It is a pleasure to serve under your guidance this afternoon, Mr Hosie, and it is great to follow the hon. Member for Strangford (Jim Shannon). The right hon. Member for Spelthorne (Kwasi Kwarteng) has made a great contribution to the House by securing this important debate and making his interesting opening speech.
The exploitation of workers, wherever they are from and whatever the circumstances, is unacceptable, and we should stand against it. Likewise, we should be deeply concerned about the state of social care in our country. The two things are clearly interlinked. The background, of which I am sure many Members will be aware, is a sharp rise in shortages in the social care workforce. That rise essentially followed from Brexit, but other issues will have led to that shrinking of the labour pool.
Perhaps understandably, the Government’s response in February 2022 was, among other things, to lower salary requirements and visa fees for migrant social care workers. That has had a significant impact on the numbers of people coming in on social care visas: there were 101,000 social care visas in 2022-23, up from 22,000 just the year before—a fourfold increase. As a result, vacancies have fallen. It does not feel like that in my part of the world, but the stats bear that out: there has been a reduction from 10.6% to 9.9% in 2023. The vacancy rate for the UK economy as a whole is 3.5%, so a bit of maths tells us that the vacancy rate in social care is getting on for three times above the national average. The increase in the number of care worker visas continues to accelerate, with 34,000 applications in quarter 3 last year.
One observation made by those who analyse the sector more scientifically—but it is my personal observation in my community as well—is that migrant workers are to a large degree replacing UK workers, who are moving to more attractive sectors. Incoming migrant workers are therefore not really filling gaps at all. Rather, they are filling additional gaps that British workers are vacating simply because care is not attractive financially or in other ways.
That highlights the big problem that is the source of all this. Social care is an utterly vital sector on which many of us depend, yet we pay a pittance to the people who lovingly and professionally care for the most vulnerable in our communities. They often have poor job security and poor working conditions, which of course impact on recruitment and retention. If this were improved, there is no doubt that we would secure more UK workers in the profession, and perhaps not put ourselves under pressure when it comes to the obvious issues of exploitation.
There was a debate in Westminster Hall this morning on hospitality and tourism. When people like me say that part of the answer is to have less restrictive visa rules for migrant labour, the Government say the answer is simply to pay British workers more. I would say to the Government, “Take your own advice.” Social care workers are paid a pittance because we underfund social care, so if the Government believe that is the way to ensure British people work in this sector, then pay them properly, and do not exploit people who come in from overseas either, because they are hugely valuable to what we are trying to achieve.
Exploitation should seriously worry us all. There are many pieces of evidence—the right hon. Member for Spelthorne set many of them out wisely and correctly—but one figure that really blew me away comes from the charity Unseen, the modern slavery and exploitation helpline. It reported a—wait for it—606% increase in the number of modern slavery cases in the care sector from 2021 to 2022. That is an absolutely astonishing increase.
As an adjunct, talking about migration policy is often emotive. Through the Government’s Illegal Migration Act 2023—it is the Act that is illegal, rather than the act of immigration—people arriving on our shores by irregular means will not have access to this country’s modern slavery provisions, unlike others. What will be the consequence? Many victims of modern slavery will not get the care they need. I also suspect that we will find that people will to our shores and simply not claim asylum, going under the radar, and that they will be exploited all the more outrageously.
Returning to the issue at hand, the director of labour market enforcement has identified adult social care as a high-risk sector for labour exploitation, with live-in and agency care workers believed to be at particular risk. Employers who are guilty of exploiting their staff are unlikely to demonstrate any better set of ethics towards the vulnerable residents who are also in their care. The increase in the salary threshold for skilled workers will not apply to those coming in on health and social care visas, yet people on those visas will, from 11 March, not be permitted to bring in dependants. That is a cruel and demoralising thing to do to people who we rely on to care for those we need the most. It is likely to lead to fewer applications, worse retention, and therefore a bigger problem for our social care sector.
In response to the vast increase in reports of exploitation of those on the health and social care visa, the Government have announced that care providers in England will be required to be regulated by the Care Quality Commission in order for them to sponsor visas. It is a good thing that care homes will have to be regulated by the CQC to sponsor migrant workers. My question for the Minister, however, is will they be required to have a minimum CQC inspection rating of good or outstanding before they are able to do so? Secondly, have any extra resources been provided to the CQC to enable them to undertake this role with the health and social care visa, given the additional effort it will involve? What powers will they have to enforce labour standards? Surely, due to the concerns raised, recruitment should only take place via agencies on the ethical recruiters list. I would be interested to hear what the Minister has to say about that.
We need to value care work, and we need to reflect that in the pay and conditions people receive. That includes treating migrant workers well. I reiterate that the decision to end their rights to have family with them is cruel and pointless, given that those people will not have recourse to public funds anyway. It is a cruel and almost performative piece of policy. It seems that the Government feel all the more inclined to give into the temptation to put silly populism and appeasing a small number of people out on the margins of the electorate ahead of governing wisely and compassionately. Whether I agree with the Government of the day or not, I always hope they will govern wisely and compassionately, yet this is another example of them failing to do that.
Labour market enforcement needs to be better resourced. It is important to establish a single enforcement body that is accessible to workers in practice and adequately funded, that is provided with robust enforcement powers, and that has secure reporting pathways. The Government must separate all labour market and immigration enforcement activity.
I have a few other thoughts about what else the Government ought to think about doing. The Health Foundation has suggested that we need to recognise that workforce planning must take account of the range of social care services and providers, as recruitment and retention can differ from place to place, and can vary considerably by care provider. For instance, places offering contract employment will find it hard to retain staff, and in some places the availability of public transport can have a massive impact on the retention of personal assistants. For those living in Cumbria, in Appleby, Ambleside or Arnside, the existence of the £2 bus fare is completely irrelevant if there ain’t no bus for them to use. That applies to people working in social care, but also to other parts of our community.
It is worthwhile getting to the very bottom of all this, which is the way we treat social care. Had we been living to the ages that we are now, when my late, great, right hon. Friend the noble Lord Beveridge wrote that important report in the 1940s, and if families had been as they are today, then I am sure social care would have been included in the national health service right from the beginning. Yet in the decades that have followed, we have attached it to the side of the health service, like a rickety lean-to. It is time we treated social care as we always should have: as integral to, and equal to, the national health service.
The situation is awful. What are the diseases we fear —those which, I guess, we fear more as we get older? Maybe the two main ones are dementia and cancer. But what a lottery: those with cancer at least get their care provided through the national health service, while those who end up with dementia are on their own and might lose absolutely everything. That is a nonsense. I want us to channel Beveridge and do what he would do today, which I am certain would be to ensure that social care workers are considered equal in value to those working in the health service, and are paid and treated accordingly.
That is why I think that free personal care is something the Government should consider seriously. I am very proud that the current Scottish Government maintain a policy that we introduced when we were in power alongside the Labour party in the ’90s and noughties. These issues are particularly relevant to communities such as mine. We are 10 years above the average age in Westmorland and Lonsdale. Our need for care is that much greater than in other parts of the country, and we value it hugely.
By the way, it is also vital that we value unpaid carers, who look after loved ones at great cost to themselves, and to whom we owe a huge debt. We should do more than just say thank you; we should change payments, benefits, and all sorts of other allowances that allow them to succeed. It was an honour for me to do the Great North Run last year, to raise funds for Carer Support South Lakes. Let us make sure we back those outfits that support our carers so well.
In conclusion, I am asking that we take the issue of exploitation seriously, that the Minister answers the questions that I and others have put to her today, and that we recognise that this is all a function of our failure to treat the labour market wisely and compassionately, and our failure to treat social care as we should. If we invested in social care properly and paid carers properly, the knock-on effect would be happier people who stayed in their positions, who were easier to recruit in the first place and who had career prospects. Those who are cared for would be happier and better cared for, and the pressure on our national health service would evaporate, or at least be alleviated, almost overnight.
In my communities in Morecambe bay and the rest of Cumbria, often more than 32% of the beds in our hospitals are occupied by people who are fit to leave, but for whom there is no care package to help them to leave. That has consequences for A&E waiting times, cancer waiting times and ambulance response times, and it is all down to the fact that no one has yet been brave and compassionate enough to tackle the care crisis meaningfully. I hope this Government will do, but if they do not, I am determined to play a part in doing just that in the next Parliament.
I thank my right hon. Friend and male colleagues on the Government Benches, including my hon. Friend the Member for Don Valley (Nick Fletcher), who are fighting so hard to improve men’s health. He is absolutely right: 12,000 men a year die from prostate cancer. That is why we are investing in the £16 million prostate cancer trial called Transform, using methods such as MRI to detect prostate cancer rather than PSA, which can be inaccurate. Thousands of men will be recruited. We are hoping that the trial will start in the spring, with recruitment in the autumn, including the recruitment of black men, who are disproportionately affected by prostate cancer.
Does the Minister agree, however, that the information she has just given about why screening for prostate cancer does not happen for men is based on a study that is 20 years old? There are 12,000 deaths a year—it is the biggest killer among men, and the second biggest killer among all people—yet here is this evil cancer for which there is no screening programme whatsoever. Will she take steps to update current NHS guidance to ensure that all those at high risk of prostate cancer receive a targeted early detection service? I think she has hinted that she may be doing that, but will she finally introduce mass screening for prostate cancer? It is the only cancer without specifically commissioned early diagnosis work, and men are dying unnecessarily because of the failure to bring this in.
We have more than hinted: we have just announced a £16 million pilot study of prostate cancer screening. We have a plan to tackle those 12,000 deaths a year, and it will work, because until now we have not had a diagnostic test. PSA is not a sensitive test in all prostate cancers: there are many men with prostate cancer who do not express PSA. That is why the Transform study, using detection tools such as MRI, will be trialled, and if they are effective, such tools will be rolled out across the country.
I need hardly say that dentistry is not the only part of the national health service that the Conservative Government have allowed to fall into crisis while shamelessly seeking to shift the blame on to others. However, it is welcome that we have the chance to focus today on dentistry and on the millions of people in this country, including many thousands in Westmorland, who are being so badly let down.
For communities in Westmorland and Lonsdale, the heart of this crisis is a basic difficulty in securing an NHS appointment. Many people in our area know that they cannot afford to have their teeth or their children’s teeth checked. They feel a crushing financial burden, and a burden of guilt, because they cannot access an NHS dentist for themselves or their family, and they know that they cannot afford to go private.
This crisis has very real, very personal, very expensive and very painful consequences for people in our communities in Cumbria and nationwide. Healthwatch found that one in 10 people in England had resorted to paying for private dental care because they could not find an NHS dentist. However, most people I speak to cannot afford to go private, so what do those families do? Well, YouGov found that one in 10 adults had tried some form of DIY dentistry, the difficulty of accessing a dentist forcing them to resort to medieval practices. This country—proud of our prosperity and proud of our NHS—is in the shameful situation of its people’s teeth and, most shamefully of all, its children’s teeth, getting worse.
In 2022, the BDA found that one in four five-year-olds in my community in Cumbria had tooth decay, and that tooth decay was the No. 1 reason for hospital admissions among young people. Regular dental appointments are vital for preventing tooth decay, and even more so for children, whose teeth tend to decay more quickly. However, fewer and fewer children are able to access those appointments because of the negligence of this Government. In Cumbria, the proportion of children seen by a dentist in the NHS each year went from 64% in 2018 to just 50% last year, a drop of 14% in five years. Half of our children in our communities—from Grasmere to Grange, Appleby to Ambleside, Kendal to Kirkby Stephen and Windermere to Warcop—do not have access to an NHS dentist. That is a disgrace.
I have heard at first hand from my constituents about the shocking scale of the difficulty of getting access to appointments for children. One attendance officer at one of our primary schools wrote to me earlier last year after she found that families in her school were going abroad for dental appointments. She said:
“Tim, I felt compelled to email you to tell you… We have a high number of children who are regularly missing out on education due to being unable to register with a local NHS dentist. A large number of our children have Polish, Romanian, Latvian and Ukrainian parents and therefore will find it easier to travel back to their parents’ original home country rather than wait for a local NHS dentist who is accepting patients.”
Wow! Let us be clear: she is saying that some children in Cumbria find it easier to get dental treatment travelling to a war zone than to access the NHS dental care that their parents have already paid for through their taxes.
For adults in Cumbria, the picture is also awful. The number of adults seen by a dentist in the past two years is also down by 14%, to only 36.5%. Almost two thirds of adults in our communities in Cumbria cannot access the NHS dentists that—as I said—they have already paid for through their taxes. This is not only a crisis, but a colossal act of fraud and an injustice. People who work hard, pay their way, and rightly expect the Government to be competent enough to provide the services they have paid for are being let down, taken for a ride, and forced into either intense and painful physical suffering or paying again to get the treatment they were entitled to receive from the state. This is more than just a health issue; it is a moral issue, a fairness issue and a justice issue. A quick search of the NHS website shows that the nearest dental practice to Kendal that is taking on NHS patients is in Accrington, an 80-mile round trip, and that the nearest NHS practice to Kirkby Stephen is in Newton Aycliffe in County Durham, a round trip of two hours.
Let us remember that, as others have said, we are also facing a cancer care crisis in the UK, and part of the problem is a failure to diagnose cancers early so that they can be treated and cured. Dentists play a crucial role in identifying oral cancers, but if two thirds of Cumbria’s adults are not seeing an NHS dentist, we can be certain that cancers will be missed. They will therefore be untreatable and people will die unnecessarily. Core to our identity as Liberal Democrats is our belief that everyone in the UK should be able to access a dental health check-up on the NHS, with an emphasis on preventative oral health. We would reform the dental contract to ensure that those things take place, and fund it properly.
I am so often told by our local NHS ICB that, when all is said and done, the Government give them the money for only about half the people in our area to have access to an NHS dentist. Outrageously, that means that the only time they will contract a new NHS provider is when a previous provider has shut its doors, such as when the Avondale practice in Grange went private, leaving 5,000 people in limbo. People with a family of four faced a yearly fee of £1,000 just to stay on that practice’s books. I have proactively gone out to persuade private dentists to accept NHS work, and although I know it is only a sticking plaster, I reckon I could find more. However, the ICB will not take those dentists on because this Government will not let them. The dentistry crisis is an outrage—an injustice meted out to people and families across our area. It seems to us in Westmorland that the best way we will defeat that injustice is to defeat the Government who are responsible for it.
My hon. Friend sets out clearly the many pressures and factors at play in running emergency departments and hospitals at the best of times, when we are not in the middle of winter and facing the pressures that it always brings on the healthcare system. I thank not only staff in his trust, but staff throughout the country for the work they have done over recent weeks to support the NHS and to bring treatment to patients. We are working hand in glove with NHSE regional and local leaders to see whether there are practical measures that can be taken to improve the flow through hospitals.
NHS winter pressures are having a huge impact on cancer surgery and other cancer interventions. In Cumbria, in the south of the county 25% of those with a cancer diagnosis are waiting more than two months for their first intervention, and in the north of the county 47% are waiting more than two months. We know that every month’s delay in treatment means a 10% reduction in people’s chances of surviving. Some 123 cancer operations have been cancelled in the last year in our area. One reason is the lack of investment by this Government, and their predecessors of all colours, in radiotherapy. Will the Secretary of State agree to meet me and Conservative and Labour members of the all-party parliamentary group for radiotherapy, which I chair, to look at solving the problem by investing in the kit that Britain desperately needs to save lives?
I hope the hon. Gentleman will be interested to know that we have made cancer treatment waiting times a key focus of our elective recovery plan, which has been backed by an additional £8 billion in revenue funding across the spending review period. We have made progress by delivering record numbers of urgent cancer checks, with more than 2.9 million people seen in the 12 months to October last year. Of course there is more to do, and I would be very happy to meet him and colleagues across the House to discuss the practical ways by which treatment can reach our constituents. He will not be surprised to know that cancer is a priority not just for me personally, but for the Government as a whole.
Yes, with both sides stopping. The hostages should be returned to Israel and we should see a ceasefire. I think that is relatively straightforward, is it not?
Finally, moving on to integrity, integrity should be the foundation of politics. Having trust that manifestos will be implemented and that policy agendas, such as the King’s Speech, will be taken through Parliament in the form of legislation is the bare minimum that folk at home expect. Instead, the British Government have thrown integrity out the window. It will be interesting to see, over the next parliamentary year, how much of what was in the King’s Speech is actually delivered.
I received a desperate appeal from the Linda Norgrove Foundation—it is named for a brave British aid worker murdered by the Taliban—for the UK Government to reopen the Afghan citizens relocation and resettlement schemes to allow 20 female Afghan medical students to come to Scotland specifically to complete their studies. It is now clear that the Taliban will never reopen schools and universities to girls. These young women are now prisoners in their own home, unable to show their face in public or to leave the house without a male guardian. Many live with the terrifying threat of forced marriage. The Linda Norgrove Foundation will pay for them to get here, and the Scottish Government have readily agreed to waive their tuition fees so that they can finish their studies. The only thing stopping these women from finding sanctuary in the UK is the British Government’s refusal to open the Afghan citizens relocation and resettlement scheme and create a legal pathway for them to do so.
That simple change would save 20 incredible women from brutal oppression at no cost to the British Government at a time when our NHS is also in desperate need of qualified doctors. I cannot think of a reason, other than performative cruelty, why the Government would withhold that permission.
I will once again say these words that are so sorely lacking down here: wisdom, justice, compassion and integrity. What could not be clearer is that Scotland’s NHS is not safe while we are tied to the financial structures of Westminster. Broken Brexit Britain is damaging our precious NHS through workforce shortages, equipment shortages and medication shortages. I look forward to a day when an independent Scotland rejoins the European Union, leaving broken Brexit Britain behind.
It is an honour to follow the hon. Member for Warrington South (Andy Carter). I agree with some of what he said, but I do not agree that the King’s Speech was ambitious, although it was graciously delivered and historic. A consensus is building not that there was much that was bad in the King’s Speech, but just that there was not much. For those of us who live in rural communities—knowing the challenges we face, particularly when it comes to the health service—that feels particularly hard to take.
When it comes to our health services, one issue that rural communities have in common is the distance people have to travel for care and treatment. That is particularly the case when it comes to cancer treatment. The average age of members of my community of south Cumbria and Westmorland is more than 10 years above the national average, and sadly cancer is a disease of ageing and therefore there is a greater incidence of cancer; and yet, 99% of my constituents have to travel beyond the recommended time—45 minutes maximum—to get to radiotherapy treatment at our nearest centre, the Rosemere cancer centre in Preston. That is a brilliant unit, by the way, but it is an awfully long way for people from Grasmere or Coniston, who are looking at a three-hour round trip every day to get treatment. People are often not referred for that treatment in the first place because their clinicians realise they are not able to make the journey; others do not take the treatment by personal choice or they simply do not complete treatment—and as a consequence, we see longer journeys leading to shorter lives.
There is a plan for a new radiotherapy satellite unit at the Westmorland General Hospital. I was pleased to discuss that with the hon. Member for Colchester (Will Quince) only the other day, so I am gutted that he has now left his ministerial position. On the record, I ask his successor to honour that meeting and the work we have been doing together to try to bring radiotherapy to Kendal. I worry greatly that the “building hospitals for the future” programme could move that Preston hospital, which is already too far away from our communities, even further south to South Ribble.
Hospices are also a major part of our armoury in tackling cancer and supporting those living with it. Of course, their costs have gone through the roof in recent times because of energy costs. They get only 21% of their funding from the national health service. Hospices serving our communities, such as ours in Eden Valley, St Mary’s in Ulverston and St John’s in Lancaster, have seen zero uplift to take account of the fact that their energy bills have trebled in recent times.
Let me comment on the future of Westmorland General Hospital in Kendal, which is of great importance as it is at the very heart of our community. We have seen good movement, with chemotherapy coming to our hospital after many years away, a new mental health unit, and growth in the amount of surgery that takes place there. However, we have seen the cancellation of overnight cover at Westmorland General Hospital three nights a week, meaning that people from Kendal, Burneside, Staveley and elsewhere are now expecting a doctor to come on call to them all the way from Penrith, which is a massive reduction in the quality of service and something that was promised years ago would never happen.
Let me turn to dentistry. I have intercepted a document from the chief executive of our integrated care board, berating his managers for not cutting deeply enough, at a time when, in Kendal, people’s nearest dentist—if they were trying to find an NHS one today—is in Preston. If they are in Kirkby Stephen, it is all the way over in Hexham in Northumberland. Half of all the children in my constituency have no access to an NHS dentist, and only a third of adults have that access. In Grange-over-Sands, where we lost an NHS surgery recently, a family was offered the chance to go private with the same surgery at the cost of £1,000 a year just to be registered with that practice. That is in addition to all the other cost of living challenges that that family, or any others in those communities, are facing. What is all the more appalling is that, through our taxes, these folks in my community have already paid for their NHS dentistry, yet they are being expected to pay again. Some just about pull the money together and afford to do it, but most do not and are left in staggeringly poor dental health; we also see the failure to pick up oral cancers as a consequence of people not attending the dentist.
GP surgeries are of great importance to us, as they are everywhere. In recent times, we have fought and successfully saved the Goodly Dale surgery in Bowness, the Central Lakes medical practice in Ambleside and Hawkshead, and, most recently, the practice at Haverthwaite, but the ongoing threat to our surgeries in rural communities such as mine comes from the fact that they cover vast areas, have relatively small roles and, therefore, struggle financially. I have repeatedly called on the Government to bring in a strategic small surgeries fund to make it possible for small rural GP surgeries to survive and serve their communities safely.
Over the 18 and a half years that I have served in this place, the biggest single increase in volume of casework has come from mental health issues among young people, and it is utterly and totally heartbreaking. Fifty per cent of young people on the books of child and adolescent mental health services in Cumbria and north Lancashire at the moment are those presenting with autism spectrum disorders, or attention deficit hyperactivity disorder—very often waiting two years just to be seen at all. That 50% of the workload is for those neurological conditions that do not attract any funding whatever from our local commissioners—nothing at all. Those young people are being held up in the system. They are being left to rot, as are their families and other young people, including those with eating disorders and anxiety disorders. If a 15-year-old were to break their leg on a football field on a Sunday afternoon, they would be seen within a couple of hours. If a person breaks something invisible inside them, they may wait months or even years to be treated, sometimes with fatal consequences. That is utterly and totally outrageous.
We need to tackle the subject of mental health at the beginning, so that we build resilience in young people, not just treat the symptoms. That is why I recommend the Government pick up my private Member’s Bill on outdoor education, which would compel every Government to fund every single child—once in primary school and once in secondary school—to take part in an outdoor education residential experience to build their resilience, help them to develop teamwork, and ensure that they are able to deal with the stuff that life throws at all of us at one time or another.
Finally, let me mention care. With many people above the average age in our community, it is no accident that 32% of our hospital beds were blocked early this year. Why was that? It is because there are not enough carers, and we do not pay those carers enough or treat them well enough. The consequence is the clogging up of our national health service from top to bottom—from A&E and ambulance response times to GP surgeries and everything else. Until we tackle the care crisis, we will not tackle the NHS crisis.
In a community like ours, one of the major reasons that nearly a third of the beds were blocked is the simple fact that there are not enough homes for people on average or below average incomes to live in. If we do not provide homes in communities like ours—by tackling the Airbnb crisis, the second homes crisis and the lack of social rented homes—we will have no workforce in care, in health or in any part of our public sector. Until the Government recognise the need to support those who work, and can potentially work, in health and social care, mental and physical health, we will continue to live in a crisis, particularly in rural communities like Westmorland.
It is always important to follow the science. That is why, at the G20, Health Ministers agreed to look at the various research being done in multiple countries, particularly on long covid but also on the lessons from that period, to ensure that research from that period is shared internationally so we can learn best practice from other countries as well as within the NHS.
The Government and NHS England are committed to ensuring cancer patients can receive high quality radiotherapy treatment. Between 2016 and 2021, £162 million was invested which enabled the replacement or upgrade of around 100 radiotherapy machines. Responsibility for investment in radiotherapy machines has sat with local systems since April 2022. I look forward to meeting the hon. Gentleman and the all-party group for radiotherapy on this matter soon.
I am very grateful to the Minister for his reply and in particular for the offer of the meeting coming soon. Radiotherapy UK says that for us to even meet average international standards we must commission 125 additional new linear accelerators. Will he make the commitment to do that and, in doing so, ensure that rural and remote communities do not lose out by placing some of those machines in new satellite centres, such as the Westmorland General Hospital?
The hon. Gentleman is hugely passionate on this subject. As I said, integrated care boards are responsible for meeting the health needs of their individual populations, and that includes capital allocation. The 2021 spending review set aside £12 billion in capital funding, and since 2016 over £160 million has been invested in radiotherapy equipment, but of course I want to see more investment in this important technology and the necessary upgrades across England. I very much look forward to our meeting, where we can discuss that further.
Again, my right hon. Friend raises an extremely important point. I am extremely keen that the families, as well as the Members of Parliament in Essex, are able to engage with the chair of the inquiry and to shape that inquiry.
As part of the discussion in Chester with families about the relative merits of a statutory or a non-statutory inquiry, one concern was that a statutory inquiry sometimes takes much longer, which is why the point around phasing is important. Of course, the court case itself will have established significant areas of factual information that can be used by the inquiry. I hope my right hon. Friend can see that the decision to put the Essex inquiry on to a statutory footing underscores our commitment to getting families the answers they need.
My prayers remain with the families who live each day with the consequences of this unspeakable evil. Among the most chilling aspects of this tragic outrage was, as we have heard, the actions of trust leaders and managers, who ignored warnings and belittled whistleblowers. We have to ask ourselves how many lives could have been saved if people had been believed sooner.
I have to say that this feels horrifically similar to the failings in maternity services in my own local trust of Morecambe Bay during the 2000s, when we saw several mothers and babies needlessly lose their lives. Since then, despite the freedom to speak up measures that have been instituted across the country, I still see whistleblowers in other departments in trusts in the north-west marginalised, bullied, unfairly treated and having their careers trashed, all because it would appear there is a culture of defending the reputation of institutions rather than protecting the safety of patients. What confidence will the Secretary of State give to potential future whistleblowers that, when they speak out in order to save lives, they will not then be singled out?
Again, colleagues across the House know that protecting whistleblowers, including whistleblowers in the NHS, is something I have long championed. As I said earlier, the guidance has been strengthened, but one of the best mitigants is having much more transparency on the data, because the more transparent the data is, the more difficult it is for concerns to be ignored. There is a number of issues. We have strengthened the data. We have the freedom to speak up guardians. We need to look at whether, in Chester, if a freedom to speak up guardian were on the board, that would be the right approach. Do we need to look at whether these roles should be on the board? But significant work has already been done since these events and since Morecambe to strengthen the safeguards around speaking up and the Public Interest Disclosure Act. Alongside that, having organisations such as the Getting It Right First Time team looking at the neonatal data is a further important safety process to have in place.
It is a pleasure to serve under your guidance this morning, Dame Maria. I pay tribute to the hon. Member for North Devon (Selaine Saxby) for leading the debate and doing so extremely well; I agree with every word she said. I also pay tribute to the hon. Member for Easington (Grahame Morris) for not just his speech, but his ongoing work in this area. He speaks with great authority and obviously with great personal experience. I also thank Professor Pat Price, who has been mentioned by both of my colleagues and leads the cancer charity Radiotherapy UK. She is a specialist who adds enormous value to our campaigns to help those in positions of influence to make wise decisions about this vital technology.
Let me start with another positive, and say a massive thank you to that small but incredibly talented workforce of maybe only 5,000 people who deliver radiotherapy in all the centres around the country, literally saving lives every single day. We are massively, massively grateful to all of them.
I apologise that there will be some repetition, but all good campaigns involve repeating one’s messages. We know that one of the most dark and terrible facts of life is that around half of us at some point in our lives will contract cancer, which means that pretty much all of us have experienced it in our families—some with remarkable and wonderful outcomes, some with tragic and incredibly sad ones. I have experienced both within mine. We know that radiotherapy is a really important tool in tackling cancer in terms of both palliative and curative treatment. As has been said, the international standard for the number of people with cancer who should receive radiotherapy is 53%; in the United Kingdom, it is only 27%. That should ring enormous alarm bells in all parts of the House and in every corner of the national health service, but I am afraid that it does not feel like that is happening. There are many reasons behind that, but one that we have already heard is that we spend only 5% of our cancer budget on radiotherapy, and the average of countries similar to ours in the western world is nearer to 10%.
Again, we have already heard—but I will restate—that in the United Kingdom we have 4.9 linear accelerators per 1 million of population. In France, there are 8.5 linear accelerators per million people. For the UK to become just average, we would need 125 additional linear accelerator machines this year, as has already been said. Put bluntly, the fact that this is quite a balkanised commissioning process is one reason why we are where we are. The lack of central commissioning means that different centres will, or will not, have sinking funds, so there is absolutely a postcode lottery. It also means that, as our survey—through the all-party parliamentary group for radiotherapy, which I am privileged to chair—discovered, 75 machines that are basically past their sell-by dates will be in use in our hospitals next year, many without a plan to replace them.
We are behind not just on the volume of technology but, as has been suggested, on the deployment of new technology, much of which was developed in this country. That makes it all the more inexcusable. For example, AI software could allow clinicians to accurately plan patient care in a few minutes rather than a few hours. Imagine the impact that would have on our workforce.
We absolutely need to invest in our workforce. We need to support them, to ensure that we boost the morale of people who are already in the service to keep them working in the service, and to bring in the perhaps 1,500 additional net posts needed to ensure that we have a properly functioning radiotherapy workforce. Alongside that, the fact that we could allow clinicians to do their planning even more accurately, in a fraction of the time, obviously makes sense because we would get even better use out of the workforce than we currently do, in terms of the hours that they put in.
We could also invest, as has already been mentioned, in surface-guided radiation therapy to reduce waiting times. Again, that was developed in the UK, but has not been deployed much here. When we have 40% of people in north Cumbria and about 30% of people in south Cumbria waiting more than two months for their first treatment—we have already heard that every four weeks of delay means that someone is 10% less likely to survive—then, surely, investing in that capacity in radiotherapy, as well as in new technology, is just a no brainer.
All of that costs peanuts—that is a Treasury term, I think—in comparison with equally worthy but vastly more expensive drug treatments. We are talking just £200 million for those 125 new linear accelerators. I am not knocking those treatments, by the way; chemotherapy and immunotherapy are vital weapons in our fight against cancer. Herceptin has saved so many lives, for example, but I have picked that drug for a reason, because the cost of Herceptin, in one year, is equivalent to two thirds of the entire radiotherapy budget.
That is understandable, because drugs do cost more than kit, but it is a reminder of how relatively straightforward this problem is to solve. For a Government that wanted to shift the dial quickly and do something of long-term value, but that would have an impact in a short period of time and would cost, relatively speaking, very little, it should be an obvious no-brainer, and it frustrates me that we are where we are.
Let us be cross-party in our self-criticism, because I can blame this Government for their inaction, and I can blame the coalition Government, and I can blame the previous Labour Government. It is 30 years of us being behind the curve here. Let all accept that we are all responsible and we will all do something about it, starting right now.
Why are we in this situation? I suspect that it is because decisions are often made when the right people are in the room. I am not knocking the pharmaceutical companies, but they have the resource to be in the room. However, when we have our radiotherapy APPG meetings, and we have clinicians from right across the country—the best people in their profession—huddled into little rooms off Westminster Hall, I realise that that is the radiotherapy industry. That is the radiotherapy “lobby”. That is it. We do not have paid specialists; the lobby is in that room. That is perhaps why radiotherapy has slipped off the radar. This is the moment in which it must go right back on to it.
The situation is even worse in rural communities. Some 3.5 million of us live in what we would refer to as radiotherapy deserts, where we are more than a 45-minute journey away from the nearest radiotherapy treatment centre. The national radiotherapy advisory group says that any trust that allows that to happen is guilty of bad practice. In my constituency, pretty much everybody lives outside that 45-minute guideline distance, and when we are looking at the travel times, they are always those from the best-case scenario—travelling at 2 o’clock in the morning, or not in the middle of the tourist season. Twenty million people visit the lakes every year; the roads get a bit clogged up from time to time. If someone is from Dent, the round trip to Preston to get their treatment will take them about two and a half hours. From Kirkby Stephen, it is two hours to Carlisle, two and a half hours to Preston. From Grasmere and Coniston, the round trips are nearer three hours.
Over my time as an MP it has been a privilege to often take my constituents to their treatment in the Rosemere cancer treatment centre in Preston. By the way, it is absolutely excellent, but just blinking miles away; it is far too far away. I remember taking a young mum—a teaching assistant—and her two young children, for her breast cancer treatment. I remember the impact it had on her, how wearying it was; and she was an otherwise fit and healthy young person. I remember taking an older woman from Kendal, some years later, also for daily treatment, and the impact that had on her and her family. It is not just that travelling those long distances is inconvenient; it is actually dangerous. Sometimes, as has already been said by the right hon. and learned Member for North East Hertfordshire (Sir Oliver Heald), it means that people will choose not to complete their treatment. It is also true—clinicians will sometimes baulk at this, but I am not criticising them—that people will not be recommended or referred for radiotherapy because it is recognised that that person will not cope with the travelling.
Not long ago there was a bus driver in my neck of the woods who gave up work for two months and moved to Preston for his treatment, because he could afford to do so. The economic impact on people, in terms of worsening their poverty because of the distances that people have to travel, is huge. The simple fact is that because of the distance they have to travel to treatment, people do not live as long in rural areas. That is outrageous.
In 2008 we launched a campaign to bring a cancer treatment centre to Westmorland General Hospital in Kendal. We have largely succeeded. We brought chemotherapy there in 2011, there is more and more surgery, and diagnostics is arriving in the coming months. The one thing we wanted that we have not got is that radiotherapy satellite unit. I want to be clear that the Rosemere unit in Preston is fantastic. We do not want to replicate it; we want to be associated with it. That is, we want a satellite unit that is attached to the Rosemere one and operating at the hospital in Kendal—just as Rosemere itself was once a satellite to the Christie. Today, there are centres that are satellites of the Christie at Oldham, Macclesfield and Bolton, all of them doing a fantastic job and allowing people who live in those communities closer access to that important treatment.
The simple reality is that over these last few years the proposal that has been made for a radiotherapy satellite unit at the Westmorland General Hospital in Kendal has been written and proposed, and the trust has been behind it. It was eventually signed off in 2014 and then cancelled in 2016. I often point the finger at Ministers and the NHS for that failure to deliver, but I also encourage the trusts and commissioners locally not to let it drop off their agenda. It has vital importance. I often hear commissioners, local trusts in Morecambe Bay and the Lancashire hospitals teaching trusts say the right things, but it feels not sufficiently urgent—tell you what, it is urgent to my constituents. It is urgent every time that somebody gets that awful diagnosis and then realises that they have weeks and weeks of travelling and might not make it. They might not complete the journeys; that might mean that they do not survive.
Yet if we look at the demographics, our need in Cumbria is increasing. It is recognised that at the moment there is demand for 1.3 linear accelerators, just in the area that is closer to Kendal than to Preston. Sadly, cancer is a disease of ageing, at least in part; as our population ages, we know that that demand will get greater.
Here is a crucial point that I really want the Minister to take on board. The evidence is that when a satellite unit is opened, there is a greater level of demand than was predicted. Why is that? There are reasons why only 27% of people are having radiotherapy treatment when it should be 53%, and access is one of them. The APPG for radiotherapy had a forum for the satellite units a little while ago. What we gained from that was the staggering news that when a new satellite centre opens, rather than just getting the demand from the parent centre that was predicted, there is at least 20% more demand than was expected, in every single one. In some cases, the increase in demand is 50%. That is because those patients were not being referred or were choosing not to complete. If you build them, Minister, they will come, and lives will be saved. That all means that people in Kendal, Grange, Windermere, Kirkby Stephen, Appleby, Sedbergh, Ambleside, Coniston, Grasmere and the rest of our communities in rural Cumbria are facing not just longer journeys, but shorter lives. That is not acceptable.
The United Kingdom needs a radiotherapy boost across the board. It would be relatively inexpensive, and if the Government committed right now, we would see dividends and lives being saved within a matter of months. Rural communities, from Westmorland to the west country and from Northumberland to Norfolk, need it even more. For the 3 million people who live in a radiotherapy desert, as I do, investing in satellite units will make an immense difference.
We are desperate for action in Westmorland. We are desperate to see our satellite radiotherapy unit delivered at the Westmorland General Hospital in Kendal. I ask the Minister to act personally now and look at our bid for a satellite unit. If he acts and instructs commissioners to get on with the business of commissioning, I promise that our community will raise at least £2 million to help him to make that case in a partnership bid. If he commits to helping people in Westmorland to have better treatment, shorter journeys and longer lives, I will be permanently, eternally grateful.
The Minister is being generous in giving way. The debate is instructive, and I am glad he has mentioned integrated care boards. As the hon. Member for Westmorland and Lonsdale (Tim Farron) mentioned—sorry, the right hon. Gentleman.
One of the issues has been commissioning. NHS England is responsible for commissioning without having a sensible plan to replace old machines, and there are bizarre disincentives to using the most modern machines, which require fewer visits. Furthermore, the fractionations are smaller, and the radiotherapy could be delivered in a shorter time. Bizarre commissioning arrangements and tariffs apply. Is the advent of the ICBs, with the responsibilities they hold, an important element in deciding where the new treatment centres are going to be? Will the Minister outline their role in the context of access to radiotherapy services?
I thank the hon. Gentleman for his question and will jump to the part of my speech that covers equipment, because the issue has been raised by all hon. Members during the debate.
We are absolutely focused on improving cancer treatment and supporting advances in radiotherapy using cutting-edge imagery and technology. As my hon. Friend the Member for North Devon pointed out, since 2016 we have invested £162 million in the most cutting-edge radiotherapy equipment, which is designed to replace or upgrade more than 100 radiotherapy treatment machines so that we can deliver the best possible outcomes for patients. As the hon. Member for Westmorland and Lonsdale said, NHS England is carrying out a stocktake of linear accelerator age, which will be completed in the summer. It is also working with partners to undertake a demand and capacity review, which will complete by the end of the year.
On AI specifically, we want to ensure that we have the best possible cutting-edge, innovative equipment and technologies in the NHS, so we have announced an additional £21 million of funding that will speed up the roll out of AI across the NHS. That will enable us to help to improve diagnosis and to reduce waiting times—one of our top priorities—and clinicians will be freed up to spend more time delivering frontline patient care. The point made by the hon. Member for Easington about AI and the benefits thereof is well made.
The hon. Member for Westmorland and Lonsdale has been campaigning on the issue for around a decade, or perhaps longer, and he has met several Ministers. I am yet to meet with the hon. Gentleman, and I know he was due to meet my hon. Friend the Minister for Social Care, but I am happy to honour that meeting. He recently met his local hospital trust to discuss radiotherapy being part of the new hospital programme. Ultimately, that is a matter for commissioners, but we can certainly have that conversation when we meet and try to find a way forward.
A number of hon. Members raised the issue of the workforce. The hon. Member for Strangford (Jim Shannon) is no longer in his place, but he laboured this point, and rightly so. We have made good progress in growing the cancer workforce. The annual growth rate of the workforce remains steady at between 3% and 4%, but we need to go further. As of February, there were 33,174 full-time equivalent staff in the cancer workforce. In trusts, that is an increase of more than 11,300 since February 2010. Specifically, the number of therapeutic radiography staff grew by 17.4% between 2016 and 2021. As has been referenced, we published our long-term workforce plan, which sets out actions that are backed by £2.4 billion of Government funding up to 2028-29, a couple of weeks ago.
On travel, the travel that a patient needs to undertake is dependent on the type of treatment they need. Decisions about treatment locations are made on a case-by-case basis. As hon. Members have pointed out, specialised services are not available in every local hospital, in part because they have to be delivered by specialist teams of health professionals with the necessary skills and experience and access to the necessary equipment and medicines. Patient-specific requirements are based on what each individual can cope with and are discussed between the patient and clinician.
The Government are, of course, striving wherever possible to reduce any necessity to travel unreasonable distances, which is why our priority continues to be to bolster the specialist workforce and ensure ever-expanding coverage of equipment. That includes by investing in new radiotherapy machines, but the responsibility for investing in that equipment sits with local systems—the ICBs, which I suspect we will discuss in greater detail when we meet. I hear the case that has been made about equality and rurality. We can address some of those issues and work with integrated care boards so that they see the benefits to patients and to outcomes, as well as the cost savings, if we get it right.
We are supporting providers to accelerate the delivery of stereotactic ablative body radiotherapy for targeted cancers, thereby lowering the risk of damage to normal cells. Specialised commissioners have allocated £12 million to support providers to deliver SABR.
The Minister has given a comprehensive response to us all. On the issue of SABR, would he look in particular at the point made by the hon. Member for Easington (Grahame Morris) about commissioning arrangements and the perverse incentives that lead to some cancer treatment centres effectively being paid more for using lesser treatment than they would be for more efficient, less invasive, less frequent but more powerful SABR technology and other similar advanced forms of treatment? It would save an awful lot of money and still do a better job.
In short, the answer is yes. There are perverse incentives that exist across Government, and the NHS is no exception. Wherever we identify them, we have to work to drive them out of the system. We have a tendency, unfortunately, to focus on processes and procedures. I want all trusts—I would like us to do this across Government—to focus more on outcomes than on processes. Perhaps when we meet the hon. Gentleman could set out that exact challenge in more detail, because I would be glad to look at it in detail.
Dame Maria, I am conscious that I have gone on for longer than I should have; you have been very generous. I again thank my hon. Friend the Member for North Devon for bringing this matter to the attention of the House, and I thank all hon. Members for their contributions on this hugely important subject. I hope I can assure my hon. Friend and Members from all parties that with the investments we have made and the innovations the NHS has adopted, and the innovations to come, we will continue to improve access to radiotherapy throughout the country. I look forward to meeting the hon. Members present, alongside NHS England, to see what is within the art of the possible in this space. I look forward to working with parliamentary colleagues throughout the House to bring about the improved cancer outcomes that we all want to see.
Not only do I agree, but I have been with my hon. Friend to see this scheme at first hand. He has championed the scheme vociferously and helped to secure that investment for his constituents. I look forward to working with him to ensure it is delivered as quickly as possible.
Plans to remove overnight primary care clinicians from Westmorland General Hospital three nights a week are a massive risk to our community and mean that, overnight, people will be reliant on Barrow or Penrith for an out-of-hours doctor. Will the Secretary of State instruct the ICB to intervene to protect people in South Lakeland from this massive reduction in the quality and accessibility of services?
Some of us remember when the Lib Dems were for greater localism. One of the things we are looking at is how to empower commissioners, on a place-based basis, to make decisions on where best to place services. We need to move more services into the community upstream, to address the frail elderly before they get to hospital and to have more community services. I am happy to look at the specific issue the hon. Gentleman raises, but I would have thought the Lib Dems would support the general trend of empowering integrated commissioning systems to make place-based decisions.
It is a pleasure to serve under your chairmanship, Ms Nokes. I pay tribute to the hon. Member for Eastleigh (Paul Holmes) for securing this important debate.
St Mary’s Hospice at Ulverston, St John’s Hospice at Lancaster and the Eden Valley Hospice at Carlisle provide tender, professional and specialist care for people with life-limiting conditions and their loved ones—something we are so grateful for. They prove that life has dignity from beginning to end. Hospitals, however marvellous they are, do not have the resources to replicate the care that is provided by hospices.
The costs of running a hospice have gone through the roof in recent times. Val Stangoe, the chief executive of St Mary’s, one of our three local hospices, said to me:
“The recent settlement by the NHS Lancashire South Cumbria ICB of 0.0%”—
as pointed out by the hon. Member for Lancaster and Fleetwood (Cat Smith)—
“has left our hospices in a state of financial deficit, with potential loss of hospice beds and services.”
She went on:
“Your local hospices”—
“are now operating on a deficit budget, have received the lowest settlements in England. The proposed 0.0% uplift equates to almost 10% in cuts, significantly impacting delivery of services. This stands in contrast to other regions, where hospices have received an average uplift of 2.7%”—
which is not enough. She continued:
“The disproportionate treatment faced by hospices in Lancashire South Cumbria is unfair and must be addressed.”
My fundamental ask of the Minister is this: will she directly involve herself in that situation to stop our hospices in Cumbria suffering? I have been asking the Government for months to come up with a scheme to help hospices that are struggling with their energy costs, which have gone up three times in recent months. There are lots of promises and no action.
There is a cost to meeting the NHS pay settlement. There is a cost to ensuring that hospices are paid properly so that they can pay their staff, keep them, and recruit them in the first place, and so that they can pay their energy bills. But the cost of not doing that is far greater, not only in terms of the health damage and people’s pain and suffering, but for the hospitals that have to pick up the pieces when hospices are not able to meet people’s needs.
As the hon. Member mentioned earlier, we have indeed met and spoken about the hospice to which she refers. I have also met with several other hon. Members. I am grateful to them for coming to me to talk about the specific difficult situations faced by some of the hospices serving their communities.
That brings me to exactly what I was coming to talk about: the financial pressures on hospices, which have been a strong theme of the debate. I know very well, not just from this debate but from conversations with hospices, about the financial challenges that hospices are facing. In fact, financial challenges are being faced by many organisations that provide care in our communities, whether NHS organisations or care homes, as the hon. Member for Leicester West (Liz Kendall) mentioned. In particular, there are the extra pressures of energy costs—such organisations often use substantial amounts of energy—and the higher costs of staff pay. We know that many hospices pay their staff in alignment with the NHS agenda for change pay scales.
An additional difficult context for hospices at the moment is fundraising. That was clearly hard during the pandemic, but since then many households have been affected by the higher cost of living and therefore have found it harder to contribute to fundraising efforts in their communities, including those organised by hospices. I know how hard that context is for our hospices.
On energy costs, many hospices have been able to benefit from the Government’s energy bill relief scheme, which ran to 31 March. Eligible organisations, including hospices, will continue to get baseline discount support for gas and electricity bills under the energy bills discount scheme, which is running from 1 April 2023 to 31 March 2024. In addition, last year NHS England released £1.5 billion of extra funding to integrated care boards in recognition of the extra costs arising from inflation in the services they commission. ICBs have been responsible for distributing that funding according to local need, including to palliative and end of life care providers in our communities, whether they are NHS organisations or hospices.
Of course, ICBs are not elected, but the Minister is. She heard what the hon. Member for Lancaster and Fleetwood (Cat Smith) and I had to say about the 0% increase that the Lancashire and South Cumbria ICB has granted—or not granted—our hospices. Will she directly get involved in that to fix it so we do not have to have the 10% cuts that St Mary’s Hospice thinks we will have to deliver?