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10 May 2006 : Column 106WH—continued
My hon. Friend mentioned interviews at port of entry. We are not in a position at present to insist that
the national minimum wage is paid to certain categories of workers, within which overseas domestic workers would fall, but we do attempt through interview to establish terms and conditions that meet the requirements that we would expect for all domestic workers in the UK, not just overseas domestic workers.
We are reviewing future requirements for admitting domestic workers to the UK and have already offered to liaise with Kalayaan, which has worked very hardon the issue. Options might include retaining theexisting requirement for employment to have existed for 12 months prior to coming to the UK, and insisting that the domestic worker is paid at least the national minimum wage. Those useful discussions would deal with points that my hon. Friend raised.
On access to employment law, we are working with the Department of Trade and Industry on the protections that are available in respect of business visitors under UK employment law, but we must bear in mind that they will be covered by other aspects of UK legislation such as the Human Rights Act 1998.
In conclusion, I hope that I have clearly set out the position for the House and addressed some of the concerns that my hon. Friend raised eloquently and with feeling. After a lengthy process of review and consultation, we have set out plans for winding up the quota-based schemes for admitting low-skilled workers for specific sectors, in light of the availability of labour from an expanded EU. Alongside that, we will not in the future provide a specific route for overseas domestic workers, who are generally low-skilled, under the points-based system.
I hope that I have given some assurance to my hon. Friend about the Government’s commitment to protect all workers from abuse and about our awareness of the issues that she raised. Furthermore, although we shall not pursue a policy of offering overseas domestic workers from outside the EU a route for settlement, we remain strongly committed to dealing with any abuse to which such workers could be subjected.
11.29 am
Sitting suspended until half-past Two o’clock.
Cancer Services (Essex)
2.30 pm
James Duddridge (Rochford and Southend, East) (Con): I am grateful for the opportunity to raise the subject of cancer services in south Essex, which is a subject that I have been working on over the past few months with my hon. Friends the Members for Southend, West (Mr. Amess), for Castle Point (Bob Spink) and for Rayleigh (Mr. Francois), co-ordinating some of the activity in south Essex on our collective behalf.
I am acutely aware that cancer is an emotive subject, with one in three people directly affected by it and virtually all of us indirectly affected. It was with some trepidation that I began to engage with the subject matter locally, but the bottom line is that, without being sensationalist, I genuinely believe that there will be a materially worse service in south Essex as a result of the changes that are taking place.
Those changes are the merger of the South Essex cancer network with the Mid Anglia network. I shall give a bit of the history of what has been happening. As far back as the mid-1980s, there was a threat of merger, which disappeared following a local campaign. The Calman Hine report in 1995 rightly suggested introducing cancer networks, and a year later the South Essex cancer network was created. In 2001-02, the network came under threat and mergers were proposed across the whole of Essex. There was a lot of local debate, and a large campaign was run by the Southend Echo and a number of colleagues who were in the House at the time to keep hands off the cancer network and to leave it as it was.
This morning, I was reading the papers from back then and Mike Richards, the cancer tsar, said that he could barely come to the House of Commons without someone mentioning Southend to him. He kindly agreed to come down to Southend and decided that it was right for south Essex and for cancer patients that the merger did not go ahead at that point. More recently, in December 2005, the strategic health authority started a consultation, which although it was extensive was fundamentally flawed and a bit of a sham. I will explain the distinction later and go into the consultation process in more detail.
In terms of parliamentary activity, we have been doing an awful lot. We spoke in the Opposition-day debate on cancer, have met the strategic health authority a number of times and a petition has gained about 5,000 signatures. Collectively and individually, we have made formal consultation submissions to the SHA and, of course, as one would expect, we have been corresponding with the main players and have visited the cancer centre a number of times. Unfortunately, on 29 March the SHA decided to press ahead with the change. Since then I have tabled a number of written questions and written to the Secretary of State. The Minister was kind enough to reply to those, and I shall go into those matters on which I was disappointed by the lack of detail in the reply and those on which I was looking to tease out whether the merger would be good for patients. The case has certainly not been proved and, on balance, would be adverse at the moment.
In summary, the South Essex cancer network was created 10 years ago. I hope that the Minister will consider not effectively abolishing it through merger. The network covers a population of approximately 730,000 and the main hospitals of Southend and Basildon. In many ways, the merger has been brought about because of activities outside south Essex, specifically the decision by Norfolk, Suffolk and Cambridgeshire to pull Ipswich out of the Mid Anglia network to the north. Crucially, the South Essex network had no involvement in that decision but was fundamentally affected by the knock-on effect.
The South Essex and Mid Anglia networks are two of the three smallest cancer networks in the United Kingdom. I wrote to the Minister asking for details of the population size, but I could not get definitive figures, so perhaps she can correct me and give some figures on the smaller cancer networks.
I want to prove, first, that there was no need for change, secondly, that one size does not fit all, in terms of cancer network sizes, and, thirdly, that the consultation was fundamentally flawed and that the decision had been taken well before the start of the consultation. I also have a number of questions that I hope that the Minister will answer either today or in writing, as she considers appropriate.
There are things that I shall not touch on. Essex cancer services is a broad subject, and I shall focus primarily on the network and the merger. I shall not talk in detail about changes to upper gastrointestinal, urological and head and neck cancer services, although other Members may want to contribute on those subjects in more detail, as they are not uncontroversial. However, very few people are affected by those cancers, and the big issue for me is the network overall, rather than the merger of services for those specific cancers.
My hon. Friend the Member for Rayleigh, when introducing me to the subject, summarised the whole issue by saying, “If it ain’t broke, don’t fix it.” That is probably a fair reflection of the overall feeling in south Essex. The cancer network is doing a fantastic job. In fact, it is one of the leading cancer networks in the United Kingdom, and I would like to pay particular tribute to the lead clinician, Dr. Colin Trask, and the lead manager, Kevin McKenny, who I am sure will read the report of the debate with great interest. The service has a fantastic reputation not only locally, but among its peers. I could quote a whole series of barometer statistics about cancer care, but suffice it to say that statistically it does an excellent job.
At the moment, most of the cancer care network, and most transport communications, in Essex go east-west, not north-south, because when people are treated in Essex and are looking for specialist services, they look to London. There are no significant patient flows north-south or south-north, so the merger is inappropriate, given the movement of people.
Early on, our campaign talked about saving the cancer centre. A few people have called us sensationalist. It is true that the cancer centre will not close tomorrow, next week, next month or even next year, but I feel that this is a case of death by a thousand cuts. A salami-slice approach is being taken to reducing things—a little bit is taken off here, and a little bit is
taken off there. There will be a reduction until a critical mass is reached, which will mean that Southend cancer centre will not be able to attract the excellent clinicians that it does at the moment and maintain its excellent reputation.
Also, we are told that the change is purely administrative. If it is purely an administrative matter, then given that there is so much public opinion against the change in south Essex, and given that we are talking about only 20 or 30 people in terms of gastrointestinal cases, why press ahead with it? I have a sinister suspicion that the change is not purely administrative, but a stepping stone to other changes, and I seek the Minister’s reassurance that that is not the case.
I need to be careful when talking about the Mid Anglia cancer network, because clearly we south Essex MPs are proud of our services, but perhaps I could quote what other people have said, rather than making a judgment on the network myself. Some people have told me that the Mid Anglia network is unstable at the moment, and others say that there are lots of problems with Ipswich having left. I recognise that there may be benefits for Mid Anglia in the merger, but there are certainly no benefits for my residents in Rochford and Southend, East, or for constituents generally across south Essex. Perhaps the strategic health authority is formulating an equation for the greater good of the residents of Essex, but the equation does not work for me. South Essex loses a little and Mid Anglia gains a lot. That may work overall, but it does not work for my constituents.
There is a feeling that bigger is better, but I am not sure that that is right when it comes to cancer networks. It seems from speaking to some patient groups and GPs that the opposite might be true and that some cancer centres may be too large. One of the greatest challenges is to identify cancer early at GP level and to refer patients to the correct person for a proper diagnosis. A closer relationship between the cancer networks and individual GP practices would be more easily facilitated if the networks were slightly smaller. I am suggesting not a radical change, but a change in direction, and it may be better to keep them as they are or to reduce them slightly.
The cancer centre made the point that it is already working across boundaries in some cases and sharing best practice. I shall go into more detail about how one size does not fit all. I mentioned the 1995 Calman Hine report. It is 10 years old but is still relevant and still resonates. I want to draw attention to some quotes from the report. The first is about the size of the population and states:
“The size of a population served by a Cancer Unit cannot be inflexibly defined but will be determined by the number of cases of each cancer type being seen there”.
It is critical that a network is based on the number of cancer incidents rather than the population. South Essex has pockets of deprivation with, sadly, a higher incidence of cancer and demographically it has a much older population. Those were the two reasons given by the Government’s cancer tzar for not going ahead with the decision to merge the network in 2002. Those reasons remain true today.
“Decisions will have to be taken forward in the light of local circumstances and take account of the views of patients”—
“and their carers as well as the professionals involved in providing care.”
“The Group recognise that the development of the ideal pattern of service should build upon existing patterns of referral and care and should take account of geographical constraints.”
That is the opposite of what is happening. There are no existing patterns of referral north and south and there are transport constraints. It is normally quite difficult to travel around south Essex and people who need cancer care do not want to be stuck in traffic for hours before receiving important treatment.
Mr. Mark Francois (Rayleigh) (Con): I apologise for interrupting my hon. Friend because he is making a good speech.
To amplify what my hon. Friend said about the quota being under 1 million, when the network was established it was specifically given a derogation from the 1 million level because the NHS accepted that there was a higher than average number of elderly people and that actuarially, unfortunately, cancer would be slightly more prevalent in that population group. There was enough business to make a cancer network of 750,000 viable. The point that I want to stress is that that was built in from the day when the network was established. It was looked at from day one and accepted, so it should not be overturned.
James Duddridge: I thank my hon. Friend for raising that. He has been involved in the matter for a considerable period, more so than I have. I completely agree that the 1 million figure is largely arbitrary and inappropriate for the South Essex cancer network. It does not take account of the local situation.
I explained why I found one of the replies to a written question unhelpful. I was trying to probe whether there was a statistical correlation between the size of the cancer network, the number of treatments and the success rate. I also asked the Secretary of State for the population catchment size for each cancer network in England and the Minister replied:
“The Department does not hold the population catchment size for each cancer network. However, a typical cancer network services a population of around one to two million.”—[Official Report, 18 April 2006; Vol. 445, c. 385W.]
That statistic perhaps went into the first column of some form of analysis. The second column would have been the actual cancers identified each year. Around 3,500 cancers are identified in the South Essex cancer network. The following column would be an indicator of the success of those units—for example, long-term survival rates. I appreciate that that is a much harder figure to obtain, but nevertheless it is important. I seek the Minister’s guidance on the exact measure that she could take within the Department.
The final column would be the statistical correlation between those first three numbers. Nowhere in my discussions, the circulated paperwork or the responses to my questions have I seen that statistical analysis for the cancer network. Following a meeting, the medical director of the strategic health authority kindly
provided details for three specific cancers, and although I cannot engage in the detail of the medical situation, there seemed to be a case that bigger might be better. However, no one has tried to prove, in anything that has been provided to us, that bigger is better for cancer networks, and many of us have been extensively involved in this subject for the past few months, and some of us for much longer.
I am concerned that this is déjà vu in respect of 2001-02. I feel embarrassed that back then, before I was an MP, colleagues were successful and that I do not seem to be getting a very good deal for my constituents. I worry about that, and I ask the Minister to give me a ray of hope, or at least an explanation. I do not want the cancer network 10-year birthday to be celebrated with effective abolition by merger.
To call the consultation a sham would perhaps be unprofessional, and such language might be unparliamentary. I use those words in anger, because I was very upset by the way I was treated, not individually but as an MP—as a statutory consultee—and, more importantly, by the way all the patient groups were treated. There was overwhelming opposition, which I think is best summarised by the people at the front line who are running the network.
The South Essex cancer network did not support the SHA’s proposals to merge. It gave a number of reasons why: there
“is no demonstrable patient benefit”;
there is a great risk of losing the clinical cohesiveness and ownership that exists in south Essex; patient flows should determine network configurations, and there are virtually no patient flows from south to north or vice versa; current network arrangements meet national peer review measures already; the restructuring of cancer networks is not required to meet national cancer site-specific guidance, with south Essex plans already either approved or well advanced; the south Essex network currently has arrangements that are working perfectly well; and the merger will produce only marginal cost savings. Finally, the cancer network pinpoints a distinct lack of clarity about the future of the Mid Anglia cancer network based on current arrangements. Therefore, there is strong opposition from the people who actually run the network.
Other key authorities also opposed the merger. The two primary care trusts within my constituency—Castle Point and Rochford PCT and Southend PCT—did so. The two local authorities in my area wrote to ask me to raise the matter. They did not just send in a consultation; they passed council motions saying that they did not want it, because it was bad for constituents. That view came from both Southend and Rochford. Patients’ groups have also come to me both formally and informally and said that they oppose the merger.
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