Ovarian Cancer

Stuart Andrew Excerpts

Wednesday 12th October 2011 Westminster Hall

[Stuart Andrew (Pudsey) (Con)]

It is a pleasure to serve under your chairmanship, Mr Rosindell. It has been a good many years since I last did so, when I was chairman of the Welsh Young Conservatives and you were chairman of the national Young Conservatives. I am grateful for the opportunity to raise this important subject. I am conscious that many hon. Members wish to contribute, many of whom have personal and constituency experience of the disease. It is important to hear from as many of them as possible, so I shall make my opening comments as brief as I can.

My personal experience of the effects of ovarian cancer occurred some 40 years ago, and it meant that I never knew my grandmother. In her 50s, she suffered from the disease, which sadly took her life in my first year of life. She was buried on my first birthday. Clearly, at that age I was too young to know, but she was, by all accounts, a truly wonderful lady and, due to the cruel nature of the disease, her death was a loss that impacted on my family for many years.

Some 40 years on, I was elected a Member of Parliament in 2010, and like all new MPs, I am sure, I felt somewhat overwhelmed when I came to this place. What staggered me more than anything was the volume of invitations that I received from many different charities. One stood out—that from Target Ovarian Cancer. It stood out because it informed me that a constituent would be attending a reception, and because of the impact that the disease had had on my family.

I worked in the charity sector for 16 years and, as I was involved in politics, I thought I knew how to get to Members of Parliament, but I realised how wrong I was when I saw the volume of correspondence that I received. I thought it clever of Target Ovarian Cancer to make its invitation personal by bringing a constituent down here. In June, I attended that reception and had the opportunity to meet my constituent, Chris Shagouri. She is one of those people with whom one instantly clicks; she is inspirational. I listened to her speak about how late diagnosis of the cancer had impacted on her, her husband and her family. She talked about her ongoing battle to keep the disease at bay, and it is clear that she has great determination, but it was easy to wonder how much easier it might have been had the diagnosis been made earlier.

As the reception continued, I heard, time and again, moving stories from other women about their experiences. That and Chris’s persuasive manner convinced me to support the all-party group on ovarian cancer, which was being set up.

Sadly, diary clashes have restricted the number of meetings that I have been able to attend, but it is impressive that they are regularly attended by women who reinforce over and again the message that early diagnosis is necessary. At the most recent meeting, we heard again from women from throughout the UK about their experiences. At the most recent reception, four women gave personal accounts of their problems, which motivated me to bid for this debate. I am grateful to have been given that opportunity.

Ovarian cancer is not rare. It is the fourth most common cause of cancer death in women after breast, lung and bowel cancers. Every year, some 6,500 women are diagnosed and, staggeringly, 4,400 die every year. Just 36% of women who are diagnosed survive for a further five years. Those figures are staggering, compared with more than 80% for those who suffer breast cancer. It is also staggering that in three quarters of women who are diagnosed, the cancer has already started to spread. Those figures are scary.

The holding of this debate prompted someone to contact me this week. They wrote:

“My mother died aged 67 in 2009 with Ovarian Cancer. By the time she was diagnosed, the cancer wasn’t in the early stages and she was given only a 2% chance of living for 5 years. She fought all the way with various treatments and lived for 7 years after diagnosis.”

[Jim Shannon (Strangford) (DUP)]

I congratulate the hon. Gentleman on raising the issue. As he rightly said, every one of us can relate to a constituent or family member with the disease, and most people are aware that the cancer is hereditary or genetic. Does he believe that whenever someone is diagnosed with ovarian cancer there should be immediate checks on other family members—sisters, nieces, and daughters—to ensure that the hereditary effect is not passed on? Does he believe that that should be done quickly after diagnosis?

[Stuart Andrew]

I am grateful for that intervention. I agree absolutely that anything we can do to ensure early diagnosis of conditions can only help. In the long term, it is better for the individual concerned, and certainly better for the rest of the family, who go through equal concern.

[David Simpson (Upper Bann) (DUP)]

I congratulate the hon. Gentleman on securing the debate. Not long ago in my constituency, we ran an event to raise money for ovarian cancer treatment. An astounding finding was the number of young women aged 18 to 25 who are affected. I was astonished, because my impression had been that the disease affected older women, but it seems to be on the rise among younger women and is known as the silent killer. Does the hon. Gentleman agree that early intervention is vital? That could be done with blood tests, which some GPs have called for, and perhaps in schools, to identify this tragic killer of women.

[Stuart Andrew]

The hon. Gentleman makes an important point. I will talk about early diagnosis, which is crucial, as is awareness—making people aware of the symptoms. That is crucial in the campaign to fight this terrible disease.

I return to the letter that I was quoting from, which is relevant to the point that the hon. Gentleman made:

“I really hope the message regarding this disease can increase, as I wouldn’t want anyone else to suffer as my mother did. If she had gone to her GP straight away when she presented with symptoms and the GP acted straight away, then she may still be with her family, who miss her so much.”

That is a powerful testament to the problem that the disease causes.

According to figures from the National Cancer Intelligence Network, only pancreatic cancer involves a higher proportion of people diagnosed with the late stage of the disease. but with ovarian cancer, unlike pancreatic cancer, we know what the symptoms are. That was not always the case. The hon. Gentleman referred to it as the silent killer, which is often how it is referred to, but in most cases the symptoms go unrecognised for some time by the women or their GPs. It is alarming that Target Ovarian Cancer has found that one third of women waited six months or more after visiting their GP for a correct diagnosis. That is staggering.

The National Institute for Health and Clinical Excellence has published guidance on the recognition and initial management of ovarian cancer, and listed symptoms such as persistent bloating or increased abdominal size, abdominal or pelvic pain, difficulty eating and feeling full quickly, and the need to urinate more frequently. If women experience such symptoms frequently, particularly more than 12 times a month, they should undergo tests.

[Ian Paisley (North Antrim) (DUP)]

Under NICE guidelines, the first thing that should be done is a CA 125 test. Is the hon. Gentleman concerned that there are apparently restrictions on a GP’s ability to obtain that test for their patients, and importantly that there have been attempts block those tests from being carried through to pathology laboratories? The CA 125 test is the one thing that can spot the disease and increase the possibility of early diagnosis and greater chances of success.

[Stuart Andrew]

I am grateful for that intervention, which proves the need for the debate. I hope that we can take forward many of the issues raised today to try to tackle the disease. The hon. Gentleman’s point is incredibly valid and important.

NICE’s information is a step forward because it offers women, and importantly GPs, the chance to distinguish between ovarian cancer and more common but less serious conditions such as irritable bowel syndrome, which is the most common misdiagnosis. The ovarian cancer awareness measure, which is an accredited tool used by Target Ovarian Cancer in its pathfinder study, showed that only 4% of women felt confident of spotting the symptoms of the disease, and just 9% were aware that persistent bloating is the most common symptom of ovarian cancer. Compare that with 76% of women who recognise that a lump is the most common symptom of breast cancer.

[Kevin Brennan (Cardiff West) (Lab)]

Does the hon. Gentleman agree that because of the specificity of the symptoms of ovarian cancer, there is a case for a specific campaign to raise awareness of the disease, rather than relying on a generic campaign, which is the approach that the Government have tended to favour so far?

[Stuart Andrew]

The hon. Gentleman is in danger of stealing my thunder, but I am glad that he has emphasised my point before I have made it.

[Iain Stewart (Milton Keynes South) (Con)]

I congratulate my hon. Friend on bringing this important matter before the House. He is right to highlight awareness, but there is also the need for better information for women and their families following diagnosis. A close relative of mine was diagnosed with the condition, but there was a lack of knowledge of where to find more information about it. That led me and others to look online at a condition that was similar, but had a very different five-year survival rate. That caused a lot of unnecessary anguish to close family members.

[Stuart Andrew]

My hon. Friend raises a valid point. I worked in the hospice movement for about 15 years, and time and again we heard from parents of children at the hospice or patients in the adult hospice that when they were told of their disease, they almost went blank; they heard not the rest of the information, but just the dreaded diagnosis. It is crucial that people are given as much information as possible to take away and digest later.

As I said, 76% of women recognise the most common symptom of breast cancer, but there is clearly a lack of understanding about the significance of symptoms that they may experience due to ovarian cancer. Furthermore, GPs are not picking up the disease quickly enough. Just 22% of women are urgently referred to the two-week cancer referral route, and the rest are either sent away, or treated or referred inappropriately. Late diagnosis has been identified by the cancer benchmarking study, funded by the Department of Health, as a key driver for the poor ovarian cancer survival rates. That study seeks to understand the differing survival rates between countries for breast, lung, bowel and ovarian cancer. For some reason, despite the findings, ovarian cancer was the only cancer in the study not to be included in subsequent awareness campaigns. A large majority of women who are diagnosed in the later stages of the disease will experience recurrences, and many will develop resistance to chemotherapy.

My constituent, Chris Shagouri, is undergoing treatment yet again to try to slow the progress of the disease. Her strength and commitment to help to improve the lives of women who are diagnosed with ovarian cancer is amazing, especially when she could be forgiven for wanting to concentrate her efforts on herself and her close family. Chris Shagouri is representative of the many women who have attended meetings of the all-party group on ovarian cancer, and who share a determination to change the status quo. They often say that if just one woman gets a quicker diagnosis it will have been worth it, because for that woman this really is a matter of life and death. I hope that we can reach a better total than just one woman.

Treatments for ovarian cancer are highly intensive and invasive. An American study showed that, compared with women who have breast cancer, those with ovarian cancer spend nearly 10 times as long being treated in hospital in the first year after diagnosis and the last year of life. There have been no new life extending treatments for women with ovarian cancer during the past 20 years.

Why do members of the all-party group on ovarian cancer want to have this debate? Because we feel that, right now, an important opportunity to make much needed progress is being overlooked. I welcome the Government’s work, and commend them for it, with the cancer drug fund and the palliative care strategy —it was long overdue. In January, the Government published their new cancer strategy, which contained a strong commitment to improving early diagnosis and a multimillion pound investment in cancer awareness campaigns—fantastic stuff. It initially included regional breast, lung and bowel cancer campaigns, and recently we have heard that a national bowel cancer awareness programme will be rolled out next year, following the success of the pilots. New campaigns on oesophogastric cancers, and kidney or bladder cancer, will be run at a local level. The all-party group remains frustrated that ovarian cancer is not included in that admirable work.

The Government are committed to saving more than 5,000 lives a year from cancer by 2014-15, and women with ovarian cancer could represent 10% of that figure. Each year, up to 500 women lose their lives unnecessarily to ovarian cancer because we do not do as well as other European countries. The Government’s study showed that late diagnosis is a key driver of deaths from ovarian cancer in the UK, and it is curious that the condition was not included in the awareness campaigns in this country.

Why can an awareness campaign on ovarian cancer not be started now, even in pilot form? We applaud the Minister for the commitment to improve people’s chances of surviving cancer, but urge him to include ovarian cancer in the awareness work that is being done. Every day we wait, another one or two women, like my grandmother or such as Chris Shagouri, and many others who have been campaigning will lose their lives unnecessarily. As a matter of urgency, I ask the Minister whether he will consider an awareness campaign and whether he will meet with representatives from the all-party group on ovarian cancer to discuss how we can take such a campaign forward and stop other women suffering in future.

Congenital Cardiac Services for Children

Stuart Andrew Excerpts

Thursday 23rd June 2011 Commons Chamber

[Stuart Andrew (Pudsey) (Con)]

I beg to move,

That this House notes the review led by the Joint Committee of Primary Care Trusts into the reconfiguration of children’s heart surgery; welcomes its aim of establishing a more sustainable provision of congenital cardiac services in England which has strong support from professional associations and patient groups; notes that concerns have been expressed during consultation on the proposals; calls on the review to take full account of accurate assessed travel and population projections, the views of ethnic minority communities affected, evidence supporting the co-location of children’s services, and the need for patients and their families to access convenient services; and therefore calls on the Joint Committee not to restrict itself to the four options outlined in the review but instead to consider further options in making its final recommendations.

I thank the Backbench Business Committee for allowing us the opportunity to hold this valuable debate. I apologise to the Committee and the Clerks for taking so long to table the motion, but I feel passionate that it is right to get a motion that has the effect that we want. I have probably learned more this week than in the past year, and if I have not got it right, I am sorry. I also thank the hon. Member for Scunthorpe (Nic Dakin) and my hon. Friends the Members for Oxford West and Abingdon (Nicola Blackwood), for Leeds North West (Greg Mulholland) and for Winchester (Mr Brine), who have helped me through the past week.

This debate is timely, as the consultation by the review of children’s heart surgery around the country will come to an end soon. I completely agree with and support the professionals and patients who say that the review of congenital cardiac services is needed. Of course, we all want what is best for our children, and we want the best centres in the world. It is absolutely right and necessary that we learn from past mistakes in other units, but serious concerns about the process have been raised with me by clinicians and parents. I believe that it is my duty and that of others to scrutinise the review if we feel that there are problems.

There have been accusations that this has been turned into a political campaign. I stress that I have been keen not to make this a political campaign, and I have been incredibly impressed by the cross-party support of the Members from across the country who have been helping us. We will hear from other Members from all over the country—the debate is not just about the unit in Leeds—but I want to highlight the fact that my concerns relate to the review and not just to one centre. Although I will naturally refer to Leeds to highlight examples, I am sure that other Members will highlight similar problems with the review and relate them to their units. I am keen that the campaign does not set one centre against another, but that they are all considered equally.

I want first to deal with what I perceive as the flaws in the review. That is my main concern. From speaking to patients and families, I know that that has made them lose confidence in the review. We would all agree that public confidence in the review is important. The review has stated that the objective is to have centres that perform 400 procedures a year. The first version of the pre-consultation business case showed that patients from Doncaster and Sheffield would travel to Birmingham. That is absolutely right and in line with advice from the Yorkshire and Humber specialised commissioners, but in version 2 and the consultation options, the flow had changed to Newcastle. I understand that that helps the Newcastle figures, but I and anyone else who knows the area would surely question the likelihood of that happening. Far more plausible is that people would go to Birmingham or Leicester. What happens to Newcastle then? In addition, one of the options—the 400 minimum procedures—is not even met. The JCPCT explains that that is due to new patient flows.

At a number of centres, activity has increased in the past year. For example, Leeds is now doing 370 procedures a year, but in the pre-consultation assessment it was not afforded the same consideration as other centres that carry out similar numbers of procedures. Furthermore, the health impact assessment had not been completed before the final options were presented for consultation. The independent company undertaking that work said that this was not the usual approach taken in large reconfiguration proposals. That means that the public will have no access to the findings during the consultation period.

An issue that affects the black and minority ethnic community is that until 24 May the consultation questionnaire was available only in English and Welsh. As a Welsh speaker, I approve of having a Welsh version, but it was not until 12 weeks after the consultation began that the questionnaire became available in other languages, leaving just five weeks for the community to respond. In Leeds, more than 20% of the patients come from the BME community, so this is an important issue that needs to be addressed.

Finally, on the flaws, yesterday when the Safe and Sustainable team were here, we heard them say that co-location of services, in their view, meant anything up to 10 minutes away, yet the British Congenital Cardiac Association issued a statement on 18 February 2011, two days after the release of the business case, to clarify its professional view of the importance of co-location. I believe this demonstrates the BCCA’s dissatisfaction with the review’s interpretation of co-location.

[Julian Smith (Skipton and Ripon) (Con)]

My hon. Friend refers to a meeting of the steering group with MPs yesterday. Does he agree that it was a slightly strange meeting and that there was a significant degree of defensiveness on the part of the steering group?

[Stuart Andrew]

That is a very good description of the meeting. I agree with my hon. Friend. If nothing else, it is good that this debate got the review board to come to Parliament and speak to MPs so that we could express our concerns.

On the case for Leeds specifically, as I said a moment ago, co-location of services is considered crucial by the BCCA. In Leeds we have one of the largest children’s hospitals in the country. A considerable amount of time has been spent bringing all the children’s services under one roof at Leeds General infirmary. The centre serves a population of 5.5 million. I cannot understand why the option has not been considered for Leeds when it has been considered for centres in Birmingham and Liverpool. Yorkshire has a growing population and a growing BME community. As I said, 20% of the patients come from that community. It is crucial that we take account of population numbers when considering the review.

How we care for all those families is also important. When I worked at Martin House children’s hospice, it was not just the care of the poorly child, but the care of the whole family, that was important. When people have a very poorly child, they want their family to be together. It has been said that parents will travel anywhere. Of course they will, but does that mean that we should make them travel when there could be alternatives?

The Yorkshire and Humber congenital cardiac network board has a well-established network model, is regarded as an exemplar in this country and is held in high regard across the region by both the professionals and the patients involved in the service. Although this was recognised by Sir Ian Kennedy’s expert panel and Leeds Teaching Hospital Trust was awarded the maximum score for networks in that assessment, the JCPCT, as part of the scoring of options for future configuration of centres, gave all potential networks the same score. It is unclear why a proven track record of delivering an exemplary network model was not considered an important factor in the ability to deliver this across a larger population and greater geographical spread in the future.

On the requirement for a minimum of 400 operations, Leeds delivered 316 cardiac operations in the 0 to 16-year-old group in 2009-10 and 372 in 2010-11. The process of recruiting a fourth surgeon is under way. By the time the review’s recommendations are implemented, Leeds Teaching Hospital Trust will deliver the minimum number of operations, which is 400, and it will have the minimum number of surgeons, which is four, that the standards require from within the current population base. Equally, Leeds Teaching Hospital Trust has provided detailed information to the Safe and Sustainable team for expansion of the current service, should it be required to deliver a change in capacity to support patients from a centre that does not get designation.

The review said yesterday that the debate is not about current services. It is about what will be provided in the future. The figures that I have cited show that Leeds’ case for being a centre caring for more than 400 patients is strong. Many patients and particularly clinicians have pointed out to me that it seems odd that we are having a review of children’s heart services without referring to adult services. Many of those patients will be the same: those children will grow up, and the doctors who perform the operations are often the same people caring for both groups, so why are we not looking at adult services now? It has been suggested that that review should come later, but if we have made decisions about children’s heart surgery, surely we have pre-empted what might happen in the future.

[Greg Mulholland (Leeds North West) (LD)]

I thank my hon. Friend and neighbour for giving way. Going slightly further on his last point, does he realise that if those surgeons are no longer there, they will not be able to perform operations on adults? Adult surgery would be very detrimentally affected.

[Stuart Andrew]

I could not agree more. My hon. Friend is right; if we have a review of children’s cardiac services, surely we must consider what will happen to adult services. We should be talking about that now.

I could go on much longer and talk about the cases of various parents whom I have met, but I know that other hon. Members will do that, probably far more eloquently than I could. I am keen that the motion is supported because I want it to send a clear message to the review team that we are asking it to consider all the points that will be made today and all the points that have been made by the campaigns across the country. It was a privilege to go to Downing street the other day with children, patients and clinicians from the Leeds centre to present a petition of more than 500,000 names. That is a significant petition by anybody’s standards and a credit to that campaign.

I am concerned that after consideration of the consultation responses, it will be difficult to respond to all the evidence by pigeon-holing them into the four options in the review. That is why our motion today urges the joint committee not to restrict itself to those four options and instead to think outside the box, as they say. Let us look at a different proposal that delivers the services and the quality that we want and also takes account of all the responses that we have received.

Finally, I want to pay a personal tribute to all the families and campaigners, especially in Yorkshire and the Humber. In all the campaigning that I have ever done, I have never seen such a well-organised and dedicated campaign. The subject is sometimes emotional, but the responses that have come from patients across Yorkshire shows that there can be an alternative that delivers the services that we want. I hope the House will support the motion.

[Several hon. Members]

rose—

--- Later in debate ---

[Greg Mulholland]

It would be very worrying if the extraordinarily overwhelming views expressed by people were ignored, but of course the clinical view is vital, and, as I have said, many clinicians have a problem with the flaws—clinical flaws—in the review.

[Stuart Andrew]

My hon. Friend mentioned the co-location of services. As I said in my speech, Leeds has spent considerable time ensuring that all children’s services are under one roof. If we lost the heart unit there, might not other services be affected as well?

[Greg Mulholland]

I have not yet had a chance to congratulate my hon. Friend on the way in which he has co-ordinated our campaign. It has been a pleasure to work with him so closely, and I look forward to continuing to work with him and other colleagues. He is right: one of those serious flaws is the failure to consider the impact on adult heart services, which would be a huge problem.

There is real concern out there, as has been demonstrated not only by the petition in Yorkshire and petitions in other parts of the country, but by the views expressed by many respected practising and retired clinicians. The concern about the closures is understandable, but there is also concern about the review itself. There is concern about the process, about the conclusions reached so far, about the lack of consistency in the recommendations, about the lack of logic in relation to the premise of the review, and, I am sorry to say, about a lack of impartiality.

That is why it is right for the House to have an opportunity to express that concern on behalf of all the areas concerned, and why it is fitting that the Minister of State, Department of Health, the right hon. Member for Chelmsford (Mr Burns), is present. I thank the Minister for the way in which he has engaged with us, and I urge Members in all parts of the House to support the motion, so that we can address the concern that has been expressed outside and inside the House by considering the possibility of other configurations.

I wish to echo three points that have been made about the wonderful Leeds unit. The first is about the co-location of services. The unit is a case of true co-location, which is what the British Congenital Cardiac Association has called “gold standard” care. Leeds is currently one of only two hospitals shown in the review to have such a type and level of service. Mr Joe Mellor, a consultant anaesthetist at Leeds, says:

“What is particularly upsetting about the proposals is that our patients from Yorkshire would leave the Leeds unit and have to travel to Newcastle or Leicester. Leeds has centralised all its children’s services onto one site. Neither Newcastle nor Leicester have come close to achieving this. Congenital cardiac surgery is a very complicated form of medical treatment. If in Leeds we encounter a problem where the child needs the help of an intestinal surgeon, or a neurosurgeon, or need renal therapy, or a host of other possible therapy, then we get it immediately in our own children’s hospital.”

Jonathan Darling, a consultant paediatrician at the Leeds General infirmary, states:

“To lose heart surgery from the Leeds Children’s hospital would be a huge blow, especially when we have just centralised services precisely to realise the benefits of having all paediatric services co-located on one site. The Review process does not seem to give sufficient weighting to this true co-location.”

I am afraid that it simply has not done so, which is worrying and quite extraordinary.

The second point that I wish to make is on the issue of population, which colleagues from the region have already raised. It simply makes no sense to close a wonderful unit that is already performing almost the number of operations that it must, when there are so many people in the area and the population is growing. I echo the comments of the hon. Member for Leeds East (Mr Mudie) when I say that of course we do not want to see the Newcastle unit close. We do not want to see any unit close, because this is about getting things right. However, I say to him and others that it would be absolutely perverse to close Leeds simply to enable Newcastle to perform a sufficient number of operations. If we stick to the number in the review, Newcastle can only perform that number of operations if Leeds closes. That is absurd.

--- Later in debate ---

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

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

[Stuart Andrew]

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

[Pat Glass]

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

--- Later in debate ---

[Catherine McKinnell]

The hon. Gentleman has put his thoughts and concerns issue on the record.

I mentioned the intentions of the Safe and Sustainable review, which was instigated by national parent groups, NHS clinicians and their professional associations. Those intentions must be the primary drivers in deciding the final outcome of the review.

I am equally concerned at suggestions that the decision and outcome of the review should be stalled, or that the remit should be altered. I am not alone in expressing such concerns. The Children’s Heart Foundation argues that that would leave

“the door wide open for another Bristol Baby tragedy”.

Meanwhile, the charity Little Hearts Matter believes that the Safe and Sustainable service reconfiguration offers—

[Stuart Andrew]

Will the hon. Lady give way?

[Catherine McKinnell]

No, I will not.

Little Hearts Matter says:

“The Safe and Sustainable Service reconfiguration offers a monumental opportunity to ensure that every child with a heart problem has access to the best heart surgery service that this country can offer—a gold standard service.”

I urge anyone in a position of influence, including hon. Members, to support that step forward, and not to halt the process because of personal bias.

A number of hon. Members are concerned about the co-location of children’s services. However, it is important to note that during the development of the £100 million new Great North Children’s hospital at the Freeman’s sister hospital, the Royal Victoria infirmary, a deliberate decision was made to retain children’s heart services at the Freeman, aligned with the world-renowned adult heart services there.

Services that simply did not exist 20 years ago have created a new generation of adults needing care, and the service at the Freeman allows for a seamless transition into adulthood. Of course, services at the Great North Children’s hospital are available to the Freeman in a matter of minutes—throughout the review process, they have been recognised as though they are on the same site.

In conclusion, I am not asking those who will make the final decision to give special treatment to the children’s heart unit at the Freeman, or indeed to the people of Newcastle and the north-east. I am all too aware how difficult this process has been for all children’s heart units under consideration. Each is valued and each has a great story to tell. However, I am asking that the decision is made on the grounds of clinical excellence and the quality of services that are currently provided, and on those grounds alone. I urge that a decision on the future of children’s congenital cardiac services is not put off or prolonged, because the safety of babies and children in need of heart surgery should be paramount in this debate.

--- Later in debate ---

[Stuart Andrew]

I thank everyone who has taken part in this debate, which I think all will agree has been very good and knowledgeable. Members have spoken passionately in favour of their units. The right hon. Member for Newcastle upon Tyne East (Mr Brown) and the hon. Members for North Durham (Mr Jones) and for North West Durham (Pat Glass) spoke passionately in favour of the Freeman hospital. The right hon. Member for Oxford East (Mr Smith), the hon. Member for Southampton, Test (Dr Whitehead) and my hon. Friends the Members for Isle of Wight (Mr Turner), for Poole (Mr Syms), for Meon Valley (George Hollingbery), for Winchester (Mr Brine), for Oxford West and Abingdon (Nicola Blackwood), for Salisbury (John Glen), for Romsey and Southampton North (Caroline Nokes) and for East Hampshire (Damian Hinds) spoke in favour of Southampton. My hon. Friend the Member for Chelsea and Fulham (Greg Hands) spoke for the Royal Brompton—I do not think I am going to get through all these.

The fact is that this debate has got to the heart of the matter. We have discussed the issues that parents and patients have been talking about, but also the concerns that clinicians have been talking about. It is important that we hear those. We heard concerns that if this review does not happen, there could be another Bristol baby tragedy. However, it was reassuring to hear that the units we have are safe. We just need to make them sustainable.

In conclusion, this has been a most excellent debate. I am sure that the Safe and Sustainable team have been listening to Members on both sides of the House. Above all, what has been brilliant about the debate has been the reassurance from the Minister that the Safe and Sustainable review is now flexible over the options and should be flexible over the number of units. That will mean a lot to the people who have been campaigning so hard on this issue, and it shows that a Backbench Business debate can work and make a real difference.

Resolved,

That this House notes the review led by the Joint Committee of Primary Care Trusts into the reconfiguration of children’s heart surgery; welcomes its aim of establishing a more sustainable provision of congenital cardiac services in England which has strong support from professional associations and patient groups; notes that concerns have been expressed during consultation on the proposals; calls on the review to take full account of accurate assessed travel and population projections, the views of ethnic minority communities affected, evidence supporting the co-location of children’s services, and the need for patients and their families to access convenient services; and therefore calls on the Joint Committee not to restrict itself to the four options outlined in the review but instead to consider further options in making its final recommendations.

Oral Answers to Questions

Stuart Andrew Excerpts

Tuesday 26th April 2011 Commons Chamber

[Mr Burns]

I am afraid that I do not accept the premise of the question. May I tell the hon. Gentleman that this Government are not seeking and will not ever seek to privatise either the whole of the NHS or an individual trust? St Helens and Knowsley Teaching Hospitals NHS Trust is, like all other health trusts, currently agreeing plans to achieve foundation trust status by April 2014. That involves ongoing discussions with the North West strategic health authority and the Department of Health to determine the issues the trust faces and the actions needed to address them.

[Stuart Andrew (Pudsey) (Con)]

May I join my hon. Friends the Members for Leeds North West (Greg Mulholland) and for Shipley (Philip Davies) in supporting the children’s heart unit in Leeds? If the review fails to take full account of, and reflect on, the issues raised, what steps will the Secretary of State take to ensure that that is done so that we can fully understand the problems that would face families in Yorkshire?

[Mr Lansley]

I understand my hon. Friend’s concern and that of colleagues in other locations across the country. If—I repeat the “if”—the consultation were not to arrive at what he or others in any specific location regarded as justified conclusions, it would be open to them, as this is a service reconfiguration of the NHS, to seek a referral of the proposal to me as Secretary of State.

Oral Answers to Questions

Stuart Andrew Excerpts

Tuesday 8th March 2011 Commons Chamber

[Mr Lansley]

I would be grateful if the hon. Lady conveyed my very best wishes to the women of Darlington on international women’s day and said to them that I know from my visits to the north-east that a general practice-led commissioning pathfinder consortium has come together in their area. It is with that consortium and their local authority that they should look at which services they think should be provided in their area, and they will have the power to make that happen.

[Stuart Andrew (Pudsey) (Con)]

What plans does my right hon. Friend have to increase the number of single rooms in the NHS? Increasing their number will help to tackle mixed-sex accommodation, and increase privacy and dignity in end-of-life care.

[The Parliamentary Under-Secretary of State for Health (Anne Milton)]

I thank my hon. Friend for that question. As was said earlier, privacy and dignity are central to all the care that we provide in the health service. Mixed-sex accommodation was not tackled by the previous Government; we are determined to tackle it now, and providing single rooms is part of that. Privacy and dignity must be maintained at all times.

Children's Heart Surgery (Leeds)

Stuart Andrew Excerpts

Thursday 3rd March 2011 Commons Chamber

[Stuart Andrew (Pudsey) (Con)]

I am grateful for the opportunity to hold an Adjournment debate to discuss the Leeds children’s heart unit.

Before being elected, I spent a considerable part of my career in the children’s hospice movement. During that time, I built up a great deal of understanding of the issues faced by families who have a child who is very poorly. Leeds MPs are working as a cross-party group to do the best for our city. We have each taken on a role, and mine has been in relation to health. During the Christmas recess, I spent two days at the two hospitals in Leeds. I was particularly interested to see Leeds general infirmary’s children’s services, which have recently been reconfigured and are all in one place. It was my first opportunity to visit the heart surgery unit there. At that point, I learned for the first time about the safe and sustainable review of heart units across the country: at the moment, there are 11 units in the United Kingdom, and the national health service propose to reduce that number to six or seven.

The review has already published four options, and I am surprised and disappointed that Leeds features in only one of those. It is my belief that if the Leeds unit closes, it will leave a huge gap in provision, from Leicester or Birmingham in the south, to Newcastle in the north, and Liverpool to the west. It will mean that children from Yorkshire, north Derbyshire and north Lincolnshire will have to travel long distances, at considerable expense to their families. Indeed, I am aware of families in your constituency, Mr Deputy Speaker, who have been using the service. People from far and wide are dependent on the service at Leeds, so there is an effect not just on Leeds but across Yorkshire and neighbouring counties.

[Nic Dakin (Scunthorpe) (Lab)]

I congratulate the hon. Gentleman on having secured this timely debate. Like him, I spent some time observing children’s heart services in Leeds a few months ago. Only this week I was contacted by a constituent who expressed concern about the impact of closures. That constituent’s daughter is now five years old. When she was eight days old, she was able to undergo important surgery in Leeds. Does the hon. Gentleman agree that Leeds is particularly well placed, and that its expertise and critical mass of children’s services make it very necessary for it to continue its excellent work?

[Stuart Andrew]

I entirely agree. I was about to deal with that point. I believe that there is a very strong case for Leeds. It has the capacity to expand, and is within a two-hour drive for nearly 14 million people. It has one of the highest population coverages among all the units in England, with 5.5 million people in the Yorkshire and Humber region. Leeds is, of course, centrally located in the north of England, and can accommodate patients from outside the current catchment area.

[Alec Shelbrooke (Elmet and Rothwell) (Con)]

I congratulate my hon. Friend on securing a debate on an issue that is vital to the people of our city. Leeds is not only central, but has been described as the motorway city. It has excellent rail links as well, which makes speedy access to the hospital possible.

[Stuart Andrew]

I am beginning to think that some Members have already seen my speech. I am getting ahead of myself. We have the M1, the A1, the M62 and excellent rail links, which make Leeds very accessible. The Leeds Hospitals NHS Trust has centralised children’s services, which I think meets the requirements of the Department of Health’s critical interdependency report. On 18 February the British Congenital Cardiac Association, which is a leading support organisation of the safe and sustainable review, released a statement saying:

“For these services at each centre to remain sustainable in the long term, co-location of key clinical services on one site is essential.”

Leeds General Infirmary is at the forefront of work on inherited cardiac conditions, and has an excellent record of providing safe, high-quality children’s heart surgery. The Yorkshire region has significantly higher birth rates than other parts of the country, particularly the north-east, and there is no doubt that demand will increase.

The review is informed by the overall opinion that a reduction in the number of centres is the best way in which to secure a safe and sustainable future service. It is guided by four principles, and I believe Leeds more than meets their requirements. The first is quality. The paediatric cardiac service at Leeds General Infirmary extends from pre-natal diagnosis to the treatment of congenital heart disease in adults, with excellent clinical outcomes. It has high standards and a personal service, and, as I have said, is located very centrally.

During the assessment process, Sir Ian Kennedy and his assessment panel visited every children’s heart surgery unit in England. They produced individual assessment reports on each of the units two weeks before the presentation meeting at the joint committee of primary care trusts on 16 February. At the meeting, the four reconfiguration options were presented. They were based on a number of factors contained in the panel’s assessment reports. However, I understand that there are significant factual inaccuracies in Sir Ian Kennedy’s report on the Leeds unit, and that its representatives were given no opportunity during the process to comment or request amendments of the factual inaccuracies before decisions were made about the configuration of the options for consultation.

At a meeting of the all-party parliamentary group on heart disease on 9 February, when asked when units would be able to challenge and amend inaccuracies in their reports, Jeremy Glyde, the programme director of the safe and sustainable review, said that that could be done during the consultation process.

The reports that the reconfigurations were based on contain fundamental inaccuracies, but they can be challenged only during the consultation period to decide which option is preferred. For Leeds, these inaccuracies include the following. Sir Ian Kennedy’s report documented that Leeds has no transition nurse and separate paediatric intensive care unit; neither point is factually accurate, to the extent that his assessment panel actually met, and talked to, one of the unit’s three transition nurses. The joint committee of primary care trusts advised at its meeting on 16 February that Leeds had stated that it could not do more than 600 operations. Again, that is factually incorrect— Leeds was never asked—but it was stated as the reason why two of the 14 options that were considered were discounted. The commissioners have acknowledged that this was an assumption and not based on what Leeds had said. In the pre-consultation business case for Leeds, start-up costs were reported as £2 million. That figure was not provided by Leeds, and is not representative of the accurate costs provided to the safe and sustainable review panel.

[Craig Whittaker (Calder Valley) (Con)]

I congratulate my hon. Friend on securing the debate. A young constituent of mine, Libby Carstairs, was in a poorly state and spent more than six months in the Leeds heart unit. The beauty of her being in Leeds was that her parents, her grandparents, and sometimes even some of her friends, could come over to aid her recovery process. Also, her head teacher from Carr Green school had the privilege of being able to go there with cards from her friends. Does my hon. Friend agree that the value of that to young Libby’s recovery process far outweighs any monetary value?

[Stuart Andrew]

I completely agree. When I worked at Martin house, we found that one of the big problems was the travelling distances—some people lived on the coast in Scarborough, for instance. It is very important that families are able to get to a centre quickly, because when a child is sick they want their mum and dad there—and we want that when we are a bit more than a child too. These facilities must be accessible, therefore.

[Julian Sturdy (York Outer) (Con)]

I too congratulate my hon. Friend on securing this important debate for our region. Many of my constituents in York are very concerned about the potential closure, which would mean that they would go to Newcastle, so my hon. Friend makes a good point when he says this is about the whole region. Because of the lack of transport links on the eastern coast of our region, it could be greatly affected by the closure, and I do not think sufficient account has been taken of that.

[Stuart Andrew]

Given the location of Leeds and the extent of the population all around it, it seems very odd that Leeds is not being considered.

[Julian Smith (Skipton and Ripon) (Con)]

I cannot think of a better colleague to lead this debate than my hon. Friend. Earlier today, I received an e-mail from Lois Brown, whose daughter Amelie was born with half a heart. She and her surgeons believe that her daughter would have died if Leeds had not been geographically close. Does my hon. Friend agree that the presence of LGI is the difference between life and death for many children in North Yorkshire, one of the most rural counties in England?

[Stuart Andrew]

I absolutely agree. For hearts, time is of the essence. We need to be sure that people can get where they need to be quickly. I met my hon. Friend’s constituent the other day, and she spoke very powerfully and emotionally about what that meant in her case. I cannot imagine how families in these situations must feel. It is imperative that there is a facility close by.

Returning to the reviews, there are also inconsistencies in the application of some of the principles. So, for example, Liverpool and Birmingham are in all the options because of density of population and access for patients, but the same does not seem to apply to the Leeds case. That is odd and I do not know why the Liverpool and Birmingham cases are different.

Not enough emphasis has been given to co-location. The facility at Leeds general infirmary is wonderful now—I am given to understand that it is the second largest children’s service in the whole country—so taking away its heart unit and the expertise that has been gathered there over the years is strange. This is not just about children’s heart services, because the process has failed to seek views from adult congenital patients. The doctors who operate on the children also operate on the adults and it appears obvious that wherever the children’s heart services go, so, too, will the services for adults. Will they have had an opportunity to be consulted on what was going to happen to those services? This is about a much wider point than just children’s services.

[Alec Shelbrooke]

My hon. Friend may be coming to this issue, but could he comment on the fact, which has been put forward every now and again, that Newcastle is favoured because its facility performs adult heart transplants? We recognise that surgeons have equal skills and just because somewhere does the adult heart transplants, it does not necessarily mean that we should move the children’s heart surgery to that department.

[Stuart Andrew]

That is a very valid point and I shall shortly discuss something that was said the other day because it will comment on that.

I shall conclude now because I know that a couple of other Members have expressed an interest in speaking in this debate. I understand that this process is going to be difficult and that there is a need for a review. Severe problems have been experienced in parts of the country and it is right that a clinically led decision is made, but I want that decision to be made on the basis of facts that matter to local people and that are accurate. As I have mentioned, there are real problems with the assessment and the options that have been mentioned. Emotions will of course run high, because this is a very emotive subject. It is incredibly moving to listen to the families I have been speaking to since this matter first arose. They describe how their children and their babies were so close to death but how, thanks to the expertise that was provided at this location, which they were able to reach, their children are at least here and receiving the wonderful care that is provided, although they may be poorly.

There is a case to be made for the facility at Leeds in terms of geography, population and access. We like to tick boxes in this country and everything is ticked in this case for Leeds. I would be grateful if the process could be examined. Some powerful comments were made and cases were mentioned at a meeting held with parents and clinicians here on Tuesday. They are desperate for this unit to remain open. As someone said at that meeting, the doctors should move where the patients are; it should not be the other way round.

--- Later in debate ---

[Mr Burns]

I am very grateful to the right hon. Gentleman for making that point. He puts me in a slightly difficult position, because I genuinely do not want to be unhelpful. A consultation is ongoing through the joint committee of primary care trusts, however, and it would be totally inappropriate to start debating the rights and wrongs, the pluses and the minuses, of any one individual hospital or centre. It would be inappropriate—it might be construed as trying to influence, pre-judge or prejudice the consultation process—and I am sure that the right hon. Gentleman agrees wholeheartedly that it would be totally unacceptable for Ministers to start getting involved in that way. I hope he will accept that, for the best of intentions, it would be inappropriate for me to start debating that issue with him, however right or wrong he might be. I can tell him, none the less, that he has ample opportunity during the consultation process to make those very points to the JCPCT.

[Stuart Andrew]

I understand that, before the consultation document came out, one member of the steering committee gave her personal view of which unit should stay open. Does the Minister not agree that that might give some cause for concern?

[Mr Burns]

My hon. Friend is pushing me and tempting me, but I shall be up front and straightforward: I am unaware of that situation, and it would be unwise of me to start commenting on something that I do not know the background to or—if the conversation was had or the statement made—the circumstances of it. I hope he will forgive me if I do not go down that path.

Hospice Care

Stuart Andrew Excerpts

Wednesday 2nd February 2011 Commons Chamber

[Dr Poulter]

My hon. Friend is absolutely right, and I am delighted to hear that a new hospice is emerging in her part of the country. I am sure that it will provide a valuable service. I shall focus most of my comments on the provision of adult care, but she is absolutely right to talk about children’s hospices, because a sick child—especially one with a terminal illness—needs a lot of support and care, as do their families in particular, during their illness. I am delighted that the communities in her part of the world are investing in that service.

I shall now discuss the hospice movement’s background, because it teases out the key areas of support that hospices provide. We all probably know that St Christopher’s hospice in Penge, south London, is likely to be identified as the first modern hospice, and I am delighted that in my constituency we have a hospice, St Elizabeth’s hospice, which provides a key service, supporting most of central and eastern Suffolk. St Elizabeth hospice delivers a number of services. It has 18 in-patient beds, some of which are for respite care, to which my hon. Friend the Member for Truro and Falmouth (Sarah Newton) alluded. These provide care to give families time off when dealing with a relative who has a terminal illness, and look after people in the very last days of their life.

However, hospices do more than that. One thing that is often forgotten when we talk about the hospice movement is the very valuable outreach service that they provide to their communities. People will want to have as good a death as possible, and part of that is about supporting them in being able to die, where possible, in their own homes in as comfortable an environment as possible. What St Elizabeth hospice does very well, as do many others, is invest in those outreach services to ensure that people can die comfortably at home.

[Stuart Andrew (Pudsey) (Con)]

It was my privilege to spend 12 years of my life working in the hospice movement, particularly on the fundraising side, in adults’ and in children’s hospices. My hon. Friend raises the very important point that there is an ongoing national review of palliative care. Does he agree that it is very important that that takes account of the full range of services that hospices offer, whether for children or for adults, because it is that range of services that the families and the patients value so dearly in the hospice movement?

[Dr Poulter]

I am grateful to my hon. Friend for contributing to the debate given his experience. He is absolutely right. In end-of-life care, different solutions work for different families, and the whole point is to ensure that people and their families are supported in the way that suits them. Some people may choose to die in the comfortable surroundings of a hospice; many may want to be cared for and looked after in their own homes. I am sure that as part of the review we will see a greater understanding of that, and particularly of what is provided in the vital outreach services looking after people in their own homes.

My hon. Friend is also right to raise the issue of funding for hospices. St Elizabeth hospice and St Christopher’s hospice receive only about a third of their income from the NHS or primary care trusts; the other two thirds are raised directly through able volunteers and their charity activities. The national end-of-life care strategy published in 2008 was rightly accompanied by the provision of £286 million over two years to be spent to support the operation of hospices. I have to say that there were concerns about how that money was being spent. It is right that a review of hospice and palliative care is being carried out under the new Government. In a recent debate in the Lords, the Parliamentary Under-Secretary, Earl Howe, said:

“A huge amount of money is being spent on end-of-life and palliative care. We know that it is often not used as it should be.”—[Official Report, House of Lords, 15 December 2010; Vol. 723, c. 694.]

The palliative care funding review aims to address that issue by identifying a per patient funding model for adult and child palliative care services across health and social care. An interim report was to be published in December that looked particularly at supporting the role of the outreach services in palliative care. That is a very good thing. The per patient tariff is obviously a complex issue involving how much it would cost to look after somebody at home and how much it would cost to look after them in the hospice setting. How, in the Minister’s view, will the per patient tariff apply at this stage to looking after people at home as opposed to in the hospice? Does he think that some allowance will be made for the additional cost, particularly in rural areas, of looking after people with terminal illnesses at home as part of an outreach service?

There is a great need throughout hospitals and throughout the hospice movement to have more specialist palliative care services. GPs and PCTs tend to associate those services only with cancer, and at the moment they generally tend to be accessed by people with cancer. I hope that one thing that may come out of the palliative care review—perhaps the Minister can comment on this—is a greater move towards Department of Health support, through the dying days of PCTs, for a greater emphasis on hospices being able to reach out to people with other illnesses such as motor neurone disease, heart disease, chronic obstructive pulmonary disease and other terminal illnesses, so that we ensure that GPs and local health care providers are more in tune with that. Hospices want to do that and I am sure that the families of patients with those terminal illnesses would receive great support and benefit from such care.

Hospices, and indeed the sector, face a number of challenges. I will raise two. First, as I have suggested, there is a need to improve relationships between hospices and primary care trusts. A good thing that I think will happen as a result of the Government’s health care reforms is that when local GPs, who understand the needs of the local communities, are in charge of health care, they will forge better relationships with hospices, and in particular their outreach services, than there are at the moment. Far too often in talking to hospices over the past two or three weeks I have found that they do not feel that there is a proper corridor or dialogue with primary care trusts. I hope that the Minister will agree that the Government’s health care reforms will better recognise the valuable roles that hospices play in local communities.

Secondly and importantly, hospices often operate under a great burden of red tape, because they fall between a number of stools. They are involved with the Charity Commission because of their charitable role, the Care Quality Commission, Monitor, local authorities, the NHS commissioning board, and possibly other public health regulators. Meeting all those requirements places a great financial burden on hospices, perhaps more so than for other NHS providers or charities that have more discrete accountability. That needs to change. Given that they are charities and organisations that do not have a great deal of public funding, their having to answer to and be accountable to so many bodies through their administration is counter-productive and draws money away from patients. I would be grateful if the Minister outlined how the Government can reduce the administrative burden so that more of the money that hospices have goes to patients, rather than being wasted on administration and bureaucracy.

To conclude, there are a number of areas to applaud. The Government policy is GP-led and there will be locally sourced knowledge, which will much better recognise the needs of local hospices. The per patient funding will be patient-centric, which can only be a good thing. The health care reforms will provide greater transparency in the delivery of funding. Of course, that all ties in with the big society.

I am grateful to the House for having this debate. I have asked a few questions and am sure that the Minister will answer them. I want hospices to have a viable and strong future in which they have more support from public bodies, but are set free from the administrative burden that holds them back and prevents them from spending money on patients. I look forward to the Minister’s response.

--- Later in debate ---

[Paul Burstow]

Hospices need to continue to work to demonstrate the huge benefits of their provision to commissioners. If the hon. Gentleman writes to me, I will pay close attention to what is happening in that regard.

My hon. Friend the Member for Central Suffolk and North Ipswich rightly mentioned the difference that GP consortia will make. GPs are the best people to bring together the provision that I have talked about, along with the new local health and wellbeing boards. The advent of GP consortia will change the relationship—quite fundamentally, and in the right way—between hospices and GPs. It will make it natural for doctors to talk to each other and solve problems together, and to draw on different sources of support to help patients get what they need. It is encouraging to note that three of the GP pathfinders—Westminster, Bristol and Somerset—are specifically looking at how they can improve end-of-life care under the new arrangements. That is a sign of GPs’ interest in such care, and the potential for GP-led commissioning to bring about change and to address that challenge.

There is a new opportunity for collaboration and innovation, but hospices must not sit back—they must actively engage. We need them to be proactive in understanding and engaging with the new systems and structures as they settle into place over the next two years. They need to be proactive in talking with their local GPs and building up the relationships and mutual connections that will be essential to how the system works, and proactive in working with local authorities, which will play an increasingly important role in shaping and integrating care through the health and wellbeing boards. Ensuring that health and social care are commissioned and planned together is critical in the delivery of good end-of-life care.

Hospices also need to be proactive in broadening their horizons and innovating to support a wider range of people. As my hon. Friend rightly said, hospices are not just about cancer. We want people to be able to die in their own homes, where they would choose to be, and we need a more flexible and dynamic approach from both the NHS and hospices in that regard.

As my hon. Friend rightly pointed out—this is a key point—contrary to popular perception, only a small number of people actually die in a hospice. A great many more people benefit from their work in other ways. People could, for instance, receive day therapy in a hospice, or, as is the case with the local hospice in my constituency, they can get help from hospice staff working in the community, which was referred to by a number of hon. Members. Children’s hospices, meanwhile, could get more involved in the long-term treatment of children rather than just end-of-life care.

We need to innovate in those partnerships. We need commissioners to make imaginative use of hospices as part of their end-of-life, palliative care plans. Hospices must also have the ambition to explore new ways of offering their skills and services to NHS commissioners. My hon. Friend is right that we need to reach out beyond cancer services—it is essential that services diversify. St Christopher’s in London, which he mentioned, is doing excellent work with people with dementia who need end-of-life care. We need to focus much more on that to deliver the national dementia strategy.

I want more hospices to play a role in supporting people with other degenerative conditions—not just dementia, but conditions of the sort my hon. Friend rightly highlighted. We make that point explicitly in the national dementia strategy, as I said, and we want to reinforce it through the end-of-life care strategy.

The levers and the incentives are in place to enable hospices to secure NHS funding in the years ahead. But in the longer term we know that a new funding model is needed. We made it clear in the coalition agreement that we want to introduce a per-patient funding system that is built around a much clearer understanding of what level of care should be available through the NHS and that is fairer and more sustainable for all providers, including hospices, because it moves us away from the vagaries of grants—we have just heard about the problems those cause to the children’s hospice in the constituency of my hon. Friend the Member for Winchester (Mr Brine)—and gives them certainty of a set level of funding per person.

The debate about this subject has been going on for some time and is well developed. I encourage hon. Members who have spoken to contribute to that work. In July, the Secretary of State for Health appointed Tom Hughes-Hallett, the chief executive of Marie Curie Cancer Care, to chair an independent review covering both adult and children’s services. That review will look at the issues raised in this debate to ensure that we have services that reach out beyond the confines of the hospice and address the wider cost issues in rural communities. An interim report was published at the end of last year, which sets out a definition of dedicated palliative care and provides initial thoughts on how a new national funding system could be built.

[Stuart Andrew]

Will the review take account of not only the similarities between children’s and adult’s hospices, but the differences? Respite care is a fundamental part of the care that children’s hospices provide.

[Paul Burstow]

I can give my hon. Friend that undertaking. Understanding of and sensitivity to those differences will be reflected in how the review is put together. I will also ensure that this debate is brought to the attention of those doing this work.

Hospices play a strong and distinguished part in our communities. We absolutely want them to have a bright future. Yes, there will be challenges, not least because the financial environment will affect hospices just as it will affect other parts of the health system, and I can understand the concern that that creates. But through the operating framework for the NHS, the funding review and the wider improvements that we are making in terms of GP-led commissioning, we are creating the right conditions for a vibrant hospice movement for the future. That will mean that institutions like the ones my hon. Friend the Member for Central Suffolk and North Ipswich mentioned can continue to make a significant and valued contribution in the years ahead.

Question put and agreed to.

HIV

Stuart Andrew Excerpts

Wednesday 1st December 2010 Westminster Hall

[Stuart Andrew (Pudsey) (Con)]

May I say what a pleasure it is to serve under your chairmanship, Mr Leigh? I congratulate the hon. Member for Inverclyde (David Cairns). I am rather reassured that, after seven years, he does not know how these debates are chosen, because I certainly do not have a clue after seven months.

This is a significant day. It is a day to remember those who are no longer with us; it is a day to acknowledge and pay tribute to those who have worked so hard on this issue; and, crucially, it is a day to raise awareness. On the first of those issues, the scars on those who have lost people, particularly in the early years, are clearly raw. Thankfully, I do not know anybody who has died from AIDS, but I have friends who do, and they recall the pain and suffering vividly.

It is important that we remember those who have died and acknowledge their suffering. There is a wonderful quote in the film “Philadelphia”, where someone says that social death precedes physical death. That was certainly true in the early days, but I hope that things will get a lot better as time goes on. It is important, however, to look at how far we have come.

This is also a day to acknowledge those who have done so much. I pay tribute to each and every person and organisation for their work. There are too many organisations to mention, but I would like to pay tribute to the National AIDS Trust and the Terrence Higgins Trust. I would also like to mention two individuals. The first is the chief executive of the Terrence Higgins Trust, Sir Nick Partridge, who is here. He has done a tremendous amount of work over the years, and he should be acknowledged. The second is Lord Fowler, and I was pleased last night when he was acknowledged for the work that he did in the very early years.

Perhaps most importantly, today gives us an opportunity to raise awareness of HIV and AIDS here and abroad. I know that we are concentrating on the UK today, but I hope that we will have an opportunity to talk about the issues abroad, because they are significant.

The latest figures from the Health Protection Agency show that more people than ever are living with HIV. Last year, there were more than 6,000 new diagnoses, which is fewer than the year before, but only slightly. That emphasises that this is still a major problem. As many Members have mentioned, statistics also show that slightly more than half of new diagnoses are among heterosexuals, but the rate of infection in the gay community is still very high. Worryingly, there is an increase in diagnoses among those over 50, as my hon. Friend the Member for Mid Derbyshire (Pauline Latham) rightly said. We have also heard about the quarter of people with HIV who are undiagnosed. That is a huge problem, which really needs addressing.

I represent a constituency in Leeds, where the prevalence of HIV cases is average for England, with about 850 people receiving treatment and care in the city. Again, however, many of those people have been diagnosed very late, which highlights the need for early diagnosis. We also have a growing African population in the city, and there is a real link between HIV abroad and in the UK, as more and more people move around the world. In addition, we have one of the most vibrant gay scenes in Yorkshire, and I hope that we can encourage as much focus as possible on those two groups, because prevention really is the key.

It is important to mention the campaigns of the 1980s. The Conservative Government of the mid-1980s faced a massive challenge on an emerging issue, and even the best experts were learning day to day. Those campaigns were scary. I was at school at the time, but I remember them, and they still have an impact on me. As the hon. Gentleman said, those old campaigns were not exactly targeted, but they were highly effective.

Developments in medicine these days mean that people with HIV can expect to live well into old age. This generation could be forgiven for thinking that the problem has gone away, and that is a big problem, particularly in the young, at-risk groups. In the 1980s, HIV had already taken root among gay men in this country. Meanwhile, a devastating HIV/AIDS epidemic was about to take off in Africa, with inevitable consequences for this country and others. It is now estimated that, by 2012, there could be close to 100,000 people with the virus in this country. That is a tenfold increase on the 1980s figures, so the problem has not gone away.

I pay tribute to groups such as CHAPs, which have worked with community groups all over the country, and I am lucky that we have such groups in my constituency. [Interruption.] I notice, however, that I need to get a move on, so I will get rid of some of the pages of my speech.

Let me quickly say that I am delighted that we are highlighting some of the work that has been done over the past few years, although I should emphasise that work still needs to be done to save lives. There needs to be foreign aid, education and greater testing. Let me also say how happy I am that HIV and sexual health have featured highly in the public health White Paper, and that is important. It is also important that we acknowledge the problem in socially disadvantaged cases.

Finally, there is no one silver bullet when it comes to preventing HIV transmission, but we can, through a range of interventions, start to reverse this epidemic. Like the Government of the 1980s, the coalition faces a considerable challenge in tackling HIV. Unlike that Government, however, the coalition can draw on 25 years of experience in dealing with the epidemic and in understanding what works and what does not. I wish them well.