or resigning because of the workload and the abuse. Some of them are really worried and saying that they will not to take on the contracts to deliver the booster jabs because of the expectation that they will still have to do the same amount of work seeing their patients and that if they are required to do the booster jabs as well, that will mean longer waits for other appointments. They are not getting the support they need in that regard, and I hope that the Minister will respond to this point. We have record backlogs—

[Simon Hoare (North Dorset) (Con)]

I very much agree with the hon. Lady’s comments, and I wish that she had amplified them more in regard to the ambulance service. I represent a large rural constituency, as many colleagues do, and if people are waiting for ambulances because people are queueing at the acute sector because others cannot be discharged, that is going to lead to huge problems during the winter months. Does she agree that that is something we should all keep at the forefront of our minds?

[Daisy Cooper]

I am incredibly grateful to the hon. Gentleman for raising that point. I have tried to raise that issue as often as I can through various means, and that is probably all I can say on the matter. Back in October, I tabled a written question to the Government to ask how many ambulance services were at level 4, and it took a couple of attempts at chasing that up before I got a response. I believe that hon. Members would benefit from having time to debate the issue in this House. In my own constituency of St Albans, there have been some incredibly tragic cases. A woman lost her baby because she was stuck in the back of an ambulance for many hours without being able to get into the local hospital. Another constituent lost their partner because they were stuck in the back of an ambulance for 12 hours and then died a week later because they had not been able to get that emergency treatment—

Autism and Neurodiversity Research Funding

Simon Hoare Excerpts

Tuesday 16th November 2021 Commons Chamber

[Robert Buckland]

I am grateful to my hon. Friend. In 2020, he and I visited his local prison in Winchester, a prison with many challenges and, there is no doubt about it, a share of the population with a brain condition, sometimes undiagnosed and often an acquired brain injury. Many people who are in for offences of violence have themselves been the subject of violence. Those issues are frankly endemic within the criminal justice system.

That is why, when I was Lord Chancellor, in last year’s sentencing White Paper, I announced a call for evidence on neurodiversity in the system. I was hugely grateful to Charlie Taylor, Her Majesty’s Chief Inspector of Prisons, and Justin Russell, Her Majesty’s Chief Inspector of Probation, for leading that independent call for evidence. Charlie Taylor was a public servant who came from the education sector, specifically the special needs sector, had real frontline knowledge and experience of autism and brain conditions and previously ran the Youth Justice Board for England and Wales.

The good news is that, thanks to the published results of the call for evidence, the Government committed—I am pleased to say I committed—to training for frontline staff and the upskilling of those staff right across the criminal and youth justice system, as part of a new custody and detention apprenticeship that is being offered and that will be completed by all prison officers. Her Majesty’s Prison and Probation Service is developing a revised policy framework and guidance all about those issues, but in particular about children in custody with those conditions. This work is carrying on. I will develop those points a little further. I know people are anxious to come in.

[Simon Hoare (North Dorset) (Con)]

rose—

[Sir Robert Neill (Bromley and Chislehurst) (Con)]

rose—

[Robert Buckland]

I will let my hon. Friend the Member for North Dorset (Simon Hoare) in first before my hon. Friend the Member for Bromley and Chislehurst (Sir Robert Neill).

[Simon Hoare]

I echo what our hon. Friend the Member for Winchester (Steve Brine) said in that it is a travesty that my right hon. and learned Friend is not speaking still from the Front Bench, but it is a delight to hear him speak this evening.

To go back to the point made by the hon. Member for Strangford (Jim Shannon), what is my right hon. and learned Friend’s assessment of the impact of covid on diagnosis, assessment, the provision of support and the crucial need to link up the Ministry of Justice, the Department of Health and Social Care, the Department for Education and the Department for Work and Pensions?

[Robert Buckland]

I am very grateful to my hon. Friend. There is no doubt that covid has had an impact on backlogs in all parts of the health system, including diagnosis. Having said that, there are significant advantages in the use of remote technology for people with autism and brain conditions. For them, very often the journey to a clinic, hospital or health centre is in itself traumatic and anxiety forming. I see remote technology as a real liberator for many people with autism, so the potential there is immense.

Sadly, the point my hon. Friend makes about the impact of covid is one that, without increased capacity and increased staffing, we will have to wrestle with for a number of years. On the point he makes about joined-up Government, I well remember saying on many occasions to anybody in Government who wished to listen that Justice could not do this on its own. As a downstream Department, it needed Education, Health, the DWP, the Ministry of Housing, Communities and Local Government and, frankly, all arms of Government to work together to identify some of these problems at the root to prevent them from becoming part of criminal justice, but I will speak more about that in a while.

--- Later in debate ---

[Robert Buckland]

I could not have put it better myself. Levelling up is about people and communities, not things. Things are important and they deliver us levelling up, but levelling up is about people. That is why the Government have to show seriousness of purpose. I am with the Government on these things—I helped to author a lot of the documents on which they will be held to account. This matters, but if we do not focus on people, we are not going to level up. That is the point that my hon. Friend made so well.

I commend the Autistica report to hon. Members, but if I may crave the indulgence of the House for a little longer, I want to outline what Autistica suggests the key stages of support should be that will make a real difference. First, the report made the important point that support for autistic families around and shortly after the time that they receive a diagnosis has to be improved, because it is big news for families. It is a big moment when they get that diagnosis. I remember now the mixture between relief that the system is listening and deep sadness, grief and anger, and all the emotions that someone goes through as a result. These are big moments for families. It sounds axiomatic, but this does not happen, because we do not empower all families of people with autism to understand the diagnosis and to come to terms with what it means for them. This is a moment when services have an opportunity to get to know these families better and to ensure that their personal profile, which should be done, is really understood.

[Simon Hoare]

Does my right hon. and learned Friend share my concern that, very often, as with so many of these things, the children of the—let me use this phrase—“sharp-elbowed middle classes” seem to get a disproportionate amount of attention, care and support and those who are often least comfortable with officialdom and challenging professionals and asking questions usually get the smaller section of the pie? Quite a lot of work needs to be done on that to ensure that we have that uniformity of levelling up.

[Robert Buckland]

Again, that is a really important point. I do not make any criticism of the sharp-elbowed middle classes; these people are doing what they think is right for their children. I have been there and I make no apology for it, but among all those dedicated, wonderful, loving parents and carers, there are many families who do not have that wherewithal, and they often come to our surgeries and offices for help. We are the last port of call and, very often, we can make a difference. Looking back on the plethora of cases that I have dealt with, I am probably most proud—I know that hon. Members will share this feeling—of bumping into families years later and being told, “You helped our son. He has just finished his education and is going to go off and pursue a skill. If you hadn’t intervened six years ago, I don’t know where we’d be.” That is wonderful, but it should not be necessary: that is the big message that I want to convey today.

Rather than just stand here and make a general cri de coeur, my aim is to look at the bigger picture. Individual cases such as the one that the hon. Member for Croydon Central mentioned are symptoms of the problem, but it is all about dealing with the challenge itself. Documents such as the Autistica plan really help to tie the threads together and give us a blueprint that the Government, working with the private and charitable sectors, can run with.

I mentioned support around diagnosis. The document has some very interesting proposals for pilots and initiatives relating to how we can improve what is referred to as the diagnostic pathway. At the moment, there is a lot of ambiguity about precisely what is offered and what works, but the time of diagnosis is not a time for ambiguity. It is no good making educated guesses at that point; we want to know with certainty what pathways work. Families embarking on this new journey need that certainty, so I strongly commend to the Minister the document’s recommendations, particularly in relation to the work of the National Institute for Health Research.

As stage one, we need a framework that can be applied nationally, rather than relying on purely local initiative. Stage two, as the document describes it, is preparing for the future: after diagnosis, what systems do we have to match the needs of people with autism and brain conditions with the right therapies and services? We need to make those connections better; we need to connect people to safe practical advice, particularly from people who have been through the system. Peer-to-peer support works in so many contexts, and particularly in this one.

What we and Autistica are asking for is not a finger in the air, but evidence-led systems. It is no good just saying that the needs of autistic people are diverse. They are diverse, believe me: when you have met one person with autism, you have met one person with autism. They are all wonderfully unique, in my experience, but that should not be an excuse to say, “We’ll let a million flowers bloom and see complete diversity.” We need less of an unguided mêlée and much more of a framework—a mechanism by which, with evidence, we can ensure better support for people as they prepare for life and work out the pathway.

Finally, the third element of the report is meeting in a realistic and feasible way—we are not trying to create something totally out of this world—the evolving, ever-changing needs of people with autism. That is particularly important at the transitions, be they from primary to secondary, from secondary to tertiary, or from tertiary out of education. Age 25 is a big time for people who have an education and healthcare plan, because it is the moment when it stops—and what’s next? All such transitions can feed anxieties that if left unchecked can develop into a co-morbid mental health problem, with the concomitant waste that I spoke about at the beginning of my speech.

The truth is that the needs of people with autism and their families fluctuate and change. Instead of inviting crisis, let us plan for it and avert it. The support that the report envisages is all about services that will be there if things start to get a bit heavy, but that can be light-touch in other circumstances. The suggestions about nurturing expertise in the NHS and social care with hubs of expertise to deliver specialised services seem the most sensible way of developing those service models.

This is going to take investment, but, as I have said, I do not believe that it should begin and end with Government, which, hopefully, is good news for my hon. Friend the Minister. If she has had a chance to see the report that I mentioned—it was published only today, but I know that her officials will be familiar with it, because Autistica works very well with the Department, and I commend those officials for working with it so constructively—she will know that it sets out a costed programme, in which Autistica itself declares it will invest, or partner, to the tune of nearly £16 million. That is money from the third sector, but we ask the Government to step up, because the total cost of the projects that Autistica envisages in its list is just over £65 million. All those projects are designed to improve the evidence base and hence to improve the way in which we can deal with each of those three stages, and I warmly commend them to my hon. Friend.

What, finally, is the context in which we should work? I have talked—at the risk of stating the bleeding obvious—about the need for Government Departments to come together: the Department for Work and Pensions on employment, the Department for Education on exclusions, the Minister’s own Department on diagnostics and care, and my former Department on criminal justice. As I have said, however, this will require an effort from all sections of society, and the private sector must step up as well.

It is in businesses’ interest to get this right, if they are to unleash the talent of autistic people not just because it is good, but because it is damn sensible. It is to that sort of enlightened self-interest in the wider community that I want, through the House, to appeal tonight. I think that the offer of finance from Autistica is significant, although I want to see it scaled up. I think that the work we need to do outside this place to harness philanthropy and the support of the private sector could start to bring us much closer to the levels of research investment that we see in, for example, the United States, which, although it does not enjoy the wonderful national health service that we have in our country, is very far ahead of what we are doing here in terms of research investment.

If we are to succeed, that partnership between the third sector, the private sector and the public sector will be essential. The quid pro quo for Government is that our wonderful officials must remember that they do not have a monopoly on wisdom. I have sat in the Minister’s seat and worked with officials and worked well with them, but sometimes there is an institutional reluctance to go outside the tent because of fears about control, whatever form it may take, and, inevitably, about accountability. We must overcome that, because Government alone will not be able to crack this.

The last two years have, in many ways, opened our eyes to the potential that Government can offer. Government-led support and declarations of Government funding meant that we were able to create a vaccine manufacturing capacity virtually from scratch. I am about to see 250 jobs come to Swindon—jobs that would not have existed a few years ago, without the terrible crisis that we have all had to live through. The Government rose to the challenge, and I was proud to see them do so, underwriting, in effect, many of these initiatives.

We heard words such as “moonshot”, did we not? We heard about the Government’s big ambition to deal with the threat posed by the pandemic, and rightly so. Let us remember that. Let us bottle it and use it here. Let us have our autism moonshot; let us have our neurodiversity moonshot. Let use the power of Government—its convening power—to kick-start this research, and to lead our society in the improvement of research. Through the gathering of that evidence and Autistica’s work, we can reach some of Autistica’s 2030 goals. Its realisable ambitions for 2030 include: halving the employment gap for people with autism; services truly centred around the person with autism; proven support from day one; public spaces being more accessible for neurodivergent people; tailored health checks for people with neurodivergence; and, yes, screening at an early age, whether in the health system or the education system. That is a wider application of the principle that I wanted to see in our criminal justice system.

This could be a decade of achievement. It is up to all of us and the Government to make it happen.

Coronavirus Act 2020 (Review of Temporary Provisions) (No. 3)

Simon Hoare Excerpts

Tuesday 19th October 2021 Commons Chamber

[The Parliamentary Under-Secretary of State for Health and Social Care (Maggie Throup)]

It is a pleasure to be closing this debate, and I thank hon. Members from all across the House for their contributions today. It is clear from the speeches we have heard—and, indeed, from the fact that the House can meet at full capacity once again—that we have made so much progress in our fight against covid-19. This is thanks to the perseverance and resolve of the British people, and also to our vaccination programme, which has now given first doses to over 85.9% of the population of the UK over the age of 12. It is this life-saving work that has disrupted the once inevitable link between cases, hospitalisations and deaths, and that has allowed us to start carefully reopening our society and our economy once again.

This battle forced us to take unprecedented steps in pursuit of a lethal virus, and the Coronavirus Act has been a vital weapon in our armoury, but we have said throughout our response that we did not want to keep these powers in place for any longer than we have to and that the House performs an essential role in scrutinising the measures every six months.

In 2020, and shortly after the one-year review, we came before Parliament to remove provisions from the Act that were no longer needed. So far 13 of the non-devolved temporary provisions have already been expired and, as pledged in our autumn and winter plan, we are looking to expire even more of these provisions and will lay regulations very soon to make this happen so that we can continue down the path to normal life.

[Simon Hoare (North Dorset) (Con)]

May I invite my hon. Friend to remind the House and the country that the instincts of the Government sitting behind this Act were benign and in support of public health, not malign and vindictive and trying to erode liberties? These were unprecedented times that required emergency action. Those actions have paid dividends; they were difficult but right. The intention was benign not malign, contrary to what some of our colleagues seem to suggest.

[Maggie Throup]

I thank my hon. Friend for that intervention. The Government were acting in very difficult times and had to take unprecedented measures, as he rightly said.

The Secretary of State explained the provisions in detail in his opening statement, so I will not repeat those that we will be expiring but they include some of the most stringent measures in the Act such as directing the temporary closure of educational institutions, the detention of potentially infectious people, and enabling Ministers to restrict or prohibit gatherings or events. Meanwhile the powers in the Act that we are retaining are those that are critical to our response to the pandemic; after all, as the Opposition spokesman rightly said, this virus has not gone away. We are facing a difficult winter, a time when we have seen from experience that the virus poses a particular threat, so we are keeping in place provisions that are fundamental to our response, for example to make sure the NHS is properly resourced and to support statutory sick pay for those who are self-isolating.

NHS Funding Bill

Simon Hoare Excerpts

2nd reading & 2nd reading: House of Commons
Monday 27th January 2020 Commons Chamber

[Simon Hoare (North Dorset) (Con)]

Let me be clear from the start that the Conservative party is clearly the party of the national health service, and the British public have trusted us with it for another five years as from December. The crucial point made by my right hon. Friend the Secretary of State, which I think is worth repeating, is that people can add noughts here, there and wherever they like, but new spending can only come from a firm, solid and growing economy. People can make all the promises they like about what they are going to do, but if the economy tanks, those promises are made out of pie crusts. I think that is why the British people have entrusted us with the health service.

I very much welcome the Bill, and hope that I can influence the Minister and his colleagues to think about where some of the new money can be spent. Let me canter through the North Dorset wishlist, if I may. For too long, health at the centre has ignored and underplayed the importance of rural community hospitals.

[Richard Drax]

My hon. Friend may canter as long as he likes, so long as he does not canter on to my patch.

[Simon Hoare]

I would not be seen dead in my hon. Friend’s patch. I have enough issues with my own.

There are two community hospitals in my constituency: Westminster Memorial in Shaftesbury and the excellent Blandford Community Hospital. I am a friend of both, and both friends’ organisations do a huge amount of vital fundraising work. The Minister is well apprised of the important role such hospitals play, particularly in rural settings after discharge from A&E, just before people can go home. Community hospitals need support and fresh attention.

Likewise—I am pleased that the Department prioritised this earlier in the year—community pharmacists play a huge and important role. I am told by our CCG that it is almost a cardinal sin to even consider this, but I would love to see a representative of the community pharmacies on the boards of each CCG, by mandate, because they have a vital role to play in our NHS family. As the previous chairman of the all-party parliamentary group on multiple sclerosis, may I also urge a greater rapidity with regard to the prescribing of medical cannabis?

NHS dentistry needs a fillip. I am often contacted by constituents about this—indeed, I was contacted by a lady from Stalbridge the other week who has now been trying to get on an NHS dentist waiting list for two years. That is simply not good enough when dental health is coming under pressure.

Speaking with another APPG hat on, I know that my right hon. Friend the Secretary of State is alert to the need for a speedy renewal of the health grant for those suffering as a result of thalidomide. That takes place in 2022-23. We all know the story of thalidomide; I am not going to rehearse it. We owe the victims of that scandal our support, and I hope that the grant will be renewed, either from new money from the Treasury in the comprehensive spending review or from the current NHS budget.

This is an opportunity to think about the future of the national health service, as my hon. Friend the Member for Watford (Dean Russell) said. We would all hold it in even greater esteem if all of us, as patients, were alert to the cost—the actual cost—of our medicines and our treatments. There would be far fewer medicines flushed down the loo and far fewer appointments missed if people knew the true cost to them, as taxpayers.

A number of hon. and right hon. Members have referenced the need to bolster preventive health still further. There is far more that we can do. Very often, the NHS is a national ill-health service; it merely picks up the problems that a more proactive preventive agenda could have solved. In that regard, I make a plea, in particular, for bowel cancer and prostate cancer—indeed, for the male cancers generally, which often get overlooked.

[Dr Whitford]

In a debate in August 2017, the Minister at the time agreed to reduce the starting age for bowel cancer screening in England from 60 to 50—as it has always been in Scotland—but here we are, two and a half years on, and there is no sign of that. Does the hon. Gentleman agree?

[Simon Hoare]

I do. The stasis of the past few years, as we have wrestled with and resolved the issue of Brexit, has almost pushed everything else out of public attention and political action. I rather hope that now, having got Brexit done, we can move on, with a comfortable majority, to deliver on exactly these things. Forgive me, Mr Deputy Speaker, but I should have declared an interest, although non-remunerative, as a trustee of a bowel cancer research charity.

Representing North Dorset, a heavily rural constituency, I know that we are all alert to—I do not think anybody has the solution to this in short term—how we are going to address the demographic time bomb of huge numbers of rural GPs retiring.

[Fay Jones (Brecon and Radnorshire) (Con)]

Will my hon. Friend give way?

[Simon Hoare]

Will my hon. Friend forgive me if I do not? I just want to make two final points because I know that other people wish to speak.

We need to focus resolutely on delivering GPs in rural areas and trying to find innovative ways to make general practice in a rural location attractive, with a very clear career path. If we do not, it will be a continuing problem and all our constituents will suffer.

Mental health is an issue, irrespective of age, that is often exacerbated in a rural setting due to isolation and loneliness. We must tackle that. My hon. Friend the Minister is now rushing for a separate sheet of paper to take a more detailed note of what I am calling for—wishing, I am sure, that I had not been called to speak in this debate.

Every Member of the House will have their pressing concerns. There will be an awful lot of overlap in the Venn diagram of pressure on the Department. However, this is a golden opportunity. Let us not just fritter it away on what is easy, but do the long-term thinking to find sustainable, sensible solutions to some of our health issues and problems in rural North Dorset and across the country—and then the Minister and his team will be thanked.

Health Infrastructure Plan

Simon Hoare Excerpts

Monday 30th September 2019 Commons Chamber

[Edward Argar]

The hon. Lady highlights an issue of great importance to her constituents and her local hospital. As she will be aware, decisions on changes to services are made by local NHS trusts and clinicians, to reflect their assessment of the best way to deliver care and meet clinical need in a particular locality. If she wishes to write to me about the details of her local hospital and the issue she just highlighted, I would be happy to respond as swiftly as possible.

[Simon Hoare (North Dorset) (Con)]

The delivery of healthcare in rural settings presents some complex challenges, so I was delighted to hear what my hon. Friend said in his statement about the importance of community hospitals. Dorset is in phase 2, for want of a better phrase; will the Minister flesh out, to the best of his knowledge, how that will come about, the timeframe and what my residents should expect?

Oral Answers to Questions

Simon Hoare Excerpts

Tuesday 7th May 2019 Commons Chamber

[Matt Hancock]

The hon. Lady rightly raises an important case, and I have met her about it and followed it closely. As she says, there is work ongoing and happening this week to try to make progress. NICE is currently developing technical appraisal guidance on the use of the drug Spinraza, to which she refers. We are working to ensure that we can get it right.

[Simon Hoare (North Dorset) (Con)]

As chairman of the all-party parliamentary group on multiple sclerosis, may I urge my right hon. Friend to ask NICE to expedite its perfectly proper processes on the licensing of cannabis-based drugs, particularly for the treatment of multiple sclerosis, Parkinson’s and motor neurone disease?

[Matt Hancock]

Yes. My hon. Friend raises another important area where progress is being made on the ability for people to get access to drugs that could help them. We now have a medicinal cannabis programme in place, as we discussed in this Chamber a couple of weeks ago, so that those with acute conditions and with clinical support for using medicinal cannabis can get it. We are also working as rapidly as we reasonably can to normalise the ability to use medicinal cannabis within the NHS.

Prostate Cancer

Simon Hoare Excerpts

Wednesday 6th February 2019 Commons Chamber

[Simon Hoare (North Dorset) (Con)]

I rise to open this five-hour Adjournment debate—that was a joke, Mr Deputy Speaker. This debate is certainly timely, given that on Monday this week we celebrated the 20th anniversary of World Cancer Day, and many Members will have attended the event held by Cancer Research UK in Portcullis House this morning. It is timely given the more than welcome announcement by the Treasury and the Department of Health and Social Care of record investment coming into the national health service. It is timely because we have the Government’s welcome and focused cancer strategy. It is timely because at no other time in our history have Government and health campaigners and providers had a greater communication platform to reach out to members of the public and explain, inform and educate. Finally, this debate is also timely because this week, under the auspices of my hon. Friend the Member for Lewes (Maria Caulfield), who has considerable nursing experience, we have seen the launch of the all-party parliamentary group on male cancers, including prostate cancer.

We need to recognise that cancer is still feared in this country. Terms such as “battle, “fight” and “lost the crusade” against cancer are used in countless obituaries, which testifies to that fear. I hope that we all take heart from the commitment in this important health area shown by my right hon. Friend the Secretary of State and the Under-Secretary of State for Health and Social Care, my hon. Friend the Member for Winchester (Steve Brine). That should provide us with a reservoir of optimism about the seriousness and determination of the Department on these issues.

It may just be something to do with my sex—I am not sure—but all the statistics and all the anecdotes tell us that men appear to have a greater aversion to going to the doctor and asking questions about their health than our female counterparts, and certainly anything below the waist is to be avoided at all costs because it is going to be painful, embarrassing and undignified.

I pause for a moment to reflect on the absolute honesty that we have heard from my hon. Friend the Member for Redditch (Rachel Maclean), and indeed the clarity of my right hon. Friend the Prime Minister at the Dispatch Box during a recent Prime Minister’s questions, about cervical cancer testing—admitting some of the inhibitions, but, given the importance, exhorting people to take those tests. I do not think that I hear such exhortations and frank honesty from men about this health issue.

[Nick Smith (Blaenau Gwent) (Lab)]

I commend the hon. Gentleman for his leadership and for securing this important debate. I have been along to the World Cancer Day event today, where I was told that more than a third of cancer cases can be prevented, and another third can be cured if detected early and treated properly. The message he is sending out today is really important for us to share across the whole country.

--- Later in debate ---

[Simon Hoare]

The hon. Gentleman is absolutely right, and I will turn to diagnosis in a moment.

Let me return to the point I made a moment or so ago about fear. We will all have had family and close friends experience being given a diagnosis of prostate cancer or, indeed, other cancers, and the first thing is always to face that in a very black mood and think that there is absolutely no cure. However, we know that there are scientists—clever men and women—striving every day to find such cures. Indeed, life expectancy post an early diagnosis is of course getting better and better. Rightly, we place huge emphasis on breast and cervical cancers, but I suggest to the Minister that, in the shape of male cancers, we need to up the game in communication and education as well.

Some statistics on prostate cancer, provided by Prostate Cancer UK, may be of help to the House. Prostate cancer is the most common male cancer in our country: 47,000 men are diagnosed each year. One in eight men will get prostate cancer, and every 45 minutes one man dies of it in our country. Men over 50—I turned 50 this year, so I do not know whether—[Hon. Members: “No.”] I know; it is almost impossible to believe. I am not sure whether I should therefore declare an interest, but men over 50 are more prone to it, particularly if they have a family history.

A statistic I have learned—I am yet to find any particular reason for it—is that black men are far more at risk of contracting prostate cancer: one in four will get it. Someone’s risk of prostate cancer is heightened—again, this was a new fact to me—if their mother or their sister has had breast cancer. I wonder how many people recognise that and see that, if a female in the family is diagnosed with breast cancer, that should act as a spur for them to go and have a test. In 2016, 11,631 men died of prostate cancer in the UK alone.

At our party conference last year, my right hon. Friend the Prime Minister said:

“The key to boosting your chance of surviving cancer is early diagnosis… Through our Cancer Strategy, we will increase the early detection rate… We will do it by…investing in the very latest scanners.”

[Mary Glindon (North Tyneside) (Lab)]

I congratulate the hon. Gentleman on securing this important Adjournment debate. As well as early diagnosis, this is about people’s awareness that they themselves may possibly have the symptoms. When my husband was diagnosed, he just thought he had a chill. Unfortunately, his is incurable, but he thought no more about it than that he had a chill. An even more important issue than having screening is that we should be aware of our bodies.

[Simon Hoare]

The hon. Lady makes an incredibly telling point, because unless people know what the full range of symptoms are, they do not really know what they should be thinking and whether one of those symptoms or a combination of them should actually trigger a visit to their doctor in the first instance. I think she is absolutely right that we need a better understanding.

This goes back to a point I made a moment or two ago. Because this is a below-the-waist issue and we men get frightfully embarrassed about those sorts of things, we are inclined to say that it might just be something else or that it will pass, and so on. However, for too many people, it is left too late to have any meaningful, beneficial outcome as and when they eventually go to see their GP and then trigger the referral process.

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

Does the hon. Gentleman agree that we can concentrate on all the negatives, but we have to get across that people are surviving and, more than surviving, actually living well? We have to present that because, with some cancers, there is still the idea that if someone gets it, “Well, that’s it then”.

[Simon Hoare]

rose—

[Mr Deputy Speaker (Sir Lindsay Hoyle)]

Order. May I just read out the deferred Division result?

[Simon Hoare]

We wait with bated breath.

[Mr Deputy Speaker]

Absolutely.

I have now to announce the result of today’s deferred Division. In respect of the question relating to long- term investment funds, the Ayes were 302 and the Noes were 262, so the Ayes have it.

[The Division list is published at the end of today’s debates.]

I must inform the House that there were errors in calculating the number of votes of Members for English and Welsh constituencies and for English constituencies in Divisions yesterday on the police grant and the local government finance report. On the police grant, the figures for the England and Wales-only vote should not have been announced as 289 for the Ayes and 242 for the Noes; they should have been announced as— Ayes 289 and Noes 244. On the local government finance report, the figures for the England-only vote should not have been announced as 270 for the Ayes and 208 for the Noes; they should have been announced as— Ayes 270 and Noes 206. The results are unaffected.

[Simon Hoare]

A restless nation will sit easier in their armchairs knowing that, and we are grateful to you, Mr Deputy Speaker, for your public service announcement.

To respond to the intervention from the right hon. Member for Alyn and Deeside (Mark Tami), I think he is absolutely right that we—not just Ministers, but health practitioners and all of us in our communities—need to stress again and again the widening range of treatments, the recovery rates and the extra lifespan one can have after early diagnosis and treatment. I suppose it is a perfectly legitimate historical response to have to such a diagnosis, but we need to end once and for all people saying, “Well, that’s it. I’ve had my chips.” To say, “You know, let’s see what we can do with the rest of it”, and in effect give up, is absolutely the worst thing that one could do.

May I raise the subject of diagnosis with the Minister? To pause there, I am not saying this to ingratiate myself with my hon. Friend, but the understanding and sensitivity that he brings to these issues and, indeed, to his wider portfolio commands respect across the House. I think we are very lucky to have him, and I am particularly pleased that my hon. Friend is the Minister replying to this debate.

[Mr Mark Francois (Rayleigh and Wickford) (Con)]

On that point, I had the privilege of attending an event that the Minister addressed a couple of weeks ago, and I was struck by the passion with which he spoke about this subject. I entirely endorse what my hon. Friend has said about the Minister’s commitment. In passing, I congratulate my hon. Friend on securing this very important Adjournment debate, and may I assure him that, when it comes to fighting prostate cancer, this is something on which he and I see absolutely eye to eye?

[Simon Hoare]

I am grateful to my right hon. Friend. I think we both stand at roughly 5 feet 6 or 7 inches, although I might be slightly taller than him when he is in his stocking feet. I get his reference and it is delightful to see eye to eye with him.

[Mr Jim Cunningham (Coventry South) (Lab)]

I wonder what you two want out of the Minister, given that you are giving him so much praise. Having said that, I am sure the hon. Member for North Dorset (Simon Hoare) will agree that the National Institute for Health and Care Excellence has sometimes been slow in making progress on treatments, as we have seen with other health problems. I echo his words that, simply put, men just do not like to tell anybody when they are not well. When people tell me that they have an illness like prostate cancer, they often say, “But don’t tell anybody.” The big problem is getting men to realise that they have to do something early, and the person who finds the answer to that very difficult issue will have done a great service.

[Simon Hoare]

I agree. In answer to the first part of the hon. Gentleman’s intervention, which I presume was rhetorical, I just want the Minister to carry on with the excellent work he is doing. The hon. Gentleman is right to say that we need to blow away the cloak of secrecy and, sometimes, shame and embarrassment. No family represented in this House will not have heard an aunt or an uncle say, in slightly hushed tones and that silent mouthed way, best exemplified by Les Dawson, that they have the big C. It is as though they cannot quite bring themselves to annunciate the word, in case it brings a plague upon their house. We have to brush all that away.

I am absolutely determined to get on to the issue that I want the Minister to address, which is what I was trying to do about 16 interventions ago. I urge him to grasp the opportunity—provided not least by the additional funding—for efficient, cost-effective and easier diagnosis. I appreciate that there is a whole range of things in the marketplace, but during my research I have been particularly struck by the opportunities presented by the pre-biopsy multiparametric MRI scan. We have a problem, because while demand for MRI scans rose by 30% between 2013 and 2016, this country still has fewer MRI scanners per head of the population than other countries with comparable populations. The additional moneys available provide a golden opportunity to do something about that.

Of course, it is never just a question of cash and kit, so allied with that are the people who can use the kit. The workforce are key. In addressing the issue of money and the benefits it can provide, we should note that we will not realise its full potential if we are short on workforce. The 10% vacancy rate in the national health service cannot be allowed to become the norm. Prostate cancer patients need and would like more clinical nurse specialists, who have the empathy and expertise to provide comfort, hope and a guiding hand. It is difficult to recruit in any specialist nurse area, but that should not put us off the endeavour.

Likewise, we need a recruitment drive for more radiologists. Prostate Cancer UK estimates that an additional 23 to 31 radiologists are needed in the UK. The Royal College of Radiologists estimates that in the financial year 2016-17, a whopping £116 million was spent on the outsourcing and insourcing of radiological skills additional to core contracted hours. To put that in perspective, £116 million would buy about 1,300 full-time consultant radiologists.

As I have said, raising public awareness of prostate cancer—its signs, symptoms, diagnosis and treatment—is pivotal, but so too is the reinforcement of messages from the Department, NHS England and others to our general practitioners. We all know that there is a growing problem of finding people who are interested in and prepared to enter general practice. The myriad drugs that come on to market and myriad other conditions make the already demanding life of a GP ever more so.

I recently met Jim Davis, the chairman of the Dorset branch of the Prostate Cancer Support Organisation, a charity that covers Hampshire, Dorset and Sussex. It is run for men diagnosed with prostate cancer, by patients with prostate cancer. Last year, they held 23 free prostate-specific antigen testing events, which delivered those tests for 4,813 men. They have found that people are more inclined to go into that sort of environment than to their GP surgery. Their work involves—as a Hampshire Member of Parliament, the Minister may already know this—raising money, advertising the tests and hiring village halls and other places. Men then come and have the test, which is sent—in effect, the work is subcontracted—to the local hospital, which analyses it and sends back the results. I will not detain the Minister, but I could read out a whole legion of extracts from letters from grateful men who availed themselves of that opportunity and found their life chances and health much improved.

Although the national health service says that any man over 50 is entitled to a free PSA test, evidence suggests that some GPs—I stress the word “some”, but one is too many—are either unaware of that entitlement or express and demonstrate an unwillingness to refer. Last May, David Radbourne, the director of commissioning operations at NHS England South East, wrote in response to a letter from Jim, who had produced a list of affected patients:

“If there are individuals who feel they are being refused legitimate access to this test…please ask them to file a complaint through the appropriate NHS complaints process.”

I say to my hon. Friend the Minister that in those circumstances, people should not be forced to go through an NHS complaints process. Like other campaigners, I see a lacuna, or an information gap—call it what you will—among certain GPs, and I urge the Department to consider ways in which to plug it. That issue needs to be addressed quickly. The official in the Box is waving a piece of paper and the Parliamentary Private Secretary, my hon. Friend the Member for Erewash (Maggie Throup), is up on her feet with alacrity, as always.

The Public Health England advisory note, “Advising well men aged 50 and over about the PSA test for prostate cancer”, needs to be reviewed and updated. It states:

“GPs should use their clinical judgement”.

That is a pejorative term—it is an open term—so perhaps that language should be revisited. The approach needs to be a little more robust.

[Nick Smith]

The hon. Gentleman is making a really important point. I am over 50, but I did not know about the test. Does he know how many men over 50 as a proportion of the population have had the test?

[Simon Hoare]

I am sure that I have come across that figure in my research, but I do not have it to hand. However, as I mentioned in my introductory remarks, the platforms to inform, encourage and educate us all as health citizens, for want of a better phrase, that we seem to avail ourselves of very much relate to—this is not a criticism; it is perfectly correct—cervical cancer, breast cancer and other cancers. The opportunity presented by additional funding and by the very welcome cancer strategy should now allow us all to give—I do not know whether this is quite the right phrase—parity of esteem between male and female cancers. Cancer has a devastating effect on family irrespective of which member has it. I am afraid I cannot answer that query, but the Minister may have that figure. As it is an entitlement, I urge as many men over 50 as possible to see it as routine and regular as going to the optician or the dentist.

In conclusion, with the cancer strategy, fantastic levels of funding and the active commitment, energy and understanding shown by Ministers in the Department, now is the time to make positive progress.

--- Later in debate ---

[Simon Hoare]

I am very grateful that the Minister is setting this out in his customary detail. In a circumstance in which all those conversations have taken place, if the patient says, “Thank you doctor, I hear what you say, but I am entitled to have this test, and I want to have this test done,” will the Minister confirm that GPs are obliged to make the referral, rather than saying, “Well, I’ve heard what you said, but I am your doctor and I am not going to let you have it done”?

[Steve Brine]

We do not often use the term, “No decision about me, without me” any more, but I always remember the former Health Secretary—now Lord Lansley—using that a lot, and that is still very true. A patient over that age has every right to request a PSA test, and certainly even more so if they believe that they have symptoms. I would be very concerned about a GP refusing it—I think it would be extremely unlikely for one to do so in such instances—but any patient has the right of travel. Every patient has the right to change GP if they are not satisfied with the relationship that they have. If my hon. Friend did know of an instance of that, I would be very interested to hear about it—as, I suspect, would the Royal College of General Practitioners —but I would be very surprised.

I want to touch on screening, which we talk about a lot at the moment, and I will come on to why. Because of the limitations of the PSA test, there is currently no national screening programme for prostate cancer. In 2016, Prostate Cancer UK, which has been rightly lauded this afternoon, began work to help to develop tests that could form part of a national screening programme. This would potentially involve better blood tests, which are currently in development, combined with more advanced scanning. It is hoping to make that happen in the next five years—nothing happens quickly in this space unfortunately—and I am sure that we all welcome their efforts.

Members will be aware—I have spoken about this quite a lot in the House recently; we have had a number of cancer debates since Christmas—that Sir Mike Richards is leading a review for the Secretary of State of our current screening programmes. As part of that—I met Sir Mike last month—we will consider how we can make screening smarter, targeting those most at risk. We expect that Sir Mike’s work will have positive implications for future programmes. He is an incredibly experienced and respected figure in this space, and I hope that his work will enable us to roll screening out faster when the evidence base is there to support it. I am very hopeful and ambitious about that work, as I know Sir Mike is.

Let us talk about public awareness campaigns, which my hon. Friend mentioned in opening the debate. The Government have to do all that they can to raise awareness of prostate cancer and target high-risk groups, while recognising that there are limitations on how much the public will listen to public health messages from Ministers at the Dispatch Box—I know that it is hard to believe that people do not take this all to heart, but they do not, so we work with our partners.

In 2014, along with Public Health England, we worked on the phenomenally successful “Be Clear on Cancer” campaign, which has had a number of iterations, on prostate cancer in black men. The campaign messaging included:

“1 in 4 black men will get prostate cancer”,

which was one of its tag lines. It urged black men over 45 who were concerned about their risk of prostate cancer to visit their GPs. The campaign evaluation showed that it had stimulated new conversations about prostate cancer among families and the black community. Public Health England has made all the materials developed for the campaign available online, so that groups and other organisations can use them locally if they wish. They are very striking and powerful, and we believe that they were very successful.

We also welcome the work that Prostate Cancer UK is doing with the Football Association to raise awareness through their “relegate prostate cancer” campaign. It is fronted by high-profile celebrity football figures, including the England football manager, Gareth Southgate, and includes the slogan:

“One man dies every 45 minutes of prostate cancer”.

Anyone who can stay awake for “Match of the Day” on a Saturday night—thank goodness for the repeat on a Sunday morning—will see very many people, including the pundits and the managers interviewed afterwards, wearing the badge that I am wearing today. Members will be very familiar with that badge, which demonstrates the widespread support that Prostate Cancer UK has in continuing to raise awareness of this disease.

Let me turn to research, as I come to a conclusion. Research has played a crucial part in the advances that we have made in cancer survival over the past four decades. More than 15 years ago, the Department identified the need for further research into prostate cancer, and we have since worked closely with Cancer Research UK—it was here this morning; I was pleased to pop into its drop-in—Prostate Cancer UK, the Medical Research Council and others, through the National Cancer Research Institute, which is a strategic partnership of the major UK funders of cancer research. NCRI spend specifically on prostate cancer research increased from £17.1 million in 2011-12 to £26.5 million in 2015-16.

NHS Long-Term Plan

Simon Hoare Excerpts

Monday 18th June 2018 Commons Chamber

[Mr Hunt]

I thank the hon. Lady for asking that important question. We have introduced a £10,000 golden hello for postgraduates who go into the learning disability field. She is right that we have had particular pressure on the learning disability workforce. In the aftermath of Mid Staffs, there has been a whole range of measures to improve hospital ward staffing ratios for nurses and that has had an impact on learning disability nurses. That is absolutely something we hope to address with this new funding.

[Simon Hoare (North Dorset) (Con)]

I echo the thoughts of my hon. Friend the Member for South Dorset (Richard Drax) on the role of community hospitals as the segue between the acute sector and patients going home. Will my right hon. Friend confirm that, with this very welcome new money coming into the health service, the drive for efficiencies and increases in productivity will continue and indeed be increased to ensure that the biggest bung—the biggest bang is felt for those bucks?

[Mr Hunt]

My hon. Friend is absolutely right not to use the word “bung” in his question and to correct that very quickly indeed. He is also right to talk about productivity. The last Labour Government made important progress in bringing down waiting times. That required significant extra resources. When Alan Milburn had a 10-year plan, there was not a big productivity element to it. This time, when resources are much tighter, we have to make sure that productivity and efficiency gains are at the heart of the progress we make.