Health Infrastructure Plan

Grahame Morris Excerpts

Monday 30th September 2019 Commons Chamber

[Edward Argar]

I know that, since my hon. Friend was first elected to this House, he has made health and the NHS his No. 1 priority. He served with distinction as a Minister in the Department and continues to champion his constituents’ interests in this respect. On the seed funding, we have made the announcement and are keen to get the money to those trusts as swiftly as possible so they can work with us to develop their plans. I agree entirely that its inclusion in this list is a vote of confidence from us and the NHS in the work his local hospital is doing.

[Grahame Morris (Easington) (Lab)]

I thank the Minister for his statement. He said that the Government would focus on outcomes, and he mentioned £200 million for new CT scanners for diagnosis, but The Times recently published the details of answers to freedom of information requests indicating that half of NHS trusts are treating cancer patients with out-of-date radiotherapy machines. The UK will remain at the bottom of the cancer survival league until we dramatically improve our radiotherapy services, so what steps is he taking to implement the “Manifesto For Radiotherapy”, invest in modern radiotherapy equipment and train personnel in IT networks, to provide modern radiotherapy services to cancer patients in every region of the UK, not just those in London and the south-east?

Non-invasive Precision Cancer Therapies

Grahame Morris Excerpts

Thursday 18th July 2019 Commons Chamber

[Grahame Morris (Easington) (Lab)]

I beg to move,

That this House recognises the vital role that radiotherapy plays in cancer treatment across the UK with an estimated one in four people needing that treatment at some stage of their life; notes that there is a significant body of expert opinion that up to 24,000 people may be missing out on the radiotherapy they need, resulting in many hundreds of unnecessary or premature deaths; further notes that the UK spend on radiotherapy as a percentage of the overall cancer budget is approximately five per cent which compares badly with most other advanced economies where the percentage varies from nine per cent to 11 per cent; notes that the current commissioning system for radiotherapy is sub-optimal as exemplified by a tariff regime which discourages NHS Trusts from implementing advanced modern effective radiotherapy; calls on the Government to provide an immediate up-front £250 million investment in the service, an ongoing extra £100 million per annum investment in personnel and skills and IT, and to introduce a sustainably, centrally and fully funded rolling programme for Linac machine replacements; and further calls on the Government to appoint a single person to oversee the commissioning and implementation of radiotherapy services.

I thank the Backbench Business Committee and its Chair, my hon. Friend the Member for Gateshead (Ian Mearns), for granting this debate, and all the Members on both sides of the House who supported the application. I must declare an interest as one of the vice-chairs of the all-party group on radiotherapy, and also as a cancer survivor—[Hon. Members: “Hear, hear.”] Thank you. Thanks to early diagnosis, I was successfully treated with both chemotherapy and, crucially, precision radiotherapy.

I want to point out to the Minister that there is currently a crisis—there is no other word for it—in the management and funding of radiotherapy in the United Kingdom. Indeed, the charity Action Radiotherapy estimates that as many as 20,000 people across the UK may be missing out on the radiotherapy they need. Many of these patients will die prematurely or unnecessarily as a result of this shortfall. Given that one in four people receives some form of radiotherapy during their lives, and that almost half of us in the United Kingdom will be diagnosed with cancer at some point in our lifetimes, I hope the Government will realise just how important it is that we invest in modern and, importantly, accessible cancer diagnosis—and not just in diagnosis, but in cancer treatments.

[Jeff Smith (Manchester, Withington) (Lab)]

I am very proud to have the Christie Hospital in my constituency of Manchester, Withington. It has a fantastic proton beam therapy unit, which is going to be the future of cancer treatment. However, when I speak to the staff at the Christie, their biggest worry is the workforce. Does my hon. Friend agree with me that the challenge is not just funding for treatment, but actually investing in our cancer workforce as well?

[Grahame Morris]

Absolutely, and I am grateful to my hon. Friend for pointing that out. Indeed, that is one of the four basic requirements, as the all-party group, the charity Radiotherapy4Life and Action Radiotherapy have pointed out. That is clearly demonstrated in the “Manifesto for Radiotherapy”, which I commend to the Minister and to all hon. Members.

I appreciate that the Minister will want to refer to chapter 3 of “The NHS Long Term Plan”, particularly paragraph 3.62 on more precise treatments using advanced radiotherapy techniques. In anticipation of that, I would like to say, on investment, that the Government have promised to complete the £130 million investment in radiotherapy machines and, as my hon. Friend has just mentioned, to commission the proton beam machines at University College Hospital in London and the Christie Hospital in Manchester. However, I respectfully point out to the Minister that that is not a new announcement of additional resources, but the recycling of previous announcements. The money has already been spent or committed, so it is not part of the comprehensive 10-year plan for radiotherapy that we advocated for in the “Manifesto for Radiotherapy”.

The £250 million for proton beam facilities, while welcome, will only treat 1,500 patients a year. I accept that many of them will be children with brain cancers, but the number represents only 1% of patients needing radiotherapy. As indicated in the manifesto, we recommend that the same sum that was spent on proton beam facilities—a relatively modest sum given the size of the budget as a whole—is all that is needed to renew radiotherapy centres and to ensure that all patients, not just those who live in London or near to major conurbations, can receive treatment within the recommended 45-minute travel time. I know that other hon. Members will say a little more about that.

We are also asking for an additional £100 million a year, increasing the cancer funding for radiotherapy from the current 5% a year to 6.5% a year, to ensure sufficient funding for workforce planning, including ensuring that there is suitable training, and ensuring that there is an effective IT network, equipment upgrades and a rolling programme to ensure that all radiotherapy machines across the UK are up to date. According to analysis of freedom of information requests made by Action Radiotherapy, more than 40% of NHS trusts in England—all bar six responded to the requests—that provide radiotherapy have machines that are past their recommended lifespan, leading to less efficient and effective care.

The current system of commissioning for radiotherapy often incentivises trusts not to use their most modern precision radiotherapy machines to their full capability. That means that some patients are treated more often and less effectively, even though there are modern stereotactic ablative radiotherapy machines that could treat them more effectively. Precision radiotherapy is needed to cure 40% of cancers, and all that we want is to ensure that all patients can get to a radiotherapy machine and that the professionals are allowed to switch on the machines and provide the appropriate treatment. However, chronic underfunding and the complications of radiotherapy commissioning and delivery are preventing that from happening.

Radiotherapy receives only 5% of the cancer treatment budget. At £383 million a year, that represents 0.025% of the total NHS budget, and I want to compare that with the cost of just two cancer drugs. The NHS budget for Herceptin—an effective drug that is used to treat about 15% to 20% of breast cancer patients—is £160 million. A recent UK trial showed that only six months, not 12 months, of adjuvant Herceptin may be needed for adjacent therapy, which is when the drug is used in combination with radiotherapy. In financial terms, the NHS could therefore save up to £80 million a year, offsetting much of the additional radiotherapy costs.

It is time to put radiotherapy back at the top of the NHS agenda, and we need someone to advocate for that. We are urging the Department to appoint a radiotherapy tsar who will ensure that the NHS has a world-class radiotherapy service. Many other MPs want to speak in the debate, so I will keep my remarks short. I am pleased that the Government have accepted that advanced precision radiotherapy is more effective and has fewer side-effects.

In summary, I want to see a modest increase in the budget for advanced radiotherapy, rising from 5% to 6.5% of the cancer budget. That would enable large numbers of cancer patients to live longer and more fulfilling lives and would achieve better outcomes and more positive economic benefits. I am keen to ensure that Members have an opportunity to participate in the debate. There are many issues that we need to highlight, including in relation to commissioning, workforce planning and IT networks, so I will leave it at that to allow others to participate.

[Several hon. Members rose—]

--- Later in debate ---

[Grahame Morris]

I thank the Minister for that considered and helpful response. I can assure her that the spirit of our contributions, and of the all-party parliamentary group, is intended to help, not to hinder progress. We certainly give her credit for the aspiration to improve cancer outcomes and to see a first-class service. We want to see that in all parts of the United Kingdom.

I thank all Members who participated in the debate. The hon. Member for Chichester (Gillian Keegan) highlighted the perverse incentives, which have been identified in the all-party parliamentary group’s inquiries. The hon. Member for Westmorland and Lonsdale (Tim Farron) mentioned the satellite centres and the number of people being denied life-saving therapy. My hon. Friend—my dear friend—the hon. Member for Blackburn (Kate Hollern), in a deeply moving contribution, talked of her personal experience. My hon. Friend the Member for Rhondda (Chris Bryant) talked about the importance of workforce planning and early diagnosis. My hon. Friend the Member for Heywood and Middleton (Liz McInnes) also mentioned workforce issues. My hon. Friend the Member for Manchester, Withington (Jeff Smith) talked about the exciting developments in proton beam therapy at the Christie Hospital. My hon. Friend the Member for Dewsbury (Paula Sherriff) gave an excellent response on behalf of the Opposition.

I also want to thank all the staff involved in delivering cancer services. We value the contribution they make—each and every one of them—and we are absolutely dedicated to ensuring that the issues we have raised here are followed through.

I have one point to make on tariffs and perverse incentives. As part of our efforts, we have met extensively with NHS England. Addressing that is potentially a quick win for the Government, because it would not involve evaluating new techniques and could be done quickly. My suspicion is that NHS England does not intend to implement that for some time—in years rather than months—so I hope that the Minister will take that up immediately.

Question put and agreed to.

Resolved,

That this House recognises the vital role that radiotherapy plays in cancer treatment across the UK with an estimated one in four people needing that treatment at some stage of their life; notes that there is a significant body of expert opinion that up to 24,000 people may be missing out on the radiotherapy they need, resulting in many hundreds of unnecessary or premature deaths; further notes that the UK spend on radiotherapy as a percentage of the overall cancer budget is approximately five per cent which compares badly with most other advanced economies where the percentage varies from nine per cent to 11 per cent; notes that the current commissioning system for radiotherapy is suboptimal as exemplified by a tariff regime which discourages NHS Trusts from implementing advanced modern effective radiotherapy; calls on the Government to provide an immediate up-front £250 million investment in the service, an ongoing extra £100 million per annum investment in personnel and skills and IT, and to introduce a sustainably, centrally and fully funded rolling programme for Linac machine replacements; and further calls on the Government to appoint a single person to oversee the commissioning and implementation of radiotherapy services.

Interim NHS People Plan

Grahame Morris Excerpts

Wednesday 5th June 2019 Commons Chamber

[Stephen Hammond]

I welcome Labour’s commitment to publish a paper, but the hon. Lady will know that the Department is going to publish a Green Paper on adult social care. We are finalising that. [Interruption.] The hon. Member for Leicester South (Jonathan Ashworth) shouts at me. I know he makes a lot of promises without detail. We want to make promises that have detail and can work.

[Grahame Morris (Easington) (Lab)]

This is an important report into NHS people planning. It is an interim report, so there is an opportunity to identify any deficiencies. My particular concern is about the cancer workforce, in particular the point made by my hon. Friend the Member for Leicester South about the loss of bursaries not just for nurses but for therapeutic radiographers. May I draw the attention of the Minister, with due respect, to the fact that the radiotherapy and oncology course at Portsmouth University recently closed? Concerns are being expressed and not just by politicians on the Opposition Benches. Mr Richard Evans, chief executive of the Society of Radiographers, said that he has concerns about whether our hospitals and specialist cancer centres will be able to recruit enough skilled and trained personnel. This could even threaten the delivery of cancer treatment and the ambitious plans that the Minister has in the new cancer strategy.

[Stephen Hammond]

The hon. Gentleman is right: this is a serious plan. As he rightly points out, it is an interim plan. It sets out a number of specific actions for this year. It also sets out a number of clear action paths and trajectories to ensure that the people plan is achieved. I would be delighted to meet him and other officers of the all-party group to ensure that we get the skills in the right places to ensure that the ambitious and deliverable plans in the long-term plan can happen.

Oral Answers to Questions

Grahame Morris Excerpts

Tuesday 7th May 2019 Commons Chamber

[Jackie Doyle-Price]

My hon. Friend is absolutely right—health tourism is a major cost to the taxpayer, so it is important that we establish that people are entitled to care. However, it is important to ensure that people without proof of ID and of residence are still entitled to healthcare. Where someone is not entitled to it, we will, of course, pursue them for payment.

[Grahame Morris (Easington) (Lab)]

2. What funding his Department plans to allocate to radiotherapy services in the next five years.

[The Secretary of State for Health and Social Care (Matt Hancock)]

Our radiotherapy modernisation programme has so far delivered 80 upgrades or replacements, with more to come.

[Grahame Morris]

One in four people currently receive radiotherapy—a number that will increase if the Government achieve their early diagnosis targets. Ministers dispute that 20,000 people in England annually miss out on appropriate access to life-saving radiotherapy. What is the Secretary of State’s estimate? Will he commit to meeting representatives of the Radiotherapy4Life campaign to discuss how we can improve radiotherapy provision in England?

[Matt Hancock]

I am absolutely happy to meet the group. According to the latest figures, about four in 10 of all cancer patients are treated with radiotherapy; it is a critical treatment to tackle cancer. As I say, there has been an investment programme to replace and upgrade radiotherapy equipment, with 80 upgrades or replacements over the past three years, but there is clearly more to do to make sure that people with cancer get the best possible treatment.

NHS 10-Year Plan

Grahame Morris Excerpts

Tuesday 19th February 2019 Commons Chamber

[Stephen Hammond]

I have listened carefully to my right hon. Friend’s intervention, and he will be pleased to know that discussions with the Treasury are ongoing about certain potential incentives to senior serving staff.

The plan is not just about numbers; it focuses on getting the right people with the right skills in the right place, ensuring that our dedicated staff are supported, valued and empowered to do their best. It has clear commitments to tackle bullying, discrimination and violence, and a programme of work to sustain the physical and mental health of staff who work under pressure every day and every night.

[Grahame Morris (Easington) (Lab)]

All good policies should be evidence-based, so let me ask the Minister about the national cancer advisory group, which prepares an annual report detailing the progress of the cancer strategy each year. That report was expected in October/November but it has been delayed. When will it be published? It may well inform the work of the 10-year plan.

[Stephen Hammond]

The publication date has not yet been finalised. I understand that it will be soon, but I will write to the hon. Gentleman to confirm the date of publication.

Through the long-term plan, we will ensure that the NHS continues to strive to be a world leader. It will continue to push the boundaries between health and social care, and between prevention and cure. It will be at the cutting edge of technology and innovation, while providing high-quality service for all patients. More importantly, it will always be there in our hour of need, free at the point of use and based on clinical need, not on the ability to pay. I commend the long-term plan to the House.

--- Later in debate ---

[Grahame Morris (Easington) (Lab)]

Thank you, Madam Deputy Speaker, for calling me in this debate. It is a pleasure to follow the hon. Member for Crawley (Henry Smith). I declare an interest as one of the vice-chairs of the all-party group on radiotherapy, and as a cancer survivor who was successfully treated with both chemotherapy and radiotherapy, thanks to an early diagnosis.

About one in four people receives some form of radiotherapy during their lives, and almost half of us in the UK will be diagnosed with cancer at some point in our lifetimes. These stark facts will I hope remind the Government of just how important it is that we invest in modern and accessible cancer diagnosis and treatments. In the brief time I have, I want to talk about chapter 3 of “The Long Term NHS Plan”, particularly section 3.62 on more precise treatments using advanced radiotherapy techniques.

On investment, the Government have promised to complete the £130 million investment in radiotherapy machines and to commission the proton beam machines at University College Hospital in London and the Christie Hospital in Manchester. However, I must respectfully point out to the Minister that that simply recycles announcements that have already been made, so this is not a comprehensive 10-year plan for radiotherapy.

As set out in the APPG’s “Manifesto for Radiotherapy”, far more is needed over the next 10 years. We need an initial investment of £250 million and then an ongoing investment of £100 million each year. Reannouncing previous expenditure commitments falls far short of what is required and will not meet the stated objective, mentioned by other Members, of improving cancer patient outcomes through improved survival rates.

Although it is needed in over 50% of cases, access to advanced radiotherapy in England is very patchy, varying from 25% to 49%, depending on the region. It is far worse in some regions—in the south-west and in the Westmorland and Lonsdale constituency, the average is about 38%. Ideally, patients should not have to travel more than 45 minutes to access this form of treatment. Considerable additional investment will be required to achieve that. At the moment, there is nothing specific in the plan to address that serious issue. The Government say they will increase the diagnosis of patients with stage 1 and stage 2 cancers. Again, we need more investment to do that.

I encourage all Members of the House, and indeed the Minister, to read the “Manifesto for Radiotherapy”, which highlights the importance and the important benefits of increasing the percentage spend on radiotherapy.

[Several hon. Members rose—]

Cancer Workforce and Early Diagnosis

Grahame Morris Excerpts

Tuesday 8th January 2019 Westminster Hall

[Grahame Morris (Easington) (Lab)]

Thank you very much for calling me to speak in this important debate, Mr Howarth. I congratulate my hon. Friend the Member for Poplar and Limehouse (Jim Fitzpatrick), and I thank my friend the hon. Member for Westmorland and Lonsdale (Tim Farron), who chairs the all-party parliamentary group on radiography, of which I am also a member.

I do not want to repeat the arguments that have just been made, but some key threads run through the whole of the debate. Although the motion refers to “early diagnosis and the cancer workforce in the NHS long-term plan”, we have to marry some concepts. Yes, early diagnosis is important, but it has to be married with a skilled and effective workforce, as well as the most effective treatment available, by which I do not mean the treatment available in our capital city only, but across the whole country. I will touch on that issue as well.

I declare an interest: I am a cancer survivor. I was successfully treated with both chemotherapy and radiotherapy, thanks to a relatively early diagnosis. I am vice-chair of the all-party parliamentary group on radiotherapy. I am not alone in having benefited from radiotherapy. As was mentioned earlier, during the course of our lifetimes, almost half of us will suffer from cancer at least once, and about half of those people will receive radiotherapy.

Although I was fortunate and count my lucky stars, I am acutely concerned about particular cancers, notably prostate cancer, pancreatic cancer—yesterday, we heard a terrible story from the hon. Member for Crawley (Henry Smith) about his caseworker who passed away as a consequence of pancreatic cancer—and lung cancers and breast cancer. For a modern industrial nation, our cancer outcomes are poor. They should be far better. I hope that the 10-year forward plan that was published yesterday is an opportunity to address some of those fundamental problems. It is important for us to invest in modern accessible cancer diagnosis and treatments.

I want to talk about the long-term plan that the Prime Minister announced yesterday, on which we had a statement in the House. I will refer in particular to chapter 3, especially section 3.62, on treatment and radiotherapy. I must admit that I was optimistic after meeting the Minister, who I have known for some years. I think he is a decent and honourable individual, and he and his staff were very positive in our meetings. I therefore hoped that, based on the evidence presented, we would have a much more positive outcome from the 10-year plan.

The Government have promised to complete the £130 million investment in radiotherapy machines and to commission the proton machines—the two proton-beam machines, at the Christie in Manchester and at University College Hospital, London—but, in all honesty, that is not a new commitment. Those machines are already or almost completed, so the commitment is a recycling of an existing announcement.

If we are to have a step change and to achieve a world-class set of outcomes and a world-class cancer treatment service, we need a modest increase—modest in relative terms—for advanced radiotherapy. As set out in the “Manifesto for Radiotherapy”—which I recommend that all Members read, because if they are not affected themselves, many of their constituents certainly will be—we ask for an initial one-off investment of £250 million, with an additional £100 million in each successive year for workforce, running costs and so on.

Radiotherapy is required in 50% of cases, but access is patchy. Access varies from 25% to 49%. For example, the hon. Member for Westmorland and Lonsdale represents a rural area, where the figures are low. The average is about 38%. Ideally, according to Cancer Research UK, patients should not have to travel more than 45 minutes to access such treatment and, if we are to achieve that, considerable investment is required. The Minister might be able to elaborate on this, but I do not think that anything concrete in the plan addresses that serious issue.

I welcome the Government commitment on early diagnosis to increase the number of patients diagnosed with stage 1 and 2 cancer by 25% and, for lung cancer, to increase the diagnosis of stage 1 patients by 47%. In practical terms, however, the Government will need more advanced radiotherapy machines to ensure that many of those stage 1 tumours can be cured, as well as additional radiotherapy machines to treat the stage 2 patients. The Government will need to rapidly expand the number of advanced radiotherapy facilities around the country, and how to do that is set out in the manifesto, which would achieve not only early diagnosis but improved survival and outcomes.

I want to give the Minister credit—he is looking a bit quizzical, but I had not intended to beat him up, because we are trying to be helpful. The aspiration and wish to improve cancer outcomes and to see a first-class service is shared in all parts of the House. I am therefore very pleased that he has recognised the representations made on hypofractionated treatment and the perverse incentive in relation to the tariff. The Government have said that they will address that issue, but I would like an assurance that it will be addressed quickly and not in 10 years’ time. The evidence is clear about that disincentive to the most appropriate form of treatment.

Many people want to speak in the debate, so I will wind up. I am pleased that the Government have admitted and accept that advanced radiotherapy is more effective and has fewer side effects. I would like to see a specification come out and to ensure that, when it comes out, we do not see what we have in effect at the moment, which is the rationing of effective treatment. Specialists in the field have told me that the specification under discussion now is in essence no different from that available a year ago. I therefore press the Minister to respond to our submissions.

I want to see an increase in the budget for advanced radiotherapy—fairly modest as part of the NHS budget, or even the cancer budget—from 5% to 6.5% of the cancer budget. That would enable large numbers of cancer patients to live longer and more fulfilling lives and would achieve better NHS outcomes and positive economic benefits. I commend that proposal to the Minister, and I urge him to look at it as part of the ongoing cancer strategy and the NHS 10-year plan.

NHS Long-term Plan

Grahame Morris Excerpts

Monday 7th January 2019 Commons Chamber

[Grahame Morris (Easington) (Lab)]

I want to concentrate on cancer services. I have tried to be very positive and to engage with Ministers through the all-party parliamentary group on cancer, but I must express my disappointment at chapter 3. The Secretary of State referred to paragraph 3.51 on cancer, particularly in relation to some of the new investments. Practicalities and resources must be linked to the ambition to improve outcomes, so we need early diagnosis and cost-effective treatment. For example, this country has the second worst survival rate in Europe for lung cancer; only Bulgaria is any worse. The “Manifesto for Radiography” by professionals, oncologists and so on set out some specific asks, including a one-off investment of £250 million in advanced radiotherapy and an additional £100 million a year to support that investment with trained staff. I am afraid that the Government’s plans set out in the 10-year plan fall far short of that, so I do hope that the Secretary of State will look at that again.

[Matt Hancock]

We very much agree with the thrust and purpose of the hon. Gentleman’s remarks. In fact, paragraph 3.56 sets out how we are learning from what has happened in Liverpool and elsewhere in the country to make sure that we get early diagnosis right because, as he says, early diagnosis is absolutely critical. I will take away his specific points, but the whole thrust of the plan with regards to cancer is about increasing early diagnosis.

Nursing: Higher Education Investment

Grahame Morris Excerpts

Wednesday 21st November 2018 Westminster Hall

[Eleanor Smith]

I thank my hon. Friend for that intervention; he is totally right. There is a difference between the mature students who come into nursing and those who are 18. There is a great loss to those people and a great loss to us in the public sector—to hospitals, GP surgeries and, indeed, all the places where nurses work in the NHS. It is a great loss, and I will cover some aspects of that issue in my speech.

The only thing that has changed is that loans have been brought in. It is ludicrous to look at the numbers and deny that forcing nursing students on to loans has led directly to a drop in applications. That is exactly what has happened. The result is that the diversity and background of nursing students has changed radically, excluding many who would previously have been able to change their personal and economic circumstances through a rewarding career in nursing. That is the very thing that my hon. Friend was saying.

I expect the Minister to say, “There are still two applicants for every place available for a student to study nursing at university.” It is the current structures that are limiting the system from being able to capitalise on that appetite to study nursing.

[Grahame Morris (Easington) (Lab)]

I congratulate my hon. Friend on securing a really important debate. It is essential that the Minister addresses the issues raised. Is not the drop-out rate for student nurses a real cause for concern? A student nurse contacted me—I did go to the lobby organised by the Royal College of Nursing this morning—and gave some examples of the mounting costs under the present system. That mental health nurse was telling me about the costs of trains, taxis and accommodation. She works 37.5 hours a week on a placement. Transport to her placement is costing her £500 a month. Surely that has an impact on a person’s ability to sustain their attendance on a course and achieve the necessary outputs.

[Eleanor Smith]

I could not have put that as clearly as my hon. Friend has. I am glad that student nurses came and explained the situation to him, because that is the very reason why we are having this debate.

With the last bit of control that they have kept since the reform, the Government fund clinical placements, but they do not match the numbers to the volume of routes that they have created. They made nursing students, apprentices and nursing associates all compete for the same places. They did choose to fund, but it was not enough. Now it is a blame game full of finger-pointing. If there are so many people interested in becoming nurses and such high levels of vacant posts, why are the Government not doing more to convert the applicants into nurses?

I expect the Minister will say, “We have introduced new routes to expand the number of nursing staff.” There are nursing degree apprenticeships that few people are taking up, because employers do not have enough cash to release people to study. Nursing associates, who were introduced in a supporting role to the registered nurse, should never be a substitute for registered nurses. These efforts have been small and unpredictable. Most importantly, they have not addressed the heart of what grows the number of nurses safely and at scale: higher education. This is workforce panicking, not workforce planning.

I expect the Minister will say, “This Government have grown the number of nurses working in hospitals,” which is factually true, but distorts the truth that the overall number of nurses has only grown by less than 1% since 2010. While there are 7% more nurses in acute settings, there are 6,500 fewer nurses in the community, 43% fewer district nurses, a quarter fewer school nurses, nearly 5,000 fewer mental health nurses and 40% fewer learning disability nurses. Despite the Government’s rhetoric about moving more care into our communities, the workforce are simply not there to deliver it. Who has overseen that? Ian Cumming of Health Education England, Simon Stevens of NHS England and the Government.

Nursing students spend 50% of their time in placement, learning in the community, a care home or a hospital, but the services are so short of staff that students are being unsafely used to plug the gaps. Due to their placements and studies, they do not have time for part-time jobs to earn extra money. Like other hon. Members, I am contacted by constituents who tell me that they always wanted to be a nurse, but money worries and the pressure they feel are making them reconsider their choice. The personal cost of becoming a nurse is turning people away when health and care services need more growth. This is disgraceful, irresponsible and short-sighted.

However, our leaders have a real chance to secure major change. Nursing students need a new deal. All that is needed is political will, and for people to stand up and be accountable. I demand the bursary is brought back. Our future nurses urgently need more financial support if the Government are ever to tackle the workforce crisis. There needs to be an extension of the hardship funds for those who need more assistance.

At what point do we say enough is enough? How can we fail to act when faced with student nurses trying to balance their placement, part-time healthcare assistant work and trying to finish their coursework? How can anyone begin in a profession when they are already burnt out? It is disrespectful for any of us to stand here and tell stories about how much nurses make a difference to us, without acknowledging their professional expertise and their critical role in transforming services. We have to stop making their jobs harder and pushing people to the brink. No nursing student or nurse should have to grind their teeth and keep going, knowing that shortages mean that vital care is left undone. This situation is unsafe for everyone. It is morally reprehensible.

The Prime Minister gave an extra £20 billion to the NHS. Simon Stevens holds the pen. The Secretary of State will sign off the long-term plan. There is a small window of opportunity to change the future of nursing. We can either propel it forward or drag it back. I am determined to leave my daughter a legacy. I take public service seriously; that is why I went into nursing and why I am an MP.

I look forward to hearing from the Minister how the long-term plan will deliver the workforce strategy, how it will fulfil the Secretary of State’s commitment to creating more nurses, and how Simon Stevens and Ian Cumming will be held to account over fixing the nursing supply and investing in it. This is our moment to rebuild public trust and confidence, so I end by asking the Minister: what are you going to do?

Budget Resolutions

Grahame Morris Excerpts

Tuesday 30th October 2018 Commons Chamber

[John McDonnell]

Of course we welcome more money for mental health, but what was required was £4 billion, not £2 billion; and that £2 billion was contained within the £20 billion that had already been announced, so it is not additional money. There are some things that we can work on on a cross-party basis in this House, but we have to be honest about the needs and the requirements, and we have to be straightforward in saying how they can be funded.

[Grahame Morris (Easington) (Lab)]

My right hon. Friend is being a little unfair; some people have done very well from austerity. A thousand of the richest people in the United Kingdom have seen their personal wealth increase by £274 billion over the past five years.

[John McDonnell]

The facts speak for themselves.

To make a real difference to the lives of young people, the Chancellor needed to address the housing crisis, deal with the toppling mountain of student loans, and restore work allowances for single people and couples without children. Instead we got piecemeal, unambitious housing announcements and re-announcements, nothing on student finances, and nothing on universal credit recipients who are single and without children.

--- Later in debate ---

[Matt Hancock]

Yes, I can confirm that. The £20.5 billion real-terms funding for the NHS in the Budget is for the NHS itself and will be channelled through NHS England. Of course there are budgets in the Department that are outside the NHS envelope, and they will be settled in the spending review. This is exactly as has been planned, and it was made clear in June. I can tell the House that the £20.5 billion is both the longest and the largest settlement for any public service in the history of this country.

[Grahame Morris]

We need to be precise and accurate about this, and I have just googled the settlement. In fact, the biggest ever increase in NHS funding happened between 1997 and 2008 when the budget went up from £55 billion to £125.4 billion—

[Matt Hancock]

indicated dissent.

--- Later in debate ---

[Grahame Morris]

Well, I am talking about being factually correct. The biggest ever funding increase came under a Labour Government. Let us be honest about this.

[Matt Hancock]

This is a single settlement for a five-year period so that the NHS can plan again.

--- Later in debate ---

[Grahame Morris (Easington) (Lab)]

It is a pleasure to follow the hon. Member for Carmarthen East and Dinefwr (Jonathan Edwards).

A little earlier, the hon. Member for Redditch (Rachel Maclean) accused Labour Members of being rather negative and sending out negative waves. Well, I have some positive waves, but they are radiotherapy waves, and some ideas. I am delighted that the Minister for Health, the hon. Member for North East Cambridgeshire (Stephen Barclay), is on the Treasury Bench; I am sorry he could not join us for the debate earlier, because there were some really good suggestions as to how we can improve the service.

I was disappointed that, despite numerous debates and questions on the cancer strategy, the Chancellor did not mention any further funding for advanced radiotherapy. He said in the statement:

“we agreed that the NHS would produce a 10-year plan, setting out how the service will reform, how waste will be reduced, and exactly what the British people can expect to get”—[Official Report, 29 October 2018; Vol. 648, c. 656.]

I declare an interest, as a cancer survivor who was successfully treated with both chemotherapy and radiotherapy. I am also now a vice-chair of the all-party parliamentary group on radiotherapy.

I am not alone in having benefited from radiotherapy. About one in four people receive some form of radio- therapy during their lives, and almost half of us will be diagnosed with cancer in the UK at some point in our lifetime. Those stark facts will, I hope, remind the Government how important it is that we invest in modern and accessible cancer treatments. Delivering the recommendations set out in the cancer strategy is crucial to improving care and support for thousands of people affected by cancer. I like to participate in the knockabout and the political point scoring as much as anyone, as Members probably know, but I am not trying to make a party political point about the nature of this policy. I am simply trying to emphasise that it requires resources, a plan, a strategy and commitment.

I have regularly raised advanced radiotherapy and its benefits and have advocated further investment in research into it. Given the cost, investment and research should be evidence-based, but there are some very exciting areas. I went to see the new proton beam therapy machine at the Rutherford Cancer Centre in Northumberland, in the constituency of my hon. Friend the Member for Wansbeck (Ian Lavery). I saw the installation of a proton beam therapy bunker and the advanced equipment there, as well as stereotactic ablative body radiotherapy, or SABR; adaptive radiotherapy based on advanced imaging, which is a form of magnetic resonance imaging combined with a linear accelerator; combinations of radiotherapy and new drugs; biomarkers, so that radio- therapy can precisely target cancer cells; and molecular radiotherapy.

I also recently visited the Elekta facility in the constituency of the hon. Member for Crawley (Henry Smith), in the company of my fellow vice-chair of the APPG on radiotherapy, the hon. Member for Chichester (Gillian Keegan), and Professor Patricia Price from the Royal Marsden Hospital. We saw these machines being built and developed. This is very impressive technology and it is being developed here in the United Kingdom.

Not only does SABR treat cancers that conventional therapy cannot but the advanced nature of the treatment is such that patients need only be irradiated four or five times, rather than 20, as was the case with conventional radiotherapy. It is not only more effective, but it would save our cancer centres money. More importantly, it can dramatically reduce the number of times that patients are exposed to radiation while still destroying the cancerous tumours.

Although it is needed in over 50% of cases, access to radiotherapy in England is patchy, varying from 25% to 49% depending on the region, with the average being around 38%. Ideally, according to research by Cancer Research UK, patients should have to travel no more than 45 minutes to access this form of treatment, and considerable investment is going to be needed to achieve that. Only 5% of the NHS cancer budget is currently spent on radiotherapy—5% of the cancer budget, not of the total NHS budget—which is £383 million. More investment is needed to increase access to modern radio- therapy because that will increase cancer survival.

I encourage all Members of the House and Ministers to read the “Manifesto for Radiotherapy”, which highlights the importance, and the important benefits, of increasing the percentage of spend on radiotherapy. Increasing it quite modestly—from 5% currently to 6.5% of the cancer budget—would secure a world-class radiotherapy service. Let us not forget that one of the justifications for the huge health and social care reforms put forward by the Government was the poor cancer survival rates. Currently, our cancer survival rates are the second worst in Europe, so there is a deal of work to do.

I suggest that investment in radiotherapy would not only enable treatment of large numbers of cancer patients, save lives and achieve better outcomes but bring positive economic benefits. I commend it to the Minister for Health and urge him to look at it as part of the cancer strategy.

Oral Answers to Questions

Grahame Morris Excerpts

Tuesday 23rd October 2018 Commons Chamber

[Matt Hancock]

I am glad that, like me, the hon. Lady cares so much about getting this right. The long-term plan, which we are writing with the NHS, for how we will spend the £20 billion funding increase is where we can get these details right. Access to mental health services was not even measured before. The first step was to put the measurement in place, and now we can act on that measurement with the huge increase in funding coming to the NHS.

[Grahame Morris (Easington) (Lab)]

5. If he will ensure that NHS England enables NHS trusts to provide advanced radiotherapy treatment.

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

Yes, we are fully committed to ensuring that the most innovative cancer treatments are available to patients on the NHS. Since 2016, the radiotherapy modernisation programme has seen £130 million of new investment to ensure that all new equipment is capable of delivering advanced radiotherapy.

[Grahame Morris]

I thank the Minister for that reply. May I point out how effective advanced radiotherapy is against many cancers affecting the soft tissue? I must declare an interest as a beneficiary of the treatment myself. The latest NHS research shows that treating prostate cancer with 20 treatments of advanced radiotherapy is far better for patient outcomes and would save the NHS more than £20 million a year, but the current tariffs system disincentives trusts from saving this money, as their income is based on the number of treatments. Will the Minister meet me and representatives of the all-party group on radiotherapy to discuss how we might address this anomaly and improve treatments?

[Steve Brine]

It is good to see the hon. Gentleman in his place and looking so well—I am glad we looked after him well. He is absolutely right that access to advanced radiotherapy treatments is critical, as is getting them against the key standard. I would be very pleased to meet his all-party group and discuss its manifesto for radiotherapy.