We now come to the second debate on an Opposition motion. I must inform the House that I have selected the Amendment in the name of the Prime Minister, and once again placed a 10-minute limit on speeches by Back-Bench Members.

I beg to move,

That this House
recognises that there have been improvements in the provision of cancer care due to the extra investment in the NHS and the hard work and dedication of NHS staff;
but notes that a different approach is now needed to raise standards of treatment throughout the entire patient pathway to the best levels achieved in other European countries;
believes that more should be done to end the postcode lottery in drugs and treatments;
wishes to see more done to raise awareness of the risk factors and symptoms of cancer;
further believes that cancer is increasingly a long-term condition and that there should now be a greater recognition of the importance of quality of life issues;
and calls on the Government to give the National Institute of Health and Clinical Excellence a much stronger role in establishing holistic standards and entitlements to care covering the entire patient pathway.

No one can doubt the significance of cancer to many millions of people in this country. The disease remains one of the biggest killers in the UK, accounting for approximately a quarter of all deaths and claiming more than 150,000 lives a year. More than one person in three will be diagnosed with cancer at some point in their lives, and there is likely to be a significant increase in the number of new cases over the next few years, partly due to our ageing population structure.

Given its importance, I hope that this debate about the future of cancer services can be constructive. I, for one, recognise that improvements have taken place under this Government, but I shall also highlight the fact that there are still failings in the system, in the hope that they will be recognised and put right.

The Government's Amendment runs the risk of appearing somewhat complacent. It is full of self-congratulation, and mainly looks back at the past. Putting that to one side, however, I accept that it would be churlish not to accept that the Government have made extra funding available and that improvements have been made. It is not often that a Shadow Minister quotes good figures on the Government's behalf, but one example of those improvements is that, whereas only 42 per cent. of patients diagnosed with colon cancer in the first half of the 1990s survived for five years, that figure had risen to 50 per cent. by the start of the present decade.

Naturally, Opposition Members congratulate staff in the NHS and the voluntary sector on their hard work and dedication to patient care, which have helped to bring about the improvements in outcomes. Those improvements are welcome, but they are not exceptional when compared with the long-term trends that date back to the 1980s.

Will the hon. Gentleman give way?

I intend to make some progress, but I assure the hon. Gentleman that I will give way in a little while.

According to figures produced by Cancer Research UK, mortality rates fell by 11 per cent. between 1988 and 1997, and by 6.5 per cent. in the first six years after Labour came to power. I hope that the Secretary of State will not copy the Prime Minister's trick of using the mortality figures since 1997 as proof of the effectiveness of the Government's cancer strategies. There has been no marked improvement in the overall trend going back to the 1980s, despite the extra funding.

The Government use more selective figures in their Amendment, but even they cannot disprove our case. Although there has been a 14 per cent. fall in mortality figures since 1996, the total death rate for people under 75 years of age also fell by 14 per cent. in the final nine years of the previous Conservative Administration.

The Opposition recognise that there have been improvements in outcomes, but they have not outstripped comparable improvements in continental survival rates. According to last year's report from the Karolinska institute, the UK still lags behind other European countries when it comes to survival rates over periods of one year and five years. In fact, Britain has one of the worst survival rates in all of western Europe: whereas 81 per cent. of cancer patients in France survive for one year, the equivalent UK figure is only 67 per cent. Even Albania and Lithuania have better one-year and five-year survival rates than we do. Estimates suggest that more than 20,000 lives a year could be saved each year if the NHS met the best European standards of care.

Meanwhile, the outcomes gap between rich and poor people in the UK is also unacceptable and getting wider. A recent report from the Public Accounts Committee highlighted persistent and unacceptable variations in outcomes, depending on where patients lived. Breast cancer death rates are 20 per cent. higher in some northern regions than they are in other areas, mainly in the south of the country.

Those are unfortunate facts, but whether cancer services are equipped to meet the fresh challenges that we face is also open to question. For example, more cancer patients are now living longer, which means that, increasingly, the disease must be regarded as a long-term condition. The emphasis of policy in the future must shift from getting patients into the early stages of treatment as quickly as possible, important though that is, to ensuring that later stages of care, information and emotional support are widely available. To achieve that, several failings need to be addressed.

I am grateful to the hon. Gentleman for acknowledging that services are improving. Does he agree that the most difficult time for any patient with a possible cancer diagnosis is the early stages of waiting for a diagnosis? Will he therefore join me in congratulating the NHS on reaching the target of ensuring that almost every patient whom a GP suspects may have cancer is seen within two weeks by an NHS specialist? The initial tests can be done quickly to reduce the awful burden of anxiety faced by someone in that position.

I take the hon. Gentleman's point, but he refers to early referrals. The problem is that far too many women are diagnosed with cancer after being referred on a routine, non-urgent basis. It could be argued that the two-week target has distorted clinical priorities. Breakthrough Breast Cancer has made that case many times.

My mother was diagnosed with breast cancer and had a mastectomy, and I had quite a scare last September. Does the hon. Gentleman agree that the Government must take steps to ensure the correct analysis of mammograms? Radiographers have got that wrong in the past, but patients need to be assured that they receive the correct results. Does he also agree that herceptin should be given to the women who need it, and that we should not have a postcode lottery?

I completely agree with the hon. Lady and I will come to those points later in my speech.

The hon. Gentleman compared the UK with European countries with better success rates, but does he agree that we have seen improvements over the past eight years? In 1997, Labour was the first major political party to mention the word "cancer" in a manifesto. In 1997, we had a green paper that set a target on death rates for 13 years' time and, in 1999, for the first time, a directorate was set up to deal with cancer. Again for the first time, in 2000, we had a 10-year plan to fight cancer. Is it not the decades of neglect that have led to the problems that the hon. Gentleman mentions?

I suggest to the hon. Gentleman that there is no point just talking about cancer—we want action, and we are trying to look forward in this debate. As I said earlier, there have been no marked improvements in mortality rates, despite all the money that has gone into the NHS. The Government can produce as many papers as they like, but what we need are improvements on the ground.

My hon. Friend is right to talk about the need for action. Does he agree that long-term survival rates could be greatly improved if everybody had proper access to the most appropriate and up-to-date medicines, without postcode prescribing? For instance, for high grade malignant brain tumours, we need to ensure that sufferers have access to temozolomide and gliadel implants.

I agree with my hon. Friend and I shall address the issue of the postcode lottery shortly.

One reason why the Government's additional funding for cancer services has not produced a marked improvement in the longer term mortality trend is that the two-week and one-month targets, to which Dr. Stoate referred, have focused attention and resources on the front end of the patient pathway, to the detriment of the other end. The later stages of cancer care have been neglected as a result. The Government's targets may have been successful in getting more people into the system more quickly, but staff shortages have created bottlenecks further down the line. Radiotherapy offers an example.

The importance of radiotherapy is that more than half of all cancer patients will undergo it at some stage of their treatment, yet in January a report in the British Medical Journal observed that pressures on cancer units across the UK have led to longer waits for radiotherapy patients and may be reducing chances of survival.

High staff vacancy rates are causing real concern. In evidence to the pay review body, the Society of Radiographers noted that vacancy rates for therapeutic radiographers in England stood at 17 per cent. There is a particular shortfall of experienced, specialist radiographers. The Government may have increased student numbers, but new graduates do not possess the skills needed to fill that type of vacancy. According to the society, the current high number of vacancies and Government targets have made managers reluctant to release existing staff for further training opportunities, so it does not look as though the situation is getting better. As a result, waiting times for radiotherapy have lengthened since 1997. According to figures collected by the Royal College of Radiologists, radiotherapy waiting times in 2005 were worse than those documented in 1998; for example, whereas in 1998, 32 per cent. of patients in need of radical radiotherapy waited longer than the recommended maximum of four weeks, by 2005 the figure had grown to 53 per cent. More than half of all patients receiving curative radiotherapy now wait longer than the recommended maximum of four weeks.

For their part, despite a recent assurance at Health questions that hidden waits would be measured, the Government have insisted that no official monitoring of radiotherapy waiting times will take place. That is a great shame. I put it to the Secretary of State: how can the Government hope to resolve the serious problems in radiotherapy if they have no official idea of the extent of the problems because they are unwilling to collect the statistics? Although I wrote to the Secretary of State about the issue after our exchange at Health questions in January, I am still waiting for a response.

Radiotherapy is not alone, however. There are similar problems for other treatments. According to the Dr. Foster organisation, there has actually been an upward trend in waiting times for surgery for the 10 most prevalent cancers since 2001. Meanwhile, according to research cited in a report by the cancer capacity coalition, a number of clinical directors expected rising demand for chemotherapy to lead to longer waiting times over the next five years.

Things must change. The Opposition believe that one solution to the problems would be to move away from targets, which distort clinical priorities by focusing resources on the front end of the patient pathway, and to instruct NICE to draw up standards and entitlements for patients covering the entire pathway—a point to which my hon. Friend Bob Spink referred. In other words, we should shift entirely the emphasis for cancer care from politicians dictating targets for patients to patients having entitlements to standards of care decided by medical professionals; the entire journey should be covered, including the later stages of treatment such as radiotherapy. Such an approach directly recognises the fact that there is no use in getting more people on to the patient pathway sooner if we do not ensure their access to all stages of life-saving treatment.

Does my hon. Friend accept that an important component of radiotherapy is being able to access the service? It is recognised by authorities that stress and concern about travel arrangements affects people's ability to benefit from radiotherapy. Will he congratulate the Isle of Wight council on announcing that it is making £50,000 available from its budget this year to fill the shortfall caused by the NHS withdrawing funding for radiotherapy patients to cross the Solent for treatment in Southampton?

I do not know the details but it sounds as though the local authority has done a good job and I duly congratulate it.

My hon. Friend mentioned that survival rates are low. Is not one of the weaknesses of the Government's strategy that not enough has been done to support cancer sufferers? Not enough attention has been paid to the work of the Bristol Cancer Help Centre or the cancer lifeline kits that are available, which offer a range of supporting therapies and address things such as diet, detoxification, relationships at home and even spiritual issues. The Government have missed those soft targets.

My hon. Friend will remember that I attended one of his meetings on this issue, and I agree that we need to consider providing much wider support—

Order. I am sorry to interrupt the hon. Gentleman, but when he turns away to address his hon. Friend, he should bear in mind that he should be addressing the Chair and that it is also important that he should address the microphones, otherwise, it creates a problem for Hansard.

I appreciate that guidance, Mr. Deputy Speaker.

The short answer is that I agree, but I shall make some progress.

Let me turn to access to drugs—another area where cancer services should be doing much better. We have the best cancer research record in Europe but among the poorest uptake of new drugs, as recently confirmed by the Karolinska report, which identified that the UK was consistently below average in adopting new drugs for the treatment of breast cancer, colorectal cancer and lung cancer. The reasons for that are varied. First, the NICE process has been too slow. Delays have meant that English patients have been forced to wait for approval, even though patients in Scotland and the rest of Europe have sometimes received their drugs more quickly.

Last year, CancerBACUP identified 23 cancer drugs that were subject to delays after NICE's budget was cut and the number of appraisal committees was reduced from three to two. Since then, some reform has taken place, and we support it. However, the success of the new single technology appraisal should not be won at the cost of other drugs going through the standard procedure more slowly. Ultimately, if NICE is to meet the growing demand for new drugs, it should be provided with the resources that it needs to support three appraisal committees.

Another problem is that, although NICE was set up to tackle the postcode lottery in drugs throughout the country, its guidelines are subject to postcode lotteries—a fact recognised by the cancer tsar, Mike Richards, in his report two years ago. More recently, the Public Accounts Committee report confirmed that, one year after NICE approval, the use of herceptin for breast cancer ranged across cancer networks from 90 per cent. to under 10 per cent. of eligible women.

For one bowel cancer medicine—eloxatin—independent research found that more than one in four consultant oncologists were not able to implement new NICE guidance in the 90-day implementation period. Those clinicians cited the lack of funding as the main reason, despite the Government's extra investment in the NHS. Such regional variations must end.

The Opposition believe that we have a system that is essentially unfair. There is an inherent inequity in the system in gaining access to drugs. The postcode lottery for the availability of drugs can only be eradicated if NICE is asked to carry out full resource implementation assessments alongside its appraisals for cost and clinical effectiveness. That will help to ensure that aspirations contained in the guidance become a practical reality. The guidance will be realistic because the decisions have been costed.

Nowhere has the controversy over access to drugs been fiercer than over the funding of herceptin for early-stage breast cancers. The Intervention by the Secretary of State for Health last October, when she suggested that PCTs should not withhold the drug for reasons of cost alone, has added to confusion about patient entitlement to unlicensed drugs. Inadvertently, the right hon. Lady raised the hopes and expectations of women with HER2 positive breast cancer that they would have access to that drug, but those hopes were crushed by the High Court ruling last month. If her original remarks at the Breakthrough Breast Cancer fly-in did not sufficiently create the impression that eligible women should expect primary care trusts to fund herceptin where a clinician was prepared to prescribe it, her subsequent decision to challenge North Stoke PCT certainly did. Now, there is still a postcode lottery in the prescribing of herceptin for early-stage breast cancer, as PCTs come to different decisions about the drug. That was the danger in the Secretary of State pre-empting NICE.

My hon. Friend is well aware that the condition of the lady who fought for the drug—Barbara Clark, who is one of my constituents—has now got worse, because its use has been okayed for late-stage cancer but no one can decide when a patient's stage changes from early to late. The postcode lottery is all right if someone is late-stage, but there is still a battle. Wales has just announced that it will stop the lottery, so has Scotland. Only England has the problem. Does my hon. Friend agree that that is a farcical position for us to find ourselves in?

I completely agree. It is simply farcical that we have got ourselves into this position and it is does not look as though the situation will get better. Unless we make the recommendations to NICE that we have suggested, there will continue to be a postcode lottery and many patients will suffer as a result.

It is impossible for NICE to make a decision on early-stage breast cancer because, as the hon. Gentleman knows, Roche only applied for a licence for herceptin in the past few days. Is he as dismayed as I am that Roche has been so slow in pushing for a licence for a drug that American studies have shown to be so useful?

The key question is: on what basis should herceptin be available now? The Secretary of State has caused confusion by intervening and overruling NICE. Primary care trusts are in a very difficult position. Some, like Swindon, will have the option of not funding herceptin if they can demonstrate doubts about its safety or clinical effectiveness. However, the PCTs that have decided to fund herceptin for early-stage breast cancer on the back of the right hon. Lady's Intervention find themselves in a difficult situation. Although many trusts are struggling with deficits, the Secretary of State has not made special funding available. Local health managers face the unwelcome task of diverting funding away from other services, including those for other cancer patients, to action a political instruction from Government half way through the financial year.

It is no surprise that Pamela Goldberg, the chief executive of Breast Cancer Campaign, has said—I hope the House will forgive me for citing her comments, but they provide a powerful illustration of the situation—that the intervention

"has caused more anxiety and confusion than clarifying the situation. Unless financial resources follow this sort of intervention we will see a situation where patients will be forced to challenge decisions on an individual basis. Primary Care Trusts have been put in a very difficult situation with their budgets already stretched to capacity."

If the point of the Secretary of State's intervention was to end the postcode lottery for herceptin, where is the evidence that that has been achieved? If it was not designed to do that, will she explain to the House what the point of her intervention was?

The hon. Gentleman is making a measured contribution, but is he saying that, if he were the Secretary of State for Health, he would ask NICE to appraise unlicensed drugs, or that he would require PCTs to pay for herceptin and would provide central funding for that?

There are a number of issues, one of which is transitional funding. As soon as drugs become licensed, they should be appraised. The fast-track process should apply in this case. If we continue with the current system, the postcode lottery will inevitably follow. We must sort the situation out and the only way in which we can do that is by making sure that there is an appraisal process as soon as a drug is licensed and that full resource implementation takes place in tandem.

I want to clarify one point about the hon. Gentleman's attitude to the postcode lottery. He has been eloquent about how much he disapproves of it, but how does that square with his leader's much-vaunted commitment to localism?

The hon. Gentleman is getting confused. At the end of the day, there is no doubt that if we aim to end the postcode lottery and have fairness in access to drugs throughout the NHS, there must be national standards and national appraisals. The bottom line is that there is a fundamental difference between standards and targets. Obviously, he has not taken that up. I am going to try to make some progress.

Before he does, may I ask my hon. Friend whether he is not simply astonished that Mr. Wills, in making his Intervention, did not mention his constituent, Anne Marie Rogers, the lady whose request for herceptin was turned down by Swindon PCT? Is not that odd? Is the hon. Gentleman saying that he likes local decision making that goes against his own constituent?

My hon. Friend makes a valid point.

rose—

The hon. Gentleman should sit down. He had his go and he blew it; he did not make a worthwhile contribution. I shall try to make some progress.

I want to focus on the importance of detecting cancers early, which is vital in giving patients the best possible start to treatment. The Government's record in this area, too, is mixed. The Public Accounts Committee report highlighted the fact that a public awareness campaign on the signs and symptoms of cancer due in 2001 has still not been fully implemented. As a consequence, the report claims:

"Patients are diagnosed with cancer at a later stage in the UK than in other European countries and this particularly affects people from deprived areas in England."

A more active policy is clearly needed.

With regard to cancers in general, as part of its new role in public health, NICE should be involved in drawing up a full, evidence-based communications campaign on the signs and symptoms of cancer to encourage patients to present earlier. But if patients are going to present earlier, and in larger numbers, GPs, many of whom see only a handful of cancers each year, clearly need improved guidance on referral. According to the National Audit Office, only about half of GPs surveyed had seen departmental guidelines on spotting cancers and found them useful. That needs to be put right.

Screening, too, has an invaluable role to play in catching cancers early, but again much more needs to be done. The success of the NHS breast screening programme, introduced in 1988, clearly demonstrates how catching cancers early can save lives, and I look forward to the day when other cancers can be detected in this way. On bowel cancer screening, for example, we welcome the Government's commitment to roll out a national programme from April, but why are Ministers now obfuscating about funding?

In October 2004, the then Secretary of State made a commitment to fund the programme to the tune of £37.5 million over two years, but now the programme is said to be subject to budgetary considerations. Perhaps this Secretary of State will explain to the House what has happened to that allocation. Is bowel cancer screening now to become the latest victim of NHS deficits?

Perhaps the right hon. Lady will also explain why her Department has been so coy when asked about the future of the programme. The charities Bowel Cancer UK and Beating Bowel Cancer hand-delivered a letter to the Department on 13 December last year, inquiring about plans for national screening. However, only last week, in reply to my parliamentary questions, did Ministers acknowledge the existence of the letter and promise to reply. That really is not good enough. Bowel cancer appears to be one of the poor relations among cancers, and that needs to be put right, if only because it kills about 17,000 people a year.

As my hon. Friend will know, this country is lagging way behind western Europe and north America in bowel screening. Has he noticed that in the Government's Amendment to the motion there is no mention at all of bowel screening? Does he agree that the House would look forward to a full explanation from the Secretary of State of what the Government plan to do on that?

I do agree. As I said, bowel cancer is the poor relation among cancers, and that has been demonstrated by the lack of response from the Department on some of the issues that various charities have raised about the screening programme. I hope that the Government will shortly put that right.

On prostate cancer, various studies have cast doubt on the effectiveness of the prostate-specific antigen test, which is why we have called on the Government to give leadership to international efforts to find a reliable test for this disease, which kills almost as many men in the UK each year as breast cancer kills women. In the meantime, the prostate cancer risk management programme supports GPs in offering men an informed choice about PSA testing. However, many GPs are not even aware that support tools exist. That, too, needs to be put right.

So far we have discussed improving survival rates, but there is also a need to transform the quality of life of cancer patients. There needs to be better recognition by Government that, because more patients are living longer with cancer, cancer needs to be treated as a long-term medical condition. Patients should be given support to manage their own care as much as possible and to make informed choices about treatments where appropriate. Access to information is crucial for people living with cancer and is vital if patients are to be put in the driving seat. Yet communication issues continue to be a common cause of complaint for people with cancer.

According to the recent Public Accounts Committee report, one fifth of patients are not made fully aware of the potential side effects of treatment. About 40 per cent. of cancer patients were not informed about cancer support or self-help groups. As well as emotional support, patients should also receive, as a matter of right, information about entitlements to benefits.

According to Macmillan Cancer Relief, three quarters of patients do not receive such advice. The last thing that patients undergoing treatment require is to have to worry about not paying Bills because of low uptake of benefits to which they are entitled. Another failing of the system is that it does not adequately address what I call the black hole between health and social care, into which too many patients fall without the care and treatment that they need. The gap needs to be bridged. That is why individual needs should be assessed on a holistic basis with professionals and health and social care staff working together through multidisciplinary teams.

Specialist clinical advice and support is also extremely important. Currently, Britain has too few specialist cancer nurses. We believe that NICE should be instrumental in drawing up holistic standards and entitlements to care that address the emotional and information needs of patients throughout the entire patient pathway, and so bridge the gap between health and social care. These standards would be for the whole journey, including, perhaps, giving patients the right to die at home if they so wish.

These standards should also be enforceable. One way of achieving that would be for clinical guidelines to be the basis of contracts between NHS commissioners and providers. In short, we should aim to create a culture of entitlements to care. For example, we on the Opposition Benches are increasingly attracted to the idea of an information prescription given by GPs or specialist nurses—I am pleased to say that the Government are picking up on this—as the starting point of patient empowerment. Expertise in meeting these challenges and improving the quality of patient care already exists in the voluntary sector, and should now be harnessed by the NHS in meeting more robust professional guidelines set by NICE.

On the subject of NICE, my hon. Friend will be aware of the arguments that relate to Alzheimer's drugs. I ask him to consider whether those arguments should apply also to cancer drugs. Should not NICE consider the economic impact on social services as much as on health services when considering the economic viability of cancer drugs?

In short, we very much agree with that. That is one criticism of the decision involving Alzheimer's drugs, in that it concentrated on health costs and benefits. The decision should have focused also on social costs and benefits, so as to bridge the gap. Cost savings could then be made with the provision of good standards of care in viewing the whole journey to the end, as it were. That is one of the faults of the system at present. It is focused too much on health and we need also to consider social care.

Reducing inequalities of outcome is not only a matter of improving survival rates. The battle against cancer must increasingly be fought by increasing awareness of risk factors and influencing lifestyle choices. This is the importance of prevention. Smoking is by no means the only risk factor that is associated with cancer. We must now put the focus on factors such as obesity, which causes about a third of all cancer deaths. Mesothelioma affects a new generation that are not aware of the risks of asbestos. They are embarking on potentially dangerous do-it-yourself renovations of old buildings, for example. There is a need for better warning about this deadly disease. These facts can be used powerfully to argue for a much better public health and awareness campaign to tackle health inequalities. We as a party were pledged to put these themes at the heart of our policies if elected last year.

As part of its new public health role and alongside communication campaigns on the symptoms of cancer, we believe that NICE should be involved in drawing up an evidence-based awareness programme of how people can alter their lifestyles to reduce risk.

The present situation is unacceptable. Despite extra investment and some improvements, Britain's cancer survival rates are still among the worst in Europe. The Government's targets focus on the front end of the patient pathway to the detriment of the latest treatments, which have been neglected. Waiting times for radiotherapy, for example, have undoubtedly increased, but the Government refuse to monitor the situation. There is still a postcode lottery in access to drugs, with British patients benefiting from new treatments later than their European counterparts. Guidance from the National Institute for Health and Clinical Excellence on technologies and standards of care has not been universally implemented.

The Secretary of State's Intervention over herceptin unfairly raised the hopes of women with early-stage breast cancer. By failing to make specific funding available, she has put primary care trusts in an impossible situation, and she has disappointed patients. Meanwhile, services have not yet fully recognised that cancer is increasingly a long-term term condition, and should be treated as such. The black hole between health and social care needs to be addressed. In future, decisions about cancer services should be taken as much as possible by clinical experts from NICE, rather than by politicians in Whitehall.

The NHS has been a political football for too long. It is time for politicians to step back, and allow the medical professionals to get on with the job. NICE should take on a much more ambitious role in drawing up guidelines on entitlement to care. Those standards should take account of patient needs on a holistic basis, including the need for information and emotional support, and they should join up health and social services effectively. Standards must cover the entire patient journey from prevention and awareness to the later stages of curative and palliative care and, like technology appraisals, they should be enforceable. To end the postcode lottery in access to drugs and treatments, NICE guidance appraisals and recommendations should be made alongside resource implementation assessments so that national guidance is realistic and successful, enabling us to end the unfairness inherent in the system.

In short, it is almost a crime that, despite a massive increase in funding, cancer services still lag behind their European counterparts. We need an ambitious programme for the future of cancer services and a fresh approach that puts patients in the driving seat by providing them with an entitlement to standards of care, as decided by medical professionals, not the politicians; by raising treatment standards throughout the patient pathway; and by recognising quality-of-life issues, which are important to patients. For those reasons, I urge the House to support the motion.

I beg to move, To leave out from "House" to the end of the Question, and to add instead thereof:

"recognises that the Government has made the improvement of cancer services a key priority through the implementation of the NHS Cancer Plan which sets out to reorganise and rejuvenate cancer services and has provided the NHS with investment to modernise these services;
welcomes the achievements set out in the recent Public Accounts Committee report, the NHS Cancer Plan: a progress report, which acknowledged that significant progress has been made across the country;
notes that the total death rate for cancer in people under 75 has fallen by 14 per cent. since 1996; acknowledges that under this Government unprecedented investment in equipment is helping to improve both access to, and reliability of, diagnosis and treatment;
further notes that specialist teams have been established across the country to help deliver co-ordinated care to patients in hospitals;
further welcomes the fact that the National Institute for Health and Clinical Excellence is introducing a new fast track assessment process to enable them to issue binding advice to the NHS on the most important new drugs within weeks of them receiving a licence;
further notes that this Government has commissioned research to enable initiatives to raise awareness of the symptoms of cancer to be targeted on people most at risk;
further notes that there has been a 43 per cent. increase in cancer consultants since 1997; acknowledges that there has been a 40 per cent. increase in cancers detected through breast screening;
and further welcomes the Government's commitment to continuing to deliver the commitments in the NHS Cancer Plan."

I welcome the opportunity to debate the future of cancer services. I welcome, too, the way in which Mr. Baron opened the debate and the tone of much, if not quite all, of his comments. I particularly welcome his recognition that we have made significant improvements in the care of cancer patients in the past eight or nine years.

The death yesterday of the wonderful Linda Smith from ovarian cancer reminds all of us again of the terrible toll of cancer—over 4,500 deaths each year from ovarian cancer alone. This evening, many hon. Members, particularly Conservative Members, will attend an event to celebrate the life of Gregor MacKay. Gregor worked as press secretary to Mr. Hague when the right hon. Gentleman was Leader of the Opposition, but he had many friends across the political divide. He died last year aged just 36, only eight weeks after being diagnosed with lymphoma. I wish the lymphoma research fund that will be launched this evening in Gregor's memory every success, and I am sure that Opposition Members will wish to join me in doing so. There is hardly a family in the country that has not been affected by cancer in one way or another. It is one of the highest priorities for the national health service, and we have made it so.

Cancer is an emotive issue, not least in south-east Essex, where a consultation is taking place about reconfiguring networks. The south Essex cancer network was given a special dispensation below the 1 million people threshold because we have a higher than average proportion of elderly people, who are unfortunately more likely to suffer from the disease. The network is popular and successful. Its headquarters are at the cancer centre at Southend hospital, which I am pledged to defend, as are other local MPs from south-east Essex. The network works and the centre is popular—it is not broken and we do not need anybody to fix it. Will the Secretary of State bear that in mind and look sympathetically on it?

The hon. Gentleman makes extremely important points which he and his hon. Friends are also making in the local consultation. Those decisions are best made locally, but I am sure that his comments will be fully taken into account.

In 1997, we set a target to reduce the death rate from cancer in people under 75 years old by 20 per cent. by 2010. I pay tribute to the work of the then Minister for Public Health, my right hon. Friend Tessa Jowell, who was instrumental in making that commitment in the public health green paper. The year after that, we set the target that every patient referred by a GP with suspected cancer would be seen by a specialist within just two weeks.

In 1999, we appointed the first national director for cancer, Professor Mike Richards, whom I thank for his outstanding clinical leadership on this issue. I find it extraordinary that the hon. Member for Billericay scorns political decision making, given that we have done so much to ensure that as we set targets and improve services, we do so on the basis of the best clinical advice and outstanding clinical leadership.

In 2000, again with the full support and involvement of leading cancer specialists, patients' groups and academic experts, we launched the first ever national cancer plan. As a result, we began an unprecedented programme of investment in cancer services, with an additional £639 million extra in the past five years. We have used that investment to train and recruit new cancer specialists, so that we now have nearly 1,400 more cancer specialists in the national health service than we had in 1997.

If we have a national plan, could the Secretary of State explain to my 10-year-old constituent, Katie Morgan from Wixhall, why her mother, Susan Morgan, and another constituent, Mrs. Margaret Bradford, are today at a public meeting in Shrewsbury trying to raise money for a £47,000-per-person herceptin treatment although that treatment is available two miles away in Wales and 10 miles away in Staffordshire? If we have a uniform comprehensive tax system, as Mr. Wills said, why do we not have comprehensive provision of this life-saving drug? Mrs. Morgan has been told by the PCT: "Your circumstances are not exceptional." Yet this is a death-dealing disease.

I shall come to that issue in due course. I would be grateful if the hon. Gentleman would wait until I do so, because I want to deal with it in some detail.

My right hon. Friend will have heard hon. Members cherry-picking from the progress report on the Government's NHS cancer plan by the Public Accounts Committee, which is excellently chaired by Mr. Leigh. Far be it from me to engage in political point-scoring, but will she comment on that report? It said:

"Across the country significant progress has been made in improving cancer services and managing them more effectively, in particular, speeding access to cancer diagnosis and treatment."

My hon. Friend is right to draw attention to that valuable report, particularly its commendation of the significant improvements that have already taken place. Obviously we will respond to it in detail in due course.

I am sure that the Secretary of State will join me in acknowledging the good work of the Neuroblastoma Society, even though she said in a recent written parliamentary answer that she will not offer it any support. If such great improvements have been made, will she explain to my five-year-old constituent, Isobel Sanders, why, on 9 May last year, two of the eight specialist paediatric oncology beds were closed in the Thames Valley strategic health authority because of staff shortages and why not a single bed in England and Wales was available to take her?

I am extremely sorry to hear about what must have been a desperately anxious and agonising predicament not only for the hon. Gentleman's young constituent but for the entire family. I do not know the background to the decision, but such decisions are rightly made by hospitals, primary care trusts and strategic health authorities in local areas. I believed that that policy was supported by hon. Members of all parties. However, I greatly hope that the hon. Gentleman's constituent has received the treatment that she needed.

I am sure that all hon. Members want to thank our superb cancer staff in the NHS. Thanks to their dedication—backed by our investment—deaths from cancer have fallen by 2 per cent. a year in people under 75 and decreased especially quickly for men who suffer from lung cancer and for women with breast cancer. We are well on course to achieving the target that we set of reducing the death rate from cancer by 20 per cent. by 2010. Already, 43,000 people's lives have been saved.

The hon. Member for Billericay referred to survival rates. We should all be proud of the improvements in survival rates, although of course they are not yet good enough. In 1970, a woman with breast cancer had a 50 per cent. chance of survival. Today, the figure exceeds 80 per cent. In 1970, a patient with bowel cancer had a 25 per cent. chance of survival. By 2000, the figure was 50 per cent. Genuine improvements have therefore occurred.

I agree with the hon. Member for Billericay that cancer does not have to be a death sentence. It is increasingly a long-term condition. More and more people—some of them relatively young—are living with cancer and after cancer. They will need continued, appropriate support.

On that point, convenient access to care becomes increasingly important. I hope that the Secretary of State is aware of the decision to close cancer services at Mount Vernon hospital from 2012. Is the best that the British Government can offer the million or more people in the west London cancer network, for whom that site is the most convenient, a journey time of an hour and a half on public transport for cancer care?

The hon. Gentleman knows that a review of services across north-west London is taking place. The proposal is part of that review and an appropriate consultation is under way. I am sure that his points will be taken into account.

The aims of the cancer plan can be summed up very simply: prevent more, diagnose early and treat fast. I want to say something about what we have already done and what we must do on each of the three elements.

We all know that smoking is the largest single cause of cancer deaths in the United Kingdom. The ban on smoking in enclosed public places, on which the House recently decided by an overwhelming Majority, will be perceived as one of the landmark Acts in the protection of public health. It builds on our work on tackling tobacco smuggling, banning tobacco advertising, placing tougher warnings on cigarette packets, and our successful NHS smoking cessation services. My hon. Friend the Under-Secretary of State for Public Health recently launched our latest advertising campaign against smoking. I am especially grateful to Trudi Endersby, who was diagnosed with lung cancer at the age of 38, and had the courage to appear in that television campaign describing how she went with her daughter to choose a plot for her own grave, thus bringing home to people the dangers of smoking.

I think that all hon. Members will agree that we need to do far more to alert young people, many of whom are gambling with their future health and happiness as they turn to smoking, binge drinking and risky sexual behaviour. I particularly want to commend the work of Professor Iain Hutchison, one of our leading oral and maxillofacial surgeons and a professor of surgery at St. Bart's hospital, who founded the Saving Faces charity. He has described to me how he and his colleagues have gone into schools to show teenagers in horrifying and graphic detail what it means to have oral cancer, and to explain the impact of smoking and binge drinking on the risk of contracting oral cancer. I agree with the hon. Member for Billericay that we need more of those public awareness campaigns, and we will ensure that there are more of them in future.

So we need to do more on prevention. However, we cannot prevent every cancer, at least not with our present state of scientific and medical knowledge. It is therefore essential that we keep doing even more to detect cancer early. In 1996, 1 million women were screened for breast cancer. This year, nearly 1.5 women will be screened, and we can be proud of the fact that the breast cancer screening programme that we operate is widely regarded as one of the best in the world. The number of breast cancers detected through our screening programme has increased from some 8,500 a year to 12,000 a year, which will lead to further improvement in survival rates. The latest estimate is that that one screening programme alone is already saving the lives of about 1,400 women a year.

My right hon. Friend has talked about the importance of detection and early diagnosis. Will she commend the network of pilot clinics that has been set up at St. George's hospital to examine the links between family history and the diagnosis of cancer? The project is already a success in south London. Does she think that it could be extended further around the country?

I commend the excellent work that is being done at St. George's. The targeted identification and screening of individuals whose family history suggests that they are at greater risk than the rest of the population will play an increasingly important part in the early diagnostic work that we do.

Is the Secretary of State saying, therefore, that, rather than screening women for breast cancer automatically when they reach 50, she might move towards automatic state-funded screening at an earlier age—possibly 40 or 45? Is that a possibility for the future?

At this point, the evidence does not really support the case for what would be a substantial investment in universal screening for all women in their 40s. However, we are of course looking at the research on that—indeed, we are funding much of it—and we expect further results from it later this year.

Every time in the past few years that I have referred someone with a suspected cancer, they have been seen and dealt with within two weeks. Does my right hon. Friend agree that it is a fantastic tribute to the enormous amount of work being done by doctors, nurses and others in the health service to achieve such tremendous results, reassuring patients who do not have cancer and dealing rapidly with those who do? That work greatly reduces the burden of anxiety felt by patients and their families.

rose—

Order. Before the right hon. Lady replies, may I say that ever longer and more frequent interventions are having their own impact on the time available for debate? I am sure that everyone will be conscious that the Chair is trying to fit in a maiden speech today as well.

My hon. Friend Dr. Stoate, who speaks with enormous authority on these matters, has saved me some time by making that point. In 1997, only two thirds of patients who were referred by their GP were seen by a cancer specialist within a fortnight. So, thousands of people every year were being told by their GP that they might have cancer, but were being forced to wait in agonising uncertainty for weeks on end before they could see a specialist. The fact that, today, 99 per cent. of patients see a cancer specialist within two weeks or less is hugely important.

I know that the Conservative party does not like targets, and the hon. Member for Billericay has made that point again. Mr. Cameron told the Health Service Journal that he wants to scrap national targets. The hon. Gentleman appeared to be arguing this afternoon that those targets, by concentrating on the early part of the patient journey, are distorting clinical priorities. I have to say that I do not understand how it can be a distortion of clinical priorities to ensure that a patient whose GP fears that they might have cancer is seen by a cancer specialist within two weeks. The people involved cannot begin to worry about the late stages of the patient pathway for somebody with cancer if they have not taken the trouble to diagnose the cancer rapidly in the first place. I believe—

Will the Secretary of State give way?

No, I shall make progress. I believe that we were absolutely right to set that target. I believe it has relieved anxiety for thousands of patients with suspected cancer. In achieving that early diagnosis, it has contributed to saving lives.

Of course, we also have to treat people fast. That is why we set a further target—perhaps another that the Conservative party would abolish if it had the chance—that no patient should wait longer than a month from diagnosis to treatment, or more than two months from urgent referral by a GP to the start of their treatment. That is particularly important because, as the hon. Member for Billericay said, people in England—indeed, people across the UK—are more likely than those in other countries to be in an advanced stage of their cancer by the time they are treated, so getting patients not only diagnosed early, but through to their treatment as quickly as possible, is critical if we are to save people's lives and improve those survival rates.

I take on board what the Secretary of State is saying, but she seems to forget that those targets relate to first treatment. Radiotherapy, for example, is first treatment in no more than 15 to 20 per cent. of cases. The risk is that these targets ignore the fact that the cancer journey can be long. Pulling resources into the front end means that radiotherapy waiting times look set to continue to lengthen at this rate.

We have never claimed that the patient pathway ends with the first treatment, but we have said that we must start by setting as a priority not only early diagnosis, but getting the patient through to that first treatment. The hon. Gentleman is quite right that at this stage we do not currently measure the waiting time for radiotherapy as a second treatment—in other words, after the initial surgery. We might need to do that next, which is one issue we will consider, but at this point we are seeking to ensure that we meet the one-month and the two-month targets. I believe we are absolutely right to do so.

No one in the House should underestimate the challenge posed by meeting those targets to get patients very rapidly indeed to their first treatment for this very simple reason: the NHS has never before proactively had to manage patients—each individual patient—throughout their pathway of care.

Will the Secretary of State give way?

No, I want to make this point. Then I will give way to the hon. Gentleman, who has been very persistent.

We have never, under Governments of either party, measured the delays in diagnostic tests, the time between additional out-patient appointments, the referrals between one specialist and another, or the referrals, often for patients with complex cancers, between one hospital and another—between the secondary and the tertiary centres, for instance. All those can add to delays, uncertainties, anxiety or even mistakes. We are changing all that, and it is a pity that the hon. Member for Billericay does not recognise the scale of our ambition, or indeed our achievement.

I hope that the Secretary of State will also address the various support services in the complementary sector, which are not commonly mentioned by Ministers, such as traditional Chinese medicine and acupuncture, particularly as the Government have been pressing for a statutory register, which should be coming on-stream soon. I would be grateful for an explanation of that. What is she doing to examine the contribution of advisory services on diet and lifestyle, because, as I mentioned earlier, according to reports from America 80 per cent. of cancers are caused by lifestyle issues?

I was not going to mention those points, as there is so much to cover, and I am sure that the hon. Gentleman will contribute to the debate on those matters later.

We are making remarkably good progress towards achieving the targets that we have set for prompt first treatment. Between July and September last year, nearly 95 per cent. of patients had commenced their first treatment within 31 days of being diagnosed, and more than 80 per cent. of patients were treated within 62 days of being referred urgently by their GP. There is still much more to do on that, but we have made remarkable progress already.

I want to deal with the issue of cancer drugs, and particularly herceptin, which has rightly been a focus of much of the debate already. I pay tribute to the superb campaigning of Barbara Clarke—who is taking an interest in this debate—and other women. When we heard the results of the initial clinical trials last year, which suggest that herceptin can make a very significant difference to perhaps one in four women who are HER2 positive and have been diagnosed with breast cancer, we immediately considered the implications for the national health service. In particular, I took steps, with the support of Professor Richards, to ensure that HER2 testing will be available across England to all women diagnosed with early-stage breast cancer, so that they and their clinicians will know whether they might be able to benefit from the drug.

The hon. Member for Billericay is right, however, to point to the difficulties that arise with drugs, not only herceptin, that are neither licensed nor evaluated by NICE for use. We have made it clear as general guidance for many years that no primary care trust should refuse any treatment on the blanket grounds that it has neither been licensed nor evaluated, because it is entirely possible for a clinician to prescribe treatment that is neither licensed nor evaluated—or that might have been licensed but not evaluated—and for a primary care trust to fund that treatment. In the light of the risk that herceptin might be ruled out because it was not licensed, not evaluated, or solely on grounds of funding, I added to the guidance already issued by making it clear that primary care trusts should not refuse herceptin purely on grounds of cost.

The Secretary of State is right. Herceptin is licensed for late-stage breast cancer, however, and has been for some time. Barbara Clarke's campaign was to get it licensed for early-stage breast cancer. Does the Secretary of State agree that if that could be rolled out across the whole United Kingdom—it is already in Scotland and Wales—we would resolve the problems that my hon. Friend Mr. Baron was talking about?

I was about to explain why we cannot do what the hon. Gentleman suggests at this point. In fact, I am not sure what he was suggesting; I think he was quite confused about it. He asked for national standards. That was our aim in setting up NICE: we wanted to end the lottery of postcode prescribing. NICE, however, cannot evaluate a drug before a licence has been applied for. It simply does not have the information that will enable it to evaluate the drug if the manufacturers who have that information from the clinical trials have not yet submitted it to the licensing authority.

Although, as the hon. Gentleman says, herceptin has been licensed for some time to treat late-stage breast cancer, it has not been licensed for early-stage treatment. When a fast-track licence was requested from the licensing authorities, the clinicians involved in the decision took the view that it would be wrong to put herceptin through a fast-track process for early-stage treatment because of serious concern about side-effects relating to heart disease. That is not a worry if a woman is in the late stages of breast cancer, but it can be of significant concern if the woman is in the early stages.

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I will not give way to the hon. Gentleman again at this stage. I have been pretty generous.

I am grateful to my right hon. Friend for giving way, especially as my Intervention relates to a constituent. I am sure that she was well aware of the case even before the premature intervention of my neighbour, Mr. Gray. I shall leave the House to judge whether it was inappropriate.

As my right hon. Friend knows, I have written to her several times on behalf of my constituent. I think that everyone who considers that case, and indeed the whole issue, realises just how difficult and delicate such matters are at this stage in the development of drugs. I welcome my right hon. Friend's rapid and sensitive intervention last year in an attempt to deal effectively with a very difficult issue. May I ask her, however—

Order. The hon. Gentleman has gone on for far too long. I have already appealed for brevity, and indeed for fewer interventions, if we are to have any debate at all involving Back Benchers.

I will be guided by you, Mr. Deputy Speaker. However, my hon. Friend has raised an extremely important and difficult case, to which I referred in a written statement earlier today. As an appeal is pending, I do not think it would be appropriate for me to comment on the individual case, which is of course particularly difficult and painful for the individual concerned and her family. I think we all recognise that.

As I have said, NICE cannot begin to evaluate a drug or a new application before a licence has been applied for. What we did—I pay tribute to the Minister of State, Department of Health, my right hon. Friend Jane Kennedy, who did much of the work—was enable the NICE evaluation to be speeded up, for herceptin in particular but also for a number of other drugs, especially cancer drugs. We did that by ensuring that, rather than having to wait until the licence is granted, in cases such as this NICE can begin its evaluation as soon as the licence is applied for. I can confirm that it has begun its evaluation of herceptin, following Roche's recent and welcome application for a licence.

The first five drugs to be subjected to the new faster process—the single technology appraisal by NICE—are cancer drugs. We expect the evaluation of herceptin to be completed within a few weeks of the granting of the licence, but until the evaluation has been completed and the licence granted, it would be wholly wrong for me as Secretary of State to overrule or prejudge the decisions of either the licensing authority or NICE. The hon. Member for South Cambridgeshire appeared to be saying that I should not do so. It is a pity that he has not supported me.

The question surely is this. The Secretary of State chose to intervene last October. It surely cannot be her proposition that primary care trusts are obliged not to refuse treatment on grounds of cost alone. She intervened in respect of herceptin. When NICE conducts an evaluation, it automatically feeds through into the resources that are made available to PCTs. There is no NICE evaluation. Therefore, no resources to support herceptin are allocated to PCTs in their overall allocation. The Secretary of State gave the impression that PCTs would be funded to provide herceptin if they thought that it was clinically appropriate, but she did nothing of the sort.

The hon. Gentleman is wrong. What I said at the time I made my statement was that I recognised full well the difficult financial position that some primary care trusts found themselves in, and that they would have to make difficult decisions on priorities in order to ensure that herceptin was not denied purely on grounds of cost, but I think that he labours under a misapprehension. As we have set out clearly, when NICE evaluates a drug and makes a positive recommendation, the NHS then has three months to ensure that its recommendation is followed. However, the NHS is expected to do that within the funding that it has already been given. There is not a separate pot of money sitting in the Department of Health waiting to be allocated as each NICE evaluation is made.

We have given primary care trusts, the local NHS, more money than ever before and devolved to them some 85 per cent. of the total health budget—a devolution of resources that I would have thought the hon. Gentleman supported—it is simply not possible to say, for each new drug that comes along, when it is positively evaluated by NICE, "Here is more money for that drug." It would not be a sensible way to allocate resources.

The resources are allocated in a single pot. They are not ring-fenced for a particular drug. They are not even ring-fenced for drugs as a whole. It is up to the local NHS, the PCT, to decide its priorities and to get the best value for money to ensure that patients receive the best possible health care and that funding is released for new drugs and therapies as they become available.

Can the Secretary of State explain in simple terms to a 10-year-old constituent of mine why their parents, who have paid their taxes, are having to spend a day in Shrewsbury starting to raise £47,000, when their neighbours two miles away in Wales are getting the drug? We do not have national health, or so-called national care, but we do have national comprehensive taxation.

The NHS in Wales, for which, of course, I am not responsible—that is a devolved matter—looks to NICE, as indeed much of the rest of the world does, for the evaluation. I make decisions about the NHS in England. I believe, and I thought at least at one point in the speech by the hon. Member for Billericay that he agreed, that it would be wrong for a politician to override, pre-empt or prejudge the decisions that should rightly be made by the independent licensing authority and by NICE.

I believe that the Secretary of State is somewhat confused herself. Does not she realise that, by intervening as she did, that is precisely what she did? She overruled NICE—she pre-empted NICE, I should say; I apologise. She caused confusion. She has not given extra budgetary finance to those PCTs that want perhaps to bring it in. That has caused more of a postcode lottery than existed previously.

I am sorry but the hon. Gentleman is wrong. I was very careful in everything I said on the subject last year not to pre-empt NICE. If he cares to ask Professor Mike Rawlins, the chair of NICE, he will find that Professor Rawlins and I are in complete agreement on that point.

As I said earlier, we have said for some years that PCTs should not deny or withhold treatment on a blanket basis—simply on the grounds that a drug is neither licensed nor evaluated. In addition, I have specified that they should not withhold funding for herceptin on a blanket basis purely on the ground of cost; rather, they must consider each individual case. If a PCT decides not to fund such treatment, that decision can of course be reconsidered on appeal by the clinical exceptions committee. The more that such decisions are taken by clinicians, the better.

I shall end my remarks—I am conscious that a number of colleagues wish to speak—by referring to the surveys carried out by the National Audit Office between 2000 and 2004, which have confirmed the significant improvements in cancer treatment to which I have already referred. They show that fewer patients reported a deterioration in their condition while waiting for treatment. Of course, fewer patients now wait weeks or even months for treatment—a wait that was, I am afraid, a feature of cancer treatment in the past. Perhaps most crucially of all, nearly nine out of 10 cancer patients reported that they were treated with dignity and respect at all times.

We are just halfway through implementing the national cancer plan. As I believe Members in all parts of the House will accept, we have already made great progress, but as I would be the first to acknowledge, there is a great deal more that we have to do. But given our continuing investment in cancer services and the record sums going into the national health service; given our confidence that by the end of 2008—after two more years of record increases—we will have achieved the European average in health care funding; given the extra specialists, the new drugs and the continuing drive for an improved patient experience and proper support throughout the cancer journey; given the provision of better advice and more choice and control for patients; and given the provision of more care in or near the home, as reinforced by our recent white paper, I believe that we are well on the way to making Britain's cancer services among the best in the world.

All the progress that we have already made and will make as we continue on this course in the years to come would be jeopardised by the new fiscal rule announced by the Leader of the Opposition, the right hon. Member for Witney, as confirmed in his most recent statement. That "proceeds of growth" rule would inevitably mean cuts in the NHS budget—thereby reversing the progress that we have made—longer waiting lists, fewer specialists and poorer services for cancer patients.

Much has been done but there is more to do and we have an absolute determination to do it. I commend the Amendment to the House.

I know that the House is keen that Back Benchers have the chance to speak before the winding-up speeches begin, and although this is a very important topic that, to judge by the contributions that we have heard so far, deserves a lot more time than has been allocated to it this afternoon, I will curtail my remarks, not least in the hope that my hon. Friend Willie Rennie can catch your eye, Mr. Deputy Speaker, and make his maiden speech.

I want to focus on the crucial issue of cancer drugs and access to them, but first I want to place on the record my support for the 10-year cancer plan, which, as has rightly been said, has made an important contribution. However, I hope that the Government will say whether and when they plan to renew and refresh that plan, because we do not want it more or less to expire, and then to be presented with a new 10-year plan. Cancer treatment provision and cancer prevention is a long-term process, so we need a long lead time into the next stage of the cancer plan. I therefore hope that the Minister can tell us this evening when we will get the shape of the next plan, rather than waiting until the current one ends. We need a longer-term horizon than that.

I turn briefly to the important issue of the "prescription for change" campaign by Breast Cancer Care, which has highlighted an anomaly. People diagnosed with breast cancer or other cancers would once have died shortly thereafter; now, they can expect to live for much longer, but as a result they suffer prescription charges, whereas people with other conditions, such as diabetes, do not. Prescription charges are causing problems for cancer patients. For example, the Minister may not be aware that a Breast Cancer Care survey found that 15 per cent. of cancer patients had not taken up the prescriptions given to them by doctors because of their cumulative cost. There is an arbitrariness in the prescription system, for example between diabetes and cancer. That was not so important in the late 1960s, when the rules were drawn up, but it is a problem now. The present system can be defended only on the grounds that it is the one that we have got and that changing it would open up a can of worms. However, that is not a good enough reason not to look at it.

I shall focus on the question of access to expensive new drugs. We will talk about herceptin today, but there will always be another new drug just around the corner. Herceptin is going through the NICE licensing process for use in early-stage breast cancer, and we hope that it will soon be approved, but our answer to the question of access must work every time, for each expensive new treatment that comes along.

My comments are informed by a meeting that I had yesterday with oncologists from Addenbrooke's hospital. They wrote to me and other hon. Members last July about the inaccessibility of herceptin, and said:

"As a group, we are conservative"— with a small "c" in that context, I am pleased to say—

"in our response to new treatments. We usually strongly resist pressure to switch our patients to new and expensive drugs for marginal benefits. But the recent trial data demand immediate action since these are certainly the most stunning results that any of us has seen during our entire professional careers."

It is interesting to note that, since the oncologists wrote that letter, their patients can now access the unlicensed drug herceptin for early-stage breast cancer. It was their clinical judgment that that should happen, but other PCTs have concluded that that would not be the right thing to do for clinical reasons. How can such matters be dealt with systematically? That is the important question, as our constituents sense that the present requirements are unacceptable.

Mr. Baron said the same, but did not propose a solution. I agree that it cannot be right that a woman suffering from breast cancer should have to go to court to get herceptin. Mr. Paterson has intervened more than once to say that it cannot be right either that a woman who happens to live in Shrewsbury cannot get herceptin, while one who lives in Staffordshire or somewhere else nearby can. Neither circumstance can be right, but we have not heard how such inconsistencies are dealt with in connection with drugs that are neither licensed nor approved by NICE. I shall make my own suggestion about that in a moment.

Some key questions on herceptin remain unanswered. First, what have the Government done to try and get it more cheaply? On average, the NHS pays more for drugs than most other health services—a fact confirmed to me in a written answer from the Department. Have we used the buying power of the NHS to beat down the providers and get a better price? That approach must be both sensible and desirable, although I understand that the producers need their research budgets and an incentive to carry out research. That means that there is a limit on how far prices can be brought down but, if other health services can do it, why cannot ours?

Secondly, the hon. Member for Billericay said that other European countries adopt new drugs much earlier than we do. Why is that? Many other European countries have better survival rates than the UK, and that is very closely linked to our failure to take up new drugs earlier. Why do the Government think that our health service is, on average, slower to adopt new treatments? What assessment has been made of that?

On unlicensed drugs, I stress that I am speaking for myself, and that I do not ascribe my views to the consultants to whom I spoke yesterday. However, they pointed out that unlicensed drugs are used all over the place and said, "Paediatricians do it all the time." Licensing is for the benefit of patients, and is about patient safety. If patients are told that the trials and tests of a drug remain incomplete and that there is a risk attached to its use, they might still conclude that they are not willing to accept the risk of not using the drug. In those circumstances, why should the patients be told that they cannot take an unlicensed drug, simply because it is unlicensed? That cannot be right.

The fact that a drug is unlicensed should not be a barrier, but we do not have a system for the systematic appraisal of unlicensed drugs by clinicians who want to give them to their patients. Such a system would mean that the use of new drugs would not vary by postcode, or require people who want them to go to court. That is the sort of system that we need, and I shall make a suggestion to that effect in a moment.

I share the concern that has been expressed about the Secretary of State's Intervention last October. She made a statement on 5 October that reiterated the undertaking that herceptin would be fast-tracked when it was brought forward for licensing. Obviously, we welcomed that. However, that statement, subsequent clarification by the Department of Health on the same day and the Secretary of State's speech to Breakthrough Breast Cancer have, according to a PCT guidance note on access to herceptin:

"raised considerable expectation that NHS patients will, from now, be prescribed" early-stage herceptin

"even though the announcement relates only to provision of testing".

Whether the Secretary of State likes it or not, she clearly raised expectations. She must accept that, because there is plenty of evidence that people heard that on the news and concluded that she was telling trusts not to refuse to prescribe it. I know that she said that they were not to refuse to prescribe it on cost grounds, but does she seriously think that if herceptin cost £1 a dose any PCT in Britain would refuse its use to clinicians who asked for it? That is patently not so. If clinicians had judged that herceptin, although unlicensed, was in the best interests of their patients—and the patients knew the risks and were willing to take them—no PCT would say no in those circumstances.

Strictly speaking, some clinicians would say no in those circumstances. For example, in the Thames Valley strategic health authority, advice has been derived from a joint professional group that clinicians should say no to herceptin, on the grounds of the risk associated with an increase in coronary heart disease.

I was talking about primary care trusts saying no when clinicians said yes. If clinicians have a patient whom they believe would be ideally suited to the treatment, they have explained the risks and the patient is prepared to take those risks because the alternative would be worse, the money would be found for herceptin if it were not so expensive. That is cost rationing, and it is no good pretending that this is not about cost. The Secretary of State told trusts not to say no on grounds of cost alone, but that clearly raised expectations that cannot be met. That is the danger of the Secretary of State intervening as she did.

We have all heard about the North Stoke case. How can it be right that one person gets the treatment because they have got on the news, the Secretary of State has thrown her weight around and, the next day, the PCT changes its mind, but another woman, who does not get on the news, does not get the treatment? That is not a rational way to allocate those treatments.

My local PCT in south Gloucestershire does not fund herceptin, on clinical grounds, because there is an academic study that says that four years down the track the chance of surviving is enhanced by only 5 per cent. However, that study was based on a broad category of women. I put that point to the consultants at Addenbrooke's yesterday and they said that out of the big sample one could pick sub-groups who have a far better chance of survival. The drug is ideally suited to some women, for whom the statistics would be much better. My local PCT has picked one study and interpreted it in a particular way and will not prescribe herceptin, but if my constituent who needs the treatment were living in Cambridge, she would get it. That cannot be acceptable.

It is all very well identifying the problem, but what should we do? We need a mechanism for allocating unlicensed and unapproved drugs. We cannot continue with the random and arbitrary approach that we take now. That has to be done nationally. Mr. Wills was right to identify a conflict between a belief in localism, local discretion and responsiveness to local circumstances, and consistency and avoiding postcode lotteries. On many things, my colleagues and I are on the side of the localists. We want local discretion over patterns of service and provision. However, I do not think that any of our constituents believe that it is right that whether a patient gets a drug should depend on where they live. That does not come into the category of decisions that our constituents believe should be made case by case, on a local basis. Therefore, we need a central evaluation process for such treatment, pre-NICE. The alternative is arbitrariness—randomness, going to court, postcode lottery—on treatments that could save lives. It must be one or the other. We cannot have both.

That arbitrariness so offends our constituents' sense of natural justice that we cannot go on. Yes, the problems with herceptin will be sorted in six months—we hope—but the next set of problems will not be. Clinicians tell me that avastin will be the next cancer wonder drug and that it will make herceptin look cheap, so we have to tackle the issue. Such drugs will first be unlicensed and then licensed but not approved. The faster the NICE approval process, the shorter the pre-NICE process I suggested, but it will have to exist, otherwise there will be only the arbitrariness and unfairness that we all feel offends against our sense of natural justice.

It is no good pretending that there will not always be rationing, but it must be systematic and consistent—

And rational.

Indeed. If there is a national process for a limited period for a limited number of treatments, it will be better than the present arbitrariness. I hope that the Government will give the proposal serious thought.

Several hon. Members:

rose—

Order. Before I call the next Speaker, I point out that the 10-minute limit on Back-Bench speeches applies from now on, but as many Members are seeking to catch my eye it would obviously be more than helpful to all of us if people could take a little less than their allocated time.

I am pleased that the Opposition have chosen to debate the future of cancer services today, because this morning, in my Constituency, the groundbreaking ceremony was held for the inauguration of the new Oxford cancer centre at the Churchill hospital site. It would be difficult to find a better pointer to the progress we are making in cancer care and treatment and to further improvement in the future.

The new £109 million centre, due to open in 2008, brings together cancer services that are currently scattered across three sites—the Radcliffe infirmary, the John Radcliffe hospital and outdated buildings on the Churchill site. It will combine all the clinical teams—surgeons, oncologists and support staff—in one place, providing prompt diagnosis and even more effective treatment, thereby contributing to fulfilment of the national cancer plan and improving outcomes by enabling more patients to come to Oxford for specialist cancer treatments that can most effectively be provided only in more specialist centres.

Patients will benefit from still closer collaboration with Oxford university, ensuring that their care is informed by the most advanced research into new cancer treatments. The new centre will include a women's health service, with a dedicated ward where patients with gynaecological or breast cancers will be cared for. Like most of the other patients, they will be able to have all diagnostic tests and treatment, whether surgery, chemotherapy or radiotherapy, on the same site.

The building, which will include a geothermal heating system pumping up heat from 120 m below ground level, was designed with advice from cancer patients themselves, who particularly wanted it to be as light as possible and to include many natural materials. Involving cancer patients in the design of such an important new facility is an extremely positive development.

Such a level of investment in cancer services just would not be happening if the Opposition had had their way when they voted against increased funding of the health service and, as my right hon. Friend the Secretary of State said, it would be at risk in the future if they had the chance to bring in their proceeds of growth rule, which would hold public spending to a lower rate of growth than the economy as a whole, regardless of the need for investment in public services. What is more, in Oxford, as elsewhere, cancer patients and services are benefiting from the fulfilment of the ambitious targets that the Opposition want to remove.

In January, every patient referred to the John Radcliffe under the two-week maximum wait rule was seen within the target time, and the number of cancer patients seen within two weeks is three times more than it was as recently as 2000—we cannot go back as far as 1997. That achievement is a result of the extra resources for staff, the better organisation of services and the streamlining and improving of patient access to cancer services across the trust.

In the past three years in Oxfordshire, the NHS has invested an extra £4 million in cancer services. New consultant oncologist, surgical and nurses specialist posts are examples of the investment in the clinical work force who are providing cancer care. The introduction of one-stop clinics, faster access to diagnostics and other improvements have particularly benefited gynaecology and urology services.

Most importantly, though, staff at all levels have gone the extra mile to ensure patients get a better, faster service—for example, by working extra hours to clear any backlog of patients who are awaiting radiotherapy. Since November, they have succeeded in maintaining no waiting time at all for new patients referred for radiotherapy. No praise is high enough for the staff who are achieving that performance through their dedication.

Getting to the current performance has been a challenge, and sustaining it will be a challenge, too. The trust will need to recruit more medical, nursing and other support staff to sustain the highest delivery performance, particularly for some clinical services, such as paediatric oncology and radiotherapy.

In high cost areas such as Oxford, there is a certain vulnerability to staff shortages in specialisms that are experiencing a national shortage, such as therapy radiologists and physicists. That makes the national drive to train and recruit more people in those specialisms especially crucial. It also means that the battle to provide more homes in central Oxfordshire is not just a housing policy, but a health service priority as well.

Another challenge is to get right the tariff for payment by results, which is particularly crucial for specialist centres as they move towards foundation status. It would be helpful if the Minister said more about the prospects for the announcement of the tariff following its recent withdrawal after it had been sent out. Clearly, it would be better if hospitals avoided such uncertainty just weeks away from the new financial year.

On the funding of new cancer drugs, hospitals and PCTs will clearly face continuing difficult pressures. The NICE procedures are the right way to resolve fairly and objectively which drugs are cost-effective and should therefore be available, but the difficult question remains of where cost-effective might not necessarily mean affordable.

A judgment that is fair to all must take account of what other treatments and which other patients are displaced by the resource consequences of such difficult decisions. That is why the Opposition Front-Bench team's proposition of handing everything over to NICE simply will not work. Surely, commissioners must be ultimately responsible for those decisions, but we all know that the minute that one PCT comes to a different conclusion from another, there will be cries of "postcode lottery".

Unlike the Opposition Front-Bench team, I do not think that there is an easy answer. Clearly, a consensus is needed on how to deal with those difficult choices. Although, as ever, I followed with interest the comments of Steve Webb, I am not sure whether he has necessarily got the answer. Further close attention and public debate must be given to this vital issue.

I could not speak in a health service debate without raising the continuing problem of the current year's financial deficit and its impact in Oxfordshire. I do not for a moment think that the remaining deficit can be eliminated in the weeks that remain of this financial year, and as Ministers come to accept that, the question will shift to one of on whose books the deficit most properly belongs—an issue of more than accountancy significance, because of its impact on finances next year. As things stand at the moment, all the deficit would be left with the Oxford Radcliffe hospitals trust, but that would not be right, given that the financial problems in Oxfordshire are not all of the Radcliffe's making.

A fairer and more rational allocation of the deficit needs to be found. That would be better for patient care, as well as for the finances at the Oxford Radcliffe hospitals trust, which has made enormous progress in recent years in turning round its financial position and costs, as well as in delivering the first-rate cancer care about which I have been speaking, and I am confident that, with the investment that Labour is making, that will go from strength to strength in the future.

I am glad to follow Mr. Smith and I agreed with much of what he had to say, particularly when he was talking about the great advances in cancer care in England in the past 10 or 20 years. However, quite frankly, it would have been rather surprising if those advances had not taken place. It would have been a scandal if we had been saying in today's debate that cancer services were precisely where they were in 1997, 1987, or 1967.

Although things have got a great deal better, I disagreed with the right hon. Gentleman when he became party political and seemed to indicate that that change was because of the Labour party. That was rather reminiscent of comments made by John Reid, who, at the Labour party conference in 2004, said:

"in the first 6 years of this government, the death rate from cancer is down by over 10 per cent . . . Isn't that just the sort of thing Labour came into government to do? . . . Thousands of real people walking the street who would not have survived under the last Tory Government."

That sort of remark—and one or two of the comments made by the right hon. Member for Oxford, East—is quite wrong. The achievements have been made thanks to scientists, clinicians and doctors.

I speak from personal experience. About this time last year, during the General Election campaign, my wife was diagnosed with breast cancer. We were somewhat discombobulated by the surgeon, who told us that the operation would be on 5 May. We had to tell him that we would be otherwise engaged then and would have to delay the operation by a week or so. I am glad to say that the subsequent care that my wife received was excellent in every possible way and that she has been given a clean bill of health. I pay tribute to the care workers at the Royal United hospital in Bath, and at Chippenham, Swindon and elsewhere, who achieved that. However, I have to say—I hope that this will not disappoint the Minister—that I do not thank the Labour party for achieving my wife's good health; I pay tribute to the scientists and health workers. It is probably wrong to reduce the matter to a party political issue.

That is why I welcome the positive tone of the motion. We are saying how well things have gone: a lot of money has been spent and a great deal has been achieved. However, the truth of the matter is that there is an enormous amount more to achieve. We do not know the cause of breast cancer. For example, why does it almost not exist in the far east? Is that something to do with health and diet? It probably is. Why is there a high incidence of breast cancer among left-handed women? We do not know, but it would be useful to find out. We need to spend more money on research. My wife happens to be left-handed, which is why I know that statistic.

On care, of course it is good that we have a target of people being seen by a specialist 14 days after they are first diagnosed by a GP, but the average waiting time in 1997 was only 11 days, so the much-vaunted 14-day target is not particularly useful. What it does result in, as I discovered when I accompanied my wife on that fateful day, is a waiting room packed full of people. I said to the surgeon, "Why are the waiting times so long? Why do we have to sit here from 8.30 am to 2 pm before being seen by you?" He said, "That is to achieve the two-week target. We cannot lay down when people are diagnosed. They have to be seen within two weeks and the clinic has to be jammed full to achieve that target. If we were allowed a certain flexibility in terms of days, it might be easier to organise timetables better." The targets may sometimes have the wrong results and are not all that they are cracked up to be.

We have to see some improvements in waiting times for treatments. My wife heard today that she will receive her radiotherapy within four weeks, but many women are still waiting for six weeks or longer. Surgery and chemotherapy tend to be done in good time, but there is a long delay on radiotherapy, even though it is an important part of the treatment.

There has been a terrific muddle with the prescribing of drugs. We have heard a great deal about herceptin, but the same situation will apply over the years to come to a variety of other groundbreaking new cancer drugs. We need to find a way in which NICE can license and approve them speedily. We cannot have another situation like the one last October when the Secretary of State encouraged women at the Breakthrough Breast Cancer event—I was there—to think that herceptin would become available, only for them to discover that it will become available only if there is plenty of money to pay for it, which there is not.

The experience of Anne Marie Rogers, in my neighbouring Constituency of North Swindon, is a vehement comment on the awful effects on women who are discovering that they may face a shortened life as a result not of anything to do with clinicians, but of a shortage of money and of Government decisions. An awful lot needs to be done in that respect and in relation to radiotherapy. In particular, an awful lot needs to be done on research.

I pay tribute to the very high standard of care that my family have benefited from in the last 12 months, and I think that we see that across the book. I do not accept that that is anything whatever to do with the Labour Government. It seems to me that science is developing quickly and that wonderful support and services are provided by doctors, nurses and researchers in our hospitals, and I pay tribute to them. I very much hope that, 10 years from now, we will have seen the statistics improve even further, and that when a Conservative Secretary of State is standing at that Dispatch Box he does not fall into the easy trap of claiming that as a Conservative victory.

This has been a very British debate. We should really be celebrating the excellent and magnificent work that has been carried out in cancer services since 1990, but particularly since 1997. I speak as someone who has chaired the all-party cancer group since 1998 and who worked in the field for many years, with patients and doing research.

You may remember, Mr. Deputy Speaker, that you and I once put some bricks into a wall around an accelerator at Ipswich hospital, some time after a Labour Government came to power. There are many such stories to be told.

Why did I set up the all-party group? People were in the habit of setting up an all-party group for every part of the body that got cancer. Somebody once asked me if they could have an all-party group on right-knee cancer, and at that point I said, "No way. You can work within the bigger all-party cancer group. There is no reason why things cannot be considered under that umbrella."

I remember, too, a Select Committee report on cancer in the 1990s, after the Labour Government came to power, which came up with the idea of joining two major cancer charities, the Imperial Cancer Research Fund—hon. Members will remember that name—and the Cancer Research Campaign. At a meeting we were told by a man who became a Nobel prize-winner in this country, a scientist backed by British money and British technicians and workers in various universities and institutes in this country, that those two charities could never merge. One reason was that they were like Omo and Daz. That did not fool me because those two products are made of the same chemical substance and can be mixed.

The scientist also said that the charities would not get as much money if they came together. They fund most of the research in this country, and that came about through support not only from the Select Committee but from the Government. The charities get twice as much money now as the total that they got acting singly, which means that more research is being done, more projects are being funded and more young people are being given the opportunity to discover things. Although it is true that science has moved on and discovered much in cancer, it has been supported to a huge extent by the Labour Government.

I sometimes feel like going back and doing research because I have had many grants turned down, and I would have a much better chance now. I see that the Minister agrees that I should go back, before a few more votes are taken. I do not think that cancer research has ever been in a better state. In 1992, to give the Opposition credit, they implemented the Calman-Hine report so that the process started, but the acceleration really happened in 1997 and 1998.

I think too that there is a new understanding, and that is the essential feature. We used to teach students that genetics had nothing to do with cancer; it was all environment. Genetics has everything to do with cancer. We understand the causes of a genetic change that brings about a rogue cell that develops into a cancer. [Interruption.] I see that the Opposition are coming in to listen.

Understanding those genetic changes allows people to target drug development. Herceptin is one such drug, glivec is another, and there will be many more. We are also going to understand the genetic basis of who will benefit from treatment with a drug and who will not. That has been pioneered in Dundee using a certain drug. Now, in this field, genetics is all, and making that discovery has given us Nobel prizes—prizes that, incidentally, were won working not on cancer cells but on yeast cells. That shows that basic blue-skies research can often turn up things that have a medical advantage, and we should remember that.

We have had two British Nobel prize-winners at a time when we thought we were losing out. There are more to follow. I predict that, in the not-too-distant future, work being done at Dundee university will win a Nobel prize. Scotland deserves another one.

There is a new subject called bioinformatics, which is all about fancy computers, that allows us to look at amazing pieces of information. There was a shortage of people when bioinformatics were first discovered. We are now making up for that shortage by training people in colleges and elsewhere. We are punching our weight in this area. We shall make many more discoveries and we are supporting young people who are trying to develop career structures. We are enticing them. We are trying to change science in medicine that is taught in schools. Why should pupils in schools not be taught about cancer, for example? That is a good example of the things that we have done, the things that we can do and, if we get down to it and get more support from Government, the things that will happen in future. We maintain our position very well throughout the world.

I give credit to my right hon. Friend Mr. Smith, who mentioned the work at Oxford. He did not mention—I was proud of this—a young 16-year-old who was leading a demonstration at Oxford that was supporting limited animal experiments. We are not saying that all work should be done with animals, and perhaps some of it should be done with computers and tissue cells, for example. The right to be able to do that is so important. Before a licence, there is a need for the toxic test. We do not stick drugs into patients and hope that they do not die. Certain tests have to be carried out in the hope that results will be obtained before the licence.

The changes that are coming about in scientific discovery will make a real difference. Quite often in science and medicine, discoveries happen long before politicians, particularly those who are lawyers, can pick up on what they might mean in terms of new Laws and regulations, for example. We have genetic modification and stem cells. Many of us knew about stem cells before the many debates in this place that led to us ensuring that we could continue with research. We are hopeful that that research might pay off.

Much has been said about the cancer plan that came through for 10 years. We are halfway through that. Many new people have been appointed. Consultants are pouring out of oncology departments in our hospitals, and there are more to come. This is real encouragement. For the health service in general, such developments have stimulated mental health people and those who work in cardiology, heart disease and so on. How did these people do it? I will tell the House: politicians, scientists and medics worked together. There is huge team work. There are 20 cancer research charities and voluntary groups that meet once a week in this place to discuss various issues from a professional, knowledgeable position. That is what we have created since 1997, and that is important. Let us do away with competition and get people working together who have the best experiences.

I heard a woman from the Christie in Manchester talking about best practice there. She was telling 19 other people how it was done. That is excellent, and that atmosphere should be encouraged. We have talked about NICE and quality of life. People with cancer, in their last few years or days, experience tremendous fatigue. We can do things about that. There is the stimulation of blood, for example, which will stop these people being tired. NICE should be asked to examine that.

Of course, NICE will evolve. It will learn by some of the mistakes that have been made. That is what it has all been about. Thank goodness that NICE has been in place to give us some evidence-based knowledge of what we do and of what we do not know. That knowledge will increase.

The vision that we have in the all-party group—please join it—is how we are going to take things on. We realise that cancer is a complete journey from the early diagnosis, through treatment and then on to care in hospices, including palliative care. The passport needs to be examined. There should be no piecemeal approach when it comes to putting in money. The patient should be considered throughout.

I am excited about what is happening, but I think that there is more to do. What we have managed to do in providing better cancer services will stimulate us to do even better, as we learn more. That knowledge will come from science, medicine and practice. We have an enthusiastic work force who want to try to do things. In the light of experiments and clinical trials—more and more of that is going on with the necessary resources—we shall learn best practice.

I am grateful, Mr. Deputy Speaker, for the opportunity to give my maiden speech and to contribute to our debate on cancer services.

It is a pleasure to follow Dr. Gibson, who has a distinguished record on cancer and in science, which is close to my heart. It is an interesting and bewildering experience to enter Parliament outside the usual intake, and I thank colleagues on both sides of the House who have helped and supported me in the past couple of weeks. When my predecessor, Rachel Squire, was elected in 1992, she brought to the House a background in social work and union representation. She brought, too, a passionate belief in the importance of equality of opportunity for women. Most importantly, she brought a warm personality and a strength of character that was appreciated on both sides of the House. Her death this year from a brain tumour was a tragedy for all who knew her. What struck me most was her dedication to her constituents, for whom she fought with tenacity. I hope to do just the same.

Dunfermline is the historic capital of Scotland. Indeed, the body of Robert the Bruce, who gave the town its charter in 1322, is buried in Dunfermline abbey. I share my constituents' pride in the city's architecture, which includes our very own Carnegie hall, donated by Andrew Carnegie, the most celebrated of Dunfermline's sons. Many visitors enjoy a stroll down the glen, which is maintained by bonds donated by Andrew Carnegie. Dunfermline, like many cities, has had its ups and downs. Daniel Defoe commented in the 18th century that it showed the "full perfection of decay". The city is not in such a plight today, but many parts are run-down, with the old Co-op site blighting our city centre. That is a cause that I intend to take up on behalf of my constituents. Dunfermline was once a magnet for Scotland, and I believe that, in time, it can become so again.

One advantage of fighting a By-election is that it draws in political representatives of all the major parties form all parts of the country. Never has Dunfermline seen so many MPs, including my party's three excellent leadership contenders. It seems that visitors were struck, as I have always been, by the landscape, the history of the city and the friendliness of the people. I am sure that that is the only explanation for the fact that so many Labour Members missed the vote on the Racial and Religious Hatred Bill. I certainly hope that Mr. Cameron enjoyed his visit to Dunfermline high street. My Liberal Democrat colleagues look forward to welcoming him to their constituencies, following the dramatic effect of his visit to my Constituency on the Conservative vote.

The constituency reaches as far west as Kincardine, which will soon have a second crossing across the Forth thanks to investment by my colleagues in the Scottish Executive. In fact, the decision to invest in the second crossing was announced by my good friend and leader of the Scottish Liberal Democrats, Nicol Stephen. I thank Nicol for his tremendous support during the by-election. He is an excellent leader with all the drive, enthusiasm and intellect that one could hope for. However, Nicol is not the only leader who has connections with Kincardine. I am sure that Mr. Salmond will recall our meeting in the village café on polling day. Unlike now, he looked surprisingly optimistic.

The iconic Forth bridge connects my consistency with that of another Liberal Democrat, my hon. Friend John Barrett. Hon. Members will know that the 1.5 mile-long bridge is the world's first major steel bridge. It has a balanced cantilever design, and its gigantic girder, with a span of more than 500 m, ranks as one of the great feats of civilization. From the top of the bridge—and I know—the views of the constituency are stunning. We are fortunate to have a rich diversity of attractions and entertainment. Fordell Firs is the national scout activity centre, and it is widely used by schools and youth groups as well. Just up the road is the Scottish base of the Mines Rescue Service, with an international reputation that we must support and protect. In Dunfermline itself, a new venture called Ceramic Experience brings out the creative potential of children from a very young age. In the north, Knockhill attracts bike and racing car enthusiasts from all over the country. Run by dedicated volunteers, the Scottish vintage bus museum is now acknowledged as a focal point for historic bus restoration.

My constituency has a rich athletic heritage, with three excellent clubs. Pitreavie, which is celebrating its 50th anniversary, is rightly proud of international athletes such as Linsey McDonald and Ian Mackie. Dunfermline and West Fife coach Jimmy Bryce has a long record of nurturing young talent, but perhaps his latest find, Gemma Nicol, could be the most promising. Finally, my own club, Carnegie Harriers, has some first-class road and hill runners, including young John Hargreaves from my own village of Kelty.

Dunfermline is proud to be a home for many important businesses. The Dunfermline building society retains its strong links with the city, which houses its headquarters. Although it has experienced significant decline, Rosyth dockyard is still a major employer, and I am determined to ensure that that remains the case for many years to come.

On the subject of employment, I am very disappointed with yesterday's decision to axe 142 jobs from D. M. Crombie, and I am seeking to meet the Minister of State, Ministry of Defence, Mr. Ingram, to discuss the decision. Following the loss of hundreds of jobs at Lexmark and Simclar, I am determined to help those employees and to work toward bringing new high-value jobs to the constituency.

I can honestly say that Dunfermline and West Fife is a great constituency and one that I am honoured to represent. I can today pledge that I will serve all of my constituents—no matter on which side of the House they sit.

Many of my constituents will be interested to hear our debate on cancer services. It is particularly fitting that I make my maiden speech in this debate, as Rachel Squire had a long and brave battle against a brain tumour. I am sure that everyone in this House will have been affected by cancer in some way or another—a friend, family or even themselves. More than 130,000 people die from cancer in the UK every year. It is an illness that takes life in such a brutal manner.

This week, I was pleased to be able to sign early-day motion 1696 on action mesothelioma day. Members will know that mesothelioma is an incurable asbestos-related cancer. It can develop 30 or 40 years after a person has come into contact with asbestos, which was widely used in the shipbuilding industry until the late 1970s. Many people predict that the epidemic will peak in around 2020. Its dockyard and ship-breaking heritage makes my constituency a national hotspot for mesothelioma. As reported in last week's Dunfermline Press, Dr. Colin Selby, a chest specialist at the local hospital, has warned that between 200 and 300 men could die in West Fife from the condition each year. At the moment, many men have not even heard of it. I am therefore grateful to the Dunfermline Press and to the British Lung Foundation for helping to raise awareness of this crippling disease.

During my election I campaigned on four key issues. First, I led the effort against the proposed increases in tolls on the Forth road bridge. We need to provide public transport alternatives to the various parts of Lothian for our commuters who are currently forced to use their cars. I look forward to working with others on developing a sustainable transport strategy for this major artery.

Secondly, I said that I would work with local health campaigners on the future of our local hospital, the Queen Margaret. We need to explore how much major elective surgery can take place there. I would like a waiting times unit to be developed at the hospital to conduct hip replacements and the like. I am pleased to say that I have already met people from the hospital and the local health board to advance that agenda.

Thirdly, many local people feel frustrated about the state of our city centre. I have pledged to press all those responsible for a revitalised city centre of which we can all be proud.

Finally, despite the best efforts of teachers, standards in our primary schools are below the national average. Our secondary schools are too large. We need a new secondary school for the West Fife villages, and I want to help to reduce the size of our secondary schools overall.

My constituents have sent me to Westminster to represent their concerns and to fight for their interests. They have placed their trust in me and I will not let them down.

I congratulate Willie Rennie on his excellent maiden speech. As a new Member—I was elected only last year—I know how scary it can be to stand here and make a speech for the first time. He did it with some flair and I am sure that he will never forget the occasion. Having all his pals around him is no bad thing. It is also rather nice that they seem to be staying to listen to my speech. I thank them for that.

I, too, welcome Willie Rennie. It is a pleasure to have him here, although it is obviously a pity that the Labour party candidate did not win. However, for me, as the last By-election victor, it will be a pleasure not to be known as, "Jim Devine, the new Labour MP for Livingston".

I must continue with the happy tone by congratulating the Government on their fantastic record of investment in cancer services, especially the first cancer plan, which we have discussed. It was published in 2000—[Interruption.] I see that some of the Liberal Democrats are leaving now. The plan has meant that more funding than ever has been pumped into cancer services—an extra £280 million in 2001–02, increasing to £570 million in 2003–04. I do not have the most recent figure but I am sure that it is even higher.

I must also draw attention to our fantastic record on waiting times, which have been reduced to two weeks to be seen by a specialist, a month for diagnosis and two months for treatment. That cannot go without recognition in the debate.

I am sure that the hon. Member for Dunfermline and West Fife, as a new Member, will be asked in what he will specialise. I gave many answers to that question as the weeks went on. I had no idea in what I would specialise, although I had many interests and many important matters came my way. However, the decision was taken out of my hands when my best friend, Joanne Smith, was diagnosed with breast cancer at the age of 34. At the time, she had a two-year-old and a seven-year-old, who are now a little older—one has had a birthday since then—but she was a young woman with a young family. The diagnosis was a tragedy, which has totally coloured my first year as a Member of Parliament.

Joanne was seen within 48 hours by a cancer specialist at my local hospital, the Queen Elizabeth hospital. Her consultant, Dr. Clark, has been incredible and her treatment has been fantastic. She had a double mastectomy and a terrible course of chemotherapy, which debilitated her. Nobody goes through chemotherapy lightly, but because she was so young she had to have such a high dose that it was shocking to see her suffer through it.

I immediately began campaigning for herceptin and joined the all-party group that my hon. Friend Dr. Gibson mentioned earlier. I was keen to get my local cancer network—the northern cancer network—to reverse its decision not to prescribe herceptin. It made the decision because the drug did not have National Institute for Health and Clinical Excellence guidance. However, after campaigns by me and other hon. Members throughout the country and the region, the decision was reversed. When I asked why the network had reversed it, it cited the comments by my right hon. Friend the Secretary of State that lack of NICE guidance should not be an excuse for not prescribing the drug and that it was up to individual PCTs.

The PCTs in my area recognise that they have the freedom to make such decisions, but they do not do that in practice because they defer to the northern cancer network. When one questions the northern cancer network, one finds that it defers to NICE guidance. So, although individual PCTs can make these decisions, in practice they do not.

Is the hon. Lady aware that the "Herceptin for Shropshire" campaign was launched in the Shropshire County primary care trust area today, as my hon. Friend Mr. Paterson mentioned earlier? The campaign is being led by a number of ladies in similar circumstances to those of the hon. Lady's friend, who have a particular reason to secure that support. It is important that they should continue to press the PCT to secure the funding, because, as the Secretary of State has said, she is prepared to allow it to take place.

I have some ideas on funding, and I want to open up a debate on that whole issue. I shall come to that in a moment. We just have to keep pressing the individual PCTs and reminding them that they have the ability to take these decisions, regardless of the budgetary pressures that they are under. We are pumping in lots of money for cancer services, and they must spend it wisely. However, I am told that they often choose to spend money that they had allocated for cancer services on other equally pressing things. It is up to everyone involved in this debate to insist that that money is spent on cancer treatment.

The hon. Lady has touched on the issue of funding. Is she aware that many people who suspect that they might have cancer are having to go privately to get diagnostic scans, because their GPs are so hesitant to spend their money on scans? The GPs are telling them that they have to go down other routes, such as consulting nutritionists or osteopaths, rather than sending them directly for a scan diagnosis. I am told that, in my area, only 40 per cent. of such patients are referred for a scan by their GP, because of funding issues.

The hon. Lady makes a good point, but time is short, so I must press on.

My campaign with my friend got a lot of press interest, and the northern cancer network reversed its decision, on which I congratulate it. My friend started her herceptin treatment two weeks ago. She is one of the first people in the region to receive it.

I want to talk briefly about brain tumours, which relates to the hon. Member for Dunfermline and West Fife, whose predecessor, Rachel Squire, sadly died after suffering from a brain tumour. Some other famous people who have suffered from brain tumours are Bob Marley, Elizabeth Taylor, Mo Mowlam and Sir Stamford Raffles. Such tumours account for one death in every 100. Someone who is not as famous as those people is a constituent of mine who is quite dear to my heart. His name is Fred Fergus, and I have been campaigning on his behalf for access to the drug temozolomide, which is awaiting NICE's approval. We were told that that would be decided by the end of the year, but I recently received some information on an appraisal consultation document—an ACD—put out by NICE. Apparently, NICE is recommending that the therapy should not be provided on a subsidised basis on the NHS in England and Wales for patients with newly diagnosed, high-grade malignant brain tumours. Perhaps the Minister will tell the House why.

My hon. Friend has been involved in two campaigns. I was involved in one in Redcar relating to a drug called alimta, which has been licensed but not NICE-ed, as it were. It is used to treat mesothelioma, which is a terminal illness. NICE was not even going to evaluate it until October 2007, but that was useless for the men suffering from the disease who had only months to live. However, NICE is now introducing a fast-track procedure. When the Minister responds to the debate, will she tell the House whether it is intended that all cancer drugs should go through that procedure?

I thank my hon. and learned Friend for that Intervention.

Mr. Fergus is receiving his radiotherapy on the NHS and paying privately for a prescription of temozolomide. He says that it has given him his life back. There has been such a change in him in terms of memory since he has had access to the drug. Obviously, brain tumours affect the brain and memory, but with this drug he can function so much better, which is why I am so concerned about NICE perhaps not approving it.

I want to move on to another very sad case involving a bowel cancer sufferer. Bowel cancer is responsible for 50 deaths a day in the UK, and it claimed the life of my constituent, Jack Wilson, at the age of 66. He was a retired miner who was hoping to get the drug cetuximab on the NHS. Again, he was told that the drug was not approved. I have already mentioned the northern cancer network and the process we go through there.

I am short of time, so I should say that I want an urgent review of the funding of cancer treatments. As Steve Webb said, there will be another drug, then another and another. More and more are on the horizon and we will have to try to fund them. Taxpayers are entitled to receive the best possible treatment and value for money from the NHS, so we need to examine how such treatments can be financed while retaining the tax base of the NHS and the principle that health care should be free at the point of need.

There is a specific problem with funding drug treatments—the hon. Gentleman also mentioned this—while they are licensed but before they are NICE approved. There is a strong case for a dedicated cancer charity that would fund specific cancer drugs during that interim period. Also, there should perhaps be a dedicated lottery card. I shall leave those thoughts with the Minister.

First, I congratulate Willie Rennie, who said that this is a bewildering place initially. I must admit, as one who continues to consider himself a new Member, that it is bewildering still. I spoke to my Whip only a few minutes ago, and he bewildered me further. However, I understand that I have a few minutes to make some comments on the important matter of cancer, having already written off my career.

My predecessor, Sir Teddy Taylor, introduced an Adjournment Debate in February 2002 on the subject of cancer care in south Essex, supported by my good friend and colleague my hon. Friend Mr. Amess and by my hon. Friends the Members for Castle Point (Bob Spink) and for Rayleigh (Mr. Francois), who spoke earlier on the issue that I want to raise: the size of the cancer networks.

Some three or four years ago, when my predecessor raised the issue, he was very concerned that cancer networks had to involve a population of more than 1 million. In south Essex, the population is only about 700,000 and we were to be merged with neighbouring areas. The cancer tsar, Mike Richards, came down, had a look and said that although we have a small population, the number of operations is large—indeed, as large, if not larger, than that of some cancer networks with more than 1 million people.

In addition, south Essex is quite densely populated, but does not have good traffic infrastructure. It would be particularly difficult for patients to get out of the existing south Essex area for care. Like many Members, I have close family who have experienced cancer: my grandmother in her later years had breast cancer and received excellent care from Macmillan Cancer Relief.

On the subject of Macmillan Cancer Relief, does my hon. Friend share my concern that nursing specialists in the Hammersmith hospitals NHS trust have been threatened with a move to general ward work from specialist oncology and palliative care, and that one of the two Macmillan counsellors is under threat of redundancy? All of that is due to a large NHS deficit.

I thank my hon. Friend for raising that point. I am horrified that that is the case—my grandmother received excellent care—and I believe that Macmillan Cancer Relief's head office is in his Constituency.

It is important that south Essex keeps its cancer network. It is like "Groundhog Day" in that the Southend Echo, my local newspaper, ran a "hands off our cancer centre" campaign at the time when Sir Teddy Taylor raised the issue, and is now running a "save our cancer centre" campaign. The cancer network believes that it is the right size and does not believe that the cancer centre should be merged, although admittedly it has a number of other reasons. The consultation on the south Essex cancer care centre ends on 13 March, and I and several of my parliamentary neighbours will present quite a large petition signed by a number of constituents.

To my mind, it is bizarre that we are told locally that this is just a small, structural, management change, and that only a small number of people will be affected this time round—as few as 20 or 30. We are deeply concerned, however, that once we are merged into a larger area including Anglia, more intermediate care cancer services, as well as specialist care, will be moved further and further away. Increasingly, with bad transport infrastructure, that journey will be two hours plus. While that might be acceptable for a one-off appointment, it is not acceptable in cases of cancer with many repeat appointments.

South Essex also faces a problem with the number of consultations. The strategic health authority has assured me that it will consult again if some other cancer services are moved elsewhere within an expanded network. Consultations always seem to be short, however. My hon. Friend the Member for Rayleigh is co-ordinating a consultation on the police that has been rushed through. On health services alone, six consultation processes, which kicked off in December, will end in the next few weeks. There is a degree of consultation overload.

If the local cancer network wants to remain as it is, and if local people who have been either writing to the Southend Echo or signing our petitions at pharmacists and doctors' surgeries say overwhelmingly that they do not want a merger, with the long distances involved, will the Minister assure us that we will be able to say to the local strategic health authority that, having gone through the consultation, people overwhelmingly want the network to remain as it is? My grandmother was in Bristol, not Southend. Her quality of life was appalling in her final years, despite the services provided by Macmillan Cancer Relief, and I fear what her quality of life would have been if she had had to travel for two hours every day.

Despite problems with the local bus and train service, people in Southend can still get to Southend hospital relatively easily, and they would be grateful for an assurance that if all the parties in the consultation call for no change, there will be no change. Let us not go through all of this again in three years—when I hope that I will still be the MP—if the issue arises once more. My predecessor seemed to have dealt with it. Sadly, that is not the case. I seek the Minister's reassurance.

First, let me associate myself and my right hon. and hon. Friends with the Secretary of State's generous remarks about Gregor MacKay, whose memorial event is taking place today. We all pay great tribute to the work that he did for us as a colleague, and indeed to his many friendships across the political divide. We pay equal tribute to Linda Smith. We have been debating a terrible disease that afflicts so many—that, indeed, afflicts almost everyone in the country, at least indirectly, in our minds. That applies particularly to someone who was so public, so much loved, and such a wonderful comedienne.

I congratulate Willie Rennie on an extremely good maiden speech. As the last Conservative By-election winner—some years ago—I am glad to be able to congratulate the most recent Liberal Democrat by-election winner. I met many of my future colleagues on the streets of my Constituency: 200 Labour Members. As it happens, the debate in which I made my maiden speech was very well attended, although I hasten to say that that was nothing to do with me. At least 400 Members present who had worked their socks off to try to ensure that I did not arrive here had to listen to my speech. I therefore had considerable sympathy with the hon. Gentleman when he described his experience. I also thought that he spoke very movingly about the experience of stepping into the shoes of a much-respected Member, Rachel Squire, who sadly succumbed to the brain tumour that she had borne so bravely. That is particularly sad in the context of today's debate. In many respects it is a highly appropriate debate—and it is for another day for us to make any points about a Scottish Member seeking to involve himself in a debate that relates only to England.

Quit while you are ahead.

Given that the hon. Gentleman, who is the Secretary of State's Parliamentary Private Secretary, is the only other Scottish Member who has been present for most of the debate, it is a shame that he has made his presence felt from a sedentary position.

The hon. Member for Dunfermline and West Fife gave us a wonderful and engaging tour of his Constituency. I am sure that his constituents look forward to his serving them with all his energy and enthusiasm. I fear that he will have to rely on the Official Report to ensure that his most notable and, I predict, his most challenging constituent, the Chancellor of the exchequer—who, for some reason, was not present for his speech—recognises what a marvellous new Member of Parliament he has.

I am glad that the Secretary of State congratulated the Opposition on making this vital subject a priority for their precious time. The debate has been characterised by the concern, care and expertise brought to it by all who have had an opportunity to speak on behalf of their constituents. I am aware that tributes in the House often sound ritual, but I know that I am joined by my right hon. and hon. Friends, and indeed by Members throughout the House, in thanking the countless people in the NHS and beyond it who work tirelessly for and with those affected by cancer.

My hon. Friend Mr. Baron made an excellent and constructive Opening Speech. I could not help being rather amused by the Secretary of State's slight discomfort over having to take the politics out of the NHS, but we were serious about wanting to debate the future of cancer services as a high priority. We heard from many Members on both sides of the House. Steve Webb talked about the possibility of securing much lower provider costs for the NHS. That is, of course, an important subject, but I was particularly interested in what he had to say about the herceptin issue. For the sake of brevity, I will give the source for everything that he said about it. It can be found in column 1062 of the 8 December edition of the Official Report, set out wonderfully by my hon. Friend Mr. Lansley. He is obviously grateful that it has been read into the record again.

In a celebration of a local investment to which he wished to draw attention, Mr. Smith mentioned tariffs that have recently been imposed in a most incompetent manner. I think he found it difficult to refrain from mentioning that. However, he rightly highlighted the uncertainty that that is causing and the quick resolution that is required to clarify the matter. He asked whether the serious deficit in the Oxford Radcliffe Hospitals NHS Trust should be spread among others. He seemed to be shifting the debate as well as shifting the deficit, rather than dealing with the fundamental issue, which is vital to so many of the issues that we face in the NHS.

Dr. Gibson, the chairman of the all-party group on cancer, as ever gave us an enthusiastic tour d'horizon of leading-edge scientific progress in this country. He advanced a wonderful argument for the success of our competitiveness internationally, intellectually and scientifically and then suggested that we get rid of competition. That was an interesting circular argument, which all of us will enjoy pondering once the Official Report is out.

We heard movingly from my hon. Friend Mr. Gray, who gave his personal testimony, particularly in the light of the difficult and dreadful experience that his wife has been through. I was very pleased, as I am sure all hon. Members were on both sides of the House, to hear that she has been given a clean bill of health and continues to receive the follow-on treatment. He made the important point, which we have sought to emphasise, that it is to the benefit of patients and to the subject as a whole that we take great care not to make it deliberately a party political issue when we look at the opportunities to improve outcomes for cancer survival and treatment.

We also heard from my hon. Friend James Duddridge. Apart from the slightly interesting start, when he called his Whip bewildering, which struck me as instant career death, he spoke powerfully and made a cogent case on behalf of himself and my hon. Friends the Members for Southend, West (Mr. Amess), for Castle Point (Bob Spink) and for Rayleigh (Mr. Francois) about the cancer network, and what the appropriate size is for the South Essex cancer care centre, considering local conditions. I hope that people at both national and local decision-making levels have taken due account of that strong and well-made case.

We also heard from Mrs. Hodgson—that is certainly one of the most confusing constituency titles, with half of each city in it. She said that she spent some time deciding what to specialise in. I felt that she spoke sensitively about her experience as a result of the breast cancer of her friend. The House was helped by hearing of that experience.

Looking at the future, we have to be clear where things stand today. As my hon. Friend the Member for Billericay said in relation to cancer care services, the present situation is unacceptable. There has been investment and continuing improvements, the Organisation for Economic Co-operation and Development has confirmed that the trend was already well established before this Government took over nine years ago, but—here is the big but—after nine years, survival rates are still among the worst in Europe, and significant inequalities of outcome persist in the UK. According to the Public Accounts Committee report, those inequalities are widening, not narrowing.

As we have heard today, difficulties have arisen following the Government's efforts to focus targets on reducing waiting times—the front end of the patient pathway. That has led to neglect of later treatment. We face a serious issue: once a patient is on the pathway, the pipeline of time is extending. There is a serious issue in respect of how to deal with the problem involving radiographers.

It was interesting to note that the future of cancer services is threatened because of the NHS's ballooning deficits. Will the Minister answer the excellent question from Vera Baird and confirm that there is no diminution or delay regarding the announcement from the Minister of State, Department of Health, Ms Winterton, as recently as August last year of a £37.5 million bowel cancer screening programme, which was confirmed just 30 days ago? Will she confirm that it will be up and running in April with five centres, not just one, as is being hinted as part of the financial cuts?

In addition to issues such as waiting times, the size of the work force, the new requirements for benchmarking and the exchange of information—so that clinicians, who are best placed to make such judgments, can draw on the very best of existing practice—there is another big issue that we need to concentrate on. The Secretary of State has had some time in which to deal with the herceptin issue. On the question of the announcement that she made in October, even if she is arguing that she did not say that she would end the postcode lottery for early-stage breast cancer and that there was no change, therefore, in her Department's policy, one is still left with the following question. Why on earth did she make the statement that she made in October, unless it was made on the ground of cost?

We were determined to raise today on the Floor of the House the future of cancer care services, because it is a priority. Such services need not merely to be maintained: the trends need to be enhanced, given the debilitating effect that cancer has on so many people in this country. At the moment, the opportunities to enhance the services available are being missed.

This has been a very interesting and useful debate, which Mr. Baron opened very disarmingly. It is much easier to respond to a straightforward political discussion across the Dispatch Box, but this has been a very thoughtful debate and, in the short time available, I shall try to respond in a way that reflects that fact, and to answer as many questions as I can.

The cancer plan is a 10-year national strategy of investment and reform, the purpose of which is to reorganise, standardise and rejuvenate cancer services. We are just past the halfway point in implementing it, and looking back—it is appropriate that we do so—I challenge anyone not to acknowledge the clear and impressive story of real improvement. Steve Webb asked when the next cancer plan will come along. There have been three reviews of the current plan and we may or may not have a further one. I take his point about wanting early warning of when another cancer plan will be considered, but that is some way down the track.

My right hon. Friend the Secretary of State spoke of the importance of prevention, detection, treatment and care. I do not want to repeat what she said, other than to say that unprecedented investment in new and replacement equipment is helping to improve reliability and access to diagnosis and treatment. We are expanding the cancer work force—I will not repeat the figures, which are in the Amendment—and there are more cancer specialists. New training programmes for specialties such as radiography and endoscopy are increasing capacity. Such investment is going hand in hand with reform. Specialist teams have been established across the country that bring together surgeons, radiologists, pathologists, nurse specialists and many others to deliver co-ordinated care to patients in hospitals.

That brings me to the Opposition's motion, and I have to say that I agree with a lot—indeed, almost all—of it. It is very much in keeping with the Opening Speech of the hon. Member for Billericay, but I disagree profoundly with the suggestion that we now need a different approach if we are to make further improvements in cancer services. It is appropriate that I deal with this issue specifically. We are close to being the world leader in developing the multidisciplinary approach that I have just described. All these advances are due largely to the cancer plan and to the work of Professor Mike Richards, as my right hon. Friend the Secretary of State said.

The hon. Member for Billericay discussed at length how the guidance and appraisals of the National Institute for Health and Clinical Excellence should be enforceable, and a number of Members referred to Herceptin and the role of NICE. When I first came into post last summer, the question arose of the length of time that NICE is taking on this issue. We issued a written statement today outlining the exact process for herceptin, but we must remember that the licensing process—which is very important for this treatment and its application—and the NICE appraisal process are absolutely critical in allowing the health service to take proper decisions on how it uses its resources locally to provide the proper available medicines and treatments. We trust NICE, as an independent organisation, to make those appraisals and to assess the new treatments. It does so in a way that is very efficient and highly regarded throughout the world.

Will the Minister give way?

Will the Minister give way?

I hesitate to give way, as I am very pressed for time, and there is a lot that I must respond to. I must tell the House that I resist the call to give NICE more powers and to change how it works, especially before it has had the opportunity to go through the appraisal process.

I very much welcomed NICE's willingness to embrace a new, single-technology appraisal process, especially given the strong defence made for its solid work in the past. My hon. and learned Friend Vera Baird asked whether that meant that all new cancer drugs will be subjected to the new, single-technology appraisal process. My quick answer is no: some new drugs will be taken alongside other treatments and medicines, and their numbers mean that they will have to go through the slightly longer process.

However, the process is critical for a drug such as Herceptin, which has serious side-effects. Quite rightly, the NHS needs the best possible advice that it can get in respect of such medicines.

I do not disagree with much of what the Minister says, but the bottom line is that the postcode lottery will still apply if the system continues to be run as it is at present. Cost assessments running alongside the appraisals would ensure that what was recommended could be afforded. That is what happens north of the border, for example, but the postcode lottery will continue to operate in the absence of such assessments

The so-called postcode lottery applies only in the period when we are waiting for a treatment to be licensed. Once NICE approval has been given, the NHS has 90 days—three months—to make arrangements for provision of the medicine. I shall look in detail at the example to which the hon. Gentleman has drawn my attention, and see what can be done.

The hon. Member for Billericay mentioned the length of time that people have to wait for radiotherapy. He made far too many points for me to answer in the time remaining, but I can tell the House that the Royal College of Radiologists published an audit on 23 February that showed that the situation is improving. However, I accept the criticisms that have been made, and much remains to be done in this regard.

Even so, I am pleased to be able to tell the House that the Department of Health has exceeded its target of recruiting an extra 1,000 radiographers. More than 1,400 additional radiographers and radiography assistants are now working in the NHS, compared with 2003. That is still not enough: a lot of progress has been made, but we recognise that more remains to be done.

The hon. Member for Northavon raised a number of points, and asked about the cost of herceptin. He will be interested to know that the new pharmaceutical price regulation scheme agreement that started in January 2005 will save the NHS more than £1.8 billion on branded prescription medicines over a five-year period. The detail of his question concerned whether the company Roche was offering anything at the moment. Although I cannot comment on that, it is an interesting thought, and I shall be happy to write to him about the matter. Many hon. Members said that the process was arbitrary, but in the long run I do not believe that tinkering with what happens before NICE gets involved will benefit the NHS in any way.

My right hon. Friend Mr. Smith works tirelessly for his constituents. As he said, quite rightly, he holds the health staff in his town in very high esteem, and I want to answer a couple of the specific points that he raised. He asked whether the tariff applied to cancer services. Under the payment by results programme, hospitals are paid according to the number and complexity of the cases treated. Chemotherapy, radiotherapy and, indeed, palliative care will eventually be included, but they are not included at present, and are treated as specialist services for the purpose of commissioning. I would be happy to talk to my right hon. Friend about the deficits that he described in Oxford on another occasion.

Mr. Gray tempted me to be party political, but I shall just echo the words that have been said about his wife and the fact that she has made a full recovery. I am also pleased to hear that her personal experience of the service provided by the health service was good. My hon. Friend Dr. Gibson—

rose in his place and claimed to move, That the Question be now put.

Question, That the Question be now put, put and agreed to.

Question put accordingly, That the original words stand part of the Question:—

The House divided: Ayes 228, Noes 294.

Question accordingly negatived.

Question, That the proposed words be there added, put forthwith, pursuant to Standing Order No. 31 (Questions on amendments), and agreed to.

Mr. Deputy Speaker forthwith declared the main Question, as amended, to be agreed to.

Resolved,

That this House recognises that the Government has made the improvement of cancer services a key priority through the implementation of the NHS Cancer Plan which sets out to reorganise and rejuvenate cancer services and has provided the NHS with investment to modernise these services; welcomes the achievements set out in the recent Public Accounts Committee report, the NHS Cancer Plan: a progress report, which acknowledged that significant progress has been made across the country; notes that the total death rate for cancer in people under 75 has fallen by 14 per cent. since 1996; acknowledges that under this Government unprecedented investment in equipment is helping to improve both access to, and reliability of, diagnosis and treatment; further notes that specialist teams have been established across the country to help deliver co-ordinated care to patients in hospitals; further welcomes the fact that the National Institute for Health and Clinical Excellence is introducing a new fast track assessment process to enable them to issue binding advice to the NHS on the most important new drugs within weeks of them receiving a licence; further notes that this Government has commissioned research to enable initiatives to raise awareness of the symptoms of cancer to be targeted on people most at risk; further notes that there has been a 43 per cent. increase in cancer consultants since 1997; acknowledges that there has been a 40 per cent. increase in cancers detected through breast screening; and further welcomes the Government's commitment to continuing to deliver the commitments in the NHS Cancer Plan.

Order. If Members are leaving the Chamber, they should do so quietly and, hopefully, in ones or twos, rather than like a football crowd. That will allow us to get on with the next items of business.