John Pugh (Southport, Liberal Democrat)
I thank all the people, from a variety of organisations, who made submissions before this debate in the hope that I could do justice to their thoughts and considerations. I may not succeed in doing so adequately, for which I apologise in advance, but other people in the Chamber, who are far better informed than me, can supplement any good, important or salient points that I fail to make.
It is a fact of the human condition that we are cell-replicating machines. I believe it is true—I am not totally certain, but I believe it is a truth—that none of the cells that were elected to this place in 2001 under the name of John Pugh are now here. They have all gradually been replaced, and some of them may actually be replaced during the course of the morning. That process goes on and on, and it is a very sophisticated one. When someone looks into the details of cellular biology, they are amazed that it occurs correctly as many times as it does. However, the longer we live, the more likely it is to go wrong, and when it goes wrong, we get the disease we know as cancer. It is a sad truth that the more we are saved from other diseases by progress in medical science, the more exposed we are to cancer.
Current stats show that, due to human longevity and the like, one in four of us are likely to die directly of cancer or a cancer-related condition. That will apply no matter what our success in investigating the environmental triggers for or the lifestyle causes of cancer.
We can all point to progress along those lines. We are no longer vulnerable to all the industrial causes of cancer, such as asbestos, and we took a momentous step forward in this place a few years ago when we backed the smoking ban, which remains the most useful thing I have done in Parliament, because it will undoubtedly reduce one of the major triggers for cancer. We now have to address other issues linked to cancer, such as obesity.
The disease is aggressive in youth and progresses slower with age, but, frankly, the longer we live, the more vulnerable we are to it. It is also true that many people will die with, but not of cancer. The challenge to any health system confronted with that crude biological fact is straightforward, and it is the same for any health system anywhere on the planet. I have divided the challenge under four headings. First, any health system needs to try to comprehend better the causes of cancer and initiate research. Secondly, any health system needs to try to prevent cancer and forfend its incidence. Thirdly, any health system—this is, of course, paramount—needs to cure people of cancer, where possible. Finally, any health and social system in any civilized society must help people living with cancer. Those four challenges are precisely the same for any health system anywhere, no matter how they are configured or delivered.
We have made substantial strides in the UK and our record should not be demeaned or lessened. During the passage through Parliament of the contentious Health and Social Care Bill, cancer stats were referred to and international comparisons were used to justify some of the changes. The oncology community had some misgivings about that, because its members felt that their real and substantive achievements were overlooked and that, for political purposes, people dwelled on what they had not achieved rather than on what they had.
The debate pack includes a good account of research by the King’s Fund and others on success in dealing with cancer. On European and international comparisons, an article in the pack states:
“While cancer deaths fell everywhere, England and Wales saw the biggest drop in mortality among males aged 15-74”—
that is, most males. The article continues:
“While mortality among women the same age declined by less, at 19%, that was the third biggest improvement”
in any civilised developed country in the world. We can, therefore, bank appreciable benefits and progress.
The difference between good and not-so-good policy is determined by the efficiency and effectiveness with which we approach the four fundamental tasks of comprehending the causes of cancer, curing people of cancer, trying to prevent cancer and trying to help people living with cancer, and by how intelligently we prioritise those tasks. An enormous amount of resources could be provided to address the problems presented by cancer, but such resources are not unlimited and we have to consider how we prioritise in every one of the four tasks. That applies to research, where people are continually examining how to prioritise the appreciable sums of money at their disposal in the most effective way. There are many debates about how we are to prioritise prevention and public health. Moreover, on prioritising treatment, recent discussions have centred on whether treatment for the elderly should be rationed or limited, because they may live longer with cancer but not actually die of it. There is also considerable debate, spearheaded by the likes of Macmillan Cancer Support, about the welfare provision for cancer patients.
I would like to turn briefly to public health, although it is not my main bone of contention. There has been a debate about how accurately we pitch our public health campaigns. Some have been excellent, particularly that on screening for bowel cancer, which I think has had an immediate and dramatic beneficial effect. My former colleague John Barrett is the former MP for Edinburgh West—he was elected in 2001—and he was diagnosed with bowel cancer through the screening programme shortly after leaving Parliament. He had absolutely no symptoms, but it is believed that it was caught in time. In fact, he was in Parliament recently and looked in pretty good shape to me. However, had the cancer not been detected—remember that he had no symptoms—it would have progressed as the years went by.
Glyn Davies (Montgomeryshire, Conservative)
I thank the hon. Gentleman for giving way and allowing me to associate myself with the point that he is making. I am one of those whose cancer was found early, and I received treatment and survived. A younger friend of mine was diagnosed at the very same time, but his cancer was more advanced and he died aged 31. This is about catching it early and I want to emphasise the importance of screening, which saves a huge amount of lives. I have played a big part in driving forward the screening programme in Wales. Screening for bowel cancer is one of the best ways possible to save people’s lives.
John Pugh (Southport, Liberal Democrat)
I am sure that the hon. Gentleman is right and that he is also aware that there have been debates about screening for cervical cancer, breast cancer and so on, and about the age at which that should be done and
the effect it would have. Although it is possible to screen everybody all of the time, that is not the most rational way to use resources, so any screening programme needs to be judged in the light of its subsequent evidence, which is very strong indeed for the bowel screening programme.
I was slightly, not amused, but distracted by the recent Department of Health advertisements—there were big adverts on buses—stating that anyone who has been coughing for three weeks should definitely go to see their doctor, because they might have lung cancer. When the advertising programme was launched, a horrible virus had gripped my office, the most lingering symptom of which was a cough that lasted for three to five weeks. Had we all trooped to our doctors’ surgeries saying that we might have cancer, a good deal of national health service time would have been wasted. Any campaign needs to be sophisticated and reviewed in the light of evidence. The one thing that we do not want a public health campaign to do is provoke alarm, because that would distract doctors from the things that we genuinely want them to address. People are not slow to be alarmed by any suspicion of cancer, which, I believe, after pornography and some other subjects, is one of the most researched topics on the internet. It is frequently referred to on various medical sites as a suspicion, rather than a diagnosis.
The academic community also has to prioritise. A lot of people leave substantial amounts of money for cancer research and it needs to be used as effectively as possible, as do welfare payments to cancer patients. Those issues need to be prioritised—Members may care to discuss that in the context of the Government’s ambitions for the outcomes framework.
I want to concentrate on the connection between treatment and health policy. The clinical armoury and tools available to medical science are pretty well known and can be put under four headings: chemotherapy, radiotherapy—possibly supplemented by more sophisticated treatments, such as proton beam therapy—and drugs and surgery. A cocktail of those methods is used to treat cancer. All, in their place, can be extraordinarily useful and effective interventions, but the key thing that determines whether they have the maximum effect on and benefit for patients is whether they are used with skill—the right skill at the right time in the right place, and probably in the hands of the right doctor or consultant.
I learned relatively recently that, although we talk broadly about categories of cancer, there are sub-categories within those categories, and not every sub-category is responsive to the same treatment. Knowing which treatment is best tailored to which patient is a genuine art, because patients and their histories are all very different, as are the remedies that work with them.
Improved outcomes are to some extent determined not simply by having the tools but using them with better and greater skill. It is the skill or its absence that explains differential outcomes. There are differential outcomes across the UK. The chance of recovering from certain cancers in some areas is greater or less than in others. The chances of acquiring certain cancers appear to be greater in some areas than others. Genuine skill—knowing what to use on what person at what time—is in extraordinarily short supply. That sort of
skill, the really effective intervention, is often allied with establishments that not just treat cancer, but research into cancer. Great skill is often, not unsurprisingly, aligned with a greater understanding of what is being dealt with. Treatment of cancer is not usually a journeyman matter or one of bog-standard clinical intervention and practice. That is why organisations such as the Christie hospital have such a well-established reputation.
I know the Government have put extra money into the drugs fund. Using the right drug in the right place at the right time is a fairly refined process. People can be given drugs that work with a cancer in general, but not for that particular patient or not at that stage in the disease, by organisations relatively unaware of the futility of the intervention. Therefore, we have all understandably come to the conclusion that we need clinical networks. We need to have people dealt with in the appropriate centres of excellence. There is a genuine readiness by patients to travel as far as they need to get the treatment. Most people in my constituency who contract any form of cancer travel across Liverpool, normally to Clatterbridge on the Wirral, generally without too much complaint, to get the treatment they want. The same group of constituents has been extremely angry and provoked by the need to travel 11 miles down the road for A and E assessment and triage.
John Leech (Manchester, Withington, Liberal Democrat)
My hon. Friend may not be aware that the Christie hospital has opened satellite centres in Oldham and Salford, so that patients do not necessarily have to go all the way to Christie, as they would have had to in the past. They still get Christie service, but in their local community in Salford or Oldham.
John Pugh (Southport, Liberal Democrat)
I think that is becoming the common pattern and could create some problems, given the way we intend to structure the NHS. However, it is a wholly desirable pattern. Clatterbridge is looking at a similar arrangement across Liverpool in collaboration with the Royal Liverpool University hospital. There is a sensible willingness on the part of the ordinary district general hospital to refer patients into an area where the maximum competence exists and where it is a matter of life and death. That is a totally laudable example of integrated service.
We can all accept there is a need to have an adequate clinical network, particularly for the more common cancers—lung, colorectal, prostate and breast cancer—in pretty well every area. That is a template that either is rolled out across the land or we wish to see rolled out around centres of excellence. We must always bear it in mind that, with cancer, a certain number of standard procedures can be done locally, without the full expertise of the top consultant.
There are certain cancers where that is not the case, for which we need national centres of excellence. To return briefly to the Liverpool Cancer Research UK Centre, that deals with pancreatic cancer almost as a speciality, with people there researching it very intensively. Its view is that there are probably about only two cases in the UK—and there may only ever be, given the relative distribution of that disease—where whatever treatment the patient gets can make a difference to outcomes, because the cancer is almost invariably fatal. It is necessary to vary the mix depending on the cancer
in question. However, for the most common cancers, having a centre of excellence, having hubs around which standard procedures can take place, having a clinical network that works, is the way to go.
That sort of network does not happen by accident. Other hon. Members, apart from me, have asked how under the new regime it will be maintained and sustained. The construction of such networks in the past was the function, duty, mandate and overview of the strategic health authorities and they, of course, are to go. I saw in the notes that they would still be dealt with under the strategic health authority bundle within the NHS Commissioning Board. Clearly, “strategy” is the word to be used here. Liz Kendall was fond of saying that during the passage of the Health and Social Care Bill. The key point is that the strategy and the template are clear; the question is how to get them in place, sustained and maintained over time under the new regime. I would like the Minister to reassure me on that point.
It is not obvious how such a desirable template would emerge through simple market forces, or through bottom-up agreements by local commissioners. Even if those things could happen, it is not obvious that that would represent the most secure or quickest way to bring about the outcome. That is especially so when one acknowledges that the best treatment often occurs in environments where there is not only integration between providers, but research is taking place. I repeat the point that there is a need to deliver various levels of intervention and care in various settings. That will not happen by accident, or without some institutional resistance. One proposal in Liverpool is to move some of the activities currently conducted in Clatterbridge to the Royal hospital and get very substantial funding for that. That proposition, though supported by the bulk of people, is not supported by all. A certain amount of controversy may still arise about the level of care that could be delivered or result from such changes, which are not effortlessly brought about.
I guess that I am trying to say that ironing out the inequalities in cancer outcomes, ensuring there is the same provision and that each network is as good as any in every area, is possibly susceptible to a more dirigiste approach or Stalinist-like solution. I understand that the chief executive of the NHS was once a member of the Communist party—I hope I am not maligning him. That approach has its attractions. If the NHS Commissioning Board, which shelters the skeletal remains of the strategic health authorities, could play a dirigiste role, acting like the Politburo to impose the right template in every place, one could see how facilities could be aligned and personnel put in the right place. There would also be an opportunity to use central funding to effect. The Government have set up some central funding both for drugs and other purposes.
I have no issue with that way of doing things, provided it is rendered accountable. However, under the new dispensation, I can see problems in going down that particular road. Some of the provision we would want in place, for example, proton beam therapy, will require substantial capital investment. Under the new regime, if I understood what the Minister said during Health questions, substantial capital investment is primarily the responsibility of providers. So we have to hope that, in all places across the UK, all providers dealing with
the common cancers feel obliged to make the same level of investment. I am not sure that there is an easy way to ensure that that happens. Clearly, the NHS Commissioning Board can commission clinical networks, just as it can commission any other piece of health provision. However, providing a substantial capital grant to a provider might create problems, particularly if it is contested by other providers. Providers may be reluctant to provide the kind of intensive capital resource that might be required when they have budgets to meet and control.
Last Tuesday, an hon. Member talked nostalgically about the days when we used to have fundraising for all kinds of scanners in hospitals. That does not seem to have taken place in the past decade or so because the money has been flowing a little more plentifully. However, we could be back in that territory if providers have difficulties in acquiring appropriate capital investment, or do not see a business case for doing so, without subsidy, by themselves.
I imagine that there are concerns about patterns of referrals within clinical networks, which, again, will test the new system. For example, dermatology providers that are unable to cope with cancer and oncology outcomes—there are such dermatology providers; I think they are now called Virgin Medical—will, under any willing provider, be one of the first ports of call for referrals, especially if they have partners in GP practices who are inclined to use them. At the same time, that may not be the right thing to do clinically, given its complexity. As incidences of melanoma have increased, it may be far better to refer people not to a dermatology provider that cannot do oncology, but to a dermatology provider that can—essentially, the existing hospital base. I can see that being a good thing clinically, but something that is contested in practice if it becomes a settled pattern.
I think we all know where we want to get to. I know that many other things need to be said and I hope other hon. Members will say them. My question is, given that there is a whole raft of agreements and evidence about the objectives and the point at which we want to end, how, under existing or future arrangements, will we ensure that the best outcome is delivered? In other words, how do we get the right clinical configuration to achieve the right clinical outcomes?
Virendra Sharma (Ealing, Southall, Labour)
It is a pleasure to serve under your chairmanship, Mr Gray, and to contribute to this important debate. I congratulate John Pugh on securing it.
Macmillan Cancer Support estimates that 2 million people in the UK today have had a cancer diagnosis—the number is expected to continue to rise by 3% a year—and that nearly 4 million people will be living with cancer by 2030. Currently, 8,000 people are living with, or beyond, cancer in my constituency alone. Those figures show clearly that the NHS has a demographic challenge on its hands. It will need to become ever more efficient in treating and supporting cancer patients if it is to continue to meet clinical and non-clinical needs and deliver improved outcomes.
Surprisingly, the findings of the international cancer benchmarking project 2010 revealed that survival rates of cancer patients in England continue to lag behind countries such as Denmark, Sweden, Australia, Canada and others. Decisive steps are needed to ensure that England matches the European average and to prevent the country letting down people affected by cancer. The Government have acknowledged that, despite some improvements, cancer outcomes in England remain poor when compared with the best outcomes in Europe, highlighting a significant gap that remains in both survival and mortality rates. In response, the Government put together a cancer strategy that set out a commitment to improve the outcomes and experiences of cancer patients and an ambition to save 5,000 additional lives a year by 2014-15.
I wish to first focus on how we plan to measure how well the NHS has responded to that cancer challenge and whether providers and commissioners are sufficiently incentivised to meet the Government’s ambition. The updated NHS outcomes framework for 2012-13 includes two cancer-specific measures to drive improvements in the earlier diagnosis and more effective treatment of cancer: for one and five-year cancer survival rates for breast, lung and colorectal cancer; and for the under 75 mortality rate from cancer. Although that is a welcome first step on the road to meeting the cancer challenge, I understand from charities such as Macmillan that those indicators are currently too limited, as they measure survival rates for the three most common cancers only. The NHS should be encouraged to improve earlier diagnosis of rarer cancers, which account for almost 50% of all new cancer diagnoses.
I have learnt recently that the commissioning outcomes framework for 2013-14, which will be used to measure improvements in cancer services and outcomes locally, might not even include one and five-year survival rates for breast, lung and colorectal cancer. That unhelpful disparity could result in clinical commissioning groups not placing enough emphasis on the early cancer diagnosis and, ultimately, undermine the ambition of saving 5,000 extra lives a year by 2015. At present, the cancer-specific indicators are too limited to truly measure how well the NHS is responding to the cancer challenge. I should be grateful if the Minister updated hon. Members on the plans to extend one and five-year cancer survival rates to cover more cancers and to include those indicators in both the NHS and commissioning outcomes frameworks.
The cancer strategy also provided that early diagnosis would continue to be a top priority and
“will be included in the mandate for the NHS Commissioning Board for the future”.
Ahead of the Department of Health consultation on the mandate, will the Minister provide assurances that the mandate will include an objective to improve early diagnosis for all types of cancer, as a way of improving outcomes?
Alongside improving early diagnosis and outcomes, the Government have placed a welcome emphasis on improving the experiences of cancer patients. I, too, congratulate the Government on agreeing to run the national cancer patient experience survey again in 2012-13. The national cancer patient experience survey 2010 revealed that
“white cancer patients report a more positive experience of care than other ethnic groups—particular differences were noted on questions around receiving understandable answers, being given enough care after discharge and staff working well together.”
Similarly, people with a disability or mental health conditions, people from the lesbian, gay, bisexual and transgender community and people with rarer cancers also reported a less positive experience.
In Ealing Hospital NHS Trust, only 48% of patients responded that they got understandable answers to questions all or most of the time and only 51% responded that patients had confidence and trust in all ward nurses. The Department of Health has stated that
“commissioners will wish to encourage providers to take note of the differences and to consider positive action to address the distinct need of people from different groups.”
I believe that the Government’s approach to improving patient experience could be even more proactive. The national cancer patient experience survey should be developed as an indicator and included in the NHS outcomes framework. That is the only way that commissioners, providers and the NHS Commissioning Board will have a clear incentive to address areas identified for improvement. Will the Minister explain whether there are plans to correlate the cancer patients experience survey with the NHS outcomes framework to improve outcomes?
Now that the Health and Social Care Act 2012 has been passed, the Government have an opportunity to refocus on effective implementation of their reforms and, more specifically, on delivering their commitments to improving cancer outcomes. It is my view that every cancer patient—regardless of who they are, where they live or what cancer they have—has the right to high quality care, support and treatment. I ask the Minister to consider the contributions that he hears today to make sure that England’s health and social care system is not just meeting the European average for cancer outcomes, but taking the lead.
John Baron (Basildon and Billericay, Conservative)
I congratulate my hon. Friend John Pugh on securing this important debate. The all-party group on cancer, of which I am chairman, has consistently called for us to see the NHS reforms as an opportunity to improve outcomes for cancer patients, and I welcome the chance to highlight that once again.
Perhaps I should start by briefly taking us back to 2009, when the all-party group produced its report on reducing health inequalities. After a long evidence session, with oral as well as written submissions, we discovered that those patients in this country who reached the one-year point stood as much chance of reaching the five-year point as patients in any other country in Europe, but we fell down badly in getting patients to the one-year point. That tended to suggest that the NHS is as good as anybody else at treating patients—once detected—but poor at detecting cancers in the early stages in particular. Other hon. Members have made that point in this debate.
How do we encourage earlier diagnosis? There are few magic keys to solutions in life, but perhaps earlier cancer diagnosis is one of them. The 2009 report concluded that the best way of doing that was to focus on
outcomes—to get the NHS to actually look at one and five-year survival rates, because late diagnosis makes for poor outcomes. Getting the local and national NHS to focus on one and five-year rates would encourage the local NHS in particular to drive forward initiatives and earlier diagnosis. We were grateful when the Government accepted the logic of that argument and included one and five-year outcome measures in the NHS outcomes framework. The NHS reforms essentially boiled down to two strands—two initiatives. One was the change in the commissioning structure; the second was the focus on outcomes. For me and for many in the all-party group, the focus on outcomes was by far the most important bit of the NHS reforms.
We welcome the Government’s response so far. The all-party group was pleased that, at the beginning of 2011, the Government released their strategy for cancer, which clearly highlighted the importance that they attached to the issue. They came up with a figure—an ambition—to save an extra 5,000 lives a year from cancer by 2014-15. We should remember that that would take us up to only the European average, not the best in Europe, but it is still a laudable ambition that we very much welcome.
We have had a constructive dialogue with the Government, experts and patients. I want to touch briefly—I am conscious that other hon. Members wish to speak—on some of the key recommendations from the all-party group that flowed from the 2009 report. We welcome the Government’s response to that report. Many others have made the same argument, but we played a small part in moving the Government in the right direction.
However, we are still ambitious with regard to some of our recommendations. For me, the first is key. There seems to be an anomaly in the different outcomes frameworks. We have the commissioning outcomes framework, which has the five-year survival rate as an outcome measure. We have the NHS outcomes framework, which has the one and five-year measures. The COF is the framework by which the clinical commissioning groups will be held to account for their performance, and we are arguing for the one-year measure to be included in the COF, just as the one and five-year measure is included in the national outcomes framework. In other words, we want standardisation.
Our concern is that if we have different outcomes frameworks focusing on slightly different things, or certainly not the same things, a disjointed message can be given. It is important that both the local and the national NHS focus on the same things. I raised that question—the Minister will forgive me for raising it in this debate—in Health questions last week. I was slightly worried about the response. The Minister will correct me if I am wrong, but he cited concerns with the quality of the data available for the one-year measure within the COF. If the one-year data are good enough for the NHS outcomes framework, why are they not good enough for the COF, particularly given that the NHS Commissioning Board will shortly provide geographic boundary data for the clinical commissioning groups? It should not be beyond the wit of man to transfer what we have in the NHS outcomes framework across to the COF once those data from the NHS Commissioning Board are available. I am led to believe that there should be no problem at all with how the data are cut. What does the Minister have to say about that?
To pick up the point made earlier by Mr Sharma, I also want to question the Minister about why we are not expanding the number of cancers in the outcomes framework. I have a little more sympathy with the Minister on the quality of the data on this one. Whereas I cannot understand why the one-year figures, which are in the NHS outcomes framework, are not included in the COF, I have some sympathy because of the quality of the data for expanding the three cancers that are already there. Those three cancers are obviously common cancers. They account for some 40% of all new cancer diagnoses—we are talking about breast, lung and colorectal cancers. The Minister accepts that there can be a disparity in survival rates between the common cancers and the rarer cancers. Our recommendation would in some respects help to close that gap with the more common cancers. Will the Minister address the point that was made earlier and the point that the all-party group has been pushing hard on for some time?
The Minister appreciates that we hon. Members in the all-party group have had a constructive dialogue, which continues, but this debate is too good an opportunity to miss, so I should like to raise some relevant issues in a more public forum. The all-party group has tended to focus on proxy measures. When we had primary care trusts, the one and five-year figures were statistically robust, because the population sizes allowed them to be so. However, we have started tinkering with the commissioning structure—first, general practitioners and fundholders and then clinical commissioning groups—and the population sizes are somewhat smaller. Therefore one and five-year figures, on their own, are not as statistically robust as we should like. That is why we in the all-party group suggested that staging and emergency admissions could be used as proxy measures to complement, rather than replace, the one and five-year figures, for the benefit of the local NHS.
Hon. Members should not forget that this is all about trying to introduce measures that allow the local NHS to focus on outcomes and introduce, through its own initiative, initiatives such as screening, which was mentioned earlier—there are many others—to try to drive forward earlier diagnosis.
In respect of proxy measures, I understand that the public health outcomes framework, published at the beginning of the year, has already identified the importance of staging data. Certainly, that is so with regard to cancers diagnosed at stages one and two. I am not alone in the all-party group in thinking that it is important that those data are shared across the outcomes framework to ensure a coherent approach throughout the NHS. I am interested in what the Minister says about that. Once again, I accept that we have to be reasonable. This is about quality of data. I hope that the Minister accepts that coherence is needed in respect of the frameworks for public health outcomes, NHS outcomes or commissioning outcomes.
If the big picture of what the NHS should focus on in respect of cancer is coherent—whether top-down or bottom-up—we stand a greater chance of achieving our goals. At the moment, there is a risk that we do not have such coherence. I know that the process is at an early stage, but I am interested in hearing the Minister’s response.
Picking up a point that was raised earlier, all hon. Members accept that improving patience experience is important, which is why the all-party group thinks that we need to do more to push on an open door. We recommended that the national cancer patient experience survey should be conducted annually. Although there is a question about feasibility, there is much merit in that suggestion. The survey should also be included in domain 4 of the NHS outcomes framework and the COF, just to ensure that the message, which is that we regard it as important, is clear. Patients can have the best treatment in the world, but unless their experience is good, particularly at a traumatic time when they have cancer, negative experiences can often act as a dampener and can affect recovery rates as well. It is important to recognise that.
I thank my hon. Friend the Member for Southport for securing the debate. The Minister knows that the all-party group is keen on a constructive dialogue—it is ongoing—and I thank him for the meetings that we have had and for the constructive way that he has liaised with us. I apologise to him for making an early exit, because I have to attend a meeting of the Select Committee on Foreign Affairs. However, he should not think that I am not interested in his response: I shall scan Hansard carefully tomorrow morning.
Jim Shannon (Strangford, DUP)
There is not one of us who has not personally been affected, or who does not have family members affected, by what is referred to as the dreaded big “C”. Last year, my sister, who lives in England, had kidney cancer. The medical services here were good in addressing that and she is on the way to recovery. My father had cancer on three occasions and, due to the skill of the surgeons, his faith and the prayers of God’s people, he got over those cancers and is still here coming up to 83 years old—or young, perhaps, which is another way of looking at it. Our health care system is good at what it does. I want to make that clear.
We have the best palliative care in the whole of Europe. That matter has been debated previously in the House. However, that does not always mean that we have the best cancer treatment in every category and sector. We must look at that.
The hon. Member for Southport spoke about pancreatic cancer. Recently, I met representatives from Pancreatic Cancer UK, who gave me some shocking figures, which are available to all hon. Members. Survival rates for pancreatic cancer have not improved for more than 40 years, making it the most deadly of all cancers diagnosed in the UK, with fewer than 3% of patients surviving beyond five years. Some 8,000 people are diagnosed with pancreatic cancer every year and it is responsible for 5% of deaths from cancer, yet it receives only 1% of research funding. There was a debate on pancreatic cancer in Westminster Hall a month or two ago. It is often regarded as a death sentence—if people get it, their chances are minimal. Perhaps the Minister can tell us what has been done to address that matter in particular.
John Pugh (Southport, Liberal Democrat)
I am glad the hon. Gentleman mentioned that, because two close friends of mine died rapidly of pancreatic cancer. One point made by the people in Liverpool to whom I spoke was that, given the almost invariably fatal outcome from this cancer, it would not be a bad idea if some of the rules regarding drugs approval were relaxed a little bit, so that people could find out what worked, because in this case there is very little to lose.
Jim Shannon (Strangford, DUP)
I thank the hon. Gentleman for that valuable contribution and agree wholeheartedly. If it comes to the stage where people’s life expectancy is minimal or reduced, I believe that they would be quite happy to take advantage of new drugs, if those were available.
All hon. Members know that finances are finite in the health budget. That being so, we are grateful for the many charities that do such magnificent work, including Cancer Research UK, Macmillan Cancer Support and Marie Curie Cancer Care. However, we must get a handle on our treatment process and outcomes, which can only come through the correct use of funding. I hope that the Minister will tell us how that will happen.
In the NHS document, “Improving outcomes: a strategy for cancer”, published in January 2011, it is clear what the Minister regarded as the way forward:
“In order to achieve these principles we must also ensure that every possible penny of money the NHS has is spent improving the quality of care and outcomes that patients experience. The Government protected the NHS in the Spending Review settlement, with cash funding growth of £10.6 billion (over 10%) by 2014/15. Compared to many other government departments, that puts us in an incredibly privileged position but this is the toughest settlement the NHS has faced in a long time.
At the same time, we need to respond to the longer term pressures the NHS faces; of an ageing population and the new demands created by new treatments and technologies. That means that, as set out in the Spending Review and the 2011/12 Operating Framework, over the next four years the NHS will need to achieve up to £20 billion of efficiency savings. These savings will be reinvested back in continuing to give patients the care that they need.”
Will the Minister say whether we are on target to make those savings? If so, when will that money go back into the system?
The document contains many examples of cost-efficient care, such as people having certain treatments as day procedures and then care at home, which makes a lot of people feel more secure as well as being cost effective. We understand the reasons and the thinking behind that: it is essential that the patient is at the heart of any decision made and any strategy must incorporate this.
I am not an argumentative person—far from it, I try to get on with most people in this world—but the hon. Member for Southport commented on the advertising campaign “Have you had a cough for three weeks or more?” We do not know how successful it was. The campaign has a role to play, and those who have had a cough for more than three weeks might well have a problem. We do not know how many people went to see their doctor and, as a result, have been made aware of problems. That is perhaps a different opinion from that expressed by the hon. Gentleman.
Jim Shannon (Strangford, DUP)
The facts will be the number of those who take up the campaign and see their doctors, perhaps ending up with the diagnosis of a problem.
I have read different consultation responses and have seen how different cancer organisations respond. All have been positive that, to improve patient experience outcomes, it will be important for patient experience to be measured and bettered throughout the entire patient pathway. Bowel Cancer UK points out that it is important that patient conditions are not ignored by an overarching patient experience indicator. For example, the overall patient experience reported by patients at a particular provider is likely to be less relevant than the specific experience reported by patients with the same condition. Thus, bowel cancer patients should be consulted about their treatment and given the necessary support and tools to make informed decisions about their care.
I will quickly outline seven suggestions that might lead to improvements in patient experience and care. Steps need to be taken to ensure continuity of care throughout the patient pathway. Key workers and clinical nurse specialists should play a central co-ordination role to achieve that—their involvement is critical. The meaningful data on service performance should be provided, to allow commissioners to make informed choices on the services that they commission and to inform patients about the services that they might wish to access.
Sometimes it is about knowledge and patients’ understanding of how the system can work to their advantage. Tailored patient information should be provided to guide patients through their care, in the form of information prescriptions; that should also include support to self-care, because that is sometimes the best way to deal with their problems and medical condition.
Symptom management should be offered to ensure that patients have the knowledge and tools to look after themselves when they can, but also so that they know when they need specialist support. In other words, when they need to call on the specialist support, they should have the chance to do that.
Patients should be given access to treatments in the most appropriate location for them, whether surgery, radiotherapy or chemotherapy—again, knowing the full choice.
Patients should be offered signposting and support to help them return to work, as well as ongoing support to manage continuing symptoms and the side effects of treatment. We might not always see such things directly, but they are important: trauma, the effect on the patient and their families, the financial implications and knowing about rights to benefits to get through that period, such as an application for disability living allowance.
Palliative care pathways should be considered alongside active treatment and not simply at the end of life. For many of us, palliative care is end-of-life care, but it has another role as well.
Lastly, the end-of-life care strategy should be rapidly implemented. Those seven suggestions are a method for the health system to address the care needed for those who have cancer.
I shall make a quick plug for those who do the experimentation and whose task is to find new drugs, which the hon. Member for Southport mentioned in relation to pancreatic cancer care. Queen’s university Belfast is at the forefront of experimentation in the
investigation of new drugs—renowned the world over—and I commend the people there for what they do, and what many others do, because we cannot do without that experimentation to find the new drugs. Nearly every other month a new drug is announced—okay, there might yet be three or four years of experimentation and investigation, but the work of the researchers is tremendous and I commend them for it.
All the responses have been noted and the document that the Minister released is precise, yet more than a year later some feel that we have not moved forward as much as we should have done. Are we achieving better patient-focused care and outcomes? I am not so sure about whether that has been achieved, but the Minister will indicate where we are. That is why I am particularly thankful for the opportunity to debate the issue and to discuss it here in Westminster Hall. We do not need pretty words in a document—if I may use that terminology, and not facetiously—we need action. The Minister must turn all the words into action, and that is why I support the hon. Member for Southport and thank him for bringing the matter before the Chamber today.
Liz Kendall (Leicester West, Labour)
I thank all hon. Members who have taken part in this important debate. I congratulate John Pugh, hard-working as always, on focusing on the issue.
Several hon. Members talked about the context of the debate and the improvements made over recent years. Several mentioned the research—published, I think, in the British Journal of Cancer—that showed that, over the past 20 or so years, the NHS in England and Wales has achieved the biggest drop in overall cancer deaths among 10 leading countries worldwide. There have also been significant improvements with individual cancers. For example, death rates for breast cancer have fallen by 40% since 1989, virtually closing the gap with other countries such as France. Furthermore, the NHS has done so despite having a smaller budget, which led the British Journal of Cancer to conclude that the NHS had achieved more with proportionately less than in other major developed countries.
It is clear, however, that far more can and must be done to bring cancer outcomes for all cancers and all patients up to the very best standards achieved in other countries. Hon. Members have rightly said that our overall survival rates are still not as good as those in countries such as Canada, Australia, Sweden and Norway and that, although survival rates are good for breast and skin cancer, for example, they are low for lung and pancreatic cancer. I am also particularly concerned about differences in outcomes for people from different minority ethnic groups or from different social and economic backgrounds. As the shadow Minister with responsibility for older people, I am concerned about the worse outcomes for older people in the UK compared with those in other countries, even after we have taken social and economic factors into account—I shall say a bit more about that in a moment.
Hon. Members welcomed the focus in the NHS outcomes framework on one and five-year survival rates but rightly questioned why the three cancers mentioned account for 40% of new cancer diagnoses and asked about the
other cancers that could be included. Although survival rates are absolutely vital, other issues need to be addressed to improve the patient experience and the quality of care—in particular, for those who will not survive cancer, at the end of life.