Covid-19: NHS Support for Prostate Cancer Patients

Feryal Clark Excerpts

Thursday 10th March 2022 Westminster Hall

[Feryal Clark (Enfield North) (Lab)]

It is an absolute pleasure to serve under your chairmanship, Ms McDonagh. I thank the hon. Member for Carshalton and Wallington (Elliot Colburn) for securing this important debate, and the hon. Members for Strangford (Jim Shannon), for Don Valley (Nick Fletcher) and for Coatbridge, Chryston and Bellshill (Steven Bonnar) for their excellent contributions.

The pandemic has had an impact on every aspect of our lives—the people we see, the services we use, and the support that we seek in times of need. While that is the case for all of us, it is particularly true for prostate cancer patients. On a number of occasions in recent months, we have heard Members on both sides of the House speak about the impact of the pandemic on cancer care and the continually growing backlog. However, this situation was not inevitable. It is right that we acknowledge the serious impact of the pandemic across our NHS and the challenges that it has presented; however, we entered the pandemic in a very vulnerable position. After a decade of the Government’s mismanagement, the NHS went into the covid crisis with a record waiting list and a staff shortage of 100,000. It is not just that the Tories did not fix the roof when the sun was shining; they dismantled the roof and removed the floorboards.

The Government blame covid, but the reality is that performance was declining for years before the virus hit. Access to treatment within 62 days of an urgent referral for urological cancer was at 70.6% in March 2020, down from 84% in 2010 when Labour left office. Now, despite the tireless work of NHS staff, performance against targets has hit a record low. More people than ever before are facing unacceptably long waits for vital cancer tests and treatment. I hope that the Minister agrees that the situation is simply unacceptable. Will she tell me exactly what is being done to address that?

We have heard the Secretary of State launch a call for evidence, but does he really think that after 12 years in power, more talk is good enough? Speed of treatment is critical to cancer patients. When every day, hour and minute counts, prostate cancer patients cannot afford to wait for the Government to consult and consider, looking to the sector for answers, because they have none themselves. Prostate cancer patients need firm action now, not another kick of the can down the road—that is rapidly becoming this Government’s trademark.

As other Members have done throughout the debate, I pay tribute to the brilliant work of Prostate Cancer UK. I am proud to support its campaign to identify 14,000 men who are absent from the prostate cancer treatment pathway because of the pandemic. Such campaigns are vital in raising awareness, and the 400,000 men who subsequently checked their risk of prostate cancer is testament to that. I welcome the investment that the Government made in the campaign, and I am keen to hear from the Minister what plans they have to continue that.

Those campaigns make a real difference, so it is important that the Government recognise the need for further development in the relationship between the NHS and the relevant charities. Awareness is just one part of the action that we need to take on prostate cancer, and much more needs to be done to improve the patient journey beyond the initial stage.

A clear and accessible diagnosis process is vital to ensure that patients can access the treatment they need in a timely manner. Diagnosis rates have continued to fluctuate for a number of years and, despite peaking in 2018, they made a noticeable drop in 2019, before the start of the pandemic. Given the problems that the pandemic has caused in accessing primary care services, I am keen to hear from the Minister what understanding the Government have of where we are now on diagnosis rates.

I have spoken to several stakeholders across the cancer sector, and they are concerned that many post-pandemic diagnoses will, sadly, be of later stage cancers. I therefore look forward to the Minister outlining the steps that the Government will take to ensure that awareness campaigns are not stunted by inaccessible diagnosis pathways, putting patients’ outcomes at risk.

As other Members and I have mentioned, referrals are one area in which prostate cancer lags behind other cancers. The Secretary of State acknowledged that himself when launching his elective recovery plan, reaffirming his commitment to get back on track with referral targets, and yet there is absolutely nothing of merit in that plan to reassure prostate cancer patients.

The Secretary of State masks his complete lack of action with grand and frankly unhelpful language when he talks about launching a “war on cancer”. Such words, far from making the Secretary of State look strong, show a gross disrespect for patients and set a dangerous precedent. I urge him and all Ministers to think about the implications of their language for people living with prostate cancer—with all cancers—and the impact that such language can have on them.

One element underpinning all the issues outlined in the debate is workforce, which other Members have mentioned. The existing prostate cancer workforce is overstretched, with prostate cancer specialist nurses having a caseload more than three times higher than that of nurses covering breast cancer. Without a robust workforce strategy, our NHS will simply not be in a place to provide the support that prostate cancer patients need as we emerge from the pandemic, and beyond, but Ministers continue to bury their heads in the sand. They have failed to bring forward a long-term workforce strategy, and with weeks to go until the end of the financial year, there is still no clarity on Health Education England’s budget. In fact, all the Secretary of State can say is that the NHS has to find money from existing budgets to address the workforce shortage. That is really unhelpful. Does the Minister really think that is good enough?

I want to take this opportunity to praise the work of colleagues in the other place in championing workforce issues in their consideration of the Health and Care Bill. I welcome Baroness Cumberlege’s amendment to the Bill to require the regular publication of health and care workforce projections. Will the Minister take this opportunity to reassure us that the amendment will not be overturned when the Bill comes to the Floor of the House? I look forward to working with Members across the House to keep the workforce issue at the forefront, ensuring that prostate cancer patients and others have the support that they need.

I am keen to hear from the Minister what plans the Government have to ensure that staff are trained and retained in a sustainable way so that prostate cancer patients can always access care. People living with prostate cancer need an NHS that has the time and resources to support them as we emerge from the pandemic. It is about time the Government delivered on that.

Oral Answers to Questions

Feryal Clark Excerpts

Tuesday 1st March 2022 Commons Chamber

[Feryal Clark (Enfield North) (Lab)]

This report is damning. The evidence shows that, over a decade of Conservative Government, we have not seen any significant change. Ethnic minority patients continue to receive poorer care because of their race at every stage of their life. The Tories have had 12 years to act. Why have they failed to do so?

[Sajid Javid]

The reason this report exists is that the Government want to see this kind of work being done by an independent organisation so that we can address these types of disparities and issues. There have been ethnic disparities in our health service for decades, sadly, under successive Governments, and it is this Government who are doing something about it. I have already referred to the medical devices review. Earlier this week, the Under-Secretary of State for Health and Social Care, my hon. Friend the Member for Lewes (Maria Caulfield), set out the maternity disparities taskforce, and we will have a lot more to say on this when we publish our forthcoming White Paper.

Down Syndrome Bill

Feryal Clark Excerpts

3rd reading
Friday 4th February 2022 Commons Chamber

[Feryal Clark (Enfield North) (Lab)]

I pay tribute to the right hon. Member for North Somerset (Dr Fox) for introducing this important Bill. I also pay tribute to all the hon. Members who have contributed today and thank them for the wonderful personal accounts that we have heard, especially from the hon. Member for Stroud (Siobhan Baillie), who told us about her sister and nephew.

As we have heard, there are about 47,000 individuals in the UK with Down syndrome. We know that they are at increased risk of some medical conditions, more susceptible to infections, and more prone to hearing and visual impairments. It is recommended that those individuals should have extra health checks in early life and regular health reviews thereafter. They may also need ongoing support for different aspects of life both in childhood and as adults. People with Down syndrome and their families are often reported as struggling to access services such as speech and language therapy, additional support in school and appropriate levels of social care. I very much welcome the measures in the Bill that seek to address those challenges.

I also support the Bill for personal reasons. At the same time I became a mother about eight months ago, some friends of mine, Sevcan and Richard, had a baby boy called Asher. He is a bundle of joy and he also has Down syndrome. In the very short time that Asher has been in this world, he has had many challenges and many operations. I see Asher’s family already struggling and having to fight for him, and I see them getting ready to continue that fight, like the families mentioned by so many hon. Members today.

The experience of Asher’s parents has given me an insight into the challenges faced by families with Down syndrome children, and it was that insight that encouraged me to stand for election as the vice-chair of the all-party group for Down syndrome. As vice-chair, I know the impact that properly informed and resourced services can have on those living with Down syndrome. Too often they are forced into provision or services that are just not suitable for their needs. That means they are unable to access the support they need, whether that be education, healthcare or housing.

Being unable to access those services properly means the life experiences and the quality of life of people with Down syndrome can be seriously affected. By ensuring that the relevant authorities—the NHS, schools or local authorities—have the correct guidance, we will have a very real impact on the experience of those living with Down syndrome. It is incumbent on all of us as policy makers to ensure that people in this country, regardless of who they are, can live as full lives as possible. I am pleased that the Bill is taking the steps to better enable people with Down syndrome to do so. For that reason, I am pleased to support the Bill today and I look forward to it progressing in the other place.

Cumberlege Report

Feryal Clark Excerpts

Thursday 3rd February 2022 Westminster Hall

[Feryal Clark (Enfield North) (Lab)]

It is a pleasure to serve under your chairmanship, Sir Graham. I pay tribute to the right hon. Member for Elmet and Rothwell (Alec Shelbrooke) for securing this important debate and for his continued campaigning on women’s issues. We have heard today harrowing accounts of women’s experiences. It is really important that we hear those accounts and that they are repeated over and again, because we need to remind ourselves that these are real human beings who have to live with this day in, day out. It is important that we record that in this House.

I thank right hon. and hon. Members for their powerful contributions to the debate. As a fairly new Member—I believe I am the newest Member in the Chamber—and having taken some time off for maternity, I have spent less time here than most Members present, so this is the first time that I am hearing about the progress that has been made on the Cumberlege review. It is really depressing to hear that we have not made much progress on the recommendations.

The pressing thread throughout the debate has been the patronising attitude to women’s voices, as was mentioned by the right hon. Member for Maidenhead (Mrs May), which continues. I take this opportunity to pay tribute to campaigners for their tireless work around the Cumberlege review—particularly the Association for Children Damaged by Hormone Pregnancy Tests, without which the review would have never taken place and we would not be here today.

We have heard that Baroness Cumberlege’s excellent review looked into the use of Primodos, the use of sodium valproate during pregnancy, and the use of pelvic mesh implants. Those medicines and medical devices have caused untold physical, developmental and emotional harm to tens of thousands of women. It is almost four years since the independent medicines and medical devices safety review was announced, but it is over 50 years since these treatments started to be used and, as has just been mentioned, women have been trying to get their voices heard for decades.

[Sir Mike Penning]

The hon. Lady may be new to the House, but she is doing very well in trying to understand the position. In the case of Primodos, that was not a drug that was going to cure anything; it was simply a tablet that told the person who took it whether they were pregnant. There were other methodologies around at the time that were deemed to be safe, but GPs continued to give out Primodos when they knew it was not safe. It is quite a clear, difficult thing: GPs were giving out a drug years after the relevant bodies said it should not be given.

[Feryal Clark]

I totally agree with the right hon. Gentleman. I am the mother of an eight-month-old, and during my pregnancy I trusted my GPs and everything they said. I was vulnerable, like all mothers, and I believed that they wanted the best for me. It is absolutely devastating that GPs knew the impact of these drugs yet continued to give them out to women. I thank the right hon. Gentleman for that contribution.

I have constituents in Enfield North who were impacted on by these medicines. My constituent Chris was given Primodos in June 1970 to find out whether she was pregnant. Her daughter Emma is now 51 years old and has suffered throughout her life from limb deformation, spinal problems, scoliosis, joint problems and mental health problems. She lives in chronic and intense pain that does not go away, and she can no longer work full time.

The review set out nine ways in which the Government could have delivered justice, made the lives of those affected—such as Chris and Emma—a little easier, and tried to prevent future incidents. Given the shocking accounts that we have heard today—accounts that the Government have been hearing for years—and the evidence in the review, one would have expected the recommendations to be accepted in full, but that is not the case. As we have heard, the Government have accepted four recommendations, but there are two that they have not accepted. They have accepted two other recommendations in part, and one in principle.

I am pleased that there has been an apology and that there is legislation for a patient safety commissioner. I am pleased that there are specialist centres for the care of those with complications from mesh implants, although I hope the Minister will address the serious concerns we have heard about that. I am also pleased about the changes to how doctors’ conflicts of interest are reported.

However, that is not why we are here today. Implementing those recommendations alone is not good enough. The Government have refused to establish a redress agency for those harmed by such medicines and medical devices, or to set up a separate scheme to meet the costs of providing additional care and support to those who have experienced avoidable harm, which would make a huge difference to families in meeting their exceptionally challenging needs every day. My constituent Emma worries about her ability to keep working and her financial stability. If a scheme were available to support her financially, she would not have to worry.

The Government claim to care about women’s health and making a change. Their vision for women’s health, announced in December, is

“to improve the way in which the health and care system listens to women, and to reset our approach to women’s health by placing women’s voices at the centre of this work.”

They then directly cited Baroness Cumberlege’s review, stating:

“Independent reports and inquiries—not least the report of the Independent Medicines and Medical Devices Safety Review…have found that it is often women whom the healthcare system fails to keep safe and to whom the system fails to listen.”

The Government accept the review and use it, but will not deliver on it. They will not truly listen to those who have been campaigning for justice for years and do right by the families. They will not take the opportunity to reset their approach to women’s health and place women’s voices at the centre of their work by implementing all the recommendations.

In November, I wrote to the Secretary of State for Health and Social Care to ask him to consider establishing a taskforce to implement all the recommendations of the review to put these injustices right. I am still waiting for a response. How can the Government claim that they are taking the review and women’s health seriously if they cannot even respond to a letter from a Member?

Will the Minister please commit to implementing the remaining recommendations? If not, will she explain how not implementing the full recommendations of the Cumberlege review changes anything, or helps to create a system that keeps women safe and listens to them? It is time for her to stand up for the families affected by Primodos, sodium valproate and surgical mesh, and for the Government to stand by their vision by implementing the recommendations in full. Otherwise, we will fail these families and these women again and again.

Cystic Fibrosis: Prescription Charge Exemption

Feryal Clark Excerpts

Wednesday 2nd February 2022 Westminster Hall

[Feryal Clark (Enfield North) (Lab)]

It is a pleasure to serve under your chairmanship this afternoon, Mr Sharma. I pay tribute to the hon. Member for Blackpool North and Cleveleys (Paul Maynard) for securing this important debate and for his continued campaigning on this issue. I also thank my hon. Friend the Member for Bristol East (Kerry McCarthy), the hon. Member for Ashfield (Lee Anderson), the hon. Member for Strangford (Jim Shannon) and the right hon. Member for South Holland and The Deepings (Sir John Hayes). As has been said, hearing the personal stories of Members brings to the fore the reality faced by CF patients, which is really important, and I thank Members for sharing those personal stories.

As we have heard this afternoon, cystic fibrosis affects over 10,000 people in the UK, with one in 25 people being carriers of the CF gene. CF is a degenerative condition with symptoms that often start in early childhood, get progressively worse and affect people’s quality of life. Although there is no cure, treatments are available to help manage the condition and reduce its effects. Sadly, life expectancy for those living with CF is still shorter than that of the general population. People living with CF are also more susceptible to other conditions, including diabetes, osteoporosis and liver issues.

Despite the debilitating nature of CF, people living with the condition face a complex and discriminatory system when it comes to accessing prescriptions. The system of prescription charges is complex for most people, but for those living with long-term health conditions, it can present multiple challenges.

As all Members have said, there are several exemptions from prescription charges, based on demographics, income and pre-existing conditions. When it comes to pre-existing conditions, the list of conditions that are exempt from prescription charges was first created in 1968, as we have heard. In the 54 years since, we have seen immeasurable changes in our understanding of long-term conditions and the outcomes of people living with them, yet just one addition has been made to that list in those 54 years—just one. That leaves those living with CF in the position of needing to have another long-term condition to access free prescriptions. This two-tier system leaves thousands of people with the same conditions facing different circumstances.

We know the difficulties faced by those living with CF who have to pay for their prescriptions. The costs of prescriptions can put people off taking the medication they need, as we have heard. With the costs continuing to rise, those problems are only going to get worse. That not only leaves people suffering more than necessary but, as set out very eloquently by my hon. Friend the Member for Bristol East, will cost the NHS more money in the long term and further increase pressure on primary care.

At a time when the cost of living is continuing to rise, the Government ought to consider what more they can do to support people with these essential costs. The fact that one in 10 people living with CF were given emergency grants by the Cystic Fibrosis Trust to help them fund their medication shows how serious this problem is. No one should be forced to choose between paying for their prescription and risking their lives. Sadly, we know the financial pressures that those with long-term conditions often face. As the hon. Member for Strangford mentioned, surveys have shown that 29% of people living with CF have not taken their prescriptions due to financial pressures. Too many people are forced to make dangerous choices that they should not have to.

The inequality in prescriptions for those living with CF is clearly a cause for concern, and something that the Minister needs to look at. In December, he stated in response to a written question that the Government’s

“policy on entitlement to help with prescription charges in England is based on the principle that those who can afford to contribute should do so, while those who are likely to have difficulty…paying should be protected.”

What weight has he given to the financial difficulties of those living with long-term conditions such as CF when establishing his principles?

Furthermore, as I and other hon. Members have pointed out, the medical exemption list for prescription charges has been updated just once since 1968. Given the Government’s levelling-up agenda, one would assume that this would be a perfect opportunity to bring health policy properly into the 21st century. Given the powerful arguments that we have heard this afternoon, I hope the Minister’s position has progressed from the response he gave to the written question just a few weeks ago. For him to say that the Government have “no plans” to look again at this, despite the overwhelming changes in our health service in the last 54 years, is frankly slightly baffling. What reassurances can he give those living with CF that the Government understand their condition as it is now, not as it was in 1968?

The Minister furthermore suggested that capping charges at £108 for those living with long-term conditions through a prepayment certificate provided support. This highlights a failure to grasp just how serious the financial pressures faced by those living with long-term conditions such as CF are. Those living with CF face an outdated and unfair system that is wholly removed from the world as it is today. If the Government truly believe in levelling up, it is time for the Minister to look at this issue again.

Oral Answers to Questions

Feryal Clark Excerpts

Tuesday 18th January 2022 Commons Chamber

[Maria Caulfield]

I thank my hon. Friend, who is pushing me constantly to improve access for her constituents, but can I reassure her that the announcement, the funds and the support are making a difference? In November last year, there were on average 1.39 million general practice appointments per working day, compared with 1.31 million in November 2019, but crucially, 62.7% of those appointments were face to face, so this is really making a difference for patients.

[Feryal Clark (Enfield North) (Lab)]

A nurse wrote this week about working on covid wards during the height of the pandemic:

“There were no vaccines or treatments then and we worked for hours in full PPE to protect ourselves and try not to bring the virus home to our families. There were no after work drinks for us…It is clear that there was a culture inside Number 10 where even if rules were not technically broken, the spirit of the rules were, and this is completely unacceptable.”

The nurse is the Minister. Surely she must agree that the Prime Minister should now resign.

[Maria Caulfield]

I am very disappointed by the hon. Lady’s question. Serious issues are facing the NHS and patients, and instead of playing party politics at the Dispatch Box, perhaps she needs to ask her own leader what he was doing in May last year.

Access to Radiotherapy

Feryal Clark Excerpts

Wednesday 12th January 2022 Westminster Hall

[Feryal Clark (Enfield North) (Lab)]

It is a pleasure to serve under your chairmanship, Mr Davies.

I start by thanking my hon. Friend the Member for Easington (Grahame Morris), both for securing this important debate and for being such a consistent champion on this issue. We have heard some excellent contributions and I pay tribute to all hon. Members who have spoken—my hon. Friend the Member for Bedford (Mohammad Yasin) and the hon. Members for Strangford (Jim Shannon) and for Westmorland and Lonsdale (Tim Farron)—for raising issues about investment, the workforce and the bureaucracy that surrounds radiotherapy. I pay tribute to my hon. Friends the Members for Rhondda (Chris Bryant) and for Easington, who speak with authority on the issue as a result of their experiences.

We have heard that radiotherapy is a vital tool in our fight against cancer and that it is one of the three pillars of treatment alongside surgery and chemotherapy. The fact that radiotherapy is needed by one in four of us across our lifetime should be a stark reminder of how important today’s debate is. I join my hon. Friend the Member for Easington in paying tribute to the work of charities such as Radiotherapy UK and the Catch Up With Cancer campaign for keeping this important issue on the agenda.

Hon. Members will know the impact the pandemic has had on cancer treatments and the devastating backlog that it has caused. In my own constituency of Enfield North, data from Macmillan shows that 73 people are missing a cancer diagnosis and a further 57 are waiting for their first cancer treatment. The backlog in treatment, coupled with the severe workforce crisis, which every Member has highlighted and which is rapidly stretching across our health service, means that we are facing a situation where outcomes for cancer patients are being put at risk. As we have heard, radiotherapy is a vital tool in our fight against cancer and should play a key part in our work to help overcome the backlog that affects both patients and staff.

As highlighted by all hon. Members, with the pandemic impacting so much of the NHS’s operations, radiotherapy provides a covid-resilient form of cancer treatment by not having an impact on the immune system or requiring admission into intensive care. It is very cost-effective, as mentioned by my hon. Friend the Member for Easington, with the average cost of radiotherapy care ranging from £4,000 to £7,000, making it cheaper than the often costly options of surgery or chemotherapy. Despite that, radiotherapy has been consistently overlooked when it comes to policy, so it has often faced a lack of investment and understanding by policymakers and successive Governments.

As we have heard, just 5% of the cancer budget in the UK is spent on radiotherapy. That means that despite significant global advancements in radiotherapy technology, patients in the UK are continuing to miss out. Half of all NHS trusts are using machines that are older than the recommended 10-year life span.

[Grahame Morris]

I apologise for breaking the flow of my hon. Friend, but these are important statistics. One worth remembering is that in over 50% of cancers, radiotherapy or precision radiotherapy would be effective as part of treatment—perhaps not exclusively. Actually, when I had my treatment, I had everything: I had surgery, chemotherapy and radiotherapy. However, it would be effective in over 50% of cases. It is currently only given to 27% of cases, so even before we start tackling the backlog, there is a huge capacity issue, and I hope my hon. Friend recognises that, and that the Minister will address it.

[Feryal Clark]

I thank my hon. Friend for his intervention; I absolutely agree with him. As was mentioned, many patients do not even have the luxury of being treated by old technology. More than 3.5 million people in the UK do not have radiotherapy centres within the recommended 45 minutes of their home, as mentioned by my hon. Friend the Member for Bedford and others. That has led to a situation where, rather than meeting the international guidance of 57% to 60%, just 27% of cancer patients in the UK are given radiotherapy. Patients are receiving a raw deal at every turn in the UK, putting their treatment and their long-term outcome at risk.

It is not just patients who are feeling the strain; radiotherapy staff, like many of their colleagues across the NHS, are feeling undervalued and under-resourced. A workforce survey carried out by Radiotherapy UK showed that 80% of radiotherapy staff were considering, or knew of someone considering, leaving the profession; 90% felt that the Government did not recognise the significant role that radiotherapy plays in reducing the cancer backlog; and 75% felt that they did not have the capacity to reach a pre-pandemic service level. A plan to improve provision of radiotherapy, or any other treatment across the NHS, will not be successful if there is not a robust workforce strategy behind it.

[Grahame Morris]

We need a plan.

[Feryal Clark]

Absolutely. I ask the Minister what other hon. Members have also asked today: how do the Government expect to tackle the cancer backlog when staff feel like no-one is listening to them? NHS staff have made immense sacrifices during this pandemic; they deserve to be heard and respected instead of having their concerns ignored.

The staff who remain in radiotherapy are met with barrier after barrier when it comes to improving the experience of patients and the effectiveness of treatment. I run the risk of repeating points, but these are key issues and need repeating. In order to justify investment to fund a new and updated machine, NHS trusts are required to conduct 9,000 treatments per year. During the pandemic, when we have seen referrals plummet and services stretched to breaking point, that target is plainly unrealistic for many trusts. It leaves staff with faulty, unreliable equipment that frequently breaks down, and patients with delays, postponements, cancellations and a much more challenging experience of treatment. I join with many other Members who spoke this morning in urging the Minister to carefully examine the situation, and look at what can be done to remove the bureaucracy that is stopping the advancement in equipment that is evidently needed.

When we know that every four-week delay in treatment for a cancer patient increases the mortality rate by 10%, the lack of investment in such a core pillar of cancer treatment is putting lives at risk. The failure to address these issues will leave the 40% of cancer patients who need radiotherapy as a curative treatment, either on its own or in combination with other methods, in a grave situation. Failure will also have a knock-on effect across all treatment pathways, increasing the pressure on already stretched cancer services as well as primary care providers.

Finally I ask the Minister, do the Government accept that radiotherapy needs an increased level of support to properly fulfil the important role it plays in overcoming the backlog in cancer treatments? Furthermore, will the Minister commit to a plan to improve both workforce numbers and satisfaction, given the increased pressure that the situation is producing on services such as radiotherapy? Cancer patients have suffered so much over the course of the pandemic; they deserve better than this. It is about time that the Government acted.

--- Later in debate ---

[Maria Caulfield]

There are satellite services—absolutely. We have seen them not just for radiotherapy, but for chemotherapy and even surgery. But it has to be a local decision, because local oncologists have to feel that they are able to support the multidisciplinary team who support the radiotherapy process, ranging from diagnostics through to the treatment itself. That has to be in place, so it does absolutely need to be done on a local basis, but I am happy to meet colleagues if they feel that the case is not being heard locally.

I want to emphasise this point, because a number of hon. Members talked about the commitment to cancer services. Our elective recovery programme has committed £2 billion this year and £8 billion over the next three years to step up activity and tackle backlogs. That will have a knock-on effect in improving radiotherapy access, because some patients cannot have radiotherapy until they have had surgery. Ensuring that we are tackling some of the backlogs to treatment resulting from covid is absolutely important.

There have been huge improvements in radiotherapy over recent years, not just in provision but in technique. We are able to deliver more targeted treatment, resulting in fewer hospital visits, because we can now give radio- therapy to a more targeted area of the body, resulting in fewer side effects from the treatment, and also give fewer fractions of radiotherapy, so that patients can get their total dose much more quickly. That maximises service capacity and minimises patient time in hospital.

Furthermore, we have invested £250 million into two proton beam therapy facilities, one based at the Christie in Manchester and the other at University College London. In addition, all radiotherapy centres in England are now able to deliver stereotactic ablative body radiotherapy. Both these treatments are able to target radiation at cancer cells more accurately, improving patient outcomes. I am really pleased to say that, as part of this year’s spending review, £32 million was made available to support the replacement of 17 linear accelerators aged over 10 years, all of which are on order and will be delivered by the end of March 2022.

NHS England is committed to improving the facilities for cancer patients, and has also offered NHS radiotherapy providers the opportunity to participate in a cloud-based technology called ProKnow. To date, 43 of the 49 radio- therapy providers have joined up. This technology, which will help satellite units, enables clinicians to collaborate virtually within and across organisations, to plan treatments, undertake peer-review assessments and participate in large-scale audits and quality improvement processes, ultimately benefiting patients.

A number of Members talked about the cancer workforce, because it is great to have state-of-the-art technology and multiple units providing radiotherapy, but if we do not have the staff to manage them and provide treatment we shall not make progress. Health Education England is continuing to take forward the cancer priorities identified in the NHS’s long-term plan. It is prioritising the training of 250 nurses to become cancer nurse specialists, 100 chemotherapy nurses and 58 biomedical scientists, and it is updating the advanced clinical practice qualification in oncology.

Further than that, particularly around radiotherapy, Health Education England is investing £52 million in the cancer and diagnostic workforce, increasing the number of clinical endoscopists and training more radiographers in image interpretation. That is all part of the radiotherapy process. As of August there have been an additional 4% of doctors working in clinical oncology, which is the field that manages radiotherapy, and there have been a further 5% working in radiology since August 2020.

We are making progress, but it is not just about the numbers of staff; it is about the skill mix and ongoing staff training. Very often, not being able to expand a role or take on exciting and innovative developments can make staff feel frustrated, but the cancer workforce is growing. Between 2016-17 and 2019-20, the cancer workforce grew by 3,342 full-time equivalents, compared with the ambition of 2,943. We are ensuring that there are more staff coming through into the workforce to deliver radiotherapy.

The shadow Minister touched on the importance of not only recruiting staff but retaining and developing them. I fully take on board colleagues’ comments and concerns. We are committed to investing in radiotherapy equipment, the staff that deliver radiotherapy and the innovation in radiotherapy. We are also committed to making it more accessible to patients, and to reducing the side effects—there are side effects from radiotherapy as well—and to making sure it is a fundamental part of cancer treatment, whether that is in the neoadjuvant setting, adjuvant or for those with metastatic cancer as part of the palliative treatment service.

[Feryal Clark]

I thank the Minister for all the information about the machines and investment into radiotherapy. Are the figures that she set out for replacing what is already out of date, or is there a plan to increase investment in radiotherapy treatment? As we have all said, radiotherapy accounts for 5% of the cancer budget. Is there a plan to increase that, or is it about replacement and keeping up what we already have?

[Maria Caulfield]

It is about replacing existing equipment, but also investing in new. Some of the equipment is 10 years old. Radiotherapy has changed a lot over those 10 years, so the replacement equipment can do more than what it replaces. As I pointed out, we are also investing in new radiotherapy equipment, with £250 million into two proton beam therapy facilities at Christie’s and at UCL—new facilities that will be able to provide state-of-the-art radiotherapy treatment. I hope I have reassured Members that we are addressing this as a top priority.

Asthma Outcomes

Feryal Clark Excerpts

Tuesday 7th December 2021 Westminster Hall

[Feryal Clark (Enfield North) (Lab)]

It is a pleasure to serve under your chairmanship, Mr McCabe.

I thank the hon. Member for Strangford (Jim Shannon) for securing this Backbench Business debate on improving asthma outcomes and for setting out so comprehensively the issues and challenges faced by the UK’s asthma sufferers. He said there are not many families in the UK who are not affected by asthma—his own son is an asthma sufferer—and I absolutely agree with him. I have a cousin currently in hospital who is a severe asthma sufferer; his covid was made worse by his severe asthma. It is a condition that affects many of us.

The hon. Member also set out some sobering statistics about asthma, which should shame us all. He made three asks and set out the areas where he believes the Government need to do more, which was echoed by many other speakers. They relate mainly to the overuse of blue inhalers, the conflicting guidelines and the need to improve them, and biologic therapy, which I will touch on.

We also heard from the hon. Member for Rutherglen and Hamilton West (Margaret Ferrier), who raised the issue of air quality and air pollution. We know that air pollution exacerbates asthma. Most Members will know the case of Ella Kissi-Debrah, the nine-year-old asthma sufferer who died, and the coroner said air pollution was a factor in her death. We know that air pollution affects asthma sufferers really badly and more needs to be done about it.

The hon. Member for Loughborough (Jane Hunt) set out very well the great work being done by businesses and the university in her constituency, and also raised the important issue of prescription charges and the need to have a medical exemption from them. Others raised that issue, too, and I absolutely agree.

Finally, my hon. Friend the Member for Blaydon (Liz Twist) set out the facts and statistics—the really terrible statistics—that the UK has on asthma and the challenges around gaining access to biological medicines. She also told the stories of some asthma sufferers.

We have heard today that severe asthma is the most debilitating, even life-threatening, condition that does not respond to conventional treatment. As has been said, it is estimated that about 200,000 people in the UK have severe asthma, and without specialist treatment and support people with severe asthma end up in a never-ending cycle of emergency trips to hospitals, relying on toxic oral steroids that have nasty side effects; we heard real-life stories about those from my hon. Friend the Member for Blaydon. She also said that four out of five people with suspected severe asthma who should be referred to a specialist do not receive the care they need, and that 46,000 people are missing out on life-changing biological treatment, an issue that was raised by almost all hon. Members who spoke today.

Today’s debate is important because currently there is no cure for asthma; it is only possible to manage the condition so that symptoms are kept under control. We must ensure that asthma treatments and outcomes are of the highest quality. The UK has one of the worst mortality rates for asthma in Europe, with a death rate almost 50% higher than the average death rate for the EU. That should embarrass us all. Despite initiatives such as the 2014 national review of asthma, asthma deaths rose by more than 33% in England and Wales between 2008 and 2018. Some 5.4 million people in the UK are receiving treatment for asthma, leading to 41,000 hospital admissions last year for asthma-related concerns, and 1,300 deaths.

If those figures are not enough to show that we must improve asthma outcomes, we should note that two thirds of asthma deaths are preventable. Three people die from asthma attacks every day. That number must be lowered.

The disruption caused by the pandemic has had a huge impact on asthma care and outcomes. Basic asthma care is an annual review, an inhaler technique check and a written asthma action plan. Members have discussed how that care is not enough. Last year, the number of people receiving even that basic level of care dropped for the first time in eight years, with more than 3.5 million people missing out on potentially life-saving treatment—that is 3.5 million people with asthma who were put at risk. However, even before the pandemic, respiratory care was lagging behind care for other conditions. Basic care levels for asthma were stalling. Recent research by Asthma UK shows that 75% of people with chronic obstructive pulmonary disease were also missing out on fundamental care.

We must understand the challenges of asthma treatment in our country and look at what we might do differently to save lives and improve patient outcomes. There are several areas for the Government to improve. Many excellent suggestions have been made today. I want to focus on the restoration of the normal delivery of care, prescription charges and air pollution. The Government’s work should not be limited to these areas and I urge the Minister to explore other avenues, such as early diagnosis and promoting the take-up of covid booster vaccinations for asthma patients.

In England, the NHS long-term plan included respiratory diseases as a national clinical priority, with the objective of improving outcomes for people with respiratory diseases including asthma. I urge the Government to therefore commit to restoring the normal delivery of care for people with respiratory diseases, so that everyone with asthma receives at the very least the most basic level of care and that 3.5 million people are not denied the basic care they deserve.

Many Members have referred to the Asthma UK survey that found that 76% of people with asthma struggle to afford their prescriptions, 57% skip their medication because of the cost, and 82% say their symptoms worsen as a result. People on lower incomes are already nearly twice as likely to have had an asthma attack than those on higher incomes. The inability to afford prescription charges is highly likely to be a contributing factor. It is putting lives at risk. People should not be forced to choose between paying for a prescription or risking their lives.

Health inequality is one of the major drivers of poor health outcomes that we see today, and asthma is no exception. We know that asthma symptoms are exacerbated by breathing polluted air, as well as from smoking. Air pollution can worsen existing health inequalities and the people living in the poorest areas are often the most exposed to polluted air, reinforcing unequal health outcomes for deprived communities. We need to make sure that air pollution is reduced across the country and must adopt into law enforceable targets set out by the World Health Organisation to bring air pollution down to below harmful levels.

In November 2020, the APPG on respiratory health produced its report on improving asthma outcomes in the UK, which we have heard about today, and I look forward to its forthcoming one-year-on report. I urge the Minister to consider those reports and reflect closely on the recommendations and issues raised by the hon. Member for Strangford.

Fibrodysplasia Ossificans Progressiva

Feryal Clark Excerpts

Monday 6th December 2021 Westminster Hall

[Feryal Clark (Enfield North) (Lab)]

It is a pleasure to serve under your chairmanship, Sir Roger. I thank the hon. Member for Carshalton and Wallington (Elliot Colburn) for introducing the debate on behalf of the Petitions Committee. As we have heard, despite fibrodysplasia ossificans progressiva—or FOP—being an ultra-rare disease affecting only one in a million, more than 111,000 people have signed the petition, including 162 people from the hon. Member’s constituency and 108 from my own, showing the high level of public support for the issue.

I pay tribute to the contribution from the right hon. Member for Hemel Hempstead (Sir Mike Penning), whose constituent, Lexi, has recently been diagnosed with FOP, and to Lexi’s mother, Alex, and father, Dave, who have been instrumental in the petition’s success while also raising awareness and money for research themselves. I was pleased to see that there were signatures from across the country, but the support from Hemel Hempstead massively outweighed that from anywhere else, evidencing the incredible drive and leadership shown on Lexi’s behalf. Again, I pay tribute to the right hon. Member. He and colleagues who have spoken today have all highlighted the issues around the lack of funding and the need to raise awareness.

We have heard lots of excellent contributions, so I also pay tribute to my hon. Friend the Member for Wythenshawe and Sale East (Mike Kane) and the hon. Members for North Antrim (Ian Paisley) and for South West Bedfordshire (Andrew Selous) for highlighting their constituents’ cases and the issues around funding and the lack of awareness. It is incredibly shocking that the only source of funding for research into the disease is from FOP Friends, so I also recognise, and thank it, for the work it has done.

As we have heard, FOP comes from mutation of the ACVR1 gene, causing muscles, tendons and ligaments to convert to unwanted bone growth, starting from a very young age. It debilitates and disables, before progressing to cause immobility and ultimately death. While progress happens at different rates, both naturally and because of the trauma it induces, most people with FOP are immobile by the age of 30.

[Sir Mike Penning]

The hon. Lady has touched on an enormously important point that I did not mention in my comments. Lots of people think this is all about trauma—that it is all about bruising or impact—but for a lot of people with this terrible condition, there is no logic. There is no trauma; it just develops and goes through. We have the two sides of it. Trauma, yes, and that is where the research into this particular condition is so important.

[Feryal Clark]

I absolutely agree. There is a need for investment into research of all aspects of this illness. Life expectancy for people with FOP is, on average, 40 years, which is absolutely shocking. It is a horrible condition that nobody would wish on their worst enemy. It is clear that we all agree on the need to act to improve outcomes for the approximately 70 people in the UK who we know of who are suffering as well as for everyone living with it across the world. Thankfully, we know that action can be effective, both in diagnosis and care.

The average age at diagnosis is eight years old, despite the existence of genetic tests to confirm diagnoses and other signs that occur far earlier than that. Usually, the benefits of early diagnosis are common sense—it is just a matter of time, and time spent untreated is time in which a disease or condition can worsen. However, FOP is different. As I and other Members mentioned, trauma generates FOP activity, worsening the condition and speeding up its progress. Any time spent undiagnosed is time when trauma can occur unknowingly, not least in young children, who are not particularly robust or careful; I have a seven-month-old myself, so I know it is really difficult to prevent little babies from moving around. We do not need to stretch our minds to imagine the accidental trauma that could take place in a child with FOP up to the age of eight.

In the first instance, early diagnosis avoids the need for investigative diagnostic procedures that can themselves trigger irreversible FOP activity in an individual, and it does not stop there. Early diagnosis means other adaptations can be made at home and school, and my hon. Friend the Member for Wythenshawe and Sale East spoke of the adaptations made in school for Oliver. It means that alternatives can be used to potentially damaging immunisations, usually injected into muscle; knowledgeable clinical care can be established; and of course, simple behavioural changes can be made to avoid unnecessary trauma in these individuals. Those simple things can make a tremendous difference, yet the genetic test that can make that happen can be requested only by specialist clinicians, of which there are not many. Given how few people suffer from FOP, the likelihood of that request happening prior to diagnosis seems monumentally low, let alone its happening an optimal time. The directory of approved tests for the NHS genomic medicine service will be updated next April, and we heard hon. Members call for the Government to ensure that the FOP test is included. I hope to hear the Minister commit to heed those calls.

I also urge the Minister to explore other avenues, such as technology to improve doctors’ awareness of symptoms or new born genetic screening, which will have impacts far beyond FOP and could help many of the one in 17 people who live with a rare condition. The Government have already set out their vision for this in the UK rare diseases framework, so I do not think anything new is being asked for today—simply for them to follow through on their promises.

Just as with diagnosis, it is often the case that the most difference can be made to rare diseases by improving standards of care. For those living with FOP, that can also be transformative. With so few specialists or experienced clinicians, it is no surprise that levels of care vary, but that does not mean that the status quo has to be maintained. The nature of FOP means that some activity needs urgent action, and of course, specialist assistance is needed throughout. The UK rare diseases framework offers an opportunity here, too. I am keen to hear from the Minister the Government’s plans to improve care for those with FOP universally through that mechanism and to ensure that all those living with FOP now and in the future get the care that they need.

My final point is a broader one that applies to rare diseases in general. We have many of these debates, and quite rightly, because every person who lives with a rare disease has a different experience. Collectively, rare diseases affect as many as 3.5 million people across the UK. Although individual approaches are needed, a collective approach is also important. I welcomed the publication of the UK rare diseases framework, because not only can collective action help to improve standards of diagnosis, treatment and care, but individual approaches can help others. For example, as we have heard, increased research into FOP could help joint replacements, military injuries, burns, sporting injuries, osteoporosis, heart disease, chronic anaemia, and even brain cancers. That principle will apply across the rare diseases spectrum. It is disappointing that after the rare disease framework was published, the then public health Minister confirmed that no new funding had been allocated. My ask of the Minister, and my question to the Government, is simple: how will the Minister deliver on the priorities that the Government set out in that framework?

Covid-19 Update

Feryal Clark Excerpts

Monday 19th April 2021 Commons Chamber

[Matt Hancock]

The latter question is really a question tied to the certification work. We have not hitherto, as my hon. Friend well knows, said that the rules for people who are vaccinated should be different from those for people who are non-vaccinated, but we know that some other countries are proposing to say that that will be case for international travel, so we do need to have a way of showing or proving it. However, we have not yet come to any conclusions about how we should do that and whether we should do that domestically. That is a matter for the Chancellor of the Duchy of Lancaster.

On measuring how effective a second dose is, we have tests in the field right now to follow a sample of people who have had both tests, having them tested regularly—weekly, typically—to check whether they test positive, and therefore testing the effectiveness of both of the vaccines in the field. So far, we have published the results of that after one jab. Very early results are coming through after two jabs, and in the next couple of weeks we will have some really rich data on that, I should hope, because we have now seen a significant number of second jabs—10 million as of midnight last night.

[Feryal Clark (Enfield North) (Lab) [V]]

The vaccination roll-out for the majority of the country has been nothing short of amazing, and I would like to thank the local NHS providers in Enfield and across the country for their herculean efforts. Sadly, for some parts of the country, including many parts of my constituency of Enfield North, a postcode lottery appears to be emerging, whereby vaccination rates are stubbornly low and falling behind the rest of the country. What is being done to combat this, and what additional support will the Department be providing to areas with consistently low vaccine rates?

[Matt Hancock]

We have a huge amount of work on to tackle exactly the phenomenon that the hon. Lady describes. I thank people in Enfield who have been working on the vaccination programme, because they have done incredibly well, but there is much more to do. We have to ensure that we make the vaccine more accessible—that it is easy to access—and that people have reassurances if they are hesitant. The Minister for Covid Vaccine Deployment, my hon. Friend the Member for Stratford-on-Avon (Nadhim Zahawi), is leading on these efforts, including with innovative approaches that we are currently trialling, such as allowing multigenerational households to be vaccinated at once, to see how we can drive up uptake in those groups in which we have not seen such high uptake. As I said, overall uptake among over-50s is 94%, which is far higher than my best possible hopes just a couple of months ago, but if we can reduce that final 6%, for every percentage point that comes off it, the safer we all get.