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Westminster Hall

Wednesday 12 October 2011

[Andrew Rosindell in the Chair]

Ovarian Cancer

Motion made, and Question proposed, That the sitting be now adjourned.—(M r Newmark .)

9.30 am

Stuart Andrew (Pudsey) (Con): It is a pleasure to serve under your chairmanship, Mr Rosindell. It has been a good many years since I last did so, when I was chairman of the Welsh Young Conservatives and you were chairman of the national Young Conservatives. I am grateful for the opportunity to raise this important subject. I am conscious that many hon. Members wish to contribute, many of whom have personal and constituency experience of the disease. It is important to hear from as many of them as possible, so I shall make my opening comments as brief as I can.

My personal experience of the effects of ovarian cancer occurred some 40 years ago, and it meant that I never knew my grandmother. In her 50s, she suffered from the disease, which sadly took her life in my first year of life. She was buried on my first birthday. Clearly, at that age I was too young to know, but she was, by all accounts, a truly wonderful lady and, due to the cruel nature of the disease, her death was a loss that impacted on my family for many years.

Some 40 years on, I was elected a Member of Parliament in 2010, and like all new MPs, I am sure, I felt somewhat overwhelmed when I came to this place. What staggered me more than anything was the volume of invitations that I received from many different charities. One stood out—that from Target Ovarian Cancer. It stood out because it informed me that a constituent would be attending a reception, and because of the impact that the disease had had on my family.

I worked in the charity sector for 16 years and, as I was involved in politics, I thought I knew how to get to Members of Parliament, but I realised how wrong I was when I saw the volume of correspondence that I received. I thought it clever of Target Ovarian Cancer to make its invitation personal by bringing a constituent down here. In June, I attended that reception and had the opportunity to meet my constituent, Chris Shagouri. She is one of those people with whom one instantly clicks; she is inspirational. I listened to her speak about how late diagnosis of the cancer had impacted on her, her husband and her family. She talked about her ongoing battle to keep the disease at bay, and it is clear that she has great determination, but it was easy to wonder how much easier it might have been had the diagnosis been made earlier.

As the reception continued, I heard, time and again, moving stories from other women about their experiences. That and Chris’s persuasive manner convinced me to support the all-party group on ovarian cancer, which was being set up.

Sadly, diary clashes have restricted the number of meetings that I have been able to attend, but it is impressive that they are regularly attended by women who reinforce over and again the message that early

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diagnosis is necessary. At the most recent meeting, we heard again from women from throughout the UK about their experiences. At the most recent reception, four women gave personal accounts of their problems, which motivated me to bid for this debate. I am grateful to have been given that opportunity.

Ovarian cancer is not rare. It is the fourth most common cause of cancer death in women after breast, lung and bowel cancers. Every year, some 6,500 women are diagnosed and, staggeringly, 4,400 die every year. Just 36% of women who are diagnosed survive for a further five years. Those figures are staggering, compared with more than 80% for those who suffer breast cancer. It is also staggering that in three quarters of women who are diagnosed, the cancer has already started to spread. Those figures are scary.

The holding of this debate prompted someone to contact me this week. They wrote:

“My mother died aged 67 in 2009 with Ovarian Cancer. By the time she was diagnosed, the cancer wasn’t in the early stages and she was given only a 2% chance of living for 5 years. She fought all the way with various treatments and lived for 7 years after diagnosis.”

Jim Shannon (Strangford) (DUP): I congratulate the hon. Gentleman on raising the issue. As he rightly said, every one of us can relate to a constituent or family member with the disease, and most people are aware that the cancer is hereditary or genetic. Does he believe that whenever someone is diagnosed with ovarian cancer there should be immediate checks on other family members—sisters, nieces, and daughters—to ensure that the hereditary effect is not passed on? Does he believe that that should be done quickly after diagnosis?

Stuart Andrew: I am grateful for that intervention. I agree absolutely that anything we can do to ensure early diagnosis of conditions can only help. In the long term, it is better for the individual concerned, and certainly better for the rest of the family, who go through equal concern.

David Simpson (Upper Bann) (DUP): I congratulate the hon. Gentleman on securing the debate. Not long ago in my constituency, we ran an event to raise money for ovarian cancer treatment. An astounding finding was the number of young women aged 18 to 25 who are affected. I was astonished, because my impression had been that the disease affected older women, but it seems to be on the rise among younger women and is known as the silent killer. Does the hon. Gentleman agree that early intervention is vital? That could be done with blood tests, which some GPs have called for, and perhaps in schools, to identify this tragic killer of women.

Stuart Andrew: The hon. Gentleman makes an important point. I will talk about early diagnosis, which is crucial, as is awareness—making people aware of the symptoms. That is crucial in the campaign to fight this terrible disease.

I return to the letter that I was quoting from, which is relevant to the point that the hon. Gentleman made:

“I really hope the message regarding this disease can increase, as I wouldn’t want anyone else to suffer as my mother did. If she had gone to her GP straight away when she presented with symptoms and the GP acted straight away, then she may still be with her family, who miss her so much.”

That is a powerful testament to the problem that the disease causes.

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According to figures from the National Cancer Intelligence Network, only pancreatic cancer involves a higher proportion of people diagnosed with the late stage of the disease. but with ovarian cancer, unlike pancreatic cancer, we know what the symptoms are. That was not always the case. The hon. Gentleman referred to it as the silent killer, which is often how it is referred to, but in most cases the symptoms go unrecognised for some time by the women or their GPs. It is alarming that Target Ovarian Cancer has found that one third of women waited six months or more after visiting their GP for a correct diagnosis. That is staggering.

The National Institute for Health and Clinical Excellence has published guidance on the recognition and initial management of ovarian cancer, and listed symptoms such as persistent bloating or increased abdominal size, abdominal or pelvic pain, difficulty eating and feeling full quickly, and the need to urinate more frequently. If women experience such symptoms frequently, particularly more than 12 times a month, they should undergo tests.

Ian Paisley (North Antrim) (DUP): Under NICE guidelines, the first thing that should be done is a CA 125 test. Is the hon. Gentleman concerned that there are apparently restrictions on a GP’s ability to obtain that test for their patients, and importantly that there have been attempts block those tests from being carried through to pathology laboratories? The CA 125 test is the one thing that can spot the disease and increase the possibility of early diagnosis and greater chances of success.

Stuart Andrew: I am grateful for that intervention, which proves the need for the debate. I hope that we can take forward many of the issues raised today to try to tackle the disease. The hon. Gentleman’s point is incredibly valid and important.

NICE’s information is a step forward because it offers women, and importantly GPs, the chance to distinguish between ovarian cancer and more common but less serious conditions such as irritable bowel syndrome, which is the most common misdiagnosis. The ovarian cancer awareness measure, which is an accredited tool used by Target Ovarian Cancer in its pathfinder study, showed that only 4% of women felt confident of spotting the symptoms of the disease, and just 9% were aware that persistent bloating is the most common symptom of ovarian cancer. Compare that with 76% of women who recognise that a lump is the most common symptom of breast cancer.

Kevin Brennan (Cardiff West) (Lab): Does the hon. Gentleman agree that because of the specificity of the symptoms of ovarian cancer, there is a case for a specific campaign to raise awareness of the disease, rather than relying on a generic campaign, which is the approach that the Government have tended to favour so far?

Stuart Andrew: The hon. Gentleman is in danger of stealing my thunder, but I am glad that he has emphasised my point before I have made it.

Iain Stewart (Milton Keynes South) (Con): I congratulate my hon. Friend on bringing this important matter before the House. He is right to highlight awareness, but there is also the need for better information for women

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and their families following diagnosis. A close relative of mine was diagnosed with the condition, but there was a lack of knowledge of where to find more information about it. That led me and others to look online at a condition that was similar, but had a very different five-year survival rate. That caused a lot of unnecessary anguish to close family members.

Stuart Andrew: My hon. Friend raises a valid point. I worked in the hospice movement for about 15 years, and time and again we heard from parents of children at the hospice or patients in the adult hospice that when they were told of their disease, they almost went blank; they heard not the rest of the information, but just the dreaded diagnosis. It is crucial that people are given as much information as possible to take away and digest later.

As I said, 76% of women recognise the most common symptom of breast cancer, but there is clearly a lack of understanding about the significance of symptoms that they may experience due to ovarian cancer. Furthermore, GPs are not picking up the disease quickly enough. Just 22% of women are urgently referred to the two-week cancer referral route, and the rest are either sent away, or treated or referred inappropriately. Late diagnosis has been identified by the cancer benchmarking study, funded by the Department of Health, as a key driver for the poor ovarian cancer survival rates. That study seeks to understand the differing survival rates between countries for breast, lung, bowel and ovarian cancer. For some reason, despite the findings, ovarian cancer was the only cancer in the study not to be included in subsequent awareness campaigns. A large majority of women who are diagnosed in the later stages of the disease will experience recurrences, and many will develop resistance to chemotherapy.

My constituent, Chris Shagouri, is undergoing treatment yet again to try to slow the progress of the disease. Her strength and commitment to help to improve the lives of women who are diagnosed with ovarian cancer is amazing, especially when she could be forgiven for wanting to concentrate her efforts on herself and her close family. Chris Shagouri is representative of the many women who have attended meetings of the all-party group on ovarian cancer, and who share a determination to change the status quo. They often say that if just one woman gets a quicker diagnosis it will have been worth it, because for that woman this really is a matter of life and death. I hope that we can reach a better total than just one woman.

Treatments for ovarian cancer are highly intensive and invasive. An American study showed that, compared with women who have breast cancer, those with ovarian cancer spend nearly 10 times as long being treated in hospital in the first year after diagnosis and the last year of life. There have been no new life extending treatments for women with ovarian cancer during the past 20 years.

Why do members of the all-party group on ovarian cancer want to have this debate? Because we feel that, right now, an important opportunity to make much needed progress is being overlooked. I welcome the Government’s work, and commend them for it, with the cancer drug fund and the palliative care strategy —it was long overdue. In January, the Government published their new cancer strategy, which contained a strong commitment to improving early diagnosis and

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a multimillion pound investment in cancer awareness campaigns—fantastic stuff. It initially included regional breast, lung and bowel cancer campaigns, and recently we have heard that a national bowel cancer awareness programme will be rolled out next year, following the success of the pilots. New campaigns on oesophogastric cancers, and kidney or bladder cancer, will be run at a local level. The all-party group remains frustrated that ovarian cancer is not included in that admirable work.

The Government are committed to saving more than 5,000 lives a year from cancer by 2014-15, and women with ovarian cancer could represent 10% of that figure. Each year, up to 500 women lose their lives unnecessarily to ovarian cancer because we do not do as well as other European countries. The Government’s study showed that late diagnosis is a key driver of deaths from ovarian cancer in the UK, and it is curious that the condition was not included in the awareness campaigns in this country.

Why can an awareness campaign on ovarian cancer not be started now, even in pilot form? We applaud the Minister for the commitment to improve people’s chances of surviving cancer, but urge him to include ovarian cancer in the awareness work that is being done. Every day we wait, another one or two women, like my grandmother or such as Chris Shagouri, and many others who have been campaigning will lose their lives unnecessarily. As a matter of urgency, I ask the Minister whether he will consider an awareness campaign and whether he will meet with representatives from the all-party group on ovarian cancer to discuss how we can take such a campaign forward and stop other women suffering in future.

9.49 am

Fiona Mactaggart (Slough) (Lab): I should start this speech by telling the House that I should be dead, because only two out of every five women with ovarian cancer survive beyond four years and my cancer was diagnosed eight years ago, at the start of 2003. I remember the dates well. Throughout that autumn term, I had been on a very serious diet. As hon. Members know, I need to do that, and I was completely unaware that the loss of appetite that was caused by my cancer was being helpful to my dieting. At the end of that autumn term, I went to see my GP about symptoms that actually were irrelevant to the cancer, but she is a very insightful woman. She took a very careful history from me and did a CA 125 test. This was about December. She referred me and I did the CA 125 test. I remember the dates fairly well because it was just before I went away for a Christmas holiday. The level was elevated. Of course, I had no idea how significant that was. I cannot remember what it was at that point—45 or something like that. I said, “Is that serious?” She said, “Well, yes.” I did not quite work out how serious it was, but she had referred me to a specialist. I came back from my Christmas holiday and had an intravaginal ultrasound in January. I went to see the doctor about the results and was told on, I think, 15 January that I was going to have a hysterectomy in an operation that might be related to cancer on 14 February—not a date one forgets.

Although I was late detecting the symptoms and, indeed, the symptoms that I went to see my GP about were not symptoms caused by my cancer, it was a very short time before I had an intervention. In fact, it was

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quicker than that. It was this time of day on a Wednesday. The day before, we had lost, by just three votes, a cross-party vote on an 80% elected House of Lords. Those three votes were hon. Gentlemen who had had too good a dinner. I was trying to do press and so on about the House of Lords vote. I was trying to get across the point that a majority of the House of Commons thought that we should have an 80% elected House of Lords, but some hon. Members went in the wrong door because they cannot manage when they do not have Whips telling them where to go. Those calls were interrupted by a telephone call from St Thomas’ hospital, which said, “We have a cancellation. Can you come in today?” I burst into tears. Then I went to the Army & Navy Stores and bought a nightie and a pair of slippers and set off to St Thomas’ hospital.

As can be imagined, I arrived at the hospital not with my head in the place where a cancer patient needs it to be, but still trying to sort everything out, because although I had known that I was to have the operation, it was originally to take place about two weeks after the House of Lords vote that I was working towards. So I arrived all shouty and dictating things, putting out press releases, bellowing into a phone and so on. I was put in my bed and was still shouting down the phone, but then this woman came up to me, took my hand and put it in a bowl. I was on the phone and I said to her, “What are you doing?” She said, “I’m giving you a manicure.” I said, “Why?” She said, “I’m a volunteer. I come into the women’s ward in St Thomas’ hospital on a Wednesday and give women manicures.” I have told the Minister that story because that volunteer helped me through the experience, as I stopped being an MP and started facing being a patient. I strongly urge the Minister to recognise how powerful such roles, which do not look clinically essential, are in the care of people. That is my first message.

My second message is that my story tells us how good the NHS can be—how fast it can respond. In my case, it was eight to 10 weeks between first going to the GP—and not reporting the right symptoms—and having an operation. One cannot ask for better than that. I know that a big reason for it was the targets that we had set, because when I was told when my operation would take place, the consultant said to me, “Oh, I’m bumping up against the date.” I therefore urge the Minister both to look after the role of volunteers and voluntary organisations and to retain those targets that put pressure on the system to help people like me to live.

Dr Sarah Wollaston (Totnes) (Con): I congratulate my hon. Friend the Member for Pudsey (Stuart Andrew) on initiating this important debate. Does the hon. Member for Slough (Fiona Mactaggart) agree that although it is wonderful that she had such rapid access to treatment, such access to diagnosis is not uniformly available throughout the country? My experience is that it is difficult for general practitioners to gain rapid access to ultrasound scans, which was a crucial factor in the hon. Lady’s diagnosis. Equally, access to CA 125 measurements, although included in the NICE draft guidelines, which is welcome, is not uniformly available to GPs throughout the country.

Fiona Mactaggart: The fact that those things are not accessible is condemning women to die. It is very simple, and they are not complicated tests. I have had an awful lot of CA 125 tests because women have a lot before

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and a lot afterwards to see what is happening to the markers in their blood. It is a very simple test and certainly should be available in primary care so that GPs can do it quickly and reassure themselves and their patients. It was thanks to Ovacome that I began to realise how important knowing one’s CA 125 level is. Until I started reading the educative materials produced by voluntary organisations, I did not know that.

I want to say one thing about all the voluntary help available to people with cancer. It is very confusing. People never really know who does the thing that they need—who provides the help. Today, the question might be, “Should I wear a wig, or are they all horrible and uncomfortable?” The answer is yes, by the way. It might be, “Do I need someone to hold my hand and explain what’s wrong with me?” People do not know these things. I wish that somehow all the wonderful charities could get together and have one doorway through which the patient goes and can say, “This is what my life’s like. I can’t afford to park at the hospital” or “The wig that I got is itching” or “Is my reaction to chemotherapy appropriate? Do other people have it?” Who are the right people to help? People in this situation never know who the right people are, so one thing that I wish the Department of Health would do is find some way of resourcing those organisations to provide a better entry to their services for people with cancer.

However, I want to focus on diagnosis and helping people to detect their symptoms early. I did not detect mine particularly early; indeed, it was my GP who detected them, not me. Many hon. Members have written to the Minister, and at the annual general meeting of the all-party group in July we considered the response that he had sent us. Frankly, to me, it seems that the message is not getting through. The work being done to improve early diagnosis of cancer, particularly awareness, will not make a difference to the women who have ovarian cancer. I am very glad to receive an account of the work being done on breast, lung and bowel cancer, but frankly it is a bit insensitive. Someone who is concerned about ovarian cancer will see all those wonderful information campaigns on other cancers, but none of them applies to the symptoms of ovarian cancer. That will not do, and it particularly will not do when ovarian cancer is such a killer.

In the letter to the all-party group, the Minister said that

“future activity will depend on the success of the Be Clear on Cancer campaigns”.

His Department has since announced that following the success of the regional pilot campaign for bowel cancer, it will be rolled out nationally. Now that we know that those awareness campaigns work, when will we have a commitment to work on ovarian cancer? We have extended the work to include stomach, oesophageal, bladder and kidney cancer. Why not ovarian cancer? It was not until long after I had had a hysterectomy, chemotherapy and so on that I realised which of the symptoms that I had had were clues to my cancer. We really must help people to know that they are at risk. Ovarian cancer is the fourth most common cause of cancer death in women. Is it just because it affects women that we are not seeing

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action? If men had it too, we might be doing better, although, of course, we have a good history on breast cancer.

I worry that ovarian cancer is being put in the “too difficult” box, and it is not acceptable to do that with the most fatal gynaecological cancer. Ovarian cancer kills four times as many women as cervical cancer, for which we have a national screening programme. Is it not time that we put in place a national screening programme for ovarian cancer and gave GPs and others proper access to diagnostic tests that will save thousands of women’s lives? It is not acceptable that so many women die of this cancer when we know how to stop it, and I urge the Minister quickly to put in train action to deal with this issue.

10 am

Mr Steve Brine (Winchester) (Con): It is a pleasure to follow such a powerful speech. I pay tribute to my hon. Friend the Member for Pudsey (Stuart Andrew). We have worked together before, and he is getting quite a reputation for calling good debates in this place. I pay tribute to him for bringing this issue before us.

Like my hon. Friend, I come to the House with many experiences, which have shaped my life thus far. Cancer—not just ovarian cancer—has touched my life many times, and I have fought it many times. So far, it has won more times than I have, and such experiences shape the work that I do in the House.

In the next few minutes, I will not rehearse the arguments we have heard or repeat the statistics that my hon. Friend set out, but I will reinforce some of the things that have been said. Clearly, the most effective way of promoting awareness and understanding of the symptoms of ovarian cancer is to raise its public profile, and I hope that this debate will, if nothing else, go some way towards doing that.

I am a member of the all-party group and I pay great tribute to Target Ovarian Cancer and cancer charities generally, which do such an excellent job on this issue. I, too, have been struck by how effective they are as a lobby and by how powerful they are; the fact that so many Members are here today and that so many are interested in this issue is testament to that.

I thought that I would give Members a few reflections on my role as co-chair of the all-party group on breast cancer. I hope that is not insensitive; it is meant to be helpful, because there are really powerful lessons to be learned from the fight against breast cancer, and I hope that they can help women with ovarian cancer.

Thirty years ago, the breast cancer survival rate in this country was barely 50%; today, it is more than 80%. My goodness, that is testament to the effort that has been made. There have been many debates in the House, which have played a tiny role. There has also been funding, and large amounts of research and expertise have been applied to the issue. Awareness, too, has been critical. Similarly, there have been new treatments and a screening programme. All those things have made a difference, and they have all been essential to the significant progress we have achieved.

What has been key, however, has been the number of women who have been prepared to stand up and put their personal experiences on the record to keep breast cancer high on the nation’s agenda. Obviously, there

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have also been some high-profile deaths. There are so many to list, but what struck me, and it is often quoted, was when Linda McCartney lost her fight against the disease. So many women had grown up with the McCartneys, and her death did so much to place breast cancer on the agenda.

Breast cancer ambassadors continue to play a crucial role in raising awareness by sharing their personal experiences and promoting cancer campaigns in their local areas, as well as nationally, through the national media and through this place. That really brings home issues of which people might otherwise have remained unaware. It was not always the case that women immediately thought a lump might mean breast cancer; that was due to a huge amount of hard work and a huge number of awareness campaigns. The ambassadors really filled the gap effectively, and I hope we can see more of that in the fight against ovarian cancer.

As a member of the all-party group on ovarian cancer, I know that some representatives of the charities might be thinking that the lack of survivors makes fighting this disease more difficult, but that is a reason to try harder, not to give up. The lack of survivors means that people such as the hon. Member for Slough (Fiona Mactaggart) and other Members who take part in debates such as this are more important than ever in raising the issue and in keeping it high on the political agenda, and we will raise it again and again.

The high number of fundraising and public awareness drives promoted by the Department that the Minister represents, as well as politicians’ willingness seriously to grapple with the issue, have meant that the fight against breast cancer has retained its high profile, to the benefit of tens of thousands of women and their friends and families. Governments have produced very effective awareness campaigns over the years to encourage women regularly to check themselves and to ensure they know what they are looking for. The TLC—touch, look, check—campaign by Breakthrough Breast Cancer, which Target Ovarian Cancer works closely with, has been incredibly effective, and TLC day is part of breast cancer awareness month, which is this month. That is another exceptionally powerful way of reminding the public of that issue and of raising awareness of the fight against breast cancer.

Such simple messages, which can be spread through the champions I mentioned, can be used successfully and powerfully in the fight against ovarian cancer. We can send a bold message that women can fight the disease and beat it, and the hon. Member for Slough is wonderful living proof of that.

Many large national studies with large research grants were carried out in years gone by in the fight against breast cancer, and we need greater commitment and funding for research grants from the Government and charitable bodies at national level in fighting ovarian cancer. By demonstrating the commitment that exists in the research community to provide the wherewithal for large studies, huge strides can be made in bringing ovarian cancer to political and public attention. Perhaps the Minister can shed some light on his Department’s proposals on the future funding and commissioning of studies on the disease. Any information that he can share with us would be much appreciated.

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Notwithstanding the connection between the familial forms of breast and ovarian cancer, which share the same defective genes to some extent, the age profile of the women affected is broadly similar, although, as the hon. Member for Upper Bann (David Simpson) rightly said, a striking number of younger women are affected by ovarian cancer. In that respect, I received the briefing from the Teenage Cancer Trust, which was very powerful.

It is not inconceivable that the same women who take on board the messaging about breast cancer symptoms will be open to messaging about ovarian cancer. We are always told, so it must be true, that women are much more receptive to health messages than men. That is absolutely right, so we have an important opportunity to make significant and potentially life-saving progress.

Obviously, there are still huge improvements to make in the fight against breast cancer, and that is even truer of the fight against ovarian cancer—particularly in terms of diagnosis and treatment. Like other Members, I urge the Minister to take action on ovarian cancer awareness as soon as possible. Currently, we are barely getting past first base. This is a silent killer, but it is also a silent national scandal. If we achieved what has been achieved in the fight against breast cancer in the past couple of decades through raising awareness, screening and better treatments, 3,000 of the 4,000 deaths a year from ovarian cancer might not occur. That might have saved the grandmother of my hon. Friend the Member for Pudsey, and it might have saved mine.

I ask the Minister please to ensure that the Government take swift action and make a start on dealing with this issue. At the moment, there is little DOH-led activity to improve awareness of symptoms among women and GPs, despite the fact that the Government have rightly committed themselves to saving the lives of 5,000 cancer sufferers a year as part of their excellent cancer strategy. I have worked closely with the Minister on the Health and Social Care Bill, and he knows that I am a huge supporter of that cancer strategy. With investment of £12 million in awareness work towards achieving that pledge, some might describe tackling ovarian cancer as low-hanging fruit.

The Minister said earlier in the year that the main focus for the Government’s national symptoms awareness campaign would be bowel cancer, but he also stated that new campaigns were being piloted on other cancers and their symptoms. I hope that he will update hon. Members on the progress that his Department has made in piloting the campaigns. Including ovarian cancer in the awareness budget will help the Government to meet their targets—I am sure of that—while enabling them to improve survival rates for those with ovarian cancer, which are among the worst in Europe at the moment. If they improve, the lives of many women can be saved.

Target Ovarian Cancer gave me an excellent booklet, “An MP’s guide to ovarian cancer”, shortly after I was elected, and it contains a lovely quotation from a lady whom I met at an ovarian cancer reception last year. Her name is Eilish Colclough—I always get it wrong when I attempt it—and she is a mother of five. We have seen her speak before, and she is fighting terminal ovarian cancer. She says:

“I look at myself as living not dying.”

Whenever she speaks, and whenever such patients, survivors, fighters and livers come to speak to the all-party groups that I am involved in, it is always infinitely more powerful

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than any Member or Minister. In my experience—and I have had a lot of it, as I have said—people with cancer are not just their cancer; they are everything else as well. I hope that we can find many more people such as Eilish—survivors—to give more proof of that, to help us fight ovarian cancer, and to drive down the number of women we lose to it.

Several hon. Members rose

Andrew Rosindell (in the Chair): Order. We have 30 minutes left for general debate, so I ask hon. Members to limit their remarks to no more than five minutes.

10.11 am

Ian Paisley (North Antrim) (DUP): I, too, congratulate the hon. Member for Pudsey (Stuart Andrew) on securing this important debate, which I hope will be a springboard for increasing awareness and for encouraging the Department to pick up the gauntlet set before it today.

In the next 12 months, between 11 and 15 women in my constituency will die because of ovarian cancer. That is not a high or low figure; it is the average across the United Kingdom. We must wake up to the reality and that figure must be checked. We must embark seriously on a national campaign that will achieve better survival results, as has happened with major cancers such as breast and lung cancer.

I want to put four important and sobering statistics before the House. Most of the women who are diagnosed—75%—have late-stage disease, when survival rates are very poor. That is a very high figure. Also, 30% of women are diagnosed following admission to their local accident and emergency ward, not by their GP. Women with ovarian cancer are five times more likely to die within a month of diagnosis than women with breast cancer, and the UK’s late diagnosis is thought to be the key driver for those survival rates. Only 4% of women are confident that they can spot the symptoms of ovarian cancer.

I have two questions for the Minister. First, why, as the hon. Member for Winchester (Mr Brine) said, is there not yet any Department of Health-led activity to improve awareness of symptoms? That is the key to addressing the issue. Secondly, I take the view that what is not measured is not done, so why is there no national measurement for ovarian cancer?

Mr Gregory Campbell (East Londonderry) (DUP): Does my hon. Friend agree that greater awareness and early detection were the key to the significant progress made with other cancers? Many charities became involved with departmental officials to ensure that those things became the driver, which led to reductions in numbers. That is the key for ovarian cancer as well.

Ian Paisley: I thank my hon. Friend for making that point incredibly well. We have all come to realise that there is a lack of awareness because of lobby groups, patients in our constituencies and the families who come to see us saying, “Why did we not know? If we had known, we would have done something else and gone to the GP earlier.”

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As I have said, a gauntlet has been thrown down to the Department. Let us have better national measurement of outcomes established and followed up—year in, year out—so that the disease, which has been described as a silent killer, can be properly tackled and we can achieve the same successes as we have with breast, lung and bowel cancer survival rates.

10.15 am

Caroline Nokes (Romsey and Southampton North) (Con): I congratulate my hon. Friend the Member for Pudsey (Stuart Andrew) on securing the debate. I want to focus on a small area of it, but first I pay tribute to the hon. Member for Slough (Fiona Mactaggart), who gave us a very personal story and identified a key problem—the complexity of the symptoms, the fact that they are sometimes confusing and the general lack of awareness of what they are.

I thank Target Ovarian Cancer for its approach to me, which was quite personal. It was one of those approaches, which I sometimes receive, that make me think, “Ouch!” It would have been great if I had been approached by the Teenage Cancer Trust to be asked to emphasise the number of very young women who suffer, but, unfortunately, as I am approaching a large birthday, Target decided that I was in the key target group of women who really should know more. That is a key point. When I added in some other risk factors, such as lifestyle and weight, I began to scratch my head and think that perhaps I should take it all very seriously and think more closely about the symptoms that present when someone is suffering from ovarian cancer.

Despite the fact that women tend to be more aware of symptoms and keener than men to go to the GP—I apologise, as there are many male MPs present in the Chamber—they also have a serious tendency to grin and bear it, and get on with things. Sadly, symptoms such as bloating are not uncommon. I see the hon. Member for Slough nodding in agreement.

We are missing an opportunity, because by the time women get to a significant birthday they are already well used to some forms of screening for cancer. Great, next year I get mammograms as well—fantastic. That is an opportunity to talk to women about the symptoms of ovarian cancer. I do not want to appear controversial or to denigrate the idea that we need a general awareness campaign, which is important, but as any good advertising company will explain, a targeted message to the audience likely to be most affected is the best way to get something across.

I suggest to the Minister that we need to look at ways to approach the women most likely to be affected. That is not in any way intended to undermine the work of the Teenage Cancer Trust. The incidence in younger women is important and alarming, but age, genetics and hereditary disposition are the largest contributory factors in ovarian cancer, and we need to give close attention to the idea that when women are called for routine cervical smear tests or mammograms they are in exactly the right caring, knowledgeable environment for explaining the symptoms. I hope that the message will get out a little more effectively to those women who are at risk and who could contribute significantly to the Government target on reducing deaths from cancer.

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10.19 am

Nick Smith (Blaenau Gwent) (Lab): I, too, congratulate the hon. Member for Pudsey (Stuart Andrew) on securing today’s debate. It is good to follow hon. Members who have made powerful and reflective comments.

Like other hon. Members, I have a personal interest in the issue. My mam died from ovarian cancer when she was aged just 42, in our hometown of Tredegar in Blaenau Gwent—too, too young. My two sisters were just teenagers. I want women in my constituency and across the UK to have the best possible treatment if they have ovarian cancer today, or the earliest possible diagnosis if they get it in future.

A comprehensive report on cancer in Wales is published every three years. The latest was published just last month, and there are good stats on Wales that are important. The report covers nearly 15 years from 1995 to 2009, and, as the hon. Member for Pudsey said, it notes that ovarian cancer is the fourth most common cancer in females. We have to shout that out loudly across the UK from here today and hope that it is picked up in other places—it is a powerful statistic.

As in the rest of the UK, there has been a slight decrease in incidence over time, but of the countries studied, most of which are European, Wales is top of the incidence table. Wales has an incidence rate of 18.8 per 100,000 of population, which is significantly above the UK average. I know that Wales has a larger older population than other parts of the UK, which leads to higher levels of cancer, but the particular worry about ovarian cancer is that women seek medical help only at a relatively late stage, so the survival rate is poorer than for other gynaecological cancers. The “Cancer in Wales” report notes:

“There is no clear link with incidence and degree of deprivation”

but there

“seems to be a slight trend towards increased survival in patients with lower levels of deprivation.”

The mean age of diagnosis in Wales is 65.1.

What has particularly struck me—this has come out in today’s discussion—is that women who often take responsibility for the health care of their families, particularly children, and visit the family GP do not themselves recognise the symptoms of the cancer. In Wales, 29% of the public said that they were not at all confident, and a further 29% were not very confident, in identifying the symptoms. Together, that makes a high 58%. As others have said, only 2% were confident in recognising the symptoms. Public Health Wales is running important public education campaigns on skin, bowel and mouth cancer, but not, to my knowledge, on ovarian cancer. It is important, again as others have said, that we have a wide public health campaign on the issue.

I have long experience of working in the voluntary sector, most recently for the National Society for the Prevention of Cruelty to Children, and, before that, the Royal College of Speech and Language Therapists. I know that the sector is fertile ground for innovation. For example, I understand that some charities in the sector have developed training programmes for women and GPs, including an online symptoms tracker called Ovacome. That will be a good initiative. Such programmes are excellent and clearly show commitment to provide early diagnosis. However, like others, I ask the Minister

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to give assurances that the Government will look into providing a nationwide campaign to help women to identify symptoms of the cancer and build on the important work that is taking place with other charities.

I note that there are two screening trials under way—one for women in the general population, the other for women with a strong family history in this regard, such as my two sisters. I hope that the evidence from those trials will support a national screening programme. As we know, if ovarian cancer can be caught in its earliest stages, survival rates can be above 70%, which is a strong stat. We could save the lives of hundreds of women in the UK and save their families from the pain of a premature and preventable death.

Where they live also impacts on the support received by women with ovarian cancer. The Minister will be aware of the significant impact of the clinical nurse specialists and what they can do to support women with ovarian cancer, yet the 2009 Target Ovarian Cancer pathfinder study showed that many clinical nurse specialist posts were under threat, with a lack of cover for sickness and leave, and with a heavy work load. Many women cited the clinical nurse specialist as the single most helpful point of contact throughout their cancer journey, yet in large parts of the country the nurses are sole operators, as it has been phrased. Certainly in Wales, we have experienced difficulty in providing such posts. Elsewhere, I hear of posts being frozen and sometimes not filled.

Finally, while ovarian cancer is noted with respect to the lack of available and new drugs, a couple can be accessed via the cancer drugs fund, but again, where someone lives determines whether they get access. I hope that the Minister will give us the assurance that, no matter where a woman lives, she will receive early diagnosis and access to the high-quality treatment she needs. I hope that I have emphasised the importance of increased care and support for the large number of women with that terrible condition, which is often fatal, but, if caught early, survivable.

10.25 am

Tim Farron (Westmorland and Lonsdale) (LD): I pay tribute to my hon. Friend the Member for Pudsey (Stuart Andrew) for securing the debate and to all other colleagues who have contributed. In my patch, in the southern end of Cumbria, we have run awareness campaigns locally with our general practitioners on the symptoms of ovarian cancer. Most people here have had a tale to tell about how ovarian cancer has touched them, and my motivation is very personal: my mother was diagnosed with ovarian cancer in October 2002 and passed away in July 2004. She was one of the 75% of women who are diagnosed at stage 3 or 4. It is depressing that things have not progressed even since then. I go back to the cancer strategy and the Government’s announcement in January, with clear awareness and honesty that we are behind in survival rates for all sorts of cancers and that lack of awareness and lack of early diagnosis is the common theme in the failure to reach targets and save lives.

With regard to lack of awareness and lack of early diagnosis, ovarian cancer comes top of a pretty grisly league. It is brilliant that breast, lung and bowel cancer were included in the awareness programme, but I was

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dismayed, as I am sure many others were, to see that ovarian cancer was not. My hon. Friend the Member for Winchester (Mr Brine) used the phrase, “low-hanging fruit”. If we look at the cold stats on how we can save lives in big numbers pretty quickly, ovarian cancer is potentially the low-hanging fruit.

I will repeat quickly some of the stats already used: 500 women die unnecessarily every year from the disease; a third of cases take longer than six months to be diagnosed; and 29% are diagnosed at A and E, which shows a complete failure of the pathway. It is the fourth biggest killer of women in terms of cancer. Although I am hugely grateful for the stuff from Target Ovarian Cancer and other ovarian cancer organisations, I repeat those stats because my mum found them on the web nearly 10 years ago—and they have not got any flaming better! It is utterly depressing that the statistics have not improved in that time.

As the hon. Member for Blaenau Gwent (Nick Smith) rightly pointed out, survival rates are very bad, given what they could be. If women are diagnosed early, ovarian cancer is relatively easy to cure, with a 70% survival rate. Things are so bad that, by investing now, a huge difference will be made, and we will see lives saved in big numbers in no time.

As is the case for all people in such circumstances, my mum’s ovarian cancer was an appalling family tragedy, which, in many ways, brought us together. She had 20 or 21 months of extremely high-quality life following her diagnosis, and I pay huge tribute to the Macmillan nurses and to Rosemere trust at Preston hospital, who made her life bearable—indeed, made all our lives bearable, and sometimes even a joy. My mum was aware that there was a genetic potential, and her concern was for my sister, my sister’s kids and my kids. I would put a plea in, with the other pleas that I will make in a moment on behalf of all of us, for effort to be put into looking at diagnosis and at the potential for genetically tracking the disease early, before it even arises.

Our collective plea—I do not see any dissent here—is for the Department of Health to act quickly to make the issue a priority and for the Minister to meet Target Ovarian Cancer, the other ovarian cancer charities and members of the all-party group to discuss a practical strategy and to invest now in a targeted awareness campaign, without waiting for the results of the diagnostic test and the trial, which I think will arrive in 2015. Two thousand more women will die unnecessarily if we sit around and wait for that. We need action now, and I would like the Minister to undertake to do just that.

10.29 am

Kevin Brennan (Cardiff West) (Lab): I congratulate the hon. Member for Pudsey (Stuart Andrew) on securing this important debate. I am sure that other hon. Members will not mind if I also single out my hon. Friend the Member for Slough (Fiona Mactaggart), who gave such a personal and passionate speech about how ovarian cancer has affected her. Like so many others here, my family has been affected by the disease. My first cousin, Mary, died in her 30s from ovarian cancer, leaving behind a young son. I am sure that all of us here are aware of the impact of this terrible disease.

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The recently published report “Cancer in Wales: 1995-2009”, which my hon. Friend the Member for Blaenau Gwent (Nick Smith) mentioned, highlights the fact that, on average, 394 women a year have been diagnosed with ovarian cancer in Wales over that period. The average number of mortalities due to ovarian cancer between those years was 237, which translates into 60.3% of those diagnosed with the disease ending up dying from it. Such startling statistics demonstrate what all hon. Members have been saying about the lack of awareness of the symptoms of this disease.

If ovarian cancer mortality rates in this country were the same as those in other EU countries, we could save 500 lives a year. That statistic on its own should make us all sit up and take notice and realise that, over many years, not enough has been done to highlight this terrible disease.

We have debated the kind of awareness campaign that needs to be run. A generic campaign is clearly not adequate in this case. There needs to be a specific campaign around ovarian cancer. As other hon. Members have said, only 3% of women recognise that increased abdominal size is potentially a serious symptom of ovarian cancer. That compares with three-quarters of women who know that a lump in their breast is potentially a serious symptom of cancer. If educating the public about the symptoms of this disease is important, of equal importance is the need for GPs to consider ovarian cancer as a possibility when patients display the symptoms.

It has been mentioned already that nearly a third of women who are diagnosed are diagnosed following an admission into accident and emergency, which also tells us that there is a serious problem.

My constituent Hazel Burrows contacted me via her granddaughter earlier this year. In her e-mail, Georgette Burrows said:

“Everywhere you look, whether it’s when you're watching your favourite soap opera or doing your weekly shop, there are campaigns for breast cancer, and rightly so. Although I do believe more needs to be done in order to make women aware of ovarian cancer.”

She is right and today’s debate has demonstrated that very clearly.

I will work with my hon. Friend the Member for Blaenau Gwent in relation to Wales and with Mark Drakeford in the Welsh Assembly on this matter. Let me say to the Minister that all of us come into politics because, whatever our views, we believe in the possibility of changing things for the better. If today’s debate has highlighted anything it is that that is possible and that we can save people’s lives. Being able to achieve that rests partly with the Minister who is in his seat today.

As all former Ministers know—I include my hon. Friend the Member for Slough—we go on in a job for some time, getting our submissions from officials, turning up at Adjournment debates, reading out the speech that has been provided and then carrying on as before. The Minister cannot do that after today’s debate. He must go back and say to his officials, “I want fresh on my desk, as soon as possible, a new strategy for raising awareness around ovarian cancer because what we have now is not good enough.” He has that opportunity to make a difference. It is a great privilege to be a Minister—I told myself that every day I walked into my ministerial office. The Minister has a chance to save people’s lives and I hope that he takes that opportunity.

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10.34 am

Mr Michael McCann (East Kilbride, Strathaven and Lesmahagow) (Lab): I congratulate the hon. Member for Pudsey (Stuart Andrew) on securing today’s debate.

Before the general election, I met a gentleman called Eddie O’Hara, who lives in East Kilbride, which is part of my constituency—at least it is until midday today. Eddie’s wife, Linda, was diagnosed with ovarian cancer on Good Friday 2000. Like so many women, the diagnosis came far too late. I did not have the good fortune to meet her, but by all accounts she was a truly gifted and inspirational woman. It was in her memory that Eddie O’Hara set up the charity, Ovarian Lets Shout For Linda, to raise awareness of the symptoms and to support all those affected by that terrible disease. I cannot help but feel that those groups that have been set up to highlight the disease are filling a gap that should really be filled by our national health service.

Like the hon. Member for Pudsey, when I was elected to Parliament last year, I had to go through a Kilimanjaro-esque mountain of mail. Underneath the big pile, I found an invitation to a Target Ovarian Cancer event. I signed up and learned much more about the killer disease. People gave all sorts of statistics and views, but the big one that got me was that 75% of women are diagnosed too late. Surely that is the saddest indictment of our health service. Much more needs to be done and, as hon. Members have outlined, there are different ways in which things can be done.

Let me give a practical example of why we should do more. I met Eilish Colclough—hopefully I have pronounced her name correctly—at the Target Ovarian Cancer event last year. I do not know whether she will thank me for saying this but she is a 42-year-old mother of five. In case she is listening to this debate, I hasten to add that she looks much younger. She was diagnosed with ovarian cancer when she was 39. She had all the symptoms but her GP dismissed her fears of cancer.

After the TOC event, Eilish and her friends joined me and some other colleagues on the Terrace because she did not want to be in the company of the doctors. She preferred to speak to people who were chatting about things other than the disease. She explained in stark terms that she did not know how long she would live. She is still here, and the world is a better place with Eilish among us. She is a tireless campaigner. She brought to mind that wonderful quote of Ralph Waldo Emerson, who said:

“For every minute you remain angry, you give up sixty seconds of peace of mind.”

As all the statistics have already been mentioned, let me ask the Minister what he is going to do to heighten awareness and improve treatment so that women across the United Kingdom do not have to suffer the anguish that Linda did or the anguish that Eilish endures today.

10.37 am

Ms Diane Abbott (Hackney North and Stoke Newington) (Lab): Let me start by congratulating the hon. Member for Pudsey (Stuart Andrew) on securing this important and well-attended debate. Every Member who spoke made an effective and moving speech. However, the speech that stands out for me is that of my hon. Friend the Member for Slough (Fiona Mactaggart). We have already heard that ovarian cancer is a very serious

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condition and that it is the fifth most common cancer among UK women. Members have also set out the relatively low survival rates for ovarian cancer—they are around 40% compared with 79% for breast cancer. That is largely due to the fact that three out of four women are diagnosed late, once the cancer has spread. It is worth repeating that survival rates could be as high as 90% if the cancer were diagnosed at an early stage. In Hackney, in east London, the five-year ovarian cancer survival rate is only 35%, which is significantly below average.

Despite the evidence relating to lack of awareness, the rates of late diagnosis and the delays in diagnosis admissions by A & E, there is still no Department of Health-led activity to improve awareness of symptoms among women and GPs. That is despite the Government’s commitment to save 5,000 lives a year from cancer by 2014. I welcome the new National Institute for Health and Clinical Excellence guidance on symptoms and the increased access to diagnostics that was announced in the cancer strategy, which mean that there will be new opportunities to improve early diagnosis. But unless women know when to visit their GP, unless the symptoms of ovarian cancer become as well known among ordinary women as the symptoms of breast cancer are and unless GPs know how to consider ovarian cancer, rates of late diagnosis and delays will not improve.

We have already heard, but it is worth repeating, that there is no national outcome measure for ovarian cancer; there are only such measures for breast, lung and bowel cancer. That is already impacting on the ability of PCTs and cancer networks to undertake awareness work about ovarian cancer, as funding for awareness work is being channelled to breast, lung and bowel cancer. That will potentially lead to a worsening of the situation, because it means in practice that there will be a decline in activity.

The quality standard for ovarian cancer will be one of the first of the new suite of quality standards to be introduced by NICE to inform local commissioners, but as yet it is not clear how the standard can be used effectively. Can the Minister tell us whether the Department of Health is considering introducing a national outcome measure for ovarian cancer? Can he also say how the Department will ensure that the quality standard is used effectively?

The Minister will be aware that the first findings of the international cancer benchmarking study—a study led by the Department of Health—showed that in the UK late diagnosis is thought to be a key driver of survival rates, which are poor compared to those in other countries in the study. However, ovarian cancer is the only cancer type in the study not to have had remedial action taken to improve awareness.

The Minister will forgive me when I say that under the last Government we saw substantial investment in cancer services and consequently outcomes improved; for instance, the survival rate for breast cancer rose from 50% to more than 80%. In the case of ovarian cancer, although the figures are not necessarily much better than they were when the hon. Member for Westmorland and Lonsdale (Tim Farron) faced the issues in relation to his mother, the survival rate has in fact doubled in the past 30 years. The commitment shown by the last Labour Government meant that in excess of 1,000 more women per year in England and

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Wales are now surviving ovarian cancer. However, the UK survival rate for ovarian cancer is still among the lowest in Europe, at 36%. If we achieve the average European survival rate, we will save 500 lives per year.

All of us, including the Minister, know that two major trials are currently taking place: the first is for women in the general population; and the second is for women with a strong family history of ovarian cancer. The former trial will report in 2015 and the latter trial in 2012. However, it is not at all certain that the findings of those trials will result in a national screening programme. Perhaps the Minister can tell the House what the Government’s position is on that issue.

Cancer Research UK tells me that it is concerned that the Health and Social Care Bill, which is currently being debated in another place, risks fragmenting responsibility for the early diagnosis of cancer between Public Health England, local authorities and the NHS. Cancer Research UK’s proposal for guarding against fragmentation is that local authorities and clinical commissioning groups should be jointly incentivised to prioritise early diagnosis, including shared indicators in the public health and NHS outcomes frameworks. That process should be supported by shared budgets, to ensure joint responsibility for delivering improvements in awareness and early diagnosis of cancer. In other words, Cancer Research UK is concerned that policies and responsibilities around early diagnosis will fall through the cracks. How will the Minister respond to that proposal by Cancer Research UK?

The Minister will be aware that, earlier this year, at the 12th international forum of the Helene Harris Memorial Trust, which was originated and facilitated by Ovarian Cancer Action, 50 of the world’s leading researchers and clinicians in ovarian cancer came together to discuss the future for ovarian cancer research. Out of those discussions came nine key actions: improving recognition that “ovarian cancer” is a general term; better targeting of clinical trials; identifying patients at increased genetic risk; developing new approaches to identify targets for treatment; ensuring that both the tumour and the tumour micro-environment are treated; better understanding of relapses of treatment-resistant ovarian cancer; setting up international collaboration to enable tissue samples to be shared and analysed in research; developing better experimental models; and ensuring that clinical trials include measures of quality of life and symptom benefit. Ovarian Cancer Action believes that those nine actions would not only help to improve the quality of life and ovarian cancer survival rates for women in the UK, but help to position the UK as an international leader in the fight against this deadly disease. Is the Minister aware of those recommendations and what is his response to them?

My hon. Friend the Member for Cardiff West (Kevin Brennan) made the point that, in the sometimes humdrum routine of the life of a junior Minister, there is occasionally a genuine opportunity to make a difference. Having listened to the informed, personal and passionate contributions of colleagues and other hon. Members this morning, I hope that the Minister will go away from this debate determined to move ahead—on the very strong basis of what the last Labour Government did and what his Government have done up to now—and actually make a difference in relation to ovarian cancer.

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10.46 am

The Minister of State, Department of Health (Paul Burstow): Thank you very much, Mr Rosindell, for calling me to speak.

I assure the hon. Member for Hackney North and Stoke Newington (Ms Abbott) that I have not found my last 12 months “humdrum” at all and I agree entirely with the comment by the hon. Member for Cardiff West (Kevin Brennan) that being a Minister is a privilege, and a privilege that one should use fully to serve the common good and the purposes that our constituents send us here for.

I want to try to do justice to the debate, and if I do not cover any issues that have been raised, that will purely be because of time and I will write to hon. Members about those issues. However, I will try to cover as much ground as I can.

I congratulate the hon. Member for Pudsey (Stuart Andrew) on securing the debate and congratulate all those who have taken part. I particularly congratulate the all-party group on ovarian cancer, which has done an excellent job in mobilising colleagues to be here in Westminster Hall today and to be persistent and persuasive in their arguments on the issue.

As others have rightly said, the speech by the hon. Member for Slough (Fiona Mactaggart) was typically powerful and typically persuasive. I think that I have served in the House as long as the hon. Lady, and during the time that she fought her cancer I certainly admired the way that she did so, while continuing to provide the service that she gives to her constituents and the House. She made a very powerful set of points today.

I think that everyone who has spoken in the debate has been touched by ovarian cancer. I had not planned to refer to my own experience, but, given that others have talked about their experiences, I will say that my aunt died of ovarian cancer some years ago. Having fought the disease for some time, she sadly died at the Royal Marsden hospital, despite receiving excellent treatment there. Ovarian cancer touches many of us.

I thank Target Ovarian Cancer, Ovarian Cancer Action, Ovacome and the Eve Appeal, which have all done an excellent job in raising MPs’ awareness of ovarian cancer, in the ways that the hon. Member for Pudsey and others have described today. That work has done a lot, not only to initiate debates in this place, but to assist us as MPs to play our part in our communities to help to raise awareness of those issues.

I could rehearse the statistics again, but will not do so because they have already been well rehearsed and powerfully illustrated with personal stories. I certainly recognise the urgency that we need to attach to our fight against cancers and I particularly note the points that have been made today about ovarian cancer. That is why we urgently came forward with the strategy that we published in January and why we have been fast in trialling and rolling out awareness campaigns. I will say more about those awareness campaigns shortly.

As has been pointed out, late diagnosis is one of the main reasons for the relatively poor cancer survival rates in England. I must crave the forgiveness of those colleagues who have spoken today from the perspective of Northern Ireland, Scotland and Wales. They all

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made important points and they need to continue, as I know they will, to raise them with their colleagues in the devolved Administrations who have responsibility for health.

Research by the National Cancer Intelligence Network showed that nearly a quarter of all cancers are diagnosed through an emergency route, as my hon. Friend the Member for Westmorland and Lonsdale (Tim Farron) said. That is at a stage when the cancer is very advanced. The research also showed that one in five patients did not visit their GP before being diagnosed with cancer. Diagnosis of ovarian cancer often comes late because the symptoms in the early stages—they have been powerfully set out—are often ignored or thought to be something else.

The hon. Member for Slough talked about volunteers, and about the volunteer who did the manicure on that day when her head was in another place. I have visited hospitals where Macmillan Cancer Support and other voluntary organisations play a part. Such volunteers bring back the key human dimension, which the hon. Lady was absolutely right to underline. We will ensure that the role of volunteers in the NHS is valued by including that point in the Department of Health’s message to the NHS in its soon-to-be-published updated volunteer strategy.

Reference has been made to the £450 million for early diagnosis work that the Government have put in as part of the spending review. The funds will support campaigns to raise public awareness of the symptoms of cancers, encouraging people to present with persistent symptoms. They will also support GPs in more effectively assessing people with possible cancer symptoms and improve access to diagnostic tests. In 2010-11, we ran local cancer awareness campaigns and a regional pilot campaign for bowel cancer, and in 2011-12 we are running a national campaign on bowel cancer, a regional campaign on lung cancer and 18 local campaigns to raise awareness of breast cancer among women over 70 and of the symptoms of some less common cancers.

A question that has been rightly put is, why, so far, have we not addressed ourselves to ovarian cancer? Understandably, Members want answers, not least because of the evidence that if we were performing at, I believe, just the average of our European neighbours—certainly if we were matching the best of them—500 additional lives would be saved every year. We are considering whether there is scope for piloting ovarian cancer awareness campaigns, drawing on the experience of our more generic campaigns on blood in urine, which can be a marker for bladder and kidney cancers, and on the evaluations of awareness campaigns on specific disease sites. That will inform us how we can most effectively roll out further campaigns. I give that undertaking, and I am more than happy to meet with members of the all-party group.

The hon. Member for Romsey and Southampton North (Caroline Nokes) spoke very persuasively about the scope for using existing screening programmes to deliver awareness-raising messages about other cancers, and ovarian cancer in particular, and we will consider how we might implement such a practical solution. Nevertheless, I hope that hon. Members appreciate that awareness raising is just one of a range of actions and that we need to look at the other aspects of the strategy

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that we set out earlier this year. We are working on other fronts to try to drive up earlier diagnosis and treatment.

A key focus of the cancer outcome strategy is primary care, which is why we are investing in providing GPs with practical tools for assessing patients who might have cancer. In addition, some of the cancer networks are reviewing referral pathways to help to shorten the time taken for patients to access diagnostic tests. I welcome the contribution of the cancer charities that have been working with primary care professionals to promote early diagnosis of cancer, and I specifically pay tribute to Target Ovarian Cancer, which, in partnership with BMJ Learning, has produced an online GP learning tool that covers the signs and symptoms of ovarian cancer, and diagnostic tests based on the latest evidence.

Ms Abbott: Will the hon. Gentleman give way?

Paul Burstow: I want to try to do justice to the debate and ensure that I get to answer a couple more of the questions posed, but I will give way in a moment if I can.

If a GP suspects cancer, it is vital that they can refer people urgently for further tests, using the two-week referral pathway. For women who do not meet the criteria for that pathway for suspected cancer but have symptoms that require investigation, we are providing additional funds over the next four years to support the diagnosis of ovarian cancer by giving GPs direct access to four key diagnostic tests, including non-obstetric ultrasound. Questions have been asked about what data are collected. We plan routinely to collect data on GP usage of the four tests and to publish them alongside data on GP usage of the two-week referral pathway, so that we can benchmark performance and expose areas that are not performing as well as others.

Several hon. Members asked about the CA 125 test and suggested that there are restrictions. I can assure Members that if there were restrictions we would challenge them. Just last month, Bruce Keogh, NHS medical director, wrote to strategic health authorities to raise questions about general access to diagnostics, and David Flory, deputy NHS chief executive, reiterated in the September edition of T he Q uarter that there must be no “arbitrary restrictions on access”. That would apply to the CA 125 test, not least because it is clearly covered in NICE guidance.

Hon. Members referred to the two ongoing trials, which are evidence of the research taking place. The UK collaborative trial of ovarian cancer screening offers real prospects for a screening tool, but on screening the Government of the day take the advice of the UK National Screening Committee, which considers the evidence from trials of the sort going on at the moment. A randomised control trial of 200,000 post-menopausal women aged between 50 and 74 is studying the use of annual CA 125 blood tests as a way to identify—along with annual trans-vaginal ultrasound—which women are most at risk of ovarian cancer. The results of the study will be available in 2015, and the Government will then respond to the recommendations that the UK National Screening Committee makes on the basis of the evidence. I hope that there will be a positive recommendation that enables us to roll out such a screening programme.

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Familial ovarian cancer screening was referred to early in the debate, and a study has shown that up to 10% of ovarian cancers can be attributed to an inherited genetic predisposition. It was mentioned that the results of that research would be available in 2012, but we understand that the study will close in 2013. We would want to act on the evidence from that study.

Research, therefore, is taking place in those two fields. High-quality applications are the key to getting research funding; we do not fund solely on the basis of something being a priority. The hon. Member for Hackney North and Stoke Newington asked about Ovarian Cancer Action’s nine recommendations, and I will respond to her in writing, with copies to colleagues.

National measurement was mentioned. The NHS operating framework for England for 2011-12 requires that cancer registries record the stage of cancer, which is a key proxy for predicting outcomes, and publish one-year, as well as five-year, survival rates. We are benchmarking, providing a useful way to see who is performing well and who is not, and, as the hon. Lady mentioned, we are in the international benchmarking partnership with other nations. Would she like to make her intervention in the remaining time?

Ms Abbott indicated dissent.

Paul Burstow: In conclusion, I hope that I have responded positively to the debate. We must make progress on a broad front in this area to improve early diagnosis and get the treatment that people need, so that we can cut the death toll in this country from all cancers. Ovarian cancer is, and will continue to be, a priority for this Government.

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Innovation (NHS)

11 am

John Glen (Salisbury) (Con): It is a pleasure to serve under your chairmanship, Mr Rosindell. I requested this debate in order to raise important issues about the ongoing review of how the national health service extracts the full potential from innovative, commercially realisable ideas generated by NHS employees and to seek clarification from the Minister about the scope of the Carruthers review of innovation in the NHS announced this July.

I was led to the subject by my involvement with Odstock Medical Ltd in my constituency, a company that has grown from Salisbury NHS Foundation Trust. OML has pioneered a technique called functional electrical stimulation that produces contractions in paralysed muscles by applying small pulses of electrical stimulation. Having experienced it myself, I can attest that it assists walking. OML has developed a range of neuromuscular stimulators to improve the functional ability of people with neurological conditions such as multiple sclerosis. The devices have been developed during many years of collaboration among clinical engineers, clinicians and patients at the National Clinical FES Centre at Salisbury NHS Foundation Trust.

Last year, it came to my attention that, because OML is partly owned by the local NHS foundation trust, under EU rules, it cannot be classified as a small or medium-sized enterprise, and therefore cannot access grants and support through normal Department for Business, Innovation and Skills channels. That seems ludicrous. I met the Minister of State, Department for Business, Innovation and Skills, my hon. Friend the Member for Hertford and Stortford (Mr Prisk), who has responsibility for small business, along with Professor Ian Swain from OML. Little progress could be made, although attempts were made to access specific funds and schemes. It is a systemic failing.

Anxious to overcome that barrier and explore other aspects of innovation in the NHS, more recently, I met with Alun Williams, the CEO of NHS Innovations South West, who has an office in my constituency and is here today. Alun is wholly committed to the NHS and is passionate, as am I, about finding ways to develop streams of revenue for the NHS. I thank him for his support and advice as we have discussed the subject in recent months.

My key concern is this: as populations age, as the cost of drugs and treatments rises faster than inflation and as medical science, thankfully, finds ever more treatments for human ailments and medical conditions, the NHS must be more radical in exploiting the bright ideas of its staff to ensure that the commercial potential of those ideas are realised fully by the NHS.

Mr Andrew Smith (Oxford East) (Lab): I congratulate the hon. Gentleman on securing this enormously important debate. I was brought to the subject by NHS Innovations South East. Does he agree that NHS staff can come up with innovations—examples cited to me include improvements in child protection investigations and adolescent mental health programmes—that do not readily or easily translate or crystallise into commercial benefit? Is it therefore not short-sighted for the Government to insist, as I understand they do, that innovation bodies must be totally self-supporting commercially?

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John Glen: I certainly contend that there are significant pockets of innovation. The challenge is bringing those ideas to their full commercial potential and getting them into the NHS so that they are cheaper for the user. The adoption and uptake of NHS-grown ideas is not wide or deep enough, few hospitals showcase their ideas and the wider benefits are not really felt across the NHS. Some ideas, when fully exploited, might realise significant streams of revenue, easing the cost pressures that I mentioned.

The review led by Sir Ian Carruthers, announced at the beginning of July by the Department of Health, will seek in its report next month to inform the strategic approach to innovation in the modernised NHS. However, it must not simply set up another framework or broad aspirations; it must deal convincingly with the gritty realities of what is needed to take a proven idea that has been honed, challenged and assessed by the innovation hubs to its full commercially realised potential.

The report must also recognise that, unless a way is found to invest in such ideas, their commercial potential will be exploited by private sector entrepreneurs who can move more rapidly and access finance more quickly. Intellectual property will thus be patented not by individual NHS trusts, as is desirable, but by the private sector, which will then charge the NHS for products and services at rates that the NHS would rather not pay. I urge the Minister to push the boundaries and ensure that we do not risk allowing the ideas of excellent NHS employees to be lost, thus losing the value and savings that could accrue.

Margot James (Stourbridge) (Con): I congratulate my hon. Friend on securing this important debate. Does he agree that, although it is important for the NHS to realise the commercial value of innovation, it is also fundamental to the improvement of patient care that innovations take hold more rapidly? Did he see this morning’s comments by Professor Williams, president of the Royal College of Surgeons, who warned of a 20-year wait before innovations start saving lives if we base innovation progress on previous experience? He cited reduced deaths from bowel cancer as a result of keyhole surgery, which took years to become widespread practice.

John Glen: I thank my hon. Friend for that extremely helpful intervention. I met Professor Williams last week, and he made that point to me. That is the nub of the matter. If the NHS does not move quickly on such ideas, someone else will, and it will cost more. My hon. Friend is absolutely right. The impact on outcomes is negative. We must move matters forward so that the advantages can accrue to the NHS.

It is important to realise that, in the big picture of NHS politics, there is an almost pathological fear of doing anything that could imply the use of the word “cut” or the even more toxic P-word, privatisation. I am not arguing for either, but I am saying that, unless we adopt savvy practices to incubate and develop proven concepts more speedily, I fail to see how the NHS can deal with the increasingly more intense systemic supply and demand pressures that it will face. Efficiency savings and ring-fenced budgets, although welcome, will not be enough to save the NHS and provide the money that it needs to continue in its present form. We need more realism about that and a radical solution that has the potential to create more money.

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I recognise that it should not be the NHS’s primary objective to develop income streams from medical devices, new treatments or services. Equally, given that great ideas are an unintended by-product of taxpayer investment in providing a world-class national health service, it would surely be wrong not to look hard at making innovation work to the NHS’s advantage. So many ideas derive from employees whom the state pays quite handsomely.

Furthermore, after initial investment, funding innovation could be self-financing, using royalties from previous successful investment. It just needs to unlock that potential. Alongside producing efficiency savings, this significant reform need not require significant capital outlay at the outset.

It feels as though successive Governments have been so concerned to avoid the tag of allowing the waste of capital on ideas that do not immediately point to a return, or being portrayed as blurring the boundaries of the NHS, that they have not fully established the means and mechanisms of making ideas realise their potential. Lip service is paid to the desire to innovate, but practical measures that make it possible on anything like the scale that is possible are not in place. It is more a question of whether the NHS can afford not to exploit the potential savings and revenue streams presented by these ideas.

I am aware that the current position is not completely bleak. The Minister will be able to cite a pipeline of ideas and he will know that the UK has established capabilities in this field. The medical device sector alone makes a significant contribution to the UK economy, with an industry turnover of £13 billion and 55,000 employees. That industry, however, is generally a supplier to the NHS. We need to move to a situation in which the NHS itself generates devices that can save—with a small s—the NHS from bearing the full commercial costs of products that the private sector has developed in its place. Why is it not possible for the Government to establish an innovation strategy with a real focus on extracting value from the pipeline?

I am not suggesting that there should be centrally driven, random speculative investment of taxpayers’ money in half-baked ideas suggested by any clinician. The regional innovation hubs are already primed to sift ideas. For example, NHS Innovations South West has criteria that each product has to meet before it can receive further assistance. First and foremost, it must bring significant benefit to patients in terms of better outcomes and quality of life. It must also be patentable. The return on investment must meet a minimum threshold and it must be commercially viable—that is, there must be an assessment of a global need for the technology, making it a worthwhile investment for commercial partners.

Once that has been established, the issue is how to develop the ideas to their full potential. Several ideas exist in the south-west. A cancer diagnostic endoscope and meniscus knee repair device are both, subject to completing clinical trials, able to meet the criteria to which I have referred. Given that oesophageal cancer is one of the fastest growing cancers globally and early diagnosis can have a significant impact on savings in the NHS, it is highly desirable that that progresses quickly. The meniscus device should significantly improve patients’ quality of life and postpone the need for an expensive total knee replacement by up to five years, thereby again saving the NHS huge sums of money.

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My concern is that it is purely by chance that the private sector has not taken this work further. The current NHS process for capitalising on these innovations is not quick enough. There is limited access to NHS funding, and progress is inhibited by insufficient incentives and enabling mechanisms to encourage trusts to invest in such promising cost-saving technologies. Hospitals exploit these ideas elsewhere in the world and significant royalty streams accrue. They would make a recurring contribution to the much required efficiency savings that the chairman and chief executive of my hospital trust are desperately trying to find at present.

In conclusion, I believe that the NHS is a powerhouse of innovation, but that that is not being harnessed sufficiently to accrue the tens of millions that would be available to individual NHS trusts if a bolder approach were taken by Government. I urge the Minister to consider carefully the potential of the ideas in the NHS and to do all he can to ensure that the scope of the Carruthers review is broad enough to deliver recommendations that will allow the huge value that exists to be realised.

11.14 am

The Minister of State, Department of Health (Mr Simon Burns): It is a pleasure to serve under your chairmanship, Mr Rosindell. I congratulate my hon. Friend the Member for Salisbury (John Glen) on securing this debate on what is widely recognised as an important issue for the NHS because of the crucial role that innovation plays in the present and will play in the future. Given his ideas, views and thoughts, he might seek to arrange a meeting, if he has not already done so, with my noble Friend the Earl Howe, who is the Health Minister with responsibility for innovation.

I shall respond by first setting out the Government’s approach to innovation, before looking at the specific issues that have been raised by my hon. Friend. As we all know, and as he has reiterated, we face a significant challenge. Without real change, the cost of health care will grow faster than the rest of the economy. Moreover, the quality of care in vital areas such as cancer will lag behind other countries, and the gap between the best and the worst NHS care will continue to grow. More of the same simply will not do. We cannot afford it and patients do not deserve it. We need, in other words, to innovate, as my hon. Friend has said.

Fortunately, there is a vast reservoir of innovation to tap within the NHS. It has a long history of innovation, invention and research by great people and great institutions. Ian Donald, for instance, pioneered the use of ultrasound in the 1950s. Sir Peter Mansfield’s work led to the MRI scanner in the 1970s. The Sanger Institute developed the first working draft of the human genome in 2000. We continue to lead the way in cutting-edge research, as the recently announced first European trial of embryonic stem cell research at Moorfields eye hospital demonstrates.

The creative spark that kick starts the long and difficult journey from initial idea to widely adopted treatment is a precious and delicate thing. We need to do all we can to encourage that creativity within the NHS—to grow and propagate the ideas that clinicians

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and others have for the benefit of their patients. While we continue to achieve great things, we must always strive for more.

Innovation does not happen when power is centralised and people are told what to do, so the single biggest thing that we are doing to encourage innovation is to devolve power to clinical professionals, trusting their professional judgment and their desire to do their best for their patients.

Our modernisation of the NHS will encourage innovation in three main ways. First, it will place the patient at the centre of decision-making about their own care—informed, empowered and able to choose the best possible appropriate care—so that providers will have to innovate to stand out. Secondly, it will have a resolute focus on improving health outcomes—publishing the data and rewarding excellence—so that hospitals and others will have a powerful incentive to innovate and improve. Thirdly, it will place power in the hands of local clinicians, thereby getting rid of the huge and wasteful bureaucracy that can strangle and frustrate innovation, and let the knowledge and expertise of clinicians drive innovation locally.

That will lead to a more personalised NHS, with services tailored to patients’ needs; a more integrated NHS, with solutions that tackle inequalities, improve access and deliver care closer to home; and a better quality NHS, with every provider encouraged, rewarded and incentivised to constantly improve outcomes for patients.

There is also a wider economic imperative for innovation. The health care sector, including pharmaceuticals, medical technology, research, equipment and services, directly or indirectly employs hundreds of thousands of highly skilled people in companies, from small and medium-sized enterprises to global giants, generating billions of pounds in revenues, all helping to drive future economic growth. Innovation in health care applies to everyone—scientists, nurses, doctors and managers. In fact, it applies to all those working to deliver better health, better care and better value. We must ensure that innovation is not simply the preserve of elite minds at the top of august institutions, because it is not just about the latest drugs or high-tech pieces of equipment. The spirit of innovation should be part and parcel of every part and every level of the NHS.

One of my favourite examples of innovation in action is a jug—a health care assistant in Milton Keynes decided that patients whose fluid intake needed close attention should each have a bright red water jug. That particular innovation gave ward staff a clear visual reminder of those patients’ specific needs, helped them to better care for patients, avoided the need for drips, reduced the risk of infection, cut patients’ stays in hospital and consequently cut the cost of their care. That is all because of a bright red jug and one very bright idea from a health care assistant.

We have also made a strong and ongoing commitment to innovation through research. The Government’s plan for growth cements our commitment to health care and the life sciences as a force for growth in the economy. The Government’s National Institute for Health Research aims to support outstanding individuals, working in world-class facilities and conducting leading-edge research focused on the needs of patients and the public. We have recently announced a record £800 million in additional NIHR funding for experimental medicine

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and translational health research. We will also streamline regulation and improve the cost-effectiveness of clinical trials, speeding up the process of translating research into better lives for patients, their families and their carers.

However, no matter how extraordinary the innovation or how miraculous the invention, it is worthless if it is not used, as my hon. Friend the Member for Salisbury said. Any innovation that is not widely adopted is a tragic waste. Like many large organisations, the NHS’s uptake and spread of innovation has often been slow. We need to raise our game, as my hon. Friend alluded to. We need to do more to recognise the contribution that innovators and innovative organisations make and to encourage adoption and diffusion across the NHS on a scale never seen before.

Mr Andrew Smith: In that context, can the Minister say what future he sees for the work presently being undertaken by the regional NHS hubs, especially in the area to which I alluded earlier where there might not be an immediate commercial return?

Mr Burns: I am grateful to the right hon. Gentleman for that intervention. I will certainly come to that matter during my comments and before we finish the debate.

A substantial amount of work is already under way, including the £60 million that has been invested in regional innovation funds, which support front-line staff to develop and spread new ideas and validate the notion that it is good to challenge the way things have always been done. The funds are massively over-subscribed and have to date given money to more than 300 projects. Further work includes the innovative technology adoption procurement programme, which aims to encourage the NHS-wide adoption of high-impact innovative medical technologies, and the innovation challenge prizes, which reward the ideas that tackle some of our big health and social care challenges, improving productivity and the quality of health care. The first innovation challenge prizes—ranging from £35,000 to £100,000—were awarded in March. Winning entries helped to reduce waste and increase the benefits of medicines, helped people with kidney failure to lead a more independent lifestyle and helped in the early diagnosis of cancer. An expert panel is going through this year’s round of applications and I very much look forward to seeing the results later in the autumn.

There is also much of value in the innovation hubs, to which the right hon. Gentleman referred. Identifying, developing and commercialising new ideas within the NHS is a must, and we need to adopt a systematic approach to that. We also need to ensure that all parts of the innovation pipeline—invention, adoption and diffusion—are more efficient and effective. The NHS chief executive’s innovation review will consider that and how we can achieve better value for money.

As announced in “The Plan for Growth,” NHS Global is being developed to help NHS organisations to compete in the global market. NHS Global seeks to build and grow the NHS brand and reputation overseas, enabling

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the NHS to compete in the international health care market and to exploit the commercial value of its technologies, products and knowledge. In doing so, NHS Global acts as another mechanism to support great ideas generated in the NHS being widely accepted across the world.

In the case of the company mentioned by my hon. Friend the Member for Salisbury—Odstock Medical Ltd—if it has not done so already, I suggest that it contacts the NIHR’s invention for innovation scheme. i4i supports product development and the guided progression of innovative medical product prototypes, and I strongly advise the company to get in touch with it if it has not done so.

The Health and Social Care Bill, now passing through the House of Lords, will place a legal duty on the NHS commissioning board and on clinical commissioning groups to promote innovation and research. Soon the NHS chief executive, Sir David Nicholson, will set out achievable, high-impact recommendations that will inform the strategic approach to innovation that is so important within a modernised NHS. We will open up NHS procurement to small and medium-sized enterprises, simplify the process and challenge them to come up with solutions to problems within the NHS. We have committed £10 million to the small business research initiative.

Innovation can never be mandated and it should never be restricted to a particular group. Innovation in health and social care will come from a wide variety of partners—for example, NHS staff and patients, private companies, the voluntary sector and academia. They all have a crucial role to play in pushing forward the boundaries in developing and dreaming up innovative products and services to meet the ever-increasing demands of a modernised NHS.

Innovation is not easy. It takes more than just a good idea to innovate; it takes courage to speak out against how things have always been. Innovators have to hold and develop an idea often in the face of opposition and keep pushing forward until it begins to bear fruit. I fully appreciate that the process of innovation can be a very frustrating time. We must encourage people, so that they do not become frustrated and give up. They should be able to pursue dreams and ideas that will bring a greater improvement to the general provision of health care and the NHS.

Let us imagine a world without antibiotics, without insulin, without cancer screening. Then let us imagine a world with a cure for cancer or where we can reverse dementia and end heart disease. Without innovation none of that would be, or could be, possible. Innovation is essential for the future of our NHS and for the future of the UK economy. I assure hon. Members that the Government will do everything in their power to continue to promote innovation, so that it can flourish and develop along the lines that we would wish.

11.28 am

Sitting suspended .

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Public Transport (Disabled Access)

[John Robertson in the Chair]

2.30 pm

Lisa Nandy (Wigan) (Lab): Earlier this year, I was visited by a group of my constituents in Wigan who were from Hunter Lodge, a facility for people with disabilities in the borough. They told me about the endless difficulties they faced in trying to do some of the simplest things that most of us take for granted—shopping, visiting friends or getting to work. They tried to go by train to a nearby town, but had been forced to travel by relay because there was only one wheelchair space available on the train. When the train arrived, the space was already taken. They were told that instead of travelling in the carriage with other people, they would have to go in the guard’s van alongside the bags, parcels, bikes and other goods.

I am angry that, in 2011, that is still considered by some people an acceptable way to treat fellow human beings. Astonishingly, when I looked into this matter, I found that they were the fortunate ones. Half of all train stations do not have level access, so it turns out that they were actually lucky to even be able to get on to the train platform in the first place. Despite some real improvements—not just under the previous Government, but under the Government before that—we are not moving fast enough. The Association of Train Operating Companies said earlier this year that progress on making train station platforms accessible to people with physical immobility is far too slow, and that Network Rail and the Department for Transport need to get a grip of this situation.

I am also concerned about the closure of ticket offices, an issue that many people have raised with me. Without a ticket office, it is nigh on impossible for many people—particularly those who have sight problems, are in wheelchairs, or have learning difficulties—to even buy a ticket to get on the train. In many instances, ticket office staff are the only people available to assist people physically to get on to the train. The McNulty review recommended closing 675 ticket offices around the country. I am aware of the economic realities, but I would like to see a commitment today from the Minister to assure us that he will not sanction proposals that would leave ticket offices entirely unmanned. That is not just because ticket office staff are often the only people available to help people on to the train. Many people contacted me in advance of this debate to say that so much of the staffing issue is about feeling safe on public transport—having the security of being able to get to where they are going without being stranded, which had happened to them in too many cases.

When I secured this debate, I was contacted by young people from across the country, who described to me, in a compelling way, how they had been unable to even get on and off trains because there were no ramps available, the ramps that were available were too short or too long, or nobody was there to help them use those ramps. More than anything else, I was struck by the indignity and humiliation that ran like a thread through all those stories. They need electronic ramps on every train so that they do not have to suffer both the indignity and the anxiety of hoping desperately that somebody will be available to help them, having to make a fuss

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as they stand on a train simply to get off it, and, in some cases, being stranded on a train because there is no one available to help them.

Although some train companies have made adjustments that already meet the demands of the law, the situation is still not good enough. For example, Virgin Trains has three spaces for wheelchairs on its “Pendolino” service. Although that is welcome, it makes it extremely difficult for people to travel together. Is it seriously too much to ask to adapt trains so that young people, such as those in the Chamber today who are listening so intently to the debate, can go out with their friends? Is that seriously, in 2011, too much to ask? Early next year, the franchise for the west coast main line will be put out to tender. Will the Minister give me a commitment today that one of the criteria for interested companies will be the progress they make on this issue?

I am also deeply concerned that the rhetoric flying around at the moment, about people on incapacity benefit, is making an already dreadful situation much worse. In an independent survey for the charity Scope, 15% said they had suffered high-level abuse on public transport. It is a damning indictment of the current situation that the campaigning organisation Trailblazers struggled to find young people who would even take part in a recent report on the issue, because they found the prospect of engaging with public transport too distressing to contemplate. People with concessionary railcards tell me that they have been questioned to a humiliating degree on public transport about the nature of their disability, particularly when that disability is not physically obvious. Will the Minister agree to take this up with the rail companies to ensure that the practice stops urgently?

The difficulty is not just restricted to trains, although that was one of the key issues raised with me by my constituents. I have also been sent stories about people trying to travel on airlines who have been asked to pay extra charges to carry medical supplies—even oxygen canisters—which were classed as excess baggage.

Mark Lazarowicz (Edinburgh North and Leith) (Lab/Co-op): On air travel, my hon. Friend might want to comment on the practice of some airlines. Even when an air bridge is available at an airport to take passengers off without the need for stepped access, airlines use the access stairways to reach aircraft for what I suspect are financial reasons. In such situations, a person in a wheelchair often has to wait until a winch or lifting vehicle is brought out from the terminal. Apart from the delay that that involves, it is very embarrassing to be picked out in such a way when the facilities are available in the airport to avoid that. That should also be addressed as part of the joined-up approach that is needed.

Lisa Nandy: I could not agree with my hon. Friend more. The example he gives highlights exactly the indignity and humiliation that far too many people must face when they try to do something that the rest of us take for granted. I am grateful to him for raising that point.

On the buses, people seem to fare little better. Half of all disabled people say that buses are a concern for them. Even something as simple as boarding the bus presents a problem. Many buses still do not have ramps and, even when they do, a common story emerges from all the reports that I have been sent from across the

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country of drivers refusing to stop because it would take too long to allow somebody to board, or because the space allocated for a wheelchair is taken up by a pushchair. I want to be absolutely clear on this point: I am not advocating that there should not be space for pushchairs; it is simply unacceptable that there is not room for everybody.

Jim Shannon (Strangford) (DUP): I congratulate the hon. Lady on securing the debate. This is an issue that concerns the whole of the United Kingdom, although this debate obviously relates to the UK mainland. In my previous job as a Member of the Northern Ireland Assembly, I sat on a Committee that was responsible for bringing forward legislative change that enabled public transport, both bus and rail, to ensure access for disabled people in wheelchairs in particular, but for visually disabled people, too. That is starting to roll off the Assembly line, to use a pun, in Northern Ireland. Does the hon. Lady feel that the Government might take that as an example of how legislation could be introduced and delivered, in conjunction with local councils and other responsible bodies, to ensure disabled access for those who are wheelchair bound or visually disabled, not just to public transport—bus and rail—but to taxis as well?

John Robertson (in the Chair): Can we keep the questions a bit shorter?

Jim Shannon: I appreciate that.

Lisa Nandy: I am grateful to the hon. Gentleman, because he gives me the opportunity to pay tribute to some of the public transport companies that have worked hard to make real strides forward on this issue. All those examples show that it can be done if there is a will for it to be done. It is up to all of us here in the Chamber to ensure that we push as hard as we can to make this happen.

Seat belts on buses are not routinely provided for wheelchair users. I have been sent some absolutely appalling stories of the indignity that people suffer when the bus drives off too fast and their wheelchair is not properly secured. Blind people have told me of their particular difficulties in identifying which bus is arriving, and knowing when to get off. Those issues could be rectified by introducing talking buses, by introducing seat belts, by introducing more space for buggies and wheelchairs, and training for drivers.

Jessica Morden (Newport East) (Lab): My hon. Friend has made an incredibly compelling case. May I commend to her the campaign of Guide Dogs Cymru, “Walk a Mile in My Shoes”, which I had the pleasure of taking part in last week with councillors and Assembly Members? She was talking about a joined-up approach, and that event brought home to me the difficulties experienced by people with sight loss and other disabilities negotiating city centres and getting to the bus or train station in the first place, let alone dealing with announcements and so on.

Lisa Nandy: I am grateful to my hon. Friend for making that point. Guide Dogs for the Blind was one of the most helpful organisations when I was preparing for

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today’s debate. I am sure that the Minister will want to consult it further about some of the difficulties my hon. Friend mentioned.

Almost half of all bus operator revenue comes from public funding. I want to see the Government putting serious pressure on companies in receipt of that public subsidy to ensure that the changes that I am outlining today happen. We not only can use our procurement power to make this happen, but we must and should do so, and make it happen quickly. What is so strikingly clear is that laws and training are essential, but alone they are not enough to solve the problem.

Several years ago I had the privilege to work for the former Member for Walthamstow, Neil Gerrard, an inspirational MP who, among many other things, while I worked for him brought into law the Private Hire Vehicle (Carriage of Guide Dogs etc.) Act 2002. It closed a loophole in the law under which black cabs had to carry guide dogs but private hire vehicles did not. It was symbolically important and particularly important to blind people, who obviously rely more on private hire vehicles than any other form of transport, but Guide Dogs for the Blind tells me that, since then, the situation has not got much better because the Act has not been enforced. That underlines how enforcement is essential if we are to make progress.

Dr Julian Huppert (Cambridge) (LD): I congratulate the hon. Lady on securing the debate and on an excellent speech so far. On the subject of guide dogs, will she join me in congratulating my colleague in the London Assembly, Caroline Pidgeon, who has recently run a successful campaign to force Transport for London and the Government to lift the ban on guide dogs for disabled people on the escalators of the tube, docklands light railway and overground railway? That is another part of the whole picture.

Lisa Nandy: I am grateful to the hon. Gentleman for mentioning that, making it clear that the issue is cross-party. The Disability Discrimination Act 1995, which started so much, was passed with cross-party consensus, and it is on that basis that we ought to go forward. All of us ought to play our part in making things happen.

Given that enforcement is so badly needed, I would like to hear a commitment from the Minister that mystery shopping exercises should be part of the franchising agreement on the railways and that he will find a mechanism to impose that condition on companies in receipt of public subsidy. Although feedback and surveys are an important part of any organisation, what is clear from the evidence sent to me by a whole range of organisations is that feedback alone is not enough. Often people’s experiences on public transport are so distressing that they do not want to relive those experiences by having to send in a survey response or make a complaint, so I want the commitment to mystery shopping exercises to be part of our agreements with such companies.

Sixteen years ago, the landmark Disability Discrimination Act was passed in this House with cross-party support, making a promise to people up and down the country that we have simply not fulfilled. We have failed many of those observing in the Chamber, and others up and down the country. A full 13 years after the regulations that breathed life into the Act came into force, it is nothing short of appalling that the situation is not

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better than it is. There are 12 million people with disabilities in the UK and, as we all live longer, that number is increasing. There is not only a moral imperative to take urgent action, but a social and economic one. Yet, in advance of the debate, I was contacted by Scope, Whizz-Kidz, Transport for All, the National Children’s Bureau, the Every Disabled Child Matters campaign, the National Union of Rail, Maritime and Transport Workers, the Association of Train Operating Companies, Passenger Focus, the Muscular Dystrophy Campaign and many others all expressing exactly the same concerns: not only did they say that the situation is not getting better fast enough, but many are concerned that the situation is getting worse and not better.

With cancelled station upgrades, cuts to discretionary travel and ticket office closures, we need a renewed focus on the area, and urgently. That is one reason why I am so deeply concerned that the Disabled Persons Transport Advisory Committee has been abolished. Will the Minister at least commit to setting up a working group, with transport companies and people with disabilities represented, to drive forward the necessary improvements to public transport by the 2020 deadline? Many of the organisations that I mentioned, which are far more expert in the area than I am, have expressed real concerns to me that we will not meet even those most basic standards that we promised to meet 16 years ago. The Government have made it a real priority to get disabled people into work. Setting up a working group would at least send a strong signal that they are committed to that. If they are going to ask people to go to work, they ought to be committed to enabling them to have the means to achieve that.

One of the most shocking things that I have found since my constituents came to see me in Wigan several months ago is that many of us—myself included—live our lives blissfully unaware that such an appalling situation is a daily reality for people up and down the country. I am pleased that so many Members are present today, and that we are using our position in this House to shine a spotlight on that situation. I am concerned, however, about what happens after today. Too often in this place we have a debate, express concerns and make our views known, but nothing happens next. Will the Minister commit to ensuring that any company in receipt of public subsidy will be required to report annually to Parliament on the progress that it makes in the area? The requirement need not be onerous—perhaps an annual letter to the Select Committee on Transport, for example. However brief, it would help to ensure that those of us who have the luxury of ignoring the problem are not allowed to do so.

Finally, I want to tell the Chamber about one of my constituents, Michael. He is 15-years-old; because of illness he is in a wheelchair and has been all his life. He was born alongside the Disability Discrimination Act which gave hope to people in his situation throughout the country. Essentially, if we will not take action to meet by 2020 the commitments made 16 years ago, we are saying to Michael, “You have lived all your lifetime with these problems. By the time that you are 24 years old, you will still struggle to work and to see friends. We will not give you the freedom that you both need and deserve.” We in the House are simply not doing enough to help Michael to live his life.

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If we are to resolve the situation, it will require not just action but a shift in our collective mindset. It is not people with disabilities who need to adapt their lives—they have already done their bit. It is the rest of us who need to change our attitudes towards them. In the end, the question is about the sort of society that we want to live in. Do we want to live in the sort of country in which we say to my 15-year-old constituent, Michael, that we have no place for him? That is not the sort of country that I want to see. We should be ashamed, and I hope that all of us, in every part of the House, will make the issue a long overdue priority.

2.47 pm

Paul Maynard (Blackpool North and Cleveleys) (Con): It is a pleasure to serve under your chairmanship, Mr Robertson. I congratulate the hon. Member for Wigan (Lisa Nandy) on a compelling and powerful speech, even if I did not quite agree with everything that she said—but such is life.

I do not wish to pre-empt my ten-minute rule Bill next Tuesday, which I recommend to everyone, but I have a few preliminary comments. All in the Chamber know how much the concessionary fares are valued by our constituents, even if we tend to argue about them at election time. One particular imbalance, however, needs to be addressed. Able-bodied pensioners who can use the buses get the concessionary fare, but disabled pensioners who cannot use the buses and have to rely on dial-a-ride services, demand-responsive services or other community transport must pay their own way. That seems to me to be a glaring imbalance, which no doubt runs contrary to the spirit of the legislation when introduced by the Labour party—none the less, an imbalance.

I understand that certain councils choose to provide free transport for the disabled, but not every council does. With the increasing budgetary pressures, I fear that fewer and fewer will. The imbalance seems not only unfair but contrary to the spirit of equality and of human dignity. However, I realise that a spending commitment would be involved, which is no doubt frowned upon. To many of the pensioners who contact me and say, “I don’t need the card; I am wealthy enough to pay myself,” I make the point that people can always pay their own way—no one is forcing them to have a card. Equally, however, my constituents in Blackpool do not deserve to be treated differently from my constituents in Wyre. Everyone should have the same right to free transport and free travel, and any hon. Member who wants to support my Bill, may add their name after the debate.

One of the great honours of being an MP is the opportunity to chair the all-party group on young disabled people. Its secretariat is wonderfully provided by the Muscular Dystrophy Campaign. I am not a great fan of the all-party group system as a whole because too many strike me as unnecessary vanity projects, or an excuse to visit obscure countries that I have never heard of. However, when I was approached, I said that I would be the chairman on one condition—that the group is meaningful. I wanted outcomes, processes and reports. I did not want to sit around just talking about the problems; I wanted to hear what we could do about them. That is certainly what I got.

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Report No. 1 of the “Inclusion Now” series is called “End of the Line”. Leaving aside the fact that that was also the title of the Conservative party’s report on coastal towns when in opposition and that that is now in the Government’s bottom drawer, I welcome it because it explains what happens to many disabled people. They may want to get off at a station, but when they arrive no one is there to help them, and they may go to the end of the line, which is often many stations away, because no one will help them to get off.

The report was followed by a public hearing of the all-party group to which we invited numerous transport providers. At the start of the meeting, I said that I did not want negativity, and to hear just the bad. As the hon. Member for Wigan said, we have made strides, and if we tell train, bus and taxi companies only what they are doing wrong, they will not be encouraged to fix what is wrong.

Some dreadful cases came to light. Buses pulled away sharply with wheelchairs going everywhere, and passengers with imbalance issues were sent flying. The assisted passenger registration service limits people’s spontaneity because they must give 24 hours’ notice. If I had to give 24 hours’ notice of where I wanted to go, I am not sure that I could live my life as it is.

The hon. Lady referred to accessibility issues at stations. I know that many of the buildings are old—they have been around for a long time—but with better creativity and a bit of thought, I am sure that solutions could be found. Perhaps the most controversial issue was staff awareness and individual members of staff who did not meet the standards expected by their own company. That is a difficult issue. Many people think that such members of staff just need more training. I take a slightly more libertarian view, because we cannot control what occurs in people’s minds. I would love to make them all think as they should think, but that cannot happen. However, every disabled person who suffers should have the confidence to enter the complaints process knowing that they will be listened to, and knowing that they will not be dismissed.

We cannot have passengers being left on trains, and we cannot have staff members ignoring them at stations. We cannot have that attitude, but we must recognise that there is a problem because of the age of many of our trains, buses and so on. I often travel by train into Manchester from Preston on what is essentially a bus on wheels. I suspect that it is older than me. It is unrealistic to expect it to have all the knobs and flashing buttons that a modern train might have to enable passengers to draw attention to the fact that a disabled passenger may be trying to get off. Such technology might ease the problems for staff also.

I pay tribute to National Express, which does an excellent job in providing for disabled people. There are issues about the Government’s funding of coach services that might threaten some of the subsidies, but I had better not go there. However, I have asked National Express why it does not introduce a 50% reduction card. If it has so many disabled passengers, I am sure it will keep them if it introduces a card under its own steam.

The hon. Lady was critical of the abolition of the Disabled Persons Transport Advisory Committee, but I do not share that criticism. We are having a quango cull, with many worthy bodies disappearing, but Equality

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2025, which is based at the Home Office, will absorb its responsibilities, and a wider equality framework may be more effective at achieving the goals that she wants.

I do not want negativity, so I shall mention a success from the Trailblazer campaign. Carrie-Ann Fleming, who lives in Kendal, often had to wait an hour at a bus stop for the right disabled-access bus to come along. She thought that that was not good enough, so she launched a campaign and fought really hard. For once, a local council listened to someone complaining about something. That rarely happens, but it did in this case, and the council will alter the timetables to ensure that she can get on a bus without having to wait an hour.

I will close with a plea for human dignity. Some 47% of disabled people experience some form of abuse on public transport, according to Alice Maynard of Scope. She is no relation; I do not know which of us is more relieved about that. Even I have experienced abuse. I take a bus to the station every morning on my way here. At 7 am, I am often a bit groggy and a bit woolly-headed, and I do not always keep my balance when the driver puts his foot down and roars off from the bus stop. I may go flying, and on one occasion I crashed into a business lady who was not very happy about that. I apologised, and explained that my balance is by no means perfect, and that I struggle on buses. She said that I should not be on a bus if I cannot stand up straight. I just said, “I beg your pardon?” I could not believe it, because I have as much right as she does to be on the bus. It is not called able-body transport; it is called public transport. That means that we should all be able to use it, not just the able-bodied.

2.57 pm

Mark Lazarowicz (Edinburgh North and Leith) (Lab/Co-op): It is a pleasure to serve under your chairmanship, Mr Robertson, and I congratulate my hon. Friend the Member for Wigan (Lisa Nandy) on the way she introduced this important subject. I also congratulate the hon. Member for Blackpool North and Cleveleys (Paul Maynard). I have spoken about the issue in several debates, and I am grateful for the opportunity to make a few further points.

The starting point must be that measures to make it easier for disabled people to use mainstream public transport are simply part of a wider objective of ensuring equality for disabled people in society overall. Public transport should be accessible and affordable, so that disabled people can travel when and where they like. That is a basic principle of equality and human rights, and it underlines all that we should be doing in this area. I know that many hon. Members want to speak, so I shall make only a few comments.

As my hon. Friend the Member for Wigan said, the percentage of the population with a disability is substantial, and the figures for Scotland are even higher than those for the United Kingdom. It is estimated that about 20% of the population of Scotland have a disability. At some stage, almost all of us in the Chamber will have a disability, which shows the scale of the issue. People with mobility issues make around one third fewer trips than those without such difficulties. Disabled people are disproportionately dependent on public transport, and 60% have no car in the household, compared with 27% in the general population. In March 2009, only

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53% of licensed taxis in Britain were wheelchair accessible, and in 2009-10, 39% of buses in Great Britain did not meet the accessibility requirements in disability discrimination legislation.

I am pleased to say that in my constituency the situation is considerably better. Every taxi, but not private hire cars, in Edinburgh must be wheelchair accessible. Two bus companies serve Edinburgh, and 100% of the buses operated by Lothian Buses, which is Britain’s largest publicly owned bus company, are accessible, as are 85% to 90% of the buses operated by First Group, to be fair. That illustrates the fact that we can make a difference and that changes can be made. It is a matter of political will, as well as legislation and regulations.

Pat Glass (North West Durham) (Lab): I am grateful to my hon. Friend the Member for Wigan (Lisa Nandy) for securing the debate. Before coming to the House, I spent 30 years working in the area of special needs and disabilities, and my hon. Friend the Member for Edinburgh North and Leith (Mark Lazarowicz) is right to say that planning sits at the centre of those issues. If we put the needs of disabled people at the centre of our planning, whether for a leisure centre, a system, a school, a college or a train, we will get it right for those disabled people, but also for everybody else—that comes from 30 years’ experience.

Mark Lazarowicz: Absolutely. I intended to make that point later, but I shall deal with it now. It is essential that regulations are tightened and that funding is provided. The wonderful phrase “joined-up government” needs to apply in this area because there are many examples of simple things that could be done to improve access for disabled people. There are also examples of where the consequences of a minor local policy or local works were not thought through and had a detrimental effect on access for disabled people. I believe it would be good to retain the Disabled Persons Transport Advisory Committee, because whatever support is provided in-house by the Department for Transport, it will not have the same voice as an independent body that speaks for its users. I shall not go into that in detail, but we shall see what the Government have to say on the matter.

A lack of joined-up thinking can make a difference. For example, I have seen trains that have good accessibility, such as spaces for disabled people and a ramp that is operated either manually or automatically, so that when the train arrives at a station, people can leave it easily. However, there may be temporary works at the station—perhaps a barrier or building work has been set up, or a load of bricks has appeared at the end of the ramp—and people cannot get off. That point is not only about accessibility for people in wheelchairs; accessibility can be difficult for all sorts of people because, to put it bluntly, not enough thinking has been done on how to join up different aspects of a service.

I will refer again to Edinburgh, where 100% of Lothian Buses are now accessible to disabled people. A few years ago, a number of buses were introduced with an increased number of spaces for wheelchairs. However, there were a number of complaints, particularly from pensioner groups, because the buses would drive off quickly and people would lose their balance and fall over. The issue

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was solved simply by installing more rails and grips for people to hold on to once on the bus—a common-sense approach that was not thought of at the time, but which, due to consultation with local people, was resolved quickly. That is an example of the need for simple, joined-up government, as well as regulations and spending, and it is why the voice of disabled people is particularly important. There is no better way to understand where services or adaptations are needed than talking to those who use them.

I have two final points to make. First, the campaign for talking buses is an eminently sensible proposal that seeks the mandatory installation of audio and visual announcements on all new buses. The cost would be small compared with the overall cost of new buses, and that provision could be attained by amending the Public Service Vehicles Accessibility Regulations 2000. As I understand it, the Department for Transport currently does not intend to legislate on that, but I hope that the Government will change their position. Such a measure would make great common sense and be useful to all passengers, not just those with issues of accessibility.

Susan Elan Jones (Clwyd South) (Lab): I am grateful to my hon. Friend the Member for Wigan (Lisa Nandy) for securing this important debate. Is my hon. Friend the Member for Edinburgh North and Leith (Mark Lazarowicz) aware that in many countries campaigns such as that for talking buses, run by Guide Dogs for the Blind, are commonplace? When I worked in Japan more than 20 years ago, talking buses were the norm and were not seen as unusual. I do not know when that began, but it is imperative that such a system is introduced in this country as soon as possible. If that is not carried out voluntarily by bus companies in receipt of public funding, strong pressure should be put on them.

Mark Lazarowicz: My hon. Friend makes a good point; I have been on buses with that facility in other parts of Europe. If regulations are not changed, the speed with which that facility spreads through the bus network will be so slow that it will take 10, 20 or 30 years for a reasonable number of buses to be equipped, if it happens at all.

Dr Huppert: Just before the previous intervention, the hon. Gentleman touched on the point that I wish to raise. A lot of the interventions that we have mentioned—not all of them, but those such as talking buses and having more grab rails—would benefit everybody. For too long, and in so many ways, we have accepted a design that is no good for either disabled or non-disabled people. The principles of inclusive design should help everybody, and we should encourage that as well as those things that specifically help some groups of disabled people.

Mark Lazarowicz: Indeed. I do not want to turn this into a debate about the advantages of publicly owned bus companies, although I am sure some hon. Members would like me to do so. However, Lothian Buses is an example of a company that, because of its nature, has the advantage of being close to local needs. The newer double-decker buses are longer and provide more space for buggies, pushchairs and wheelchair access. They are gradually introducing audio and visual announcements. It can be done; it is about making a choice and taking a

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decision on what is needed. I suspect that legislation on public transport might allow local authorities to specify regulations on improving local access more clearly—perhaps that point is for another day.

My final point is to emphasise the need for a joined-up approach. We will not get every bus and train in the country fully accessible overnight—it takes time to make such things happen. People on train journeys frequently use more than one operator. They may get on a train that is accessible, but change en route to a service that is entirely inaccessible. They may not have realised that and assumed, or even inquired and been assured, that the next train would be accessible. However, if it is not, they will be stuck on a station, perhaps without assistance, and will have difficulty in completing their journey. A bit more thinking and a more joined-up approach would improve such situations, although I accept that that cannot be done overnight in every part of the country.

That takes us back to the issue of equality. Every passenger, whatever their position, should have the right to start and complete their journey without unreasonable obstruction or a lack of facilities that prevents them from doing so. In spite of the work carried out by the previous Government, which I hope will be continued by this Government, the issue needs to be pushed up the agenda more often. Thinking and regulation need to change, or else, despite all the improvements, it will be many decades before we can say that we have a fully accessible transport service in this country.

3.7 pm

Jack Dromey (Birmingham, Erdington) (Lab): It is a pleasure to serve under your chairmanship, Mr Robertson, and I pay tribute to my hon. Friend the Member for Wigan (Lisa Nandy) for securing the debate and for her passionate advocacy of a noble cause.

My hon. Friend is right: how we support and care for the blind, the partially sighted and the disabled in our communities is the hallmark of a civilised society. I pay tribute to many friends from over many years, including those I represent in my constituency of Erdington, who have battled against adversity, often in the most extreme circumstances. Their approach to life was captured by one sufferer of multiple sclerosis from Castle Vale who has been confined to a wheelchair for many years, but said, “I’m disabled, but I’m proud of being disabled.” Disabled people do not want our pity; they want to play a full part in society. They expect us to discharge our moral duty to them, and for those with responsibility to comply with obligations in the law.

My hon. Friend was right to say that there was all-party consensus on some of the landmark changes over the past 20 years, including the Disability Discrimination Act 1995. However, if that is the hallmark of a civilised society, by that test and under successive Governments, our society has sadly too often failed the disabled. Having said that, this Government are moving in the wrong direction.

Today, we rightly focus on transport, and the problems with it are set out in the excellent Trailblazers report. That report includes the personal experiences of an admirable woman, Jagdeep Kaur Sehmbi—Jagz, to her friends—who is here today. She has undertaken tremendous work on behalf of those who are wheelchair bound and the disabled more generally, and she has demonstrated

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just what the problem is. Let me quote just two paragraphs from what she says in the report. On the issue of trains, she says:

“A couple of times there has been no one with the ramp to help me off the train at my destination platform, even though I had informed them at the other station and been assured that someone would have the ramps ready.”

On the issue of buses, she says:

“Once the driver didn’t drive up to the pavement, not because he couldn’t, but because it was easier for him to drive off after the other passengers had got on, so I had to get off in the road, which meant the ramp was very steep and then I had to find a place to get up onto the pavement.”

Jagz has not been deterred from continuing to travel, but it is clear from my experience that many who have such bitter experiences give up and stay at home, just when they want to play a full part in society.

The report goes on to detail its findings, and I want to refer briefly to four. First, on transport, the disabled end up having less choice and paying more. Secondly, the young disabled, in particular, feel very much that they are second-class citizens. Thirdly, disabled people cannot always access the first taxi, train or bus to come along. As a result, one disabled person told me, “I felt humiliated about being there on the pavement. Everyone else could get on board, but I couldn’t.” Fourthly, the assisted passenger registration scheme demands 24 hours’ notice, which in turn restricts spontaneity and independence. It also fails to provide a service that passengers can count on, which again is evidenced by Jagz’s experience.

Of course, there is an obligation on the companies that provide those services, and I will come to one such company in a moment. Crucially, however, the Government must also act—not only on the framework of regulation, but where there is evidence that companies are not discharging their obligations properly.

That leads me to London Midland. The company is proposing—the proposals are on the Secretary of State’s desk right now—to make significant changes, including to the manning of stations. In my constituency, for example, Gravelly Hill station and Erdington station will no longer be manned after 5 o’clock in the evening. Centro has concluded a consultation process, and 18,000 representations have been made, including many from the disabled, objecting to the proposals and seeking to bring home what they would mean.

I have been working with the Royal National Institute of Blind People, Mencap and the Muscular Dystrophy Campaign to bring home what the impact of the proposals will be, and I want to give one example. The formidable Mike Hughes, who is a former police officer, is now blind. He is chair of the west midlands region of the RNIB. He tells a story about how he got off at Sutton Coldfield station at 9.30 one evening. Normally, he immediately rings for a taxi—he has two numbers programmed into his phone—but this time he could not get a signal. He was completely lost, and this is a strong, self-confident individual. Fortunately, the person manning the ticket office, who was about to close it down, helped him out and took him somewhere where he could get a signal and call a taxi. Like Jagz, Mike said, “I wasn’t deterred, Jack, but I know many people like me who’ve had bad experiences and who were deterred from travelling.”