Cancer Outcomes: Tees Valley

Tim Farron Excerpts

Monday 16th January 2023 Commons Chamber

[Mr Clarke]

I echo what the hon. Gentleman says about the importance of ensuring that our equipment is absolutely the best it can be. I had the privilege of seeing the new equipment at the James Cook’s interventional radiology department before Christmas, which was incredibly impressive. The hon. Gentleman is absolutely right that such investment is vital to ensuring that once treatment commences, people can get the best possible care.

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

The right hon. Gentleman is being staggeringly generous in giving way; it is noted and appreciated. The technology is important, but what is also important is where it is. I echo the call for linear accelerators to be up-to-date so that radiotherapy treatment is as up-to-date as possible. That is incredibly important, but the National Radiotherapy Advisory Group also says that nobody who needs radiotherapy should have to travel for more than 45 minutes to get it. Areas a little more rural than Middlesbrough may face lengthy journeys; there is nobody at all in Westmorland who lives within 45 minutes of our nearest radiotherapy centre. Does the right hon. Gentleman agree that having satellite units, with linear accelerators placed away from the main centre—for us, that would be in Kendal—would be one way of ensuring that people in more remote and rural communities get the treatment they need so that their life can be longer?

[Mr Clarke]

The hon. Gentleman is absolutely right. Representing East Cleveland as I do, I have some insight into the challenges of distance in rural areas. Bringing care to people to the greatest extent possible and commensurate with the challenges is vital, particularly for things like screening.

That leads me neatly to a point raised by Mr Jonathan Ferguson, the consultant lung surgeon at the James Cook University Hospital in Middlesbrough and clinical cancer lead for South Tees Hospitals NHS Foundation Trust. He has done much to bring to my attention the fantastic work that is already going on in the Tees Valley to increase early diagnoses. Much of that work is clearly led by him, although he is far too modest to say so. Jonathan is a linchpin of our local healthcare system, and a hugely impressive consultant. In the light of the impact of covid, this progress is more vital than ever. Macmillan estimated that by March last year there were still at least 37,000 fewer cancer diagnoses than expected as a result of the disruption caused by the pandemic. It is clearly vital for us to address that.

Over the last 12 months, Mr Ferguson has been the driving force for the new targeted lung health check programme in the Tees Valley. That region-wide service is now up and running, identifying curable cancers that would otherwise have been undetected for longer through effective collaboration between local NHS teams and an independent-sector diagnostic specialist. This approach has identified a curable cancer every two days, which is fantastic, through scanners operating 12 hours a day, seven days a week, from mobile units—a subject raised by the hon. Member for Westmorland and Lonsdale (Tim Farron)—in supermarket car parks, with the facility operating at a 97% occupancy rate, which is wonderful. The facility is staffed and appointments are managed by the independent partner, with target patients identified through NHS records and an initial telephone questionnaire.

This enables our brilliant local NHS teams to focus on treating patients and tackling the backlogs, which we know will allow them to deliver great results. The superb clinicians at the James Cook University Hospital have an excellent track record of innovating to improve patient care, with recent initiatives including the Macmillan-supported thoracic surgery community nursing programme, which won the Nursing Times award for the best surgical nursing team. It has reduced both the length of hospital stays and readmission rates for patients following thoracic surgery. Many of those are, of course, lung cancer patients.

It is exciting to hear the proposals for a new Tees Valley diagnostic hub in Stockton, which I think the Minister will say more about in her speech—I look forward to that. It was originally not expected to welcome patients until 2025, but it has been fast-tracked and is now expected to open much sooner. Mr Ferguson believes passionately that opening the hub this year would

“save more lives on Teesside than I have throughout my surgical career”,

so we should all welcome it warmly, given the practical difference it will make on the ground.

I know it is a mission of this Government to ensure that we address health disparities, and there is probably nowhere in England where a greater difference can be made than on Teesside. I am joined tonight by my hon. Friends the Members for Stockton South (Matt Vickers), for Redcar (Jacob Young) and for Sedgefield (Paul Howell), and we are all very grateful for the action that the Government have taken.

When we are looking at our future options, we should bear in mind that the more we can do with the private sector as well to increase our capacity, the better. Through what he has been doing with his supermarket car park screening, Mr Ferguson has shown the value of such partnerships in unlocking extra capacity. I urge the Government to look at all the options to ensure that we can get the maximum number of people through the system, receiving the care that they need through all parts of our healthcare system.

Coupled with last week’s exciting announcement about the cancer vaccines trial partnership between the Department of Health and Social Care and BioNTech—which could allow eligible patients in England early access to revolutionary personalised mRNA therapies through trials as soon as next autumn—are the Government’s significant steps to give cancer patients improved chances of survival, and to give families and friends more precious time to spend together. I know that colleagues on both sides of the House will join me in welcoming those efforts, which will make an enormous difference to our constituents.

This is a practical and tangible debate on an issue that touches nearly every family at some point. I would be grateful if the Minister could tell us what the Government are doing to ensure that cancer outcomes across Teesside continue to improve in the way that has been so encouraging to us all so far.

--- Later in debate ---

[Helen Whately]

The hon. Gentleman is absolutely right to pick up on what I said about the importance of supporting people to stop smoking, but for the sake of this Adjournment debate I will focus on responding to my right hon. Friend’s speech, particularly looking at cancer diagnostic services.

We want to level up diagnostic services for cancer around the country so that people with symptoms of potential cancer can receive an accurate diagnosis and begin treatment as quickly as possible. That is part of our ambition to reduce health disparities in more deprived areas, such as some areas in my right hon. Friend’s constituency, and to improve early-stage cancer diagnosis rates for all. A key part of improving early diagnoses is ensuring that people come forward when they suspect that they have cancer.

Sadly but understandably, during the pandemic we saw the number of urgent referrals for cancer fall, but it is positive that in the North East and North Cumbria integrated care board over 13,000 patients had their first consultation appointment following an urgent GP referral in November last year. That is an 18% increase from November 2020 during the pandemic, and nearly a 20% increase on the figures for November 2019 prior to the pandemic. That indicates that in the Tees Valley, as we are seeing across the country, people are coming forward to be diagnosed or discover that they have the all-clear from cancer, which is the case for most people.

In a moment I will talk about our innovative new community diagnostic centre programme, but first I want to highlight some of the other things we are doing to improve the early diagnosis of cancer. One important innovation is introducing the serious non-specific cancer pathway, which Tees Valley has successfully implemented. This means that GPs can refer patients into the service when there are possible symptoms of potential cancer, or someone has a gut feeling that something is not right. That is especially important for patients who do not fit specific pathway referral criteria but whose symptoms are more generic.

In addition, Tees Valley has initiated a programme of targeted lung health checks aimed at people aged between 55 and 74. My right hon. Friend referred to that and the impact that it is having. It is anticipated that the programme will result in around 530 diagnoses of lung cancer over the next four years. In deprived areas of Middlesbrough, Hartlepool and Darlington, clinicians are taking part in a trial to assess the benefit of the new GRAIL test that looks for signs of cancer in a sample of blood. This is hugely exciting as it can identify cancer where no symptoms are even present, allowing for earlier diagnosis.

However, the waiting list for diagnostic tests in England currently stands at over 1.59 million patients, with around 26% of those patients waiting more than six weeks. In the North East and Yorkshire region, the waiting list for diagnostic tests has over 200,000 patients, with just over 20% of those waiting more than six weeks. These are figures that we very much want to improve because, as I have said, earlier diagnosis can mean better outcomes. We want to get to the point where 95% of patients needing a diagnostic test receive it within six weeks by March 2025. Equally, early-stage cancer diagnosis is a key ambition of the NHS long-term plan, which aims to ensure that 75% of cancers are identified at stage 1 or stage 2.

[Tim Farron]

What the Minister says about the waiting time for diagnostics is very troubling. What is even more troubling is that in my part of Cumbria 43% of people who have had a diagnosis of cancer are now waiting more than two months for their first treatment. In North Cumbria and Northumberland, the figure is 62%. Can she say what she is going to do to speed up treatment for those people who have had a diagnosis of cancer?

[Helen Whately]

Yes of course. More people coming through for referral for cancer diagnosis and increased early rates of diagnosis feed through into us needing to increase the rates of treatment. The NHS is treating more people for cancer, but of course this is taking time because of the increased levels of referrals. We are working very hard to do this.

I want to return to talking particularly about cancer diagnosis and what we are doing to do that earlier, and specifically about the community diagnostic centres that are being rolled out across the country supported by £2.3 billion of capital investment. Local health systems can bid for a share of that funding when they make the case for community need and clinical value, and I am delighted to say that 89 community diagnostic centres are currently operational across the country. Hard-working NHS staff have so far delivered more than 2.7 million additional checks at these centres. Specifically in the Tees Valley, I know that my right hon. Friend has been working with his local NHS to support its proposal for a new diagnostic centre in Stockton-on-Tees, and I can update him with the good news that this new site has been approved, with a planned opening date of December 2023.

NHS: Long-term Strategy

Tim Farron Excerpts

Wednesday 11th January 2023 Commons Chamber

[Wes Streeting]

I cannot believe that the Member for Dover and Deal seems to be standing up and telling her constituents that when it comes to the NHS they have never had it so good. I know she is desperate and scraping the barrel because Prime Minister after Prime Minister have broken their promises on immigration and the Prime Minister is not dealing with small boat crossings, but I am afraid that pretending the NHS is working will not save her at the next general election.

To govern is to choose and the last Labour Government showed that investment plus reform equals better standards for patients. You do not need to do A-level maths to get to that equation. The right hon. Member for Gainsborough (Sir Edward Leigh) asked his Health Secretary:

“What is our long-term plan? We cannot leave the Labour party to have a long-term plan while we do not. How are we going to reform this centrally controlled construct?...What is the Secretary of State’s plan?”—[Official Report, 9 January 2023; Vol. 725, c. 297.]

What indeed is the Secretary of State’s plan? He has been in power for 13 years. His Government have presided over this record and still, after 13 years, they have no plan. Conservative Members asked what my plan was and I outlined it: a fully costed, fully funded plan to deliver the biggest expansion of NHS staffing—[Interruption.] They are saying, “Where is it?” I will repeat it for them again: double the number of medical school places; 10,000 more nursing and midwifery clinical training places; 5,000 more health visitors; and doubling the number of district nurses qualifying, paid for by abolishing non-dom tax status, because we believe that people who make Britain their home should pay their taxes here, too.

I understand that, in their partisan fury, because they cannot bear the fact that Labour has a plan and they do not, Conservative Members cannot swallow humble pie enough to take our plan and run with it. If they do not believe me, they should at least believe their own Chancellor, because this is what he said about Labour’s plan:

“I very much hope the government adopts this on the basis that smart governments always nick the best ideas of their opponents.”

If we were in any doubt already, this is not a smart Government and it will take a Labour Government to deliver Labour’s plan. That is why we end up with these sticking plasters, as we saw on Monday, to deal with this crisis.

Why did the Government choose to leave 230,000 patients languishing on NHS waiting lists when the spare capacity was there for them to be treated in the private sector? We know what our priority is: get patients treated as quickly as possible, pull every lever available to make it happen and make sure that patients do not have to pay a penny. The Government could act on doctors’ pensions to stop doctors retiring early for no reason other than that there is a financial disincentive to stay, but they still have not done it. They could bring strikes to an end by negotiating with the unions instead of threatening to sack the staff, but they still have not done it.

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

I want to give the hon. Member an idea to nick. He mentioned earlier the chronic situation with cancer waiting times, with 40%-plus of people diagnosed with cancer waiting two months to be seen. I wonder if he is aware of the work of the all-party parliamentary group on radiotherapy; I chair the group and his hon. Friend, the hon. Member for Easington (Grahame Morris), is a vice-chair. Fifty per cent. of people with cancer need radiotherapy. We spend 5% of the cancer budget on it. The average across developed nations is about 9%. Will he agree to give a bit of time to come to the group’s inquiry on 18 January? In looking at Labour’s plan, will he consider how we can fund radiotherapy, so we can treat people and do not have so many avoidable deaths?

[Wes Streeting]

Unlike the Government, we are happy to look at good ideas wherever they come from. I do not know whether I can make 18 January, but I am certainly happy to meet the hon. Gentleman so that we can ensure that Labour’s plan tackles the appalling waits that we are seeing for cancer treatment.

--- Later in debate ---

[Steve Barclay]

I am very open to that idea. For all the sound and fury that there sometimes is within the political debate, I know that there are certain topics within health on which people across the House are keen to work. Cancer is one issue that affects all families and all constituencies, and there is often scope to work extremely closely together on it. Knowing the hon. Gentleman well, I am happy to work with him moving forward.

[Tim Farron]

rose—

[Steve Barclay]

May I just answer the last point, as the hon. Member for Easington (Grahame Morris) raised an important issue, and one that matters to many families? On the substance of his point about equipment, tech and innovation, we are looking at how we innovate. GP direct access is part of that, as it provides direct access to diagnostics. More patients are having their first cancer consultation following an urgent GP appointment. If we take the cohort of more than 810,000 who have started treatment for cancer since March 2020, the statistics show that 94% did so within their first month.

Given the seniority of the hon. Member for Westmorland and Lonsdale (Tim Farron), I will take his intervention, but then I must make some progress.

[Tim Farron]

I wanted to seize the moment, based on the excellent question from the hon. Member for Easington (Grahame Morris). The inquiry by the all-party group for radiotherapy is on 18 January, but we have not had a response to our request for the Secretary of State, or indeed any of his ministerial team, to attend. Will at least one of them do so?

[Steve Barclay]

Let me check the diaries with the Department. These things are always dangerous because we need to know what the travel plans and various commitments are, but I hear the hon. Gentleman and the hon. Member for Easington, and we will absolutely look at what can be done.

NHS Winter Pressures

Tim Farron Excerpts

Monday 9th January 2023 Commons Chamber

[Steve Barclay]

To address my hon. Friend’s two points, first, the NHS will take immediate action to start arranging additional step-down care; that is a clear message that she can take to her constituents to show that the Government have listened and acted on the very real pressures we have seen. On the wider social care system, an example from Hull—the hon. Member for Kingston upon Hull West and Hessle (Emma Hardy) is not in her place now—is the Jean Bishop Integrated Care Centre, which co-locates social care and NHS staff. The feedback I received from those staff was that that integrated model is extremely rewarding for staff and a much better way of operating than working in silos. The workforce themselves have said that that co-location and greater integration between social care and health is extremely beneficial.

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

Patients living with cancer, their families and the outstanding cancer workforce will be staggered—as am I—that we have just had a statement on NHS pressures that put forward no serious plan to tackle the deadly cancer backlog. Some 17,000 cancer patients in the last three months have had their targets for cancer treatment delayed or missed; 43% of people diagnosed with cancer in south Cumbria waited more than two months for their first lifesaving treatment, and in north Cumbria that figure was 63%. Where is the urgent plan to tackle the cancer backlog? On a practical, cross-party level, will the Secretary of State or one of his Ministers attend the all-party parliamentary group for radiotherapy’s inquiry on 18 January, so that we can work together to come up with some quick technical solutions that will save lives?

Oral Answers to Questions

Tim Farron Excerpts

Tuesday 6th December 2022 Commons Chamber

[Helen Whately]

My hon. Friend makes an important point. I, too, have heard from family carers about the difficulties that they have faced in getting skilled professional help, which, in turn, gives them support and respite. At the moment, we provide £11 million annually for a workforce development fund, which social care employers can access to help to pay for staff training. Looking ahead, we are working on social care workforce reforms, of which training and skills will form a substantial part. I commit to looking into his suggestion that specialist training for MND care should be part of that.

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

In the lakes, we have a problem with social care: although the people working in the care industry are phenomenal, talented and dedicated, the average age of the population is 10 years above the national average, so the number of people who need to be cared for is greater and the size of the workforce is smaller. Undoubtedly, poor pay, poor conditions and a lack of career prospects are a major problem in recruiting and retaining the care staff that we need. We also have a special problem in our area because of the absence, or indeed, the evaporation, of the long-term private rented sector, which is where the carers normally would have lived. Will the Minister talk to her colleagues in the Department for Levelling Up, Housing and Communities to make sure that we have a comprehensive package for communities such as mine in Cumbria, so that we have well-paid carers and places in which they can afford to live?

[Helen Whately]

The hon. Member makes a really important point. I will say two things. In the short term, we are supporting social care with £500 million through the discharge fund this winter. That will go into increasing capacity in social care and addressing some workforce challenges in areas such as his. In the long term, we are introducing social care reforms, including in the workforce. One thing we need to look at is ensuring that housing is available for the social care workforce.

Accountability in the NHS

Tim Farron Excerpts

Wednesday 30th November 2022 Westminster Hall

[Sir Mike Penning (Hemel Hempstead) (Con)]

I beg to move,

That this House has considered accountability in the NHS.

It is a pleasure to serve under your chairmanship, Sir George. I called this debate on accountability in the NHS. As a nation, we love our NHS which does a fantastic job for us, day in, day out. However, like any human being or organisation, sometimes it makes mistakes. When the NHS makes mistakes, the process of trying to get an apology or a mistake rectified is invariably a bureaucratic nightmare.

I have a couple of examples I would like to raise. I have permission from one to use their name, but I probably will not do so, because I will yet again pass correspondence to the Minister. I appreciate that the Minister here, my hon. Friend the Member for Colchester (Will Quince), is not responsible in the Department for this subject. The relevant Minister, my hon. Friend the Member for Lewes (Maria Caulfield), is on the Floor of the House answering questions, and I thank this Minister for explaining why she is not here.

We in Parliament are here to speak up for those who sometimes cannot speak up for themselves. When something goes wrong, Sir George, you would think we could get answers for constituents and get matters rectified, but within the NHS there is a lack of ministerial accountability, which I will come to in a moment. The complaints procedure eventually ends up with the ombudsman, but it takes for ever. There is a feeling in my constituency that, when things go wrong, the longer the process can be delayed, the more people will just accept what has happened. In some cases, they will sadly not be around any more. For their families and loved ones, this short debate is very important.

Probably the most dramatic example for me, not of the physical effects of surgery but of the effect on someone’s life, concerns one of my constituents. The NHS decided in 1986 that he needed an operation on his nose, but the operation that took place was not the one that was supposed to. I will use the language: it was botched. It was probably not intentional; it was a mistake but, to this day, that has had detrimental effects on his quality of life.

My constituent tried to go through the process of getting it rectified. I have tried to find out what was going on. He has pushed from pillar to post by different trusts: University College London and West Hertfordshire. I have written to previous Ministers over the years, only to be told that Ministers do not interfere in individual cases. I accept that but, when we reach a situation where there is nowhere else to go, ministerial accountability is important.

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

I am grateful to the right hon. Gentleman, not least for the sensitivity of the issues he is raising. Ministers under Governments of all colours have sought to keep NHS operational matters at arm’s length. Does he agree that that reduces accountability and effectiveness? I am thinking more generally about the current huge backlog in cancer diagnosis and treatment. I do not see any direct and urgent Government intervention. Does the right hon. Gentleman think that is partly the result of the lack direct operational accountability for Ministers to the service?

[Sir Mike Penning]

I thank the hon. Member for his intervention. We have seen during covid that, actually, when things get really bad, Ministers can step in and Prime Ministers can step in, but when we talk about individual cases, they cannot.

In the case I am referring to, I ended up writing to the Minister, to be told to go to the ombudsman. I got fobbed off by the ombudsman, after we had been to the trust three or four times. I then wrote to the Minister again—this is over the course of years—to be told to take legal advice. This particular person has now been told, “Go back to your GP and get them to re-refer you if you’ve still got problems.” He has problems because they did not do the operation properly in the first place, and it has had a massive long-term effect on this gentleman’s quality of life.

That is not the only case. I have been here for nearly 18 years, and I worked for a Member of Parliament for many years before that. In every constituency, this sort of case is brought before the MP. I have another example. Last summer, in the middle of heatwave in July, when the temperatures were unbelievably high, a very vulnerable young lady was brought in for a scan at my local hospital. She is the most vulnerable young lady. Her mother cares for her 24/7. She has carers in. She is a wheelchair user or bed-bound. She was left on a trolley in the heat for five hours when her ambulance did not arrive.

When I contacted the trust and said, “What happened there?” it blamed the ambulance trust. When I contacted the ambulance trust, it said, “No, it was cancelled by the trust—it was their fault.” I do not care whose fault it was. It was the NHS’s fault that this happened to a very vulnerable young lady. She had no drink and no food. She was very, very ill. The ambulance trust said that the return journey was cancelled because she was so poorly on the trolley—well, she was so poorly because she had been left there for five hours!

Trying to get to the bottom of what happens within the NHS when something goes wrong is so difficult. We have seen terrible situations in maternity services and in trusts around the country. These problems need to be addressed early on, instead of the drawbridge being brought up and people having to go through a massive complaints procedure where they have to complain three times before going to the ombudsman, and then the ombudsman will say it is out of time, and if they are not careful, they cannot go to court because that is out of time too. Is that the way we want our NHS to be seen by the public, who love the NHS?

The NHS sees the NHS as a single entity. As MPs—and I was a shadow Health Minister for four and a half years—we understand that it is not a single entity. It is a set of silos where everybody passes the buck back and forth. What we need is joined-up thinking. When Members like myself write to Ministers about these issues, the answer is not to say, “Nothing to do with me, guv” and pass it down the line to the ombudsman or a lawyer. That surely costs more money and does not put the NHS in a particularly good light with my constituents who have had their operations botched

NHS Staffing Levels

Tim Farron Excerpts

Tuesday 22nd November 2022 Westminster Hall

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

It is a pleasure to serve under your guidance again, Mr Hollobone. I am grateful to the hon. Member for Wirral West (Margaret Greenwood) for securing a really important debate.

I want to say a massive thank you to NHS and care staff. Undoubtedly, every year is a tough one for those working in this area, but the last few years have been incredibly demanding. The pandemic has taken its toll on people’s mental and physical health, and has led to real attrition within the various clinical and non-clinical services. It is worth bearing in mind how much worse it would have been had we not collectively taken the right decision to try to tackle the pandemic early on. Nevertheless, it has been incredibly hard.

I will focus on a few areas that are significant for NHS staffing, starting with dentistry. It is worth bearing in mind that we all pay our taxes, so 100% of my tax-paying constituents have paid for NHS dentistry, but only about a third of them are getting it, including roughly half of the children. At the moment—I have checked—there is not a single NHS dental place anywhere in the entire county of Cumbria, which is a disgrace. That could be solved in no small part if the Government were to address the issue of the treadmill of units of dental activity. If it were done differently, it would not necessarily cost the Government any more money to make sure that they do not push dentists into a position where they feel that they have no alternative professionally than to leave the NHS, that we bring back the people who have left, and that we value the ones we have working within it.

Secondly, I want to talk about GPs. The simple reality is that we have far fewer GPs entering the service than we need. Many rural communities in Britain, such as mine, have a smaller surgery population-wise because of the vast area that they cover. We are currently dealing with the potential closure of the Ambleside and Hawkshead medical practices—the Central Lakes Medical Group. It is out to tender at the moment, because the Government removed what was called the minimum practice income guarantee, a sum of money that made small rural surgeries financially sustainable. Their removal has led to three closures that I can think of in Cumbria—one in Eden and two in South Lakeland. A relatively small amount of money would keep those surgeries sustainable and make sure that we kept people working at them. Otherwise, we have NHS staff who are determined to work and serve those communities who simply find that they cannot.

Nothing is more important to solving the NHS staffing crisis than tackling care—we have talked about that a lot—and it is outrageous that the Government have chosen to kick dealing with that issue into the long grass for another two years. We have 32% bed-blocking in the hospitals of south Cumbria at the moment. The reason why is obvious: there are not enough care packages to help people when they leave hospital, because there are not enough carers. The impact on hospital capacity, on the capacity of A&E, on ambulances that take so much longer to drop off their patients and therefore take longer to respond to calls, and the lives put at risk, is blindingly obvious. For the Government to delay dealing with care, and to think it is delayable for two years is not a tough decision for them. It is a tough decision for the millions of people who will be affected and for the tens of thousands of people working in our care sector.

The lack of availability of affordable homes for care workers and NHS workers in communities like mine is also worth bearing in mind; that is a major reason why there are not enough staff working in health and social care. We now understand that the Government will kick the Levelling-up and Regeneration Bill into the grass on the other side of Christmas. That was an opportunity for the Government to decide that they would change the law to protect homes for local occupancy.

My final comment is on the cancer staffing situation. We currently have an outrageous situation where, in the south of Cumbria, 43% of people diagnosed with cancer are not getting their first treatment for two months, and 62% in north Cumbria are not getting their treatment for two months. That is an outrage. It is costing lives. Undoubtedly, staffing is a major part of that. I am chair of the all-party parliamentary group for radiotherapy, and we are to meet the Minister or his colleagues soon. Can I press him for a date?

In the meantime, I will share one important statistic with him. Radiotherapy UK surveyed 622 radiotherapy professionals—10% of the entire workforce nationwide—and 94% of them felt that the Government did not understand the impact of the current situation on their service; 72% felt that NHS senior managers did not either. As a consequence, we are losing people from the industry. We need a workforce plan specifically for cancer.

I hope the Minister will agree to meet with me and the APPG soon so that we can give him the all-party manifesto on radiotherapy, which will solve some of the problems and give those working in the NHS, particularly in cancer, some hope for the future.

Oral Answers to Questions

Tim Farron Excerpts

Tuesday 1st November 2022 Commons Chamber

[Steve Barclay]

First, I pay tribute to the work my right hon. Friend is doing to raise awareness of this issue. It is important that those patients who want access to face-to-face appointments are able to get them, and campaigns such as Movember are a great way of raising that awareness.

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

In Cumbria we have lost one in six of our GPs in the past six years, most recently at the Central Lakes medical practice in Ambleside and Hawkshead. Will the Secretary of State pay special attention to the letting of that new contract to ensure that there is a GP service running out of the surgeries in Ambleside and Hawkshead? Will he also give thought to the fact that the Government’s removal of the minimum practice income guarantee has cost many rural surgeries their ability to be sustainable, and consider bringing back a sustainable small surgeries fund so that small rural surgeries can stay open?

[Steve Barclay]

As a rural MP and having worked in Kendal earlier in my career, I know the geography to which the hon. Gentleman refers. That is why we are investing in more GP training, increasing the number from 2,671 in 2014 to 4,000, but it is also why we introduced the payment of £20,000, to encourage GPs into those areas that are hard to recruit in.

Rural Healthcare

Tim Farron Excerpts

Wednesday 12th October 2022 Westminster Hall

[Anne Marie Morris (Newton Abbot) (Con)]

I beg to move,

That this House has considered rural healthcare provision.

It is an absolute pleasure to serve under your chairmanship, Ms Elliott. I have already provided the Minister with a copy of the report by the all-party parliamentary group on rural health and care, which followed a three-year inquiry that we undertook with the National Centre for Rural Health and Care. It contains a lot of detail about the issues and suggested solutions. It looked far and wide across the world, not just across the United Kingdom, and I certainly hope that the Minister will give it more time than I suspect he already has in preparing for this debate.

The number of people living in rural settings is not small—9.7 million people live in rural England—and they have very different needs, so the current one-size-fits-all approach simply does not work. We have a different demographic. Generally, our constituents are older, they have complex comorbidities, they live in isolation, and many are in severe deprivation, but much of that is often hidden because the data collected is at such a high level that the issues are simply not identified. If levelling up, which is a commitment of the Government, is to mean anything, that has to change.

Covering everything in the report would take me more than the time available, so I will limit myself to the Government’s alphabet. Let me go through A, B, C and D. On ambulances—A—I absolutely applaud the Government’s position that the current situation is unacceptable and that we need shorter response times, particularly for category 1 and category 2 emergencies, but I am sure the Minister is well aware that the data shows that rural and coastal areas have some of the worst response times across the country, often because it is simply not possible to reach particular parts. In Devon, there are some areas where it really does not matter how many ambulances there are and how fast the roads might be—they are not—as there comes a point where it is not possible to get further.

We have not looked at a different approach. We have not looked at how we triage this differently so that we improve, rather than reduce, health outcomes. A one-size-fits-all approach means that those in rural areas are at much greater risk than those in urban areas. There is not a specialist centre of excellence for strokes that people can get to very quickly by being popped into an ambulance.

Money is clearly an issue, but if we properly integrated our use of fire services, police, ambulances and first responders, we would get a better outcome. Let us triage the calls as they come in differently, and then let us use those individuals and organisations better. Currently, the barriers are different pay for different forces and the fact that those organisations—fire services, police and ambulances—have different lines of accountability to different Departments, which means that they do not work together.

We could find a much better and more efficient way of doing this. Fire services are vital, because they are often physically located in some of these very rural areas. There is not a lot of point trying to get an ambulance in every rural village; that would be completely inappropriate and unaffordable, and it would not work. Let us look at how we can deal with those blockages and do this differently.

B is for backlogs. The Government’s aim to reduce the backlogs is commendable, and the plan to get waits down to one year by 2025 is fabulous. However, those of us who have rural constituencies know that the resources right now are simply not available, and rural areas have a real challenge to recruit. They are seen as unattractive. Youngsters want to be near the nightlife and the fun when they are off duty. The idea of coming to a rural area is not attractive. That is well known to the Government, because there have been various planned pilots and initiatives to pay individuals more to attract them to rural areas. It simply does not work.

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

The hon. Lady is making an important point. When it comes to waiting times for cancer treatment, 41% of cancer patients in south Cumbria and 59% in north Cumbria are waiting more than two months to get their first treatment after diagnosis. We know that is certainly costing lives. Does she agree that tackling the cancer backlog has to be the absolute priority for this Government?

[Anne Marie Morris]

More than that, we need to look at the different pathways in rural communities for heart, cancer and stroke treatment. I agree with the hon. Gentleman, but there is a lot more than just cancer, and the rural pathway to care has to be reviewed to see what is realistic in a rural area.

All of this has been made worse by a funding formula that is not fit for purpose. Although there is provision to uplift for rurality, it is not enough and it has been done without any real understanding of some of the challenges.

--- Later in debate ---

[The Minister of State, Department of Health and Social Care (Will Quince)]

It is a pleasure to serve under your chairmanship, Ms Elliott. Before I start, let me pay tribute to the work of those in the NHS and social care services across England, who are delivering excellent care now and have done so throughout the pandemic. The country is rightly proud of each and every one of them.

I congratulate my hon. Friend the Member for Newton Abbot (Anne Marie Morris), who has been a champion not only for her constituency but, more widely, for the importance of improving health services in rural areas. I thank her for securing this important debate, and I pay tribute to her work and that of the APPG, whose report I read with interest.

Although my constituency of Colchester, a relatively new city, does not share the rural characteristics of Newton Abbot, I am committed to excellent healthcare outcomes for all people in rural and urban areas across our country. I probably cannot cover every single aspect of the report, or even all the issues raised by my hon. Friend today, but I will certainly try to cover as many of them as I possibly can. Of course, I am very happy to meet her and any other colleague who would like to meet. I am proud never to have turned down a meeting with a colleague, and that is a record I intend to keep.

We certainly recognise many of the challenges caused by rurality, including the distinct health and care needs of rural areas and the challenges of access, distance and ensuring a sufficient population to enable safe and sustainable services. I assure my hon. Friend that this Government will remain committed to improving health services in rural areas, as we are committed to doing across all of England.

[Tim Farron]

The Minister alludes to GP surgeries in rural areas, which the hon. Member for Newton Abbot (Anne Marie Morris) also mentioned. Generally speaking, they serve smaller numbers of people over much larger areas. They were supported in their sustainability by something called a minimum practice income guarantee. That disappeared a few years ago, leading to many closures. In Ambleside and Hawkshead in the Lake district in my constituency, some surgeries are facing potential closure because of the removal of that funding. Will the Minister consider introducing a specific rural surgeries subsidy fund to help ensure that surgeries in rural communities in Cumbria and elsewhere are sustainable?

[Will Quince]

I thank the hon. Member for his question. I am not going to make policy on the hoof, so I will not say yes now, but we are fast approaching the next GP contract, which will run from April 2024, so we have an opportunity to look at all these things in the round. I am passionate about securing access to GPs in rural and remote areas. Perhaps we can double-tag our meeting, make it twice as long and discuss that issue too. I will respond to some of the issues raised about GPs in a moment.

I reassure my hon. Friend the Member for Newton Abbot that we are in full agreement that the NHS needs to be flexible enough to respond to the particular needs of rural areas. That is vital, and that is why we passed the Health and Care Act 2022. The Act embeds the principle of joint working right at the heart of the system, promoting integration and allowing local areas the flexibility to design services that are right for them. Integrated care boards and integrated care partnerships give local areas forums through which to design innovative care models, bring together health and social care, and, importantly, prioritise resources to ensure that they best align with the needs of individual areas.

We are also enabling the NHS to establish place-based structures covering smaller areas than an integrated care system. That could match the local authority footprint, for example, or in some cases it could be even smaller—a sub-division based on local need. That is fully in line with the view expressed in the APPG report that the NHS should foster and empower local place-based flexibility. I think that is at the heart of the report.

As my hon. Friend knows, in establishing those models for the NHS to follow, we have set the framework but have left it to individual areas to tailor them to local needs. I think that is the right approach, because local areas know better than Ministers. We do not always hear Ministers say that, but I think local areas often know better than I do, sitting here in Whitehall, how best to organise themselves, and how to design and, importantly, deliver the best possible care for patients. While we in Westminster can support, guide, hold accountable and occasionally chest prod, it is right that we also protect local flexibility.

[Will Quince]

I have made a note of my hon. Friend’s question and I am going to come to it in a moment. The answer is no, but only because it is not my responsibility. It is the Minister of State, Department of Health and Social Care, my right hon. Friend the Member for Newark (Robert Jenrick), who has responsibility for hospital funding, and in the next seven minutes I intend to commit him to lots of meetings with every single Member present.

Let me turn briefly to the question of resources, about which I know a number of Members are concerned, and which has just been raised by my hon. Friend the Member for Isle of Wight (Bob Seely). It is vital that we allocate resources fairly, as my hon. Friend the Member for Newton Abbot mentioned. That is why NHS England asked the Advisory Committee on Resource Allocation to consider the issue and provide a formula for allocations to integrated care boards. That formula took into account various factors, including population, age and deprivation —but we changed it.

In 2019-20, we produced a new element of the formula, recognising the points that my hon. Friend the Member for Newton Abbot makes, to better reflect the needs of some rural, coastal and remote areas, which on average tend to have a much older population. With an older population very often comes complex health needs. NHS England is using that formula to make allocations accordingly, but we recognise that some systems are significantly above or below target, and NHS England has a programme in place to manage convergence over several years. We also recognise the important challenge in ensuring that rural areas have the workforce—another point rightly raised at length—to provide the integrated patient-centred services that we all want to see.

We know that doctors are more likely to stay in the places where they trained, as my hon. Friend said. That is why, as part of a 25% expansion of medical school places between 2018 and 2020, we opened five new medical schools in rural and coastal locations that historically have been hard to recruit in: Sunderland, Lancashire, Chelmsford, Lincoln and Canterbury. I am conscious that my hon. Friend would want far more; that is perhaps a conversation to have at a later date. We hope—in fact, we expect—that graduates from those schools will stay in the area and will have a far greater understanding of the lives, needs and challenges of the people they serve in the locality.

My hon. Friend mentioned ambulances. As part of our plan for patients, which we launched in July, there is an extra £150 million for 2022-23 to address issues relating to ambulances. I hear what she says about differential pay rates, particularly in rural areas, between different blue light services, and I will take that away. Ambulances fall under the remit of my right hon. Friend the Member for Newark, and I know that he would be delighted to meet my hon. Friend the Member for Newton Abbot to discuss that issue.

On backlogs, I completely understand the points that my hon. Friend makes about recruitment challenges. I will take away her point about incentives not working, and I will look at other measures to attract people to rural and coastal areas, because we know that is a particular challenge.

The hon. Member for Westmorland and Lonsdale (Tim Farron) raised cancer wait time variance. As the Minister with responsibility for cancer, that absolutely concerns me. We are opening new diagnostic centres, but we have to look at more.

[Tim Farron]

rose—

[Will Quince]

I am conscious of time, so I will have to come back to the hon. Gentleman. We are going to meet, and we can discuss that at length. I know it is a concern of his.

[Tim Farron]

This is about treatment, not diagnosis.

[Will Quince]

Yes—absolutely right.

My hon. Friend the Member for Truro and Falmouth (Cherilyn Mackrory) raised seasonal visitors. I know that is an issue across Cornwall and Devon, and I would be very happy to look at that. My hon. Friend the Member for Bosworth (Dr Evans) raised the issue of GPs, and extending training and career opportunities in rural areas. I totally agree, and we will soon have a date in the diary to meet and discuss that.

My hon. Friend the Member for Newton Abbot was right to raise community hospitals. Again, my right hon. Friend the Member for Newark will be delighted to meet to discuss that at great length, as he would be to discuss unavoidably small hospitals, which I know my hon. Friend the Member for Isle of Wight has raised with the Secretary of State.

My hon. Friend the Member for Newton Abbot and others mentioned doctors. I entirely hear what she says about data. Data is important for choice, but I completely understand that in some rural, remote and coastal areas, there is no choice; there is just one GP, pharmacist and dentist, so we have to look at it differently. But data is important, because it allows the local integrated care board to identify where there are challenges and which practices are struggling. From November, for the first time, we will be publishing practice-level data on appointments and missed appointments. That is important because the patient deserves to see how their tax money is being spent. It also enables us to hold the integrated care board to account for how it is holding to account the practice and ensuring it modernises, is more efficient, and addresses the issues that its patients face. As part of our plan for patients, we are looking at that at great length.

Dentists are a real passion of mine. Dentistry is not looked at in the depth that it should be as part of wider NHS services. My hon. Friend rightly pointed out a number of reforms that were put in place in July. They are starting to take effect, and she will see more as they come to fruition. It is a top priority for me, and I am looking for areas for potential further reform. I encourage my hon. Friend to talk to her integrated care board about what more can be done on centres for dental development.

We absolutely recognise the importance of giving rural areas special consideration. They face a different range of challenges to the NHS in urban and suburban areas, and it is right that we give local systems the flexibility to respond to that. I hope I have reassured my hon. Friend and others that the current system does that. I am sure she will want to continue her work and the important work of the all-party parliamentary group. I certainly look forward to working with her.

Question put and agreed to.

Oral Answers to Questions

Tim Farron Excerpts

Tuesday 19th July 2022 Commons Chamber

[Steve Barclay]

As part of the Government’s wider commitment to levelling up, we are very interesting in taking a place-based approach. Indeed, the essence of the integrated care boards is to help facilitate that. I am very happy to have discussions with colleagues across the House on how we best deliver that.

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

We all know that NHS dentistry was in crisis long before the pandemic. In my community, only a third of adults have seen an NHS dentist in the last two years, and fewer than half of children have seen a dentist in the last 12 months. It is obvious why: we have an ageing system—units of dental activity—based on a snapshot taken 15 years ago, which is completely unfit for purpose, as dentists and patients around the country are telling the Government. Will the Secretary of State listen to dentists and patients and reform the system urgently?

[Steve Barclay]

I hope the hon. Gentleman will look at today’s announcement, because it shows that the Department has listened. That is why, for example, it will facilitate better contract management, better reflect the floor price for units of dental activity and reward complex treatment, which was one of the key concerns. Equally, I hope that the hon. Gentleman recognises that this Government, through the £1.7 billion of income protection during the pandemic, have done much to facilitate dentistry’s ability to bounce back.

Health and Care Bill

Tim Farron Excerpts

Consideration of Lords amendments
Wednesday 30th March 2022 Commons Chamber

[Edward Argar]

I may regret giving way to my right hon. Friend. I do not often say that, but perhaps I do now. I believe that this is about striking an appropriate balance in workforce planning and understanding supply and demand. I believe that the approach we have adopted as a Government, with the commission and the subsequent commission from the Secretary of State, is the right one. We are working closely with all NHS organisations from NHS England down, and I am sure that we will continue that collaborative work and that they will recognise the value being added by these commissions.

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

Will the Minister give way?

[Edward Argar]

I will make a little progress if I may, but if the hon. Gentleman can shoehorn his way in a little later, I will, assuming I am making good progress, try to find a way to come back to that point for him.

On Lords amendments 30 and 108, while we recognise the concerns of the other place, we think it is important to enable the Secretary of State to intervene in reconfigurations with greater flexibility where such an intervention is warranted. While the Secretary of State already has powers over reconfigurations, our proposals will allow them to better support effective change and respond in a more timely way to the views of the public, health oversight and scrutiny committees and, indeed, parliamentarians in this House. It will reduce wasted time and effort, and it will allow Ministers to become involved at the right stage, not simply at the end stage of the process. For that reason, we urge the House to reinstate clause 40 and schedule 6.

[Tim Farron]

rose—

[Edward Argar]

I think the hon. Gentleman is seeking to intervene. I find it difficult to say no to him, so I will give way.

[Tim Farron]

The Minister is a thoroughly good man, and I am very grateful. He will be aware of the National Audit Office’s projection that there are probably 100,000 undiagnosed cancer cases since the pandemic. Tragically, clinicians reckon that probably 20,000 of those people have already passed away. Will he agree and commit to a specific workforce strand when it comes to cancer? We desperately need cancer specialists, nurses, oncologists, radiotherapists and so on if we are going to be able to tackle this problem, but also make sure that we are not overburdened in the future, so that we can save lives?

[Edward Argar]

I am pleased I took the hon. Gentleman’s intervention on an issue that I know he has long taken an interest in. As well as the overall macro-trends of supply and demand, I expect the work being undertaken to look at the specialisms sitting beneath. He and I have discussed the significant increase in percentage terms in the number of radiographers, radiologists and others since 2010, but I acknowledge his underlying point that there is more to do if we are to achieve the ambitions set out in our consultation on the 10-year cancer plan and our broader ambitions for cancer care and treatment. We continue to look at that, and those specialisms will form a part of that work.

The hon. Member for Lewisham East raised a subject that I suspect will come up in contributions to the debate, including from my right hon. Friend the Member for South West Surrey (Jeremy Hunt). Regarding Lords amendment 48, we have heard the strength of feeling in the other place about the gravity of this issue, and I know that no one in this House would support the use of forced labour in creating NHS goods or their coming from areas where genocide may be taking place. We are fully committed to ensuring that that does not happen and we are now proposing further measures to tackle the use of forced labour, but we do not believe that this is the right legislative vehicle for introducing those changes, especially those made in the other place relating to genocide.

The Government will bring forward new rules for transforming public procurement in the forthcoming procurement Bill, which will cover all Government procurement and further strengthen the ability of public sector bodies to exclude from bidding for contracts suppliers that have a history of misconduct, including forced labour. We believe that that is the right vehicle for such provisions. The review of the 2014 modern slavery strategy will be published in spring this year, and will provide an opportunity to build on the progress we have made and to adapt our approach to take account of the evolving nature of these terrible crimes. We know that the NHS is one of the biggest procurers in this country, and it is for that reason that we are introducing measures in this Bill to ensure that NHS procurement works for the good of all.

NHS England and NHS Improvement agreed a new slavery and human trafficking statement for 2022-23 on 24 March, with new modern slavery countermeasures in the NHS supplier road map, updates to the NHS standard contracts to strengthen our position on modern slavery, and the development of a new strategy to eradicate modern slavery across the NHS supply chain. We are going to go further than that, though. In amendment (a) in lieu of amendment 48, we propose to introduce a duty on the Secretary of State to carry out a review into the risk of slavery and human trafficking taking place in NHS supply chains, and to lay before Parliament a report on its outcomes. That review will focus on Supply Chain Coordination Ltd, which manages the sourcing, delivery and supply of healthcare products, service and food for NHS trusts and healthcare organisations across England. As well as supporting the NHS to identify and mitigate risk with a view to resolving issues, the review will send a signal to suppliers that the NHS will not tolerate human rights abuses in its supply chains and will create a significant incentive for suppliers to revise their practices. I will listen to my right hon. Friend the Member for South West Surrey when he makes his contribution and endeavour to respond when I wind up this debate. I know he has strong views on this subject, as do other hon. Members