Lung Cancer Screening

Tracey Crouch Excerpts

Monday 26th June 2023 Commons Chamber

[Steve Barclay]

The hon. Gentleman raises a valid and important point on the targeting of mining communities. Of course, the roll-out will be shaped by clinical advice, but I will flag that point as we consider the targeting of the programme as it expands.

On the hon. Gentleman’s first point, the major conditions paper will look at these issues in the round. That matters because one in four adults has two or more conditions, so it is important that we look at conditions. A moment ago, I touched on the fact that obesity is the second biggest cause of cancer after smoking, so it is right that we look at multiple conditions in the round. His point about targeting is well made, and I will make sure the clinical advisers respond.

[Tracey Crouch (Chatham and Aylesford) (Con)]

In Medway, which is an area with high levels of deprivation, mortality rates for lung cancer and chronic obstructive pulmonary disease are significantly higher than the average in England, as is smoking-attributed mortality. Due to the towns’ shipbuilding and heavy industry heritage, to follow on from the point made by the hon. Member for Barnsley Central (Dan Jarvis), we also have one of the highest rates of mesothelioma, which is a type of lung cancer.

Although today’s announcement of the national roll-out is welcome, what plans do the Government have to bring vital lifesaving early detection to the doorstep of the Medway towns, as those most affected by lung disease are probably the least able to afford the 47-mile journey to Dover, where Kent’s screening pilot will be based?

[Steve Barclay]

My hon. Friend speaks with great authority on this issue, and she is right to highlight the importance of mesothelioma. A key theme of the pilots is the importance of convenience of access to screening, and a key part of the programme’s expansion is enabling it to be targeted at those communities that are at highest risk, as we heard a moment ago. I take on board her concerns about some of Medway’s challenges, and I know that she has called for this direction of travel more widely in the past—for the targeting of early detection in the community, because early detection brings far better patient outcomes.

Cancer Medicines: Appraisals

Tracey Crouch Excerpts

Tuesday 13th June 2023 Westminster Hall

[Tracey Crouch (Chatham and Aylesford) (Con)]

I think this is my first time speaking under your chairmanship, Mrs Harris; I am sure it will be a great pleasure. I congratulate the hon. Member for Strangford (Jim Shannon) on securing this important debate, and on his excellent speech setting out the issues with the new NICE methods and processes for cancer drugs. The hon. Member for Mitcham and Morden (Siobhain McDonagh) described him as a national treasure. As a Minister, I was once in charge of national treasures; I feel I lost the opportunity to enshrine his legacy in a Bill before Parliament, during whose passage I am sure he would have intervened.

The hon. Member for Strangford set out an interesting problem, and, like him, I am grateful for the briefing I have received on the matter. I am humbled to follow the hon. Member for Mitcham and Morden. I have been on the cancer treadmill, and I think that, as patients, people become incredibly compliant; they do as they are told. It is often much harder for those who love someone who has cancer. They fight for better treatment and care on behalf of their loved one because it is all that they feel they can do, as the hon. Lady set out.

We need to do so much more on rarer cancers, particularly brain cancers. I quickly googled global survival rates for glioblastoma; the survival rate in the US is 26%, compared with 10% in the UK as the hon. Member for Mitcham and Morden set out. That shows that factors such as access to drugs can make a significant difference to outcomes. I am sure that the Minister heard very much what she said, and many people who are suffering from brain tumours will be grateful for her contribution.

I have no intention of becoming the poster girl for all things cancer. In some cases, I still find talking about my experience of the disease quite hard, but I wanted to speak in this debate because I also find it infuriating that we lag behind so many countries on many cancer-related areas, including access to medicine. However, I want to give some good news on cancer targets from my area. It is extremely worrying for anyone to read front-page news of missed targets, backlogs, delays and so on at the start of their cancer journey, but in Kent and Medway we are fortunate to have one of the top performing alliances in the country for meeting the 62-day standard, with both Maidstone and Tunbridge Wells NHS Trust and Medway NHS Foundation Trust reaching 85%. In fact, MTW, which is where I was treated, has consistently met its targets for the last three years, having kept all its cancer services open during the pandemic. The improvements are generally down to achieving more rapid diagnoses by triaging referrals and sending as many patients as possible straight to their diagnostic test.

A lot of evidence links early diagnosis with better outcomes. Despite having top-notch treatments available on the NHS, the UK still lags behind Europe and the US. There may be many reasons, but my view and that of many others is that the main push should be for diagnosing patients as early as possible to improve outcomes. However, we really cannot afford to get into a situation where we do not have access to the latest treatments; otherwise, outcomes may worsen. There is a conundrum, which can be summarised as: methods and processes versus cost versus data—and it is really hard to squish that triangle into a circle. I met two pharmaceutical companies to learn about this issue. Although I am not naive to its aims, I was struck by the disadvantage that the changes to NICE’s methods and processes could leave UK cancer patients with.

The hon. Member for Strangford outlined the background to the changes so I will not repeat them in great detail, but in summary, in 2022 NICE changed the way it reviews disease severity as part of its assessment process. It introduced the severity modifier and removed the end-of-life criteria, which gave a higher value weighting to medicines for terminal illnesses. That change is likely to negatively impact cancer medicines in particular. Capacity issues, cost containment measures and other commercial environment factors are steadily combining to create a life sciences sector that is disincentivised to focus on cancer innovations or invest in the UK. That in turn will pose challenges to achieving the Government’s ambitions to accelerate access to oncology medicines and meet the policy targets set out in the “Life Sciences Vision” and the NHS long-term plan.

What worries me is that big, global oncology conferences take place—like the recent American Society of Clinical Oncology conference in Chicago—which are brilliantly reported in our newspapers, with references to breakthrough drugs for x cancer sending shivers of hope down the spines of people like me and many others, when the truth is that very few of those drugs will reach our NHS due to NICE methods.

That is when I see the other side of the argument, at least to some extent. We should really be congratulating whoever does the procurement negotiations with pharma to drive down the cost to the NHS so that investment can be made in other areas of cancer, such as diagnostics, although that can be stretched only so far before companies pull their drugs from the market. It is about finding a sweet spot that works well for both.

Data is another challenge. There is a lack of outcome data available to NICE in the full assessment of some medicines. The problem for pharmaceutical companies is that this data is hard to come by. Outside of a clinical trial, they have little or no access to outcome data from the use of the drug in the real world, and if it is expensive, it is hard to prescribe it without a NICE recommendation in the first place—thus we have come full circle due to a lack of evidence and, of course, the increasing cost.

[Siobhain McDonagh]

Does the hon. Lady agree that it seems crazy that in a system as universal as the NHS there should not be access to outcome data? To give just one example, South West London Elective Orthopaedic Centre at Epsom Hospital is the largest hip and knee replacement centre outside of America. It is the lowest for blood risks, and has the lowest infection rates and quickest turnaround. It has its own small charity and keeps the data, making £1 million a year from it. That could go some way towards paying for the latest cancer drugs.

[Tracey Crouch]

I entirely agree. Data sharing will help cancer outcomes full stop, not just in the example she gives. If my GP sent me for a breast screening, for example, the person doing the screening could not currently see whether I have had a cervical screening. Having the conversation about screening for other cancers while having some form of cancer screening is an important aspect of long-term survival rates, so I completely agree with the hon. Lady.

It appears that NICE, through changes to its methods and processes, has probably got stricter on the level of evidence it requires before it will make a recommendation, so that it ensures that there is a survival benefit to the things it recommends, all of which is a potential reason that we should collect and share data better across the NHS. We could allow pharma better access to anonymised NHS data, and some trusts already do so with strict governance in place. Working together in this way would allow us to access the actual impact of a drug when it is used outside of a trial and allow NICE to make a real-world evidence-based recommendation, which would be particularly helpful for rarer cancers such as glioblastoma.

We have to get over the clinical reticence of not using a drug before it has a NICE recommendation, otherwise we will never get the real-world data. Some 80% of cancer drugs recommended by NICE were only recommended if the price to the NHS was reduced, so, given that in the UK clinicians tend not to prescribe without a positive NICE recommendation, the pharmaceutical companies essentially have to drop the price to get the recommendation for the drug to be on the market. In all those points, it is forgotten that at the centre of this is a cancer patient just wanting to get the best possible treatment to live for as long as possible.

We all want positive outcomes for cancer. NICE has committed to keeping its new methods under review. During this time, it is essential that flexibility is maintained when considering disease severity so as to ensure timely and ongoing patient access. Pharmaceutical companies want to be at the forefront of developing life-enhancing, cancer-beating drugs for the market. There has to be a sensible way forward, but at the moment it feels like the changes may have made things worse for current and future cancer patients hoping for breakthrough life-enhancing treatments.

I know the Minister to be a sensible and reasonable person. I hope he will take renewed vigour from what he has heard so far in the debate and will sit down with all the interested parties to see how we can go forward, because without doing so, I fear that on this issue—coupled with others around screening, diagnosis and access on to pathways—we will continue to lag behind other countries in beating cancer.

--- Later in debate ---

[Andrew Gwynne (Denton and Reddish) (Lab)]

It is a pleasure, as ever, to serve under your chairmanship, Mrs Harris, and to respond to this debate on behalf of the shadow Health and Social Care team.

I begin by congratulating the hon. Member for Strangford (Jim Shannon), who I call my hon. Friend, on securing this important debate, and I thank him for his tireless work campaigning on such issues.

Also, I pay tribute to my hon. Friend the Member for Mitcham and Morden (Siobhain McDonagh) for the powerful case that she put to the Minister in respect of brain tumours generally and specifically the glioblastoma manifesto. I very much hope that the Minister is able to take up her challenge, because the inequalities in outcomes that she laid out are unacceptable. In the year 2023, we should not be looking at a situation in which there have been zero improvements in life expectancy from cancers such as glioblastoma since 2005-06 when we have seen dramatic improvements in the other areas that she mentioned. We owe it to Baroness McDonagh—Margaret McDonagh—and to others such as Tessa Jowell to ensure that we see improvements in this area, too.

As for the hon. Member for Chatham and Aylesford (Tracey Crouch), she said herself that she has been on the cancer treadmill, and it is lovely to see her back in her place and up to her old usual tricks. We welcome her.

[Tracey Crouch]

I just want to say that I was never not in my place; I was fortunate enough to go through cancer treatment during covid, when we were all working under a hybrid procedure. Actually, that experience has helped to form some of the contributions that I have made to the Procedure Committee about how we in this place support people who are going through significant illnesses.

[Andrew Gwynne]

Absolutely—the virtual Parliament hid a multitude of sins. I know that as somebody who struggled with long covid through that period. Many people would not have known just how ill I was, because I just appeared on a screen. However, it is nice to see the hon. Lady in person; I should put it like that. And she was entirely right to say that cancer touches us all, which is why we can all cite personal experiences of it. I lost my mum to ovarian cancer when I was 19; she was just 50. I lost my dad last year to rectal cancer. I am not alone; we all have people, including close family members and friends, who we have lost to cancer.

I also pay tribute to the hon. Member for Midlothian (Owen Thompson), who responded on behalf of the SNP, for his contribution to the debate and to the right hon. Member for Dwyfor Meirionnydd (Liz Saville Roberts), for her intervention.

I am sure that I speak for everybody from all parties in the House when I say that ensuring that patients have quick access to the most innovative and effective treatments is an absolute priority. This country has a proud history of medical innovation, a reputation that we should try not only to protect but to enhance, as we have already heard today.

We are talking today about the appraisal process for cancer patients, which, as we have also heard, has changed markedly over recent years in several areas. We have seen increased focus on targeted treatments and immunotherapies, as well as reform of the cancer drugs fund in 2016, a move that was taken to improve people’s access to cancer drugs while allowing NICE to collate more information on potential areas of clinical uncertainty.

In a recent report, the Association of the British Pharmaceutical Industry highlighted that 78% of medicines have been able to exit the cancer drugs fund with a positive recommendation, with most of them spending about two and a half years in the CDF process. It also recognised improvements as a result of the relaunched CDF, but raised concerns that the CDF has

“perhaps been overly relied upon”

in order to

“delay making routine recommendations.”

It states that

“a new balance may need to be struck between NICE and manufacturers in considering which treatments should enter the CDF to resolve genuine uncertainty surrounding long-term clinical outcomes and for how long.”

Given that NICE recently set out specific circumstances when committees may be able to accept a higher degree of uncertainty in routine commissioning decisions, can the Minister set out whether his Department has assessed the ABPI’s findings and whether more can be done to improve access to innovative treatments for patients via routine commissioning? That links to a wider point that I wish to raise on clinical research and trials.

Clinical trials provide an opportunity for the NHS, businesses and brilliant researchers to work together for the benefit of everyone. Unfortunately, however, in recent years the UK trials industry has collapsed. The number of commercial trials in the United Kingdom decreased by 41% between 2017 and 2021. Worryingly, the UK has dropped from fourth to 10th in the global rankings, behind Spain, France and Italy. Of most concern is that in 2020-21, the NHS lost £447 million in revenue due to a drop-off in clinical commercial trial activity. Those figures should seriously worry the Minister. They risk putting patients at a disadvantage for all kinds of innovative treatments, including cancer medicines.

In Labour’s recent health mission, we committed to putting Britain right at the front of the queue for new medicines and vaccines. Alongside our pledge to spend 3% of GDP on research and development across the public and private sectors, we want our clinical trials to be more competitive, efficient and accessible. Making those ambitions a reality means tackling unnecessary bureaucracy in how trials are set up and reducing the administrative burden on everyone involved in the clinical trial, including the NHS. Will the Minister set out how his Government plan to reverse the drop-off in clinical research and trials—a drop-off that is costing our NHS financially and clinically?

Finally, I want to touch on the issue of patient access to innovative medicines, including for cancer patients. In 2021, in its “Life Sciences Vision”, the Government committed to identifying and addressing “unwarranted variation” in the uptake of innovative medicines. But in February this year, in the innovation scorecard commissioned on behalf of the Department of Health and Social Care, it was found that a number of areas were still falling short of the NICE recommended levels of new medicine uptake.

Will the Minister provide an update on what work he is doing to improve regional variation in uptake of innovative medicines so that no matter where someone lives, they can access the treatment they need when they need it. Will he also commit to improving the data collected as part of the innovation scorecard to include information on cancer medicines so that we can meaningfully assess uptake and isolate areas for improvement where necessary? That is something that the life sciences sector has called for, so I would welcome more information on that from the Minister.

In conclusion, Labour is wholly committed to ensuring that cancer patients in this country receive access to the very best medicine and care. That means ensuring that appraisals for cancer medicines remain fit for purpose and adapt in line with evolving technologies and scientific advancements. It also means turbocharging clinical trials and tackling the unacceptable gaps in access to cutting-edge treatment. In his response, I hope that the Minister will meet the ambition set out by the Labour party and that we can work together towards making Britain a world leader in cancer care and treatment, because we owe it to all those people on the treadmill right now.

--- Later in debate ---

[Will Quince]

The answer to both is yes, and yes. If the right hon. Lady would write to me with the details, I will certainly raise the issue and meet to discuss radioisotopes specifically.

NHS England is working very closely with the independent sector to ensure that we are using all the available capacity to us to deliver both diagnoses and treatment as quickly as possible. The Government announced the major conditions strategy on 24 January, which is important for cancer as it draws on previous work on cancer. Over 5,000 submissions were provided as part of our call for evidence last year, and we will continue to work closely with stakeholders, the public and patients—whose voice should never be forgotten, as the hon. Member for Strangford rightly points out—and the NHS in the coming weeks to identify the actions we need to take as part of the strategy that will have the most impact.

Specifically on NICE appraisals, the hon. Member raised several concerns about the way in which cancer medicines are appraised. Members will know that NICE is rightly independent of Government. It is an expert body that makes evidence-based recommendations to the NHS on whether new medicines should be routinely funded by the NHS on the basis of on assessment of clinical and cost effectiveness. Those recommendations then develop, mainly for the NHS in England, but as was mentioned, they are usually adopted by the NHS in Wales and in Northern Ireland. Scotland has its own system. This is a difficult matter to raise, but it is important to point out that every pound that we spend on a new medicine is money that is not available for other services, and the NICE appraisal process ensures that NHS funds are spent in a way that provides the greatest health benefit to society. That is a hugely difficult job, which NICE does with great professionalism.

Again, it is important to point out that NICE appraises all new medicines and that its approval rate for cancer medicines has consistently been around 90%–I think that the latest figure is 92%. It is absolutely right that when NICE recommends a medicine for the NHS, it is available for patients and NHS England is required to fund that drug or treatment. I know that the NHS in Northern Ireland and in Wales has adopted a similar model.

NICE’s methods and processes for assessing new medicines are internationally respected, and they have evolved over time to ensure that they reflect best practice and keep pace with advances in medical science. As my hon. Friend the Member for Chatham and Aylesford (Tracey Crouch) pointed out—I will come on to this in some detail— NICE concluded a comprehensive review of its appraisal methods and processes last year, which it carried out with a high level of ambition and transparency. As she pointed out, changes include the introduction of a new severity modifier, which will give NICE more flexibility to recommend medicines for more severe diseases at higher prices. The severity modifier replaces the previous flexibility for end-of-life treatments.

My hon. Friend raised some concerns about that, and I always listen very carefully to what she says on this and many other issues, especially given her personal experience and campaigning. She is right to say that the situation is hugely complex, and her point about data is a really good one, because decisions need to be informed by good-quality data. I would be happy to meet her to discuss how we can ensure that we are collecting data not just on a regional basis, but nationally, so that we can make sure that NICE is making informed decisions. As she rightly points out, we need to ensure that patients and their voices are always at the heart of all the decisions made by not just the Government, but NICE. I would be happy to meet her to discuss that in greater detail.

On the broader point about whether the introduction of a severity modifier in place of an end-of-life modifier will affect cancer drugs specifically, analysis was carried out by NICE in developing the modifier. It indicated that the vast majority of cancer medicines that would have been eligible for the end-of-life modifier would also be eligible for a weighting under the severity modifier. I am happy to meet my hon. Friend and any other Members who would like to meet NICE to discuss this issue further.

[Tracey Crouch]

I think it is very important that the Minister also meets the pharmaceutical companies, because there is a counterclaim to the statistic from NICE that he has just given. The pharmaceuticals say that, actually, a significant percentage—I cannot remember off the top of my head what it is—of drugs would not pass the test. My plea to him is to sit down with all interested parties and not just listen to NICE’s statistics on this issue.

[Will Quince]

My hon. Friend is absolutely right, and I regularly meet the pharmaceutical industry, not least because of VPAS, which I will come on to discuss because it has been raised by a number of Members. While I understand the concern, it is absolutely right that assessment of clinical and cost effectiveness reflect up-to-date clinical pathways, evidence and evaluative methods and processes. However, my hon. Friend is absolutely right to say that we should also hear and understand the views and concerns of the pharmaceutical industry so that we have a rounded, balanced view and the full picture, to make sure that there are no unintended consequences because of the action that is being taken.

The hon. Member for Strangford mentioned non-uniform pricing and VPAS, so let me come on to that specifically. The tricky thing is that the negotiations for the next VPAS are currently under way. Given that there are ongoing discussions, it would not be appropriate for me to go into too much detail, because of the commercial sensitivity. It would also be inappropriate to set up a working group to review NHS England’s policy on non-uniform pricing. What I would say is that if changes were made to the wording in the next VPAS on commercial flexibilities, they would be reflected in an updated commercial framework for new medicines.

The hon. Members for Strangford and for Denton and Reddish raised clinical trials. We are doing a huge amount of work in that space because I recognise some of the issues and challenges that the hon. Member for Denton and Reddish set out. That is why we commissioned the O’Shaughnessy review into clinical trials, and why we accepted Lord O’Shaughnessy’s recommendations in full. We should take a step back for one moment and look at the work that we did as a country and an industry on clinical trials, particularly relating to covid. We basically shut down huge numbers of clinical trials to focus on a vaccine. To be fair, this country absolutely led the way in that, and we should be very proud of what we did, but we have not been fast enough in switching clinical trials back on and we have lost some of our competitive edge in relation to other countries, as the hon. Gentleman pointed out. The reality is that it is a race; clinical trials are globally competitive, and other countries, including Spain, have seized the advantage and are fighting hard for market share. We have to make sure we are a competitive place. That is about clinical trials but also our regulatory environment.

The hon. Member for Midlothian (Owen Thompson) made good points about the MHRA. We are absolutely looking at its processes and procedures, and we are putting an extra £10 million into it over the next two years to ensure it is a world-class regulator that is one of the fastest and most effective and efficient. It is already highly respected, but we must ensure that it does things at the right speed. That is very much on my radar, and as I said we are accepting the recommendations.

The hon. Member for Denton and Reddish also raised the cancer drugs fund. Since 2016, NICE has been able to recommend medicines for use through the Government’s £340 million cancer drugs fund, which enables patients to receive promising new treatments for a time-limited, managed access period while further evidence is being collected. That is then considered by NICE when determining whether a medicine should be routinely funded by the NHS. Since that fund was created in 2016, it has helped more than 91,000 patients in England, and more in other places, to access innovative medicines.

Oral Answers to Questions

Tracey Crouch Excerpts

Tuesday 1st November 2022 Commons Chamber

[Steve Barclay]

I am very happy to look at this case.

[Tracey Crouch (Chatham and Aylesford) (Con)]

Suicide is the biggest killer of under-35s in the UK, with more than 200 school-aged children taking their own life every year, including two, very sadly, in my constituency in recent months. We have heard about the pressures on mental health services, so will the Secretary of State look at alternative ways of supporting mental health by meeting the 3 Dads team and his counterpart in the Department for Education to discuss how we can embed age-appropriate suicide awareness and prevention in schools?

[Steve Barclay]

Part of the reason why we are putting an extra £2.3 billion into mental health is to recognise the sensitivity and the importance of this issue. I am very happy to look at all practical suggestions. The tragedy for constituents is something that unites the House. In particular, I will look at what technology can do to support people.

Contact in Care Settings

Tracey Crouch Excerpts

Thursday 27th October 2022 Commons Chamber

[Tracey Crouch (Chatham and Aylesford) (Con)]

Ordinarily when we stand up in the Chamber, we say that it is, for example, “a pleasure to follow my hon. Friend,” but given the very powerful speech from the hon. Member for Liverpool, Walton (Dan Carden), may I say that it is an absolute privilege and that I am very humbled to follow him in this debate, which I am very proud to co-sponsor? I echo his thanks to the people who have engaged with us and taken time to give us their testimony, especially the groups and the people he referred to, as well as those who have sent briefings for the debate.

In 2015, my father had a stroke, which left him physically and neurologically impaired, requiring him to spend the rest of his days in residential nursing care. My sister and I visited him on a regular basis, observing his decline from manly patriarch to someone with childlike vulnerabilities in just over the course of a year. I will not romanticise the relationship that I had with my father, which had been fractured since my teenage years, but I can honestly say that those months of us visiting him in care were the closest that we had felt to him in years. It is true to say that, during covid, I often remarked that I was glad that he had died long before the pandemic, because while no one wants to see their parent or loved one lying on a bed—a thin, pallid skeleton—saying their final goodbyes, blessings or apologies hours before their death, nor should they be denied that right.

Tragically, during the pandemic, and in some cases still today, many of my constituents and others around the country were denied visiting rights, whether that was to care, to celebrate or, sadly, to say goodbye. We should pause for a moment to cast our minds back to the start of the pandemic in early 2020, when the virus was ripping around communities, transport systems, offices, retail places and, of course, health and social care spaces. It was killing people in large numbers, especially the most vulnerable in society. People were frightened and our understanding of the virus was limited. We went into lockdown and isolated our loved ones because we thought that it was the kindest and safest thing to do. We all understood why.

When I looked back through my casework files in preparation for the debate, I found hardly any complaints about limited access to relatives in the first lockdown, because in a Blightyesque spirit, we got on with it and found alternative ways to communicate with those we could not ordinarily see. Many of us here stamped our feet about care workers not getting enough personal protective equipment and rightly included them in our doorstep clapping, because they were heroically looking after their residents when family and friends could not visit any more. We understood the fear that if one resident caught the virus, it could be devastating for the entire setting, and the duty of care that they held. But then lockdown ended, the summer arrived, the virus declined, our understanding of it improved and our hopes of going back to see residents in health and social care settings were raised—yet when I looked at my casework, I saw that that was when the problems began, and, unfortunately, they still continue.

I stress that I am in no way criticising any individual care home manager or any staff for the examples that I am about to cite. My criticism lies squarely with the Department of Health and Social Care. Its guidance that was published for managers to interpret was wishy-washy at best and is why I now firmly believe that, although we can still respect the individual business that a care home is, a right of access should be enshrined in law to give the manager, the resident and the relative clarity about visiting.

In November 2020, I was contacted by Francesca, whose nan was admitted to a care home following a short stay in a local hospital. Francesca’s family were not able to visit, despite having been told that Francesca’s nan was dying and that they would potentially be allowed only a one-hour goodbye. That was hugely distressing, not only for Francesca and her family but for her grandmother, who was coming to the end of her life without her loved ones around her.

The guidance was often cited, but its lack of clarity left care settings making decisions that were understandably in their own interest, but not in the interest of the resident or the family. After my intervention, visits to Francesca’s nan were allowed and goodbyes were said, but the uncertainty and distress caused could perhaps have been averted with a simple right of access that was clear in its intention.

Likewise, Mura’s mother was in a specialist nursing home that houses some very vulnerable and elderly people. Everyone, including Mura, understands the need for caution. When the virus surged in December 2020, care settings like the one that Mura’s mother was in effectively went back into lockdown. Named visitors were allowed if they underwent testing, a process that no relative has ever complained about. However, because the guidance enabled homes to design and implement their own covid outbreak procedures, many were able to prevent access even to the defined essential care giver, denying love and support from loved ones during another period of isolation.

One important point was reiterated when I listened with colleagues to powerful and—as the hon. Member for Liverpool, Walton said—harrowing testimony on access and support rights from campaigners, many of whom are in the Gallery today. This is not just about older people in care homes, or those at the end of life. We heard from Wendy Mitchell, who is living well with dementia, as those who follow her joyous Twitter feed know. She highlighted her experiences of going to appointments alone during the pandemic. I do not need to explain in detail the utter idiocy of allowing people with dementia to attend a healthcare setting where there are discussions about condition, medication and so on. In the head of a 1970s scriptwriter, it would have formed an idea for some sort of sketch show, but it is serious and potentially extremely dangerous.

Youngsters fared particularly badly during the pandemic, and those within care settings were affected quite acutely. I was reading back through my correspondence relating to a young man called Thomas, who has learning disabilities and is in a residential care home. He had a birthday coming up, but the care home was denying his parents the ability to take him home to celebrate, despite the fact that it was—wonderfully, I hasten to add—taking Thomas out for community visits. My correspondence to the care home explains perfectly well what the problem was:

“I have managed to speak to colleagues in both the Health Department and the Education Department about Thomas’ particular set of circumstances and both encouraged me to look at the ethical framework that care settings are required to operate under. I was also reminded that those with learning disabilities, such as Thomas, are not considered clinically vulnerable and therefore do not require shielding in the same way as others with significant health conditions.

I know that Government guidance in residential settings has not exactly been perfect and that care home managers and teams are doing their absolute best to navigate their way through, doing what they think is best for both the client and their staff. However there is a difference between the home Thomas is in and that of an older much more vulnerable person and therefore flexibility is perfectly possible.

It is with that in mind, and with the guidance for the whole nation being slowly eased to allow greater human interaction, alongside an appeal to your sense of compassion given Thomas’ mother’s deteriorating health condition, that I write to urge you to reconsider your decision to not allow Thomas to visit his family home tomorrow for his birthday. There are no ‘rules’ that stop you from doing this and I know that the family will forever be grateful.”

I am pleased to say that the home did allow Thomas to go home for his birthday, but the fact that Thomas’s case related to two different Departments, and the unclear guidance, caused great anxiousness.

In September 2020, a similar case arrived from Dawn about her son with complex medical needs living in 24-hour nursing care. She rightly noted the impact that the first lockdown had had on her son. She wanted me to write to the then Minister, who I am pleased to see back at the Dispatch Box today, to make it clear that a family member could be recognised as an essential part of the care home staff and be allowed to come as much as any member of staff. She felt that homes like the one that her son was in were never mentioned because people automatically thought of care homes in respect of our elderly population. I think that Dawn’s message and that of many others was heard, but its application remains sketchy, even today. [Interruption.] Oh—here is a lesson for Members: make sure you take the last page of your speech off the printer. [Laughter.]

Having reread the accounts of those cases and having listened, back in March, to the testimony of others who had suffered as a result of being unable to visit loved ones, I believe it is a no-brainer to have an absolute position on this matter. The guidance was not clear enough, and it caused distress to residents and relatives as a consequence. I know that the Minister will cite CQC guidance, but it is not strong enough, which is why so many now feel that it needs to be enshrined in one form or another. The Minister will note that there is cross-party support for such a move. We could do it quickly, in time for the winter, so I hope she will consider our pleas seriously. This would protect care home managers, as well as giving residents the right to have their loved ones with them providing whatever support and care are necessary.

We can learn a lot from the pandemic, and I am sure that we will. One of the lessons must be about the devastating impact of isolation on the physical and mental health of those in social care settings. Let me finally repeat my initial point, drawing on my experience with my own father, six years after his death. No one wants to see their loved one vulnerable, incapable of basic functions or in their final hours, but nor should anyone be denied that important time with them. Sadly, many were and some still are, and it is with that in mind that I urge the Minister to think carefully about her response this afternoon, but ultimately to introduce legislation as soon as possible.

[Mr Deputy Speaker (Mr Nigel Evans)]

I call the other co-sponsor of the debate, Daisy Cooper.

Urgent and Emergency Care

Tracey Crouch Excerpts

Monday 5th September 2022 Commons Chamber

[Steve Barclay]

What I can guarantee is that, through the taskforce, we are prioritising how we get ambulances back on the road and how we speed things up to reduce handover delays. We are looking in particular at the 10 trusts in which the issue is most acute, because there is an unmet need in the community if the ambulance is not there.

On the hon. Member’s point about the backlogs with electives, we announced over the summer, as part of the work that we have been doing, a whole series of surgical hubs and community diagnostic centres. We are working with the Getting It Right First Time team, under Professor Sir Tim Briggs, on different patient pathways. A whole range of work is being done to reduce waiting times, which is why we have already cleared the longest waits—the two-year waits—and are now turning to the 18-month waits.

[Tracey Crouch (Chatham and Aylesford) (Con)]

National headlines do not often reflect the hard work of those in our local hospitals. Although there will be—indeed, there have been—cases of unforgivable waits, will my right hon. Friend join me in thanking all the hard-working paramedics, first responders and emergency department teams who serve Medway, Maidstone and Tunbridge Wells hospitals, supporting my constituents in their time of need? Will he update the House on any conversations he may have had with the Department for Levelling Up, Housing and Communities about major planning applications that have progressed without the appropriate healthcare facilities being provided?

[Steve Barclay]

I am happy to join my hon. Friend in thanking the paramedics in Medway, in Maidstone and beyond for all their fantastic work, especially given the pressures the system has been under during the summer. As for levelling up, a number of Members have raised with me the need to ensure that developers are making a sufficient contribution as part of their housing plans, and I shall be happy to draw that to the attention of my colleagues in the Department for Levelling Up, Housing and Communities.

Oral Answers to Questions

Tracey Crouch Excerpts

Tuesday 19th July 2022 Commons Chamber

[Steve Barclay]

I am not sure that I will urge my predecessor to do so, but if indeed there is a successor, I will be happy to share that with them. The hon. Lady raises an important point, and I am happy to look into it.

[Tracey Crouch (Chatham and Aylesford) (Con)]

We are becoming more aware of how poor lifestyles, including with respect to diet, physical activity and stress, can contribute to an increase in the risk of cancer. Research is also highlighting that exercise, particularly moderate-intensity aerobic training, reduces side effects from treatment, anxiety, depression and recurrence rates. With that in mind, will the Secretary of State ensure that alongside diagnostics and treatment, exercise forms a fundamental part of the forthcoming 10-year cancer strategy, not only for preventing cancer but for reducing its recurrence?

[The Parliamentary Under-Secretary of State for Health and Social Care (James Morris)]

My hon. Friend makes an important point. As part of our public health messaging and so on, exercise as a preventive mechanism against cancer is extremely important. We have had a call for evidence; we will consider the evidence that has been provided when we look at the 10-year plan, of which exercise will be an important component.

Childhood Cancer Outcomes

Tracey Crouch Excerpts

Tuesday 26th April 2022 Commons Chamber

[Mark Tami]

I agree, and I think that vital work needs to be carried out now.

Fundamentally, psychological support should not be an add-on. It is not something that we should have to seek or press for our children to receive; it should be part and parcel of the overall treatment programme. For many people, it is about coming to terms not only with the treatment, but with the fear that the illness could come back again. That is a hell of a pressure to be put on a young person.

Young people may also find it difficult to talk to their own families about some of these issues and the concerns they have. That is why professional counsellors and clinical nurse specialists can play an important role in this respect. Reintroduction into school, for example, can be a traumatic experience for young cancer patients, as well as for their classmates, because they might look very different from when they left the school. I remember a young girl telling me that the worst part of what had happened to her was not the treatment, but the fact that she lost her hair—coming to terms with that is very difficult.

[Tracey Crouch (Chatham and Aylesford) (Con)]

On that point, will the right hon. Gentleman take this opportunity to congratulate the Little Princess Trust, which takes donations of hair to create wigs for children? Quite often, it is other children who donate their hair to make those wigs. It is a great charity, and I hope that many people will acknowledge it.

[Mark Tami]

I agree. It is so important to help young people feel as normal—if we can use that word—as possible. I have always been struck by how important the hair issue, and having fit-for-purpose wigs, is to girls in particular—in some circumstances the wigs are not very good.

As has already been touched on, support should be available for family members of young cancer sufferers. I remember when everyone would phone up all the time and ask how my eldest son was, but no one would ask how his younger brother was. They were not being mean; it was just that their focus was on that child. During the whole treatment process, there is a financial cost to travelling to and from a specialist centre, and for some the choice is between employment or caring for their child. That is the choice that a lot of people have to make, so there are enormous pressures there. I found it particularly helpful to speak to a nurse from CLIC Sargent—now known as Young Lives vs Cancer—who would come round to give my son his treatment. She understood how you felt, and it was good to have an honest discussion with her about some of the issues you were facing.

I think we need to place psychological support on an equal footing with addressing the physical treatment of childhood cancers, with equal access to support, not as an afterthought or an add-on, but as part and parcel of the process, from diagnosis to dealing with the long-term effects.

Social Prescribing: England

Tracey Crouch Excerpts

Tuesday 1st February 2022 Westminster Hall

[Alexander Stafford (Rother Valley) (Con)]

I beg to move,

That this House has considered social prescribing in England.

I wish first of all to make clear to the House my interest as chair of the all-party parliamentary group on health and the natural environment. I am delighted to be sponsoring what is, to my knowledge, the first dedicated debate in the UK Parliament on social prescribing. There is no doubt in my mind that this debate is timely, if not overdue, given that social prescribing as an effective and respected field of medicine has come to the fore in the past few years and accordingly has an important role in the future of our health system.

So what is social prescribing? Put quite simply, social prescribing embraces the need for psychosocial support to be considered alongside biomedical interventions, to take us back to a more natural way of keeping well and improving our health when things go wrong. Importantly, social prescribing is about being connected to activities in our communities to improve health and wellbeing, whether by joining a community choir or running group or volunteering at a local nature reserve.

To understand why social prescribing is crucial to the future of care, we must understand its place in the health and social care context. All Members can agree that biomedicine is brilliant, and there is no better example than the Government vaccination programme for covid-19. Biomedicine will always play a crucial role in supporting people’s health and wellbeing. However, we have also known for a long time that what determines our health is not what goes on inside hospitals and GP practices. We also know that biomedicine has limitations—for example, addiction to opiates.

Recent guidance from the National Institute for Health and Care Excellence promotes the use of exercise for pain, alongside drugs. In fact, the NHS chief pharmacist’s recent report into over-medicalisation demonstrated that one in five over-65s are in hospital not for a condition they have, but due to the medicine they take, while 10% of prescriptions dispensed address the symptom and not the cause of a person’s depression. Evidence also shows that one in five GP appointments are for non-medical needs, such as mental health, relationships, housing, loneliness, social isolation, managing a long-term health condition and debt.

[Tracey Crouch (Chatham and Aylesford) (Con)]

I congratulate my hon. Friend on securing this debate. I am not sure if he was aware, but I was the world’s first Minister for loneliness. We produced a strategy to tackle loneliness, of which social prescribing formed a significant part. As a consequence, social prescribing was beginning to be rolled out, to the benefit of our GPs up and down the country, supported by a dedicated team of link workers, who really grasped the importance of tackling loneliness through social prescribing. Will he join me in thanking all those link workers, who get why social prescribing is important and continue to signpost people towards organisations that tackle loneliness?

[Alexander Stafford]

I thank my hon. Friend for that intervention and for all the work she did as Minister for loneliness to address this important issue, which she continues to drive forward, including in all-party groups. She is exactly right: link workers are vital. Indeed, a big part of my speech is about them, because it is so important to give them the support they need and thank them for their great work to improve the health of our nation.

Demand for GP appointments has increased by 30% compared with pre-pandemic levels, but the ecosystem of social prescribing support is fragmented. Healthcare professionals have limited visibility of what local support is available, as directories of services are often outdated and the referral pathway to different agencies is complex. There is also significant inequality of access to nature. About one third of the population accounts for 80% of all visits taken, and 2.69 million people do not live within a 10-minute walk of a green space. People from low-income households are about 25% less likely to live within a five-minute walk of a green space. Someone from a black, Asian or minority ethnic background is nearly four times as likely as a white person to have no access to outdoor space at home. Almost 40% of people from ethnic minority backgrounds live in areas most deprived of green space.

The inequality of access to green space seen for adults in England is also seen among children and young people. Most of our children spend not nearly enough time outdoors. Unequal provision means that those at greater risk of poor physical and mental health often have the least opportunity to benefit from green space. In other words, inequality breeds greater inequality. Improving contact and connection to nature is one way to help break that cycle of inequality.

It is exciting to see the positive impact of social prescribing borne out by the evidence. When we talk about health, we should always talk about evidence. Data indicate that people who visit nature regularly feel that their lives are more worth while. There are links between a greener living environment and higher life satisfaction, including improved mental health and reduced stress, fatigue, anxiety and depression. Among people who have good access to nature, inequality and mental wellbeing between different social groups are vastly reduced.

People who visit nature at least once a week are almost twice as likely to report good general health. However, it is an individual’s feelings of connectedness with nature that are important for their wellbeing. When controlled for time spent outside, people with high nature connectedness were 1.7 times more likely to report that their lives were worth while, versus those with low nature connectedness. Evidence shows that living in green environments is associated with reduced mortality, and green space may mediate detrimental health effects of long-term deprivation.

Since the pandemic, 43% of adults say that visiting green spaces has been even more important for their wellbeing. The evidence is equally impressive for children, reinforcing the point that schools and other educational settings are crucial gateways, if we are to ensure that all children have contact and connection with nature, especially those who otherwise have little opportunity to access the outdoors.

We have already made great progress rolling out social prescribing across health and social care services. For the NHS, social prescribing is a relatively new model of care that improves the health and wellbeing of individuals. It builds community capacity and reduces demand for statutory services, particularly GPs—we all know the pressure GPs are under at the moment. Social prescribing sits at the heart of NHS ambitions for system change, as a practical embodiment of personalised, joined-up, preventive, community-based care that addresses the social determinants of health.

In 2019, the NHS long-term plan committed to the recruitment of 4,500 social prescribing link workers. Link workers take a holistic approach to health and wellbeing, connecting people to community groups and statutory services for practical and emotional support. The NHS long-term plan envisions that social prescribing link workers would work alongside other roles being created in primary care, as part of multidisciplinary teams. Those teams include other personalised care roles, such as community pharmacists, mental health workers and health and wellbeing coaches.

Social prescribing is part of a wider suite of community-based interventions, including programmes around hospital discharge and higher intensity use of accident and emergency services. Together those programmes are part of an overarching shift towards greater collaboration between health services, systems, capacity and assets of wider local communities. The plan envisions that that would be funded by bringing together resources across systems to support thriving health communities.

Making that shift is now more urgent than ever. The covid-19 pandemic laid bare the devastating realities of health inequalities across our communities. It has shown that we need to do better at reaching out to marginalised communities, closing the gaps in the support available in the most deprived areas. The pandemic has also increased the urgency of finding a way to support people to stay well within their communities, reducing pressure on health and care services. Social prescribing in its broadest sense encompasses a whole ecosystem of support for people’s health and wellbeing in the community. It is a core priority for much of the voluntary community and social entrepreneur sector.

My seat of Rother Valley is a former coalmining area with deep pockets of poverty and deprivation, and many of my constituents suffer from lung conditions caused by exposure to harmful particulates in the mines. I have witnessed at first hand the poor health outcomes associated with a lack of access to high-quality green space, the mental and physical costs of social isolation from one’s community, and the price of late stage reactionary overmedication, in contrast to early preventive measures. In my experience, it is true that those at greater risk of poor physical and mental health are the most likely to benefit from green space, but the least likely to able to access it. Members of my family who work in the NHS have made me acutely aware of the pressures on the national health service from preventable conditions. I am thus determined to increase access to nature for left behind communities, and therefore to improve my constituents’ lives.

I recently announced my campaign for the creation of a Rother Valley leisure arc, stretching from Treeton dyke through Rother Valley country park via Gulliver’s Valley theme park resort, taking in the award-winning Waleswood caravan park and family favourite Aston Springs farm, to the Chesterfield canal, where I wish to see the construction of the Kiveton Park marina and the reopening of the nine-mile stretch of canal, including a Rother Valley link to the rest of the waterways system. The Rother Valley leisure arc aims to make Rother Valley the heart of tourism in South Yorkshire, bringing jobs, wealth and farming to our area. It will be a vibrant and dynamic leisure cluster, with provision for exercise and hobbies, physical and mental health, education and skills, business and employment, and tourism.

The Chesterfield canal is a crucial part of the Rother Valley leisure arc. Accordingly, I am pleased that the Canal & River Trust is focusing on the concept of blue health, which recognises the health and wellbeing associated with spending time by the water. The South Yorkshire and Bassetlaw integrated care system social prescribing pilot, funded by the Department for Environment, Food and Rural Affairs, seeks to better understand the best ways to connect residents with their local green spaces. Rotherham Titans rugby club also hosts a great social prescribing programme, which is already achieving great things.

Members and my constituents will know that I am a history buff, so it will be no surprise that I welcome the growing body of evidence about the wellbeing benefits of engaging with heritage and the historic environment. Local to Rother Valley, Heeley City farm’s community heritage team have engaged thousands of people from the Sheffield area, including many volunteers, work placements and general participants of all ages, in a variety of local heritage and wellbeing projects. In 2020, it played an important part as a community hub in Sheffield’s voluntary sector response during lockdown.

As a result of my strong belief in social prescribing, in April 2021 I founded the all-party parliamentary group on health and the natural environment to investigate the benefits that connecting with the natural environment might have on health and wellbeing. Recent sessions have focused on evidence and transforming delivery. We would welcome the Minister coming to speak at one of our sessions in the near future, if she is available. Our secretariat, provided by the National Academy for Social Prescribing, is working on fostering closer working relationships with other all-party groups that are focused on the theme of wellbeing, such as that of my hon. Friend the Member for Chatham and Aylesford (Tracey Crouch).

The National Academy for Social Prescribing, known as NASP, was established in 2019 by my right hon. Friend the Member for West Suffolk (Matt Hancock), who was then Secretary of State for Health and Social Care, to work with the NHS to accelerate the development and expansion of social prescribing activities delivered by voluntary organisations and community groups across the country. Over the past two years, NASP has worked with a wide array of partners to develop a number of ambitious and varied programmes.

One such programme is Thriving Communities, a national support programme for voluntary, community, faith and social entrepreneur groups. It works alongside social prescribing link workers to support communities impacted by covid-19 in England. Another programme is Accelerating Innovation, a partnership between NASP, the Royal Voluntary Service, NHS England and NHS Improvement that supports national voluntary organisations to develop their social prescribing ideas so that they can develop projects and approaches that have a greater impact and a wider reach, and that help to reduce health inequalities.

Furthermore, NASP has formed a Global Social Prescribing Alliance in coalition and collaboration with the World Health Organisation, the UN and the World Health Innovation Summit, with the aim of establishing a global working group dedicated to the advancement of social prescribing information, collaboration and innovation. The membership is currently 18 countries and growing. NASP is working through academic partnerships and NHS England to bring together leading researchers in the field of social prescribing to ensure that the evidence on it is accessible, useful and compelling. All of those programmes work closely with NHS England with a focus on outcomes for people, local systems and communities.

There are several areas of focus for my APPG and NASP in the coming months, in respect of forthcoming reports and policy developments. These include the implementation of the Government’s 25-year environment plan, the recently published Dasgupta review, the Environment Act 2021, the landscapes review by Julian Glover, and the Chief Secretary to the Treasury’s cross-Whitehall committee to set the direction for the comprehensive spending review on using access to outdoor spaces to support better health outcomes. I hope that the Minister will touch on those developments, and tell us more about their impact on the expansion of social prescribing in our health system.

As is relevant for all models of care, the Minister will be pleased to hear that social prescribing provides good value for money through reductions in GP appointments and financial savings in drug prescriptions and freed-up GP salaried time. For example, poor mental health is estimated to incur an economic and social cost of £105 billion a year in England, with treatment costs expected to double in the next 20 years. As for poor physical health, the cost of obesity alone to wider society is estimated at £27 billion. However, urban green spaces support 2.1 million people to adhere to their weekly physical activity guidelines, which is worth £5.6 billion and avoids health service costs of around £1.4 billion. These are good savings; they are better for people’s health and for the Government’s wallet.

A recent assessment of the economic impact of social prescribing by NASP, which drew on the best available evidence, concludes that social prescribing can be a cost-effective intervention that reduces pressure on primary care, especially GP services. NASP’s preliminary forecasts indicate that the NHS social prescribing link worker programme could save the taxpayer more than £480 million over three years by reducing the need for GP appointments, which would cover the total cost of the programme.

There is no doubt that investment in green space is good value for money. For example, a study into the economic values of Birmingham’s city-wide Be Active programme found that approximately £23 was recouped for every £1 spent, which is a huge return on investment. The valuation of urban parks in Sheffield, my constituency of Rother Valley’s local city, showed that for every £1 spent on maintaining parks, there was a benefit of £34 in health costs saved.

The Minister will appreciate that I have some policy asks of the Government to accelerate the development of social prescribing, in order to provide direct support for our recovery from the pandemic and the Government’s levelling-up agenda. To achieve these aims, I ask the Department of Health and Social Care to focus on eight main policy asks—so not too many.

First, we must accelerate the recruitment of social prescribing link workers, so that all 4,500 are in post by 2023. Secondly, we must ensure that the newly created integrated care boards have a duty to produce specific plans in their area for implementing social prescribing. Thirdly, we must build leadership, skills and capacity in the voluntary sector, by investing in NASP’s Accelerating Innovation and Thriving Communities programmes. Fourthly, we must commit to social prescribing being at the heart of the Government’s levelling-up and health inequality agendas.

Fifthly, there must be faster and greater levels of funding into social prescribing activities and services, particularly grassroots organisations such as charities, aligned to the health needs of the population within each of the 42 new integrated care systems. Sixthly, there must be greater investment in the digital infrastructure to facilitate social prescribing. Seventhly, every social care organisation and every hospital should have a dedicated team of social prescribing link workers. Eighthly and lastly, social prescribing needs to be integrated into the everyday processes of frontline health and care staff, to change the culture whereby it is easier and more natural to prescribe a pill than to make a social prescription.

It is clear that social prescribing can improve the physical and mental health and wellbeing of our population, improve people’s lives and save money. It not only helps to manage existing conditions, but addresses underlying issues that cause poor health and wellbeing, and so helps to prevent future illnesses. It is better to prevent future bad health than to cure it.

Social prescribing supports local projects in the community and fights social ills, such as loneliness and isolation, which traditional medicines do not address. By integrating social prescription into our health and care system, we will simultaneously save taxpayer money and take the strain off the NHS, freeing up capacity for essential treatment. Social prescribing has an enormous role to play in the future of health and care in England, so I am proud to be the first parliamentarian to make the case for it to the Minister.

Oral Answers to Questions

Tracey Crouch Excerpts

Tuesday 19th October 2021 Commons Chamber

[Sajid Javid]

I thank the hon. Gentleman for raising that case. I am very sorry to hear about his constituent Anne and send my condolences to her family for what has happened.

The hon. Gentleman will understand that, during the pandemic, sadly, many people stayed away from the NHS, on which there was a huge amount of pressure. Despite everyone, especially those working in health and care, doing as much as they could, it just was not enough for some people. There is not only emergency spending to deal with the pandemic pressures—this year there is an additional £34 billion—but much more investment in equipment and diagnostic processes, such as the community diagnostic hubs that we announced last week, which will help to make a real difference.

[Tracey Crouch (Chatham and Aylesford) (Con)]

Unsurprisingly, I have become more acutely aware of stories about backlogs in cancer diagnosis and treatment, the impact of which should not be underestimated, so I welcome the Secretary of State’s sensitive and sensible response. Will he join me in recognising the multidisciplinary teams throughout the country that are working non-stop to meet cancer pathway targets, including Maidstone and Tunbridge Wells NHS Trust, which continued to operate cancer services throughout the pandemic last year and has met the 62-day target for 26 months in a row? Will he consider a visit to the hospital that treated me and thousands of others, to hear how the team there continues to strive to achieve improvements in diagnostic services and outcomes for cancer patients in my constituency and others in Kent?

[Sajid Javid]

Yes. It is great to see my hon. Friend, who speaks with real knowledge on this issue. Not only would I be pleased to visit that hospital but I wish to join her in congratulating the multidisciplinary teams throughout the country—especially the Maidstone and Tunbridge Wells multidisciplinary trust—that have been doing fantastic work on cancer.

Oral Answers to Questions

Tracey Crouch Excerpts

Tuesday 23rd February 2021 Commons Chamber

[Nadhim Zahawi]

I am grateful for the right hon. Lady’s question. She and I visited the Hatzola first responders, who did an incredible job that Saturday night of vaccinating 364 people from not only the Haredi Hasidic Jewish community but the Muslim community as well. Our uptake plan has four key enablers: working in partnership with local government and directors of public health; removing barriers to access—in other words, access being available at the time and place that people need it; data and information, which we share with directors of public health, and we want to share it in more granular ways; and, of course, engagement, engagement, engagement.

[Tracey Crouch (Chatham and Aylesford) (Con)]

What plans he has to improve liver disease treatment pathways.

[The Minister for Care (Helen Whately)]

The NHS is working to improve care for patients with all types of liver disease. Development and improvement of clinical care is supported via NHS England’s hepatobiliary clinical reference group. This clinical reference group has started work on the development of liver networks in England to enable quicker access to specialised liver services, as well as providing clinical advice on disease prevention and referral practice.

[Tracey Crouch [V]]

Liver disease has become one of the major causes of premature mortality in the UK, and covid has highlighted the susceptibility of people with liver disease to more serious cases of the virus. With that in mind, what plans does the Minister have to include improvements to liver care in the NHS recovery plan?

[Helen Whately]

Last autumn’s spending review included £1 billion of funding to address backlogs, tackle long waiting lists and support up to 1 million extra checks, scans and additional operations in the NHS. As the NHS recovers, for liver care, as for other areas of treatment, we will look to not only recover backlogs but continue to improve the care provided and help people to live healthier lives to prevent illness in the first place.