NHS Outsourcing and Privatisation

Wes Streeting Excerpts

Wednesday 23rd May 2018 Commons Chamber

[Jonathan Ashworth]

My hon. Friend has, with great eloquence, explained why failing to plan properly on the workforce is such a false economy. It means that trusts are spending more and more on locums and expensive agencies.

I trust that no Conservative Member will try to pretend in this debate that it is possible to reduce beds, reduce staff, cut social care and fail to invest while patient numbers are increasing without the quality of care suffering. If any Conservative Member does try to tell us the opposite, they should look at the latest performance standards. The lack of hospital capacity and staffing means that the waiting list has risen to more than 4 million. Simon Stevens, of NHS England, has warned that

“on the current funding outlook, the NHS waiting list will grow to five million people by 2021. That’s an extra million people on the waiting list. One in 10 of us waiting for an operation—the highest number ever.”

The blanket cancellation of elective operations has seen waiting lists rise by nearly 5% compared with last year, and we have waiting times up and performance against targets down. In overcrowded A&Es, in the past year, 2.5 million have waited more than four hours. Just 76.4% of patients needing urgent care were treated within four hours at hospital A&E units in England in March—that is the lowest proportion since records began in 2010.

[Wes Streeting (Ilford North) (Lab)]

Of course, A&E waiting times would not be as long if the Government were investing properly in primary care. In my borough, we have the ludicrous situation of private companies advertising in London underground stations, saying:

“Fed up waiting? Our private GPs can see you now…ONLY £80”.

Does my hon. Friend agree that people should not be forced to pay £80 to see a GP, and they should not be waiting unnecessarily long in A&E because of the Government’s failure properly to fund and deliver the workforce that primary care needs?

[Jonathan Ashworth]

My hon. Friend has hit the nail on the head. The problem is that, when the Government allow our national health service to deteriorate by such a scale and push it into this level of crisis, they are essentially forcing people, often reluctant refugees from a public NHS, into self-pay options. That is what happened last time the Conservatives were in government and it is happening again.

Cancer Treatment

Wes Streeting Excerpts

Thursday 19th April 2018 Commons Chamber

[Heidi Alexander (Lewisham East) (Lab)]

It is a genuine privilege to speak in this debate, and I congratulate my hon. Friend the hon. Member for Croydon Central (Sarah Jones) and the right hon. Member for Old Bexley and Sidcup (James Brokenshire) on securing it. It is entirely appropriate that this debate has been led by two south London MPs. As a fellow south Londoner, may I start by saying what a special place in our heart is occupied by the very noble Baroness Jowell? There are some people we meet in life who radiate positivity, and Tessa is one of them. She has a lightness of step but a firmness of view that is a formidable combination; there was no way those Olympics in 2012 were going anywhere but London! It is right and proper that this House has the chance to debate her latest and perhaps most important campaign: the need to increase research on, and improve outcomes for, individuals diagnosed with brain cancer. The figures on research funding, and the availability of effective drugs and treatment, speak for themselves, and I will not repeat them, as I know time is short.

Last year, I lost two people close to me to cancer. One was my father-in-law, Nigel Ballantyne. I hesitate to say what I am about to say, as I have questioned whether my own grief has skewed my perceptions of the care that he received. I do not think it has. I also hesitate because I wonder whether today is the appropriate time to raise these issues, but I have concluded that Tessa would not want me to pull any punches.

My father-in-law was told that he had lung cancer when he was on his own, in a hospital bed, with only his mobile phone for company. There were complicating circumstances, but there were no excuses. He had struggled to get an appointment to see his own GP and had been passed from pillar to post for months—a situation admittedly not made better by the usual reticence of a 76-year-old man not wanting to cause a fuss, and his understandable desire to go on that holiday that he had been looking forward to. Having said that, the delay in his diagnosis and the way his diagnosis was delivered were unacceptable. He died six days before the general election last year.

Five months later, a good friend died at home after a long struggle. His wife speaks of how she had to fight tooth and nail to get palliative care support in place on the night he died. She described to me a ward that lacked sufficient nursing staff to administer injections without her physical help.

When the national cancer strategy talks about placing patient experience on a par with clinical outcomes and quality of life, it rings a bit hollow to me. I do not want to sound overly bleak, as I know that there are many wonderful examples of good care with positive outcomes, but we do need to be honest. We need to ask ourselves tough questions about how patients are treated on all steps of the care pathway.

Those living with cancer also need more support. Last Friday, my constituent, Amanda Mahoney, whose breast cancer has recurred four times in seven years, came to my advice surgery to ask me to campaign alongside her to change the face of cancer. She said:

“We’re not all bald, we’re not all having chemo. I don’t want to be told ‘sit on a park bench and wait till it gets you.’”

She wants to continue doing the job she loves—she is an outreach worker with autistic children—but her recurring experience has been employer after employer who does not know what to do and a benefits system that seems to make things harder, not easier.

This issue is not going away. This debate is the product of Tessa’s campaigning. She has been able to do what she does best—make her contribution by making those in power sit up and listen. She has been able to continue her working life. Others should be able to do the same, if that is what they want, and employers should be supported to make that happen.

There is so much more that needs to be said, but in the time available it is impossible to do this subject justice, so I will touch on just one other issue, which I know is also close to Tessa’s heart: our impending departure from the EU, which includes our probable departure from the European Medicines Agency and Euratom. Promises were made about extra cash for the NHS after Brexit, but, in stark contrast, Brexit has potentially huge negative implications for cancer research and treatment. We need urgent answers.

The continued ability of British cancer sufferers to participate in pan-European clinical trials is critical, especially for those with rarer cancers. We must ensure that we have a reliable supply of medical isotopes for diagnostics and treatments—that supply is at risk as we leave Euratom. We must not become a second-tier country for access to the newest and the best medicines. The next generation of immunotherapies holds great potential. We cannot willingly put ourselves at the back of the queue.

There are not yet answers to those questions, nor are there answers to the chronic NHS staffing crisis, which is exacerbated by Brexit, yet we are 11 months from leaving. We need a global, cross-border approach to research. We need to be a country that is open to talent and ideas from around the world. We need a properly resourced, adequately staffed NHS that is capable of embracing innovation.

[Wes Streeting (Ilford North) (Lab)]

Will my hon. Friend give way?

[Heidi Alexander]

I am drawing my remarks to a close.

It saddens me that we seem a long way from that aspiration, but if we are to honour the work of people such as Tessa and the memory of people such as my father-in-law, it has to be worth fighting for.

--- Later in debate ---

[Wes Streeting (Ilford North) (Lab)]

I rise today to talk about some very special people with an Ilford North connection. Perhaps even more impressive than crossing the party political divide in this debate, Tessa Jowell crosses an even greater political divide in London— the River Thames. I say respectfully to my hon. Friend the Member for Dulwich and West Norwood (Helen Hayes) and her constituents that we actually had Tessa first, because, in 1978, a fresh-faced Tessa Jowell embarked on a by-election campaign there. She was defeated, obviously, by the great tides of national politics of the day but, undeterred, she persisted in 1979.

What was so remarkable when I shared the video of Tessa Jowell speaking in the House of Lords in that powerful debate on cancer was just how many of my constituents responded, not just with great love and affection, but with strong memories of meeting Tessa during that by-election 40 years ago. That speaks so strongly of the warmth, empathy and infectious personality that Tessa has brought to her politics. As so many people have said, that certainly made its mark in so many ways on public policy in this country, but anyone who has ever met Tessa has been personally affected by her, and that is why we are all here today, determined to carry forward her legacy in such an important area.

I also want to talk about my constituent Kaleigh Lau. Today is a very special day for Kaleigh and her family—her father Scott, her mum Yang and her brother Carson. Two years ago today, Kaleigh was diagnosed with a diffuse intrinsic pontine glioma, or DIPG, which is a brain tumour located in the pons of the brainstem, for which there is currently no cure. At the time, Kaleigh and her family were told that life expectancy with DIPG was just nine months and that they should focus on making memories. Well, last month, Kaleigh celebrated her eighth birthday, and two years on from that awful day Kaleigh, her family and her huge band of friends and supporters are determined to make history, not memories, as they battle to defeat DIPG.

Their journey during the past two years has not been easy. I have followed the family through their tremendous ups and downs: the 30 radiotherapy sessions that young Kaleigh experienced between April and June 2016; that awful moment in December that year when Kaleigh was in progression, eight months in; the closeness with which Kaleigh almost got on to the convection enhanced delivery treatment programme through the compassionate treatment route, only to be told at the eleventh hour that the tumour had spread and CED would no longer be possible; the 10 more radiotherapy sessions that she underwent in January and February 2017; and the moment when Kaleigh’s condition declined to such an extent that the family took her on what they thought would be her last holiday, in March 2017.

Today is also an important day for the family because things changed a year ago today when Kaleigh began experimental treatment in Mexico. By her second treatment, she had regained all her functions. Five other UK families followed her to Mexico. Kaleigh was the first European to receive this treatment. More than 50 people around the world have now undergone the same treatment. None of this has been easy and we do not yet know whether this experimental treatment will be successful, but we know one thing for sure: if Kaleigh had stayed in the UK, she would not be with us today.

Kaleigh’s family have spent over £250,000 to fund her treatment so far, and her ongoing treatment costs them £15,000 every four to six weeks. I pay tribute to Kaleigh’s remarkably resilient family, particularly her father Scott, with whom I speak regularly. Scott has a full-time job and is a full-time dad. He is an utterly selfless human being, to such an extent that every time I call him back, without fail his first words are always, “Thanks for calling. I know you must be busy.” I am nowhere near as busy as Scott is, as a father trying to look after and care for his family on top of everything else that they are dealing with. This is why I address my remarks to Ministers.

I thank successive Ministers—most recently Lord O’Shaughnessy—for engaging with Kaleigh’s case, but they will understand the family’s frustration. After three meetings with the Department of Health, two online petition campaigns and a huge fundraising effort to pay for Kaleigh’s treatment, they do not feel that things are really moving forwards. As Scott says:

“How is the UK government going to help Kaleigh now? Not in the future, but now? Without funding we have no treatment. Overnight we have been forced to become an expert on DIPG, a carer, a fundraiser, a counsellor, an adviser, a leader, a beggar. But ultimately we need help from our government to take the burden off us so that we can focus on Kaleigh.”

There are just a few things that I want to say to Ministers in the short time I have left. We need to become a global leader in tackling DIPG, which has already taken over 200,000 children. We can do this through research, spearheading clinical trials and ensuring earlier access to treatment. We need to do more to ensure financial support to access experimental treatment. I understand the ethical dilemmas, particularly where experimental treatment is concerned, but we have to place greater trust in patients and parents who are willing to take risks.

[Siobhain McDonagh (Mitcham and Morden) (Lab)]

I am sure that everyone in the House is paying rapt attention to my hon. Friend’s explanation of Kaleigh’s care and determination, and that of her family. Will he conclude the story and tell us what is going on at the moment?

[Wes Streeting]

I am so grateful to my hon. Friend for that additional time.

If Ministers cannot fund treatment, let us at least look at funding the flights, accommodation and all the additional costs that families face. It was remarkable listening to the comparison between what Tessa has been through and what Kaleigh’s family have been through in this respect. We need better care plans, advice and guidance. Scott has to do it all himself, to such an extent that he has become an adviser to families around the world on top of looking after his own children. We need to do a lot more to ensure consistency.

[Caroline Flint (Don Valley) (Lab)]

My hon. Friend is coming up with some practical suggestions and creative ways of supporting such families. Does he agree that it is important that the NHS thinks sensitively and creatively about how it can support aftercare once Kaleigh and her family come home?

[Wes Streeting]

That is absolutely right. I pay tribute to Great Ormond Street Hospital and other great NHS services that have supported the family.

As my hon. Friend the Member for Croydon Central (Sarah Jones) said when she opened the debate, we have all been affected by cancer in some way. The worst experience of my life was losing my nan to cancer when I was aged 10. It is a great source of regret to me that I do not still have that great left-wing firebrand who occupied County Hall when Mrs Thatcher decided to shut it down, and allegedly threw a brick at the trucks as they rolled into Wapping. Some of that has rubbed off on me.

I hope that, in looking at what we can practically do to support families, Ministers have heard the powerful contributions made today. I want to say to Kaleigh’s family, to Tessa, and to other families who have been affected by childhood brain tumours that their strength, their courage and their resilience, but most remarkably of all, their enormous generosity of spirit in seeking to help others while they go through an enormous struggle themselves should be an example to us all. Tessa, that is the example that we are following today, and we are determined to make sure that our country gets this right for you.

Oral Answers to Questions

Wes Streeting Excerpts

Tuesday 20th March 2018 Commons Chamber

[Mr Hunt]

I congratulate my hon. Friend on being born five years before the NHS was founded—a very short while ago. Kent is an area that, although it is the garden of England, has some profound challenges in its health economy. One of those challenges is attracting doctors to work in Kent and other more geographically remote areas, so I am very hopeful that this big new announcement for the University of Kent will be a big help.

[Wes Streeting (Ilford North) (Lab)]

The GP-patient ratio in my constituency is unacceptably high, meaning that many people cannot get a GP appointment when they need it and they are turning up at the A&E—not only creating additional pressure but costing more in the process. What is the Secretary of State going to do to make sure that outer-London boroughs such as mine get the GP support that they need, because frankly, the assurances that he has already given are not manifesting themselves on the ground in terms of practical results for patients?

[Mr Hunt]

I appreciate that there are pressures in the hon. Gentleman’s constituency. I think most hon. Members would say that there are pressures in their constituency when it comes to general practice, so what have we done so far? Let me put it that way. This year, 3,157 medical school graduates will go on to specialise in general practice, which is the highest ever, but we still have to do more to improve the retention of GPs who are approaching retirement.

NHS Winter Crisis

Wes Streeting Excerpts

Wednesday 10th January 2018 Commons Chamber

[Mr Hunt]

I thank my hon. Friend for his work as a first responder; that is a fantastic example in his community. We have 1,700 more paramedics than we did seven years ago. My hon. Friend is absolutely right because the role of paramedics has changed dramatically over recent years. It used to be about scooping people up and taking them to hospitals; now, we are treating many more people on the spot. Paramedics have an extraordinarily important role, but it has changed. There is a changed emphasis, as in other parts of the NHS—a move towards doing as much as we can to treat people safely outside hospitals and to keep them at home, because we know that is the safest way.

[Wes Streeting (Ilford North) (Lab)]

I am grateful to the Health Secretary for giving way. The simple fact is that if we want more care in the community, the Government have to stop slashing social care budgets. If we want to stop people appearing at hospital with preventable conditions, we need to stop cutting public health funding. The Government do not have an economic record to be proud of, but even looking at the public spending that is being made, we see that the Government are penny wise and pound foolish.

[Mr Hunt]

I am sorry, but 3 million additional jobs have been created, so we do have a strong economic record, and that is why we have increased funding for social care recently. We have increased NHS funding significantly. As for slashing funding, the hon. Gentleman’s local trust received £9.7 million before Christmas.

Diffuse Intrinsic Pontine Glioma

Wes Streeting Excerpts

Tuesday 14th November 2017 Commons Chamber

[Ian Murray]

I thank the hon. Gentleman for his intervention. I shall come on to the subject of research and development. I have been in the House for seven years, and I live in hope of receiving a positive response from the Treasury Bench. Perhaps tonight we will get that far; indeed, I am sure that we will.

I welcome the research that is being done, but the current lack of sufficient research, available information, awareness of the condition and effective treatments can make DIPG all the more distressing for those diagnosed with it, as well as their extended families.

When it comes to treating the tumours, patients are usually offered courses of radiotherapy over three to six weeks. Because of the dangers of operating on such a critical area of the brain, surgery for some is simply not an option. In the UK, various studies show that chemotherapy is ineffective in treating childhood DIPG, although it is used in innovative ways in other countries, such as Mexico. I shall say more about that shortly.

Because the treatment options are extremely limited, the prognosis for children diagnosed with DIPG is poor. Although each child’s condition is unique, 70% of children with DIPG are not likely to survive for more than a year after diagnosis, and 90% do not survive for two years. The lack of knowledge of the condition means that children and their families are living from day to day. Greater investment in research on the condition might bring us one step closer to finding out more about the specific genes and molecules involved in DIPG tumour formation. That vital research could go on to create innovative new treatments, meaning that 40 more children each year—those who are struck down by the disease—could go on to become the doctors, scientists and even politicians of the future. It is important that we give those children the opportunities that they deserve, and give their families the hope that they need.

The famous astronaut Neil Armstrong’s daughter Karen died of DIPG 40 years ago at the age of just two, yet to date there have been very few advances in the treatment offered, which is devastating for parents. One such story is that of Luke Stewart. Luke is a seven-year-old boy who is happy, healthy, active, kind and caring. He comes from a loving family—mum, dad and two little brothers: Lewis, who is five, and Lochlin, who is just one. In January this year, their world was blown apart when Luke was diagnosed with DIPG. Doctors advised Luke’s mum and dad that he could survive for six to nine months if he received radiation treatment, the only option offered by the NHS in the UK. I cannot imagine what that kind of news does to a parent.

The family were informed that radiation treatment would prolong Luke’s life by only a few months, and that, although it would make him more comfortable, he would not survive. They were advised by the NHS that there were no other treatments available worldwide, or any clinical trials, that could help their son, and that on completion of the radiation treatment he would receive only palliative care. They were broken by that news, but they knew that they had to keep fighting for Luke, so they began to search for hope elsewhere. That was the start of their incredible journey to Mexico to save their son’s life. The journey to Monterrey began when, during a visit to the Chelsea football club training ground, they met a family from London whose daughter had the same condition. They had known of each other from Facebook conversations, but were totally unaware that both families would be at the venue at the same time. The London family were leaving for Mexico within days so that their daughter could receive a new, ground-breaking treatment.

That gave the Stewart family renewed hope. They researched the entire programme, which is called intra-arterial chemotherapy. Catheters are placed in the basilar and femolar arteries, and systematically deliver drugs approved by the Food and Drug Administration into the brain stem. The treatment has also been combined with intrinsic and T-cell immunotherapy. The Stewart family left for Mexico at the beginning of May, when they witnessed Luke’s condition deteriorating rapidly. This was the only hope that they had to offer him at that time: it was their last hope. Not only were they in emotional turmoil, having to deal with such a devastating situation, but they had to fundraise continually to secure money for the treatment.

[Wes Streeting (Ilford North) (Lab)]

The London family to whom my hon. Friend referred are constituents of mine, the Lau family. No one can imagine what a family goes through following a diagnosis of this kind, but I have been struck by how much more pressure is placed on families who are willing to move heaven and earth—and literally move across the earth—to ensure that their children have access to treatment that could potentially extend their lives, but at considerable cost. Does my hon. Friend agree that the Government should look urgently at what can be done to make sure that no families who can have access to treatment are prevented to do so by financial barriers?

[Ian Murray]

Absolutely, and that is one of my key asks of the Government. Indeed, when a family are put in a situation where they are about to lose their child, they only have the hope of trying anything they can find, and many families, including my hon. Friend’s constituents, have made the journey to Mexico.

When Luke arrived in Mexico with his family, it made him the seventh child worldwide to receive this ground-breaking treatment; he was also the second child from the UK. The website makingdipghistory.com is where people can see more about this condition and its history.

Luke’s clinical condition on his arrival in Mexico was extremely serious. This once active, confident and independent little boy could not walk properly, was constantly falling over, and was always tired, and his previously happy demeanour had changed completely. During this period, he regularly talked to his parents about dying—no words a parent should hear from their child.

The family spent four months in Mexico. During this time Luke received six IA treatments and four immunotherapy treatments. The costs associated with these treatments and all living and travelling expenses were self-funded by the family as the result of the generosity and financial support they received through their justgiving.com page.

During this period, Luke’s clinical condition improved dramatically; he was outgoing, happy, walking without any risk of falling over, running, playing with his brothers, communicating normally with his family, and making no further mention to his parents about dying. In the time that Luke had been receiving his treatment, his tumour had shrunk, the cancer activity was lower, his new cell generation was high, and his cyst had shrunk and become pure fluid. His clinical improvement means that he can live life as a seven-year-old in the knowledge that he is 11 months past diagnosis, a point at which the NHS said he would not survive. As if it was a miracle, he is now back at school. It is too soon to tell, but Luke’s improvement is an enormous step in the right direction. Cancer treatments are by their very nature evolutionary, so do we not need to embrace this treatment instead of ignoring it? Luke’s parents had no hope—their son would die. They had to at least try. Luke and his mum, and often his grandad, Robert, now require to go back to Mexico every five weeks for a period of five days to ensure that he continues to receive these ground-breaking treatments.

Before and after each treatment, Luke gives a sporty thumbs-up to tell the world on Twitter that he is okay, and now people from all over the world are posting selfies at #thumbsupforluke. We can follow everything about Luke at his Facebook page, “Help Luke make history”.

It is important to highlight the incredible resilience of families, just like Luke’s, who do not take no for an answer and carry on fighting, searching for access to treatments that could save their child’s life. The family have asked me to express their heartfelt thanks to all who have supported Luke’s crowdfunding campaign, which has managed to raise over £180,000 of the £350,000 to fund his treatment in Mexico. There is no NHS or other Government resources to financially support families when they have to have treatment elsewhere outside the NHS.

So what about the future? Not only do advances in research help progress new treatments, but that will also allow us to instil awareness of this rare condition throughout our healthcare system. This will help us improve the level of support we provide to the family. It is usually left to the parents and families to search the internet for ways to find help, with most healthcare providers in the UK left with their hands tied, with limited treatments to offer. As I have mentioned, Luke’s family were incredibly lucky to have such a successful crowdfunding campaign, but that is not available to everyone, and they still need more help.

The level of support for families is simply not good enough. We need extra support as soon as a child is diagnosed, and it must be support which recognises the fast-acting nature of the disease. Families will experience extreme pressure on their relationships, as they have to come to terms with understanding such a rare condition, as well as the huge financial turmoil that can come with a diagnosis. DIPG, as well as other childhood brain tumours, have a huge impact, and that is why I am asking for more investment, and more research and development to create that awareness and hope of a cure.

So may I ask the Minister to look at developing greater incentives for research and development into DIPG, so that families and children can access the support and information that they require at their time of need? May I also raise the critical issue of funding for research as a whole? Following a debate on childhood brain tumours in this House last year, it is very welcome that the Government set up a working group, looking at how to increase the impact and quantity of brain tumour research. I look forward to the group’s second report, which is due to be released imminently; perhaps the Minister can give us some guidance about when this report might be released.

I acknowledge that a significant amount of money is already contributed through the National Institute for Health Research and the Medical Research Council, but much more needs to be done, and quickly. I hope that the Budget at the end of this month will contain an allocation for this kind of research. Some progress is being made with a programme called Instinct, involving pioneering research by experts from Newcastle University, the Institute of Cancer Research and the University College London institute for child health, which looks at high-risk childhood brain tumours, including DIPG. This extremely important effort is led by Dr Chris Jones, who has extensive experience in understanding the genetic basis of these tumours and what is driving tumour growth.

Can the Minister confirm that when the UK leaves the European Union, the UK medical research community will continue to have access to critical EU funding and collaborative programmes once Horizon 2020 has ended? Given Luke’s example, and the fact that the family have had to go to Mexico, it is essential that co-operation on research is global, so that every child in need of help can access it, no matter where they are. Could Luke’s case be the pathway for better treatments and understanding of DIPG here in this country?

The number of children dying from cancer each year in the UK has fallen in the last 20 years, but we must not stop here. Research is the key to our progress. It is not right that the rarer a cancer is, the less attention is paid to the funding of research. There must be a unified approach in applying the progress that is made. The rarity of such conditions means that they accumulate to a far smaller market for pharmaceutical companies, which tend not to supply the drugs that are required. Research and development is difficult, particularly in relation to children.

I know that it would mean a lot to Luke and his family if the Minister or even the Prime Minister could meet them to talk about their experiences and listen to their views on how research, funding and information in this area might be improved to secure a better future for all children with DIPG. Will the Minister make that commitment to meet the family? I would like to finish by paying tribute to the resilience of Luke and his family, and of all the other families who continue to fight for their children. I hope that this debate has made a small dent in raising awareness of DIPG and other killer cancers in children. Luke has a chance, his parents have hope, his extended family have pride, and we all watch and admire their strength, resilience, dignity and love for Luke. Let us use this half hour of valuable parliamentary time to make a difference to all families who are affected by DIPG and similar diseases, and to give those children hope.

--- Later in debate ---

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

I pay tribute to the speeches of the hon. Members for Edinburgh South (Ian Murray) and for East Lothian (Martin Whitfield). The House needed to hear about the bravery of Luke and Alex, and no one could fail to be moved by their courage and the courage of their families or by the commitment of the community in raising the much needed funding for their treatment. I thank both hon. Gentlemen for bringing those stories to life, and my thoughts go out to the brave boys and their families and friends. I agree with everyone who has spoken that research is crucial in the fight against cancer, and childhood cancers in particular. Nobody wants to hear the news that those families heard about their children, but the fact that they are approaching things with so much hope is quite inspirational, and I have the utmost respect for them.

To bring the House up to date with what the Department of Health is doing, research is absolutely critical, which is why the Department invests a billion pounds a year in health research through the National Institute for Health Research. The Department also works closely with a wide range of partners for research funding. Spending on cancer research specifically has risen to £137 million in this financial year, which is the largest NIHR spend in any disease area. However, the challenges of increasing research into brain tumours persist, and I wholeheartedly agree that that research is essential in order to improve treatment for sufferers and their families. The hon. Member for Edinburgh South referred to the Westminster Hall debate on brain tumours in 2016, and the Department has established a task and finish group on brain tumour research to investigate what more can be done. I am pleased that that report will be published before the end of the year. It has been slightly delayed—not because we are obfuscating, but because its impact can be increased by taking a little more time. I hope that that will reassure hon. Members.

The hon. Member for Edinburgh South and the hon. Member for Ilford North (Wes Streeting) both referred to the treatment in Mexico experienced by their constituents, and I acknowledge that that has come at great expense to the families and could not have happened without the generosity of the many people who have been inspired by the stories. I can tell the House that leading experts from Great Ormond Street and Alder Hey Children’s Hospital, as well as their colleagues from Europe and the USA, have reached out to the team in Mexico to better understand the treatment that is being given to patients. Without further data and discussion, it is not possible to say whether the exact treatment being offered in Mexico could be considered in the UK as part of a clinical trial, but I can assure the House that there is certainly an openness among UK experts to understand more about the treatment, which I hope will be welcomed.

[Wes Streeting]

I am grateful to the Minister for giving way on that point. One of the important functions that Great Ormond Street provided for Kaleigh Lau’s family was support when she was back in the UK. Immense pressures on Great Ormond Street at one point meant that a lack of access to beds and support led to a delay in her being admitted to the hospital. Will the Minister ask her officials to look at that particular issue? The nature of the condition and the time pressures—there is often a lack of time—make some of those delays even more stressful to the family. The Minister ought to probe and examine that issue.

[Jackie Doyle-Price]

I acknowledge the hon. Gentleman’s point, but the stress would be removed if we could actually investigate whether the treatment could be offered here, rather than have people travelling to Mexico. My priority will be to encourage discussions to enable that to happen.

Turning to some of the research that is happening at Great Ormond Street, which is the centre of excellence where we want childhood cancers to be tackled, research is being undertaken to develop T-cell immunotherapy delivery to tumours and selective therapies based on the molecular profiles of tumours. The research centre at University College London is also researching tumour markers and drug uptake. I am pleased to say that the NIHR clinical research network is supporting the NHS to deliver three clinical trials of new treatments for children with diffuse intrinsic pontine glioma. In the summer, Cancer Research UK announced its intention to fund up to two brain tumour centres of excellence to support multidisciplinary research, and the NIHR stands ready to provide full support to those new centres, together with other centres already funded by other charities, in delivering their research in the NHS. The working group is chaired by Professor Chris Whitty, the Department’s chief scientific adviser. The report is being finalised, and it should be ready before Christmas.

We know that early diagnosis is essential for all cancers if we are to provide the best treatment and support from the very start. I therefore welcome initiatives such as HeadSmart, which is working to increase awareness of the common signs and symptoms of brain tumours in babies, children and teenagers. The Department encourages the use of that initiative by professionals to signpost specialist advice, if needed, and the Department has promoted the awareness campaign with colleagues in NHS England, health visitors and school nurses.

The Government are also funding a radical upgrade of equipment to treat cancer, including £130 million to modernise radiotherapy across England. In April 2012 the Government announced a £250 million investment to build proton beam therapy facilities at the Christie Hospital in Manchester and at University College London Hospitals. The more precise targeting of radiotherapy afforded by this treatment means that higher doses can be delivered with fewer side effects and fewer long-term consequences, which is particularly important for paediatric patients.

We support the Less Survivable Cancers Taskforce, which also launched earlier this year. The taskforce aims to raise awareness of five cancers, including brain cancer, where survival rates have remained stubbornly poor for decades. The taskforce is also working to increase the number of clinical trials and treatments approved for those cancers as well as the level of research invested in them.

Despite the difficulties involved in researching new treatments for diffuse intrinsic pontine glioma, important studies are under way.

King George Hospital, Ilford

Wes Streeting Excerpts

Monday 10th July 2017 Commons Chamber

[Mike Gapes]

The ongoing social care crisis poses major difficulties. We all know that private care homes are struggling and that there is an issue of quality. It seems to me that one advantage of the King George Hospital site is that it is co-located next door to the facilities of the North East London NHS Foundation Trust’s Goodmayes Hospital and various other facilities that provide support for people with learning difficulties and people with acute, severe and less severe mental health problems. It would seem logical, if we are to have joined-up NHS treatment, to have alongside a hospital facilities for those who need short-term, temporary or longer-term care in transition to or from the NHS facilities next door. The site is big enough to do that and, with imagination, could be a model to be followed.

We also have a third cloud on the horizon, which is the north-east London draft sustainability and transformation plan. The Minister will recall that he and I had a very useful meeting in February, along with his then colleague, Mr David Mowat. We had a useful discussion about the implications of the huge deficit in north-east London—£586 million—the potential huge cuts in the budget over the next four years, and the implications they might have. I raised the issue in detail in a debate on 16 December 2016 and that was why I had the meeting with Ministers.

I am very concerned that the funding gap, even if we have predicted regular savings of about £220 million or £240 million in the NHS, would still be £336 million by 2021. One of the most worrying points about the plan—I understand it is still a draft and has not been signed off—is that I went to a meeting last week when the people involved in the organisation considering the plan were discussing it and senior figures in the London NHS referred to it, saying, “You have to work within the basis of the plan.” It has not been signed off or approved, but the people in the NHS health economy in London are thinking ahead as though it will be.

The plan points out that the population of the north-east London boroughs will increase by 18% over the next 15 years, equivalent to a new city. Normally that level of population increase would require a new hospital, but there is no provision, no funding and no expectation of a new hospital. Instead, the proposal is to downgrade King George Hospital in my constituency and take away its accident and emergency department. That is still in the plan, and it is not a new proposal. In fact, I have been campaigning to save the A&E in my constituency for more than 10 years. But the formal decision was taken by the former Health Secretary, Andrew Lansley, only in 2011. That decision, which was linked at the time to a suggestion of closing maternity services at King George Hospital, provided that those two things would happen in around two years. That was in October 2011.

The reality is that maternity services went to Queen’s Hospital in early 2013—I do not question that there have been improvements—but the A&E could not close as there was no capacity at other hospitals in the region. In addition, it was quite clear that it required huge capital investment, which was not forthcoming. The decision was made in 2011, but in 2013 there was no action and the issue was deferred. The trust then went into special measures three years ago because of a variety of issues, which I have already mentioned.

As the trust comes out of special measures, the question becomes whether it will go ahead with the plans to close the A&E. Practically, it is impossible for that closure to happen soon, but the sustainability and transformation plan still states that the intention is to close the A&E in 2019. The original suggestion was that it would stop the 24-hour service, getting rid of the overnight A&E from September this year. That plan was dropped in January, and I welcome that, but the reality is that it is still in the plan and is still proposed. That cloud still hangs over the trust and all its excellent staff, who have done so much to bring our hospital out of special measures.

[Wes Streeting (Ilford North) (Lab)]

I congratulate my hon. Friend on securing this important debate. In my capacity as a Labour councillor in the London Borough of Redbridge, I currently chair a cross-party working group on the future of A&E provision in north-east London. One frustrating thing is that all the local health leads in the area are working to a decision made by a previous Secretary of State. That ministerial decision still stands and the leads have to work towards it. They do not believe that is achievable or clinically sound. Yet, they point to the Secretary of State when pressed to abandon the plans. I hope that the Minister might be able to reverse that ministerial decision and remove the sword of Damocles from our A&E department.

[Mike Gapes]

I am grateful for that intervention as it saves me from making the same point. During the election campaign, the Secretary of State went to my hon. Friend’s constituency for a private Conservative party function. He was asked by the local paper, the Ilford Recorder, about the plans to close the A&E at King George Hospital. He said that there were no plans to close it in the “foreseeable future”. Now, I do not know how big the crystal ball is. I do not know what kind of telescope the Secretary of State has and which end he is looking through. The fact is that “foreseeable” does not necessarily mean that the A&E will not close in 2019. If it is not going to close in the near future or even in the medium term, why not lift the cloud of uncertainty over the staff and over the planning process? Then we could have a serious look at the draft sustainability and transformation plan for north-east London, which is partly predicated on the closure of A&E at King George Hospital.

In January, the trust wrote a letter saying:

“It is our intention to make the changes by 2019 but please be assured nothing will happen until we are fully satisfied all the necessary resources are in place, including the additional capacity at the neighbouring hospitals, and we have made sure it is safe for our patients. In the meantime, the existing A&E facilities at King George will continue to operate as now.”

The reality is that there is no additional resource in terms of the capital that would be required to provide the beds for 400 patients at King George overall. We face a very uncertain future. If the A&E closed, where would those patients go? There would be a need for capital investment at Queen’s and for big capital investment at Whipps Cross. That would take time and resources, at a time when NHS budgets are seriously pressed. And we still have that huge deficit in our regional health economy.

Why not take that issue off the agenda? Last month, my hon. Friend and I jointly wrote a letter with the leader of Redbridge Council, Councillor Jas Athwal, to the Secretary of State. We requested that he formally reverse the decision taken by his predecessor, to allow certainty and to allow more sensible planning.

Last week, one of our health campaigners, Andy Walker, who put in various questions and freedom of information requests—he is a very persistent campaigner—received a response from the Barking, Havering and Redbridge trust, commenting on this issue. It used the same formulation:

“We have been very clear that no changes will be made until we have the relevant assurances that it is safe to do so and this remains the case.”

That formulation has been used for several years; it is like a stuck record. It is not safe to make the changes. Why not have a new, imaginative approach that says, “Let’s look at social care. Let’s look at the potential for developing the site. Let’s look at collaboration between the mental health services of the North East London NHS Foundation Trust. Let’s look at providing particular forms of housing and support.” This area could be a model for a new way forward.

I know from discussions I have had that people in various NHS organisations are working on such possibilities, but they cannot go any further than possible explorations while this cloud—the threat to close the A&E—still lies on the table. If the Secretary of State would take it off the table, we could have some serious discussions about improvements to health facilities. We could deal with not just the A&E but other issues.

On the King George site at the moment, we also have an urgent care centre. It recently had a Care Quality Commission inspection and was rated as “requires improvement”. That is an indication, again, of the problems we face. I have a lot of inadequate GP facilities in my constituency; I have lots of problems with people coming to me complaining that they cannot get through. Primary care in north-east London faces a crisis of retention, recruitment and standards of services. If we could make imaginative use of the facilities at the King George Hospital site, we could make a big difference to primary care, as well as to the acute services and the mental health services next door.

My plea to the Minister and the Government is this: take the closure of the A&E off the table, and let us then work collaboratively to improve the NHS in north-east London and in my constituency.

[The Minister of State, Department of Health (Mr Philip Dunne)]

It is a pleasure to serve under your chairmanship, Mr Speaker, and to contribute to another debate introduced by the hon. Member for Ilford South (Mike Gapes). I congratulate him on his tenacity in keeping the subject of King George Hospital at the forefront of Health Ministers’ minds in recent years, not least during my tenure. As he rightly said, he and I had a meeting in February with my former colleague, David Mowat, to discuss many of the issues that he has raised this evening. I therefore hope that he will forgive me if he has heard some of my remarks before. I congratulate the hon. Member for Ilford North (Wes Streeting) on joining us. He obviously has experience of these matters as well, given his role in the local council.

I join the hon. Member for Ilford South in paying tribute to the achievement of all the staff and management involved at Barking, Havering and Redbridge University Hospitals NHS Trust in exiting special measures after what has undoubtedly been a long journey for them over the past three years. I was very pleased that they were able to exit special measures in March of this year. That is a huge tribute to everyone involved in ensuring that they were focused on the areas where the CQC had identified what was not best practice. They have focused on improving the deficiencies, and the fact that they were awarded an “improved” rating enabled us to take the decision we did. I also join him in congratulating the quality of management now substantively in place within the trust, at least one of whose members has himself been a beneficiary of treatment locally; I think it was for a different complaint from the one that the hon. Gentleman was treated for in the intermediate treatment centre. That was a very substantial experience, and all credit to that member of the executive team.

The hon. Gentleman touched on a couple of clouds, as he described them. The first was the intermediate treatment centre, which conducts elective and planned procedures provided by an independent provider, Care UK. As he will appreciate—in fact, this took place under the previous Labour Government, when the independent sector provided capacity to support the NHS in a number of areas—we have had a policy of allowing independent providers to be commissioned to undertake care, and it is a matter for the local commissioners in his area to do so; it is not for me to tell them who are the best providers to be able to undertake care. I am very pleased that he was a beneficiary of some of that care. It will be up to the commissioners, working with the NHS, to decide who is best to provide services in his area as they come up for renewal from time to time.

The hon. Gentleman referred to the social care challenge that exists in north-east London, as it does in many other parts of the country. That is why we decided in the Budget in March this year to inject an additional £1 billion into the adult social care budgets of local authorities across the country and a further £1 billion in the next financial year. Moreover, last week, we announced some measures to scrutinise the performance of local authorities in managing those budgets—in particular, so that they contribute to the patient flow challenge, which we experience in many of our hospitals, including the King George: patients occupying hospital beds in acute settings who have no medical reason to continue to be there, because of the challenge of providing placements in the community. It is important that there is closer integration with social care through the local authorities, but also, as he rightly identifies, through other NHS providers, particularly if they are co-located on the site. He mentioned what he describes as an opportunity for the North-East London NHS Foundation Trust to work alongside Barking, Havering and Redbridge University Hospitals NHS Trust to try to smooth the passage and find other opportunities in the community for more appropriate flow. That is very interesting and I hope he is engaging with the leadership of the sustainability and transformation plan and proposing imaginative ideas, in the hope that they will be assessed appropriately when consideration is given to the provision of the future pattern of healthcare in his area.

The hon. Gentleman focused mostly on the challenge to A&E at King George. I will spend most of the rest of my remarks addressing his concerns as best I can. He will appreciate that, across the country, the NHS is coming together, through the STPs published at the end of last year, to identify the right pattern of care across an individual NHS footprint. North-east London has come together with the STP for that area. Our view is that that is the right way to encourage a more holistic approach to the future provision of NHS services. It needs to be led by clinicians and those responsible for managing NHS organisations, and it needs to work in a collaborative and perhaps more open way than it has in the past with local authorities, which have a part to play, as I have said, in facilitating the passage beyond hospital and back into the community.

We are absolutely clear that any significant service change that arises out of the implementation of STPs, if they get to that stage, must be subject to full public consultation, and proposals must meet the Government’s four reconfiguration tests, which are support from clinical commissioners, clarity on the clinical evidence base, robust patient and public engagement, and support for patient choice. Additional NHS guidance means that proposed service reconfigurations should be tested for their impact on overall bed numbers in the area, which the hon. Gentleman has identified appears to be absent from the STP at present. I urge him to continue to challenge that in his area.

[Wes Streeting]

Will the Minister clarify whether he expects the STP process to now publicly consult on any future proposal to close the A&E at King George Hospital? Furthermore, were the STP to recommend to Ministers that the A&E should remain, will they heed that advice and agree that the STP process should not be constrained by the decision made in 2011by the then Secretary of State?

[Mr Dunne]

I am going to have to disappoint the hon. Gentleman, because I am not in a position to second guess the conclusions of the STP discussions and recommendations. It is appropriate for them to take into account clinical decisions made in the recent past, one of which is the decision about the A&E at King George. It is up to the STP management to decide whether to take that forward as the STP evolves. It is right that the STP management looks at health provision in the round. It will be responsible for delivering healthcare to local residents and it needs to take into account all the information sources available to it. I do not think it is right to say that it necessarily has to re-consult on certain issues. It needs to form a view on the right configuration and then use its available data sources and go through the processes.

I will try to explain to the hon. Gentleman the process that, as I understand it, is now under way in his area. Both hon. Gentlemen are right to say that, in 2011, on advice from the independent reconfiguration panel, which approved the proposal, the then Secretary of State took the decision that the north-east London scheme should be allowed to proceed. The Secretary of State made it clear at the time—it has since been repeated in response to questions about the health authorities in the area—that no changes were to take place until it was clinically safe to do so. I believe that remarks that the Secretary of State might have made when visiting the area recently must be considered in that context.

There have been a number of changes since the decision was made, and there are four elements to the process. First, the STP team is reviewing and revalidating the modelling used back in 2010 to ensure that the proposals that were made remain appropriate, as one would expect the team to do. Secondly, the governing members of the CCG board, the trust board and the STP board will need to agree the business case that arises from the STP recommendations. Thirdly, if that is achieved, NHS England and NHS Improvement will be required to approve the business case. Finally, it is envisaged that a clinically led gateway assurance team—an NHS construct —will manage a series of gateway reviews at different stages of the process from planning to implementation, as the project proceeds, to assure system readiness and patient safety at every step of the way, should the decisions necessary to get there be taken in the intervening period.

[Mr Dunne]

I will have to disappoint the hon. Gentleman, because it is not for me to prejudge how long the process would take. In all honesty, I think it is most unlikely that it would be completed in less than two years. It is conceivable that it would be concluded by the end of 2019, but a two-year process is likely to be required as a minimum.

In the meantime, CQC visits and reports will continue on a routine basis. Now that the trust is out of special measures, those visits will be somewhat less frequent than they were while the trust was in special measures. Any information coming out of that process will inform decisions taken by the trust and the STP area.

In my final comments, I want to reassure the hon. Gentlemen and their constituents that the proposals include a new urgent care centre at King George Hospital to provide emergency support to local residents for the majority of present A&E attendances. Blue-light trauma and emergency cases requiring full support from emergency medical teams would be taken to other hospitals in the area, but the majority of cases currently treated at King George would continue to be treated there. The new urgent care centre would benefit from several improvements, including more space and access for diagnosis, X-ray, blood tests and so on. I hope that that gives the hon. Gentlemen some reassurance that the facilities that remained at King George would continue to provide the majority of their constituents with the care that they would need in an emergency.

[Wes Streeting]

Is the Minister saying that the STP process should not be constrained by the 2011 decision if those in charge of the process think that that was the wrong decision?

[Mr Dunne]

The process should be informed by the decisions taken in 2010, but it will be up to today’s STP leadership to decide what to do.

Question put and agreed to.

Oral Answers to Questions

Wes Streeting Excerpts

Tuesday 4th July 2017 Commons Chamber

[Wes Streeting (Ilford North) (Lab)]

The fact is that when the Government chose to charge students record levels of tuition fees and scrap their NHS bursary, the Secretary of State and his Ministers were warned that that would lead to a fall in the number of applications, and what has happened since then? The number of applications for nursing degrees has fallen by 23%. Given that the Secretary of State has already acknowledged that we cannot continue our over-reliance on EU staff following Brexit, when will Ministers understand that the biggest challenge facing nursing recruitment is not our policy on the EU, but the Government’s own health policies?

[Mr Dunne]

The hon. Gentleman is right to draw attention to the fact that we continue to have a surplus of applicants for nursing degree courses in this country. The level of that surplus has fallen somewhat as a result of the change in funding structures. We shall have to see where it ends up, because at present universities are not recruiting directly outside the UCAS system, but we are confident that there will be more applicants than places this year by a ratio of some 2:1.

Agenda for Change: NHS Pay Restraint

Wes Streeting Excerpts

Monday 30th January 2017 Westminster Hall

[Catherine McKinnell (Newcastle upon Tyne North) (Lab)]

I beg to move,

That this House has considered e-petition 168127 relating to pay restraint for Agenda for Change NHS staff.

It is a great pleasure to serve under your chairmanship, Mr Evans. At a time when the number of deeply concerning and time-consuming issues on the international political agenda is increasing, it is important that we and, most importantly, the Government do not lose focus on our domestic priorities and the challenges affecting our constituents’ day-to-day lives. The national health service is at the very top of that list, so I am pleased to introduce this debate. The way we treat our NHS staff is surely one of the most decisive factors in whether we have the functioning health service that we all need.

The petition is titled:

“Demand an end to the pay restraint imposed on agenda for change NHS staff.”

It has been signed by more than 104,000 people across the country, including 4,500 from my region, the north-east. It reads:

“Agenda for change staff including nursing, midwifery, healthcare assistants and associated healthcare professionals have suffered a pay restraint since 2010. Losing approximately 14% in real terms of their pay, staff are struggling nationwide and many have been pushed into poverty.

The impact of the pay restraint is harsh. Many are sadly leaving the professions they love. There is an NHS staff crisis. In London we lack 10,000 nurses. Yet two fifths of nurses living in the capital plan to leave as they are unable to pay their rent. Staff reporting using food banks and hardship funds is increasing. The pay restraint must end.”

The petition’s creator, Danielle Tiplady, a nurse and supporter of the Royal College of Nursing’s “Nursing Counts” campaign, said:

“Nursing staff deserve a pay award that reflects our knowledge, skill and dedication.”

She added that the interest in her petition

“is a huge achievement, but colleagues are struggling to pay bills and even turning away from the profession, and it’s time Parliament debated why.”

[Wes Streeting (Ilford North) (Lab)]

Danielle Tiplady is one of my constituents, and I am proud that she started the petition. The Royal College of Nursing’s most recent employment survey of its members found that 30% had struggled to pay gas and electricity bills, 14% had missed meals because of financial difficulties, and more than half had been compelled to work extra hours to increase their earnings. Given the demands of the type of work that nurses do, does my hon. Friend agree that our nursing profession is in a terrible place and that the Government surely must act?

Child Cancer

Wes Streeting Excerpts

Monday 28th November 2016 Westminster Hall

[Wes Streeting (Ilford North) (Lab)]

It is a pleasure to serve under your chairmanship, Mr Davies. I thank the hon. Member for Bath (Ben Howlett) for opening the debate so well, and I thank other hon. and right hon. Members who have spoken. We are here this afternoon because of Andrew Barnard, who lost his daughter Poppy-Mai to a brain tumour. We owe a particular debt of gratitude to him for the effort that he put into campaigning on behalf of so many other children whose lives will sadly be blighted, and even tragically ended, as a result of childhood cancer. The theme of families and the courage and bravery that they show in campaigning, not only for their own children but on behalf of so many others, is a theme I will return to.

I want to raise three issues during this afternoon’s debate: first, the extraordinary courage and resilience of families and the need to support them; secondly, the importance of awareness and early diagnosis and intervention; and thirdly and most importantly, the need for research so that we can reduce and even eradicate the number of children dying needlessly from cancers that will be found to be curable.

I am here this afternoon because of my six-year-old constituent, Kaleigh Lau, and her remarkable family, Scott, Yang and Carson. Like most girls her age, Kaleigh is active and fun. She enjoys dancing, singing, swimming and playing with her friends. In April, things changed for her. She complained of double vision, and her family noticed that there was a problem with her eyes. Fortunately, they took immediate action and took her to Moorfields eye hospital. After some initial checks, there was found to be no problem with her vision, so on the same day she was referred to the Royal London hospital for a CT scan and an MRI scan.

When a lump on Kaleigh’s brain was identified, she was immediately referred to Great Ormond Street hospital, where two days later she was diagnosed with a rare form of childhood brain tumour called a diffuse intrinsic pontine glioma. It is a brain stem tumour that mostly, although not exclusively, affects children. It is estimated that fewer than 40 children a year develop them in the UK and that they account for just 10% to 15% of all brain tumours. They are high-grade brain tumours that are fast-growing and can spread throughout the brain stem. As a result, they are difficult to treat and have a poor prognosis. The main treatment offered is radiotherapy. The tumours are not suitable for surgery because of their location in the brain stem, and chemotherapy has been shown to have little effect, but research in that area is ongoing.

[Seema Kennedy]

The hon. Gentleman’s constituent has exactly the same brain tumour as my constituent, Katy. Although only 40 children a year develop such tumours, they are primary school children with a whole lifetime ahead of them. Research in that area would pay dividends, because although 40 is a small number, those children could go on to be productive members of our society. The important point is that they have a lifetime ahead of them.

[Wes Streeting]

I wholeheartedly agree, and I will come on to talk about the personal impact that such a diagnosis can have on families.

As the hon. Lady knows, the prognosis is poor. Only 30% of children with DIPG are likely to survive for more than a year after diagnosis, and 90% do not survive for two years. According to the Minister’s response on 13 September to a written question that I submitted, there has been only one UK trial relating to DIPG. Although there are some great initiatives—particularly the INSTINCT project, which brings together experts from Newcastle University, the Institute of Cancer Research, and the University College London Great Ormond Street Institute for Child Health in London—we have yet to find a cure.

Dr Darren Hargrave at Great Ormond Street is leading a new clinical trial to test three new drugs in 150 children affected by DIPG. Professor Chris Jones and his team at the Institute of Cancer Research have found links between the genetic faults in the DNA of children with DIPG and people with stone man syndrome. Lots of work is being done on the links between DIPG and other diseases, but it has yet to lead to a cure. There is some hope that the work being undertaken by Professor Steven Gill, who is leading a team based at the Harley Street Clinic to develop a treatment known as convection-enhanced delivery, may produce a treatment that leads to an extension of life, as some of the initial experiments have shown. It is hoped that CED might lead to a cure, but the overall outlook for those children is not positive.

As the hon. Lady said, the number of children affected in the UK is relatively small, but the impact on them and their families is simply unimaginable. Without being from a family that has been directly affected by a childhood brain tumour or another form of childhood cancer, it is impossible to know what those families go through. I have been given some insight through the work I have done with my constituent’s family—particularly her father, Scott.

We need early diagnosis. The swift response of Kaleigh’s family and the hospitals that she visited enabled an early diagnosis. I pay tribute to the clinicians and staff of Moorfields eye hospital, the Royal London hospital and Great Ormond Street hospital, and, in particular, to Kaleigh’s family. When families are affected in that way, it has an impact on the whole of family life. So many anxieties, issues and day-to-day challenges are thrown up. Is the cough or cold that the child is experiencing simply a winter condition, or is it something more serious? Most parents would not be worried when their child comes home after a fall or a scrape at school—they dust them off and it is fine—but so many of these parents have to worry about what caused the fall. Was it an innocent childhood accident or something more worrying?

There are some fantastic charities that provide support to the families that are affected. In my constituency, Hopes & Dreams provides dreams to children with life-limiting or terminal illnesses. It enabled Kaleigh and her family and friends to go to Center Parcs, which gave the family welcome respite and gave Kaleigh the opportunity to enjoy herself with her family and friends in the way she normally does.

I have also had to see Kaleigh’s family battle for information—in particular, about accessing some of the experimental treatments that are available. They have had to battle on numerous fronts. They have battled against bureaucracy and tried to navigate their way through the system, and getting partners and agencies to work together to ensure their child is at the centre of health managers’ and clinicians’ thinking has been a particular challenge.

There is also the issue of money. Kaleigh’s family raised considerable amounts of money through both the generous support of family friends and members of the public, and their own finances. I am struck by the concern that her father raised about the families who are not in the same position, do not have access to a network of support and have not been able to find funding. It is simply not right that some families lose out because they do not have the money or are not able to raise the funds needed to access treatments that could lead to an extension of life or a cure. I hope the Minister will address the issue of what we can do to ensure that access to treatment—experimental treatment and clinical trials—is not limited by families’ wealth.

I also want to raise the issue of funding for research. I pay particular tribute to Kaleigh and her family. I am in awe of the fact that, amid all the day-to-day challenges that her condition presents and the battle to ensure that she gets access to treatment that could alleviate her symptoms and extend her life, Kaleigh’s family and Kaleigh herself have engaged so energetically in a campaign for more funding for research into DIPG and other forms of childhood brain tumours. In the past few months, they have engaged a range of celebrities. JK Rowling supported their petition, and for the past two weekends Kaleigh has been touring “The X Factor” studio, signing up a range of the finalists to tweet the petition. She has got members of the cast of “The Only Way is Essex” on board—they are an Essex family, and I am an Essex MP. The cast are supporting our local family, which is fantastic.

I have been overwhelmed by the number of right hon. and hon. Members who have wanted to support Kaleigh’s campaign by having a picture taken with the Kaleigh bear, which has been on tour around Parliament, and by tweeting links to the petition for more Government funding. We have also had great support from our local newspapers—the Ilford Recorder, the Wanstead and Woodford Recorder, the Wanstead and Woodford Guardian and the London Evening Standard. I thank them for their support in raising awareness of Kaleigh’s campaign in search of more funding for a cure.

It is very welcome that the Government have a working group, which we hope will report in 2017, to look at how to increase the impact and quantity of brain tumour research, but however much effort they are putting in, the sad truth is that in the 12 months or so before the report is published and the Government take action, so many children across our country will be diagnosed with DIPG and other brain tumours. The urgency of this task cannot be overstated. A significant amount of money already goes in through the National Institute for Health Research and the Medical Research Council, but much more clearly needs to be done. There are competing demands and pressures on Government budgets, but for so many families in our country today and in the coming days, weeks, months and years, that funding could save a child’s life. I hope that the Minister will make a commitment to see what more she can do within the constraints of the health budget to invest in a crucial area that matters so much to so many families throughout the country.

I urge all right hon. and hon. Members present in the Chamber and throughout the House, as well as members of the public who might be watching this debate, to support Kaleigh’s Trust, to tweet links to the petition and to share it with family and friends, and to continue applying pressure to get more people to understand the impacts of terrible conditions such as DIPG and the urgency to fund and find a cure.

In closing, I again pay tribute to the extraordinary courage and resilience of Kaleigh and her family, and to so many other such families, who in spite of troubling and traumatic times continue to battle on, not only for their children but for others. That should inspire us all to do more individually and collectively.

--- Later in debate ---

[Thangam Debbonaire]

I, too, will be mentioning similar services later in my speech. Absolutely, the last thing parents facing such awful situations need to be worrying about is where they will stay, how they will afford it and how they will afford even to put petrol in the tank.

My nephew was diagnosed at age 12 with osteosarcoma, a very rare childhood cancer. We were all so focused on getting him and his mum, and his sisters and brothers, though that illness that the longer-term impacts felt very much secondary. Specialist units such as the one in Bristol help the family as well as the young person with cancer to see the whole of life as important, to think about the longer-term implications and to prepare for them. I pay very personal tribute to the teenage and young adults cancer unit in Bristol for its work and to the Teenage Cancer Trust for its support of the unit.

As my hon. Friend said, getting the number of units right is difficult. Given the thankfully low numbers of childhood cancer victims, if the units are to be truly specialist, it will not be an easy matrix. To ensure an appropriate number of specialist units, the Government need to be clear with appropriate commissioning guidance and take responsibility for following it through.

In October when I asked the Department of Health in question 50795 what proportion of specialist units were funded by charitable trusts, the Under-Secretary of State for Health, the hon. Member for Warrington South (David Mowat), replied:

“This information is not held centrally.”

For me, that is simply not good enough. Yes, commissioning is done locally, and increasingly commissioning groups and trusts are collaborating, but Government leadership is necessary to work out how many units are needed and how to fund them. Will the Minister commit to gathering that information centrally in order to estimate properly the funding needed to commission appropriately throughout the country? Will she further commit to consulting on and publishing clear commissioning guidance so that the responsibility for commissioning and funding specialist treatment centres for children, young people and young adults is clearly identified, and so that a structure for commissioning across health regions is clear?

On the future of research into childhood cancers, there is clear potential for harm when the UK leaves the EU—I say “potential”, because any such harm can be mitigated, but the Government need to act urgently to address it. Earlier this month in answer to my question 50081 about research, the Minister for Universities, Science, Research and Innovation gave welcome assurances about funding. I welcome those assurances, but he did not mention research cohorts. Thankfully, childhood cancer is rare, so it is vital for UK researchers to be able to collaborate fully with their EU counterparts so that they can carry out clinically adequate research with a sufficiently large enough group of children and young people to provide clinically useful and secure results. Yes, funding is vital and I am grateful to him for those assurances, but it is not enough. My next question to the Minister present is this: will she commit to discussing that with her colleagues in the Department for Exiting the European Union, along with research about other rare childhood cancers?

As my hon. Friend the Member for Alyn and Deeside (Mark Tami) mentioned, children and young people with cancer and their parents often need to travel long distances for specialist treatment. That might always be unavoidable and, in any case, there are other huge financial costs for parents. In September, I was proud to chair the parliamentary launch of a report by CLIC Sargent, which does so much wonderful work to support children and families affected by childhood cancer. The report shows that the costs of cancer are not only emotional, educational and physical, but financial.

One young person at the launch spoke about how he had to prove repeatedly to the benefits agency that he had cancer and that his treatment was still not over nor his recovery complete. Another young person found that her student loan was stopped because she was deemed to be a student no longer, but her halls of residence still charged her rent. A lone parent spoke of her struggles to manage her finances while faced with losing her income from employment and the increased costs of driving her son a long distance many times each month for treatment, as well as the added costs of heating a home all day for a very sick child, which is often overlooked, and the costs of keeping clothes, bedding and house scrupulously clean, which is so important because the risk of infection is extremely high for those undergoing gruesome treatments such as chemotherapy, as other hon. Members have mentioned.

CLIC Sargent and other charities I know help with all those things and more. I have had the privilege of being shown round the CLIC Sargent house in Bristol, located a few minutes’ walk from the Bristol Royal infirmary. That house, run by a wonderful woman who knows all too well what childhood cancer means, provides a haven just when it is needed.

[Wes Streeting]

May I, too, pay tribute to Haven House children’s hospice, which is just outside my constituency and serves many of my constituents? Hospices are often associated with end-of-life care, but as in the case of Haven House, they also provide great support to families whose children may not be near the end of their lives and help them on that journey. They are such a powerful and important source of support, and of course they are all voluntary and rely on the public’s generosity.

[Thangam Debbonaire]

My hon. Friend is absolutely right. There are many charities across the country that do everything they can to try to help the families of children and young people with cancer. I pay tribute to them all, even though I cannot possibly know their names.

The CLIC Sargent social worker is on hand in the Bristol royal infirmary when a family receives a devastating diagnosis and is told that their child needs to start treatment right away. Such families are often many miles from home. They can arrive that night at CLIC Sargent house with nothing and be given somewhere to stay for as long as they need it, clothes and bedding if they have come without them and, when necessary, space for the whole family so brothers and sisters can be with their family and their sibling who is being treated. I am proud to declare an interest in CLIC Sargent: my beloved sister-in-law works for it. She gives her time and expertise to an organisation that has done so much for our family and many others.

Will the Minister commit to discussing with her colleagues in the Department for Work and Pensions the financial impact of childhood cancer on families, and will she use the CLIC Sargent report as a reference point? Will she further consider supporting the provision of such homes for the families of children with cancer? If those homes are essential for allowing children to be treated, we must surely consider prioritising them along with other specialist support for statutory funding, at least in part. I do not believe it is right that such homes, which are so essential, must rely entirely on the generosity of volunteers and charitable giving, although I pay tribute to people who raise money. The Government must consider providing that funding.

As other hon. Members have said, until someone has known childhood cancer in their own family, it can be difficult for them to comprehend its full impact. Yes, there are excellent briefings available from specialist cancer charities—CLIC Sargent, Teenage Cancer Trust, Cancer Research UK and other charities provided briefings for this debate. My family was fortunate. Despite an initially very difficult prognosis, that 12-year-old child is now a happy, well adjusted young man in his 20s with a responsible job and a secure relationship with his partner, but I grieve for those who are not so fortunate. I want to ensure that, whatever the prognosis, no family has to worry about money at that most difficult time. I want us to do everything we can—the Government must lead—to improve awareness, early diagnosis, treatment and support, so that one day deaths from childhood cancer end and we alleviate and reduce, if not completely eliminate, the terrible suffering that it brings. I also hope against hope that one day, no parent will ever have to hear the word “cancer”. I long for that day, as I am sure we all do.

--- Later in debate ---

[Julie Cooper (Burnley) (Lab)]

It is an honour to serve under your chairmanship, Mr Davies. This debate has arisen in response to a petition signed by more than 115,000 people, including 922 from my constituency, following the sad passing of Poppy-Mai, the little daughter of Mr and Mrs Barnard. First and foremost, my thoughts are with that Lancashire family and all the other families who have endured a similar devastating loss of their children. There can be nothing worse than the loss of a child, so this debate is especially important.

It is important that we increase awareness of the scale of the problem facing children and young people who have cancer and their families, and look for ways to tackle the problems. How can we improve diagnosis? How can we improve research? How can we ensure better access to treatments? Ultimately, how can we improve survival rates? The debate, outlined so well by the hon. Member for Bath (Ben Howlett), has given us the chance to search for answers to those important questions.

In the UK every year about 4,000 children and young people under the age of 25 are diagnosed with cancer. Worryingly, research by CLIC Sargent published last year found that 44% of young people and 42% of parents felt that their local GP did not take them seriously when they presented with symptoms, and 53% of young people felt that their diagnosis had been delayed. Clearly that is not an acceptable state of affairs. Inevitably, delayed diagnoses mean delayed treatment, with implications for survival rates.

In an attempt to improve awareness among GPs, CLIC Sargent embarked on a joint project to develop an e-learning module specifically focused on cancers in children and young people. That welcome work will go some way in helping to improve diagnosis and primary care support for children and young people with cancer, but far more needs to be done. It is a fact that children in the UK with a brain tumour can take up to three times longer to be diagnosed than children in other countries, most notably the United States. Reducing the time to achieve an accurate diagnosis improves survival rates and can reduce long-term disability, which many children and young people diagnosed with a brain tumour currently experience. I hope the Minister can give us some understanding of what the Government intend to do to improve diagnosis times.

Recent figures published by Cancer Research UK demonstrate that in the past 20 years we have seen a 32% reduction in the child cancer death rate. We have also seen five-year survival rates increase from 40% in the early 1970s to 82% today. It is widely believed that those improvements have arisen as a result of more research and better treatments. While they are extremely welcome, they go nowhere near far enough, because the fact remains that cancer is still the leading cause of death among children. Five children and young people die of cancer in Britain every week, and those who survive often go on to suffer long-term side effects from their treatment that can continue into adulthood.

A considerable amount of research is carried out each year in the UK by a multitude of organisations including Cancer Research UK, the Brain Tumour Charity, the Institute of Cancer Research, the Institute for Child Health, Great Ormond Street Hospital and the Teenage Cancer Trust. Last year, Cancer Research UK committed to doubling research spending on children’s cancers. That will go some way in helping to discover new treatments. We all thank it and welcome that commitment, because currently only 3% of UK funding into cancer goes to child cancers.

It is important to remind the Government that many of those organisations are charities, which have relied on high levels of funding from the European Research Council. The Brain Tumour Charity stated that the result of the referendum on EU membership has created great uncertainty for charities conducting research into childhood cancers. Post-Brexit, the Government must ensure that the UK medical research community continues to have access to EU funding programmes once Horizon 2020 has ended. Similarly, I seek reassurance from the Minister that any shortfall in research funding as a result of our exit from the EU will be met by the UK Government. If we are to improve outcomes for children with cancer, it is paramount that we have research conducted to understand further these awful diseases.

Following improvements to diagnosis processes and research, we must ensure efficient access to treatment. Children and young people with cancer face a range of barriers in accessing new and better treatments, including drugs not being tested in their age group or in the cancers they are likely to get, even when a drug may be effective in treating their cancer. Simply challenging the age restrictions set on new trials is already increasing participation rates. That should be done in tandem with the provision of age-appropriate information about trials delivered by skilled, specialist staff.

Currently, the cancer patient experience survey does not collect data on cancer patients under the age of 16, and we have seen a 40% decline in response rates from teenagers over the age of 16 and young adults in the past five years. It is unacceptable that little or no progress has been made on this issue. Understanding patient experiences is important to improve future services. The cancer strategy includes plans to deliver a methodology to collect under-16s’ experiences, and NHS England is doing that alongside CLIC Sargent. Will the Minister helpfully update us on that work and tell us when we can hope to see the data being collected?

Achieving viable numbers for clinical trials on child cancers is understandably problematic given the relatively small numbers and rarity of some child cancers. However, we cannot allow that to be used as an excuse for not improving treatments for children and young people with cancer; instead, it should push us to innovate. Cancer Research UK has led the way in challenging the age restrictions on clinical trials, calling for more flexibility when it comes to age and ensuring that researchers justify age restrictions so that they rethink approaches to include children and young people.

[Wes Streeting]

Particularly for rare forms of cancer or brain tumours such as DIPG, it is important that clinical trials take place at scale. Does my hon. Friend agree that, after the UK leaves the European Union, the Government should seek to ensure that there is as much alignment as possible in the regulatory framework between here and the rest of the European Union so that clinical trials on the European level can continue to take place?

[Julie Cooper]

I am grateful to my hon. Friend for making that important point. It is essential that the UK’s exit from the EU does not negatively impact on further research. We must benefit collectively from work done in other countries. To pick up on the point other Members made, we must pool good practice and ensure that our good practice and successful research are shared throughout the world and that we benefit similarly from experience elsewhere.

In the cancer strategy, there were specific recommendations relating to children, teenagers and young adults’ services and how they can be improved. I was concerned, though, that in September the Government made an announcement on wider measures in the strategy but failed to mention anything about the important issue of seeking consent from children and young people for their data and tissue collection to be used in future research studies and the development of services, nor did they include a requirement significantly to increase access to clinical trials for teenagers and young adults with cancer.

Currently 30% of teenagers and 14% of young people aged 20 to 24 enter trials for common cancer types in children and young people. In 30 years there has been no progress in that area. The cancer strategy set a target for NHS England to recruit at least 50% of children and young people in cancer centres or designated units treating teenagers or young adults. That is welcome, but will the Minister give us a progress report and tell us how long it will be before the target is likely to be met?

I pay tribute to the Barnards, to the other families mentioned today and to the children and families across the UK affected by cancer for their courage in the face of this most awful of illnesses. I ask the Government to understand those families’ need for support. We have heard some moving stories today. They need support in a wide sense—from specialist units and through better access to information. Importantly, they also need financial support. Several hon. Members have powerfully made the point today that the costs of cancer are physical and emotional but also financial. We must do more and better.

I want to hear what specific plans the Government have to improve the speed of diagnosis; I want a guarantee that the Minister will protect research funding post-Brexit; and I want to know what plans she has to increase the number of clinical trials, to ensure that access to life-saving treatments is the best possible. Children and young people deserve no less.

--- Later in debate ---

[Nicola Blackwood]

My hon. Friend is absolutely right. It is important to make sure that all different groups and diseases get the attention that they deserve. That takes me on to the issue of patient cohorts and the importance of collaboration across Europe.

For particularly rare diseases or cancers, it is sometimes necessary to look across borders to make sure that research includes the right numbers of patients. That has been a particular focus of the Department, and I am confident, owing to the work that we have been doing, that international—particularly European—networks and data sharing for research purposes will continue. We need to make sure that initiatives that have facilitated research, such as the paediatric medicines regulations, continue. My noble Friend Lord Prior is leading on that area of policy. I know that he is closely involved in all of those issues, and I am going to ensure that the specific concerns that have been raised today are passed on to him and are not dropped.

I assure the shadow Minister that the Chancellor has guaranteed that the UK will continue to have all of the rights, obligations and benefits that EU membership brings, including EU funding—up until the point that we leave, obviously. The Treasury has also committed to underwrite the payment of awards to UK organisations that make competitive bids to the European Commission —for example, for universities bidding for Horizon 2020. In addition to all of the funding I have spoken of, those moneys are protected.

My hon. Friend the Member for Bath made a couple of points about reviewing the work undertaken by NHS England to ensure that more children receive the treatment that they deserve. We will be working closely with NHS England and all partners to make sure that the strategy we have put in place becomes a reality and that the right performance metrics are in place, although that is a challenging process. Our best measure of success will be the cancer survival statistics. Those are currently provisional, but the Office for National Statistics will hopefully be assessed by the UK Statistics Authority in the future.

We have heard from many hon. Members of some deeply moving cases of young people battling cancer. We have heard of their courage and resilience, and of the fortitude of their parents and siblings.

[Wes Streeting]

I am grateful to the Minister for giving such a thorough and thoughtful response to the debate. As I mentioned, Kaleigh’s family are campaigning on DIPG. It would mean a lot to them if the Minister or one of her Departmental colleagues met them to talk about their experience and their hopes for how research funding in this area might improve the search for a cure going forward. Is the Minister able to make that commitment?

[Nicola Blackwood]

I am sure that either I or a Departmental colleague will be delighted to meet the hon. Gentleman and his constituents. It was moving to hear of their campaign.

Holding the Government and the NHS to account in this way could not be more important. I hope that my response has made completely clear not only my personal commitment but the Government’s wholehearted commitment to funding life-changing innovation and research into cancer, to delivering the cancer strategy in a way that transforms cancer care for current and future generations and to improving the long-term quality of life of childhood cancer survivors. That is surely the greatest memorial that we can offer to each and every one of those brave children who, like Poppy-Mai, have lost their battle with cancer. That is our task, and as I look around the Chamber, it is clear to me that each and every Member here will work as hard as they possibly can to make sure that they hold us to it.

Social Care

Wes Streeting Excerpts

Wednesday 16th November 2016 Commons Chamber

[Mr Hunt]

We are absolutely determined to clamp down on employers who do not pay the national living wage. If the hon. Gentleman or any other hon. Member has any evidence at all of that happening, they should let HMRC know. HMRC has a policy of naming and shaming employers who do not do the right thing and rightly so.

[Wes Streeting (Ilford North) (Lab)]

rose—

[Toby Perkins]

rose—

[Mr Hunt]

I will give way to the hon. Member for Ilford North (Wes Streeting) first.

[Wes Streeting]

It is welcome that the minimum wage will increase and that money will hopefully reach the workers we are discussing. Will the Secretary of State acknowledge, however, that the consequence of the increase is that the precept that local authorities charge residents for social care will be eaten up by the wage increase—even in local authorities such as the London Borough of Redbridge, of which I am still an elected member? What will he do to alleviate the very real financial burden on my local authority and others to ensure that everyone gets the quality of care they need?

[Mr Hunt]

I acknowledge the financial impact of the national living wage and will talk about the funding of local authorities.