Interim NHS People Plan

Grahame Morris Excerpts

Wednesday 5th June 2019 Commons Chamber

[Stephen Hammond]

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

[Grahame Morris (Easington) (Lab)]

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

[Stephen Hammond]

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

Oral Answers to Questions

Grahame Morris Excerpts

Tuesday 7th May 2019 Commons Chamber

[Jackie Doyle-Price]

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

[Grahame Morris (Easington) (Lab)]

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

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

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

[Grahame Morris]

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

[Matt Hancock]

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

NHS 10-Year Plan

Grahame Morris Excerpts

Tuesday 19th February 2019 Commons Chamber

[Stephen Hammond]

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

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

[Grahame Morris (Easington) (Lab)]

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

[Stephen Hammond]

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

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

--- Later in debate ---

[Grahame Morris (Easington) (Lab)]

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

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

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

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

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

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

[Several hon. Members rose—]

Cancer Workforce and Early Diagnosis

Grahame Morris Excerpts

Tuesday 8th January 2019 Westminster Hall

[Grahame Morris (Easington) (Lab)]

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

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

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

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

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

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

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

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

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

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

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

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

NHS Long-term Plan

Grahame Morris Excerpts

Monday 7th January 2019 Commons Chamber

[Grahame Morris (Easington) (Lab)]

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

[Matt Hancock]

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

Nursing: Higher Education Investment

Grahame Morris Excerpts

Wednesday 21st November 2018 Westminster Hall

[Eleanor Smith]

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

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

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

[Grahame Morris (Easington) (Lab)]

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

[Eleanor Smith]

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

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

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

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

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

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

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

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

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

Budget Resolutions

Grahame Morris Excerpts

Tuesday 30th October 2018 Commons Chamber

[John McDonnell]

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

[Grahame Morris (Easington) (Lab)]

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

[John McDonnell]

The facts speak for themselves.

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

--- Later in debate ---

[Matt Hancock]

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

[Grahame Morris]

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

[Matt Hancock]

indicated dissent.

--- Later in debate ---

[Grahame Morris]

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

[Matt Hancock]

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

--- Later in debate ---

[Grahame Morris (Easington) (Lab)]

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

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

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

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

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

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

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

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

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

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

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

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

Oral Answers to Questions

Grahame Morris Excerpts

Tuesday 23rd October 2018 Commons Chamber

[Matt Hancock]

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

[Grahame Morris (Easington) (Lab)]

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

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

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

[Grahame Morris]

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

[Steve Brine]

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

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.

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[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?

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[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.