Pancreatic Cancer

Stephen McPartland Excerpts

Monday 8th September 2014 Westminster Hall

[Barbara Keeley (Worsley and Eccles South) (Lab)]

It is a pleasure as always to speak with you in the Chair, Mr Chope. I congratulate my hon. Friend the Member for Scunthorpe (Nic Dakin) on the excellent way he opened the debate and the hon. Member for Lancaster and Fleetwood (Eric Ollerenshaw) on working with my hon. Friend to secure the debate and his very moving contribution. I join them in congratulating Mrs Maggie Watts on gaining more than 106,000 signatures for the petition. Anyone who takes or promotes petitions through social media will know what a mountain 100,000 signatures is to climb.

Mrs Watts started the e-petition to help to push pancreatic cancer higher up the political agenda, to raise the disease’s profile and to encourage more funding and research into it. That is certainly starting to happen with the debate today. As Mrs Watts has said,

“pancreatic cancer has been neglected both in terms of funding and awareness for way too long.”

The fact that her husband stood

“no better chance of survival in 2009 than his mother did in 1969 demonstrates completely how little progress has been made.”

As the petition states, pancreatic cancer is the

“5th leading cause of UK cancer death, with the worst survival rate of all cancers”.

Yet, as we have already heard, it receives only about 1% of the research spend. Further, the five-year survival rate of less than 4%, as we have heard,

“hasn’t improved in over 40 years, whilst survival rates for other cancers have.”

It is worth looking at those survival rates. The current survival rate for bowel cancer is 54%; it was 22% in 1971. The current survival rate for breast cancer is 84%; it was 56% in 1971. For prostate cancer, to which I recently lost a friend, the current survival rate is 81%; it was 31% in 1971. From those figures, we can see that pancreatic cancer lags behind. Clearly, as has already been discussed, more funding and more public awareness are vital so that progress can be made, both in earlier detection, to which hon. Members have already referred, but, ultimately, in better survival rates.

Pancreatic cancer is termed the silent killer. As we have heard, many of its symptoms mirror other, less critical illnesses. We have also heard that GPs may not recognise these early enough, looking first at other possible causes, resulting in lost time before diagnosis. That is serious because in many cases the prognosis will be terminal by then. It is quite a disturbing fact that deaths from pancreatic cancer did not just stay the same but increased between 2002 and 2013, while deaths from most other cancers declined.

It is clearly difficult that the signs and symptoms of pancreatic cancer can be late occurring and non-specific. As my hon. Friend the Member for Scunthorpe said earlier, these non-specific symptoms may lead to patients being treated or investigated for other more common illnesses, such as gallstones, before a diagnosis of pancreatic cancer is made. This in turn can mean significant delays in diagnosis and treatment, including potential curative surgery. As we have heard—I am sure we will come to this point and put more questions to the Minister on it—we are talking about patients whose symptoms and diagnosis do not fit our system. Our system needs to change, so that these patients get the investigations and diagnosis they want.

[Stephen McPartland (Stevenage) (Con)]

Is the hon. Lady as shocked as I am that apparently 48% of people are diagnosed with pancreatic cancer following an emergency admission, as opposed to following a referral from their doctor or following a screening?

[Barbara Keeley]

Yes, indeed I am. As is always the case in these debates, I was coming to that point. We have had an excellent briefing from Pancreatic Cancer UK, which says that there are symptoms that lead patients to visit their GPs. As the briefing said:

“If patients can present at an earlier stage and GPs are better trained and supported to identify and investigate the possible signs of pancreatic cancer, more people will be diagnosed at a stage when curative surgery is still an option.”

The NHS England cancer patient experience surveys have shown that more than 40% of pancreatic cancer patients visit their GP three or more times before being referred to hospital. I found examples in case studies that were many more times than that. Some people, as in the tennis ball example mentioned by my hon. Friend the Member for Scunthorpe, went to GPs 10, 15 or 16 times. That is not acceptable. By comparison, figures show that 75% of all cancer patients combined are referred to hospital after only one or two visits to their GP. That is as it should be for this dreadful disease.

The hon. Member for Bracknell (Dr Lee), who is no longer in his place, spoke about the difficulties for GPs. Pancreatic Cancer UK found in a survey it conducted that, although most GPs could list one or two of the symptoms of pancreatic cancer, half of GPs were not confident that they could identify the signs and symptoms of pancreatic cancer in a patient. All these facts underline the need for better awareness of pancreatic cancer. Leading charities want to see a campaign based on the specific symptoms of pancreatic cancer.

The briefing reminds us of the need to challenge perceptions of pancreatic cancer as a disease affecting small numbers of elderly, male patients. Although it is true that incidence increases with age and the majority of cases are reported in older patients, it may be that they would be younger if the diagnosis and investigations were better. However, about 25% of cases still occur in people under the age of 65. We have heard examples concerning people in their 40s. The disease affects men and women equally.

Pancreatic cancer awareness month in November, which the hon. Member for Redditch (Karen Lumley) referred to, will help raise awareness. We know the awareness-raising value of storylines such as the one in “Coronation Street” with Hayley Cropper, which developed the pancreatic cancer that led to the character’s death and helped to create a great upsurge in internet traffic, inquiries and donations to pancreatic cancer charities. Like my hon. Friend the Member for Scunthorpe, I pay tribute to Julie Hesmondhalgh for her support for campaigns and for the petition that led to the debate. We need to see much more of that.

We have had excellent briefings for the debate, but I wanted some insight into treating pancreatic cancer. I asked a doctor working in palliative care. He described his thoughts and his experience of treating patients with pancreatic cancer in these words:

“The issue is not only one about cure rates but that pancreatic cancer presents a massive challenge to the health service in terms of the consequences of this awful disease.

The symptom burden in patients with pancreatic cancer is both substantial in the number of patients affected but also in the intensity of those symptoms.

From the research, 75-80% of patients present with pain at initial presentation. Of these, 44% of the patients admitted to a palliative care setting have severe pain.

Because of the anatomy of the pancreas, many of these patients will have infiltration of the coeliac plexus causing neuropathic pain which is often difficult to treat and may require complex pain interventions including nerve blocks.”

Another important factor is, of course:

“Pain is linked with depression and anxiety…it underlines the importance of treating pain.

Whereas, overall, advanced cancer patients…have a 30% chance of developing major depressive illness this rises to 50% for pancreatic cancer one of the highest instances of depression for any cancer.

The incidence of obstruction of the bile duct is common requiring hospital admission for stenting in the last months”—

and weeks—

of life when patients would rather be at home.

In short, not merely in terms of survival and early diagnosis is pancreatic cancer a major health issue, it constitutes a major burden of symptoms and distress for patients and their families, requiring careful, sensitive integrated care between primary care, hospital staff, oncology and palliative care services.”

Low awareness of pancreatic cancer among GPs and the public, late diagnosis and poor survival rates are not the only issues we have to deal with. Even after people are diagnosed, there is a huge burden of symptoms for the NHS to treat. Those symptoms can mean misery, depression, pain and surgical complications for the patient with pancreatic cancer. As the Minister will know, not all patients are able to benefit from the type of careful, sensitive, integrated care that has been described as what they need. It is clearly an aspiration for the health service, but it is not always achieved.

There is much to do, and the Minister has already been asked to take several actions, but I will ask her, too, because we should all press those points. What action could the Minister take, and what action is she taking, to boost public awareness of pancreatic cancer? It is vital that its symptoms should be better understood by the general public. What can she do to boost awareness among GPs and other medical professionals of pancreatic cancer signs and symptoms? As we have heard and will repeatedly hear, survival rates remain stubbornly low, and mortality rates have been increasing even as they fall for other types of cancer. Will she consider ensuring the development of specific awareness campaigns through appropriate media? The success of the “Coronation Street” story underlines the importance of that for all aspects of the campaign. What action will she take to end the state of affairs in which a patient can be pictured as a tennis ball? What can be done to give GPs more direct access to CT scans or ensure that patients with symptoms that could be pancreatic cancer have all the appropriate investigations in a more timely way?

As my hon. Friend the Member for Scunthorpe and the all-party group have said, it is time to change the story. I hope that the debate will ensure that change takes off, from today.

--- Later in debate ---

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

Thank you for calling me, Mr Chope. I apologise for not being present for the whole debate; I meant no discourtesy to colleagues. I wanted very much to speak in the debate. I begin by congratulating my good and hon. Friend the Member for Scunthorpe (Nic Dakin) and the hon. Member for Lancaster and Fleetwood (Eric Ollerenshaw), who made a very moving contribution. I also thank the Backbench Business Committee and, indeed, all the volunteers. I had the pleasure of meeting Maggie Watts, but there are also many hundreds of others working in charities and as volunteers who have campaigned so effectively on this issue; they have helped secure the signatures to get this debate on what is very often a forgotten and neglected form of cancer.

I know that there are time constraints, but there are some specific issues that I want to raise with the Minister. I will just make some general points and then move straight to my questions. We know from earlier contributions that pancreatic cancer is not an uncommon cancer. My understanding is that by the time this debate has concluded, three more people will have lost their lives to the disease.

We heard in the contribution from the hon. Member for Basildon and Billericay (Mr Baron) that the UK still lags behind most other European countries when it comes to cancer survival rates. To be fair, there have been significant improvements in cancer treatments across the board in recent decades, but as we are aware the rates for pancreatic cancer, at 5.2%, have virtually stood still in the past four decades, so this is not a criticism of the current Minister or the present regime—the present Government.

The very nature of pancreatic cancer contributes towards poor survival rates. I do not intend to go over the arguments put so eloquently earlier about the difficulty of getting a proper diagnosis and the lack of an effective pathway to make the necessary early referrals. However, one thing that I am concerned about—I want to put this point to the Minister—is this. Yes, it is very important to have awareness campaigns, and I pay tribute to the campaigners who have brought this subject to Parliament today, but if we are to have real progress, there need to be improved treatments as well. Pancreatic cancer receives just 1% of the National Cancer Research Institute partners’ research spend. That equates to £625 per death.

[Philip Davies in the Chair]

I fully understand that we one cannot equate such things in financial terms, but that compares with almost £3,500 per death on breast cancer, the campaign against which receives much more public attention. If we as politicians—I am talking about all politicians; this is not a criticism of the Minister or the Government—are serious about improving survival rates for pancreatic cancer, our rhetoric must be backed up with firm action on the allocation of resources.

We have heard that relatively few treatment options are available for patients with pancreatic cancer, and research into the development of new drugs and treatments is key if we are to bring survival rates for pancreatic cancer down towards those of other common cancers. Over the past week or so, the case of the little boy Ashya has been in the news, and we have heard about the terrible circumstances and trauma that his parents went through in being unable to access the advanced radiotherapy that they felt was an appropriate form of treatment for their son. The hon. Member for Lancaster and Fleetwood has already referred to the potential of advanced radiotherapy. Forms of the treatment such as NanoKnife and CyberKnife, which can target tumours very precisely with intense bursts of radiation, may be particularly effective for some, although not all, pancreatic cancer patients.

I know that the Minister is sick of me going on about advanced radiotherapy, but we are not doing as much as we should to develop the evidence base for the treatment. I fully understand that it is not suitable for all types of cancer, or even for all types of pancreatic cancer; there are a number of different forms. The National Institute for Health and Care Excellence insists that before it allows routine use of the treatment, particularly in the NHS, there must be an evidence base.

Many of the cancer charities that I have spoken to have argued that, as a matter of urgency, the technology for advanced radiotherapy must be verified. I make an appeal to the Minister on that. Patients already receive advanced radiotherapy for other cancer types, and the treatment is available for private patients. I fully understand that we need to have an evidence base and see what is effective in different circumstances. Until research into advanced forms of radiotherapy for the treatment of pancreatic cancer is increased and the viability of the technology can be properly verified—until we actually grasp the nettle and fund the research and the trials—NHS patients will continue to miss out.

[Stephen McPartland]

The hon. Gentleman and I have debated radiotherapy and chemotherapy several times. I am proud that my NHS hospital trust was given the first CyberKnife by a wealthy donor, so it has the evidence required for advanced techniques and advanced radiotherapy. I sound a note of caution, however. My constituents have to make a 60-mile round trip to access that treatment. We have just opened a chemotherapy unit that can be used by someone who has cancer in Stevenage, but if they receive radiotherapy they often have to make a 4,000-mile journey over the course of their treatment. Although patients can have advanced radiotherapy, the difficulty is accessing that treatment.

Oral Answers to Questions

Stephen McPartland Excerpts

Tuesday 1st April 2014 Commons Chamber

[Norman Lamb]

I agree that I am not a bystander. That is why I have acted to introduce choice for mental health patients for the first time—something that the Labour Government completely failed to do. Perhaps the hon. Lady could explain to the House why on earth they would leave out mental health patients from the legal right of choice. It is extraordinary. This Government are taking decisive action to ensure that there is real parity—real equality—in the way that mental health patients are treated.

[Stephen McPartland (Stevenage) (Con)]

9. What recent steps he has taken to improve maternity care.

[Henry Smith (Crawley) (Con)]

11. What recent steps he has taken to improve maternity care.

[The Parliamentary Under-Secretary of State for Health (Dr Daniel Poulter)]

We have made improving maternity services so that women have a named midwife responsible for ensuring personalised maternity care the key objective in our mandate to NHS England. Since May 2010 the number of full-time equivalent midwives increased by more than 1,500, and over the past two years I have set up a £35 million capital investment fund, which has already seen improvements to more than 100 maternity units.

[Stephen McPartland]

The Diamond Jubilee maternity unit at the Lister hospital in Stevenage is doing an amazing job for young mums, and the neonatal unit has just won a national award. I will be visiting the staff on Friday to thank them for their hard work. Would the Minister like to record his support for the staff who do such a great job?

[Dr Poulter]

I would be happy to do so. I am aware of the positive difference that the Diamond Jubilee unit has made to local maternity services. My hon. Friend will be aware that the East and North Hertfordshire NHS Trust and the unit have received £314,000 of this Government’s capital funding to support the hard-working staff on that unit delivering high-quality care to women.

Oral Answers to Questions

Stephen McPartland Excerpts

Tuesday 11th June 2013 Commons Chamber

[Dr Poulter]

The hon. Gentleman is right to point out that historically there have been challenges with intensive care beds. We are now seeing increases in some areas of intensive care, particularly paediatric intensive care and paediatric cots, to ensure that there is greater support in that service, but he is absolutely right that we need a greater emphasis on specialist centres focused on intensive care. That is something that the NHS Commissioning Board, NHS England, is focused on delivering. We need to ensure that across each region of the country there is more focused care and more specialist intensive care.

[Stephen McPartland (Stevenage) (Con)]

6. What progress he has made on improving cancer waiting times and diagnosis.

[The Parliamentary Under-Secretary of State for Health (Anna Soubry)]

Cancer waiting time standards set out a maximum two-month wait from urgent GP referral for suspected cancer, through to diagnosis, to the first definitive treatment. Quarterly performance in the past 12 months has consistently exceeded the performance measure of 85%; indeed, the current data show that 86.3% of patients were treated within this time frame.

[Stephen McPartland]

I am a firm believer in bringing cancer care closer to people’s homes. My constituents have to travel thousands of miles during the course of their radiotherapy treatments. Will the Minister support my campaign for a satellite radiotherapy unit to be based at Lister hospital in Stevenage?

[Anna Soubry]

I pay tribute to my hon. Friend’s campaign, which he has been running for some time, and to all the great work that he does for Lister hospital. I am slightly worried that if I give him any support it might be the kiss of death for his campaign, but I wish him all the very best and all power to his elbow.

Accident and Emergency Waiting Times

Stephen McPartland Excerpts

Wednesday 5th June 2013 Commons Chamber

[Stephen McPartland (Stevenage) (Con)]

I am proud of the NHS and of the staff who work for it daily in my constituency; they are part of a huge team that saves lives every day.

The issue of A and E waiting times has shot up the political agenda, but I am concerned that many of the staff working in those departments will fear that their deeply held commitment to the job will not be getting the recognition it deserves. Across the country, 22 million people have visited A and E, with 96% being seen within four hours—that is nearly 1 million more people than a year ago, which is positive news.

I have great respect for the shadow Secretary of State, but I do not think the A and E crisis is as acute as the Opposition like to suggest. The reality is that in some areas A and E is going incredibly well. Let me talk about my constituency and the Lister hospital, where our team sees about 135,000 patients a year, about 25% of whom are children, with 21% of the patients seen by our A and E department being admitted to hospital.

I shall read a couple of quick reviews from the past few months. One said:

“I Twice needed help in last 2 months, in each case response on phone was excellent and doc phones back within 20 min. Ambulance was there quickly and I was in A&E within the hour. Excellent treatment there and can’t recommend the service highly enough. Could not have done better anywhere. Everyone involved needs to have a big thank you and how lucky we are to have such a great service. I am 83 and still going strong because of this great care. Again thank you all very much.”

Another said:

“I was recently admitted to Lister via A&E and can only praise every member of staff who dealt with me from that point until I left.”

A third said:

“My son quickly became very ill with strep A and toxic shock syndrome and from the immediate ambulance response to being put in the Short Stay Unit after A&E, he received the most wonderful care and compassion. All of the staff were lovely and we can’t thank them enough.”

So A and E across the country is not as bad as people like to make out. I visited the A and E in Stevenage, spending two and a half hours sitting in the waiting room and then being dealt with very courteously and professionally. It was a very positive experience. I have also been out with the ambulance service in Stevenage and gone around the constituency. I dealt with a number of 999 calls, one of which involved a nine-year-old boy being rushed to A and E. He was dealt with incredibly efficiently by the teams there, who were waiting for him upon his arrival and helped to save his life. They had to put him into an induced coma because of the severity of the condition he was admitted with.

I know that there are issues to address in some parts of the country, but in Stevenage we are benefiting from a £150 million redevelopment of our hospital, which will make it one of the most modern and advanced facilities in the UK. As part of that, a new £20 million A and E unit is being built at the moment. It will be fully open in autumn 2014. I visited the building about a month ago and I can tell hon. Members that it is almost twice the size of the current one. It will have a range of fantastic facilities and services; we have doubled the equipment and doubled the number of people. The staff have been involved every step of the way in designing the new facility with the builders, even pushing the carts around the building to understand the best way in which they can achieve what they want. It will also have a dedicated adult section and a dedicated child section. The Lister hospital and its A and E are doing a great job in my constituency for people every day. A legion of doctors, nurses and clinical staff are doing this fantastic job, and I am proud of them and I am proud of the A and E in my constituency.

NHS Funding

Stephen McPartland Excerpts

Wednesday 12th December 2012 Commons Chamber

[Stephen McPartland (Stevenage) (Con)]

Thank you, Mr. Speaker, for giving me the opportunity to contribute to this important debate. Let me first pay tribute to the impassioned speech made by the right hon. Member for Cynon Valley (Ann Clwyd). The tales that she told almost left me in tears, and it is hard to imagine how difficult it must have been for her to read so many stories of that kind, given the unfortunate position in which her own family have been. I know that there are a number of nurses in the Chamber today, and in my constituency, who would be horrified to hear what happened to those individuals, and to the right hon. Lady’s family. No one would want anyone to be treated in such a manner. I think that her speech illustrated the difficulties involved in arguing about whether 0.1% is an increase or a decrease, and underlined the fact that today’s debate should focus on whether or not we provide good-quality patient care.

[Sarah Newton (Truro and Falmouth) (Con)]

Will my hon. Friend join me in praising NHS members of staff, including nurses, who are brave enough to come forward and express concern to the senior management of hospitals and in other settings when they see that their colleagues are not putting patient care first and are providing poor-quality care, so that appropriate action can be taken and atrocities such as those about which we have just heard can be prevented?

[Stephen McPartland]

I entirely agree. My hon. Friend has made an important point about the courage of staff whom many would describe as whistleblowers, and who are getting into a great deal of trouble not only with their management for casting light on what is going on in a particular hospital, but with their colleagues for telling tales.

I am proud of the NHS, I am very proud of the staff who work in it, and I am proud to have the Lister hospital in my constituency. We have heard much impassioned talk about the NHS throughout the Chamber today. I think it is fantastic that Members on both sides of the House, and all Members individually, do all that they can to improve the NHS and the service with which their constituents are provided on a day-to-day basis. I know how proud I am of the doctors, nurses and clinical staff who save lives every day in my constituency, and I know that the headlines only appear when things go wrong.

In my constituency there is an organisation called POhWER that provides an advocacy service to some of the most vulnerable individuals who are having difficulties with the NHS. It now has contracts for London, the south-east, the midlands and the east of England. It was created many years ago by a group of service users who were severely disabled and had difficulties daily in interacting with their NHS and other services. They created this charity and are its trustees. It has helped hundreds of thousands of people. It launched a telephone service in the middle of last year, and it has already received 30,000 telephone calls. I had the great pleasure yesterday of taking those involved to see the Minister with responsibility for charities, The Party Secretary, Cabinet Office, my hon. Friend the Member for Ruislip, Northwood and Pinner (Mr Hurd), to demonstrate some of the work they are doing.

Every Member, irrespective of party, wants their NHS to be the best it can be and to provide the best possible care to their constituents. We can all make political points, and my hon. Friend the Member for Southport (John Pugh) referred to the fact that the Whips on both sides put out lots of statements for us to use to attack each other. We could argue that spending in the health service in Wales is going down by 8% under the Labour Administration there, but I do not want to put that case.

Instead, I want to say how much I respect the right hon. Member for Leigh (Andy Burnham). It was refreshing to hear him say he felt he did all he could in terms of NHS spending given the constraints of the budget he had. I do not want to cast political aspersions, because I have a great deal of respect for the right hon. Gentleman. I believe he wanted to improve the NHS every bit as much as our Secretary of State and Ministers want to do so. I dearly wish the NHS was not a political football and we did not bandy about figures and information.

A great deal has been said about the first and second part of a sentence in a letter from Mr Dilnot. I have read the letter. I imagine most people would not really care about whether 0.1% less or more money was going into the NHS. They are interested in the fact that £12.5 billion extra is going in over this Parliament. The Health Committee Chairman, my right hon. Friend the Member for Charnwood (Mr Dorrell), made a powerful and eloquent speech—it was far more eloquent than mine. He explained that revenue expenditure has been growing modestly over the past couple of years, and that is the expenditure that the day-to-day care delivered to patients in the NHS comes from.

[Nigel Adams (Selby and Ainsty) (Con)]

Does my hon. Friend accept that there is discrimination against certain parts of the country, such as rural constituencies, including mine in North Yorkshire? As my constituency is rural and has a lot of elderly residents, we do not seem to get our fair share from the funding formula.

[Stephen McPartland]

I do not represent a rural constituency, but I think everybody in every part of the country should have access to the best possible heath service and there should not be any postcode rationing issues. My hon. Friend’s constituents should have access to the best NHS care; indeed, I hope it is almost as good as the care my constituents get.

NHS spending should be focused on improving the quality of care and the experience of patients and their families. We all know that things go wrong, and one of the problems is that when things go wrong, doors get closed and people feel very vulnerable and lonely. People put their mother, father, brother, sister, son or daughter in the hands of someone whom they consider a professional, and they place their trust in them. I hope all of us feel able to put our trust in those professionals.

[Gloria De Piero (Ashfield) (Lab)]

In Ashfield, there are proposals to close down wards at the community hospital. If the closure goes ahead, the situation will be particularly difficult for some patients who suffer from severe dementia, as their relatives will have to travel 17 miles to see them. Does the hon. Gentleman agree that that is unacceptable?

[Stephen McPartland]

I understand that the hon. Lady has a specific issue in her constituency, and I would like to point out one in mine: anyone in my constituency who requires radiotherapy treatment has to travel to Hillingdon in London to have access to the linear accelerators, with the typical journey being more than 4,000 miles during the course of the treatment. I do not want to blame any particular Government or party, but the reality is that there are difficulties everywhere. I have a campaign, which I would love all hon. Members to join, to bring cancer care closer to people’s homes, and I want to have a radiotherapy unit based in my constituency. There are discrepancies and disparities all over the country, and it would be great if we could iron them out.

[Grahame M. Morris]

Does the hon. Gentleman agree that a good use, not only in Stevenage, but across the country, of some of the underspend that has been mentioned by hon. Members from across the House would be to buy advanced forms of radiotherapy equipment?

[Stephen McPartland]

That would be fantastic use of the money, but Hillingdon already has eight linear accelerators and a cyber knife, which reduces the course of someone’s treatment from about 25 visits to eight. The key for my constituents is that the people accessing that service are generally elderly and they would have to access it by public transport, which they find very difficult, so they rely on friends and family. I want that treatment to be brought closer to their home, which goes back to my point about the patient’s experience.

Earlier in the debate, Mr Deputy Speaker called for a little bit of Christmas cheer, so I have great pleasure in being able to announce that earlier this morning, when it was minus 6°, I was outside my local hospital having my photograph taken and the Government were announcing £72 million of funding for infrastructure in the Lister hospital—the money is part of an ongoing investment programme worth more than £150 million. That is the third of 11 projects. We are having a huge accident and emergency department rebuilt, and a lot of people are going to be accessing it; and we are having new ward blocks, theatres and endoscopy units. A huge range of services are coming to the Lister hospital in Stevenage; it is fast becoming a centre of clinical excellence. I know that many hon. Members think I am quite lucky, and I am very proud and happy about what is happening.

That investment highlights one of the issues I want to raise. When we have these debates, we often find that the passions of hon. Members on both sides about small amounts and figures can create a sense of fear in the NHS that services are being delivered poorly day to day. In my constituency, for the past two years, construction has been going on and new services have been coming to my local hospital, with a range of users able to access them. That building will go on until 2014 to early 2015, and it is what we are calling phase 4. I refer to my radiotherapy campaign as phase 5—people are not aware of that, but we are keen to access the money for it. The hon. Member for Easington (Grahame M. Morris) suggested using the £1.6 billion underspend, and it will now be my target for where we get the funding.

In my constituency, the NHS is daily delivering better and better care; a legion of doctors, nurses and clinical staff, backed up by great administration staff, are providing a fantastic level of service and improving the NHS. I am proud of the NHS and of the staff in my constituency who work in the NHS, and I am delighted that we have had the opportunity to have this debate.

Health and Social Care Bill

Stephen McPartland Excerpts

Monday 31st January 2011 Commons Chamber

[Stephen McPartland (Stevenage) (Con)]

Does my hon. Friend accept the figures from the Royal College of Midwives showing that in 1997 there were more midwives than managers in the NHS, and in 2009 there were 18,000 more managers than midwives?

[Dan Byles]

I am grateful to my hon. Friend for making the point exactly. The NHS cannot carry on with management levels and layers of bureaucracy of the kind that the previous Government put in place. With an ageing population, it is even more important that the largest possible slice of the NHS budget is spent on patient care, and as little as possible on management and administration. Reform of the commissioning process is central to that.

The Bill has been criticised by Opposition Members for doing something that Government Members have been critical of in the past: reorganising the management structures yet again. However, anyone who looks at the Bill honestly and dispassionately will see that it does not reorganise NHS management structures, but sweeps away a whole tier of NHS management structure. It is not another round of shuffling the management deck chairs, but a bonfire of some of those management deck chairs. I strongly welcome the fact that the Bill abolishes primary care trusts and puts general practitioners in charge of commissioning services on behalf of their patients. I criticise nobody who works within PCTs, but I freely criticise the structure that puts health care commissioning in a bureaucratic body that operates at arm’s length from patients and doctors.

I am conscious that many hon. Members still wish to speak, so I will draw my remarks to a close with one plea to the Minister. I understand that under the new GP commissioning process, GP consortia will, in effect, be given control of two budgets: the budget for clinical services and a small budget to cover the management costs of taking over the commissioning process. I also understand that they will not be permitted to transfer unspent funds from the management budget to the clinical budget. If my understanding is correct, I urge the Minister to reconsider that restriction. In giving the consortia a budget for management that cannot be transferred to the clinical budget, there is no incentive for them to drive down their back-office costs. For the process to work most efficiently, GP consortia must have an incentive to drive down their back-office costs in the knowledge that it will allow them to spend more on their patients. To do otherwise gives the incentive to use up the management budget regardless of need—to hire that extra secretary, not because there is a need, but because the budget is there to do so. Such unfortunate incentives from central Governments over the years have led to many productivity problems throughout the public sector and to a use-it-or-lose-it culture. I urge the Minister to look again at that restriction, which seems to go against the new culture of efficiency and responsibility for budgets that we are trying to instil across the public sector.