Cancer Poverty
The final item of business is a members' business debate on motion S3M-1972, in the name of Michael Matheson, on cancer poverty. The debate will be concluded without any question being put.
Motion debated,
That the Parliament recognises the wider social impact of dealing and living with a cancer diagnosis, including the significant financial consequences of the disease; is concerned that 90% of people affected by cancer in the United Kingdom experience a significant drop in income and an increase in daily living expenses as a direct result of their diagnosis; welcomes the work of Macmillan Cancer Support, in partnership with the regional cancer advisory groups and local government, in developing a network of cancer-aware benefits advisors in Falkirk and across Scotland; supports the embedding of referral to benefits and financial advice within routine NHS clinical practice, and recognises the need to address cancer poverty in the Better Cancer Care strategy and ensure that financial advice becomes an integral part of every Scot's cancer journey.
I thank those members who have taken the time to support my motion. I am particularly pleased that the motion has gathered support from across the chamber.
Unfortunately, most families will be touched by the illness of cancer at some point, either directly or indirectly; my mother is currently being treated for cancer and, thankfully, her treatment has been successful so far. Given the trauma that individuals experience when they are informed that they have cancer, the last thing that will be on their mind is the financial consequences of having such an illness, but the wider social impact of dealing and living with a cancer diagnosis has only recently been properly acknowledged. A central issue is the recognition of the significant financial consequences of the disease and the emotional impact that the experience can have on the lives of patients and their families.
Recent research from Macmillan Cancer Support demonstrates that many people in Scotland who are affected by cancer experience significant levels of poverty as a direct result of a cancer diagnosis. For people who are living with cancer, financial concerns are a cause of considerable stress, second only to physical pain. About 90 per cent of people who are affected by cancer experience a drop in income and an increase in their daily living expenditure because of their diagnosis. It is simply wrong that patients who have the considerable worry of a cancer diagnosis should also be burdened with financial worries. Too many Scots who are affected by cancer do not get the financial support to which they are entitled, and the take-up of benefits among terminally ill people in Scotland is the lowest in the United Kingdom.
Experience has shown that effective, targeted social support for patients and their carers can have a positive impact on a range of outcomes, including physical health and mental wellbeing. Many patients and families who are affected by a cancer diagnosis require financial advice and support on a range of issues. To help address that, Macmillan Cancer Support has developed a benefits and financial advice service in different areas of Scotland in partnership with national health service boards, local authorities and the voluntary sector, and some 35 welfare rights officers funded through Macmillan are now operating in different areas.
The Macmillan money matters project has had a significant impact. Macmillan Cancer Support in Scotland has been at the forefront of this initiative—for example, the first cancer-specific benefit advice service in the United Kingdom was launched in Lanarkshire back in 2003. Since then, the service has grown to such an extent that Macmillan, in partnership with the regional cancer advisory group and local authorities, is creating a network of cancer-aware benefit advisers across Scotland that, by the end of 2009, will provide advice and support services for cancer patients and their families in every local authority area in Scotland.
The advice service in my constituency started in March 2007, as part of the Forth valley Macmillan money matters service. A partnership involving Macmillan, Falkirk Council, Stirling Council and Clackmannanshire Council, the service aims to promote and support the financial wellbeing of all patients who are living with a cancer diagnosis by providing advice and financial aid to families and carers when they need them most.
It is important to note that the advice covers not only benefits but employment rights, debt, savings and borrowing, pension rights, fuel poverty and insurance. Moreover, the service helps the person through the process of applying for benefits. I am sure that all members are aware of the difficulties that constituents face when they are negotiating the very complex benefits system.
During the past 17 months, the Forth valley service has helped people to claim £3.1 million in benefits, £1.65 million of which has been claimed in my constituency alone. Before the project's establishment, that money would have gone largely unclaimed. However, even with the significant progress that has been made, too many cancer sufferers still do not get the financial support to which they are entitled. Macmillan estimates that each year in Scotland £30 million-worth of benefits to which cancer patients are entitled go unclaimed.
The purpose of this debate is not only to give recognition to Macmillan's service and its significant benefits for individuals and their families but to try to ensure that all cancer patients benefit from it. At present, a patient is referred only if a member of staff, carer or the patient himself or herself knows that the service is available. Because chance still plays such a big part in getting support, far too many cancer patients are still missing out.
I hope that the Minister for Public Health will be able to support my proposal that a person be given information about the service or, with their consent, be automatically referred for information and advice at the very point at which they are diagnosed with cancer. The best way of achieving that would be to embed this type of service in the forthcoming cancer strategy and to make it a part of the patient's journey. Such a move would ensure that as many patients as possible benefit from the scheme, which would, in turn, help to relieve some of the worry that goes with a cancer diagnosis.
On the service that they received from money matters, a constituent said:
"If it wasn't for the Money Matters team, we would never have been able to access the help we needed by ourselves. We are eternally grateful for all your assistance and advice. Keep up the good work and thanks again."
Let us help to tackle cancer poverty by ensuring that people get the advice that they really need.
I congratulate Michael Matheson on securing this debate on such an important topic. I, too, want to express my appreciation for the work of the Macmillan adviser in the Forth valley area, because—as Mr Matheson pointed out—that work has reaped huge benefits.
Living with cancer is now a fact of life. The five-year survival rate for people who have been diagnosed with prostate cancer has increased by 35 per cent, the survival rate for those who have been diagnosed with breast cancer is up by 20 per cent, and the survival rate for those who have been diagnosed with leukaemia is up by 25 per cent. The figures go on. Improved cancer care is being developed in Scotland, and palliative care has improved enormously over the past generation, with the founding and development of the hospice movement in Scotland.
However, living with cancer or in a palliative care situation is made infinitely harder if only the person's medical symptoms are dealt with. Enormous stress for the individual and their family can result if a social care package is not adequately developed. We know from considering cancer survival rates and deprivation characteristics that there are still significant inequalities in those rates. A factor in that is that the situations of people who are already in poverty or are close to poverty are made worse because they do not get the support that they need.
Successive UK Governments have developed systems with various care packages, but those packages have been extremely complex—as Michael Matheson rightly said—and the benefits that have been available have been difficult to work through. If a person has an illness that is clearly terminal, the general practitioner can sign them up for attendance allowance, for example, and their claim can be fast-tracked. They then get that allowance, which is helpful. However, it can be tricky to claim the other benefits that are necessary to people who are living with cancer. A person may have to take prolonged periods off work for treatment in the hope and expectation that they will return to work. It is important that adequate support is provided in the intervening period. I am not sure that our national and local systems are yet sensitive enough to support such an approach.
Today, Parliament has been concerned with the demise of HBOS. I praise HBOS for what it did for one or two patients I had, who had cancer or who had a partner with cancer. HBOS was particularly supportive in allowing them to have time off, and its return-to-work process allowed them to get back to work at a speed and in a manner that they could manage. Balancing what to do for their benefit was difficult, but important. It is also clear that other groups, such as citizens advice bureaux, have been particularly helpful to patients in guiding them through the process.
It is important in the cancer strategy that we join the cancer networks, which are among the most successful developments in the health service in Scotland, with the social care package. The Maggie's centres do quite a bit of that and are extremely important in that regard, but we need a universal package that means that a person who is diagnosed with cancer will be supported through a social care package.
Cancer sufferers have other problems. For example, they find that there are difficulties with insurance if they wish to travel. I am pleased that a new company—I cannot remember its name, but I have been trying to find it—is offering travel insurance to people aged over 65 who suffer from cancer. It is particularly difficult for those people to get travel insurance. I welcome the approach that insurance companies have taken to providing insurance to allow people to travel, but that is only a small part of the package.
I commend my colleague Michael Matheson for lodging the motion, but I also take him to task, because this is not a new debate for the chamber. A very similar motion that was lodged by Elaine Smith and which expressed many of the concerns that we are debating today was debated in February 2005. Perhaps recognising that change is very slow is the penalty of being in Parliament for nine years.
We all know about the financial implications for cancer sufferers and their families. The onset of cancer can be immediate and severe, and the financial implications are the second-biggest worry after the worry that is caused by the disease itself. That speaks for itself. A person's partner and their family may feel guilty about even thinking about the financial implications, let alone doing something about them.
It is interesting that I attended a conference back in November 2004—that is how far back the issue goes—in which evidence was produced from a report entitled "Benefits Access for People Affected by Cancer in Northern Ireland". It was a nine-month study that involved secondment of a member of staff from Northern Ireland's Social Security Agency—social security is devolved there, which is a key point. The report addressed all the issues that we are exploring and identified problems such as the definition of the term "terminally ill". People go into respite, but the cancer could be cyclical. Should their benefits be taken away? For how long? Those are huge questions, but interpretation is not the same nationally. Northern Ireland made progress on the matter, so I commend that report to members.
On the benefits to which people are entitled, how much further on are we, four years later? The website of the Macmillan benefits helpline states that there are 11 possible benefits, but a person would need a degree in benefits to work their way through them all. They go from disability living allowance to something that I would never have considered, which is road tax exemption. Frankly, given all the emotional problems that occur and the fears about cancer, we should not ask people to deal without assistance with the 11 benefits to which they may be entitled, the interactions between those benefits, and the issues of whether their cancer is cyclical, they are terminally ill or otherwise.
In that earlier debate, we talked about the important co-operation between citizens advice bureaux and Macmillan, and between Macmillan and local authorities. I took Scottish Borders Council and Borders NHS Board to task and urged them to provide advice, either on the doorstep of the Borders general hospital or through the local authority. However, despite the sympathetic words about it being a good idea, the information that Macmillan has provided shows that, four years down the road, the Scottish Borders Council's project is "In development". That is disgraceful, so I will take up the issue with the council again.
The council in Alasdair Morgan's constituency has done a lot better. Dumfries and Galloway Council established a project in 2004. As a result of its advice, people accessed £1.096 million in 2007, and so far this year the figure is £867,000. So what are people in the Scottish Borders being deprived of? We will find out, because I will make sure that next time I speak in a debate on the issue, the Scottish Borders Council is on the list. The situation is absolutely disgraceful.
On a day when banks are having a hard time, not because of us, but because of shoddy speculators, Richard Simpson commended HBOS. I want to commend the Royal Bank of Scotland, which provides substantial support—in the millions of pounds—to Macmillan Cancer Support to help people through their debt problems. However, my job for tonight and tomorrow is to take Scottish Borders Council to task.
I will have the utmost sympathy for Scottish Borders Council when Christine Grahame turns up on its doorstep tomorrow, but I wish her well.
It is not so long ago that we discussed issues for cancer sufferers relating to travel insurance, in a debate on a motion by Brian Adam. I record my support for the excellent work of Macmillan Cancer Support in health care and in addressing all the needs of patients, particularly those that cause worry, which can in turn affect patients' recovery, as Richard Simpson so eloquently said. Many people go on to live long and healthy lives following cancer treatment. We therefore need a benefits and support system that helps people through their cancer treatment and helps them get back to work, but which also addresses the needs of terminally ill people.
To take a local example, patients and carers from throughout the Highlands and the Western Isles have access to independent information, advice and advocacy services, which are provided by a partnership between Inverness Citizens Advice Bureau and Macmillan Cancer Support that is based in the grounds of Raigmore hospital. I acknowledge and praise its excellent work. Macmillan has funded the project, with an undertaking to continue to do so until December this year. Beyond that, the project hangs in the balance, as it awaits the outcome of a Big Lottery Fund bid to migrate the project to a wider remit to include other life-limiting illnesses. The partners in the lottery bid include Highlands and Western Isles citizens advice bureaux, Chest, Heart and Stroke Scotland, Arthritis Care, the Parkinson's Disease Society, Highland Hospice, the Roy Castle Lung Cancer Foundation and Macmillan Cancer Support.
The existing Macmillan-CAB service also provides a one day a week drop-in advice session at Maggie's Highlands, which is situated in the grounds of Raigmore hospital. It has, since it was set up in 2004, helped 2,400 clients and secured a financial gain of £6,500, a high proportion of which is benefits, in addition to debt write-offs and grants. At present, there are on average 60 new cases a month, and Macmillan says that the contribution to the health and wellbeing of their clients is crucial.
Given, however, that each person's circumstances are unique, I found the case studies in the Macmillan guide to benefits and financial help very interesting. Anyone with cancer, whether they are familiar or unfamiliar with the benefits system, would find the guide to be of tremendous help. I looked up a case study of a 48-year-old man with bowel cancer who faced a 16-week course of chemotherapy. He applied for and received disability living allowance, income support, housing benefit, council tax benefit, an income tax refund, road tax exemption and a disabled parking badge. Because he was awarded income support, he also became eligible for free prescriptions, free eyesight tests, a voucher for glasses, a full refund of fares to hospital and free NHS dental treatment.
I do not imagine that many people are aware of the full range of benefits, advice and support that can be given. Even less is probably known about the help that is available for carers, and there is no doubt that the projects between Macmillan and Citizens Advice throughout Scotland are hugely beneficial to patients who are affected by cancer. The ability to deal with the financial problems frees up energy to deal with the illness. I thank Michael Matheson again for bringing the debate to the chamber and giving us the opportunity to read up, learn more and raise the issue in Parliament. I trust that the Minister for Public Health will be equally supportive.
I congratulate Michael Matheson on securing today's debate on a very real problem for cancer patients throughout Scotland. I am sure, however, that something important is going on that has prevented any Liberal Democrat members from being here tonight.
As Michael Matheson said, being diagnosed with cancer is a stressful enough time for sufferers and their families without the added burden of having to worry about their financial situation. Incomes plummet for people who have cancer and, as we have heard, benefits take-up is at its lowest among cancer sufferers in Scotland. The strain on finances results in nine out of 10 households with a diagnosed cancer sufferer encountering financial difficulty.
I will concentrate on one area of financial burden for people who are diagnosed with cancer: travel. In Tayside, a new case of cancer is diagnosed every four hours. As we have heard, having cancer puts a huge strain on people's finances, and even small costs can be hard to meet. From the day of diagnosis, the average cancer patient in Tayside will require 60 trips to hospital. In addition to rising fuel costs, patients who attend consultations at Ninewells hospital must pay £1.60 to park there, and their family and friends must pay £1.60 every time they visit. Figures show that cancer patients are, in fact, paying the highest rates for travel in the UK, at £636 per year.
I welcome the action that the Government has taken to alleviate that burden by scrapping the car parking charges at hospitals throughout Scotland. Unfortunately for people who visit Dundee's Ninewells hospital, however, car parking charges will remain because of a private finance initiative contract that was signed before the establishment of this Parliament. I await the publication of the cancer care plan, and I hope that the Government will address parking at hospitals that are under PFI contracts.
As Michael Matheson said, the Macmillan benefits advice service can make a huge difference—we heard evidence of that from Falkirk. In 2009, there will be seven Macmillan advisers in Tayside working to provide financial support and advice to people who have cancer. That is to be welcomed but, as Michael Matheson said, we must ensure that people who have cancer are aware of the service. I support his and other members' calls for referral to the advice centres, including Maggie's centres, to be given at the time of diagnosis.
Parliament enjoys the trust and support of the people of Scotland because we have not turned away from the health problems that face our nation. Under the previous Administration, the Parliament proved to the people of Scotland that it cares about the health and wellbeing of the nation by introducing free personal care and the smoking ban. That commitment to putting the health of Scots at the top of the agenda has been continued with the phasing out of prescription charges and the introduction of the human papilloma virus vaccine by the current Government.
We must continue to put the health of the nation at the forefront of whatever we do. The highlighting of the important issue of cancer poverty by Michael Matheson and other members, and the calls for the provision of financial advice to people who have been diagnosed with cancer are a continuation of what Parliament has previously stood up for.
I look forward to the publication of "Better Cancer Care", which I hope will go some way towards addressing cancer poverty. That is what cancer patients and their families deserve and that is what the people of Scotland expect from Parliament.
For the second day running, I will praise Michael Matheson, not only for securing the debate but for speaking very effectively in support of his motion.
In the past year, I have had to take over my father's finances after he was diagnosed with cancer, so I appreciate at first hand the complexities that are involved in the change of financial circumstances as well as the change in health circumstances, which combine and lead to a great deal of stress for the individual affected. One problem is that stress contributes to the physical problems that are associated with cancer. It is not only the patient who is affected; relatives and other people around an individual find that they have extra things to do, whether it is finding ways of easing the individual's pain by getting items such as chairs, going to the chemist to get prescriptions regularly, purchasing new foods or doing all kinds of other things. Circumstances can often change quickly: some cancers are slow and others are quick, so adaptations have to be made.
Many cancer patients do not know what help they are entitled to, because they do not know what to claim or how to apply. They may never have been in touch with social security or the various other agencies from which they must now seek support. It is important that the process be made as easy as possible. In my constituency, in Clydebank, the issue has been addressed in a very positive way: West Dunbartonshire Council is the first local authority in the UK to have an advice partnership with Macmillan Cancer Support, which has been extremely successful in helping people to access resources that they urgently need.
I raised the issue of support for cancer services with Lewis Macdonald, the previous public health minister, and with Shona Robison shortly after she came into office. There have been significant steps forward. In my area, a service that was started at the Beatson west of Scotland cancer centre in October 2007 means that welfare services are available to patients at the point at which they go to get their cancer diagnoses. Two full-time benefits advisers are in place and hospital staff are being trained. Some really important steps are being taken.
I will highlight some issues that arise from the current financial circumstances. I think that cancer patients have problems with mortgage repossessions. We should examine that, given the current circumstances in the housing market. Fuel poverty is also an issue. One characteristic of cancer patients is that they require a higher standard of heating as a result of their circumstances.
Access to insurance and other financial services also cause problems. Macmillan has taken the issue up with the Financial Services Authority and, in a joint initiative, the charity and the FSA have produced guidance on financial capability, called "It All Adds Up". The more we look into the issue, the more needs are identified.
It is crucial that people who contract cancer and suddenly have a terrifying diagnosis are given the maximum support in the most accessible form. We have made huge strides. Macmillan, West Dunbartonshire Council and other councils have worked hard and are coming together to address the issue. We must ensure that we give their efforts our blessing and as much support as we can. Michael Matheson's debate is a good opportunity to raise the issues and to get them taken on board by Parliament and by the Scottish Government.
I join those who have congratulated Michael Matheson on securing this evening's debate and thank him for focusing Parliament's attention on the physical, social, emotional and financial challenges that are faced by people who live with cancer, and by their families. I particularly thank him for highlighting the work of Macmillan Cancer Support. I join him in acknowledging the work of its staff and partners in providing support and advice in a network of centres throughout the country.
The debate is timely because, as many members have said, the Scottish Government is finalising its new cancer plan—"Better Cancer Care" will be published in the next few weeks. I record my thanks to the many people who took the time and trouble to contribute in person or in writing to the hugely successful and informative national discussion that helped to shape the plan.
As the Scottish population ages, as treatments advance and as our screening programmes become ever more effective at detecting cancers earlier, many people find themselves living with and, indeed, beyond cancer. We recognise that, throughout their journeys, patients and their carers will face uncertainty and might need to cope with the unpleasant and sometimes debilitating consequences of treatment.
Cancer does not care about a person's age, responsibilities or potential. It does not care that they are about to start a family, that they are looking forward to a long and active retirement, or that they are in the middle of a glittering career. However, people do care, so our task is to find whatever ways we can to support people with cancer, to give them access to the highest quality advice, and to enable them to live their lives to the full.
"Equally Well: Report of the Ministerial Task Force on Health Equalities" identifies the big killers of cancer and cardiovascular disease as priorities for action. It commits us to enabling people to take advantage of opportunities to improve their life circumstances and to shaping our public services so that they meet the needs of those who are at greatest risk of ill health, now and in the future. That includes a clear commitment to helping people to maximise their income and encouraging them to take up the benefits to which they are entitled. I will return to that point in a moment.
As has been mentioned, we are moving towards the abolition of prescription charges for all by 2011, which will rid the country once and for all of an unfair tax on ill health that has had an impact on many people who live with cancer and on their families. As Joe FitzPatrick said, we announced earlier this month that car parking charges at NHS hospitals will be abolished from the end of the year, in order to help to reduce the financial burden that is placed on patients and their visitors at a time when there are pressures on family budgets. I acknowledge what Joe FitzPatrick said about the situation at the private finance initiative hospitals, but we encourage those three hospitals, if they have not done so already, to introduce assistance schemes for regular patients.
In November, we and the Convention of Scottish Local Authorities will publish a joint framework to tackle poverty, inequality and deprivation in our country. It will be based on the best available evidence and will set out a series of actions to help to reduce inequalities, tackle the drivers of low income, support people who experience poverty, and make the tax and benefits system work for Scotland. It is good that Des McNulty acknowledged the good work that West Dunbartonshire Council has been carrying out, although from what Christine Grahame said, it sounds as if there is more work to be done and progress to be made by other local authorities. We hope that that will occur.
I confirm that we intend to set out before the end of the year the actions and resources that are needed to implement the new self-management strategy for Scotland, which was developed in a groundbreaking partnership with the Long Term Conditions Alliance Scotland. Among other things, a new self-management fund will be launched that will provide grants to improve the information and advice that is available to patients, support self-management education programmes, and enable people to share their experiences with others who are in similar circumstances through support groups and other opportunities that will be designed and delivered by the voluntary sector.
The cancer plan "Better Cancer Care" will be published on 22 October. I am pleased to announce that the plan will include specific actions to support people who live with cancer. Importantly, it will also include specific actions to support the work of Macmillan Cancer Support and other partners in raising awareness of the benefits that are on offer, and in enabling people to take advantage of them. That commitment encompasses a belief on our part that referrals of this kind are a legitimate and necessary part of the complete assessment of a person's needs, and are therefore a legitimate and necessary part of effective clinical practice.
Obviously, I cannot give an awful lot of detail before the plan is published, but I am sure that Michael Matheson and others will be reassured by what is in the plan. I am also sure that it will meet the aspirations of Michael and others to improve, and make more systematic, the way in which patients can access help.
Taken together, the measures that I have outlined demonstrate our commitment to supporting people in living with cancer and living beyond cancer. When it is published in a few weeks' time, I look forward to the plan having the support of the whole Parliament. I look forward to hearing members' comments on it.
Meeting closed at 17:41.