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

Elective Treatment

Tim Farron Excerpts

Tuesday 8th February 2022 Commons Chamber

[Sajid Javid]

I agree with my hon. Friend about the importance of the workforce, but I am afraid I do not agree with his comments about the plans for mandatory vaccination. I will not go through the details again; I did make a statement to the House on that last week, and in fact it was supported by the vast majority of Members of this House. The short answer to his question is that it is all about patient safety. The Government and the NHS are always absolutely right to put patient safety first, and although the Government have now, in the light of omicron, rightly changed their plans, it is still the professional responsibility of everyone working in healthcare to get vaccinated.

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

I am grateful for what the Secretary of State said about diagnostic hubs. Will he investigate personally why the planned hub for Westmorland general hospital has been delayed until 2023? I am also grateful for what he said about cancer services more generally. He knows that there have been 60,000 missed cancer diagnoses over the last two years, and I am sure he knows that radiotherapy is a key factor in tackling the backlog. Is he aware that radiotherapy ought to be accessed by 53% of cancer patients in this country but is accessed by only 23%, and that, as a proportion of our cancer budget, funding for radiotherapy in this country is only a little more than half the average for similar developed countries? Will he therefore make it a priority to meet with the all-party parliamentary group for radiotherapy and look at our manifesto, so that we can work together to save tens of thousands of lives that would be needlessly lost otherwise?

[Sajid Javid]

The hon. Gentleman raises a series of very important points, especially in what he said about cancer and radiotherapy. I believe he already has a meeting in the diary with Health Ministers, and I will look out for the output of that meeting. I agree with what he said about radiotherapy and the importance of investment in that, and there is a lot more investment. I referred earlier to the £6 billion extra capital budget, and a large part of that will be used for new diagnostics. I hope he also agrees with me that, as well as radiotherapy, we need to invest in the very latest cutting-edge technology for cancer care, such as proton beam therapy, which I saw for myself last week in London.

Health Inequalities: Office for Health Improvement and Disparities

Tim Farron Excerpts

Wednesday 26th January 2022 Westminster Hall

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

It is an honour to serve under your chairmanship, Mr Twigg. I congratulate the hon. Member for Bootle (Peter Dowd) on securing the debate and making an excellent opening speech. I also endorse what has been said by hon. Members on all sides—predominantly those from urban areas, because poverty is a major driver of health inequalities and discrepancies. I hope that my colleagues will understand if I now focus on some rural discrepancies, which are also significant and in some ways overlap with those on which hon. Members have focused so far.

The first area I will look at is social care. Social care is, obviously a huge issue and under massive pressure everywhere in the United Kingdom. There is an extra problem in rural communities like Cumbria. In my constituency, the average house price is 11 times the average household income; there are twice as many second homes in my patch as there are council houses. At this moment, 150 people who should be in social care are stranded in hospital beds, and one of the reasons for that is that the Government underfund social care. Not a penny of the national insurance rise that is coming will go into the pockets of hard-working care workers, so it is hard to retain and recruit them from a relatively small working-age workforce.

That has led to a number of issues. Just the other day, I was speaking to a person who needs a rota of six carers in order to function, but that person has not been able to find more than three for the last six to nine months. That is caused by a number of things, including silly visa rules, which the Government need to look at again, and the massive discrepancy between house prices and income—the availability of anywhere affordable to live for folks in the area.

Secondly, there is the issue of mental health—particularly young people’s mental health. Similar issues are present there when it comes to recruiting and retaining staff. There are wonderful staff—too few of them. When I did a survey of families in my constituency last year, we discovered that more than 50% of young people who presented with mental health conditions that needed attention waited more than three months, and 28% waited more than six months. Some 52% said their experience of that care was poor as a consequence.

If a 15-year-old broke their leg on a football field on a Sunday afternoon, they would be seen immediately, but if something invisible breaks within one of our young people, they wait six months or more. That is intolerable anywhere, but it is fuelled by the fact that we are in a rural area that is underfunded for mental health provision.

When it comes to GPs, a few years ago the Government got rid of the minimum practice income guarantee, which subsidised small surgeries. Small surgeries in rural areas are not small because they are bad, but because they cover the size of a small country but a relatively small population. Coniston, which mourns its doctor, Dr Simon Fisher, who sadly passed away just a few weeks ago, has a roll of just 900 patients, not because its practice is poor quality but because it covers a vast area. The Government took away that money.

The sticking-plaster money, called atypical practice funding, that went to some surgeries just to keep them going will fold when the clinical commissioning groups go and the new integrated care boards come in, in just a few months’ time. I ask the Minister to look carefully at that, as otherwise we may lose dozens, if not hundreds, of rural GP surgeries around the country.

On cancer provision, the National Radiotherapy Advisory Group states that it is bad practice for any patient needing radiotherapy to have to travel for more than 45 minutes for treatment. I can tell the Minister that not a single person in my constituency lives within 45 minutes of radiotherapy, and many of them must make four-hour round trips, day after day, in order to get treatment at an excellent but distant centre in Preston. If the Minister is committed to tackling discrepancies, she will finally do what Government after Government, including the one of which I was part, have failed to do—deliver the satellite radiotherapy unit at Kendal that we have long been campaigning for. That will shorten those journeys and save lives.

My final point is about accident and emergency. The nearest accident and emergency centre to most of my constituency is at Lancaster. There is a lot wrong with the hospital at Lancaster. It is an old site, at the wrong end of the one-way system, and could do with renewing. Talk of hospital improvement money going into it is welcome, but what is not welcome is the Minister’s Government’s continued insistence on looking at the option to close the Royal Lancaster Infirmary, merge it with the hospital at Preston and have a new hospital somewhere in the middle. If the answer is to make A&E for south Cumbria another 10 or 15 miles further away, that is the wrong answer. I ask the Minister to talk to the Secretary of State for Health and Social Care and others to take that option off the table, so that people from my communities do not have to travel dangerous distances to get the treatment they deserve.

I endorse what my colleagues from more urban areas said earlier in the debate, but I want the Minister to focus on the fact that many people in rural communities think they are overlooked by this Government, that their votes are taken for granted, and that as a result we get the situation that I have just outlined.

Oral Answers to Questions

Tim Farron Excerpts

Tuesday 18th January 2022 Commons Chamber

[Maggie Throup]

There are now six vaccination sites in the Bolsover district. A regular pop-up clinic was also set up in Shirebrook to address and identify the shortfall in uptake, but that has been phased out as new community pharmacy and primary care network clinics came on board to support the local vaccination programme and increase the number of Bolsover sites at the end of 2021. I am sure that my hon. Friend will be delighted to hear that a new roving vaccination van is being deployed across Derbyshire. It will visit Bolsover and surrounding villages to provide extra capacity and ensure that everyone has another way to get their booster jab. It will also allow those not yet vaccinated to come forward for this life-saving protection.

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

Undoubtedly, additional vaccine sites in rural communities will increase vaccine uptake, which is vital. However, does the Minister agree that, for NHS staff, counselling and one-to-one conversations are right and far more effective than the Government’s current plan potentially to sack the 5% of hospital staff in the Morecambe Bay region and indeed across the country who have not been vaccinated? That would cause a serious capacity problem in the NHS.

[Maggie Throup]

I reassure the hon. Gentleman that we are talking about patient safety. He is quite right that it is important to have that dialogue, and I know that colleagues across the board in the NHS are having that. It is interesting to note that more than 94% of NHS staff have already had their vaccine, and I commend them for that. As the chief medical officer Chris Whitty rightly said, those looking after other people who are very vulnerable have a “professional responsibility” to get vaccinated.

Access to Radiotherapy

Tim Farron Excerpts

Wednesday 12th January 2022 Westminster Hall

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

It is a huge pleasure to serve under your chairmanship, Mr Davies. I pay tribute to my friend, the hon. Member for Easington (Grahame Morris), for securing this debate and for an excellent speech, which contained some points that I make no apology for repeating because this issue matters hugely.

I lost my mum at the age of just 54. Eighteen years on, of course I still miss her massively; I miss especially the grandmother she would have been. Few issues that we deal with in this place are more personal than cancer. Half of us will have the disease at some point in our lives. Cancer touches absolutely every family.

The good news is that, increasingly, cancer is a disease that need not be a death sentence, partly because of the advances in radiotherapy. Radiotherapy kills cancer cells through radiation targeted at a tumour. It is becoming more and more precise, and is able to cure cancers that would otherwise be untreatable, with fewer side effects, as the hon. Member for Easington set out.

Just over 50% of people with cancer should expect to receive radiotherapy, yet, as has been said, Cancer Research UK estimates that only 27% of cancer patients in the UK actually receive it. The clue to why that is is that the UK spends only about 5% of the cancer budget on radiotherapy. The equivalent average spend of similar countries in Europe, Australia and so on is about 11%. The total budget for radiotherapy each year is £383 million; compare that to the £2 billion spent on cancer drugs every year, even though radiotherapy is eight times more likely to be curative than chemotherapy.

That historic underinvestment—the responsibility of lots of Governments of all colours—is undoubtedly a reason why the UK has some of the worst cancer survival rates in Europe. Lives are being lost needlessly because the UK is so painfully slow at keeping up with and grasping the opportunities that radiotherapy provides. That is why we set up the all-party parliamentary group for radiotherapy, which I am privileged to chair. I send huge thanks to Members from all parties, especially the hon. Member for Easington, to leading clinicians across the country and to the charity Radiotherapy UK, which is led by the rightly much esteemed Professor Pat Price, who has already been mentioned.

We set up the APPG in spring 2018. We booked a room in 1 Parliament Street. A handful of MPs turned up, but 50 or 60 of the leading oncologists in the country turned up and crammed into the room—they would not be allowed in today because of covid restrictions. Why had those people left their massively important jobs for the day, just to come to London for that meeting? It struck me then that it was because there is no radiotherapy lobby. I am not in any way going to criticise pharmaceutical companies, but we know that they are large and they have large coffers. We all get letters most weeks from constituents asking for this drug or that drug to be commissioned, and very often that is right. There is no such lobby for radiotherapy.

Lobbying, in its purest and most fair form, is about being in the room with the people who make the decisions. Radiotherapy has not had someone in the room with the people who make decisions. That is the best I can come up with as an excuse for why this Government and previous Governments, including the one I was part of, have not taken radiotherapy anything like as seriously as it should be taken, why we are investing such a paltry amount in radiotherapy, and why we are so far behind comparable countries.

At the local level, a bad situation is made worse because access to radiotherapy is simply not fair or equal. In south Cumbria, cancer patients have to travel each day all the way to Preston to our nearest radiotherapy centre. The Rosemere unit at Preston is excellent, but dangerously distant. The National Radiotherapy Advisory Group stated that it is bad practice for patients to have to travel for more than 45 minutes for treatment, yet not a single person in my huge constituency reliably lives within 45 minutes of radiotherapy.

Over the years, I have had the privilege of driving constituents to Preston for their treatment. I have seen how people from Kendal, Windermere, Grasmere, Grange, Coniston, Sedbergh and other communities have to make round trips of between two and four hours every day for weeks on end. I have seen their exhaustion and the impact on their health. I have seen people whose lives would have been longer if they had had radiotherapy turn it down, because they physically could not cope with the travelling. I have seen clinicians who have chosen not to refer people for radiotherapy, understandably but sadly, because they knew that their patient’s condition would be made worse by those long, gruelling journeys. In Cumbria, because NHS England and the Department of Health and Social Care will not act, those longer journeys mean shorter lives.

For 13 years, we have run a campaign collectively in Westmorland, calling relentlessly for a radiotherapy satellite unit to be placed at Westmorland General Hospital. We also campaigned to bring chemotherapy to Kendal and were successful in that fight. I am proud of everyone who supported our radiotherapy campaign, but we have submitted petitions with more than 10,000 signatures; I have had numerous Westminster Hall debates; I have met countless Ministers from all three parties that have been in government during my time in Parliament; we have marched for the hospital in our thousands; a team walked from Preston to Kendal just to make the point; 1,000 people wrote detailed, personal, heartbreaking stories to explain why we need the unit in Kendal; and we have demonstrated that there is clearly enough demand for at least one linear accelerator at Kendal, drawing patients from the south lakes, Furness and the western dales. With an ageing population in our community, there is also clearly a growing need.

We have the space at the hospital, designs have been done, the bid has been written and rewritten, and the inaction of managers in NHS England and Ministers in the Department of Health is inexcusable. It is a reminder of why rural communities feel so taken for granted and ignored by the Government and by NHS bosses nationally and regionally. Talk of levelling up the north is meaningless when Ministers appear not to realise that there is 100 miles of England north of Preston until the next nearest cancer centre.

Networked satellite radiotherapy units have been a huge success elsewhere in the country and, once they open, have been shown to increase the number of people able to take up that life-saving treatment. Satellites save more lives. Today, I ask the Minister to instruct NHS England to work with our local trusts in Cumbria and Lancashire finally to deliver our long-awaited satellite radiotherapy unit at Kendal. Our community will listen carefully to her response.

Radiotherapy, as the hon. Member for Easington said, provides the Government and the NHS with their best way through the cancer backlog. Owing to the pandemic, 740,000 cancer referrals have been missed. Therefore, at least 60,000 people are out there with cancer, but undiagnosed. That is terrifying. There is also an enormous backlog for treatment, with people dying as a result. In the Morecambe bay area, about half of cancer patients are having to wait for more than the scheduled 62-day limit to get their first treatment. As the Chair of the Health and Social Care Committee, the right hon. Member for South West Surrey (Jeremy Hunt), rightly said, it would take the NHS working at 120% of its existing capacity for two solid years just to get back to where we were in March 2020. The need for an urgent and ambitious boost to cancer care is therefore obvious, but we see next to nothing specific from the Government.

Money was pledged for diagnostic hubs, but just on Monday this week, I discovered that in South Lakeland we will not see ours until next year. Where is the urgency? The Government and the NHS have done so well—commendably—on the vaccine roll-out. Why will they not treat cancer and the cancer backlog in the same way, with a ring-fenced and targeted programme to catch up with cancer?

Radiotherapy is covid-secure and non-invasive, carries no infection risk, does not need intensive therapy unit beds or precious operating theatre time, does not compromise one’s immunity, is curative, palliative and, per capita, incredibly inexpensive. We could massively increase capacity very quickly. It has been the stand-out treatment in covid, often substituting for surgery, and it is the obvious first choice for getting through the backlog of cancer cases.

As an all-party group, we first wrote to the Secretary of State on 1 April 2020 to highlight the key role that radiotherapy needed to play to tackle the covid-induced cancer backlog. Since then, multiple spending reviews and Budgets have been passed with no significant investment in radiotherapy. The oft-repeated £130 million announced in 2016 as part of the long-term plan was spent long, long ago, so I hope that the Minister will not trot that out again. Yet a relatively modest investment of £850 million over three years could have a guaranteed and dramatic impact on cancer survival. I hope the Minister will take up the hon. Member for Easington’s request that she meet us as an all-party group and, more importantly, the clinicians, so that we may talk her through this all-party plan backed by the clinicians, which will help her out and help her deal with the backlog.

The Minister should tackle perverse tariffs that do active harm to cancer treatment, and she could do so at no cost whatsoever to the taxpayer—it is about spending the money differently and less foolishly. Staff are restricted from using centres with more modern, precise kit that can treat patients in fewer sessions; instead, they must treat less effectively and over more sessions because, stupidly, the tariff rewards the number of visits, not the precision or effectiveness of treatment. The Government must be pragmatic and accept the offer from the private sector to centrally commission its capacity—at cost and not for profit—to deliver treatment on the NHS to clear the backlog and to save lives.

We must especially care for, value and boost the work- force. Radiotherapy oncologists, radiographers, engineers and physicists—dedicated, passionate professionals —are close to breaking point. The survey by Radiotherapy UK and the Institute of Physics and Engineering in Medicine, to which the hon. Member for Easington referred, showed that 75% of those professionals believe that their unit could not meet pre-covid capacity with the kit they have. Some 80% reported seeing more advanced tumours than ever before in their careers and, as has been said, nearly 80% had thought about leaving the profession.

In Cumbria and right across the UK, radiotherapy treatment and the outstanding workforce have so much more to offer in the fight to save lives than successive Governments have seen fit to acknowledge. All parties bear responsibility for that. I ask the Minister to be a laser trailblazer and to deploy radiotherapy at its full capacity, so we can end needless deaths and catch up with cancer.

--- Later in debate ---

[Maria Caulfield]

I absolutely take that point on board. There are clinical reasons, if a patient has presented later, why radiotherapy may or may not be suitable. Again, they are clinical decisions that a patient needs to be discussing with their oncologist.

The hon. Member for Westmorland and Lonsdale (Tim Farron) raised the issue of satellite units. Again, I would just be slightly careful. Cancer alliances are mapping out cancer services in their areas, and I am very happy to meet colleagues who would like better provision in their local area, but they also need to meet their cancer alliances, which are looking at service provision locally.

I would just caution Members on the issue of having multiple sites for radiotherapy. These are specialist treatments, needing specialist equipment and specialist staff. I went into oncology more than 20 years ago, when surgery was done by general surgeons. They were doing mastectomies on women and colostomies on bowel cancer patients. Moving surgery into being a specialist field, with specialist provision, has transformed the way that we are able to look after women who are going through mastectomies, and bowel cancer patients, who may not necessarily need a colostomy now, because surgical treatments have advanced so much. There is sometimes a rationale for those services to be offered by specialist units, rather than multiple satellite sites.

[Tim Farron]

I want to answer a point that the Minister made earlier. Obviously, during the pandemic, radiotherapy has been used as substitutionary treatment for people who would otherwise have had chemotherapy or surgery, because it is a covid-secure treatment. But my main point is with regard to what the Minister just said about satellites. Has she looked at the data and evidence from those satellite centres that have been opened in the last few years?

For instance, at Hereford, we saw a doubling of the number of patients being treated at that new satellite centre. Why? Well, there was an assumption that the parent centre people, from that postcode, were simply transferred to Hereford. No, it turned out that a lot more people, who would not travel or who were not referred because of the travelling distance for treatment at the original place, were then referred for treatment and therefore had a longer life expectancy because of the satellite centre. With more networking capability, it is of course possible now to treat in specialist ways, with the best people, remotely and through these satellite centres. The Christie has just opened its third satellite, so surely, for more rural communities such as mine, and also in east Lancashire, the time has come to ensure that no one is left behind.

[Maria Caulfield]

There are satellite services—absolutely. We have seen them not just for radiotherapy, but for chemotherapy and even surgery. But it has to be a local decision, because local oncologists have to feel that they are able to support the multidisciplinary team who support the radiotherapy process, ranging from diagnostics through to the treatment itself. That has to be in place, so it does absolutely need to be done on a local basis, but I am happy to meet colleagues if they feel that the case is not being heard locally.

I want to emphasise this point, because a number of hon. Members talked about the commitment to cancer services. Our elective recovery programme has committed £2 billion this year and £8 billion over the next three years to step up activity and tackle backlogs. That will have a knock-on effect in improving radiotherapy access, because some patients cannot have radiotherapy until they have had surgery. Ensuring that we are tackling some of the backlogs to treatment resulting from covid is absolutely important.

There have been huge improvements in radiotherapy over recent years, not just in provision but in technique. We are able to deliver more targeted treatment, resulting in fewer hospital visits, because we can now give radio- therapy to a more targeted area of the body, resulting in fewer side effects from the treatment, and also give fewer fractions of radiotherapy, so that patients can get their total dose much more quickly. That maximises service capacity and minimises patient time in hospital.

Furthermore, we have invested £250 million into two proton beam therapy facilities, one based at the Christie in Manchester and the other at University College London. In addition, all radiotherapy centres in England are now able to deliver stereotactic ablative body radiotherapy. Both these treatments are able to target radiation at cancer cells more accurately, improving patient outcomes. I am really pleased to say that, as part of this year’s spending review, £32 million was made available to support the replacement of 17 linear accelerators aged over 10 years, all of which are on order and will be delivered by the end of March 2022.

NHS England is committed to improving the facilities for cancer patients, and has also offered NHS radiotherapy providers the opportunity to participate in a cloud-based technology called ProKnow. To date, 43 of the 49 radio- therapy providers have joined up. This technology, which will help satellite units, enables clinicians to collaborate virtually within and across organisations, to plan treatments, undertake peer-review assessments and participate in large-scale audits and quality improvement processes, ultimately benefiting patients.

A number of Members talked about the cancer workforce, because it is great to have state-of-the-art technology and multiple units providing radiotherapy, but if we do not have the staff to manage them and provide treatment we shall not make progress. Health Education England is continuing to take forward the cancer priorities identified in the NHS’s long-term plan. It is prioritising the training of 250 nurses to become cancer nurse specialists, 100 chemotherapy nurses and 58 biomedical scientists, and it is updating the advanced clinical practice qualification in oncology.

Further than that, particularly around radiotherapy, Health Education England is investing £52 million in the cancer and diagnostic workforce, increasing the number of clinical endoscopists and training more radiographers in image interpretation. That is all part of the radiotherapy process. As of August there have been an additional 4% of doctors working in clinical oncology, which is the field that manages radiotherapy, and there have been a further 5% working in radiology since August 2020.

We are making progress, but it is not just about the numbers of staff; it is about the skill mix and ongoing staff training. Very often, not being able to expand a role or take on exciting and innovative developments can make staff feel frustrated, but the cancer workforce is growing. Between 2016-17 and 2019-20, the cancer workforce grew by 3,342 full-time equivalents, compared with the ambition of 2,943. We are ensuring that there are more staff coming through into the workforce to deliver radiotherapy.

The shadow Minister touched on the importance of not only recruiting staff but retaining and developing them. I fully take on board colleagues’ comments and concerns. We are committed to investing in radiotherapy equipment, the staff that deliver radiotherapy and the innovation in radiotherapy. We are also committed to making it more accessible to patients, and to reducing the side effects—there are side effects from radiotherapy as well—and to making sure it is a fundamental part of cancer treatment, whether that is in the neoadjuvant setting, adjuvant or for those with metastatic cancer as part of the palliative treatment service.

--- Later in debate ---

[Maria Caulfield]

My understanding is that it is available for stage 3 melanoma, as the hon. Gentleman has highlighted, and that it is still in clinical trials for stage 2. It is available within clinical trials. We expect the data to come forward shortly and then a decision will be made. That is where we are with melanoma.

[Tim Farron]

Will the Minister give way?

[Maria Caulfield]

I will give way one more time.

[Tim Farron]

The Minister is being very kind and I really appreciate it. I have two quick points that I do not think she has mentioned. First, will she take up the request from myself and the hon. Member for Easington for a meeting with the APPG for radiotherapy? We would love to meet her.

Secondly, I do not think she referred to the tariff situation. A lot of the issue is that we need more money. We want the Minister to accept—it is not just her fault; it is the fault of every party in this place, over decades—that we are behind comparable countries and we need to strengthen radiotherapy. The reality is that there are lots of state-of-the-art machines out there, in trusts up and down the country, that are not being used because the tariff is stupid. It incentivises trusts to do second-division radiotherapy, if I can put it that way, because more visits equal more cash, rather than targeted and specific radiotherapy—stereotactic, as she mentioned, for many cancers—because the tariff rewards number of visits, not precision or effectiveness of treatment. Would she look at that? It is free.

[Maria Caulfield]

I am very happy to look at the tariff situation, but my experience is that when a clinical oncologist is referring someone for radiotherapy, that decision is not based on whether they have smaller numbers of fractions as opposed to traditional courses. I am very happy to meet the all-party parliamentary group to discuss that further. I reassure patients that clinical decisions are what decide the type and the number of fractions that a patient needs for their treatment.

Radiotherapy is a priority cancer treatment and this Government are absolutely committed to investing not just in the equipment, but in the workforce that provides it. I say a huge thank you to all the staff across the NHS, particularly in cancer services, who kept going through all the pandemic lockdowns, made sure that cancer patients got their treatment, and helped to support them and their families through what is a very difficult time.

Covid-19 Update

Tim Farron Excerpts

Wednesday 8th December 2021 Commons Chamber

[Sajid Javid]

My right hon. Friend will not be surprised to hear that we will be taking measures to increase substantially capacity in the NHS. He will know that it is not just about beds, whether Nightingale or elsewhere, but having the right amount and type of workforce to help with those beds.

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

We have a range of measures put in front of us, some of which will perhaps help a little bit, but will not actively control the virus very much, coupled with a colossal attack on civil liberties, which is a strange juxtaposition. Can I ask the Secretary of State to pay special attention to something that the Government have overlooked too much over the past two years, which is to invest in catching up with cancer? What the Government have done through this period is do a great job on vaccine roll-out, but I would love to see them show the same ringfenced dedication and commitment to catching up with cancer, given that we know that at least 50,000 additional people will lose their lives as a consequence of the covid situation.

[Sajid Javid]

The hon. Gentleman is right to talk about the importance of cancer and he will know that it remains a priority for the NHS. That is one reason why recently, when the Government set out the extra catch-up funding for the NHS over the next three years to pay for a lot more elective operations and diagnosis, cancer was a priority in that.

Covid-19 Update

Tim Farron Excerpts

Tuesday 9th November 2021 Commons Chamber

[Sajid Javid]

I can tell the hon. Gentleman that the antiviral drug that he refers to has been approved by the Medicines and Healthcare Products Regulatory Agency. We do have that drug, and since the point of approval last week we have already started deploying it in certain settings across the United Kingdom. We have put an order in for another antiviral, which has had very successful trial outcomes, but it has not received any final approval. If the MHRA independently decides to approve it—of course, that is a decision for the MHRA—the country will be in the fortunate position of having procured that drug, too.

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

One of the major objectives behind the successful vaccination programme is obviously to reduce infections, reduce hospitalisations and allow health professionals to focus on other, even more dangerous conditions, including cancer. The Secretary of State will be aware that in 2020, there were 35,000 missed cancer diagnoses. The London School of Economics study shows some 60,000 potential years of life being lost to cancer as a consequence of covid, and it is estimated that the NHS’s diagnostic and treatment services will have to work at 120% capacity for two solid years just to get back to March 2020 levels.

I suspect that the Secretary of State was as disappointed as I was that there was nothing in the Budget to help us to catch up with cancer. Will he follow the Government’s good example on the vaccine roll-out and adopt the same relentless focus on catching up with cancer, with targeted resources and leadership? Will he agree to meet clinicians and those involved in the cross-party Catch Up With Cancer campaign so we can work together to save those tens of thousands of lives, which will otherwise be unnecessarily lost?

[Sajid Javid]

The hon. Gentleman is absolutely right to raise the importance of cancer. For all the reasons he set out and more, it has remained an absolute priority of the Government and the NHS throughout the pandemic, despite the huge pressure that the NHS was under. Sadly, he is also right—I have spoken about this, just as he has—that many thousands of people went undiagnosed because they were asked to stay away from the NHS to protect it. We all understand why that happened, but sadly it had an unintended consequence. He is not right, though, to suggest that there was nothing in the Budget or the accompanying spending round to help with that problem. I draw his attention, for example, to the billions of investment in the new community diagnostic centres. There will be more than 100 across England, which will mean it will be much easier and quicker for GPs or others to refer people with suspected cancer for diagnosis. There are other examples, but I hope he is reassured that this remains an absolute priority.

Covid-19 Update

Tim Farron Excerpts

Monday 6th September 2021 Commons Chamber

[Nadhim Zahawi]

I can give my hon. Friend that reassurance. We have a pretty substantial outreach programme, including webinars with midwives so that they are given all the available tools to ensure that pregnant women are given the protection that they so vitally require.

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

The effective cut-off for care home staff to get their first jab in order to comply with the Government’s deadline is just 10 days away, and those who are not double-jabbed in time will not be able to work in care homes. However, there has yet to be any unequivocal guidance on who will be exempt from this, and care home managers in my constituency are desperately concerned, especially in the light of the most unprecedented care home staffing crisis in a generation. They are desperate for that guidance. Will the Minister provide it today?

[Nadhim Zahawi]

The hon. Gentleman is absolutely right: 11 November is the date by which care homes and care home providers will have to comply with the legislation on the vaccination programme. I would be happy to share with him the guidance and the communication that we have sent out to the sector, and I will write to him after this statement.