Building an NHS Fit for the Future

Tim Farron Excerpts

Monday 13th November 2023 Commons Chamber

[Amy Callaghan]

I would get behind a ceasefire. We are talking about a ceasefire.

[Tim Farron (Westmorland and Lonsdale) (LD)]

With both sides stopping.

[Amy Callaghan]

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.

--- Later in debate ---

[Tim Farron (Westmorland and Lonsdale) (LD)]

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.

Oral Answers to Questions

Tim Farron Excerpts

Tuesday 17th October 2023 Commons Chamber

[Steve Barclay]

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.

[Tim Farron (Westmorland and Lonsdale) (LD)]

10. How many and what proportion of NHS radiotherapy linear accelerator (LINAC) machines will reach the end of their recommended lifespan in 2024.

[The Minister for Health and Secondary Care (Will Quince)]

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.

[Tim Farron]

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?

[Will Quince]

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.

Countess of Chester Hospital Inquiry

Tim Farron Excerpts

Monday 4th September 2023 Commons Chamber

[Steve Barclay]

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.

[Tim Farron (Westmorland and Lonsdale) (LD)]

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?

[Steve Barclay]

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.

Radiotherapy: Accessibility

Tim Farron Excerpts

Tuesday 18th July 2023 Westminster Hall

[Tim Farron (Westmorland and Lonsdale) (LD)]

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.

--- Later in debate ---

[Grahame Morris]

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.

[Tim Farron]

I am merely honourable.

[Grahame Morris]

Well, I am sure it is only a matter of time.

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?

[Will Quince]

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.

[Tim Farron]

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.

[Will Quince]

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.

Oral Answers to Questions

Tim Farron Excerpts

Tuesday 11th July 2023 Commons Chamber

[Steve Barclay]

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.

[Tim Farron (Westmorland and Lonsdale) (LD)]

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?

[Steve Barclay]

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.

Hospice Services: Support

Tim Farron Excerpts

Wednesday 14th June 2023 Westminster Hall

[Tim Farron (Westmorland and Lonsdale) (LD)]

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”—

our 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.

[Caroline Nokes (in the Chair)]

Because one speaker has dropped out, I am going to increase the time limit back to three minutes.

--- Later in debate ---

[Helen Whately]

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.

[Tim Farron]

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?

Oral Answers to Questions

Tim Farron Excerpts

Tuesday 6th June 2023 Commons Chamber

[Tim Farron (Westmorland and Lonsdale) (LD)]

There was a net loss of 577 full-time equivalent GPs last year. A contributing factor in rural communities was the Government’s decision a few years ago to remove the minimum practice income guarantee, making it unsustainable for small surgeries—and many rural surgeries are necessarily small—to survive. Will the Minister consider whether it is time to reintroduce a strategic small surgeries fund, to allow smaller rural surgeries in communities such as mine to survive and thrive?

[Neil O’Brien]

The funding formula already takes account of rurality. I hear the hon. Gentleman’s argument, but it is worth noting that our GPs are doing more than ever before. In the year to April there were nearly 10% more appointments than before the pandemic, or 20 more appointments in every GP practice per working day. GPs are working incredibly hard, as well as putting in extra staff, and I pay tribute to them for the sheer amount of work they are doing.

NHS Dentists: South-West England

Tim Farron Excerpts

Wednesday 24th May 2023 Westminster Hall

[Tim Farron (Westmorland and Lonsdale) (LD)]

It is a pleasure to serve under your chairmanship, Ms Elliot. I congratulate the hon. Member for West Dorset (Chris Loder) on securing an important debate and opening it very well. Access to NHS dentistry is becoming harder across the country, but, as we can sense from the contributions we have heard, especially so in rural communities such as those in Cornwall, Devon, Somerset, and Dorset, as well as in areas such as my own, in Cumbria.

Rural communities struggle more than others with access to dentistry because of pressures such as high housing costs and lower working-age populations, which mean there is a smaller dental workforce. Access to dental care in rural communities is also worse because we are dealing with sparsely populated areas and fewer economies of scale are available for the surgeries in question. There is the additional and crucial matter of the physical distances that people have to travel to receive treatment. Last week, I did a quick search and found that for a family in Coniston in my community the nearest available NHS dental place was in Hexham in Northumberland, which is a 160-mile round trip.

Every month it seems that we lose another NHS dental practice. I am sure that is the case for Members in every part of the country—from the contributions so far, especially in the south-west. I have recently lost a surgery in my community that saw 5,800 patients lose their NHS status overnight. The private plan that those patients were offered to replace those places would have cost a family of four £1,000 a year just to stay registered and on the books. With increasing prices, such as the rise in mortgage costs, rental costs, fuel duty and food—the cost of just living in any respect—how is that acceptable or affordable, given that that family, like everybody here, have already paid for their NHS dentistry through taxes?

People across our country have paid for a service, as my hon. Friend the Member for Tiverton and Honiton (Richard Foord) said, that the Government have not delivered. It is about not just the financial costs to families if they have to go private when an NHS dental service is no longer available but the physical pain, the anxiety and the sense of guilt, for parents, that their child is not seeing a dentist because they cannot afford to send them because NHS dentistry is not available. My hon. Friend the Member for Bath (Wera Hobhouse) talked about oral cancers and the fact that many dentists are the first to spot them and provide life-saving treatment.

For what it is worth, I do not blame the dentists, because I speak to so many of them. They are as angry as the rest of us, for many reasons. First, the Government take the public’s money but do not pass it on to the dentists. There is not enough money in the system, as the hon. Member for South Dorset (Richard Drax) wisely pointed out. That is true nationally, but it is also true surgery by surgery. Dentists tell me that it is often the case that the Government’s funding per unit of dental activity may be less than what a patient paid over the counter for their treatment. Dentists and patients, then, are both being ripped off.

A unit of dental activity payment, at the most basic level, could net perhaps £20 or £30 for a single examination. Diligent dentists seeking to do a good job might do three of those in an hour. Let us do the maths—that funding is not enough to pay to keep the lights and heating on, pay the rent and pay for staff salaries and materials. Many dentists feel that treating patients at a good standard therefore costs them and their practice more money, and that they have to subsidise the NHS. There are incentives to cut corners, to be on a treadmill, to rush through more patients and to do a job that the dentists themselves feel professionally dissatisfied with. As we have heard, good dentists who are committed to the NHS find that they cannot afford to stay, so they leave and it breaks their heart. That leaves thousands of our constituents without access to adequate, affordable dental care, which leads to more expensive, painful and damaging emergency hospital dental care further down the line.

There are many things that we can do as local MPs. I have written to my local surgeries to encourage them to take advantage of things that the integrated care system has offered to bring some back to the NHS, but unless there is radical reform of the system, good dentists will leave the NHS and thousands on thousands of our constituents will not be able to access the dental care that they have already paid for through their taxes for themselves and their children.

Oral Answers

Tim Farron Excerpts

Tuesday 25th April 2023 Commons Chamber

[Helen Whately]

My hon. Friend makes a really important point about the very important work that hospices do in our communities, and I fully support hospices as a sector. The funding for hospices generally comes through the NHS and the local integrated care boards that commission the services they provide, as well as, of course, from their own fundraising efforts. I am speaking to NHS England about the support it provides to hospices, because I am very keen to make sure that they get the support that they need.

[Tim Farron (Westmorland and Lonsdale) (LD)]

T8. I have in my hands the draft business case for a satellite radiotherapy unit at the Westmorland General Hospital in Kendal. If it is approved and commissioned, residents in my community who have cancer will no longer have to travel two, three or four-hour round trips every day to get lifesaving treatment; they will be able to get it closer to home. Will Ministers meet me and the clinical specialists who helped draft the business case, so that we can make it come to fruition?

[Helen Whately]

Yes, I am very happy to meet the hon. Member.

Cancer Care

Tim Farron Excerpts

Tuesday 14th March 2023 Westminster Hall

[Tim Farron (Westmorland and Lonsdale) (LD)]

It is an honour to serve under your guidance today, Mr Paisley, and to follow the hon. Member for Bootle (Peter Dowd), who made some important points, for which I thank him. I express massive congratulations to the hon. Member for West Bromwich East (Nicola Richards) not just on securing an important debate, but on making an excellent speech. I commiserate, console and offer my condolences to her on the loss of her mother. I also lost my mum to cancer. The hon. Lady is a bit younger than I am, so I assume we lost our mums at about the same age.

My mum, Dr Susan Farron—she would like me to mention her title, I am sure—passed away from ovarian cancer 19 years ago. Although we are here to represent our constituents and do what is right, whether we are personally affected or not, there is an element of honouring our mothers in what we seek to do today. I am sure the hon. Lady’s mother would be massively proud of her, not just for what she has done today.

This is a huge issue. It is said that half of us will get cancer at some point in our lives, and 100% will be affected by it in one way or another. We deal at the moment with terrifying waiting times for cancer treatment. They are not quite as awful as they were a month or so ago. The Minister may say that, and we will grab some positives where they exist, but they are still deeply troubling.

In my constituency, in south Cumbria, 27% of people with cancer are not being seen within two months of being diagnosed. Someone who has cancer and has been told they have this dangerous thing within them that is potentially going to kill them then waits for two months for treatment. In north Cumbria, 44% of people diagnosed with cancer are waiting more than two months for their first intervention. What terror does that spark in an individual with cancer and all their loved ones? What frustration does that lead to within the clinical community, who desperately want to care for those people? To add substance to that terror, we know that on average—although there is no average cancer—for every four weeks that treatment is delayed, there is a 10% reduction in life expectancy. That is disastrous and massively worrying for everybody who faces that challenge.

Covid has played a part, with its massive impact on our health service. People perhaps did not come forward with symptoms during the pandemic as soon as they might have done. I have many disagreements with the Government about how they handled the pandemic, but it is important to say that, if they had not locked down, the situation would have been far, far worse. Let us remember that many of the pressures that we face are because we sought to protect the NHS to save lives, and we did just that. However, the waiting times are unacceptable. They are explicable but not excusable.

I want to focus my remarks on radiotherapy. I chair the all-party parliamentary group on radiotherapy. One reason for doing that is that I recognise that radiotherapy is one of an important range of tools that can be used to treat, and often cure, that terrible disease of cancer. Across the world, in countries with similar levels of GDP to ours, such as other European countries, Australia and New Zealand, there is an average international target that 53% of patients living with cancer should receive radiotherapy. In the UK, the proportion is 27%. One reason is the lack of investment from Governments of all colours represented in this room. I will point the finger at this Government for not taking the action they need to now, but I could point the finger inwards at the coalition Government and the Labour Government. We have collectively neglected this situation, I am afraid.

Only 27% of people with cancer who should or could receive radiotherapy are getting it. For a clue as to why that is the case, let us look at Australia, where the five-year survival rates for lung cancer are a third better than those in the UK. Australia spends around 10% or 11% of its cancer budget on radiotherapy; in the UK, we spend just 5%.

[Peter Dowd]

I am pleased that the hon. Gentleman raised that. Radiotherapy UK provided some figures indicating that

“by the end of 2024 there will be 74 out of date machines in the NHS,”

and that

“by 2025 it will be 90.”

Does he agree that that is a pretty grim statistic?

[Tim Farron]

It is, and in a moment, I will come on to how we might tackle that. It is a real problem, and not all of it is down to money—some of it is down to where and how the money is spent.

The all-party parliamentary group on radiotherapy has been working with the charity Radiotherapy UK, which the hon. Gentleman rightly referred to. We have been delighted with the coverage that we have received recently through the Daily Express, which has run a campaign alongside us calling for a £1 billion boost in radiotherapy. The Minister can read all about it not just in the Express, but in the manifesto put together by the all-party group, which details that.

To put it bluntly, in the run-up to the Budget this week, we know that the Chancellor has something like £30 billion more to spend than he thought because of underspend on energy support and an increase in tax revenues, not least because of people spending more money on goods due to inflation, and therefore spending more VAT. The Government therefore have that windfall to play with. I am asking for one thirtieth of that to be spent on radiotherapy, so that we can save thousands and thousands of lives.

What would we spend that money on? We would spend it on new kit. Not all of that would need to be new money; it could just be money that is spent more wisely. As the hon. Member for Bootle alluded to, part of the problem is that we have ancient kit. He mentioned the 74 machines—linear accelerators—that will be out of date by the end of next year. Why do we have so many out-of-date linear accelerators and other bits of radiotherapy kit? It is largely because the funding for those machines is feast and famine, and because it is devolved to 42 different specialist commissioners, when we actually need a central, national, well-funded rolling programme to replace and update linear accelerators. It is not rocket science—though it is science—and the Government could do that without spending an absolute fortune.

I want to ask the Minister again about the issue regarding tariffs. Many of our cancer centres are using second-division kit, to put it crudely. The tariff for using a second-division piece of kit means that centres can be paid for the 30 fractions a person might need to deal with their cancer, whereas with a first-division piece of kit, it might take only four, five or six trips to treat someone. Centres are paid per fraction, so there are perverse incentives whereby trusts are more likely to be rewarded if they use poorer kit more often than better kit less often. That has been fixed in part, but not for every cancer, not for every machine and not for every unit. That needs to be dealt with, and again, it could be done freely.

We talked about the workforce. The radiotherapy workforce is really small—about 6,400 individuals. There are 30% fewer entrants coming into the sector than there are places available, which has an impact on the morale of the people already working there. We are losing people as a consequence. Retention is becoming a problem because recruitment is such a problem. People feel under such weight. With such a small workforce, it would not involve an awful lot of effort to significantly increase that. We need to invest in training to bring clinical oncologists and clinical radiologists into the profession, and also to alleviate the pressure that staff are under now by supporting new admin staff up-front, which could be done very quickly, to allow people currently in the profession to be able to concentrate more on their frontline duties, rather than on admin.

I will make a final remark regarding radiotherapy, which is about access. Among the reasons why only 27% of people with cancer are getting radiotherapy in England—as opposed to the 53% who really should—is that many people, particularly in my community, are just too far away from the treatment. In our communities, the majority of patients using our nearest radiotherapy centre are making two or three-hour round trips every single day. The national radiotherapy advisory group says that it is bad practice for people to have to travel more than 45 minutes for treatment—never mind three-hour round trips every day for 30 days. As a consequence, some people do not get referred for treatment at all, or may even make the choice themselves not to finish that treatment. There is no doubt that that is having an impact on survival rates.

We have built a strong case, in our community, for a radiotherapy satellite unit from the Rosemere unit in Preston—our nearest unit—to be deployed at the Westmorland General Hospital in Kendal. A solid clinical and business case was put for that, and I would be grateful if the Minister might agree to meet with me, even for just 15 minutes, to review that and consider the extent to which the Department might be able get behind it and other satellite units around the country that could cut waiting times and save lives.

There are no silver bullets to many problems that we face in this place, but this is quite close to being one. For a relatively small amount of money, the UK Government could do something that would save lives, and do so quickly. I encourage them to do so.

--- Later in debate ---

[Helen Whately]

I will come on to talk about radiotherapy, but I can say to the hon. Gentleman here and now that I will indeed look into what has happened to the response to that letter.

However, I will start by talking about the waiting times, recovery from the pandemic and reduction of the pandemic backlog. Our elective recovery plan included the ambitious target to return the number of people waiting for more than 62 days for an urgent cancer referral back to pre-pandemic levels by this month. Since the publication of that recovery plan, the NHS has seen enormously high demand for cancer checks. More than 2.8 million people were seen in the 12 months to January 2023—up by 19% compared with the same period before the pandemic. The return in demand, with people coming forward for cancer checks, is very positive after the falls we saw in the pandemic.

When giving evidence to the Health and Social Care Committee last week, Dame Cally Palmer, NHS England’s national cancer director, said that

“we are not going to meet the pre-pandemic target by the end of March, simply because of those record levels of demand.”

That is already in the public domain. However, I assure hon. Members that we are working closely with NHS England to reduce the time people are waiting to receive a diagnosis, or an all-clear, and to start treatment, and we are making progress on that. The latest published figures show that the 62-day cancer backlog for the week ending 26 February stood at just over 22,000, which is a fall of 35% since its peak in the pandemic. However, that is 22,000 people too many who have had to wait 62 days, and many of them will have had to deal with the anxiety of waiting for a diagnosis or an all-clear, which is why we are working so hard on this issue with NHS England.

As I said, it is good that more people have come forward for cancer checks but, in response, we must increase our capacity to diagnose and treat cancer. That is one reason why we have been investing in community diagnostic centres, and we have more than 93 centres open and operational. That is why the NHS is rolling out what we call fit tests to speed up diagnosis for people who may have, for instance, bowel cancer. That is why the NHS is rolling out teledermatology to speed up diagnosis for people who may have skin cancer, and speeding up access to MRI scans for people who might have prostate cancer. Those are the three types of cancer with the most people waiting for a diagnosis or an all-clear or, if they have a diagnosis, to start treatment, and I am determined to reduce those waits.

When I meet charities and clinicians, the one message I consistently hear is how important early diagnosis is for improving patient outcomes and care, and that was something my hon. Friend the Member for West Bromwich East referred to. She talked about the ambition in our long-term plan to be diagnosing 75% of cancers at stages 1 or 2 by 2028. As part of achieving that, we are extending targeted lung health checks, with more than double the number of community lung truck sites. The targeted lung health checks programme had diagnosed 1,625 lung cancers by the end of December 2022, with 76% of those diagnosed at an earlier stage.

To help people get a cancer diagnosis or an all-clear more quickly, since November GPs have been able to directly order diagnostic tests such as CT scans, ultrasounds or brain MRIs for patients with concerning symptoms who fall outside the National Institute for Health and Care Excellence’s guideline threshold for urgent referral. Alongside that, community pharmacists in pilot areas are helping to spot signs of cancer in people who might not have noticed symptoms or realised their significance, and we continue to see non-specific symptom pathways rolled out. As of December 2022, more than 100 are live across the 21 cancer alliances.

To encourage people to contact their GP if they notice, or are worried about, symptoms that could be cancer, NHS England has run the “Help Us, Help You” campaign, which seeks to address the barriers deterring patients from accessing the NHS if they are concerned they might have cancer. In March and June 2022, we saw a 1,600% increase in the number of visits to the NHS website’s cancer symptoms landing page, so the campaign had a huge impact on the number of people looking to see whether they might have cancer symptoms. NHS England is in the process of planning “Help Us, Help You” activity for 2023-24, to make sure we continue the momentum and continue to encourage people to come forward if they have worrying symptoms of something that might be cancer.

However, we all know that diagnosis is just the first step on a patient’s journey, so we are also taking steps to improve cancer outcomes by rolling out innovative new treatments, such as the potentially life-saving drug pembrolizumab for one of the most aggressive forms of breast cancer, and mobocertinib to treat a specific form of lung cancer. The National Institute for Health and Care Excellence has made positive recommendations in all 18 of its appraisals of breast cancer medicines since March 2018, and those medicines are now available to NHS patients. NICE is also able to make recommendations to the cancer drugs fund, which has benefited more than 88,000 patients, with 102 medicines receiving funding for treating 241 different cancers.

My hon. Friend the Member for West Bromwich East mentioned radiotherapy equipment, as did the hon. Members for Westmorland and Lonsdale and for Bootle (Peter Dowd). Since 2016, more than £160 million has been invested in radiotherapy equipment so that every radiotherapy provider has access to modern, cutting-edge radiotherapy equipment. That investment enabled the replacement or upgrade of around 100 radiotherapy treatment machines and in some cases the roll-out of new techniques, such as stereotactic ablative radiotherapy. On top of that, £260 million has been invested in establishing two services to deliver proton beam therapy in London and Manchester.

On the workforce, from 2016 to 2021, the number of therapeutic radiotherapy staff grew by more than 17%, and the number of clinical oncologists by more than 24%. From 2021, there has also been an uplift in the number of entry-level places available, with 108 in clinical oncology, up from an average of around 60 per year in previous years.

I want to pick up on the claim that only 27% of cancer patients are treated with radiotherapy. That claim is outdated and incorrect, as it includes radiotherapy only as part of a patient’s primary treatment for cancer and does not capture a substantial proportion of patients who receive radiotherapy as a subsequent treatment. Also, I am told that the data is from 2013-14, so that is also out of date. NHS England has assured me—I have looked into this—that those who need radiotherapy treatment can access it.

[Tim Farron]

Will the hon. Lady give way?

[Helen Whately]

If the hon. Gentleman will allow me, I want to move on to the major conditions strategy, which my hon. Friend the Member for West Bromwich East mentioned as well. I want to talk about going beyond the immediate action we are taking here and now to improve people’s access to cancer diagnosis and treatment and about what we are doing looking further ahead.

In January, we announced that we will publish a major conditions strategy, which will tackle the conditions that contribute most to morbidity and mortality across the population in England, one of which is cancer. Many people now experience major conditions as part of a wider set of illnesses or needs, known as multi-morbidity. A 2020 academic study of cancer patients in England found that most had at least one co-morbidity and nearly one in two had multiple co-morbidities, so many people with cancer also have another long-term condition. We want to support individuals by diagnosing them earlier, helping conditions to be better managed and improving the overall co-ordination of treatment and care for those who have cancer and other major conditions.

The strategy will draw on the previous work on cancer, and hon. Members mentioned the long-term plan on that. It includes more than 5,000 submissions that were provided as part of our call for evidence last year. I can assure hon. Members that we will continue to work closely with stakeholders, the public and the NHS, including those involved in cancer care, in the coming weeks and months as we work up the details of that strategy. We will look at the health of people at all stages of life and, in reference to the point my hon. Friend the Member for West Bromwich East made on health disparities, focus on the geographical differences in health that contribute to variations in health outcomes.

[Tim Farron]

Will the hon. Lady give way?

[Helen Whately]

I just want to spend a little time on research, and I am conscious of the clock ticking.

[Tim Farron]

She mentioned a couple of points about the figures.

[Helen Whately]

If the hon. Gentleman will allow me to proceed, I want to talk briefly about the third priority—research—which is so important to improving cancer outcomes.

The Department of Health and Social Care invests £1 billion a year in health and care research through the National Institute for Health and Care Research. The NIHR spent almost £100 million on cancer research in 2021-22. I should also say that, among other charities, Cancer Research UK makes a huge contribution to funding research. Thanks to the generosity of the British public, it spent £388 million in 2021 on research activity.

There is a huge amount of research for us to be excited about. For example, the NHS-Galleri trial looks for markers in blood to identify signs of more than 50 cancers, and a vaccine taskforce-style approach is being taken to invest over £22 million in cancer research as part of the life sciences cancer mission. A memorandum of understanding that the Secretary of State for Health and Social Care signed with BioNTech SE will aim to deliver 10,000 doses of personalised therapies to UK patients by 2030.

As another example, just last week I visited Imperial College London. I saw some truly exciting research that could help us to diagnose pancreatic cancer and other upper gastrointestinal cancers early through a relatively simple breath test. It is in its early stages, but it could make a huge difference for cancers such as pancreatic cancer, which can be so hard to diagnose early.

Before I close, I will mention the hospital that my hon. Friend the Member for West Bromwich East talked about. The exciting rebuild of the Midland Metropolitan University Hospital, as part of our new hospital programme, will bring together urgent care centres from three hospitals across the region into one state-of-the-art site, providing services to 500,000 people. As my hon. Friend said, construction has already commenced, and the hospital should be completed and open for patients in 2024.

The hospital will introduce a new model of care, which means that out-patient clinics, day case surgery and routine diagnostics will be provided from the Sandwell and City Hospital sites, while maternity services, emergency care, general surgery and medical wards will all be based at the Midland Metropolitan University Hospital. The new hospital will be a centre of excellence for clinical care and research. The new therapeutic model of care will encourage patients to maintain mobility and independence during a hospital stay. I spend a lot of time looking at the downside of people having long stays in hospital. Maintaining independence and mobility is an important thing for us to try to achieve. I share my hon. Friend’s excitement about the forthcoming opening of the new hospital.

To conclude, I once again thank my hon. Friend for raising this issue. Improving cancer care is a priority for the Government, and I assure her and other hon. Members that we will continue to work hard to beat this terrible disease.