Improving Cancer Outcomes

John Glen Excerpts

Thursday 5th February 2015 Commons Chamber

[John Glen (Salisbury) (Con)]

It is a great pleasure to contribute to this important debate, because so many of our constituents are eager for us to grasp the underlying issues relating to cancer, to explore how to deal with the inadequate service they sometimes receive, and to address some of the challenges we will face in future. As has been mentioned, Cancer Research UK said this week that one in two people will be diagnosed with cancer. As we heard in the moving testimony from my hon. Friend the Member for Filton and Bradley Stoke (Jack Lopresti), sometimes that diagnosis comes out of the blue; it is random and unrelated to previous medical history. We need to recognise that, but we also need to look at the public health challenges. I will therefore focus my remarks on two points: first, the important role that public health has to play; and secondly, how we can ensure that patients have access to timely diagnostic procedures, regardless of where they live.

Four in 10 cancers are thought to be preventable, which is why it is crucial that we view prevention as one of the best cures and work relentlessly to pursue what is required to reduce the number of people who suffer from cancer. We need to work at changing attitudes to prevention across the population, and keep pressing the message that cancer is not always a disease of chance. The 2011 strategy rightly placed an emphasis on that and on delivering a “whole society” approach. In my constituency, NHS nurses run an excellent annual fair to raise awareness of the link between cancer and factors such as smoking, diet and lifestyle. That proactive initiative by a group of local nurses offers a targeted solution. It is combined with clear national campaigns, such as the successful Be Clear on Cancer campaign, which enable us to reach as many people as possible.

I become very weary when Ministers bring forward sensible measures for dealing with some of the drivers of cancer, only to hear an outbreak of great ideological proportions about what we should be doing. It is undoubtedly critical that we continue the vital research into new treatments, but we must also remember that reducing the prevalence of smoking in the UK by just 1% could prevent 3,000 cases of cancer a year. I therefore welcome the decision to introduce standardised tobacco packaging, at a time when around 600 children start smoking every year. I welcome that on the basis of evidence and as a pragmatic decision, but I also want to challenge the assumption that somehow everyone has a free choice about whether to start smoking. I think there are many communities, in my constituency and up and down the land, where peer pressure to start smoking plays a crucial role. If there is anything we can do to reduce the attractiveness of smoking—which we know is so addictive and distinct from other health pressures—we should get on and do it.

Next, I want to highlight the crucial role of GPs. They are the gateway to wider diagnostic and treatment services, and we need to invest in them. We must invigorate their leadership and role in guiding patients to healthier lifestyles and earlier diagnosis, and therefore to earlier treatment and better outcomes. In 2011, as part of the cancer outcomes strategy, the Government provided £450 million of funding to help GPs access diagnostic tests earlier. The benefit of this investment is clear and will save about 12,000 extra lives every year. However, there are significant inequalities in referrals for diagnostic tests. There is a ninefold variation across GP practices in referring patients for the CA 125 test to identify ovarian cancer, and a fivefold variation in referrals for the PSA test used to identify prostate cancer. I visited a group of GPs in my constituency who were somewhat frustrated when they read the comments of the Secretary of State about wide disparities in diagnostic rates. However, this is not about criticising GPs but about recognising that we have unacceptable differences across the nation. NHS England has proposals to enable patients to self-refer for tests, and to establish multi-disciplinary diagnostic centres that allow patients to have several tests done at once. Those are welcome steps, as is the commitment from the Chancellor in the autumn statement to increase the proportion of funding allocated to GPs.

I pay tribute to the work done by charities across the UK to raise awareness and funds for research—in effect, to carry out life-saving interventions to ensure that even when forms of cancer are very rare, the best possible treatment is accessed. I know from my own modest experience—last week I was a blood stem cell donor—that Delete Blood Cancer UK, the Anthony Nolan Trust, and Love Hope Strength do an enormous amount of work to find matches for patients with blood cancer. On 17 March, we will hold another recruitment event in the House to get more people registered. I commend that to all Members present and to all colleagues. Only half the people in this country who have blood cancer find a match, so we can make a small contribution in that way.

I will conclude by focusing on a concern that I have deep inside me whenever we have a debate on the NHS. The fundamental dynamic is one where the supply of treatments and new procedures is ever growing, people are living longer and longer, and demand will increase. Everything we talk about relies on more money going into the NHS, whether that is more transparency, greater awareness of what cancer rates exist across the country in one year, or how we can differentiate the quality of outcomes for 85-year-olds and 65-year-olds. Wherever we know that inequalities and differences exist, there will be yet more pressure to fund more services and more work. We can try to counter this through bigger public health campaigns and greater awareness of how to live—how not to eat, smoke or drink too much—but we also need to be honest about what the NHS can tolerate in this never-ending dynamic of increased supply of services, increased demand, and increased expectations. The right hon. Member for Sutton and Cheam (Paul Burstow) talked about our coalition partner’s commitment to put up £8 billion, and he welcomed the fact that there will be £2 billion more from April.

[Paul Burstow]

The hon. Gentleman is making the important point that we must debate the resourcing of the national health service. I made the point that removing inexplicable and unfair variation in access to early treatment for cancer will not cost more, but will save money.

[John Glen]

Absolutely, and I was going to come on to that. My fundamental point is that we must change the appetite of the nation for the NHS. Yes, we want it to be there when random events take place, but we must also recognise that if we are to promote better health, everyone in this country has a responsibility as individual citizens to reduce the demands on it. Unless we do that, every five-year forward view will imply further and further increases. We need to be realistic about the fact that, unless we make real changes, we as a country will be presented with profound challenges.

[Mr Baron]

My hon. Friend is making a thoughtful and powerful point, but may I push back very gently? For me, the most transformational improvement we could make would be to put the one-year figures up in lights, as I said earlier. That will not cost money; it is about our sense of priorities, as he is fully aware. When we consider that we spend almost as much money per head of population on our health care system as many continental countries, but are still 5,000 lives behind the average—let alone 10,000 lives behind the best—there are still vast improvements to be made within existing resources, and those improvements would save money.

[John Glen]

I absolutely take that point, but I am challenging the fact that it is extremely demanding to deliver structural changes to how we provide the volume of services in a national system. For 18 months, I went through the experience of dealing with Naomi House, which provides palliative care for children and serves Hampshire, Berkshire and Wiltshire. I met four Ministers and the Prime Minister, but we still did not get a concession on bringing forward guidance on the use of tariffs by local authorities supporting palliative care for children. It was a case of being told that there would be a review, which would happen this year, next year or whenever. Because of my great frustration that delivering this change demands such effort, I doubt that continuing with the NHS as it is now will ever satisfy people. We must be more nimble in dealing with such challenges.

The other outstanding issue relates to the use of data. My hon. Friend the Member for Basildon and Billericay (Mr Baron) rightly pointed to the need for more awareness of data transparency so that we can target resources more effectively. I hope that he is right about the sufficiency of the resources that every party in the House will no doubt pledge in the run-up to the general election. However, when we have a lot of data, we need to be able to process and deal with it, and ensure that we use it to guide resource allocation decisions. I resist strongly all the voices saying that we need to be extremely cautious about using data. Unless we can aggregate data on health outcomes in different dimensions, and use them to drive the reallocation and refocusing of resources, we will not deal with inequalities.

I have probably said enough, but I want to thank my hon. Friend who has given us all something to aim for by championing cancer issues. I once again commend the recruitment event pushed by my local paper in Salisbury, the Salisbury Journal, to make us the place with the highest number of people on the register of Delete Blood Cancer UK. Will the Minister reflect on the key point about the sufficiency of resources and the challenges that the NHS faces and give us an honest answer, as I know she will? It is really important that people outside Parliament know that Members understand the challenges involved in the vital area of how to tackle cancer.

--- Later in debate ---

[Jane Ellison]

I completely understand that point, which is well made. We will not have the next best international benchmark until 2017-18, but my hon. Friend is absolutely right that that does not mean that we are without proxy benchmarking and real benchmarking in the interim. He is right to draw attention to the one-year survival rates. I was trying to give a sense of the international picture and of comparisons.

On how further to improve cancer outcomes, I am sure all Members will be delighted that on 11 January, NHS England announced a new independent cancer taskforce to develop a five-year action plan for cancer services, to consider the vital survival rates and to improve them, saving thousands more lives. The taskforce has been set up to produce a new cross-system national cancer strategy, bringing all the strands together, as so many Members wanted. This is a strategy—by the NHS for the NHS—to take us through the next five years to 2020, building on NHS England’s own vision for improving cancer outcomes, as set out in the “Five Year Forward View”.

Picking up a point made by my hon. Friend the Member for Salisbury, many of the major charities involved in the taskforce have told me that much of it is about working smarter. It is not necessarily to be measured purely by spending more. I thought my hon. Friend made a very thoughtful contribution on that topic. The taskforce is an expression of our ambition for outcomes. It has been set up in partnership with the cancer community and other health system leaders, and it is chaired by Dr Harpal Kumar, chief executive of Cancer Research UK. It met for the first time on 27 January. The new strategy will set a clear direction covering the whole cancer pathway from prevention to end-of-life care; a statement of intent will be produced by March 2015; and the new strategy will then be published in the summer.

I have always been keen in responding to these debates to emphasise the need for the NHS and all others intending to improve cancer outcomes to come together and interact effectively with Parliament. That is vital. The expertise is here in the all-party group, so I am pleased that the cancer taskforce yesterday sent a call for evidence to the various all-party groups—on pancreatic cancer, brain tumours, breast cancer, ovarian cancer and cancer generally. I of course encourage colleagues to submit evidence to the taskforce. After the debate, I will speak to the chairman and of course draw his attention to the quality of the inputs into this debate.

Turning to deal with early diagnosis, I shall not reiterate all the points made about the importance of tackling late diagnosis. We have heard some important illustrations of just how crucial this can be. We have invested over £450 million to achieve earlier diagnosis. As part of the recent taskforce announcement, NHS England also launched a major early diagnosis programme, working jointly with Cancer Research UK and Macmillan Cancer Support, to test new approaches to identifying cancer more quickly.

The new approaches include offering patients the option to self-refer for diagnostic tests; lowering the threshold for GP referrals; creating a pathway for vague symptoms such as tiredness—a big issue for pancreatic cancer, so it is important to work on this; and setting up multi-disciplinary diagnostic centres so that patients can have several tests done at the same place on the same day. So many Members have spoken in today’s and other debates about the wearying journeys and the debilitating effects that multiple tests on multiple occasions can exert on their constituents—another important area to look at. NHS England’s aim is to evaluate these innovative initiatives across more than 60 centres around England to collect evidence on approaches that could be implemented from 2016-17.

Briefly, all Members will need to debate and bring more into the open in the coming years the inevitable tension between the concentration of expertise to carry out early diagnosis, particularly in rarer cancers and those with more difficult symptoms, and the understandable desire that Members and members of the public have to have facilities closer to people. There is a tension, and we will inevitably have to debate it. I think it was the hon. Member for Heywood and Middleton (Liz McInnes) who made the point about the number of rare cancers that GPs see. The issue has been teased out in these debates before, but in reality the number of common cancers seen by the average GP is very few, while the number of rare cancers they see is very few indeed.

[John Glen]

Does the Minister acknowledge that there is a difference between urban and rural in this context? While those who represent rural constituencies understand the need to aggregate services to get the specialism, we are also concerned about access. Is this not a careful judgment to be made?

[Jane Ellison]

I entirely agree; I think there is a balance to be struck. One of the issues that was discussed at about the time of the launch of the “Five Year Forward View”, by the NHS among others, was that of moving consultant expertise from secondary to primary settings. There are a number of ways of looking at that. I urge Members to feed the points that they have raised to the taskforce, because it is exactly that kind of new way of looking at things that we want to capture in its work.

Since 2010-11, the Department of Health has undertaken a series of local, regional and national Be Clear on Cancer campaigns to raise awareness of signs and symptoms of specific cancer types, and to encourage people with such symptoms to visit their GPs. Decisions on further Be Clear on Cancer activity will be made during 2015, and will be based on all the available evidence relating to the effectiveness of the campaigns. I will argue strongly for their continuation, because I think that the case for them has been conclusively made. Many have been very successful, and they are evidence-based, which I think is important. The Department will continue to work with Public Health England, NHS England and all the relevant experts and stakeholders to keep the campaigns under review.

Let me briefly update the House on the ovarian cancer campaign, which was mentioned by the hon. Member for Washington and Sunderland West (Mrs Hodgson), and for which she is a long-standing and doughty champion. I recently lost a dear friend to ovarian cancer, so the issue is very close to my heart. Public Health England ran an ovarian pilot campaign in the North West television region between February and March last year, which, as the hon. Lady said, focused particularly on awareness of bloating as a symptom of ovarian cancer. Public Health England is waiting for the full evaluation results of the campaign, but we expect the interim report to be shared with the charities later this month. Public Health England has also agreed to meet them. A decision on how to proceed will then be made, at a national level.

A draft policy proposal for BRCA gene testing is among those on which NHS England’s clinical priorities advisory group is awaiting consultation. That consultation will probably take place following a 90-day public consultation on the decision-making framework. I understand that NHS England will soon consult on the lowering of the threshold for BRCA1 and BRCA2 testing in line with guidance from the National Institute for Health and Care Excellence.

Let me now briefly touch on the point made by the hon. Member for Heywood and Middleton, from whose health expertise we benefited earlier in the week during another debate. In May last year, before the hon. Lady entered the House, we had a very good debate about cervical cancer and screening following a tragic case involving a young woman in Liverpool. She may find it interesting to read the report of that debate, in which Members described cases similar to that of the young woman to whom she referred.

If people have gynaecological symptoms that make them alarmed enough to visit their GPs, they should be referred for diagnostic tests. Smear tests are screening tests, not diagnostic tests. In fact, the best clinical guidance is that if there are gynaecological symptoms, a smear test will only delay possible diagnosis. I think it important to send young women the message that if they are worried about gynaecological symptoms, they should seek a diagnostic test rather than a smear test.

My hon. Friend the Member for Castle Point (Rebecca Harris) raised the important issue of brain tumours. I can update her on the work that has been done. Representatives of the Brain Tumour Charity recently met representatives of Public Health England, and the meeting went very well. The charity is to give a presentation to the school nursing partnership in March. It is also going to contact the NHS England’s national clinical director for cancer to see how it can contribute to work on early diagnosis. Other actions were agreed on, but I understand that that particular piece of work is proceeding well.

As we know, screening is an important way of detecting cancer early, and under this Government there has been a £170 million expansion and modernisation of cancer screening programmes. They are reviewed regularly, and I am always happy to tell Members how further information can be submitted to the UK National Screening Committee.

On cancer waiting times, the NHS is treating more cancer patients than ever and survival rates are improving. In the last 12 months, nearly 560,000 more patients were referred with suspected cancer than in 2009-10, an increase of 60%. In 2013-14, almost 35,000 more patients were treated for cancer than in 2009-10, an increase of 15%.

Most waiting times standards are being maintained despite the growing numbers, although we are aware of the dip in the 62-day pathway standard in the last three quarters. Of course it is vital that all patients fighting cancer should have high-quality, compassionate care and we expect every part of the NHS to deliver against those national standards. Therefore, the NHS is looking urgently at any dips in local performance to ensure that all patients can get access to cancer treatment as quickly as possible. It has a specific waiting times taskforce looking at that.

Radiotherapy has long been championed by the hon. Member for Easington (Grahame M. Morris). Radiotherapy can be a helpful treatment for some patients. His points about its success rate when used at the appropriate time were well made. As part of its recent announcement, NHS England also committed a further £15 million over three years to evaluate and treat patients with a modern, more precise type of radiotherapy, stereotactic ablative radiotherapy, or SABR, to which he referred. That new investment is in addition to NHS England’s pledge to fund up to £6 million over the next five years to cover the NHS treatment costs of SABR clinical trials, most of which are being led by Cancer Research UK. Those are for pancreatic cancer, lung cancer, biliary tract cancer and prostate cancer.

I can confirm that we are investing £250 million in two proton beam therapy centres. One is at UCLH—I saw the foundations being built when I visited the hospital recently; it was exciting to see that centre being built—and the other is at the Christie in Manchester, so that patients can be treated in the UK. As Members will be aware, patients are currently referred abroad

On the cancer patient experience and the cancer patient experience survey, nothing could more amply demonstrate the importance of putting cancer patients’ experience at the heart of treatment and of the NHS response than the speech by my hon. Friend the Member for Filton and Bradley Stoke (Jack Lopresti). It was impossible to remain unmoved by it. It could not have more aptly underlined the importance of taking patients’ experience into account. Therefore, I was pleased to see that the results of the 2014 cancer patient experience survey, published in September, show some improvement on many of the scores since the previous survey—89% of patients reported that their care was either excellent or very good.

Following the 2014 survey, NHS Improving Quality is launching a pioneering project that pairs highly rated cancer trusts with trusts that have potential to improve. That “buddying” programme will involve up to 12 trusts and will be directed at clinical and managerial staff so that we can continue to use that survey to drive improvements.

As to the future of the survey, on which there has been some discussion, my hon. Friend the Member for Basildon and Billericay mentioned the new tendering of the contract, which NHS England is taking forward. For those reasons, it is unlikely that there will be a survey report in 2015. I know that that will be a disappointment to him, but it is very much the intention to run a survey this year for publication next year. NHS England is working with a range of stakeholders, including cancer charities, to ensure that that survey is even more effective.

NHS Services (Access)

John Glen Excerpts

Wednesday 15th October 2014 Commons Chamber

[Mr Hunt]

I will make some progress.

The right hon. Gentleman said that the reforms have made it harder to access NHS services. The opposite is true. Scrapping the primary care trusts and strategic health authorities meant the introduction of clinical leadership, which he wants to abolish, and allowed the NHS to hire 6,100 more doctors and 3,300 more nurses. Those members of staff are helping the NHS to do 850,000 more operations every single year compared with when he was in office. How can he possibly stand before the House and say that access to NHS services is getting worse, when nearly 1 million more people are getting operations every year compared with when he was Health Secretary?

[John Glen (Salisbury) (Con)]

What is more, the evidence from Labour’s last years in office shows that the number of managers was increasing at three times the recruitment rate for nurses. What does that say about Labour’s priorities in office?

[Mr Hunt]

My hon. Friend is absolutely right. That is why the management pay bill doubled under Labour and why we took the difficult decision, which the Opposition bitterly opposed, to get rid of 19,000 administrators and managers so that we could recruit the extra doctors and nurses. I notice that Opposition Front Benchers are very quiet on that point because they cannot answer the simple question of how they would pay for those extra doctors and nurses if the Health and Social Care Act 2012 was reversed. [Interruption.] Ah! They would pay for the extra doctors and nurses by bringing in new taxes that the country is not paying at the moment.

The right hon. Gentleman talked about structural reforms. We ought to discuss the structural reforms that he chose not to talk about, such as making the Care Quality Commission independent, with new chief inspectors for hospitals, adult social care and general practice. He tried to vote down that legislation in this House. So far—[Interruption.] I know that this is uncomfortable for Labour Members, but they should listen, because the new inspection regime has put 18 hospitals into special measures. Five of them have been turned around completely and have exited special measures, and important improvements are being made at the others.

The motion talks about Government mistakes, so will the right hon. Gentleman finally accept the catastrophic mistakes that he made as Health Secretary, such as failing to sort out the problems at those hospitals, even though there were warning signs at every single one of them? Does he accept that because Labour ignored those warning signs, patients were harmed and lives lost? Will he finally apologise to the relatives of patients at Mid Staffs whom he made wait outside in the cold because he refused to meet them and hear their concerns? Will he make that apology now? He has not apologised and it is clear that he does not want to do so today.

The right hon. Gentleman talked about A and E. Just as when he was Health Secretary, there have been weeks when the target has not been met. What he did not tell the House is that, thanks to our reforms, we have 800 more A and E doctors than four years ago and nearly 2,000 more people are being treated within four hours every single day than when he was Health Secretary.

As the motion refers to Government mistakes, perhaps the right hon. Gentleman might like to acknowledge some of his own mistakes on A and E, such as the 2004 GP contract that removed personal responsibility for patients from GPs, making it more likely that people would end up in A and E, or the failure over 13 years to integrate the health and social care systems, meaning that many vulnerable older people continue to end up in A and E unnecessarily—something that we are putting right through the Better Care programme.

When the right hon. Gentleman spoke about NHS performance, he talked repeatedly about missed targets. That is a really important issue and is perhaps the biggest dividing line between his approach to the NHS and mine. Of course targets matter in any large organisation, but not targets at any cost. That is why the Government have been careful to ensure that in the new inspection regime, waiting time targets are assessed not on their own, but alongside the quality and safety of care.

Public Health England Hub Programme and Porton Down

John Glen Excerpts

Wednesday 3rd September 2014 Westminster Hall

[John Glen (Salisbury) (Con)]

May I say what a pleasure it is to serve under your chairmanship for the first time, Mr Robertson?

I have called this debate on the back of two similar debates in June 2010 and September 2013, several questions in the House, the lobbying of Ministers and meetings with officials over the past four years. Today, I urge the Minister critically to appraise the recommendations that she and her ministerial colleagues have received from the board of Public Health England to move significant elements of the PHE facility at Porton Down to a new site in Essex.

The UK Government have had capabilities at Porton Down for more than a century, which have evolved into a unique asset overseen by PHE. The facility is recognised around the world for its role in responding to some of the gravest threats facing mankind today. Indeed, several of my constituents have been deployed abroad to support the international response to the Ebola crisis, which is widely reported in the media.

However, it is well known that the facilities at Porton Down have been in need of a substantial upgrade to remain fit for purpose. Until 2009, the board of the Health Protection Agency, PHE’s predecessor organisation, felt that its objectives would be best achieved by expanding and redeveloping the existing site at Porton. The PHE board has submitted three different business cases—in June 2010, April 2012 and, after a two-year gap, in 2014 —as it has sought to justify its intention to create a single science hub in Harlow. The PHE board has submitted the outline business case to Ministers, and the preferred option is to collocate its assets on a new campus in Harlow modelled on the USA’s Centers for Disease Control and Prevention in Atlanta. The latest publicly available analysis from Professor George Griffin’s 2012 due diligence report disclosed that the Harlow option would produce a mere 2.6% cost saving for the Treasury compared with redevelopment with Porton, over a 68-year time frame.

I want to use the debate to highlight the risks associated with relocating such a sensitive facility. PHE’s primary mandate is to

“protect and improve the nation’s health and wellbeing”.

Some of the work done at PHE Porton, especially translational research into taking products from the workbench to commercial markets, arguably does not fit comfortably in that mission statement. Consequently, I am led to believe that the business case does not fully assess the potential of a redeveloped site at Porton to drive growth in the UK life sciences sector. The Government clearly view that sector as important to the UK economy, given that they selected one of our colleagues to become Minister with responsibility for life sciences in the July reshuffle. I emphasise the critical importance of translational research and urge the Minister to be the one who finally unleashes PHE’s full potential at Porton in that area.

Public Health England Porton is on course to generate £65 million in external revenues this year; it receives just £8 million in funding from the Department of Health. PHE Porton is operating in an increasingly competitive global environment where outcomes are harder to achieve, and it is doing so very successfully. Understandably, PHE’s primary mandate is not about seizing commercial opportunities, and the translational research capability at Porton has arguably never been fully realised, and its potential never fully exploited, as a consequence.

One of the key arguments for relocating to Essex is that Harlow is ideally sited between London and Cambridge, which would allow PHE to establish links with companies and research institutions based there. My fear, however, is that that argument is flawed because the team at Porton has never been disadvantaged by its current location. As the useful document from the Porton life sciences group sets out, the team at Porton currently works with more than 250 partners across the world, including more than 130 universities, the US Government, five international health agencies, nine global pharmaceutical companies and more than 60 small and medium-sized enterprises. The list includes more than 30 entities currently based in London or Cambridge.

In 2012, the Boston Consulting Group carried out a comprehensive study of the drivers of research productivity in 420 life science companies. The study found that location was not a key factor and that accumulated research expertise was twice as significant. PHE Porton has some 3,750 years of scientific acumen relating to infectious disease in its ranks. Almost half of those individuals are operating above PhD level. PHE argues that new staff can easily be moved or recruited to Harlow and that it is a desirable place to work, but the fact remains that, when the staff at Porton were last surveyed, just 7%, or one in 14, were inclined and prepared to move.

I find it perplexing that in the modern age, when the Government are increasingly looking beyond geographical borders for commercial opportunities, when digital by default is the preferred option and when the Government are actively seeking to disperse their functions outside the south-east, Ministers could accept a plan that flies in the face of those aspirations. The entire business case is dependent on the premise that an organisation will be more effective if its staff and resources are in one location, but across PHE employees perform a wide range of functions, many of which have little day-to-day operational co-dependency.

The idea that a physical hub will result in “water cooler conversations” leading to improved research outcomes is, at best, highly questionable. The private sector left that mindset and approach long ago in favour of more effective use of technology and flexible working practices. The outline business case also makes the assumption that existing partnerships will be able to continue operating effectively throughout at least a 10-year transition period.

I want to imagine a different scenario in which Porton is finally given the operational freedom to capitalise fully and extend its current external research relationships, as I have consistently suggested in debates in the House over the past four years. Other Departments have recognised the potential of what exists at Porton. On the same day that Public Health England’s board made public its recommendation to move to Harlow, the Department for Business, Innovation and Skills announced an investment of several million pounds to establish a new science park at Porton, which was supported by the local authority, Wiltshire council, and the local enterprise partnership. The science park will be next door to Public Health England and the Defence Science and Technology Laboratory. The Department of Health’s first spin-off company emerged from PHE Porton, and one of the reasons why the science park was conceived was to provide space for similar likely companies in the future.

Imagine if the ambition of the universities of Oxford and Southampton to create a second corridor of excellence to rival Cambridge and London could be fostered. The regional life sciences industry proposed to create a new national centre for translational vaccinology, which the Medical Research Council could not support further because of the uncertainty around PHE at Porton Down. The project is not some blue-sky ambition proposed at the last moment, either. There are signed expressions of interest from two multinational pharmaceutical companies and SMEs across the region. It is not a new project but one that has developed from existing working relationships. The university of Southampton, for example, is involved in more than 30 projects with PHE Porton, such as the one awarded $1.4 million by the US National Institute of Health last month to continue its groundbreaking work on tuberculosis treatments.

I will now discuss PHE Porton’s one geographical partnership that depends on physical location. The Defence Science and Technology Laboratory is currently located immediately adjacent to PHE, and there is a natural synergy in the work that the two organisations do and the security arrangements that they share. I am told that staff have worked particularly closely in emergencies. They have a close historical connection, their staff share a number of unique competencies and both organisations retain a significant proportion of the UK’s containment level 4 laboratories.

Although I understand that greater collaboration with DSTL has nominally been considered as part of the single science hub programme, I seek reassurance that that option has been fully evaluated, particularly in light of what I know to be the willingness of DSTL’s management to embrace the programme. It has been known since 2008 that there is spare capacity in DSTL’s high containment facilities, as Professor Griffin told the Select Committee on Innovation, Universities, Science and Skills. He reported in 2012 that it is important that the relationship is preserved:

“A move to Harlow would not prevent collaboration with DSTL but it would be more difficult, particularly since outside the UK ‘Porton Down’ is perceived as being managed more under common control than it really is and this carries considerable brand value.”

I emphasise that point. When the Prime Minister said that our laboratories had confirmed that there were chemical weapons in Syria, he referred not to DSTL or PHE labs but to our labs at Porton Down. The media reports on samples of Ebola being sent to “our experts at Porton.” Porton has a global reputation built up over several decades, which Harlow will need to work hard even to establish.

Although I fully concede the need to do what is best for the national public health interest as a whole, my concern is that the translational research function and the complex relationships and revenue generation activities that have been built up over many years will be put at serious risk if the outline business case is accepted as is. Given the pace of technological change, the notion of a single science hub might become redundant, too. Earlier this week I met my hon. Friend the Member for Mid Norfolk (George Freeman), the new Minister with responsibility for life sciences, and he is a great believer in the power of genome sequencing to revolutionise care in the NHS. He will know that the direction of travel undermines the case for physical collaborations as more laboratory-based diagnostic work is replaced by computer-based modelling.

Before approving the plan, I ask the Minister to be sure that the business case contains a rigorous analysis of the issues of transitioning and recruiting teams of world-class scientists and that the security concerns about sensitive work, which we hear nothing about, are not optimistically handled in the business case. Please be sure that the economic value associated with 10-year contracts with the US Government and other external parties will not be seriously jeopardised during an extended, uncertain transitional period in which facilities at both Porton and Harlow will need to co-exist.

Perhaps more importantly, I urge the Minister to recognise that, although translational science may not be core to the entity that is currently Public Health England, it is certainly core to the UK’s life sciences industry. Please be sure that the outline business case demonstrates conclusively that the commercial opportunities for PHE will be significantly improved by relocating to Harlow and that the anticipated gains clearly outweigh the opportunity to create a new world-leading corridor of translational vaccinology in the south-west at Porton.

I stand here today, for the third time in an Adjournment debate since I was elected in 2010, not because I want to articulate a narrow “keep the jobs in my constituency at all costs” argument. My primary concern is that this decision is motivated by a misjudged desire to tidy up different entities within the PHE organisation into a single site, when the day-to-day functional synergies of the different components of PHE are not significant, the advantages of co-location are notional, uncosted and unproven and most of all, sadly, the risks to the life science sector and the international Porton Down brand are so significant that they render the recommendation to proceed with the Harlow option even more questionable.

Mitochondrial Replacement (Public Safety)

John Glen Excerpts

Monday 1st September 2014 Commons Chamber

[Mr David Burrowes (Enfield, Southgate) (Con)]

It is a pleasure to follow the hon. Member for Stockton North (Alex Cunningham) who gave us that moving account of Jessica. That account has also raised other matters in relation to the principles and the ethics of the issues with which we are dealing. In 2008, I was involved in the scrutiny of the Human Fertilisation and Embryology Bill and the Joint Committee and I still bear the scars. We are focusing here on public safety. We are not doing that as a guise, as some hon. Members have wrongly suggested. The focus is on safety, because that is what Parliament intended to be the case. We need to be absolutely satisfied about the safety of the process. Concerns over the painful, debilitating, serious mitochondrial diseases have been well made, but we must consider safety.

The hon. Member for Cambridge (Dr Huppert) says that we need an honest debate. He quoted Lord Winston, who said—the Government need to take heed of this when they seek to make some redefinitions—that mitochondrial transfer is genetic modification, and that modification is handed down the generations. Lord Winston said that it was totally wrong to compare it with a blood transfusion or a transplant and that an honest statement might be more sensible and encourage public trust.

The point is that Parliament intended to proceed cautiously and not in the permissive way suggested by some in 2008 who said that we did not need regulations and should just let the HFEA get on with it. The idea was that the question needed to be explored carefully. The Minister at the time, the right hon. Member for Bristol South (Dame Dawn Primarolo), said:

“there are so many questions that we cannot yet answer, the Bill provides for the principle…They can be drafted only when the research is at a more advanced stage.”

That deals with why this has taken so long, as the research was not at a stage to allow the regulations even to be drafted. We must also take heed of the fact that the then Minister also said:

“The Bill provides the flexibility for further consideration by the public and Parliament, and for the specific details of the techniques to be specified in regulations.”

That is where we supposedly are now. She went on:

“More importantly, the Bill allows that once the safety of the technique is established and not before.”––[Official Report, Human Fertilisation and Embryology Public Bill Committee, 3 June 2008; c. 25.]

That was the intention of the Minister at the time and I hope that it is the Minister’s intention now.

[John Glen (Salisbury) (Con)]

My hon. Friend is making a thoughtful and powerful case. My concern is that if the implications are not fully understood, instead of dealing with the legitimate concerns of all the parents of children who are suffering greatly, we risk creating even worse conditions in future generations.

[Mr Burrowes]

My hon. Friend makes an important point. We recognise that this is not an uncontroversial technique similar to blood transfusion. It is controversial, and we must recognise that if we want to bring the public along with us. We must also recognise that, as my right hon. Friend the Member for Havant (Mr Willetts) said, we would be leading the way in scientific advancement, but we would be leading the way not just because of scientific development but because other countries had considered the ethics, complications and risks and said that they were not going to go down that route. Some might say that we are out there at the forefront, but others might say that we are out there on a limb.

On 22 July, the Minister responded to the consultation by saying:

“We wanted everybody with a view on the regulations to comment and the majority of people were positive.”

We have heard from the hon. Member for Stoke-on-Trent South (Robert Flello) that there is another view. The Minister went on:

“We will now progress with our plans.”

Given that I was present during the scrutiny of the Human Fertilisation and Embryology Bill, I would suggest that the then Government—I had much against them as regards the Bill—clearly intended that safety must come first. The issue is not whether the majority want it or who has the loudest voice—scientific or otherwise—but about safety. We need to be convinced so we must take heed of the HFEA, which says that although we have had the detailed submissions,

“Let us be clear: safety is and will always be of paramount importance...progress being made towards safety in this area”.

Progress is being made towards safety, but we are not there yet. The HFEA agrees that further research is needed. Pre-clinical data and research need to be considered, and that must all happen before we progress further. I urge the Minister to take heed of the concerns and to proceed only after we are clear about safety. We are not there yet.

NHS Investigations (Jimmy Savile)

John Glen Excerpts

Thursday 26th June 2014 Commons Chamber

[Mr Hunt]

I do not agree with that. The CRB checks that were introduced by the last Labour Government were a very important step forward when they started in 2002, but what is also important, as I am sure Labour recognises, is that they have limitations, because they identify whether someone has a criminal record. Jimmy Savile was never convicted of a criminal offence, so CRB checks alone would not have stopped this abuse. That is why we need a broader system, which is what the disclosure and barring scheme is intended to be. It is deliberately set up as something that is risk-profiled, so the higher the risk, the higher the standard of investigation, but that is one of the things that Kate Lampard will look at and we need to listen to what she says when she gives us her final report.

[John Glen (Salisbury) (Con)]

I was grateful for the opportunity early this morning to look at the thorough report of Jimmy Savile’s visits to Odstock hospital. At Odstock, although it seemed that Mr Savile visited, the report concluded that there was no evidence of any wrongdoing. However, one recommendation was that the Department of Health issue national guidance on VIP policy and VIP visits. Can the Secretary of State confirm that he will look at that, so that all hospitals, including the successor to Odstock, Salisbury district hospital, can have a reliable policy in place?

[Mr Hunt]

I think that is a very sensible suggestion. I want to wait until Kate Lampard gives her final report in September, so I do not want to pre-empt what she says, but certainly, one of the blindingly obvious things that jumps out at us from these reports is that too generous treatment was given to someone on the basis of that celebrity status, and we definitely need to learn lessons. As I am sure my hon. Friend would appreciate from his own constituents’ point of view, the fact that there is no evidence of abuse sadly does not mean that there was no abuse, and that is why it is really important for us to remember that there may well be many people who are not mentioned today who have been quietly suffering for many years. I hope today will give them encouragement to come forward.

Patient Safety

John Glen Excerpts

Tuesday 24th June 2014 Commons Chamber

[Mr Hunt]

I hope that they are. I think that in the end we shall be judged on how successful we are in turning around hospitals in special measures. Last week I met Anne Eden, the chief executive of Buckinghamshire Healthcare. I think she has done an excellent job in extremely difficult circumstances, but I know she would agree that there is still much work to be done. Taking hospitals out of special measures is the first step, but ultimately we must reassure the public that when there are problems, we shall be on their side and try to sort those problems out.

[John Glen (Salisbury) (Con)]

I welcome today’s announcement, and I assure the Secretary of State that Salisbury district hospital, which is in Odstock in my constituency, will be keen to sign up to the campaign. However, will he acknowledge that it and several other hospitals have been alive to issues of patient safety for a long time, and have recently been involved in a new patient safety initiative launched by Wessex academic health science network? Is it not important for existing arrangements to be acknowledged, so that there is no duplication of effort?

[Mr Hunt]

That is absolutely true. A number of initiatives are taking place, and I welcome them. The involvement of universities can help us to understand some of these very difficult issues. This is uncharted territory for the NHS, because nowhere else in the world are we seeing the rigour with which we are going about our task. I think that we should be open about anyone who can contribute to the debate.

Tobacco Products (Standardised Packaging)

John Glen Excerpts

Thursday 3rd April 2014 Commons Chamber

[Jane Ellison]

The Government are seeking to consider all measures that have an impact on children taking up smoking in the first place, and many of our laws and measures are beginning to bear fruit as smoking is at its lowest ever level in this country. Every child who takes up smoking is one child too many, and I urge Members to read Sir Cyril’s report and examine the evidence and what he says about the pressures on children. When Members have reflected on that, I hope they will join me in supporting any measure that can make an impact in this area.

[John Glen (Salisbury) (Con)]

I welcome today’s statement and I support sensible evidence-based measures to curb smoking among the very young. However, I seek reassurance from the Minister about mission creep. Does she agree that chocolate, alcohol and sugary drinks are considerably less addictive and do not kill when consumed in moderation, and that the Government should not be looking to extend their remit into areas where we do not need more regulation?

[Jane Ellison]

Some of the issues to which my hon. Friend alludes have been debated on many occasions in the House. Today’s statement is about standardised tobacco packaging, not about banning anything. It is to consider the potential of this policy to stop children taking up smoking, and I welcome my hon. Friend’s support for that.

Mitochondrial Transfer (Three-Parent Children)

John Glen Excerpts

Wednesday 12th March 2014 Westminster Hall

[Jacob Rees-Mogg]

It is essential with such a fundamental change in our understanding of humanity that it is made with the fullest consultation and parliamentary approval. I believe that the Government are sympathetic to that.

[John Glen (Salisbury) (Con)]

Will my hon. Friend explain what evidence he has seen of any preparatory work on the ethical considerations that would be necessary? Is it not the case that many of the regulatory approval processes have commenced, but no proper work has been done with respect to public opinion on the ethics involved?

[Jacob Rees-Mogg]

There is consultation, but it worries me that it has been done before the prior research has been completed, so we cannot be certain about safety.

I am glad that my hon. Friend raises the issue of public opinion, which is unpersuaded. A ComRes poll for Care will be released tomorrow, and I can exclusively reveal some of the results to the House. It found that 34% are opposed and 35% are in support, so there is no strong balance of support but, crucially, 44% agree that as it is currently illegal to grow most genetically modified crops for commercial purposes on the ground of safety, it ought to be illegal to create genetically modified children.

I return to the point that change of even 0.1% leads to genetically modified children. It is not sufficient to say that that is a tiny modification so it does not matter. It is the essence of the line of inheritance that we all have from our mothers through successive generations and centuries.

NHS Patient Data

John Glen Excerpts

Thursday 27th February 2014 Westminster Hall

[John Glen (Salisbury) (Con)]

I welcome the great opportunity to speak in this debate, Mr Amess—what a pleasure it is to serve under your chairmanship. I congratulate my hon. Friend the Member for Mid Norfolk (George Freeman) on his tireless campaigning, and on the full and sensible way in which he made his case.

Research is the most powerful weapon we have in the fight against disease. For decades, access to medical data has been integral to meaningful research—in the 1950s, it showed the link between smoking and lung cancer; in the 1960s, it proved that thalidomide was harmful to unborn children; and today, it helps our doctors identify the most effective treatments for cancer patients—but it is clearly time to move on from hastily scribbled GP records residing in dusty filing cabinets. Patient data are becoming increasingly critical to ensuring the delivery of better treatments, and they can radically improve how long-term conditions are managed and understood in the NHS and the world of medicine.

Aligned to that, we have personalised care, which is, frankly, the future of medicine. Just a few years ago, cancer was treated by giving all patients very similar, or the same, surgery and damaging radiotherapy. As an example, I understand that Cancer Research is now using some 11,000 patient records to see how their cancers respond to particular treatments. The stratified medicine programme, as it is known, goes to the genetic core of a cancer to detect the mutations that cause it and identifies the specific drugs that can stop it.

Researchers can take on those fragmented pieces of data and collate them. By identifying broad patterns, they can start to understand the most effective treatment for specific cancers at the molecular level. That has undoubtedly developed our understanding significantly. We now know that one drug is more effective than standard treatment for one branch of lung cancer and less effective for another. Unlike the trial-and-error approach of the past, the success of care in the future will depend on researchers analysing a sample and then cross-referencing it with a reliable database to identify genetic markers. A targeted treatment can then be tailored.

It is not just cancer that presents opportunities for better data use. Long-term conditions present one of the most significant challenges for the NHS, but research enables us to identify the most successful medications to manage them. The King’s Fund estimates that we spend £77 billion every year treating long-term conditions. NHS spending on diabetes, for instance, is set to rise from £9.8 billion to £16.9 billion over the next 25 years. We would be spending 17% of our current NHS budget just to manage that. If we replicated those sums of money in lots of other areas of expenditure, it would clearly be unsustainable. That highlights that we must use research to identify the most effective treatments, so we can target resources at them.

A recent Cardiff university study looked at just 10% of GP records in this country. It compared two different treatments used for type 2 diabetes over the course of 12 years and found that one of them has a mortality rate that is 58% higher than the other. Patients naturally seek reassurance that they are being given the best course of treatment. Colleagues would acknowledge that constituents who come into our surgeries are very anxious when they believe that the treatment or drugs they have received are not optimal for their use, and want to know why others are not available to them. Patients naturally seek reassurance, but the reality, if we are to reply honestly to our constituents, is that without expanding the evidence base, it will not be an easy task to maintain the narrative that most people get the best drug all the time. We have a duty to ensure that clinicians and scientists are given the right support from Government to make the ambition of personalised care a reality.

I will respond to the comments made by the hon. Member for Leeds East (Mr Mudie), who raised a number of concerns that my constituents have expressed in e-mails to me, in a few minutes.

The British Heart Foundation tells us that its researchers face considerable barriers due to a complex legal framework and the multitude of bodies involved. That is unacceptable, and it is right that we take steps to tackle unnecessary red tape and barriers to the sharing of information. However, we should also remember the implications. Just this week, we heard that researchers are exploring a test that can identify perfectly healthy patients who are at risk of fatal medical complications based on the proteins in their cells. I do not presume to understand all that, but I recognise the principle that as we have more information, we have the capability to do more, but we remain constrained by the finite budget of the NHS.

On ethics, the hon. Member for Leeds East referred to security of data and the lack of assurance. We have presented the use of data as leading to better outcomes and personalised solutions for patients. We must recognise that there are also enormous ethical implications in respect of the prioritisation of finite resources to treat new conditions and provide new therapies, which may well be just as expensive. So much more will be possible, but it is important that, in parallel with the discussion on access to data, we recognise the challenges of providing an ethical framework for prioritising those finite resources. We will never defeat human frailty altogether, but I want the medical community to reflect on the choices that need to be made to prioritise treatments. Research may find the cure for diabetes or lung cancer, but the second challenge will be to ensure that it is accessible to the population at a time of competition for resources.

Access to data must undoubtedly include safeguards, and obviously there is a lot of scepticism about the reliability of safeguards. My hon. Friend the Member for Mid Norfolk set out five actions that he feels would address some of those concerns. Legitimate questions must be asked on how we handle large amounts of data and ensure that they are used in the right way and for the right purposes. The six-month delay in the consultation is clearly the right time to explore those issues. However, it would be a great shame if we were to miss the opportunity to open up patient data for medical use.

Hon. Members should not rely on the argument, which has been in the headlines of some newspapers, that the data will be used for malign purposes. I instinctively take a positive view of the state. I think it acts in the interests of its citizens, although I am a relatively new Member of Parliament and my optimism may fray if I am still here in the years ahead. I find it deeply frustrating that, when we have the opportunity to relieve suffering and find ways of delivering personalised care for our constituents, we fall back on arguments about the loss of banking data. I listened carefully to what the hon. Member for Leeds East said, but the idea that somebody will know our individual medical histories is pretty unlikely. It would be a real shame if we did not move forward by allowing the data to be accessed more readily.

My hon. Friend the Member for Mid Norfolk is right that Parliament should be involved. It is essential that there are annual reports so we understand where things are moving and the positive outcomes. That would improve public understanding of progress. However, it is deeply wrong to prevent medical science from providing more options for health care. I acknowledge that there are security risks, but it is not beyond the wit of my former industry and the IT industry to work out the necessary protocols and safeguards.

I welcome the opportunity to contribute to the debate. It is right that we are having it, and it is right that we project the Government’s aspirations and hear concerns about them. I hope the Minister will set out in her response the safeguards that she feels are proportionate and necessary, and explain what the positive outcomes will be for our constituents, who are often frustrated by gaps in provision. The NHS is an incredibly complicated organism, and it is very difficult for a constituency MP to grasp where the problems lie. However, something positive can come from the proposal. I thank once again my hon. Friend the Member for Mid Norfolk for his deep knowledge, enthusiasm and inspiration on this subject.

Cancer Priorities

John Glen Excerpts

Thursday 13th February 2014 Commons Chamber

[John Glen (Salisbury) (Con)]

It is a pleasure to speak in this important debate. I congratulate the all-party group on its work and, especially, my hon. Friend the Member for Basildon and Billericay (Mr Baron) who, since I came to the House four years ago, has been a determined advocate on all matters relating to cancer, such as funding and NHS treatment. He has set a good example to us all of how to campaign forensically on such matters.

There is little need for me to repeat what other hon. Members have said: cancer is a devastating disease. It is obviously right that the Government do all they can to put the best support in place and to set up appropriate frameworks to prioritise finite resources. I welcome the all-party group’s report and its recommendations on improving survival rates and supporting patients through recovery. A third of a million people are now diagnosed with cancer each year, and despite the considerable advances in research, about half those cases will sadly still be fatal.

I shall focus my remarks on end-of-life care. There is a considerable gap between what people want and what they receive. We know that 63% of all patients would prefer to die at home, while a further 29% would choose a hospice. Just 3% of patients would choose to die in hospital, yet more than 53% ended up dying there last year. Among cancer patients, nearly three quarters—73%—want to die at home, but only 29% are able to do so, which means that 36,400 cancer patients died in hospital last year although they wanted to be at home, surrounded by their loved ones. That causes great distress to family members, and many hon. Members will have met constituents who have expressed a lot of frustration about what happens at such a difficult time in their families’ lives.

The national end-of-life-care strategy has rightly called for that to change as a priority, and it has support from across the House. However, practical barriers need to be overcome to make it a reality. This is rooted in reprioritisation of resources, which, if done properly, will not mean increased costs. That is the challenge with so much that happens in the NHS. If small changes are made in certain procedures—the way that things work and research is conducted, and the way that referral processes take place—money can be saved.

There are three challenges. First, high quality 24-hour community support needs to be available. Secondly, patients need to be able to see how their services perform in helping people to die at home. Thirdly, the NHS needs to use innovative tools more effectively so that hospital professionals know what a patient has told their general practitioner. Nearly half of all primary care trusts in 2010 did not provide 24/7 community services, despite groups such as Macmillan Cancer Support and Marie Curie Cancer Care emphasising its importance and despite the clear economic case for doing so. A day of community care costs around £145, compared with £425 for a hospital bed. Improving community care is one of the most effective ways to free up much-needed bed space and prevent emergency admissions, and, of course, give a better quality of life experience for the patients involved.

In Wiltshire, we have a dedicated community nursing team, and Sarum clinical commissioning group in my constituency has chosen to focus on improving end-of-life care. It has a clear target to ensure that there is not just 24-hour community care, but specialist support and advice, which is particularly important in the context of cancer. In addition, it has chosen to set an outcomes indicator on the number of patients who are supported to die in their place of choice.

I wanted specifically to highlight this as the APPG cancer report recommends that the national indicators set by the National Institute for Health and Clinical Excellence should include it. I agree. It is important that patients can see how their local health services are respecting their wishes, or, in some cases sadly, not. It is important that where they fail to do so they can be held to account and a local dialogue can take place. This can only happen with clear and transparent data. If this measure were adopted nationally, it would mean that pressure could be exerted when patient preferences were not being respected.

Patient choice and accountability are at the heart of many of the NHS reforms in recent months and years. Those principles need to apply to end-of-life care. In some London boroughs, I understand that as many as 70% of all patients die in hospitals, yet fewer than half of Wiltshire patients end their days in the same way. It is unacceptable that one area can support 49% of cancer patients at home, while another can reach only 16% of patients. It is important that patients can readily see these numbers, and clinical commissioning groups can account for progress towards meeting their goals and targets.

In 2013, NICE recommended that death in the preferred place of care should be taken forward as an outcome indicator. I urge the Minister to make progress on this issue and ensure that the data will be available as soon as possible in a form that can be understood and digested by our constituents. But it is not just about data for patients; it is also about data for professionals. Innovation allows us to ensure that this is used more effectively, and electronic palliative care co-ordination systems are a real step forward in that area. The proportion of patients on EPaCCS who have died in their preferred place is 76%, and just 8% died in hospital. Not only is that a substantial relief for the families who have benefited, but it delivers, on average, a saving of £270,000 to a clinical commissioning group.

Salisbury district hospital, the outstanding hospital at Odstock that serves my constituency, has taken that concept further. Through greater integration with GPs in the area, emergency department doctors can now access medical records that include an end-of-life care plan. They have trialled an innovative rapid discharge pathway for patients in the last 72 hours of life, and 20 patients were successfully supported at home last year. As a result, the scheme is being rolled out across the hospital and will bring great benefit to patients in the last few days of their life.

Obviously, cancer will continue to present a significant challenge for the NHS, but I hope that the progress that has been made on palliative care can be built upon so that the NHS can support patients during an extremely difficult time. I would like to finish by once again reiterating my support for the work of the APPG and the considerable efforts being undertaken to challenge the Government, in a constructive way, to come forward with measures that will make such significant improvements in the quality of the experience for our constituents and to the functioning of the NHS.