20 Michelle Donelan debates involving the Department of Health and Social Care

Oral Answers to Questions

Michelle Donelan Excerpts
Tuesday 5th May 2020

(3 years, 10 months ago)

Commons Chamber
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Owen Thompson Portrait Owen Thompson (Midlothian) (SNP)
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What discussions he has had with Cabinet colleagues on support for the further and higher education sectors during the covid-19 outbreak.

Michelle Donelan Portrait The Minister for Universities (Michelle Donelan) [V]
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I take this opportunity to thank all staff in the further and higher education sector for their hard work in responding to this unprecedented challenge. I reassure the House that we have protected grant funding for the FE sector for the full year, and we will provide additional targeted support. Yesterday, we announced an HE package of measures to boost support for students, stabilise the admissions system and ease pressures on universities’ finances.

Joanna Cherry Portrait Joanna Cherry [V]
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I thank the Minister for her answer. A survey by the National Union of Students has shown that 85% of working students will need additional financial support after losing their jobs as a result of the current crisis. With rent being the most significant financial demand on students, will the Minister tell us what discussions she has had with the private rental sector to ensure that students are not being charged for rooms that are lying empty?

Michelle Donelan Portrait Michelle Donelan
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We understand that this is a difficult time for everyone, including students, which is why we have worked with the Office for Students to help providers. We have reallocated funds totalling £46 million for April and May for hardship funds for students. On accommodation specifically, we have sent the clear message that accommodation providers need to be fair and transparent in their policies for students. The Treasury has announced additional measures to protect renters who are tenants.

Owen Thompson Portrait Owen Thompson [V]
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Researchers at the University of Edinburgh’s world-leading Roslin Institute in my constituency are at the very heart of the global fight to find solutions for covid-19, but such higher education institutions are struggling to get the support that they need through existing Government schemes. Given the complexities of the funding models for higher education and the immense impact of the lockdown on such institutions’ current and future finances, will the UK Government provide a support package specifically tailored for jobs in the higher education sector, to support the economy and their covid-19-fighting efforts? What additional support is the Minister seeking to support research groups throughout the UK?

Michelle Donelan Portrait Michelle Donelan
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We should not underestimate the impact of the package that we announced yesterday, which builds on the Treasury announcement that universities are eligible for Government financial support worth at least £700 million. This package also brought forward £100 million of research funding. We have also brought forward £2.6 billion in tuition fees to help with cash flow. Most fundamentally, this is a package that is designed to stabilise the higher education sector and safeguard it as a whole.

Carol Monaghan Portrait Carol Monaghan (Glasgow North West) (SNP) [V]
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May I take this opportunity to welcome the new Labour Front-Bench team to their positions and also to pay tribute to all those working in the education sector to support our young people through this pandemic?

The £100 million of quality-related research funding that the Minister has just referred to is research for England. Can the Minister confirm that this is indeed new funding and that these increases to the English QR grants will deliver Barnett consequentials for universities in Scotland?

Michelle Donelan Portrait Michelle Donelan
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I can confirm that this is QR funding that has been brought forward for English universities, but the hon. Member will have noted in the announcement yesterday that it also included a research taskforce designed to prioritise safeguarding our research base. That is a cross-governmental taskforce on which the devolved Administration Ministers will have a seat.

Robert Courts Portrait Robert Courts (Witney) (Con)
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What steps the Government is taking to support the early years sector. [R]

ME: Treatment and Research

Michelle Donelan Excerpts
Thursday 21st June 2018

(5 years, 9 months ago)

Westminster Hall
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Westminster Hall is an alternative Chamber for MPs to hold debates, named after the adjoining Westminster Hall.

Each debate is chaired by an MP from the Panel of Chairs, rather than the Speaker or Deputy Speaker. A Government Minister will give the final speech, and no votes may be called on the debate topic.

This information is provided by Parallel Parliament and does not comprise part of the offical record

Carol Monaghan Portrait Carol Monaghan
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I thank the hon. Gentleman for his intervention. Worryingly, the WHO is looking at reclassifying ME, too—we should all be aware of that—and its current classification of ME as a neurological condition has been ignored in terms of the treatment we have offered to patients here in the UK.

The Royal College of Psychiatrists goes on to state that symptoms are

“not due to a physical illness in the body. However, they can be explained, but to do this, we need to think about causes that are not just physical.”

Under the new “Improving Access to Psychological Therapies” guidance for people with long-term conditions, patients who present with ME are classified as people with medically unexplained symptoms who should undergo CBT therapy, in conjunction with other treatments—in other words, graded exercise therapy. However, as ME is classified as a psychological condition, patients risk getting trapped in the psychological care pathway.

Michelle Donelan Portrait Michelle Donelan (Chippenham) (Con)
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I am co-chair of the all-party group on Lyme disease. Does the hon. Lady agree that there are many similarities between Lyme disease and ME, in that patients may be misdiagnosed and may not know where to turn, and that we need to invest in research in both those important areas?

Carol Monaghan Portrait Carol Monaghan
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There are many conditions that we now think could be grouped under the wide umbrella of auto-immune conditions. Lyme disease, multiple sclerosis, rheumatoid arthritis and ME may all be in that group, but without research we do not know.

Some people consider ME to be a psychological condition, despite the fact that people with ME are not allowed to be blood or organ donors. Unfortunately, those who hold such beliefs often are in influential positions and have a blinkered view of the condition. I wonder what they have to fear from proper biomedical research into ME. If such research showed they were correct, their views would be vindicated. However, if it threw up new information that had an impact on ME treatment and care, as medical professionals they should surely support that.

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David Drew Portrait Dr David Drew (Stroud) (Lab/Co-op)
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I am delighted to take part in this important debate. I thank the hon. Member for Glasgow North West (Carol Monaghan) for introducing it and all other hon. Members who supported the application for a three-hour debate; we will certainly need it with the number of hon. Members who wish to speak.

I owe my knowledge of ME to friends who have suffered from it and, particularly, to constituents who have written poignant letters to me about their experiences and the hurt they have suffered when people just would not recognise that they had a condition—whether we call it ME, chronic fatigue syndrome or a post-viral condition. All those different elements make ME a problematic condition.

I mainly want to thank my constituent and friend, Dr Charles Shepherd, who is in the Gallery and to whom I mainly owe the few words I will say. He has advised the ME Association for many years now. Along with Dr Chaudhuri, he has written a book on ME. Hon. Members might like to go through it if they have a few moments; I went through it again last night. They will be staggered by some of the things that they did not know. However, I have to say that it is not the easiest read. It is very technical and very medical, but this is an incredibly technical and medical disease, which is why we do not know enough about it.

I will try to avoid the points made by other Members, but I make no apologies for going through some of the points made to me by Dr Shepherd. I also mention Sarah Reed—the wife of Andy Reed, the former Member for Loughborough—who has for a long period of time also suffered from ME and has been in touch with me about it on many occasions.

On medical education, it is quite clear that GPs, in particular, have no experience in how to diagnose this disease, so there is a need for training at both undergraduate and postgraduate level to make sure that doctors become more aware of what the condition looks like and the ways in which they could begin to treat it. That continuing lack of medical education adds to the misery that our constituents have faced. Dare I say it, it behoves the Minister—I know he will be tied in what he can say—to say something about the training programmes that we should expect our doctors to go through. It is vital that ME is understood not only by junior doctors but all the way up through the profession. We have understood, from some of the arguments on research, that there are still those who are not necessarily as keenly aware of ME.

Michelle Donelan Portrait Michelle Donelan
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Does the hon. Gentleman agree that this is about awareness not only among doctors but among teachers, employers and the wider community? The lack of knowledge in those sectors exacerbates the conditions that those with ME suffer from, and that causes great distress.

David Drew Portrait Dr Drew
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I agree, and the hon. Lady makes her point strongly. All I will say is that I will concentrate mainly on the medical side of things. However, everybody needs to be more aware because of the numbers—two in every 1,000 people are thought to suffer from the condition.

We have heard a lot about the PACE trial and the need for NICE to rewrite its guidelines, so I do not really want to labour those points, other than to say that it is not helpful that cognitive behavioural therapy and graded exercise therapy are still suggested as the appropriate way forward after ME diagnosis. We know for all sorts of reasons that that is not so. I am sure the Minister heard that and will want to comment on it.

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Kerry McCarthy Portrait Kerry McCarthy (Bristol East) (Lab)
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Thank you, Mr Rosindell, for calling me to speak.

I am here to speak today partly because constituents have been in touch to ask me to do so, but also because I have a very good friend who has been affected by myalgic encephalomyelitis, or ME, since about the age of 15 and she is in her early forties now. When I say “affected by” ME, that means that she did not go on to college and she has never held a job. She is not at the worst end of the spectrum of severity, but I think I can probably best describe her condition as just almost constantly feeling rough. So, it is like either having flu or migraines, or aches and pains.

I am aware of my friend’s condition. Obviously, it is one thing to read up on the condition or to hear accounts from constituents who come to see me, and I have had constituents with ME and fibromyalgia, which is a similar condition, come and talk to me. However, when someone has a very close friend with ME, they know that every time they try to make a social engagement with them, it will always be, “Well, Lucy will come if she’s up to it that day.” My friends and I are all planning to watch the football together on Sunday. However, we will not know until Sunday morning whether Lucy is well enough to attend, and half the time that she does come along to events, it is possible to tell that she is struggling with a migraine or flu, but she just desperately wants to see her friends. That really brings home just how debilitating a condition ME is.

As the hon. Member for Cheltenham (Alex Chalk) said, there is a cumulative effect with ME. People make such a big deal of having a cold, or just feeling a bit under the weather, or feeling hungover. Lucy feels like that most of the time and obviously there are other people with ME who are completely bedridden or who cannot bear bright lights. I had a member of staff whose younger brother came to her wedding in a wheelchair, because he had ME. So it affects people in many ways.

However, in some ways the cruellest impact of ME is the fact that sufferers are not believed and that it is a hidden illness, so to speak. The ME campaign group, Millions Missing, recently held an event in Bristol, where friends and relatives of those with ME laid out pairs of shoes to represent some of those who are suffering from the illness, which effectively renders them invisible, and they also read out stories of the battles that their friends and family members had gone through, as well as expressing their determination to see real change happen.

The organisation Action for ME used to be based in the centre of Bristol but is now based just outside. What really hits home is its raison d’être, as set out on its website, which says the organisation exists

“to take action to end the ignorance, injustice and neglect faced by people”

who have ME. Most other campaign groups for medical conditions do not have to start from there; their starting point might be to raise awareness of the symptoms of particular conditions, or to make calls for treatment. To have to start from the point of view of emphasising the injustice and neglect, because so many people deny that ME exists, just shows how much of a battle we have on our hands.

It was an excellent speech by the hon. Member for Glasgow North West. As she said, ME affects around 250,000 people in the UK. I will just cite one of my constituents, who contacted me to stress the lack of support and understanding that had been experienced when dealing with medical professionals; there are many people with ME for whom it takes a long, long time to get a diagnosis, because of that lack of support and understanding.

My constituent got in touch to share the story of her close friend’s 28-year-old son, who has had ME for last couple of years. She said that the impact on his life has been catastrophic. He was a highly skilled and highly valued journalist for a national newspaper, with a busy and vibrant professional and social life. Since contracting ME, he has been unable to work and is now living at home with his parents, who act as his carers. He has severely limited energy, he is in constant pain and he has obtained no relief or satisfaction from the treatments currently available through the NHS, his GP and the specialists to whom he has been referred. His parents have been left to research and self-fund investigations and treatment themselves, which is plainly not good enough.

In Bristol, we have a chronic fatigue syndrome/ME centre, but it has no doctors and focuses primarily on training in activity management. One of my constituents who received treatment there was highly complimentary about the staff, but she echoes the view of many other patients that occupational therapy is an inadequate approach for people with a highly disabling, multi-systemic disease.

The current National Institute for Health and Care Excellence guideline recommends treatment consisting of graded exercise therapy and cognitive behavioural therapy, but it has been criticised by all ME charities, patient organisations and representatives registered with NICE as stakeholders. We have already heard from a few people today about that.

Michelle Donelan Portrait Michelle Donelan
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On that point, one of my constituents is a 15-year-old who finds the graded exercises very debilitating; actually, they make her condition worse, which has been echoed by ME charities and the ME community. Does the hon. Member agree that we need to look at graded exercise again in the new NICE guidelines?

Kerry McCarthy Portrait Kerry McCarthy
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Yes. So much concern has been expressed about graded exercise therapy and many patients prefer the concept of pacing, which is balancing activity and rest to help them to manage their ME and work towards recovery. However, that approach is not currently recommended by NICE. I very much hope that the Minister picks this issue up, because it is probably the most controversial issue around the treatment of ME at the moment. I welcome NICE’s decision to review its guidelines—the new guidelines are expected in October 2020, I think—and I urge NICE to listen to the voices of patients with ME.

We have heard from other speakers about biomedical research and the decades of underinvestment in that research. We have also heard that the average research spend per person living with ME is less than £1 a year and that much of that money is provided by charities rather than Government. We can also consider the economic cost of not helping people at least to find a way to manage a condition such as ME; ideally, we would find the cause of ME and a cure for it. Clearly, that economic cost is unacceptable.

Oral Answers to Questions

Michelle Donelan Excerpts
Tuesday 19th June 2018

(5 years, 9 months ago)

Commons Chamber
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Jeremy Hunt Portrait Mr Hunt
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Will the hon. Gentleman be transparent, if he disagrees with the Brexit dividend, and challenge his own party leader, who supports it?

Michelle Donelan Portrait Michelle Donelan (Chippenham) (Con)
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I am delighted that our NHS will be getting an extra £20 billion. This has long been at the top of my agenda, and the agenda of my constituents. Does my right hon. Friend agree that, to ensure that that money is always spent on the NHS, we need to consider a hypothecated tax as part of the funding plan?

Jeremy Hunt Portrait Mr Hunt
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As I say, there are compelling arguments in favour of hypothecated taxes, but there are also strong reasons why we have to be cautious—namely, the fact that tax revenues go up and down, year on year, while the NHS needs stable funding. Important arguments and discussions need to happen between now and the Budget, when the Chancellor will make that decision.

Acquired Brain Injury

Michelle Donelan Excerpts
Monday 18th June 2018

(5 years, 9 months ago)

Commons Chamber
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Michelle Donelan Portrait Michelle Donelan (Chippenham) (Con)
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I welcome this opportunity to speak briefly on such an important topic that affects a number of my constituents, either personally or through their family and friends. I echo the sentiment that has already been expressed about the great work that is done by charities such as Headway that focus on acquired brain injuries.

As we have heard, every year 1.5 million people attend A&E with a head injury, and some 200,000 of them are hospitalised. That is why it is so important not only that A&E training in the detection of brain injuries is up to date, but that there is strong public awareness of the symptoms, to ensure that help is sought immediately. Equally, that is why we must continue to invest in research so that we can detect earlier and treat more effectively.

The key point that I wish to make is that brain injuries affect all aspects of a person’s life. They are not only an issue for the NHS, because they also have massive implications for a person’s social care, eligibility for employment and disability benefits, ability to navigate the judicial system, and education, to name but a few. That is why cross-departmental working is so vital and why the support available and knowledge of it is so crucial, as is increasing general awareness, especially given the fact that every acquired brain injury is so different.

For example, I have a constituent who has been able to work a number of hours with a severe acquired brain injury and is on universal credit. However, when an error was made, a request for back-payment was issued. A factual letter was sent, but it was an inappropriate letter to send to someone with a severe brain injury. It caused great distress, and it would have been better had a personal approach been taken. I pick that up with the Minister because that could and should have been done. We also need to get individuals and families to volunteer the information to work coaches and those sectors that need it, which is why I welcome the roll-out of communities partners. That will help to facilitate that work up and down the country.

I praise the investment in the network of well-resourced major trauma centres that have been established since 2012. Treating severe and complex brain injuries is a highly specialised area and requires dedicated personnel and equipment. There are now 27 of these centres in England alone. These free at the point of use, specialised centres are predicted to save over 600 more lives a year. They are an example of the NHS at its best and highlight why protecting the NHS is so important. Centres such as these are why I welcomed the funding announcement today to give more than £20 billion extra in real terms to the NHS by 2023-24.

The NHS is not a national treasure because of nostalgia, but because it saves our families and our friends. I end my remarks by reiterating how important the work of local charities is and by stressing the great contribution that those suffering from acquired brain injuries make to our communities, our workplaces and our charities.

Mental Health Units (Use of Force) Bill

Michelle Donelan Excerpts
Jackie Doyle-Price Portrait Jackie Doyle-Price
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First, I thank and congratulate the hon. Member for Croydon North (Mr Reed) on his tireless work getting this important Bill to Report, and I hope it makes further progress. It is an important reform that will significantly enhance the rights of patients in mental health settings and will be a force for justice. We have had numerous references to its inspiration, and I pay tribute to the dignified and determined way in which Olaseni Lewis’s family have pursued an important reform that will materially improve the treatment of patients.

The Government welcome the measures on monitoring and reducing the use of force in mental health settings. The Bill will provide clarity in several areas, including on recording and reporting, and is very much in the spirit that sunlight is the best disinfectant—that transparency is the most effective tool for ensuring good treatment and performance. It will facilitate better and more consistent data collection, which in turn will give us better evidence by which to measure the success of the Bill and these reforms in minimising the use of force in mental health units. I take up enthusiastically the challenge from the right hon. Member for North Norfolk (Norman Lamb). We who believe strongly in these issues owe it to the public to campaign for the adoption of best practice and the minimisation of restraint. I will say more about his amendments later.

The Government have tabled amendments to clause 4 to remove an unintended consequence of amendments made in Committee, where we unwittingly inserted a loophole that might have enabled providers not to inform patients of their rights. We have made amendments to close that loophole, while still enabling an element of discretion in the system where advising patients might cause them further distress. I notice that my hon. Friends the Members for Shipley (Philip Davies) and for Christchurch (Sir Christopher Chope) tabled similar amendments. I hope they will support at least the action I have taken in response to those concerns.

The Government agree that it is important that patients have access to advocacy services, which are very much a part of the right to information on rights and something that the hon. Member for Croydon North and his stakeholders have repeatedly raised with me, but we do not want to put this provision in the Bill. That said, to reassure them about how we are treating the issue of advocacy, which we recognise is important, I remind the House that the independent review of the Mental Health Act 1983, which was set up to look at how its provisions were being used and how practice could be improved, will examine this issue. The interim report was published in May and the final recommendations will appear in the autumn. Following that, we will develop guidance through consultation. The report and recommendations will give us another opportunity to discuss this and ensure we are happy with the standards of advocacy in place. I hope the hon. Gentleman will understand why I cannot accept his representation.

I turn now to the hon. Gentleman’s amendments on the independent investigation of deaths and legal aid. I am grateful for the opportunity to address these points, which go to the heart of what he is trying to achieve in the Bill. The appalling, dehumanising experience suffered by Seni’s family during the investigation, which went on for an unacceptably long time, is really the test by which we should measure the effectiveness of the Bill.

Let me now explain why we would resist the amendment, describe the steps that we have taken to improve investigations of deaths in custody, and, hopefully, give the House some reassurance that the experience we are discussing today will not be repeated under the current regime. That is at the heart of the Bill: we want to ensure that what was experienced by Seni’s family is never repeated.

Clause 10 in its current form requires that when a patient dies or suffers a serious injury in a mental health unit, the responsible person must have regard to the relevant guidance relating to investigations of deaths or serious injuries, published by a list of organisations that are responsible for regulation: for example, NHS Improvement and the Care Quality Commission. That means that in the current NHS Improvement guidance, the NHS serious incident framework, which was last revised in 2015, will be put on a statutory footing. The framework outlines the process for conducting investigations of deaths and other serious incidents in the NHS for the purpose of learning to prevent recurrence. It requires the treating clinician to report an unexpected death when natural causes are not suspected. All deaths of detained patients must be reported to the coroner, the CQC and the provider’s commissioner as serious incidents. That will ensure that all deaths in custody are automatically reported.

If the death occurred in a mental health in-patient or hospital setting, NHS providers are responsible for ensuring that there is an appropriate investigation into the death of a patient detained under the Mental Health Act, or where the Mental Capacity Act 2005 applies. The death of a voluntary in-patient will also be investigated by the coroner, and under the NHS serious incident framework, if it was violent or unnatural. These are not inquiries into how a person died, as that is a matter for coroners, and they are not conducted to hold any individual or organisation to account. Other processes exist for that purpose, including criminal or civil proceedings, disciplinary procedures, employment law, and systems of service and professional regulation. That is an important point, because overlapping interests will need to be managed. I hope that I can give the hon. Gentleman some comfort, and reassure him that we are tackling the real problem that the Bill is intended to tackle.

Independent investigations within the framework are commissioned and undertaken independently of those directly responsible. I know that throughout our discussions on the Bill, the issue of independence was extremely important to everyone with an interest. It will be normal for the provider to conduct its own internal investigation, but that investigation will be reviewed by the relevant commissioner, and it will be for the relevant commissioner to commission an independent investigation. Commissioners must satisfy themselves that the investigation is clearly independent, and that there is no potential for conflicts of interests and no previous relationships. It will be their responsibility to establish that.

We expect commissioners to ensure that the family is properly informed throughout an investigation, and that all agencies involved in an investigation are held to account for their roles. We expect them to take the lead in commissioning an inquiry, and to take a number of steps including listing all the agencies that have had a stake in the care of those involved with the incident, and ensuring that they are aware of the process and their responsibilities in relation to the inquiry. It is up to them to identify all legal issues that may be relevant to the independent investigation or court proceedings and obtain appropriate legal advice. It is for them to co-ordinate meetings and discussions between the investigation team, the trust representatives, the police representatives and other agencies with an interest that have agreed to participate, so that all are agreed as to what their responsibilities are. They are responsible for early discussion with the local coroner. Crucially, they are responsible for informing the patients, carers and families about how the process will work and how they can be involved.

It is extremely important that as part of the investigation process the families’ needs and wishes are properly respected and they feel some ownership and accountability and can hold the process to account if dissatisfied with how things are progressing—that is extremely important. It will be for the commissioner as well to ensure they have access to the investigation team if they so wish. I also expect the commissioner to agree the timescale for the investigation together with timings and setting a date for the report. As much as I would like to be able to say that we will never have such a situation ever again, we can never say never, and if there were to be any delay the reasons must be clearly explained to the patients and families involved as part of keeping them fully informed and making sure they are fully supported.

The serious incident framework sets out clear guidance on who should be involved in the independent investigation team and that the healthcare commissioner is to identify a lead investigator who appoints the investigation team. The framework says the following, and I will quote directly again to underline the real independence of these investigations:

“In order to ensure independence and avoid any conflict of interest, no member of the independent investigation team can be in the employment of the provider or commissioner organisations under investigation, nor should they have had any clinical involvement with the individual(s) to whom the investigation relates.

Investigators must declare any connectivity that might, or might appear to, compromise the integrity of the investigation.”

I hope that is explicit and gives the hon. Member for Croydon North some comfort about what we are doing to establish that independence.

I should also mention that we have just completed a consultation on the serious incident framework, and independence of investigations was a key theme, so we will be continuing to review this to make sure we can guarantee that independence. We will be bringing forward our response to the consultation by the end of the year, so we have another opportunity to ensure that we are satisfied that what we have is fit for purpose.

Another complication in the case of Seni Lewis was the interaction with the police investigation. That is where there is still the possibility of delay, and again we need to do everything we can to ensure that families are supported in that context.

Michelle Donelan Portrait Michelle Donelan (Chippenham) (Con)
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Does my hon. Friend agree that this Bill is vital and it is a testament to the work of Seni Lewis’s family? Is she as concerned as I am about jeopardising this Bill, because it is so important, not least to my constituents, that we tackle this important area?

Jackie Doyle-Price Portrait Jackie Doyle-Price
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This is an important reform that will considerably alter the balance of the scales of justice in favour of patients and bereaved families. I want it to make rapid progress, and the specific case of how long it took for Seni’s family to get a resolution in relation to his death is the inspiration for this Bill.

Education (Student Support)

Michelle Donelan Excerpts
Wednesday 9th May 2018

(5 years, 10 months ago)

Commons Chamber
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Michelle Donelan Portrait Michelle Donelan (Chippenham) (Con)
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Will my right hon. Friend give way?

Robert Halfon Portrait Robert Halfon
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This is genuinely the last time I give way. It is impossible to say no to my fellow member of the Education Committee.

Michelle Donelan Portrait Michelle Donelan
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Further to the intervention made by my hon. Friend the Member for South West Wiltshire (Dr Murrison), my constituency neighbour, I, too, met Wiltshire College last week, and it is eager to take on nursing apprenticeships. The college shows we can get past the few roadblocks, because it is already affiliated with universities in offering degrees. That is one way in which we can look positively at increasing the number of apprenticeships, rather than looking at it negatively, as we hear from the Opposition.

Robert Halfon Portrait Robert Halfon
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My hon. Friend is a remarkable member of our Committee and she is right in what she says. It is good that the Minister for Health, the Minister for School Standards, the Minister for Universities, Science, Research and Innovation and the Minister for Apprenticeships and Skills are here, because we need to unblock the roadblocks and bureaucracy and really make these things happen, so that thousands of people are doing this, not just 30.

We need to ensure that we are making the progression as smooth as possible. Our Committee is concluding its inquiries on value for money in higher education and the quality of apprenticeships and skills training. Nursing bursaries are relevant to both, so we decided last week to hold a one-off evidence session on the subject in the next few weeks. I hope that the Minister for Health will accept our invitation to discuss the matter in greater detail then. I urge him to carry on championing nursing apprenticeships for other healthcare professionals and to set out in detail, at a later date, what the Government will do on apprenticeships. Let us make that culture change, so that apprenticeships are not seen as the inferior option to traditional courses. The change must start in Whitehall, and only when it happens will we see nursing apprenticeships used to their full potential, contributing effectively to tackling the skills deficit and helping the most disadvantaged to have the careers that they and our country need.

Breast Cancer Screening

Michelle Donelan Excerpts
Wednesday 2nd May 2018

(5 years, 11 months ago)

Commons Chamber
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Jeremy Hunt Portrait Mr Hunt
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I believe that the IT work, which is a collaboration between the Scottish NHS and the English NHS, will be completed in the week of 15 May. That is why we are confident that we will be able to get the letters out to people registered with Scottish GPs who have moved from England by the end of May, which is the same timescale as for getting the letters out to people living in England. We will then know that number, and I will of course let the hon. Lady know.

Michelle Donelan Portrait Michelle Donelan (Chippenham) (Con)
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My grandmother died of breast cancer a few years ago, and my heart goes out to all women affected by this fatal IT malfunction. I welcome my right hon. Friend’s assurance that he is going to do everything he possibly can to ensure that this does not happen again. Has any consideration been given to the impact of this on GP surgeries? I expect that, during the next few days while women wait for their letters, they might make appointments with their GPs in anticipation, and in fear.

Jeremy Hunt Portrait Mr Hunt
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Yes, we are briefing all GP surgeries and all GPs about what the appropriate response is, because we recognise that that might happen. Of course, GPs are there for people to talk to at any time if they have concerns, and some people may choose to do that. We have also set up a specialist helpline that will be open seven days a week from 8 am to 8 pm, where people will be able to get advice straightaway by picking up the phone. We think that that will be the most practical option for most people.

GP Recruitment and Retention

Michelle Donelan Excerpts
Wednesday 28th March 2018

(6 years ago)

Westminster Hall
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Westminster Hall is an alternative Chamber for MPs to hold debates, named after the adjoining Westminster Hall.

Each debate is chaired by an MP from the Panel of Chairs, rather than the Speaker or Deputy Speaker. A Government Minister will give the final speech, and no votes may be called on the debate topic.

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Bridget Phillipson Portrait Bridget Phillipson
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I agree with my hon. Friend and I am sure his constituency, in common with mine, has significant problems with industrial illness and long-standing health problems, which means that we do not need just the national average number of GPs, or just enough to get by. To deal with the health need we face in the local population, we need a much better service to ensure that we drive down some of the health inequalities that most seriously affect communities such as mine and, I am sure, his.

More generally, constituents are also worried that changes to the GP workforce at their local practice are producing a less effective service. Many are concerned by rates of retirement, especially among family doctors with whom they have built up a close relationship over many years. They also believe that the overall decline in the number of family-run practices resulting from retirements is damaging the continuity of care they expect from their local practice.

On the securing of timely appointments, constituents who work full time are frustrated by restrictive booking systems and a lack of availability in the evenings and at weekends. Others complain that constraints in the system mean that the 10-minute consultation period is so strictly enforced that multiple appointments are necessary just to outline the problems that they face. Their frustration grows if they cannot see the same doctor on each occasion and have to repeat the same problems time and again.

There is a general sense among my constituents, and indeed in the comments posted on the House of Commons Facebook page ahead of this debate, that the pressures on general practice will only increase as more new homes are built in communities where public services are already under pressure.

Michelle Donelan Portrait Michelle Donelan (Chippenham) (Con)
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Does the hon. Lady agree that the pressures have been compounded by the ageing population, by retirements and by an increase in expectations? Does she welcome the new hospital schools announced this week?

Bridget Phillipson Portrait Bridget Phillipson
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I will touch on all the points the hon. Lady raises as I continue through my contribution.

I am clear that addressing the housing crisis in our country should be an absolute priority for the Government, but I argue that building thousands of new homes without ensuring that the necessary infrastructure is in place to meet increased demand on health, transport and education services would be a recipe for disaster. Poorly planned housing developments that do not take account of local need will only undermine public confidence in supporting a housing revolution in this country.

It is not just our constituents who are concerned about the deteriorating state of general practice in the north-east. Just over 18 months ago I was contacted by the Sunderland local medical committee about the findings of a confidential survey of local GPs and practice managers, which showed that almost half of those surveyed had seen a large increase in their workload and a further 31% reported an increase to unsustainable levels. Although two thirds of practices had attempted to recruit new family doctors, many had found recruitment difficult, and a majority reported that patient care had been adversely affected by the failure to recruit and retain GPs, the increasing workload that imposed on existing GPs and the significant reduction in core funding allocated to their practices. As a result, 60% of Sunderland GPs and practice managers said that their practice was viable only for between one and three years, with many local doctors considering early retirement or a career change.

That survey highlighted the profound problems at the heart of general practice in Sunderland, further evidence of which was laid bare in statistics I requested from the Department of Health later in 2016. Those figures showed not only a shocking 25% reduction in the number of full-time equivalent GPs in the NHS Sunderland clinical commissioning group area between 2013 and 2015 but also an accelerating rate of decline from one year to the next. The way in which full-time equivalent GP numbers were measured changed in 2015, but the new methodology shows a continued decline of 9% in the Sunderland CCG area between September 2015 and December 2017.

I am sorry to say that the most recent figures for other parts of the north-east make for even more painful reading. In the Hartlepool and Stockton-on-Tees CCG area there was a 15% drop in numbers over the last two years. In the South Tees CCG area it was 14.9%. In the Darlington CCG area it was 13%, and in the Durham Dales, Easington and Sedgefield CCG area it was also 13%. I could go on, but it is obvious that the exodus of family doctors from the profession is having a serious impact on the number of hours being made available for general practice in our region.

As a result, the demand on family doctors who continue to soldier on is intensifying. Not one practice in my area has a lower ratio of patients to full-time equivalent GPs than the England average of 1,738:1. In fact, each and every practice is consistently and significantly above that. The situation will be similar, if not worse, in other parts of the north-east.

Coupled with the plummeting number of full-time equivalent GPs is the similarly concerning decline in the number of GP practices in the area, from 53 in 2013 to just 40 today. I accept that there are merits to the argument that consolidating practices makes them more sustainable in the long term by creating larger patient lists. However, it is really important to remember that practice closures can leave behind big holes in communities.

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Luke Pollard Portrait Luke Pollard (Plymouth, Sutton and Devonport) (Lab/Co-op)
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It is a pleasure to serve under your chairmanship, Mrs Moon. I congratulate my hon. Friend the Member for Houghton and Sunderland South (Bridget Phillipson) on making such a powerful opening speech. I want to talk about primary care in Plymouth, because I am worried that the crisis we have is at risk of getting much worse in the coming months, as GPs are considering whether to hand back their contracts in the next couple of days.

A lot has been done in Plymouth to integrate our healthcare system and our social care system. Sometimes our distance from London has meant that we have managed to avoid the headlines, but not the hard work. There has been a huge effort of innovation and integration in the west country, merging social care, mental health provision and our acute hospital trust together. Enormous thanks and credit should go to the hard-working staff who have pioneered that, along with the city council and other providers.

There is, however, a problem with primary care in particular. That is exacerbated by other parts of the system that do not seem to work, as my hon. Friend the Member for Stroud (Dr Drew) said, but there does seem to be a real crisis in primary care that needs to be addressed. I welcome the news given by Simon Stevens on his visit to Plymouth last week that we will get an additional 12 GP training places for our university, but there is a real crisis today. I am looking for actions from the Minister to assist us in combating that crisis today.

Nurse and GP vacancies persist in Plymouth’s primary care sector, and waiting lists continue to be high. It is important to say that this is not because the superb staff in our NHS are not working their socks off, because they really are. However, there is persistent underfunding of not only general practice but the wider sector. NHS England estimates that one in seven GP posts in Plymouth have not been filled, which is an alarming statistic. I have heard of one GP surgery in the heart of the city that has been advertising a GP vacancy for a year and has had no applications so far.

Michelle Donelan Portrait Michelle Donelan
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I have similar issues in Melksham in my constituency. Is the hon. Gentleman aware of the targeted enhanced recruitment scheme, which offers £20,000 to attract trainees in areas that have failed to fill places for a number of years? That is available in Swindon, in Wiltshire, but also in Plymouth.

Luke Pollard Portrait Luke Pollard
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The problem is that the schemes that currently exist are not having the effect that we need them to in Plymouth, because we have a crisis today.

I want to talk about the concern that a lot of GPs have expressed to me. My remarks will be about what GPs have told me, rather than my analysis of what I believe GPs are saying, because I think it is important that their voice is heard in this debate. Will the Minister meet those GPs so that they can raise their concerns in person? There are a number of GPs who have solutions or suggestions about what can be done.

At the moment each GP in Plymouth has about 2,364 patients. As we heard earlier, the average is about 1,700, so there is a greater demand on the GPs we have in Plymouth. One GP told me last night:

“I’ve just walked in the door after a day where I saw my first patient at 0825 and left my last patient’s home at 8.15pm. Because the district nursing service is currently unreliable (through no fault of their own), I will go back to the latter at 0800 tomorrow as the patient is housebound and needs blood tests.”

He went on to say:

“A large part of the pressures on...GP’s is the fact that other community services have had such drastic cutbacks.”

He said:

“I feel very...lucky to have a secure well-paid fascinating and rewarding job but it is all a little overwhelming and I constantly worry that just one major problem will mean things become very, very unsafe.”

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Philippa Whitford Portrait Dr Whitford
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I absolutely agree. As I have said, it is not particularly an issue in Scotland, but it is very much one in England. I know that it is being looked at under the new contract. Hon. Members may remember the Prime Minister’s challenge fund: extra surgeries at the weekend are better paid and do not involve the same indemnity issues as going to do a stint at the local out-of-hours. Unconsidered consequences of that kind must be looked at.

There is obviously increasing demand. We talk negatively about the ageing population, but living longer is a good thing, and I would like to recommend it. I spent 30 years trying to achieve it. In Scotland the number of GPs increased by 9% between 2005 and 2015, but the number of patients over 65 increased by 18%. Obviously, much innovation across the UK is to do with trying to reduce workload. Scotland was first to get rid of the quality and outcomes framework, which had encouraged significant quality improvements but grew into a huge bureaucratic machine. We are working on developing the multi- disciplinary team, with physios, access to counsellors, and pharmacists. That is happening in England as well. One innovation in England is known as “time for care” and concerns extra training at the frontline—reception—to encourage triage of patients to the right member of the team. However, my attention has been caught by the development of a new app that allows patients to book appointments directly; that would remove the option for triage. It is important for innovations to be joined up.

We need to innovate and to use all community resources. Scotland has for 10 years had community pharmacies providing minor ailment services. Our optometrists are allowed to make direct referrals to hospital for cataracts, and now they treat 90% of all acute eye problems. Those are things that may at the moment be referred to general practice simply to ask for a letter to be passed on. That is a waste.

There has, obviously, been a climb in the number of practice vacancies, including in Scotland. Our whole-time equivalent has fallen, in the past three years, by 1.9%—in England the figure is 2.8%. There has been a 50% increase in the number of GPs taking early retirement, at the age of about 57. Some of that is because of the change in pension tax rules. The problem of having too big a pension is a nice one to have; however, if people who invested 40 years ago in very expensive added years are finding suddenly, as they approach retirement age, that that means they are accruing no further pension, we have a problem.

Brexit is definitely a threat. In Scotland, 3.5% of the health and social care workforce—and 5.8% of doctors—are from the EU. In London the figure is 14%. We know that 14% of EU doctors in Scotland, and 19% in England, are already in the process of leaving and, as has been said, that is simply because they feel unwelcome. As we have seen with the difficulty of getting tier 2 visas over the past four months, recruiting from outside the EU is a real issue. Businesses in London can increase someone’s salary to get past the limitations, but the NHS is not able to be so flexible.

Michelle Donelan Portrait Michelle Donelan
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Does the hon. Lady agree that we also need to tackle social injustices to ensure that the most disadvantaged in our society have the confidence and know-how to pursue a medical career? Does she welcome Government programmes to tackle that?

Philippa Whitford Portrait Dr Whitford
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I absolutely welcome them. Similarly, in Scotland the new graduate medical programme will take on people who have done other degrees, and that is particularly aimed at encouraging those people to go into general practice and rural practice.

Organ Donation (Deemed Consent) Bill

Michelle Donelan Excerpts
2nd reading: House of Commons
Friday 23rd February 2018

(6 years, 1 month ago)

Commons Chamber
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Geoffrey Robinson Portrait Mr Robinson
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The right hon. Lady raises a difficult but important issue. As part of the soft opt-out, there will certainly be arrangements for families and close friends to express their opinions. It is interesting to note that in Spain, which has no register and operates what is effectively an opt-out system, there is always consultation with every family who can be reached in time in the absence of a register, and as a result of those consultations there is a tremendous rate of consent. It can, of course, work the other way as well, and the Bill will make full provision for that. It needs to be carefully worded, and I invite those with a particular interest to look at it, but the intention is to give families in that position an effective veto. I may not have fully picked up the point made by my hon. Friend the Member for Rochdale (Tony Lloyd).

Michelle Donelan Portrait Michelle Donelan (Chippenham) (Con)
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I, too, congratulate the hon. Gentleman on the Bill, which I support. Does he agree that the point about Spain highlights the fact that the Bill is not actually the answer, but only part of the solution? After its Bill was passed, Spain took 10 years to increase the rate of donation by investing heavily in transport and infrastructure and a national organ donation system.

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Michelle Donelan Portrait Michelle Donelan (Chippenham) (Con)
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I begin by congratulating the hon. Member for Coventry North West (Mr Robinson) on getting this Bill here today. I echo the support for the Bill that Members throughout the House have expressed.

When three people die a day because of a lack of organs, while eight out of 10 people say they would be willing to be an organ donor but are not formally on the register, it is time that we take action. I can only begin to imagine the emotional rollercoaster that families and people waiting for organs must go through in the long and trying wait, which can be years. I appreciate the personal stories that Members have shared today, which must be quite distressing. I think we have all gained greater insight.

I do not want to reiterate the merits of the Bill, because we all seem to be very much in favour of it. I want to talk briefly about how we can make sure that the Bill is as successful as it can be. As I alluded to in my intervention, I think that it is only part of the solution and not the complete answer. It is the essential building block, and it is important that we are now laying that building block, but I want us to make sure that we build the house.

One key issue is fostering a culture and making sure that we educate people from a very young age, so that they see organ donation as a positive thing that they want to do. That will counter the argument about people potentially seeing it as the state owning or seizing our organs. It needs to be seen as people giving their organs to help other people.

We need to spread the message that families should have a conversation about organ donation. It should not be something that we do not like to talk about. We should actively promote a conversation so that when the time comes, people are aware of their children’s or spouse’s decision. That will prevent any possible overriding of the decision, as we see in Spain. At the moment, it is estimated that only half of all families have that conversation.

Fostering a culture in which people want to donate their organs is achievable. At the moment we have one of the lowest donation consent rates in Europe. However, we have one of the highest rates in Europe for donating living kidneys. That implies that it is not against British culture to donate organs, but that we are doing something fundamentally wrong.

One way to achieve that culture is to ensure that there is absolutely no stigma around opting out. While some of us might be organ donors, that does not mean that everybody has to be, and we need to appreciate people’s religious cultures, customs and beliefs. I hope that people will be able to opt out of donating certain organs. I know that people of some religions, including even some denominations of the Christian faith, do not want to donate their heart, so it is very important that we do not exclude people from this process.

Luke Pollard Portrait Luke Pollard (Plymouth, Sutton and Devonport) (Lab/Co-op)
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About 10% of people who are signed up to the organ donor register have excluded donating their eyes, sometimes because they are a bit squeamish and sometimes because of the thought of someone else looking through their eyes in the future. Does the hon. Lady agree that in registering as many people as we can to donate, we should preserve people’s ability to opt out of donating organs that they do not wish to donate?

Michelle Donelan Portrait Michelle Donelan
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I agree. Choice is the key to making the Bill as successful as possible, as is education. Some people might donate those organs if they knew how the process would work, but there needs to be an element of personal choice. It is our body, at the end of the day, and we should be encouraging people to help others rather than forcing them, which will not be successful.

Members have made the point—I do not want to labour it, but it is important—about reaching out to all communities, including those from ethnic minorities, among whom the number of donors is particularly low at the moment. In fact, shockingly, in March 2017 there were 634 people from the black community in need of organs, and only 72 people on the donor list died and were suitable organ donors. That is a really small proportion.

Eleanor Smith Portrait Eleanor Smith (Wolverhampton South West) (Lab)
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I thank the hon. Lady for raising that issue. Our community is experiencing what is called a silent crisis, because of the lack of knowledge and willingness to discuss organ donation with family members and concerns about the integration of the body after death. I take on board what she says—we must be mindful that there is a lack of knowledge among our community, and the Bill would improve that.

Michelle Donelan Portrait Michelle Donelan
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I thank the hon. Lady for her intervention.

Only 1% of people a year die in circumstances suitable to allow their organs to be donated. It is important that we have an honest conversation today and do not say that the Bill is the panacea that will solve the problem, and that if someone is on the organ register, they will automatically get a donation. That would give people false hope. That statistic also means that we should potentially review the current regulations on age restrictions for the donation of certain organs. For example, heart valve donations have an age restriction of 60, whereas countries such as Spain just look at the quality of the organ.

The most important mechanism for ensuring that the Bill is as effective as possible is transport infrastructure and investment in staffing. It is no good unless we have enough helicopters, bikes, trained staff and support workers to facilitate the Bill. We must ensure that it does not just help people who live in urban areas. My constituency is very rural in parts, and some areas are harder to get to, but that does not mean that people there should be any less likely to benefit from donations. Other countries that have introduced Bills such as this, including France, Sweden and Bulgaria, have seen a reduction in their organ donation rates partly because of a lack of investment in infrastructure, so that is crucial.

We should be quite bold in reviewing this issue. Some countries have adopted a policy that I admit I was originally very uneasy about, whereby someone who is an organ donor and has not opted out of the system is higher on the priority list to receive a donation. I now think that that is quite fair, because if someone is prepared to give a donation, they should be more likely to receive one.

The UK has one of the lowest donation consent rates in the world, and that is really not good enough. I am hugely supportive of the Bill, but I echo the caution that it depends on the infrastructure, education and support that we give people, so that we can ensure that the Bill is as successful as possible.

Cancer Strategy

Michelle Donelan Excerpts
Thursday 22nd February 2018

(6 years, 1 month ago)

Commons Chamber
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Michelle Donelan Portrait Michelle Donelan (Chippenham) (Con)
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I thank the hon. Member for East Kilbride, Strathaven and Lesmahagow (Dr Cameron) for securing this debate. It is an honour to follow the hon. Member for Bristol West (Thangam Debbonaire) in her passionate and very well-informed speech.

We all have loved ones who have been affected by cancer. I lost my maternal grandparents to breast cancer and oesophageal cancer. Many in my family have suffered from melanoma, including my mother, and one of my friends is currently battling cancer. We have all heard harrowing stories from constituents. Cancer is indiscriminate: it does not care whether you are young or old, or someone’s mother or brother. Yes, we can make dietary and lifestyle changes to try to avoid it, and be aware of the symptoms, but advances in medicine mean that we can fight it more effectively and detect it earlier to increase the odds of survival, although there are still no guarantees.

Cancer survival rates are at a record high, with about 7,000 people alive today who would have not have been had mortality rates been the same as in 2010. This is a fantastic step in the right direction, but we are not at our destination. That is the point that I want to labour. For all those who lose their mother or child or friend today and hear of this debate, I want them to know that the Government, and all MPs, do “get it”. We get that we are on the right track, but equally that there is a long way to go, because cancer is still the most dangerous serial killer that remains at large in our communities. That is why we must continue to prioritise this area.

The formation of the £1.2 billion cancer drugs fund in 2010 was a massive step forward and has helped more than 95,000 people to access the life-extending drugs that they need, as was the implementation of the independent cancer taskforce’s strategy, seeking to save a further 30,000 lives by 2020. As I said, we are on the right track. In 2010, we had some of the worst survival rates in Europe, but we are now closing that gap. Last year, there were 7 million more diagnostic tests than in 2010, and 57,000 more patients started cancer treatment.

When it comes to cancer, prevention is key. I welcome the increased investment in cancer research by the National Institute for Health Research since 2010 and the work that the Government have done with Cancer Research UK, including a jointly funded network of 18 experimental cancer medicine centres aimed at driving the development and testing of new anti-cancer treatments.

I would like to draw attention to the high uptake of the HPV vaccination among teenage girls, which can prevent around 600 cancers per year and 99% of cervical cancer cases. I have spoken before in the Chamber on Public Health England’s tobacco control plan, which aims to usher in the first smoke-free generation by 2022.

Improving diagnosis is equally essential. Public health campaigns such as “Be Clear on Cancer” are vital to raise awareness of early symptoms, especially of less common cancers. Crucially, the £200 million that has been invested to ensure that patients receive a diagnosis or the all-clear within 28 days by 2020 will make a huge difference.

That would have benefited my constituent, whose symptoms were initially dismissed as irritable bowel syndrome. She then waited a long time for testing. She is now terminally ill with bowel cancer, but inspiringly, she is trying to work hard every day to raise awareness and help others to get diagnosed quickly. Nearly everyone will survive bowel cancer if diagnosed early—in fact, nine in 10 people—yet shockingly and sadly, only 15% of people are diagnosed at that stage.

George Freeman Portrait George Freeman
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I thank my hon. Friend for giving way; she is making a powerful point. On early diagnosis, prevention and screening, the 100,000 Genomes Project that we launched here in the UK, focused on cancer and rare diseases, is seeking volunteers for genome sequencing to combine with patient data, to identify people at risk. That is a brilliant way for people to get involved, and if anyone is concerned, they should contact the NHS and enrol. We still need another 50,000 patients, and that is a marvellous way of getting access to early diagnosis. Does she agree?

Michelle Donelan Portrait Michelle Donelan
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I thank my hon. Friend for making that point. Unfortunately, time does not permit me to cover that, so I am delighted that he has.

I welcome the new bowel cancer test, the faecal immunochemical test, known as FIT, which will be rolled out in April. It is more sensitive and accurate and can detect twice as many cancers as the current test. Currently only half of those invited to take part in bowel cancer testing do, but FIT is proven scientifically to increase the number participating in the programme, especially as it is easier and more hygienic to post than the current test.

However, new awareness of symptoms, coupled with the new test and the ageing population, is leading charities within the sector to voice concerns of a looming endoscopy workforce crisis. Bowel Cancer UK and Beating Bowel Cancer question the realism of getting 400 non-medical clinical staff by 2020 to carry out the 450,000 procedures, especially as only 48 have been trained so far. I would like to hear more from the Minister in response to that, so that my constituent can be assured that others may be diagnosed earlier than she was.

A key issue when it comes to beating cancer and preventing cancer is getting screened regularly when applicable. That is especially the case with cervical cancer. The NHS cervical screening programme in England offers screening to women aged 25 to 49 every three years and women aged 50 to 64 every five years. Every year in the UK, around 3,000 women are diagnosed with cervical cancer, but research shows that the number of women using the service has dropped to a 20-year low, with more than 1.2 million not attending their screening in the last year. A recent report by Jo’s Cervical Cancer Trust showed that embarrassment is a key barrier to attendance for between a third and a half of all women, as is the desire not to miss work. There is also a severe lack of understanding about the importance of screening. Shockingly, one in three women aged between 25 and 29 miss their smear, yet cervical cancer is the most common cancer for women under 35. We must address this.

I note that Imperial College has conducted a trial to assess the effectiveness of texting non-responders to improve coverage, but I think that we should just do this—it can only help. I also welcome the fact that the Department of Health and Social Care’s behavioural insight team has undertaken a trial to investigate the use of behavioural insights to optimise the content of the invitation letter for cervical screenings.

I must admit that I was one of these women: I put off my screening for years. I left it at the bottom of my to-do list until I could fit it in around my job, and it just kept slipping year on year. I must admit, if I am honest, that I really did not realise that cervical cancer is most common in women under the age of 35. When I did have my screening, I had to go through the processes necessary after abnormal cells show up. As my results showed high-grade abnormalities, I am extremely thankful that I went when I did. I want to take this opportunity to praise the work of Jo’s Cervical Cancer Trust, which provides women with information and support, which I found extremely helpful.

We seem to be very British about cervical smear tests. We do not really like to talk much about them, and that does not promote women going for them. Yes, it is not nice—it hurts a little, it is awkward and a bit embarrassing —but it could save your life. That is the message we need to get out. We need to promote cervical screening from school age, so that women recognise all the risks and the importance of going from the age of 25.

In September and October 2017, Jo’s Cervical Cancer Trust sent freedom of information requests to all upper-tier and unitary local authorities and clinical commissioning groups in England to ask what activities they had undertaken to increase cervical screening coverage from August 2016 to August 2017, along with the outcomes of those activities. Of the 149 local authorities that responded, 32% had not undertaken any activities at all. I ask the Minister to commission a review—and to adopt a strategy to increase the falling rate of cervical screenings—looking at availability and the challenges of reaching all women and at the need for awareness of cervical cancer.

To conclude, Macmillan claims that, by 2020, 47% of people will get cancer at some point in their life, which is almost one in two. That is the scale of the problem we face. While we have come so far since 2010 in terms of diagnosis and treatment, there is still so far to go.