Oral Answers to Questions

Thangam Debbonaire Excerpts

Tuesday 20th December 2016 Commons Chamber

[Nicola Blackwood]

I am grateful for that immediate promotion from the hon. Gentleman.

We have made considerable progress in establishing the building blocks of our domestic AMR strategy, including better data, guidance for primary care, and a strengthening of the framework for antimicrobial stewardship, which involves introducing incentives for the NHS to improve the prescribing of antibiotics. That has led, in the last quarter, to the first reduction in such prescribing, which I think we can take as an encouraging sign.

[Thangam Debbonaire (Bristol West) (Lab)]

One of the 10 recommendations of the O’Neill review on antimicrobial resistance was for a massive global public awareness campaign. Given that 700,000 people die each year as a result of AMR, and given the review’s estimate that that figure will rise to 10 million a year by 2050, what assurances can the Minister give that she is behind that awareness campaign?

[Nicola Blackwood]

The hon. Lady is right to identify the scale of the challenge, which is why we have put AMR on our national risk register, and she is also right to point out that no one country can tackle AMR alone. The United Kingdom has played a global leadership role. We co-sponsored the World Health Organisation’s 2015 global health plan and created the £265 million Fleming fund so that we could specifically help poor countries to tackle drug resistance, and we will continue to play that global leadership role.

Terminal Illness: Support

Thangam Debbonaire Excerpts

Monday 5th December 2016 Commons Chamber

[Catherine McKinnell (Newcastle upon Tyne North) (Lab)]

It is appropriate that this debate, on an issue that will touch millions of people and their families at some point in their lives, should take place today, given that 5 December has been designated International Volunteer Day by the United Nations since 1985. Its purpose is to

“celebrate the power and potential of volunteerism”.

The UN states that IVD is

“an opportunity for volunteers, and volunteer organisations, to raise awareness of, and gain recognition for, the contribution they make to their communities”.

This year’s IVD theme of #GlobalApplause seeks to give volunteers around the world the recognition they deserve, while also “giving a hand” to potential volunteers by encouraging them to give up some of their time for others.

Of course, the link between IVD and this debate is that the vast majority of end-of-life palliative care outside hospital is provided by the charitable sector and only partly funded by the NHS. For that reason, people who donate their money to—and, crucially, their time through volunteering with—end-of-life-care charities play an immeasurably important role in ensuring that the majority of us, and our loved ones, will get the right care and support when we are dying. We will need more volunteers as more people die each year and the demand for high-quality palliative and end-of-life care increases, which is something I will return to later.

I have long been an advocate of the need for good palliative care and support to be available to those who need it, but it is as a result of my recent work locally with the charity Marie Curie that I sought this debate. As I am sure all hon. Members will know, Marie Curie has been providing care and support for people living with terminal illness and their families for the last 65 years. It was able to care for more than 40,000 people across the UK in the last year alone, in large part thanks to the support of more than 10,000 volunteers.

In October, I had the absolute privilege of meeting my constituent Don Lowther, who has terminal cancer, and Faye Morrison, a 21-year-old student from Gateshead who has befriended Don through Marie Curie’s helper service. This pioneering service, which has been available in the Tyne and Wear area since last year, matches trained volunteers with people living with terminal illnesses, providing them and their loved ones with companionship, emotional support and practical help with the aim of ensuring that their quality of life is the best it can be in its final stages.

Since last December, Faye has been making regular visits to see Don in his home, and over that time they have developed a close friendship. Faye is able to ensure that Don, who can no longer drive, can still get out of the house to places such as North Shields for fish and chips. Perhaps most importantly, Faye is a non-family member who Don can talk to and share his concerns with. The impact of Faye’s volunteering on Don’s quality of life, and that of his wife’s, is clear to anyone who meets them, but Faye is the first to say that she has—from giving her time and being part of the helper service—gained as much as Don has.

The Marie Curie helper service also helps to co-ordinate local services, enabling people affected by a terminal illness and their families to understand what is happening, and ensuring that they are supported throughout this challenging journey. In the case of Faye and Don, this has involved signposting Don to the services provided by Marie Curie’s Newcastle hospice, which I also heard more about from Lead Nurse Michelle Scott when I recently visited this facility, which is located in the west end of the city in the constituency of my hon. Friend the Member for Newcastle upon Tyne Central (Chi Onwurah).

I saw for myself the newly opened complementary therapy and relaxation area, with its Alnwick garden theme, and the different types of accommodation available to patients and their carers, including for respite care. I learned more about the wide range of medical and nursing care, physiotherapy and occupational therapy available, and about the practical, psychological, emotional and spiritual support provided by the highly experienced hospice team. What I took away most from my visit, however, was the hospice’s absolute dedication to celebrating life and to ensuring that those using its services—whether terminally ill parents with young children or those, such as my constituent Don, who use their day services and activities—receive the best possible support and enjoy the best possible quality of life as their time comes to an end. Don told me he was concerned that once he stepped inside the hospice, he would never leave, but that is just not the case. Thanks to the helper service and Faye, he was signposted to the care and support provided at all stages of terminal illness. That support is not negative about death and dying, but treats them as a part of life. Of course, not all Marie Curie’s nursing care takes place in a hospice setting, because the charity’s nurses also provide overnight care in people’s own homes.

Marie Curie is certainly not the only charitable organisation providing end-of-life care in the Newcastle area. Other vital organisations include Macmillan Cancer Support, with whom I recently had the pleasure of enjoying coffee and cake at the Lemington Centre and St Cuthbert’s Primary School in Walbottle, as well as St Oswald’s hospice in Gosforth, which has worked to

“make the most of time and improve quality of life for everyone in the North East living with an incurable condition, and their families”

for the past 30 years.

Despite the incredible efforts of these charities and the NHS for people who are dying, the risk that they will not get the care that they need to manage their symptoms and to maintain their quality of life until the end of their life is worryingly high. Research undertaken last year by the London School of Economics on behalf of Marie Curie found that a deeply concerning 92,000 people who need palliative care in England each year are not receiving it. That means that one in four people are not getting the good end-of-life care—care for managing pain and other symptoms, alongside psychological, social and spiritual support—that they clearly need.

The people who miss out most frequently on this support are those with a terminal illness other than cancer, such as heart failure or chronic pulmonary disease. Indeed, written evidence submitted by the National Council for Palliative Care to the Health Committee’s inquiry into end-of-life care, which was published last year, drew attention to the fact that people with cancer access over 75% of specialist palliative care services, although cancer causes around 30% of all deaths. Concerns about the availability of palliative care for people with non-cancer diagnoses have been raised with me by a constituent living with idiopathic pulmonary fibrosis.

Others who are likely to miss out are people aged over 85, including those with dementia, despite the fact that dementia is now identified as the leading cause of death in England and Wales. Written evidence submitted by Age UK to the same Health Committee inquiry highlighted that while one third of all deaths are of people aged over 85, only around 15% of the people who gain access to specialist palliative care fall into that age group. Worrying inequalities already exist regarding the quality of end-of-life support available, depending on a person’s illness, age and, as ever, where they happen to live.

A growing concern is that the existing system, which is already unable to provide care for all who need it, is coming under ever greater pressure as our social care services fast approach breaking point. Marie Curie states that in its own services, it is seeing people waiting weeks in hospitals and hospices for social care packages to be put in place so that they can get home or into a care home to spend their final days in the place of their choosing. Very sadly, that situation means that it is not uncommon for people to die while waiting. This does, of course, have a terrible human impact, not only on the person dying, but on their families, making what is already a hugely traumatic situation immeasurably worse. This state of affairs is also totally cost-inefficient for our NHS, which could be using those hospital beds for people who need acute care.

The situation I have outlined will come as no surprise to any hon. Member, given that adult social care budgets have been cut by some £4.6 billion, or 31% in real terms, since 2011. They continue to fall in the face of an increasingly elderly population and therefore increasing demand. I have no doubt that the Minister will want to champion the social care council tax precept that the Government have allowed local authorities to raise for this purpose, but I gently remind him that that is anticipated to raise £1.4 million a year in Newcastle, yet the city council faces a social care shortfall of some £15 million.

[Thangam Debbonaire (Bristol West) (Lab)]

I thank my hon. Friend for bringing this issue to the House’s attention. She is making a powerful speech. Let me also pay tribute to the hospices in my constituency— St Peter’s hospice, and the hospice that cared for my father and my mother-in-law in their dying days.

Does my hon. Friend share my concern about the fact that the Government have not made adequate progress in meeting the recommendations of last year’s inquiry into end-of-life care by the Health Committee? Will she join me in asking the Minister to explore the question of how well the five principles of end-of-life care are being followed across the country?

[Catherine McKinnell]

I think that we would all like the Minister to try to explain that key point. Marie Curie’s main concern, which I know is shared throughout the sector, is that the provision of palliative care is simply not growing to meet the demand for services. That is clearly extremely troubling, given that one in four people are already unable to access the end-of-life care and support that they need. Like the rest of our health and social care services, the palliative and end-of-life care sector—including those who provide such care in hospitals and care homes—is facing a demographic crisis. More people are dying each year, at an older age, and with more long-term and often complex conditions. Indeed, the number of deaths per year will rise by 100,000 over the next five years.

Given those facts, when the Government announced in July this year in their

“response to the independent review of choice in end of life care”

that they would establish a board within NHS England to implement the recommendations of the review, it came as a grave disappointment to all involved in the sector that they had chosen to reject the review’s key recommendation that £130 million of funding should be made available at the next spending review to

“invest in social care and NHS-commissioned services, to deliver a national choice offer in end of life care.”

Along with my hon. Friend the Member for Bristol West (Thangam Debbonaire) and, I am sure, others who are listening to the debate, I ask the Minister to state clearly how, without the additional funding that was recommended by the independent review, the Government will ensure that palliative and social care services grow to meet existing and increased demand in the coming years.

[Thangam Debbonaire]

Does my hon. Friend agree that the autumn statement provided an ideal opportunity for the Government to produce sums to meet the ever-increasing demand for social and end-of-life care, and that that opportunity was missed?

[Catherine McKinnell]

That is a good point. Everyone was disappointed not to hear a commitment from the Government. I think we would all like to know how, without those additional funds, the Government will end the distressing and unacceptable circumstances in which 92,000 people—one in four—are missing out each year on the care and support that they and their families need at the end of their lives, and how on earth the Government will prevent that deeply concerning figure from growing ever bigger.

I am acutely conscious that there are many more issues that I could have raised in a debate about such an important issue. They include the provision of end-of-life care for children and young people with life-shortening conditions, which, according to the charity Together for Short Lives, is often

“inappropriately coupled with the palliative care needs of adults, when their needs can be much more complex”.

A key concern for that charity, and for all of us, is that the number of children and young people affected by life-shortening conditions is not properly monitored, which makes it impossible for the Government, the NHS and local authorities to plan properly and budget for their needs.

Another serious issue relates to the fact that our welfare system can let down too many people with debilitating and terminal conditions such as motor neurone disease. While welcoming the recent and long overdue announcement that people with severe lifetime conditions will no longer have to undergo reassessments for employment and support allowance, the Motor Neurone Disease Association and many other charities remain extremely concerned about the Government’s determination to devolve attendance allowance to local authorities, and the impact that that could have on the vital support that people with extremely challenging conditions currently receive.

I have raised a number of issues with the Minister this evening about the additional funds for end-of-life care that the NHS, charities and their much-needed volunteers clearly need. When people do not have the palliative care that they need, there are real and damaging consequences. They may die in pain or discomfort, which causes distress not just to them, but to their families, friends and loved ones. That will be avoidable if the Government can make a commitment to those people. I look forward to hearing the Minister’s response to the important concerns that I have outlined this evening.

--- Later in debate ---

[David Mowat]

I thank the hon. Gentleman for that intervention. He is right. There are about a quarter of a million informal carers under the age of 25, half of whom are under the 16-to-18 age range. There are issues for education and future employment. The carers strategy is addressing that and I will have more to say about that.

On the context, 480,000 people in England die every year. Thirty-six per cent. of those are over 85 and about 350,000 of those deaths are expected, in the sense that they are not a surprise. Roughly half that number get some specialist palliative care as part of the pathway. The hon. Lady talked about that not being enough, and I will come back to that. Forty-seven per cent. die in hospital, which is an improvement: 57% of people were dying in hospital 10 years ago. There is an emphasis—the charities, particularly Macmillan, are offering a lead on this—on ensuring that fewer people die in hospital.

In terms of authoritative evidence of how that is working—the hon. Lady mentioned some of the points made by Marie Curie—the Office for National Statistics conducts a yearly survey called “Bereaved VOICES”, which looks at how carers and bereaved people evaluate the last three months of the end-of-life care for their loved ones. About 75% of those services are regarded as good, excellent or outstanding. Ten per cent. are regarded as poor. Ten per cent. is 48,000 deaths a year, and that is still too high. Nevertheless, 75% of those services are regarded as good, excellent or outstanding. The highest proportion of those services are in hospices. Care homes rated about the same as hospices, with hospitals doing less well. The figures are patchy, however, and that is generally linked to deprivation. They are not as good in areas of relatively high deprivation as they are in other areas. That is partly because hospice availability is somewhat skewed by the fact that the charities that run them tend to operate in more affluent areas.

The hon. Lady mentioned the need for spiritual and emotional attention at the end of life, and I can tell her that 70% of those who responded to the survey regarded their loved ones as having received good or outstanding spiritual or emotional care. That reflects well on those in the voluntary sector and the NHS who provide that care, and we should acknowledge that.

I do not wish to sound complacent, because I acknowledge that things could and should be better. I have had this job for four or five months, and there are very few of the areas I cover in which the UK could be said to be the best in the world. Let us take cancer outturns as an example. We know that our one-year survival rates for most types of cancer are worse than those of most other countries in Europe. Last year, however, the Economist Intelligence Unit compiled a quality of death index, which evaluated 50 or 60 countries in the world against a number of criteria, and the UK came top in end-of-life care. As I have said, I do not know the situation across all the areas for which I am responsible, but we should acknowledge this finding. To put it into context, Germany came seventh, France came 10th and Sweden came 16th. That has been achieved through the work of people in charities and in the NHS, but we must also acknowledge that things could be better.

The hon. Lady spoke about social care funding—although that is a slightly different area—and about delayed transfers of care and all that results from them. I have acknowledged many times in the Chamber that social care funding is under pressure and that that can cause delayed transfers of care, or bed-blocking, if we want to use that term. However, in terms of adult social care, if we compare the top 10% of councils with the bottom 10%, we see that there is a factor of 30 times in the difference between their performance in delayed transfers of care. That is not related to budgets; it is related to best practice, leadership and all that goes with that. We are sometimes quick to say that money is always the issue, but although that is of course part of it, it is not the only issue. It is important to understand that other factors are involved. Among other areas that need to be improved, we need to continue our drive to ensure that more people do not receive their end-of-life care in hospitals, where they generally do not wish to be. We should also acknowledge that there can be non-uniform commissioning among clinical commissioning groups, and we can do better in that regard as well.

The hon. Lady talked about the choice review, which was produced in 2014 by the National Council for Palliative Care, helped by Macmillan and Marie Curie. It contained some 62 recommendations. The Government’s response came out in July—it was one of the last acts of my predecessor—in the form of a five-point charter. In it, we accepted that we would have personalised care plans in place by 2020, that everyone was entitled to an honest discussion about their end-of-life care and to support in making informed choices, that family and carers would be involved in those choices, and that all people going through an end-of-life process would have an identified contact at all times.

Those elements will need to be implemented right across NHS processes, technologies and pathways, and we have set up the end-of-life care board under Bruce Keogh, the chief medical officer, to oversee that. All arm’s length bodies will be represented on the board. This has not yet been published—it is my role to ensure that it is—but the requirement now is to turn the commitments in the review response into tangible milestones, deliverables and responsibilities. I recently met several members of the End of Life Care Coalition and undertook to have a transparent process so that between 2016 and 2020 we know what we are implementing and when and how that is being done. It is important that that happens. We are extremely committed to it—it is a Government priority. We could do things better as a country, but we do pretty well and we need to do this to make things even better.

[Thangam Debbonaire]

I thank the Minister for his responses to my hon. Friend the Member for Newcastle upon Tyne North (Catherine McKinnell). On that point about the plan for between 2016 and 2020, given that the last days of someone’s life are etched into the memories of those who are left behind—I can remember every single moment of the day 23 years ago yesterday when I lost my father—will the Minister commit to report back to the House at various points over that four-year period, or will he report on progress in other ways?

Child Cancer

Thangam Debbonaire Excerpts

Monday 28th November 2016 Westminster Hall

[Thangam Debbonaire (Bristol West) (Lab)]

I thank the hon. Member for Bath (Ben Howlett) for his introduction and other hon. Members for their personal and heartfelt speeches and interventions. In particular, I thank the parents of Poppy-Mai, who started the petition and so brought this matter to the attention of the House.

My five asks are clear. First, more units such as the specialist one in Bristol for teenagers and young adults with cancer are needed. The units need to be carefully commissioned so that the maximum amount of specialist clinical knowledge is available to the maximum number of young people.

Secondly, a clear commissioning structure for services for children, teenagers and young adults with cancer is needed, so that everyone knows where the buck stops and who is responsible. Thirdly, the benefit system needs to be adjusted, as other hon. Members have said, so that the families of children and young people are not put into awful financial difficulties such as we have heard about just at the time when they most need to concentrate on their child and nothing else.

Fourthly, Government leadership is needed—I urge the Minister to respond to matters raised by me and other Members—with commissioning guidance, clear priorities and funding for specialist services. Fifthly, the Government need to take responsibility and say how we will go about researching childhood cancers in collaboration with European Union partners after we leave it.

Earlier this year, I visited the specialist teenage and young adults unit in Bristol, accompanied by Christine from the Teenage Cancer Trust, which contributed to the cost of the unit. The unit creates and maintains an environment that provides care for the whole person, helping that young person to cope with the emotional side of their illness, as well as giving them time and space to do school work, to be with friends and family, and to just be a young person not defined by their cancer.

The decor definitely does not make the unit feel like a cancer ward. Yes, per patient, that is more expensive than adult cancer wards. Thankfully, cancer is rare in childhood and youth, but young people have very different specific needs to be met.

[Mark Tami]

As my hon. Friend is making clear, we have to have specialist centres, but we must not think that we can have them on our doorstep everywhere. That will just not happen, and it would not make sense for it to happen. If we have specialist centres, however, people will have to travel, and families need support and somewhere to stay. I put on record my support for the Ronald McDonald House Charities, which do incredible work providing parents with somewhere to stay. The actual cost burden on parents alone for what can be long treatment periods is astronomical, and a lot of people simply do not have the money.

[Thangam Debbonaire]

I, too, will be mentioning similar services later in my speech. Absolutely, the last thing parents facing such awful situations need to be worrying about is where they will stay, how they will afford it and how they will afford even to put petrol in the tank.

My nephew was diagnosed at age 12 with osteosarcoma, a very rare childhood cancer. We were all so focused on getting him and his mum, and his sisters and brothers, though that illness that the longer-term impacts felt very much secondary. Specialist units such as the one in Bristol help the family as well as the young person with cancer to see the whole of life as important, to think about the longer-term implications and to prepare for them. I pay very personal tribute to the teenage and young adults cancer unit in Bristol for its work and to the Teenage Cancer Trust for its support of the unit.

As my hon. Friend said, getting the number of units right is difficult. Given the thankfully low numbers of childhood cancer victims, if the units are to be truly specialist, it will not be an easy matrix. To ensure an appropriate number of specialist units, the Government need to be clear with appropriate commissioning guidance and take responsibility for following it through.

In October when I asked the Department of Health in question 50795 what proportion of specialist units were funded by charitable trusts, the Under-Secretary of State for Health, the hon. Member for Warrington South (David Mowat), replied:

“This information is not held centrally.”

For me, that is simply not good enough. Yes, commissioning is done locally, and increasingly commissioning groups and trusts are collaborating, but Government leadership is necessary to work out how many units are needed and how to fund them. Will the Minister commit to gathering that information centrally in order to estimate properly the funding needed to commission appropriately throughout the country? Will she further commit to consulting on and publishing clear commissioning guidance so that the responsibility for commissioning and funding specialist treatment centres for children, young people and young adults is clearly identified, and so that a structure for commissioning across health regions is clear?

On the future of research into childhood cancers, there is clear potential for harm when the UK leaves the EU—I say “potential”, because any such harm can be mitigated, but the Government need to act urgently to address it. Earlier this month in answer to my question 50081 about research, the Minister for Universities, Science, Research and Innovation gave welcome assurances about funding. I welcome those assurances, but he did not mention research cohorts. Thankfully, childhood cancer is rare, so it is vital for UK researchers to be able to collaborate fully with their EU counterparts so that they can carry out clinically adequate research with a sufficiently large enough group of children and young people to provide clinically useful and secure results. Yes, funding is vital and I am grateful to him for those assurances, but it is not enough. My next question to the Minister present is this: will she commit to discussing that with her colleagues in the Department for Exiting the European Union, along with research about other rare childhood cancers?

As my hon. Friend the Member for Alyn and Deeside (Mark Tami) mentioned, children and young people with cancer and their parents often need to travel long distances for specialist treatment. That might always be unavoidable and, in any case, there are other huge financial costs for parents. In September, I was proud to chair the parliamentary launch of a report by CLIC Sargent, which does so much wonderful work to support children and families affected by childhood cancer. The report shows that the costs of cancer are not only emotional, educational and physical, but financial.

One young person at the launch spoke about how he had to prove repeatedly to the benefits agency that he had cancer and that his treatment was still not over nor his recovery complete. Another young person found that her student loan was stopped because she was deemed to be a student no longer, but her halls of residence still charged her rent. A lone parent spoke of her struggles to manage her finances while faced with losing her income from employment and the increased costs of driving her son a long distance many times each month for treatment, as well as the added costs of heating a home all day for a very sick child, which is often overlooked, and the costs of keeping clothes, bedding and house scrupulously clean, which is so important because the risk of infection is extremely high for those undergoing gruesome treatments such as chemotherapy, as other hon. Members have mentioned.

CLIC Sargent and other charities I know help with all those things and more. I have had the privilege of being shown round the CLIC Sargent house in Bristol, located a few minutes’ walk from the Bristol Royal infirmary. That house, run by a wonderful woman who knows all too well what childhood cancer means, provides a haven just when it is needed.

[Wes Streeting]

May I, too, pay tribute to Haven House children’s hospice, which is just outside my constituency and serves many of my constituents? Hospices are often associated with end-of-life care, but as in the case of Haven House, they also provide great support to families whose children may not be near the end of their lives and help them on that journey. They are such a powerful and important source of support, and of course they are all voluntary and rely on the public’s generosity.

[Thangam Debbonaire]

My hon. Friend is absolutely right. There are many charities across the country that do everything they can to try to help the families of children and young people with cancer. I pay tribute to them all, even though I cannot possibly know their names.

The CLIC Sargent social worker is on hand in the Bristol royal infirmary when a family receives a devastating diagnosis and is told that their child needs to start treatment right away. Such families are often many miles from home. They can arrive that night at CLIC Sargent house with nothing and be given somewhere to stay for as long as they need it, clothes and bedding if they have come without them and, when necessary, space for the whole family so brothers and sisters can be with their family and their sibling who is being treated. I am proud to declare an interest in CLIC Sargent: my beloved sister-in-law works for it. She gives her time and expertise to an organisation that has done so much for our family and many others.

Will the Minister commit to discussing with her colleagues in the Department for Work and Pensions the financial impact of childhood cancer on families, and will she use the CLIC Sargent report as a reference point? Will she further consider supporting the provision of such homes for the families of children with cancer? If those homes are essential for allowing children to be treated, we must surely consider prioritising them along with other specialist support for statutory funding, at least in part. I do not believe it is right that such homes, which are so essential, must rely entirely on the generosity of volunteers and charitable giving, although I pay tribute to people who raise money. The Government must consider providing that funding.

As other hon. Members have said, until someone has known childhood cancer in their own family, it can be difficult for them to comprehend its full impact. Yes, there are excellent briefings available from specialist cancer charities—CLIC Sargent, Teenage Cancer Trust, Cancer Research UK and other charities provided briefings for this debate. My family was fortunate. Despite an initially very difficult prognosis, that 12-year-old child is now a happy, well adjusted young man in his 20s with a responsible job and a secure relationship with his partner, but I grieve for those who are not so fortunate. I want to ensure that, whatever the prognosis, no family has to worry about money at that most difficult time. I want us to do everything we can—the Government must lead—to improve awareness, early diagnosis, treatment and support, so that one day deaths from childhood cancer end and we alleviate and reduce, if not completely eliminate, the terrible suffering that it brings. I also hope against hope that one day, no parent will ever have to hear the word “cancer”. I long for that day, as I am sure we all do.

--- Later in debate ---

[Thangam Debbonaire]

On the point about upgrading Linac machines for radiotherapy, one of the key problems that Cancer Research UK raised with me was radiographer and radiologist staffing shortages. Can the Minister add anything to reassure us that when the Linac machines are upgraded there will be sufficient staff?

[Nicola Blackwood]

There is also work being done on making sure the workforce are in place; and there is an overall strategy with Health Education England to do that. I am happy to write to the hon. Lady to give her details. I am slightly concerned that I have a lot to get through and I am going to bore everyone.

The taskforce has also recommended a new drive to deliver chemotherapy e-prescribing, which makes a significant difference to the experience of families who are supporting children being treated for cancer. Providers are working to implement plans for children by September 2017. Under the strategy, proposals will have been developed by March 2017 to improve the transition of young patients with cancer between children’s and adult services. As the hon. Member for Bristol West (Thangam Debbonaire) has said, transitions continue to pose a problem in some areas, with paediatric services stopping at 16 in some hospitals, but adult services not starting until 18. In addition, pathways between specialist centres and shared care units currently cause great difficulty for patients. The strategy says that there is a need to address that, and I hope that the hon. Lady will be reassured that work is being done on it.

An important recommendation of the strategy is that NHS England, the National Institute for Health Research and cancer research charities should work together to consider how to achieve a significant increase in access to clinical trials for teenagers and young adults with cancer—the shadow Minister, the hon. Member for Burnley (Julie Cooper) spoke about that. A far smaller proportion of teenaged and young adult patients than of younger children take part in clinical trials. There is obviously an opportunity that we need to grasp. The strategy recommends that we explore ways in which clinical trials for children and young adults with cancer could be significantly increased. As the shadow Minister said, NHS England should set an expectation that all centres should aim to recruit at least 50% of their patients for those trials by 2025. That is the target that we are reaching for.

Outside London, only four centres treat more than 100 children with cancer a year, across all types of cancer. The strategy recommends that NHS England, working through the children, teenagers and young adults clinical reference group, should consider whether outcomes could be improved through further reconfiguration of services, as the shadow Minister said. Any review should again be based on patient outcomes, including patient experience, as few centres offer comprehensive specialist services for children at the moment.

Many hon. Members have rightly called for research to be prioritised in that context. It is good that, since 2010-11, we have increased annual investment in cancer research through the National Institute for Health Research, including research into childhood cancers, from £101 million to £142 million. However, we know that a lot more needs to be done if we are to deliver the changes that we want to see. That is why the Government announced the largest ever investment in health research in September— £816 million over five years from April 2017. Some 20 NHS and university partnerships across England have each been awarded funding through the NIHR, and we expect to see significant research activity in childhood cancers within that programme of investment.

The NIHR is also collaborating with three charities—Teenage Cancer Trust, Children with Cancer UK and CLIC Sargent—to identify gaps and unanswered questions in research into young peoples’ cancer and to then prioritise those gaps that patients and clinicians agree are the most important. The initial survey opened just last month, so we expect to see progress on that soon.

A new working group has brought together clinicians, charities and officials to discuss how we can increase the level and impact of research into brain tumours, including those in children. The group first met in October and the Government anticipate that it will complete its tasks by September. I will be co-chairing the next meeting in January with the Department of Health’s chief scientific adviser, Professor Chris Whitty, to make sure that we make the progress needed.

Junior Doctors Contracts

Thangam Debbonaire Excerpts

Monday 25th April 2016 Commons Chamber

[Mr Hunt]

My right hon. Friend is right; the tragedy here is that what the Government want, which is to eliminate the weekend effect, whereby there are higher mortality rates for those admitted at weekends, is exactly what every doctor wants. We should be sitting around the table discussing how we can achieve a proper, consistent, seven-day service for urgent and emergency care. When it comes to elective provision, that is not part of our plans, although some trusts are operating elective care on a seven-day basis—that is their choice. We are trying to reduce the higher mortality rates for weekend admissions, and that will be at the heart of our vision for a true seven-day NHS.

[Thangam Debbonaire (Bristol West) (Lab)]

Can the Health Secretary name a single medical college that backs his decision to impose this contract?

[Mr Hunt]

All I would say is that every medical college agrees with me that doctors should not withdraw emergency care in tomorrow’s strike, because, as one of my right hon. Friends said, this is a line the medical profession has not crossed before. I do not think it should cross it tomorrow either.

BMA (Contract Negotiations)

Thangam Debbonaire Excerpts

Monday 21st March 2016 Westminster Hall

[Thangam Debbonaire (Bristol West) (Lab)]

Thank you, Sir David, for allowing me to make my first speech on my return to Parliament after a nine-month absence in the care of the NHS. [Applause.] Thank you. Forgive me if I am a little unsure of the procedure. I thank my hon. Friend the Member for Warrington North (Helen Jones) for making an excellent opening speech and other colleagues for their contributions. My constituents asked me to speak in this debate on behalf of patients, junior doctors and other NHS professionals in Bristol West, and I am grateful for the opportunity to do so.

Junior doctors in my constituency told me that they already work in a seven-day NHS, and so do other NHS professionals. Although the subject of this debate pertains to junior doctors, it is relevant to mention other NHS professionals. As other Members have said, pushing this contract onto junior doctors appears to be a proxy for pushing for a fully seven-day NHS—indeed, that is what Government Members seem to be hinting at—so it will affect all NHS professionals.

I have had a lot of opportunity recently to observe at first hand, and at close quarters, over nine months how hard NHS professionals, including junior doctors, work and how dedicated they are to all of their patients. During my treatment for breast cancer, the radiology department found just after Christmas that it was under severe pressure. There was a backlog of patients who all needed daily radiotherapy. I was one of them. People cannot just wait for radiotherapy to happen; it has to happen when it needs to happen. The staff worked out a way of meeting patient needs by offering extra appointments at evenings and weekends. Indeed, I went for my radiotherapy at 8 o’clock in the morning on a Saturday, such was my dedication to my treatment.

Much more important than my approach was what the staff did. The doctors went out of their way to help and advise me and other cancer patients. For instance, I received text messages from my surgeon over a weekend and inquiries on my progress following an infection from a breast cancer nurse in the evenings. All the staff seemed to me, and to the breast cancer and other cancer patients around me, to routinely go out of their way to meet patient needs.

All of that is by way of explaining to Government Members that my experience and that of other patients is that NHS professionals are dedicated, professional, caring and willing to be flexible about working over seven days. As other hon. Members have said, there already is seven-day care for patients. The junior doctors I met individually in Bristol West confirmed that that was the case, and the BMA representatives I consulted told me that they wanted a negotiated settlement. The Secretary of State appears not to understand that there are more than 56 medical specialties, each with different work patterns. They all need rostering, and they do not all work in the same way. Lab technicians, nurses and others, such as receptionists and cleaners, would all need to work weekends for the proposal to work. I have not seen any sign from the Conservative party that the Government would provide funding for that. If they would, I urge the Minister to tell us about it.

My overwhelming conclusion is that the Government do not seem to be aware of where they are starting from or where they are going to. They definitely do not know how to work respectfully and honourably with the people they need to work with professionally to make the changes they want to make, whatever they are.

[Rachael Maskell]

My hon. Friend is making an excellent speech. On the delivery of a seven-day service, where are the professionals going to go, as we have a recruitment crisis and have to use agency staff?

[Thangam Debbonaire]

I thank my hon. Friend for that excellent point. The Opposition are only too aware of that.

[Catherine West]

May I say that my hon. Friend is making a moving and eloquent speech? I am almost tearful that she is so well and back with us. Were it not for the NHS and its wonderful staff, she might not be with us today. I thank her for being here and for making such a beautiful speech.

[Thangam Debbonaire]

I thank my hon. Friend for her support. I will try not to get too emotional, although I find it difficult when I think of the impact that NHS staff have had on my life and what a difference it would make to have a Government who are truly dedicated to meeting the needs of patients. My hon. Friend reminded me of something that I did not write in my notes. In 2000, the Labour Government introduced the first ever national cancer strategy, to which I owe my life.

I met professionals in Southmead hospital, just outside my constituency, where I was treated, and in Bristol royal infirmary, in the heart of my constituency. I have met professionals individually and I received letters from them in my constituency postbag. They want only the best for their patients, of whom I am still one. They go out of their way seven days a week—evenings, daytime and weekends—to do that. I do not have command of the full statistics, facts and figures; I can only argue from the heart. I urge the Secretary of State to get back to the negotiating table. Most importantly, please go there to negotiate, not to dictate. Our NHS, NHS professionals and, most importantly, NHS patients—of whom we will all be one some day—deserve nothing less.

Health and Social Care

Thangam Debbonaire Excerpts

Tuesday 2nd June 2015 Commons Chamber

[Thangam Debbonaire (Bristol West) (Lab)]

Thank you for calling me to make my maiden speech, Mr Deputy Speaker. I congratulate the hon. Members for Central Ayrshire (Dr Whitford), for Vale of Clwyd (James Davies) and for Eastbourne (Caroline Ansell) on making their maiden speeches. I am sure that everyone present will join me in congratulating them on their most heartfelt and eloquent statements of commitment to their constituents and constituencies.

Members will not be surprised to hear that I too am rather proud of my constituency, Bristol West, but I will begin by paying tribute to my predecessor, Stephen Williams, for his diligent service to Bristol West and his constituents. I was particularly impressed by his commitment to equalities, human rights and fair trade, causes for which we both share passion. I wish him well in the future.

I would like to go further back and thank Valerie Davey, who was elected Member of Parliament for Bristol West in 1997. Her work in helping to establish the education maintenance allowance transformed the lives of thousands of young people, helping those from low and modest income families who would otherwise have found it difficult to manage financially to stay on at school or college. Sadly, this has now gone.

Even further back is Mr William Waldegrave, who was lobbied by many in Bristol West, including me, to take a stand in Parliament against the provisions in section 28 of the Local Government Act 1988, which banned what was then called “promoting homosexuality” in schools. This hated provision held schools back from supporting and protecting many young people, to the detriment of their mental health. To his credit, Mr Waldegrave listened to us, his constituents, and he acted in this place. As he was, as I am now, privileged to represent Bristol West, a constituency with a significant proportion of lesbian, gay, bisexual and transgender people, I commend him for so doing.

My most famous predecessor, however, is of course Edmund Burke. A favourite quote attributed to him is that

“All that is required for evil to flourish is that good men do nothing.”

This quotation cannot be fully verified as Burke’s own words, and I hope that during my time in this House I, too, should be so handsomely misquoted.

My constituency of Bristol West is wonderful. People are buzzing with activity and activism on causes from gay rights to climate change, from food waste to renewable energy, and of course on the NHS. The vibrancy is palpable in business and enterprise, in creativity and music and the arts, new media and old, innovative restaurants and well-tended allotments. There is street entertainment, street stalls and street art of high quality. Do come to Bristol West, Mr Deputy Speaker, and I will take you on a tour of the greatest works of Bansky and co.

Yes, Bristol is a fun city and a festival city, with festivals of one kind and another, from balloons to boats, pretty much every weekend in the summer. Thousands of people walk the streets for the sheer pleasure of looking around, and looking around is indeed a pleasure. From any stroll around my constituency of Bristol West, with listed buildings including Elizabethan almshouses, a well-preserved Norman arch, 17th century Christmas steps, John Wesley chapel, Brunel’s Temple Meads station and his suspension bridge, any visitor will know they are somewhere special.

Yet we also have poverty—poverty that can be seen in the streets less well-visited. There are rough sleepers. Some have been there so long I know their names. We try to look out for them and we want to see them better off. Others live in hidden homelessness on friends’ sofas, not knowing when they will be rehoused due to a chronic housing shortage and a lack of cash. In parts of Bristol West there is rising child poverty. In one ward, Lawrence Hill, more than half the children live in poverty despite the best efforts of their parents, who struggle to get by on low-paid, part-time or zero-hours jobs. This is shameful. Children growing up in poverty miss out for the rest of their lives. They are more likely to suffer poor health, with damp, unsafe and unhealthy housing, air pollution and other problems all contributing to shorter life expectancy.

As well as poverty, poverty of opportunity affects an entire generation of school leavers, 20-somethings and 30-somethings. These are young people from across the constituency who feel that they cannot get started properly. They tell me of insecure jobs, sky-high rents and little hope. Their parents—whether they are on low incomes or modest incomes, or are better-off—fear for their children’s future and wonder if they will ever have grandchildren. This will store up trouble for our health and social care systems when this generation of young people reach their later years. This is a shocking indictment of the extent to which we do, or do not, share our wealth in this country. In the 21st century we cannot and should not stand by and just wait for things to get better. Things only get better when we act. Why, if the nation gains in wealth, do we not all gain? Why is wealth so unevenly and unfairly distributed? In my time in Parliament, I hope to find out both the answers to these questions and the solutions to the problems, and I will play my part in solving them.

To return to one of Bristol’s most famous sons, Isambard Kingdom Brunel, and his suspension bridge, if one stands on the bridge in a howling gale one can feel it move. Engineers tell me that this is safer than a rigid structure which would sooner or later snap. But Brunel did not know that—he could not be sure. So he over-engineered, just to be sure that all the people crossing the bridge would be safe. This principle, of building safety into a structure, is surely one we should all apply to protecting our health and social care and other public services, and to standing up for all the people in all our constituencies.

My father came to this country by sea in the late 1950s from what was then called Madras and is now called Chennai. My mother, who is here in the Gallery today, came from the working-class end of Oxford. Her parents were trade unionists, co-operators and lifelong Labour activists.

People can measure just how British I am by the fact that—sadly, and in common with so many of us born in this country—the only language I speak fluently is English. But in my constituency in the city of Bristol, 91 different languages are spoken and there are people from 50 or more different countries of origin, a quarter of whom are from black or other minority ethnic backgrounds. I am proud to be the first non-white MP in any of the four constituencies of Bristol.

I bring to this House a quarter of a century of experience in work to prevent domestic violence. I started out as a professional cellist and I have a personal interest in promoting the needs of people on the autistic spectrum. I look forward to contributing these experiences, knowledge and interests to the work of this House. I am proud that I help to bring the proportions of women and people from the global ethnic majority closer to making this place more truly reflective of the country we serve.

I seek to earn the trust of the 126,000 or so people in Bristol West, and to be measured by my contribution to ending poverty, tackling climate change and promoting equality, as well as by how hard I work for the people of Bristol West, who I will work for with care and determination.

Mr Deputy Speaker, I thank you for your indulgence and I thank this House for its kind attention.