Oral Answers to Questions

Tim Farron Excerpts

Tuesday 7th May 2019 Commons Chamber

[Matt Hancock]

Yes, that is exactly right. That is why we have put in place the new LINACs—linear accelerators, the equipment that is being rolled out across the country in a £130 million programme. We are always looking at what more we can do to help people to beat cancer.

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

Will the Secretary of State agree to look personally at the case for a new satellite radiotherapy unit at Westmorland General Hospital, tied to the Rosemere unit in Preston? I had the privilege last week of driving my constituent Kate Baron to her treatment at Royal Preston Hospital. Wonderful treatment though it is, it is a three-hour round trip that she has had to take on 15 separate occasions—I went with her only the once. Hundreds of people in the south Lakes have to make debilitating, lengthy round trips to get treatment day after day, which is damaging to their long-term health and to their ability to access radiotherapy at all.

Oral Answers to Questions

Tim Farron Excerpts

Tuesday 26th March 2019 Commons Chamber

[Matt Hancock]

There is no better advocate for Hornchurch in the Chamber than my hon. Friend. She made her case with passion and commitment and I was very impressed by it. I will write to her with the full details, once they are published, of exactly how the process will work, and I look forward to working with her.

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

The north-west of England has only half the number of ambulances per head of population as London. In rural Cumbria, the situation is far worse. Will the Secretary of State agree to our proposal for an additional two ambulances for Westmorland so that we can keep our communities safe?

[Stephen Hammond]

The hon. Gentleman will know that, in the winter funding round, extra ambulances were provided across the whole country. I am happy to meet him and discuss his proposals, which I will then consider carefully.

Eating Disorders Awareness Week

Tim Farron Excerpts

Wednesday 27th February 2019 Westminster Hall

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

It is a pleasure to serve under your chairmanship, Mr Bailey. I, too, pay tribute to the hon. Member for Angus (Kirstene Hair), who secured this debate and made an excellent speech, and to the other colleagues who have contributed to it so far.

Without doubt, eating disorders have acquired a greater profile in recent years, and there are two things that are apparent and that we can learn from. One is that, as a society, we are better at talking about these things, and organisations such as Beat, which has already been mentioned, do outstanding work in making people feel that the stigma around these issues is something that we, as a society, need to get over, and therefore people will feel more comfortable about coming forward, which is good.

The second lesson that we might learn is that we are a society that, for some of the reasons that have already been mentioned, increasingly breeds poor mental health. So, I will focus my remarks on the support—or lack of it—for young people living with mental health conditions and particularly for those with eating disorders in my constituency of Westmorland and Lonsdale.

Very often, it is the parents who come to me first. Parents come to me with two clear emotions: one is terror; and the other is guilt. It is absolutely essential that we are clear to people with eating disorders, and indeed to those who love and support them, that there is absolutely no need for guilt; there is no blame attached whatever. Likewise, we need to tackle the fear and the terror, which often stem from a lack of understanding or an absence of hope as to where to go next, by showing that there are things that we can do to help.

In my constituency, we estimate that three quarters of young people with eating disorders were not seen within the target time of one month, and that 100% of those with an urgent need were not seen within the target time of two weeks. That is not acceptable, but what is even more terrifying is that the numbers involved are ludicrous. In the year up to August 2018, a grand total of 13 young people in South Lakeland were registered as living with eating disorders, which is baloney: we all know that that is not true. I would comfortably say that the real number is 10 times higher. In my office, we deal with at least one new case of an eating disorder every single week. So what is happening, such that our young people with eating disorders are falling through the gaps? We need to look at a whole range of things, but I especially ask the Minister to investigate personally why this is happening, particularly in South Lakeland but—I suspect—around the country as well.

One GP got in touch with me about this issue. I will not name her, but she was very keen for me to share her experience with everyone here in Westminster Hall and everyone who is listening. She did not have any training at all in mental health while she was gaining her qualifications, but she has sought to bring herself up to speed on it in her job. She is a general practitioner. She does her best to help young people and indeed people of all ages presenting with mental health conditions, but she feeds people into the system, or refers people into it, and there is no triage.

There is no general triage once a young person has been referred for help: “Does this person have anxiety?”; “Does this person have an eating disorder?”; or, “Does this person have some other condition?” That person could be referred to the wrong silo and then sit there for months, undiagnosed or misdiagnosed. I am sure that is one window into why such pitifully low numbers of people are being diagnosed, against the backdrop of what I think are many hundreds of people living with a condition who are left in desperation and not even getting the beginnings of the support that they desperately need. We are failing to catch our children and our young people when they are at their most vulnerable, so how can we then go and help them?

Anorexia nervosa has the highest mortality rate of any psychiatric disorder in adolescence. The consequences for someone of not getting the right treatment are absolutely huge and extremely serious. However, even those who are diagnosed—this goes for younger people and for adults—may not get the help that they need. Colleagues have already referred to the fact that people will have experience—I have, with constituents of mine—of being told, “Frankly, you’re not thin enough yet. Come back when you are. You are not manifesting physical conditions to back up your mental health condition, therefore come back later on.”

Would somebody who had been fortunate enough to have been diagnosed with cancer at stage 1 be told, “Clear off till you’ve got stage 4. Come back when you’re at death’s door”? Come off it, but that is how we treat people with mental health conditions and in particular people living with eating disorders. There are people with eating disorders—I can think of some who I know myself—who may have experienced no appreciable or noticeable weight loss. They still have an eating disorder, which needs to be tackled, and tackled quickly.

In Cumbria, three years ago—to the week—we were promised a specialist one-to-one eating disorder service for young people. Three years on, it still does not exist. That is why so many people will be cynical about promises made at this time of year at events such as this. We want to see real delivery for all of our young people in every part of the country.

Finally, the Government—rightly—emphasised preventive care in the NHS long-term plan just a few weeks ago. However, just a few days before Christmas they had sneaked out the funding cuts for public health, which is genuinely preventive care. Those cuts included a £500,000 cut in preventive health care in Cumbria. At the moment in Cumbria, we spend 75p per child on preventive health care. If we want to support those people who may struggle with eating disorders in the future, it is vital that we invest early and invest now. That will be not only more efficient and more effective, but far, far kinder.

Oral Answers to Questions

Tim Farron Excerpts

Tuesday 15th January 2019 Commons Chamber

[Matt Hancock]

I have not heard any of the details of that case before now. If the hon. Lady will write to me, I will be very happy to talk to her and engage with her on what we can do for her constituent.

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

It is 12 long months since the Government closed their consultation on whether to upgrade NHS radiotherapy facilities. Meanwhile, in south Cumbria, cancer patients have to make daily round trips of up to four hours for weeks on end to receive treatment. When will the Government respond to the consultation and when will they invest in satellite radiotherapy provision in places such as Westmorland General Hospital?

[Matt Hancock]

We will respond to the consultation very soon. We wanted to get the NHS long-term plan published first, because clearly the two are strongly linked. I pay tribute to the hon. Gentleman’s work chairing the all-party group on radiotherapy and I look forward to working with him.

Cancer Workforce and Early Diagnosis

Tim Farron Excerpts

Tuesday 8th January 2019 Westminster Hall

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

Thank you, Mr Howarth. It is a pleasure to serve under your chairmanship. I wish everyone a happy new year and congratulate the hon. Member for Poplar and Limehouse (Jim Fitzpatrick) on securing this incredibly important debate, which is timely in the light of yesterday’s announcement of the NHS long-term plan.

I will restrict my remarks on the cancer workforce to the radiotherapy workforce and other issues relating to radiotherapy. Sadly, at some point in our lives, one in two of us will have cancer of some form or other, and one in two of those with cancer will receive radiotherapy treatment, so one in four of us will need radiotherapy. Roughly speaking, 1,500 people—clinicians, medical physicists and therapeutic radiographers—make up the entire radiotherapy workforce of the United Kingdom. In the plan that we have been digesting since yesterday, there are many things worthy of remark and which are to be welcomed, but many questions remain unanswered.

On radiotherapy, the focus on survival and early detection is clearly crucial. The United Kingdom is very low down in the league table of European countries when it comes to early detection of cancer, which is the chief reason why survival is so poor compared with other nations of similar prosperity. That is tragic on a personal level and deeply humiliating on a national level. If the Government, the National Health Service and we all are successful in our bid to detect cancer earlier at stage one and stage two, treat it effectively and cure patients—radiotherapy is eight times more likely to be curative than chemotherapy and 50% of those with cancer are already having radiotherapy—it stands to reason that the need for capacity for radiotherapy will increase manifold.

There are 52 radiotherapy centres in England with a number of other satellites. There is nothing in the plan that scopes forward how the national health service will cope with the additional work required if early diagnosis becomes more successful. It is worth bearing in mind that, as things stand, there are significant pressures with a workforce of 1,500. There are two ways of looking at it: one is that the workforce is a very small and precious resource that we need to protect, and the other is to remind ourselves that those are relatively small figures, and that with a relatively small amount of investment, we could make a significant difference to increase that workforce. Relatively small numbers equals a huge percentage, which equals the ability to tackle many more cancers and, indeed, to cure many of them.

I will focus briefly on one profession within the radiotherapy workforce—therapeutic radiographers. I do not know whether hon. Members are aware, but in the current academic year, there has been a 50% drop in applications to therapeutic radiography courses at UK universities. One of the leading universities had to cancel its entire intake altogether due to under-recruitment. The cause is almost certainly—99% certainly—the removal of the bursary from that programme. The standard applicant is a mature student who chooses to do something different with their life, having done something else first, and the withdrawal of the bursary has had a huge impact on those people. If the Minister wanted to do something quickly to tackle that workforce issue, I will throw out there the suggestion that he could reinstate the bursary for radiographers.

I am chair of the all-party parliamentary group on radiotherapy, and one of our vice-chairs is here—the hon. Member for Easington (Grahame Morris). We and many other hon. Members had a really good meeting with the Minister at the end of November last year. I am very grateful to him and to his staff for their time and attention. They have yet to respond to the manifesto that we presented to them that day, although I did not expect them to have done so by now. That manifesto calls for a number of things: new investment and more money—it would be surprising if we did not ask for that, but I will put it in context.

As I have said, half of those who have cancer in the United Kingdom will require radiotherapy, yet only 5% of the cancer budget goes on radiotherapy. That compares poorly with other countries. In Australia, the figure is about 5% but the European average is something like 7% or 8%. Our cross-party proposition is that the Government invest £100 million every year into machine upgrades for high-quality, targeted, stereotactic, and other advanced forms of radiotherapy. That fund would cover all trusts, which would not have to delve into their own reserves. We also propose a £250 million up-front, one-off investment so that people who live in communities like mine an awful long way from the nearest treatment can have a satellite unit developed close to them.

Many of my constituents in South Lakeland have to make three or four-hour round trips to get good treatment at Preston, but a large percentage—up to 50%—of those who could have radiotherapy in my constituency and in other parts of south Cumbria do not get it because they are considered to be too far away for it to be a reasonable journey time. Radiotherapy is so often more curative than chemotherapy, ergo people do not live as long because they live too far from treatment. That is why the radiotherapy satellite centre at Westmorland General Hospital in Kendal is a key example. Access and travel times are a problem in other parts of the country, which is why investment in satellite units is important. They do not necessarily involve that much more staffing because, with proper IT networking, we would be able to do many of those things remotely.

In conclusion, the NHS plan announced yesterday contains much that is interesting, but when it comes to radiotherapy, it is entirely a rehash of things that we already know. Some things are welcome, but there is nothing new. I look forward to the Government’s response to its consultation on radiotherapy, which closed 12 months ago, and I ask for an update on that. I also ask that the National Cancer Advisory Group’s 2018 report is released as soon as possible. Finally, I very much look forward to the Government’s response to the manifesto by the all-party parliamentary group on radiotherapy, which was presented to them in November.

[Several hon. Members rose—]

NHS: Staffing Levels

Tim Farron Excerpts

Tuesday 11th December 2018 Westminster Hall

[Tracy Brabin]

Capacity, particularly in midwifery, is a massive issue, and midwife recruitment is also a problem. A mum who is about to have a baby wants to make sure that they are guaranteed a bed and a midwife who will be with them throughout the process, so of course that is a concern. There are almost 41,000 vacant nursing posts in the NHS and it is estimated that that number will grow to almost 48,000 by 2023—just five short years away.

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

The hon. Lady is being generous. Does she agree that the problem with the recruitment and retention of staff also stretches to our mental health services? In Cumbria, three years ago, the Government promised a specialist one-to-one eating disorder service for young people, which has yet to be delivered. Does she agree that it is not good enough for the Government to make promises that they cannot deliver because they cannot recruit the staff?

[Tracy Brabin]

We are seeing increasing problems around recruitment and retention in mental health services, which I will go on to. We know that nurses are heroes of our health service and that they will always voice their concerns.

A survey conducted by the RCN in 2017 had some deeply worrying results. More than half of the nurses said that care was compromised on the last shift and more than 40% said that no action was taken when they raised concerns about staffing. If there was any doubt about the commitment of nurses, nine in 10 were not paid for extra unplanned time worked in the NHS. Unpaid time worked by nurses in the NHS saves the NHS hundreds of millions of pounds a year.

I am not just talking about nurses and the worryingly low levels of recruitment. The Royal College of Physicians informs me that in Yorkshire and Humber 36% of physician consultant posts advertised were not filled. Across the UK, a total of 45% of advertised consultant posts went unfilled, due to the lack of suitable applicants. The RCP believes that we need to double the medical school places to 15,000 a year to alleviate this problem in the long term and it is seriously hard to disagree with that assessment.

The RCP is also calling for investment in public health initiatives, which I am sure is another thing that we all agree on. The desperate need for more mental health staff is well reported. The consultant psychiatrist vacancy rate in the northern and Yorkshire region, which Batley and Spen falls under, is 11.7%, which is higher than the average consultant psychiatry vacancy rate in England. One in 10 consultant psychiatrist posts are vacant. Doctors specialising in mental health are uniquely placed to look at a person’s brain, body and psyche. Such specialists will only become more important, so I ask the Minister to update Members on his plans to meet the target of 570 junior doctors specialising in psychiatry by 2020-21 and to say what plans he has to ensure that all trainee doctors have experience of working in psychiatric settings?

The British Medical Association has provided information on the potential impact of Brexit on staffing levels in the NHS. Nearly 10% of doctors working in the UK are from the European economic area. Doctors, as well as many other professionals, make a massive contribution to our NHS. However, the BMA warns that many EEA doctors continue to feel unwelcome and uncertain about their future here. Given the uncertainty that we have seen in the past few days, I imagine that that feeling will not change any time soon. The results could be devastating, with more than a third of doctors from the EU considering moving away from our country. That is the last thing we need, as hospitals are already chronically understaffed, with more than one in four respondents to a BMA survey reporting that rota gaps are so serious and frequent that they cause significant problems for patient safety.

Alarmingly, some doctors feel bullied into taking on extra work. It is clear that something needs to change, particularly now we are in winter again. There are too few staff, who are too stretched, and trusts across the country are struggling to fill vacancies. However, in order to fix a problem, we need to know whose remit it is to provide a solution. Shockingly, there are no specific legal duties or responsibilities at UK Government level to ensure that health and social care providers have enough staff to provide safe and effective care to meet the needs of the population. Health Education England has some powers related to the higher education supply. In practice, however, those powers relate only to the funding for the 50% of their courses that nursing students spend on placements. Health Education England no longer commissions higher education university places, meaning that it is responsive to students signing up for nursing courses rather than proactively seeking them based on areas of need and workforce planning.

We know that the number of European workers in the NHS has fallen dramatically since the referendum. Mid Yorks recruited highly skilled workers from the Philippines, but delays to visa applications meant that 50% of them have now gone elsewhere and into other jobs. We need to do better than that.

The case is clear to me and to many others that we need a proactive and accountable power-holding body that makes robust assessments of population need, and uses that need to calculate the workforce requirements. No action has been taken to assess the level of population need for health and social care support now or in the future. Nobody has calculated how many nurses are needed to meet those needs safely and effectively. No workforce strategy is in place to set up the mechanism through which new registered nurses can be generated through a supply line.

Workforce plans are not consistently available and when they are they are based on affordability and finance, rather than on the expertise and skills mix of staff required to care for patients. Plans are limited in their ability to make effective change. Providers may identify a need for more nursing posts but then find themselves unable to fill them. Vacant posts stay vacant and gaps on the frontline are filled by more expensive bank and agency staff, and—as we heard from my hon. Friend the Member for Barnsley East (Stephanie Peacock)—by volunteers, or substituted lower-qualified staff. Patient care is left undone, with lengthening waiting lists.

That is the sad truth of where we are and when the Minister responds I would be grateful to know what plans are in place to enforce accountability for the NHS workforce. Simon Stevens has confirmed that the long-term plan for the NHS could not definitely deal with the NHS workforce and there are serious concerns that without investment a new plan will ultimately fail.

Six years on from the Health and Social Care Act 2012, it is still unclear which organisation is accountable for workforce strategy. Too often, no one is taking responsibility. Health Education England has been consulted, but it has failed to deliver a workforce strategy. Now is the time for leadership and action, and I look forward to hearing from the Minister.

Oral Answers to Questions

Tim Farron Excerpts

Tuesday 27th November 2018 Commons Chamber

[Steve Brine]

There are active discussions going on between my right hon. Friends the Health Secretary and the Secretary of State for Housing, Communities and Local Government about this, but the bottom line is that Parliament legislated through the Health and Social Care Act 2012 for local authorities up and down the country in England to be public health authorities. We believe that they are well placed to make these spending decisions with the ring-fenced grant—£16 billion —that we have given them.

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

The underfunding of public health in Cumbria means that the NHS spends only 75p per child per year on preventive mental health care. Added to that, over three quarters of young people with eating disorders are not seen within the target time of a month, and in the event that they are seen, there is no specialist one-to-one eating disorder service to see them, despite the Government promising three years ago that there would be. Will the Minister meet me and our local NHS so that we can get a better deal for our young people on all three of these points?

[Steve Brine]

The hon. Gentleman will remember, of course, that £1 billion extra was put into mental health in the Budget last month, but I would absolutely be interested to hear from him. There are very good things going on up and down the country in local authorities with the ring-fenced £16 billion that we have given them. We are very interested to hear about where there are good examples of things going on, and the long-term future discussions around them will take in the spending review, as I have said.

Oral Answers to Questions

Tim Farron Excerpts

Tuesday 23rd October 2018 Commons Chamber

[Matt Hancock]

The announcement the details of which I have just set out comes with £1.6 billion of the £20 billion uplift we are putting into the NHS written into the long-term plan, so the funding is there to deliver on this policy, too.

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

The Secretary of State is right to say that early diagnosis provides more opportunity to cure and treat cancers. Some 60% of those treated for cancer will receive radiotherapy, and nearly every radiotherapy centre in the country has linear accelerators that are enabled to provide the advanced SABR, or stereotactic ablative body radiotherapy, technology, but Government—NHS England—contracts mean that out of the 52 centres in England no more than 20 are contracted to actually use this technology. That means that either patients are not receiving the highest quality life-saving standard of treatment that they could be or that trusts are providing it anyway but are not being paid and valuable data on mistreatment are being completely lost. Will the right hon. Gentleman order NHS England to stop this recklessness, and frankly lethal, nonsense and agree to every—

[Mr Speaker]

Order. [Interruption.] Order. The thrust of the question is entirely clear. I was going to offer the hon. Gentleman an Adjournment debate on the subject until I realised that he had in fact just conducted it.

Phenylketonuria: Treatment and Support

Tim Farron Excerpts

Tuesday 26th June 2018 Westminster Hall

[Liz Twist]

I most certainly agree that it places an incredible strain on parents, who must live with that all the time. I recommend the “Patient Voices” booklet and video to anyone who has not already seen them.

In this debate, I will highlight very specific concerns about treatment and support for PKU. The first is the issue of access to a drug treatment, sapropterin, which is thankfully more commonly known as Kuvan. Although it is available in 25 countries across Europe, and was licensed for marketing over 10 years ago in the European Union, Kuvan is not available to people with PKU in the UK.

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

I congratulate the hon. Lady on this important debate. She makes a hugely important point about the licensing of Kuvan. The European Medicines Agency licensed the drug in 2008, and 10 years on we have buck-passing between the National Institute for Health and Care Excellence, the Department of Health and Social Care and NHS England. It is deeply concerning. I am representing two children with PKU—I am sure there are many more—in my constituency. I got a letter back from NICE just a few weeks ago that said that the condition and the treatments for PKU are

“the subject of a NHS England commissioning policy…not covered by any existing NICE guidance.”

It went on to pass the buck back to NHS England. Does the hon. Lady agree that it is time for the buck-passing to stop, and for the treatment to be licensed?

[Liz Twist]

I absolutely agree. I hope that one of the good things that will come out of this debate is that the buck stops being passed, and the assessment gets done as quickly as possible. It is so important for people to have access to this drug; we need that to be sorted.

There is evidence that for a significant proportion of people with PKU—about 25% —this drug can significantly improve their condition. It does not cure it, but it does make it much easier to deal with the dietary issues, which have such an impact on the way people live their lives. Despite the drug having been around for so long, NHS England has only recently considered it for the management of PKU. The drug has now been referred to NICE for assessment and technology appraisal. The APPG on PKU recently heard from NICE about the process, but there is concern about the timescales and how the benefits of the treatment will be assessed. Understandably, there is huge frustration on the part of the PKU community that there are children and adults who could be benefiting from Kuvan now, and there is substantial evidence to support its benefits.

There is a particular issue about prescribing Kuvan for pregnant women with PKU, who can understandably find it hugely difficult to control their diet, and who fear the effect of any problems on their unborn child. While there is a 2013 commissioning policy in place that allows Kuvan to be prescribed to some pregnant women, it can be difficult for women to be prescribed it in a timely way.

Some people, some of whom are in this room, have had access to Kuvan through individual funding requests, or on a trial basis. Those people have found real benefits from the drug. My constituent Archie, who is here, started on the treatment earlier this year. Archie tells me he has benefited from having Kuvan, not just because his diet is now much less restricted and he is able to do what many of his school mates do, but because it has improved his energy and his life. As his mum Barbara said to me, “If we had been coming here before the treatment, we would have been bringing our own special breakfast for Archie to eat in the hotel, and would have had to watch everything he ate very carefully. It has made a real difference.” I hope that the Minister will be able to assure us that the assessment of Kuvan will be done very quickly, and that it will be available to the people it can help.

NHS Staff Pay

Tim Farron Excerpts

Wednesday 21st March 2018 Commons Chamber

[Mr Hunt]

I am happy to do that and to congratulate the staff at my right hon. Friend’s hospital, which he has long championed and whose pressures and needs he has highlighted assiduously. To come out of special measures is a huge achievement. I have recorded a video message, but I am happy to say in the House how proud we all are of what the staff have achieved. I also recognise the capital issues at the hospital and the fact that the building is not fit for purpose.

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

The minimum amount that nurses in south Cumbria will have lost since the pay freeze is £4,306. Given that the average house price in my constituency is 10 times the value of the average nurse’s salary, Members will understand the huge impact that there has been on retention and recruitment. The rise is therefore deserved, welcome and overdue, but without a long-term plan for funding health and social care, this announcement will not be trusted, so does the Secretary of State not agree that we need a new deal to refresh Beveridge’s vision for the 21st century, and should we not be prepared to be honest with the British people and say that this will involve a modest but clear increase in taxation?

[Mr Hunt]

I disagree that the deal will not be believed—it is a concrete deal. NHS staff still have to vote for it, but the Government have committed to significant rises in pay. I agree, however, that we will need to find the best way of getting more money into the NHS and social care system as we face the pressures of an ageing population.