2.58 pm

Mr David Lammy (Tottenham) (Lab): I am grateful for the opportunity to speak under your chairmanship for the first time, Ms Buck. You have made a considerable contribution to the lives of black and ethnic minorities in your constituency over many years and to the broader debate within the Labour party, and you continue to do so. I congratulate the hon. Member for Lanark and Hamilton East (Angela Crawley) on securing this debate. I thank her for the manner in which she delivered her opening remarks and for all that she is doing north of the border.

I have a short opportunity to put on the record once again the work of my predecessor, Bernie Grant. Activists and campaigners are perhaps more prominent now than they have been in the past, particularly with the selection of my hon. Friend the Member for Islington North (Jeremy Corbyn) as the leader of the Labour party. He knows that campaigning and work often take place at the margins, with very few people paying attention and listening. For many mornings over many years, Bernie Grant campaigned outside the British Museum about the artefacts sitting inside that had been effectively stolen from Africa. He raised the issue consistently, day after day, with no one paying attention. There is now a lively debate on outreach and how to support museums and communities in Africa and the developing world, which is now a very real subject.

My predecessor campaigned for years to introduce these subjects to our national curriculum, and we have made progress. When I was a Culture Minister, I made the decision to introduce the abolition of slavery from the perspective of not only William Wilberforce, but Equiano and others, to the national curriculum, but we need to do more to ensure that our national curriculum tells a rich and complex story about the contribution of both different parts of the British Isles and the Commonwealth.

Many young people do not know that more than 1 million Indian young men died on behalf of this country in the first world war. They do not know that 200,000 young men from the Caribbean died contributing to this country in the same conflict or that, across the Commonwealth, people signed up to come to this country and other parts of Europe and gave up their lives. That is a rich story, and it illustrates why Black History Month is not just a moment when black and brown children in inner-city schools can focus on these issues; it is a national moment when all children in our country, whatever their background, draw inspiration from these stories and reflect on that coming together and those trials and tribulations.

Kirsten Oswald: I echo the right hon. Gentleman’s sentiments about the soldiers from across the world who came to serve with forces from the UK; as the Scottish National party spokesperson on the armed forces and veterans, I associate myself with what he

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says. I also wish our children to be as aware as possible of our diverse communities in Scotland and the UK and of the rich contribution they have all made.

Mr Lammy: I am grateful for the hon. Lady’s words. Globally, we reflect on these huge heroes of black history. Of course, I think of Martin Luther King, Nelson Mandela and Rosa Parks, but this is also a moment to think of our homebred heroes such as Paul Stephenson, who organised the boycott of the Bristol buses because of their refusal in 1955 to employ anyone of a black background; that contributed to our getting the Race Relations Act 1965. This year, we celebrate 50 years since that Act was passed, and I hope Parliament will celebrate that occasion appropriately.

All those contributions led to a place in which my father, like the father of my hon. Friend the Member for Streatham (Mr Umunna), arrived in this country as part of the Windrush generation. Those were very different times, and my father would be proud to see me standing here—he is not alive today. That generation made a contribution, and the fight continues. We do not stand still, and huge challenges remain in these tough economic times.

We have heard about the tremendous challenges that exist in our boardrooms. Across the country there is a lack of diversity for black and ethnic minority people at the higher echelons of our companies, which is an issue. Progress was being made in the public sector, particularly in local government and the NHS, but to some extent that progress has stalled. My predecessor, Bernie Grant, was the leader of Haringey Council before becoming the Member of Parliament for Tottenham. We do not see that leadership replicated in the same way these days, although I recall that Muhammed Butt is the leader of Brent Council here in London.

Progress needs to be made in the judiciary and our universities. It is great to see Valerie Amos appointed the director of the School of Oriental and African Studies, adding to the panel of vice chancellors, but there is a considerable amount still to do. As you know, Ms Buck, there remain real issues in mental health and in relation to deaths in police custody. There are also real issues for young people in London, particularly given the unemployment figures.

This is a moment to celebrate, but it is also a moment to redouble our efforts. We must recognise and celebrate 50 years of the Race Relations Act, but we need to ensure that race remains on the agenda and that we do not just talk about diversity and equality but recognise that discrimination exists and that we have to act to address that discrimination. That sometimes means positive discrimination, but it also means that people’s right to challenge in court and elsewhere must be ensured in future.

3.5 pm

Anne McLaughlin (Glasgow North East) (SNP): I was expecting to be the last speaker, so I might be a little all over the place. I had a prepared speech last time I responded to a debate, but now I will try to respond to what other Members have said.

It is a privilege to speak about Black History Month, a month when we in the UK join together in celebrating and valuing the countless inspirational individuals and historic achievements of our black and minority ethnic

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communities. Since its British incarnation was launched in 1987, Black History Month has addressed a disgraceful blind spot in our national story: the contribution of people from BME backgrounds. There are events highlighting inspiring figures from the BME community who fought injustice and inequality over many years and in different times and places. It is wrong that we should need Black History Month, and the sooner we start honestly portraying our shared history, the less likely it will be that white children will grow up believing that everything happened because of their forefathers and foremothers, and the greater our chances will be of genuine racial integration. When that happens, when we all just see each other as people and when we accept that in history, as today, we all contributed and we all contribute to the development of this country and to the world, we will not need Black History Month.

In addition to its political side, Black History Month has a vital creative element, with the arts being used to tell some of the stories that we want people to hear. I loved “Record Breakers” as a child, and it horrifies me that there are people here who will not know what I am talking about. [Interruption.] The Minister should not pretend not to remember it. I always wanted to be a record breaker. That is perhaps why, in October 2012, my Jamaican partner and I organised 17 Black History Month events. It was exhausting, but I had a ball because, as well as history lectures and political debates, we had reggae, dancehall and soca nights, African films, Jamaican food and football games.

On football, I wonder how many people know the name of the Scotland footballer who captained the team when they beat England 6-1 in 1881 down the road at the Oval in Kennington. He captained the team on two more occasions, beating Wales 5-1 and, the following year, beating England again, this time only 5-1. I appreciate that it was a long time ago, but allow me to revel in it and to share the final sentence of the match report:

“In the ten matches now played, the Scotch have kicked 34 goals and the English 20.”

The captain of the team was an impressive chap in that he was not only a skilled sportsman but a marine engineer and a successful businessman. Given that this was the 1800s, he surely accomplished more than enough to be held up as a historical role model, yet until recently few people knew the name of Andrew Watson.

Andrew Watson was the Caribbean-born son of a Scottish slave owner. I have not been able to establish whether his mother was a slave or a free woman, but she was a Caribbean woman. The point of that story is that many children came from a slave and slave owner relationship. Many people in Scotland, including people with Scottish surnames, have ancestors who came from the Caribbean.

Mr Lammy: If the hon. Lady will indulge me, I am one of those people of Caribbean descent who took a DNA test a few years ago. I found out that part of my ancestry is indeed Scottish. How proud I was to find out that, like Bob Marley, I have Scottish genes running through me!

Anne McLaughlin: In that case, I would like to ask the right hon. Gentleman which team he would have supported in that 1881 football game.

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I will turn to the slave trade in a little more detail later, but I absolutely concur with one comment from the hon. Member for Edmonton (Kate Osamor), who said that an apology is needed from not just the British Government, but the Government in Scotland, for the involvement of all parts of the country in what happened. Like her, I was also outraged when the Prime Minister told Jamaicans to move on.

I was in London during the summer, and I got caught up in a whole load of crowds and traffic. An annual event seemed to be taking place to celebrate—or certainly to mark—the bombing of another country. If we are not going to move on from such things, I do not see why Jamaicans should move on from thinking about this terrible time in their history, which impacts on their country today and will continue to do so until they get the reparations the hon. Lady spoke of.

I want to say a little about the wonderful Mary Seacole. For the life of me, I cannot understand why she is not at least as revered as Florence Nightingale. She was Jamaican born and half-Scottish. She was born Mary Grant, and Grant is one of the names in my family, so I am going to take some of the credit—no, I cannot. She did what women did not do in the 19th century: she travelled, she ran a business and she went to war. When she faced racism—and she did—she did not back down; she continued to risk her life to help others. How did she do that? She went to the Crimean war, and she risked her life helping soldiers—they called her “Mother Seacole”. She applied to be one of Florence Nightingale’s nurses, but was turned down. We know a little more about her now, but it astonishes me that I had not heard of her until four years ago. She is a bit of a hero of mine now, but why did I have to seek her out? I found out about her at a Black History Month event, which is why I think such months are so important.

I want to say a little about someone who is less of an historical figure—he will be pleased to hear me say that if he is listening—and more of a current figure. Professor Sir Geoff Palmer is absolutely passionate about bringing black history to the masses. He is Jamaican born—I appreciate that there are other nationalities, although we seem to be a bit obsessed with Jamaica today. He has lived in Scotland for the past 50 years and has become one of the top professors of brewing science—in other words, he teaches Scottish people how to make the best whisky. He is also the author of a number of books, including one called “Citizens of Britishness”. In it, he talks about the importance of education. He says that if children learned from an early age that the development of our country and our world was down to not just white people, but absolutely everybody, they might not see themselves as different from children in their class who have a different skin colour. I encourage people to read that book.

I want to come back to some of the things that other Members have said. I have not congratulated my hon. Friend the Member for Lanark and Hamilton East (Angela Crawley) on securing the debate, so I do so now. She said that 41 MPs are from a BME background, and the hon. Member for Streatham (Mr Umunna) said that 12 are of African or Caribbean heritage. I agree with them both that that is not enough. Both spoke about BME people being under-represented and about there being a glass ceiling. However, there are a number of glass ceilings, which are sometimes pretty low, and it

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is difficult to break through them. There is lots of evidence to back that up—I am going to give anecdotal evidence, but I would not like anyone to think that there is not actual evidence.

I have a Cameroonian friend, and she is an incredible person. She is extremely articulate and very intelligent. She held down a really senior job in Cameroon, and she speaks about seven languages fluently. One day, she went into two temp agencies. Hon. Members will know the kind I mean—the ones with the posters in the window saying, “400 typists needed” or “25 telephonists needed”. There were posters all over the windows of these agencies, so my friend went in. Both of them said, “No, we don’t have any jobs,” when they clearly did. She said, “Could you put me on a waiting list for when you do?” They said, “No. We don’t have a waiting list. It’s closed.” The glass ceiling is not necessarily all that high, and it is difficult for people to break through.

The right hon. Member for Tottenham (Mr Lammy) spoke of the contribution of people from India, the Caribbean and other places to the British armed forces. People need to know that we white people, on our own, did not go round the world winning all these wars or bringing progress. That is a really important point.

To come back to the Caribbean slave trade, we in Scotland once tended to believe—I will blame this on the lack of education in the whole of Britain at the time—that we did not really have anything to do with the slave trade, that it was the English who were responsible and that we did not have any choice. It turns out that that is not true. It has come to light, however, that Scottish people are happy to face up to their past and want to know the truth about it. Professor Sir Geoff Palmer had a lot to do with bringing the issue to the fore. However, a historian by the name of Stephen Mullen also wrote a book about it. Its title—I do not know how many Members here have been to Glasgow, so I do not know how many will understand this—was “It Wisnae Us”. In other words, the Scottish thought they had nothing to do with slavery, although that is not true.

Two years ago, I was at a talk by Professor Sir Geoff Palmer. He was talking about compensation payments after the slave trade ended—again, this is something I did not know about. I was thinking, “How could you ever compensate somebody for having to live as a slave?”, but I suddenly realised that it was not the slaves who were being compensated, but the slave owners. I was absolutely horrified. Professor Palmer told us that Scotland made up 9% of the population of Britain at the time, but took 16% of the compensation package, which shows how enmeshed in the slave trade Scotland was. Books such as “It Wisnae Us” help us to face up to that.

Much as I love Black History Month, I cannot wait for there to be no need for it. I love history, but I do not want to read about black history. I just want to know our history—to have an honest assessment of our past, not a spin-doctored version where everyone who is not white is airbrushed out of existence. I want an honest history. We are all grown up now. Surely we can face up to the bits of our past that we are not so proud of. Surely we do not have to take the credit for absolutely everything.

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As I said at the start, I really look forward to the day when Black History Month does not exist, because that will be the day when we are all equal, and our forebears are celebrated equally, regardless of skin colour, religion or gender. That is not the case right now.

As women, we often feel we are offered fewer role models than men, and nobody seriously argues that that is because women contribute less. It should be alarming to all of us that black children can go through school believing that all our heroes, inventors, revolutionary leaders and significant historical figures were white. What must it do to a child’s self-esteem to see no role models who look like them? How must it feel to be led to believe that even the black struggles and the black victories were really led by white people? I mentioned the example of the abolition of the slave trade. White people may have assisted in that, but it was the black slaves who freed themselves. Black History Month simply shines a light on that and other lies. As I said, I look forward to the day when we do not have to be disabused of the notions I have described because they will have long since left our history books.

3.19 pm

Cat Smith (Lancaster and Fleetwood) (Lab): It is a pleasure to serve under your chairship, Ms Buck, and I congratulate the hon. Member for Lanark and Hamilton East (Angela Crawley) on securing this important debate.

I want to mention some of the speeches that have been made. My hon. Friend the Member for Streatham (Mr Umunna) made some important points about the glass ceiling that black and minority ethnic people face. He raised issues about higher education institutions and the lack of diversity among professors, and that is incredibly important. The Government should take action and call on all the universities that take public funding to address the issue as a priority. I join my hon. Friend in congratulating Greg Clarke and the Football League on their excellent work to try to increase diversity in the league. They set a great example to encourage premier league clubs to follow suit.

My hon. Friend the Member for Edmonton (Kate Osamor) made a lovely speech and raised the important issue of slavery, a shameful chapter in Britain’s history, in which the port of Lancaster in my constituency played a significant role. I try to be very aware of that in the work I do. I hope that future chapters in the book of the history of Britain will make amends for the role that we played in the international slave trade.

My right hon. Friend the Member for Tottenham (Mr Lammy) has long been a campaigner for race equality, following in the footsteps of his predecessor, Bernie Grant, who was a pioneer at a time when black people did not have it easy. He led the way and was a shining example to everyone. I hope he is an inspiration to many young people today, who can look to figures like him and the hon. Members present in the Chamber to show that no door should be closed to them. I thank my right hon. Friend for reminding us of the role that Commonwealth countries played in the first world war, and of the fact that it is 50 years since the Race Relations Act 1965 was passed. My goodness, we still have a long way to go.

I also thank the hon. Member for Glasgow North East (Anne McLaughlin) for the lovely compliment she paid me as she looked at me when asking whether

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anyone would remember “Record Breakers”. I must look younger than I am, because it finished airing in 2001, so I do remember it, and I enjoyed it very much. I am not that young.

It is often said that history is written by the victors. I certainly heard a lot about that when I was growing up, as my father was an enthusiastic lover of history. History is written by dead white men, because they were the people who had power and who wrote it down. Black History Month therefore offers an opportunity to learn more about history that has not been recorded and that is not talked about in the same way that the dead-white-men history is written about. We rightly celebrate many victories and achievements, but, sadly, the legacy of racism and discrimination remain in too many areas of public life today. The stories of many of those who fought for the advances that have been made have not yet been told properly, so Black History Month is as vital for children in schools as it is for Members of Parliament, to enable us to learn about the communities we represent.

I want to play particular attention today to the contribution that black and ethnic minority communities have made to the labour movement. The Labour party and the wider labour movement can be proud when it comes to fighting racism and discrimination.

3.24 pm

Sitting suspended for Divisions in the House.

3.48 pm

On resuming

Ms Karen Buck (in the Chair): The debate may continue until 4.25 pm if necessary, but I stress that that is not mandatory.

Cat Smith: Labour Members took a leading role in the anti-colonial campaigns in the first half of the 20th century and in the anti-apartheid campaigns more recently. Labour Governments introduced the Race Relations Act 1968, the Race Relations Act 1976 and the Equality Act 2010 to ensure that all our communities receive equal treatment under law.

There are, however, episodes in our history of which we must be sadly less proud, particularly from the first half of the 20th century, when many black and ethnic minority workers were not welcomed into the labour movement in the way that they should have been. I therefore pay tribute to those who stood up for their rights and successfully changed attitudes and transformed the labour movement into the proudly anti-racist movement that we have today, although there is, as Members have mentioned, some work to do in respect of representation among its leadership.

Those who stood up for their rights include the black workers in Cardiff who formed the Coloured Seamen’s Union in 1936 to fight against the operation of the colour bar in Cardiff docks. The Indian Workers’ Association was also formed around that time in Coventry. It fought not only against racism, but for better employment rights and Indian independence.

In Bristol in the 1960s, black communities boycotted bus services owing to the refusal of the Bristol Omnibus Company to employ black or Asian bus crews. The boycott lasted four months and forced the company to back down and overturn its colour bar. In 1972, Pakistani

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workers at Crepe Sizes Ltd in Nottingham went on strike over working conditions, redundancies and pay. They were supported by the local community and won union recognition and the reinstatement of workers made redundant.

More well known is the 1976 strike at Grunwick by Asian and West Indian women who walked out owing to poor working conditions and attempts to cut pay. Although the strike was ultimately unsuccessful, it represented one of the first times that a dispute affecting BME workers received the mass support of the trade union movement, with electrical workers, miners, electricians and Post Office workers all backing the strike.

Those episodes represent just a fraction of the contribution that BME workers have made to the labour movement during the 20th century. Those workers not only improved their own lives and those of their communities, but they transformed the labour movement into a more inclusive movement that today has equality at its heart. We owe all of those workers a huge debt of gratitude and we must learn from their example to address the challenges we face. It is shameful that, earlier this month, we learned that black people are three times more likely to have a Taser used against them than white people. It cannot be right that the number of black and Asian workers in low-paid jobs increased by 12.7% between 2011 and 2014 compared with a 1.8% rise for white workers in the same period.

As a society, we need to show solidarity and stand shoulder to shoulder with those fighting injustices today. I look forward to hearing the stories of victories over such forms of discrimination in Black History Months to come.

3.51 pm

The Parliamentary Under-Secretary of State for Communities and Local Government (Mr Marcus Jones): It is a pleasure to serve under your chairmanship, Ms Buck. I congratulate the hon. Member for Lanark and Hamilton East (Angela Crawley) on securing this important debate on Black History Month. We have had a very good and passionate debate.

Black History Month is an opportunity for us to celebrate the UK’s African, Caribbean and Asian communities and the enormous contribution they have made to our country. It is right that we should use Black History Month to look at the part that black people have played in shaping history. Too often, it is a part that has been ignored or forgotten. We remember the huge number of people from Africa, the Caribbean and Asia who gave their lives fighting for this country in the first and second world wars. Our commemorations of the centenary of the first world war rightly mark the contribution and sacrifice of thousands of men and women from across the Commonwealth.

We remember the bravery of Walter Tull, a black British footballer who played for Tottenham and Northampton. He was a soldier who died in 1918 in France and the first black officer to lead white British soldiers into battle. We also remember Eugent Clarke from Jamaica, who fought at the battle of the Somme, and Khudadad Khan VC, born in what is now Pakistan, who was the first Indian army recipient of the Victoria Cross. And we remember others who fought together, fell together, and together defended the freedoms that we enjoy today.

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We remember that, after the second world war, people from across the Commonwealth helped to rebuild our country. Many people came here with nothing, but they and their descendants have built successful and prosperous lives here in Britain. Today, we can claim to be a successful multi-ethnic and multi-faith country. In recent years, members of African, Caribbean and Asian communities have made their way to the top in many different areas: in business, in sport, in the arts, in Government, and in the House. I am thinking of people such as my right hon. Friend the Secretary of State for Business, Innovation and Skills and President of the Board of Trade—I had the pleasure of being his Parliamentary Private Secretary in the previous Parliament. I am thinking of the right hon. Member for Tottenham (Mr Lammy), who has taken part in the debate, and the hon. Members for Streatham (Mr Umunna) and for Edmonton (Kate Osamor), who are also in the Chamber.

Despite the strides that we have made in recent years, we know there is a long way to go, as hon. and right hon. Members have said in the debate. The Government want to create a genuine opportunity country, where ethnic origin and background are not allowed to become a barrier to getting to the top. As my right hon. Friend the Prime Minster recently pointed out, opportunity does not mean much if someone is facing discrimination or inequality—for example, when they do not get called for an interview because they have an ethnic-sounding name on their CV.

This December is the 50th anniversary of the Race Relations Act 1965, the historic legislation that opened the way to all subsequent equalities legislation. We can all be proud of the UK’s world-class equalities legislation, but we know that, on its own, it is not enough. We must all champion equality and recognise and challenge discrimination.

We have set some ambitious goals to improve opportunity for black and minority ethnic people in our 2020 vision. We aim to get a 20% increase in black and minority ethnic people in employment. We want 20% more black and minority ethnic people going to university, 20% more taking up apprenticeships and up to 20% more entering our police forces and armed services. Those are stretching and challenging targets, but we are determined to do all that we can to meet them.

[Nadine Dorries in the Chair]

The employment rate for black and minority ethnic groups is at a record high of 61.4%. Half a million more people from ethnic minorities are in work in Great Britain than in 2010. That is an increase of around 20% in the past five years, but we must go much further. That is why we have made a commitment to increase BME employment by a further 20% by 2020. That challenge is critical to achieving our full employment objective, ensuring that British business makes the most of the talent and potential that exists in all communities in the UK.

Anne McLaughlin: The Minister is talking about the targets to have more people from BME backgrounds employed, but the forthcoming Immigration Bill will make that difficult. If an employer is not sure whether someone is British, it will make it more difficult for anyone who might not look British, sound British, or

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have a British-sounding name to get employment and somewhere to live. Does he agree that that will not help him to reach those targets?

Mr Jones: I note what the hon. Lady says. Further on in my speech, I will come to the measures that the Government are taking to support people to ensure they get into higher education and have the opportunities to get the skills to get the best jobs in the country. I will come to the points that she makes in a moment.

People from all communities want the police to fight crime while having confidence that their individual needs will be understood and respected. That is fair and effective policing. Police forces that reflect the communities they serve are crucial to cutting crime in a modern diverse society. The police have made real improvements in diversity and there are now more women and black and minority ethnic officers than ever before, but we are clear that forces need to do more. Police and crime commissioners and the College of Policing will play a key role in ensuring improvements in forces. New entry routes to policing are proving attractive, and are increasing the diversity of the police workforce.

Many black and Asian performers have excelled in the arts, but we are continuing to keep the spotlight on the main broadcasters and creative industries—the hon. Member for Streatham mentioned that. The Minister for Culture and the Digital Economy has been championing black and ethnic minority representation in the media. All the major broadcasters, along with the Arts Council and the British Film Institute, have launched projects to promote diversity in the past 18 months.

Angela Crawley: Does the Minister agree that the media have a responsibility to portray black and minority ethnic members of the community effectively and responsibly? That is all too often not the case.

Mr Jones: I agree with the hon. Lady’s sentiment.

Moving on to the questions that hon. Members asked, the hon. Member for Lanark and Hamilton East mentioned apprenticeships. As I said earlier, the Government have ambitious plans to increase the number of apprenticeships available to black and minority ethnic people by 20% by the end of this Parliament. I can tell the hon. Member for Streatham that the Department for Business, Innovation and Skills has a high-level action plan for how to increase the number of apprentices from BAME backgrounds. I am sure that the Department will work hard during this Parliament to fulfil the Prime Minister’s obligation. The hon. Gentleman also quite rightly mentioned stop and search, and the Home Secretary has been absolutely clear that no one should be stopped on the basis of their race or ethnicity alone. The Government have therefore revised the Police and Criminal Evidence Act 1984 regulations to prevent unnecessary stop-and-search procedures.

The hon. Gentleman also rightly discussed football coaching and management, an area where black and ethnic minority people have been under-represented, unlike among the players themselves. He mentioned Greg Clarke, not my esteemed right hon. Friend the Secretary of State for Communities and Local Government, but the chairman of the Football League. I welcome its work on this important issue and hope that that will spur the Football Association on to greater work. My right

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hon. Friend the Chancellor set out in December 2014 plans to invest £2 million a year for the next five years in football coaching and grassroots development. To be fair to the FA, it is matching that funding and setting up bursary schemes to fund qualifications with specific targets for female coaches and coaches from the black and ethnic minority community. I hope that the hon. Gentleman will be pleased to hear that.

Mr Umunna: I agree with the Minister about what the Football League is doing, but the league that everyone knows and talks about the most, the premier league, is where we ultimately have to ensure that we see action. Chris Hughton, as the manager of Newcastle United, was I think the last black manager in the premier league, but since then there has been none.

Mr Jones: I completely agree with the hon. Gentleman. The premier league is the biggest and most recognisable league in the world. I accept what he said about the Football League and the lead that it has taken. I am sure that the FA will be listening to what has been said in this debate about what the Football League has done and I hope that it will look intently at the lead that it has taken.

Several Members, including the hon. Member for Lancaster and Fleetwood (Cat Smith), the Opposition spokeswoman, mentioned higher education. The Department for Business, Innovation and Skills has been successful in supporting participation in higher education by young people from ethnic minorities, with entry rates for English 18-year-old state pupils rising in every ethnic minority group. That said, far more still needs to be done, but we aim to continue that improvement as part of our 2020 vision. Universities plan to spend over £745 million on measures to improve access and success for students from disadvantaged backgrounds, and we sincerely hope that many young people from ethnic minority groups will gain entry to university as a result.

In response to the contribution from the hon. Member for Edmonton, I reassure her that the Government absolutely deplore the human suffering caused by slavery. There can be no doubt that the chapters relating to the slave trade are among the most dishonourable and abhorrent in the history of humanity. We regret and condemn the historical slave trade and slavery. They were shameful events that rightly belong in the past. I completely understand the hon. Lady’s points. We can certainly agree that the horror of the slave trade should never be forgotten. She will probably know that the Prime Minister learned from the past before looking to the future when we introduced the Modern Slavery Bill in the previous Parliament, in particular to try to prevent people trafficking today. The Prime Minister cares deeply about the subject and has transformed my party’s representation on our Benches in terms of not only gender but ethnicity. We should celebrate that and his 2020 pledges.

The right hon. Member for Tottenham commented on council leadership. It is quite rightly down to political

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parties to do more to ensure that more local authority leaders are from black and minority ethnic communities.

In her contribution, the hon. Member for Glasgow North East (Anne McLaughlin), the SNP spokeswoman, alluded to the fact that I am old enough to remember “Record Breakers”. I certainly am, but I am old enough to remember the Roy Castle and Norris McWhirter version—

Anne McLaughlin: Who?

Mr Jones: I am sure the hon. Lady knows exactly who they were! They were great people who are unfortunately no longer with us. The hon. Member for Lancaster and Fleetwood mentioned the 2001 version of “Record Breakers”, and Kriss Akabusi and Linford Christie, the Great British black Olympians, were actually presenters during its last few series. I remember watching it many years ago, and I think I remember seeing several episodes in which they made a fantastic contribution.

Moving back to football, the hon. Member for Glasgow North East mentioned Andrew Watson, whose story contains valuable lessons. I am glad to say that I am not old enough to remember when Scotland used to beat England by five or six goals to one on a regular basis. As a proud England supporter, I hope that that does not happen during my lifetime. The hon. Lady was also among several Members who referred to Mary Seacole, and I join them in paying tribute to her. My Department now shares lodgings with the Home Office and the three wings of the building are named after three great figures from British history: Robert Peel, the former Home Secretary; Elizabeth Fry, the great prison reformer; and Mary Seacole. So my colleagues and I are reminded of Mary Seacole every day when we go into the Department for Communities and Local Government.

I again thank the hon. Member for Lanark and Hamilton East for securing this important debate on Black History Month. I am delighted that it has given Members an opportunity to celebrate the achievements of Britain’s black communities. I take on board the comment that it would be good to have this debate in the main Chamber. That is obviously a job for Mr Speaker and his office, or for the Government at the time, but I would certainly welcome the opportunity to respond to a debate on the Floor of the House, if that were to happen.

We should celebrate the contribution of Britain’s black communities and remember the part that they have played in building what is becoming a successful multi-ethnic society. I pay tribute to the contribution and sacrifice of so many African, Caribbean and Indian people in the two world wars. As a Government, we reiterate our commitment to bringing an end to discrimination and to building a society in which there is real opportunity for all.

Question put and agreed to.


That this House has considered Black History Month.

4.10 pm

Sitting suspended.

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Accessible Toilet Availability

4.25 pm

Toby Perkins (Chesterfield) (Lab): I beg to move,

That this House has considered accessible toilet availability for disabled adults and children.

It is a pleasure to serve under your chairmanship, Ms Dorries, and to have the opportunity to discuss the thorny issue of accessible toilets for disabled or incontinent adults and older children in general, as well as the Changing Places campaign in particular. I will take this opportunity to explain a little about what that campaign is all about and reflect on why it is needed, as well as on the tremendous, world-leading success we have already in Britain. I will discuss how it fits into a broader strategy on accessible tourism and its untapped economic potential, and then make a specific request for the Government to consider.

I was grateful to learn that today’s debate would be a good while after people had eaten their lunch. This is not the most edifying of subjects, but perhaps it is appropriate that we should all feel a little uncomfortable while considering the daily indignities that incontinent adults and children, and their parents and carers, are forced to suffer.

I pay particular tribute to Jane Carver and Gillian Scotford, campaigners from my constituency who are doing tremendous work to raise the profile of accessible tourism and of Changing Places toilets. I will discuss that in more detail later. I also acknowledge the work of Mencap in campaigning for an increase in the number of Changing Places toilets, and the work of the British Toilet Association and the wider Changing Places consortium, which includes the Centre for the Accessible Environment and PAMIS—the Profound and Multiple Impairment Service.

This agenda is important not just because of human dignity but because of the huge strain that is put on the families of disabled older children and young adults. We should all be aware of the many challenges they face. Parents of disabled children are more likely to separate or divorce than the average. They live in an era when the support that was once there for families through embattled social services departments has shrunk, and respite care is scarce. On top of all those challenges, the parents of disabled or incontinent children face the additional weekly strain on the rest of their families of having a child who demands more attention than other children, with all the pressure that will bring.

Families with incontinent children have to organise all family outings around being able to have access to a toilet every two hours or so. It is impossible to overestimate the extent to which consideration of access to toilets is a dominant factor for someone with an incontinent child or adult in their family unit. Before every outing, those families have to consider how long they will be able to go until they need to change their loved one, and what the facilities will be like when they are out. Barely a single family affected will have avoided the experience of changing an adult or large child on a dirty toilet floor. Having to lie on a toilet floor as an adult or large child, being changed like a baby, is unimaginable for most of us, yet that is what life was routinely like for those families before Changing Places toilets.

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Jim Shannon (Strangford) (DUP): This is a delicate but important issue. Although we are in a time of financial restraint—we are all aware of that, across the whole of the United Kingdom—does the hon. Gentleman agree that it is important that people with physical disabilities are not disadvantaged, however that may be, by financial restraints, and that the Government must be committed to delivering services for them across the whole country? It is important that we do not let those services disappear into the ether of financial restraints.

Toby Perkins: I agree entirely—that is precisely why I wanted to have the debate. We can and will have broader discussions in the House and in the other place about the extent to which the Government fulfil the test the hon. Gentleman has set. In that regard, delivering those services is vital. I intend to make the case today that not only do we have a moral obligation to get this right, but there are arguments that doing so is in Britain’s economic interests.

Before there were Changing Places toilets, families were routinely forced to face the circumstances that I described, and, to expand on the point I was just making, child health experts have also spoken about the impact of inadequate toileting provision, with children or adults presenting with infections, skin disorders and mental health problems linked to urinal and faecal incontinence. We should be in no doubt that there is a significant cost to the Government, through increased healthcare costs, in continuing to fail these people and their families.

Changing Places criteria mean that toilet buildings are designed to have more room for equipment for people with multiple disabilities or people who need help to use the toilet. Each Changing Places toilet has a height-adjustable, adult-sized changing bench and a ceiling hoist and has enough space for a disabled person and two carers. Each is a safe and clean environment that includes a large bin and a non-slip floor. Changing Places toilets are utilised by and would make a difference to around 250,000 people in the UK. However, if we consider the impact that the lack of those facilities has on their family members, around 1 million people are affected.

Nic Dakin (Scunthorpe) (Lab): I congratulate my hon. Friend on securing this important short debate, which focuses on this key issue. I join him in congratulating those campaigners, such as Lorna Fillingham in my constituency, for the work that they have done to support the Changing Places campaign, which is so important.

Toby Perkins: My hon. Friend is absolutely right to give credit to those organisations and individuals, many of whom have fought very bravely for that. The Changing Places consortium, which I mentioned, involving PAMIS and a number of organisations coming together to work collectively, has made a really powerful case, which is why we have we have seen the progress that we have.

Carol Monaghan (Glasgow North West) (SNP): I thank the hon. Gentleman for allowing this intervention, and I congratulate him on securing this debate, but I would like to take this opportunity to share some sad news. Loretto Lambe, the founder of PAMIS, sadly passed away at the weekend, following a long illness.

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The disabled community will know of Loretto’s passionate and tireless campaigning for disability rights. Although Loretto officially retired last summer, it is to her great credit that she continued her work right up to the end of her life. I am sure the House will join me in paying tribute to Loretto’s work and in passing on our condolences to Loretto’s husband, James, and her family.

Toby Perkins: I am very glad that the hon. Lady was able to pay that tribute. She is absolutely right to say that the contribution that Loretto made is gratefully reflected on by people right across the country, and we all mourn her passing.

Let me remind the House of the number of people affected: there are 250,000 such people in the UK, and if we take into account their family members, too, that number rises to 1 million people. There also around 900,000 children—most of whom would not be included in the original figures—who are diagnosed as having continence problems, many of whom would not be considered disabled, but none the less require appropriate space for changing. What those numbers tell us, apart from simply the scale of the problem and the health-related cost implications, is the huge potential tourism market available to venues that are accessible to disabled people—not to mention the moral obligation that we have as a civilised society to disabled people and their families. The case for having Changing Places toilet provision as widely available as possible is utterly compelling.

Before I go on to talk about what more can be done to further the case for Changing Places toilet provision, it is worth reflecting for a moment on the successes that campaigners have already achieved in Britain.

Dr Philippa Whitford (Central Ayrshire) (SNP): I briefly mention that even ordinary toilets are under threat within local government areas. With an ageing population and more people with stomas and other problems of urinary or faecal support, I think the numbers that would be affected by high-quality toilets are even greater.

Toby Perkins: The hon. Lady makes an incredibly important point. The impact of local authority budget cuts on this and a huge number of other areas is something we return to time and again within the political arena. I thank her for making that point.

As I was saying, it is worth reflecting for a moment on the successes. Britain leads the world in provision of this sort; in no other country is the scale of provision of this kind of facility as advanced as it is here. The Prime Minister spoke today of the pride that we should feel in what we do for disabled people in this country. Although in some areas, that is questionable, huge strides have been made in our country, with legislative victories such as the Disability Discrimination Act 1995 and subsequently the Equality Act 2010. The progress on Changing Places means that we can justifiably argue that Britain is the leading disability-friendly holiday destination in the world.

We now have 770 Changing Places toilets in Britain, including 18 in Derbyshire. I would like to take a moment to highlight the work of Accessible Derbyshire, a ground-breaking charity with a mission to make Derbyshire the most disability-friendly county in Britain. It works with local tourist hotspots to advise them on

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what more they can do to make their offer more accessible and it promotes those organisations on its website, which means that any families with disabled people can learn more about what Derbyshire has to offer.

In Derbyshire, we are of course spoilt for great tourist destinations, from the world-famous Crooked Spire church in Chesterfield—where, among other things, I was married—to Chatsworth house, which is one of the most visited tourist destinations outside London. We have other great country houses like Hardwick hall and Bolsover castle, and, of course, the majesty of the Peak district on our doorsteps. However, even a county not so naturally blessed as we are in Derbyshire must be able to see the huge potential that exists.

The more arithmetically talented Members will have observed that with 770 different Changing Places toilets, there is an average of just over one toilet per parliamentary constituency. I am proud to say that in Chesterfield we have four Changing Places toilets—at the Queen’s Park sports centre, the Chesterfield Royal hospital, the new Chesterfield market hall and the Proact stadium, home to Chesterfield FC. Chesterfield football club may not currently be topping the league one table, but they are one of just six football clubs—alongside Arsenal, Liverpool, Brighton and Hove Albion, Tranmere Rovers and Preston North End—to have Changing Places toilets at their grounds, and Chesterfield’s community hub is an exemplar in catering for disabled football fans. There is positive progress, therefore, but just imagine for a moment that I was standing here saying that there was only one public toilet in a constituency. There would be an outcry, yet practically, for some of our citizens, that is precisely the case.

I come to what can be done. In part M of the Building Regulations 2010, section 5.6 states:

“In large building developments, separate facilities for baby changing and an enlarged unisex toilet incorporating an adult changing table are desirable.”

I would like to see Changing Places toilet provision move to being mandatory in all new large public buildings, rather than desirable as it is today. The cost of a Changing Places toilet is on average around £12,000 to £15,000, and it seems to me incongruous that in an era when we have the Equality Act, which is designed to ensure that disabled people are able to live in a fair and equal society, we can tolerate a situation where 1 million people have their choices so restricted by access to something as basic as toileting.

I would also like the Government, through the Minister’s Department, to make available grant funding to support new and existing building developers to install Changing Places toilets. It would not necessarily need to cover all the cost, but I feel that any support would enable more installations to happen. For example, a grant fund that provided perhaps up to half the cost of Changing Places provision, up to a maximum of a £10,000 grant, would make a real difference to the number of Changing Places toilets available. I also commend the work that the Government are doing with the Changing Places consortium on a new website, which I believe will be launched on World Toilet Day—who knew?—on 19 November. It will provide a detailed map highlighting all the Changing Places toilets currently available.

May I ask the Minister to confirm whether there are any plans to consider amending the building regulations to make Changing Places toilets mandatory in large public buildings? Will he investigate setting up a fund to

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support part of the cost of Changing Places toilets for developers and local authorities who include them in their design? Will he also advise what current sources of funding might be available to organisations that are considering making Changing Places toilets available in their premises?

Will the Minister say more about what the Government are doing to promote the importance of Changing Places toilets and make awareness of them more easy to access for families planning their trips? Finally, will he say a bit more about the steps that his Department are taking to market Britain as an accessible tourist destination? What opportunities does he envisage could be created to promote more effectively the steps that Britain takes to make our tourist destinations accessible to disabled visitors?

In closing, I should say that, to me, this is one of the really important civil rights issues of our time. It may be an unfashionable cause, but it is about justice and equality of access—a principle that I hope all of us would recognise. If there were five Changing Places toilets in every constituency, there would be reasonable access to appropriate toilet facilities for these families wherever they were. That should be our target in the coming years, and the measures I have outlined would help us to achieve that. One day, the misery that this issue has brought to families of disabled adults and children will be at an end. Why not let that time be now?

4.39 pm

The Parliamentary Under-Secretary of State for Communities and Local Government (Mr Marcus Jones): It is a pleasure to serve under your chairmanship for the second time this afternoon, Ms Dorries. I thank the hon. Member for Chesterfield (Toby Perkins) for bringing forward this important issue for debate. It is a matter that Members of both Houses have taken a keen interest in over the years. I will endeavour to answer the hon. Gentleman’s questions.

It is important to recognise that there is no dispute about the importance of accessible toilets for disabled people. Most of us take the availability of toilets for granted. Part M of the Building Regulations 2010 sets out a minimum standard for accessible toilets in most public buildings, which helps to ensure that a wide range of needs is met. However, for adults and children whose needs are not met by the standard toilet provision, and for their families and carers, we recognise that the availability of facilities such as Changing Places toilets is central to planning any activity that takes place outside the home.

We can all agree that having more Changing Places facilities is a good thing, which is why my Department has worked with partners including the Changing Places campaign, PAMIS, Mencap and the British Toilet Association to improve the provision of Changing Places toilets, and we intend to continue. I pay tribute to Loretto Lambe of PAMIS. I send my condolences, on behalf of the Government, to her family and friends at this difficult time.

There has been a lot of success. The number of Changing Places toilets in the UK has increased from about 140 to more than 750—I think it is now 770—since my Department became involved in 2007, and more facilities are planned in new locations.

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Alex Chalk (Cheltenham) (Con): Does the Minister agree that proper access to toilets for disabled people is not just a moral imperative, for the reasons we have heard? It also makes sense because it encourages more people to come into town centres, such as Cheltenham. That, in turn, is good for business.

Mr Jones: I agree. Cheltenham is a fantastic place; if disabled adults and people with disabled children are able to visit places across the country such as Cheltenham and Chesterfield, we will have a better society and more prosperous town centres.

Our success has been driven by local campaigners, with the broader support and backing of national organisations. Campaigners, including the constituents of the hon. Member for Chesterfield, who made this debate possible, deserve great credit for their dedication and success in ensuring that the number of Changing Places toilets continues to rise. I would like to take the opportunity to recognise the great work that those campaigners have undertaken in their local communities.

Alongside the work of campaigning groups, the Government have been active in considering what we can do to help. Before I come to the issue of Changing Places toilets and building regulations, I will explain what has already been done to support and increase the number of Changing Places toilets. For some years, the Department has hosted the Changing Places Charter Group, which brings together campaigning and business interests. It meets periodically to discuss how voluntary provision of Changing Places facilities can be improved, and it has had some notable successes. It has helped to identify problems that need to be resolved to improve provision, and it has worked to address those issues over time.

The group found that, although building more Changing Places facilities is important, it is only one aspect to be considered in ensuring that Changing Places toilets genuinely improve choice for disabled people and their carers. Changing Places toilets need to be located in the right place, and they need to be easy to find and access. This is a strategic planning issue that requires careful consideration to make the facilities effective. Building a Changing Places toilet in the wrong location is a missed opportunity. Changing Places toilets need to be well maintained, and building owners must ensure they remain open for use. There is no point in forcing a developer to build a Changing Places toilet if it is then locked or used for another purpose. The key is to ensure that building owners are willing hosts who recognise and embrace the importance of Changing Places toilets, and proactively support and promote their use.

Carol Monaghan: The Minister is talking about building Changing Places toilets in the correct locations, but one of the issues for my constituents and many disabled people who make long journeys by road is the lack of Changing Places toilets at motorway service stations. Does the Minister agree that those are sadly deficient at the moment?

Mr Jones: Over the years, motorway service stations have become an extremely important part of people’s ability to travel—particularly people who need to use facilities when they are travelling. I agree that we should do whatever we can to encourage the development of

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Changing Places toilets that are suitable for the people we have been talking about when service stations are built.

In addition to ensuring that Changing Places toilets are built, it is important that disabled people and carers know where their nearest Changing Places toilet is, when it is open, how to access it and what equipment is installed at each location. I am pleased to say that earlier this year, as the hon. Member for Chesterfield said, my Department gave a grant to Mencap, which, working with the Changing Places campaign and the British Toilet Association, has developed a web application that will transform the way in which people are able to find and use Changing Places toilets. That work was funded by the devolved Administrations, and it should be launched shortly.

The website will enable disabled people and their carers to find the nearest Changing Places toilet anywhere in the United Kingdom at the touch of a button. They will be able to navigate to the location using GPS, which has been precisely located; see photos of the outside and entrance, which will make the toilet easy to find; and find opening times and access arrangements. They will also be able to see photos from the inside and obtain all of the necessary details to be confident that the facility will be suited to their individual needs. It is important that people and their carers are not embarrassed when they go to a Changing Places toilet, as the toilets need to satisfy the needs of the people who use them.

The website will also provide a journey planner that will enable people instantly to find the location of every Changing Places facility along their proposed route. In addition, having an accurate map of every Changing Places toilet in the UK will enable Mencap and its partner organisations to identify geographical gaps in provision. Those areas can then be targeted to identify how Changing Places toilets can be provided. We believe that that will have a transformational effect on the lives of disabled people who rely on Changing Places toilets, and their carers. It will help to maximise the benefit of each Changing Places facility that is built.

As I said, it is important that more Changing Places toilets are built and successfully operated over time. The key issue, which brings me to the hon. Gentleman’s question, is how that can be best brought about. The guidance in “Approved Document M”, on accessibility and facilities in buildings, which supports the requirement in part M of the Building Regulations 2010, was amended in 2013 to include a reference to Changing Places toilets; it provides links to information on their installation and use developed by the Changing Places campaign. That important endorsement not only signalled the importance of such facilities but gave building owners and operators confidence that Changing Places toilets can be successfully integrated into their properties. However, that change in guidance does not mean that building regulations require that Changing Places toilets be provided. Instead, it indicates that they are desirable in large buildings and complexes.

There are a number of important factors to take into account when considering the use of building regulations in this context. I note that building regulations are a devolved matter and therefore I can speak only for England in this respect. It would be up to the devolved Administrations in Scotland, Wales and Northern Ireland to consider the issue with respect to their own building standards.

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Building regulations apply only where building work is taking place. That means that building regulations are not necessarily best suited to ensuring that provision is made in the most important locations. The building regulations are not retrospective. That means that any requirement for Changing Places toilets would apply only in new buildings or to works involving major refurbishment. That means that the number of facilities likely to be provided would be low by comparison with the existing building stock overall.

The building regulations do not apply to all types of buildings. Railway stations, airports and ports are among the most relevant exceptions. More importantly, building regulations do not ensure that Changing Places toilets are retained in use or made available to the public once built. On that basis, it has been the Government’s preferred approach to see voluntary provision coming forward, rather than introducing specific regulatory requirements. A partnering approach helps to ensure that Changing Places toilets are in the right place, are maintained to the right standard and continue to be available for use once built.

Toby Perkins: I want to press the Minister slightly on this point. We are talking about large public buildings, such as leisure centres and concert venues. We are talking about places that by definition will generally be accessible and in relevant places because the providers of those places want people to be able to get to them. I think that just a bit of a push would make a real difference to the number of these facilities that are built. It is really worth the Government’s considering that.

Mr Jones: I thank the hon. Gentleman for putting that point. That brings me nicely on to saying that we will certainly keep an open mind about whether there is a role for building regulations. I am pleased to tell him that the Department for Communities and Local Government has already commissioned research into how well part M of the building regulations is working. That includes specific reference to consideration of the need for Changing Places toilets. We will consider the results of that research in deciding whether a review of the current guidance in relation to part M is necessary. As the hon. Gentleman can tell from that, we take this issue extremely seriously.

Let me pick up on a couple of the hon. Gentleman’s other points. I completely agree with him about tourism. I mentioned that town centres would be beneficiaries if we had more Changing Places toilets available. Certainly many tourist attractions could benefit. It is great that his county of Derbyshire has a lot of Changing Places toilets compared with elsewhere in the country. That is good because much of Derbyshire is not that accessible as a result of the terrain. It is quite a hilly place, particularly up in the Derbyshire dales and so on. It is great to see the people of Derbyshire taking this issue so seriously.

On the fund that the hon. Gentleman mentioned with regard to encouraging developers, that perhaps would be an issue for after the spending review, when we will know the position that the Department is in on future spending. However, he can be assured that the Government take Changing Places toilets extremely seriously. I have listened intently to this debate and I can see so many

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hon. Members here who are concerned about the issue. It is certainly something that we will consider in the review of part M of the building regulations.

Question put and agreed to.

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Secondary Breast Cancer

4.54 pm

Craig Tracey (North Warwickshire) (Con): I beg to move,

That this House has considered secondary breast cancer.

It is a pleasure to serve under your chairmanship, Ms Dorries, in the first Westminster Hall debate that I have secured. As a co-chair of the all-party group on breast cancer, I am delighted to be able to raise the extremely important issue of secondary breast cancer. I thank all the people and organisations that have provided me with valuable information for today’s debate, not least Breast Cancer Care and Breast Cancer Now, both of which provide vital support to the all-party group. I particularly welcome the volunteers from those charities who are in the Public Gallery, representing the approximately 36,000 people living with secondary breast cancer in the UK today.

Last Tuesday was Secondary Breast Cancer Awareness Day. It underlines the importance of the issue that, at an event held in Parliament, nearly 90 MPs from both sides of the House turned up to support. Cancer is a disease that will sadly affect us all in one way or another during our lifetime, but the subject of today’s debate, secondary breast cancer, is often overlooked. Before making progress, I apologise to everyone for the number of acronyms that I will use, but given the number of hon. Members who want to speak, if I used the full names each time, we would never get through everyone.

Secondary breast cancer, also known as metastatic, advanced or stage 4 breast cancer, is where breast cancer cells have spread from the breast to other parts of the body—most commonly to the bones, lungs, liver and brain. It is incurable, but treatable. On average, people live with the disease for two or three years after diagnosis. However, that can vary considerably from person to person, with some living only months after diagnosis and others living many years longer. Unfortunately, research has shown that many secondary breast cancer patients receive inadequate care. All too often, it is much poorer than that which they received following their primary diagnosis. They do not always have access to palliative care, specialist nursing or the treatments that could extend their lives. Much of the current discussion and debate on cancer focuses on promoting early diagnosis and improving survival outcomes. That is extremely important and should be at the forefront of any cancer strategy. However, it is vital that it does not mean that people living with incurable secondary breast cancer are forgotten about. For them, efforts to improve early diagnosis rates will have no effect.

However, there are many things we can do, and for the purposes of today, I would like to focus on five key areas. First, one of the key issues underpinning many of the problems in care is the lack of data about the disease. At present, we have no idea how many people are being diagnosed with secondary breast cancer or how the disease progressively affects life over time. It is surprising that we still do not have an accurate figure for the number of people living with secondary breast cancer. Without that number, it is extremely difficult for the NHS to plan and commission services effectively to meet the needs of patients.

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Andrew Stephenson (Pendle) (Con): I congratulate my hon. Friend on securing this important debate. He is making a powerful case—a case that has also been made to me by my constituent Jade Braithwaite from Colne, whose mother sadly lost her life to secondary breast cancer. Given that it is already mandatory for hospitals to collect the data on secondary breast cancer, does he agree that it is absolutely shocking how few data we currently have?

Craig Tracey: I thank my hon. Friend for that intervention. I am coming on to that point now—well anticipated! As I said, it is surprising that we do not have accurate figures and it is therefore difficult to plan and commission effectively. That is acutely demonstrated in the lack of specialist nurses and poor access to palliative care, which both Breast Cancer Care and the secondary breast cancer taskforce first raised in 2008.

In 2010, Breast Cancer Care, along with other breast cancer charities and the APPG, met the Prime Minister to discuss the issue. He agreed that data collection was necessary and committed to achieving that. As a result, in the 2011 cancer strategy, “Improving Outcomes”, there was a commitment to collecting data for the first time. It stated:

“During 2011/12 we will pilot the collection of data on recurrence/metastasis on patients with breast cancer with the aim of undertaking full collection from April 2012.”

The pilot was run by the National Cancer Intelligence Network, the NCIN, in collaboration with Breast Cancer Care, and it involved 15 breast cancer units across England. The pilot report published in March 2012 identified 598 patients with recurrent or metastatic breast cancer. Of those, only 53% were recorded as having been referred to a clinical nurse specialist, palliative care nurse or specialist keyworker at the time of diagnosis. The pilot recommended that all breast cancer units in England submit data on patients with recurrent and metastatic breast cancer using the existing data collection mechanisms, and in January 2013 that was made mandatory in all new diagnoses recorded in England. Unfortunately, the data have yet to be published, and I understand that hospitals are not collecting them consistently. Indeed, a report was due to be published by the NCIN on the topic earlier this year but, disappointingly, it has been repeatedly delayed.

An investigation with health professionals by Breast Cancer Care into why data are not being collected consistently revealed that many of the barriers lie in the practicalities. Time constraints mean that there is often not enough time to input data manually, because patients’ needs, rightly, come first. Structural constraints were cited. Many of the data are expected to be collected through discussion at the multidisciplinary team meeting, but healthcare professionals tell us that most secondary patients are not discussed at MDT level. I welcome the recommendation in the new cancer strategy to review the role and function of the MDT in relation to secondary cancers. IT constraints cause further problems, because online record forms are not set up to collect the data in the cancer outcomes and services dataset, and there is a lack of access to online systems in some hospitals, especially in tertiary centres outside main hospital sites. Finally, there is a lack of awareness about what data are required and confusion about who is responsible for inputting various data items.

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Leadership is required to help to drive robust data collection in all hospitals, and we want the Minister, who has responsibility for public health, to make that a priority and lead the way in ensuring that data are collected in every hospital. The new cancer strategy, “Achieving world-class cancer outcomes”, which was published earlier this year, includes a recommendation that data should be collected on all secondary cancer patients. We urgently need the implementation of the plan for how that will happen. In theory, as I have said, breast cancer data should be submitted through the COSD, which replaced the previous national cancer dataset in January 2013 as the new national standard for reporting cancer data in the NHS in England. It has the potential to provide a much broader overview of the treatment, care and outcomes of secondary breast cancer patients. Unless that happens consistently across England, however, we will not see the data that we need to improve care.

Julian Knight (Solihull) (Con): I congratulate my hon. Friend on securing the debate and on the powerful case that he is forensically making. He knows as well as I do that, in our area of the west midlands, we were hit by the Ian Paterson scandal at Spire Parkway hospital. Does he believe that a greater ability to collect and collate statistics would have gone some way to alleviating that problem, because it could have been spotted earlier?

Craig Tracey: I agree completely. The lack of data is astounding, and they would help in so many different areas of treatment.

My second objective is access to specialist palliative care. For those living with a diagnosis of secondary breast cancer, such care can make all the difference in enhancing their quality of life, but for too many, support is not available. In many cases when support becomes available, it is too little, too late. Research for Secondary Breast Cancer Awareness Day in 2014 showed that 90% of people living with secondary breast cancer experience regular pain, and 78% find that it affects their ability to undertake everyday activities. For those reasons, palliative care is an absolute essential for secondary breast cancer. Hospices and community-based services can provide symptom management and pain control so that no one has to live with secondary pain. Furthermore, emotional support for both patient and family can help people come to terms with having an incurable disease, as well as ensuring that decisions are taken and adhered to about their choices at the end of life. Palliative care should come at the point of diagnosis, or at a timely point such as when a patient becomes symptomatic. It should provide both symptom control to help them live as well as they can for as long as possible, and emotional support to help them to cope with having an incurable disease and to make informed choices about the end of life.

The third area that I would like to mention is specialist nursing care. We know from the cancer patient experience survey that having a clinical nurse specialist as part of someone’s care is the biggest driver in improving patient experience. The National Institute for Health and Care Excellence quality standard states that everyone with secondary breast cancer should have access to a CNS. A CNS can help to co-ordinate care, provide emotional support and guide a patient through treatment and

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beyond. However, we know that it is far less common for someone with secondary breast cancer to have a CNS than for someone who has primary breast cancer, mainly because only a handful of CNSs have specific experience of and expertise in secondary breast cancer. A 2010 study found that there were only 19 dedicated secondary breast cancer nurse post-holders across the UK—the current estimate is 25—as opposed to 600 conventional breast cancer care nurse posts. That number must be increased, given that we estimate that there are 36,000 people living with secondary breast cancer—that figure is likely to grow as the population ages and treatments improve.

We need to commit to training more secondary breast cancer CNSs. Anecdotal evidence from existing nurses and from patients who receive care from a CNS suggest that that measure could save money in the long term by keeping patients out of hospital and highlighting problems before they become crises in A&E. We would also expect someone who has a CNS to be more likely than someone who does not to be referred to palliative care when they need it.

My fourth point is about access to drugs and treatments. The cancer drugs fund, which was introduced in 2011, has been an important initiative to improve access to clinically effective drugs that have been deemed by NICE not to be cost-effective enough to be provided routinely on the NHS. Government figures show that, to date, 72,000 people have received life-extending cancer drugs as a result of the CDF. However, it was recently announced that two secondary breast cancer drugs would be removed from the list with effect from November this year. Although NHS England has stressed that any patient who is on a drug when it is de-listed will continue to receive it until it is no longer clinically effective, the change creates anxiety for people living with secondary breast cancer. Cancer charities hear from a lot of people who are concerned that their options for treatment in the future, when their current treatment is no longer effective, are being reduced.

I understand that new cancer drugs can be extremely expensive and it is important to remember that the NHS has finite resources, but there is a clear opportunity to reform the drug appraisal system and bring together pharmaceutical companies with healthcare professionals to ensure that secondary breast cancer patients can access new drugs at a price that is affordable to the NHS. The CDF was only ever meant to be a short-term solution to the problem, and it is vital that we find a long-term solution.

The final key area that I want to see addressed is co-ordinated and joined-up care. The role of a multi-disciplinary team is to bring together all the healthcare professionals involved in a patient’s care to help to co-ordinate the support that that patient receives. For many primary breast cancer patients, it works very well, bringing together oncologists, nurses, radiotherapists and other professionals to ensure that the patient’s care is joined up and integrated. However, the secondary breast cancer taskforce found that that was simply not the case for secondary breast cancer patients, largely because people living with the disease are under the care of only an oncologist rather than a team of professionals. Because of that gap, opportunities—for example, the opportunity to identify when palliative care would be

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most beneficial—are being missed. The cancer strategy includes a recommendation that MDTs consider new pathways for secondary patients. The implementation of that recommendation would go a long way towards joining up care more consistently and ensuring that patients’ holistic needs are more likely to be met.

To conclude, I ask the Minister to consider five clear steps: better data collection; greater access to palliative care; more specialist nurses; access to better drugs and treatment; and co-ordinated and joined-up care. To achieve the Government’s aim of being the best in Europe for cancer care, we need to ensure that people survive cancer and that those who are living with incurable cancers like Sue, who I met at the event last week, and Dee, who I believe is in the Public Gallery, are getting the care and support they need to ensure that they can live as well as they can for as long as they can.

5.10 pm

Jim Shannon (Strangford) (DUP): Thank you for giving me the chance to speak in this debate, Ms Dorries. I congratulate the hon. Member for North Warwickshire (Craig Tracey) on bringing this matter to the House for consideration. This is an opportunity for all of us to participate and throw in our knowledge. We are all fond of the Minister and we know that her replies will be positive because of her knowledge of this subject, which we have discussed on many occasions. I look forward to her response.

This issue is of the utmost importance. I am my party’s health spokesperson at Westminster, so I am well aware of these issues back home, which come much too close to many of us and indeed our constituents.

In yesterday’s debate on the availability of cancer drugs, we discussed many issues. Today we are specifically discussing breast cancer and the hon. Member for North Warwickshire is right that we should take an interest in it. Almost 80 MPs attended the breast cancer function just over a month ago.

I would like to focus specifically on Northern Ireland. The Minister will know that health is a devolved matter, but I want to give some statistical evidence on how important it is to us in Northern Ireland and how much help we need for it in Northern Ireland and on the mainland. According to the Northern Ireland Executive, breast cancer is the most common form of cancer among Northern Irish women, excluding non-melanoma skin cancer. I am sure that Members will agree that the figures are worrying: some 1,200 women are diagnosed with breast cancer in Northern Ireland each year and one in nine is expected to develop the disease at some stage in their life.

We all know about the high-profile cases in the press every week—Angelina Jolie is one and Kylie Minogue is another. We think of them because they are household names, but, by speaking about their personal circumstances, they have raised the profile of this disease. In some cases, surgical operations have been done before the disease comes. When we hear about that sort of step, we know that we are talking about something most serious.

There have been welcome developments in breast cancer treatment and care in the Province, including free breast cancer screening for 50 to 70-year-olds every three years. That new initiative, announced by my colleague, Simon Hamilton, illustrates the need for specific action on diagnosis, and early diagnosis in particular, as the

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hon. Member for North Warwickshire mentioned. We need to step up to the plate and instigate action wherever we can.

Breast cancer screening is an effective way to detect cancer in its early stages. Early detection is essential to increase survival rates. Just yesterday I tabled a question, asking “what steps” the Minister’s Department

“has taken to ensure that people diagnosed with cancer are (a) diagnosed early and (b) treated immediately.”

Early diagnosis and the availability of treatment are important issues. As the hon. Member for North Warwickshire outlined in his speech, there is a period of time in between them, but we need early diagnosis and early treatment—let us have the two of them together.

Complications arise and treatment is made more difficult when the primary cancer spreads to another part of the body. It is the secondary cancer that we are here—

Nadine Dorries (in the Chair): Order. More speakers have requested to speak in the debate than we realised at the beginning. Therefore, accounting for the winding-up speeches, the time available has narrowed considerably to just over five minutes each. I have to push you, Mr Shannon. Having now spoken for four and a half minutes, could you begin to wind up so that we can get everyone in? That would be fantastic. Thank you.

Jim Shannon: I appreciate that. I spoke to you earlier, Ms Dorries, and looked at the figures. I was not aware that we would be down to five minutes, so let me focus on these points.

It is estimated that over a third of those diagnosed with primary breast cancer will develop a secondary cancer within 10 years of their first diagnosis. Again, early detection is the issue. Advancing new treatments and improving those in existence is of the utmost importance, but we must also publicise and promote research and findings on what can be done to prevent both primary and secondary breast cancer and to reduce the risks of them developing.

I see that the hon. Member for Central Ayrshire (Dr Whitford) from the Scottish National party is here to make a contribution. I know of her interest in this issue from her previous job, so I look forward to hearing what she and her party have been able to do in Scotland. That is important for the debate.

We should also look at partnerships between Governments, universities and the pharmaceutical companies. In the Minister’s response, will she say what steps will be taken to review the NICE criteria? It seems that some new drugs on the market that could be used to reduce deaths from breast cancer are held up by those criteria. Will she look at that?

I do not believe that we can put a price on life and, when it comes to these issues, we cannot make decisions based on anything other than genuine human compassion and empathy. I hope that the debate will raise awareness for those with breast cancer.

The Minister always responds in a positive fashion. We need to look at the availability of drugs, early diagnosis and early provision of medicine and medical help. We also need to raise this issue with the pharmaceutical companies and review the NICE regulations, because, by doing so, I think we will get more drugs available.

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5.17 pm

Michelle Donelan (Chippenham) (Con): I pay tribute to the Members who have made contributions so far on this important subject, which affects residents in all of our constituencies. Cancer is, as we all know, a harrowing illness for those who suffer from it and for their families and friends. Three million people will be living with cancer in the United Kingdom by the end of the Parliament.

Two of my close friends who helped me get into this place have fallen victim to cancer since the election. For their sake and that of the 550 people in Wiltshire under the age of 75 who die of cancer every year, cancer must remain at the top of the agenda. There must be a long-term strategy for combating this dreadful illness.

Cancer touches everyone’s lives at some point. Most people with cancer want to ensure that they have the best information as fast as possible. Many go trawling through the internet, looking at not just drugs, but other treatments that could help such as diet, exercise and complementary therapies.

Today’s cancer patients know that there are things they can do to improve their chance of survival. They want to increase their knowledge so that they can make personal, well informed decisions and create personal treatment packages around their doctors’ treatments.

No two patients wish for identical forms of care, which is why it is important that the Government have taken steps on personal support. There are now clinician nurse specialists for those with secondary breast cancer, which is a good step in the right direction.

As the Minister will know, Macmillan Cancer Support is calling on the Government to fund an independent review of choices for end-of-life care. I encourage them to look closely at what Macmillan has to say. I know that Ministers are committed to improving the detection and treatment of breast cancer, in particular to avoid the risk of secondary breast cancer developing. I am encouraged that breast cancer survival rates have increased, but there is a lot more to be done.

The only way I can foresee that we can combat secondary breast cancer is by focusing on reducing primary cancer. Survival time post-diagnosis depends on several factors, including the stages of diagnosis, the overall health of the patient and the quality of care they receive.

I have been concerned for a long time that one group of people is often overlooked: the older generation. Cancer is not part of old age, although it is seen by many to be. We need to consider how we reach our elderly through information and support, to give them the confidence to seek medical treatment. Too often, pensioners such as my grandmother are too afraid to go to the doctor because they fear they will end up going into hospital and never coming back, so they leave it until it is simply too late. It does not have to be that way.

One solution to combat that is providing more services at a community level, so that the fear of going to hospital is reduced. I am pleased to say that that has already been piloted in Wiltshire for chemotherapy services with the help of Hope for Tomorrow, a charity that provides mobile chemotherapy units and for which I am a regular fundraiser. That is just one example of how we can go much further in the field.

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There is work to be done to reduce the health inequality shown by higher rates of mortality in deprived areas. Assessing risky lifestyle behaviours such as smoking and poor diets, combined with active screening and symptom awareness programmes, is vital.

Last weekend, a close family friend of mine lost their battle and died of secondary breast cancer. I learned from first-hand experience that the most important thing we need to do is improve care across the entire cancer journey. We need to start looking at it as a journey and to ensure that a personalised and individual programme is developed, with the family playing a part. It is of the utmost importance that secondary breast cancer patients have access to appropriate services or are referred to specialist palliative care, which can provide more effective pain relief in the management of illnesses, if they so wish.

The cost of cancer will undoubtedly continue to rise during this Parliament. That is why I return to the need for a clear long-term strategy to address this problem. That includes investing in reducing the impact of primary cancers to save money and to save lives in the long run, as well as personal cancer care plans for those living with cancer.

In conclusion, I hope we will do even more to support those living with cancer because this disease touches so many of our lives and affects so many people. I hope the Minister will look closely at Macmillan’s proposals to fund an independent review of end-of-life care choices.

5.22 pm

Dr Lisa Cameron (East Kilbride, Strathaven and Lesmahagow) (SNP): It is a pleasure to speak under your chairmanship, Ms Dorries. I congratulate the hon. Member for North Warwickshire (Craig Tracey) on securing this extremely important debate. I refer Members to my entry in the Register of Members’ Financial Interests, having worked as a clinical psychologist in the NHS for 20 years.

A diagnosis of secondary breast cancer means that the cancer can be treated but not cured. In those cases, the aim of treatment is to control and slow down the spread of the disease, to relieve symptoms and to give the person the best possible quality of life for as long as possible. At present, there are many treatments that can keep the cancer under control, often for many years. However, when it comes to breast cancer, it appears that the focus has overwhelmingly been on primary breast cancer, and there has been a lack of awareness of and attention to secondary breast cancer. This is therefore an extremely important debate, particularly as this month is Breast Cancer Awareness Month.

There appear to be real problems with equity of care across the country. While there are examples of good practice, it appears that quality of care can depend upon location, and that people with secondary breast cancer often receive inadequate care. Access to a clinical nurse specialist from the point of diagnosis onwards has been highlighted as an extremely important development, as has a multidisciplinary team approach to people’s care.

I would like to highlight the relevance of continuity of care between hospital and community services, alongside timely information on all aspects of treatment and care

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for patients. Access to information, as has been described, about both local and national services is crucial, as well as access to expertise in palliative care for symptom control and ongoing management of troublesome symptoms. It is important that support is provided for the partners, families and children of patients, and I hope the Minister will comment on that in her response. Access to appropriate treatments is also important, as is being made aware of the availability of local clinical trials that may be pertinent.

There has to be a regular assessment of patients’ emotional wellbeing and access to an appropriate level of psychological support. That support should be available whenever needed by the patient, particularly at diagnosis, when cancer progresses and at the end of each treatment. I am aware that Breast Cancer Now has highlighted the huge emotional toll for women living with secondary breast cancer in terms of the anxiety and uncertainty of having to go for regular scanning to monitor their condition. In a video on Breast Cancer Now’s website, one patient describes her experience of going for scanning every three months and then having to wait two weeks to find out the result. During that period, she describes experiencing “scan anxiety” about the potential outcome. Before getting the results, she mentally prepares herself to expect the worst, so as not to be disappointed. She describes crying due to the emotional stress, even when the news is good, and then going away to live her life for another two months before having to start the cycle again.

I am aware of three important articles in The Lancet from 2014 that looked at the prevalence of depression and mental health problems in oncology patients, including those with secondary cancer, the majority of whom were receiving no form of treatment for their mental health difficulties. The recovery from and management of physical conditions is aided by people having good mental health and wellbeing, and that is corroborated by NICE guidance from 2009. There is therefore a need for greater access to psychological therapy provided by the NHS, which has often been inadequate. There should be increased training for clinical nurse specialists in psychological modes of therapy such as cognitive behavioural therapy, so that they can directly assist patients. Greater parity between physical and mental health services is key, alongside greater integration of those services for patients who have a dual diagnosis.

5.26 pm

Jo Churchill (Bury St Edmunds) (Con): I thank my right hon. Friend—sorry, my hon. Friend the Member for North Warwickshire (Craig Tracey); I just gave him a promotion—for securing the debate.

I come to this with a slightly different hat on. As I prepared to speak, I tried to decide whether the word “cancer” or “secondary” was the scariest. For me, it is “secondary”. I have had cancer a couple of times, and the scan anxiety that the hon. Member for East Kilbride, Strathaven and Lesmahagow (Dr Cameron) talked of is so real, as is the need for joined-up services and clinical nurse specialists. We need to be able to be a person in the pipeline. Owing to the shortness of time, I will not say a lot of what I was going to say, but I will try to concentrate on what it feels like for the person.

We know the statistics. We know that 50,000 women and men—we must remember that there are men with breast cancer too—get breast cancer per year. The good

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news for primary breast cancer sufferers is that many of those people are survivors. Victoria Derbyshire is a fine example to us only this morning, in the papers; good luck to her with her battle.

Some of my friends and constituents to whom I have spoken have had secondary or metastatic breast cancer. It sounds hopeless, but it is not. With improved drugs and more targeted and tailored treatment, survival time is longer. Yes, there are 36,000 people living with breast cancer, but it is better quality survival that most of us want. It is about the quality of survival.

I started my journey to becoming an MP by talking in 2010 in one of the rooms in this place about primary cancers and how we had some of the poorest outcomes in Europe. Things are not so much better in 2015. We need to keep our feet to the fire and ensure we push hard on this disease, so that we start to get real progress for primary, and particularly secondary, cancers.

My hon. Friend the Member for Chippenham (Michelle Donelan) mentioned old age but those from various ethnic minorities also have extremely poor outcomes. We must pay heed to that. How can we get better outcomes? The cancer strategy for England calls for improvements from pre-diagnosis to post-treatment. That is vital but we should ensure that patients receive optimum support and interventions so that they can get on with their lives. We need to think about lifestyles and lifetimes, and about which cancer services we need, to enable people to carry on working for as long as they want, so that they feel like people, not like cancer patients. That is the important thing for people living with this disease. We want people to lead healthy, fulfilled and productive lives, whichever stage of the disease they are at. The strategy proposes the development of a national metric of quality of life, underpinned by a robust approach to measurement, which will incentivise the provision of better aftercare interventions.

We want multidisciplinary teams. They really improve outcomes for patients and, when people are diagnosed, they want people other than oncologists. They want to talk to a psychologist as the disease sometimes messes with their heads more than it does with their bodies. That important pipeline is, oh, so needed. There should be robust surveillance systems, as my hon. Friend the Member for North Warwickshire said. It is important that we know what we know, so that we know how to get to the root cause of the problem.

Since 2011, six breast cancer drugs have been available. There was a debate in this place yesterday about the cancer drugs fund. We need sustainable funding to ensure that women and men get the treatment that they need. Treatment should not be a lottery. In my view, this pot is a sticking plaster that has gone a bit curly around the edges. It needs revising and refreshing. There needs to be an efficient way of moving drugs from the cancer drugs fund into positive and routine commissioning. Currently, it is out of date and not fit for purpose.

I welcome the accelerated access review, which reports at the end of the year, and the cancer drugs fund, but I urge the Government to make some speedy decisions because, as 4 November looms, people are sitting on the edge of decision making, not knowing whether they are likely to get treatment or not. Although we have said that women and men who are on their treatment programme will still receive that treatment, it is not so certain for those who are not yet on those drugs.

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We could learn a little from the Scottish Medicines Consortium because, on this, it does some things a little better than we are managing to do. It commissions and moves more swiftly. We could also unblock our pipelines. We are potentially disabling innovative medicines. We need to trial innovative drugs that can be used to prolong life and have a conversation with pharmaceutical companies if England does not want to fall behind in the race to make the medicines of the 21st century.

Research is so important, as is this debate on secondary breast cancer because science will unlock the ability to fight the disease. Geneticists on the 1000 Genomes Project have already discovered more than 100 regions of the genome that contain genetic variants. Work goes on in labs, such as the Genesis Genetics research, targeting who is susceptible and why. If we know people are more susceptible, the better they can be treated. Evidence-based is good but it charges industry and researchers with helping to drive things forward.

As a survivor and someone who has held too many women for whom secondary breast cancer has not offered longevity, I dream of a day when immunotherapy, CyberKnife and the work of drugs companies means that this insidious disease is a has-been. We need a lifetime approach, preventive medicine and preventive care. We need to watch our weight, keep healthy and be active, and the drugs that we need when we need them—in hospital or in the community.

5.33 pm

Dr Philippa Whitford (Central Ayrshire) (SNP): I commend the hon. Member for North Warwickshire (Craig Tracey) for securing this debate, which marks breast cancer awareness month. Most Members know my interest. I was a breast cancer surgeon for 33 years. The hon. Gentleman said that secondary breast cancer does not gain from the focus that we put on primary breast cancer. I have to disagree with that. In Scotland, we collect the stage at diagnosis and one in five patients still have metastases at the time of diagnosis. That means that we still have a huge job to do to get earlier diagnosis through screening and raising awareness, which is what October is all about. We are limited for time and I will do my best to respond to as many points as possible.

Regarding audit, I chaired the discussions on quality improvement standards for breast cancer in 2001, at which time we discovered that about a quarter of units did not gather any data at all. By 2003, we had managed to change that and we were getting data on the primary treatment of patients. That was against the breast cancer standards that we had set for the entire journey that a patient would go through. In 2007, I was chair for the update of those standards and, at that point, it became a standard that all patients with recurrence or metastases must come back to the multidisciplinary team for discussion. At that point, those data are also gathered. As yet, we do not have a Scottish-wide, absolutely rock-solid way of providing the data. They are being collected through our cancer registry, from SMR01 data and from what we do in-house.

In my unit in Ayrshire, we had a follow-up page for the patient at the end of the data system. Every year when the patient came for the follow-up, a chitty was ticked, sent up to the office and on it went, showing that the patient was alive and well on whatever date they had come. For patients moving to mammographic follow-up,

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if the mammogram is clear and there are no issues, the procedure is the same. The data on patients with recurrence or metastases must be collected at the multidisciplinary team. That is something that we were doing. We have to look at the systems to make it easy and not burdensome, but that requires that hospitals and trusts have an audit team. Our auditor sits in the multidisciplinary team, where she captures all the treatment of the primary and secondary patients. That is really important.

The hon. Member for North Warwickshire mentioned CNSs. There are different approaches. In our unit, we treat approximately 400 new breast cancers every year, which means that a significant number of patients have recurrent and secondary breast cancer. We talked about whether we should split our teams and have one for secondary breast cancer. We decided against that because we have a breast cancer team, which the patient will have met at the beginning. I felt that meeting the same team—a friendly face or someone the patient knew from three or four years ago—is a benefit.

Many units have surgical cancer nurse specialists, who do not move into chemotherapy or oncology. Obviously, that would not work that way. Our cancer nurse specialists travel the whole journey with the patient, looking after the patient in the surgical part of the journey and in the oncology clinic during chemotherapy. They are also there if the patient is unlucky enough to face recurrence or metastases. I believe that this linear approach—as long as enough nurses are provided for that support—gives the advantage of continuity.

My hon. Friend the Member for East Kilbride, Strathaven and Lesmahagow (Dr Cameron) mentioned looking at the wellbeing of patients. In Scotland, we use something called the distress thermometer, which is used for patients undergoing treatment for primary and secondary breast cancers. It is quite a quick, easy tool that, at least, allows us to pick out a patient who is not doing so well and therefore identify them for additional support. Our cancer nurse specialists have all had additional training. We have a specialist oncology psychologist on our health board, who provides additional training to the nurses. Therefore, for someone who needs it, that extra help and counselling is available. For someone with more complex needs, or where the diagnosis of breast cancer or metastatic breast cancer comes on top of mental health issues, the oncology psychologist would give us that back-up by taking on the patient.

The hon. Member for North Warwickshire mentioned palliative care. In Ayrshire, we are lucky enough to have a hospice. It is routine for us to refer patients at the point at which they are metastatic and symptomatic. We do not refer them as soon as they are metastatic because if a patient is hormone-sensitive, they have a 50% five-year survival with metastatic disease. That is because we have so many treatment options and breast cancer appears to behave quite differently from other cancers in that we can get it into a balance. The patient can be very well and active, yet the disease is sitting there. As soon as the patient starts to have symptoms, we have liaison nurses in our hospitals and we make a referral. Part of our GPs’ quality outcome framework is that patients who are defined as palliative must be discussed regularly in primary care and be on a palliative care register.

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We had the debate on assisted dying just last month. The clear decision of the House was that we would not go down that route. That throws back on to the Government, and us all, the responsibility to ensure that high-quality palliative care services are there. We cannot vote that way as convincingly as we did and then not step up to the mark. That is really important.

I do not have a lot of time to speak, but I should say that we are doing good things in Scotland. Because we are smaller, we have been able to create a single day when all the teams in Scotland come together—actually, they come together for two days: a trial and research day and an audit day. Our whole audit—all the dirty washing—is put up in a PowerPoint presentation and we have a completely open learning discussion about it. A one-year project is starting now, so hopefully the data, including detail on secondary, recurrence and survival, will be available in autumn next year.

5.41 pm

Andrew Gwynne (Denton and Reddish) (Lab): I congratulate the hon. Member for North Warwickshire (Craig Tracey) on securing this important debate and the laudable and worthwhile work he is doing as a member of the all-party group on breast cancer.

We have made huge progress on improving cancer services—in the past decade, five-year survival rates for nearly all types of cancer have improved—but we still lag behind other countries, and there is worrying evidence from the past five years that the progress we have been making on cancer care has stalled, or potentially even gone backwards. In government, Labour created 28 cancer networks to drive change and improvement in cancer services. The networks brought together the providers and commissioners of cancer care to work together to plan and deliver high-quality cancer services in their areas. They helped to oversee and drive up the quality of services delivered to cancer patients. By significantly changing their structure and cutting millions from their budgets, as well as by scrapping the highly regarded national cancer action team, the coalition Government disrupted those networks.

Our hard-working clinicians and staff are trying their best within the system; despite the challenges, they continue to deliver quality care, so we should all pay tribute to them. Early diagnosis is critical to improving cancer survival because treatment is more likely to be successful at an earlier stage. Naturally, far too many of those people diagnosed through the emergency route are in the advanced stages, meaning the prognosis is poor compared with that for cancer diagnosed through other routes.

The nature of cancer is changing. Just as with AIDS, rapid advances in technology have meant that for many cancer is no longer the death sentence it once was. Such welcome changes do, however, mean that cancer is increasingly being considered a long-term condition, which has its own requirements in terms of long-term care and support. The chance of recurrence, as in secondary breast cancer, underlines the importance of remaining vigilant. It is possible to reduce considerably the probability that people with cancer will experience long-term poor health following treatment by providing appropriate and co-ordinated support and intervention. That is what we must do.

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No breast cancer patient should end up lost in our vast health system, unable to find the treatment to which they are entitled. Cancer survivors have to be properly supported once their treatment stops to help their recovery and minimise the impact of their illness on their overall health and wellbeing. The current formulaic approaches are not meeting the needs of cancer patients, and the current hospital-based follow-up service simply will not cope with the growing cancer population.

If implemented, the strategy developed by the Independent Cancer Taskforce in its report would be a huge leap forward. I am pleased that the Department of Health has already made some commitments, and we look forward to hearing more following the spending review, but we need to ensure that these things actually happen. Equally, the cancer strategy recommendation of a “living with and beyond cancer” programme to ensure that people are fully supported and their needs are met should be followed through. I commend those developing support networks in their local areas, but they deserve more backing from the Government. I welcome the Government’s commitment to ensuring that everybody has a recovery package by 2020. That is crucial, as one in three people experience moderate to severe unmet needs after their treatment.

We owe it to the families battling secondary breast cancer today to continue to have high ambitions. I thank all Members for their contributions. Despite political differences, we do all have the same ambition: to bring forward the day when this terrible disease is beaten.

5.45 pm

The Parliamentary Under-Secretary of State for Health (Jane Ellison): I congratulate all colleagues on an excellent debate. It is a shame that time has slightly beaten us. I fear it will beat me as well: if I am to allow a minute or so for my hon. Friend the Member for North Warwickshire (Craig Tracey) to respond at the end, I might not have the chance to make some of the points I would like to have made. Nevertheless, this debate in Breast Cancer Awareness Month is very timely for all the reasons mentioned. There have been some important contributions. I always enjoy listening to the hon. Member for Central Ayrshire (Dr Whitford); she brings incredible experience to debates of this nature.

As the cancer drugs fund was debated in this Chamber only yesterday with my hon. Friend the Under-Secretary of State for Life Sciences, I will not touch on that so that I save a little time. As others have said, we want to do a lot better in tackling cancer, and our aim is to lead the world. Survival rates are getting a lot better: for people diagnosed between 2011 and 2015, we are on track to save a projected 12,000 more lives a year. But we do want to go further. Nevertheless, as we ask what more we can do, we should acknowledge that we are making progress, although much of the rest of the world is too.

In January, NHS England asked the independent cancer taskforce to draw up a five-year strategy. It was published in July and recommends a range of improvements across the cancer pathway. Some Members were present in the House in July when the chair of the taskforce, Harpal Kumar, presented its conclusions to us. The strategy is an excellent bit of work and, as our manifesto made clear, we are working with the NHS, charities and patient groups to deliver it. It is important to tell the

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House that to support the delivery of the strategy, NHS England has appointed Cally Palmer, chief executive of the Royal Marsden NHS Foundation Trust, as NHS national cancer director. While continuing in her current position, she will lead the implementation of the strategy, alongside work to test new models of care at the Royal Marsden hospital and University College London hospital, in partnership with Manchester Cancer. Those are important developments.

The importance of secondary breast cancer was acknowledged in the taskforce report, which noted that all NHS trusts should now be recording recurrent and secondary breast cancer patients, but we acknowledge that uptake has been variable thus far, as highlighted in the opening speech. I made the importance of data collection one of the strategic priorities in my letter to Public Health England earlier this year, so we know that we need to do better.

Following a 2012 pilot managed by the National Cancer Intelligence Network, all breast units have been required to submit information on all patients diagnosed with a new recurrence or metastatic disease through the cancer waiting times process. For breast cancer cases, that now includes a data item on cancer recurrence. Data have been submitted monthly since January 2013, but collection remains challenging because relapsed patients may re-present in many different ways and through many referral routes, as the hon. Member for Central Ayrshire mentioned. For example, they might re-present through a routine follow-up appointment, by contacting their GP with renewed symptoms or by presenting with another unrelated condition, at which point secondary breast cancer has been diagnosed. There are some practical barriers, but we do need to do better.

To drive up the quality and completeness of the data, trusts are sent monthly reports so that they can benchmark themselves against other trusts, which has been effective in driving up performance in other areas of cancer care. Over the next year, those reports will include data on recurrence of cancer. In addition, more work is being scoped by NHS England and Public Health England based on the recommendation from the cancer taskforce to establish robust surveillance systems to collect relevant data. We know there is more to be done on the detection of secondary breast cancer, which can be diagnosed many years after primary breast cancer, as other Members have said. Although survival rates are improving, the breast cancer clinical reference group of NHS England is determined to ensure that everything possible is done to reduce the risk of secondary breast cancer. The group is in the final stages of producing a guideline on breast cancer services to improve information given to patients about the risk of secondary breast cancer. Such information is currently variable and sometimes inadequate, as highlighted by my hon. Friend the Member for Bury St Edmunds (Jo Churchill).

Mark Durkan (Foyle) (SDLP): Will the Minister give way?

Jane Ellison: I will take the briefest of interventions.

Mark Durkan: The Minister touches on a point that reinforces the fact that, as a basic rule of thumb, policy makers and service planners should know the numbers and the needs. She addressed the numbers when she

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spoke about data. Knowledge about needs is best developed by listening to the patients themselves, who expressed those needs forcefully in the five-point bucket list from Breast Cancer Care.

Jane Ellison: I am sure we would all agree with that important point.

I will finish by discussing the new guideline that the clinical reference group is developing. The guideline will state that all patients with primary breast cancer should have a consultation with a clinician at the end of treatment that will include advice on spotting signs and symptoms that might indicate secondary breast cancer. That information will be delivered together with an assessment of the patient’s physical, psychological and social needs—I am interested in the distress thermometer that the hon. Member for Central Ayrshire mentioned, as well as in the contribution of the hon. Member for East Kilbride, Strathaven and Lesmahagow (Dr Cameron). The overall recovery package is being developed in partnership with Macmillan Cancer Support. The evidence is that that work is very effective where it has been done well. The advice that has been given will be recorded in the records of every breast cancer patient so that we know it has happened and so that we can track it.

NHS England hopes to publish the new guidance as a cancer resource on its website in the next few weeks. We will promote that guidance through the usual channels, but we would appreciate it if hon. Members with a particular interest, and particularly my hon. Friend the Member for North Warwickshire—I congratulate him on his appointment as co-chair of the all-party group—could draw this important document to people’s attention.

The clinical reference group will also consider how the care and support of patients diagnosed with secondary breast cancer can be improved, including through the provision of clinical nurse specialists. Of course, we agree that clinical nurse specialists play an important role. The number of patients reporting that they have been given the name of a CNS rose from 84% in 2010 to 89% in 2014, including 93% of breast cancer patients. We are doing a lot better, but hon. Members are right to highlight that, in the case of secondary breast cancer, we have some distance to go.

Members have said that we need to step up on palliative care, particularly in the light of last month’s debate—the hon. Member for Central Ayrshire made an important speech in that debate. We are committed to ensuring that everyone has access to high-quality, personalised palliative care. Breast Cancer Care’s new report, “Too little, too late”, is an important contribution to the debate about what we need to do. The Government

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have introduced five new priorities for end-of-life care—those are five important new principles—and my ministerial colleagues will be taking that forward. Nevertheless, I welcome Parliament’s new focus on palliative care and quality end-of-life care, which is important.

In the few seconds that I have remaining, I want to give people confidence that a lot of research is going on in this area. There is more research into cancer than any other disease in terms of National Institute for Health Research funding. In particular, the NIHR’s clinical research network is currently recruiting patients for nearly 100 trials and studies in breast cancer. One is a global trial that aims better to control secondary breast cancer using a drug called a dual mTOR inhibitor. I am delighted to say that the network recruited the first patient in the world to this trial, which I hope is an indication of the importance of our research infrastructure.

Dr Whitford: Will the Minister give way?

Jane Ellison: I am afraid that I do not have time to give way. We can speak after the debate; I apologise.

A lot of other things are going on in that area, but I will leave just a few seconds to my hon. Friend the Member for North Warwickshire. However, I reassure Members that this subject is of huge importance to the Government.

Nadine Dorries (in the Chair): There are 30 seconds left for Mr Tracey.

5.54 pm

Craig Tracey: I will be very quick.

I thank the Minister for her response. I also thank the other Front-Bench spokesmen, especially the hon. Member for Central Ayrshire (Dr Whitford) who obviously brings a great deal of expertise to the debate. I thank all colleagues who have taken part in this debate, particularly my hon. Friend the Member for Bury St Edmunds (Jo Churchill) for sharing her experience.

It is clear from the debate that we all have the same objectives; we all want to get the same thing and there are many common arguments. However, the fact remains that 11,700 people still die from secondary breast cancer every year, so there is more that we can do. I ask the Minister to ensure that more is considered in relation to secondary breast cancer.

5.55 pm

Motion lapsed, and sitting adjourned without Question put (Standing Order No. 10(14)).