Defence Spending

Debate between John Baron and James Clappison

Thursday 19th June 2014 Commons Chamber

[Mr James Clappison (Hertsmere) (Con)]

I welcome the debate and I agree with every word that my hon. Friend has said so far. Does he agree that although this Government face a difficult financial situation, it is very important that we stay true to our defence commitment to spending at least 2% of our GDP—our NATO commitment and the signal that we must send to our allies?

[Mr Baron]

Yes, I completely agree. If anything, we need to spend more than 2%, but there have been quite authoritative reports, most notably in the Financial Times, suggesting that our defence expenditure as a proportion of GDP will fall below 2%. One of my questions to the Minister—if he cannot answer it in this debate, I am happy to take a written response—is what truth is there in the suggestion that our defence spending will fall well below 2% or, as some figures suggest, 1.8%?

Cancer Priorities

Debate between John Baron and James Clappison

Thursday 13th February 2014 Commons Chamber

[Mr John Baron (Basildon and Billericay) (Con)]

I beg to move,

That this House has considered the All-Party Parliamentary Group on Cancer report on cancer priorities in the NHS.

The motion stands in my name and those of other hon. Members.

It is not an exaggeration to say that thousands of lives, if not tens of thousands, depend on our getting the cancer strategy right. That is the scale of things. I therefore thank the Backbench Business Committee for granting the debate and allowing the all-party group on cancer to debate its recent report, “Cancer across the Domains”. I thank fellow officers, Macmillan and the secretariat to the all-party group, particularly Tim Nicholls and his team, for their support and hard work.

The all-party group on cancer is recognised as the wider cancer community’s voice in Parliament and has a proud campaigning track record. It was an early advocate of the need to focus on survival rates as a means of promoting earlier diagnosis. It has campaigned on a range of other issues, including cancer networks and the cancer drugs fund. As hon. Members will know, the group hosts the annual Britain Against Cancer conference, at which the cancer community comes together. Last December, it attracted about 500 delegates and heard excellent speeches from the Secretary of State for Health, the shadow Secretary of State and other experts.

[Mr James Clappison (Hertsmere) (Con)]

I warmly congratulate my hon. Friend on his sterling work in this field. He mentions cancer survival rates. The most recent European study, published in December last year, showed that UK survival rates are still lagging behind those of comparable western nations in most, if not all, cancers. Does he therefore agree that the need to focus on cancer survival rates is as great as ever?

[Mr Baron]

My hon. Friend makes an excellent point. The fact remains that, although there have been good increases in survival rates and there has been progress when it comes to cancer care generally, we still lag behind European and international average survival rates. That alone means they are costing this country thousands of lives. Thousands of families are suffering as a result of our not being able to match international averages on cancer care. That is not to say that cancer care has not improved over recent decades—it has. Survival rates have improved, but they have done so in line with survival rates across the world. That is good, but it somewhat masks the fact that we remain well behind international averages.

Despite all the additional funding, we still have not managed to catch up with other health care systems and thousands of lives are being lost as a result. My hon. Friend alluded to the fact that if we matched European averages on survival rates we could save an additional 5,000 lives a year. The OECD recently ranked Britain towards the very bottom of the 35 countries whose survival rates it measured, and it suggests that up to 10,000 lives could be saved if we matched international survival averages. Indeed, the Secretary of State for Health himself, speaking at the Britain Against Cancer conference in December, described survival rates as disappointing.

Reliable predictions suggest cancer incidence is on the rise. The World Health Organisation suggests its incidence will increase by 70% in the coming decades. Macmillan Cancer Support estimates that by 2020 almost one in two people will receive a cancer diagnosis—a phenomenal increase. The challenge for the NHS is to ensure that the significant structural change it has seen in recent years is not allowed to obstruct the much-needed improvement in cancer services and survival rates that are necessary if we are to catch up with our neighbours and save those thousands of extra lives.

The report by the all-party group on cancer should be seen in this context. We now have an NHS based around five domains, each with a responsibility for delivering improved outcomes. The report makes recommendations across each of those domains, and is the product of an extensive consultation with the cancer community, from NHS England right through to cancer patients, carers and charities. The recommendations of this year-long project can therefore truly be said to reflect the views of the whole cancer community. I should take a brief moment to thank all those who are involved in the production of the report, from those who responded to the consultation to the charities that devoted significant time and expertise to crafting it, including Macmillan Cancer Support, Cancer Research UK, Prostate Cancer UK, Teenage Cancer Trust and Breakthrough Breast Cancer.

“Cancer across the Domains” makes 18 recommendations and believes that the Government have an important role to play. Although the recommendations are specifically aimed at NHS England—the body that now has responsibility for commissioning services—it is the Health Secretary who retains overall responsibility for health services. The support of his Department is invaluable in achieving these goals, so my first question for the Minister is: will she formally respond to the recommendations set out in the report, or commit her Department to do so?

Other hon. Members will address other parts of the report, but I want to focus on the importance of earlier diagnosis and accountability. There are very few magic keys— where someone can open a door and suddenly untold opportunities lie before them. In cancer, such a magic key does exist: earlier diagnosis, the importance of which cannot be overestimated. When the all-party group on cancer produced its 2009 report, “Tackling Cancer Inequalities”, we found that patients in this country who reached the one year point stood as much chance of making it to five years as most other health care systems. Where we fall down is in getting patients to the one year point. We came to the conclusion, which expert witnesses confirmed at the time, that this clearly showed that the NHS was as good, if not better, at treating cancer when it was detected, but very poor at detecting it in the first place, and that is why we fell so far behind on survival rates.

We sat down with the cancer community and asked: what is the remedy? Do we bombard the NHS with more targets and regulation to try to encourage earlier diagnosis? Should we adopt a much simpler approach—and this is what we concluded—and put up in lights one and five-year cancer survival rates, broken down at a local NHS level, then primary care trusts, now clinical commissioning groups, to encourage earlier diagnosis? We all know that late diagnosis makes for poor survival rates. Therefore, putting the survival rates up in lights and broken down by the local NHS should encourage underperforming CCG management to promote initiatives, at primary care level, aimed at promoting earlier diagnosis. It would be up to them to choose which initiatives suit their local populations: better prevention and awareness campaigns, better uptake of screening programmes, better diagnostics at a primary care level or better education or information for GPs. There could be a host of initiatives in isolation or in combination, but the bottom line is that it would be up to local CCGs to introduce them. Those at the bottom of the table would be particularly encouraged to do so. That was the logic behind the idea of one and five-year figures. We are happy to say that, with the rest of the cancer community, we now have one and five-year figures as outcome measures in the DNA of the NHS. This is to be welcomed. It is in the NHS outcomes framework and it is in the CCG outcomes indicator set governing CCGs at a local level. I will come back to the five-year outcome measure at the outcomes indicator set level a little later, but that is all encouraging.

I will not complicate issues by going on about the importance of introducing other proxy measures at a local level, such as staging and emergency admissions. We have recommended those initiatives, and they have been taken up as complementing the one and five-year figures at a local level because of the smaller population sizes of CCGs compared with PCTs. The campaign has been a success, but it is a success only in that we have managed to get these measures included. Actions speak louder than words and the true success will be judged on what effect these measures are having on survival rates. On that measure, the jury is still out.

That brings me on to my next point: accountability. There is no point in having these wonderful initiatives on one and five-year figures, staging and emergency admissions to try to promote earlier diagnosis if it is not followed through and there are no teeth in the system or levers of change to ensure that underperforming CCGs raise their game on behalf of their local patients. Key questions therefore remain on accountability.

How accountable is NHS England to Parliament? NHS England’s annual report is laid before Parliament, but it is the Secretary of State who must assess performance. The extent of ministerial accountability remains unclear. Parliament seems to have a very limited role in this process. So does the Minister agree that there appears to be limited scope for Members to scrutinise NHS England’s performance? Furthermore, how will the Department of Health monitor NHS England’s performance on cancer care against the NHS outcomes framework and address areas that need improvement?

If that is one concern, a greater concern I have is the accountability of CCGs themselves. While some cancer services, as hon. Members will be aware, remain the responsibility of NHS England, owing to their specialised nature, many vital services are CCG-commissioned, hence the importance of the CCG outcomes indicator set as a means of monitoring performance. What remains unclear is the extent to which NHS England will hold underperforming CCGs accountable. For example, what happens if a CCG is continually at the bottom of the one-year survival rate figures? Where are the levers of change to correct that? The mathematicians in the House will understand that if we raise the game of those at the bottom of the table, it will have a disproportionate effect on averages in general, and that is what we are talking about: catching up with European and international averages on survival rates.

We need clarity, therefore, about what action will be taken should CCGs continue to languish in poor performance. What support would NHS England give to a CCG to improve survival rates, and, should CCGs continue to languish, what powers will be used, what levers of change will be implemented, to ensure that improvements are made at a local level? There is no point having the CCG OIS if failure is not addressed and there are no teeth to the correction regime. We need clarity, both to ensure that corrective action is taken, if needed, and because CCGs need to know that the regime is in place.

Other questions remain, which our report addresses, about the differences between the last two CCG OIS iterations, and perhaps a little clarity from the Minister would be helpful to the wider cancer community. In the 2013-14 OIS, our call for indicators for one and five-year survival rates for all cancers was accepted, and in the 2014-15 OIS, our call, in the “Cancer Across the Domains” report, for indicators on staging and emergency presentations was also accepted—all very good news—but the indicators for the five-year survival rates were dropped from the 2014-15 OIS.

NICE argued there were potential problems with the five-year indicator, as the numbers were small, but those arguments had been made before, when we campaigned for one and five-year survival rate inclusion. Will the Minister help the House and the wider cancer community by explaining what changed in the data between 2013-14 and 2014-15? That would be helpful. We now have an NHS outcomes framework that retains one and five-year indicators, but a local CCG OIS that does not have the five-year indicator. This suggests a disconnect. It is important that the NHS speaks with one voice, yet it has measures nationally different from those at a local level. How will her Department work with NHS England to address this apparent disconnect?

While earlier diagnosis increases survival rates, without data on longer-term survival rates, it will be harder for NHS England to ensure that early diagnosis is being improved by CCGs. Will the Minister re-examine the case for five-year survival rates in the next iteration of the CCG OIS, or at least communicate to the cancer community the logic behind the move and carry the community with the Department so that it is clear for everyone to understand. It remains to be answered, however, why there was a difference between the 2013-14 and the 2014-15 iterations.

The removal of the five-year survival rate indicator raises questions about the process. The development of the CCG OIS is complex; suffice it to say that the system provides for newly suggested indicators, but does not appear to recommend indicators for removal. In the development of the 2014-15 OIS, while emergency diagnosis and stage of diagnosis were flagged for inclusion, five-year survival rates were not flagged for exclusion, meaning that the removal does not appear to have been consulted on. I find this particularly alarming.

The cancer community campaigned hard for the inclusion of one and five-year survival rates, both nationally and locally, to promote earlier diagnosis, but then, at the last minute and without any consultation, was made aware, practically on the last day before Parliament rose before Christmas, that the five-year figures were being removed. There was a lack of communication, and certainly the process itself raises questions. Will the Minister comment on this process? Why does she think it delivers appropriate transparency? It was not clear to the wider cancer community that the five-year indicators would be removed until the final document was published.

On 17 December, the hon. Member for Scunthorpe (Nic Dakin) asked the Minister whether five-year survival rates would be included, and he received an unequivocal answer:

“NHS England will be publishing the 2014-15 CCG OIS next year…which will set out measures aimed at supporting improvements in the five-year cancer survival.”—[Official Report, 17 December 2013; Vol. 572, c. 594W.]

However, the OIS released three days later, on 20 December, excluded the five-year figures, and it would help to know why the position apparently changed completely in those three days.

I thank the Minister for responding to this debate. I appreciate that she has drawn the short straw, given that this is the last debate before the half-term recess, but the all-party group would welcome a detailed response to all our recommendations, if not in this debate, certainly subsequently. She has a great responsibility. She is well aware that few ministerial posts can literally save thousands of lives if policy is got right, and she brings to her post a dedication and professionalism that are welcomed across the cancer community, but I remind her, on behalf of that community, that the Government’s goal to save an additional 5,000 lives every year by 2015 will not be achieved unless the NHS raises its game, particularly on earlier diagnosis. With that thought in mind, I look forward to her response to our recommendations.

Cancer Patient Experience

Debate between John Baron and James Clappison

Wednesday 30th October 2013 Westminster Hall

[Mr Clappison]

I am grateful to the hon. Gentleman for that intervention. I agree that communication skills are important; the important factor is that kindness should be received by the patient.

I put a point to the Minister on behalf of Macmillan Cancer Support: I hope that the Government will deal with the matters we have discussed and put patient experience at the heart of the inspection process being put in place for our health service. One way of doing that is to use the results of the cancer patient experience survey to inform ratings at a cancer team and service level and to monitor and assess providers of care—for example, as part of the foundation trust assessment process.

In the light of all that, I have four specific questions for the Minister, on behalf of Macmillan Cancer Support and other charities. First, will the Government consider making relational care a priority area in the refreshed 2014-15 mandate to NHS England? Secondly, will the Government support the use of cancer patient experience data in the inspection regime of the Care Quality Commission, which is led by the chief inspector of hospitals?

Thirdly, will the Government work with commissioners and providers to ensure that the results of the national cancer experience survey continue to drive improvements in cancer care? Fourthly, and specifically on breast cancer, can the national cancer patient experience survey include a question asking whether the respondent has secondary breast cancer? The Breast Cancer Campaign specifically asks to have that included.

More generally, I welcome the Government’s ambitious plans to improve cancer care in the United Kingdom, including those they set out in January 2011 in “Improving Outcomes: A Strategy for Cancer”, which promised action on a number of important fronts, such as diagnosing symptomatic cancer earlier; helping people live healthier lives to reduce the incidence of preventable cancers; screening more people; introducing new screening programmes, as recommended by the National Screening Committee; and ensuring that all patients have access to the best possible treatment, care and support.

Those measures should save at least an additional 50,000 lives every year by 2014-15. Many of us will be aware of the efforts being put into those different fields, to encourage people to come forward for screening, to make screening available, to make members of the public more aware of symptoms and to encourage people to lead healthier lives. That has been much more evident than it had been hitherto. In the light of all that, it would be good to hear from the Minister what progress has been made on the ambitions that the Government set out in January 2011.

Furthermore, what progress has been made in tackling inappropriate regional variations in cancer outcomes? Many advances have been made in cancer treatment in the UK, of course, but historically there has been a disparity on cancer survival rates between the UK and other comparable western nations. That has been the case for many years, under Governments of all parties, but it was underlined most recently by a 2009 Eurocare study, which revealed a disparity between UK cancer survival rates and those achieved in countries with the best outcomes.

England rated 16th in the survey for both men and women. Wales was ranked just in front, and Scotland and Northern Ireland were just behind. Apart from Ireland, every other major western European nation performed better than the UK, and some of them much better. Sweden was the best performing country.

The 2009 analysis was a little old, because it was based on patients diagnosed between 1995 and 1999, although that had to be the case to detect survival rates. More recent surveys have also seen the same pattern, such as one comparing the USA with the United Kingdom. With older patients, there is an even more marked gap between the UK and other comparable nations and economies. I have seen figures from the British Journal of Cancer that show that for women over 70 with breast cancer, the three-year survival rate in the UK is 79%, but in Sweden, it is 91%.

[Mr John Baron (Basildon and Billericay) (Con)]

I congratulate my hon. Friend on securing the debate. Although comparisons are always dangerous, a further acknowledgement of how far we remain behind our European partners is that even if we met the Government’s laudable target of saving an extra 5,000 cancer lives over the next couple of years, that would still only bring us up to the European average on survival rates.

[Mr Clappison]

My hon. Friend makes an excellent point. I am sure he would agree that there is a lot of ground to make up. The important point is that we should not only take encouragement from the improvement of survival rates as a result of advances in medical science; we should judge ourselves by how well we use those advances compared with other countries. We should set ourselves the more ambitious target of not just improving survival rates, but improving them so much that we close the gap on other countries.

Members of the British public who fall ill with cancer and their families expect cancer treatment to be on a level with that of comparable countries, our neighbours and other western developed economies. Sadly, it is not at that level, although I hope the Minister will tell us that we have made some progress.

Yesterday, some encouraging statistics were released that showed a trend of increasing survival for patients diagnosed between 2007 and 2011. The Minister will agree that that is good news, but I look forward to hearing from her that the Government’s ambition is to close the performance gap between ourselves and other countries and that the gap is being closed.

In closing, I should like to pay the utmost respect to doctors, nurses and all clinicians working in the field. We owe them a great debt of gratitude and my comments are no reflection on them. We are all hugely indebted to their work and I am sure that many of our constituents would echo that sentiment. I am just drawing attention to how the system has operated in this country over a number of years, and the experience of the patients within it. I hope that the Minister can tell me that the Government have ambitious plans for improving the cancer patient experience and that there is evidence that those plans are on the road to fulfilment.

Defence Reforms

Debate between John Baron and James Clappison

Thursday 17th October 2013 Commons Chamber

[Mr Baron]

I would need further clarification of the comment, but I can tell the hon. Gentleman that there is real concern about the plan among both the regular and the TA/reservist units in the Army, not just at the front end but in the highest echelons.

[Mr James Clappison (Hertsmere) (Con)]

I congratulate my hon. Friend on securing this timely debate. Before he deals further with the question of cost, may I as a layman suggest to him that, if the reservists cannot make up their membership in time for the disbandment of the regular battalions, there is bound to be a gap in capability?

[Mr Baron]

My hon. Friend is absolutely right. I shall be dealing with the capability gap—very briefly, if my hon. Friend will forgive me—because I think that it is an important issue, but may I test the patience of the House and stick to the cost issue for the time being? There is a real risk that, if costs rise faster than anticipated, we shall create false economies that will bring the whole project into doubt. That is terribly important, and we are right to ask questions about it on behalf of the taxpayer.

The Government have not come here to present a fully costed plan, but the pieces of the jigsaw that we can see do not reveal a rosy picture. We know from the Green Paper—and the Independent Commission to Review the United Kingdom’s Reserve Forces has confirmed this—that it costs more to train a reservist than to train a regular. We know that those who leave the regular forces to join the reserves will be given a £5,000 bounty, payable over four years. We have some questions about the reservist award, which is the difference between reservists’ pay and what they earn in civilian life. We are told that the potential cost has been accounted for, but the assumptions have not been made clear. We also know that, because employers are reluctant to let key employees go for extended periods, the Government have come up with an incentive for prospective employers amounting to £500 per reservist per month. Those are all added costs, but we still do not know what the fully costed plan is.

Economic Growth

Debate between John Baron and James Clappison

Wednesday 15th May 2013 Commons Chamber

[Mr John Baron (Basildon and Billericay) (Con)]

I would like to thank you, Madam Deputy Speaker, for selecting the amendment standing in my name and those of other hon. Members, and I would like to thank those Members who have signed it for their unwavering support. There can be no doubt that the nature of our relationship with the EU is of fundamental importance to this country, but the EU has changed since we first joined, and it is still changing. “More Europe” is the cry, and “More political and economic harmonisation” is the shout, but that is not why we joined.

[Mr James Clappison (Hertsmere) (Con)]

Does it not follow that the time for the British people to be given their say is long overdue and that we should give them every assurance that they should have that say?

[Mr Baron]

I completely agree. I think that the political system has denied the electorate their say for far too long and that Parliament needs to understand that. That is why some of us on the Conservative Benches have been campaigning for some time for a referendum in the next Parliament. I am pleased to say that the Prime Minister deserved credit for listening. In January he became the first major party leader to offer the country a referendum in 2017. But we, as a group on these Benches, have also long argued that our commitment must be both credible and believable. It is credible because the referendum in 2017 has an “out” option, but it is not yet believable.

The British electorate, quite understandably, are deeply sceptical of any politicians making promises about matters European, particularly EU referendums. Too many promises have been broken in the past. They remember Tony Blair’s broken promises about a referendum on the EU constitution, which never materialised. They are constantly reminded about Liberal literature promising an in/out referendum, which never materialised, even when they came to power. That is why we on these Benches have also campaigned for legislation in this Parliament for a referendum in the next, not because we do not trust the Prime Minister, but because the electorate do not trust politicians generally. I would argue that we as a party are more united on this issue than we have been for a generation. We have all signed up to the referendum in 2017; what we disagree on is the best way of convincing the electorate of the seriousness of our intent.

National Referendum on the European Union

Debate between John Baron and James Clappison

Monday 24th October 2011 Commons Chamber

[Mr Baron]

I am sure that the majority in the House can agree with that view.

Let us look at some of the other red herrings that have been discussed this evening. There is the argument that if the motion was passed and we had a referendum, that would somehow weaken the Foreign Secretary’s hand. I completely disagree with that. A Foreign Secretary or Prime Minister going to negotiate would be emboldened by knowing that the voice of the British people had indicated the direction of travel and how they wanted the relationship to progress.

Then we have had the argument that says, “Why bother with the motion? We’ve already got an à la carte Europe”—that is, people are already opting in and out of this and that, and so on. However, that argument does not stand up either, for the simple reason that what is happening, under the very noses of the British people, is that our sovereignty is being salami-sliced, week in, week out. We may talk about a referendum lock on future treaty changes, but to a certain extent that is tilting at windmills, for the simple reason that there is no treaty on the horizon; rather, what is happening, week in, week out, is that key competences and powers are being transferred over to Brussels. One example is in criminal justice, with the European investigation order.

[Mr James Clappison (Hertsmere) (Con)]

That is a valuable point. Is it not the case that legislation regularly comes forward within the extensive competences that the European Union already enjoys? The European Union is occupying ground and legislating in matters that should be the preserve of this House.

[Mr Baron]

Absolutely, and my hon. Friend is well placed to see that for himself, sitting as he does on the European Scrutiny Committee. Key competences and powers are transferred across to Brussels almost daily, yet the political leaders in this place seem not to recognise that fact.

The political elites across Europe—not just here—should understand the growing frustration with the current situation. We joined what was essentially a free trade area; it has turned more and more into political union. People do not like that. They want to be consulted, but they will be denied that freedom of choice if Members in this Chamber defeat the motion this evening. That, in my view, has to be wrong.

The time to put it right is now. This is the motion that some of us have long believed is right and that was going to happen, but because of U-turns and deliberations by party leaders we have been denied this say. The political elite need to understand that at the end of the day they must answer to their electorate. They cannot justify ignoring the electorate when there has been so much fundamental change in our relationship with the EU. I would urge hon. Members—particularly those who may still be undecided—to support the motion this evening, if only in the name of democracy.

University Admission

Debate between John Baron and James Clappison

Tuesday 8th March 2011 Westminster Hall

[Mr Clappison]

I have only half an hour, but if I have time at the end I will give way to the right hon. Gentleman.

[Mr John Baron (Basildon and Billericay) (Con)]

May I suggest to my hon. Friend that in addition to quotas smacking of social engineering and lacking clear justification through evidence, they could harm the long-term economic interests of this country, which would adversely affect everyone? The answer is not quotas, but ensuring that standards in the state education system are brought up to the level that allows those within it to compete on merit, not by quotas.

[Mr Clappison]

My hon. Friend makes an excellent point, which I was coming to. It answers in part the point raised by the right hon. Member for Tottenham (Mr Lammy). There is a question of raising standards in some quarters of the state system, and also of raising aspirations among pupils, critically by their teachers. The universities have been playing their part, but there must be a limit at some point to how much we expect universities to do in reaching into schools and raising aspirations. Teachers have day-to-day contact with pupils, and there is a responsibility on them in some quarters to raise aspirations.