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29 Oct 2008 : Column 284WH—continued


The Minister for the Armed Forces (Mr. Bob Ainsworth): I congratulate the hon. Member for North-East Hertfordshire (Mr. Heald) on securing this important and timely debate. We have 8,000 military personnel and 400 civil servants and contractors in Afghanistan, and we have lost 121 people in that benighted country since 2001. During 16 Air Assault Brigade’s recent six-month tour—it has just arrived home—we lost 32 people, and a further 30 were seriously wounded. In recent days, the murders of Gayle Williams and David Giles by militants in Kabul reminded us that the country’s capital remains a dangerous place. I am sure that we all pay tribute to those who have paid the ultimate sacrifice, and to all those who take such a risk on our behalf. Our thoughts are with the families of those we have lost, and our eternal gratitude belongs to all those who serve our country.

Such investment in blood and sweat, to say nothing of pounds and pence, rightly raises challenging questions. Why are we doing this? Is it worth it? Should we continue and, if so, for how long? A further key question, which I have heard only my hon. Friend the Member for City of York (Hugh Bayley) ask so far today, is: what are the consequences of our not continuing? A related question is: how much is our effort in Afghanistan in our self interest? My hon. Friend the Member for Newport, West (Paul Flynn) said that we should never have gone in there in the first place because were stirring up a hornets’ nest, and it is all terrible. That presumes that if we had not stirred up the hornets’ nest, the hornets would have remained quietly buzzing in the corner, and would not have stung us hard.

My hon. Friend complains and worries about the furore at the loss of life, and at the inquests into the loss of some of our people, which will continue. But what about the furore if we have another 9/11 or 7/7? We cannot say that the country is over there and unconnected with our national interest and security. Yes, I want us to open schools, I want women to be able to participate in education, and I want Afghans to be relieved of the mediaeval tyranny of the Taliban, but that is not my main motive for allowing our people to go to, and sometimes to die, in a faraway place. My main motive is the protection of our people back home. If I did not believe that our involvement in Afghanistan was inextricably tied up with our security back home, I would not support our involvement in Afghanistan.

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Mr. Ellwood: I think we all agree that we shall be in Afghanistan for some time, so perhaps I could bring the Minister back to that debate. I understand from my visit to Helmand recently that the Americans are building a second runway at Camp Bastion, and are introducing 9,000 combat troops. That will dwarf the British presence there at the moment, and change the dynamics considerably. Will the Minister explain why that move has been made, and how command and control will work?

Mr. Ainsworth: The move has not yet been made, but it is under consideration, as the hon. Gentleman knows. Several hon. Members have said that the Americans are having a review, and asked whether we are having one and should have one, and the hon. Member for North-East Hertfordshire made that a central point. I sometimes think that when we have review after review, we are in danger of pulling up the plant to see whether the roots are growing. Of course, the Americans are having a review. They will shortly have a new President and a new Administration, and they will want a completely fresh look at what they do, how they do it, and so on. We will be involved in that. We will have our people there, and we will try to exercise whatever influence we can over American interests, but our policy is still totally and utterly justified in my opinion, and I have heard nothing today to suggest that it is not.

My hon. Friend the Member for Newport, West said that we must move away from the fiction of military victory, but I do not know where that fiction comes from. It is not a fiction that the Government have ever spread around. It is not new when people say that the military alone cannot win in places such as Afghanistan. Everyone understands that, from the Prime Minister down to Defence Ministers, commanders on the ground, and right down to captains. They know that the operation is about winning the people; it is not about killing the Taliban. The hon. Member for Newark (Patrick Mercer) understands the military procedures and doctrines better than I do. The operation is counter-insurgency. That is well understood at every level in our military, and is built into our thinking.

Jeremy Corbyn: The troops have been in Afghanistan for seven years, and the Ministry of Defence talks openly of their staying there for another 30 years. How much longer does the Minister honestly expect us to bear the cost of deploying the troops and suffering the loss of life in Afghanistan before there is any political settlement?

Mr. Ainsworth: We have never tried to say, and no one has ever suggested, that our involvement in Afghanistan would be short-term, or an easy and quick win. I return to the question: what if we were not involved? The hon. Member for Colchester (Bob Russell) asked the question, as did my hon. Friend the Member for City of York. There is no easy way of walking away and turning our backs on the situation.

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Paul Flynn: The hornets’ nest that we stirred up was the incursion into Helmand province. Our decision to invade Afghanistan was originally supported by every member of the House, including me, on the basis of reducing the threat of terrorism by weakening the Taliban and removing al-Qaeda’s safe base from which to operate against us, but the Taliban have been greatly strengthened, and Osama bin Laden and al-Qaeda have an even safer base in Pakistan, so the threat of terrorism is the same.

Mr. Ainsworth: The heart of the insurgency is in southern Afghanistan, in Kandahar and Helmand. To suggest that one can go into benign parts of the country, but not the dangerous parts, and somehow deal with the insurgency is not reality.

The situation is far from perfect. There is much to be done and there are major challenges ahead, but we should not allow the fact that the situation is difficult make us defeatist. We must be strong and determined, and we must remain unflinching in our commitment to Afghanistan, because our vital national security is at stake. This is a question of our national interest. Unless we are happy for those who seek to wreak havoc on the streets of our country to be free to train in the ungoverned space that is there, as they were doing before 2001, our involvement is inevitable.

Mr. Bernard Jenkin (North Essex) (Con): The right hon. Gentleman makes some eminently sensible points, but it seems likely that, with either new President, we will be asked to take part in some kind of military surge in Afghanistan. This debate has shown that all parties are very concerned and that there needs to be considerably more debate, understanding and confidence that the Government will support a policy of engagement with the tribal leaders to promote local governance in the provinces to ensure that this campaign is effective. Will he undertake to have a debate on the Floor of the House, before those decisions are made?

Mr. Ainsworth: The hon. Gentleman knows that I cannot promise debates on the Floor of the House. He knows that we have five defence debates every year and that Afghanistan features significantly in those. We have Defence questions next Monday and we will have debates here in Westminster Hall. In addition, the Opposition have their own opportunities to raise these issues.

Reconciliation has been mentioned by the hon. Member for Newark and other hon. Members. Our policy has always been that we are not against reconciliation. It is part of our strategy in Afghanistan, but one can reconcile only with the reconcilable. One cannot reconcile with the top end of al-Qaeda who have shown no propensity to talk to anyone, and one cannot reconcile with the hard-line end of the Taliban leadership who are totally and absolutely at one with al-Qaeda. We will reconcile where it is possible as part of our strategy.

4 pm

Sitting suspended for a Division in the House.

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Cancer Services (Kendal)

4.18 pm

Tim Farron (Westmorland and Lonsdale) (LD): It is a pleasure to serve under your chairmanship, Mr. Taylor. I am grateful for the opportunity to make the case for a new cancer treatment unit at Westmorland general hospital. Over the past few months, I have been in discussion with the University Hospitals of Morecambe Bay NHS Trust and Cumbria primary care trust about the need for a cancer unit in south Cumbria. I am delighted that the trusts are now pushing forward with that bid and that only last week the local cancer network agreed to go ahead with the feasibility study, with a strong steer that the unit should become a reality as soon as possible. My hope in this debate is that the Minister will give us some commitments as we seek to establish the cancer treatment unit in Kendal, and encourage us in our campaign and our bid.

The need for the new unit is clear: residents of south Cumbria face some of the longest travelling times in the country when they go to receive vital cancer treatment. The Minister will know that NHS Cumbria has provided figures showing that from some locations in south Cumbria, cancer patients have to make a three-hour round trip to receive treatment. In my constituency, cancer patients living in the main town of Kendal must travel 41 miles, taking almost 50 minutes, to receive treatment. That is just a one-way journey. For residents in Grange-over-Sands and Windermere, the one-way trip to Preston takes an hour. For the vast number of my constituents—for example, those in Coniston, Grasmere, Sedbergh, Chapel Stile, Elterwater, Ambleside and Cartmel—the journey to Preston takes in excess of an hour, and in some cases an hour and a half. Patients from other towns and villages in south Cumbria outside my constituency also suffer as a result of the ludicrously excessive travelling times.

The Minister will know that Cancer Reform Strategy supports the findings of the National Radiotherapy Advisory Group, which concluded that radiotherapy units should be planned so that no patient has to travel for more than 45 minutes by car to receive treatment. The appalling reality is that not one cancer patient in my constituency can reliably access radiotherapy treatment within that time. Cancer patients in Westmorland and Lonsdale have, on average, to make a round trip of more than 100 miles every time they have to go for treatment. For some cancers, patients need to make daily trips. Those living with and fighting to overcome cancer should not have to face unnecessarily arduous, stressful and painful journeys to receive essential care.

Many people have spoken to me of their difficulty in coping with the journeys involved. They tell me that they feel worn down, and ready to give up treatment that could save or extend their lives. In talking to Cancer Care, a local charity in south Cumbria and north Lancashire that takes care of and provides counselling and support for cancer sufferers, it is also clear that a cancer unit in Kendal would make a huge difference to the lives of children and young people who have cancer, or whose siblings, parents or other carers have cancer.

The trauma is bad enough without the additional logistical difficulties of having to arrange time out of school and the other child care problems that treatment
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at a distant centre can throw up. For those who have to spend half a day travelling, the opportunity to take advantage of vital counselling, through charities such as Cancer Care, is massively squeezed.

On a personal level, my wife and I lost our mothers to cancer during the last four years. In both cases, we saw the outstanding way in which NHS staff, at all levels, showed commitment and compassion, along with tremendous professional skill and expertise. We also witnessed the reality, which is that cancer treatment is extremely gruelling, and the fact that tackling the disease can often wear down and debilitate the patient. Indeed, many patients decide to discontinue treatment because they are so badly affected.

When patients, families and clinicians are considering initial treatment, or its continuation, one of their concerns is the reality of travel times. Putting it bluntly, the requirement on people who are extremely poorly to make a difficult regular round trip of up to three hours leads many to decide against treatment that could extend their lives.

[John Bercow in the Chair]

I am sure that you will agree, Mr. Bercow—I welcome you to the Chair—that it is scandalous that people should effectively be forced to give up life-saving treatment simply because it is too painful for them to get to the units where the treatment is delivered.

I have bags of evidence from my constituents that backs up the reality, but I shall concentrate on a few statistics. The NHS recommends that around 52 per cent. of patients with cancer should receive radiotherapy, but for patients in south Cumbria the figure is only 30 per cent., 10 per cent. lower than for our neighbours in the north of Cumbria. Cancer admissions for south Cumbria are 10.6 per 1,000, compared with 11 per 1,000 for Cumbria as a whole and 11.9 per 1,000 for England. Our cancer admissions are among the lowest in the country, and the number of patients receiving radiotherapy is also one of the lowest in the country.

Furthermore, the average cost in south lakeland of GP prescriptions for malignant disease and immunosuppression is, at £900, the highest in our area. For our neighbours in north Cumbria and Carlisle, the figure is £400 and in the Eden district, the figure is £325. It is not rocket science to infer that the huge difference in those figures is due to the fact that those patients in south Cumbria who are much further from radiotherapy centres are opting for drug treatments closer to home rather than having more effective radiotherapy many miles away.

There can be no doubt that the staggering distances between patients in my constituency and the nearest radiotherapy treatment centre are having a tragic impact on survival rates. That is why NHS Cumbria has stated that the siting of a new cancer unit at Westmorland general hospital would significantly benefit patients from south lakeland and Barrow, as it would hugely reduce travelling times.

I encourage the Minister to support the bid being made by NHS Cumbria, the North Lancashire primary care trust, the University Hospitals of Morecambe Bay NHS Trust, the Lancashire and South Cumbria Cancer Network and me for a new cancer treatment unit to be established in Kendal. The need for such a unit is clear, and we believe that Kendal is undoubtedly the right place to locate it.

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Westmorland general hospital is easily accessible. It is on the edge of town and about eight minutes drive from the motorway. There is plenty of space around it for expansion, it has good car parking provision and it is set in tranquil surroundings. That is important, because the feel and atmosphere of a cancer unit is of the utmost importance when people are attending for treatment under extreme emotional pressure. It is the most central location for a population who would be drawn from Barrow in the west to the villages of the Yorkshire dales in the east, and from the Eden valley in the north to the Lancashire border to the south.

The Minister will recall that I have raised concerns about the future of Westmorland general hospital on numerous occasions, and I am grateful for her continued attention and for her interventions over the past year or so since she took up her post.

Westmorland general hospital is the only hospital in south lakeland. In other words it is the only hospital serving an area that is larger than Greater London. It has recently lost many of its emergency medical services, although a strong local campaign succeeded in winning back a cardiac assessment unit and two GP-managed medical wards, for which we are grateful. Our fight to bring back other medical emergency services, especially for heart patients, continues. Nevertheless, the Minister will doubtless understand our real fears about the future of our hospital.

The primary benefit of a cancer unit in our hospital in Kendal would be for cancer patients and their families, but there would be a further benefit of vast importance: locating a new cancer centre at the hospital would demonstrate a commitment to retaining and strengthening Westmorland general. Indeed, it would reinvigorate our hospital. I speculate that the Minister would find herself a Westmorland heroine if she made that happen on her watch. What is more, I will personally make arrangements for the statue! That is a promise.

Over the next few weeks, I shall be meeting Professor Mike Richards, the national clinical director for cancer, and Mike Farrar, the chief executive of the strategic health authority for the north-west of England. My aim is to win their support for the bid and to get the wheels in motion, so that we can see the unit built and operating within two years.

The Cancer Reform Strategy requires strategic health authorities to take an overview of radiotherapy planning. It also requires that the cancer action team should keep a national overview of locations for treatment. Given that the Cancer Reform Strategy is clear in saying that no one should have to undergo a journey of more than 45 minutes to receive treatment, and that no one in south lakeland can access treatment within 45 minutes, I hope that the Minister will put her full weight behind our bid to win support for the proposed cancer treatment unit at Kendal. I encourage the strategic health authority and the cancer action team to do the same.

For the record, let me explain exactly what we are asking for. We want a unit that will deliver radiotherapy and chemotherapy. The unit would need a CT simulator, laboratory facilities and on-site oncology support. In my view, the presence of on-site clinical oncology in Kendal would underpin the new unit, ensuring that long arduous journeys for patients for the purpose of treatment planning as well as for the treatment itself were rendered unnecessary. We must ensure that
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chemotherapy treatment is available at the new unit, along with radiotherapy. If we are to put an end to unacceptable journey times, we need to do so for as many treatments as possible.

There is some discussion about whether the trusts should bid for one linear accelerator or two. The population comfortably create demand for at least one accelerator, but along with local clinicians I can make a strong case for two. Senior oncologists have told me that it is essential to have two accelerators to allow for down time and to ensure that there is no interruption in service, which is vital.

Such a unit will clearly involve a significant capital investment in new buildings and equipment, and the local NHS trusts estimate a total bill of about £15 million. It is estimated that the running costs would be about £1 million. We must also ensure ongoing capital support to sustain the Kendal cancer unit. Once built, it is essential that the unit keeps up with advances in technology, and that the machinery is properly maintained over time. With developments in technology such as image-guided radiotherapy and intensively modulated radiotherapy now available, we would want to be sure that our new unit was able to keep pace with, and to provide equivalent quality treatment to, other centres.

Our previous radiotherapy units have been funded through national capital, and I would be interested to know how the Minister thinks the Kendal cancer unit could and should be funded. I also ask for her support in allowing us to fast-track the procurement process for the unit, essentially to allow the NHS to run the service and to get on with the job, given that it is extremely unlikely, as with all units of this type, that a private provider would come forward. Of course, the new unit would also need staff, so I ask the Minister to work to front-load the recruitment process, given the need that we would have for nuclear physicists, radiographers and clinical oncologists.

Now that the Government are, rightly, bringing forward public works as they seek to employ the wisdom of the great Liberal, John Maynard Keynes, to counter the economic downturn, may I encourage the Minister to do all in her power to bring the construction of the unit into being as soon as possible? With her support, I believe that it could be up and running by 2010, a time scale that the University Hospitals of Morecambe Bay NHS Trust, the primary care trusts and the local cancer network believe to be entirely feasible.

On Saturday, I stood in the rain in Kendal town centre—it was slightly better than being involved in the marathon near Keswick—with a petition calling for the establishment of the unit. Despite abysmal weather, I was overwhelmed by the support of local people. Many of them shared personal testimonies with me, of relatives who gave up on treatment because of the journey times involved, and of how those relatives’ last weeks were rendered all the more painful and dismal by soul-destroying, painful round trips of 100 miles or more. I also heard tales of the wonderful treatment that is provided at existing centres such as Preston, where my own mum was cared for. There was a strong desire for care to be provided as close to home as possible.

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