NHS 10-Year Plan

Philippa Whitford Excerpts

Tuesday 19th February 2019 Commons Chamber

[Dr Philippa Whitford (Central Ayrshire) (SNP)]

I welcome the principle of the long-term plan, as it certainly makes things easier for those who are running the health service, particularly after over eight years of real-terms cuts over the term of the last three Governments. It is trumpeted that there will be £20 billion extra by 2023-24, but that is still quite some time away, and on an annual basis that is 3.4% uplift. That is better than the real-terms cuts but less than what the NHS got in every year from its inception to 2010—and actually less than the 3.6% promised by the Prime Minister last August. It shows little recognition of growing demand and it should be considered per capita. In Scotland, we spend £163 per head more on health than is allocated in England. It is unfair to have just an overall figure and not recognise the growing demand on those services. It again focuses all the money on NHS England, basically to make it sound good, with cuts for public health and insufficient funding for training and for capital projects, and again insufficient funding for social care.

Social care will get a 2.9% increase, but it is estimated that the pressures are growing, at nearly 4%, and it cannot meet unmet need. Age UK estimates that 1.2 million people across the UK are not getting the care they need. In England, although need has almost doubled since 2010, the number of local authority-funded patients is down by over a quarter.

In Scotland, we have allocated £113 more per head for elderly care, which allows us to provide free personal care and keep people in their own homes for as long as possible. If they can stay in their own homes, rather than in hospitals or even in care homes, that is more cost-effective. We are still waiting for the Green Paper on adult social care—I seem to have been hearing about it almost since I was first elected.

The Secretary of State talks about the prevention agenda, and how prevention is better than cure, but public health funding will be cut by £200 million, and that comes on top of the £500 million cut it has already faced since 2014-15. The hon. Member for Central Suffolk and North Ipswich (Dr Poulter) mentioned alcohol and addiction services, and we have heard about cuts to sexual health services. The long-term plan talks about reducing the burden of cancer, but it makes no mention of cuts to smoking cessation services, or of an obesity strategy that does something to stop junk food being advertised to children on television before 9 pm.

The Secretary of State has mentioned the “making every contact count” approach, which has been in place for most of my career. When I am dealing with a breast cancer patient, I always get them to promise me that they will come back, once we have got through the stress of their treatment, and that they and their partner will commit to giving up smoking, but I cannot deliver their smoking cessation; I still need a service that I can refer them to, such as Fresh Air-shire, where they will get support to achieve it.

As has been mentioned, the biggest challenge of all is workforce. It runs right through the long-term plan, which will not be deliverable unless the workforce challenge is dealt with. NHS England faces 100,000 vacancies, including 41,000 nursing vacancies, yet Health Education England is not facing an uplift in its funding and has previously faced a real-terms cut. The Minister talked about the move to community nursing, but there is a 50% cut in district nurses, and in 2021 none will graduate because the course is being lengthened. That will not support moving services into the community.

The nurse vacancy rate is 11.6% in England, which is more than twice the rate in Scotland. Indeed, Scotland has already reached what is supposedly the target for NHS England by 2028. In fact, the Royal College of Nursing estimates that in the next 10 years vacancies will grow to 48,000. That creates more stress on staff, encourages more people to leave, reduces quality of care and increases waiting times.

It is absolutely critical to tackle that, but what do we have? We have the removal of the nursing bursary and the introduction of tuition fees. We did not do that in Scotland, which is why we have a 14% increase in the number of students starting degree courses. In England the number is actually down by 4%. The Minister might well respond by talking about apprenticeships, but only 300 of those were taken up in 2017-18, instead of the thousands that were trailed, so they will not replace the drop of 900 in degree students. That means the Government are simply not producing enough nurses ever to fill the 41,000 vacancy rate. With a 90% drop in those coming from the EU, that will only get worse.

The Secretary of State loves to talk about digital. I have to say that I think he has a bit of an obsession with replacing GPs with apps. As a surgeon, I cannot promise that rubbing a mobile phone over the belly will diagnose appendicitis, so good luck with the app. But there are parts of the NHS where digital could really help. In Scotland, we have a system called PACS—the picture archiving and communications system—which allows radiologists elsewhere in the country to look at images. We have electronic prescribing, which saves time and effort as well as being a safety action, because we cannot prescribe a drug that the patient is allergic to, and it will pick up interactions. Electronic records make cancer pathways easier.

The Government’s response is integration and I have supported that on many occasions in the Chamber. However, it is important how it is done. The NHS in England has gone round and the round the loop of reorganisation. It is critical that those integrated care systems have a statutory body at the top and that section 75 of the Health and Social Care Act 2012 is repealed to stop forcing the outsourcing of contracts. Tariffs also need to be tackled. Tariffs reward hospitals for admitting, when it is important that people are treated in the community.

We will make a difference only when the Government take a “health in all policies” approach. Poverty is the biggest driver of ill health, so stopping the welfare cuts would be a good start.

Oral Answers to Questions

Philippa Whitford Excerpts

Tuesday 19th February 2019 Commons Chamber

[Matt Hancock]

I have already given the assurance that if everybody does what they need to do, I am confident that supplies will be unhindered. In the case of insulin, the stockpiles are already double what we requested. However, on the point about the deal, the hon. Gentleman has a really important point about ruling out no deal being the best thing for people’s supply of medicines. He knows as well as I do that if we want to rule out no deal, we need to vote for a deal, so he and everybody in this House should vote for the deal.

[Dr Philippa Whitford (Central Ayrshire) (SNP)]

The serious shortage protocol statutory instrument would allow pharmacists to dispense alternative drugs when there is short supply, but, crucially, without consulting a GP. The problem is that they cannot access patients’ records and might dispense a drug that has previously caused serious side effects. Is the Secretary of State really expecting such extensive shortages that phoning a GP will be impractical?

[Matt Hancock]

This change is to respond to the shortages that happen from time to time regularly in the NHS. Given that the supply of 12,300 drugs is typical across the NHS, there are always some logistical challenges. This protocol is to try to ensure that we can respond to those challenges as well as possible. Pharmacists are highly trained in what they do and perfectly able to carry this out as proposed.

[Dr Whitford]

The problem is that the key issue is not consulting the GP. The medical legal responsibility for any problems normally lies with the prescriber, yet the General Medical Council was not even consulted on this SI. Does the Secretary of State really think that such a significant change should be pushed through with a negative resolution and no scrutiny and debate?

[Matt Hancock]

Well, it is getting scrutiny and debate now. The change that is being proposed is about making sure we can get people the drugs they need. Of course the responsibility is on the pharmacist to ensure that it is the appropriate drug and, if necessary, that the GP is involved. However, it is absolutely right that we make changes to ensure that we have an unhindered supply of medicines whenever there are shortages—whether that is to do with Brexit or not.

World Cancer Day

Philippa Whitford Excerpts

Wednesday 30th January 2019 Westminster Hall

[John Lamont]

The hon. Gentleman makes an excellent point, and raises a very good example. My brother’s father-in-law sadly died a couple of weeks ago. His treatment was provided by Leeds hospital, so I know the tremendous amount of resource and expertise they have in that particular hospital.

For breast cancer in Scotland, the mortality rate was 53 per 100,000 women in 1992. That has fallen to 32 per 100,000, despite the incidence of breast cancer increasing. In short, we are much better than we used to be at both identifying and treating cancer. That is because the UK has taken the steps that World Cancer Day promotes—in particular, tackling tobacco use and obesity levels and rolling out national cancer strategies.

Big issues clearly remain; pretty much all the cancer charities I have spoken to ahead of today’s debate agree with that. We need to get better at early diagnosis, because we know how much of a difference it can make. For example, if bowel cancer is diagnosed early, nine in 10 people will survive, but with a late diagnosis, the survival rate is only one in 10.

[Dr Philippa Whitford (Central Ayrshire) (SNP)]

Does the hon. Gentleman agree that research shows that the awareness around breast cancer means that women come forward quickly, but with bowel cancer people do not? Research done in the west of Scotland showed that the biggest delay was in going to the GP. We need to get people to talk about it, be open about it and go and get help.

[John Lamont]

I could not agree more. There is an awareness issue. Often, when people develop some symptoms that they are unsure of, they are nervous about going to the doctor. People need to be encouraged to step forward and go to their GP, to ensure that if there is an opportunity to get an early diagnosis, that is achieved, because the results are clearly much more positive if that is the case.

That is why we have early diagnosis targets across the UK, and why it is so serious that in Scotland, more than 20% of patients are waiting for longer than the six-week standard for diagnostic tests. Too many people are waiting too long for treatment. NHS boards north of the border are meant to take no more than two months to start treatment, but that target is being missed for every type of cancer. In some health boards, one in five patients did not meet that target. I am sure we have all received emails from patients who are faced with an agonising wait for treatment, knowing that they have cancer. While the missed targets are by no means unique to Scotland, I hope that we can all come together here—Scottish National party colleagues included—to call on the Scottish Government to make clear that that needs to get better.

I should also be interested to hear the Minister’s views on whether any consideration has been given to reviewing treatment target times with a view to introducing faster treatment targets for certain types of cancer. It strikes me as odd that across the UK our targets are the same for all cancers, regardless of type.

One significant reason for the time taken to diagnose and treat is problems to do with workforce. Demand for tests is only going to increase, due to a growing and ageing population, but we already do not have enough staff in a range of areas.

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[John Lamont]

I am grateful to the hon. Lady for sharing her experience. This all needs to be looked at. As I said, DLA and PIP should at the very least be backdated to the date of diagnosis. Additional support, particularly for parents like those in my constituency who have to travel such long distances to access treatment, should be factored into the calculation of how much they might be entitled to. We need to ensure that the system at least recognises those extra financial pressures.

[Dr Whitford]

I utterly agree with the hon. Member for High Peak (Ruth George) on financial support. Macmillan Cancer Support estimates that having cancer costs £570 a month, which is very difficult for some families. Will the hon. Gentleman suggest to the Minister that removing the expensive parking charges at hospitals in England would make a little difference? At the moment, a parent being stuck in hospital for eight hours and then paying through the nose for parking adds insult to injury.

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[Bill Grant (Ayr, Carrick and Cumnock) (Con)]

It is a pleasure to serve under your chairmanship, Sir Christopher. I thank my hon. Friend the Member for Berwickshire, Roxburgh and Selkirk (John Lamont) for securing this important debate.

It is staggering that about 4,600 women and more than 20 men in Scotland are diagnosed with breast cancer each year. Sadly, few people, particularly males, realise that men can also be affected. My researcher was diagnosed with breast cancer nearly 16 years ago and remains eternally grateful for the care and support she received from the national health service. Her paternal grandmother and great-aunt were of a different, less fortunate generation and lost their lives to breast cancer shortly after diagnosis, although a delay in seeking assistance was undoubtedly a factor in their demise.

Regrettably, previous generations were often reticent to seek assistance, perhaps due to a lack of knowledge or embarrassment. Encouraging openness and interaction, as World Cancer Day does, and media campaigns from the national health service and various cancer charities are vital if we are to empower people through education and advocacy, including peer support, to improve their quality of life and life expectancy following a cancer diagnosis.

[Dr Whitford]

I welcome the mention of embarrassment. Does the hon. Gentleman not think that we have a particular job to do with men to get beyond the embarrassment of talking about bowels, bowel motions and other bodily functions? If people cannot talk about it with their families, they will struggle to talk about it with a GP.

[Bill Grant]

I totally agree; I am of the embarrassed generation. It is challenging for males—I concede that it is men in particular—to go to the general practitioner, but we need to educate them about making that first contact and being conscious of the risk. It is particularly my generation; the generation following are a bit less self-conscious and more eager to go to the GP, where they will find that help.

As a member of the Select Committee on Science and Technology, I have become acutely aware of the importance and benefits of research. In 2014, the city of Glasgow, not far from my constituency, hosted the European breast cancer conference. Such conferences bring together experts in their respective fields to share knowledge and experience for the benefit of patients and to consider preventive measures for the future, such as developments in immunotherapy that harness the body’s immune system to target cancer cells. As I understand it, such developments may be able to complement, if not replace, radiotherapy and chemotherapy, the side effects of which many breast cancer patients find more challenging than the cancer itself.

Treatment has very much improved, recognising the importance of body image in an era when the media often seek to portray the perfect person. The charity Breast Cancer Care stages regular fashion shows in which those who take to the catwalk have themselves been cancer patients. The male and female models, resplendent in their latest outfits, send a very clear message that they have beaten or are robustly fighting cancer.

Tamoxifen, a common medication for breast cancer treatment, is now just one of a range of drugs available to patients. It was heartening to learn of the Scottish Medicines Consortium’s decision to approve the life-extending drug Perjeta for routine use in treating secondary breast cancer on Scotland’s national health service. Compared with existing treatments, the drug apparently has the potential to offer valuable time to those with incurable HER2-positive secondary breast cancer.

Nowadays, cancer is treated by multi-disciplinary teams that include GPs, surgeons, oncologists, radiographers, radiologists and clinical nurse specialists. It is crucial that we have appropriate succession planning so that we can replace those vital experts as they reach retirement age or change career for whatever reason. It is quite concerning that 20% of breast radiologists in Scotland are predicted to retire before 2025, according to the charity Breast Cancer Now. We need to get the wheels in motion to replace those very important individuals.

Cancer is a challenge to our society. It changes people’s lives in different ways, and sadly some go on to develop lymphoedema. However, collectively we can meet that challenge. Some countries have a lesser incidence, so it may be prudent, as an aspect of self-help, to reflect on diet and lifestyle choices in the UK that may have a bearing on development or outcomes. The potential effects of obesity, cigarettes and alcohol need to be seriously addressed. That apart, we need to focus on the future needs of the researchers and medical professionals to protect the population who are at risk of cancer.

Finally, my constituents and I thank the national health service professionals, the volunteer drivers, the penguins of Dundee, the marathon runners from the borders and the charities. They all make the challenge of living and dealing with cancer that wee bit easier.

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[Dr Philippa Whitford (Central Ayrshire) (SNP)]

It is great to have this debate on the 20th World Cancer Day and I, too, congratulate the hon. Member for Berwickshire, Roxburgh and Selkirk (John Lamont)—we need shorter constituency names—on securing it.

Obviously, it is very clear in my record and from my previous speeches that I have been a breast cancer surgeon for over 30 years. When I graduated in the 1980s, the survival rate from breast cancer at five years was approximately 53%; we are now in the high 80s and approaching 90%. However, breast cancer is not just about survival. In those days, treatment was incredibly destructive. Women lost their breasts through mastectomy and had very harsh radiotherapy, the side effects of which were awful, and there was very little in the way of other forms of treatment.

Now, we practice much less destructive surgery; we have computed tomography-planned radiotherapy; and our drugs are designed and developed, such as the immunotherapy that the hon. Member for Coatbridge, Chryston and Bellshill (Hugh Gaffney) mentioned. So the treatment has moved on, the survival rate has moved on and the impact on patients has moved on.

Critical to that movement, as is said over and over, is early diagnosis; that is the importance of screening. However, what we are seeing in many screening programmes, particularly in breast cancer screening programmes, is a gradual fall-off. So it is important that we encourage people to attend the screening that they are suitable for, whether that is cervical screening or breast cancer screening, or—as I say—people putting poo in the post once they reach that age, examining themselves, and not being embarrassed to go and see a doctor.

We have raised this issue in previous discussions, but we are lucky enough in Scotland that bowel screening—the poo in the post programme—starts at 50, and because the endoscopy that results from a positive test does not just treat cancer but gives us the opportunity to remove a polyp, the incidence of bowel cancer in men in Scotland has fallen by 18%. So bowel cancer screening is not just finding cancer early; it is a chance to prevent the cancer from developing. The Government said last August that they would also move to that earlier screening age instead of 60, and I would be grateful to know from the Minister roughly when that change will happen.

However, what challenges screening, as Members have already talked about, is workforce. Radiology is not just an issue in Scotland; radiology is an issue right across the UK. I am co-chair of the all-party parliamentary group on breast cancer and our report last year—“A Mixed Picture”—showed very clearly that as three radiologists retire, they are likely to be replaced by only two.

The other group is endoscopers. If we are running screening, and if screening in England is going to start earlier, that will generate more endoscopies. The NHS is not buildings and machines; it is people. That is a challenge for all of us and I have to say that unfortunately I think Brexit will make workforce more difficult as we go forward.

The number of cancers increases as we get older, as does the complexity of treatment. We are discovering new drugs by design, genetics and cell biology rather than just by accident, as many drugs in the past were found. We have to turn that around. We talk about access to a new drug that might be £100,000 a treatment, but how much cheaper to try to prevent the cancer in the first place? Most members of the public know that smoking is the No. 1 cause, but smoking has been going down, particularly since the smoking ban in the mid-2000s. In fact, lung cancer incidence in men is down by just over 17%. That means 17% of men not getting lung cancer, not having a big operation and not dying from it. There is absolutely no treatment that will achieve that.

What many people do not know is that obesity is the second commonest cause. We have discussed things such as childhood obesity strategies, and the need for a watershed on advertising, high-quality school meals and active transport, so that it is easier for people to maintain a healthy weight and to remain fit. We live in an obesogenic society; it is really hard for people to resist things when they are bombarded from every direction. Low-quality carbohydrate food is still much cheaper than fresh vegetables and protein. That always means people are slanted in the wrong direction.

Alcohol is also a cause of cancer. I am proud that, after five years of being dragged through the courts, the Scottish Government have managed to introduce minimum unit pricing, particularly to tackle white ciders—the really poor-quality alcohol at the lower end of the spectrum.

To tackle cancer, the best strategy is to prevent it. That requires a health-in-all-policies approach right across every Department and Government. As well as preventing cancer, that would prevent many of the chronic illnesses that cause debility in older life. As well as preventing cancer, it would prevent other suffering; we would improve the quality of life of our senior citizens. That is something we should all aspire to.

Appropriate ME Treatment

Philippa Whitford Excerpts

Thursday 24th January 2019 Commons Chamber

[Dr Philippa Whitford (Central Ayrshire) (SNP)]

I thank my constituents who have written to me to share their experiences, both as patients and parents. I also have a close friend who has battled this condition for 18 years. I know that many sufferers find it dismissive to refer to the condition as chronic fatigue syndrome because it sounds so trivial. At very least it should be chronic exhaustion syndrome, because that is what it is—absolute exhaustion. ME affects a quarter of a million people, 10% of whom are children and young people. A quarter of those are so severely affected that they are either housebound or bedbound.

The basic problem is that we do not know the cause of ME. It often seems to start post-viral; I, no doubt like many others here, have had post-viral syndrome, and it can often take weeks or even months to recover from. What is it about ME sufferers that makes the condition become long-term and chronic? That is the crux of the matter. We need biomedical research to consider whether it is an autoimmune cause, a genetic weakness, or a neurological problem. Is it metabolic? There is some interest in whether the mitochondria—the little power packs in the cells—are at fault. Such things need to be considered, and at the moment the only real funding of research is by ME charities.

The UK has not funded any biomedical research since 2012. That makes diagnosis problematic because it is based only on symptoms. We do not have a test because we do not know the cause or what to test for. Naturally enough, I will stick up for doctors and say, “That makes it kinda hard for them.” It becomes a diagnosis of elimination—when they do not find the other obvious causes, the symptoms are put down to ME.

Following on from that, there is simply no treatment. There is no cure because we do not know the cause. There are no drugs coming down the pipeline, no procedures. That means that we are dependent purely on management and support. As has been said, CBT is not a cure or a treatment. It may help some people cope with the depression and mental health issues that come from being so disabled, but it does not tackle the underlying ME.

As has been said, graded exercise can actually make things much worse. The suggestion that it might work was based, as has been said, on the flawed PACE trial published in The Lancet in 2011. I think it is quite sinister that some of the funding for that trial was from the Department for Work and Pensions; that added to the implication of malingering, despite the fact that 90% of sufferers were working before they were diagnosed. That figure drops to 35% afterwards. It was an unblinded study, because it is not possible to hide from people what treatment they are getting. That means that all other aspects should be very strict, yet CBT and GET were promoted to patients as something that would help them. The researchers did not analyse their planned outcomes, which is critical in research. They lowered their defined targets simply because the treatment was failing, and used subjective rather than objective measures. Re-analysis of the PACE study has shown minimal benefit to these treatments; indeed, as my hon. Friend the Member for Glasgow North West (Carol Monaghan) said, some people got worse but still had their treatment classified as a success.

The only thing that has been shown to make a difference to some patients is what is called adaptive pacing—listening to one’s body, balancing activity with rest, and planning one’s day, or one’s weekend activities with the family.

The United States Centres for Disease Control and Prevention removed the recommendations of CBT and GET, but as has been said, they have still been NICE recommendations since 2007, and although they are under review, with the results due to come out in 2020—too far away—the NICE website still promotes CBT and GET. There should be a red warning, saying, “Don’t follow this. We are looking into it.”

Most of all, we need research to define the underlying cause of this condition, and to develop treatments. We have heard about the £300,000 of funding that the Scottish Government have given to Action for ME to develop peer support projects, but research needs to be on a bigger scale, considering the £3.3 billion economic impact. The US has moved to biomedical research and, as has been said, the UK is still totally focused on psychological research.

In the meantime, until we have answers, the DWP needs to recognise the impact and the disability of ME. GPs, NHS staff and care staff need to provide support, including emotional support, to help manage the condition, and all of us need to recognise the impact of the condition and reduce the stigma that simply adds insult to injury.

Oral Answers to Questions

Philippa Whitford Excerpts

Tuesday 15th January 2019 Commons Chamber

[Matt Hancock]

We are working to ensure that the prioritisation of not just medicines, but medical products and other things needed for the health of the nation, is taken into consideration. There is detailed work under way that is clinically led; the medical director of the NHS is heavily engaged in that work and works very closely with the Department on it. I am very happy to go through the details of my hon. Friend’s constituency case to make sure that that is also being dealt with appropriately. I am glad that, because she does not want no deal, she will be voting with the Government tonight.

[Dr Philippa Whitford (Central Ayrshire) (SNP)]

Legislation was passed two years ago so that the Secretary of State could end profiteering by some drug companies. Now drug shortages after a no-deal Brexit could mean soaring costs across UK health services, so why have the Government not set the regulations from this legislation so that we can use the powers and avoid a black market in medication?

[Matt Hancock]

We have already taken action to ensure that the cost of drugs is reduced. I am very happy to write to the hon. Lady with the extensive details of the agreements that have been made. The legislation is indeed important; so, too, is working with the drugs companies to make sure that we keep those costs down and yet also get the drugs that people need.

[Dr Whitford]

As the precursors of medical radioisotopes have a half-life of less than three days, they cannot be stockpiled. I have frequently asked the Government how they will maintain a steady supply if there is a no-deal Brexit. Can the Secretary of State answer—and please don’t say “Seaborne Freight”?

Cancer Workforce and Early Diagnosis

Philippa Whitford Excerpts

Tuesday 8th January 2019 Westminster Hall

[Dr Philippa Whitford (Central Ayrshire) (SNP)]

It is a pleasure to serve under your chairmanship, Mr Howarth. I, too, congratulate the hon. Member for Poplar and Limehouse (Jim Fitzpatrick) on securing the debate. It is a slight pity that it is less than 24 hours after the publication of the long-term plan, but people seem to have done lots of fast reading last night.

Like others, I welcome the plan and particularly the extra funding for the NHS, but it is important to remember that this brings it back to 3.4%, which was the average over many years—indeed, below the average over many years—prior to 2010. As the Secretary of State highlighted yesterday, with a million extra patients, the money per head of the population is actually going down. That is something that should be looked at, because it is a much better comparative measure.

In Scotland, we spend £163 per head more on health than here in England, and £113 per head more on elderly social care. We know that if we do not fix social care, then unfortunately any money put into the NHS is haemorrhaging out because of elderly people trapped in hospital, where they do not want to be. We see money focused on the NHS, because that sounds good to the public, but also further reductions in public health, despite all the talk in the plan about prevention. That does not make sense.

I welcome the Making Every Contact Count initiative. In Scotland, we have had Making Every Contact Count for years. As a breast cancer surgeon, I have discussed issues around smoking with all of my patients, because they inevitably ask, “Why did I get breast cancer?” We do not have the answer for breast cancer, but we do have the answer for the majority of lung cancers. I do not make my patients give up smoking immediately, when they are under stress, but I get them to promise me that they will do it in the long term, and quite a number of them do that. I do not have time to support them through that journey. We still need smoking cessation services, to which they can be referred. Those services are being cut, and that is a problem.

In the plan and in the Secretary of State’s letter yesterday, we again have a focus on cancer, which, as a breast cancer surgeon for over 30 years, I welcome. In his letter he talks about early diagnosis, but not about prevention, yet smoking is still the biggest cause of cancer, with obesity chasing it up as a close second. We need to tackle childhood obesity and we need a 9 pm watershed for advertising foods that encourage it.

Half of us will get cancer. As all the speakers have said, early diagnosis is crucial. It is particularly important to avoid diagnosis as part of an emergency admission, as that tends to result in a very poor outlook. For symptomatic cancers, as the Member for Shannon highlighted—[Interruption.] I keep saying that; I mean the hon. Member for Strangford (Jim Shannon). It is because the Shannon is another body of water in Ireland; I always get mixed up. We will just change it—you can be the Member for Shannon. [Laughter.] As the hon. Gentleman said, it is important to know the symptoms, but the public and sometimes GPs are too focused on late symptoms. Weight loss, jaundice and even, for some cancers, bleeding are not early enough. We need to educate people about that.

In Scotland, we have used humour. There was a testicular cancer advert over Christmas talking about men’s baubles. I do not care what kind of humour people need, whether it is toilet humour for bowel cancer or talking about boobs for breast cancer. If it gets people talking about it, that makes it easier for them to come forward. Many years ago we did an audit in Scotland looking at the whole patient pathway. It showed that for particular cancers, including bowel cancer, the longest step was from the first sign or symptom to going to the GP. The plan talks a lot about the pathway after going to the doctor, but there are only a couple of lines about educating the populous about what to look out for. That means we have to get people talking about it.

In Scotland, we have had bowel cancer screening starting at the age of 50 right from the beginning. I am sorry that the hon. Member for Torfaen (Nick Thomas-Symonds), who is no longer in his place, lost his mother in her 50s. In the last year or so we have also had celebrities diagnosed late with bowel cancer, who might well have been picked up if the screening had started at the age of 50. Last August, I welcomed the Government’s commitment to making that change, but there has been no discussion in any announcements or in the plan about when that change will happen.

When I turned 50 and the poo-in-the-post envelope landed on the mat within two days, I found it a bit harsh. As my birthday is Christmas eve, I got another one last week. I would not mind if they were a bit more sensitive, but it is something that people have to do. In Scotland, we have already changed completely to the faecal immunochemical test, which involves only one sample. We have already seen a 10% increase in uptake. Again, the Government have committed to that and the roll-out has commenced, but when will it be complete?

It is important to be prepared for the impact that that will have on the NHS here. If the starting age for bowel screening is dropped from 60 to 50, there will be an increase of two thirds in the screening population. If there is then the same 10% increase with FIT, together that will mean an increase of three quarters in the colonoscopies required. The NHS will have to be prepared with endoscopists and, as mentioned earlier, pathologists, who will analyse the samples. In Scotland, we have seen an increase in waiting times for colonoscopies, just with the change to FIT, so it is important to be prepared.

There is a similar impact with public education campaigns. Intense campaigns alone are no use. When we did the first Detect Cancer Early campaign, an audit of the breast cancer units across Scotland found that there had been a doubling in referrals, but not a significant change in the number of cancer diagnoses. Women are pretty breast aware, but the adverts need to be trickled throughout the year, or the chances are that there still will not be an advert when someone is sitting and ignoring a symptom.

As well as endoscopists and pathologists, the other workforce is radiologists. Not all radiologists can be identified as cancer radiologists; they will find cancer in all sorts of parts of the body. This diagnostic workforce is critical. If we look at the waiting time performance across the UK, we see that people are struggling, particularly with the 62-day target, which has fallen below 80% in England. Everyone is struggling with it. Looking at the 31-day target—from diagnosis to treatment—we see that most cancers are at over 90%, or indeed 95%. Once the NHS knows that someone has cancer, the pathway is relatively swift, but there is long gap to be diagnosed.

In my own speciality of breast cancer, radiologists are critical for the initial test, the investigation and the follow-up. For every three breast cancer radiologists who will retire in the next five years, they will be replaced by only two. The problem is that breast screening came in around 1990, so all the young consultants who were appointed at almost the same time will all, sadly, be retiring at the same time. The clinical radiology workforce census report shows that the UK has a shortfall of 1,000 full-time radiologists at the moment, which will grow to 1,600 by 2022. Some £116 million is being spent on outsourcing and overtime. The issue is not even money, because that amount would fund 1,300 full-time radiologists; the issue is that we do not have the workforce. Yet we see in the plan that health education has had its funding cut over recent years, despite grand statements about all the extra nurses, radiographers, allied health professionals and doctors who will be trained.

The plan talks a lot about IT, but instead of focusing on digital GPs it should be focusing on internal IT. We have had electronic prescribing, referral and response letters for years in Scotland, and one of the things we have that can help with the radiology shortage is the picture archiving and communication system, where imaging is shared right across Scotland. Every hospital uses the same system, which means that if one place is short of radiologists or is very rural, an image can be sent hundreds of miles to be looked at by someone else. The plan talks about generalists, and they are needed, but we also need specialists. The workforce plan is critical.

Leaving the EU: Tobacco Products and Public Health

Philippa Whitford Excerpts

Monday 7th January 2019 Commons Chamber

[Dr Philippa Whitford (Central Ayrshire) (SNP)]

Again we are rushing through a statutory instrument because of the threat of a no deal. I would be interested to know what the Minister might be doing differently if we were not having to rush this through.

Smoking is obviously a critical cause of cancer, and although smoking rates have dropped over the past 20 years, there are still far too many people smoking. I welcome the commitment in the explanatory memorandum and the regulations to minimal change in tobacco control. It is important we recognise that smoking also causes non-cancerous diseases such as heart and lung disease and strokes, and is probably the biggest single cause of morbidity in our country.

The regulations mention that we are revoking the common European notification system for both e-cigarettes and tobacco—this is not just about tobacco—and that it will be replaced by a UK system. The Minister talked about the MHRA taking on that work. Will it be ready by the end of March? As the hon. Member for Washington and Sunderland West (Mrs Hodgson) asked, will the guidance to industry definitely appear before the end of this month? That is very close, yet the Government are asking industry to change the pictures it is using, and may be asking it to change how some of the warnings are constructed.

Under proposed new regulation 53A of the Tobacco and Related Products Regulations 2016, the Secretary of State will be able to collect fees to fund this work. Will the fees be collected on a continuing basis, with industry having to register with such a body and pay ongoing fees, or will it be only on the registration of a new product? What we might see is the same as we are likely to see on drugs: if a company has to register a product in Europe and then go through a separate process here, it might not register the product here. Although I am obviously not a big fan of tobacco producers, it is important that we do not undermine those producing e-cigarettes and vapes that have helped people come off cigarettes.

The new pictures have been mentioned. The hon. Member for Harrow East (Bob Blackman) talked about the need to rotate them. Unfortunately, it does not matter what image we are talking about, but if people see it all the time they become inured to it. It is important that any regulations in the UK shadow what we have been doing with our EU colleagues as much as possible.

The Minister talked about the consultation in October, and the explanatory memorandum referred to industry and stakeholders. Will he perhaps clarify for us whether any anti-smoking charities or any health bodies were represented?

Proposed new regulation 16A(2) gives the Secretary of State the ability to allow change in e-cigarette and vape formulations and standards. What concerns me is that paragraph 6.4 of the explanatory memorandum mentions the discussion about the standards being “too onerous”—not for the user, but for the industry—and too restrictive. It is absolutely critical that we do not lower these standards, because if this decision just slips through without our being able to interrogate it, we may regret it further on.

The regulations will revoke section 2(4) of the Tobacco Advertising and Promotion Act 2002, which means that no EU member state is allowed to advertise tobacco in another member state. The explanation is that EU member states could advertise tobacco in the UK, and we should therefore revoke our obligation not to do that to them. Unfortunately, this is exactly the tit-for-tat race to the bottom that the EU regulations were intended to avoid. Does the Minister really think that allowing UK companies to advertise in Ireland, Holland or France is going to benefit people here?

It is of concern that proposed new regulation 53A, which is on setting fees, says that such statutory instruments must be carried through using the affirmative process, yet all other changes to regulations will be allowed to be carried through under the negative procedure.

It is critical that the standards of tobacco products, e-cigarettes or vaping mixtures are maintained at as high a quality as possible. There is evidence that young people are beginning to use vaping de novo. Initially, there has been great benefit in getting cigarette smokers off tobacco and vaping using or e-cigarettes. However, it must be remembered that the pulmonary membrane in our lungs is the most sensitive membrane in the body, and we cannot allow the addition of harmful chemicals that may cause destruction or fibrosis and leave people crippled in the future. We do not yet have long-term experience of these vaping fluids, and it is critical that the Government keep them under observation and maintain as high a standard as possible.

NHS Long-term Plan

Philippa Whitford Excerpts

Monday 7th January 2019 Commons Chamber

[Dr Philippa Whitford (Central Ayrshire) (SNP)]

I note that the Secretary of State referred to the Churchill Government in 1944, but had he looked at Hansard he might have seen that Churchill cited the Highlands and Islands Medical Service, which was the first national health service in 1913.

I welcome the long-term plan, but the integration to which it aspires is going to be frustrated if there is no reform of the internal market and the fragmentation continues. The Secretary of State cites the funding, which he describes as 3.4% per year. That is actually just back to what the NHS received prior to 2010. He talks about a million extra patients. With this enormous increased demand, does he not think that it would be more honest to describe funding per head, rather than just a total? Scotland spends £163 more per head. Perhaps he should aspire to spend the money on the patients and then perhaps the NHS would keep up.

Again, like the previous funding agreement, the funding is focused only on the NHS, with cuts to public health, no extra money for health education and still no Green Paper on social care. I totally agree that prevention is better than cure, so will the Secretary of State reverse the cuts to public health? In his own letter, which was circulated, he emphasised reducing cancer deaths, yet there was no mention of prevention at all. That is the best way to reduce cancer deaths. Public health is crucial, smoking cessation is crucial and tackling childhood obesity is crucial, so will he liaise with his colleagues in the Department for Digital, Culture, Media and Sport and set a nine o’clock watershed on advertising rubbish foods?

I agree with the aim of improving screening. Last year, the Government agreed that they would reduce the bowel cancer screening age from 60 to 50. Can the Secretary of State tell us when that will actually happen? Does he recognise that it will mean a bigger need for endoscopists and radiologists? So will he fund Health Education England to provide them and to provide the other doctors, nurses and staff that the NHS will need to deliver this long-term plan?

[Matt Hancock]

My response is yes on the cancer screening—it is in paragraph 3.53. I want to return to the point that was made by the hon. Lady and by my right hon. and learned Friend the Member for Rushcliffe (Mr Clarke) about the link to social care. Of course that is critical. The plan has a section on the link to social care and the social care Green Paper will then tie into the plan. Of course, the two come together and the Green Paper on social care will be provided soon.

Draft Blood Safety and Quality (Amendment) (EU Exit) Regulations 2019

Philippa Whitford Excerpts

Wednesday 19th December 2018 General Committees

[Dr Philippa Whitford (Central Ayrshire) (SNP)]

All of us with constituents who have suffered under the contaminated blood scandal recognise the absolute importance of maintaining the standard of blood for transfusion, as well as other donated tissues and organs. I welcome the draft regulations and that we will maintain the standard. The issue will be in paragraph 7.12 of the explanatory memorandum on technical updates under article 29: as technology develops and issues arise, will we continue to match that standard? The hon. Member for Washington and Sunderland West asked who in the UK will take on that responsibility.

I notice in section 7.3 of the explanatory memorandum that approximately 6.5% of plasma is imported from the EU, although the UK is largely self-sufficient in blood itself. I take the opportunity to remind people, whether or not they are blood donors, that there is still time to donate a wee pint of blood before we go into Christmas. As a surgeon I can say that we always run out or come close to running out. There is still time to save a life. How will we compensate for that 6.5% of plasma that we import for direct clotting factors and immunoglobulins, to which the Minister referred?

The explanatory memorandum states that there will no longer be an obligation on UK authorities to report serious adverse effects. Although I understand there would not be an obligation once we are outside the EU, I would have thought it was still good practice to share information on serious adverse effects that have occurred here and that might occur elsewhere in Europe and, similarly, to encourage the sharing of information so that if there is an adverse event, we are given that information in return.

I am slightly surprised that, in section 7.9 of the explanatory memorandum, Gibraltar is defined as a third country—it defines EU member states as third countries, but also Gibraltar. I am a little confused about why it would be considered a third country.

I welcome the draft regulations in general, but there seem to be a few little threads hanging. I would be grateful if the Minister could give us comfort on those or further information either from reviewing it or by sending it to us later.

NHS: Staffing Levels

Philippa Whitford Excerpts

Tuesday 11th December 2018 Westminster Hall

[Dr Philippa Whitford (Central Ayrshire) (SNP)]

It is an honour to serve under your chairmanship, Mr Hollobone. I, too, declare an interest as a longstanding NHS worker of more than 30 years.

Healthcare is not delivered by machines or buildings; it is delivered by people. People are the core of the NHS. The problem relates to workforce, and it is hitting all four nations. Although Scotland has the highest ratio of every group of healthcare staff per head of population, we too face challenges. We have a 4.8% nurse vacancy rate in Scotland, but in England it is more than 11.5%. The Royal College of Nursing says that there are 41,000 nurse vacancies at the moment, and if action is not taken, that will rise to 48,000.

As other Members mentioned, since the introduction of the bursary in 2015, there has been a one third drop in applications. Acceptances in England have gone down by almost 4%, whereas in Scotland they have gone up by almost 14.5% over the same period. The bursary is having a huge impact, particularly on mature students, who might already have a degree and have therefore also been hit by the removal of the post graduate bursary that allows a nurse to be trained in just two years.

There has been a 15% drop in mature students, which is hitting those with mental health issues and learning disabilities in particular, as those specialities tend to attract the more mature nurse student. There has been a 13% drop in mental health nursing staff and a 40% drop in nurses looking after those with learning disabilities. That makes those services unsustainable.

Brexit is affecting the workforce, as it is every other aspect of life. There has been a 90% drop in European nurses registering to come and work in the UK, and a trebling of EU nurses who are leaving the UK register. That does not help to solve the problem, and those nurses cannot be totally replaced by UK staff in enough time. It does not matter that the Government come out with warm words if the Home Office’s actions make people feel insecure. Friends of ours who have been GPs for more than 20 years in Scotland applied for citizenship for their children. The eldest and youngest children were granted it; the middle child was refused. What are they now talking about? “Maybe we should go back to Germany where we’d be safe.”

From every angle, the Government are taking actions that are making staffing levels worse. The former Secretary of State for Health, the right hon. Member for South West Surrey (Mr Hunt), used to go on about the lack of junior doctors and consultants as a cause of excess deaths among those admitted at weekends. Actually, the only staffing impact proven through research is on the ratio of registered nurses to patients—not healthcare assistants or others.

[Dr Poulter]

I am sure that most of us had great concerns about the previous Secretary of State’s use of statistics, but a mental health study was carried out and the highest morbidity rates were in the middle of the week, not at weekends, which rather disproved the assertions that he was making.

[Dr Whitford]

We pointed that out repeatedly at the time. It has been shown time and again that quality, well-trained, experienced nurses—not so much agency nurses or healthcare assistants—who know a ward are the bedrock of every single service in healthcare.

Brexit is having an impact. Even though in Scotland our Government have promised to pay settled status fees for all those working in public services, we have already lost, according to the British Medical Association survey, 14% of our doctors. England has lost almost 20%. We cannot reach a point where England has 50,000 nurse vacancies. That would be unsafe. The Government need to take action and, like the Scottish Government, put the bursary back, get rid of tuition fees, and make it sustainable for people to train to become nurses. If they do not do that, the sustainability and safety of the NHS in England will deteriorate further.

--- Later in debate ---

[Dr Whitford]

Will the Minister give way?

[Stephen Hammond]

I would give way, but I cannot—