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.

Oral Answers to Questions

Grahame Morris Excerpts

Tuesday 24th July 2018 Commons Chamber

[Steve Brine]

I thank my hon. Friend for his work chairing the all-party group on cancer over many years, as I know he is about to step down. He has two answers in one here. Yes is the answer. Improving cancer patient outcomes will be the seam that runs through the centre of the NHS’s long-term plan, like the proverbial stick of rock.

[Grahame Morris (Easington) (Lab)]

Only 5% of the NHS cancer budget, about £385 million a year, is spent on radiotherapy, and that underinvestment is affecting patient access to advanced modern radiotherapy and outcomes. Is it not time to make the cancer drugs fund a cancer treatment fund and extend those opportunities?

[Steve Brine]

We are looking at the future of the cancer drugs fund as part of the new 10-year plan. There is a radiotherapy review at the moment, as the hon. Gentleman will be aware. Knowing him, he will be engaging with the review in his area. He talks about the latest radiotherapy and, of course, we have the new proton beam therapy treatment coming online in London and Manchester, for which children and patients are currently sent overseas. That is a great step forward, but there is an awful lot more to do, which is why the 10-year plan will have cancer at its heart.

Draft Nursing and Midwifery (Amendment) Order 2018

Grahame Morris Excerpts

Wednesday 20th June 2018 General Committees

[Stephen Barclay]

The hon. Gentleman absolutely sees my enthusiasm for this order, and that is why I hope that colleagues on both sides of the Committee will support it. Alongside the apprenticeship levy, it offers an alternative to a student loan and what we might see as a more conventional degree. That is not to say that we will not continue with that route, because obviously it will remain a main pathway into nursing, but it is good to give flexibility to employers and to school leavers and others who see the opportunity to go into nursing. We are conscious that, currently, many people who want to do nursing are rejected when they apply, so having different pathways is a key part of the system.

[Grahame Morris (Easington) (Lab)]

rose—

[Stephen Barclay]

I did say that I would make some progress, but I am conscious that I have not taken an intervention from the hon. Gentleman, so I will take one more and then, with the leave of the Committee, I will make some progress.

[Grahame Morris]

It is interesting that the Minister is setting out arguments for a kind of continuing professional development. We are talking about an additional grade of people who could go on to become registered nurses, but I wonder how that might be possible, given that Health Education England’s budget for workforce development, which is largely used for continuing professional development for nurses, has been cut by more than 60% in the last two years, from £205 million down to £83.45 million in the current year. How does that square with that ambition?

[Stephen Barclay]

The hon. Gentleman raises an important point, because continuing professional development is key. When two thirds of what we spend on the NHS goes on staff, how we effectively train them is key. That is in part why my right hon. Friend the Prime Minister made the commitment she did on Monday on the funding settlement—again, that is slightly beyond the scope of today’s deliberations. It is also why the Government have committed to, for example, 1,500 new doctors being trained, opening five new medical schools and other initiatives, including, as I said a moment ago, the apprenticeship levy, as other vehicles.

One piece of feedback that I get from nurses when I go out to visit hospitals is the importance of CPD, which I am looking at very closely, because of the need for a wider skills mix. To take GPs, for example, it is important to look at whether all the activity that they are currently doing is necessary or whether some of those tasks could better be performed by others, if there were a wider skills mix. However, that is slightly beyond the scope of today’s deliberations, so I will make some progress.

The draft order amends the offence provisions in the Nursing and Midwifery Order 2001. The amendments provide that a person commits an offence in connection with the nursing associate part of the register, nursing associate qualifications or the use of the nursing associate title when not entitled to. The offences were drafted to reflect the fact that nursing associates will be regulated in England only.

The draft order makes provision to allow admission to the register to those who complete or commence their training by 26 July 2019 through the pilot courses run by Health Education England or through an apprenticeship route. It excludes nursing associates from being given temporary prescribing rights in a time of national emergency, such as a pandemic flu outbreak. It also removes the screener provisions from the 2001 order, as they are now redundant.

The draft order makes consequential amendments to the Nursing and Midwifery Council’s rules and to other legislation, and closes sub-part 2 of the nurses part of the register by amending the Nurses and Midwives (Parts of and Entries in the Register) Order of Council 2004, which determines the parts of the NMC’s register and the titles that may be used by those included in that register. The Department carried out a full public consultation across the United Kingdom on the proposed amendments and received 373 responses. There was broad agreement on the proposed legislation to regulate nursing associates in England.

Health Education England has established two pilot groups of 1,000 nursing associate trainees, who are due to complete their training in early 2019, and the Health Secretary has announced plans for up to 5,000 additional nursing associates to commence training via the apprenticeship route in 2018, and up to 7,500 a year thereafter. The draft order will insert a new provision in the Nursing and Midwifery Order 2001 to allow applicants who have started or completed a nursing associate qualification through either the HEE pilot or the apprenticeship route by 26 July 2019 to have their qualifications recognised.

In summary, these are important changes to the governing legislation of the Nursing and Midwifery Council that will see the nursing associate role regulated. Nursing associates will support nurses so that they can focus on the more clinical aspects of patient care, and will support the increase in nurse numbers by providing a clear pathway into the nursing profession, which the hon. Member for Huddersfield alluded to.

[Grahame Morris]

I am grateful to the Minister for giving way; he is being generous. What is his estimate of the current number of vacancies for registered nurses in the system?

[Stephen Barclay]

The Health Committee’s estimate of 11% is at odds with the actual working vacancy rate of 1%—obviously, if one factors in places filled by agency and bank staff, one gets a different number. However, that is an interesting point, because the whole draft order is about how we get additional staff into the workforce to support nurses—it is about how we provide more resource to work alongside nurses. If the hon. Gentleman’s point is that we need more nurses in our workforce, that will be achieved both by increasing the clinical profession, which the Government have done—we can run through how many more people there are in the profession compared with 2010—and by creating new pathways into nursing. That is what the draft order does, and that is why I commend it to the Committee.

--- Later in debate ---

[Justin Madders]

It is fair to say it is on board the train. On whether it is fully behind this, it is a question of ensuring that it is done in the right way. I will go on to outline where its main concerns lie.

As the Minister will know, there is a question about substitution. I commend his ingenuity in claiming that the vacancy rate in the nursing profession is only 1%, which must be a record for the public sector. I am sure he will be talking to his ministerial colleagues about how he has managed to achieve that. There is clearly an issue with the level of money spent on agency and bank nurses in the NHS, so we must remind ourselves that the real figure is much higher.

As my hon. Friend the Member for Huddersfield said, there is anxiety about substitution, particularly in the context of the high vacancy rate we believe there is. The fact is, more nurses are leaving the profession than joining it, and there is also a demographic challenge in that one in three nurses are due to retire in the next decade. In that context, there is well-founded anxiety that nursing associates could be used as a substitute for registered nurses.

I appreciate what the Minister said about providing a bridge or a ladder between particular roles, but there may be concerns, as some trusts have acted in, shall we say, a quite remarkable or coincidental way. The Warrington hospital trust agreed to reduce the number of full-time equivalent nurses on its wards by 23.58, and at the same time created 24 new nursing associate roles. That seems quite a remarkable coincidence and shows why there will be legitimate questions about whether the order will continue to be fit for purpose if it turns out that nursing associates are taking on more of the nursing role.

[Grahame Morris]

My hon. Friend makes an important point. If nursing associates are going to be used to replace registered nurses, that is a huge concern. Everything that we have learned about some of the terrible things that have happened—including the announcement in today’s statement—shows that numbers are important, but so is the right skill mix. We have to ensure that we have an appropriately skilled nurse workforce to ensure that we deliver high standards of care in hospitals and social care settings.

[Justin Madders]

My hon. Friend is absolutely right. We need to keep a close eye on that. It is not fair on the professionals involved, and it is certainly not fair on patients, if people are asked to do things beyond their capacity or competence. The order would be a fool’s errand if we found that that became commonplace.

Was the Minister aware of the issue in Warrington, and has he made inquiries about any risks or trends in substitution? Does he intend to put safeguards in place to prevent it from becoming commonplace?

--- Later in debate ---

[Stephen Barclay]

I am grateful to the hon. Gentleman for his support for the role of nursing associates. He raised several important issues, which I will address.

Let me first respond to the point that the hon. Member for Huddersfield raised about the Royal College of Nursing. Under the heading “Our position”, the RCN has said in a briefing note:

“We support the introduction of the nursing associate…role and the plans to regulate it.”

It goes on to raise several points, some of which the hon. Gentleman gave good visibility to. I hope that gives the general tenor of the RCN’s support for the role, although that support is not unqualified and it has some questions—I do not want to mischaracterise its support. I hope that addresses that issue.

The hon. Member for Ellesmere Port and Neston raised the replacing of nurses, and he is absolutely right that it would be a concern if that were the intent behind the draft order. He will be aware that the CQC has oversight of staffing models, and that it will therefore be for trusts to discuss with the CQC how they will satisfy the necessary models.

Members referred to the harrowing report that Bishop Jones published today. I recently went up to Liverpool Community Health NHS Trust, on which the Kirkup report contained some shocking revelations, highlighted, as the hon. Gentleman knows, through the tenacious campaign of the hon. Member for West Lancashire (Rosie Cooper). We have also seen what happened at Morecambe, after the tireless work of James Titcombe following the death of his baby, Joshua, and at Mid Staffordshire. Too many such cases sadly come before the House, and I know there is consensus on both sides of the House that we must ensure that the right staffing and the right regulatory system are in place.

[Grahame Morris]

The Minister is absolutely right about ensuring that standards are maintained. I served for five years on the Health Committee, which oversees, and has an annual hearing with, the Nursing and Midwifery Council. A point of contention was always the level of fees that its members must pay, because it is linked to professional standards and professional development. Will the Minister clarify what level of fees will apply to nursing associates? Is that set out in the draft order?

[Stephen Barclay]

From memory, the fee is the same as for a nurse in the NMC, which is £120, although I am sure that my colleagues will correct me if my memory is misplaced on that. That is a flat rate applied by the NMC across the board.

The hon. Member for Huddersfield and the Opposition Front Bencher also raised the issue of overseas staff. This will be a new role, and the Prime Minister’s announcement on tier 2 visas applies to existing roles, such as doctors and nurses, whereas this role is not currently in place. However, the opening of the nursing associate part of the register will provide a new registration route for overseas nursing staff whose competence and qualifications fall short of those of a registered nurse, providing that they can demonstrate that they meet the same high standards expected of a nursing associate trained in England. Again, just as it is a ladder for his constituents, it is a pathway through which European staff could potentially enter the NHS. [Interruption.] My memory was correct: the NMC has consulted on applying a fee of £120.

The hon. Member for Ellesmere Port and Neston mentioned the guidance. The Department is working with arm’s length bodies, NHS Employers, healthcare environment inspectorates and the regulators—the NMC and the CQC—to develop guidance. That will obviously need to be in place before the first tranche of nursing associates come out of their training in January ’19. I also note his point on panels. It is a perfectly fair observation, and I take it on board.

Oral Answers to Questions

Grahame Morris Excerpts

Tuesday 8th May 2018 Commons Chamber

[Stella Creasy (Walthamstow) (Lab/Co-op)]

5. What assessment he has made of the effect of the withdrawal of NHS bursaries on applications for nursing degrees.

[Grahame Morris (Easington) (Lab)]

10. What assessment he has made of the effect of the withdrawal of NHS bursaries on applications for nursing degrees.

[The Minister for Health (Stephen Barclay)]

Nursing remains a strong career choice, with more than 22,500 students placed during the 2017 UCAS application cycle. Demand for nursing places continues to outstrip the available training places.

--- Later in debate ---

[Stephen Barclay]

It is not a false economy to increase the supply of nurses, which is what the changes have done. Indeed, they form part of a wider package of measures, including “Agenda for Change”, pay rises and the return to practice scheme, which has seen 4,355 starters returning to the profession. More and more nurses are being trained, which is why we now have over 13,000 more nurses than in 2010.

[Grahame Morris]

I respectfully remind the Minister that this is about recruitment and retention. The RCN says that we can train a postgraduate nurse within 18 months, which is a significant untapped resource, so why are the Government planning to withdraw support from postgraduate nurses training, too?

[Stephen Barclay]

We have a debate involving postgraduate nursing tomorrow, but the intention is to increase the number of such nurses by removing the current cap, which means that many who want to apply for postgraduate courses cannot find the clinical places to do so. That is the nature of tomorrow’s debate, and I look forward to seeing the hon. Gentleman in the Chamber.

Cancer Strategy

Grahame Morris Excerpts

Thursday 22nd February 2018 Commons Chamber

[Grahame Morris (Easington) (Lab)]

I thank the hon. Member for East Kilbride, Strathaven and Lesmahagow (Dr Cameron) for opening this debate on behalf of the hon. Member for Basildon and Billericay (Mr Baron), and I pay tribute to his excellent work over many years as chair of the all-party group on cancer. I am delighted to support this debate, and as someone who has always taken a key interest in cancer strategy, I wish to highlight three issues. Pancreatic cancer has been well covered by my hon. Friend the Member for Scunthorpe (Nic Dakin), so I will refer to it only briefly. I also want to mention transformation funding and make a plea to the Minister, and I will say something about advance radiotherapy—a hobbyhorse of mine.

As hon. Members may be aware, I have recently recovered from a reoccurrence of lymphatic cancer, so I have first-hand knowledge of the importance of getting the cancer strategy right, not least in terms of early diagnosis and appropriate treatment. Delivering the recommendations set out in the cancer strategy is crucial to improving care and support for thousands of people affected by cancer. I do not seek to make a party political point about the nature of that policy, but essentially it requires resources, a plan, a strategy and commitment.

Sadly, pancreatic cancer has taken friends of mine, and it is particularly nasty. It has the worst five-year survival rate of the 20 most common cancers at less than 7% across the UK—a figure that has hardly changed over the past 40 years. In most other types of cancer, survivability has gone up. For pancreatic cancer, however, it has remained fairly flat. We urgently need investment and action, because pancreatic cancer is set, on current trajectory, to become the fourth biggest cancer killer by 2026. Currently, 80% of pancreatic cancer patients are diagnosed at the stage where the disease is advanced. Surgery is the only potential curative treatment, but sadly it is not an option when the disease is at an advanced stage. As far as I am aware, pancreas transplants are not an option. Early diagnosis is therefore absolutely key to improving the appalling survival rates and ensuring that patients are able to live longer following diagnosis.

I looked up the figures for my own area. Between 2010 and 2014, pancreatic cancer took the lives of 188 people in the Easington, Durham dales and Sedgefield clinical commissioning group area. It is clear that much more work is needed to deliver the kind of change we must see for the people affected, and their families, so we can achieve the improvements in survival rates that are so desperately needed.

Not long ago, I had the pleasure of visiting a local National Citizen Service group of young volunteers in my constituency—I think many Members have taken similar opportunities. The House might be interested to note that one group of young people were raising money for a chemotherapy ward because of their personal and family experiences. They thought that the facilities available were inadequate. This was because the ward, although filled with excellent and committed staff, was grappling with an increase in demand and a lack of funds. These young people raised enough money to buy an assortment of things, including floor fans to keep the patients cool. It is an indictment that, when we are putting additional money into the recovery fund and encouraging people to get through the treatment and to go on, we are relying on charitable donations.

At the Britain against Cancer conference 2016, the chief executive of NHS England announced £200 million of funding for treating cancer, along with improving early diagnosis and funding stratified pathways. The money was intended to support the roll-out of the recovery package. However, since this transformation funding was announced, there have been significant delays in its reaching cancer alliances, with only nine of 16 alliances having received funding. At the Britain against Cancer conference in December 2017, the Secretary of State for Health said that the release of funding to cancer alliances would be delayed in areas that were unable to demonstrate an improvement in their 62-day waiting time standard. That was an additional requirement that had not been included as part of the original criteria set during the bidding process.

Every person diagnosed with cancer—it does not matter where they live—should be able to rely on timely diagnosis and treatment when they are told they have cancer. However, as the final report from the all-party group on cancer’s inquiry concluded, the delayed release of funding to the cancer alliances has had a significant impact on their ability to make progress. I hope the Minister is paying attention, because I want to ask him a question.

[Steve Brine]

He is.

[Grahame Morris]

I am very glad to hear it, because this is a serious point. The Department of Health and Social Care must decouple the release of transformation funding to cancer alliances from progress against the 62-day waiting time standard. I hope the Minister will address that point in his remarks. [Interruption.] I look forward with anticipation to his remarks.

It would not be a contribution on health from me if I did not mention advanced radiotherapy. I have raised regularly its benefits and advocated further investment in its research. Investment and research, given the cost, should be evidence-based, but there are some really quite exciting areas: in particular, proton beam therapy—I visited University College Hospital in London for part of my treatment and saw the installation of the proton beam therapy bunker and equipment there; stereotactic ablative body radiotherapy; adaptive radiotherapy based on advanced imaging—a kind of magnetic resonance linear accelerator; combinations of radiotherapy and novel drugs; biomarkers with selections for altered radiotherapy strategies so that radiotherapy can precisely target the cancer cells; and molecular radiotherapy. It is necessary that we evaluate the use of these new radiotherapy techniques and compare them with conventional radiotherapy and some surgical techniques, as radiotherapy is sometimes more effective than surgery and pharmaceutical products. I am advocating that they be used not instead of, but alongside other treatments and following considerable evaluation. This could result in better outcomes and reduced treatment costs.

Finally, I would like to thank all my colleagues on the all-party group on cancer, the cancer charities that continue to do excellent work and all those in our national health service working in cancer prevention and treatment.

--- Later in debate ---

[Mrs Sharon Hodgson (Washington and Sunderland West) (Lab)]

I thank the hon. Member for East Kilbride, Strathaven and Lesmahagow (Dr Cameron) for leading the debate and for her excellent speech, and I thank the hon. Member for Basildon and Billericay (Mr Baron) for securing the debate. He is not in the Chamber, but I also want to thank him for the excellent contribution that he has made to the work of the all-party parliamentary group on cancer for many years. His expertise and passion about this matter are what has made the APPG so successful.

I also thank the other Members who have made excellent speeches about this important issue. I thank the hon. Members for Bosworth (David Tredinnick), the hon. Member for North Warwickshire (Craig Tracey), with whom I co-chaired the all-party parliamentary group on breast cancer—he raised the important issue of breast density, which, as he said, is an issue on which we really do need to make progress—the hon. Members for Dumfries and Galloway (Mr Jack) for Chippenham (Michelle Donelan), for Strangford (Jim Shannon), and for Inverclyde (Ronnie Cowan), the Scottish National party spokesman. I thank my hon. Friends the Members for Coventry North East (Colleen Fletcher), for Scunthorpe (Nic Dakin), and for Bristol West (Thangam Debbonaire), and my hon. Friend the Member for Lincoln (Karen Lee). She is no longer in the Chamber, but she made a powerful and emotional speech about her daughter, who would be so proud of her bravery today—as, I am sure, her grandchildren will be. I hope that the whole family were watching the debate today. I also pay tribute to my hon. Friend the Member for Easington (Grahame Morris), who, I think, has fought cancer twice.

[Grahame Morris]

Three times.

[Mrs Hodgson]

It is an absolute pleasure to see my hon. Friend in his place. Long may he stay there.

Cancer is, understandably, a very emotional topic. One in two people in the UK will be affected by cancer in their lifetimes, and, as we have heard from almost everyone who has spoken today, we have all been affected in some way ourselves. When my children were very small, I lost my mother-in-law to breast cancer. That is one of the reasons why I joined the all-party parliamentary group on breast cancer, and I am vice-chair of the group to this day. It is this emotion that encourages us and gets us all to come together to tackle cancer.

Over the years, there has been a steady improvement in cancer survival rates in England. However, we still lag behind the improvements of our European counterparts, and the number of new cancer cases continues to rise year on year. If these trends continue, it is estimated that by 2020 some 2.4 million people in England will have had a cancer diagnosis at some point in their life. That is why the Government must take urgent steps so that cancer diagnosis care and outcomes in England can be improved.

The cancer strategy was a welcome step forward to achieving the best cancer care and outcomes in the world, and Labour is fully committed to delivering, and helping to deliver, that strategy in full. However, as has been mentioned, there are some concerns across the House about the progress of the strategy. I am pleased that some of the targets have already been met, but I am under no illusions—many are no closer to being reached than they were almost three years ago. Will the Minister today commit to publishing a detailed progress update on each of the 97 cancer strategy recommendations by the end of this financial year, so we are all able to celebrate success but also focus our attention on more pressing challenges where needed? There are many challenges that the Government must face before achieving world-class cancer outcomes, but I will touch on only a few today: early diagnosis; waiting times; the workforce; and prevention.

On early diagnosis, we know that if a cancer is diagnosed early, treatment is more likely to be successful, but for cancers such as ovarian cancer and lung cancer it is often too late. The National Cancer Registration and Analysis Service found that over a quarter of women with ovarian cancer are diagnosed through an emergency presentation. Of those women, just 45% survive a year or more, compared with over 80% of women diagnosed following a referral by their GP. I should state at this point that I am chair of the all-party group on ovarian cancer. Similarly, research by the British Lung Foundation found that more than a third of lung cancer cases in England are diagnosed after presenting as an emergency. As a result, the Roy Castle Lung Cancer Foundation found that, if caught early, a person has up to a 73% chance of surviving five years or more. However, the current five-year survival rate for lung cancer is just 10% and, sadly, one in 20 lung cancer sufferers was not diagnosed until they had died. Cancer survival rates have doubled over the last 40 years, but those are shocking statistics. I therefore ask the Minister what his Department will be doing to ensure that cancers are detected even earlier, so that patients are no longer pushed from pillar to post trying to find a diagnosis.

Unfortunately, we know that once a patient has been diagnosed, they then have an agonising wait for treatment. Even if it was a wait of just a week, it would be agonising, but the 62-day target between urgent GP referral and treatment has not been met now for two years, meaning that patients are having to wait much longer than they should for treatment. Since the target was first breached in January 2014, over 95,000 people have waited for more than two months for treatment to start. Cancer patients should not be expected to wait so long. I therefore ask the Minister what his Department is doing to address this issue.

It is no secret that the NHS and the NHS workforce are under extreme pressure due to underfunding and understaffing by this Government. I want to place on record the fact that Labour Members do not take the NHS workforce for granted. We are incredibly grateful to them for their hard work, support and kindness to patients and their families. They are doing an incredible job despite the circumstances we currently find ourselves in, and we should never stop thanking them for the work they do to diagnose, treat and care for patients. The cancer workforce really are the backbone of the cancer strategy.

The improvement of early diagnosis and waiting times relies on an efficient cancer workforce, so the Minister must make these concerns a top priority if the targets in the cancer strategy are to be fulfilled. A report by Macmillan Cancer Support found that more than half the GPs and nurses surveyed in the UK say that, given current pressures on the NHS workforce, they are not confident that the workforce are able to provide adequate care to cancer patients. That is deeply worrying. The NHS workforce should be suitably equipped to diagnose, support and care for cancer patients, during and beyond cancer.

Through my work with the all-party parliamentary group on breast cancer, I have heard—as I am sure the Minister did during his time as the group’s co-chair—of the overwhelming support that a cancer nurse specialist can bring to breast cancer patients and their families. As we have heard, however, patients with secondary breast cancer are unlikely to have access to a cancer nurse specialist. Research from Breast Cancer Care shows that 42% of hospital trusts and health boards in England, Scotland and Wales do not provide dedicated, specialist nursing care for people with secondary breast cancer, even though they often have complex emotional and supportive care needs. Patients with secondary breast cancer are subject to a postcode lottery when it comes to having a cancer nurse specialist. What steps is the Minister taking to ensure that every cancer patient has access to a clinical nurse specialist?

There is no doubt that, if the cancer workforce had the time, resources and support they so desperately need, the recommendations in the cancer strategy would be achieved. I know that that is something the cancer workforce plan, published in December last year, aimed to address. Will the Minister update the House on the progress of the plan and outline how much funding the Government will be granting to ensure that the proposals in the plan soon become a reality? The NHS cancer workforce care for and support their patients every day, and we really need the Government to support the workforce, too.

Finally, I move on to the first issue raised in the cancer strategy: prevention. The World Health Organisation estimates that a third of deaths due to a cancer are the result of the five leading behavioural and dietary risks: high body mass index; low fruit and vegetable intake; lack of physical activity; tobacco; and alcohol. The subject of alcohol was raised by my amazing hon. Friend the Member for Bristol West. Tobacco was identified as the most important risk factor, responsible for approximately 22% of cancer deaths. Taking all five risk factors into account, it is estimated that between 30% and 50% of cancers could be prevented.

The Government’s tobacco control plan—which the Minister thankfully pushed to be published in his first weeks in the job—and the childhood obesity plan are welcome steps towards reducing the high rate of preventable cancers, but they will not go far enough if the Government continue to slash public health budgets. Will the Minister therefore commit to strengthening public health budgets, so that fit and healthy lifestyles can be encouraged across all our communities and help to contribute to cancer prevention? I know that, like me, he is passionate about making sure that England is one of the world leaders when it comes to cancer outcomes, but we are currently lagging behind. However, with the right funding and support from the Government, the cancer strategy has the potential to achieve that. I hope that he will take on board all that we have heard today and go back to his Department with an action plan of how best to move forward, so that we can really achieve world-class cancer outcomes in 2020.

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

I should like to thank my friend the shadow Minister, the hon. Member for Washington and Sunderland West (Mrs Hodgson), for her remarks. I congratulate the members of the all-party parliamentary group on cancer on securing the debate, in particular the hon. Members for Scunthorpe (Nic Dakin) and for East Kilbride (Dr Cameron)—I shall leave it at that in describing the hon. Lady’s constituency, lest I make a total fool of myself. As the cancer Minister—Members will know that that is the job I always wanted to do—I thank them for the constant work they do on the all-party group and on the Britain Against Cancer conference. Linked to that, I want to extend my appreciation to the Members on both sides of the House who chair the all-party parliamentary groups on different kinds of cancer for the work they do. Some of them are here today. As has been mentioned, I was a co-chair alongside the shadow Minister and the previous Member for Mid Dorset and North Poole and we were quite a team. We were often referred to as Steve and the girls—I found my inner girl. We chaired the group together for five years and I was so proud to do that. We met some amazing people and I think we did some good.

With the shadow Minister, I was also vice-chair of the all-party parliamentary group on ovarian cancer—she still chairs that group—so I know how important it is that Parliament allocates time for this subject, both upstairs in the APPGs and here in the Chamber. Looking at how many people are in the Public Gallery and around the Chamber, this is about quality more than quantity. I say to those watching today who may say, “This is a debate on the cancer strategy. This is so important. Why isn’t the House as full as it is for PMQs?”—this is not all about what goes on in here. This is about what goes on in government, what goes on upstairs in the APPGs and Select Committees and, for so many Members, what goes on within ourselves. I did not know the shadow Minister’s motivation for chairing the APPG. I have never said my motivation—I will one day—but I realise now why she was so passionate.

The hon. Member for East Kilbride pretty much summed things up in the first line of the first speech of this debate when she said that we are all “on the same side” when it comes to cancer—what a brilliant way of putting it. The hon. Member for Coventry North East (Colleen Fletcher) talked about her husband, who lives with cancer. Macmillan has been brilliant with some of its communications, and we have all seen the television adverts saying that a mum with cancer is still a mum. There are so many people who are living with and beyond cancer—they call it “survivorship” in America—and we should always remember that.

Let me start by reassuring the House, if I need to, that cancer is a huge priority for me, for the Secretary of State and for this Government. As several Members have said, cancer survival rates have never been higher, and the latest survival figures show an estimated 7,000 more people surviving cancer after successful NHS cancer treatment compared with three years prior. Our aim is to save 30,000 more lives by 2020 through the cancer strategy that we are debating.

However, I know more than anybody that there is still so much more to do and so much potential, which is why we accepted all 96 recommendations in the cancer strategy. We have backed that commitment with over £600 million of additional funding up to 2021. We are now just two years into the implementation of the strategy, and the fantastic NHS cancer doctors and nurses supporting us to achieve our vision have made tremendous progress in many areas. I echo what many Members have said in their support.

The shadow Minister and others asked whether I will report back on how we are doing on all this. In October, NHS England published its “two years on” report on the day that I gave evidence to the all-party parliamentary group on cancer’s inquiry, which led to its report and to this debate. That was our latest progress report, and I hope that we will be doing something again later this year. NHS England’s national cancer director, Cally Palmer, who is based at the Royal Marsden Hospital and is an incredible lady with whom I enjoy working, is leading the implementation of the strategy. She agrees with me that there are many areas where we agree with the APPG’s report. We do not shy away from scrutiny, which is exactly why we are here. However, progress in many areas was not given sufficient prominence in the APPG’s analysis of progress. We said that at the inquiry. It is important that I put that on the record.

The measure of the strategy’s success will of course be about significant improvements in early diagnosis, which I will come on to, and obviously treatment and research. However, I am increasingly aware in this job that we need to make cancer services even better beyond 2020 and that there needs to be a greater focus on a fourth pillar—the “fourth Beatle”, if you like—which is prevention. Of course, we want to be the best in the world at delivering positive outcomes for patients after a diagnosis, but we have to understand the position. Earlier this week, I responded to a Westminster Hall debate attended by Members from Oxfordshire. There has been a 120% increase in the number of people presenting with cancer in Oxfordshire alone in recent years.

The number of people presenting with cancer continues to rise. We can do very well on the first three pillars, and we are, but prevention is where we will really move the dial. That is why my whole mission as the Minister for primary care and public health, a role created by this Health Secretary, has been to put in place a comprehensive system of measures to reduce the risk of cancer, as well as to treat cancer when it occurs.

As my hon. Friend the Member for Chippenham (Michelle Donelan) and the shadow Minister mentioned, one of my first acts as Minister was to launch the tobacco control plan. Why was I so keen to get it out there? Because we promised we would, but also because tobacco is the biggest preventable killer in our country today. The previous Labour Government and this Government have done well with the legislative framework. It is now about supporting local areas to continue bringing down the number of people who smoke from what are already record lows and to ensure that people do not start smoking in the first place.

Last year, we also launched a cross-Government air quality plan, which has been in the news and in the House this week. That plan is important, too, because it will significantly reduce the carcinogens in the air we breathe, which we know has a big impact on the development of disease. Furthermore, in 2016 we published our child obesity strategy, which was just the start of a conversation about how we will reduce child obesity over the next decade. Our overarching focus in all that work is to ensure that our children are supported to live healthy, active and happy lives, so that they grow into healthy, active adults who are less likely to develop cancer. We have always said that the child obesity strategy is constantly under review—it is part one—and we will go further, if needed, to build on that.

As has been mentioned a few times in this debate, perhaps the biggest game changer in preventing cancer is the world-leading work on genomics happening in our country. The chief medical officer’s 2016 annual report, “Generation Genome,” which was published the year before I was appointed, set out the huge potential for genomics in helping us to understand the inherited and acquired genomic causes of cancer and in shaping future research and future personalised cancer treatment, which is so important—it is something we should talk more about, as we should the whole prevention agenda.

Many subjects have been raised today and I am grateful to you, Madame Deputy Speaker, and to Members for giving me time to respond to them. As I suspect she would like me to do, I will give a couple of minutes to the hon. Member for East Kilbride, who opened the debate.

As I have already said, the workforce is key to our strategy. We have already committed to investing in and expanding our diagnostic workforce to improve survival rates by diagnosing cancer earlier. The first ever cancer workforce plan, which Health Education England published in December, set out how we will expand our workforce, how we will continue to invest in the skills of the staff we have, and how we will use their time and expertise where it is most needed.

HEE has already committed to training 746 more cancer consultants and 1,890 more diagnostic and therapeutic radiographers, which we know are in short supply, by 2021. The plan further commits to the expansion of capacity and skills, including 200 additional clinical endoscopists and 300 reporting radiographers by 2021. HEE will also expand the number of clinical nurse specialists, as the shadow Minister rightly mentioned, and develop common and consistent CNS competences, with a clear route into training, to ensure that every cancer patient has access to a CNS or other support worker by 2021—that subject was constantly raised when I chaired the all-party group. HEE will follow the plan later this year with a longer-term strategy looking at the workforce needs beyond 2021.

The hon. Member for East Kilbride and others, including the hon. Member for Easington (Grahame Morris), talked about the link between the 62-day standard and the performance and phasing in of transformation funding. Cancer alliances, as the House knows, are an important mechanism for improving performance on the 62-day standard from urgent referral through to treatment. They bring together clinicians from primary and secondary care, as is right—one NHS. They ensure collective responsibility for the cancer services they provide, and they provide the necessary leadership for the transformation of services. So £76 million of funding has already been allocated to the cancer alliances.

It is imperative that the alliances have the operational rigour and readiness to achieve the transformation that we need. After all, our constituents’ money is being allocated. So it is only right and proper, as the Secretary of State made clear in the question and answer session at Britain against Cancer, that the alliances demonstrate their preparedness for this funding. That is not to say that the 62-day standard is a requirement, but it does give a basis on which NHS England and NHS Improvement, along with other senior clinical advisers, can assess an alliance’s readiness to transform services. Transforming services is what we want to do.

[Grahame Morris]

What happens when cancer alliances do not achieve the 62-day target? It seems completely perverse that individuals suffering from cancer in those areas are penalised by lack of funds from the transformation fund. Is the Minister saying that those cancer alliances can still apply for that funding and measures will be put in place to ensure that they do reach that target?

[Steve Brine]

Yes, this is not hard and fast. I noted that NHS England has written to me as a constituency MP and to all other MPs today with details of the cancer alliances that they have in their individual areas. I bang on about this every time, as the shadow Minister knows, but I implore Members to engage with their local cancer alliances. I suspect that the people in this debate do that, but I would hazard a guess that many other Members do not. Members should know who the cancer alliances are in their areas and should have a relationship with them.

Let me now discuss CPES, which the hon. Member for Strangford (Jim Shannon) mentioned, as did the hon. Member for Lincoln (Karen Lee). On her speech, let me just say, wow. I said to my officials before this debate that there is always one speech in these debates—the shadow Minister was that person a few weeks ago—who leaves not a dry eye in the House, and today it was the hon. Member for Lincoln. I know she is not in her place now and I do not blame her for that. I think the whole House wanted to run over to give her a hug—many Labour Members did, and bless them for doing that. I think that the House, in its own way, gave her a collective hug, and I say well done to her for an amazing speech.

We totally recognise how important CPES is in our continued drive to improve cancer treatment and care, and to monitor that progress. I have always been clear that I want any future survey to continue to deliver the high-quality data that CPES does. I can tell the House that CPES will continue in its current form in 2018-19. We will engage with the cancer community to ensure that any decisions about future delivery and the model to be adopted, should the commissioning arrangements be revised, are informed by all parties and ultimately protect the integrity of the survey and quality of the data. I saw Dame Fiona Caldicott last week in Oxford and discussed the subject with her. Obviously, her work as the patient data guardian led to the challenge we now have—it was necessary work, but it certainly left us with a challenge. Cally Palmer, the national cancer director, and I will meet all the major cancer charities next week at my second roundtable, and this is on the agenda and we will be discussing it with them. I hope Members know that CPES remains very much at the top of my agenda.

Let me touch on early diagnosis, because everybody else has and because it is one of the most important shows in town. In every conversation I have ever had about how we can beat cancer, I have been told, “Early diagnosis”. Historically, our cancer survival rates have lagged behind the best-performing countries in Europe and around the world. The primary reason for that is, without question, late diagnosis. Sir Harpal Kumar will stand down as chief executive officer at Cancer Research UK shortly, but I had the privilege of having lunch with him a few weeks ago, when I asked him what we should think about in terms of the next cancer strategy. He said, “The rock upon which you build your church is early diagnosis.” I will not forget that, which is why one of the key priorities of the strategy is to diagnose cancer earlier, when the disease is more treatable.

How are we doing that? As part of our drive to ensure early diagnosis, we are also introducing the new 28-day faster diagnostic standard from GP referral to diagnosis or the all-clear. I have often said, and I repeat now, that 28 days is not a target; it is a maximum. I well know that when people have a cancer worry, 28 minutes seems like a lifetime, let alone 28 days. However, the 28-day standard is really important. It will be introduced from April 2020. Five pilot sites have started testing the new clinical pathways to ensure that patients find out within 28 days whether they have cancer or the all-clear.

Today, Public Health England, for which I have ministerial responsibility, has launched its 14th “Be Clear on Cancer” campaign, which focuses on breast cancer in women aged over 70, something monitored by my hon. Friend the Member for North Warwickshire (Craig Tracey)—my excellent successor chair of the all-party group on breast cancer—mentioned. That campaign will run until the end of March. It focuses on age-related risk, encouraging older women to be breast aware, and particularly to be aware of non-lump symptoms, which, understandably, have lower levels of awareness.

The other point I want to make on early diagnosis is that we know that the hardest cancers to detect are those where early symptoms can be vague and often symptomatic of less serious illnesses. Patients often see their GP multiple times before that all-important referral. That is why we are piloting 10 multidisciplinary diagnostic centres as part of wave 2 of what we call the ACE— accelerate, co-ordinate and evaluate—programme. Patients presenting to their GP with vague symptoms can be referred to an ACE centre for multiple tests, one after the other, and receive a diagnosis or the all-clear on the same day. The initial findings are incredibly exciting; I do not get easily excited, but I am excited about this. I had the pleasure of visiting one of the ACE pilots at the Churchill Hospital in Oxford last Tuesday, during recess, and I have to say that the enthusiasm and feedback I got from clinicians and patients about the potential of the ACE centres were really quite incredible. I look forward to seeing the analysis on that work in the coming months.

The shadow Minister talked about emergency room presentations, which are something I was quite shocked by as a Back Bencher when I went to all-party group meetings. It is true that emergency room presentations for cancer are horrible, but that is why the 28-day standard and the ACE centres are so important. When I talk to GPs, they tell me that they will refer and that there will then be a wait. Patients who are, understandably, worried and terrified may then present themselves at an A&E, at which point they may be diagnosed with a primary cancer. That then hits the stats around emergency room presentations for cancer. It does not mean that those people have been carried in; they have often walked in. That all explains why we need to grip early diagnosis better than ever.

My hon. Friend the Member for Bosworth (David Tredinnick) talked about Baroness Jowell’s speech in the other place last month. The Secretary of State was there to listen to the speech, and it was incredibly powerful. Baroness Jowell met the Secretary of State and the Prime Minister this morning. Investment in brain cancer research has been limited by a pretty low volume of research proposals focused on the topic in recent years, and we have been working with charities, academics and the pharmaceutical industry to address that over the last 12 months.

To accelerate our efforts in brain tumour research, the Secretary of State has today announced, alongside Cancer Research UK and Brain Tumour Research, a package to boost research and investment into this most harrowing form of cancer. We have announced £20 million through the National Institute for Health Research over the next five years, with the aim of doubling this amount once new high-quality research proposals become available. CRUK has confirmed it will provide £25 million of its money over five years in major research centres and programmes dedicated to brain tumours. Today’s announcement is incredibly positive.

Oral Answers to Questions

Grahame Morris Excerpts

Tuesday 10th October 2017 Commons Chamber

[Steve Brine]

I thank the co-chair of the all-party group on breast cancer in what is BCAM—Breast Cancer Awareness Month. We must never forget the treatment and support we give to those living with and beyond the cancer diagnosis. We must always remember those living with secondary breast cancer and the work of the third sector—brilliant charities such as Breast Cancer Haven and Breast Cancer Care—so that we can focus on access to a specialist nurse. As my hon. Friend says, the collection of data is critical, and I will be discussing that at my roundtable with some of the main players in the cancer community later this week.

[Grahame Morris (Easington) (Lab)]

Will the Minister abolish the patient penalty and scrap hospital car parking charges, which punish both the sick and hard-working NHS staff, as well as causing problems for residents living adjacent to NHS hospitals, such as Peterlee Community Hospital in my constituency?

[Mr Hunt]

I do understand the concerns raised, and all hospitals are under a responsibility to make sure that they have proper arrangements in place for people on low incomes and people who have to visit hospitals regularly.