Thursday 10 March 2022
[Judith Cummins in the Chair]
Covid-19: Deteriorating Long-Term Health Conditions
I beg to move,
That this House has considered people with deteriorating long-term health conditions during the covid-19 pandemic.
It is a pleasure to see you in the Chair, Mrs Cummins. I thank the Backbench Business Committee for allowing time for this debate on what I believe is an important topic: dealing with the deterioration in people with long-term conditions during the covid-19 pandemic. On several occasions in Westminster Hall and the Chamber, we have discussed the various impacts of the pandemic on the health service and various sections of society, but this issue has not been highlighted before, so I am grateful for the opportunity. I thank hon. Members who have supported the debate.
It is worth remembering that we are dealing here with a range of conditions, and I refer to my entry in the Register of Members’ Financial Interests. As Members know, I have a family interest in rehabilitation for survivors of stroke, which I will certainly touch on. However, we are not simply talking about stroke. There are many other conditions that affect people, including cardiovascular conditions, neurological conditions such as multiple sclerosis, and cystic fibrosis—to name but a few. They have all been affected in one way or another by the consequences of the pandemic. That is why a number of the organisations who support people with such conditions—I am grateful to various charities, to which I will refer in a moment—have come together to assist us in bringing together some information for the debate, which we think needs greater public airing.
There are hundreds of thousands, if not millions, of people in the UK with long-term conditions, which range from stroke and dementia to Parkinson’s and spinal injury. They have all been particularly affected, and often acutely affected, by the pandemic. Sadly, some people have lost their lives during the pandemic, and we must be honest and recognise that. Some people may be clinically vulnerable as a result of their condition. In other cases, people will be more vulnerable because of other factors that are linked to their condition. In both circumstances, however, they have suffered because of the effects of the pandemic, and we need to turn that situation around.
We all know that, for many people in society, the lockdowns and other restrictions that we had to have meant social isolation and the suspension or adaptation of things that they were used to doing. However, the pandemic has had a much greater impact on people with long-term conditions than on the rest of us, because it meant missing out on crucial support from informal carers—the family and friends who come in and help—and fewer opportunities to use the cognitive, physical and social abilities that are so important for rehabilitation. Trying to keep one’s mobility going is one example. If someone is unable to do that for a number of months, it is inevitable that the situation can deteriorate and the adverse effects of the condition progress. That is a real and measurable impact.
Some conditions are progressive, meaning that they get worse over time, whereas others are not. However, even where they do progress over time, it does not mean that the level of progression of the condition cannot be arrested and delayed with support and therapy. It can make a difference for everyone.
Of course, there is an impact on mental health as well as physical health. For example, the Stroke Association’s research suggests that 69% of stroke survivors feel more anxious and depressed than before the pandemic. Similarly, people suffering from MS and other neurological conditions have found it tougher during the pandemic. Some 29% of people with MS have had appointments cancelled or delayed, and 53% said there had been a reduction in specialist support.
The British Heart Foundation has raised particular concerns, to which I am sure we will return, about delays in diagnosis and treatment for people with heart conditions. That includes preventive measures—diagnosis and then drugs that can prevent worsening cardiovascular conditions.
The situation is similar, too, for people in the UK living with cystic fibrosis. It is a smaller number—some 10,800 in the UK—but again, they are particularly vulnerable. Many found that specialist staff with respiratory expertise were being redeployed elsewhere, which created challenges for the specialist units dealing with them. People have had real difficulties right across the board.
The pandemic also meant the suspension of many community rehabilitation services. That is important, because those services are often delivered by a range of therapists. In the case of stroke, for example, that will involve physiotherapists, speech and language therapists, clinical psychologists and occupational therapists. For other conditions, people will have dieticians, podiatrists and others. Community rehab services underwent an enormous change in the pandemic, and with many staff being redeployed elsewhere, we need a strategy for getting them back. We need a strategy right across the piece for recovery from the pandemic in relation to these long-term conditions. I have made calls in this House in the past for a long-term strategy and plan to deal with stroke, but the same applies to many of these other conditions too, and they all ought to be linked together.
In the case of stroke, about half of stroke survivors had therapy appointments or home care visits cancelled, and of course many people—this applies to other conditions too—felt unsafe going into hospital for appointments, so we need to be catching up fast. Virtual therapy can work in some cases. For example, my wife’s speech and language therapy was able to be done online to some degree, but she cannot do the physiotherapy online in the same way, which leaves a significant gap. If I may, I will start with stroke and then move on to the other conditions, simply because stroke is the one that I am most familiar with.
The rehabilitation for stroke survivors is just such an important part of the pathway. We sometimes think of it as something that happens only in the first weeks and months after a stroke. That is not the case. Research increasingly shows that, with good rehab, people can continue to improve over a significant number of years after their stroke. Unfortunately, we are not delivering the level of services for the length of time that we would wish and that the Government want to deliver them for. NHS England’s national stroke service model outlines the aspiration for all stroke survivors to receive rehab support for as long as they can benefit from it. It should not be time limited but, as of April 2021, 58% of services were time rather than needs based. That does not seem to have improved; the situation has been made harder by the pandemic.
Of course, not only is rehabilitation important for the individual’s quality of life but it makes a cost saving. If we could get more people on the stroke pathway receiving early supported discharge rehabilitation, that could save about £1,600 over five years. That may not seem a vast amount, but when we think about the significant number of stroke survivors in this country, it is a really worthwhile saving, even in relation to that one condition.
We have done great work in improving acute stroke care, but what we have not done at the same pace is keep up with the rehab and life after stroke. That has been the Cinderella end of the service, and I think that that is true for many other conditions too. There was a lack of consistent provision even before the pandemic, and unfortunately the pandemic has made that situation worse.
I will quote one stroke survivor’s carer referring to what happened after their family member’s stroke in early 2020:
“My mum has severe dysphasia and with no speech therapy for 5 weeks while with me, and limited speech therapy while in hospital, her progress is not what it should be. This is severely impacting on her recovery and wellbeing.”
I know personally the importance of consistency in speech therapy and other matters. A stroke survivor says:
“I have felt my mobility worsen as my usual exercise activities were not available”.
Nobody disputes that some restrictions were necessary. What I am saying now is that we need to have an urgent plan, with funding behind it and a set of measures and goals, and a means of measuring attainment of those goals, to ensure that we catch up across the piece.
The latest snap figures suggest that we are struggling to meet even our own aspirations. Just one third of community rehab teams meet treatment time targets. Over 43% have waits of 15 days or more and, alarmingly, stroke survivors wait, on average, 10 weeks to see a psychologist. One of the things that people really do not appreciate about strokes is the significant psychological impacts that can occur. Unless we get the psychological issues resolved as best we can, that has an impact on the survivor’s ability to get the maximum benefit from the other therapies available. That is why it is really important. There is a real opportunity to join those various things together, to allow people to regain the skills that they have lost, and to hone and keep the skills that they retained after their stroke, or other condition. That would bring both social and economic benefits for all.
Community rehabilitation services for all these conditions have been hugely overstretched. Just 17.3% of stroke patient received the guideline recommended levels of support in 2021. We have discussed in the House before the real problem with a workforce strategy. Allied health professional representative bodies have all said that they are willing to step up to the plate, but they need the numbers. It is particularly difficult to get speech therapists, neuro- psychologists and so on. We need to do more on that.
I recognise that the Government are doing a lot more to improve things in many areas of the NHS, but we need to do that on rehabilitation as well. In addition to the other benefits that I listed, rehabilitation ultimately means fewer visits to GPs, less delayed discharge, and less demand, in the end, for acute care in the health sector and for social care as people get older and struggle with other issues. It reduces demand right across the piece.
The 2021 paper “Moving forward stronger” had contributions from some 20 charities and professional bodies representing a range of conditions. It was headed up by the Alzheimer’s Society, which called for a fully funded national rehabilitation strategy to run for two years, and for the NHS to appoint a national clinical lead to implement it. I welcome the fact that NHS England has appointed Jennifer Keane as its first director of rehabilitation. That is good news. The devolved Administrations do not yet have one; I hope that they will soon follow that example, and that this debate will enlighten some of the priorities that I hope the new director will have in drawing up her programme of work. We ought to have strategies for rehabilitation in local areas, as well as at a national level, to ensure that things are delivered on the ground. We have part of it but, although we have the director, we do not as yet have the strategy for her to work to and implement. That is the bit that I hope the Minister will assure me is coming next.
I referred to strokes, but I will touch briefly on some other conditions. I mentioned MS, which affects about 130,000 people in the UK. If we look at neurology overall, about one in six people in the UK is living with a neurological condition of one kind or another. Again, management throughout the pathway can really improve outcomes for people with those conditions. I mentioned the number of MS appointments that were cancelled. One in four people surveyed by the MS Society had not seen an MS nurse or neurologist in the past 12 months but needed to, so there is a glaring gap in provision.
I talked about a workforce strategy. Here is another area of the workforce. Adjusting for population, France and Germany have over seven neurologists for every two in the UK. We need to up recruitment into those specialist skills. That is a significant difference from our two largest and nearest comparative western European advanced economies. There should not be that level of divergence between us and France and Germany.
An audit of 51 UK MS services in 2020—while the pandemic was going on, but before the whole consequences had worked their way through—found that, on average, neurologists had caseloads of 1,815 patients with MS. The recommended caseload is 615, but the average caseload is nearly three times that recommendation, demonstrating the need to redouble our efforts on workforce. Some 64% of professionals said that it was not only recruitment that was an issue, but also staff leaving the neurology workforce. We need a strategy for recruitment and a strategy for retention.
For stroke services, when my wife was in the rehab unit, we could see quite a marked turnover of staff. They were good people, but we were unable to keep them, unfortunately, even in a trust with a specialist unit and rewarding work, very close to London. The situation is probably even harder in other parts of the country.
For many people with cystic fibrosis, the isolation has been particularly acute, because of their particular vulnerabilities. They had to shield as they were at acute risk. That has made it harder to bring forward their return into society. The Cystic Fibrosis Trust awarded 713 covid-related grants between April and September 2020, including 101 due to loss of work, and 96 due to financial difficulties, because people were unable, due to the need to shield and the lack of support, to carry on as they were otherwise doing. We cannot condemn people to that twilight situation for very much longer.
Finally, I turn to cardiovascular conditions. I am plucking out only four conditions, but there are others. We could talk about Alzheimer’s and dementia, and many other things—perhaps other hon. Members will.
The British Heart Foundation suggests that in the first year of the pandemic England saw around 5,800 excess heart and circulatory disease deaths—some because of medical factors, but some because of the difficulty in getting acute treatment. Beyond that, there are 61,000 people in England who had been waiting more than six weeks for an echocardiogram—a heart ultrasound—at the end of November 2021, which is 20 times than before the pandemic. The Minister may have more up-to-date figures, and I hope she will be able to tell us that they are coming down, but, if not, we need a strategy to make that happen.
Analysis from the Institute for Public Policy Research found 470,000 fewer new prescriptions of preventive cardiovascular drugs were issued between March and October 2020 compared with the previous year. That potentially translates into 12,000-odd extra heart attacks over the next five years or so that might otherwise be preventable. If people are not diagnosed and given the preventive drugs, the risk of acute attack becomes that much higher.
NHS England’s statistics show that the number of people in England waiting more than six weeks for a diagnostic echocardiogram had climbed to 64,962—very specific—at the end of September. The key point is that that is 44% of those waiting. The number fell slightly by November, to 61,000, and I wait to see how much more it has fallen by now. At the end of February 2020, there were 3,238 people waiting. That is a massive jump, demonstrating the scale of the mountain we have to climb to get back to where we are before the pandemic. At the end of December 2021, in all, some 300,000 heart patients were waiting for care of one kind or another, be that emergency, urgent, elective or routine, in so far as anything is routine in such treatment, and some 29% had been waiting for more than 18 weeks.
I know the Government do not want that to be the case. They have real ambitions to reduce such waiting times, as I think all parties in this House do, but the point of this debate is to highlight how significant the issue is to make sure it is no longer the bit of the health service that gets forgotten about because it does not grab the headlines in the same way that waiting lists for acute care, operations and other things do. It is just as profoundly important for people’s lives, the lives of their families and for the community as a whole. That is why I am grateful for the chance to raise these issues.
I hope the Minister will respond and set out what the Government intend to do by way of a specific strategy and set out a timeframe, its objectives, how it will be implemented, how its success will be measured, how it will deal with the workforce, and how funding will be made available. I hope that we will have a useful debate going forward, Mrs Cummins, and I am grateful for the time to put these matters before the House.
It is always a pleasure to serve with you in the Chair, Mrs Cummins. I thank the hon. Member for Bromley and Chislehurst (Sir Robert Neill) for opening the debate and for putting a lot of material as well as a lot of data before us to consider, which is incredibly useful. I am also indebted to the Backbench Business Committee for allowing today’s debate to go ahead.
Even pre-pandemic, there were many challenges for people with long-term health conditions and their management. There was a really good focus on the acute phase, but as people moved into the more chronic phase of their illness, the amount of rehabilitation and support individuals received waned. It was dependent on geography, where someone lived, and on how many in-person interventions they had. Through that time people’s baselines lowered as their function decreased, but it did not need to decrease. That is why it is so important to look at the issue today.
I echo the remarks of the hon. Member for Bromley and Chislehurst on prevention. Of course, prevention is always better than cure, and having a strong public health strategy is crucial. In the acute and early intervention phases, many people missed out during the pandemic. We think about delays in diagnosis, the scale of treatment that people had because clinicians were placed elsewhere, and the value of input. We have talked about strokes today, and people having fewer rehabilitation sessions and less intervention from some of the leading clinicians, which meant they did not leave hospital at the same level that perhaps they did pre-pandemic. We need to pick that up now.
Early discharge has put more pressure on achieving a good baseline for somebody to move into the more chronic phase, the longer phase, of their rehabilitation. We know that once somebody goes home they do not have the physio nagging them every day and telling them to do certain things, so their function deteriorates unless there is good community intervention, which is what I want to focus my remarks on today.
We are talking about a broad range of conditions—neurodegenerative and other neurological conditions. The hon. Member for Bromley and Chislehurst set out some of those, but we can think about motor neurone disease, where time is simply not on your side, or Parkinson’s, where intervention is really important to ensure people maintain function.
We have learnt a lot about respiratory conditions over the last two years with covid, and suddenly lungs have come into central view. Cystic fibrosis has been mentioned. Chronic obstructive pulmonary disease is a condition that really does need good management in the community. There are cardiovascular, psychological and other conditions. We must remember that comorbidity is an issue that impacts on and intersects with many conditions. Somebody who has a combination of COPD and Alzheimer’s will often not remember or be able to steer the management of their condition. As a result, they are perhaps more susceptible to getting an infection and then finding it difficult to clear their lungs or to follow whatever treatment is prescribed, so they are more at risk and early morbidity is a serious risk factor. Therefore, we need to consider these issues in that context.
As I said, intervention at the acute phase of a disease can be intense, but it is about what happens next. We know that often there are not enough rehabilitation beds available to continue someone’s treatment. I have always argued that the convalescent stage is also really important for people to build their confidence, which is often what is needed after the acute stage. That is where the biggest challenge lies.
As the hon. Member for Bromley and Chislehurst outlined, some services have been able to be delivered through new mechanisms, such as Zoom, that simply were not there before. However, as a physiotherapist myself who spent 20 years working in this area, I must say that I would find stroke rehabilitation very difficult on Zoom, and anything involving respiratory medicine as well, because it is all about diagnosing and treating people through the physiotherapist’s hands. Body-to-body contact is absolutely crucial in the development of interventions. Clearly, the lack of it has impeded people’s rehabilitation and had an impact on it. It is not just physiotherapy or occupational therapy that are affected; other services, from dietetics right through to psychological therapies, are also affected. For somebody who is already impaired, face-to-face contact is vital, particularly if they are neurologically impaired and have just had a new diagnosis. Therefore, the risks of a patient regressing and not reaching their baseline, and then regressing further from that, are even greater.
The NHS is in some ways now coming under greater pressure than it did during the covid period. My concern is that the focus, politically and clinically, will be on the elective list and those numbers—we will drive up those numbers for sure and the Government will look at them—and will move on to dealing with acute care as it appears and to dealing with the elective backlog. GPs will of course make the same call, saying, “Look at our waiting lists, look at what is happening here.” Consequently, people with long-term conditions will be squeezed out of the system. That is why I am really grateful to the hon. Member for securing this debate. People absolutely need intervention. Without it, their progress and even their functions will decrease, and that will put even more pressure on both social care and the health system. The debate today is therefore really timely, allowing us to consider the new pathways that need to be created in order to support people with long-term conditions. They have been the poor relation for some time and we cannot let that situation continue.
In the last decade or so, Labour in particular has been looking at pathways that could be developed, such as the expert patient, which enabled people to have control and management of their own disease. Enabling the patient to lead wherever possible is really important. New technology has come on board. Under this Government there has been a particular focus on how new technology can help to provide support, measure things and move medicine forward. All those interventions are absolutely welcome, but they should not detract from the importance of the physical interventions that are necessary. We must ensure we maintain that baseline, so that if somebody does regress, we can give them an injection of rehabilitation to get them back up again to their normal functioning. It is really important to do that in a timely way.
I very much look at this issue from a physical perspective because of my professional background, but I recognise that people with other clinical expertise and competencies will look at their particular field and the need that particular types of intervention. As the hon. Member said, it is right that people have the correct balance between physical and psychological health, and they have to be brought into one space. Sadly, if someone has a physical diagnosis, the psychological aspect is often left behind, because doctors are looking at the primary root of someone’s condition. We must look at people far more holistically than we do currently.
I therefore want to set out a four-stage rehabilitation service to support the physical and psychological needs of people living with chronic ill health. Taking that approach forward will need funding and a workforce plan, which the Chair of the Health and Social Care Committee, the right hon. Member for South West Surrey (Jeremy Hunt), has been incredibly powerful in calling for. I see a concept in which the first phase looks at assessment and measurement, the second at self-management, the third at therapeutic interventions, and the fourth at the psychosocial support, which is also needed.
First, interventions clearly need to be individualised. Everybody is unique in their presentation. We need to recognise that there is an opportunity to develop the service not only in domiciliary settings, but in rehab settings and, for some, in group settings. We have lost some of the collective healthcare that is important for not only the socialisation of health, but the encouragement from one patient to another. We have to capture that again. Often, a patient will be encouraged by seeing somebody else doing what they want to do and that will spur them on to go that little bit further.
Secondly, we have to look at patient management and how people enter services. It should be a given that patients will continue with their interventions once they leave formal healthcare settings. We need to make sure there is a continuum of regular assessment and monitoring. For some individuals, some of that assessment and monitoring can be done at home, but some of it will need external intervention.
Thirdly, regular support may not always require an intensive burst of intervention—sometimes it will—but if it can enhance function, it does need to be examined. I looked at some statistics provided by the Chartered Society of Physiotherapy. Only 15% of people with lung disease deemed eligible for pulmonary rehab are able to access it, which is quite shocking and we really need to address that. Some 50% of people eligible for cardiac rehab cannot access it. From running cardiac rehab classes, I know how people gain confidence from rehab to do things they never thought they would be able to do. They no longer live in fear, but live a confident life.
One in five people receive post-hip fracture rehab on discharge. I know of many cases where all the money is spent on repairing somebody’s hip or getting them a new hip, then getting them up, standing and walking in hospital, only for them to go home and just sit in a chair. Those patients then become fearful, which means social care has to come in, costing the NHS and the care system. It also means that somebody loses their independence, which is the biggest cost of all. This issue needs to be addressed.
Some 44% of people with a neurological condition do not access the services they need. We have a big amount of catching up to do. The biggest thing is that if somebody loses their confidence there is a rapid decline. We must remember that many of these people are elderly and live on their own. They do not have the interventions and the injection of hope that they need. We are talking about life-changing events—people’s whole world is reoriented. We need to make sure that patients maintain social connection, where possible, and are able to access that support.
Waiting lists for elective treatment have become so long. I cannot remember if we are at 6.2 million people or more, but with those kinds of figures many people will need additional support—for example with their diet, or they may be less mobile—so as not to trigger other thresholds that further delay their surgery. It is important that people do not become sedentary and that they have the support they need. If people have a lung disease, it is important that they do not increase the damage to their lungs, lose function or become psychologically impaired, because it is then harder to regain function. We do not want to see people spiralling, which can happen very quickly. Once people get into that place—which is not a great place to be—it is much harder to get people back, so let us really focus on that area.
Fourthly, I want to talk about people living with chronic conditions. Often, people get locked into a space where their life has changed so much that they become more isolated. They lose those social connections, and they also lose their ability to move forward. That might be because, for instance, they have lost their speech, or they might not have the same ability to communicate with people in all sorts of ways. We need to look at how we bring social prescribing into this agenda, as well as the voluntary sector and community support, which is necessary. I want the Minister to look at different pathways to bring that whole family of measures together. Often, we have isolated that into the various parts of someone’s body or mind, as opposed to looking at the person holistically.
Of course, if someone is more isolated, they may experience more loneliness and that impacts on anxiety, depression, motivation and function. People’s skills and confidence then decline even further. We need to ensure the programme has the resources it needs. People are whole beings, and we need to recognise that in our health systems. For too long, we have talked about arms and legs or lungs and brains, but we do not talk about people, and it is people who need that support. If we can look at such a model, we need to think carefully about how we socialise our health system.
I have been looking, in a completely different context, at fostering. There is a programme called the Mockingbird programme. I do not know if the Minister has heard of it, but groups and different people come and support the family. It may be an individual, a partner and their carer, or a family unit. They get that more community- based support. In the context of fostering, it is different families, so there is that concept of a community raising a child. Why do we not look at that for later in life for people with chronic conditions and for how we can provide support? Carers are often with their partners for weeks at a time with hardly any social interaction, and that can be quite telling if someone has an acute psychological condition as well.
Much more can be done for carers, as well as patients, as we move forward. We need a strategy, a workforce plan and funding. In this new world of integrated care partnerships, we have an opportunity to deliver that. July is day one. That is the moment to break out of the past which has let down people with long-term health conditions and move into a new era. I very much hope the Minister will be able to bring that forward.
It is a pleasure to serve with you in the Chair, Mrs Cummins. I congratulate my hon. Friend the Member for Bromley and Chislehurst (Sir Robert Neill) on securing the debate and thank the Backbench Business Committee for granting it. I join colleagues in thanking a coalition of charities and organisations that have come forward to support us with research and briefings in advance of the debate, particularly the “Moving forward stronger” policy paper.
Prior to being elected in 2019, I also had a background working in the national health service. Never in my wildest nightmares could I have imagined so early on in the job, after leaving the NHS, that we would be dealing with a global health pandemic on the scale of covid-19. It has permanently changed the way we look at and plan health and care services in the UK. In the London Borough of Sutton, where my constituency of Carshalton and Wallington is situated, 600 lives were tragically cut short due to covid-19. I am sure that that number would have been higher had it not been for the dedication, bravery and care of our local health and social care services.
I know that hon. Members across the House have the deepest gratitude and thanks for the unsung heroes. They were not just our doctors and nurses, but associated health professionals, pharmacists, volunteers and all those who stepped up to do their part. Part of the reason why I launched the Carshalton and Wallington unsung heroes scheme was to recognise their dedication. Unsurprisingly, our local health and care volunteers and staff featured heavily among the hundreds of nominations that I received. I cannot possibly name them all, but I would like to thank the St Helier Hospital eye treatment team; Reena, Sanja, Ravi and other local pharmacists; the head of occupational health at Epsom and St Helier University Hospitals NHS Trust; and of course the staff at vaccination centres across Carshalton and Wallington.
At the time of the outbreak of the pandemic, there was very little public discourse—understandably, as we were grappling with something that was unprecedented—about the long-term indirect impacts of the pandemic on our health and social care system. I know that I am not alone in receiving thousands and thousands of cases from constituents during the opening weeks of the pandemic and at its peak, when there were way too many incidences of people with long-term and pre-existing conditions experiencing disruption to their care. Many of them experienced much faster deterioration than would be usual or expected, and I hasten to add that it was through no fault of health and social care staff; it was simply because of the situation that we faced.
Some of the constituency cases that I heard of involved people with long-term cardiovascular problems who were unable to get treatment, spinal cord patients who were not able to be housed appropriately, and people with dementia and Alzheimer’s who were cut off from the social interactions that were crucial to keeping their cognitive and communication skills alive. As an officer of the all-party parliamentary group on dementia and someone who has had personal experience of dementia in my family, I would like to focus on this area.
In the London Borough of Sutton there are over 2,400 people living with dementia. Based on recent trends, it is estimated that well over 3,000 residents over the age of 65 will be living with dementia by 2030—an increase of approximately 25% in a very short space of time. There are almost 1 million cases of dementia nationwide. People with dementia were badly hit by the pandemic, as indeed were many people with long-term conditions. Dementia was the most common pre-existing condition for people who died from covid-19: people with dementia accounted for more than a quarter of all covid-19 deaths in England and Wales during the first wave of the pandemic.
However, the effect of the pandemic on people living with dementia goes far beyond the statistics. Tragically, they have also seen accelerated progression of their conditions, for a number of reasons. We know that social contact is very important for people living with dementia, but it was of course restricted—again, for a very understandable reason. That has exacerbated the issues for people living with dementia. For people living in care homes, where more than 70% of residents have a form of dementia, the restrictions were particularly serious, given that the Office for National Statistics estimates that 97% of care homes were closed to visitors at one point.
People with many long-term conditions, including dementia, rely on rehabilitation services to maintain their skills and abilities. When provided with the right support, rehabilitation services can help people living with dementia to maintain their cognitive, social and emotional skills, as well as meeting their physical needs and any other related conditions. As mentioned by my hon. Friend the Member for Bromley and Chislehurst and the hon. Member for York Central (Rachael Maskell), those services were not able to meet everyone’s needs at the height of the pandemic. That was particularly true for people living with dementia, whose condition often makes it difficult for them to engage digitally, even if the service could be provided that way, which means that many people living with dementia have not been able to preserve their skills in the way that they could have done. That is exactly what happened to my constituent’s mother who is living with dementia and saw a dramatic deterioration during the first wave of the pandemic, suffering severe memory loss by the time she could meet her family again.
For those living with dementia, interaction with family is not just a nicety. It actually forms an integral and formal part of their care and treatment plan, as there is a causal link between lack of social interaction and the worsening of the condition. As we now emerge from restrictions and come out the other end of the pandemic, the long-term impact on the NHS, the care sector and people living with dementia will continue. I welcome the determination shown by the Department of Health and Social Care in dealing with the elective backlog. It is a mammoth task.
I also want to congratulate my own local NHS trust—Epsom and St Helier University Hospitals NHS Trust— for the work it has done. Previously, I welcomed the announcement of £500 million both to upgrade Epsom and St Helier hospitals and build another hospital in the London Borough of Sutton. I particularly want to applaud the trust’s ingenuity. As soon as it realised the scale of the pandemic, it had the foresight to amend its plans for the development of the new hospital to ensure that it can future-proof itself against future pandemics.
I believe we need to see determination from the Department to deal with the backlog of deterioration that we have seen among those with long-term conditions. I join colleagues and the coalition of charities and organisations in support of that national rehabilitation strategy for everyone who has seen their long-term condition progress throughout the pandemic. If planned properly, the rehabilitation strategy is an opportunity to reduce pressure on other services in our health and social care system.
Colleagues will have heard plenty of examples of people in their constituencies ending up in hospital needing round-the-clock care for entirely avoidable reasons, such as a fall. If we help people maintain the skills they have, they will be less likely to require support from acute care. The Alzheimer’s Society estimates that up to 65% of emergency admissions for people living with dementia could be avoided. Both rehabilitative and memory services are under significant pressure, and the waiting lists are still getting longer. That means that we need strategies to deal with the backlogs. With the right planning, we can not only overcome these issues but deliver better, more personalised support, because people living with dementia deserve nothing less.
It is a pleasure to serve under your chairmanship, Mrs Cummins, and I seem to be doing so regularly. I am pleased to participate in this debate. I want to thank the hon. Member for Bromley and Chislehurst (Sir Robert Neill) for bringing it forward and for setting the scene with the detail and information to help us participate. I am pleased to see the shadow spokesperson, the hon. Member for Denton and Reddish (Andrew Gwynne), and the Minister in their place.
We often parley in this Chamber. Indeed, the Minister, the two shadow spokespersons, myself and others here, including the hon. Member for York Central (Rachael Maskell), are always willing to come to these debates. I am my party’s spokesperson for health, so I am always pleased to speak in health debates. People may say that I speak in every other debate, but that is by the way. If I am spared another hour, I will speak in the next debate as well. Members of Parliament in a small party find that they have more portfolios than most. I have got a lot of issues, and that is why my participation in debates is so frequent.
During the pandemic I repeatedly spoke about the impact on schoolchildren and those who were ill. My fears have unfortunately been realised. We have children with issues catching up on basic education. We have a raft of people who are undiagnosed or misdiagnosed, and treatable conditions have escalated. As the hon. Member for Carshalton and Wallington (Elliot Colburn) has done, I want to thank all health workers—doctors, GPs, pharmacists, nurses, care workers. I also want to thank family members, who gave up a lot of time to look after family members who were unwell. Pharmacists have also been mentioned, and it is important to place on the record our thanks to them. It is because of their industrious efforts that we have all been able to get to the other side of this pandemic.
I would also like to thank the Minister and the Government for what they have done. Covid and the vaccine roll-out enabled us to move toward what I always hoped we would see, and which the Prime Minister has been keen on—a normal life, where we do not react to covid but learn to live with it. That is where I want to be, and I believe it is where the people want to be as well.
There are those who suffer from long-term deteriorating health conditions who have not received the necessary treatment and care. In some areas, people will have had a poorer quality of life because of covid.
I am always reminded of one gentleman in particular, who is a minister of the church in Newtownards—we call him Pastor Mark. He took covid early on and is very fortunate to be in this world. He was ill for a long period of time. He is a young man with a wife and a young family. He suffers from long covid, the deteriorating effects of which are very clear to him. Today he does not have the stamina and energy that he once had. He tires easily. He refers to brain fog. I am not sure what that means, but I understand when he tells me. These are some of the repercussions of the pandemic. The sad fact is that covid has robbed us of so many, and we must rebuild where we can.
Some of those with severe health problems were in a queue to receive treatment. For some, delays were part of the reason for the numbers of those who passed away. I recall with sadness people I knew who were on a list to get an operation or a treatment. They were put to the back of the queue because of covid, and they are no longer here today. That operation is lost and the opportunity for treatment was not given. I cannot say that it would have prolonged those lives, but it would have given a better quality of life and would maybe have added a few years. We must think of all those people who were not able to get the help they needed.
The hon. Member for Carshalton and Wallington spoke about dementia. We had a debate on dementia in Westminster Hall some time ago. He is right. Probably because of my length of time as an elected representative, I know lots and lots of folk who, over the last period of time, have developed dementia and Alzheimer’s. I see the detrimental effect on their wellbeing and on their families—how dementia and Alzheimer’s robs people of their quality of life and their knowledge of their family members.
A wee lady passed away just this week. Her daughter phoned me on Sunday and let me know. I have known her all my life—she was 94 or 95 when she passed away. She took dementia and she came home. Some things people do remember. One thing her daughter told me on Sunday was, “Jim, she bought the Chronicle every week”—that is our local paper—“and when she saw your picture, she knew it was you, though she might not have known that I was her daughter.” Some things rob people of the very core of their life, and that concerns me.
More than 150,000 had their lives cut short by the virus. As the Alzheimer’s Society, Macmillan, Stroke Association, Age UK and many others have highlighted, across the UK, many people with pre-existing long-term health conditions have deteriorated faster than usual since the pandemic began. The increased rate of deterioration is due to the effects of having covid-19, as well as the measures taken to contain the virus, such as lockdown to reduce social contact and the suspension of rehabilitative services.
During the first wave of the pandemic, maybe professionals who provide rehabilitation were deployed to acute services for covid-19 patients. We understand the logic behind that, but there is an impact and there are side effects, which we are pointing to. Community rehabilitative services moved to primarily offer virtual support. As a result, rehabilitation services were unable to provide the same level of support that they did pre-covid. Community services are vital in helping to support people with long-term conditions. The mental wellbeing of those undergoing treatment for cancer, MS and heart conditions, and of disabled people, was greatly impacted, which gives us some cause for anxiety and concern.
The question for the Minister today, and for my Government, is where to go next. I support the aims of the organisations that produced “Moving forward stronger” and its specific recommendations, three of which I will cover in the timescale that you have indicated, Mrs Cummins. First,
“fully fund a national two-year rehabilitation strategy that ensures people with significantly deteriorated long-term conditions get the therapeutic support they need”.
That is really important. The second is to
“appoint a national clinical lead to implement this rehabilitation strategy”
and thirdly, to
“ensure local partners—such as local authorities and Integrated Care Systems…develop and deliver their own localised rehabilitation strategy, and that each ICS has a regional rehabilitation lead.”
When the Minister responds, I have every confidence that she will be able to reassure us that the things we are asking for today—collectively, but from different parts of this great United Kingdom of Great Britain and Northern Ireland—will be addressed.
I know that the Minister has regular contact with the Minister back home—Robin Swann of the Northern Ireland Assembly. I think that is important. I am a great believer in the Union, not because I come from Northern Ireland and am a Unionist, but because I believe in the Union for England, for Wales, and—with great respect—for Scotland, with equal passion and concern. I would therefore ask the Minister what talks she has had with the Minister back at the Assembly.
I will give a quick plug for those who are waiting for cataract operations, and those who had glaucoma. Do you know what really annoys me, Mrs Cummins? It annoys me that some people have lost their eyesight because they have not had the care within the time when they should have had it. Maybe the Minister can give some reassurance on that.
I finish with this: these are things that I absolutely stand behind. I ask the Minister, to address the possible reasons why Government will not stand behind and implement the “Moving forward stronger” recommendations —although I hope that she will reassure me otherwise. We have people with a quality of life that can be improved with the right strategy, and the document lays a foundation to build on as we seek to repair that which has been decimated—through no fault of Government; it was covid-19 that did it. We are taking the approach that we must live with covid; those people have lived with the side effects it has had on their illnesses, and that cannot be allowed to continue. With that in mind, I very much look forward to the Minister’s response.
It is a pleasure to see you in the Chair, Mrs Cummins. I, too, am grateful to the hon. Member for Bromley and Chislehurst (Sir Robert Neill) for leading this important debate for us today.
I will start with a quote from a doctor in my constituency of Coatbridge, Chryston and Bellshill, who was working throughout the pandemic in University Hospital Monklands’ accident and emergency department. He told me:
“People are presenting with conditions that are unfortunately too severe for us to treat. Covid has caused appointments to be missed and regular health checks to be postponed. The simple loss in social contact with healthcare professionals has created a lasting impact that we are only just beginning to realise.”
Sadly, due to the pressures on our hard-working healthcare professionals and the measures required to prioritise resources towards those contracting covid-19, many of our regular NHS services have been paused or delayed. That disruption and continued backlog will indeed take time to be addressed fully—we know that—but our foremost thoughts must be on how we support our constituents whose long-term conditions continue to deteriorate.
Undoubtedly, the reality is that the greatest support package that any Government can give the sector is direct investment. I am proud to say that, once again, Scotland is showing the way, with the Scottish Government in Holyrood making the Scottish NHS the best-funded health service in the United Kingdom.
In February 2021, the former Health Secretary in Scotland, Jeane Freeman, announced a new community living change fund of £20 million to deliver and redesign a service for people living with long-term illness and complex needs, including intellectual disabilities and autism, and those enduring mental health problems. We know that there are many conditions that we could highlight, as the hon. Member for Bromley and Chislehurst (Sir Robert Neill) did in his opening remarks, and that there will be a legacy of mental health implications for us all to tackle in the wake of the pandemic.
That £20 million funding is the beginning of the Scottish Government’s implementation of the Feeley review—the independent review into social care in Scotland, which delivered many recommendations for the reform of social care in Scotland. The Scottish Government understands that we need not only to make up for what has been lost over the pandemic but to make healthcare provision even better than it ever has been before. We must ensure that nobody who is ill or suffering feels it best that they do not ever go to a hospital; we can never have a repeat of that.
The new Scottish Budget 2022-23 delivers record funding of £18 billion for the health and social care portfolio, which will be used to support the remobilisation of services, as well as delivery on the priorities relating to prevention and early intervention. This is a 20% increase in NHS frontline spending, which equates to £183 per person in Scotland and is 12% higher than the £163 of investment per person planned for England in the coming year. On top of that, the Scottish Government will of course abolish all dentistry charges, eye examination costs and non-residential social care charges for those in need of our support.
My question to the Minister is this: these are simple changes being made through targeted investment decisions, so where is the difficulty in applying such a scheme in England and Wales? The only answer that I can determine is that there is no such difficulty, and that there is simply a complete lack in prioritisation of the NHS and a lack of political will to safeguard the most precious resource that these four nations have to offer.
I had the privilege recently of witnessing another of the Scottish Government’s new schemes and strategies to achieve early diagnosis when I visited Mackie Pharmacy in my constituency. They are one of many pharmacies across Scotland that are taking part in a campaign to promote local pharmacies as the heart of first-contact healthcare services and provision. The development of this “pharmacy first” scheme will relieve the pressures on GP practices and on our accident and emergency departments, by allowing for the diagnosis and treatment of common ailments on a more localised basis.
In addition, the constant contact that our pharmacies have with our communities allows them to identify issues even before people themselves are aware of them. During my visit to Mackie Pharmacy, one assistant told me how she noticed that an elderly lady who regularly comes into the store was not her usual self. After a few exploratory questions about how the woman was feeling and then noticing some changes in her over the course of a few days, the pharmacist recommended an admission to hospital and it was found that she had a serious heart condition. That visit to the pharmacy that day saved that lady’s life. That is how prevention post-pandemic can and should happen. Schemes such as “pharmacy first” will play a vital role in helping us to better support those with long-term conditions.
The Scottish Government are caring for our elderly population in other ways as well, by delivering a new deal for our care sector. The independent Feeley review into social care in Scotland delivered many recommendations for reform. The review estimated that implementing its recommendations, including a national care service, would cost £660 million. The Scottish Government are going further, increasing social care investment by over 25% during this Parliament, which is equivalent to over £840 million.
Among the recommendations of the Feeley review are the creation of a national care service and the scrapping of non-residential social care charges, and we are going to deliver those things. While the UK Government delay, the SNP are taking action right now in Scotland to deliver a modern social care service that is fit for the 21st century. Why not match our ambition or our approach?
I believe that the crux of the matter is that the Government here in Westminster cannot be trusted with the protection of the NHS. How do we protect those who are deteriorating with long-term health conditions after the severest pandemic that this country has witnessed in recent history, when the Tories are geared towards creeping privatisation in England while forcing hard-working families to pay more in national insurance and income tax to access what healthcare remains public?
It must also be noted that even when England’s healthcare provision is so reliant on immigrant workers, the Tories create a “hostile environment” in attempting to drive away the workers they rely on so much. Some workers in England have even left the NHS to work for multinational companies such as Amazon that pay their staff better than the NHS does and have better conditions. These facts speak for themselves.
While Scotland pushes forward with new ideas to deliver a health and social care service fit for the 21st century, the UK Government continue merely to paper over the cracks of their own mismanagement and continue to pursue policies in other areas that actively harm healthcare provision in these countries.
The pandemic is an opportunity for Governments all over the world to look again at the way that things have always been done. I sincerely hope that this UK Government will regard the pandemic as an opportunity finally to look after our NHS and all those in desperate need of its support.
It is a pleasure to serve under your chairmanship, Mrs Cummins.
I, too, congratulate the hon. Member for Bromley and Chislehurst (Sir Robert Neill), both on securing this debate through the Backbench Business Committee and on the powerful and detailed way he opened the debate today. I particularly thank him for sharing his and his wife’s experiences of rehabilitation and recovery from a stroke.
The last two years have placed extraordinary pressures on our healthcare systems, social lives and livelihoods. To protect the NHS, we were forced to make unprecedented decisions and put in place measures to stem the tide of covid-19 infections. We are now in a far better position, and the vaccine roll-out has allowed us to reclaim the freedoms and liberties that we were forced to forgo. However, in the wake of the pandemic, we now face a new challenge—one that will impact the public health of the country for generations to come.
As Members from both sides of the Chamber have passionately conveyed, we face a crisis with long-term healthcare and deteriorating conditions. As health leaders have noted, during the pandemic many professionals who provide rehabilitation services were deployed to other acute services for covid-19 patients. That resulted in reduced support for those with long-term pre-existing health conditions, and worse prognoses as a result. Examples of long-term conditions that have been particularly hard hit are included in the excellent “Moving forward stronger” report, which has been referenced by several Members.
The report, co-authored by charities and organisations including the Alzheimer’s Society, the Stroke Association, Macmillan Cancer Support and Age UK, paints an incredibly stark picture of the current situation in long-term care and rehabilitation. The Alzheimer’s Society outlines an almost 6% fall in dementia diagnosis rates. That puts individuals at risk of further deterioration, as reduced diagnosis ultimately results in reduced access to care. Diagnosis rates are also highlighted by Macmillan Cancer Support, which notes in the report that, as a direct result of the pandemic,
“there are more people being diagnosed at a later stage with more complex rehabilitation needs.”
Diagnosis is just one part of the problem. Cancer waiting times have been in freefall since 2010 and have now reached record levels. When Labour left office, 80% of patients who received an urgent GP referral for suspected cancer were seen for their first treatment within 62 days, which is above the target. Under successive Conservative Governments since 2010, that figure has plummeted. The NHS performance standard of 85% has not been hit since 2014. Right now, almost 30% of patients are having to wait anxiously for longer than two months to be seen for suspected cancer that may or may not be spreading.
That trend is also made clear by the Stroke Association, which highlighted that in 2019-20 only 34% of stroke survivors received guideline levels of physiotherapy and that only 19% received the right amount of speech and language therapy. Is the Minister aware of these statistics, and what is her Department planning to do to address them? Make no mistake: ignoring rehabilitation and long-term care has a massive impact on patients and the NHS more broadly. If we do not provide people with the proper treatment as soon as they need it, they will rely on the health system more and more. Put simply, rehabilitation is preventative.
The “Moving forward stronger” report makes several clear recommendations to the Government. I would be grateful if the Minister gave an assessment of these in her response. In particular, I would be interested—as I am sure other Members would—to hear her thoughts on the recommendation to ensure that each integrated care system has a regional rehabilitation lead and that a national clinical lead is appointed to implement a national rehabilitation strategy.
I think there is a consensus across the Chamber that we need to get a grip on long-term health conditions and that these issues have probably been neglected for far too long. They had not been brought into such public view before covid-19 hit, but it is important that we work across parties to ensure that they are dealt with.
I want to touch on something that the hon. Member for Strangford (Jim Shannon) mentioned: long covid, which is something that I suffer with. Recent statistics show that there are now 1.5 million long covid sufferers in the UK, with over 685,000 people living with symptoms for more than a year. I can tell the hon. Gentleman that brain fog is not fun for a politician. Seeing the words, but not being confident that you have grabbed them and put them in the right order, is really quite debilitating and hits your confidence hard. I have struggled with it, and I know many other people struggling with brain fog and other symptoms. I say to the Minister that the number of people with long covid is growing. Unless we urgently tackle the condition, I fear that we will face extraordinary pressures on our workforce and, indeed, on the healthcare system. Will she reassure long covid sufferers that her Department takes the condition seriously and will do everything it can to provide the requisite support and research to tackle it?
Finally, I want to focus on the mental health crisis, which is one of the issues to come out of the pandemic. There is no doubt that the lockdowns affected people’s mental health. In England, an estimated 10 million people have additional mental health support needs as a direct consequence of the pandemic. Two thirds of them had pre-existing mental health conditions that have been worsened by the pandemic, so perhaps the Minister could tell us what action the Government are planning to take to help those people.
Mental health care in this country needs a real injection of both political vigour and resources. It needs urgent attention, and those who access treatment at the moment experience, on average, a three-and-a-half-year gap between the recognised onset of illness and the start of treatment. In order to provide some solutions, the next Labour Government will guarantee mental health treatment within a month for all who need it, as well as recruit 8,500 new staff so that 1 million extra people can access treatment every year by the end of our first term in office. This is an ambitious but wholly necessary plan, which will not only revolutionise care, but meaningfully address the impact of the pandemic on our nation’s mental health.
I thank again the hon. Member for Bromley and Chislehurst for the way that he introduced the debate, and I thank other Members for contributing to it. The one thing that comes out of this—it was a compelling case put by Member after Member—is that we need a proper strategy to reform long-term care in this country. We will support the Government in doing that, but we need action now.
It is a real pleasure to serve under your chairmanship, Mrs Cummins, and to follow the hon. Member for Denton and Reddish (Andrew Gwynne), who showed no symptoms of brain fog in his eloquent speech. He has my personal assurance that we will definitely focus on both research into long covid and its treatment.
I thank my hon. Friend the Member for Bromley and Chislehurst (Sir Robert Neill) for raising this very important issue, and for his proud advocacy for patients with many different long-term conditions who rely on NHS services, particularly those who have had a stroke. I extend my best wishes to my hon. Friend’s wife, Ann-Louise, who I am sure informed much of his powerful speech. Many of the experiences we have heard about will resonate with many of us. My father had a stroke a couple of years ago, and rehabilitation has been vital to his recovery, which is a long road that he is still on.
I was deeply moved to hear of the difficulties that the pandemic has caused people with deteriorating long-term conditions, many of which have been outlined. I want to reassure all hon. Members that we remain committed to making sure that everyone has access to the care and support that they need and deserve. We know we have to catch up after the impact of the pandemic.
My hon. Friend the Member for Bromley and Chislehurst mentioned spinal cord injury. I attended the all-party parliamentary group on spinal cord injury yesterday to hear about the concerns and the impact that the pandemic has had on people with the condition, and what more we need to do to respond to it.
We know that covid has had a significant impact on the health and care system, including on rehabilitation services. It has had a real and profound impact on people with rehabilitation needs and their treatment. I am very sorry for any undue suffering that that has caused. We remain committed to making sure that everyone has access to the care and support that they need and deserve. Throughout the pandemic, we have worked to maintain access to health services in what has been an extremely challenging environment, but we recognise that getting that support at the right time is vital for people’s health. That is why we protected priority services across England during the pandemic, which included rehabilitation and post-acute services, for people who had survived a stroke, and their families and carers.
Continued service delivery was in part supported by innovative methods of care—we have talked about a few of them—throughout the pandemic. NHS England and Improvement supported people with long-term conditions by providing safe and person-centred assessments and diagnosis via remote methods, or in face-to-face consultations when appropriate. Providers innovated and rolled out remote consultations using video, telephone, email and text message services, and health services implemented new models of care with effective triage processes to make sure that patients received the care appropriate to them and in outpatient settings closer to home.
Clinical teams used and will continue to use virtual rehabilitation services alongside face-to-face contact to ensure that every patient gets the treatment and support that they need. Almost half of stroke survivors have received virtual care since the pandemic began, transforming their experience of the health system. Over 80% reported positive or very positive experiences, as my hon. Friend the Member for Bromley and Chislehurst outlined, but we know that remote consultations are not suitable for everyone or for every situation, as eloquently outlined by the hon. Member for York Central (Rachael Maskell), who has experience in this matter. We will continue working to make sure services are suitably tailored to meet patients’ often complex needs.
For example, NHSE&I has worked with memory assessment clinics to capture best practice on remote consultation and virtual diagnosis of dementia, which is vital, as mentioned by my hon. Friend the Member for Carshalton and Wallington (Elliot Colburn), to promote its use. It has published guidance to help enhance best practice in dementia assessment and diagnosis, and to support a personalised approach with choice over the delivery of remote consultation and diagnosis.
There has been further guidance for a range of conditions to help health systems adapt to the challenges of the pandemic, including the National Institute for Health and Care Excellence guidance on chronic obstructive pulmonary disease and the Association of British Neurologists guidance to help healthcare professionals prioritise neurological services.
People with different long-term conditions may also need emotional and psychological support, as has been mentioned by many hon. Members, and that is why NHS mental health services stayed open throughout the pandemic, and why local areas continued to offer talking therapies—remotely in many cases—with a face-to-face option if appropriate. We are investing in a mental health recovery action plan, which will help us to provide more appointments, which, sadly, were missed during the pandemic. That will help us catch up.
We are committed to ensuring that those who need it are given outstanding and tailored care with choice, control and the support that they need to enable them to live independent lives, and we are committed to ensuring that people find adult social care fair and accessible. A lot of reforms are coming forward in this area. We recently introduced our strategy for the social care workforce in our “People at the Heart of Care” White Paper, which is supported by at least £500 million to develop and support the workforce over the next three years.
As highlighted by the “Moving forward stronger” report, rehabilitation services were particularly affected by the pandemic. The health system has long recognised the importance of rehabilitation. Many hon. Members mentioned how important that is to lifelong conditions and how important it is to enable people to avoid more acute illness later on, requiring more services from the health service. Specific commitments are set out in the long-term plan, which include the expansion of pulmonary rehabilitation services over 10 years from 2019, new and higher-intensity care models in respect of stroke rehabilitation, and the scaling up of cardiac rehabilitation to prevent up to 23,000 premature deaths.
Following the publication of the national stroke service model in May 2021, NHS England and NHS Improvement have committed to creating integrated stroke delivery networks across England, bringing together health and care services across the whole stroke pathway, from prevention to rehabilitation. As my hon. Friend the Member for Bromley and Chislehurst mentioned, linking those services is vital. More than 20 integrated stroke delivery networks are now operational, bringing together health and care services across the whole stroke pathway. Over £3.3 million has been dedicated to the establishment and ongoing delivery of those networks, which have already brought about some improvements to the co-ordination and direction of how the stroke care pathways across England are delivered.
The NHS is committed to delivering personalised, needs- based stroke rehabilitation to every stroke survivor who needs it, and we recognise the vital role of multidisciplinary teams, comprising occupational therapists, speech and language therapists and physiotherapists, in assessing, diagnosing and treating issues concerning different daily activities, speech and cognitive communication. Community rehabilitation services continue to benefit from extra investment, with £4.5 billion of investment in primary medical care and community health services by 2023-24 and productivity reforms set out in the long-term plan. The long-term plan committed to the rolling out by 2024 of new two-hour urgent community response and two-day reablement ambitions, which will improve the responsiveness of community health services to people’s needs across the country. We anticipate that the wider package of investment in community and intermediate healthcare will eventually free more than 1 million hospital beds, allowing health systems to better support those in need.
Underlining our commitment to improving rehabilitation services, the NHS has created the new role of national director for hospital discharge and rehabilitation, which was rightly called for. Jenny Keane, who was appointed to the post in December 2021 and started recently, will lead a team of 60 people responsible for hospital discharge and rehabilitation. Her team within NHSE is already taking forward important work in this area, including a programme to identify the optimum bed-to-home model of care for non-acute rehabilitation services. That will support the implementation of the discharge-to-assess policy, and improve the delivery of timely and high-quality care in home settings. Ultimately, that will empower more people to recover and maintain their independence following an unplanned event or a period of acute care.
The programme will estimate the capacity for bedded non-acute rehabilitation care that integrated care systems will require for their populations. Systems will be supported to shift towards new rehabilitation models through a range of guidance, frameworks and tools. I anticipate that rehabilitation will also benefit from the wider reforms set out in the Health and Care Bill, reorienting systems towards co-operation and strengthening NHS action to reduce health inequalities. Rehabilitation will also benefit from the plans that we have set out in the integration White Paper, under which patients will receive better, more joined-up care.
Looking ahead, the NHS published its delivery plan for tackling the covid-19 backlog of elective care last month. The plan sets out a clear vision for how the NHS will recover and expand elective services over the next three years, including how it will support patients. We plan to spend more than £8 billion between the next financial year and 2024-25. That is in addition to the £2 billion elective recovery fund and £700 million targeted investment fund already made available to systems this year to help to drive up and protect elective activity. However, my hon. Friend the Member for Bromley and Chislehurst is right that we must ensure that the voice of rehabilitation services does not get lost in that considerable investment.
That funding could deliver the equivalent of around 9 million more checks, scans and procedures, and it will mean that the NHS in England can aim to deliver around 30% more elective activity by 2024-25 than it was delivering before the pandemic. A significant part of that funding will be invested in staff, in terms of both capacity and skills. The delivery plan also contains some targets to ensure that by March 2025 people will not wait longer than a year for elective care.
I am finding the Minister’s response very helpful and supportive of what we are trying to do, but I asked a specific question in relation to those who are waiting for eyesight-saving operations. We need to ensure that they do not lose their eyesight because of the delays. If the Minister is able to give me a response today, that will be great, but if she cannot, I am happy for all of us to receive a response by letter.
I thank the hon. Gentleman for his intervention and I am very happy to respond by letter. However, I do know—I have had conversations about it—that these prioritised electives will be prioritised. Somebody whose sight can be saved through an operation would, I imagine, be a key priority for our NHS colleagues.
At the October 2021 spending review, the Government announced a further £5.9 billion of capital funding to support elective recovery, diagnostics and technology. That funding will drive investment in technology to improve patient experiences of care and help patients manage their experience.
The NHS has been working on rolling out 44 community diagnostic centres, which will massively increase diagnostic activity. As we take the road to recovery, we are also reforming and transforming how care and health services are delivered for patients, including through dedicated surgical hubs and more convenient and efficient community diagnostic centres.
Finally, I want to thank hon. Members for the points that they have made in the debate.
I am very grateful for the Minister’s detailed response and for her commitment to trying to improve these matters. She referred to a delivery plan for recovery of elective services, but is not the logical thing to ensure that the voice of those with long-term needs and of rehabilitation is not lost, and that we also have a specific delivery plan for rehabilitation and for catching up on the backlog? I did not hear mention of that. Are we going to have that?
I mentioned the work that Jenny Keane will be doing following her recent appointment. She will be responsible for work on rehabilitation and discharges, as well as other areas covered by NHS continuing healthcare and the better care fund. That work is ongoing but does not include a specific commitment at this point to a strategy, as outlined.
I think it is only fair to say that, obviously, Jenny Keane has just started her work in this area—it is very new—but I know that she will be dedicated to ensuring that we make progress on the plans that I have set out. I hope that they reassure hon. Members that we will continue to support people who are living with long-term conditions and, by learning the lessons from the pandemic, ensure that they have access to the right services, at the right time, to enable them to live the fullest and happiest life they can. A lot of work is ongoing. We need to get behind that work and, obviously, support the team who are looking to deliver it. I thank everybody very much for their contributions.
I am very grateful to all those who participated in this debate, from both the Front and Back Benches, for the tone of the debate and their contributions. I particularly appreciated hearing about the personal experience of the shadow Minister, the hon. Member for Denton and Reddish (Andrew Gwynne). All of us bring our experiences to bear on these matters, and that is hugely important.
I welcome the Minister’s commitment—I do not doubt it—politically and personally. I am glad that we have a director in place. May I just gently say that perhaps the first task that the director should be given is actually to produce a strategy? A number of excellent initiatives have been referred to, but we need something to pull them all together and join them up. The Minister knows as well as I do that the way government works is that if we do not have something that gives us a proper framework and a proper set of measures to deliver on and something to hold people’s feet to the fire with—even for those with the best of intentions—things do get lost, so I urge her to take away that message. With the director, one part of the solution has been put in place, but we need a framework and a strategy for that director to work to. I am sure that many of us here today will happily work with the Minister, her officials and the NHS to help to deliver that. But I hope that she will not think that that is enough—there is still more to do.
Question put and agreed to.
That this House has considered people with deteriorating long-term health conditions during the covid-19 pandemic.
Covid-19: NHS Support for Prostate Cancer Patients
[Siobhain McDonagh in the Chair]
I beg to move,
That this House has considered NHS support for prostate cancer patients after the covid-19 pandemic.
Ms McDonagh, as your constituency neighbour, it is a pleasure to serve under your chairmanship for the first time in Westminster Hall. I extend my thanks to the Backbench Business Committee for granting time for such an important debate. I also thank the many Carshalton and Wallington residents who came forward to share their experiences of prostate cancer, either having had it themselves or having supported a loved one or friend through it.
Many people in this room and many of those watching will know a male relative or have a friend in their life who has had prostate cancer. I hope this important debate will raise awareness of the need to get yourself checked. There will be many striking statistics mentioned in the debate that will concern Members present, but I am keen to begin with a positive. Cancer survival rates in the United Kingdom have never been higher. Survival rates have improved each year since 2010. Prostate cancer survival has tripled in the past 40 years, with 85% of men surviving for five years or longer. However, the covid-19 pandemic threatens to derail this progress through a decrease in diagnostics, especially for men over the age of 50.
There are over 47,000 new prostate cancer cases every single year, with a man dying every 45 minutes from the condition. Early diagnosis is the key to fighting this disease. The pandemic has resulted in fewer men coming to their GP to get tested for prostate cancer, with the “stay at home” messaging particularly deterring older men, who are most at risk from prostate cancer, from coming forward. While the referral rate for prostate cancer has recovered to 80% of pre-pandemic levels, it still lags behind those for other forms of cancer, such as breast cancer, which is operating at 120% of pre-pandemic levels.
Stark figures from the charity Prostate Cancer UK reveal that there have been 50,000 fewer referrals for suspected prostate cancer patients than the usual trends would predict. The impact of that is incredibly worrying. Some 14,000 fewer men in the UK started treatment for prostate cancer between April 2020 and December 2021 compared with the equivalent months prior to the pandemic. That means that 14,000 men are living without the knowledge that they have the condition, and it means that 14,000 men have not yet started that all-important treatment plan.
Prostate Cancer UK has warned that, because of that, 3,500 men risk being diagnosed with late-stage prostate cancer. I cannot stress enough the importance of people getting themselves checked if they have symptoms or if they fall into the high-risk categories. Those include men over the age of 50, black African and black Caribbean men, and men with a father or brother who have had prostate cancer.
Sadly, the statistics and anecdotes that many of us will have heard point to the fact that men are far less willing to get themselves checked. Whether that is out of embarrassment or fear, getting diagnosed early can make an enormous difference to survival rates; five-year survival rates for men who are diagnosed with prostate cancer between stages 1 and 3 are over 95%. There are fantastic NHS campaigns, such as the “Help Us Help You” campaign, which has urged people with potential cancer symptoms to come forward for life-saving checks. The second stage of that campaign addresses the fear that often comes with booking the first appointment. Despite the fantastic work that is already being carried out, I hope that the Minister will be able to enlighten us about what more the Government are doing to destigmatise men coming forward to check their symptoms.
While being checked for prostate cancer is important for all men, it is especially important for men of black African or black Caribbean origin. I was taken aback to learn that, while one in eight of all men will get the disease, one in four black men will be diagnosed with prostate cancer in their lifetime; black men are also far more likely to be diagnosed with a more aggressive type. People from black and ethnic minority groups are also 4% less likely to receive radical treatment than people from white ethnic groups.
Through covid-19, we have seen what we can achieve when we work together. Last year, I was proud to host a roundtable in Carshalton and Wallington in collaboration with the NHS, the third sector and community groups to encourage ethnic minority communities to come forward and get the jab. The roundtable was well attended and demonstrated what we could achieve in prostate cancer diagnostics if the Government worked closely with the third sector and community groups to spread awareness.
However, improving awareness requires a corresponding increase in imaging capacity. Imaging services such as multiparametric MRI are critical to achieving earlier diagnoses, which, as I stated earlier, is key to survival. MpMRI scans can confirm or rule out prostate cancer in an accurate and timely manner, reducing the stressful wait for patients and their families. From speaking with cancer charities, I know that the significant variation in access to mpMRI provision is concerning. If we are to bring prostate cancer diagnoses back to pre-pandemic levels—and, indeed, increase them—we must address that postcode lottery. MpMRI provision must, as a minimum, be expanded in line with growth rates prior to the pandemic if we are to get diagnoses back to pre-pandemic levels. The 10-year cancer plan provides a golden opportunity to address this issue.
I have already mentioned the negative impact the pandemic has had on the prostate cancer community, but I am keen to highlight some positives that could be considered in a post-pandemic setting. Prostate Cancer UK has noted that the policy change during the pandemic to grant special access to certain covid-friendly novel hormone therapies for patients was very warmly welcomed by the community. This policy change has been wanted for some time, and it not only kept patients safe at home during the pandemic but improved their care experience, as they spent less time in hospital. Along with the increased interaction between patients and clinicians using technology, the change has made for higher levels of patient satisfaction and experience.
I look forward to seeing greater access to diagnosis and treatment and increased use of technology in my constituency at the London cancer hub, an exceptionally exciting project in the London Borough of Sutton. As a former employee, the Minister will know the Royal Marsden Hospital very well. I will not go over ground that she already knows, as cancer nurse who, I believe, is still practising.
The Minister is nodding. The Royal Marsden and the Institute of Cancer Research already form one of the leading cancer research and treatment centres in the world. The development plans for the London cancer hub will double the capacity for cancer research on the site, making the United Kingdom second only to the United States. It will be a game changer and will take our cancer research to the next level. It is a prime opportunity to ensure that the reduction in prostate cancer diagnoses remains a temporary blip in the overall effort to achieve early diagnosis for everyone with the condition.
This effort must include the cancer workforce. The Government have already invested money to address the cancer backlog, but the workforce issue must also be addressed. Patients with prostate cancer and their families go through one of the most difficult things in life to navigate. They are desperate for more clinical nurse specialists, who provide holistic, patient-centred care, with the empathy needed in these very dark times. Having access to clinical nurse specialists means that prostate cancer patients are far more likely to be positive about their care and treatment and to receive more individualised treatment plans.
One suggestion to be considered for the post-pandemic NHS is non-medical practitioner-led prostate cancer clinics. Such clinics would not only enhance the clinical pathways in prostate cancer, but relieve time burdens on oncologists and help to reduce costs that can be cycled back into the system. With one in four consultant clinical oncologists reporting risk of burnout, and with covid-19 exacerbating those issues over the past two years, investing in non-medical practitioners or increasing the number of clinical nurse specialists—or both—could be solutions to workforce concerns. I urge the Government to work with NHS England, Health Education England and the devolved Administrations to ensure that professional working groups in the prostate cancer workforce are addressing the workforce backlogs, including with clear training routes for healthcare professionals wishing to upskill.
I appreciate that there is strong interest in the debate, so I am keen to conclude my remarks. If the Minister takes anything away, I hope it is the need to find those 14,000 men missing from the prostate cancer treatment pathway, and to ensure that workforce issues are looked at by the Government. The pandemic has provided the NHS with a unique opportunity to rethink how we provide care not just to prostate cancer patients but to all cancer patients, with greater use of technology and the benefits of covid-friendly treatments that patients have had access to throughout the pandemic.
Finally, the one message that I hope those watching the debate—especially those in high-risk categories—will take away from it is: “Please get yourself checked”. The support available for patients and their families is fantastic, and it is out there. I say to people watching: “You are never alone”. I urge them to book that vital first appointment. I look forward to hearing the contributions from other hon. Members on this incredibly important issue.
It is a pleasure to serve under your chairmanship, Ms McDonagh, and to make a contribution on this issue as my party’s health spokesperson. I thank the hon. Member for Carshalton and Wallington (Elliot Colburn) for setting the scene so well, as he always does, and for being so relatable.
I did a quick head count earlier. There are nine men in this room and the fact is that one in six of us—possibly two of us—will succumb to prostate cancer. That being the case, the effect of prostate cancer really hits home. I am also pleased to see the Minister in her place and recognise her contribution not just as a Minister but in the NHS, as the hon. Gentleman referred to. I am pleased to be alongside my colleague and friend, the hon. Member for Coatbridge, Chryston and Bellshill (Steven Bonnar), who is the shadow health spokesperson for the Scottish National party. It is also nice to see the hon. Member for Enfield North (Feryal Clark) in her place, and I look forward to her contribution.
As I have mentioned many times, the pandemic has had a significant impact on all aspects of life, but undoubtedly on our health service. As my party’s health spokesperson, it is great to be here to talk about what further steps we can take to support those who suffer with prostate cancer.
I want to quickly tell a story, because nothing illustrates the case better than a story. I have a very good friend. I am not going to give his name or say where he works, but we would work closely every week of my life. I always phone him and seven or eight weeks ago, I asked him how he was and he said to me, “I just went to get a wee health check to see how I was. They tell me I’ve got prostate cancer.” I said, “I hope it all works out.” He waited for the tests to come back, and the test was positive. They did not hang about. Within two weeks he had the operation. The NHS in Northern Ireland, where it is a devolved matter, paid for his operation and he went to Dublin to get it done. He did not realise that that check to see if everything was all right would lead to a prostate cancer operation, but that early diagnosis means that he is able to have same normality of life as everybody in this Chamber.
That illustrates the issue raised by the hon. Member for Carshalton and Wallington said. We have to put in place a prostate cancer strategy or plan for, as the hon. Gentleman said, men of a certain age—and I am one of them, by the way. It is not for me to comment on people’s age, but a few others present may also qualify.
Prostate cancer is the most common cancer for men, with over 47,000 new cases every year. Even prior to the pandemic, challenges in delivering the highest quality of care for patients had increased. It was exacerbated by staff shortages, inadequate care pathways and limited access to effective diagnosis. That is what we have to address. I know the Minister recognises the need for early diagnosis on any condition, but today’s debate is about prostate cancer. One in six men in the UK will be diagnosed with prostate cancer. It accounts for 27% of all new male cancer patients in the UK. That gives Members an idea of the size of the subject matter and why it is so important to debate it.
I always want to give a Northern Ireland perspective in debates, because we are part of this great United Kingdom of Great Britain and Northern Ireland, and what happens in Northern Ireland is replicated here. Our population is only 1.8 million, but we can none the less illustrate the issue. In Northern Ireland, 1,100 men are diagnosed with prostate cancer every year, with sadly 276 of those on average losing their lives to the disease. That is a large number—26% or 27% of those with prostate cancer unfortunately do not make it. Whether this is due to late diagnosis owing to the pandemic or to men downplaying their symptoms as they feel that there are more important things to deal with, we must encourage and raise awareness of the importance of checking for prostate cancer.
Speaking as a man, I know that those watching and present in the Chamber will know that there is no cold as bad as a man’s cold. But when somebody tells us to go to the doctor, we say, “No, I won’t.” If we are asked to go to the doctor, we put it off because we do not want to bother them. We say, “It’s not that bad really. I was exaggerating a wee bit. I think I’ll be alright.” That is our attitude. How do we change that attitude? We cannot do it by raising awareness alone. Perhaps one way of addressing it is by highlighting the brutal facts of how prostate cancer is taking people out of society. Perhaps we need to shock men into responding.
I have been in contact with Prostate Cancer UK, which has highlighted the troubles faced during the pandemic. First, reduced access to MRIs as a result of covid impacted on the ability of the NHS to diagnose prostate cancer, and there has been significant variation in the provision of services. How are the Government addressing the issue of early diagnosis and of access to MRI scans and biopsies to check it out? Crucially, what impact did the “Stay at Home” message have on people in need of diagnosis?
The pandemic has had many detrimental effects on society, one of which is people getting used to not seeing others. They are not going out in the way that they did in the past. We have to address that. In particular, older men, who are in a higher risk group for covid, were less likely to visit their GP and more likely to downplay their symptoms. Could the Minister give an indication of how we can address that?
Workforce issues and staff shortages were already significant before covid, with a growing shortage of oncologists and workforce burnout exacerbating the challenges faced by healthcare professionals in providing high-quality care. NHS England has been working with cancer alliances to ensure that improvements made during the pandemic are retained and improved further. I urge the Minister to have conversations—I know that he already does this—with our counterparts in the devolved nations to ensure that no man, nobody, is left behind by health provisions across the United Kingdom.
Education also plays a crucial role in health improvement. It should provide clear and simple messaging to educate men who are at risk of prostate cancer about the potential impact of diagnosis. Do we advertise that on TV, or are there more adverts in the press? It is advertised in my surgery in Kircubbin; I suspect that the same is true of everybody’s surgery. I do not go to the doctor very often, except for my diabetes check-ups. Perhaps the messaging is not getting to the people it needs to get to. How do we do that better?
Prostate Cancer UK has shared an online 30-second risk checker, which is very helpful for men across the United Kingdom. They can enter basic details and assess the risk that they face. That involves men taking a minute out of their day, and the online tool will direct them in the right way.
I will draw to a finish, as I am conscious that others wish to speak. The pandemic has had a significant impact on all aspects of life and disrupted the provision of routine care, forcing providers and patients to postpone many services and to adopt virtual consultations. I can almost feel my blood drain when I hear the term “virtual consultations”, because people need to see their doctor face to face. This has highlighted the need for face-to-face appointments in order to embrace and enhance the services that our NHS provides.
For too long, cancer patients have felt let down by the prioritisation of covid. Today’s debate gives us a chance to address the issue. I thank the hon. Member for Carshalton and Wallington for securing the debate, and I look forward to the Minister’s response. I am never disappointed with her responses. I know that she understands the issues and we look forward to her answers.
It is a pleasure to serve under you, Ms McDonagh. I congratulate my hon. Friend the Member for Carshalton and Wallington (Elliot Colburn) on securing the debate, and I thank Prostate Cancer UK for our wonderful badges and for all the work it does. It is an honour to speak in the debate, and I note that March is both Ovarian Cancer Awareness Month and Prostate Cancer Awareness Month.
I would like to start by stating that we have no men’s health strategy in this country, but we should do. I refer to the great work done by the all-party parliamentary group on issues affecting men and boys, which I have the honour of chairing. To date, we have issued two reports that show the need for a men’s health strategy, which would provide an overarching and joined-up plan to end the gender age gap. That is desperately needed in the UK, where one in five men will die before their retirement. One man commits suicide every 2 hours, and 86% of homeless people are men. Some 95% of prisoners are men, and 97% of fatal accidents at work happen to men. These are appalling statistics.
Far worse than the awful numbers is the sobering fact that 30 men die every day from prostate cancer, which amounts to 11,900 deaths a year. Let me explain what those numbers mean. There are 430 male MPs in this House, out of a total of 650 Members. Some 16.7% of all men will get prostate cancer, which means that 71 male Members of the House will get it. That is more than 11% of all Members—more than one in 10 of us.
Many deaths could be avoided if we had a prostate screening programme. The UK has a policy that we do not need to have a national screening policy for men to check whether they have prostate cancer. Until now, the NHS has taken the view that screening for prostate cancer would not meet the national and international criteria laid down for a viable and valuable screening programme. Instead, the NHS adopts a wait-and-see policy. However, medical science has progressed, and the historical objections are no longer valid.
The data shows that the age of 50 onwards is the danger zone for men. Only four cases of prostate cancer per 100,000 happen in men aged 40 to 44, but the figure rises to 6,285 for men aged 60 to 64. Men between 50 and 80 are most at risk. The data shows beyond doubt that a man of African heritage is twice as likely as a Caucasian male to contract prostate cancer. Research from 1995 showed a drop of 44% in mortality over 14 years when screening takes place, and another trial showed a reduction of 21%. Whichever figure we take, it is a staggering number of lives that could have been saved—2,000 lives or more every year.
The issue has been the effectiveness of screening and the cost, but medical science has moved on. A simple prostate-specific antigen blood test is inexpensive, costing literally pennies, and it will help to identify high antigen counts so that we know who is most at risk. These men can then be monitored and retested after a further three months. The relatively few men who still have a high number of antigens can then be given an MRI scan to confirm beyond doubt whether they have prostate cancer or not. Those who are diagnosed can then be treated, thousands of lives will be saved, and thousands of lives will be longer and will be quality lives.
Does screening work? The current breast cancer screening programme is believed to save 1,300 lives a year. Around 2,600 women are diagnosed with cervical cancer each year and 690 women die of it each year. It is estimated that 83% of cervical cancer cases would be avoided if all women used the cervical cancer screening programme. Screening works well for breast cancer and cervical cancer. It is proven to work. So why do we not have a screening programme for prostate cancer?
Implementation of a prostate cancer screening programme would obviously be beneficial for the men involved, but it would also be beneficial for their family, their friends and the country at large. Early diagnosis will save the economy money, as it will enable those affected to continue working rather than being dependent on the welfare state. It saves the NHS money in avoiding the expensive treatments that would be needed for advanced cancer. Wives will not lose their husbands, children will not lose their fathers, and friends and other loved ones will not be emotionally scarred by grief.
What can be said against introducing a national screening programme for all men between the ages of 50 and 80? The criteria for a screening programme have been met: it would extend many thousands of lives; it would save the NHS money; prevention is better than cure; and it causes no harm, instead providing a real benefit at a reasonable cost.
I have two asks today: can we seriously consider putting in place both a national prostate screening programme and a men’s health strategy? These initiatives will save money, but much more importantly they will save lives.
It is a pleasure to see you in the Chair today, Ms McDonagh. I am grateful to the hon. Member for Carshalton and Wallington (Elliot Colburn) for securing this vital debate on a subject that unfortunately does not receive the attention that it deserves.
For a long time, prostate cancer has been wrongly labelled an old man’s disease. In fact, all men are at risk of developing prostate cancer at any age, with one in six of us facing a diagnosis in our lifetimes, and we have also heard that it has a disproportionate effect on black African and Caribbean men. Yet there is still a lack of awareness of this disease—awareness that is needed to support affected men. That was particularly true during the pandemic, which has seen our healthcare provision being put under great and unprecedented pressure.
The earlier prostate cancer is found, the better the chance of a good outcome. Analysis by Prostate Cancer UK suggests that between April 2020 and September 2021, 600 fewer prostate cancer diagnoses were confirmed in Scotland. Prostate Cancer UK estimates that, because of the pandemic, 14,000 men across Scotland and the rest of the UK have not yet started treatment for prostate cancer.
Just a couple of weeks ago, Prostate Cancer UK launched a UK-wide campaign alongside the NHS to find those 14,000 missing men, and we in the Scottish National party welcome this initiative. Throughout the covid-19 pandemic, cancer has remained a Scottish Government priority, and the Scottish Government are focused on ensuring that patients are diagnosed and treated as quickly as possible. Scotland has 76 general practitioners per 100,000 citizens, compared with a UK average of 60 GPs per 100,000 citizens. That has undoubtedly helped to improve early detection of cancer in Scotland, and I am sure that right hon. and hon. Members will agree that GP provision—or a lack of it, in many respects—is hugely impactful in the wider healthcare arena.
Throughout the ongoing health crisis, the First Minister of Scotland has persistently stressed that the NHS remains available for those who need it. Advice has been sent to all cancer services in Scotland, including the key message that boards are expected to maintain full urgent cancer services. Indeed, most cancer treatment continued throughout lockdown; even at the height of the pandemic, patients in Scotland waited on average just two days before starting treatment. Regrettably, I understand that that was not the case in England or Wales.
The impact of this decision in Scotland undoubtedly saved the life of one of my constituents in Coatbridge, Chryston and Bellshill. After feeling unwell and explaining their symptoms to the NHS 24 helpline, they were quickly admitted to hospital, with specialist cancer treatment and support to hand. However, the only available treatment option that could be offered was invasive surgery, bringing with it, of course, a longer recovery time and more risk compared with a keyhole surgery procedure. None the less, that early diagnosis proved to be critical.
In order to ensure that this does not spiral into a secondary health crisis, a large amount of investment will be needed to clear the backlog of screening and treatments, to get cancer services back operating at the level that they were before the pandemic. We should actually be aiming to make them even better. The Scottish Government continue to engage with the cancer community to ensure that all key partners involved in the delivery of the national cancer recovery plan, which will support cancer patients to have equitable access to care regardless of where they live, improve patients’ experience of care and roll out innovative treatments to improve cancer services.
To improve cancer performance over the next five years, the Scottish Government are taking a range of actions, including ensuring that everyone across Scotland who meets referral criteria has access to an early cancer diagnostic centre, and investing £40 million to support cancer services and improve cancer waiting times, with a focus on the most challenged cancer pathways, including neurology, colorectal and breast cancer. Of that, £20 million will support the Detect Cancer Early programme, providing greater public awareness of signs and symptoms of cancer and supporting the development of optimal cancer pathways to improve earlier diagnosis routes. We are also supporting a rehabilitation programme for cancer patients, to ensure the best possible preparation for treatment and improve both the experience of treatment and its clinical outcomes. That is what a Government with their priorities in the right place look like.
The UK Government must begin to invest properly in the NHS in England. That, of course, will ensure that adequate consequentials are delivered to Scotland to enable us to recover from the pandemic. Those improvements should be funded through efficient decision-making, strategy and budgeting, not by raising national insurance, which threatens to hit those on the lowest incomes in the midst of the cost of living crisis. They are the very people who are most likely to rely on the services of our NHS, so they are facing quite the double-edged sword. I urge the Minister and the Government to take a leaf out of our book in Scotland and take the necessary steps to safeguard the prospects of prostate cancer patients in the light of the pandemic, and for generations to come.
I reiterate the comments of the hon. Member for Carshalton and Wallington, and I urge all men to go and get that check. That moment of discomfort and embarrassment may just be the moment that saves your life.
It is an absolute pleasure to serve under your chairmanship, Ms McDonagh. I thank the hon. Member for Carshalton and Wallington (Elliot Colburn) for securing this important debate, and the hon. Members for Strangford (Jim Shannon), for Don Valley (Nick Fletcher) and for Coatbridge, Chryston and Bellshill (Steven Bonnar) for their excellent contributions.
The pandemic has had an impact on every aspect of our lives—the people we see, the services we use, and the support that we seek in times of need. While that is the case for all of us, it is particularly true for prostate cancer patients. On a number of occasions in recent months, we have heard Members on both sides of the House speak about the impact of the pandemic on cancer care and the continually growing backlog. However, this situation was not inevitable. It is right that we acknowledge the serious impact of the pandemic across our NHS and the challenges that it has presented; however, we entered the pandemic in a very vulnerable position. After a decade of the Government’s mismanagement, the NHS went into the covid crisis with a record waiting list and a staff shortage of 100,000. It is not just that the Tories did not fix the roof when the sun was shining; they dismantled the roof and removed the floorboards.
The Government blame covid, but the reality is that performance was declining for years before the virus hit. Access to treatment within 62 days of an urgent referral for urological cancer was at 70.6% in March 2020, down from 84% in 2010 when Labour left office. Now, despite the tireless work of NHS staff, performance against targets has hit a record low. More people than ever before are facing unacceptably long waits for vital cancer tests and treatment. I hope that the Minister agrees that the situation is simply unacceptable. Will she tell me exactly what is being done to address that?
We have heard the Secretary of State launch a call for evidence, but does he really think that after 12 years in power, more talk is good enough? Speed of treatment is critical to cancer patients. When every day, hour and minute counts, prostate cancer patients cannot afford to wait for the Government to consult and consider, looking to the sector for answers, because they have none themselves. Prostate cancer patients need firm action now, not another kick of the can down the road—that is rapidly becoming this Government’s trademark.
As other Members have done throughout the debate, I pay tribute to the brilliant work of Prostate Cancer UK. I am proud to support its campaign to identify 14,000 men who are absent from the prostate cancer treatment pathway because of the pandemic. Such campaigns are vital in raising awareness, and the 400,000 men who subsequently checked their risk of prostate cancer is testament to that. I welcome the investment that the Government made in the campaign, and I am keen to hear from the Minister what plans they have to continue that.
Those campaigns make a real difference, so it is important that the Government recognise the need for further development in the relationship between the NHS and the relevant charities. Awareness is just one part of the action that we need to take on prostate cancer, and much more needs to be done to improve the patient journey beyond the initial stage.
A clear and accessible diagnosis process is vital to ensure that patients can access the treatment they need in a timely manner. Diagnosis rates have continued to fluctuate for a number of years and, despite peaking in 2018, they made a noticeable drop in 2019, before the start of the pandemic. Given the problems that the pandemic has caused in accessing primary care services, I am keen to hear from the Minister what understanding the Government have of where we are now on diagnosis rates.
I have spoken to several stakeholders across the cancer sector, and they are concerned that many post-pandemic diagnoses will, sadly, be of later stage cancers. I therefore look forward to the Minister outlining the steps that the Government will take to ensure that awareness campaigns are not stunted by inaccessible diagnosis pathways, putting patients’ outcomes at risk.
As other Members and I have mentioned, referrals are one area in which prostate cancer lags behind other cancers. The Secretary of State acknowledged that himself when launching his elective recovery plan, reaffirming his commitment to get back on track with referral targets, and yet there is absolutely nothing of merit in that plan to reassure prostate cancer patients.
The Secretary of State masks his complete lack of action with grand and frankly unhelpful language when he talks about launching a “war on cancer”. Such words, far from making the Secretary of State look strong, show a gross disrespect for patients and set a dangerous precedent. I urge him and all Ministers to think about the implications of their language for people living with prostate cancer—with all cancers—and the impact that such language can have on them.
One element underpinning all the issues outlined in the debate is workforce, which other Members have mentioned. The existing prostate cancer workforce is overstretched, with prostate cancer specialist nurses having a caseload more than three times higher than that of nurses covering breast cancer. Without a robust workforce strategy, our NHS will simply not be in a place to provide the support that prostate cancer patients need as we emerge from the pandemic, and beyond, but Ministers continue to bury their heads in the sand. They have failed to bring forward a long-term workforce strategy, and with weeks to go until the end of the financial year, there is still no clarity on Health Education England’s budget. In fact, all the Secretary of State can say is that the NHS has to find money from existing budgets to address the workforce shortage. That is really unhelpful. Does the Minister really think that is good enough?
I want to take this opportunity to praise the work of colleagues in the other place in championing workforce issues in their consideration of the Health and Care Bill. I welcome Baroness Cumberlege’s amendment to the Bill to require the regular publication of health and care workforce projections. Will the Minister take this opportunity to reassure us that the amendment will not be overturned when the Bill comes to the Floor of the House? I look forward to working with Members across the House to keep the workforce issue at the forefront, ensuring that prostate cancer patients and others have the support that they need.
I am keen to hear from the Minister what plans the Government have to ensure that staff are trained and retained in a sustainable way so that prostate cancer patients can always access care. People living with prostate cancer need an NHS that has the time and resources to support them as we emerge from the pandemic. It is about time the Government delivered on that.
It is a pleasure to serve under your chairmanship, Ms McDonagh. May I start by declaring an interest? I still work, as my hon. Friend the Member for Carshalton and Wallington (Elliot Colburn) said, as a cancer nurse. I was slightly disappointed by the tone of the shadow Minister, the hon. Member for Enfield North (Feryal Clark). I did not want to be political but, for the record, I got into politics because, as a cancer nurse, I was so frustrated with the previous Labour Government’s target-driven approach, which looked good on paper, but in reality did not make a huge difference to patients.
I welcome this debate that was secured by my hon. Friend the Member for Carshalton and Wallington. Prostate cancer absolutely deserves a debate that focuses on the key issues that he described so well. I want to reassure colleagues that cancer treatments and diagnosis have remained a top priority throughout the pandemic—one of the few areas of healthcare where much of it stayed open—with over 330,000 urgent referrals and more than 170,000 treatments for urological cancers between March 2020 and December last year.
I want to thank the amazing work of NHS staff up and down the country who maintained cancer treatment levels at 94%, which is an astonishing record when they had to deal with covid in the workforce and patients undergoing prostate treatment also coming through covid, too. Although treatment levels remained very high during the pandemic, there is no doubt that referrals suffered. We asked men and women to stay away from the NHS to protect it during that time and we saw a huge drop-off in referrals. It is estimated that up to 32,000 fewer people than expected have started cancer treatment because of that, but we are seeing a change with record levels of referrals coming through the system right now. Last month’s figure was around 11,000 cancer referrals a day.
Although people stayed away during the pandemic, they are coming back in their droves now, and the ambition is to try to get as many of those diagnosed as quickly as possible and into treatment. We are trying to get prostate cancer in particular diagnosed as quickly as possible by implementing best practice timed pathways for prostate cancer, including the use of mpMRI, which my hon. Friend the Member for Carshalton and Wallington mentioned. It captures images of the prostate in a much better way than the standard MRI does, so that is a focus and we have seen a major uptake in that. Back in 2016, only 335 people were going through that system, but by 2020 that had gone up to 11,000 people. We are seeing a real shift in the use of that technology, which better diagnoses men with prostate cancer.
Partnering with Prostate Cancer UK, we are delivering a cancer risk-awareness campaign, which started in February and will continue to run until the end of this month. As a number of colleagues have said, we must raise awareness about the symptoms of prostate cancer and encourage men to come forward.
Although I do not wish to generalise, I take the points made by my hon. Friend the Member for Don Valley (Nick Fletcher) and by the hon. Member for Strangford (Jim Shannon) about the differences in how men and women face health issues. When women have an issue, they will come forward, although they often feel as if they are not being heard and that there is a delay in accessing healthcare. Men are slightly different in that often they will not come forward in the first place, so the campaigns let them know about the symptoms, encourage them come forward and reassure them that diagnosis and treatment will happen relatively quickly.
The outcome is good for many men with prostate cancer, but we encourage people to come forward quickly because the prognosis is improved the earlier they can get involved in treatment, and the treatment is often less invasive. There are good reasons to encourage men to come forward.
The purpose of our campaign is to educate people about their risk of prostate cancer. As we have heard, some people are more at risk than others. As a cancer that does not present with many symptoms, particularly at an early stage, it is vital to encourage those at risk to discuss that with their GP and have a prostate-specific antigen test. To address the point made by my hon. Friend the Member for Don Valley, gentlemen over the age of 50 can request a PSA from their GP.
There is no national screening programme at the moment because the PSA test on its own is not foolproof. It is a simple blood test that measures the PSA level in the blood which, if raised, can be indication that prostate cancer could be present. However, many men with prostate cancer do not have a raised PSA, and many men who have a raised PSA that does not change over time do not have prostate cancer. We do not have a national screening programme because it is not a foolproof test in the way that a mammogram is for breast cancer.
A huge amount of research is going on about that right now. The team at University College London is working on PSA and integrating it with another test, to combine them to see if accuracy can be improved. If there were a more accurate screening test, there would be a strong case to bring that forward, but at the moment the accuracy of the test is holding us back.
Prostate Cancer UK has reported that over 310,000 people have completed their risk checker, so obviously a lot of good work is happening that is getting the voice out there. This debate today also helps raise awareness. As many hon. Members have said, we are encouraging men to come forward if they have concerns.
We also have the “Help Us Help You” NHS campaign, which is looking at a number of cancers, including prostate cancer. It has raised awareness of non-specific symptoms, which are often experienced by the patients who we have the hardest time diagnosing. This month, we are launching a campaign specifically about prostate cancer and the barriers to seeking treatment. The phases of the campaign that have run to date have contributed to the high levels of urgent cancer referrals the NHS has seen—around 11,000 referrals per day—as I mentioned earlier. The campaigns are working and people are coming forward, but there is a huge amount more that we can do.
In addition to these national initiatives, we also fund more local awareness raising through cancer alliances, where we specifically target communities who may be more at risk or less likely to come forward if they have symptoms. As part of that plan, every system will need to take ongoing action to support general practice capacity, so that if people come forward they are able to be seen as soon as possible.
We are also working on long-term prostate cancer improvements. Clearly, the covid pandemic had an impact on referrals, but there were long-term issues before the pandemic, as outlined by the shadow Minister, that we are now trying to address. Research is one of those issues. There is a wide range of treatments for prostate cancer. My hon. Friend the Member for Don Valley talked about the watch and wait policy, and it has been quite successful. There are many older men with prostate cancer that may have a less aggressive form, and this is where techniques such as watch and wait and seeing whether PSA is showing in their blood are very helpful. Many of those men will die of things other than prostate cancer. Watch and wait is a useful and robust treatment.
Treatments for prostate cancer are not without their side effects, despite our best efforts. We are working hard to improve treatments, both in terms of their success rate and the impact they have on a man’s quality of life. The use of stereotactic radiotherapy, for example, to target prostate cancer and reduce side effects is making a huge difference to outcomes for men. Better surgical techniques, and state-of-the-art surgery, are also improving outcomes and the side effects from surgery. Hormone treatments are also available; research is pushing the barriers there. However, hormone treatments are not without their side effects. I reassure men that there is a wide range of treatments, depending on the type of prostate cancer that they have, that will not only treat their cancer but reduce the side effects.
In the spending review we announced an extra £5.9 billion of capital to support our recovery programme, particularly in diagnostics. That includes £2.3 billion to increase the volume of diagnostic activity in our community diagnostic centres. What we are trying to create in local communities is a situation where if someone presents with non-specific symptoms to their GP, we can use the community diagnostic centres to refer people so that they can have the tests—whether it is an ultrasound, an MRI, or blood tests—and can get a more rapid diagnosis than has historically been the case. We are rolling out 44 community diagnostic centres to increase our capacity, which could deliver up to 2.8 million scans in the first full year of operation. By 2024-25, the aim is to deliver at least another 56 of those centres. That will allow the NHS to carry out 4.5 million additional scans. The diagnostic centres will make a big difference, diagnosing people as quickly as possible and at as early a stage of their cancer as possible.
There are some pilot works going on that look at self-referral; that is particularly the case with breast and skin cancers. I do not want to speak for cancer alliances, but there could be an argument for prostate cancer to be included too, if people have specific symptoms. Watch this space with regards to self-referral and its ability to get people into the system as quickly as possible.
We also talked about workforce. As someone who has worked as a nurse specialist, I take it on board that a urology nurse specialist will often cover all urology cancers. There is a difference between treating someone for testicular cancer; they often tend to be younger men who need very different treatment. Prostate cancer is a very different type of cancer, but it is often lumped in under urology. I recognise that nurses there have a greater volume of patients to see than nurses treating other types of cancer. There is huge progress being made on that. There is investment going into workforce planning, and we are supporting the training and development of nurses, in particular, to become specialists and practitioners in both screening and diagnostics. It is not just about increasing numbers in our workforce; it is about giving them the skills and training to expand the roles and services that they can go into. That is at the forefront of our mind.
My hon. Friend the Member for Don Valley talked about a men’s health strategy. I will say to him that just by having a women’s health strategy does not mean we are ignoring men at all. We are producing our health disparities White Paper very soon. Some of the issues that he talks about around life expectancy and differences in suicide rates will feature quite heavily in that. However, if he does not feel that that goes far enough, I am very happy to have a further conversation. There are differences, in some areas, for men and, on prostate cancer particularly, we can do more to support them with their diagnoses and treatment.
For many men, prostate cancer will be a chronic illness. We will be able to treat and cure many, but some will need to learn to live with their disease—people can live with quite advanced prostate cancer for many years—and it is about providing them with support. Living with prostate cancer often causes psychological challenges, where people are just getting on and dealing with it but are not getting the support that they need with many of the issues that they face. We fully recognise that that is something that we need to focus on.
I reassure colleagues that prostate cancer is very much top of our agenda in the cancer sphere. We are improving the facility to try to diagnose it much more easily. Treatments for prostate cancer are changing and improving all the time. We must focus on supporting men with prostate cancer through their cancer journey. We must encourage men to come forward and reassure them that they will be diagnosed quickly and receive the treatment that they need for their prostate cancer.
I thank all hon. Members for their contributions throughout this debate. I think that the hon. Member for Strangford (Jim Shannon) highlighted very well the danger in men often downplaying their symptoms. I was struck by the statistic, given by my hon. Friend the Member for Don Valley (Nick Fletcher), that one in five men will die before retirement. That is not a statistic that I had heard before; it is shocking, and shows the importance of taking these issues seriously.
I thank the shadow Minister, the hon. Member for Enfield North (Feryal Clark), and the SNP spokesperson, the hon. Member for Coatbridge, Chryston and Bellshill (Steven Bonnar), for their contributions and, indeed, the Minister for her reply. I know, as someone who has worked in the NHS, as she has, that she obviously brings a great deal of expertise to the role. I know how seriously she takes it, as she was a cancer nurse in my borough.
We are lucky in the London Borough of Sutton; we have the Royal Marsden base, the Institute of Cancer Research and the Epsom and St Helier University Hospitals NHS Trust, all of which are working together to really drive improvements in cancer patient outcomes. Indeed, the £500 million investment that the Department has given to the two hospitals will do just that, so I really welcome it.
However, if there is one message for us all to take away from this debate, it is to encourage men to check their level of risk and to get themselves tested. If we have learned anything from the pandemic, it is the importance of getting tested, so I say to people, please, get out there and encourage people to, “Check your symptoms” and, “Get yourself tested”.
Question put and agreed to.
That this House has considered NHS support for prostate cancer patients after the covid-19 pandemic.