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Westminster Hall

Wednesday 30 October 2013

[Albert Owen in the Chair]

Cancer Patient Experience

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

9.30 am

Mr James Clappison (Hertsmere) (Con): Mr Owen, it is a pleasure to have you chairing the debate on a subject that is important to many families up and down the country. Some 2 million people in the UK are living with or beyond cancer, and that figure is set to rise to 4 million by 2030. Although it is a cause for celebration that more people than ever survive after a diagnosis of cancer, a significant challenge must arise in ensuring that their clinical and human needs are met and that patients have the best possible experience.

Before turning to the nature of the challenge and the points I wish to raise, I pay tribute to all those who work in and support the many charities and voluntary organisations that address the challenge posed by cancer. There are many such organisations, but, with utter respect to all those involved in the field, I shall mention just a few: Macmillan Cancer Support, Cancer Research UK, Breakthrough Breast Cancer, Marie Curie Cancer Care, Breast Cancer Care, Beating Bowel Cancer, the Roy Castle Lung Cancer Foundation and the Teenage Cancer Trust. There are many others. They all do fantastic work and much to improve patient experience and give hope to many of our constituents.

The Government have set great store by patient experience and all the issues that naturally interest cancer patients. I warmly welcome my right hon. Friend the Prime Minister’s ambition to give every cancer patient the opportunity to be a research patient if he or she so wishes; that must interest many people in that position.

The UK now leads the world in recruiting cancer patients to take part in research. One in five cancer patients in the UK takes part in some form of research, which compares with 3% of people in a similar position in the United States. I pay tribute to the research of Cancer Research UK in that regard. Last year, 36,000 patients took part in its trials in this country.

I welcome the fact that NHS England has said that it plans to continue the important national cancer patient experience survey. The results of the 2012-13 survey showed that there is room for improvement in some areas of care. I make that point not as a criticism of the NHS, but to highlight areas where there is room for improvement. Macmillan Cancer Support highlighted some such areas in particular, and has urged Ministers to take notice of and act on them. I urge Ministers to listen to the representations being made to them by Macmillan Cancer Support and others.

The national cancer patient experience survey highlighted several important issues, and I will mention three. The first is care planning and information. The most recent

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cancer patient experience survey reveals that before starting treatment, 45% of patients were not fully informed about the side effects that could affect them in future, that 78% were not offered a written assessment and care plan, and that 41% were not given enough support from health and social services after leaving hospital. As a result, not all patients felt that their families were given all the information needed to help care for them at home. That is clearly an area where there is room for improvement.

David Simpson (Upper Bann) (DUP): I congratulate the hon. Gentleman on obtaining this important debate. He mentioned Macmillan, which says in the research paper on the survey:

“The lack of basic care, dignity and respect experienced by cancer patients in hospital is shocking.”

It also says that 15% of patients experienced humiliation. That should not happen to someone suffering from cancer.

Mr Clappison: The hon. Gentleman makes an excellent point, and some of the matters I will turn to in due course underline its strength. May I apologise to hon. Members? I mentioned NHS England, because that is what the survey covers, but I will turn to the situation in Northern Ireland, Wales and Scotland in due course. I am delighted that so many Members from Northern Ireland are here this morning.

The next issue is financial support. Cancer patients and their families obviously need financial support, just as everybody else does. Although significant progress has been made since the first cancer patient survey in 2010, almost half of patients who would have liked information about how to get financial help or benefits still do not receive it.

Mr Robin Walker (Worcester) (Con): I congratulate my hon. Friend on securing this hugely important debate. He mentioned the importance of financial advice and support, but does he agree that service design is also important? I came across a case of one constituent, David Wilson, who, while undergoing chemotherapy, received 270 different pieces of paper from our city council in just one month—August this year. It is vital that we design services so that Her Majesty’s Revenue and Customs, local councils and the Department for Work and Pensions work together to make life for patients easier and simpler and to ensure that they understand the financial entitlements.

Mr Clappison: My hon. Friend makes an excellent point that I am sure the Minister will want to address. The last thing that somebody coping with the treatments and everything else wants is to be bombarded with different pieces of information and requests from central or local government bodies, which could do something much more coherent and easy to understand if they streamlined their services.

I would like to address relational care, which the hon. Member for Upper Bann (David Simpson) raised in his intervention. It covers matters such as communication, trust in nurses and being treated with respect, all of which are important for cancer patients. There is still room for improvement, according to the findings of the most recent survey. For example, 42% of respondents

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said that not all doctors and nurses asked what name patients preferred to be called by, which can be important to older people. It is a question of finding the right amount of kindness. Our clinicians—nurses and doctors—are marvellous, but that did emerge from the patient survey. Kindness can make a great difference to people in that situation.

Macmillan Cancer Support’s report showed that patient experience across the NHS is still not regarded as having equal importance as clinical effectiveness and patient safety. The Government’s decision to make patient experience one of the five domains against which the health service will be held to account should be warmly welcomed. It is clear, however, that a lot of effort needs to be put into the institutional framework to reinforce that priority.

The NHS mandate and outcomes framework needs a stronger focus on improving relational care. Hospital boards need to take a lead on prioritising patient care; a recent survey showed that its importance to different hospital boards varies considerably, which is clearly wrong, because all hospital boards should take it seriously. Commissioners of cancer services have a vital role to play, as does the chief inspector of hospitals. All such bodies need to reinforce the need for relational care and kindness in dealing with cancer patients.

Nic Dakin (Scunthorpe) (Lab): I congratulate the hon. Gentleman on securing the debate, and I apologise for having to leave before the end. Does he think that it is also important that priority be given to communication skills between medical staff and patients? That is the core of what he has outlined.

Mr Clappison: I am grateful to the hon. Gentleman for that intervention. I agree that communication skills are important; the important factor is that kindness should be received by the patient.

I put a point to the Minister on behalf of Macmillan Cancer Support: I hope that the Government will deal with the matters we have discussed and put patient experience at the heart of the inspection process being put in place for our health service. One way of doing that is to use the results of the cancer patient experience survey to inform ratings at a cancer team and service level and to monitor and assess providers of care—for example, as part of the foundation trust assessment process.

In the light of all that, I have four specific questions for the Minister, on behalf of Macmillan Cancer Support and other charities. First, will the Government consider making relational care a priority area in the refreshed 2014-15 mandate to NHS England? Secondly, will the Government support the use of cancer patient experience data in the inspection regime of the Care Quality Commission, which is led by the chief inspector of hospitals?

Thirdly, will the Government work with commissioners and providers to ensure that the results of the national cancer experience survey continue to drive improvements in cancer care? Fourthly, and specifically on breast cancer, can the national cancer patient experience survey

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include a question asking whether the respondent has secondary breast cancer? The Breast Cancer Campaign specifically asks to have that included.

More generally, I welcome the Government’s ambitious plans to improve cancer care in the United Kingdom, including those they set out in January 2011 in “Improving Outcomes: A Strategy for Cancer”, which promised action on a number of important fronts, such as diagnosing symptomatic cancer earlier; helping people live healthier lives to reduce the incidence of preventable cancers; screening more people; introducing new screening programmes, as recommended by the National Screening Committee; and ensuring that all patients have access to the best possible treatment, care and support.

Those measures should save at least an additional 50,000 lives every year by 2014-15. Many of us will be aware of the efforts being put into those different fields, to encourage people to come forward for screening, to make screening available, to make members of the public more aware of symptoms and to encourage people to lead healthier lives. That has been much more evident than it had been hitherto. In the light of all that, it would be good to hear from the Minister what progress has been made on the ambitions that the Government set out in January 2011.

Furthermore, what progress has been made in tackling inappropriate regional variations in cancer outcomes? Many advances have been made in cancer treatment in the UK, of course, but historically there has been a disparity on cancer survival rates between the UK and other comparable western nations. That has been the case for many years, under Governments of all parties, but it was underlined most recently by a 2009 Eurocare study, which revealed a disparity between UK cancer survival rates and those achieved in countries with the best outcomes.

England rated 16th in the survey for both men and women. Wales was ranked just in front, and Scotland and Northern Ireland were just behind. Apart from Ireland, every other major western European nation performed better than the UK, and some of them much better. Sweden was the best performing country.

The 2009 analysis was a little old, because it was based on patients diagnosed between 1995 and 1999, although that had to be the case to detect survival rates. More recent surveys have also seen the same pattern, such as one comparing the USA with the United Kingdom. With older patients, there is an even more marked gap between the UK and other comparable nations and economies. I have seen figures from the British Journal of Cancer that show that for women over 70 with breast cancer, the three-year survival rate in the UK is 79%, but in Sweden, it is 91%.

Mr John Baron (Basildon and Billericay) (Con): I congratulate my hon. Friend on securing the debate. Although comparisons are always dangerous, a further acknowledgement of how far we remain behind our European partners is that even if we met the Government’s laudable target of saving an extra 5,000 cancer lives over the next couple of years, that would still only bring us up to the European average on survival rates.

Mr Clappison: My hon. Friend makes an excellent point. I am sure he would agree that there is a lot of ground to make up. The important point is that we

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should not only take encouragement from the improvement of survival rates as a result of advances in medical science; we should judge ourselves by how well we use those advances compared with other countries. We should set ourselves the more ambitious target of not just improving survival rates, but improving them so much that we close the gap on other countries.

Members of the British public who fall ill with cancer and their families expect cancer treatment to be on a level with that of comparable countries, our neighbours and other western developed economies. Sadly, it is not at that level, although I hope the Minister will tell us that we have made some progress.

Yesterday, some encouraging statistics were released that showed a trend of increasing survival for patients diagnosed between 2007 and 2011. The Minister will agree that that is good news, but I look forward to hearing from her that the Government’s ambition is to close the performance gap between ourselves and other countries and that the gap is being closed.

In closing, I should like to pay the utmost respect to doctors, nurses and all clinicians working in the field. We owe them a great debt of gratitude and my comments are no reflection on them. We are all hugely indebted to their work and I am sure that many of our constituents would echo that sentiment. I am just drawing attention to how the system has operated in this country over a number of years, and the experience of the patients within it. I hope that the Minister can tell me that the Government have ambitious plans for improving the cancer patient experience and that there is evidence that those plans are on the road to fulfilment.

9.46 am

Jim Shannon (Strangford) (DUP): I am grateful, Mr Owen, for being called to make a contribution to this debate. It is on cancer patient experience, but we will all have personal experience of the issues. I congratulate the hon. Member for Hertsmere (Mr Clappison) on tabling the subject for debate. In his introduction he rightly said that the debate refers to the NHS in the UK, and there are four Northern Ireland MPs here because each of us can contribute to the debate by relating our experiences. I hope that the Minister will consider a strategy that involves not just the mainland, but all four regions.

As I was saying to my hon. Friend the Member for Upper Bann (David Simpson) earlier today, when I first considered my contribution to the debate, I realised that I have never before known so many people in my age group, so many of my friends and so many of those just older than me who have had cancer, and I have never experienced so many people passing away as a result of it.

I have had a number of meetings with the Minister back in Northern Ireland, Edwin Poots, and I intend to have a public meeting in my constituency to review cancer care with the general public and the trust and look at how best we can do it. My frustration is compounded by discussions with the trust. I do not want to be critical, because that is not how I do things—I try to see how we can move forward and be more positive—but I am concerned about the magnitude of cancer cases in my area and across the United Kingdom.

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I suspect that other Members will confirm what I already know. A 10% increase in cancer cases in Northern Ireland is extremely worrying.

My father and sister suffered from cancer. Of the four staff employed in my Newtownards office, my parliamentary aide had two grandparents die from cancer and her father suffers from cancer, my secretary had her mother die from cancer and she recently buried one brother-in-law to cancer and has another undergoing chemotherapy. Only my office manager seems to have escaped cancer in their immediate family. Some 75% of my office staff have experienced cancer in their close family and individually.

If we look into the community, we can see that my examples provide an accurate reflection of the way that cancer affects entire communities. Someone in the United Kingdom is diagnosed with cancer every two minutes. More than one in three people in the UK will develop some form of cancer during their lifetime, which is a horrifying statistic. The risk of developing cancer before 50 is 1 in 35 for men and 1 in 20 for women, so the situation is more extreme for ladies.

As elected representatives, our constituents often come to our offices to ask how to find their way through the benefits system. They experience health pressures to start with, but financial pressures soon follow. Just yesterday, my hon. Friend the Member for East Londonderry (Mr Campbell) and I went to the Macmillan Cancer Support reception here in the Houses of Parliament and we had the important opportunity to speak to carers. I will highlight some of the issues raised as we go through this debate.

Mr Gregory Campbell (East Londonderry) (DUP): Before my hon. Friend moves on to discuss carers, which is an important matter, does he agree that a big issue is people’s reluctance and sometimes failure, in particular among us males, to visit the GP when there may be a problem? We should encourage everybody, but males in particular. I do not understand the logic. If my television does not work, I get a TV repair man in. If the washing machine does not work, I get the washing machine repair man in. If people have a health problem, they go to their GP. Unfortunately, however, males seem reluctant to do that.

Jim Shannon: I thank my hon. Friend for that contribution. The males of the species do tend to wait just that wee bit longer. I will not relate my personal case to Westminster Hall, but we do sometimes leave things a little longer than we should, which is perhaps a failing on our part. The Health Minister and his Department in Northern Ireland have run several campaigns to highlight prostate cancer in particular. It may be that MPs know more people, but I have two close friends who were diagnosed with cancer. Thankfully, in both cases, they acknowledged early that something was wrong and went to their doctors and were then referred for health checks. I am happy to say that the treatment that they are now receiving will save their lives, but if the diagnoses had been made a couple of months later, I suspect that it may have been different. My hon. Friend is absolutely right. Entire families and communities are affected by this cancer pandemic. The House must deliver an effective strategy to help those experiencing the scourge of cancer.

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I read with great interest the Macmillan report and the hon. Member for Hertsmere outlined the many cancer organisations and societies that do tremendous work. Macmillan’s document, “Improving care for people with cancer: Putting cancer patient experience at the heart of the NHS”, wants patient care at the core of the NHS and I heard yesterday from carers and people involved with Macmillan how important that is. The report references England and Wales only, but the overall message is mirrored throughout the UK, and the other Northern Irish Members and I are here today to provide the experience of Northern Ireland.

I recently met Edwin Poots, the Minister of Health, Social Services and Public Safety in Northern Ireland, regarding the provision of cancer carers in my area, as it is clear that changes that could really make a difference cannot be implemented due to a lack of funding, which is part of the problem, and the lack of a strategy for the increases in demand over the next 10, 20 or 30 years. Looking at the Ulster hospital in particular—I am not going to be critical of the staff, who are tremendous and can never be paid enough for what they do—I can see greater demand and that needs to be taken on board. I ask the Minister to consider holding discussions with those in the regions, in particular with the Northern Ireland Assembly and Edwin Poots, because we need a strategy that takes into account the whole of the United Kingdom and not just the mainland. We can work together. Experiences, interests, qualifications and knowledge may differ across the UK, but it is time that we exchanged some of that in order to help each other.

Getting back to the Macmillan report, it states what I am sure that everyone here believes:

“Every person diagnosed with cancer should have a positive care experience and be treated with dignity and respect throughout their cancer journey.”

My hon. Friend the Member for Upper Bann said in his intervention that people needed to be treated as human beings and not just as numbers.

David Simpson: Will my hon. Friend join me in praising young carers, who look after family members until Marie Curie or Macmillan move in? Their lives are detrimentally affected by the trauma. Young carers cannot be praised enough.

Jim Shannon: I thank my hon. Friend for that comment. In my constituency, we have a young carers organisation that also works with adults. I have met some young carers and am aware of young sons and daughters who look after mothers, fathers and other siblings. We could not do without them. We are ever mindful of their experiences. I know young carers, my hon. Friend knows them and I suspect that everyone in the House knows individual young carers.

Some people may ask how the cancer experience can ever be positive, but although going through cancer will always be horrific, the care that is given can and does impact upon how a patient feels. The Macmillan report states:

“Good patient experience is closely connected to improving other outcomes such as recovery from an illness. However, the sad reality is that many people still have a poor experience of care.”

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We can hopefully try to address that problem today. Cancer is no respecter of persons, but that does not mean that cancer treatment precludes the sufferer receiving the utmost respect and dignity through treatments that may be undignified in their essence. We have all lost a little dignity while in the doctor’s surgery and the manner of the doctor or nurse often determines how embarrassed we become. If we are treated gently and with care rather than being pushed through the process as quickly as possible to get the next patient seen, we may feel better as a result. That does not always happen and I can certainly appreciate the pressure that doctors and nurses are under to do the procedures, tick the red-tape boxes and bring down waiting lists. However, the fact that we are not dealing with lists but with people must never be far from our minds.

Again, I stress that I am not placing the blame on the providers of care, but something must be done to address the fact that, on average, only 56% of cancer patients in England said that doctors and nurses asked them by what name they wanted to be called, which was an issue highlighted by the hon. Member for Hertsmere. A little bit of consideration and allowing the patient to maintain their dignity does not take a whole lot of effort. It may seem trivial, but this is a serious point: a girl called Betty works in my office and were I to call her “Beatrice”, she would get upset and would tell me. Similarly, should I refer to the other lady in my office as Mrs Cotter when she is actually Mrs Armstrong-Cotter, she would immediately put me in my place. I use those examples because it is important that a caring bond is formed with cancer patients. A wee bit of time, consideration, humility and dignity can really make a difference. The same can be said on a greater scale when people are doing intimate things to patients while always reminding them that patients do not know them. That is a small thing that the Macmillan report highlighted that could make a patient feel that much more comfortable and indeed that much more safe.

The carers at the Macmillan reception also described some things that they thought should be happening in hospitals. They outlined the need for someone to be available to hospitals across all regions. The six people we met yesterday were all from different parts of the United Kingdom and all had different stories to tell. It seems that some trusts are responding well, but others are not. We need a universal response that encompasses all areas. The Macmillan representatives also suggested that someone should also be available to provide advice on benefits and on care and just to give support.

Another point that came out of yesterday’s discussion was about respite care. Some of the ladies we met were single carers—in other words, a wife looking after a husband, with no sons, daughters or other family members close at hand. We also need to consider the issue of respite care and how we can help such carers get a wee bit of time for themselves.

Mark Durkan (Foyle) (SDLP): The hon. Gentleman said that Macmillan Cancer Support has suggested that help with understanding social security and welfare advice is important. Is he aware that, in the Altnagelvin area hospital in my constituency, Macmillan and the Western Health and Social Care Trust run the independent Macmillan/North West advice service to do exactly that? It basically navigates people through the benefits

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system and all the other support mechanisms. It does not expect people to be experts on such arrangements in the public administration system, but takes away an awful lot of the worry and provides pathways to care and support that they would not otherwise know was available.

Jim Shannon: The hon. Gentleman is absolutely right. I have such a service in my area. I am pleased that Macmillan and others provide such a level of care and support at times of great concern and worry in the Ulster hospital in Dundonald. I must say a great thank you to the volunteers—a great many of them are volunteers —who provide that service.

It is nice to see the shadow Minister, the hon. Member for Leicester West (Liz Kendall), in her place, because she and I had a discussion the other day about the report on care that is coming to the House for consideration. I hope that some of the points made by the ladies to whom we spoke will be part of our next debate on the draft Care and Support Bill, and I am sure that no one will be found wanting in responding to that.

In my opinion, the ethos of a hospital is reflected in how patients are treated. The Macmillan survey, which highlighted the priority of patient experience, has painted a picture of how each different hospital board views the importance of the patient care experience. It found that boards raised patient experience as an agenda item in policy meetings, but that only 5% of such items led to further action: boards noted the patient experience, but did not deem it important enough to follow up.

When I wore my other hat as a councillor, for some years I chaired the council’s audit and risk management committee and read the absolutely endless reports on matters prioritised as categories 1, 2 or 3: something in category 1 needed immediate attention, something in category 2 needed attention in a reasonable time, and something in category 3 needed attention just at some stage. It is safe to say that many of the category 3 priority cases remained the same and did not change from year to year, because time never permitted for making those changes, as something more urgent was always pressing. In other words, there were always category 1 and 2 priorities and, unfortunately, category 3 priorities sometimes sat on the shelf. My belief is that patient experience should not be a category 3 priority, but should be considered as a category 1 priority; it should not have to wait until everything else is fixed before it receives attention.

To conclude as I began, cancer is a wretched illness, whose deadly or grimy fingers reach out to impact on wide family circles, as well as entire communities. The experience of going through cancer has an impact on not only the individual, but the people around them. I believe that it is time to make cancer a priority, with a UK strategy for the Government here and those in the regions of Scotland, Northern Ireland and Wales. That is why I wholeheartedly support the hon. Member for Hertsmere and, in doing so, I again ask that any decision taken by the Secretary of State will look at having a UK strategy as well as additional funding. I thank the hon. Gentleman for bringing forward this debate.

10.4 am

Mr John Baron (Basildon and Billericay) (Con): I congratulate my hon. Friend the Member for Hertsmere (Mr Clappison) on securing this important debate.

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I apologise to him that I will have to leave slightly early to meet, coincidentally, the new cancer tsar, Mr Sean Duffy. That appointment has been in the diary for some time. I echo my hon. Friend’s warm words of praise for all those charities and individuals who work towards combating this disease. They do excellent work, which I know all of us across the House very much support and praise.

As chairman of the all-party group on cancer, I congratulate the Government on their excellent work on cancer in recent years. Focusing on outcomes as a driver of change within the NHS has been crucial in not only driving up outcomes, but ensuring that changes in the NHS take place for the benefit of patients.

I will not speak for long, because I am conscious that there will be other speakers after me, but to give a little bit of the history, the all-party group produced a report in 2009 on cancer inequalities across the UK. We tried to analyse why patients who reach the one-year point in this country stood as much chance of getting to the five-year point as in any other health system in Europe, while we fell down on getting patients to the one-year point. That result tends to suggest that the NHS is as good as, if not better, at treating patients once cancer has been diagnosed, but is very poor at diagnosing cancer in the first place.

We tried to come up with a solution for how to drive forward earlier diagnosis. I suggest that that is the magic key for cancer. There are very few magic keys in life that will unlock the door to a panoply of unexpected treasures, but one exists for cancer—earlier diagnosis. With the wider cancer community, the all-party group—it sees itself as representing that community in Parliament—proposed putting up in lights the one-year and five-year survival indicators.

Instead of bombarding local primary care trusts, as they then were, with lots of targets and bureaucracy, we decided to put up those indicators in lights, with the emphasis on the one-year point, as a driver of change. PCTs—now clinical commissioning groups—that were towards the bottom of the table would, if their managers were worth their salt and their large salaries, introduce local initiatives, peculiar to their population: for example, whether theirs was an ageing population, whether an adaptation was needed for an industrial illness, such as mesothelioma, or whether there were black and minority ethnic communities. Those local initiatives would drive up earlier diagnosis to combat those poor one-year survival figures, because we all know that late diagnosis makes for poor one-year survival figures and, in turn, poor five-year figures.

The Government listened not only to us, but to the cancer community that also came up with the idea, and to Members from both sides of the House who came in behind it. We campaigned together, and we are delighted that the Government have now put in place one-year and five-year survival figures both nationally and locally through the CCG outcomes indicator set—brilliant news.

There has to be a bit of tweaking, for the simple reason that we were previously dealing with PCT populations that were larger than those of CCGs, so the issue of statistical significance comes into play. I was not wholeheartedly behind—in fact, if anything, I was quite sceptical—about the structural changes to the NHS, but that is now history and we have to deal with the future. Given that the populations are smaller, we

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are now arguing for the introduction of proxy measures locally to supplement, although not to replace, the one-year figures. Measures focusing on accident and emergency and on staging would be two ways to supplement the one-year figure. That is an ongoing conversation, and the Government and NHS England are in constructive dialogue with us about it.

I mentioned the focus on outcomes because, to achieve improved cancer outcomes, it is essential to put up in lights the patient experience and to prioritise it nationally and locally. If I have one concern about the present direction of Government policy, it is that patient experience is built in at national level, through the outcomes framework, but as yet, it is not built in at the local or outcomes indicator set level. I am not alone in worrying that there will be a disconnect. Setting the bigger picture strategy is well intentioned and essential, but if we are really to improve patient experience, we need to ensure that that national policy is followed through locally. At the moment, that is not taking place, and if we do not put that right pretty quickly, we risk not meeting the Government’s laudable target of an extra 5,000 lives saved by 2015, which is something that we all very much want.

The Minister, to whom I wish the very best in her new post—I did not get the opportunity to say that in Health questions—will know from her civil servants that the cancer community and the APPG on cancer participated in the public consultation on the 2013-14 clinical commissioning group outcomes indicator set. Held by the National Institute for Health and Care Excellence, it listed patient experience of cancer services as a potential indicator for future development. The NICE CCG OIS advisory committee agreed that such experience would be useful, yet it is not included in the 2014-15 CCG outcomes indicator set. I ask the Minister in all earnestness to look at that again. We are talking about NHS England to a very large extent, but I would be very surprised if there were not conversations with it about such issues. Will the Minister use her influence and best offices to try to influence the debate?

There is no shortage of reasons why cancer patient experience is important and why it should be included locally. I will bombard the Minister with one or two facts. We know, for example, that there is vast variation of cancer care across the country. There are unacceptable geographical variations, and we need to iron them out. There have been some particularly bad examples recently in London, and we need to look at them.

Within cancer itself and the condition of cancer, there are huge variations. For example, people with rarer cancers report a worse experience. People in the most deprived areas report less favourably on their care. Those are reasons why the monitoring of cancer patient experience locally is important.

Furthermore, the cancer patient experience survey is effective at driving improvements locally, and that must not be overlooked. By contrast to the current CCG OIS indicators under domain 4, the cancer patient experience survey captures detailed service specific data about trusts’ performance across a range of aspects of cancer patient experience. For example, all London trusts put action plans in place, following the 2010 cancer patient experience survey, so we know that that is effective. We do not need to reinvent the wheel on that one; we have

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something within our possession that is effective in driving forward improvements. The idea of monitoring cancer patient experience locally is feasible.

As my hon. Friend the Member for Hertsmere mentioned, more than 2 million people are living with and beyond cancer. That will rise to 4 million by 2030. Cancer is a unique and complex medical condition, and as we well know, certain aspects of patient experience have a particular emphasis for people living with cancer.

The CPES has a high sample size and response rate. Data from the 2010, 2011 and 2012 surveys are already easily accessible for CCGs to analyse. They are useful and user friendly. Furthermore, the CPES is regarded as an example of best practice in measuring holistic patient experience of care—looking at the complete pathway—which is something that we do not talk enough about in the NHS. It is particularly important, as the Minister fully understands, when it comes to cancer patients.

In conclusion, lots of good work is being undertaken by the Government on cancer. The Minister will know that I am not afraid to come forward and say otherwise if I think that that is the case. None the less, I urge her to look again at what appears to be a disconnect between a national priority and implementation locally. The cancer patient experience survey is terribly useful, helpful and effective. We need to get it into the CCG OIS. I hope the Minister will respond to that point when she sums up, but I apologise that I will not be here to listen to her.

10.15 am

Mark Durkan (Foyle) (SDLP): It is a pleasure, Mr Owen, to meet under your chairmanship this morning. I congratulate the hon. Member for Hertsmere (Mr Clappison) on introducing this important debate. I want to raise a few points on the cancer experience that arise from my constituency.

As other Members have said, it is important that, in providing and modelling our services, we should directly draw on the experience, both in qualitative and quantitative terms, of patients and focus on outcomes. We also need to harness fully the insights that patients can give us into how services can be improved, better managed, better modelled and, more importantly, better accessed and understood.

In my constituency, there has been a major campaign for a localised radiotherapy unit. It was meant to happen as part of the overall improved cancer strategy in Northern Ireland, but for various reasons it got held up. The campaign was led by the Pink Ladies, a group who have gone through the cancer journey. They have all experienced breast cancer, but they are in no way exclusive about their cancer as opposed to other types of cancer experience.

On Monday morning, I attended a Pink Ladies event, which focused on the new partnerships in which the group was involved. It has spread its involvement to include not just Macmillan Cancer Support and Action Cancer but local community partnerships. It discussed providing new services at a neighbourhood level, including counselling services, listening-ear services and complementary therapy services. All are supported by professionals in the Western Health and Social Care Trust.

The issue is about making the services more accessible, comfortable and compatible with local users, who will rely very much on those who have been through, and

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are going through, the cancer experience, because such people are best placed to give support to others who are new to the journey.

On the point made by the hon. Member for East Londonderry (Mr Campbell) about male sufferers, an offshoot of the Pink Ladies has been formed comprising males who have been through, or are on, the cancer journey. They, purely in derivative terms, call themselves the Pink Panthers, but they are addressing exactly the issues that the hon. Gentleman mentioned. Part of the role of the groups is to help to provide advice to other patients, and their families and carers, about some of the issues that might arise and to anticipate some of the questions that might be going through patients’ heads—questions that they are just not able to articulate or are not yet ready to vocalise.

Mr Robin Walker: I am grateful to the hon. Gentleman for giving way. I apologise for having to leave the debate before the summing up.

I want to pick up on the hon. Gentleman’s point about how cancer patients can contribute to the campaigns. I have had a radiotherapy campaign in my own constituency in which Paul Crawford, a former head and neck cancer patient, has played an important role. Does the hon. Gentleman agree that cancer patients can play an important role by getting on the boards of local health trusts and health bodies and providing knowledge and experience, as indeed my constituent has?

Mark Durkan: I fully accept the hon. Gentleman’s point. The point that I was about to make myself exactly “rhymes” with his observation. It is that these people are in a position to offer advice to others diagnosed with cancer; to offer advocacy to politicians, service providers and managers as to how things can be improved; and to offer real insight in administrative terms, by helping to future-manage such services and review them against the sort of yardsticks that other hon. Members have said they must be measured against.

I said that the radiotherapy unit now to be based at Altnagelvin, which will be funded on a cross-border basis in Ireland, is really a roll-out of part of the wider cancer strategy in Northern Ireland. A number of years ago, I served as Minister of Finance in Northern Ireland in the first Executive following the Good Friday agreement, and then as Deputy First Minister. One of the most important things I did was when we negotiated what was called a reinvestment and reform package, with new borrowing powers coming from Westminster but also a funding package that was to complement the infrastructure fund that we as the Executive had developed.

The first item that I was able to insist on with Tony Blair and then with the right hon. Member for Kirkcaldy and Cowdenbeath (Mr Brown)—the two former Prime Ministers—was that funding should go to the regional cancer centre. It was meant to be a key part of the cancer strategy in Northern Ireland that was being led and advocated by Professor Paddy Johnston. We were able to fund that scheme, which was not coming forward and which did not seem to be breaking through in the Department of Health’s plans or budget submissions to me or to anybody else. We had been on the point of losing Paddy Johnston, who was going to go back to the United States, where he was going to be funded to do all sorts of things and use his skills.

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However, as I say, we were able to create that cancer centre without going to a private finance initiative or anything else. Great work is being done there, not only for the patients it serves in Northern Ireland but because of the calibre of people it can attract and the clinical trials it can run, which are all part of improving the picture of cancer services throughout the United Kingdom.

As other hon. Members have said, staff at that centre and others are helping to work miracles every day with people who are suffering from cancer, but they are very conscious and very clear that their task is still to keep narrowing the gap between what the services ought to be and what they actually are, which is why we constantly need to drive on performance and outcomes in these areas.

Regarding the cancer experience, I am also very conscious of a constituent of mine who wrote a book a number of years ago, based on her experience, which basically says, “I have cancer but it doesn’t have me.” She is a lady called Kate Dooher and her book sets out very clearly her experience of a cancer journey and the implications for her family, colleagues and friends. Again, policy makers can get real insight from that about what the issues mean in real and practical terms.

I am a member of a number of the all-party groups on cancer, including all-party groups on different cancers, here in Parliament. Those groups can provide a platform for those with real insights, those who are providing care, those who are leading a lot of the professional fight against cancer and those who are driving the research platform. We should not underestimate the importance of either research or the linkage between good care networks and research. That is why Cancer Research UK is one of the most prominent advocates for more radiotherapy provision, because it believes that such provision not only makes services more accessible but that it is important in qualitative terms and in the research benefits that can come from improving services and treatment models in the future.

Going back to what the hon. Member for Hertsmere said, that is why, when we are talking about the patient experience, we very much have to listen to the patients themselves and base things not on what we think is the “nice fit, reasonable fit, just about cost-effective patient experience” but think in real and wholehearted terms about the patient experience.

Patients know how they have been able to improve their own experience for themselves, and they know how services whose staff might think they work do not really work for them, and how those services can be improved and modified. We need to gain their insight and emancipate their understanding as part of lighting the way forward for ourselves.

Albert Owen (in the Chair): In calling Eric Ollerenshaw to speak, I remind Members that I will be calling the Front-Bench spokespersons at 10.40 am at the latest.

10.24 am

Eric Ollerenshaw (Lancaster and Fleetwood) (Con): I would like to think that I take the message, Mr Owen. It is a pleasure to serve under you.

It is also a pleasure to congratulate the new Minister, my hon. Friend the Member for Battersea (Jane Ellison), on her appointment. She has a reputation as a listening

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Minister and I am sure that, when she makes her closing remarks, she will prove to have listened to all of us here today.

I start off in a very partisan situation. As the hon. Member for Strangford (Jim Shannon) said, we are getting to the “cancer world”, as I call it; it is like a separate world that involves different people, often through personal experience. My experience of it is personal, but also through being secretary of the all-party group on pancreatic cancer. If I may, Mr Owen, I will give a little plug here—the all-party group is producing a report, which the Secretary of State for Health has agreed to take at a meeting on 25 November. All hon. Members will be invited to that meeting.

The report is about improving outcomes. I congratulate my hon. Friend the Member for Hertsmere (Mr Clappison) on securing this debate at this timely moment. What we in the all-party group are trying to see is a further improvement in outcomes, at a time when outcomes for cancer patients are improving. When I was growing up in the 1950s and 1960s, if somebody mentioned the word “cancer” it was almost as if a life sentence had been passed. We are in a different situation now.

Pancreatic cancer is seen as perhaps the most difficult cancer, and there are issues connected with that. I will cite some statistics to demonstrate the situation that pancreatic cancer patients often find themselves in. My hon. Friend the Member for Basildon and Billericay (Mr Baron) is far more experienced in this area than I am, and he put his finger on the issue by stressing the importance of early diagnosis.

I will give the figures from the national cancer patient experience survey: 40% of pancreatic cancer patients visited their GP three or more times before diagnosis; and 25% visited their GP five or more times before diagnosis. Those figures compare with 75% of all other cancer patients who are referred to hospital after one or two GP visits.

From the investigation that the all-party group made, I can cite the specific example of someone who came to us to give their own personal experience. They said:

“With regard to early diagnosis, the most important aspect for us was the fact that Gemma went to her GP on a total of 10 separate occasions between the middle of April 2009 and the end of August, when she was finally referred to a specialist”.

That is the experience of most people with pancreatic cancer. In my own case, I think that my partner went to the GP six or seven times before somebody then said, “Better go to a hospital.”

Then, when a patient gets to the hospital situation, quite often there is no access to a specialist in pancreatic cancer. If a clinical nurse specialist is not available, the patient is even more lost. I underline the importance that the all-party group attaches to the clinical nurse specialist in almost holding the hand of somebody with cancer as they go through the system.

Andrew Percy (Brigg and Goole) (Con): I want to tell my hon. Friend about a meeting that I had with a radiotherapist in my constituency just a week or two ago. They told me that, all too often, patients who appear for treatment tell him that they visited their GP

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on numerous occasions and, sadly, often they were sent home. I know that it is incredibly difficult for GPs. We are expecting a lot of them, but there is still a lot more to be done in ensuring that GPs across the country are consistent in their approach to people who present with certain symptoms.

Eric Ollerenshaw: My hon. Friend is absolutely right and I totally agree with him. That is the kind of information that we, as an all-party group, have been receiving from right across the country.

As I said, there is a lack of specialism, even in a hospital situation sometimes. The issue with pancreatic cancer is that there is a repetition of non-specific symptoms. Again, I cite my own personal experience from the case of my partner—he just had a stomach ache that went on and on, without a particular issue. Other hon. Members have referred to what males tend to do, and they are absolutely right; we often put these things to one side and say, “It is a stomach upset”, despite the repetition of symptoms. What we are trying to get GPs to look at is this: if they are seeing somebody who has never been to them before, somebody who never really goes to a GP but keeps turning up, an alarm bell should be sounding.

I will cite some other figures, although I am aware of the time factor. Some 33% of pancreatic cancer patients feel that they have been given conflicting information, compared with 29% of all other cancer patients. Some 13% of pancreatic cancer patients did not get answers to important questions all or most of the time, compared with 9% of all other cancer patients. Some 36% of pancreatic cancer patients felt less likely to feel that their views were being taken into account by doctors and nurses when discussing treatment, compared with 30% of all other cancer patients.

As I said, I am being totally partisan. The all-party group’s experience and my experience personally is that, for some reason, this country is way down the line on pancreatic cancer—despite it being the fifth biggest cancer, in terms of the number of people who die from it—when it comes to international comparisons for improved outcomes. There are treatments, but far too often they are far too late, because of people’s constant appearances at GPs.

Other Members have talked about dignity and humiliation. I will be utterly personal about the issue, because, in one sense, that is what has driven me to get so involved. I remember my partner’s situation. It was a case of finally going to hospital, being told that people there would do some tests and then that they would carry out an operation because they thought it was cancer. “What does that mean?” We did not know.

I can remember being sat in the hospital and my partner coming back, straight from surgery, with things wrapped round. We said, “What is it?” The doctor turned round and said, “Oh, it’s terminal.” That is the kind of situation that happens. Where is the understanding? Where are the few minutes where they say, “Let’s just go through this. Let’s look at the options”?

I understand that people working in hospitals are under pressure, but there were repeated examples of such experiences at the all-party group. As other hon. Members, particularly those from Northern Ireland,

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have said, a person should not have to be brain of Britain or have gone on a training course to have a little more time and to treat people with a little more dignity.

I finish with two particular demands, or requests, for the Minister. The all-party group wants consideration to be given to an awareness campaign, particularly about pancreatic cancer. I add my praise for the involvement of Macmillan and Pancreatic Cancer UK, which is the charity that backs up the all-party group and continues to support us, in terms of the campaign on awareness.

Macmillan has been piloting decision tools to help GPs assess the risk of cancer, including pancreatic cancer, and make decisions about further referrals. We would like to see those properly evaluated with consideration given to a full roll-out of the pilots that Macmillan has been spearheading so fantastically.

We have also been trying to raise awareness that pancreatic cancer is not an old man’s disease, in crude terms. The risk increases with age, but 35% of all diagnoses of pancreatic cancer occur in people under the age of 65—that is about 3,000 of the 8,500 diagnosed each year. The split among men and women is reasonably even, with slightly more cases in women than in men. I am not sure that that is clear, so that would be part of what we would request in a campaign. It would lead to greater awareness and, hopefully, earlier referrals and better outcomes.

My final request relates to the national cancer patient experience data. Pancreatic Cancer UK paid for a separation of data for pancreatic cancer patients—in fact, the Department of Health paid for that to be done once. We would like pancreatic cancer patients to be routinely separated out from all upper-gastrointestinal cancer patients as part of the system of getting such statistics. I do not see why a charity or the Department should try to do that as an extra thing. It should be part and parcel of the routine, given the nature and impact of this dreadful, increasingly misunderstood cancer.

10.34 am

Liz Kendall (Leicester West) (Lab): It is a pleasure to serve under your chairmanship, Mr Owen, and I really want to congratulate the hon. Member for Hertsmere (Mr Clappison) on securing this important debate.

I will start with why this issue is so important. At the risk of stating the obvious, first and foremost, it is crucial for patients and their families, and as the hon. Member for Strangford (Jim Shannon) said, many of us—not only people of his age—are affected. Today, the father of one of my dearest and oldest friends is going through yet another operation for cancer. I saw him on Saturday night. I shall spend today thinking about him and all his family, and I hope that it goes well.

We know that a good experience makes all patients feel as though they have been supported and respected as individuals, whereas a bad experience can make them feel, at best, as though their needs do not matter and, at worst, that their basic human dignity has been denied. Cancer patients whom I speak to, such as those at the local Macmillan Cancer Support group, which I recently joined in my constituency, constantly emphasise their experience of care and how they are treated by NHS staff as absolutely critical at such a frightening time in their lives. However, the importance of the patient experience goes far beyond the personal value to individuals.

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There is now strong evidence that good patient experience is consistently and positively associated with better health outcomes and safer and more clinically effective care. A systematic review of 55 studies, which was published in the British Medical Journallast year, found that good experience is linked to better outcomes for individual patients—both the outcomes that patients themselves report and objectively measured outcomes. It was also found that patients who have a good experience are also more likely to stick to their recommended treatments and medicines and to use preventive services, such as screening, immunisation and healthy living programmes.

The third reason why patient experience is important is that there is increasing evidence—from the US, if not from the UK—that it is linked to getting better value for money. A good patient experience, in the US at least, is associated with a reduced length of stay in hospitals and fewer problems with patient safety—so-called adverse patient events. Hospitals that achieve good scores on patient experience also have higher staff retention rates, which also contribute to lower costs through lower staff turnover. Understanding the link between staff experience and patient experience is absolutely essential in this debate. That is actually common sense: when staff feel valued and respected, they are more likely to treat patients in the same way.

What makes for a good experience for cancer patients? Macmillan Cancer Support says that three issues are consistently highlighted. The first is meaningful involvement in their care, not only for individual cancer patients, but for their families, too. The second is excellent communication, so the patient’s diagnosis, treatment options, risks and follow-up care are clearly and simply explained. The third is properly co-ordinated care. When people are going through a desperately difficult time, the last thing that they want to face is a battle between all the different services. They want their hospital, primary and community services, social care and wider help—such as financial information and welfare and benefits advice—brought together in a seamless package that is built around their needs and not the individual institutions. That kind of whole person care is vital to all patients, not only those with cancer, but if we can get it right for cancer patients, I think that we can get it right for all patients, too.

The previous Government made huge strides in improving cancer care through the work of the national cancer plan and the cancer networks. There is still further to go, particularly with earlier diagnosis, but major progress was made in starting to bring NHS care for cancer patients up to the standards in other countries. The national cancer patient experience survey, which was started under the previous Government, was absolutely integral to that. The latest results, from August this year, found that about 80% of cancer patients rate their care as good or excellent. However, there are warning signs that problems are building in the system, which could harm that progress.

Waits for vital cancer tests are getting longer. The number of people waiting more than six weeks for diagnostic tests, including ultrasounds, colonoscopies and gastroscopies, has increased by 65% between July 2010 and July 2013. The cancer networks that were so important in improving the quality and co-ordination of care have been abolished, with their work subsumed

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into generic clinical networks, and many staff say that that risks losing their vital specialist and local expertise. We have seen a reduction of 5,000 nursing posts since 2010, including in vital specialist services, which is putting huge pressure on remaining staff.

Many hon. Members have talked about the persistent long-term variations in the experience of cancer patients. The national cancer survey has consistently shown worse outcomes for patients with rarer cancers, for younger patients—an issue highlighted by the Teenage Cancer Trust—and for patients from ethnic minority communities, which is an issue particularly close to my heart as an MP for the very diverse city of Leicester. There are also continuing problems with ensuring that patients get the financial information and benefits advice they need and with the crucial issue of end-of-life care.

I am sure hon. Members saw the excellent report published earlier this week by Macmillan Cancer Support, which found that 73% of people with cancer would prefer to die at home but that less than a third are able to do so. Therefore, some 36,000 cancer patients died in hospital when they would have preferred to die at home. That is not only terrible for cancer patients and their families at an awful and difficult time; it does not deliver best value for taxpayers’ money either. Research by the national end-of-life care programme suggests that there are potential net savings of some £950 for every person who dies in the community, rather than in a hospital, because of the reduced use of hospital beds.

The Minister, whom I welcome to her post, may not be aware of this because she was not in her post at the time, but in the cross-party talks on Andrew Dilnot’s recommendations for funding social care, the shadow Health Secretary and I proposed removing the means test for end-of-life social care to help make choice a reality at that difficult time. I hope that the Minister will be able to update us on the Government’s actions.

I will now focus on what we need to do to put cancer patient experience much more fundamentally at the heart of the NHS. I understand that the national cancer patient experience survey is currently under review. Will the Minister commit to that survey continuing to happen during each year of the coalition? Those data are vital, but we must use them effectively. A key point highlighted by the hon. Member for Basildon and Billericay (Mr Baron), who chairs the all-party group on cancer, is that we must ensure that each clinical commissioning group is properly held to account for improving patient experience, including for cancer patients.

Currently, there are generic indicators on patient experience of hospital care and the friends and family test for acute inpatient care and A and E, but is NHS England developing more specific patient experience indicators for individual hospital services, including cancer, and, across the whole patient pathway, for primary and community services, too?

As hon. Members will know, last week, the Care Quality Commission published results of its new hospital inspection scheme, which is based on 150 indicators. I welcome and pay tribute to the excellent work of the chief inspector of hospitals, Professor Sir Mike Richards, who is the former national clinical director for cancer, but only two of the 150 indicators in the CQC’s new methodology currently address patient experience. Again,

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those indicators are generic. What plans does the CQC have to ensure that patient experience of individual services, including cancer services, is assessed? Will the chief inspector of hospitals work with the chief inspectors of social care and GPs to ensure that we join up our thinking in that area?

I will conclude on an important point relating to what the hon. Member for Basildon and Billericay said. We must ensure that we address patient experience locally and on the ground, not just nationally. Although holding CCGs to account and the CQC’s monitoring of hospitals are important, they essentially happen after the event—after care has been delivered. We must ensure that patient experience is at the heart of what all parts of the NHS and all staff do day in, day out. I have two suggestions for how we can make that happen.

First, we have to transform the use of what I call real-time patient feedback—not annual surveys or annual monitoring, but day in, day out use of patient feedback. There are brilliant services such as Patient Opinion, which allows patients to tell their story, positive or negative, online, by phone or in writing. Hospitals, GPs and social care providers that register with Patient Opinion can see what people are saying about them on that same day. I know because I used the service when I had to make an unfortunate visit to an urgent care centre this time last year. Patient Opinion is a powerful tool for individual patients to tell their story, for members of the public to see what others are saying about their service and for staff to hear first-hand, immediately what they can do to improve the quality of care. What plans do the Government have to encourage greater use of such services across the NHS and social care?

Secondly, the education and training of NHS staff is important. Last week, I visited the university of Worcester, which is doing pioneering work. Patients and users help to interview student nurses who apply for the course to ensure that they have the right values and attitude. Patients and users help to develop the curriculum used to train student nurses and other health professionals to ensure that it covers the issues that really matter to patients. Patients and users are also an integral part of the course, and they help with the training process.

In Leicester, we also have a groundbreaking project between De Montfort university and Macmillan Cancer Support in which students training to be nurses, NHS managers or pharmacists volunteer for Macmillan. Those students get vital skills and experience of communicating with cancer patients. How will the Government ensure that such work to improve the skills, knowledge, experience and training of staff starts when they begin working for health services? What vital work is being done to hold CCGs to account and to monitor the quality of care in hospitals?

Albert Owen (in the Chair): I also congratulate the Minister and welcome her to her new role.

10.47 am

The Parliamentary Under-Secretary of State for Health (Jane Ellison): Thank you, Mr Owen. It is a pleasure to serve under your chairmanship.

I congratulate my hon. Friend the Member for Hertsmere (Mr Clappison) on securing this debate. I am conscious that I am still relatively new to my post—I am in my

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fourth week—so if I am unable to respond in total detail to some of the points raised, I will undertake to get back to the relevant hon. Members.

This has been a very good debate. Many extremely constructive points have been made, and there have been some thoughtful contributions. Members, some of whom have not been able to stay for the end, have brought great insight and experience to the topic.

Cancer patient experience is close to our hearts, and I echo the tributes paid to NHS staff and, particularly, to the charities that campaign in this area. We have all taken part in moonwalks and Macmillan Cancer Support fundraisers or gone round at the back of the race for life year after year talking to cancer survivors and people running or walking with the names of loved ones on their chests, and we know what amazing work those charities do, particularly on highlighting patient experience.

In England, each year more than 250,000 people receive a cancer diagnosis. As we have heard this morning, being diagnosed with cancer can be a traumatic experience. Like the shadow Minister, a dear friend of mine has just had that experience, so I am going on that journey with my friend to understand how she will be cared for and treated as she goes through what I hope will be a full recovery.

We know that receiving personal care that is responsive to people’s needs is vital. The Government have committed to making England a global leader in producing great cancer outcomes. We are making strides, but we know there is further to go. We are improving access to treatments, including investing £750 million during this Parliament, and we are strongly committed to saving an additional 5,000 lives by 2015.

The cancer outcomes strategy remains at the core of what we are doing and what we hold the NHS to account for in terms of delivering. However, if the NHS is to deliver high-quality care, patients’ voices and experiences are vital, and I could not agree more with what everyone has said about the end-to-end experience of care being important and a big part of recovery.

My hon. Friend rightly asked that the NHS give parity of esteem to the patient experience, alongside patient safety and clinical effectiveness. I agree, and through the mandate we have asked NHS England to deliver continued improvement in patients’ experience of care. Domain 4, which is one of the key areas of the NHS outcomes framework, is

“Ensuring that people have a positive experience of care”.

I reassure my hon. Friend that that is of equal importance to the other key areas.

Mr Clappison: I was remiss in not welcoming the Minister to her post. I welcome her most warmly, and I am sure she will do an excellent job. Will she take on board the fundamental plea made by Macmillan Cancer Support and echoed in the debate that the patient experience be put at the heart of the inspection process and of the assessment of different NHS organisations? Will she ensure that that is made a real priority?

Jane Ellison: Absolutely, and I will talk a little about some of the ways in which that will be done, but I would make the point that the Secretary of State has made this an absolute priority. He could not have been clearer recently about the priority that the Government and he

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personally put on the patient experience. We have never given such high-profile attention to talking about the patient experience and patient care. I hope that gives some reassurance, but I will talk later about some specifics.

In the same vein, let me pick up some of the shadow Minister’s interesting points. I was interested in some of the initiatives she mentioned. Again, they all feed into the idea of putting patient care and the patient experience absolutely at the heart of things. I certainly undertake to look at some of the specific local examples she highlighted.

To drive a good patient experience, we must listen to patients’ voices. In December 2010, the Government published the first national cancer patient experience survey report. The survey was the first cancer patient survey to take place for six years, the first to involve patients with all types of cancer and the first national survey explicitly to use the word “cancer”. The survey revealed that, while there had been substantial improvements in the patient experience since 2000, there are still unacceptable variations in the quality of care people receive, as hon. Members have highlighted.

To drive improvement locally, reports were produced for individual trusts. This is where the transparency agenda the Government set such store by is really important. The data are openly available and published, and all of us—not just people in the NHS, but hon. Members, local councillors and local government—can hold commissioners and providers to account, based on that openly published data at local trust level. Commissioners and providers can be directly challenged and incentivised to improve. Providers can benchmark their performance against each other’s. Quality Health, which provided the survey, also visits poor-performing trusts to discuss their results in detail. A number of those discussions have led to really quick improvements in local outcomes, but there is always more to do.

The cancer outcomes strategy, which we published in January 2011, built on those results. We have acted to improve the patient experience at national level by implementing the cancer information prescriptions programme and expanding the Connected national advanced communications skills programme, which is a bit of a mouthful, but which is essentially about supporting thousands of clinicians to work more effectively with patients, picking up the many issues highlighted by my hon. Friend, the hon. Member for Strangford (Jim Shannon) and others regarding how seemingly small issues and small aspects of communication actually matter an awful lot at an intensely difficult time for patients and their families.

Since 1 April this year, NHS England has been responsible for delivering improvements in the cancer patient experience. That is one reason why I cannot just stand here and make particular commitments. Such debates are, however, useful because they help NHS England to know parliamentarians’ priorities in terms of where it should focus some of its attention.

Building on the work of the 2010 and 2012 patient experience surveys, NHS England published its report on the 2013 survey at the end of August. It showed improvements in many areas and some very positive experiences of aspects of care, including on privacy, being treated with respect and being listened to. Overall, 88% of cancer patients reported their care had been

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excellent or good, and there were some real highlights. As my hon. Friend highlighted, some of the percentages in key areas were in the 80s and 90s, although we are obviously interested in the areas where we could do better.

It is clear that many trusts acted on the findings between 2010 and 2013, and they are to be congratulated on that. Many have reorganised their pathways and services, retrained staff and created further mechanisms for patients. Cancer charities have been involved in further analysing the data to understand particular aspects of care and particular groups of patients and to create new information for patients, where needed. Much of that has been touched on this morning.

We have also looked at some of the variations in care. The hon. Member for Strangford and others mentioned care plans. Over the past three years, more work has been done on them, but given that only 22% of patients were offered care plans, everyone would acknowledge considerable improvement is still needed.

NHS England has convened a cancer patient experience advisory group to get direct input on priorities for service improvement. The group includes clinicians, experts concerned with cancer care and, crucially, patients. The group’s first meeting has now taken place. It examined the results of the 2013 survey, and actions have been agreed. As a result, NHS Improving Quality will develop a rapid-response programme to visit trusts with poor scores to discuss results and suggest improvements. I hope that gives Members some assurance about the fact that the survey does not just sit there; it is very much being acted on.

NHS England also wants to highlight high-performing trusts and identify best practice. It will put that information into toolkits that other trusts can use to develop better service in response to poor scores. NHS England is also encouraging the use of the Macmillan values-based standard and other patient-led tools, which engage patients and staff in co-creating and measuring some of the things that matter so much with regard to dignity and respect. All organisations involved in delivering care are urged to look at the survey and take it extremely seriously.

Time is a little short, so I will try to answer some of the specific questions raised. First, we recognise that making relational care a priority is important. That includes communication, trusting nurses and all the

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other things that have been talked about today. Rather than include references in the mandate, we have included important pledges in the NHS constitution, setting out what patients have a right to expect. All NHS services have a duty under the constitution when carrying out their functions, and we have a range of indicators to capture how well the NHS is performing in delivering dignified and personal care.

On the CQC inspection regime, I can reassure my hon. Friend that the CQC has made a commitment to listen and to take the experiences of people using services very much to heart. The new inspection teams include trained members of the public called “experts by experience”. In addition to public listening events, that will be an important way of putting patient experience at the heart of inspections.

A specific question was asked about including secondary breast cancer in the survey. NHS England is trying to ensure the survey catches the needs of all patients and looks across all cancers, but my hon. Friend’s point will have been taken.

I was asked about the future of the survey, including by the shadow Minister. NHS England has confirmed it will be run in 2014. The organisation will then undertake a review of all the surveys it runs. The debate will have highlighted to it the value that so many people place on the survey and the important role it has played in driving improvement. I cannot say whether NHS England will continue it, but I will certainly vividly describe to NHS England how strongly Members feel and what role they think the survey has had in driving change.

My hon. Friend’s last question was about using the survey to improve cancer care, and I have alluded to the ways in which we are trying to do that. In particular, I give him the assurance that the patient experience, putting the patient first and championing their care is absolutely at the heart of what all of us at the Department of Health are doing, taking our lead from the Secretary of State.

I thank my hon. Friend for highlighting the issue, and I echo his words from the start of the debate. I, too, thank the NHS staff and charities that do such amazing work in this area, and I hope hon. Members will continue to debate this important topic.

Albert Owen (in the Chair): I am grateful to the Minister, the sponsor of the debate and all the Members who took part.

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Jam and Similar Products (England) Regulations 2003

11 am

Tessa Munt (Wells) (LD): I am concerned that this debate may herald the end of the British breakfast as we know it. Following a consultation, the Department for Environment, Food and Rural Affairs has ordered a reduction in the permitted sugar level for jams, jellies and marmalades from 60% to 50%, and the removal of the UK national limit for reduced-sugar jam and of the national provisions for curds and mincemeat. The focus of my opposition is the reduction of the permitted sugar levels for jams, jellies and marmalades, and the removal of the national provisions for curds and mincemeat, which sounds their death knell.

Reducing permitted sugar levels from 60% to 50% would in time destroy the characteristic quality of British jams, jellies and marmalades, and could mislead consumers. We all know what we expect when we go to the supermarket: something of beautiful quality with beautiful colour, with a shelf life of about a year. Traditional jams use cooked fruit, without additives—that is important: the quality of those preserves is determined by the proportions of sugar, fruit, pectin and acid. If the total sugar percentage is reduced, the characteristic gel in the consistency of jams, jellies and marmalades will be lost, and the result will be a homogenised, spreadable sludge, bearing no resemblance to the product we know and enjoy in England as British jam.

Scientists who worked at Long Ashton agricultural research station at the university of Bristol in the 1920s examined the shelf life of jam and other, similar products. The recommendation that they made was for a minimum sugar content of 60%, regardless of the type of fruit used in the recipe. That ensured a good shelf life of at least a year. The 60% level has its origin not in Brussels, as many people think, but in Bristol.

Of course, many people are slightly squeamish about the sort of thing that my grandmother would do—opening jam that had not been used for a couple of months and scooping the top off, where it had fermented slightly. Many people fear greatly, for food safety reasons, that they should not eat jam when there is a bit of fluff on the top, but it is important to understand that jam has a shelf life of a year.

Mr Tobias Ellwood (Bournemouth East) (Con): I am grateful to the hon. Lady for bringing this important and interesting subject to the House. Can she put the recommendation into context? Many recommendations, good and bad, make their way into the annals of Brussels. Not all of them come out of the sausage machine as legislation. What stage has the idea reached, and does the hon. Lady’s presence here today, outlining its daftness, mean that there is scope to stop it in its tracks?

Tessa Munt: I rather hope so. That is a question that the Minister will be able to answer. I understand that he signed the order last week, but that the statutory instrument has not been put before Parliament. I hope we can stop it dead in its tracks.

As well as today’s debate, there has been an amazing amount of publicity, including my debates with the Minister this morning on Radio Somerset and Radio

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Devon—and I have a little list of people who want to talk to me about jam later today. I suspect that all that shows that the public are greatly interested. Sometimes, Departments want to slide regulations through, and those things do not always hit the public. We do not all read the Parliament website and DEFRA press releases. I forgive the Minister that, but it is good that we are having the debate.

The new regulations are part of the Government’s red tape challenge to reduce the regulatory burden on industry—particularly on small and medium-sized businesses. They revise the Jam and Similar Products (England) Regulations 2003, which I regard as completely adequate. Those regulations state that the percentage of soluble solids content for jams, jellies and marmalades must be 60% unless the product is one with reduced sugar, when it has a permitted percentage of between 25% and 50%.

There will be encouragement to make more reduced sugar products, as they might be perceived as more healthy. Some jam manufacturers have urged caution with the percentage. The Department’s impact assessment document for the new regulations cited a potential for increasing the risk of spoilage. Currently, reduced-sugar products, with a percentage of 25% to 50%, may contain chemical additives to ensure that they have a good shelf life, which sugar will give naturally. Potassium sorbate or E202 will be added if we reduce the level of sugar in jam.

At a time when public attention is being directed to the content of food, it seems inadvisable to encourage the unnecessary production of food items with additives and artificial flavours. With a 60% sugar content, the colours of sweet preserves are bright and the fruit is fantastic. A lower percentage produces products with a darker, muddier colour, which may affect consumer confidence in a well known British product. In addition, if the consistency lacks the characteristic gel, and is more like that of a fruit spread or fruit butter, consumer confidence in the properties of jam and other products may be lost. I urge the Minister to consider calling things fruit spread or fruit butter, as happens on the continent.

The 50% permitted sugar level will be lower than the 55% minimum adopted by France and Germany; something similar is done in America as well. The jams produced by those countries have always been different from ours. I spent some of my summer in France, and what they call jam is completely different from what we expect to pluck from the shelves in shops, farm stores and supermarkets.

Historically, continental jams and similar products have been made using completely different methods. The countries I mentioned do not make products whose consistency has the characteristic British gel; to make their jams, fruit and sugar are cooked together or soaked and then cooked together. They are referred to as soft set products, and have a loose, almost pouring consistency.

British jams are traditionally made in two stages. The fruit is cooked, either with or without water, to extract any acid and pectin. Sugar is added to the cooked mixture, dissolved and then boiled to a setting point. Marmalades are made by first cooking the citrus fruit in water and then dissolving sugar into the cooked mixture and boiling it to a set. Jellies are made by

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cooking fruit in water and straining the cooked mixture through a jelly bag. The residual juice is boiled with sugar to a setting point. We in Britain love our jams, jellies and marmalades to be traditionally made, to produce a natural set.

The consumer was clearly protected by the Jam and Similar Products (England) Regulations 2003. A product labelled as jam had 60% sugar and consequently had the traditional characteristics I have described. Reduced-sugar jams had to be labelled as such, which alerted the consumer to the fact that they were a different product.

There is no appetite for a reduction among some of the high quality manufacturers in England, Scotland and Wales—notably Wilkin and Sons of Tiptree, Mackays, and Wendy Brandon Handmade Preserves; I note that the hon. Member for Witham (Priti Patel), who has Tiptree in her constituency, is present for the debate. The regulations have been driven by a small number of small producers to increase their sales of apple-based spreads, which they want to label as jam. They are nothing like traditional British jam—I have tasted them. Given the high acid and pectin properties in cooking apples, it is possible to set the product with less sugar, but that does not apply to all fruits, as the pectin and acid content varies between them.

As a member of the women’s institute of Mark in Somerset, I am curious to know how the National Federation of Women’s Institutes responded to the regulations. Historically, the WI is the best known organisation to give instruction—to its members and the wider public—on the characteristics of sweet preserves. Its publication “On With The Show” lists the criteria for judging those preserves.

I understand that out of the 132 organisations consulted by DEFRA, the National Federation of Women’s Institutes was one of a handful claiming to have received a consultation letter. Sadly, I understand that it declined to respond, but the WI will be left with its rules to consider. How will the new products be judged in competitions and how will preservation judges’ training courses be affected? I can only assume that the WI will leave its rules unchanged, as preserves with the traditional characteristics are the only naturally produced ones with a long shelf life.

Deregulation of the provisions for curds and mincemeat, as listed in the 2003 regulations, would stimulate the creation of other products labelled as curds and mincemeat. In 2003, DEFRA asked the industry whether it wished to retain the national rules for curds and mincemeat, and the overwhelming response was yes. At the time, the industry felt that there was a need to set minimum rules to ensure the quality of the products and to prevent poor quality or inferior substitutes. The 2003 regulations included a minimum sugar content of 65% for curds and mincemeat. Those rules were notified to the European Commission, as required, and there were no objections to the UK’s setting rules in that area. Curds and mincemeat have continued to be UK-specific products.

In spite of that, DEFRA’s impact assessment for the new regulations suggested that the deregulation of curds and mincemeat would cut red tape and free the industry to innovate and/or reformulate, provided that the customer was not being misled. Curds and mincemeat are uniquely

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British, with their origins firmly established for centuries; they are not part of the culinary culture of other European Union member states.

Curds and mincemeat are made using a small list of specific ingredients. Mincemeat has a history traceable back to the late 17th century, in the period following Cromwell’s two-year ban on Christmas festivities. After his death, and once Christmas had been reinstated as a festival, the mincemeat that we know today was introduced—a product with a quantity of vine fruits, sugar, citrus peel, suet or equivalent fat, and optional alcohol.

Fruit curds, lemon curd in particular, became well known in England in the late 1800s. Recipes with eggs, butter, sugar and fruit were called transparent puddings; the method of storing them in jars became popular in the 19th century. Fruit curds are an emulsion of edible fat, sugar, whole egg or egg yolks—or both—and fruit. The 2003 regulations specify percentages of ingredients for the quantity of fat and eggs for every 1,000 grams of the finished product. The quantity of fruit is sufficient to characterise the finished product.

For mincemeat, the 2003 regulations specify the quantity of vine fruit, suet and citrus peel used for every 1,000 grams. Curds and mincemeat have a soluble dry matter of 65%, unless they are reduced-sugar products. Any product with less than 65% is labelled as a “low sugar substitute”. Deregulation would stimulate the introduction of products materially different from the existing definitions of curds and mincemeat. There is no case for deregulating curds and mincemeat.

I have some particular questions for the Minister. The 2003 regulations were based on scientific research. Is the Minister aware of any published research that supports the new regulations? For producers, there is an attraction in using the words “jam”, “marmalade”, “jelly”, “mincemeat” and “curd”—how can DEFRA be confident that consumers will not be misled when lower-sugar fruit spreads are labelled as jam, despite being very different from traditional jams?

I understand that the Minister has signed the proposals, but the statutory instrument has yet to be laid before Parliament. How can we keep the jam regulations unchanged? Now that the matter has received additional public interest and scrutiny, what should members of the public do to change the Department’s mind? What criteria will the Secretary of State or the Minister be using to review the regulations?

If we really want to have continental jam, we can go to the continent, or we can buy it. So far, I have resisted the temptation to use all the amazing jokes that have come out—

Mr Ellwood: Go on!

Tessa Munt: Perhaps I shall.

Priti Patel (Witham) (Con): I congratulate the hon. Lady on securing this important debate. She has already highlighted the fact that the world’s greatest jams and marmalades are made in my constituency, in Tiptree. There is no doubt that we have the best jams in the world, and we export a lot of them. Does she not agree that the Government should be working with producers with a great international reputation for exporting their

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jams throughout the world, so that we can increase our profile and market share internationally and outcompete Europe?

Tessa Munt: I could not agree more. I do not agree with the idea that the new proposals will encourage exports; we will end up exporting, and importing, more gloop, as opposed to having something that we all know well—British jam, jelly, marmalade, curds and mincemeat are completely classic British products. If we want to export them, we need to help people to do so, but we need to keep the quality and the standard of what we see on the British breakfast table.

As I was about to say, the Minister seems to have found himself in a sticky situation, or in a bit of a jam. Jam today, please, but I would like to see jam tomorrow as well.

Albert Owen (in the Chair): I call the Minister to entertain us by spreading the DEFRA word.

11.14 am

The Parliamentary Under-Secretary of State for Environment, Food and Rural Affairs (George Eustice): Thank you, Mr Owen. I also thank the hon. Member for Wells (Tessa Munt) for securing the debate, which has indeed gathered a bit of interest. The hon. Lady and I had a dry run of this discussion in the media this morning. I can understand her concerns about some elements of the proposed changes, but I feel that there is a degree of role reversal—as a Conservative who is sceptical about having the EU telling us what to do, I am all up for loosening regulations and letting markets decide, so to hear a Lib Dem taking such a strident position on the issue was surprising.

I come from a family involved in fruit farming. The jam industry is itself important, but having it as an outlet, a market, for the fruit industry is also important. One of the things that I learned, to my cost, while trying to grow strawberries is that a lot of things can go wrong in the fruit industry, whether bad weather, bruising of fruit or pallets of fruit tipping over, so having the jam industry market for some of the damaged fruit is very important. I ought to let the House know that my family’s business, Trevaskis Farm, makes jam for sale in small quantities through the farm shop. I have a little knowledge of the area through that.

To provide the context, the proposed changes to the regulations are part of DEFRA’s contribution to the Government’s red tape challenge initiative. The regulations were one of a number that were identified under the food and hospitality theme that could benefit from improvement and where potential savings could be delivered to businesses. The jam regulations were identified as an area in which we could consider changes that might provide businesses with greater flexibility and less restrictive rules.

One impetus behind the change was a request by some in the industry for the UK to consider taking up an optional derogation in the EU jam directive that permits—but, crucially, does not require—a sugar level lower than 60% to be set, which is something that a number of other member states have already done. The derogation allows member states to set a lower minimum sugar level for jam and similar products.

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Organisations such as the Food Processors Association, an organisation that incorporates the United Kingdom Sweet Spreads Association and represents many in the jam industry, were keen for the Government to amend the regulations to ensure that the UK was on a more level footing with other major EU jam manufacturing countries, such as France and Germany.

Tessa Munt: The clue is in the title, the Sweet Spreads Association, and that is not jam. The Minister should come cooking with me—I do not know what else I can do, but suggest a master class in jam cookery in DEFRA. Let us have a go. Frankly, if people want to call something a fruit or sweet spread, they may, but they should not be calling that stuff jam.

George Eustice: All right. Since that original request, which was for a minimum permitted sugar level of 55%, others have requested that we consider lowering the minimum permitted level even further, to 50%, which would remove the so-called no man’s land that currently exists between sweet spread products, which are supposed to be below 50%, and jam products, which are supposed to be 60% or above.

After considering all the responses, we decided to reduce the minimum permitted sugar level for jam from 60% to 50%, but to retain the national provisions for fruit curds and mincemeat—an issue that the hon. Lady raised later in her speech. That will all be subject to the necessary clearances. The reduction in the minimum permitted sugar level to 50%, however, delivers the greatest flexibility to the industry as a whole, in a way that will not be detrimental to those who are in compliance with the existing regulations and can continue to make their jam as they do now.

The hon. Lady has expressed concerns about the possible impact on British jam, but I believe in the market—the market will dictate what does and does not sell. I mentioned earlier that my own family’s farm business produces small quantities of jam for sale through the farm shop. I took the liberty of talking last night to my mother, who is in charge of making the jams. She said that there has been a trend among consumers over the past 10 to 15 years to seek out products with lower sugar levels. They want products with more fruit and less sugar. We should not resist that, if there is a market demand for such products. They do not have to be the gunge or dreadful products that the hon. Lady mentioned —I assure her that the products sold in our farm shop are very good.

Tessa Munt: I have been contacted by diabetics and others who require products with a reduced sugar level and that is fine, but they are always accurately labelled on supermarket shelves and in farm shops as reduced-sugar jam. People know what they are buying. But if everything with a minimum sugar level of 50% and above can be called jam, there will be utter confusion about what is really jam and what is a fruit spread or whatever.

George Eustice: I understand that. The sugar content of a fruit spread is supposed to be below 50%, so we are removing that no man’s land between 50% and 60% and allowing products with a sugar content of below 60% but above 50% to be labelled as jam.

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My hon. Friend pointed out that the 60:40 sugar-to-fruit ratio was recommended following research at the Long Ashton research station in Bristol in the 1920s. That was a long time ago and since then there have been technical advances and recipe experimentation. In the last few years, our market has included fruit spreads and jam with a sugar level of less than 60% with no increased spoilage reported. The reduction of the minimum requirement to 50% removes the current gap for products that fall into the 50% to 59% category. The flexibility delivered by the change will help to ensure that British jam manufacturers remain competitive because they will have the option to market their jam products with a higher fruit content on a level playing field with other member states.

It is worth reiterating that we are talking about a minimum permitted sugar level. That does not mean that existing manufacturers must work to the new minimum.

Mr Ellwood: I congratulate the Minister on his position. I do not know whether the Prime Minister had the foresight to appoint him knowing that this question about jam was coming his way. He seems perfectly placed to take the matter forward. If the producers of “Celebrity Masterchef” or the “Great British Bake Off” are watching, there may be some invitations coming through to pursue it further.

The Minister said that manufacturers, wherever they are based, in Dorset as well as other places around Britain, may continue to do what they are doing now. Will he confirm that no one in the industry will be affected by the prospect of a change in the regulations and that they may continue to do what they are doing now?

George Eustice: That is the case because these are minimum not maximum requirements. If there were a maximum requirement requiring all jams to have 50% sugar we would be having a totally different discussion. We are discussing minimum requirements and giving the industry flexibility. Those who want to develop products with a lower sugar level that they can market in Europe will be able to do so, and traditional jam manufacturers who want to retain a 60% level, are resistant to any change and do not accept that there have been changes in techniques or recipes may continue as at present and market their products as traditional jam with a premium in the market.

Tessa Munt: If the minimum level is set at 50%, all the organisations that are making jam with less than 60% sugar will be entitled under the regulations to call their products “jam”, not “reduced-sugar jam” or whatever else they are attempting to make. We need that clarity for the British public’s attachment to jam and what it means. I have bought stuff from supermarket shelves that is like mud—it has lost its colour, it is not the right texture and it is a completely different product. All those products will be entitled to be called jam.

George Eustice: I do not think it is in any company’s interest to market products that, to use my hon. Friend’s words, taste like mud. We must let the market decide. Makers of brands who passionately believe that a quality

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product must have 60% sugar will carry on with that. Nothing in the change will affect that. If my hon. Friend is right and brands with a lower sugar content will have an inferior product and if customers conclude that, as she suggested, they taste like mud, they will not buy it again. The market for that product will be small. In a free market economy, we should have a light-touch approach to regulation, and that has come out of the Government’s red-tape challenge. The market must decide. If my hon. Friend is right, the market for such products will be small.

Our changes will provide jam businesses with increased flexibility. We are keen to help small businesses that are trying to break into the market, and some exciting new products are coming on to the market based on the unique British Bramley apple. Jams made from it set more easily because of its high pectin content and do not need quite as much sugar. My hon. Friend said that the market for such products is small, but an internet search showed quite a number of products using Bramley apples as part of a mixed jam, such as Bramley and blackcurrant and Bramley and blackberry. There are exciting prospects for them, and there is nothing more British than the Bramley apply. We are almost unique in Europe in having specialist culinary apples rather than just generic apples. This is a good potential market for our excellent Bramley apples.

The regulations will be improved in respect of reduced-sugar jams. Since 2006, when new regulations on nutrition and health claims were introduced, there has been an overlap with the 2003 regulations that specify that a reduced-sugar jam must have a sugar content of between 25% and 50%. In contrast, the nutrition and health claims rules require all products labelled “reduced sugar” to have at least a 30% energy reduction compared with a standard product. To sort out this discrepancy, we are doing away with the specific rules for reduced-sugar jams so that they will need to comply only with the same rules as all other foods. That will provide improved clarity for the industry and consumers, and respondents to our consultation agreed it would be much simpler to work with one set of rules in this area.

We consulted on the proposed changes earlier in 2013 and received some useful contributions. One option that provoked strong opinions was in response to whether the UK’s national provisions for fruit curds and mincemeat—the sort in mince pies—were still useful or whether they could be removed. I can reassure my hon. Friend, who highlighted many concerns, that although she may not agree with our proposals to reduce the minimum sugar content of jam, we have acted on the evidence put to the Department and we will not change the regulations on fruit curds or mincemeat.

The main justifications cited were that curd and mincemeat standards help to maintain the production of these uniquely British products whose origins are firmly established and go back centuries. They are not part of other member states’ culinary culture and UK producers manufacture them to traditional recipes. The current rules reflect those practices.

The standards provide an important yardstick and their removal could result in a reduction in quality and could stimulate the introduction of products that are materially different from our current traditional curds and mincemeat products. So, as a direct result of the cogent arguments put forward in the consultation process,

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including a response from my hon. Friend’s constituent, Mrs Lloyd, we will retain unchanged the national provisions for fruit curds and mincemeat. That decision is positive and demonstrates the benefit of consultation to help to ensure that the final policy decision is fit for purpose.

Mr Ellwood: At the heart of the matter is a description of what is on the shelf so that people can recognise the sugar content and whether it is really British jam or from elsewhere with a different content. Will the Minister consider a jam kitemark or indication so that people can recognise true jam as defined at present and the different spreads that we may see more of from the continent?

George Eustice: As I said, I am a great believer in the market. Individual jam manufacturers who pride themselves on their brand and who passionately believe that jam must have 60% sugar to be good will be able to market their product as a niche, specialist product. If there is no market for products with less than 60% sugar, it will not develop. It is for the industry voluntarily to come together if they want to and jointly market traditional jams. I welcome this important debate, which has provided exactly the detailed scrutiny that the House should undertake.

11.30 am

Sitting suspended.

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Electric Vehicles (Vulnerable Road Users)

[Mr Jim Hood in the Chair]

2.30 pm

Mrs Mary Glindon (North Tyneside) (Lab): It is a great honour to introduce this debate under your chairmanship, Mr Hood, and I am grateful to colleagues for coming along today.

In June this year, at the request of a number of my constituents, I attended a reception, here in Parliament, for the “Safe and Sound” campaign run by Guide Dogs. It was there that I was alerted to the dangers faced by blind and partially sighted people from silent electric cars. The development of electric and hybrid vehicles is very much welcome across the country; they reduce the cost to motorists who buy them, and they are important for our greener environment. I have to say, parochially, that their success is particularly important to the economy of my region, the north-east, where Nissan in Sunderland has invested more than £400 million in the development of the Leaf electric vehicle. In addition, the Government have pledged more than £800 million in subsidies for the ultra-low emission market.

However, the downside to such vehicles is that they are so quiet that they pose a danger to members of the public, and particularly the elderly, the blind and the partially sighted, all of whom rely on hearing sound to judge when it is safe to cross the road. Guide Dogs “Silent but Deadly” report, which is an excellent report that I am sure everyone here today has read, states:

“If you can’t see or hear a vehicle approaching, how do you ‘stop, look and listen’ to stay safe?”

Statistics and research show that electric cars pose a greater threat to vulnerable road users than average vehicles. Research conducted by the University of California showed that some quiet vehicles travelling at low speeds cannot be heard until they are just one second away from impact with a pedestrian.

Mr Andrew Smith (Oxford East) (Lab): I congratulate my hon. Friend on securing this enormously important debate. As well as this issue being important for those who suffer from hearing or sight impairment, would she also add to her list of those who are vulnerable from these otherwise very welcome vehicles, children and cyclists, who often rely on the noise of an approaching vehicle to alert them to the fact that something is behind them?

Mrs Glindon: I thank my right hon. Friend for that intervention. It is understated, or perhaps more widely taken for granted, that those people are also vulnerable—in fact, who among us are not? We must remember that being able to hear a vehicle also allows road users to judge the direction and speed of nearby traffic, which are crucial factors in deciding when it is safe to cross the road. For all pedestrians, 80% of our perception to danger is from our hearing.

Jim Shannon (Strangford) (DUP): I congratulate the hon. Lady on bringing this matter to the Chamber for our consideration. I suspect that every one of us in the House have had the opportunity to do a walk with the Guide Dogs association, where we put on a blindfold

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and do a 2-mile walk through a very busy town. If ever an illustration was needed of how dangerous it is for a blind person, and how vulnerable they are, that is one way in which the message is brought home very quickly. Does she feel that when it comes to electric cars, there is an onus on the Government—perhaps the Minister will address this point today—to have some sort of method of warning people, whatever that may be? I am not an expert, but blind people and vulnerable people need to be protected on roads and on footpaths.

Mr Jim Hood (in the Chair): Order. For future reference, that sounded more like a speech than an intervention. I hope that any other intervention will be a lot shorter than that.

Mrs Glindon: The hon. Member for Strangford (Jim Shannon) is right, and the tenet of our debate today is to ask the Government to do more. I have to confess that I have not yet done a walk around with a blindfold on, but I know people who have, and I do not think that any of us here who are blessed to have our sight can imagine what it is like or what the dangers are until we have experienced what people with poor sight or no sight have to experience.

Research by the TAS Partnership that was published only last month shows that electric and hybrid vehicles were involved in 25% more collisions, causing injury to pedestrians, between 2010 and 2012, than conventional vehicles. Moreover, between 2005 and 2008, crashes involving quiet vehicles trebled. In 2011, research for the Department for Transport found that electric and hybrid vehicles were far more difficult to detect than internal combustion engine vehicles at the lowest steady speed and, when pulling away from rest, at the lowest speed. EU research has shown that 93% of blind and partially sighted people have experienced difficulties with electric vehicles.

All those figures are very concerning. The fact that people have been injured in accidents with these vehicles is frightening enough, but as Guide Dogs has pointed out, loss of confidence is also a massive problem for blind and partially sighted people, and a bad experience, as already described, could ultimately lead to someone not wanting to leave their home, and therefore losing their independence. Many blind and partially sighted people are easily discouraged from independent mobility if any element of their journey is adversely impacted by outside factors. Guide Dogs estimates that about 180,000 blind and partially sighted people never leave home alone.

Research by the eVADER—electric vehicle alert for detection and emergency response—project found that 91% of blind and partially sighed people want to see quiet vehicles recognised as a problem, and with 81% of the general public, according to a survey by Orange, wanting electric vehicles to emit a noise at a level equivalent to conventional vehicles, it is surely time for the Government to act.

Mr John Leech (Manchester, Withington) (LD): I thank the hon. Lady for giving way and I welcome this debate. Is she aware of any evidence that the situation has resulted in people with electric cars getting higher

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insurance premiums? If there have been more accidents, insurance premiums will be higher. That would be an incentive for makers of these cars to increase the noise levels, so that in future, people will not get higher insurance premiums if they buy these cars and are more likely to have an accident.

Mrs Glindon: I thank the hon. Gentleman for that intervention. Unfortunately, I have not looked at insurance, and it has not come up in anything that I have looked at, but that seems to be a logical step to take and a convincing argument, if not for insurers—well, even an insurer would have to pay out, so I hope that the Minister will say something about that.

In 2010, Japan and the United States legislated for alert systems to be put into cars. Any such system is cheap and simple to fit, and in the UK it would add only about £20 to the cost of a car. I am sure that everyone here would agree that that is a very small price to pay for road safety.

In February this year, Members of the European Parliament voted for an amendment to the EU regulation on the sound level of motor vehicles to make acoustic vehicle alerting systems mandatory for all quiet vehicles. That amendment is now being negotiated by the European Commission, European Council and European Parliament. The UN Economic Commission for Europe is developing a global technical regulation to specify standards for AVAS around the world. It will be finalised next year and will form the basis of the EU regulation, but unfortunately it seems that our Government are pushing for only the voluntary introduction of AVAS and have reservations about making those systems mandatory.

I ask the Minister to say why the Government think that making the systems mandatory will place a financial burden on car manufacturers when, as I said, the inclusion of such a system will add only £20 to the cost of a car. Motor manufacturing companies are not averse to developing alert systems. Nissan, which I make no apology for mentioning again because it is a local car company and therefore I have been in contact with it, has been researching and working with cognitive and acoustic psychologists to produce a practical system that is safe and environmentally friendly. Many technical issues need to be considered with regard to the right sound in order to be heard without encroaching on the environment, but it is good to see that companies such as Nissan, which has been so successful, are being proactive in this field.

It was greatly concerning to learn that the Government do not accept the national and international evidence of which I have spoken. It does show a link between silent vehicles and a road safety threat to vulnerable road users. Does the Minister think that the opinions of organisations such as Guide Dogs, the Automobile Association and the Royal Automobile Club are not trustworthy on this matter?

The next EU negotiation on the matter will be on 5 November, and an agreement must be reached by the time of the next Transport Council in December in order to be finalised within this EU Parliament. There are already nearly 3,000 electric cars and more than 133,000 hybrid vehicles on our roads. What commitment will the Minister give to make AVAS in electric vehicles mandatory, so that the many more motorists who will be buying these cars and other road users, especially the

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most vulnerable, can all be confident that they will be able to travel safely in the future? I hope that he does not agree with his predecessor—now the Minister for Crime Prevention—who, in a reply in July to a letter that I had sent him, said:

“To date the number of electric and hybrid electric vehicles on the road is small compared to conventional vehicles and more data will need to be gathered over the next few years before we can be certain of the best approach.”

As I said, the Government have already committed more than £800 million. Car manufacturers are committing large sums. People are buying these cars. We shall see many more of them on the roads. However, the numbers of people who are vulnerable—elderly people, children, cyclists and the blind and visually impaired—are not decreasing. Those people remain vulnerable, and I hope that the Minister will listen today to what all these people feel.

Annette Brooke (Mid Dorset and North Poole) (LD): I congratulate the hon. Lady on achieving the debate. She has made excellent points. It seems to me that now is the time to be taking action, before we have the very rapid rise in the number of these vehicles, which I gleefully anticipate. We have only to look at how fearful our elderly residents are of people on bicycles riding around, especially when they are on pavements. I go to meetings that are packed out with elderly people saying, “Why don’t cyclists use their bells?” There is real fear out there, and I concur that this is a matter of urgency now.

Mrs Glindon: The hon. Lady just got in before I concluded. This debate has attracted an awful of attention outside Westminster. I thank Guide Dogs in particular for the work that it has done, because it has spurred on people such as me and, I am sure, other MPs to bring up this issue. Again, it is a timely issue, and I hope that the Minister will be able to send us away today feeling that he has listened and that very soon we will see mandatory systems, so that people who are blind or visually impaired and any other vulnerable road user will no longer have to fear that they have only one second to decide whether they should cross the road.

2.45 pm

Mr Mark Spencer (Sherwood) (Con): Unfortunately, Mr Hood, I cannot stay for the whole debate, but I trust that you will allow me to contribute on this very important issue. I hope that is in order. I congratulate the hon. Member for North Tyneside (Mrs Glindon) on calling this important debate. The issue is rapidly rising up the agenda as we approach the time when the EU will make its decision.

I say that I am fortunate, although I do not know whether I am fortunate or not, to have taken part in the blindfold test in my constituency. I had the privilege of walking blindfolded with a guide dog. I found the experience half terrifying. To put one’s trust in a guide dog and walk along the high street with no vision is terrifying—it was for me as an individual. At the same time, our ability to train these animals to assist people who are partially or wholly unsighted was inspiring, and it should be celebrated. However, we have a responsibility to ensure not only that such people have access to these animals, but that they are safe in their use of them on our high streets.

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While I was walking along with my blindfold on, it became apparent to me that people have to make use of all their other senses to try to access the environment around them. Those include hearing and touch. I put my hands up to not being aware that when someone presses the button at a pedestrian crossing, there is a little button underneath that twists round and tells them via touch that it is safe to cross if they cannot hear the beepers or see the green man. It was a real education for me and something that drew me to the cause.

The Government are making some progress. First, we have a Minister with a track record on road safety. He has done an enormous amount of work on road safety during his parliamentary career. The Home Office is listening on the issue of attacks on assistance dogs, and we are making some progress on that. What we are discussing today is probably the last piece of the jigsaw—to try to help people in such circumstances to cope with electric vehicles that are silent.

I want to encourage my hon. Friend the Minister to think the matter through thoroughly and properly and ensure that we get to the right point, because we need to get the tone of the vehicle correct. If we get that tone wrong, it could cause nuisance in residential areas, but it needs to be audible to those who need to hear it. I hope that the Minister and his colleagues in Europe will give some thought to the decibel level. It is important to get that correct, so that members of the public can hear the vehicle coming without there being the antisocial effect of residents being woken at midnight.

Given how modern technology moves, I wonder whether it is possible not to have the vehicle emitting a noise on a motorway, for example, where there will not be pedestrians, and whether, once the vehicle reaches a particular speed level, that sound—

Mrs Glindon: I do not profess to be a very technical person, but I believe that the sound systems in these vehicles operate differently from normal car engines, whose sound can go throughout the whole of the atmosphere. The sound goes forwards or backwards, so it does not create the same noise pollution. That is what I am led to understand.

Mr Spencer: I am grateful for that intervention. That is exactly the sort of technology that we need to embrace. The sound needs to be projected forward to those people who are in danger.

Mr Leech: I was going to make a point similar to that made by the hon. Lady. Existing non-electric vehicles make quite a lot of noise. I do not think there is any suggestion that the noise created by some sort of warning system on an electric vehicle would be any more obtrusive than noise from existing petrol and diesel engines.

Mr Spencer: I thank the hon. Gentleman for that intervention. It is important to establish those facts while the discussions are ongoing.

My final point to the Minister is that we need to give some thought to retrospective action for silent vehicles already on the road. Should the law change? How do we encourage people in possession of a silent electric vehicle to fit kit that will assist others to hear it coming?

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I congratulate the hon. Lady again on securing this important debate about an issue on which I hope we can make progress in the coming months.

2.50 pm

Mr Iain McKenzie (Inverclyde) (Lab): It is a pleasure to serve under your chairmanship again, Mr Hood. I congratulate my hon. Friend the Member for North Tyneside (Mrs Glindon) on securing this important debate.

Silent cars, be they electric or hybrid vehicles, are becoming more and more popular and their number is increasing year on year. In 2006, more than 39,000 such cars were sold, and the latest study shows a growth rate of about 5% by 2012. The reasons for increasing demand include the EU policy objectives of reaching the 2020 target for reducing carbon emissions and rising consumer awareness of climate change and the need to reduce the use of fossil fuels. Car manufacturers are well aware of buying trends and aim to meet the expectations of consumers who want the benefits of lower fuel consumption and emissions.

We have all become accustomed to the traffic noise that the internal combustion engine causes—be it petrol or diesel, two or four stroke—but in the modern age, it has been made quieter by means of a reduction in moving parts or engine compartment noise dampening. Some cars still make a lot of noise and some owners still like to hear the roar of an engine—if you were the lucky owner of a Ferrari, wouldn’t you?

Electric and hybrid cars make little or no sound when running at low speeds and their use contributes to quieter urban areas. However, not everyone benefits from that innovation, and others’ needs must be considered. That group comprises people with visual and hearing impairments, children and older people and other road users, such as cyclists. They are all exposed to danger, because they are no longer warned by audible noise from a vehicle engine and may be unable to react accordingly. We are, after all, taught from an early age to cross the road safely by looking and listening.

Silent cars have created an unforeseen tension among car manufacturers, environmentalists and organisations representing pedestrians. Guide Dogs in the UK has raised concerns about the implications of hybrid and electric vehicles. As we heard from hon. Members, silent cars can limit the independence of blind and visually impaired people in everyday life. Guide dogs are equally vulnerable to the dangers of silent cars.

Children are exposed to the dangers of traffic daily. Most children involved in accidents are under 10 years of age. The risks raised by the distractions of playing in the street do not need to be stressed, and they are increased by the use of silent cars. The youngest children have great difficulty in assessing the speed of an approaching vehicle, and silent cars increase the difficulty, because speed cannot be associated with engine noise. It is not only children and pedestrians with visual impairments who are affected—cyclists, who might not look behind before making a manoeuvre, people listening to an iPod or using mobile phones and older people are all at risk if they do not hear a vehicle approaching.

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Awareness is growing in the USA and Japan of the dangers of silent cars. General Motors has been working with the US National Federation of the Blind to develop a safe level of sound to alert pedestrians.

Mr Andrew Smith: My hon. Friend makes a persuasive speech. Does he agree that an important argument from an industry perspective is that, although motor manufacturers want to be consulted fully and are ingenious in bringing forward solutions to problems, there are advantages in the certainty of knowing where they stand, rather than the uncertainty of not knowing when a regulation is coming or whether it will be voluntary or mandatory?

Mr McKenzie: My right hon. Friend makes a good point. When changes have been made to vehicle regulations in the past, there has been an area of overlap or a time scale to allow manufacturers to bring in the change. The safety aspects of this matter would override giving a discretionary term to bring in changes.

General Motors looked at a vibrating sensor that transmits sounds as vibrations, but its effectiveness is dependent on the vehicle emitting a sound. Although sound is deemed a critical component for the increased safety of silent cars for vulnerable pedestrians and other road users, experts in the USA believe that such cars also need to indicate directions and show acceleration or deceleration.

In Europe, Guide Dogs has worked with Lotus Engineering Ltd on developing a synthesised sound system that can be added to vehicles. The UK Government commissioned the Transport Research Laboratory to conduct two items of work: first, assess whether there is an increase in the incidence of accidents between silent or quiet vehicles and pedestrians; and secondly, assess sound requirements through simulated trials.

Not everyone supports adding sound. Opponents claim that artificial sounds will do more to cause noise pollution in the environment than aid pedestrians or other road users. There needs to be a clear definition of a recognisable sound and set requirements, to ensure that the sound conveys distance, speed, acceleration or deceleration and the size of the vehicle to the pedestrian or other road user. Safety must be paramount.

The European Parliament voted in February 2013 to require manufacturers to install an acoustic vehicle alerting system in hybrid-electric and electric vehicles. The legislation has been through the Parliament and is awaiting First Reading at the EU Transport Council. Guide Dogs, which works hard to give blind and partially sighted people the confidence to get about, has intimated its concerns.

Guide dogs are trained to sit at kerbs and await their owner’s assessment of when it is safe to cross the road. If the owner cannot detect a vehicle, they do not know whether it is safe to cross. One near-miss with a quiet vehicle could severely hamper a person’s confidence, and the lack of certainty resulting from the presence of quiet vehicles could be enough to deter people from leaving their home alone, for fear of being involved in a collision. Studies have shown that some electric vehicles cannot be heard until one second before impact with a pedestrian.

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Guide Dogs “Safe and Sound” campaign for audibly detectible vehicles calls for the installation of artificial engine noises on all quiet vehicles to ensure their audibility for pedestrians. It also asks EU decision makers to support the introduction of mandatory artificial engine noises at the earliest opportunity and reject the addition of a mandatory pause switch to the regulation. We all expect the Government to use their position on the Council of the European Union to ensure that quiet vehicles in the UK are made safe for our pedestrians.

2.58 pm

Tracey Crouch (Chatham and Aylesford) (Con): It is a pleasure to serve under your chairmanship, Mr Hood. I congratulate the hon. Member for North Tyneside (Mrs Glindon) on securing this debate on an incredibly important issue, although, as she pointed out, it is not as simple as one would hope.

The growth of electric vehicles is good for not only our economy, but our environment, so we as MPs should welcome it. However, it is clear from the research, cited several times in the debate, that such vehicles bring with them hidden and silent dangers to pedestrians and cyclists.

I have visited my local Guide Dogs branch, as well as the Kent Association for the Blind, and I will speak later about the challenges they face from electric vehicles. It is important, though, that we remember other pedestrians in this debate. I do a lot locally and nationally on the issues that affect elderly people. We have to recognise that they face particular challenges when they try to cross the road or stay connected within their local community. We welcome the growth of these silent vehicles—the electric cars—but some of them are frightening our elderly population, especially those in the early stages of dementia, who perhaps do not understand some of the technological changes. We always need to be aware of the issues that face them.

Let us not forget children. When they are taught the green cross code, they are told to stop, look and listen. We grow up remembering those three words. We would all confess that in our busy days, we often look, although in London we might not even stop. But we almost always listen. If we are not giving people the opportunity to hear cars coming, we are automatically removing a key aspect of the green cross code. We need to pay close attention to that.

Stuart Andrew (Pudsey) (Con): I wonder whether, like me, my hon. Friend has walked between this building and Portcullis House and had a Government vehicle suddenly appear at her knee because she did not hear it come through the archway. It is bad enough for people like us; it must be difficult for anyone who is elderly or has a sight problem. We must think about those people, because that situation is challenging.

Tracey Crouch: I agree entirely. I have always thought that the sudden appearance of those vehicles is a consequence of my voting record and that there is an intention from Ministers or Whips.