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29 Oct 2008 : Column 290WH—continued

It is a great honour to speak on behalf of local health professionals, trust managers, patients and their families, and the whole community of south lakeland, and to make what I hope the Minister agrees is a considered
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and realistic bid for her support for a new cancer unit at Westmorland general hospital. The unit will save and extend lives. It will provide accessibility of care for patients throughout south Cumbria and new cause for hope and confidence in the future of our much-loved hospital in Kendal.

4.32 pm

The Parliamentary Under-Secretary of State for Health (Ann Keen): May I say what an absolute pleasure it is to serve under your chairmanship, Mr. Bercow? I congratulate the hon. Member for Westmorland and Lonsdale (Tim Farron) on securing this debate. He has shown an acute interest in the welfare of his local health services and I commend the dedication with which he serves the needs of his constituents. I share his gratitude for the care that his family members received from the health service—it is a tribute to all health service staff and to the care and commitment that they show.

I am pleased to hear that the local health community across Cumbria and north Lancashire is working on proposals to develop a new cancer unit in the region. Importantly, however, I also acknowledge that the plans are at a very early stage—the hon. Gentleman will be interested in how I develop the discussion on that. I understand that the relevant organisations are putting together a feasibility study to identify the service specification and to consider a number of care models. Once that is done, clarity will be gained on the specifics of the scheme, which will allow detailed and well considered plans to be put in place.

It is right and proper that that initial scoping process and subsequent decision making be undertaken in a thorough and impartial manner, so that the local health community can ensure the most effective use of money, and so that it can be assured that it decides on the model of care that is best suited to the needs of the local population. Furthermore, I understand that the project structure has yet to be agreed and that a stakeholder group is in the process of being convened.

A number of work streams have been identified, including the much-needed clinical pathways work force, business and financial planning, and estates and facilities. Those will inform the commissioners’ service specification. However, I understand that preliminary plans by the Lancashire and South Cumbria Cancer Network suggest that the first satellite unit in the area should be commissioned between 2010 and 2012. I am advised that Cumbria PCT has identified cancer as one of the main priorities in its commissioning strategy, particularly because of the gap in life expectancy between those from the most affluent and the most deprived parts of the county. Its strategy includes initiatives to increase investment in cancer services, coupled with a radical reform of service delivery. That includes increasing the number of oncologists and radiotherapy treatments. The plan is that those services will be provided increasingly within the Cumbria area, in line with the “closer to home” strategy.

The hon. Gentleman has tabled an early-day motion on the proposed cancer unit for Kendal, and he is keen to see a clear way forward for funding. As I hope I have made clear, the plans are at too early a stage reasonably
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to give assurances on that. The next steps are for the local NHS to produce a strategic outline case, which must be agreed by all affected NHS organisations, and then an outline business case, which, in addition to being supported by local parties, must be approved by North West SHA, given the size of the scheme. There are no shortcuts around that, but there is no reason why work cannot start immediately.

The purpose of the strategic outline case is to demonstrate that there is at least one feasible option for delivering the proposed scheme. The outline business case is required to explore several options, including “do nothing or do minimum”, and to choose a preferred option. It must show that a site capable of securing planning permission is available for the preferred option and, if it is not already owned by the NHS, that the owners are prepared to sell to it. It must also show that the proposed development is technically feasible on the chosen site, by means of an outline design; that it is affordable, given reasonable assumptions of activity funded under tariff; and that local NHS organisations support the preferred option.

I understand that the proposals by the Lancashire and South Cumbria Cancer Network, as they stand, aim to meet recommendations made by the National Radiotherapy Advisory Group on travelling time for patients—the hon. Gentleman made a strong point on that—and access to services. In a visit to Preston last August, I was made aware that cancer patients in south Cumbria have to endure very long travelling times to access radiotherapy treatment. Within the very large geographical scope of University Hospitals of Morecambe Bay NHS Trust, there is no radiotherapy provision. Patients must travel to Preston, which is more than 60 miles away. Oncologists and the very knowledgeable specialist nurses who are involved in this area of care made points about that to me on my visit. The advisory group has recognised that a maximum of 45 minutes’ travel time for radiotherapy patients is good practice. It acknowledged that that might not be achievable in some areas of the country, and I am pleased to report that a survey of driving times revealed that 87 per cent. of the population already live within 45 minutes of a radiotherapy centre, and that Cumbria PCT is taking steps to achieve that aim for the local population.

On 3 December 2007, the Government launched the cancer reform strategy, which sets out plans further to improve and develop cancer services throughout England over the next five years. It includes measures to improve cancer prevention, speed up the diagnosis and treatment of cancer, reduce inequalities, improve the experience of people who live with or who are beyond cancer, and ensure that care is delivered in the most appropriate settings and that patients can access effective new treatments quickly.

The December strategy sets out the fact that to achieve world-class radiotherapy services nationally, local investment is needed, both in equipment and work force. In addition, in line with the recommendations of the advisory group’s report, the strategy recommends that local PCTs, with their cancer networks, review their local radiotherapy services to ensure that recommended levels of treatment activity are achieved. Cumbria PCT and the local cancer network are proactively addressing those issues, and should be commended for that.


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To support local clinical teams and commissioners as they review and develop radiotherapy services, the National Radiotherapy Advisory Group Implementation Group has been set up. The group is chaired by members of the Royal College of Radiology, and has representation from all appropriate royal colleges, other professional bodies, radiotherapy service managers and cancer networks. However, the location of new radiotherapy equipment or centres will remain a matter for local determination.

Those plans and recommendations are in place to capitalise on the progress made in NHS cancer services over the past decade.

Tim Farron: I am encouraged to hear the Minister say that the location of centres such as the one that I have been talking about will be chosen locally. However, will she specify whether she is talking about the local primary care trusts in north Lancashire and Cumbria or the strategic health authority?

Ann Keen: I am talking about both. We should always communicate with the strategic health authority and local PCTs when we are making changes of the nature that we envisage.

I am pleased to advise that nationally, cancer mortality among people under the age of 75 fell by over 18 per cent. between 1996 and 2006, which amounts to 9,000 saved lives. Whenever I am asked to hold meetings on long-term conditions, I am pleased to say that many of them are on cancer. Cancer is no longer considered to be an acute, lethal diagnosis; it is a long-term condition. Many more patients are living longer and now require totally different services, such as those offered by specialist cancer nurses.

Such a change is down to significant improvements in NHS cancer services. The improvements include extending breast screening to women aged up to 70, and significantly reducing waiting times for patients. The latest figures show that 99.9 per cent. of patients with suspected cancer were seen by a specialist within two weeks of a referral from their GP. There are now more cancer specialists. An extra 1,655 consultants have been employed in the NHS since 1997. We are going even further on cancer waits by extending the existing cancer waiting times targets to more patients. That will include extending the 31-day standard to cover all cancer treatments, not just the first, which will enable hospital specialists to place patients, where appropriate, on the 62-day treatment pathway.

I know that the hon. Gentleman will continue to champion and support health services within his constituency, and I encourage him to engage with local organisations through the planning stages of the cancer centre in Kendal. I feel that he needs little encouragement because leadership is already being demonstrated. The past 10 years has seen real progress in cancer services nationally, and I hope that his proposals will make a real and tangible difference to the people of Kendal.

The hon. Gentleman set me quite a challenge when he asked me to approve and fund the work force and have everything built by 2010. If I achieve that all by myself, a statue is more than required. I would not feel in the slightest bit embarrassed if a statue were erected. However, I feel that the challenge may be a little beyond my bounds. I end by saying to the hon. Gentleman, “Trust me, I am a nurse.”


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Social Enterprise

4.44 pm

Margaret Moran (Luton, South) (Lab): I am pleased to be having this debate under your capable chairmanship, Mr. Bercow.

I welcome the new Minister to his post and to what I guess is his first debate on social enterprise. Knowing him and knowing how well briefed he will be, I will not need to define terms for him. The key and distinguishing factor of social enterprises is that they are profit-making businesses that are established to tackle social or environmental need. As he will discover, if he has not already, the social enterprise movement is extremely active and diverse, and encompasses organisations such as development trusts, community enterprises, co-operatives, housing associations, social funds and leisure trusts.

Such businesses operate across an incredibly wide range of industries and sectors including health and social care, renewable energy, recycling and fair trade. They are also of all scales, from small operations to large international companies. They range from the small community social enterprise to the Divine chocolates of this world.

4.45 pm

Sitting suspended for a Division in the House.

5.5 pm

On resuming—

Margaret Moran: I paused for the Division on the happy thought of Divine chocolate, which has seen me nicely through the Lobby, although some of the real stuff would have been better.

I should declare an interest because, in the real world, before coming to this place, I was the chief executive of a housing association that had the twin aims of addressing housing need and tackling unemployment. I now chair the all-party group on social enterprises, and a black and minority ethnic-led social enterprise, eQuality Networks, which does a superb job, particularly in regeneration, community engagement and digital inclusion. That is my plug for today, although today’s debate is a big plug for all social enterprise.

Some would say that it is strange, at this time of global economic downturn, to be discussing how the Government might increase their support to social enterprises, but they are coming forward with some good measures to support small and medium-sized enterprises generally. My first plea, therefore, is to ask them to remember that many social enterprises are SMEs with a social purpose, and not to ignore them in any reference to assisting SMEs. Why is social enterprise scarcely mentioned in “‘Solutions for Business’—funded by government”, the national package of publicly funded business support products announced on 23 October? In the package, social enterprise is mentioned only twice—once as a case study and once under the section describing who is eligible for one product.

I am not here with a begging bowl for social enterprises. I want to raise with Government the undoubted fact that, at times when businesses face problems with liquidity and there is a prospect of them laying off staff, this
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sector is most likely to be fighting to retain staff. Social enterprises provide the jobs, skills, and services that are needed to hold the economy and communities together in times of crisis. They are also effective agents of social and economic resilience. Consequently, now is when we need our social enterprises the most, and supporting them will require a fraction of the resources being used to recapitalise major financial institutions.

There are several ways in which we can support social enterprises. First, the Government must recognise that SMEs are a priority when it comes to protecting the real economy and protecting hard-working people and communities from the effects of the downturn. Social enterprises, most of which are SMEs, have support needs that are distinct from those of mainstream businesses. Secondly, the role of social enterprises in maintaining services and jobs, especially in the communities that are most at risk, is even more important in the current economic climate. Some 85 per cent. of social enterprises recently surveyed by the Social Enterprise Coalition expected that the needs they serve, either social or environmental, will increase in the coming period.

Thirdly, social enterprises have already developed skills, expertise and the trust of their communities, which should be utilised. Social capital is even more valuable when other capital is in short supply. Fourthly, social enterprise lenders are better than high street lenders at providing liquidity where it is most needed. In particular, CDFIs—community development finance institutions—and credit unions are among the few who have increased their lending to those who need finance most.

Fifthly, social enterprises reinvest their profits in the business and for the benefit of the community. They have a strong local multiplier effect, stimulating local economic activity rather than capital flight.

Sixthly, I believe that more attention should be given to supporting social enterprises that provide embedded employment solutions as the job market shrinks. That may include redefining what counts as “results in payment by results contracts” for employment services.

Seventhly, employees taking ownership and converting failing private businesses into social enterprises is an opportunity to keep jobs, skills and productivity. Therefore, there is a need to join up some of the agendas of the Department for Business, Enterprise and Regulatory Reform, or BERR, and the Department for Work and Pensions, or DWP—I give up on the acronyms—to support that activity.

Finally, the Government really must get their act together and consider the leverage that they have through contracts, procurement and tendering, so that we can rapidly take advantage of the economic opportunities and provide a level playing field for social enterprise.

I want to develop a few of those themes to see how the Government can take advantage of the new opportunities that I believe social enterprises bring in troubled economic times, in the process recognising their unique ability to stimulate local economies, particularly in the most deprived areas. As I said, we first need to take practical steps to ensure that the help that is in place for SMEs also clearly applies appropriately to social enterprises and that we monitor that such help is taking place effectively.


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In a recent survey, late public service payments were cited as a problem for 37 per cent. of social enterprises, more than any other issue. So I believe that the Government need to provide details on the progress of their plans to extend the payment target to social enterprises and explain how social enterprises can hold to account those who do not meet that target.

As I have mentioned before, the Government have also committed to supporting SMEs in these difficult times by providing free business health checks through Business Link, a service that I must say many social enterprises have had some mixed experiences with. I would like the Government to assure us that health checks will also include specialist advice that is appropriate for businesses with primarily social or environmental objectives and that that advice and those support services will be made accessible and promoted to social enterprises.

The good news for the Minister is that, as I have mentioned, there is liquidity in the sector, which is vitally needed at this time. Social enterprise lenders such as credit unions and CDFIs are increasing their lending. They provide liquidity where it is most needed, often in areas where conventional finance markets have failed. They often support those who are most excluded from financial services and support those social enterprises that support the communities in greatest need. The Government need to recognise that while they continue to negotiate with high street lenders. Could the Government provide even more effective liquidity where it is most needed by channelling capital through social enterprise lenders such as CDFIs and credit unions? I therefore ask the Government to negotiate to encourage high street lenders to work with CDFIs and credit unions as trusted intermediaries to improve liquidity where it is needed most.

The Government need to ensure that banks’ commitments to the financial inclusion action plan 2007 are delivered soon. Those commitments included support for institutions such as credit unions, which provide services to the most excluded. The Government are already working with four high street lenders to access European Investment Bank funding. Will the Government support building a pool of social lenders, such as CDFIs and credit unions, to make a second-tier approach to the EIB?

The Government also need to speed up the review of credit unions that is going through the Treasury to ease access to their services. Will the Government consider amending that review to include incorporated associations and corporate bodies, such as full credit union members, so that small and community organisations can access services?

Another major area that the Government can address is that of larger-scale investment. Many social enterprises suffer from the fact that, beyond start-up, borrowing is a problem as major banks really do not “get” them, despite their excellent business plans.


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