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.

Oral Answers to Questions

Tim Farron Excerpts

Tuesday 20th March 2018 Commons Chamber

[Mr Speaker]

Not only was the hon. Lady present in Speaker’s House this morning, but her sister and distinguished speech and language therapist Rosalind Pow was present as well, so we had two doses of Pow in the course of a breakfast meeting. It was an unforgettable experience for all concerned.

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

I cannot compete with that, Mr Speaker. Back in November, I wrote to the Secretary of State about the increased service charges on GP practices. Ambleside surgery in my constituency, which serves an increasingly ageing population, faces a huge increase of £25,000—more than double—and the staff there fear they cannot keep the surgery going long term with that kind of increase. A ministerial written response in November did not mention Ambleside once, so will the Secretary of State commit now to intervening directly to guarantee that Ambleside will not have to pay this unjustified additional £25,000 a year?

[Mr Hunt]

I will re-look at the issue and the response that the hon. Gentleman was given. The issue is that there is unevenness and unfairness in the rates charged to GPs whose surgeries belong to NHS Property Services. We are trying to make this fair across the country, but we also want to make sure that no GP surgeries close.

Oral Answers to Questions

Tim Farron Excerpts

Tuesday 6th February 2018 Commons Chamber

[Mr Hunt]

We are absolutely going to do that. We have a big programme of expansion in perinatal health support, because there is a lot of evidence that pressures on mothers around the time of birth transmit to their children and can leave lasting damage.

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

Specialist mental health crisis care for young people in south Cumbria is available only between the hours of 9 and 5 from Monday to Friday. Does the Secretary of State agree that in the light of the Care Quality Commission’s recent damning report of the partnership trust, that is not acceptable? Will he join me in asking the Morecambe Bay CCG to ensure that there is out-of-hours and weekend care for all people?

[Mr Hunt]

I am happy to look into that issue. The hon. Gentleman’s colleague, the right hon. Member for North Norfolk (Norman Lamb), did a huge amount to set up crisis care provision around the country. We need to build on that for the simple reason that, if we are to have parity of esteem, people need to be able to get help in a mental health crisis, just as they are if something goes wrong with their physical health.

Cancer Treatment: Patient Travel Times

Tim Farron Excerpts

Wednesday 10th January 2018 Westminster Hall

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

I beg to move,

That this House has considered patient travel times for cancer treatment.

It is a great pleasure to serve under your chairmanship, Sir Christopher. I should also like to consider satellite radiotherapies at Westmorland General Hospital.

Almost every story that I have heard or read in recent times about the national health service has been negative. I understand why, given the debate in the main Chamber at this moment, but I sometimes wonder how much this further damages the morale of the thousands of professionals who work in the national health service. So I want to start by paying tribute and saying a massive thank you to those NHS professionals who work tirelessly up and down the country, day in and day out, to look after us and our loved ones when we need it most. I especially want to put on record my appreciation for those who work in cancer care. We have some of the best cancer care in the world. We should all take a moment to recognise the fantastically high standard of treatment that we have in this country, delivered by professionals whose competence and compassion are the hallmark of our NHS.

But here is the problem: yes, we have world-leading treatment, but it is not truly available equally. The availability of care depends hugely on people’s ability to access it. I welcome, and have done so on the record, the £130 million announced by NHS England that is to be invested in improving radiotherapy treatment, and the new service specification, which aims to improve standards across the country. Working in clinical networks and developing specialised services has a strong evidence base, but what is not addressed is the inequality in access to services that already exist. That inequality will only get worse if it is not addressed now by NHS England. I am grateful to the Government that the consultation on allocating that investment has been extended to 24 January, not least because it gives the Minister the chance to amend the criteria and the priorities for allocating services.

I passionately believe that one of the criteria in allocating improved radiotherapy services must be the shortening of the distances that people have to travel, especially for those with more common cancers. My position is backed up by evidence, including a publication in The BMJ in 2016 indicating that outcomes are worse for people who need to travel further. Let me be clear what “worse outcomes” actually means. Worse outcomes can mean patients actively deciding to forgo potentially life-saving or life-lengthening treatment because getting to hospital is just too much of a trauma for them owing to the length and difficulty of the journey that is required. Worse outcomes means choosing forms of treatment that may be less effective than radiotherapy because the nearest unit is too far away. Worse outcomes includes patients failing to complete a vital course of radiotherapy treatment because they simply cannot cope with the gruelling, wearying travelling every single day.

Action Radiotherapy estimates that one in six of us will need radiotherapy to treat cancer at some point in our lives, but easy access to this treatment can depend entirely on a postcode lottery. It is the sad reality that in rural areas of England travel times to cancer treatments can be unbearably long for too many people, and patients are often forced to cover these long distances on public transport. Not everyone has the option of travelling in the relative comfort of a personal car, and even if a person does, driving themselves or being driven, day in and day out for four to six weeks, is a massive challenge. I believe that it is frankly cruel, if we could do otherwise, to force people who are already very poorly to make a two or three-hour round trip every day, for weeks, in order to receive life-saving care.

[Jack Lopresti (Filton and Bradley Stoke) (Con)]

I congratulate the hon. Gentleman on securing this debate. I am a cancer survivor. I survived stage 4 cancer and I had a month of radiotherapy; I had to get the bus most days to get there, and caught a nasty infection because of the travel time, so I fully appreciate where he is coming from. I would like to highlight the cases of families with children with cancer. According to CLIC Sargent there are fewer than 20 treatment centres nationally, and that makes life extremely difficult for families who are having to travel for treatment. Will he pay tribute to CLIC Sargent for the respite care, finance and accommodation that it provides to families going through this terrible process and journey?

[Tim Farron]

I am grateful to the hon. Gentleman for raising those issues and his own personal experiences. As I will come to in a moment, the issues affecting children and young people are even greater. I am very happy to pay tribute to the work and provision of CLIC Sargent and, in particular, to recognise the impact on people with cancer who have young children themselves. Maintaining an income and maintaining family life is an immense challenge, and the distances involved can make it yet harder, so I thank him for that intervention.

In its 2007 report, the national radiotherapy advisory group recommended that cancer patients should have to travel no more than 45 minutes one way—an hour and a half both ways—to receive radiotherapy treatment. This was adopted in the service specification by NHS England, but has since disappeared. Experts in the field maintain that travelling any longer could have a hugely negative impact on treatment outcomes and patient wellbeing. If preventing unacceptable travelling times became a part of NHS England’s criteria for delivering radiotherapy, it would hugely increase our chances of bringing a radiotherapy satellite unit to Westmorland General Hospital in Kendal.

[Bill Grant (Ayr, Carrick and Cumnock) (Con)]

I thank the hon. Gentleman for giving way during his important and passionate contribution to this debate. I know that he is focused on England, but may I share with him that in Scotland the issue is the same, if not worse, because of the rurality of Scotland and the distances travelled? I find some of his points very interesting when we have the Ayrshire and Arran health board not closing, but reviewing, a chemotherapy unit, Station 15, at University Hospital Ayr. The closure of that unit would impose a 32-mile round trip on patients who, to exacerbate that, may have travelled a 40 or 50-mile round trip. The issue is UK-wide, so I thank him for securing this debate.

[Tim Farron]

I very much acknowledge the hon. Gentleman’s powerful point. In general, it is important that none of us are misunderstood here: centres of excellence are incredibly important; nevertheless access to treatment is also important. Where we are at the moment means that we are looking at the former to the exclusion of the latter, when both could be considered.

[Chris Davies (Brecon and Radnorshire) (Con)]

If I may, I would like to declare that my wife is a therapeutic radiographer in an NHS cancer trust, and put that on record. I agree with my hon. Friend the Member for Ayr, Carrick and Cumnock (Bill Grant). From a Welsh perspective, we are seeing some people travelling 60, 70 or more miles to get radiotherapy treatment. Does the hon. Gentleman agree that satellite centres from specialist centres are the way forward? My wife works in the Hereford cancer unit, a satellite centre from the specialist centre in Cheltenham, which knocks 40 miles off people’s journeys.

[Tim Farron]

I would like to thank the hon. Gentleman’s wife for her work, but also to say that he is absolutely right. There are great models, including from the Christie in Manchester, where they already operate satellite services. Arguing for rural or any form of standalone cancer services is foolish and is not what I am asking for. I am asking for satellites of existing, established, high-quality cancer units such as the Rosemere in Preston, the Christie or others of that nature. Making sure that we meet those needs by having a satellite unit at the Westmorland General Hospital in Kendal would have a positive impact on the lives of thousands of people in south Cumbria who are living with cancer. That is what I ask the Minister to do.

Radiotherapy treatment at Westmorland General Hospital is long overdue and would mean the world to local people, who now have to make the long journey to Preston for treatment. Let us be clear: the Rosemere unit in Preston is excellent—my own mother received wonderful treatment there, and the quality of the service and care provided by NHS professionals still moves me when I look back today—but for most people in south Cumbria, it is ludicrously distant.

[Julian Sturdy (York Outer) (Con)]

I congratulate the hon. Gentleman on securing the debate. Will he also note the importance of local charities? In my constituency, we have a charity called York Against Cancer, which has raised £15 million over the past three years. That money goes towards running a local minibus from York to Leeds for patients who have to be treated at Leeds in the radiology department.

[Tim Farron]

I am very happy to acknowledge the work of local charities in my area. The Rosemere Cancer Foundation and South Lakes CancerCare do immensely good work, just like the charities in the hon. Gentleman’s constituency.

For some people living in the remotest areas of my part of the world—in south Cumbria—who are eligible for hospital-provided pick-ups, a round trip to access treatment in Preston, including waiting times, could easily surpass six hours. That is on a good day, when all standards are being met.

[Steve Double (St Austell and Newquay) (Con)]

I congratulate the hon. Gentleman on securing a debate on this very important matter. The area of Cornwall that I represent has similar issues to those in Cumbria, and NHS England is consulting on closing our only treatment centre for radiography in Truro. That would mean people from the far west of Cornwall having to travel all the way to Plymouth for treatment. At the height of summer, when the roads are busy, that could easily be a five or six-hour round trip. Does he agree that that is far too long to expect patients to have to travel to receive this essential treatment?

[Tim Farron]

Yes, I fully agree. That is why the NHS England consultation is the right time to set criteria. If we all say, “We’d rather like it if these issues are addressed,” nothing will happen, but if they are set as firm criteria and priorities as a consequence of the consultation, something should happen. The hon. Gentleman was right to raise that point.

Requiring NHS trusts to make it a priority for investment to ensure that radiotherapy is available more locally—such as by bringing a satellite unit to our local hospital in Kendal—would significantly improve outcomes for patients. That has been the focus of our long-running community campaign. I want to say a massive thank you to the many thousands of people who have been involved in that campaign so far. Just before Christmas, on behalf of our community, I presented a private Member’s Bill that would specify 45 minutes as the maximum time that patients have to travel to access radiotherapy treatment. I urge the Minister to support that Bill and ensure that the Government accept it.

I was asked on the radio this morning why, after nine years of fighting this campaign, I had not just accepted defeat and walked away. The answer is that every week in Westmorland, more families learn that they must fight cancer, and we have no right to turn our backs on them. Sadly, the challenge of cancer renews itself week after week, and so our zeal in fighting for those families must also be renewed week after week.

[Gillian Keegan (Chichester) (Con)]

Some 840,000 people live in West Sussex and yet we are the only county in the whole of England that has no radiotherapy facilities within its boundary. I can also confirm the point made by my hon. Friend the Member for Filton and Bradley Stoke (Jack Lopresti). I recently visited the Sussex Snowdrop Trust, which looks after desperately ill children. The stories of them traveling up to London or Southampton and having to stop several times along the way were heartbreaking; it is the worst thing to happen when they are facing that kind of trauma. I agree with the hon. Member for Westmorland and Lonsdale (Tim Farron) completely that patient travel times need to be taken into account during the consultation. I hope that they are, and that St Richard’s Hospital in Chichester is considered as a worthwhile investment for LINAC—linear accelerator—machines to help local people in West Sussex.

[Tim Farron]

All the points that the hon. Lady makes are absolutely right and relevant to those of us who are here today—especially so, given the nature of her county.

Our community in south Cumbria remains proud that we won part one of our fight for a cancer centre. When we launched our campaign in 2009, it was for chemotherapy and radiotherapy. In 2011, we cut the ribbon on the Grizedale ward—the chemotherapy unit—and we are determined to win our fight for radiotherapy too. We have had an overwhelming response to the petition we launched again last September, adding to the 10,000 people who signed the original petition. Thousands more have written in and shared their stories with me locally and nationally. They include stories of the pain they went through in travelling hours every day to get the treatment that they desperately needed; stories of families who suffered watching relatives deteriorate as the long days of arduous travel visibly took their toll; and stories of choosing not to proceed with treatment because of the unbearable rigours of travelling huge distances. All those people have told me how a centre at Kendal could have helped them and their loved ones.

Most of us know, and all can imagine, the shock of being diagnosed with cancer. It is a life-shattering blow. Imagine then being faced with weeks of daily, grindingly long and tiring journeys to receive care. The travel can become the biggest part of the problem. One of my constituents, Philip from Grange-over-Sands, gave me this story, and his words speak more powerfully than any I could use. He said:

“At the age of 81 I had to attend 37 visits for treatment between the May and July 2013. The round trip from Grange to Preston Hospital was in excess of 100 miles per day whether by road or by train and then bus to the hospital. The times of my treatment varied day by day from 8am to 6pm. The treatment machine was not always available at the specified time which meant further time added on to the days travelling. All the above resulted in a very stressful time for myself and my wife on top of suffering from prostate cancer.”

Thankfully, Philip has now been discharged following three years of follow-up visits. He added:

“I trust that future patients may get their treatment at Kendal so good luck with your efforts.”

I was also contacted by the parents of Josie from Oxenholme. They told me:

“After a truly horrific chemo-therapy regime, which nearly killed her, Josie was left shattered and we faced the prospect of having to make daily trips for 4 weeks to Preston for Radiotherapy. The round trip typically takes 4-5 hours. She is left tired and with little time in the day to do much else. A unit in Kendal would have transformed this experience and left her with more energy and time to take more care of herself.”

Lastly, the words of Magda from Windermere sum up the problem perfectly:

“The whole idea of ever having to do any of this again would make me think twice about undergoing the treatments I was offered”.

Thousands of residents joined me back in 2009 when we launched a similar campaign to bring chemotherapy treatment to the south Lakes. Back then, patients had to travel many miles for any kind of cancer treatment. Thanks to local support, the chemotherapy ward at Westmorland General Hospital opened in 2011, and since then hundreds of local people have benefited from treatment there. We showed that when a community gets behind a campaign and the Government recognises that there is a real issue, changes can be made, funding can be allocated and problems can be solved.

It is true that the problem of outrageous travel times thankfully affects a relatively small proportion of the population throughout the UK—evidenced by the fact that although this is a massively important issue, only a few of us are here today—but in the places where access is a problem, it is a dreadful problem. NHS England must address it directly and explicitly in its current consultation on radiotherapy. I ask the Minister to ensure that NHS England does just that.

Solving the problem for south Cumbria would not create an expensive precedent—there are relatively few sizeable communities in this position—but for the people who are affected, living in rural areas makes accessing treatment unbearably difficult and arduous. That was highlighted recently by Age UK’s Painful Journeys campaign. It would cost the Government a relatively small amount to fund a satellite radiotherapy unit in Kendal: a capital cost of about £12 million—a sum that had been earmarked during the coalition Government in early 2015. That investment would lead to important changes. Above all, it would stop local people opting not to take up lifesaving treatment because of the need to travel those distances. In south Lakeland, the number of people aged over 60 is 10% above the national average, so older people and people with disabilities in our area are disproportionately negatively affected by distant access to radiotherapy treatment. That makes it all the more important for us to take advantage of this consultation to tackle the problem.

The Equality Act 2010 was passed by the House to ensure that services are offered to people in such a way as not to discriminate against older and disabled people, among other characteristics. Through those unbearably long travel times, those groups are disproportionately disadvantaged and indirectly discriminated against in breach of that Act.

My request is simple. I want travel times and equality of access, particularly for people who are older or who have disabilities, to be key criteria when allocating cancer services. This NHS England consultation on radiotherapy is the opportunity to ensure that those criteria are set so that access is prioritised. I want the Minister to agree to do that today. An expectation should then be placed on hospital trusts to ensure that satellite units of existing established centres are provided in rural communities such as the south Lakes to meet those criteria. Only then will our community be able to access cancer treatment fairly, equally and safely.

[The Parliamentary Under-Secretary of State for Health (Jackie Doyle-Price)]

It is a pleasure to serve under your chairmanship, Sir Christopher. It is also a pleasure to respond to the hon. Member for Westmorland and Lonsdale (Tim Farron). I wish to associate myself with his opening comments in praise of the NHS. Demand for NHS services is constantly increasing. We always want the best we can possible get, but by making that case, we often sound as if we are talking the NHS down. Nothing could be further from the truth—we have the best national health service in the world. I am glad to see that the hon. Gentleman is nodding his head, and I am grateful for the persuasive way in which he made his case. He can consider that a very good representation in response to the consultation to which he referred. The points he has made will be reflected on keenly.

Improving cancer outcomes remains a priority for the Government. The work under way is making a difference: cancer survival rates in England have never been higher and have increased year-on-year since 2010. The decrease in cancer deaths means that around 7,000 people are alive today who would not have been had things stayed the same.

We are committed to implementing every one of the 96 recommendations in the cancer strategy for England and to making a difference to the millions of people living with the disease and the thousands more diagnosed each year. We are providing the funding to match our commitment. NHS England has confirmed £607 million in funding to support the delivery of the strategy between 2017-18 and 2020-21.

We want our cancer services to be the best in the world, and we want patients to have access to the treatment and services that will give them the best chance of a successful clinical outcome. That includes the time they spend travelling for treatment. We know that cancer treatments can be arduous. Patients often undergo treatment daily and treatments can last several weeks at a time. Ideally, we want patients to have treatments at their local hospital.

However, specialised cancer treatments are not always best delivered locally. We want patients to have the best possible care available, but for certain cancers that sometimes means seeing a specialist multidisciplinary team with a full range of clinical expertise and capability. Although local is good, we clearly cannot always have specialist care provided as locally as we would like.

A perfect example of that is proton beam therapy treatment. Patients with high-priority cancer types requiring that treatment are sent to Florida and Switzerland at great cost to the NHS, because we have been unable to provide it here. In April 2012, the Government announced a £250 million investment to build proton beam therapy treatment facilities at the Christie in Manchester and University College London Hospitals. The Christie’s facilities will become operational later this year and will offer patients access to world-class treatment on the NHS.

Over the last few years, we have seen astounding technological advances. The UK is leading from the front in using cutting-edge technology in the form of whole genome sequencing to transform healthcare and health research. Wherever possible, it is right that patients have easy access to those life-saving treatments.

The same principle applies to radiotherapy. Around four in 10 of all NHS cancer patients are treated using radiotherapy. Recent advances have helped to target radiation doses at cancer cells more precisely, which means far fewer doses, better outcomes and improved quality of life for patients. That is a crucial part of why survival rates have continuously risen in England.

One of the cancer strategy’s key objectives is to deliver a modern, high-quality cancer service. In October 2016, NHS England announced a £130 million fund to modernise radiotherapy across England that will upgrade or replace older treatment devices over two years.

[Tim Farron]

The hon. Lady mentioned proton beam therapy, which is a wonderful treatment. We are grateful for the investment of more than one Government, which has ensured that it is coming to Manchester and London. She also talked about upgrading existing equipment, which is a reminder that 80% of commonly occurring cancers will still be treated by linear accelerators, albeit regularly upgraded. Therefore the delivery of proton beam therapy and other specialist and precise treatments, and the investment in more locally delivered treatment from linear accelerators in places such as Westmorland, are not mutually exclusive. We need to do both.

[Jackie Doyle-Price]

I absolutely agree—the two are complementary and need to be key ingredients in a successful strategy to combat cancer.

NHS England is not only modernising existing radiotherapy services; it is currently consulting on a new model for them, as the hon. Gentleman said. The aim is to encourage radiotherapy providers to work together in networks to concentrate expertise and improve pathways for patients requiring radical radiotherapy for less common cancers. That will help to improve access to more innovative radiotherapy treatments, increase clinical trial recruitment and ensure that radiotherapy equipment is fully utilised. There is no intention to reduce the number of radiotherapy providers, nor is that considered to be a likely outcome of the proposals being consulted on.

We will continue to ensure that travel times are taken into consideration when looking at cancer treatment in this country. The National Cancer Registration and Analysis Service is evaluating the impact on cancer outcomes of patients living different distances from a cancer centre. Public Health England is also testing travel times from several available datasets, so a programme of work can be established that incorporates data on travel times.

One of the first outputs of that work will be a report on whether there is any demonstrable difference in radiotherapy treatments associated with the time taken to travel to a specialist cancer centre. We expect the first results of that work to be published in the spring. I am sure the hon. Gentleman will have a considerable interest in the outcome.

In the current NHS England consultation, there are proposals that would allow local commissioners and providers to plan, review and redesign services through a joint radiotherapy board. Any case for change would determine the optimum location to achieve the best impact for patients, so it would be possible for patients requiring radiotherapy for common cancers to be treated at a satellite centre. Specialised commissioners will always want to balance patient travel with issues such as the sustainability of the service, whether the service is accessible enough to patients to be financially viable, and ensuring that patients who have to travel are supported in other ways, including through transport and accommodation.

I hope that meets with a positive reaction from the hon. Gentleman. We are consulting on making services more accessible and looking at travel times. I dare say that we will continue to have this debate over the coming months, not least because of his private Member’s Bill.

I understand that the hon. Gentleman recently met his local clinical commissioning group at Morecambe Bay to discuss the accessibility of services. I am encouraged that that dialogue is taking place at a local level.

I hope that what I have set out gives the hon. Gentleman some reassurance. I emphasise that cancer remains a priority for the Government. We remain committed to ensuring the best possible treatment and to achieving easy access in terms of travelling time for all cancer patients, regardless of where they live. I am grateful to the hon. Gentleman for securing this debate.

Question put and agreed to.