Oral Answers to Questions

Tessa Munt Excerpts

Tuesday 16th April 2013 Commons Chamber

[Anna Soubry]

We are building two new machines specifically to deliver that treatment. I accept that these things often take a long time, but those machines are planned. In the meantime, NHS England has made it clear that people who need this specific type of treatment can receive it overseas and it will be funded accordingly.

[Tessa Munt (Wells) (LD)]

Two years ago, the Prime Minister accepted the installation of CyberKnife as the latest in cancer radiosurgery equipment at the world-leading Royal Marsden hospital cancer centre. At the last Health questions, I asked the Secretary of State whether he would accept one of the countless invitations to visit the Royal Marsden. The consultant clinical oncologist has issued and reissued that invitation, but has had no response from the Department. Will the Secretary of State now please visit CyberKnife at the Royal Marsden?

[Anna Soubry]

I have to tell the hon. Lady that, as she knows, there is some controversy over this treatment, which is backed by a very large and powerful American company. The Under-Secretary of State for Health, my hon. Friend the Member for Central Suffolk and North Ipswich (Dr Poulter), has visited, and I know that the Secretary of State has an extremely busy and full diary. It is not as simple as a visit; it is all about whether there is any clinical value.

Oral Answers to Questions

Tessa Munt Excerpts

Tuesday 26th February 2013 Commons Chamber

[Mr Jeremy Hunt]

If the hon. Gentleman had listened to my previous answer, he would have heard that the regulations are consistent with the procurement guidelines that his own Government sent out to PCTs. It is not our job to be a champion for the private sector or the NHS sector; we want to be there to do the best job for patients. That is the purpose of the regulations.

[Tessa Munt (Wells) (LD)]

T4. Two years ago, the Prime Minister welcomed the installation of CyberKnife, the latest in cancer radio surgery equipment at the world-leading Royal Marsden cancer centre, as an example of how the NHS has progressed. Since then, the Royal Marsden has invited successive Health Ministers to visit the cancer centre but no one has accepted the invitation, and I am aware that Ministers have been to see other cancer treatment systems. Will the Secretary of State follow the Prime Minister’s lead and visit the Royal Marsden to see for himself the great progress that has been made there?

[Anna Soubry]

I understand that the Secretary of State has been to the Royal Marsden, but I am more than happy to accept the invitation and look forward to going along and seeing it for myself.

Backbench business

Tessa Munt Excerpts

Thursday 14th February 2013 Westminster Hall

[Tessa Munt (Wells) (LD)]

I congratulate the hon. Members for Romsey and Southampton North (Caroline Nokes), for Enfield, Southgate (Mr Burrowes), and for North Tyneside (Mrs Glindon) on recognising the importance of eating disorders awareness week 2013. As we have heard, more than 1.6 million people in the UK are affected by eating disorders; they are young, middle aged and older. They are every age from eight to 80, and they are women and men. This serious mental illness has the highest mortality rate of any mental illness.

Over the past 25 years, the incidence of eating disorders has increased enormously. There are many possible contributory factors. I observe the tiny size of models, actors and actresses, and screen, tabloid and magazine heroines and heroes; the cult of celebrity; the obsession with gyms and exercise; the constant barrage of advertising through every medium; the pressure on us to diet and to eat low-fat, low-calorie food; the ranges of “light” foods on sale and the so-called “healthy eating” regimes. There is bullying and name calling in the playground, in the workplace and during our leisure, and pressure to remove what is called excess weight and achieve someone else’s idea of a perfect body shape. We have life on the run. Eating on the go is now more common. There is an absence of what I used to have: formal lunchtime at school, at which a teacher sat at my table and watched me eat—even the semolina. If a child takes in a packed lunch, they can give it away or bin it, and no one has any control or sight of what they are eating.

[Mr Charles Walker in the Chair]

I also observe that things are different from when I was young, which was quite a long while ago. Young women are often physically mature at a very early age. It is confusing for an eight, nine or 10-year-old to find out that they are much larger than their friends; they will not necessarily understand that their body is getting ready for full maturity.

We can even look to an escalating divorce rate, which means that many of us are single. There is huge social pressure to have a partner, and there is the implication that in order to count, we must be gorgeous, attractive or at least half of a couple, rather than an individual, with our own rights and responsibilities. I recognise that I am saying this on Valentine’s day. My list, of course, is not exhaustive, but feeling inadequate, worthless and lacking in self-esteem are common factors, and the list starts to provide some clues to the settings in which eating disorders can be triggered, and how they are sustained. That constant pressure has contributed to the suffering of those 1.6 million people, and their families and carers.

So often, eating disorders are evident when a patient perceives that choosing whether they eat or not is the only area of his or her life where he or she can exert complete control. Anorexia and bulimia are serious mental illnesses, and need recognition and the appropriate responses from our national health service. In the next few minutes, I will refer to anorexia, but I want it to be noted that my concerns also relate to bulimia and eating disorders generally.

Most patients with an eating disorder in this country struggle to find effective treatment. They may find that a GP looks at the figures, and not what is in front of them—the patient. I refer to cases where patients are told that they are “not ill enough”, and that their body mass index would need to be lower for them to qualify for referral for help or treatment. When they do qualify, in many cases patients are admitted to medical wards in hospitals where the nurses unfortunately know little about psychiatric problems, and even less about nutrition. Patients are given little or no family therapy or individual therapy.

Others go to psychiatric units, where they are offered psychological support, but where their physical problems and need for weight gain are severely neglected. The few good dedicated units, which combine re-feeding with therapy and education, are mostly privately run. However, at £700 a night, these units are often out of the reach of most families, unless their primary care trust or its replacement NHS organisation funds the treatment.

I want to concentrate particularly on the problems facing children and young people with anorexia and bulimia. In hospitals all over the country, there are children and young people—some as young as seven or eight—who are being treated by doctors and nurses who have very little training in dealing with eating disorders, and who often have no knowledge of how to set a safe target weight. Sometimes, they weigh patients who still have their clothes on, or who have their pockets filled with kitchen weights, or who have their stomachs filled with three or four litres of water. Families are not given the support they need, or clear-cut advice. Patients see a different doctor or specialist at each appointment, and the appointments are too far apart. Little heed is paid to the patient’s physical condition. I have heard about children attending out-patient clinics because of their weight loss, but having neither their pulse nor their blood pressure taken. Monitoring pulse and blood pressure is vital if we are to prevent a child from collapsing, and if we are to know when a child needs hospital admission.

There are very few doctors who specialise in the treatment of children with eating disorders, so the waiting lists for children who need to access those doctors are often dangerously long. Eating disorders must be a condition that students are taught about in medical school, and awareness of them must be included in the postgraduate training of GPs, psychiatrists and paediatricians. If children were seen early in their illness by professionals working as part of a multidisciplinary team, so that parents were given the consistent, sensible advice they needed on how to re-feed their child, and if patients were seen by a family therapist and an individual therapist, as well as having a medical doctor who understood the long and short-term risks, and who could make a referral to an in-patient unit before the patient became irreversibly damaged, we would have fewer chronically ill adults in later life.

No one should die from an eating disorder. At present, however, there are more deaths from eating disorders than from any other mental illness, and it is estimated that 10% of all sufferers of eating disorders die as a result of their condition. For adults, the courts always support an application for nasogastric feeding, but tragically the request for a court order is often made too late, or not at all. However, working with children with eating disorders reveals another serious problem, one that interferes with the ability to help them. That problem is the implications of the Children Act 1989, which deems children of 16 capable of making their own decisions about treatment. However, anorexic patients rarely want to eat voluntarily. Although many of them are crying out for help, the guilt wrapped around food and eating means that they need someone to help them to eat, and not someone to ask their permission as to whether they would like to eat.

Despite an excellent ruling a few years ago, which in summary states that anyone who seeks to starve themselves to death is not competent to make decisions, we nevertheless require 16-year-olds to give written consent before they can be admitted to a medical unit. There are some units where, in order to protect themselves and their staff, this permission is sought from 14 and 15-year-olds. Once children are in the unit, if they refuse to eat, no staff member would dare use a nasogastric tube for fear of being sued. Until the passage of the Children Act 1989, units treated anyone under the age of 18 and fed them if and when necessary, requiring only parental consent. What a ridiculous situation we are now in. The reality of the current situation leaves parents feeling completely ineffectual and frustrated. It also leaves the child feeling quietly victorious, as they go on their way home with medical permission not to eat.

Today we find ourselves in the ludicrous situation whereby staff have to tell parents of often very ill children who will not consent to eat that they must wait until their daughter or son loses another X number of kilos, whereupon that young person can be sectioned under the Mental Health Acts and treated compulsorily. That puts lives at increased risk, and being sectioned is an overly serious response to the problem. We should seek a more appropriate solution. Being sectioned jeopardises any hopes that that child in recovery might have of joining the armed forces, for example, or becoming a doctor or nurse, which is particularly sad, because when they have recovered, many of these children are attracted to working in the caring professions, such as health care. The Children Act might need to be amended, so that we are able to treat children who are damaging their health through starvation before they become so ill that their lives are in danger.

The hon. Members for Romsey and Southampton North, and for Enfield, Southgate, and I have met the Under-Secretary of State for Education, the hon. Member for Crewe and Nantwich (Mr Timpson), who is the Minister with responsibility for children, to explore the legal situation regarding the Mental Health Acts. I am very glad that the Minister of State, Department of Health, my hon. Friend the Member for North Norfolk (Norman Lamb) is here today. I am grateful to him for agreeing to meet us to explore whether practical solutions are available, or inventable, to allow those who care for young people with eating disorders to trigger some action short of using sentencing as a route to treatment and help.

I particularly want to recognise the work of two charities. One is the Somerset and Wessex Eating Disorders Association, or SWEDA, which is a user-led registered charity based in Wells in Somerset, in my constituency. It works on the principle of self-help, and its phone number is 07511 499 494. It has an online “health unlocked” community, and people can seek support and advice about self-help through that group.

The second charity is, of course, Anorexia and Bulimia Care, or ABC, which is a national registered charity that also happens to be based in my constituency. It is doing an amazing job. ABC was founded and is governed, run and supported by people whose lives have been touched by eating disorders. It offers kindness and compassion to sufferers at a time when they are desperate and alone. It has staff, professional advisers and a national network of volunteers, all of whom are carers or recovered sufferers. It provides positive, practical advice by telephone, by e-mail and via its website. It also offers a befriending service, and a range of literature and training advice. Lastly, it has a young people’s blog, called “To be honest”. ABC’s work is fantastic and its telephone number is 03000 11 12 13. That number will lead to a parent helpline, a sufferer helpline and a self-harm helpline.

We need a fairer system. Every child who develops an eating disorder should have access to first-class treatment, rather than the somewhat cobbled-together, inadequate provision that most have to accept. It is time that this life-threatening and debilitating illness was taken more seriously, and I truly hope that the Minister will consider what changes might be made to ensure that fewer lives are lost, recovery comes more quickly and families do not suffer the terrible consequences that often come with loving a patient with an eating disorder.

Lastly, I appeal to all those who suffer from this challenging mental illness: there is hope, and there is help out there for you. Our responsibility is to make sure it is better and easier for you to accept treatment and help.

Cancer Care (England and Wales)

Tessa Munt Excerpts

Tuesday 12th February 2013 Westminster Hall

[Alun Cairns]

I am grateful to my hon. Friend for sharing those data. In interventions, hon. Members have talked not only about pre-screening, awareness, social issues and treatment, which I will focus on, but the aftercare that is needed, the emotional support that is provided, and the need for and responsibility and role of a whole host of agencies, including those in the charitable sector.

Returning to the point about treatment, I had been comparing the different approaches to breast cancer in England and Wales. The wait before seeing a consultant in England is 10 days. It is interesting to note that the Welsh Government removed 10-day monitoring in 2006. Although data are recorded locally, they are not published nationally. In the interests of transparency, it would be helpful if those data were published to allow fair and just comparisons. Waiting time targets improve survival outcomes, reduce emotional distress and improve the quality of life for people with cancer and those who turn out not to have cancer.

There are similarly alarming figures for prostate cancer. Five-year survival rates can be higher than 80%. There are no figures comparing the rates of the home nations, but the side-effects of the sort of treatment one receives for prostate cancer can be significant and can have a huge impact on future lifestyle. Again, there is a different approach to prostate cancer care in the two nations.

I want to draw attention to the availability of treatment. There was significant attention some years ago to access to brachytherapy. Even when it was finally approved by the Welsh authorities, after having been widely available in England, Scotland and Northern Ireland, the threshold for intervention was much higher in Wales. As far as I know, that remains the case.

Currently an identical debate is focused on robotic surgery. A constituent who suffers from prostate cancer, who is qualified medically and who consulted widely before making the decision with his clinicians on the most suitable form of treatment for himself, wrote to the Welsh Health Minister. He shared a copy of the letter with me, in which he said:

“I was both surprised and disappointed to find that this option is not available to Welsh men in Wales and that a significant number of Welsh men are opting to go to England, where this technology is established and available throughout the country.”

[Tessa Munt (Wells) (LD)]

Does my hon. Friend accept that if that kind of treatment—be it robotic or radio surgery—was available perhaps in a location such as Bristol, it would be accessible for patients in south Wales, along the M4 corridor and elsewhere, and those who go down the M5, right the way through to Cornwall?

[Alun Cairns]

My hon. Friend makes a valid point about the need for joint working and better co-ordination between the health services. Devolution can provide valid comparisons to establish the success of various treatments, but on many occasions there is a need for joint working where capital investment is needed, allowing patients to benefit from a different sort of intervention, but with shared responsibility between the two organisations.

I was talking about my constituent who had wanted robotic treatment for prostate cancer. He was later forced, in his stressful situation, to raise the £13,000 necessary to receive the form of treatment that he thought best suited him. I am pleased to report that the outcome of the treatment was positive.

The Wales Minister argued that if local heath boards do not provide treatment routinely, people could follow a process for individual patient funding requests. The panel meets monthly, which hardly reflects the urgency of some cases. I am not aware that any case of robotic treatment has been successfully applied for.

That leads me on to the cancer drugs fund, which is available in England but not in Wales. The fund allows clinicians and patients to prescribe and receive the latest drugs. Again, that is not available in Wales, where there is a cumbersome process to seek such a prescription.

The Rarer Cancers Foundation reported that 24 cancer treatments that are not routinely available in Wales may be available in England through the cancer drugs fund. It concludes that people in Wales are five times less likely than people in England to gain access to a cancer drug that is not routinely available. It also states that if the same approval rate occurred in Wales as it does in England, 159 cancer patients in Wales would gain access to life-extending treatment, instead of the 31 recorded. I raised the issue with the Welsh Health Minister, and she reported that establishing such a fund would reduce the money available for treating other serious conditions, as in England. I find that worrying, and I would be grateful if the Minister could address that point in her response.

That deficiency applies to other cancers, too. Selective internal radiation therapy is an innovative treatment for inoperable liver tumours. Although the University hospital of Wales in Cardiff is part of the UK-wide phase 3 clinical trial, not one patient from Wales has been funded for treatment. The patients under trial have been financed by the cancer drugs fund, yet the hospital is in Wales and demonstrates the expertise that exists in Wales in the field.

Survival rates for pancreatic cancer also differ significantly, and I could go on at length about those. When it comes to five-year survival rates for pancreatic cancer, Wales scores better than England. Unfortunately, that tends to be the exception rather than the rule. Those differences are worrying, and had I referred to Scotland and Northern Ireland selectively, I would have been able to paint a more alarming picture, but that is not the point; it is not about the politics of the issue, but about sharing best practice and getting the right treatment for the right people.

The motivation for the debate came from individual cases in my surgery. Having researched the data, I was forced to bring the matter to the House’s attention. I hope the Minister and Members present will be able to use their influence on colleagues here and elsewhere to raise standards, allay fears and improve survival rates for cancer patients.

Oral Answers to Questions

Tessa Munt Excerpts

Tuesday 27th November 2012 Commons Chamber

[Norman Lamb]

Whenever the NHS is under financial pressure, there is the risk that mental health services will get squeezed. As the Health Select Committee identified, that is exactly what happened under the last Labour Government in 2006. I share the hon. Lady’s concern, however, about the report on schizophrenia highlighting how money is used: too many people in in-patient facilities and not enough prevention work. I am committed to working with others to ensure that we use the money more wisely to get better care for those patients.

[Tessa Munt (Wells) (LD)]

T7. Since the Prime Minister made his radiotherapy promise to current and future cancer patients last month, cancer centres all over the country have been telling me that it cannot be delivered, because there is not enough investment in new radiotherapy machines and in the recruitment and training of staff to operate them. Will the Secretary of State give the same financial commitment to the annual radiotherapy fund as he is giving to the cancer drug fund, and will he meet me to discuss the matter?

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

I thank my hon. Friend for her question, because it touches on a matter of concern to me, notwithstanding the £15 million radiotherapy innovation fund, which, as she said, was announced by the Prime Minister. Indeed, last night, at my ministerial surgery, the hon. Member for Easington (Grahame M. Morris) came along to discuss this very matter, and he raised several important issues, all of which I have this morning taken up with my officials. I am more than happy to meet my hon. Friend to discuss the matter further, however, as I think there is work to be done.

Nursery Milk Scheme

Tessa Munt Excerpts

Monday 5th November 2012 Commons Chamber

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

I congratulate my hon. Friend the Member for Mid Dorset and North Poole (Annette Brooke) on securing this debate. During her years in the House she has not only shown a keen interest in the nursery milk scheme but has been a strong parliamentary ambassador for the National Society for the Prevention of Cruelty to Children and, since 2006, a champion of Save the Children. That is a long track record of supporting and standing up for issues that matter to children—in this case, the nursery milk scheme. She rightly outlined the tremendous health benefits not only of the nursery milk scheme but of a healthy diet in young children, and highlighted the benefits of drinking milk, given the proteins, minerals and vitamins that it contains. I want to confirm to the House again that the nursery milk scheme is here to stay.

Before I address the points that my hon. Friend raised, it is worth highlighting a few of the issues. While we fully endorse the provision of nursery milk, she is absolutely right to point out that the cost of the scheme has gone up considerably over the past few years. In an average supermarket, a pint of milk costs about 50p to 55p. According to the most recent figures of June 2011, within the scheme there are 23,000 claims—well over 50% of the total—where milk costs 70p to 79p per pint, and almost 9,000 claims where it costs over 90p per pint, which is almost double the cost in the supermarket.

Many hon. Members representing rural constituencies will be concerned that dairy farmers across the country are struggling, and that the increased cost of milk is not rewarding those farmers in the farm-gate price. We must reflect on the cost of the scheme. Since the scheme costs a lot of money, it would be nice if those companies that profit from it also recognised that some of that profit could be passed back to famers in the farm-gate price. The Government and the National Farmers Union do not see that happening as part of the scheme, and although the NFU and the Department for Environment, Food and Rural Affairs support the nursery milk scheme as a way of supporting dairy farmers, it is nevertheless disappointing that companies that supply nursery milk are not supporting our farmers in the way we would like.

As my hon. Friend rightly said, the nursery milk scheme is of long standing and has been running throughout Great Britain since the 1940s. The devolved Administrations in Scotland and Wales fund milk supplied through the scheme to children in their countries, and Northern Ireland has its own, similar scheme—I am pleased to see the hon. Member for Strangford (Jim Shannon) in his seat as usual.

As we know, the scheme funds free milk for around 1.5 million children under five years of age at 55,000 child-care providers throughout Great Britain. Nursery milk is a universal benefit, meaning that child-care providers can claim the cost of milk provided to any child, regardless of the child’s home circumstances. The scheme is valued by parents and pre-school staff, and its health care benefits were thoroughly outlined earlier in the debate.

The Government recognise, however, that the nursery milk scheme is expensive, and the consultation was about improving its operation and ensuring that it remained fit for purpose. The scheme remains largely unchanged since it was first introduced as a wartime measure, and in recent years prices claimed for milk purchased under the scheme have risen significantly, owing largely to third-party agents who seek to make considerable profits by delivering milk to child-care providers. As I said earlier, unfortunately those profits are rarely paid back to farmers in the farm-gate price.

The prices claimed for milk supplied under the scheme have risen significantly, with some claims reaching almost £1 a pint. That has led to a corresponding increase in the overall cost of the scheme. In 2007 and 2008, the scheme cost £27 million, but by 2010-11 that had risen to £53 million—it almost doubled in only four years. If we do nothing, that trend looks likely to continue, with costs potentially rising to £76 million by 2016.

Under the current system, there is no limit on the price at which child-care providers may purchase milk, or even a requirement for each provider to review their milk expenses. In many cases, agents supplying milk handle the claims themselves, rendering child care providers unaware of the price paid. For those reasons, the total cost of the scheme has risen dramatically over the past few years, and although the amount of milk supplied has risen by 25% since 2009-10, the total cost of the scheme has risen by 45%.

[Tessa Munt (Wells) (LD)]

Does the Department of Health have a grip on the procurement process involved in this scheme? When providing milk across the nation, surely we should be able to supply from local sources or distributors. The costs that the Minister mentions seem to have escalated greatly, but farm-gate prices have not changed much. It seems extraordinary that someone has not got a grip on procurement.

[Dr Poulter]

My hon. Friend is absolutely right, and that is why the Government launched the consultation in the first place. The scheme was devised in the second world war, and its provisions mean that the Department of Health currently has no role in active procurement. The Government embarked on the consultation in view of the rising costs, and my hon. Friend will rightly feel concern for dairy farmers in her area of Somerset. Profits from this scheme are going to intermediate companies, and the cost has recently escalated out of control. My hon. Friend also highlights the fact that farm-gate prices have not improved as a result of those increased prices and profits for intermediate suppliers of milk.

It is worth pointing out that an important factor contributing significantly to the scheme’s accelerating costs seems be embedded in its design. No mechanism exists to incentivise child-care providers to economise and search for the highest attainable value for money in their local markets, to support their local farmers or to source their milk from a certain provider. Over the last three years, the average price paid for a pint of milk in a supermarket has been 50p, but the average charged by agents is 78p, which is well over 50% higher. That shows that the scheme is rapidly becoming unfit for purpose, which is exactly why the Department embarked on the consultation.

Community Hospitals

Tessa Munt Excerpts

Thursday 6th September 2012 Commons Chamber

[Tessa Munt (Wells) (LD)]

I congratulate the hon. Member for Totnes (Dr Wollaston) on securing this debate.

My part of Somerset has some fantastic community hospitals—Burnham-on-Sea, Glastonbury—but I would like to draw particular attention to Shepton Mallet, which provides a valuable and popular service to local people in my area of rural Somerset, despite the fact that several of its buildings are substandard as a result of serious under-investment. Many patients who cannot be treated at home are admitted to our community hospitals by local GPs, who love these places, instead of being sent to acute hospitals in Bath, Bristol, Yeovil and Taunton. Most of those journeys are about 20 to 25 miles, but local people accept that acute hospitals will be some distance away. There is no expectation that we should be able to access an acute hospital on our doorstep in such a rural area.

There are 174 communities in my constituency, and people will happily travel from them to those main hospitals. Some spend time in our local hospitals following treatment at an acute hospital—it is clearly a stage of recuperation—so that they can be close to their home, friends and family. My father was a patient, and he was a frequent visitor to Wells cottage hospital, which is now unfortunately closed. It was an essential part of his recuperation, and there were many happy visits that kept his spirits up and helped his recovery. People came to read or just talk to him.

The point will not have been missed that community hospitals help to free up scarce and much more expensive beds in the bigger hospitals. Some of our patients are there because caring for them in their homes has failed or is just not an option. Many patients are elderly or infirm, as often are their relatives, and visiting distant hospitals regularly is a great hardship, stressful and, for some, impossible. Public transport provision in Somerset is limited at best, diminishing in many areas and in most cases almost non-existent in rural patches, as a direct result of the withdrawal of support for public transport by the county council.

The latest Somerset joint strategy needs assessment on population changes shows rapid increases in elderly patient numbers in the county over the next 30 years—the expected lifetime of most of our NHS estate buildings. In round terms, the number of over-85-year-olds in the county has doubled in the past 25 years and is expected at least to double again by 2030. Two thirds of our NHS patients are already over 65.

The community hospital is cost-effective and provides an essential and popular service to the people of Shepton and those in what is a vast local area. Losing its beds would mean a significant reduction in the quality of services to the local community. Despite that, Shepton Mallet hospital is under threat of closure. An NHS review of community services for Shepton Mallet is taking place and is focusing on the 17 beds in the community hospital. There is no review of beds in the other 12 community hospitals in Somerset. Campaigners can only assume that Shepton is being singled out, because the NHS has not maintained the hospital properly, despite spending millions on new and other community hospitals. However, in one of the many meetings that I have held with the save our hospital beds campaign group, I was given figures from the NHS that showed that, even as late as this April, bed occupancy has been extremely high. Indeed, April’s figures show the occupancy rate at over 96%.

Last week I was at the summer fete in Glastonbury, and last month I was at the summer fete at Shepton Mallet hospital. I pay tribute to the leagues of friends of the Shepton Mallet and other community hospitals, and to Mid Somerset Newspapers, which publishes the Shepton Mallet Journal. The friends have done a fantastic job of rallying the people of Shepton and the local press, including the Journal, and have generated enthusiastic support for the save our hospital beds campaign over the past few months. I have received hundreds and hundreds of letters, e-mails and petitions, and have attended many meetings about the issue with concerned local people, which only goes to prove that the hospital is popular and greatly valued. There are now definite indications that the sheer weight of public concern expressed and the influence of our great GPs, working quietly behind the scenes, have had an effect. I pay particular tribute to the local GPs, especially Dr Chris Howes, who keeps trying to retire, but has been busier than ever finding a sensible, practical, realistic and workable solution to the problem facing Shepton. The first aim of the save our hospital beds campaign has been achieved, with the immediate threat of ill-considered cuts averted, and proper evidence gathering and an options appraisal process are now taking place. However, the hospital is not yet safe. Closure would result in short-term savings, but losing the beds would mean a significant reduction in the quality of service to the local community.

I finish by asking the Minister for an assurance that the coalition Government are committed to ensuring that local people and local doctors, as well as other health professionals, are consulted fairly and fully about any changes to the role and ownership of our popular, local and essential community hospitals, and that she agrees that none should be closed without agreement and very good cause indeed.

NHS Annual Report and Care Objectives

Tessa Munt Excerpts

Wednesday 4th July 2012 Commons Chamber

[Tessa Munt (Wells) (LD)]

Over the past year, the Department of Health has made statements about the fact that radiotherapy is eight times more effective than drugs. It is said that the cancer drugs fund is £100 million underspent and the figures of £150 million and £750 million have been mentioned in connection with new radiotherapy and radiosurgery services. Will the Secretary of State consider transferring at least that underspent funding into radiotherapy and radiosurgery services so that new services in the south-west do not depend on charitable funding?

[Mr Lansley]

I am grateful to my hon. Friend. The issue is important. In the cancer outcomes strategy, we responded positively to the recommendations of the National Radiotherapy Advisory Group. There was a £400 million programme for the support of radiotherapy; more recently, I have added to that a commitment to build two new centres for proton beam therapy. From about 2015, patients requiring such therapy will not have to go abroad to access it.

My hon. Friend makes an important point. In the early part of this year, we made additional resources available to the NHS supply chain so that more radiotherapy machines could be readily available for purchase or lease through the NHS without costs being incurred over the same period. I will look at what my hon. Friend has said. I think that in the cancer outcomes strategy we have set out all the investment in radiotherapy that we think is clinically indicated, but I will continue to review it.

Stereotactic Body Radiotherapy

Tessa Munt Excerpts

Wednesday 8th February 2012 Commons Chamber

[Tessa Munt (Wells) (LD)]

I asked for this debate because for nearly 12 months I have been questioning the Department of Health about why the latest radiotherapy techniques and equipment to treat cancer patients are not being used by our NHS. I have pressed hard on this subject because, like Cancer Care UK and many other respected organisations, I believe radiotherapy is underused in the front line for curing cancer.

This country has a history and a habit of resorting to pumping cancer patients full of pharmaceuticals. Do not get me wrong, I am not knocking cancer drugs—many are highly effective and a great help to patients, and many cancer patients are alive today thanks to them. However, a lot of those drugs also have some pretty horrific side effects, and patients are often reluctant to take them for that reason. So in reality, throughout the latter part of the last century, heavy doses of drugs or death were almost the only choices that cancer patients had.

Although there has been plentiful use of drugs throughout the last 60 years, the uptake of radiotherapy as a front-line treatment has been slow. Radiologists have told me that one reason for that is they have not been as successful at lobbying as the pharmaceutical companies, but that is a matter for another debate. The main reason why there was resistance to using radiotherapy in the past was its method of delivery—single large beams of radiation being fired into the body to ensure that the tumour at which they were aimed was radiated. Unfortunately, those large beams also radiated an awful lot of healthy tissue around a tumour, especially if the tumour was moving, and frequently caused more damage than good. Patients often complained that the side effects of radiotherapy were worse than the cancer.

During this century, there have been huge advances in the delivery and accuracy of radiotherapy treatment. Around the world, radiosurgery is being used increasingly to cure cancer as a front-line treatment. Stereotactic body radiotherapy treatment, or SBRT, uses multiple very fine beams of radiation locked directly on to just the tumour. With some new technologies the beams move as the tumour moves, ensuring that the surrounding healthy tissue is not harmed and only the tumour is radiated.

Unfortunately, in the UK we are failing to embrace the new technologies that allow for the effective use of SBRT to treat cancer patients. We are falling behind both Europe and the US. On 22 November last year, I asked the Secretary of State for Health in the Chamber how many radiotherapy centres in this country were providing SBRT to cancer patients. When he told me the figure was 25%, I must admit to having been surprised—not as surprised, I would add, as some of the medical professionals I know, who found the figure unbelievable, but that was what he said.

Within a few days, the cancer tsar repeated that same figure in a letter to The Times. Thus, 25% suddenly became received wisdom for the standard of provision of SBRT in England. I therefore asked the Secretary of State in a written question on what evidence he had based his statement. “Not really sure,” was the reply. The evidence was based on an “informal study” conducted by the National Cancer Action Team. NCAT also said it believed there were more than 20 machines in the country that could deliver SBRT.

I am not a fan of Government policy making based on “informal studies” and vague beliefs, so I conducted my own, very formal study on the availability of SBRT in the UK. Under the terms of the Freedom of Information Act, I wrote to every hospital in the country that provides radiotherapy and asked each a series of questions about its ability to deliver SBRT. I am pleased to say that 57 replied—all but the Royal Shrewsbury hospital—and very helpful they were too.

For the record, I shall share the data with the Minister, so he can pass them on to the Secretary of State. In 2011, only seven centres in England and one in Scotland treated cancer patients with SBRT. There were no centres in Wales or Northern Ireland. Only four of the centres conducted a large enough number of procedures to comply with national radiotherapy implementation group recommendations. Therefore, 14% offer SBRT and just 8% are compliant. The total number of patients treated in those centres was just 323. That figure is not surprising when we consider that, according to the hospitals, there are only seven machines in the country capable of delivering SBRT—a good deal fewer than the number NCAT believes there are.

The Minister will not be surprised that my questioning did not stop there. I had also asked what indications the centres treated with SBRT. The data became even more interesting. Those centres using the Elekta or Varian systems treated only lung cancer. Centres using the CyberKnife system treated lung cancer, but they also treated liver, prostate, spine, breast, myeloma, sarcoma, head and neck, and ovarian cancers.

I asked the centres what their estimates for SBRT treatment in 2012 were. Again, they were very helpful in providing that information, and I place on record my gratitude to them for it. The centres estimate that approximately 725 procedures will take place in hospitals planning SBRT programmes for this year: 48 using the Varian system; 195 using the Elekta system; and 385 using CyberKnife system. The remaining 97 procedures were claimed as “estimates” by centres that have not conducted any SBRT in the past, and which do not appear—from their responses—to have suitable equipment for conducting such procedures.

I must admit that I found that last statistic, and the fact that only four centres conducted the number of procedures necessary to comply with the NRIG recommendations, very alarming. I, for one, would not wish to be treated at a centre where the team carries out only half a dozen procedures each year. How can it possibly have any expertise in such a complex treatment process if the staff so rarely conduct the procedure? For the Minister to allow that to continue would be contrary to the aims of the new Health and Social Care Bill and all that the Secretary of State has said about concentrating resources in centres of excellence to improve patient outcomes.

A number of other things alarmed me when I read the returns from the centres. On numerous occasions, the Minister has assured me that work is in hand by NCAT to establish a national tariff, or price tag, for SBRT, and yet, while the centres tell me they would welcome a national tariff, they also tell me that no progress is being made towards it. In fact, the vast majority have not even been consulted about establishing one. One of the most well known and respected centres has gone further, and said that

“a national radiotherapy tariff without SBRT would be seriously flawed and its fitness for purpose questionable.”

Will the Minister comment on that?

[Naomi Long (Belfast East) (Alliance)]

The hon. Lady is aware of a case involving Brian Withers, my constituent. He has been able to access the treatment, but has had to self-fund to do so. One reason it was not included in his clinical pathway was that it was argued that there was no clinical trial evidence for it in his situation. Does she agree that part of the problem is that SBRT is treated as a novel treatment for cancer as opposed to the development of an existing one? Therefore, without the tariff, people from other regions will not be able to access it on a routine basis.

[Tessa Munt]

I could not agree more. As the hon. Lady and others are well aware, I have spoken with her constituent, Mr Withers, and it is clear that radiosurgery is a well-established and proven therapy—it is just that we have to wait to get it.

In an answer to a parliamentary question, I was told that a price tag would not be set up until 2014. NCAT must be the only organisation in the NHS that believes it should take three years from the point that an esteemed committee recommends a national tariff until one can be implemented. From what they tell me, the centres do not believe it, and I do not believe it, and I do not think that the Minister believes it. The question of establishing an SBRT tariff, as recommended in the report from NRIG last April, is not just a question of the administration involved in setting up some codes so that the NHS can cost it; this lack of tariff has a direct impact on cancer patients’ lives.

Let me tell the Minister about my friend Kerry Dunn, a 42-year-old mother from Somerset who was diagnosed with cancer. Last September, her clinicians in Bristol concluded that the only treatment available that could save her life was SBRT on CyberKnife. The CyberKnife experts in London agreed. Her clinicians applied for funding from North Somerset primary care trust, but it took them two months before it refused. It said no because, according to it, there was not enough evidence to suggest that CyberKnife would work.

It is important that the Minister fully understands the train of events in this case. Kerry Dunn’s clinician in Bristol, one of the leading oncologists in the country, believed that CyberKnife could treat her, and the clinicians in London, who routinely use CyberKnife to treat cancer, said that they could treat her, but the bean-counters on North Somerset PCT thought otherwise. Kerry Dunn told me what had happened at the beginning of December. She and her family were in absolute despair over this decision. Once I had contacted North Somerset PCT and after the local press had, separately, taken an interest in her case, the PCT allowed Kerry Dunn to appeal its decision. Three weeks after the first decision, the PCT changed its mind and agreed her funding for CyberKnife.

If Members were expecting a happy ending to this story, I am sorry to disappoint them. Kerry went straight back to the CyberKnife people in London, but her tumour had grown so much that they could no longer treat her. Kerry and her family now face an uncertain future. Three months earlier, there was considerable hope that she would beat her cancer.

The Minister will know as well as I do that if the NRIG report had been implemented last April and an SBRT tariff set at that time, North Somerset PCT would not have delayed approval for Kerry’s treatment and she would be a much healthier woman than she is today. Over the past 12 months, the Department of Health has painted a very different picture of the provision of SBRT in the NHS. I must say to the Minister that I am shocked by the disparities between what the Secretary of State has told me and what all the hospitals have told me in answer to my freedom of information requests. Knowing the Minister as well as I do, I trust that it has more to do with his officials keeping him in the dark than their misleading hon. Members.

In conclusion, I would like some answers from the Minister today. Will he instruct the National Cancer Action Team to conduct a full review of the SBRT facilities available in the NHS? That review should establish whether hospitals are using technology that is fit for purpose and can treat a wide range of tumours with SBRT, and whether hospitals are conducting the number of procedures needed to comply with the NRIG recommendations. Will he commit to speeding up the process of establishing an SBRT tariff in line with the NRIG recommendations, and will he start immediately by asking NCAT to establish a costing code? Finally, I would like a commitment from him to investigate why decisions to fund SBRT by PCTs can ignore clinical opinions of medical professionals when assessing the need for treatment for people such as Kerry Dunn.

--- Later in debate ---

[Paul Burstow]

No. Many points have been put to me, and to be fair, I now need to respond to them.

Currently, eight centres are active in providing these services, but I recognise and appreciate the work my hon. Friend has done, and we will certainly need to review carefully the information she has presented tonight.

CyberKnife can deliver only SBRT and cannot deliver conventional radiotherapy. Large, expensive radiotherapy delivery systems such as these are purchased by public tender. After vigorous and rigorous evaluation of the many different systems available to deliver this treatment, many hospitals around the country have chosen systems provided by other manufacturers, as they enable them to provide flexible, accurate and cost-effective radiotherapy and radio-surgery services. The promotion of CyberKnife over other alternatives does a disservice to other manufacturers that are successful in providing equipment to trusts, and distorts the nature of the debate.

Let me be clear: timely access to high-quality radiotherapy for cancer patients in this country should improve cancer outcomes and survival. That is why we have made a commitment to expand radiotherapy capacity by investing about £150 million more over the next four years. That will increase the utilisation of existing equipment, support additional services and ensure that all high-priority patients with a need for proton-beam therapy get access to it abroad.

Significant progress has been made in improving radiotherapy services since the publication of the National Radiotherapy Advisory Group report in 2007. The collection of the radiotherapy dataset, which the hon. Member for Easington (Grahame M. Morris) talked about, has enabled us to establish more accurately than ever before the measure of the number of patients being treated with radiotherapy, and to identify and address unacceptable and inexplicable variations around the country. Almost all patients referred for radiotherapy treatment receive that treatment within the waiting time standards. This improvement in waiting times, compared with historical waiting times, saves lives each year. New modelling tools have been developed that allow local services to model the needs of their populations and to predict demand and ensure that they have capacity to treat all patients who will benefit from the treatment without unnecessary delay as demand changes over the years.

However, there can be absolutely no room for complacency, and we realise that more work needs to be done to identify why the variations that the hon. Member for Easington has talked about in terms of referral rates in some parts of the country have existed. The dataset shows that some variations in access rates between cancer networks persist, and there is currently lower uptake in certain parts of the north that cannot be explained by variations in cancer incidence. That new dataset allows local commissioners to examine their referral practices in detail, and I understand that networks in the north-east are looking at capacity and travel times to start to address the concerns that the hon. Gentleman has brought to the House tonight.

Access to advanced radiotherapy techniques needs to be improved, particularly intensity modulated radiotherapy. Experts estimate that around a third of all treatments given with the intention of cure should be delivered by IMRT. Some centres are already delivering at that rate, but many are far below it. All centres have equipment that is capable of delivering that technique and a national training programme has been rolled out. We now need to ensure that IMRT, as well as image guided radiotherapy, is offered to all patients who might benefit.

As we have heard, radiotherapy treatment involves the delivery of a dose of radiation to a cancer tumour. That dose is delivered to each patient in fractions or treatments and the number of fractions delivered varies with the type of cancer. The ultimate goal in radiotherapy is to deliver the treatment to the tumour with pinpoint accuracy, thus sparing surrounding tissue and requiring as few fractions, or treatments, as possible—in other words, to treat and cure more cancers with shorter courses of radiotherapy and fewer side effects. For that reason, radiotherapy is continuously evolving with innovations and the development of new techniques and technologies that move us increasingly closer to that goal, but those new developments need to be evaluated in clinical studies.

It is a challenge for providers and commissioners to keep up with the evolving nature of radiotherapy treatment and to ensure the evaluation and adoption of new techniques. The royal colleges and other professional bodies provide guidance to their members to assist the continuous update of clinical practice. Commissioners in turn need to ensure that they are aware of sources of updated guidance. The radiotherapy community in this country can be rightly proud of its ability to deliver clinical studies and explore the use of delivering radiotherapy in fewer fractions. Indeed, the role of the Royal College of Radiologists and the National Radiotherapy Implementation Group in producing such guidance is absolutely crucial.

Let me come back to stereotactic body radiotherapy, which is an important example of specialist radiotherapy technique. It allows radiotherapy to be given to smaller target areas in higher doses with fewer treatments. Its greatest potential is in its possible use as an alternative to surgery and, because of its precision, to treat and potentially cure cancers that would otherwise be untreatable. However, as has been mentioned, it is regarded as a novel technique and it provides a very high dose of radiation per treatment. With conventional radiotherapy, a patient might receive their dose over 20 to 25 visits, but with SBRT that dose is delivered in five or six. More treatments need to be delivered within clinical studies so that clinicians can carefully follow up in both the short and long term to confirm the efficacy of the treatment and study any side effects. Side effects have been mentioned in the context of drugs, but we need to be conscious that there can also be side effects from radiotherapy and not be so anxious to expose people to risks if we are not confident. We should apply the standards of clinical trials to this area. It would be wrong for this Government to promote any form of treatment before the evidence has been collected. Evidence is about more than just making speeches in the House—it is also about looking at the clinical evidence.

All new techniques, including advanced radiotherapy, need to be justified on the grounds of cost and clinical effectiveness. Last year, the National Radiotherapy Implementation Group, published guidance, which has been mentioned, on the use of SBRT, including a clinical evidence review, and concluded that there is a substantial evidence base for the clinical effectiveness of SBRT in early stage lung cancer for patients who are unsuitable for surgery.

There are about 1,000 patients in the country who would benefit from that sort of procedure. There are ongoing clinical trials examining the use of the technique for other cancers, but they have yet to confirm its benefits for those cancers. For that reason, the national radiotherapy implementation group recommended that any patient receiving SBRT should receive it in a clinical study to enable the evidence to grow, and at specialised centres treating high volumes of patients with the necessary quality assurance safeguards in place. The implementation of the recommendations cannot be rushed, and the welfare of patients should be paramount in the introduction and use of novel techniques. Staff must therefore be thoroughly trained in this technique.

My hon. Friend asked me to consider a number of issues. I will certainly undertake to examine the tariff programme to establish what more can be done to expedite it, but I should point out that it is no small task to introduce new tariffs in the NHS. In 2012-13 we are mandating the use of the necessary resource groups and currencies in regard to contracting for external beam radiotherapy, and that is an essential first step. I hope that when my hon. Friend has a chance to sit down with officials, they will be able to talk in more detail about the work that is being undertaken to make progress with the implementation of tariffs.

It is possible that there will be a significant increase in demand for this treatment in the coming decades, but many tumours will continue to be treated better with conventional radiotherapy, and in particular with intensity-modulated and image-guided radiotherapy techniques.

[Tessa Munt]

May I clarify one point? I understand that the group recommended the setting of a tariff, but that the Department of Health will not set it until 2014. There is an acceptance of the technology, but there is also a delay of two years, and in that time people might die.

[Paul Burstow]

There are already local arrangements for the contracting of these services. Specialist centres can use the opportunity to include people in clinical trials, so that we can demonstrate that this is a worthwhile treatment for many cancers. At present, the evidence suggests that it is beneficial only in the case of inoperable lung cancers. I hope that, as we progress, we shall be able to demonstrate that this is not the only technology, and that CyberKnife is a brand, not—

Oral Answers to Questions

Tessa Munt Excerpts

Tuesday 22nd November 2011 Commons Chamber

[Tessa Munt (Wells) (LD)]

There are 3,000 cases each year of early stage inoperable lung cancer, but as yet no national stereotactic body radiotherapy treatment for lung cancer. What number of patients does the Secretary of State consider to be the appropriate threshold at which he will instruct his Department to establish a national lung cancer tariff?

[Mr Lansley]

I am grateful to my hon. Friend for that question. I do not think I am in a position to say what figure is appropriate, but the national clinical director for cancer has already indicated to the NHS that he wishes us to develop a national tariff for stereotactic radiotherapy. A quarter of centres across the country already provide it, and our intention is to ensure that that is supported by a national tariff as soon as possible.