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Westminster Hall

Tuesday 19 June 2012

[Mr James Gray in the Chair]

Armed Forces Day

Motion made, and Question proposed, That the sitting be now adjourned.—(Michael Fabricant.)

9.30 am

Alex Cunningham (Stockton North) (Lab): I am pleased to have this opportunity to serve under your chairmanship for the first time, Mr Gray, and to have the privilege of opening this debate in tribute to the people who protect our country and the world and who often pay the ultimate price by losing their lives in the process.

I have found it extremely heartening to see greater support for our armed forces in recent years. It was always there, but now we see real evidence of the pride our people take in the men and women who serve, lining the streets for freedom ceremonies, paying tribute to those who have lost their lives and committing to activities to give those who serve a better deal. The fourth annual Armed Forces day will be held on Saturday 30 June. While it is a time of celebration, it is an opportunity to do two particularly important things: first, to raise even more public awareness of the contribution made to our country by those who serve and have served in the armed forces; and, secondly, to give our nation an opportunity to show our support for the men and women who make up the armed forces community, from currently serving troops to service families, and from veterans to cadets.

The armed forces defend the UK and its interests and play a crucial role in making our world as safe as possible. Through centuries of service to the nation, they have established a record unequalled in the world. They work selflessly with honour and distinction in the most challenging circumstances imaginable. Every day the world becomes more and more interconnected, and instability in one corner of the earth can have far-reaching consequences for the rest of us. Our armed forces are therefore busy working around that world, promoting peace, delivering aid, tackling drug smugglers, providing security and countering terrorism, whether in the fight against the drugs trade in the Caribbean, in working to prevent and deter conflict in places such as Cyprus and the Falkland Islands or, of course, in continuing to fight for a safer Afghanistan, a safer Britain and a safer world.

It is because our values and interests do not stop at our shores that we are a country that cherishes our forces, who have the power to persuade and the ability to act. Since the second world war, more than 16,000 servicemen and women have lost their lives in a score of campaigns. That is why we should never take the incredible bravery and service of the British armed forces for granted. Everyone needs to understand the sacrifice that they make on our behalf. Their contribution to our safety and security is immense, and we owe them all a huge debt.

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The love for the armed forces among the British people is not in doubt. Opinion polls suggest that up to 95% of the public respect the role of the Army—I can speak for the whole of this Chamber and perhaps the whole of Parliament when I say that we all very much envy such approval ratings. A testament to the hard work of organisations such as the Royal British Legion is that there has been a separation in the minds of the public between the Iraq and Afghanistan issues and the soldiers fighting and risking their lives there. Although the past decade in Iraq and Afghanistan has proved contentious, public support for our veterans and their families has been unequivocal. People all over the country continue to come out on to the streets to welcome home after gruelling tours sons, brothers and daughters in uniform. We all remember the special service undertaken on our behalf in past years by the people of what is now Royal Wootton Bassett, lining the streets as the bodies of the fallen are brought home to the UK.

I am immensely proud, as we all are, that the British public have more than stepped up to the mark in support of our armed forces. Help for Heroes has raised more than £50 million in less than three years. The Royal British Legion has had its best three ever poppy appeals, and all the major service charities have felt a boost in popular support.

Armed Forces day has provided a formal focus for support. Once the British public saw the need, they simply answered that call. In my constituency of Stockton North, from where there are 71 service personnel, with a further 67 from the rest of the Stockton borough, I am delighted that a range of events has been planned to celebrate Armed Forces day, beginning with a picnic this Saturday. Along with towns and cities throughout the country, we will raise the Armed Forces day flag at our historic town hall on Monday, 25 June, and that will be followed by a small parade and a speech from Lieutenant-Colonel Heron, secretary of the Durham Light Infantry friends’ group.

Later in the week, a fair in Stockton will celebrate our armed forces, past and present. Stands and stalls set out in the local high street will host a variety of exhibits and displays, such as by civilian support associations or a range of military vehicles from the second world war to more up-to-date times. I am used to my borough of Stockton doing things differently so, while we will not see alien and earth-based forces fight it out in the skies over the high street, we will see a fun, “Star Wars”-themed element that will look forward in time and explore a possible vision of the nation’s future forces standing alongside celebrations of past and present armed forces. I am sure that children and younger people will enjoy that, helping them to appreciate a little more what happens to protect them and their families in today’s society. Other events currently planned to recognise the contributions made by our armed forces include a service of thanksgiving and a tea dance at the Baptist tabernacle. Wednesday 27 June will witness reservists and cadets from throughout the borough ditch their civilian clothes to wear their uniforms to work.

Local and national Government have their role to play not only in leading recognition and celebration of our armed forces but in ensuring that they get the support they need while serving and afterwards. Nationally, we have the armed forces covenant, which many of us

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would like to see have even stronger commitments to service personnel and their families, but local councils in north-east England are doing their bit, too.

In appreciation of the risks undertaken by the armed forces during the course of their duties and in recognition of the important contribution that service personnel, their families and veterans have made and continue to make, I am delighted to say that Stockton borough council is one of the eight north-east councils to have introduced an armed forces community covenant. The community covenant exists to support the national armed forces covenant introduced in May 2011, but at the local level. The principle behind the community covenant is that the armed forces community should not face disadvantage because of its military experience. In some cases, such as with the sick, injured or bereaved, that means giving special consideration to enable access to public or commercial services that civilians would not normally receive, ranging from issues such as housing and education to support after service. For Stockton borough council and partner organisations, the community covenant presents an opportunity to bring their knowledge, experience and expertise to bear on the provision of help, advice and support to members of the armed forces community, and to build on existing work such as the north-east scrutiny review of the health needs of ex-service personnel.

Although all that positive work in Stockton and up and down the country to celebrate the forces is going on, polls in recent years have, however, found that more than half of people—53%—believe that there remains a gulf between the Army and the rest of society. As the older generations who fought in the world wars or undertook national service dwindle, and as the services have reduced in size since the end of the cold war, public understanding of our armed forces has declined. The unique nature of military service, too, often goes unrecognised and misunderstood. What a life in today's armed forces is like and the impact that service life has on modern families is less widely understood. That is why Armed Forces day is so important in raising people’s awareness of the impact of service life.

I am sure that all of us who have met and know service personnel agree that one finds that a fantastic variety of people makes up our armed forces, with an amazing range of skills. For British servicemen and women, it is not only a question of fighting the enemy with an array of armoury and the latest hi-tech weaponry, but about what happens when the fighting is done, when they take their helmet off, put the beret on and start to engage with people, building trust to make a lasting peace. They do all that in the most difficult circumstances, in the 40° heat of Afghanistan and Iraq, seeing violence and suffering on an imaginable scale and while separated from their loved ones. Yet, through all that, they retain their courage, their professionalism and, let us not forget, their sense of humour.

While we celebrate those accomplishments, in all parts of the political spectrum we must also acknowledge the difficulties faced by the armed forces and their families and work harder to improve their quality of life. Our veterans deserve the best equipment, services and support we can offer. Those who have selflessly defended our country and interests for no personal gain

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or glory must never be abandoned or forgotten. I am sure that all hon. Members who are here from both sides of the House agree that it is important that on occasions such as this we speak with one voice in support of our veterans and servicemen and women. This is not a time for party political point scoring.

It is important that, to ensure the armed forces are given the support they so deserve and need, we constantly scrutinise the Government of the day’s policies, encouraging a healthy debate on the issues and speaking up when we believe the interests of the armed forces are not being put first. That is why Labour is calling for urgent cross-party talks to end discrimination against our armed forces. Greater legal protection for the armed forces and their families must be examined as we seek to end abuse of the service community. It is shocking to hear that more than one in five members of the forces have said they had experienced strangers shouting abuse at them while wearing their uniform in public in the UK in the last five years. Nearly one in 20 said they had experienced violence or attempted violence, and 18% have been refused service in hotels, pubs or elsewhere. The Government must bring all parties together, including the military and service charities, to discuss how to end that appalling abuse of the service community.

The previous Labour Government changed the way in which the armed services, their families and veterans are supported by Departments. For example, they introduced the armed forces compensation scheme, the doubling of welfare payments to those on operations, the advancement of education services for service leavers who have served for six years, increased access to the NHS, and improvements in accommodation through joint working between the Government and voluntary organisations. Studies have shown that that has led to a fall in homelessness among former service people from about 22% to 6%. I pay tribute to the work of charities such as the Royal British Legion, the Soldiers, Sailors, Airmen and Families Association, Help for Heroes, and many others, all of which contribute so much to supporting our armed forces.

This debate is about not just servicemen and women, but their families, some of whom have lost loved ones, and we must do all we can to support them. Quite simply, supporting families is supporting the front line. Their contribution to our country is enormous, and the support they receive should reflect our country’s values and character. Last year, more than 1,000 service personnel suffered major injury. The care provided by the services and our health professionals is first class, but the impact of injury, whether physical or mental, may be lasting and demand long-term care, and it is often family members who take up the responsibility for loved ones hurt in the line of duty.

The UK currently has no specific working leave rights for carers of service personnel or veterans, so it is vital that military families have the support they need to provide a caring role, something that Labour is strongly campaigning for. Service personnel have consistently stressed how important community support is for their families—things as simple as ensuring that teachers are aware if children in their class have fathers away on operations.

Defence issues transcend partisan politics, and that should include welfare. My right hon. Friend the Member for East Renfrewshire (Mr Murphy), the shadow defence

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spokesman, has consistently argued that the three main parties must agree on issues involving military action, and far more so on support for veterans and families.

The sacrifice that service families make is huge. Families miss out on special moments with those they love, whether birthdays or anniversaries or just sharing a simple family day, not to mention the sacrifice of those who move around the country and who live with fear for those who fight in our name. Families often deal with the long-term consequences of conflicts that protect us and others around the world. We should repay them by ensuring that they have the ability to care for our forces.

I am grateful for the opportunity of this debate today. I know that many right hon. and hon. Members are sorry that they cannot be with us because of other activities. They include my hon. Friend the Member for Stoke-on-Trent South (Robert Flello), who was Parliamentary Private Secretary to the former Defence Secretary, my right hon. Friend the Member for Coventry North East (Mr Ainsworth).

I want to finish by emphasising how important and unique Armed Forces day is. It simply unites the whole country. Indeed, the British public are as big a part of the day as the forces. They provide support in countless ways, and their tremendous work enables our armed forces to continue to do such an excellent job.

Mr James Gray (in the Chair): Perhaps I could deviate from normal procedure and, as the Member of Parliament whose constituency includes Royal Wooton Bassett, thank the hon. Gentleman for his kind remarks about my constituents. As chairman of the all-party group on the armed forces, I remind hon. Members that at 3.30 pm they will have the opportunity of welcoming 20th Armoured Brigade, who will march through Carriage Gates to the north door of Westminster Hall. All hon. Members, peers and staff of both Houses will be very welcome at that occasion.

9.45 am

Oliver Colvile (Plymouth, Sutton and Devonport) (Con): It is a pleasure, Mr Gray, to serve under your chairmanship in this debate and on the all-party group on the armed forces, of which I am delighted to say that I am a vice-chairman with responsibility for the Royal Marines. I have always taken a keen interest in this issue, because I come from a service family. I did not serve in the armed forces, but my father joined the Navy at the age of 14 and went to Dartmouth, and my grandfather was first lieutenant of the naval barracks in Plymouth and gunnery officer on HMS Valiant at the battle of Jutland. My great-uncle was killed in the first world war at Ypres. I followed the issue very closely during my childhood, and I remember two brothers—the Goldney brothers—who lived up the road from us who had been responsible for keeping the Panzer division at bay during the battle of Dunkirk and then spent the next four or five years in a prisoner of war camp.

This is an important debate at an apt time, because next week is national Armed Forces week, with a commemoration day, which will culminate on Plymouth Hoe, when the hon. Member for Plymouth, Moor View (Alison Seabeck) will also be present as a fellow Member of Parliament for Plymouth. We have worked hard

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during the past two years to encourage my right hon. Friend the Minister to ensure that Plymouth is the centre and focus for the national Armed Forces commemoration. I thank him for listening to our wishes and desires, but if I have nagged him a little too much, I am sorry.

I pay tribute to the people in Plymouth who are putting together an effective week of commemorations, especially Commander Crichton, who has sometimes found it difficult to get people to work together, but is working incredibly hard on the matter. I just hope that the weather will not be as bad as it was when 3 Commando Brigade returned to Plymouth for its welcome home, when rivers of water were running past, and some of us had to step out of the large river that was running down the Hoe at the same time. I was reminded of that just the other day.

Last Thursday, I spoke in the excellent debate on mental health. One issue that I looked at in a big way was combat stress and the mental health of our armed services. I have spoken regularly about that in the House, and I hope that a difference is being made and that there will be better co-ordination between Departments’ policy making on such issues. The debate coincided with the 30th anniversary of the Falklands war. Last Sunday, I joined the Royal Marines and 3 Commando Brigade on the Hoe to lay a wreath on behalf of the 32 or 33 members of the brigade who were killed during the Falklands war.

In preparing for the debate last week, I had quite a long conversation with Combat Stress, which his based in the constituency of my hon. Friend the Member for Mole Valley (Sir Paul Beresford). That excellent charity told me that, of the 4,800 veterans on their books, 221 served in the Falklands. The youngest is now 46, and the oldest is 74.

This year, the charity has been contacted for the first time by no fewer than 10 Falkland veterans, 30 years after the conflict. Evidently, such contact is not something that happens today or tomorrow, and people may suddenly experience recall and flashes that refer back 30 years. Three of those who contacted the charity have waited for more than 25 years between being discharged and making that first contact, and a further three have waited for more than 16 years.

Last year, 18 Falkland veterans contacted Combat Stress for the first time, one of whom had waited for more than 28 years to deal with the issue. That trend was confirmed the other day when I visited the Glenborne unit—the mental health unit at Derriford hospital—and I was told that it has seen a significant rise in the number of veterans who suffer from mental health illnesses.

Last week, I congratulated my hon. Friend the Member for South West Wiltshire (Dr Murrison) on his paper on combat stress, which has formed the basis for the Government’s approach to much of this issue. I also congratulate the House on enshrining the armed forces covenant in law. That was important.

This issue, however, concerns not only mental health; we must also consider other factors such as the quality of housing that we deliver and how we can ensure that service families and service children have access to good schools. I pay tribute to HMS Heroes in Plymouth, which looks after some of the children whose parents serve in the armed forces. It does an incredibly good job.

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Service families who move from one garrison to another sometimes find it difficult to access schools, and we must ensure a much more level playing field. If a family arrives in Portsmouth in July, having previously been in Plymouth, and try to enrol their children into one of the local schools, they may find real difficulty because all the school places have already been allocated. It is important to do something for those families, as well as for Territorial Army reservists, because if there is a reduction in the number of regular troops, the slack will be taken up by the reservists. Indeed, I urge the Minister to ensure that we have a strategy that looks after the health—in particular, the mental health—of those reservists. At the moment, they seem to fall through the net, and we must ensure that a box is included in their application form to allow information to be shared with charities such as the Royal British Legion, which does an excellent job, and Combat Stress.

Recently, I heard that children of parents who have been killed in active service could lose their pupil premium after 12 months. We must address that important issue—perhaps it is something that the all-party group on the armed forces might consider. We must also consider the accommodation in which our service troops and their families must live. I pay tribute to Alabaré, which is based in my constituency, and an organisation called Riverside that does an enormous amount of work to ensure that armed forces families are looked after in a big way.

Another issue on which I feel strongly concerns those people who leave the armed forces. We must ensure that they have employment opportunities and can take the qualifications and experiences that they gained while serving into other jobs. My father left the Navy at the age of 45 as a two and a half—a lieutenant commander—and he ended up as the head of outside broadcasting at Rediffusion Television, which demonstrates how long ago that was. Having been a signalman, he was able to use his experience in communication. I have spoken to a number of people who feel that it is difficult for members of the armed forces to use their experiences in such a way, because they are not necessarily recognised in NVQs or other qualifications. I urge the Ministry of Defence to look at that issue.

Over the past month or so, I have been in discussions with the Minister because Plymouth university is looking at a way to create something similar to the Royal hospital in Chelsea and provide accommodation and a home for some of our veterans. The idea is to ensure that students at the medical school can buddy up with some of those veterans who have to live without accommodation, and it is a very good thing to do. Plymouth is also the home of the Haslar unit, which deals in prosthetics and similar matters.

Finally, in my opinion, the contribution that Plymouth has made and will make during the great commemoration for national Armed Forces day is exemplary, and I pay great tribute to everybody’s hard work and effort. We have a great story to tell as a great naval city and the home of Sir Francis Drake.

9.56 am

Mrs Madeleine Moon (Bridgend) (Lab): It is a great honour for me to serve under your chairmanship, Mr Gray, just as I do in my role as vice-chairman for the RAF group in the all-party group on the armed forces.

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Mr James Gray (in the Chair): You do a very good job.

Mrs Moon: Thank you, Mr Gray. I very much appreciate your comments. I sometimes wonder what my father would think about my chairing the RAF group. During the second world war he served in the merchant navy, and when he left at the end of the war, he entered the Royal Naval Reserve—interestingly, he too was a lieutenant commander. I remember that all family occasions would end up with my father and my two uncles—Uncle Joseph who served in the RAF, and Uncle John who served in the Army—arguing over which branch of the armed forces had made the most important contribution. They would constantly poke each other and tell each other that they belonged to the senior service, and I remember that well as a major aspect of my childhood. Although I do not fit the bill for someone who comes from a traditional military family, the armed forces played a major part in my childhood. When I came to the House that led me to take an ongoing interest in the work of the Defence Committee and the all-party group on the armed forces.

When I attend events that relate to the armed forces in my constituency, there is clearly a widely held assumption that those who have an interest in the armed forces belong to two different branches—older veterans and families with members who are currently serving. We see those as two distinct groups and tend to forget about the reservists and the Territorial Army, as well as the cadets, many of whom are often planning a career in the armed forces. In fact, people who have served in the armed forces are all around us. When someone leaves the armed forces they retain the ethos that they gained during their service, which often remains relevant in the work that they do and the way they view their life and service to their community. To challenge the assumption that people in the armed forces are either elderly veterans or those currently serving, to celebrate the fact that former armed forces personnel are all around us, and hopefully to mark Armed Forces day in a new way, for the past two years I have organised in Parliament an exhibition called “Standing Next to You.”

I know that you, Mr Gray, took part in that exhibition last year and sent us an amazing photograph of an extremely youthful James Gray during his time in the military. The exhibition is designed to highlight the former armed forces personnel working in Parliament. They work in many different branches of Parliament. Each contributor provides a photograph of themselves when they were serving, a current photograph and a short biography. Contributors have come forward from both Houses and across departments, including Doorkeepers, Officers and Committee Clerks, and all with a story to tell. I hope that the exhibition will serve as a fitting recognition of the ongoing contribution and commitment that former armed forces personnel make just in the very small, localised community of the Houses of Parliament. This year’s exhibition will be staged in the Royal Gallery from Monday 25 June. I encourage everyone to come along and see for themselves how many former service personnel are around us in Parliament.

We are discussing Armed Forces day, so it is appropriate that this week is carers week. Armed Forces day is not just about those currently serving or even veterans. It is

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also about their families and the major contribution that they make to the effectiveness of our armed forces. We must not forget that the families are often on the front line of dealing with the absence of a loved one while they are on active service but also with the consequences of that service when they return home. Sadly, some of those family members will become carers, dealing with the impact of physical injuries but also the mental scars that active service can leave. Carers UK uses carers week to highlight the impact of caring: 83% of carers report that caring has had a negative impact on their physical health and 87% report a negative impact on their mental health. Military families are no different. In fact, military families and the requirements of the military led the way in the development of mental health services in this country. We often forget that. It was the need to help people to recover from their experiences in the trenches during the first world war that led us to begin to discover ways of dealing with people with mental health problems and helping them to recover their mental health. The Royal Marines have done excellent work in the development of TRiM—trauma risk management—which has also been important in highlighting the people who are beginning to find their service difficult and has helped them to find their way back to recovery.

The number of people in these circumstances is difficult to quantify. American studies show that one third of Vietnam veterans needed psychological care and that one in five soldiers suffered combat-induced psychological problems post-Iraq. Our regimental system seems to help people to avoid suffering the same high levels of post-traumatic stress. Regiments help to provide comradeship and support. However, after almost a decade and a half of war in the Balkans, Iraq and Afghanistan, we have to be aware that the number of traumatised and psychologically damaged military and ex-military personnel will grow.

Combat Stress reports an increase in referrals of 66% over the past six years. The most common diagnosis is post-traumatic stress disorder. Interestingly, an analysis of its referrals clearly shows that the common time lag between someone finishing their service and seeking help is, on average, over 14 years. When I was in the United States looking at the work being done there on post-traumatic stress disorder, one of the interesting issues raised was how many in the States are reservists. As we move towards Future Force 2020 and increasing numbers of reservists, whom we will be moving towards the front line, we must consider how we will deal with people suffering post-traumatic stress—how we will provide support to them. That is a step that we have to take. We must plan for it now—we have to be prepared.

Although the services available to help veterans have improved by leaps and bounds, it is important that we do not forget about the toll on their families and the help and support that they might need. I, too, want to refer back to last week’s debate on the Floor of the House about mental health. It was shocking to hear the figures showing the lack of support for people suffering mental health problems in the community. With the potential time lag of 14 years between someone finishing their service and seeking help, we must ensure that veterans can access services after 14 years, when perhaps they do not have the same access to services as those who are currently serving in the military.

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It is also vital that we do more to encourage veterans who are reluctant to seek help to come forward. The hon. Member for Plymouth, Sutton and Devonport (Oliver Colvile) gave the example of someone coming forward 28 years after the Falklands conflict. That is unacceptable: we must ensure that people feel able to come forward much sooner. Many out there are suffering in silence while their lives and those of their close family members disintegrate.

We will also need to tackle compassion fatigue, ensuring that funding for psychological services does not fall away as memories and identification with a conflict fade. It is possible that in 10 or 20 years’ time, we will see a rise in the number of veterans seeking help. By that point, we will have withdrawn from Afghanistan and the armed forces may not have the profile that they have today.

We must ensure that Afghanistan does not become something associated solely with the Army. Let us not forget that large numbers of personnel from the Royal Navy, the RAF and the Royal Marines are also serving in Afghanistan. There are also large numbers of reservists in Afghanistan. There are also large numbers of people working for private sector defence companies. They, too, are seeing and experiencing trauma. Those are all people who may well in the future need our help and support.

As I draw my speech to a close, I want to mention the impending decision on the future of certain regiments and the impact that that will have on veterans of those regiments, the serving soldiers and their families. Last week, I met veterans of the Queen’s Dragoon Guards who had come to Westminster to lobby Ministers on the future of their regiment. The fear is that Wales’s only armoured regiment will be lost simply because it is considered to be that regiment’s turn or it will be a victim of politicking with regard to the proposed referendum on independence for Scotland.

People’s link with their regiment is very important. They see their regiment as their extended family. I appreciate the difficulty that the Ministry of Defence has with the downsizing of the Army, but the proposed cut is not just about numbers and our ability to engage in future operations. It is about the individuals who have invested part of their lives in regiments that face amalgamation and those returning from Afghanistan who may be facing an uncertain future. That is devastating for them and their families. Those left behind when someone is on service overseas have a difficult enough time as it is, but to be facing an uncertain future at a time of great economic difficulty is doubly hard. Losing one’s Army job ultimately means losing one’s home and community. If those cuts are to be made in the Army, it is especially important that careful consideration is given to the families, who will also feel that impact.

Armed Forces day and particularly the military covenant serve as useful vehicles for keeping the needs of our armed forces personnel high on the agenda. They are certainly high on the agenda in this place. I am pleased to say that I will be attending the welcome home later today of the 20th Armoured Brigade. Those who serve this country need to know that the House is not interested in them only in times of service during conflict. It is an ongoing interest and an ongoing commitment. Armed Forces day is a way of demonstrating that throughout the country.

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10.9 am

Jonathan Reynolds (Stalybridge and Hyde) (Lab/Co-op): It is a pleasure to be here under your chairmanship, Mr Gray, to make a brief contribution to this debate to mark Armed Forces day. I congratulate my hon. Friend the Member for Stockton North (Alex Cunningham) on securing the debate, which is greatly to his credit.

Two years ago, as a new MP, I chose to make my maiden speech on the defence section of the Queen’s Speech so that I could pay tribute to one of my constituents, Corporal Harvey Holmes, of 1st Battalion the Mercian Regiment, who had lost his life in Afghanistan just days before. Sadly, he is one of many young people from my area whom we have lost.

Since that speech, I have taken advantage of the many ways that Members can support the armed forces, including becoming secretary of the all-party group on the armed forces, which is so ably chaired by yourself, Mr Gray, and enlisting in the armed forces parliamentary scheme. That scheme has taken me everywhere from the armour centre in Bovington, Dorset to the university officer training corps in London, and from the plains of Canada at the British Army training unit Suffield to current theatres of operation, such as Afghanistan. It is important to mention that such visits are held not because they are enjoyable for MPs, but to increase our familiarity with and understanding of the armed forces at all levels. We receive excellent intelligence and other briefings in Parliament, but it is important to get out and see for ourselves. A message that we might want to send out from the debate today is that there are MPs on both sides of the House who are willing to do that and to support the armed forces in all parts of the job that they do.

If I were to make just one point, it would be that not only are our armed forces an asset to the country in their defence capability, though obviously that is the most important reason we have them, but, more than that, they are important national institutions in their own right. They make a huge contribution to our culture, history and identity, and provide vital opportunities to people from all parts and sections of the country. At a time when the unity of the United Kingdom faces a significant challenge, they are an important pillar of national unity. In the constituent parts of the UK, there is great pride in the extremely strong representation of the north of England, the regions and constituencies such as mine in the armed forces.

We can be extremely proud of the armed forces. In a world where we are always looking for competitive advantage as a nation, they represent something that we do exceptionally well. That does not mean, of course, that there are never any problems or that there are not things that we could do differently. Equally, there are things that our armed forces are right to ask of us. I would like to highlight three principal areas of concern.

First, there is discrimination, as my hon. Friend the Member for Stockton North described in detail. We are all appalled that anyone could abuse a serviceman or woman in uniform—it is appalling that someone could abuse anyone in the street—but we know that it happens. I find it even more concerning that people in uniform have been refused service in a pub, hotel or similar leisure establishment. We need a national, cross-party effort to stamp that out, and if it requires new legal

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protections and legislation, we should be willing to bring that forward. I would vote for it, as I am sure many other Members would.

Secondly, not all discrimination is overt, as we should continue to recognise. Sometimes how we run our society produces institutional problems for service personnel because of the different way that their lives are structured. We have heard in the debate that such problems include everything from getting credit at the bank to getting a mobile phone contract and problems accessing health care and schools. There must be a way to solve such problems. I know that a great deal has been done in recent years, but we are clearly not there yet. It is a widely held and shared concern on both sides of the House.

Thirdly, there are concerns around mental health, which the hon. Member for Plymouth, Sutton and Devonport (Oliver Colvile) ably discussed. We have asked our armed forces to do an exceptional amount over the past decade, particularly the Army. An incredible number of soldiers have served in combat situations. In the years ahead, we must honour that legacy by investing the appropriate amount of money into research into how best to provide for those people to safeguard their long-term well-being.

I briefly want to mention Army redundancy. This is not the debate or the day for any sort of partisan exchange, but the personnel who are leaving the military in the years and months to come will need a great deal of support. Will the Minister say what the Government plan to do to provide the assistance that they need?

Armed Forces day is an important national event because it allows us to show our respect not only to those who have served, but to those who are currently serving. We can highlight a lot of initiatives and good practice around the country that help us do that. In my area, we have ensured that our war memorials are memorials not only to the first and second world wars, but to the people who have lost their lives since those conflicts. That move has been very well received by their families.

Sometimes, things like Armed Forces day are criticised for being part of some sort of creeping militarisation of society. I reject that entirely. The public want an opportunity to show their respect. In my area, they will have that opportunity and it will be well received, although I cannot say that it will be quite on the scale of the “Star Wars”-themed celebrations that my hon. Friend the Member for Stockton North described. People appreciate such opportunities. The show of support for such events in recent years is extremely good and it is welcome that people have such chances.

Given that we have the Minister’s attention, I would like to raise one constituency campaign with him. He is aware of it, because I have sent quite a bit of casework to him recently on how we can assist veterans who have lost medals that have been stolen or misplaced. A Ministry of Defence programme allows that to happen, and a certain amount of evidence obviously needs to be provided, but for some, the level of bureaucracy required is a little too much. Could more effort be made to give veterans a chance to replace their medals, particularly those that have been stolen? It would be extremely well received.

It is a pleasure to speak in Parliament in an event such as this. It is important that a message goes out from Parliament that we are very big supporters of

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things such as Armed Forces day, that work goes on across all parties to support our armed forces and that we, as parliamentarians, are always available for the armed forces to have dialogue not only with Government, but with Parliament. We have been able to do that through, for example, the all-party group on the armed forces. People should be aware that such work is ongoing and that many of us are very big supporters of the armed forces now and in the years to come, whatever the situation in terms of future conflicts, structures and presentation.

10.16 am

Gemma Doyle (West Dunbartonshire) (Lab/Co-op): I am delighted that we are serving under your chairmanship today, Mr Gray. I congratulate my hon. Friend the Member for Stockton North (Alex Cunningham) on securing the debate to mark Armed Forces day, which is taking place later this month, and all the Members who have spoken.

Armed Forces day gives us the opportunity to pause and reflect on the bravery and sacrifices our forces make, doing what is asked of them without question or hesitation, and so often placing their lives on the line to protect others. This year on Armed Forces day, we will once again think about those who continue to serve in Afghanistan of course, but also in other theatres around the world. The bravery and professionalism of our forces, past and present, should be recognised.

I agree that medals should be earned, not expected, and I welcome the medals review. Decisions on awarding medals should remain free of party politics. I believe that the Conservative party has had its fingers a little burnt recently over that issue. The process needs to be open and transparent, and those who make the decisions should be accountable in some way.

As an Opposition defence spokesperson, I am fortunate to meet and visit service personnel around the UK. In the past year, however, I have also visited them in the Falklands, where they are very far from home, but make use of the excellent facilities there and ensure the security of the Falklands along with the South Sandwich Islands and South Georgia. Last month I visited Bosnia, where our intervention in the ’90s helped to end the horrific atrocities that were taking place. A few days after returning from that visit, I attended the yearly service for Dunkirk veterans at Jamestown parish church in my constituency, with an excellent sermon, as usual, from the Rev. Norma Moore.

Thinking about Dunkirk and our actions in Bosnia made me reflect on the huge variety of tasks and operations that we ask our soldiers, seamen and airmen and women to undertake, sometimes in the glare of the media spotlight, sometimes away from the cameras, but always with the utmost professionalism and dedication. We are lucky that we still have veterans with us who were at Dunkirk. They remind us of the true value of freedom and why standing up for it at home and around the world is so important.

We should also remember that our veterans’ community in 2012 is varied. It includes you, Mr Gray, and the Minister, as well as the men and women who served in world war two, the Falklands, Bosnia, Libya this year and of course Iraq and Afghanistan, to name only some theatres. I pay tribute to my hon. Friend the

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Member for Bridgend (Mrs Moon) for all her work, particularly the “Standing Next to You” exhibition, which helps us understand the veterans’ community better. Indeed, it is one of the reasons why, when I entered Parliament, I was keen to be involved in defence issues: my generation is part of the new generation of men and women who have seen battle, witnessed harrowing sights and undertaken operations with a courage most of us cannot imagine. Some of them have survived appalling injuries, and live with the consequences every day, and some of course did not survive, and their families and loved ones miss them every day.

The medical and rehabilitation care that the injured receive in the UK is second to none, but in the years to come many will require continuing support in the form of equipment and treatment. The Government have made welcome progress in the provision of prosthetics, but they should consider what guarantees should be provided for those with other long-term, life-changing injuries. As hon. Members have said, we must especially remember on Armed Forces day those who made the ultimate sacrifice for their country—from those long fallen, to those men and women whose names, unfortunately, we still hear in news bulletins. Their sacrifice will never be forgotten.

In the past year, we have reached an agreement in the House to recognise in law the principles of the armed forces covenant, securing a new bond between the Government and the forces. The last service personnel Command Paper paved the way in introducing many of the changes that are now considered integral to the covenant, from better access to health care to greater levels of compensation for injured personnel under the compensation scheme. It marked a sea change in the way our forces were treated, across Government. We now need the Government to show us where the next steps lie. I have asked the Minister previously what is happening in government and the public sector to conform to the principles of the covenant. I am yet to be reassured that sufficient action has been taken. I do not doubt the Minister’s commitment to making the change a reality, but the covenant will be worthless unless it is backed up by action. We need a wee bit more of that action.

Disappointingly, even now, when public awareness of the forces’ work is higher than ever, the recent report by Lord Ashcroft, “The Armed Forces and Society”, which some hon. Members have mentioned, reported that about one in five members of the forces have been refused service in a bar or hotel while wearing their uniform. That is unacceptable deliberate discrimination. The service community can face other discrimination, as my hon. Friend the Member for Stalybridge and Hyde (Jonathan Reynolds) mentioned, creating difficulties in matters that we take for granted: getting credit, mortgages or even a mobile phone contract, because they have moved around so often. We should not just accept that as inevitable. The principles of the armed forces covenant should apply throughout society. When those principles are routinely or blatantly breached it may be necessary to consider introducing measures to deal with it. Routine disadvantage or discrimination should never come hand in hand with serving one’s country. Our forces should not have to expect or put up with routine deliberate or indirect discrimination, whether that is in access to hotels, pubs, housing, health care, mortgages or mobile phones.

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Lord Ashcroft’s survey highlighted the fact that about the same proportion—almost one in five—of the armed forces had been verbally abused while wearing their uniform. My right hon. Friend the Member for East Renfrewshire (Mr Murphy) last week outlined how we think that matter could be dealt with. There are already legal protections in place for other groups in society, and we believe we should consider whether they should be extended to our forces. The Minister said at Defence questions last week that he is always willing to discuss issues on a cross-party basis. May I press him to say whether he is willing to enter into cross-party talks on this matter? We would like to work with him on the issue.

More than 4,000 members of the forces were given their marching orders last week. Yes, many of them volunteered, but some of those who did so were worried that they simply did not have a future in the services. I asked the Minister last week—I hope he may have an answer today—how many vacancies for posts comparable to those being lost are being advertised in the three services.

Jim Shannon (Strangford) (DUP): Is the hon. Lady aware of the pensions issues affecting service personnel who have been given their marching orders before their time—that some of them, if they were to continue in employment for another month, or perhaps three months, would qualify for a full pension? Does she feel, as many do, that that should be honoured?

Gemma Doyle: I am indeed concerned about that issue, and will ask the Minister to respond to that point.

The Government need to be honest with MPs and the forces about the impact of the cuts on the UK’s capability. As the hon. Member for Strangford (Jim Shannon) points out, it has been reported this week that soldiers were sacked days before they would have become entitled to a full pension. Will the Minister look into that issue, to ensure that people have not missed out in that way? Will he comment on reports today that the Government are considering increasing by five years the age at which forces personnel can receive a full pension?

The Government intend to rely much more heavily on reservists in future, and the Minister will, I hope, recall that when the Armed Forces Act 2011 was in Committee I drew to his attention concerns about the fact that Reserve Forces (Safeguard of Employment) Act 1985 was listed on the Government’s Red Tape Challenge website as under consideration for scrapping. The Act gives reservists employment protection. It protects against unfair dismissal by making it an offence to sack someone because they are likely to be mobilised, and gives a right to reinstatement to their job. In Committee, the Minister said that he believed the Act had been superseded by the Reserve Forces Act 1996, but that Act makes it clear that the 1985 Act is still necessary. Will the Minister clarify the Government’s position, given that the 1985 Act is still listed on the Red Tape Challenge website? Will the Government ask more of reservists, while scrapping their employment protection? That issue should be re-examined.

Redundancy is not a concern only for servicemen and women, of course. It is a big worry for forces families, because when people lose a job in the forces it is not

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only the loss of an income that must be dealt with—it can also be the loss of a home and a way of life. Forces families put up with an awful lot, and we do not do enough for them. We need to do more on many issues, not least improving the air bridge when serving family members are deploying or coming home, spouses’ employment, and housing.

Housing remains one the issues—if not the issue—that causes most concern among service families. The recently published Army Families Federation annual report of inquiries from 2011 bears that out. Housing came top of the list. The Minister has brushed that concern aside at the Dispatch Box, but he needs to be honest about the fact that the money that the Chancellor announced for forces housing in the Budget—which is very welcome—still leaves a gap of £41 million, because £141 million had already been cut from the budget. The Minister may want to pull the wool over our eyes, but I think he knows he cannot do that with service families or service charities. I urge him to think carefully before making any changes to the rules on service accommodation. He will know that leaked plans to change the entitlement to married quarters were not well received earlier this year. Perhaps he will tell us whether that is still being considered.

I again congratulate my hon. Friend the Member for Stockton North on obtaining the debate, and thank him. Our forces make immense sacrifices in all aspects of their lives, showing courage in defending our country. They have our gratitude and thanks. They will face challenges in the coming years, but I am sure that, as with everything else that is asked of them, they will put everything to one side and get on with the job in hand. In West Dunbartonshire we shall hold our own celebrations on Sunday and I am sure that the national event in Plymouth will be a great success.

10.29 am

The Parliamentary Under-Secretary of State for Defence (Mr Andrew Robathan): It is a joy to serve under your chairmanship, Mr Gray, particularly since you are, of course, the chairman of the all-party group on the armed forces. I congratulate the hon. Member for Stockton North (Alex Cunningham) on securing this debate to discuss Armed Forces day and on his speech. We have heard from several hon. Members—I shall come on to their individual speeches later—who have shown their support for the armed forces. We must remember that the fortitude of those who served in the past has shaped the armed forces of today.

Armed Forces day is a great opportunity for the nation to show its support for its regular and reserve forces. Importantly, it also allows us to show our appreciation for their families, who are such a vital part of our defence effort. It marks the contribution of former service personnel of all ages—from those who have recently left in their 20s to those who may be in their 90s, or indeed people in their late middle age, such as myself.

Last month, the armed forces mustered to mark the 60th anniversary of Her Majesty’s accession to the throne. Crowds gathered at Windsor and service personnel did themselves and their respective services proud. It felt like a sort of family occasion, and I felt both proud and privileged to be invited. I was slightly worried that the day would fall flat but, in the event, it was a brilliant

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occasion. Marching on sand is always difficult—there was sand in the arena—but the services did extremely well.

I pay particular tribute to the Royal Air Force, which led a brilliant and emotional fly-past. One has to be careful about what one says in the House, but despite the old joke that the Royal Air Force does not normally work at weekends, it was present at this Saturday event—I see a wry smile from a serving officer in the public gallery. I reiterate my appreciation of all three forces, but especially of the RAF, which led this excellent fly-past.

Two weeks ago, the armed forces were at the centre of the ceremonial procession for the service of thanksgiving, and they paid a tribute to Her Majesty on the forecourt of Buckingham palace and in the sky above. This weekend, the Queen’s birthday parade on Horse Guards parade took place—I am glad to say that it was dry. Again, I was privileged to be there, as I suspect were other hon. Members. Indeed, I am sure that the hon. Member for Strangford (Jim Shannon), who is in the Chamber, was there. It was an excellent occasion and my old regiment performed especially well. The crowds in the Mall showed their appreciation to Her Majesty on her diamond jubilee, and to the armed forces that work with her so closely.

We all remember times not so long ago when members of the armed forces were actively discouraged from wearing their uniform in public and lived under constant threat from terrorism. Many of us used to search underneath our cars to establish whether it was safe for us and our families to travel in them. Such a practice was not unique to Northern Ireland; it was standard in all military communities. Thankfully, those days are behind us and, God willing, they will not return.

Public support has never been higher. For example, we have all been touched by the scenes at Royal Wootton Bassett. Who has not shed a tear seeing these brave young men coming back from Afghanistan in coffins? Members of the public have travelled great distances to attend the repatriations, and similar scenes continue today at RAF Brize Norton. Such respect is deeply appreciated by not only the families, but service personnel themselves. I have spoken with many of them in Afghanistan and at home, and they say that these events are of huge importance to them.

Public support is not limited to repatriation ceremonies. Today we see homecoming parades in which returning service personnel parade through local towns and villages. Thousands of members of the public line the streets to applaud their return and take the time to reflect on those who never made the journey back. In addition, military ships, regiments and units will often be granted freedom of the borough, which is also marked by a military procession through the streets of their home town. The unit 3 Rifles exercised such freedom in the constituency of the hon. Member for Stockton North. Last year, I went to Market Harborough to celebrate the freedom of the borough being awarded to the Royal Anglians. Today we have a march into the House of Commons, which people should see because it is a much appreciated ceremony.

Before turning to the matter of Armed Forces day, I would like to make a brief mention of that other notable annual event—the 11th day of the 11th month marking Armistice day. It is heartening to see that this

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event continues to gain in stature and significance as each year passes. The two-minute silence is one of those rare moments when the nation pauses to reflect on those who have made the ultimate sacrifice to allow us the freedoms that we enjoy today.

Derek Twigg (Halton) (Lab): Will the Minister say when the Government will set out their plans for marking the 100th anniversary of the start of the first world war?

Mr Robathan: I am happy to give the hon. Gentleman an answer on that score. We have been working hard on those plans; indeed, I spoke to my French counterpart earlier this month about exactly that. Of course the French are particularly concerned about the great war, as it was fought over their soil, so we are working with them. My hon. Friend the Member for South West Wiltshire (Dr Murrison), as the Prime Minister’s representative, is going around the Commonwealth and the allied nations to see how we should mark the anniversary in two years’ time. There are no surviving service personnel from the first world war, but its memory is deeply etched in our regimental traditions and in the psyche of Britain and other nations. It is important that we commemorate—not celebrate—the first world war with the right level of remembrance, that we understand the awfulness of it and the impact it had on 20th century history, and that we educate the young people of this country to understand what it was about and the effects it had. I assure the hon. Gentleman that we are taking the matter seriously, not least because people such as him will harass us if we do not.

Armed Forces day is a celebration of the unique contribution that committed servicemen and women continue to make to the nation. It has become a valuable occasion in the last few years, although this year marks only the fourth Armed Forces day. The first time such a format was adopted was in 2006, when Veterans day was initiated—I am not sure whether the hon. Member for Halton (Derek Twigg) was responsible for that. The day sought to raise the public profile of veterans and the support available for that diverse community. There was a series of events throughout the country, including one at the Imperial War museum. The following year, an event in Birmingham included a parade of standards, and Blackpool had its turn in 2008. However, it was thought that more could be done, because Veterans day did not seem to reflect the fact that current service personnel were deployed in the most demanding area of conflict. The previous Administration commissioned an inquiry into the national recognition of our armed forces that led to measures to highlight the contribution of all those who serve and have served in the armed forces. One measure was to expand Veterans day to a more inclusive Armed Forces day, and the strap line “Show your support” was printed on flags that were flown on all Government buildings and town halls on 25 June 2009. A national event took place in the Historic Dockyard in Chatham the following day. Members of the reserve forces were invited to wear their uniform to work, as will be the case next week, and former service personnel were encouraged to wear a veterans’ badge. In addition, local communities held their own Armed Forces day events. The Yorkshire Regiment marched through Stockton and received the freedom of the borough.

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In 2010, the celebrations took place on 26 June with the national event being hosted by Cardiff. That built on the success of the previous year, with some 260,000 fans being recorded on a dedicated Facebook page and Armed Forces day getting almost 1,300 followers on Twitter. The fly-the-flag initiative continued to expand and, once again, wearing uniform to work was encouraged. That year more than 170 registered events were held to mark the occasion throughout the country.

In 2011, Armed Forces day was hosted in Edinburgh. There were some 1 million followers on Facebook. I am not a devotee of either Facebook or Twitter—I see the shock on the faces of several hon. Members—but I do vaguely know what they are. As a matter of interest, some 72 celebrity supporters provided messages and videos of support for the Armed Forces day website, which had more than 41,000 visits on the day and more than 142,000 page views.

As we have heard, Plymouth, a city with a rich military history, will be acting as host city on 30 June. Activities are planned up and down the country for schools, cadet forces and veterans’ organisations. Uniform-to-work day is planned for 27 June, which will highlight once again the vital contribution our reservists make to the armed forces. Naturally, the armed forces themselves will be taking part in Plymouth and elsewhere. Once again, this will be an opportunity to celebrate their vital and wide-ranging contribution to our nation.

Armed Forces day allows communities to come together and plan their own events to show their support. Sometimes they are social occasions in a village hall or a community centre, or they can be something involving “Star Wars”—I am not sure what that is exactly. Other Members also look slightly puzzled, but we shall see in a couple of weeks. An occasion does not always have to be formal, with service personnel in uniform, for it to be successful. I know that service personnel welcome the personal tribute as a sign of appreciation. On this day, they want to be shown that they are special because of the work that they do.

Of course, our armed forces are busy on operations in Afghanistan and elsewhere. They will form a notable presence to support a number of diamond jubilee events as part of Her Majesty the Queen’s regional tours. Their support during the Olympic games will be an important defence task this summer, and we are contributing a large number of personnel—mostly regulars, but some reservists—to provide support to the police, and other civil and Olympic authorities.

The hon. Member for Bridgend (Mrs Moon) talked about the reorganisation of the Army but, if she will forgive me, I will not go into the details of that because a decision is yet to be made and it would therefore be inappropriate for me to speculate about what the announcement might contain. I genuinely do not know what it will say about individual units, and I think that we all understand the importance that individual units can have, particularly in local traditions.

The very basis of the armed forces covenant is to remove any disadvantage incurred as a result of service. It acknowledges that the armed forces community is entitled to recognition for the unique contribution it makes on behalf of this country.

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A few things that I shall now discuss were mentioned by Opposition Members. We are working on a defence discount scheme to help to provide special offers and discounts to members of the armed forces when purchasing goods and services, and I will update the House on the scheme shortly. In addition, many businesses provide concessions to servicemen and ex-service personnel. The “tickets for troops” initiative allows service personnel and their families to attend sporting fixtures and film premieres free of charge. The covenant sets out the principle that those who serve or have served in the armed forces, as well as their families, should face no disadvantage compared with other citizens regarding the provision of public and commercial services, and that special consideration is appropriate in some cases, especially for those people who have given the most, such as the injured and the bereaved.

The interim annual report on the armed forces covenant, which was published last year, was written in conjunction with our key partner charities, the families federations, other Departments and the devolved Administrations, all of which are members of the covenant reference group. The report highlighted progress across a range of areas and identified work still to be done. Such work has to evolve, because times and conditions change.

My hon. Friend the Member for Plymouth, Sutton and Devonport (Oliver Colvile) made a good speech in which he raised several issues related to the covenant, particularly schooling. We are determined that when service personnel move around the country or come back from abroad, their family members will not be disadvantaged in schools, and that is specifically written into the covenant. That involves co-operation with teachers and schools, although we do not necessarily want the heavy hand of the state banging down on a primary head teacher who is struggling with a lot of other problems. We are determined that children and families should not be disadvantaged because of service elsewhere.

My hon. Friend also mentioned the pupil premium. The idea of the premium, which we introduced, is to compensate for movement. There are other ways in which we will support the children of service personnel who have been killed in combat, so I am not sure that the pupil premium is the right way forward on that point. There are, for instance, scholarships for the children of those who have been killed in service.

My hon. Friend talked about reservists’ mental health, and I can assure him that we are very concerned about that because if reservists disappear back into the general population, it is more difficult to get hold of them. He also mentioned employment. Not all, but most people who leave the armed forces are very employable, and I would encourage any employer to look favourably on them because I think that they would find that they, not just the person they took on, would gain from that.

Discrimination has been mentioned, and I was delighted to hear Labour Members describing Lord Ashcroft as an exemplar that they wish to follow, because it is fair to say that that has not always been the case over the past few years. For 18 years, I had the privilege of being proud to wear Her Majesty’s uniform. There was discrimination, but one was proud to wear one’s uniform, although, as I have mentioned, one tended not to wear it out of barracks. I recall going to a club called Joe Bananas in the Wan Chai area of Hong Kong—I see one or two Opposition Members with guilty faces; they

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have obviously been there as well—and there was a sign that I think said “No troops”. It was just down the road from the royal naval base, HMS Tamar. I and my two colleagues—all of us company commanders—remonstrated with the very large bouncer on the door about that, and he let us in. Such signs are not that different from others that were put up in windows in the past, which we have now outlawed.

I am glad that attitudes are now rather better—not that I have been to Joe Bananas in the past 25 years—but they are not perfect. The covenant tackles genuine problems that have been raised. I am rather sceptical about whether legislation is needed, but I am happy to talk about it. The sort of discrimination that has often hit the headlines has been, for instance, “Officer training course banned from freshers fair at university”, or “Uniform forbidden in student unions”—or indeed in schools, because some teachers object to it. Perhaps the hon. Member for West Dunbartonshire (Gemma Doyle) will pass on to the right hon. Member for East Renfrewshire (Mr Murphy) that I seem to remember National Union of Students motions about getting troops out of Northern Ireland. Such motions were pretty unfriendly to the armed forces, so I am glad that that attitude has changed—[Interruption.] The right hon. Member for East Renfrewshire was a president of the NUS, as I am sure the hon. Lady remembers. We need to be careful before we create more work for lawyers. We need to consider whether the best way forward is to introduce legislation, or whether we need to work further on attitudes, although they have changed dramatically over the past few years, as we have heard.

Mrs Moon: The right hon. Gentleman referred to the troops out of Northern Ireland campaign—I remember it well—but we have an ongoing problem with differentiation. We had it with Iraq. Many people were unhappy about the involvement of our armed forces there, just as there were people who were unhappy with our forces being in Northern Ireland, but it was not the armed forces they objected to, but our political decisions. We must be careful to differentiate between the political decisions that lead the armed forces to carry through our wishes, and the armed forces themselves. These are attacks not on the forces but on the political decisions, and I hope that the right hon. Gentleman does not object to my making that differentiation.

Mr Robathan: The hon. Lady is absolutely right. That is the right differentiation, and it is particularly true for Afghanistan. Polls show that a large proportion of the population perhaps opposes our involvement in Afghanistan, yet at the same time supports our troops there. That is an important distinction. There has been a change in attitude because, if we go back 30 years, that was not the case in Northern Ireland. Our troops there took a lot of individual abuse—I know that to be the case. The hon. Lady is right to raise this important distinction, and I applaud that. It is not our soldiers’ fault that they are in Afghanistan; it is because they are following the will of the Government and of Parliament.

It is important to recognise that we as a Government cannot do everything. The hon. Member for Stockton North talked about the community covenant. The covenant was launched by my right hon. Friend the Prime Minister last year in Oxfordshire and is hugely popular. There

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are now some 50 community covenants, with another 50 pending, and I will be at Westminster council next week to witness the signing of the covenant there. Covenants are voluntary statements of mutual support between a civilian community and the local armed forces community, in the form of a written pledge. Usually, such local partnerships are made between the armed forces in an area and the local authority, being joined by local businesses, organisations, charities and other public bodies. I understand that the lord mayor of Plymouth will, on behalf of the city council, sign the area’s community covenant during the national event.

To turn to redundancy and pensions, may I say that making members of the armed forces redundant is not anything that we as a Government or I as an individual would wish to do? The redundancy terms are actually quite good. The hon. Member for Strangford mentioned the 18-year period. Soldiers normally have to serve for 22 years before they qualify for an immediate pension, but the redundancy scheme has reduced that by four years so that after 18 years of service, those selected for redundancy can qualify for an immediate pension. That will enable many individuals to receive an immediate income for which they would otherwise not have qualified. I am afraid that there always has to be a cut-off date. We have shifted it by four years, as I understand it, but unfortunately there has to be a cut-off date at some time.

Jim Shannon: Through the armed forces parliamentary scheme, I had the opportunity in the past few weeks to visit Cyprus, where I met some soldiers who are facing redundancy and, as a result, losing out on their pension. I am really asking the Minister whether there can be a bit of flexibility in the system to enable people to stay on for another six months so that they can qualify for the full pension.

Mr Robathan: The problem, as I have said, is that there always has to be a cut-off. We have shifted the date by four years—that was done by the services—which is a sensible allowance. Otherwise, we would have to allow everybody to serve up to the qualifying period. Redundancy is not something we wish to do. We are faced with a very difficult situation—I will not make any partisan points—and we cannot afford the level of defence spending that we had. Regrettably, we therefore have had to instigate redundancies, but I should say that the redundancy terms are pretty good. More than two thirds of those in the armed forces who are being made redundant are doing so voluntarily because they can see that such good terms will allow them to pursue another career. Everybody has to pursue another career in the long term, even me—I had to come into Parliament because I needed a job. Everybody has to leave the armed forces at some stage.

The hon. Member for West Dunbartonshire asked about other vacancies in the armed forces. I would be grateful if she would table a parliamentary question about that so that I can give a specific answer with the assistance of my excellent civil servants. I will need to write to her about the issue she raised about the guarantee of employment that we give to reservists. I promise her that it is not our intention to disadvantage reservists in any way; if that is the case, we will make sure that we do not do it.

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May I say how much I appreciated—I do not often say this—the point made by the hon. Member for Stalybridge and Hyde (Jonathan Reynolds) about valued national institutions? This is one I think a great many people believe in. I would still recommend a career in the armed forces to anybody. My son, who is 15, surprised me recently by saying that he wanted to join the Army—his mother said, “Over my dead body,” but we shall see. This is something that we should encourage.

Mrs Moon: Youngsters in cadet forces in my constituency who were planning careers in the armed forces have raised with me the uncertainty that they feel. They particularly feel uncertainty in relation to the RAF, in which I take a particular interest. A number of youngsters were days away from completing their training when they were made redundant. We have to ensure that this round of redundancies, particularly those involving youngsters who have lost early commissions, does not leave young people who are about to enter the armed forces with the feeling that they might not be able to have a lasting career and complete the service that they so wish to offer their country.

Mr Robathan: The hon. Lady speaks with passion. Each individual case can be a matter of great pain for the individual concerned, so I entirely take her view. The problem is that if we are reducing the armed forces—frankly, that is not what we want to do, but we are compelled and constrained so to do—there will be fewer opportunities, so some people, I regret to say, will have to be made redundant or will not be given the job that they would wish to do.

Nevertheless, I still maintain that joining the armed forces is an excellent career and I wish everybody the best opportunity. It is true that a lot of people who wish to get into the armed forces now cannot do so, whereas

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not so long ago, when the economic situation was more buoyant, we were frankly a bit short of recruits. In many ways, although it is unfortunate for those who cannot get in, we are in a fortunate position in that we can pick and choose more than before. As I said earlier, it is important that people can learn valuable things, such as attitudes, values and skills.

The hon. Member for Stalybridge and Hyde mentioned replacement medals. If he would like to grab me, I will be happy to talk that through with him. He raises an issue, but it is one with two sides, as most issues are.

Our armed forces want and deserve to be valued. Not everybody in the armed forces is perfect, but they do an excellent job on our behalf. They do not want to be patronised. Most of them are high-quality individuals who can make their way in life, and they do not want to be talked down to; they want to be given opportunities, not to be discriminated against, and to carry on their lives in the best possible way. They deserve our support and recognition because of their outstanding contribution to this country. They make personal sacrifices to defend the United Kingdom and its interests, and they contribute to international peace and security.

A wide range of support and advice is already available from the Government, ex-service organisation charities and the voluntary sector. We are unwavering in our commitment to ensure that our armed forces and their families are not disadvantaged by service, and we will continue to raise awareness of the role of the armed forces in society. I urge all hon. Members and all members of society to show their support on Armed Forces day and to make it the success that service personnel, their families and ex-service personnel so richly deserve.

Mr James Gray (in the Chair): I thank hon. Members for an excellent debate, and may I remind everybody that at 3.30 pm we will have the opportunity of welcoming 20th Armoured Brigade through the gates of Parliament?

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Cancer Treatments

10.58 am

John Pugh (Southport) (LD): I thank all the people, from a variety of organisations, who made submissions before this debate in the hope that I could do justice to their thoughts and considerations. I may not succeed in doing so adequately, for which I apologise in advance, but other people in the Chamber, who are far better informed than me, can supplement any good, important or salient points that I fail to make.

It is a fact of the human condition that we are cell-replicating machines. I believe it is true—I am not totally certain, but I believe it is a truth—that none of the cells that were elected to this place in 2001 under the name of John Pugh are now here. They have all gradually been replaced, and some of them may actually be replaced during the course of the morning. That process goes on and on, and it is a very sophisticated one. When someone looks into the details of cellular biology, they are amazed that it occurs correctly as many times as it does. However, the longer we live, the more likely it is to go wrong, and when it goes wrong, we get the disease we know as cancer. It is a sad truth that the more we are saved from other diseases by progress in medical science, the more exposed we are to cancer.

Current stats show that, due to human longevity and the like, one in four of us are likely to die directly of cancer or a cancer-related condition. That will apply no matter what our success in investigating the environmental triggers for or the lifestyle causes of cancer.

We can all point to progress along those lines. We are no longer vulnerable to all the industrial causes of cancer, such as asbestos, and we took a momentous step forward in this place a few years ago when we backed the smoking ban, which remains the most useful thing I have done in Parliament, because it will undoubtedly reduce one of the major triggers for cancer. We now have to address other issues linked to cancer, such as obesity.

The disease is aggressive in youth and progresses slower with age, but, frankly, the longer we live, the more vulnerable we are to it. It is also true that many people will die with, but not of cancer. The challenge to any health system confronted with that crude biological fact is straightforward, and it is the same for any health system anywhere on the planet. I have divided the challenge under four headings. First, any health system needs to try to comprehend better the causes of cancer and initiate research. Secondly, any health system needs to try to prevent cancer and forfend its incidence. Thirdly, any health system—this is, of course, paramount—needs to cure people of cancer, where possible. Finally, any health and social system in any civilized society must help people living with cancer. Those four challenges are precisely the same for any health system anywhere, no matter how they are configured or delivered.

We have made substantial strides in the UK and our record should not be demeaned or lessened. During the passage through Parliament of the contentious Health and Social Care Bill, cancer stats were referred to and international comparisons were used to justify some of the changes. The oncology community had some misgivings about that, because its members felt that their real and substantive achievements were overlooked and that, for political purposes, people dwelled on what they had not achieved rather than on what they had.

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The debate pack includes a good account of research by the King’s Fund and others on success in dealing with cancer. On European and international comparisons, an article in the pack states:

“While cancer deaths fell everywhere, England and Wales saw the biggest drop in mortality among males aged 15-74”—

that is, most males. The article continues:

“While mortality among women the same age declined by less, at 19%, that was the third biggest improvement”

in any civilised developed country in the world. We can, therefore, bank appreciable benefits and progress.

The difference between good and not-so-good policy is determined by the efficiency and effectiveness with which we approach the four fundamental tasks of comprehending the causes of cancer, curing people of cancer, trying to prevent cancer and trying to help people living with cancer, and by how intelligently we prioritise those tasks. An enormous amount of resources could be provided to address the problems presented by cancer, but such resources are not unlimited and we have to consider how we prioritise in every one of the four tasks. That applies to research, where people are continually examining how to prioritise the appreciable sums of money at their disposal in the most effective way. There are many debates about how we are to prioritise prevention and public health. Moreover, on prioritising treatment, recent discussions have centred on whether treatment for the elderly should be rationed or limited, because they may live longer with cancer but not actually die of it. There is also considerable debate, spearheaded by the likes of Macmillan Cancer Support, about the welfare provision for cancer patients.

I would like to turn briefly to public health, although it is not my main bone of contention. There has been a debate about how accurately we pitch our public health campaigns. Some have been excellent, particularly that on screening for bowel cancer, which I think has had an immediate and dramatic beneficial effect. My former colleague John Barrett is the former MP for Edinburgh West—he was elected in 2001—and he was diagnosed with bowel cancer through the screening programme shortly after leaving Parliament. He had absolutely no symptoms, but it is believed that it was caught in time. In fact, he was in Parliament recently and looked in pretty good shape to me. However, had the cancer not been detected—remember that he had no symptoms—it would have progressed as the years went by.

Glyn Davies (Montgomeryshire) (Con): I thank the hon. Gentleman for giving way and allowing me to associate myself with the point that he is making. I am one of those whose cancer was found early, and I received treatment and survived. A younger friend of mine was diagnosed at the very same time, but his cancer was more advanced and he died aged 31. This is about catching it early and I want to emphasise the importance of screening, which saves a huge amount of lives. I have played a big part in driving forward the screening programme in Wales. Screening for bowel cancer is one of the best ways possible to save people’s lives.

John Pugh: I am sure that the hon. Gentleman is right and that he is also aware that there have been debates about screening for cervical cancer, breast cancer and so on, and about the age at which that should be done and

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the effect it would have. Although it is possible to screen everybody all of the time, that is not the most rational way to use resources, so any screening programme needs to be judged in the light of its subsequent evidence, which is very strong indeed for the bowel screening programme.

I was slightly, not amused, but distracted by the recent Department of Health advertisements—there were big adverts on buses—stating that anyone who has been coughing for three weeks should definitely go to see their doctor, because they might have lung cancer. When the advertising programme was launched, a horrible virus had gripped my office, the most lingering symptom of which was a cough that lasted for three to five weeks. Had we all trooped to our doctors’ surgeries saying that we might have cancer, a good deal of national health service time would have been wasted. Any campaign needs to be sophisticated and reviewed in the light of evidence. The one thing that we do not want a public health campaign to do is provoke alarm, because that would distract doctors from the things that we genuinely want them to address. People are not slow to be alarmed by any suspicion of cancer, which, I believe, after pornography and some other subjects, is one of the most researched topics on the internet. It is frequently referred to on various medical sites as a suspicion, rather than a diagnosis.

The academic community also has to prioritise. A lot of people leave substantial amounts of money for cancer research and it needs to be used as effectively as possible, as do welfare payments to cancer patients. Those issues need to be prioritised—Members may care to discuss that in the context of the Government’s ambitions for the outcomes framework.

I want to concentrate on the connection between treatment and health policy. The clinical armoury and tools available to medical science are pretty well known and can be put under four headings: chemotherapy, radiotherapy—possibly supplemented by more sophisticated treatments, such as proton beam therapy—drugs and surgery. A cocktail of those methods is used to treat cancer. All, in their place, can be extraordinarily useful and effective interventions, but the key thing that determines whether they have the maximum effect on and benefit for patients is whether they are used with skill—the right skill at the right time in the right place, and probably in the hands of the right doctor or consultant.

I learned relatively recently that, although we talk broadly about categories of cancer, there are sub-categories within those categories, and not every sub-category is responsive to the same treatment. Knowing which treatment is best tailored to which patient is a genuine art, because patients and their histories are all very different, as are the remedies that work with them.

Improved outcomes are to some extent determined not simply by having the tools but using them with better and greater skill. It is the skill or its absence that explains differential outcomes. There are differential outcomes across the UK. The chance of recovering from certain cancers in some areas is greater or less than in others. The chances of acquiring certain cancers appear to be greater in some areas than others. Genuine skill—knowing what to use on what person at what time—is in extraordinarily short supply. That sort of

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skill, the really effective intervention, is often allied with establishments that not just treat cancer, but research into cancer. Great skill is often, not unsurprisingly, aligned with a greater understanding of what is being dealt with. Treatment of cancer is not usually a journeyman matter or one of bog-standard clinical intervention and practice. That is why organisations such as the Christie hospital have such a well-established reputation.

I know the Government have put extra money into the drugs fund. Using the right drug in the right place at the right time is a fairly refined process. People can be given drugs that work with a cancer in general, but not for that particular patient or not at that stage in the disease, by organisations relatively unaware of the futility of the intervention. Therefore, we have all understandably come to the conclusion that we need clinical networks. We need to have people dealt with in the appropriate centres of excellence. There is a genuine readiness by patients to travel as far as they need to get the treatment. Most people in my constituency who contract any form of cancer travel across Liverpool, normally to Clatterbridge on the Wirral, generally without too much complaint, to get the treatment they want. The same group of constituents has been extremely angry and provoked by the need to travel 11 miles down the road for A and E assessment and triage.

Mr John Leech (Manchester, Withington) (LD): My hon. Friend may not be aware that the Christie hospital has opened satellite centres in Oldham and Salford, so that patients do not necessarily have to go all the way to Christie, as they would have had to in the past. They still get Christie service, but in their local community in Salford or Oldham.

John Pugh: I think that is becoming the common pattern and could create some problems, given the way we intend to structure the NHS. However, it is a wholly desirable pattern. Clatterbridge is looking at a similar arrangement across Liverpool in collaboration with the Royal Liverpool University hospital. There is a sensible willingness on the part of the ordinary district general hospital to refer patients into an area where the maximum competence exists and where it is a matter of life and death. That is a totally laudable example of integrated service.

We can all accept there is a need to have an adequate clinical network, particularly for the more common cancers—lung, colorectal, prostate and breast cancer—in pretty well every area. That is a template that either is rolled out across the land or we wish to see rolled out around centres of excellence. We must always bear it in mind that, with cancer, a certain number of standard procedures can be done locally, without the full expertise of the top consultant.

There are certain cancers where that is not the case, for which we need national centres of excellence. To return briefly to the Liverpool Cancer Research UK Centre, that deals with pancreatic cancer almost as a speciality, with people there researching it very intensively. Its view is that there are probably about only two cases in the UK—and there may only ever be, given the relative distribution of that disease—where whatever treatment the patient gets can make a difference to outcomes, because the cancer is almost invariably fatal. It is necessary to vary the mix depending on the cancer

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in question. However, for the most common cancers, having a centre of excellence, having hubs around which standard procedures can take place and having a clinical network that works, is the way to go.

That sort of network does not happen by accident. Other hon. Members, apart from me, have asked how under the new regime it will be maintained and sustained. The construction of such networks in the past was the function, duty, mandate and overview of the strategic health authorities and they, of course, are to go. I saw in the notes that they would still be dealt with under the strategic health authority bundle within the NHS Commissioning Board. Clearly, “strategy” is the word to be used here. The hon. Member for Leicester West (Liz Kendall) was fond of saying that during the passage of the Health and Social Care Bill. The key point is that the strategy and the template are clear; the question is how to get them in place, sustained and maintained over time under the new regime. I would like the Minister to reassure me on that point.

It is not obvious how such a desirable template would emerge through simple market forces, or through bottom-up agreements by local commissioners. Even if those things could happen, it is not obvious that that would represent the most secure or quickest way to bring about the outcome. That is especially so when one acknowledges that the best treatment often occurs in environments where there is not only integration between providers, but research is taking place. I repeat the point that there is a need to deliver various levels of intervention and care in various settings. That will not happen by accident, or without some institutional resistance. One proposal in Liverpool is to move some of the activities currently conducted in Clatterbridge to the Royal hospital and get very substantial funding for that. That proposition, though supported by the bulk of people, is not supported by all. A certain amount of controversy may still arise about the level of care that could be delivered or result from such changes, which are not effortlessly brought about.

I guess that I am trying to say that ironing out the inequalities in cancer outcomes, ensuring there is the same provision and that each network is as good as any in every area, is possibly susceptible to a more dirigiste approach or Stalinist-like solution. I understand that the chief executive of the NHS was once a member of the Communist party—I hope I am not maligning him. That approach has its attractions. If the NHS Commissioning Board, which shelters the skeletal remains of the strategic health authorities, could play a dirigiste role, acting like the Politburo to impose the right template in every place, one could see how facilities could be aligned and personnel put in the right place. There would also be an opportunity to use central funding to effect. The Government have set up some central funding both for drugs and other purposes.

I have no issue with that way of doing things, provided it is rendered accountable. However, under the new dispensation, I can see problems in going down that particular road. Some of the provision we would want in place, for example, proton beam therapy, will require substantial capital investment. Under the new regime, if I understood what the Minister said during Health questions, substantial capital investment is primarily the responsibility of providers. So we have to hope that, in all places across the UK, all providers dealing with

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the common cancers feel obliged to make the same level of investment. I am not sure that there is an easy way to ensure that that happens. Clearly, the NHS Commissioning Board can commission clinical networks, just as it can commission any other piece of health provision. However, providing a substantial capital grant to a provider might create problems, particularly if it is contested by other providers. Providers may be reluctant to provide the kind of intensive capital resource that might be required when they have budgets to meet and control.

Last Tuesday, an hon. Member talked nostalgically about the days when we used to have fundraising for all kinds of scanners in hospitals. That does not seem to have taken place in the past decade or so because the money has been flowing a little more plentifully. However, we could be back in that territory if providers have difficulties in acquiring appropriate capital investment, or do not see a business case for doing so, without subsidy, by themselves.

I imagine that there are concerns about patterns of referrals within clinical networks, which, again, will test the new system. For example, dermatology providers that are unable to cope with cancer and oncology outcomes—there are such dermatology providers; I think they are now called Virgin Medical—will, under any willing provider, be one of the first ports of call for referrals, especially if they have partners in GP practices who are inclined to use them. At the same time, that may not be the right thing to do clinically, given its complexity. As incidences of melanoma have increased, it may be far better to refer people not to a dermatology provider that cannot do oncology, but to a dermatology provider that can—essentially, the existing hospital base. I can see that being a good thing clinically, but something that is contested in practice if it becomes a settled pattern.

I think we all know where we want to get to. I know that many other things need to be said and I hope other hon. Members will say them. My question is, given that there is a whole raft of agreements and evidence about the objectives and the point at which we want to end, how, under existing or future arrangements, will we ensure that the best outcome is delivered? In other words, how do we get the right clinical configuration to achieve the right clinical outcomes?

11.23 am

Mr Virendra Sharma (Ealing, Southall) (Lab): It is a pleasure to serve under your chairmanship, Mr Gray, and to contribute to this important debate. I congratulate the hon. Member for Southport (John Pugh) on securing it.

Macmillan Cancer Support estimates that 2 million people in the UK today have had a cancer diagnosis—the number is expected to continue to rise by 3% a year—and that nearly 4 million people will be living with cancer by 2030. Currently, 8,000 people are living with, or beyond, cancer in my constituency alone. Those figures show clearly that the NHS has a demographic challenge on its hands. It will need to become ever more efficient in treating and supporting cancer patients if it is to continue to meet clinical and non-clinical needs and deliver improved outcomes.

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Surprisingly, the findings of the international cancer benchmarking project 2010 revealed that survival rates of cancer patients in England continue to lag behind countries such as Denmark, Sweden, Australia, Canada and others. Decisive steps are needed to ensure that England matches the European average and to prevent the country letting down people affected by cancer. The Government have acknowledged that, despite some improvements, cancer outcomes in England remain poor when compared with the best outcomes in Europe, highlighting a significant gap that remains in both survival and mortality rates. In response, the Government put together a cancer strategy that set out a commitment to improve the outcomes and experiences of cancer patients and an ambition to save 5,000 additional lives a year by 2014-15.

I wish to focus first on how we plan to measure how well the NHS has responded to that cancer challenge and whether providers and commissioners are sufficiently incentivised to meet the Government’s ambition. The updated NHS outcomes framework for 2012-13 includes two cancer-specific measures to drive improvements in the earlier diagnosis and more effective treatment of cancer: for one and five-year cancer survival rates for breast, lung and colorectal cancer; and for the under-75 mortality rate from cancer. Although that is a welcome first step on the road to meeting the cancer challenge, I understand from charities such as Macmillan that those indicators are currently too limited, as they measure survival rates for the three most common cancers only. The NHS should be encouraged to improve earlier diagnosis of rarer cancers, which account for almost 50% of all new cancer diagnoses.

I have learnt recently that the commissioning outcomes framework for 2013-14, which will be used to measure improvements in cancer services and outcomes locally, might not even include one and five-year survival rates for breast, lung and colorectal cancer. That unhelpful disparity could result in clinical commissioning groups not placing enough emphasis on the early cancer diagnosis and, ultimately, undermine the ambition of saving 5,000 extra lives a year by 2015. At present, the cancer-specific indicators are too limited to truly measure how well the NHS is responding to the cancer challenge. I should be grateful if the Minister updated hon. Members on the plans to extend one and five-year cancer survival rates to cover more cancers and to include those indicators in both the NHS and commissioning outcomes frameworks.

The cancer strategy also provided that early diagnosis would continue to be a top priority and

“will be included in the mandate for the NHS Commissioning Board for the future”.

Ahead of the Department of Health consultation on the mandate, will the Minister provide assurances that the mandate will include an objective to improve early diagnosis for all types of cancer, as a way of improving outcomes?

Alongside improving early diagnosis and outcomes, the Government have placed a welcome emphasis on improving the experiences of cancer patients. I, too, congratulate the Government on agreeing to run the national cancer patient experience survey again in 2012-13. The national cancer patient experience survey 2010 revealed that

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“white cancer patients report a more positive experience of care than other ethnic groups—particular differences were noted on questions around receiving understandable answers, being given enough care after discharge and staff working well together.”

Similarly, people with a disability or mental health conditions, people from the lesbian, gay, bisexual and transgender community and people with rarer cancers also reported a less positive experience.

In Ealing Hospital NHS Trust, only 48% of patients responded that they got understandable answers to questions all or most of the time and only 51% responded that patients had confidence and trust in all ward nurses. The Department of Health has stated that

“commissioners will wish to encourage providers to take note of the differences and to consider positive action to address the distinct need of people from different groups.”

I believe that the Government’s approach to improving patient experience could be even more proactive. The national cancer patient experience survey should be developed as an indicator and included in the NHS outcomes framework. That is the only way that commissioners, providers and the NHS Commissioning Board will have a clear incentive to address areas identified for improvement. Will the Minister explain whether there are plans to correlate the cancer patients experience survey with the NHS outcomes framework to improve outcomes?

Now that the Health and Social Care Act 2012 has been passed, the Government have an opportunity to refocus on effective implementation of their reforms and, more specifically, on delivering their commitments to improving cancer outcomes. It is my view that every cancer patient—regardless of who they are, where they live or what cancer they have—has the right to high- quality care, support and treatment. I ask the Minister to consider the contributions that he hears today to make sure that England’s health and social care system is not just meeting the European average for cancer outcomes, but taking the lead.

11.32 am

Mr John Baron (Basildon and Billericay) (Con): I congratulate my hon. Friend the Member for Southport (John Pugh) on securing this important debate. The all-party group on cancer, of which I am chairman, has consistently called for us to see the NHS reforms as an opportunity to improve outcomes for cancer patients, and I welcome the chance to highlight that once again.

Perhaps I should start by briefly taking us back to 2009, when the all-party group produced its report on reducing health inequalities. After a long evidence session, with oral as well as written submissions, we discovered that those patients in this country who reached the one-year point stood as much chance of reaching the five-year point as patients in any other country in Europe, but we fell down badly in getting patients to the one-year point. That tended to suggest that the NHS is as good as anybody else at treating patients—once detected—but poor at detecting cancers in the early stages in particular. Other hon. Members have made that point in this debate.

How do we encourage earlier diagnosis? There are few magic keys to solutions in life, but perhaps earlier cancer diagnosis is one of them. The 2009 report concluded that the best way of doing that was to focus on

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outcomes—to get the NHS actually to look at one and five-year survival rates, because late diagnosis makes for poor outcomes. Getting the local and national NHS to focus on one and five-year rates would encourage the local NHS in particular to drive forward initiatives and earlier diagnosis. We were grateful when the Government accepted the logic of that argument and included one and five-year outcome measures in the NHS outcomes framework. The NHS reforms essentially boiled down to two strands—two initiatives. One was the change in the commissioning structure; the second was the focus on outcomes. For me and for many in the all-party group, the focus on outcomes was by far the most important bit of the NHS reforms.

We welcome the Government’s response so far. The all-party group was pleased that, at the beginning of 2011, the Government released their strategy for cancer, which clearly highlighted the importance that they attached to the issue. They came up with a figure—an ambition—to save an extra 5,000 lives a year from cancer by 2014-15. We should remember that that would take us up to only the European average, not the best in Europe, but it is still a laudable ambition that we very much welcome.

We have had a constructive dialogue with the Government, experts and patients. I want to touch briefly—I am conscious that other hon. Members wish to speak—on some of the key recommendations from the all-party group that flowed from the 2009 report. We welcome the Government’s response to that report. Many others have made the same argument, but we played a small part in moving the Government in the right direction.

However, we are still ambitious with regard to some of our recommendations. For me, the first is key. There seems to be an anomaly in the different outcomes frameworks. We have the commissioning outcomes framework, which has the five-year survival rate as an outcome measure. We have the NHS outcomes framework, which has the one and five-year measures. The COF is the framework by which the clinical commissioning groups will be held to account for their performance, and we are arguing for the one-year measure to be included in the COF, just as the one and five-year measure is included in the national outcomes framework. In other words, we want standardisation.

Our concern is that if we have different outcomes frameworks focusing on slightly different things, or certainly not the same things, a disjointed message can be given. It is important that both the local and the national NHS focus on the same things. I raised that question—the Minister will forgive me for raising it in this debate—in Health questions last week. I was slightly worried about the response. The Minister will correct me if I am wrong, but he cited concerns with the quality of the data available for the one-year measure within the COF. If the one-year data are good enough for the NHS outcomes framework, why are they not good enough for the COF, particularly given that the NHS Commissioning Board will shortly provide geographic boundary data for the clinical commissioning groups? It should not be beyond the wit of man to transfer what we have in the NHS outcomes framework across to the COF once those data from the NHS Commissioning Board are available. I am led to believe that there should be no problem at all with how the data are cut. What does the Minister have to say about that?

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To pick up the point made earlier by the hon. Member for Ealing, Southall (Mr Sharma), I also want to question the Minister about why we are not expanding the number of cancers in the outcomes framework. I have a little more sympathy with the Minister on the quality of the data on this one. Whereas I cannot understand why the one-year figures, which are in the NHS outcomes framework, are not included in the COF, I have some sympathy because of the quality of the data for expanding the three cancers that are already there. Those three cancers are obviously common cancers. They account for some 40% of all new cancer diagnoses—we are talking about breast, lung and colorectal cancers. The Minister accepts that there can be a disparity in survival rates between the common cancers and the rarer cancers. Our recommendation would in some respects help to close that gap with the more common cancers. Will the Minister address the point that was made earlier and the point that the all-party group has been pushing hard on for some time?

The Minister appreciates that we hon. Members in the all-party group have had a constructive dialogue, which continues, but this debate is too good an opportunity to miss, so I should like to raise some relevant issues in a more public forum. The all-party group has tended to focus on proxy measures. When we had primary care trusts, the one and five-year figures were statistically robust, because the population sizes allowed them to be so. However, we have started tinkering with the commissioning structure—first, general practitioners and fundholders and then clinical commissioning groups—and the population sizes are somewhat smaller. Therefore one and five-year figures, on their own, are not as statistically robust as we should like. That is why we in the all-party group suggested that staging and emergency admissions could be used as proxy measures to complement, rather than replace, the one and five-year figures, for the benefit of the local NHS.

Hon. Members should not forget that this is all about trying to introduce measures that allow the local NHS to focus on outcomes and introduce, through its own initiative, initiatives such as screening, which was mentioned earlier—there are many others—to try to drive forward earlier diagnosis.

In respect of proxy measures, I understand that the public health outcomes framework, published at the beginning of the year, has already identified the importance of staging data. Certainly, that is so with regard to cancers diagnosed at stages one and two. I am not alone in the all-party group in thinking that it is important that those data are shared across the outcomes framework to ensure a coherent approach throughout the NHS. I am interested in what the Minister says about that. Once again, I accept that we have to be reasonable. This is about quality of data. I hope that the Minister accepts that coherence is needed in respect of the frameworks for public health outcomes, NHS outcomes or commissioning outcomes.

If the big picture of what the NHS should focus on in respect of cancer is coherent—whether top-down or bottom-up—we stand a greater chance of achieving our goals. At the moment, there is a risk that we do not have such coherence. I know that the process is at an early stage, but I am interested in hearing the Minister’s response.

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Picking up a point that was raised earlier, all hon. Members accept that improving patient experience is important, which is why the all-party group thinks that we need to do more to push on an open door. We recommended that the national cancer patient experience survey should be conducted annually. Although there is a question about feasibility, there is much merit in that suggestion. The survey should also be included in domain 4 of the NHS outcomes framework and the COF, just to ensure that the message, which is that we regard it as important, is clear. Patients can have the best treatment in the world, but unless their experience is good, particularly at a traumatic time when they have cancer, negative experiences can often act as a dampener and can affect recovery rates as well. It is important to recognise that.

I thank my hon. Friend the Member for Southport for securing the debate. The Minister knows that the all-party group is keen on a constructive dialogue—it is ongoing—and I thank him for the meetings that we have had and for the constructive way that he has liaised with us. I apologise to him for making an early exit, because I have to attend a meeting of the Select Committee on Foreign Affairs. However, he should not think that I am not interested in his response: I shall scan Hansard carefully tomorrow morning.

11.44 am

Jim Shannon (Strangford) (DUP): I congratulate the hon. Member for Southport (John Pugh) on bringing this matter to Westminster Hall.

There is not one of us who has not personally been affected, or who does not have family members affected, by what is referred to as the dreaded big “C”. Last year, my sister, who lives in England, had kidney cancer. The medical services here were good in addressing that and she is on the way to recovery. My father had cancer on three occasions and, due to the skill of the surgeons, his faith and the prayers of God’s people, he got over those cancers and is still here coming up to 83 years old—or young, perhaps, which is another way of looking at it. Our health care system is good at what it does. I want to make that clear.

We have the best palliative care in the whole of Europe. That matter has been debated previously in the House. However, that does not always mean that we have the best cancer treatment in every category and sector. We must look at that.

The hon. Member for Southport spoke about pancreatic cancer. Recently, I met representatives from Pancreatic Cancer UK, who gave me some shocking figures, which are available to all hon. Members. Survival rates for pancreatic cancer have not improved for more than 40 years, making it the most deadly of all cancers diagnosed in the UK, with fewer than 3% of patients surviving beyond five years. Some 8,000 people are diagnosed with pancreatic cancer every year and it is responsible for 5% of deaths from cancer, yet it receives only 1% of research funding. There was a debate on pancreatic cancer in Westminster Hall a month or two ago. It is often regarded as a death sentence—if people get it, their chances are minimal. Perhaps the Minister can tell us what has been done to address that matter in particular.

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John Pugh: I am glad the hon. Gentleman mentioned that, because two close friends of mine died rapidly of pancreatic cancer. One point made by the people in Liverpool to whom I spoke was that, given the almost invariably fatal outcome from this cancer, it would not be a bad idea if some of the rules regarding drugs approval were relaxed a little bit, so that people could find out what worked, because in this case there is very little to lose.

Jim Shannon: I thank the hon. Gentleman for that valuable contribution and agree wholeheartedly. If it comes to the stage where people’s life expectancy is minimal or reduced, I believe that they would be quite happy to take advantage of new drugs, if those were available.

All hon. Members know that finances are finite in the health budget. That being so, we are grateful for the many charities that do such magnificent work, including Cancer Research UK, Macmillan Cancer Support and Marie Curie Cancer Care. However, we must get a handle on our treatment process and outcomes, which can only come through the correct use of funding. I hope that the Minister will tell us how that will happen.

In the NHS document, “Improving outcomes: a strategy for cancer”, published in January 2011, it is clear what the Minister regarded as the way forward:

“In order to achieve these principles we must also ensure that every possible penny of money the NHS has is spent improving the quality of care and outcomes that patients experience. The Government protected the NHS in the Spending Review settlement, with cash funding growth of £10.6 billion (over 10%) by 2014/15. Compared to many other government departments, that puts us in an incredibly privileged position but this is the toughest settlement the NHS has faced in a long time.

At the same time, we need to respond to the longer term pressures the NHS faces; of an ageing population and the new demands created by new treatments and technologies. That means that, as set out in the Spending Review and the 2011/12 Operating Framework, over the next four years the NHS will need to achieve up to £20 billion of efficiency savings. These savings will be reinvested back in continuing to give patients the care that they need.”

Will the Minister say whether we are on target to make those savings? If so, when will that money go back into the system?

The document contains many examples of cost-efficient care, such as people having certain treatments as day procedures and then care at home, which makes a lot of people feel more secure as well as being cost effective. We understand the reasons and the thinking behind that: it is essential that the patient is at the heart of any decision made and any strategy must incorporate this.

I am not an argumentative person—far from it, I try to get on with most people in this world—but the hon. Member for Southport commented on the advertising campaign “Have you had a cough for three weeks or more?” We do not know how successful it was. The campaign has a role to play, and those who have had a cough for more than three weeks might well have a problem. We do not know how many people went to see their doctor and, as a result, have been made aware of problems. That is perhaps a different opinion from that expressed by the hon. Gentleman.

John Pugh: I said that all those things need to be reviewed in the light of evidence, that there were good campaigns and bad campaigns, and that evidence decided which category they fell into.

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Jim Shannon: The facts will be the number of those who take up the campaign and see their doctors, perhaps ending up with the diagnosis of a problem.

I have read different consultation responses and have seen how different cancer organisations respond. All have been positive that, to improve patient experience outcomes, it will be important for patient experience to be measured and bettered throughout the entire patient pathway. Bowel Cancer UK points out that it is important that patient conditions are not ignored by an overarching patient experience indicator. For example, the overall patient experience reported by patients at a particular provider is likely to be less relevant than the specific experience reported by patients with the same condition. Thus, bowel cancer patients should be consulted about their treatment and given the necessary support and tools to make informed decisions about their care.

I will quickly outline seven suggestions that might lead to improvements in patient experience and care. Steps need to be taken to ensure continuity of care throughout the patient pathway. Key workers and clinical nurse specialists should play a central co-ordination role to achieve that—their involvement is critical. The meaningful data on service performance should be provided, to allow commissioners to make informed choices on the services that they commission and to inform patients about the services that they might wish to access.

Sometimes it is about knowledge and patients’ understanding of how the system can work to their advantage. Tailored patient information should be provided to guide patients through their care, in the form of information prescriptions; that should also include support to self-care, because that is sometimes the best way to deal with their problems and medical condition.

Symptom management should be offered to ensure that patients have the knowledge and tools to look after themselves when they can, but also so that they know when they need specialist support. In other words, when they need to call on the specialist support, they should have the chance to do that.

Patients should be given access to treatments in the most appropriate location for them, whether surgery, radiotherapy or chemotherapy—again, knowing the full choice.

Patients should be offered signposting and support to help them return to work, as well as ongoing support to manage continuing symptoms and the side effects of treatment. We might not always see such things directly, but they are important: trauma, the effect on the patient and their families, the financial implications and knowing about rights to benefits to get through that period, such as an application for disability living allowance.

Palliative care pathways should be considered alongside active treatment and not simply at the end of life. For many of us, palliative care is end-of-life care, but it has another role as well.

Lastly, the end-of-life care strategy should be rapidly implemented. Those seven suggestions are a method for the health system to address the care needed for those who have cancer.

I shall make a quick plug for those who do the experimentation and whose task is to find new drugs, which the hon. Member for Southport mentioned in relation to pancreatic cancer care. Queen’s university Belfast is at the forefront of experimentation in the

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investigation of new drugs—renowned the world over—and I commend the people there for what they do, and what many others do, because we cannot do without that experimentation to find the new drugs. Nearly every other month a new drug is announced—okay, there might yet be three or four years of experimentation and investigation, but the work of the researchers is tremendous and I commend them for it.

All the responses have been noted and the document that the Minister released is precise, yet more than a year later some feel that we have not moved forward as much as we should have done. Are we achieving better patient-focused care and outcomes? I am not so sure about whether that has been achieved, but the Minister will indicate where we are. That is why I am particularly thankful for the opportunity to debate the issue here in Westminster Hall. We do not need pretty words in a document—if I may use that terminology, and not facetiously—we need action. The Minister must turn all the words into action, and that is why I support the hon. Member for Southport and thank him for bringing the matter before the Chamber today.

11.55 am

Liz Kendall (Leicester West) (Lab): I thank all hon. Members who have taken part in this important debate. I congratulate the hon. Member for Southport (John Pugh), hard-working as always, on focusing on the issue.

Several hon. Members talked about the context of the debate and the improvements made over recent years. Several mentioned the research—published, I think, in the British Journal of Cancer—that showed that, over the past 20 or so years, the NHS in England and Wales has achieved the biggest drop in overall cancer deaths among 10 leading countries worldwide. There have also been significant improvements with individual cancers. For example, death rates for breast cancer have fallen by 40% since 1989, virtually closing the gap with other countries such as France. Furthermore, the NHS has done so despite having a smaller budget, which led the British Journal of Cancer to conclude that the NHS had achieved more with proportionately less than in other major developed countries.

It is clear, however, that far more can and must be done to bring cancer outcomes for all cancers and all patients up to the very best standards achieved in other countries. Hon. Members have rightly said that our overall survival rates are still not as good as those in countries such as Canada, Australia, Sweden and Norway and that, although survival rates are good for breast and skin cancer, for example, they are low for lung and pancreatic cancer. I am also particularly concerned about differences in outcomes for people from different minority ethnic groups or from different social and economic backgrounds. As the shadow Minister with responsibility for older people, I am concerned about the worse outcomes for older people in the UK compared with those in other countries, even after we have taken social and economic factors into account—I shall say a bit more about that in a moment.

Hon. Members welcomed the focus in the NHS outcomes framework on one and five-year survival rates but rightly questioned why the three cancers mentioned account for 40% of new cancer diagnoses and asked about the

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other cancers that could be included. Although survival rates are absolutely vital, other issues need to be addressed to improve the patient experience and the quality of care—in particular, for those who will not survive cancer, at the end of life.

[Mr Edward Leigh in the Chair]

I want to focus my comments on three key areas of care in which we need to improve services: first, early diagnosis and intervention; secondly, tackling treatment variations; and thirdly, ensuring that the patient experience is at the heart of all aspects of cancer care. There is a very important issue about how we prevent cancer from happening in the first place, but I will not focus on that in this debate.

The hon. Member for Basildon and Billericay (Mr Baron) —I pay tribute to the all-party parliamentary group—hit the nail on the head when he said that the survival rates at one year are crucial, and the differences between our survival rates and those in other countries are largest around that first year. We have to ensure either that patients present to their doctors earlier or that we identify them through effective screening. We then have to ensure that GPs properly examine, diagnose and quickly refer patients to appropriate specialist and other services.

International comparisons generally indicate that England has high-quality cancer screening programmes, although there is considerable regional variation in uptake. The key to improving uptake of screening programmes and ensuring that patients present early is to improve public awareness. I am worried about who will be responsible for promoting public awareness of cancer and running cancer awareness campaigns.

In April 2013, local authorities will take over responsibility for public health. The main focus will be on strategic needs assessment for their local population and developing joint strategic health and well-being strategies, but they will also be responsible for commissioning specific public health services, and they will be free to set their own priorities.

Mr Baron: The hon. Lady is absolutely right in saying that cancer survival rates have been improving for 30 to 40 years, but we still lag behind the European average, although I accept that we must be careful when comparing statistics. Will she confirm that, although we heard a lot about the Opposition’s concerns about changes to the commissioning structures, we did not hear much about the other key element of the NHS reforms: the importance of focusing on outcomes, particularly in cancer, as a way to drive forward earlier diagnosis? The spotlight should be on the local NHS and areas with poor outcomes, which should introduce initiatives to drive forward earlier diagnosis, including awareness of cancer screening programmes and so on, but we did not hear a lot about that from Opposition Members.

Liz Kendall: I thank the hon. Gentleman for his intervention. He was lucky enough not to experience the 16 weeks of the two Public Bill Committees that considered the Health and Social Care Bill, when I regularly raised the key concerns, such as how to improve outcomes for cancer and heart disease and how services, not structures, needed to be reformed to do that. If he

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has a spare moment and reads the report of those debates, I am sure that he would become aware that I was very concerned about how to improve patients’ lives, their experience and the quality of care, which is always the issue for me. My concern was always about whether the reforms would do that.

I return to the point that I was making about local authorities’ role and the concern that, under the mandated public health services that local authorities will have to commission, public awareness campaigns, including those for cancer, are not included. There is a real worry among public health professionals and those working for and with cancer patients about whether public health awareness campaigns, such as the bowel cancer awareness campaign, which certainly attracted my attention, will continue.

A second issue is how to improve GPs’ skills and their awareness of cancer. Many GPs see cancer patients relatively infrequently, particularly those with rare cancers. Will the Minister explain what national or local action may be taken to ensure that skills and awareness improve?

We want to ensure that, when people are referred by a GP, they have swift access to diagnostic tests. That is about not just good outcomes, but the quality of their experience. Anyone who has had the misfortune of themselves or a family member waiting for cancer diagnostic tests knows that it is a frightening experience and that it should be done as quickly as possible. There were big improvements under the previous Government in speeding up diagnostic tests, but there is evidence that the service is going backwards. Some 78% more patients now wait more than six weeks for diagnostic tests compared with May 2010, and there are even bigger increases in the number waiting for vital tests to diagnose cancer. Some 230% more patients now wait more than six weeks for endoscopic diagnostic tests, and that includes a 242% increase in the number waiting more than six weeks for colonoscopy and a 140% increase in the number waiting more than six weeks for MRI scans. What action could and should be taken to reduce those diagnostic waits, which is vital to improve one-year survival rates?

Turning to the important issue of treatment variation, I want to put on the record the excellent briefing from the King’s Fund, “How to improve cancer survival”, which goes through the issues in detail, with the best clinical evidence and the implications for services on the ground. Treatment factors can be divided into four main groups: surgery, radiotherapy, cancer drugs and the overall co-ordination of care. On surgery, there is a lot of evidence that the outcomes for many types of cancer might be better in centralised, specialist centres, particularly for complex surgery, because their use can lead to better training for surgeons. If they have a higher case load, doctors develop greater expertise and experience. More specialist support is available, such as nursing and intensive care, as well as superior equipment. One concern that we raised when discussing the Health and Social Care Bill and reorganisation was who will lead the strategic configuration that is needed to centralise some services, such as cancer, into specialist centres.

Radiotherapy has a significant although modest overall impact on five-year mortality rates. Obviously, the optimum proportion of patients with cancer who should receive radiotherapy varies by tumour type and stage, but it is thought that overall around 50% of patients with cancer would benefit from radiotherapy. However, in 2005, the

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radiotherapy access rate in England was 38%. That was one reason why the former Government introduced a new strategy, “Radiotherapy: developing a world class service for England”, in 2007. Can the Minister update me on any progress on that?

I am sure that the Minister will talk about the cancer drugs fund and the Government’s aim of improving access to such drugs. He will know that concern remains that the fund has not removed variations from the system. There have been underspends in some parts of the country, and some regional cancer drug funds approve drugs that others do not. The King’s Fund raises a bigger question in its document. It says that it is more important to improve access to surgery and radiotherapy overall. It is worried that there has been almost too much attention on the cancer drugs fund and not enough on the variations in radiotherapy and surgery.

I am really concerned about older people and the variation in their care. Will the Minister say whether the Government will look into that specifically? Older people are under-treated, and their outcomes for cancer are worse as a result, even when account is taken of the different types of tumour and the presence of other diseases or co-morbidity. Older people are less likely to receive intensive treatment and more likely to be admitted as an emergency.

Crucially, major international studies show that differences in survival rates between the UK and other countries are greater for older people. We are not sure of the reasons for that based on the evidence, but the King’s Fund suggests that there may be three key issues: even later presentation; co-morbidity with older people having two, three or more other long-term chronic conditions, which may lead to cancer then being misdiagnosed or not diagnosed; and age discrimination and the feeling that, because someone is getting older, their health is perhaps not so important. I am pleased that the Minister will implement the ban on age discrimination in public services that the former Labour Government introduced. I am very keen that the Government look more into that issue as part of their work on cancer.

I wish to say something about co-ordination of care, which, as we know, is important for patients and the patient experience. During debates on the Health and Social Care Bill, we asked whether cancer networks would continue in the NHS and, if so, how they would be funded. In May last year, the Secretary of State for Health said that the Government would fund and support cancer networks in 2012 and that, after that, the NHS Commissioning Board would continue to support and strengthen them. Over a year later, however, the future of cancer networks is still unclear.

The NHS Commissioning Board has recently published early proposals for clinical networks, which include the new strategic clinical networks prescribed by the NHS Commissioning Board. The proposals also mention 14 to 15 overarching networks in England that will cover a specific geographical area and review the work of the prescribed strategic clinical networks every six months. I think, however, that people are still quite confused about how that will work, and the Government’s proposals do not refer specifically to the 28 cancer networks. I therefore ask the Minister whether all

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28 current cancer networks will become prescribed strategic clinical networks, or will their number be reduced? How will they fit into the umbrella networks?

Funding is crucial. In response to a parliamentary question on 21 May this year, the Minister stated that strategic health authorities will be given £18.5 million to fund cancer networks in 2012-13, just as in the previous two years. Page 6 of the recent document from the Department of Health, “Progress Update on the Design of the NHSCB” states:

“Around £10 million of the costs of supporting Networks and Senates are expected to count against running costs.”

That seems to imply that the £10 million is to run not only cancer networks but all clinical networks and senates and that would be a cut of £8.5 million to the cancer networks. Will the Minister say whether the £10 million referred to in the document about the future functioning of the NHS Commissioning Board covers all networks, or cancer networks alone? That is a real concern for people who work in cancer networks and are already worried about the future.

I will conclude by mentioning the patient experience. Several hon. Members have rightly mentioned the need for the patient’s experience of a service to be placed at the heart of what the NHS is trying to achieve. I agree with the call from Macmillan Cancer Support and Breakthrough Breast Cancer for the NHS cancer patient experience survey to be included as part of the fourth domain of the NHS outcomes framework, which is about ensuring that people have a positive experience of care.

The cancer patient experience survey shows that the NHS does well on issues such as waiting times, pain control and patients who feel that they have been treated with dignity and respect. It does not, however, do as well as it could on issues such as patients receiving written information about their condition, financial help, clinicians who work well in a hospital and the community and whether there is enough nurse support. Those are important matters for patients.

Mr Virendra Sharma: Does my hon. Friend agree with expectations that the system will work more closely in partnership with the third sector, so that when patients come into the community they get support from that as well? We need a partnership that works together to improve the condition of patients once they are released from hospital.

Liz Kendall: I absolutely agree. Last year, I visited the oncology and radiotherapy wards at Leicester royal infirmary, and I saw the work done by Macmillan Cancer Support to help patients with cancer and their families. It had a multi-disciplinary team that worked around the needs of the individual patient and their family and involved not only doctors, nurses and radiographers in the hospital, but GPs, physiotherapists, occupational therapists, dieticians and pharmacists in the community. Macmillan Cancer Support does excellent work to improve the information and advice that is given to patients and their families, and it deals sensitively with issues such as when patients might want information, how it is provided and what is wanted by different family members. I am very supportive of that.

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Mr Edward Leigh (in the Chair): Order. I know that the hon. Lady will wish to leave time for the Minister to reply. The debate must finish at 12.30 pm.

Liz Kendall: I am about to sit down, Mr Leigh. The Minister will know that the Opposition have put forward proposals for social care to be free at the end of life, to avoid the awful situation in which families have to fill out means-test forms and might struggle to get the care package that they need at that crucial time—the end of their loved one’s life. There is evidence that such a proposal would be cost-neutral, as it would reduce the number of more expensive bed days spent in hospital. Survival rates are absolutely critical, but we must not forget other issues, such as the quality of the patient experience and end-of-life care.

12.16 pm

The Minister of State, Department of Health (Paul Burstow): I congratulate my hon. Friend the Member for Southport (John Pugh) on securing the debate and on setting out—as he always does so admirably—the terrain that he wished us to traverse. Other hon. Members have done just that, and it is helpful to have this opportunity to mention the progress that has been made since the publication of the Government’s cancer outcome strategy in 2011. The annual report that we published last December set out that strategy in greater detail than I fear I will be able to provide in the time available today, and I commend it to Members.

Interestingly, one common theme in this debate has been touched on, quite rightly, by most of those who have contributed. Health inequality has been raised in the context of patient experience surveys—with which the Government will continue—and of age. The Government take health inequality so seriously that we have placed for the first time clear duties on commissioners and other parts of the NHS to act to reduce it, and we will say more about that soon when we publish the draft mandate for the NHS Commissioning Board.

The hon. Member for Leicester West (Liz Kendall) referred to age and the differences in outcomes from cancer services for older people. I approved funding for a joint piece of work by Macmillan Cancer Support and Age UK to explore some of the obstacles and barriers that may prevent people from taking up cancer treatment or accessing it in the first place. We recently visited Barts Health NHS trust, which is taking part in that pilot programme, and we are looking at issues such as comorbidity and services in the community. We will report accordingly and take action to ensure that lessons are learned. The hon. Lady was right to raise the issue, and the Government have decided to implement provisions on age with regard to goods and services in the NHS and social services. On taking office, one of my first responsibilities was to take the necessary decisions to ensure that no part of the NHS would be exempt from those provisions, and key decisions needed to be taken to make it clear that age can be used only on an objective basis in health care and social care decision making.