Public Health

Tim Farron Excerpts

Monday 4th May 2020 Commons Chamber

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

The Government were right to follow the scientific and medical advice to introduce the lockdown. They did so to keep people safe. I recognise the sacrifices made by people around the country who are diligently following the rules to protect themselves, their loved ones and the most vulnerable. However, doing the right thing comes at a heavy cost, so I welcome this opportunity to scrutinise the legislation and focus on the ways it is affecting our country, especially our communities up here in Cumbria.

I am so grateful to our police, in Cumbria and across the UK, for putting our safety above their own. As the Government consider easing the lockdown, they must provide clear guidance so that the police can continue to keep us safe with consistency and confidence.

We are battling to save lives, but also to save a way of life. We must not treat lightly our democracy and our freedom. Let me briefly put on the record my concern about the use of the Public Health (Control of Disease) Act 1984 to pass the regulations and urge Ministers to ensure that the three-week review of these measures is open and honest, and that there is full scrutiny of all new legislation.

The restrictions are necessary to save lives, and we should be extremely cautious about lifting them too soon. It is right that we are led by the science and not by politics. However, we have a responsibility to spare people from hardship and ruin. Here in Cumbria, we are deeply concerned about our tourism and hospitality industry, which had to shut down completely just as it was gearing up for its high season.

For many in the lakes, the dales and the rest of Cumbria, hospitality and tourism are seasonal. They operate their trading year on something of a “feast and famine” basis. The coronavirus hit right at the end of the famine, and now this year there will be no feast. If we do not get this right, we may inadvertently kill off an entire industry that is essential to our wider economy.

It is a humbling honour to speak for and from a part of Britain as breathtakingly beautiful as the south lakes. Our communities here are as strong as the landscape is beautiful. Hundreds of volunteers, many facing severe hardship themselves, are involved in serving their neighbours in their hour of need. We may need to stay a safe distance apart, but our communities have never been closer. I am proud of our people, and I am determined that they should be financially stable and secure at the end of all this.

In normal times, we are one of Europe’s biggest visitor destinations. Last year alone, we received 16 million visitors. Visitors come from Britain and all over the world, not only for the landscape but because we have a world-class hospitality and tourism industry, with the best pubs, restaurants, accommodation, attractions, heritage and history, and an innovative retail sector fully integrated with the visitor economy.

In the Lake district alone, 80% of the working population are employed in tourism or hospitality. The Cumbrian visitor economy contributes £3 billion a year, and £1.45 billion will already have been lost by next month, with 80% of the workers in the hotel and food industries currently furloughed. The RSA study indicated that Cumbria was the most exposed economy in the country, with one in three jobs now at risk. That would be utterly devastating to families throughout our area, so I am determined to defend them and to find a way to avoid that. We are encouraged by the Government’s announcement of £617 million of support to help those businesses that are falling through the gaps, but it remains to be seen whether that money will be enough to support all those currently struggling, such as small B&Bs and home-based businesses. I urge Ministers to ensure that no one is left behind and no one left destitute.

When it is safe to do so, the lockdown will ease, but it seems likely that hospitality and tourism will be the last to return to normality under the Government’s plans. We understand that. Our priority is to protect our people and to save lives. The problem is that if hospitality and tourism are phased back in in the autumn, having missed out on the feast of the summer months, they will have to try to keep themselves afloat just as the famine of winter begins. Additional grants and an extension of the furlough scheme will be needed over the summer, but if that is all we do, the Government will simply be delaying the failure of businesses, the loss of jobs and the hardship and misery of the families of the south lakes. I will not stand for that, and I hope that Ministers will not do so either. That is why I urge the Government to protect this vital industry by committing to a 12-month funding settlement for tourism and hospitality so that they can survive the winter and be ready to lead the revival in the spring of 2021.

Covid-19

Tim Farron Excerpts

Monday 16th March 2020 Commons Chamber

[Matt Hancock]

It is of course a matter that I discuss with the Transport Secretary, who I am sure will be coming to the House sooner rather than later.

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

May I encourage people across the country to have complete confidence in the Government’s medical and scientific advice, and that is essential for the safety of the country? I also encourage the Secretary of State to ensure that the population as a whole have confidence in their own economic futures. We spent £500 billion bailing out the banks in 2008. We need to be prepared to go even further than that to ensure that people—for example, the 60,000 people working in tourism and hospitality in Cumbria—know that their economic future is not about to be burnt.

[Matt Hancock]

I understand the concerns raised by the hon. Gentleman, and it is important that they are addressed. Coming from a small business background myself, I understand the impact that a change like this can make, especially to the tourism industry, which is so important in the hon. Gentleman’s constituency. We regret having to take the measures that we are taking today. As I said earlier to the former leader of the Labour party, the right hon. Member for Doncaster North (Edward Miliband), this is something on which we are working at pace.

Oral Answers to Questions

Tim Farron Excerpts

Tuesday 10th March 2020 Commons Chamber

[Matt Hancock]

That is an incredibly important question—one that we will be addressing in the run-up to the spending review. The truth is that the public health grant is but one small part of the overall effort of local authorities to improve the health of the residents they serve. Although it is an important part, and it is good that it is going up in real terms for every local authority, we have clearly got to ensure that the whole effort of a local authority is there to improve public health.

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

All the evidence suggests that coronavirus is of greatest risk to those who are older in our population. The average age in my constituency is 10 years above the national average, yet in public health allocations Cumbria gets only £36 per head, as opposed to the national average of £63 per head and £100 per head for many parts of London. Does the Secretary of State agree that that is a dangerous inequality? Will he fix it in the upcoming statement?

[Matt Hancock]

The inequalities in health outcomes are what I am particularly concerned about, especially the length of healthy life expectancy, which is of course affected by both communicable and non-communicable diseases, the public health around both of those important considerations and the wider issues that my right hon. Friend the Member for South West Wiltshire (Dr Murrison) just mentioned. We will take all of that into account as we look at how the public health grant is best allocated and best used, ahead of the spending review.

Oral Answers to Questions

Tim Farron Excerpts

Tuesday 28th January 2020 Commons Chamber

[Matt Hancock]

The commitment that we have made is that we will have 6,000 more GPs and 26,000 other clinical staff in general practice. That is the commitment that we have made, and that is the commitment on which we will deliver.

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

In rural communities such as mine, GP surgeries often serve huge geographical areas with relatively small patient numbers. Coniston, for example, has a roll of about 900 patients, yet the next nearest surgery is two lakes away. Will the Secretary of State commit to establishing a strategic small surgeries fund to ensure that small surgeries in rural communities remain sustainable for the long term?

[Matt Hancock]

The hon. Gentleman makes an incredibly important point. General practice, where 90% of all NHS appointments take place, needs to reach every part of this country, including his beautiful constituency, which is, as he says, very sparse. Of course we need to ensure that the practices there are sustainable, and again this is an area in which technology can be of particular help. There is great enthusiasm for using technology so that the travelling times of patients and sometimes of GPs can be reduced.

Oral Answers to Questions

Tim Farron Excerpts

Tuesday 29th October 2019 Commons Chamber

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

Last week in the Queen’s Speech debate, I mentioned a constituent of mine, Liz, who had declined the offer of palliative radiotherapy treatment simply because it would involve a four-hour round trip to get from the Lakes to Preston. Does the Minister agree that it is wrong for cancer patients to be forced to choose shorter lives because they cannot cope physically with the longer journeys?

[Caroline Dinenage]

The hon. Gentleman is absolutely right to raise this matter, and I know that he is meeting the Minister for Health, my hon. Friend the Member for Charnwood (Edward Argar), shortly to discuss the details of that individual case. More broadly, the long-term planned commitment to spend that additional £4.5 billion- worth of investment in primary and community health services will definitely help those services to be delivered much closer to people’s homes.

The National Health Service

Tim Farron Excerpts

Wednesday 23rd October 2019 Commons Chamber

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

It is an honour to follow the hon. Member for Crawley (Henry Smith), who made some excellent points. I am not alone in this debate in wanting to peddle a manifesto, but in my case it is the manifesto of the all-party parliamentary group on radiotherapy, which I hope I can encourage Members of all parties to take very seriously. Fifty per cent. of people with cancer—which we have already established is going to be half of us at some point during our lives—need radiotherapy, yet only 5% of the cancer budget is spent on radiotherapy. As the hon. Gentleman mentioned, the NHS long-term plan rightly identifies the need to diagnose more cancers earlier. Early diagnosis is massively important. The United Kingdom stands below average among European countries for cancer survival for nine out of 10 cancers, and has the second-worst survival rate in Europe for lung cancer. Only in September, The Lancet demonstrated that we have the worst survival rate for cancers across a range of comparable countries.

Poor survival rates are, in part, down to late diagnosis, but they also are down to poor access. The increase in early diagnosis that I hope will result from the NHS long-term plan’s success will of course increase demand for radiotherapy. There is no provision within the NHS long-term plan to provide that radiotherapy to deal with the extra demand that ought to be created if it is successful.

Radiotherapy is used for curative purposes eight times more than chemotherapy, yet, as I said, it gets only a fraction of the investment. The all-party group discovered during our inquiry that 20,000 people in the United Kingdom who would benefit from radiotherapy treatment are not getting it, and nor are 24% of people living with stage 1 lung cancer. That is largely down to poor geographical access to radiotherapy treatment. Despite the fact that all 52 cancer centres in England are enabled for precise SABR—stereotactic ablative radiotherapy—technology, only 25 of them are commissioned to deliver it. That means that 27 of the cancer centres in England using the tariff are being rewarded for using less effective radiotherapy and penalised for using more effective radiotherapy. Fixing that would be free, by the way, but for months and months NHS England has been refusing to deal with it.

The all-party group found that, when new satellite centres from existing large cancer centres are built, there is an average 20% increase in demand for them. That proves that there is unmet demand in our communities for radiotherapy. People live too far from the radiotherapy centre. I therefore ask Ministers to consider our local proposal in South Lakes for a satellite centre at Westmorland General Hospital in Kendal. We have been campaigning for that for many years. We have an excellent cancer treatment centre at the Rosemere centre in Preston. There is nothing wrong with the Rosemere centre whatsoever; it treated my dear late mother. The only problem is that it is too flipping far away for those of us who live in the Lake district and the Yorkshire dales.

I accompanied a young woman called Kate on one of her many trips to Preston to get treatment. It was a three-hour round trip, and she lives at the south end of my constituency. Only last week, I went to a prostate pals meeting in a pub in Kendal, where there were several men who are making four-hour round trips every day for six weeks, which is often debilitating financially as well as physically. That is why we desperately need that cancer centre at Westmorland General Hospital in Kendal, linked to the Rosemere satellite. Longer journeys mean that people have shorter lives. An older lady called Liz diagnosed with skin cancer told me, again not very long ago, that she was choosing to decline the radiotherapy treatment that had been recommended by her oncologist. Why? Because of her age, she just could not cope with the journey. So Liz made the conscious choice to have a shorter life because the journey that she would have to take to get the treatment was too long.

Will the Minister accept the radiotherapy manifesto in full to enact all the things that are set out within it, as agreed cross-party? I am bound to ask, on behalf of the people of my communities in South Lakes, that we invest now to end the long, long wait for people to have a radiotherapy satellite unit at our hospital, the Westmorland General in Kendal.

Community Pharmacies

Tim Farron Excerpts

Wednesday 2nd October 2019 Westminster Hall

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

It is a pleasure to serve under your chairmanship, Sir David. I thank the hon. Member for Halifax (Holly Lynch) for bringing forward this issue, which is important for the whole country. Community pharmacies play a vital role wherever they are, but that is especially so in large dispersed rural communities such as mine.

As we have heard, many of those community pharmacies are in increasingly marginal positions and are at risk of closure—indeed, many have closed. That is tragic for them, their patients and the communities that they are at the heart of. It is also a tragic wasted opportunity. The Government should make far better use of our community pharmacies to secure their futures and to benefit patients. The Government could provide sufficient funding for pharmacies so that they can provide an agreed range of patient services to prevent ill health and to keep people who are living with chronic conditions from getting worse, as hon. Members have mentioned.

I sat down with one of my local pharmacists in Kendal a few weeks ago. He told me that the Government have an opportunity to commission a national minor ailments service provided by community pharmacies. The key objective would be to use the talents and expertise of our pharmacists and, in doing so, to remove pressure from GPs and A&E departments in other parts of primary care in the NHS.

Pharmacists in my area serve communities as diverse and widespread as Sedbergh, Hawkshead, Ambleside, Staveley, Windermere, Milnthorpe, Kendal, Kirkby Lonsdale and many others. All the pharmacists I speak to fear that their numbers may be further whittled away by the Government, either by design or by attrition. The Government and people in the sector have talked about there being 3,000 fewer pharmacies. On behalf of local pharmacists and their patients, I say that that would be unacceptable. We want clarity from the Government on the number of pharmacies that they envisage, and we want a commitment to maintain the number that we have.

In the past, Health Ministers have expressed admiration for the French community pharmacy model, which pays for community pharmacies across the board to provide more patient services, such as conditions tests, smoking cessation and blood tests. Will the Minister commit to commissioning such services from community pharmacies across England comprehensively, not just case by case?

Community pharmacies would also be aided by having greater flexibility to dispense authorised medication when the pharmacist is away for a short time, perhaps visiting a local care home. The Government should also consider allowing big national pharmacy chains to share their automation platforms for prescription assembly with smaller independent community pharmacies to reduce costs across the board.

There is also the issue of fair payments. Many independent pharmacies in the south lakes are in danger of going out of business because of reductions in payments for prescriptions by NHS England. Often, the money that pharmacies receive from the national health service does not even cover the cost of the drugs being dispensed. In one shocking case, a pharmacist in my constituency in a relatively small Lake district village, who I have visited regularly, received in one single month £5,000 less in NHS payments than they had to pay out in wholesale drug payments. And that is on top of that pharmacy losing on average 10% of its NHS income each year over the last three years. That is utterly unsustainable, but it is replicated across our communities. So I ask the Minister to intervene personally to put this matter right.

We see a picture of a community pharmacy network that is full of wonderful, talented, highly skilled and dedicated professionals, who provide vital services to patients and their families, and that is part of the glue that holds communities—particularly rural communities—together, but it is being let down by an unambitious approach to community pharmacy from Government, which undervalues what these pharmacies do and, even more importantly, undervalues what they could do.

Therefore, I ask the Minister to consider the proposal in my early-day motion—which, thanks to the non-Prorogation, is still alive—for an essential community pharmacy scheme, to support community pharmacies in rural areas such as mine and to keep them open and thriving. Moreover, will she heed the calls from pharmacists across the country, who are merely calling for fairness in payments and for the ability to use their skills to serve their patients and communities, removing debilitating pressure from other parts of the NHS?

Social Care Funding

Tim Farron Excerpts

Tuesday 1st October 2019 Westminster Hall

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

I am grateful to my right hon. Friend for giving way. He rightly points out the importance of unpaid carers. Any new consensus, which must come, should make clear provision to support those who do the caring— 12,000 unpaid carers in my constituency alone. If they were to cease caring—if we do not care for the carers—the social care burden on the taxpayer more generally becomes even more unmanageable.

[Sir Vince Cable]

Indeed. My hon. Friend is right, and he reinforces the central point I am making.

Oral Answers to Questions

Tim Farron Excerpts

Tuesday 23rd July 2019 Commons Chamber

[Stephen Hammond]

I do not always agree with the hon. Gentleman, but he is right to make that point. I know from very personal experience that dementia affects people in different ways, which is why I am proud to be part of a Government who are committed to delivering in full on the challenge on dementia 2020, to make England the best country in the world for dementia care.

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

The huge rural area covered by the Morecambe Bay NHS Foundation Trust has and needs three hospitals, but it is funded as if it had only one. As a result, the trust has been fined more than £4 million in debt interest over the past three years. That money could have been spent on nurses, paramedics or doctors. Will the Minister intervene to stop this at once?

[Stephen Hammond]

I met the hon. Gentleman recently to talk about ambulance provision in his constituency and the Morecambe bay area, and I hope he is now satisfied with the progress we are making on that. I will look into the individual case he mentions and respond to him.

Non-invasive Precision Cancer Therapies

Tim Farron Excerpts

Thursday 18th July 2019 Commons Chamber

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

It is a great pleasure to follow my hon. Friends the Members for Easington (Grahame Morris) and for Chichester (Gillian Keegan), who are vice-chairs of the all-party parliamentary group on radiotherapy, of which I am honoured to be the chair.

Many of us know too well the pain, hardship and heartbreak that cancer causes. As my hon. Friend the Member for Easington said, it is widely accepted that half of us will get cancer in our lifetime. While I am on my feet, there will be people getting their diagnosis and families coming to terms with it, and lives turned upside down. Most of us have been affected by cancer in some way; cancer took my mum, far too young. But increasingly cancer is a condition to be overcome, not a death sentence. Advances in medical science mean that there are often a host of possible treatments when the diagnosis comes.

Perhaps the form of treatment of which we hear the least is radiotherapy. It is widely accepted that 50% of those who suffer from cancer will require radiotherapy at some point in their treatment. However, in its recent radiotherapy specification, NHS England reduced the figure for cancer patients needing radiotherapy to 40%. It reached that figure on an interpretation of the Malthus model; if only 40% of cancer patients need radiotherapy, then the current level of investment will be just about adequate, as everyone who could benefit from radiotherapy would receive it, so we might as well conclude this debate and go home—only that figure is wrong, as NHS England has had to admit.

The APPG on radiotherapy recently held a number of evidence sessions, in part to get to the bottom of this inconsistency. We heard from a wide range of experts, including one of the authors of the Malthus model, who explicitly stated that NHS England’s interpretation of the model underestimates the number of patients requiring treatment, because it takes into account only those patients whose initial treatment is radiotherapy, not those who need it after the initial point. When pressed, NHS England accepted that, acknowledging that the 40% estimate was not accurate and fell shy of the true figure. This matters, because the real figure is roughly 50%, which means that NHS England is not commissioning sufficient radiotherapy treatment to meet the needs of cancer patients. The Government must plan on the basis of true demand, not of a figure discredited by the experts and now disowned by NHS England. The Royal College of Radiologists has confirmed that this combination of factors means that, as my hon. Friend the Member for Easington said, 20,000 people in Britain are not receiving the radiotherapy that they need.

The major issue in my patch is access. Those needing radiotherapy across our communities in south Cumbria have to travel to the Rosemere unit in Preston. That unit is excellent. The staff are wonderful and the kit is brilliant. There is only one thing wrong with Rosemere: it is far too far away. The National Radiotherapy Advisory Group has said that it is bad practice for people normally to have to travel more than 45 minutes to receive radiotherapy treatment. I drove Kate from Kendal to her treatment in Preston the other week; it was a three-hour round trip. She had been doing that every day for six weeks. For those living in Garsdale, Langdale or Coniston, those trips could be five or six hours, or far longer on public transport, every day for weeks. Those are ludicrous distances to travel to receive vital treatment, and that is why we want a satellite of the Rosemere unit to be based at Westmorland General Hospital.

I spoke to one lady over 80 years of age who was recommended a course of radiotherapy. She decided to forgo that treatment because of the distance she would have to travel. She did not have the option of a shorter journey, so she has instead taken the option of a shorter life. And she is not alone.

A group of leading UK professionals at the British Institute of Radiology met to discuss their experience of setting up satellite centres. They calculated an average 20% uplift on top of the projected figures for those using the service, while the centres of which they were satellites saw no decline in numbers. That means that in areas such as mine, where access to radiotherapy is poor, 20% of people who should be getting radiotherapy are not getting it, but if a satellite centre was built, they would get that treatment. This is not about convenience; it is about saving lives.

My hon. Friend the Member for Easington has already raised the problems with commissioning. I will simply say that 100% of radiotherapy centres in the UK are equipped with SABR—stereotactic ablative body radiotherapy—technology. That is the best technology, giving the most focused and concentrated treatment that is most effective at killing cancerous tissue and causing the least damage to surrounding healthy tissue. That means fewer treatments, fewer side-effects and better results. The scandal, however, is that only 25 of those 52 centres are commissioned to use it.

Is it any wonder that cancer survival rates in this country are among the worst in Europe? We have the second lowest survival rate for lung cancers and below average survival rates for nine of the 10 main cancers. Do not hear me wrong—I know that radiotherapy is not the only solution. Surgery is vital, as are drugs and chemotherapy. We are very proud of the battle we won to deliver chemotherapy to Kendal—countless people have benefited from that—but when chemo improves survival by 2% whereas radiotherapy improves survival by 16%, we need to think carefully about the disparity in investment.

The simple fact is that radiotherapy lacks the financial backing to be heard. Drugs companies lobby passionately and legitimately for the treatments they provide. Radiotherapy has no such lobby. The all-party group has been struck by the realisation that we are the entire UK radiotherapy lobby, along with those people who work in the industry. Radiotherapy has become a Cinderella service because it lacks a champion. We invite the Minister to become that champion.

Finally, enthusiastically we welcome the Government’s focus on earlier cancer diagnosis, but earlier diagnosis will increase demand for radiotherapy. When tumours are spotted earlier and are smaller, they will need more precise and focused treatment—they will need radiotherapy. Twenty thousand people a year are missing out on radiotherapy already, but if we do not invest now, as more and more cancers are diagnosed earlier, that figure will rocket and this secret scandal will become painfully public.

Our cancer survival rates are distressingly low. Radiotherapy is, after surgery, the most effective cure for cancer—far more so than drugs. It has been left behind in terms of investment for many years under many Governments. This is the moment when that shameful state of affairs must end. People should have the best treatment for their cancer, and where at all possible they should have it close to home—because shorter journeys equals longer lives.

[Several hon. Members rose—]