Oral Answers to Questions

Tim Farron Excerpts

Tuesday 6th June 2023 Commons Chamber

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

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

[Neil O’Brien]

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

NHS Dentists: South-West England

Tim Farron Excerpts

Wednesday 24th May 2023 Westminster Hall

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

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

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

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

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

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

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

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

Oral Answers

Tim Farron Excerpts

Tuesday 25th April 2023 Commons Chamber

[Helen Whately]

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

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

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

[Helen Whately]

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

Cancer Care

Tim Farron Excerpts

Tuesday 14th March 2023 Westminster Hall

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

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

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

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

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

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

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

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

[Peter Dowd]

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

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

and that

“by 2025 it will be 90.”

Does he agree that that is a pretty grim statistic?

[Tim Farron]

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

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

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

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

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

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

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

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

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

--- Later in debate ---

[Helen Whately]

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

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

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

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

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

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

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

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

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

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

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

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

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

[Tim Farron]

Will the hon. Lady give way?

[Helen Whately]

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

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

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

[Tim Farron]

Will the hon. Lady give way?

[Helen Whately]

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

[Tim Farron]

She mentioned a couple of points about the figures.

[Helen Whately]

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

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

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

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

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

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

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

NHS Workforce Expansion

Tim Farron Excerpts

Tuesday 28th February 2023 Commons Chamber

[Wes Streeting]

I wholeheartedly agree with my hon. Friend. Unless the NHS has the staff it needs, patients will not get the timely care they deserve. It really is as simple as that. We have a plan; the Government do not, and they are very welcome to take ours.

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

The shadow Secretary of State is making a very good speech. On the issue of cancer, around half of cancer patients need radiotherapy, but barely a quarter get it. One reason is that the workforce in radiotherapy is small— 6,400 people. At the moment, the number of posts vacant in radiotherapy centres is 30% higher than the number of new graduates leaving college and coming into the professions that make up that workforce. We also found in the Radiotherapy UK survey that 80% of the workforce in radiotherapy centres reported that either they or a colleague had considered leaving. Does he think that the cancer workforce is essential to a cancer plan that will actually save lives?

[Wes Streeting]

The hon. Gentleman is absolutely right, and I have been following his work and that of the all-party parliamentary group on radiotherapy in this area, because he raises issues that ought to be taken very seriously. I was very grateful to my hon. Friend the Member for Easington (Grahame Morris) for coming to meet me about these challenges in particular. Of course, this has to be at the heart of a serious plan to improve cancer outcomes.

There is no doubt but that Labour’s workforce plan—supported by the NHS, supported by the professions, supported by so many members of the public—would make a difference. In fact, our inboxes have been filling with people welcoming the plan. It was a particular surprise to me to see one piece of fan mail that said:

“Despite my obvious political allegiances it would be remiss of me not mention the fact that Labour has pledged to double the number of medical school places and recruit additional health visitors and district nurses.”

It goes on to say that it

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

Well, what luck that this particular fan of Labour’s policy joined the Government just two weeks after he sent the email. It is, of course, the Chancellor of the Exchequer, who I must say I thought was an excellent Chair of the Health Committee. It is almost as if he had learned from all his mistakes when he was the Secretary of State for Health.

This is Lent, a period for atonement and a time for forgiveness, so I make this pledge today: if the Chancellor realises the errors of his ways and comes to this House to double the number of medical school places in the Budget and adopt Labour’s NHS expansion to deliver the biggest expansion of the NHS workforce in history, I will cheer him on from the Opposition Front Bench during the Budget. I will cheer him on—

Urgent and Emergency Care Recovery Plan

Tim Farron Excerpts

Monday 30th January 2023 Commons Chamber

[Steve Barclay]

My right hon. and learned Friend has been key to securing the funding. He has assiduously lobbied me and ministerial colleagues to make a powerful case on behalf of his constituents, and I think he should be proud of the outcome, which reflects his and his parliamentary colleagues’ work on this issue. He is right; indeed, the case he made was around how this frees up capacity in the system, which will result in much better care for patients in Swindon.

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

There is nothing in this plan to address the fact that thousands of people are now turning up at A&E as a direct result of being unable to get regular access to an NHS dentist. Last week, another Cumbrian dental practice, in Grange-over-Sands, wrote to all of its 5,800 patients, as it had been forced to quit the NHS too. There is now not a single NHS dental place available anywhere in Cumbria. What will the Secretary of State do to fix an NHS dentistry crisis that leaves a family of four having to cough up an extra £1,000 a year during a cost of living crisis to get access to dental care that they have already paid for through their taxes?

[Steve Barclay]

I have addressed that point, in that we are bringing forward the third component of our three plans. I spoke earlier about the elective recovery plan; today’s announcement is on the urgent and emergency care recovery plan; and the third element will be the primary care recovery plan. Of course, alongside the work we are doing on dentistry it is also about access to services, both dentistry and A&E. That comes together in things such as the 111 service and how we review that, as well as the NHS app. It is about looking at how we better manage demand at the front door, and the demand for dentistry is not only through NHS dentistry but often manifests itself through a lot of patients coming forward for dentistry at A&E.

Sudden Unexplained Death in Childhood

Tim Farron Excerpts

Tuesday 17th January 2023 Westminster Hall

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

It is a pleasure to serve under your chairmanship, Mr Twigg, and a pleasure to follow the right hon. Member for Spelthorne (Kwasi Kwarteng), who made a very moving and thoughtful speech. I especially congratulate him on securing this really important debate.

SUDC is an unimaginable tragedy to strike any family. We are here because people in our communities have reached out to us to share their experiences with us. I know we all feel that it is a huge responsibility and an honour to share their experiences.

I spoke last night and previously to my constituent Charlotte and her husband Andy regarding their little son Wilfred, who was two years and 10 months old when he died a little over a year ago. Charlotte and Andy refer to Wilfred as a

“vibrant, energetic little boy who had a vivacious and fearless lust for life.”

She goes on to say:

“The shock that reverberates into every aspect of your life when your child dies unexpectedly and suddenly is unimaginable”.

Unimaginable it is to those of us who have not personally experienced that tragedy. As I seek to honour Wilfred, perhaps the best thing that I can do is speak briefly about actions that could spare other families from experiencing the grief and tragedy with which Wilfred’s family continue to live.

The challenges are what to do with the evidence and what to do about the lack of evidence. Those are the two things that it would be good to consider. Let me first turn to what to do about the evidence. Wilfred passed away at two years and 10 months. At 10 months old, he suffered his first febrile seizure. He was never referred for further investigations to ascertain the cause or to ascertain whether a febrile seizure could lead to anything more dangerous. Wilfred had his sixth febrile seizure, which led to a cardiac arrest, and he passed away just a few days later.

Research by the US branch of the charity Sudden Unexplained Deaths in Childhood shows that roughly a third of sudden unexplained child deaths happen to children with a history of febrile seizures. So they are not totally unexplained, are they? At least some of them are not. However, febrile seizures are mostly not treated as serious or potentially serious. Most NHS trusts do not have a pathway to deal with children who have suffered a febrile seizure, and that surely must be addressed urgently. Febrile seizures must be seen as a red flag that all NHS providers should be aware of, and they should be equipped to act accordingly.

I want also to refer to something that tends to affect not very young children, but young people who are still minors: deaths caused by undiagnosed heart conditions. In particular, I want to refer to the work of CRY—Cardiac Risk in the Young—which does tremendous work in screening young people, particularly those who have any kind of family history but even those who do not, to see whether there is a potential risk. Thousands of people have been assessed by Cardiac Risk in the Young, which is a wonderful charity that works across the north-west and further—indeed, it has done sessions in Kendal. I encourage the Minister to look into how we can screen young people, particularly if there is any family history, to ensure that we do not lose them to undiagnosed heart conditions.

That is what to do with the evidence. What do we do about the lack of evidence? Simply, for the children we lose to sudden unexplained death, it is indeed totally unexplained: there are no clues. We ask collectively today that the Government prioritise scientific research into sudden unexplained deaths among children, potential causes and modifiable risk factors. We also ask that the Government and the NHS prioritise medical education to increase awareness.

[Andy Slaughter (Hammersmith) (Lab)]

I agree with what the hon. Gentleman said. I am here because a constituent told me about the tragic death of her two-year-old nephew in 2021. I am educating myself, with the help of SUDC UK, but it is difficult because there is so little debate, publicity and awareness. I hope that this well-attended debate will mean that research and education is forthcoming. It is a very rare but absolutely devastating condition.

[Tim Farron]

I agree with the hon. Gentleman.

In memory of Wilfred, in honouring his family, and as we remember all those who have tragically died and we seek to support their loved ones, we ask that the Government take practical steps to help us to tackle the horror of sudden unexplained deaths among children.

I spoke to another family—I will not name them—who talked about the loss of their child not so long ago. The mother said to me:

“It clouds everything you do, feel and breathe. I hate that it happened to him and not me. I will never not be able to see him in A&E, thinking this can’t be happening, he is healthy, and I left him a couple of hours ago absolutely fine.”

There is a reason why it is such an uncomfortable issue, but it is important to grasp uncomfortable issues, not only in honour of the memory of Wilfred and everybody else who has passed away and to honour their families, but to prevent any other families from going through the same thing in future.

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?