Medicines and Medical Devices Safety Review

Michelle Donelan Excerpts

Wednesday 21st February 2018 Commons Chamber

[Mr Hunt]

All I can say is that we completely understand those concerns and the despair that many people feel about this issue, but it is difficult to resolve it quickly when there is disagreement among the scientists. What we are trying to do today is to create a process to resolve that disagreement, and that is what I very much hope will happen.

[Michelle Donelan (Chippenham) (Con)]

I welcome the announcement of this much needed safety review. All UK citizens should be confident that the most rigorous safety standards are in place. Can my right hon. Friend confirm that the review will not have an impact on initiatives such as the accelerated access review and the cancer drug fund, which have fast-tracked access to much needed drugs and treatments?

[Mr Hunt]

I can confirm that, although it is also important to say that if we discover changes in procedures that will improve the safety of medicine use or medical device use, the people who put those new drugs on the market would want to benefit from any changes in regulatory processes, but what we would not want to do is reduce the speed.

Acute and Community Health

Michelle Donelan Excerpts

Thursday 8th February 2018 Commons Chamber

[Stephen Barclay]

My hon. Friend is right: although 37 trusts have gone into special measures, a significant number have not just moved out of special measures, but moved from “room for improvement” to “good”. That is relevant to a much wider challenge in the NHS, whether it involves procurement, workforce planning, or mentoring for junior doctors. I met the family of a junior doctor last week to discuss mentoring and support, particularly for those in their first year out of medical college. Trusts have shown leadership on a number of issues, and I think that the special measures regime has shown the scope to spread that best practice much more widely across the system.

[Michelle Donelan (Chippenham) (Con)]

I agree with the Minister that it is vital for us to expose and tackle failings in the NHS, especially when they put people at risk of harm. Does he agree with me that this case highlights the fact that money is not always the only answer? Effective leadership and responsible management are also important.

[Stephen Barclay]

My hon. Friend is right. I think that at the heart of Dr Kirkup’s findings was the conclusion that what drove these events was not money—and he made that point specifically in relation to the finance for the initial services—but the desire to seek foundation trust status, which led to a wholly unrealistic cost improvement plan and an unwillingness to address the issues that arose as a consequence.

Oral Answers to Questions

Michelle Donelan Excerpts

Tuesday 6th February 2018 Commons Chamber

[Mr Hunt]

I have a great deal of respect for the hon. Gentleman, but that is not the first time that he has presented a somewhat incomplete picture of what is actually happening. In the last five years, we have 15,700 more nurses, and the reason for those vacancies and for the pressure is that, as he knows very well, under the last Labour Government we had Mid Staffs, which was a crisis of short staffing that this Government are putting right. That is why we want to recruit those extra nurses.

[Michelle Donelan (Chippenham) (Con)]

5. What steps he is taking to improve mental health provision for children and young people.

[Edward Argar (Charnwood) (Con)]

8. What steps he is taking to improve mental health provision for children and young people.

[The Secretary of State for Health and Social Care (Mr Jeremy Hunt)]

This week is Children’s Mental Health Week, and still too many children and young people wait too long for their mental health provision in the NHS. That is why, by the end of next year, we will have invested an extra £1.4 billion, meaning that 70,000 extra children and young people are seen every year.

[Michelle Donelan]

A constituent’s 14-year-old son suffers severe obsessive compulsive disorder, resulting in self-harm. Treatment options have failed and his doctor recommends an intensive residential programme, but as Ministers are aware, places are very limited. He has been waiting seven weeks and counting, with 24-hour parental support and supervision. What more can be done to ensure that that boy and other adolescents who are in desperate need of help get that help before it is too late?

[Mr Hunt]

I thank my hon. Friend for raising that issue, and I understand that in that particular case clinicians are meeting this week to resolve those issues. She is right: we need to expand the number of beds available for children and young people. They are at a record level—1,440, and that went up by another 81 last year—but more needs to be done, which is why we published our children and young people’s mental health Green Paper.

NHS Winter Crisis

Michelle Donelan Excerpts

Monday 5th February 2018 Commons Chamber

[Stephen Barclay]

I thank the hon. Gentleman for his more mature approach, in recognising the huge amount of work performed by NHS staff. Indeed, as I pointed out, 1,200 more people a day are being treated in A&E, which reflects how much more is being done in our NHS with more resource, more money, more doctors, more nurses and more paramedics.

In terms of the specifics on money, the Government have given £1.6 billion to support performance improvements, which will be used to treat a quarter of a million more patients in 2018-19. The NHS planning guidance also shows that it expects performance to improve in the face of growing demand. That shows how more is being done, and more needs to be done.

[Michelle Donelan (Chippenham) (Con)]

All over the world, every winter sees a spike in illness and pressures on healthcare. Does the Minister agree that this Government have been proactive? In fact, for the first time ever, care home staff can receive vaccinations for free.

[Stephen Barclay]

My hon. Friend is right to highlight the importance of vaccinations. This year we have seen 1 million more vaccinations than last year, which is part of addressing the demand on A&E. The number of 111 calls dealt with by clinicians has more than doubled, which has mitigated much of the demand from the flu virus.

Tobacco Control Plan

Michelle Donelan Excerpts

Thursday 19th October 2017 Commons Chamber

[Michelle Donelan (Chippenham) (Con)]

I am delighted to have the opportunity to speak in today’s debate on the Government’s tobacco control plan, which was unveiled in July 2017 and is supported by the British Heart Foundation. It is a co-ordinated effort to bring together the NHS, the Department of Health and local government to tackle smoking.

Although smoking in the UK is declining, the problem should not be underestimated. There are still 7.3 million adult smokers in the UK, and more than 200 smoking-related deaths a day in England, which costs the NHS millions every year. I welcome the plan and the £16 billion that has been ring-fenced by the Government for local public health services until 2021.

Those who use a local stop-smoking service are four times more likely to quit. The figures are astonishing. As the daughter of a smoker of more than 20 years, I have seen at first hand the journey that needs to be replicated to achieve the goal of a “smoke-free generation”.

The success of the 2011 to 2015 tobacco control plan reduced adult smoking rates from just over 20% to just over 15%. The aim now is to reduce rates to 12% and lower by 2022. That is not only right, but essential. We must work to save the 79,000 preventable deaths in England per year and the £11 billion that smoking is costing the economy.

Smoking is not a necessity. A cigarette is not a fashion accessory; it is the way towards lung and mouth cancer, strokes and heart disease and a host of other ailments and illnesses that kill. Let me be clear: I believe in choice and individual freedom, but I also believe that the Government have a role not only to guide, but to signpost and to promote the choices that will lead to healthier lifestyles. That is why I am so proud that the Government are prioritising the issue of smoking.

Some people have said to me: “Michelle if people want to smoke, let them.” I respond by saying that we must arm those people with all the information—the warnings and the facts. We must work together to deglamorise smoking. As has been pointed out, the smoking industry also has a responsibility to play its part. We must guide people and steer them to make informed choices. We must also discourage them, otherwise we will have to pay their NHS bills—money that could be spent in other sectors of the NHS. I often ask people, “If smoking were invented today and we knew all the risks and effects, would it be so freely available and popular?” Armed with the facts, we often make different choices in life.

My mother started smoking in an era when the health consequences were not known. I saw her struggle, desperately trying to give up. My Dad describes that time as a caricature, with my mother wearing anti-smoking patches and smoking cigarettes, while chewing anti-smoking gum and seeing a hypnotist, all at the same time. She simply tried everything. All the hypnotist did was to get her on to menthol cigarettes and give her a fear of hypnotists, so that did not go quite to plan. That taught me that, to break the cycle, it needs to be killed at the root, and people need to be prevented from smoking in the first place. I must add that my Mum has now not smoked a cigarette for seven years. [Hon. Members: “Hear, hear.”] Instead, she has e-cigarettes. Although that cannot be seen as the answer, it is very much part of the solution.

As part of the tobacco control plan, I want to touch on the support provided for pregnant workers, which aims significantly to reduce the likelihood of a person smoking while having a child. Currently, more than 10% of pregnant women smoke, and the plan is to get it down to 6%. Smoking during pregnancy increases the risk of stillbirth. Babies born to mothers who smoke are more likely to be born underdeveloped and in poor health. It is important that we give those mothers all the support and information available. For example, within the plan, NHS England will work to reduce smoking in pregnancy through carbon monoxide testing at antenatal care facilities and referrals to stop smoking services through the Saving Babies’ Lives care bundle.

Support, advice and information are crucial. We must make sure that all mothers are aware of the dangers of smoking. I urge us to be bold—bold with our information and bold with our warnings.

[Alex Cunningham]

Information is key to this matter as well. ASH has told me that the Government no longer have the measure of the number of people with mental health conditions who smoke. Does the hon. Lady agree that the Government need to re-establish a national measure for smoking rates among people with mental health conditions, as that will aid planning and the provision of services?

--- Later in debate ---

[Michelle Donelan]

Indeed, we have problems among many categories in the country. By 2018, the target is to ensure that all mental health facilities are smoke free. We need to identify why people with mental health problems are turning to smoking and then target those issues.

I urge us to be bold with our information and warnings. We should not be afraid to shock in our marketing material, because we in this House have a duty to those who have yet to have a voice and the ability to choose for themselves.



As I mentioned before, perhaps the section of the plan that will prove the most successful is the backing of evidence-based research into e-cigarettes. As the right hon. Member for Rother Valley (Sir Kevin Barron) said, it is the first plan to reference e-cigarettes. In 2016, it was estimated that 2 million people had used e-cigarettes and completely stopped smoking, while a further 470,000 were using them as an aid to quit.

There has been a great deal of discussion on e-cigarettes—the pros and the cons—so what is needed now is more evidence to support them and enable their use positively. They are not risk free and they are addictive—it would be wrong not to mention that—but I agree with Public Health England, which recommends that e-cigarettes are used in areas not covered by the smoke-free legislation and that organisations do not include them in their smoking policies. It is true that we do not know the full extent of the medical effects, but we do know that, for the majority of people, they are the only way to stop smoking and they are by far a better alternative.

In addition, statistics show that people rarely start on e-cigarettes. They use them as a way of breaking their cigarette addictions. It is important to remember that, to tackle smoking effectively, we need a prevention strategy as well as a strategy to help people quit smoking. Dr Andy McEwen, executive director of the National Centre for Smoking Cessation and Training, stated that switching from tobacco to e-cigarettes substantially reduces the major health risk. I urge the Minister to push the case for a review by the National Institute for Health and Care Excellence, which currently is at odds with Public Health England on this topic.

As I said, we have seen many worried headlines about e-cigarettes, particularly for young people. However, the latest and largest study, based on five separate surveys, gathered data from 2015 to 2017 and was from a collaboration including experts from Public Health England. It showed that a tenth to a fifth of 11 to 16-year-olds had tried an e-cigarette. However, only 3% or fewer used them regularly, and they were already smoking tobacco-based products. Among young people who have never smoked, the use of e-cigarettes was completely negligible, despite the media headlines. It is also important to remember that they are restricted in terms of the minimum age sale and the tight restriction on marketing. Let us be clear: the best thing that a smoker can do is to quit smoking. However, the evidence is increasingly clear that e-cigarettes are significantly less harmful to health than smoking tobacco.

Another area that I want to mention is inequality in smoking. By 2022, the Government expect to reduce the inequality gap in smoking prevalence between those in lower paid or manual occupations and those in higher paid or professional occupations. For example, the plan includes promoting links to “stop smoking” services across health and care systems in the UK. However, it is important that we look at the causes, not just the symptoms, when we examine why those in lower economic circumstances smoke more, and why they struggle more to quit. That is why support to councils is so vital, so that they can identify local trends and solutions. I would be interested to hear more about the Government’s plans to invest in research into the causes. We do need to pay more attention to the challenges that are faced by the disadvantaged and those from lower socio-economic groups.

As someone who believes in low tax in general, it would be remiss of me not to point out that on this subject I passionately argue that we should maintain a high duty rate for tobacco products. It is a disincentive for people to start smoking, especially the young, and I urge the Government to go further in the upcoming Budget. Of course, enforcement is nothing without encouragement to give up. So, to conclude, I echo the sentiments that tackling smoking requires a plan—a plan that seeks to prevent smoking, but also assists those who currently want to give up smoking. This plan does that. Treating smoking-related illnesses is estimated to cost the NHS £2.5 billion a year, while the wider cost to society is a staggering £12.7 billion. But the real cost is the human lives—those that are cut short, and the families that suffer: families in Wiltshire, in my constituency, and up and down the country. I am delighted that in Wiltshire there are now 25% fewer hospital deaths from smoking-related illnesses, but that is still too many, and that is why creating a smoke-free generation is essential.

Baby Loss Awareness Week

Michelle Donelan Excerpts

Tuesday 10th October 2017 Commons Chamber

[Michelle Donelan (Chippenham) (Con)]

I feel extremely humbled to be able to speak in the debate. Let me start by paying tribute to my hon. Friends the Members for Colchester (Will Quince), for Eddisbury (Antoinette Sandbach) and for Banbury (Victoria Prentis), as well as all members of the all-party group. They have shone a much-needed light on the issue of baby loss, its effect on parents, and the need for action. They have not only pushed for change, but helped to achieve it. On behalf of everyone who has ever suffered, I take this opportunity to say thank you.

We must also pay tribute to the medical professionals who work day in, day out to prevent baby loss and deal with it, and to organisations such as the Royal College of Obstetricians and Gynaecologists, as well as charities such as Sands. They play an important role in developing programmes and reviewing the care provided for expectant and bereaved parents.

Baby loss is not a regional or even a national problem, but an international one. It affects people in all our constituencies, and hurts and devastates families in Wiltshire and throughout the country. It has touched my own family. My grandma experienced the loss of her first-born in 1948 when the child was breached. Tragically, the ambulance reached her too late. The months after that were probably the hardest that she experienced in her life, and I heard about them when I was growing up. Like other women in the same situation, she struggled with the ordeal of having carried the baby and prepared for its birth, only to lose that child as soon as it arrived. Devastated and receiving no help, my grandmother suffered a period of depression.

That is the story of the strongest, most no-nonsense woman I have ever met in my life. She was a woman full of grit and strength, yet she had no help in her time of need, and even the strongest among us do need help. My grandma is long passed and now in heaven, but I think that she would want me to share her story, and to ask the question: why, after so many, many years, are the rates of baby loss still so high? The most recent review of stillbirths and neonatal deaths in the UK reports that of 782,720 births in 2015, 3,032 were stillbirths and 1,360 were neonatal deaths. Yes, there has been a reduction since 2013, but the number remains higher than those in comparable European countries.

I am proud that the Government have taken action to address maternity care and set an ambitious target, which I think is bold and moral, to halve stillbirth rates by 2030. Now we must all work together to ensure that we meet that target by keeping the subject on the agenda. I hope that debates such as today’s will help to serve that purpose so that 69 years from now, when another MP is standing here, they are not saying the same thing.

I think that my grandmother would also ask why, 69 years on, we have failed to improve our bereavement care to a satisfactory and appropriate level. Bereavement care, as has been pointed out, is the focus of this year’s Baby Loss Awareness Week. Bereavement care is vital, both for psychological and emotional support, and for advice and signposting. Since 2010 we have invested £35 million in the NHS to improve birthing environments, including better bereavement rooms in 40 hospitals. We need that for every hospital and facility. The current guidelines vary far too much between setting and service. In addition, most of the frameworks are guidelines, and they are not mandatory, or indeed monitored, in all areas. That is why the Government’s work to create a national bereavement care pathway is so important. That will reduce the variation in the quality of bereavement care provided by the NHS so that residents in Wiltshire get the same care as those in, say, London or Manchester. That is essential.

One can only imagine how harrowing and devastating the loss of a baby must be. I think that the courage that Members have displayed by sharing their experiences in this House is remarkable. Bereavement care must be of a high quality, consistent, individualised and available across the UK. It is time that we achieved that so that, as I have said already, we do not look back in 69 years’ time and again ask why we are not doing more for those in need.

It is estimated that today about 15 babies in the UK will die before, during or shortly after birth. Today let us not only remember those who have suffered and the babies they have lost, but pledge to work together, across parties, to support the Government’s work and ensure that nobody faces a postcode lottery when it comes to baby loss. We need to determine what should be the level of bereavement support and ensure that it is consistent across the country so that parents receive what they deserve if they tragically lose a child.

Oral Answers to Questions

Michelle Donelan Excerpts

Tuesday 7th February 2017 Commons Chamber

[Mr Speaker]

Time is against us, but I would like to make a little further progress with Back Benchers’ questions. I call Michelle Donelan.

[Michelle Donelan (Chippenham) (Con)]

12. What steps his Department is taking to increase routes into nursing.

[The Minister of State, Department of Health (Mr Philip Dunne)]

Developing a variety of routes into nursing is a priority to widen participation and reflect the local populations served by nurses. That is why we have developed a new nursing associate role and nursing degree apprenticeships, which are opening up routes into the registered nursing profession for thousands of people from all backgrounds and allowing employers to grow their own workforce locally.

[Michelle Donelan]

Are there any plans to roll out the associate role to include Wiltshire, and to enable the new nursing degree apprenticeship schemes to be offered in larger further education colleges so that counties like Wiltshire that have no university can still make that provision?

[Mr Dunne]

We have announced the first 1,000 nursing associates. In fact, the first cohort commenced at the beginning of this month. I visited, in Queen’s hospital, Romford, the first very enthusiastic group of nursing associates. We have announced a second wave of 2,000 associate roles. I regret to say that Wiltshire does not have any of those at the moment, but that will not stop it bidding for them in future. I will look at my hon. Friend’s point about further education colleges.

Oral Answers to Questions

Michelle Donelan Excerpts

Tuesday 11th October 2016 Commons Chamber

[David Mowat]

First, may I welcome the hon. Lady to her post and wish her luck in the new job? There has been an increase in delayed discharges in England over the past year. Only a part of that increase is due to difficulties in the integration between social care and the NHS—a large part of it comes from within the NHS itself—but it is not uniform across local authorities. Indeed, many local authorities are improving in this regard. What is very clear is that those making the most progress the most quickly are those that have gone furthest in integrating social care and healthcare.

[Michelle Donelan (Chippenham) (Con)]

6. What the timetable is for the review of the diagnosis, treatment and transmission of Lyme disease announced on 10 May 2016.

[The Parliamentary Under-Secretary of State for Health (David Mowat)]

The Department of Health has commissioned three separate reviews on the diagnosis, treatment and transmission of Lyme disease. The work will be carried out by the epicentre of University College and be clinically driven and evidence-based, and it will be published in late 2017.

[Michelle Donelan]

Although I am delighted that the Government are looking into this serious and important disease, as the reviews progress thousands of people contract Lyme disease each year, particularly in areas such as Wiltshire, and they can receive inadequate treatment, so will the Minister look into speeding up these reviews?

[David Mowat]

It is fair challenge that this work is high priority, and we need to go as fast as possible, but we are working with research teams. The work will be trial-based and needs to be as definitive as possible. In the meantime, early diagnosis is the key way to make progress. Public Health England continues to work with GPs and the public on it.

Carers

Michelle Donelan Excerpts

Thursday 9th June 2016 Commons Chamber

[Mims Davies]

I thank the hon. Gentleman for that point. I absolutely agree. Pointing out that there are difficulties at home can be a frightening experience, and young carers may wonder what it will mean for them. It may feel better to say nothing, but that is a frightening place in which to be.

Young carers often miss school days. When they become young adults, they are more likely to drop out of college or be unable to head to university. That is not good enough after all they have put into their families and given the impact on their lives. They need support when helping their loved ones. They display real human decency at such a young age and suffer as a result. We should be nurturing, supporting and applauding our young carers.

The vast majority of carers are of working age. Many of them want to work, and 3 million people juggle full or part-time work with their caring duties. At the House of Commons carers event this week, I spoke to carers who are juggling their desire to do it all and who are not dropping the ball even though their health is often suffering. They are sometimes aware that they are able to care for their loved ones only for a limited time: they need to stay in the workplace for financial reasons. It is often not a choice; it is forced.

It is bad for companies if they lose our carers because the carers feel they have no choice but to walk out the door, which is what I did. If I was not in this place, I would now be without any caring responsibilities—apart from the two small children who do not seem to have been adopted yet, so I have to remember to look after them! I would be looking for a job and would have been out of the workplace for some time.

[Michelle Donelan (Chippenham) (Con)]

I commend my hon. Friend for securing this debate today. Does she agree that carers contribute a great wealth of experience and other skill sets to employers that non-carers perhaps cannot?

[Mims Davies]

Absolutely. Carers have a can-do attitude that they bring to the workplace. If I was rewriting my CV, I would hope to put that on there.

It is bad for carers to fall out of the workplace. When asked about their experiences, the results were astonishing. Over a third of carers felt that their employer simply did not understand their caring role, and a third said that their employer did not have policies in place to support them. Flexible working is a key support mechanism to help carers to do their valuable work. Some progress has been made in supporting flexible or agile working. A limited right to request flexible working was introduced in 2002, and I am pleased that the Children and Families Act 2014 extended that to all employees after 26 weeks. However, given the pressures that carers face, that is not long term enough. The Government need to look to do more. The new legal right also paves the way for a possible culture shift in flexible working, and I want employers to take up the mantle.

It is deeply worrying that there seems to be a strong gender bias, with caring falling mainly on women in their 40s, 50s and 60s. Let us make it acceptable for all to take the time to care. One in four women aged 50 to 64 has caring responsibilities for older or disabled loved ones compared with one in six men, but I have met men in my constituency who have given up their jobs to care. I would like to see that as a real possibility. If someone wants to be there and can be there, it does not matter who they are.

This debate is an excellent opportunity to pay tribute here in the House to the crucial work of carers. Some 20% of carers currently receive no support with their caring work, because they simply have not put their head above the parapet. They do not realise that they are carers, and I know how that feels. Half of carers expect their quality of life to get worse in the next year, which people made clear at the carers event in the House earlier this week. People are concerned that they are not looking after themselves and simply do not know how to facilitate that. The national carers strategy is currently being written, and I am delighted that the Minister has written to me as part of the process and that I am involved. He is allowing time to focus on the matter to ensure that we get it right. I hope that the debate will give hon. Members the chance to set out clearly to the Government and to the country that we are not doing enough for our carers and that they are struggling.

--- Later in debate ---

[Michelle Donelan (Chippenham) (Con)]

Many people think of carers as a small but dedicated group, yet as we have heard today, as many as three in five people will be carers at some point in their life. There are an estimated 50,000 carers in Wiltshire alone—roughly 10% of our county’s population—and 3,000 of those are under the age of 24. Mr Deputy Speaker, you or I could be a carer one day, but chances are that we would not realise our role. We would just think that we were caring for our loved ones. Some 70% of carers in Wiltshire continue to remain hidden, and it is believed that many of those people do not understand or recognise their caring status.

That is why this week and this debate are so important, and I applaud my hon. Friend the Member for Eastleigh (Mims Davies) for securing the debate. I also thank the Backbench Business Committee for granting it. We need to work together to raise the profile of these silent heroes, these astonishing individuals who give and give, time and again. Carers enable hundreds of my constituents to continue to live in their own home. Let us face it: without carers, our NHS would not cope, our care homes would be flooded, and the independence of thousands would be compromised. The care provided, unpaid, by the nation’s carers is worth an estimated £119 billion a year, but their role in our community and economy is invaluable.

I was delighted that the Government made an additional £400 million available to the NHS between 2011 and 2015 to provide carers with the breaks that they need from their caring responsibilities, and that we are developing a new national carers strategy to look at what more can be done for existing and future carers. That highlights an understanding and, importantly, appreciation of the role. Fundamentally, it shows the importance of caring for carers.

The charity sector plays a crucial role in enabling carers. An excellent example is the Independent Living Centre in Semington in my constituency, a charity that offers first-class impartial advice, and solutions for easier living. A support network is equally essential for carers. It can be an isolating role, and one about which non-carers often know little and have little understanding. In a study of more than 6,000 carers, half had let a health problem go untreated, or seen their mental health get worse, as a direct result of the time and effort that they had put into caring for their loved ones.

Fun4All is an impressive local charity in Chippenham. One of its aims is to improve the health and wellbeing of carers by providing social events and breaks, and crucially, it forges a network between carers. I attended one of its fish-and-chip lunches with entertainment, and I can assure the House that it is certainly fun for all.

Also based in my constituency is Carer Support Wiltshire, with whom I have volunteered. I saw at first hand its extremely high level of work and dedication, and its enormous impact on the lives of so many local people. Its role as a charity locally cannot be overstated. It helps carers to access support, services, education and training, as well as breaks from their caring role. This Sunday, it is organising an awareness and fundraising event called “Walk a mile in my shoes” in Chippenham. Last year it proved very successful. I look forward to participating once again, and wish it success.

A key hurdle for carers, as we have heard, is juggling their caring role with employment. Last year we made a massive leap forward when we extended to carers the right to request flexible working arrangements to help them balance work and care; but many problems remain, and it is still a huge challenge to balance the two. It is often about having the ability to cope, but also a level of understanding from the employer.

Carer Support Wiltshire has devised a scheme intended to raise awareness and understanding among employers. It has a strategic arm dedicated to that. I have worked with it on this, and although the strategy is in its early stages, it is a blueprint that could be replicated throughout the country. Employers need to understand the benefits that carers offer and not see them only as a strain on their business. It is important to stress that the issue of supporting carers needs to be targeted nationally and locally, and within the voluntary sector.

Nationally, the Care Act 2014 gave carers fundamental legal rights, and I hope that the national strategy will directly challenge the problems that carers face. Specifically, I hope that we will look at supporting more training opportunities locally to ensure that those in a caring capacity always have the confidence, abilities and skills to perform their role.

Wiltshire Council is finalising its local strategy on carers, which will bring many organisations together to support carers. A variety of services are already in action in my constituency, such as complementary therapies, outings, trips, counselling, befriending services, talk and support services, carers’ cafés—the list is endless, but still much more work is needed.

Fundamentally, there is a complete and utter lack of understanding of the role of carers and the support available. I have seen that time and again in my constituency surgeries. Very many constituents have come to me, complaining that they are struggling, stressed, worried. They do not know what benefits they are entitled to. If I had £1 for every time someone has come to me who is entitled to the carer’s allowance but does not realise it, I would have sent out a lot more leaflets by now. We need to address this head-on. We need to go even further, and I am confident that the national strategy will encompass strenuous efforts to address the awareness and entitlement issues.

Many of the constituents who come to me are pensioners, and they do not realise that if their state pension falls below the amount of the carer’s allowance, they are in effect entitled to a top-up. Alternatively, if they are not in that bracket, they have what is defined as an “underlying entitlement to carer’s allowance”, which means that when they are means-tested, that is reviewed. I mention these entitlements today because I am convinced that it is important to stress them, and to get the message out to any elderly carers who are watching.

[Mims Davies]

My hon. Friend hit the nail on the head when she talked about the importance of better communication—of communicating to carers who feel isolated and vulnerable about the support that is available and the opportunities to make things better. As a result of today’s debate and through the Minister, we could look at communicating better with that group of people.

[Michelle Donelan]

I thank my hon. Friend. I could not agree more with her comments today. Another thing that concerns me deeply is that it is very easy to stereotype a carer, yet the reality is very different from the stereotype. The 2011 census identified 166,363 young carers under the age of 18 caring for a family member or friend; more than 110,073 were under 16. The real figure, allowing for hidden carers, is very much greater. Yes, the Children and Families Act 2014 extended the right to an assessment of support needs to all young carers under the age of 18; and since 2010 the Government have created specific training guides for teachers and teaching staff, to enable them to identify and support young carers.

However, there is still a big problem, which we need to face up to. Around one in 20 young carers regularly miss school because of their caring role. Young carers often get lower grades; a recent survey showed their most common grade at GCSE to be D. Young carers are twice as likely as their peers not to be in education, employment or training. They are therefore more entitled than other groups to the support that we can offer. That is why it would be completely wrong for me not to stress that I completely and utterly support the campaign to allow the pupil premium to show its understanding of the stresses, strains and pressures on young people who are carers. Does not a young carer, like any other young person, deserve the best shot at life, the best chances, the best opportunities? It is extremely hard to be a carer at any age. Imagine combining that with struggling to cope with schoolwork, GCSEs or A-levels, while growing up. Imagine the impact of that—the emotional pressure it would create. In this country we have a pupil premium, which is designed to develop a level playing field. Surely it is time that young carers were allowed on the pitch too.

National Carers Week is all about highlighting the silent heroes, of all ages, in our community, whose dedicated love keeps people safe, secure and often living in their own home. Without them, the economy and the community that we all love in our constituencies would collapse. Today, I hope that we help raise awareness and understanding, show our support, and highlight the different ways that we can improve and develop our national strategy.

I would like to finish by thanking each and every carer in my constituency and in the country for all their hard work.

Secondary Breast Cancer

Michelle Donelan Excerpts

Wednesday 21st October 2015 Westminster Hall

[Michelle Donelan (Chippenham) (Con)]

I pay tribute to the Members who have made contributions so far on this important subject, which affects residents in all of our constituencies. Cancer is, as we all know, a harrowing illness for those who suffer from it and for their families and friends. Three million people will be living with cancer in the United Kingdom by the end of the Parliament.

Two of my close friends who helped me get into this place have fallen victim to cancer since the election. For their sake and that of the 550 people in Wiltshire under the age of 75 who die of cancer every year, cancer must remain at the top of the agenda. There must be a long-term strategy for combating this dreadful illness.

Cancer touches everyone’s lives at some point. Most people with cancer want to ensure that they have the best information as fast as possible. Many go trawling through the internet, looking at not just drugs, but other treatments that could help such as diet, exercise and complementary therapies.

Today’s cancer patients know that there are things they can do to improve their chance of survival. They want to increase their knowledge so that they can make personal, well informed decisions and create personal treatment packages around their doctors’ treatments.

No two patients wish for identical forms of care, which is why it is important that the Government have taken steps on personal support. There are now clinician nurse specialists for those with secondary breast cancer, which is a good step in the right direction.

As the Minister will know, Macmillan Cancer Support is calling on the Government to fund an independent review of choices for end-of-life care. I encourage them to look closely at what Macmillan has to say. I know that Ministers are committed to improving the detection and treatment of breast cancer, in particular to avoid the risk of secondary breast cancer developing. I am encouraged that breast cancer survival rates have increased, but there is a lot more to be done.

The only way I can foresee that we can combat secondary breast cancer is by focusing on reducing primary cancer. Survival time post-diagnosis depends on several factors, including the stages of diagnosis, the overall health of the patient and the quality of care they receive.

I have been concerned for a long time that one group of people is often overlooked: the older generation. Cancer is not part of old age, although it is seen by many to be. We need to consider how we reach our elderly through information and support, to give them the confidence to seek medical treatment. Too often, pensioners such as my grandmother are too afraid to go to the doctor because they fear they will end up going into hospital and never coming back, so they leave it until it is simply too late. It does not have to be that way.

One solution to combat that is providing more services at a community level, so that the fear of going to hospital is reduced. I am pleased to say that that has already been piloted in Wiltshire for chemotherapy services with the help of Hope for Tomorrow, a charity that provides mobile chemotherapy units and for which I am a regular fundraiser. That is just one example of how we can go much further in the field.

There is work to be done to reduce the health inequality shown by higher rates of mortality in deprived areas. Assessing risky lifestyle behaviours such as smoking and poor diets, combined with active screening and symptom awareness programmes, is vital.

Last weekend, a close family friend of mine lost their battle and died of secondary breast cancer. I learned from first-hand experience that the most important thing we need to do is improve care across the entire cancer journey. We need to start looking at it as a journey and to ensure that a personalised and individual programme is developed, with the family playing a part. It is of the utmost importance that secondary breast cancer patients have access to appropriate services or are referred to specialist palliative care, which can provide more effective pain relief in the management of illnesses, if they so wish.

The cost of cancer will undoubtedly continue to rise during this Parliament. That is why I return to the need for a clear long-term strategy to address this problem. That includes investing in reducing the impact of primary cancers to save money and to save lives in the long run, as well as personal cancer care plans for those living with cancer.

In conclusion, I hope we will do even more to support those living with cancer because this disease touches so many of our lives and affects so many people. I hope the Minister will look closely at Macmillan’s proposals to fund an independent review of end-of-life care choices.