Breast Cancer Screening

Tim Farron Excerpts

Wednesday 16th December 2020 Westminster Hall

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

It is a pleasure to serve under your chairmanship, Sir Edward. I thank the hon. Member for High Peak (Robert Largan) for securing this debate. The hon. Member for West Bromwich East (Nicola Richards) made a remarkably good speech, citing her own family’s experience.

Both hon. Members have spoken about Breast Cancer Now’s assessment that almost 1 million women have missed a screening during this period. Its assessment is that that would mean 8,650 women may be out there with undetected breast cancer. Cancer Research UK assesses that screening services are running at 60% capacity. That means the situation is getting worse week by week. A hundred fewer women started treatment for breast cancer each day in May and June than during those months in 2019.

If we look beyond breast cancer, in my county of Cumbria there is a 17% reduction in the number of people starting cancer treatment this year compared to 2019. It is fair to assume, therefore, that roughly one in six people who would have been diagnosed with cancers of all kinds is out there undiagnosed. We know that for every four weeks treatment is delayed, for whatever reason, the chances one has of survival fall by 10%. That delay in treatment can be due to a delay in people coming forward, a delay in diagnosis and a delay in treatment.

Any Government of any combination of colours would have been thrown by the coronavirus. In those early months the messaging was really good and powerful: “Stay at home. Protect the NHS. Save lives.” It often occurs to me that the position of the NHS in British society, the affection in which it is held, was a key driver. I suspect that in another country, where the message might have been, “Protect the expensive private healthcare that you use, through exorbitant insurance models,” would probably have been less compelling. The NHS was a key driver and the Government deployed it well.

Why were we protecting the NHS? We were doing so not only so that we could tackle covid, but so that the NHS could carry on its lifesaving work in every other area. People not coming forward for treatment, for reasons that have been mentioned, such as being scared of being infected or nervousness about being a burden and troubling staff, is a huge part of the reason why the backlog exists.

There were treatment cancellations for perfectly good clinical reasons, as well as those for not good clinical reasons. I am chair of the all-party parliamentary group on radiotherapy, and Members would be staggered if I did not talk about radiotherapy as a treatment for breast cancer and other forms. Radiotherapy is the clean form of cancer treatment. It does not affect immunity and is not likely to open up someone to infection. The amount of radiotherapy being delivered during that period should not have been changed, because people are at no more risk of covid from taking it and, because it is a clean form of treatment, it should be substitutionary. It could be used, and in some cases has been, as a substitute for more risky forms of cancer treatment, such as chemotherapy and surgery, where that was necessary. In some cases, that has happened, which should be noted.

For example, bladder radiotherapy treatment is now at 160% of normal levels and capacity. In that area at least, we are using that clean technology to catch up with cancer in that area. The problem is that it is not the case across the board. We do not have figures since summer, but Public Health England has just released figures from April to the summer, which showed a 15% drop in radiotherapy treatments started during that time. That includes starting in April, so that cannot have been a response to fewer people coming through.

The National Institute for Health and Care Excellence recommendations and guidance at the beginning of coronavirus were to stop, postpone or delay radiotherapy treatment—for no clinical reason whatsoever. Some cancer centres followed that advice and people did not get treatment. We know what that means for people’s likelihood of surviving. That 15% drop in radiotherapy treatment will have cost lives. It was unnecessary and it means that the backlog is even greater than it would have been.

Cancer Research UK has estimated that we will unnecessarily lose 35,000 lives to cancer because of the crisis. The British Medical Journal published research a few weeks ago that showed we would lose, as a country, 60,000 additional years of life to cancer, because of the coronavirus crisis.

When breast cancer screening services are running at just 60% of capacity and we are witnessing a 50% reduction in the number of people starting radiotherapy treatment, we see a backlog that can only be getting worse as we speak. I want to endorse what has been said by the Chair of the Health and Social Care Committee, the right hon. Member for South West Surrey (Jeremy Hunt)—that it will take NHS cancer screening, diagnostics and treatment services, as a piece, operating at 120%usb capacity for two solid years to catch up fully with the backlog, to catch up with cancer.

Members will have been as deeply moved as I was by the recent sad death of Sherwin Hall, a 27-year-old father of two, as a result of delayed treatment. His family have been supported by the Catch Up With Cancer campaign, launched by the family of Kelly Smith, who also died far too young as a result of delays to her treatment during this process. Catch Up With Cancer estimates that the backlog might be up to 100,000 people. This is a national crisis on the scale of covid—different, but on the same scale—and it needs a response as ambitious and as urgent as the NHS’s correct response to covid. However, in the comprehensive spending review there was just a single mention of cancer in the entire document.

There are three issues at play here, the first of which is people having the confidence and awareness to come forward, as has been mentioned. The second is the diagnostic process and the third is the treatment. Issue one, the issue of people being brought forward or encouraged to come forward for treatment, is about strong public health and public information messages, and all of us getting behind them and being open about the necessity—as was mentioned, rightly, by the hon. Member for West Bromwich East—for a person to come forward if they have the slightest hint of a doubt that something might be wrong or unusual with any part of their body.

Issues two and three, diagnostics and treatment, need more than an ad campaign. They need more than good public relations and public information: they need money. It has been mentioned that within the CSR, £325 million was set aside for diagnostic machines, but the CSR says that that is

“enough funding to replace over two thirds of imaging equipment that is over 10 years old.”

In other words, it is money to replace some of the stuff that ought to have already been replaced. It is not new—it is not expanded capacity—and yet, when it comes to treatment, we have not got even that.

This was the Government’s opportunity. As chair of the all-party parliamentary group on radiotherapy, along with the Catch Up With Cancer campaign and the all-party parliamentary group on cancer—which I am proud to also be a member of—we made a submission to the Department of Health and Social Care and to the Treasury, calling for an immediate fund to catch up with cancer. That did not arrive, and I am going to shock the Minister by reminding her of a promise that she made me in this place a couple of weeks ago—to meet me and the Catch Up With Cancer team before Christmas, to look at how we can get that urgently needed ring-fenced investment through the spending review and into additional cancer diagnosis and treatments. I would like to hold her to that promise, and I hope she will refer to it in her closing remarks.

Alongside covid, the early diagnosis of women with breast cancer, so that we can treat them and cure them, is an ongoing problem. The United Kingdom is towards the bottom of the league tables for most of the major cancers when it comes to survival. To the Government’s credit, they acknowledged that in the NHS long-term plan released two years ago. Its fundamental aim—the headline part of that NHS long-term plan—was to diagnose more people early with all cancers, including breast cancer, so that we could treat them and cure them, and so that survival rates would be far better than the terrible situation that we have for most cancers in this country now.

I say to the Minister that if we are successful in diagnosing more people sooner, earlier—and we must be successful—we will then need the capacity to treat those people, and we do not have that. Radiotherapy is part of the solution, so it is absolutely essential to invest now in the kit, the technology and—as has been mentioned—the workforce, in order to be able to deliver treatments to those people who have been diagnosed early. How tragic would it be to diagnose maybe tens of thousands more people earlier than we do at the moment, and then not have the kit, the capacity, the staff or the technology to treat them? That is a challenge that the Government can meet, and I hope the Minister will take that on board and do just that.

Covid-19

Tim Farron Excerpts

Monday 14th December 2020 Commons Chamber

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

Point taken, Madam Deputy Speaker. Thank you very much for calling me.

This has been the most peculiar of years. When we look at the media coverage of where we are with the virus, the vaccine, all the political issues that go alongside that, and the challenges over how the Government are handling things—well, badly or indifferently—many of us overlook what an appalling tragedy this has been and continues to be. Sixty-four thousand people in this country have lost their lives. Around 600 people or more in my county have lost their lives, and I knew dozens of them. One thinks about those people for whom Christmas will be not just lonely, difficult and challenging because of the restrictions we are all under, but a time of deep distress because they have lost someone close to them in the last nine months. When we see debates about the necessity of lockdown or restrictions of one kind or another, we need to remember what it is we are seeking to do: it is to save lives, and it will continue to be to save lives.

The tragedy that has hit my community, as it has every other community, feels almost too much to bear. We are a community where the average age is 10 years above the national average age in the United Kingdom. We are an area that, after London, is the next most visited place in the United Kingdom—the Lake district. Arguments are made about whether that meant that we had a higher than average incidence of the virus early on. We do not know that; what we do know is the way in which communities have responded to the virus.

In community after community, whether in our large town of Kendal, in Windermere, Grasmere, Ambleside and Sedbergh or in smaller places like Dent, Coniston, my own village of Milnthorpe, Arnside and Grange—everywhere I could mention in my patch, which is bigger than Greater London, and by the way I could mention another hundred—people have stepped up to take responsibility and have been desperate to meet the needs of their neighbours, though their own needs may be very significant. I pay tribute to every single one of them. I am proud to represent the south lakes and to represent those communities. Diverse though they are, they are also utterly determined to support one another.

There are so many within those communities who deserve our thanks and support, such as those working in care homes. I talked to one lady who worked in a care home, and not even a particularly large one, in my community. Back in April, on one night she saw nine residents lose their lives—in a single night. That was a tragedy for every single one of those people and every single one of those families. What does that mean? What does it feel like to be somebody who works in a place like that, administering love, care and concern for people as they go through their last moments? What is the cumulative impact on the mental health and wellbeing of people working in those communities?

We say thank you very often, and it is right that we do so in this place, but I want people who work in care homes, personal carers and those who work in the health service to know that we are not saying it glibly—we really, really mean it. We are utterly in their debt for the way they have cared for people at their moment of greatest need.

I think also of another group of people in a community like mine, where unemployment has gone up nearly sevenfold over the period of the pandemic: people who work for the Department for Work and Pensions in the jobcentre. They are people who serve people—people who perhaps were living in a state of relative comfort back in February or March, and then discovered that everything had collapsed around them. They are there for people at a moment of desperate need. They are not the only people, but I just want to draw them to the front of our attention. I thank those people on the frontline who have been supporting others who found themselves in need of benefits when they never thought in advance that they would.

I could say so many things about those who have stepped up to the mark at this time, but I also wish to pay tribute to those who have ensured that we have got to a stage where a vaccine is imminent—it turns out that we do need experts, after all. I am utterly indebted to those people, be they in this country or elsewhere, who have used their expertise and brilliance to do in 10 months what we would normally expect to take 10 years. Here is the thing that concerns me: we are close, potentially, to seeing light at the end of the tunnel and we can almost sense people beginning not to dip for the tape but to just let their guard drop. On behalf of everyone in this Chamber and beyond, I just want to say that this is the moment for utmost vigilance.

My dad was sharing that very thought with me the other day and he made the analogy with those tragic people who fell in the hours before the guns stopped on 11 November 1918. What a particular tragedy it was to be those who died at the end when the end was in sight. That is what we have ahead of us now, which is why if we need to tighten up restrictions over Christmas, miserable though that may be, we must think, “For pity’s sake, don’t we want our loved ones to see summer? Aren’t we prepared to make some restrictions now?” We know we are not going to have to live with this for years and years. We know that the light at the end of the tunnel is now visible. That is a glorious thing we can cling on to, but it is not an excuse to let our guard down—in fact, it is the opposite of that.

I want to encourage Ministers to think carefully about how the vaccine is administered. Of course, it should go first to those who are the most vulnerable, and those working in care homes and in the national health service. I have talked about the scale of my constituency, so it is great that we are likely to have a centre in Kendal and in Windermere, and we are looking at centres being rolled out through the primary care network, through GP surgeries and the like. I encourage the NHS within Lancashire and south Cumbria to ensure that there are centres in places such as Grange-over-Sands and Sedbergh, and other more rural, remote parts of Cumbria, so that this is not hard to access, particularly for people who are older and more vulnerable.

A community such as mine, which relies so heavily on tourism, with half the workforce working in tourism, has been deeply hit by the coronavirus. We operate on a feast and famine basis in hospitality and tourism, with the winter famine and the summer feast, and then back to the winter famine. The problem for us is that we have had three winters in a row. The Government’s investment in hospitality and tourism early on was of real benefit. Those £10,000 grants ensured that many businesses that would have failed were able to take advantage of the unlocking through the summer, so July and August were not a bad couple of months for hospitality and tourism in the lakes and the dales. I suggest to the Government that their failure at this point to repeat that grant support on that scale risks throwing away all the advantages they got from supporting hospitality and tourism in the early part of the year. What is the point of investing billions into it only to let those companies die in the next couple of months, so that when we are able to get back to some kind of normality, rather than having a hospitality and tourism industry ready to fight back and bounce back, we may have a bunch of dead businesses? So I encourage the Government now to repeat those £10,000 loans, to support hospitality and tourism.

I also encourage the Government to recognise the challenges faced in areas such as mine, which have been in tier 1 and are now tier 2, and are adjacent to tier 3 areas. The Lake District and Yorkshire Dales are in tier 2, but our neighbouring huge communities, the big population centres, are tier 3 So we are not compensated in the same way as businesses in tier 3 are, but we are massively affected by the fact that people in tier 3 cannot travel to take advantage of the wonderful facilities available in south Cumbria. I encourage the Government to consider making sure that support is provided.

[Jim Shannon]

With the advent of the vaccine for covid-19 almost here, does the hon. Gentleman feel that an extra push at this time for the goal of being covid-free should be what we all focus on? If we do that—collectively, singly and all together—we can make it happen, and that should be the positive message we are trying to send out from the Chamber tonight.

[Tim Farron]

I am grateful to the hon. Gentleman for his intervention. The fact that we know that the vaccines are now on their way surely changes how we look at all this. It means we now know we are not throwing billions and billions into a pot where we will never see the bottom. We know some kind of end is in sight, so what a terrible waste of tens of billions of the public’s money it would be, were we to be penny pinching in the last part of this pandemic. That is why we should back hospitality and tourism, which is the fourth biggest employer in the country and the biggest employer in Cumbria. It is essential to our economy as a whole and is worth £3.5 billion to the Cumbrian economy every year. This is the point; to invest in hospitality and tourism to see us through to the end.

In my community, there is a preponderance of businesses afflicted by having been excluded from support. Something like 4,000 people in my constituency alone were given no support. We are often talking about people who became self-employed in the past 18 months or so—the directors of small limited companies, hairdressers, personal trainers, taxi drivers and the like—but got nothing throughout this period. People on maternity leave have had their support cut at one end or the other. Often, these are the people—the entrepreneurs—who we will desperately rely on to build back our economy once we are through the coronavirus. Not only is it lacking in compassion for the Government to not back those people who have been excluded, but extremely stupid when they are the engine of our recovery, or at least they would be, if only the Government would help them.

A source of employment and a very important sector within my constituency and constituencies like mine is the outdoor education sector. It has been overlooked in many ways, although I am pleased to be part of the all-party group that the hon. Member for Aberconwy (Robin Millar) chairs, which is looking at how we can support outdoor education.

It is worth bearing in mind that about 15,000 people work in outdoor education around the country, and 6,000 of them have lost their jobs already, largely because residential stays have effectively been banned by the Department for Education under advice from the Department of Health and Social Care. I understand that, although I would argue that residential stays at outdoor education centres are at least as safe as children going to school in the first place.

It is important that we save our outdoor education centres, which are hugely at risk at this point, not only because it is right to save them, but because this is the moment to deploy them. I and others in this Chamber have talked about the impact this period has had on the mental health of young people and their disengagement with education. Those children have lost three months at school, but some of them went back two years as a consequence of all this. In our outdoor education centres, we have the skill and talent to engage young people in learning, to foster a love of learning, to improve their mental health and wellbeing and to engage them with the education process again. Will the Government bring forward a specialist package, as they have in Scotland, to make sure that we lose no more outdoor education centre jobs and protect all our outdoor education centres?

Finally, I will say a couple of words about health in general, but in particular mental health. In my constituency, we saw the closure of our adult mental health ward, the Kentmere ward, at Westmorland General Hospital for covid reasons. We understand why that is the case, and we are pleased that the foundation trust is now putting £5 million into redeveloping that service and opening again within the next year. I encourage Ministers to put pressure on the Lancashire and South Cumbria NHS Foundation Trust to make sure that happens as soon as possible, and also to ensure that it remains a site to support people of all ages and all genders with mental health problems. It is incredibly important that we do not end up at the end of all this with a more exclusive and less accessible mental health service available in South Lakeland.

Finally, cancer. We have learned during this period that there is a backlog in cancer treatment of around 100,000 people. Cancer Research UK estimates that 35,000 additional deaths may happen as a consequence of covid through people dying as a result of cancer. We believe that for every four weeks’ delay in diagnosis and, indeed, in treatment starting, we see a 10% drop in the likelihood of surviving that cancer. I want to encourage the Government to look carefully, if belatedly, at the comprehensive spending review submission that the all-party parliamentary groups on cancer, including the radiotherapy group that I chair, put to the Treasury, but which the Government did not match or fund. That proposal would allow us to massively expand radiotherapy, which would be a way not just of treating people who would normally expect to get radiotherapy but of ensuring that we substitute for those other treatments that are not possible due to covid-19. It would be an absolute tragedy if we ended up losing tens of thousands of people to cancer through this period because the Government did not catch up with cancer when they had the chance to invest and to do so.

Covid-19: Access to Cancer Diagnosis and Treatment

Tim Farron Excerpts

Wednesday 2nd December 2020 Westminster Hall

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

I beg to move,

That this House has considered access to cancer diagnosis and treatment during the covid-19 outbreak.

It is a great pleasure to serve under your chairmanship, Ms McVey. I am grateful to have the opportunity to raise this issue. Of the many vital issues discussed in this place in recent months, the impact of covid-19 on cancer treatment must be at the very top of the list for importance to families right across the United Kingdom. I want to start by saying very clearly that there is a national cancer crisis—a backlog that we need to catch up with urgently—so I will be concluding my speech by asking the Minister to meet me and the clinical advisers who support the Catch Up With Cancer campaign as a matter of priority in the coming days.

Since the start of the pandemic, organisations, charities, frontline NHS staff and MPs have been urging the Government to invest in cancer services to prevent a national tragedy in cancer. Indeed, the experts we work with warned at the start of the pandemic that tens of thousands of people were set to die as a result of cancellations, delays and disruptions to their treatment. Sadly, it looks as though those warnings have been proved right, although for thousands of families it is not yet too late for us to catch up with cancer.

I have two main points to address. Both relate in large part to the covid-induced backlog and the apparent failure to make addressing it a central feature of the Chancellor of the Exchequer’s comprehensive spending review just last week. The first point I would like to address today is the scale of the cancer backlog itself. All the feedback from the frontline and from our expert clinical advisers strongly suggests that the Government and NHS management are repeatedly failing to grasp the true size and scale and danger of the backlog. The Government and senior NHS managers keep saying that services are back to normal levels and that good progress is being made on the backlog, but all the evidence from frontline staff provides a clear picture that it is just not true to say that we are back to normal.

Even then, the simple fact remains that, with the scale of the backlog, “back to normal” is nowhere near good enough anyway. Even if services were back to pre-covid levels—we contend that they are not—it would be mathematically impossible to have caught up. Why? Because the flow of patients was all but stopped for several months, but cancer, of course, did not take a break. It kept striking people at the same rate it always does, so the only way we can catch up with cancer is to have services super-boosted to levels in excess of pre-covid capacity. We estimate that cancer services need to be running at something like 120% of pre-covid levels for two solid years to catch up. That view is shared by other keen observers of this problem, such as the chair of the Health and Social Care Committee, the right hon. Member for South West Surrey (Jeremy Hunt). But the brutal reality is that services are not yet even at their pre-covid capacity. In September, treatment was at only 94.5% capacity, and as long as the treatment rate continues to be below 2019 levels, the cancer backlog will continue to grow.

We are hearing from frontline staff that services were not yet back to normal before the recent lockdown in November. One cancer centre has told us that during that lockdown, referrals have yet again “fallen off a cliff”. Analysis from Macmillan Cancer Support, using the Government’s own monthly cancer waiting times data, shows that during the pandemic around 1,000 fewer people in south Cumbria and Lancashire will have had their first cancer treatment, compared with the same period last year—a 17% drop—which suggests we are missing one in six people with cancer. There is no serious doubt about what is happening to those missing people. Their cancers will have grown and spread and, in many cases, become incurable by the time they are identified and by the time, if at all, they are treated. Across the country we hear of patients presenting with more advanced cancers due to not being seen early enough. Some staff tell us that they have never seen such advanced cases.

The all-party parliamentary group on radiotherapy, like all the all-party groups on cancer, is strenuous in its insistence on a consensual and collegiate approach, and sees Ministers, especially the Minister here today, as partners and not opponents. I am grateful to the Minister for her courtesy, her willingness to engage and her very clear concern. I am also grateful to all Members here and to those who are not present but who dearly wanted to be. Many are absent because this Chamber is not yet enabled for virtual participation. They include the hon. Members for North Devon (Selaine Saxby), for West Lancashire (Rosie Cooper), for Rhondda (Chris Bryant), for Central Ayrshire (Dr Whitford), for Liverpool, Riverside (Kim Johnson) and for Bootle (Peter Dowd).

Our collective view is that we need urgent action to catch up with cancer. I mentioned the figures for my own area, but Macmillan estimates that across England as a whole there are a terrifying 50,000 missing diagnoses. Clinicians report that more patients are now coming through needing palliative rather than curative care—people who could have survived who are now on end-of-life pathways and are simply being treated to alleviate the pain.

[Grahame Morris (Easington) (Lab)]

That is a really important point. How do we quantify the scale of the backlog to enable us to have an action plan to address it? Specialists say that whereas the ratio is currently 50:50 in terms of the therapeutic application of radiotherapy for treatable cancers and therapeutic palliative care, last year it was 70% treatable and 30% palliative. Do we not need the release of the datasets to quantify that in an accurate way?

[Tim Farron]

I am extremely grateful to the hon. Gentleman for making a very important point. I have heard the same reports from the frontline that treatment would normally be 70:30 curative to palliative and that now it is 50:50. That is a blindingly obvious consequence of the fact that when we catch cancer, we catch it too late.

I have a request of the Department, which we have made before, including in face-to-face meetings with the Secretary of State. I want the Department of Health and Social Care team responsible to sit down with the frontline experts—we can provide them this afternoon—and go through the evidence of the backlog. There is no way of tackling the problem if the NHS management and the Department are not cognisant of it and prepared to listen to the people working their socks off in cancer units all over the United Kingdom.

I want to make another important point. Whoever was in power during this time would have been handed the same challenge and would have made many mistakes. The Government have rightly sought to control the virus so that we can protect the NHS and save lives. The lives that we seek to save are those at risk from not just covid but other illnesses, including, of course, cancer.

We as a country have stood together and defended our NHS so that it has the ability to fight cancer in the midst of a pandemic, which is what every clinician is desperate to do. The great success of this year, for which Ministers should rightly be proud, is that our NHS has not collapsed and did not fall over. Our doctors, nurses, paramedics and clinicians of every sort have saved lives, defeated the odds and kept our NHS on its feet so that it can fight cancer, and yet a failure at senior levels of NHS England and in Government to recognise the scale and nature of the cancer backlog means that people are dying today who did not need to die.

We have terminal diagnoses for cancers that could have been treatable among my constituents and yours, Ms McVey—among all our constituents. Their lives have been cut short when earlier, more urgent and more ambitious action from our leaders could have saved them. What troubles me so much is that we hear statements from some in senior management in the NHS, and from within the Department, that suggest they do not quite get the scale of the backlog problem. They freely admit that they do not know how big the backlog is. On more than one occasion, I have heard the Secretary of State seek to reassure us by saying that progress has been made on recovering the 62-day wait. If people understand what is happening, however, that does not reassure them. It does the exact opposite: it sends a shiver down their spine—it confirms the problem.

Surely Ministers know that the 62-day waiting time target for treatment does not give a complete snapshot of the situation, because it captures only patients who are already in the system. I am sorry to be brutal, but as more people die, there are fewer people in the system. The target does not take into account the tens of thousands of undiagnosed patients who may be going about their daily life completely unaware that they are living with cancer.

I fear that the Government hugely underestimate the cancer backlog, and the consequence will be thousands of unnecessary deaths and lost life years. An article last month in The BMJ estimated that there will be 60,000 lost years of life as a result. Does the Minister recognise the significant fall in people receiving cancer treatment this year compared with 2019? Like me, is she worried that this will mean there are thousands of people out there with undiagnosed cancer who have yet to come forward?

I move on now to my second point, which relates to the Chancellor’s recent comprehensive spending review, which was a pivotal opportunity to signal that the Government, the Department of Health and Social Care, the Chancellor and NHS leaders understood the need for investment in the techniques and treatment required to quickly build capacity in order to clear the cancer backlog and ensure a resilient service going forward—to build the capacity that is vitally needed if we are to make sure cancer patients are not the collateral damage of covid. Far from seizing that pivotal opportunity, the Government appear to have turned it into a missed opportunity. As far as we can tell, there is no boost to cancer treatments in the comprehensive spending review. There is no increase in capacity to catch up with cancer, and there is no plan to do what is needed to save thousands of cancer patients’ lives.

The Action Radiotherapy charity estimates that the true cancer backlog could be as high as 100,000 patients. It supports the estimate of the Chair of the Health and Social Care Committee that it would take cancer services working at over 120% pre-covid capacity two years just to catch up. Members of all political persuasions, working with clinicians and experts who are desperate to make a difference, are clear about how the Government could provide the boost required to catch up with cancer and to save thousands of lives. The answer is not to exhort our heroic frontline staff to work harder—they continue to be inspirational, straining every sinew. It is not to carry on doing what we have always done, but just doing it a little better. It requires some new thinking. It requires taking an axe to some of the internal bureaucracy that has held back some treatments, such as radiotherapy. Crucially, it requires investment, but that critical investment seems to be missing from the comprehensive spending review. That is a missed opportunity on a massive scale, and I hope it is not too late to make a change.

I have to say that there has been a collective gasp of disbelief across the oncology and radiotherapy sector, as it appears—unless we are all mistaken—that there is not even an explicit mention of radiotherapy in the spending review, never mind of the investment in it. Radiotherapy is covid-safe and is required by over 50% of cancer patients. It already plays a significant role in 40% of cancer cures and is able, where clinically appropriate, to substitute for chemotherapy and surgery at times when they are deemed not to be appropriate because of the fact that we are in a pandemic. It is hugely cost-effective: it cures patients for as little as £5,000 to £7,000 apiece.

The reality is that radiotherapy has huge untapped potential to do even more to clear the backlog. For many reasons, however, it has been actively restricted and held back for years. Although radiotherapy treats 50% of cancer patients, it receives just 5% of the annual cancer budget—something for which recent Governments of all parties must share the blame. That is why the UK is massively behind on technology that could empower the workforce to do more. Pre-pandemic it was estimated that as many as 24,000 patients were missing access to radiotherapy treatment each year. It is worse now.

Faced with the current crisis, the radiotherapy community came together to put together a transformation plan for consideration at the comprehensive spending review. The six-point plan would deliver a super-boost to cancer services to clear the backlog, with innovative technology and digital solutions to deploy linear accelerators at the many covid-clean hospital sites in England, such as the Westmorland General Hospital in my constituency, that are perfectly suited to adding satellite capacity to their main cancer units while protecting patients and clinicians from covid infection risk. The plan would also see an immediate boost in precision radiotherapy at existing cancer units, upgrading linear accelerators to perform curative treatment over shorter periods. However, on our reading of the spending review, that appears to have been totally ignored. In fact, as far as we can tell, there is no clear plan of investment in cancer treatment capacity at all.

While the investment in diagnostic machines over 10 years is truly welcomed by all of us here, it is not enough. According to Freedom of Information Act requests carried out by the Radiotherapy4Life campaign, more than half of NHS trusts are using radiotherapy machines that are more than 10 years old. To replace only the machines that deliver diagnostics, or radiology, and not those that actually cure people—the radiotherapy machines—is a baffling decision, to me and, more importantly, the experts. Patients and the public will be shocked to learn that immediate solutions presented by expert professionals to the covid-induced cancer crisis are being overlooked.

Every week that we delay giving an immediate boost to cancer services—capacity, diagnostics and treatments —we increase the risk of losing cancer patients needlessly. Recent data shows that for every four weeks of delay in starting treatment there is as much as a 10% increase in deaths. Some departments report a 20% drop in the number of patients classified as curable, leading to downgrading to palliative treatment instead. Patients—our constituents, families and friends—are being told that their cancer now cannot be cured and that their treatment will be palliative instead. Yet the decision to catch up urgently with cancer has been either delayed or ignored. We will pay a huge cost for missing out on the chance to correct things at the spending review. That is why I hope it is not too late to do so. The public inquiry, when it happens, will reveal the situation. The cost of the understandable litigation by patients and families who have been failed will be needlessly huge.

We first wrote to the Secretary of State about the growing crisis in April, and we have not stopped warning of the devastating impact that there will be on the lives of cancer patients. Three hundred and seventy-five thousand people have signed the Catch Up With Cancer petition and have hundreds of patients shared their heartbreaking stories. Experts are saying that there will be as many as 35,000 unnecessary deaths and, as I have said, 60,000 life years lost to cancer because of the impact of the covid crisis. Cancer survival rates have been pushed back to where they were more than a decade ago.

I know that the Minister cares. She is a good person seeking to do a good job. I hope that she will forgive me for being direct today, but thousands of people could have their lives lengthened or saved, and their families could be spared unspeakable grief, if we acted urgently to catch up with cancer. I conclude by repeating my plea in the strongest possible terms. Will the Minister meet me and, most importantly, the expert clinicians who advise the Catch Up With Cancer campaign, in the next few days so that we can turn the tide on the crisis?

[Esther McVey (in the Chair)]

Just for the ease of colleagues, I will say that I am looking to call the Front-Bench speakers at 10.30 am, so divide the time among yourselves.

--- Later in debate ---

[Tim Farron]

The hon. Members for Warrington South (Andy Carter), for Gower (Tonia Antoniazzi), for Easington (Grahame Morris), for Strangford (Jim Shannon), for Angus (Dave Doogan) and for Nottingham South (Alex Norris), and indeed the Minister, all made excellent points, and I am extremely grateful. I thank the Minister for what she said and for agreeing to meet us this side of the recess. To be specific, we are after a meeting with her, of course, and departmental finance officials so that we can revisit the investment decision—that decision is problematic—and have our experts meet hers to get to the bottom of the data. We need to see the datasets so that we can explore the extent to which there is an urgent crisis—we are certain that there is one.

Finally, the Minister talked about the importance of diagnosis. The Government are making progress on diagnostics. Of course, in the NHS long-term plan, we see the desire to find more cancers earlier so that we can treat them. If we find more cancers early, however, we will have more people to treat. That is why the radiotherapy investment that we have called for is essential, not just now but in the long term.

Motion lapsed (Standing Order No. 10(6)).

[Esther McVey (in the Chair)]

I will suspend the sitting for two minutes so that hon. Members can exit safely and the next lot can come in safely.

Covid-19

Tim Farron Excerpts

Wednesday 18th November 2020 Commons Chamber

[Jo Churchill]

I am going to push on a little bit and then I will give way again.

This enormous national effort has put our country on a strong footing for today and years to come. We are using the best of British ingenuity to help us to deliver in this area. Progress has also been seen in other areas. As the pandemic unfolded, the UK could not call on a major diagnostic industry. From a standing start of about 2,000 tests a day in March, our capacity is now over half a million tests per day. This matters, because it has often been said in this place that in order to beat the virus we need to draw on different parts of our armoury to help to get us through. Testing works. It helps to deny the virus the connections it needs to spread. Mass testing therefore offers us a chance to achieve that on a much bigger scale. We are making progress in city-wide testing in Liverpool. I thank Joe Anderson for his leadership in helping to deliver not only in testing but in other areas too. We are also rolling out a further localised approach to other areas with the help of directors of public health, among others, who know their local areas. Some 83 local authorities have now signed up to receive regular batches of lateral flow tests, which allow for a result to be seen in 15 minutes.

Further, I know that hon. Members will celebrate Monday’s announcement of two mega-labs coming on stream early next year—very high-throughput laboratories, one in the midlands and one in Scotland, adding a further capacity of some 600,000 tests per day. These are massive gains that we are achieving by embracing cutting-edge technology such as automation and robotics and harnessing the best of British industry and academia, meaning that we will not only be able to process more tests but that they can be processed quicker and at a lower cost. The mega-labs will be another powerful weapon in our defence against this deadly virus in order to get back to a more normal way of life, but more than that, they will form a permanent part of the country’s new diagnostic industry. They can help us to respond in the future and build further resilience.

I am excited at the potential for a new diagnostic industry to help to care and deliver across other disease types, not least cancer. Hon. Members will know that, informed in large part by my own experience, I was an advocate of improved cancer outcomes long before I came to this place or took on this role. Early diagnosis is the key to beating the disease, and with bold steps forward in diagnostics, I would like it to make it my mission—I am sure with many others across the House—that we seize new opportunities in cancer services so that covid-19 is not a derailer but an opportunity for a new phase in smarter, faster diagnostics.

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

rose—

[Jo Churchill]

I would be happy to hear from the hon. Member, who champions radiotherapy.

[Tim Farron]

I very much appreciate the Minister’s work in this area. She will have seen that leading clinicians think it will take five years for us to catch up with the cancer backlog. Indeed, Cancer Research UK has recognised that there have been 35,000 avoidable deaths from cancer over this period. Only very recently, there was an awful figure in an article in The BMJ saying that there have been 60,000 lost life years as a consequence of cancer during this period. I absolutely acknowledge that progress is being made when it comes to diagnostics; I am less convinced that progress is being made when it comes to treatment. Will she confirm whether her Department is making an urgent bid for spending review funding for smart radiotherapy, for delivery at satellite sites and for digital technology, to ensure that we clear the backlog, save lives and catch up with cancer?

[Jo Churchill]

I thank the hon. Gentleman for his intervention. As he will know, the comprehensive spending review will deliver forth, and bids have been put in across the piece. I am sure he will understand that it is not my place to answer, as those decisions are still being made.

We know that some of these figures relate to specific challenges. For example, endoscopy is still a particular challenge because of the aerosol-generating procedure. That is why I was really pleased that Cally Palmer, Professor Peter Johnson and other stakeholders, including charities, have formed the cancer recovery taskforce. They will be laying out a national plan for how we beat this, and also how we optimise the use of new treatment paths. As the hon. Gentleman knows, we are using fewer radiotherapy treatments, or fractions, so that people do not have to attend so much. There is also oral chemotherapy and many other advances that need building in, to ensure that patients get timely and quick treatment.

As the first wave subsided, the NHS rose to the challenge of restoring cancer services: it kept focus and did some amazing reconfiguration work around cancer hubs and rapid diagnostic centres. I recognise that, as the hon. Gentleman says, there is a way to go, but I am aware of how much each day spent waiting for a diagnosis, for treatment or for an answer suspends time and feels like a year for the individual. We will continue to ensure that cancer services are prioritised and we thank those who work in the cancer workforce for everything they are doing.

In September, slightly over 86% saw a cancer specialist within two weeks of a referral from a GP, and 94.5% had treatment within 31 days of a decision to treat. I would really urge people who are worried about cancer or any other major issue, “Please, don’t leave it. Help us to help you.” It is always challenging, and many people have said to me that they do not want to overload the system, but doctors are keen to help.

A vaccine will perhaps be our most potent weapon, once we know that it is safe and effective. However, we do not yet have a vaccine. I must be very clear on that point. We are not quite there yet—we must ensure that we stick to hands, face, space and ventilate our environments by opening windows for short bursts—but progress on this front is encouraging. Last week, we heard about phase 3 trials from Pfizer and BioNTech, stating that their vaccine was more than 90% effective in preventing covid. Today, further data indicates that the vaccine is now thought to be around 94% efficacious for those who are 65-plus, with good data on many other groups. As I say, we are constantly learning. Earlier this week, preliminary trial data from Moderna suggested that its vaccine had an effectiveness of 94.5%. Additionally, we have had the start of Janssen’s phase 3 trials in the UK this week, and we will hopefully have more phase 3 trials reported in the next few weeks.

This is all very positive, but of course, our regulator will not approve any vaccine until it is proven to be clinically safe and effective, and the way to get there is via trials. On that note, I would like to give a shout-out to my hon. Friend the Member for St Austell and Newquay (Steve Double), who is taking part in the trial, and my hon. Friend the Member for Saffron Walden (Kemi Badenoch), who is also doing so. I know that my hon. Friend the Member for Vale of Clwyd (Dr Davies) and my hon. Friend the Member for Thirsk and Malton (Kevin Hollinrake) have registered, although I do not know whether they are part of it. I am sure several other Members across the House have also stepped up.

We have already struck commercial deals to secure access 355 million doses of seven vaccines, and the Department is working at pace with the NHS to ensure that we will be ready to roll out any that are proven safe and effective immediately. That will be a massive undertaking, and I thank everyone for their hard work thus far.

Mr Deputy Speaker, you were not in the Chair yesterday, but I somewhat embarrassed myself by perhaps displaying more of the parent in me than the Minister. This country’s journey in beating the pandemic, however, has been a little like watching one’s child grow: it is a huge undertaking, it comes without a manual, we are proud of the successes and, when things are trying, we attempt to learn and move on—but the work is never done. Over the past year, so many parts of our country have risen to meet an incredible set of challenges; challenges they are facing every day. Only by ensuring that we have those different lines of defence, and by pulling together in local, regional, national and international ways will we protect those on the frontline and allow family and business life to resume and get back to a different, albeit more normal way of life.

--- Later in debate ---

[Alex Norris (Nottingham North) (Lab/Co-op)]

I am grateful for the opportunity to open this debate for the Opposition. It is an important debate, though a solemn one: 589 deaths of our countrymen and countrywomen were reported yesterday, having perished from this virus. The total official number of deaths from covid is now more than 50,000, but the real figure is likely to be much higher. Those are big numbers, but behind each number is a person and a grieving family. All our thoughts are with them.

It is important and appreciated that the Government continue to give Government time in this place for the consideration of covid. Often—we understand this—the Government need to act swiftly to tackle the virus, but it is crucial that we get parliamentary opportunities to scrutinise their actions. I hope that we find the Government in listening mode, because we could do much to improve the current response.

In that spirit, I turn first to test and trace. Test and trace is important for two reasons: first, it is our best weapon to break the chain of transmission, and secondly, it is the part of the process that the Government have the greatest control over. Of course, the behaviour of the public is paramount, and it is critical that we guide them as best we can, but eventually it becomes a matter of personal responsibility. Test and trace, however, we have direct control of—we have control over the implementation and the commissioning.

Let us start with the good news. We recognise and welcome the overall volume of capacity developed by the Government, which the Minister talked about. That was done from scratch, and it is a very good thing indeed. However, that is as far as the good news goes, because the rest of the system is simply not delivering.

I was concerned that the Minister talked about testing but did not talk about tracing or isolation, because the system is failing, not on my terms or on political barriers put up by me or my colleagues, but on the Government’s own terms. The Prime Minister promised test results within 24 hours by the end of June. The current figure is 37.6%. That is a failure on the Government’s own terms. I hope that the Postmaster General will say when the 100% target will be reached.

On tracing, the Government say that of those with the virus, 80% of their close contacts must be reached for the system to be effective. Last week, it was 60%. It has never been at 80%; it has bumped along, frankly, in the 50s and 60s throughout. For last week, that represents 126,000 people who ought to have self-isolated but did not, simply because they did not know that they were supposed to. Each of them is walking around unaware, working as usual, living as allowed by regulations, and in close contact with goodness knows how many people. Again, that is a failure on the Government’s own terms. Tomorrow, we will get the latest weekly figures. Do we expect performance to have reached that 80%? I do not. I raise this issue every day, whether in the Chamber, online, in the media or, frankly, to anyone who will listen. That is because the failure of the system is the root of our loss of control of this virus.

If this debate follows the patterns of previous ones, we will hear contributions from Government Back Benchers critical of the symptoms of that loss of control—damage to the economy, delayed or cancelled healthcare, restricted civil liberties. Those are all exceptionally important symptoms, but I cannot understand why we do not hear greater concerned scrutiny of the cause of the problems, which is the failing system. I hope that those Members will join us in pressing the Government to do better, not because of the politics—on this occasion, I could not care less about that, frankly—but because this is a hole beneath the water line when it comes to tackling the virus. Nothing will truly get better until this gets better.

The final weak link in the chain is about isolation. Even if all elements of the system over which the Government have direct control work flawlessly, the enterprise will fail if the person at the end of the process does not isolate when supposed to. The Prime Minister has bemoaned that issue previously, which I suspect is part of his attempts to shift the blame on to other people—'twas ever thus. In reality, however, even before the pandemic, too many people were just getting by on low wages and insecure work. People were in work but in poverty, and forced, hour by hour, to earn that poverty. Now they are being told to forego even that income in favour of sick pay. That might be the right thing to do to beat covid-19, but people do not know how to isolate and feed their family at the same time.

The Health and Social Care Secretary himself said that he could not live off statutory sick pay, and it took seven months until the £500 stipend came in. The Prime Minister thought that the stipend was weekly—it is not, and it is still not enough. Until we change the situation so that those who have least in our country, and who often work in frontline jobs where they are more likely to contract the virus, do not have to choose between the national effort and financial reality for their family, we will not get people isolating in the numbers we need.

[Tim Farron]

The hon. Gentleman is making a good point, and the 60-something-per cent. success rate of the national system is deeply regrettable. As in many other parts of the country, Cumbria public health has been far more successful, with a 97% success rate. However, because of a flaw in the system, if someone is contacted by Cumbria public health, they are not able to get the isolation grant. That is preventing many people from making the choices that they need to make to keep everybody safe, while also putting food on the table. Does he agree that the Government need to answer calls from the director of public health in Cumbria, and ensure that those who are contacted and asked to isolate by that body get that grant?

--- Later in debate ---

[Neale Hanvey (Kirkcaldy and Cowdenbeath) (SNP)]

This global pandemic has shaken the lives of so many. The pain from the loss of loved ones, friends and colleagues has been compounded by redundancy or business failure, as support for key sectors has failed to materialise or people have found themselves excluded from the UK Government schemes. As we now pin our collective hopes on the brightest and the best delivering promising vaccine candidates into clinical use, we must turn our minds to our recovery and how we choose to build a better, greener and fairer future for our communities.

I would like to take a moment to pay tribute to those who have contributed to the spirit of community across my Kirkcaldy and Cowdenbeath constituency. First, I pay tribute to Tricia Marwick, the chair of the NHS Fife board, and to its members, to Dr Chris McKenna, the medical director, and Helen Buchanan, the director of nursing, and to every single member of staff on the frontline, to whom we owe so much.

I would also like to pay tribute to the local media outlets—the Fife Free Press, the Central Fife Times, K107 community radio and Kingdom FM—all of which have helped my constituents stay informed and updated and have kept us all safe. I pay tribute to the many community lifeline groups, such as the Cottage Family Centre, which aims to ensure that no child or family goes hungry, cold or without presents this Christmas; Love Cowdenbeath, whose online presence has been supporting the local community and retailers; and Linton Lane Centre, which sadly, like other groups across my constituency, had to cancel its annual Christmas day meal for seniors, but will aim to distribute 100 hampers to those who would have attended.

There are so many other examples that I simply do not have time to mention, but the spirit of community that has emerged from this dreadful pandemic is built on hope and an aspiration to do better by our neighbours and, like much of my constituency, is bursting with vision, ambition and confidence that a better future is possible.

Such a future is possible, but it is imperilled by decisions made in this place, led by a Prime Minister who considers our considerable achievements in government and our shared aspirations a mistake and does not see a case for further consideration. I put it to the House that, in our recovery from covid-19, it is the independent countries that will do better. By following the path of regaining democratic control of our own country, our people will be richer, our influence for good greater and our future brighter.

However, the PM’s unguarded words have undermined even article 19 of the Acts of Union, which he purports to uphold. He poured scorn on Scots’ ability to make their own laws while, in his words,

“free-riding on English taxpayers”,

describing it as “simply unjust”. I would be interested to know if the Minister genuinely thinks that the people of Scotland believe that a Government with such an appalling track record—of austerity, welfare cuts, the two-child cap, the bedroom tax, benefit sanctions and the unfair manner in which the Women Against State Pension Inequality have been treated—are uniquely benevolent when it comes to Scotland. Of course she does not, and the facts expose the mendacity of that obtuse notion.

It is a matter of record that in each of the 30 years prior to the introduction of “Government Expenditure and Revenue Scotland”, Scotland generated more tax revenue per head for the UK Treasury than the rest of the UK. If the Minister believes that with 8.2% of the population Scotland creates between 50% and 60% of the UK deficit, will she please direct me to where that money was spent and by whom? Will she also tell me why the people of Scotland should have any confidence in this place to help Scotland build a better future post covid? I can provide the Minister with the answer: they do not.

According to the latest gold-standard Scottish social attitudes survey, 61% of people say they trust the Scottish Government to work in the national interest, but just 15% trust the UK Government to do likewise. The gulf is even wider when it comes to leadership. First Minister Nicola Sturgeon’s approval rating in Scotland is 100 points above that of the Prime Minister, with one commentator—a Unionist, as it happens—stating today that

“that is the good news”

for the Prime Minister, since he suspects that he has

“not yet reached rock bottom”.

That distrust will only grow as the cronyism at the heart of this Government continues to be exposed. Today the National Audit Office released its damning report on the UK Government’s procurement practices during the pandemic, which confirms what we have been saying for months about a Government failing to manage conflicts of interest, doling out public money to clearly unsuitable companies and improperly avoiding scrutiny.

[Tim Farron]

I think the hon. Member will probably agree with me that what is galling for so many people is the £10.5 billion of contracts given out without proper tender processes and without transparency, if we contrast that with the 3 million people in this country—people who have been self-employed for a short time, company directors of small limited companies and many others—who have been completely excluded from support. A small fraction of that amount of money would have kept food on their tables and a roof over their head.

[Neale Hanvey]

The hon. Gentleman makes the extremely important point that the avarice attached to these contracts undermines any sense that the Government are putting their arms around anyone, let alone the whole country. I would be interested if the Minister could indicate whether the Prime Minister will heed SNP calls—in fact, cross-party calls—for a full public inquiry into the cronyism at the heart of this Government. Convincing answers are urgently needed as to why so many Tory friends, relatives, donors and prominent lobbyists were awarded jobs and privileged access to UK Government meetings and decision making.

The National Audit Office has exposed and confirmed the existence of VIP lanes in which unsuitable companies were often placed by the private offices of Ministers, and they were more than 10 times as likely to win a contract as other suppliers. Recent weeks have seen reports that £1.5 billion of taxpayers’ money has gone to companies linked to the Conservative party. Concerns have also emerged over the weekend about privileged access for lobbyists with links to the Conservative party, without any public process or announcement.

With so much suffering across these islands, it is vital that there is full transparency and that the public have confidence in the manner in which the UK Government spend taxpayers’ money fighting coronavirus. As we heard last week from the hon. Member for Sefton Central (Bill Esterson), rather than support experienced and established UK-based PPE providers, the Government chose 12-week-old businesses with no experience or capacity to provide PPE. How can UK-based companies survive when their Government cut them off at the knees? If everything is above board, surely the Minister will have no issues indicating her support for an inquiry.

Yet that is not the only economic vandalism of this Government during the pandemic. Despite the promises to wrap their arms around everyone, support remains poorly targeted and offers no relief for people who have become self-employed more recently or to businesses in my Kirkcaldy and Cowdenbeath constituency such as RG Construction, which was denied £64,000 of furlough support on a technicality it could never have predicted or met. Will the Minister undertake to ask the Treasury to review these entry requirements to open up support to self-employed people and other businesses that have so far been excluded?

The Government sprang into action to provide countless contracts for their wealthy friends, but that sense of urgency is sadly lacking when it comes to taking action on social care reform, pay awards for frontline NHS staff or addressing the poverty of carers. This week on the Health and Social Care Committee, we heard evidence that healthcare assistants were not being provided with the same standard of PPE as more senior staff, leading to stress, anxiety and burnout. This risk of burnout is all the more concerning when it comes to how we recover the delays in cancer treatment precipitated by the pandemic. The King’s Fund has described an already existing problem of chronic excessive workload in the NHS. This week we heard expert evidence that that, in combination with the culture that demands ever more, can lead to serious mental health problems. What action is the Minister taking to address these pressures and challenge such an unhealthy culture in the NHS?

I would like to pay tribute to Macmillan lead cancer nurse Denise Crouch for her valuable evidence highlighting the pressure cancer nurses have been facing before and during covid-19. Macmillan has highlighted serious shortages in the cancer workforce, in which 2,500 specialist cancer nurses are needed to meet current demand, rising to 3,700 by 2030. I say with genuine sensitivity that this pandemic has thrown into even sharper focus the fragility of our NHS workforce and the need for fast-paced and substantial action. I would be interested in what action the Minister has taken to secure additional capacity in the NHS beyond March 2021 and to invest in the cancer workforce as part of next week’s comprehensive spending review.

Work-related stress is also being amplified elsewhere. Where is the urgency or action addressing the deeply immoral exploitative practice of firms firing workers only to rehire them on significantly reduced terms? This fire and rehire practice has sadly emerged in many sectors, most notably in aviation. Those are not the only threats to our ability to build back better after covid. To pile misery on misery, the Government are persisting with their plan—I use that word in the loosest of terms —with no regard to the consequences or the views of the people of Scotland.

What of the £20 uplift to universal credit? With so many now facing redundancy, this must be made permanent and extended to legacy benefits. These calls are backed by the Joseph Rowntree Foundation and Save the Children. Can the Minister not see the need for this support and the positive impact that such support could have on health and wellbeing? If the UK Government are as keen they claim to be on protecting people, why is it that their own workforce in the Department for Work and Pensions, already equipped to work from home as part of a pilot, are being forced to work in an office one day a week in the face of covid clusters occurring among their colleagues?

In Scotland, we see things through a different lens. As a small country, we ascribe more value to the view that intangible infrastructure such as education and healthcare form the backbone of a country. The Credit Suisse country strength indicator places six small countries in the top 10. Small countries make up more than half of the world’s top 30 countries, with Scotland showing higher scores on the UN human development index than the UK as a whole.

Scotland must build back better, and that is only possible with the full powers of an independent nation. A new YouGov poll across Britain revealed that 85% of respondents from Scotland think that the UK Government are doing badly at handling the UK’s exit from the European Union. An expert study from Warwick University earlier this year revealed that Scotland is already £3.9 billion worse off as a result of Brexit, losing £736 per head of population, with Aberdeen the worst hit at £9,000 per head. Separately, Scottish Government analysis revealed that Tory plans to end the transition period in 2020 could cut £3 billion from the Scottish economy in two years on top of the impact of coronavirus. It is no wonder then that 14 polls in a row now show a majority of support for independence in Scotland, with the most recent poll by Panelbase showing support at 56%. I know that my focus on Scotland and the interests and aspirations of my constituents tire some on the Government Benches, but there is a simple and obvious solution available to them.

In closing, the difference between the independence regularly celebrated on the Government Benches and the one that Scotland will choose soon is that Scotland wants independence to join the world whereas the real separatists sat on the Government Benches have sought separation to be an isolated and rudderless state. It is no wonder that support to abandon the UK separatists is growing, and growing in the majority of Scotland.

Covid-19 Update

Tim Farron Excerpts

Tuesday 10th November 2020 Commons Chamber

[Matt Hancock]

Yes, that is a really important point. Part of the challenge of, and the reason for, a second lockdown was NHS capacity. The more we protect those who work in the NHS, the fewer are unavailable to work, precisely as the right hon. Member for Normanton, Pontefract and Castleford (Yvette Cooper) said, and the more capacity we have in our NHS.

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

As families begin to dare to hope in the possibility of a vaccine, it is vital that we prioritise mental health resilience and confidence in learning among our young people. Outdoor education centres in Cumbria and across the country are uniquely equipped and able to help with just that, yet most of those centres face closure, essentially because the Government advice remains against residential school visits, even though outdoor education centres are just as covid-safe as schools. Would the Secretary of State agree to work with the Department for Education to try to change that advice and to make sure outdoor education centres remain open?

[Matt Hancock]

I am very happy to look at that matter with my right hon. Friend the Education Secretary. It is, of course, a Department for Education lead, but I am happy to do my bit.

Covid-19 Restrictions: South Yorkshire

Tim Farron Excerpts

Wednesday 21st October 2020 Commons Chamber

[Edward Argar]

I can give my hon. Friend exactly that assurance.

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

The hospitality and tourism industry in Cumbria is comfortably our biggest employer. It was very much looking forward to half-term next week, as a chance for businesses to pick up after the enormous damage they have sustained as a result of the virus. However, we are seeing cancellation after cancellation, because neighbouring economies in Lancashire, Greater Manchester, Merseyside and now, of course, other parts of the north England have been put into tier 3 and people are therefore not able to travel. Rather than quibbling over £5 million, people in Cumbria are getting nothing—no compensation for their businesses collapsing. Will the Minister commit to making sure there is support of the hospitality and tourism industry in tier 1 places such as Cumbria, where our market has dried up because our neighbours are in tier 3?

[Mr Speaker]

This is about Yorkshire, so if we could mention Yorkshire it would help.

Public Health

Tim Farron Excerpts

Tuesday 6th October 2020 Commons Chamber

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

I, too, am deeply concerned that the evidence for the rule of six is not extensive enough to demonstrate that it does more good than harm. I will wait to hear what the Minister says, and we will hopefully hear in days to come more of the evidence behind this rule. However, for all the reasons set out by my hon. Friend the Member for Twickenham (Munira Wilson), the hon. Member for Bexhill and Battle (Huw Merriman) and others, there is deep concern about undermining consent for the process.

In a sense, this is a mobile lockdown for families who may well be able to leave their home and do various things but cannot mingle. I am very concerned—not least because of the growing presence in my inbox, in my phone surgeries and at the one or two physical surgeries that I have started again—about the serious growth in the volume of mental health-related cases, and specifically among younger people. They are heartbreaking individually and deeply alarming when we see the volume of them collected together. That is why we need to be very careful in understanding the complexities of human relationships and how important they are to our sense of wellbeing.

[Chris Elmore (Ogmore) (Lab)]

In relation to a four-nations approach, the First Minister of Wales has called on the Prime Minister to ask people in restricted areas in England not to travel into Wales. The Prime Minister has refused. The First Minister of Wales has now said that people living alone—including in my constituency, which is under restrictions—can bubble with one person within the county to help improve mental health. As the hon. Member for Bexhill and Battle (Huw Merriman) mentioned, groups of 30 can gather outside in Wales. Does the hon. Gentleman agree that, if we had a genuine four-nations approach to this, we could learn from decisions taken by the Welsh Government in the way that they can learn from ones taken by the UK Government? At the moment, there seems to be some sort of blockage to the four nations working together, and I put it to him that it is partially the Prime Minister and No. 10.

[Tim Farron]

The hon. Gentleman makes a really good point. Any party in power anywhere would have been like a rabbit in the headlights over the last six months, given what has happened, so I am not making a particular partisan point. It could happen in any Administration with any combination of colours of party. I am always careful not to use the phrase “U-turn” as an insult or a barb, because it shows that someone was listening and has enough substance to take on board the fact that somebody else may have had a better idea. I always say that all my best ideas were somebody else’s first. It is critical that this is a learning and iterative process, so I take that point on board.

It is the mental health concerns that I have for families, and particularly younger people, that make me sceptical and lead me to ask questions about the lack of evidence behind this. Much as I want to support the Government in doing tough things that need to be done to control the virus until we can eradicate it through a vaccine, we need more evidence.

I think inconsistency is an issue for all of us, and certainly for most of us who are here today with a particular interest in this matter. If we stick to the rule of six, I do not see why multiples of six cannot be used as the building blocks of bigger events. At the moment, there is a limit of 15 people allowed at a wedding. It seems entirely possible to make that an event of 36 or 48 people with building blocks of six, if the venue was big enough. Up to 300 people are allowed at a non-league football match below the seventh tier, so if someone wants to get together with their mates, they can just turn up at the mighty Kendal Town on Saturday. Those things are possible, and that inconsistency makes it difficult for people to understand why the Government are doing it and why they should be obedient.

The impact on the wedding industry, the events industry and the leisure industry is huge, and it is adding to the economic hardship that many people are experiencing. It seems wrong for us to be unnecessarily forcing people through that hardship, particularly as we come to the end of furlough in a few weeks’ time, when an intelligent approach could allow us to restrict people’s behaviour and protect against the virus but not kill several industries in the process.



I will finish by focusing on something else that worries me deeply. Our ability to get people to comply with regulations that exist to keep them safe, save lives and protect the national health service depends upon the credibility of the rules to which we expect them to be obedient. That is why the evidence is here. The rules also need to be coherent and easy to understand, which the rule of six just about is—that is the best argument that I have heard for it so far. They also have to be consistent from week to week, and with other areas of application, as I mentioned.

If people are going to be expected to be obedient and to comply with restrictions that exist to protect themselves and others, they also have to be able to afford to comply. That is my great concern moving forward. If the Government are looking at a traffic light system, which in itself is not a bad idea, that allows there to be blanket closures of the hospitality, tourism and leisure sector in certain towns, boroughs or counties, we surely cannot expect those industries and employers to close down and for there to be no compensation, and no return to furlough for those areas or grant system for those businesses.

In Cumbria, hospitality and tourism is the biggest single employer. It is the fourth biggest in the country. We cannot, when the traffic light gets to red, expect those businesses to close down completely without compensation. People will not comply with the rules if they fear that they will be unable to pay their rent or mortgage or feed their kids in the process. Let us ensure that the rules that we have are credible, coherent and consistent, and that people can afford to obey them.

Covid-19 Update

Tim Farron Excerpts

Monday 5th October 2020 Commons Chamber

[Matt Hancock]

All of the 15,000 have been contacted for the first time.

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

In the Secretary of State’s statement, he spoke with pride about the Prime Minister’s announcement on Friday of the additional capital programme for hospitals. In Cumbria, we met that announcement with some dismay. As the hon. Member for Lancaster and Fleetwood (Cat Smith) said, there is a proposal to close the Preston and Lancaster hospitals and merge them into a single hospital somewhere in between. Does the Secretary of State realise that that will mean even longer journeys for acute care for people from the South Lakes? Will he have a word with the Prime Minister, and drop that dangerous proposal from the consultation, so that people in south Cumbria do not have to make dangerous journeys for emergency care?

[Mr Deputy Speaker (Mr Nigel Evans)]

Order. That was only touched on briefly in the statement, which was a covid update. It would have been really nice if the hon. Member could have asked his question in relation to the covid update, which is what the statement was mainly about.

Coronavirus Act 2020 (Review of Temporary Provisions)

Tim Farron Excerpts

Wednesday 30th September 2020 Commons Chamber

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

Will the Secretary of State give way?

[Matt Hancock]

If I could just make some progress.

The fourth part of the Act contains measures for managing the deceased. This is a devastating virus that has caused pain and suffering for many and, tragically, has taken away many loved ones before their time. We have worked hard to treat them with the utmost dignity, along with protecting public health and respecting the wishes of the families of the bereaved.

The Act expands the list of people who can register a death to include funeral directors, and sets out that coroners only have to be notified when a medical professional is not available to sign a death certificate. It allows death certificates to be emailed, instead of physically presented, removes the need for confirmatory medical certificates in order for a cremation to take place and relieves coroners from the need to hold inquests with a jury in suspected covid-19 deaths. Over the past few months, those powers have eased pressure on coroners, reduced distress to the bereaved and allowed funerals to take place without delay. We therefore propose to keep them.

Finally, the fifth part of the Act includes measures to protect and support people through this crisis. The financial support provided by the Government has proved to be a lifeline for so many. These measures in the Coronavirus Act made that support possible. The Act provides for the furlough scheme, the temporary increase in working tax credits and making statutory sick pay payable from day one. Without the Act, we would not have furlough or the job support scheme. The Act also includes measures to protect both business and residential tenants by delaying when landlords can progress evictions.

I know the burdens that the virus has placed on the livelihoods of so many, and we have worked to give as much protection as possible. I think that the whole House will want to keep these powers in place so that we can continue to help people in future. Without the passage of this motion, the financial support for people that is provided for and legally underpinned in this Act would not be legally possible. I understand that many colleagues may have concerns about individual parts of the Act, but a vote for this Act allows many of the necessary legal powers that have been required, including underpinning the financial support that has kept so many people afloat during the crisis.

[Tim Farron]

I am grateful to the Secretary of State for giving way. Will he agree, though, that the inconsistent and sometimes nonsensical application of some of the rules is doing damage to some of the businesses that he talks about? In particular, I am thinking of the wedding industry and the many families who have been affected by that. The rule of six surely can apply so that a place that can take many multiples of six could host weddings and give people their special day, and so that it does not kill a vital industry not just in the lakes and the dales, but across the country.

[Matt Hancock]

I think we have shown throughout that we are always willing to try to improve the way the rules operate in a way that is safe. At weddings, of course people tend to come together physically. It is a time of celebration of love, and that is in its nature, so we make restrictions with huge regret, but we always keep an open mind on the public health evidence.

Covid-19 Update

Tim Farron Excerpts

Monday 21st September 2020 Commons Chamber

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

Over the weekend I have been listening to headteachers from around the south Lakes, who tell me that they are under increasing pressure, with teaching staff, teaching assistants and others off work, struggling to book a test slot. Some have been advised to travel as far as Brighton, a 10-hour round trip, and some pupils are off school for 10 days waiting for a test of their own. Our teachers are doing their job brilliantly. Is it not time that the Government did theirs and provided a testing scheme that works?

[Matt Hancock]

I would be very interested in the examples, especially of people being sent long distances, because, as I said earlier, the information I have been given is that that problem has been resolved. I am working incredibly hard to resolve all the other problems and to bring to bear the record testing capacity that we have.