Cancer Strategy

– in the House of Commons at 2:48 pm on 8th December 2016.

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Photo of Nicholas Dakin Nicholas Dakin Opposition Whip (Commons) 2:48 pm, 8th December 2016

I beg to move,

That this House
has considered the Cancer Strategy one year on.

In moving this motion, which stands in my name and that of Mr Baron, I wish to recognise all those in the cancer community for all their work, day in, day out, fighting this disease, and the huge number of Members of this House who, through a wide range of cancer-related all-party groups, carry out work in this very important area.

The hon. Member for Basildon and Billericay who is chairman of the all-party group on cancer, is unable to be here today, but he wanted me to say how much he appreciates the Backbench Business Committee’s granting this debate. As Members may know, the hon. Gentleman’s wife is undergoing treatment, and I am sure that everyone in the House would want to send their best wishes to him and his family at this difficult time.

It is estimated that there are more than 2.4 million people living with cancer in the UK, and that number continues to grow. Cancer is becoming more complex, with many more treatments available. Many patients are living with co-morbidities and with the consequences of a cancer diagnosis many years after treatment has finished.

The all-party group on cancer has a proud record of successfully campaigning on a number of issues. Just two days ago, we held our annual Britain against Cancer conference in Central Hall—it is one of the largest cancer conferences in the UK. On behalf of the group, I wish to pass on thanks to all the contributors, including the Under-Secretary of State for Health, David Mowat, and the shadow Secretary of State for Health, my hon. Friend Jonathan Ashworth, for their contributions. Delegates very much appreciated everybody’s input.

The last two years have seen significant developments in cancer policy. In July 2015, the independent cancer taskforce published the England cancer strategy. Since we last debated this issue in November last year, NHS England has published its England cancer strategy implementation plan, setting out how it will roll out the 96 recommendations.

More recently, we have seen the publication of the National Cancer Transformation Board’s progress report, outlining what steps NHS England has taken over the past year in implementing these recommendations across the country. Only last Friday, the Office for National Statistics published the latest one-year cancer survival rate figures for those patients diagnosed in 2014 and followed up to 2015. As NHS England chief executive Simon Stevens pointed out at the Britain against Cancer conference, that showed the dramatic improvement in patient outcomes that has been achieved over the past 20 years. That is something to be celebrated, but there is still much more to do.

The all-party group has been active in monitoring progress on the England cancer strategy, holding a short inquiry early in the year to assess progress. We concluded that positive progress is being made, but that there is still much more to do to realise the ambition of the England cancer strategy. Having taken evidence from a wide range of people, we made a number of recommendations, which I will use to highlight some of the key themes that emerged from the inquiry.

The first key recommendation focused on the need for greater clarity on funding for all the 96 recommendations of the England cancer strategy. It was positive, therefore, to see more detail in the National Cancer Transformation Board’s progress report, which set out the funding available per year for the next four years. I very much welcome the announcement by Simon Stevens at our Britain against Cancer conference that Cancer Alliances will be able to bid for £200 million of funding to invest in early diagnosis, care for people living with cancer, and cancer after treatment. That is very good news, and I look forward to getting further clarity on how the full funding package, set out in the progress report, will be allocated across the cancer strategy’s recommendations. This is particularly important given the lack of clarity around cancer funding to date. The estimates for the total amount spent on cancer care in the NHS per newly diagnosed patient have not been published beyond 2012-13, which has been described as a significant data gap when it comes to evaluating the cost and efficiency of cancer care. Will the Minister today commit to publish an update on those figures in the House of Commons Library at the earliest opportunity?

Alongside funding, another recommendation and concern that was raised by stakeholders in our inquiry was around the need for further transparency on how the cancer strategy is being delivered, what the priorities are, and who is responsible for delivering key recommendations. Again, the progress report from the National Cancer Transformation Board went some way to address that concern. However, further detail around how the strategy is being delivered, particularly the membership and terms of reference for the six oversight groups tasked with overseeing delivery, is vital to ensure that the wider cancer community is properly engaged.

We also heard from many organisations that were unclear on how the delivery of recommendations will be monitored at a local level.

Photo of Fiona Mactaggart Fiona Mactaggart Labour, Slough

One of the things that shocked me in a debate on ovarian cancer was to find that there are parts of the country where CA125 is not routinely available to women who are suspected of having ovarian cancer. I have also had letters from a number of constituents who say that they are unable to get access to bisphosphonates, a drug that helps to prevent breast cancer. Did the all-party group come up with recommendations to try to ensure that wherever people live, they get the best possible cancer prevention and care? At present there clearly is not universal provision of these important diagnostic tests and drugs.

Photo of Nicholas Dakin Nicholas Dakin Opposition Whip (Commons)

My right hon. Friend makes an important point about equal access across the country. We are all concerned about that and focused on it.

It is positive news that the 16 cancer alliances have been established and that NHS England will publish further guidance for alliances to help them develop their plans to deliver the cancer strategy locally, but if they are to monitor the delivery of the strategy, it is vital that they are given the right resource to do so effectively.

A particular issue which was raised in relation to both transparency and accountability was workforce. Most people, I believe, will agree with me when I say that our NHS workforce is under great strain. The cancer workforce is experiencing significant gaps in key areas, including radiography and clinical nurse specialists. For example, Anthony Nolan highlights the fact that access to post-transplant clinical nurse specialists is inconsistent across the country. At the same time, demand is growing, and cancer is becoming more complex, as patients often have multiple co-morbidities. Unless they are addressed, these workforce pressures will undoubtedly have a severe effect on cancer services.

Another area of growing need for cancer patients is access to timely and appropriate mental health support which, if achieved, can reduce pressures on other parts of the health service.

The all-party group welcomes the recommendation in the strategy that Health Education England would deliver a strategic review of the cancer workforce by March 2017, and we were grateful to Professor Ian Cumming for meeting us earlier this year. However, we have strong concerns about progress on this crucial piece of work. Although we are aware that a baseline report of the current cancer workforce has been produced, it has not been published, and there is currently little detail on how Health Education England is planning to conduct the strategic review. We are not aware of any plans from HEE to engage with the sector on the strategic review, and we continue to be concerned by the lack of transparency and involvement of the wider sector. We were pleased to see a reference to the strategic review of workforce in the Department of Health’s mandate to HEE. Will the Minister outline how he is holding HEE to account on that recommendation?

Diagnosing cancer earlier improves survival rates, and the all-party group believes that focusing on outcome indicators such as the one-year survival rate is crucial to driving progress in this area. The inclusion of the one-year cancer survival indicator in the clinical commissioning group improvement and assessment framework—formerly the delivery dashboard—is very much welcomed by the all-party group, which has long campaigned for that. Since then, the all-party group has continued to champion this cause and earlier this year at our annual summer reception we were the first to congratulate and recognise clinical commissioning groups that had improved their one-year cancer survival figures.

So it was music to our ears to hear Simon Stevens at this week’s Britain Against Cancer conference further commit NHS England to increasing its efforts on diagnosing cancer early. Last week the latest one-year cancer survival rates were published, and we were pleased to see an improvement, with the average one-year cancer survival rate in England standing at 70.4%. However, incremental improvements are not enough to match our neighbours in Europe and across the world, as our figures are below the standard set in countries such as Sweden, which has a one-year survival rate of 82%.

As chair of the all-party parliamentary group on pancreatic cancer, I am acutely aware of the difficulty of diagnosing some cancers early. My constituent Maggie Watts lost her husband to pancreatic cancer. Kevin’s mother had died from pancreatic cancer 40 years earlier. Difficulty in early diagnosis is one of the reasons why the outcomes for pancreatic cancer had not improved over those 40 years. Some 74% of patients across the UK cannot name a single symptom of pancreatic cancer, so there is a need for further cancer awareness campaigns to improve the outcomes for these “stuck” cancers, as well as further research into better diagnostic tools in these areas.

Be Clear on Cancer campaigns have been very effective but, as Bloodwise points out, we need further thought on how the NHS can work closely with cancer charities and patient organisations to increase awareness of cancers with non-specific symptoms, such as blood cancers.

I recently met representatives of the Roy Castle Lung Cancer Foundation, who were clear that early diagnosis of lung cancer dramatically improves patient outcomes, the biggest cancer killer. In some countries, screening for lung cancer is being introduced, with positive outcomes. Should we actively consider that here?

It is worth pausing to recognise the excellent work that public health campaigns have played in fighting cancer. Since the smoking ban was introduced nearly 10 years ago, the number of adult smokers in the UK has dropped by 1 million. Smoking cessation is still the most effective cancer preventive strategy, and all of us need to ensure that, when local government budgets are under pressure, that does not lead to reductions in public health budgets for short-term fiscal gain, with long-term negative health consequences and associated costs. As Cancer Research has made clear, the Government must publish the tobacco control strategy without delay.

The final recommendation I want to highlight from our inquiry is on a similar theme: the involvement of patients and organisations in the cancer community in the implementation of the cancer strategy across England. This recommendation has been supported by other groups, such as the Cancer Campaigning Group, which noted in its recent report that the National Cancer Transformation Board and the Independent National Cancer Advisory Group should collaborate with organisations with an expertise in cancer and involve patients in delivery.

The issue is particularly pertinent to people with rarer or less common cancers, many of which are childhood and teenage cancers. The all-party group was concerned when the cancer transformation board’s implementation plan did not highlight rarer cancers specifically. Rarer cancers—particularly those with vague symptoms—tend to be diagnosed later than most common cancers, with many diagnosed through emergency presentation. That not only impacts on survival but leads to poor patient experience. In addition, many patients with rarer cancers, and particularly those with blood cancers, can live with their conditions for many years, and it is vital that provision to support people living with and beyond cancer, such as the Recovery Package, consider the needs of these patients. While many of the recommendations in the cancer strategy will go some way to address that issue, it is vital that NHS England retain a strong focus on this group. What discussions has the Minister had with NHS England about how it is ensuring that organisations across the cancer community are involved in the delivery of the cancer strategy?

Currently, cancer medicines, including those for rare cancers, are appraised by the National Institute for Health and Care Excellence on a timetable designed to ensure that a recommendation can be issued at the time of licence. However, there is growing recognition in the cancer community that current NICE methodology and process are not suitable for assessing treatments for rarer cancers, and that the one-size-fits-all model adopted by NICE could result in patients with rarer cancers losing out on access to treatments that patients in other developed countries are able to access.

There is an ongoing joint consultation by NICE and NHS England, which incorporates changes to highly specialised technology appraisal thresholds, introduces an affordability assessment and creates a fast-track route for highly cost-effective drugs. However, the consultation does not address or acknowledge any specific recommendations for the assessment of treatments for rarer cancers. Concern has been raised by the cancer community that this makes these available treatments vulnerable to always falling through the net. What is the plan to ensure that the NICE process and methodology applied to rarer cancers incorporate the limited patient numbers and data collection, rather than applying the same process irrespective of the rarity of the cancer? What additional flexibility will be applied to NICE criteria when assessing rare cancers, to account for inevitable uncertainties in clinical data?

In summary, it is important to recognise the progress that is being made in implementing the cancer strategy one year on, but there is much more to do. Together, properly supported by Government, those in the cancer community are willing and eager to deliver the better outcomes that would mean we were not just closing the gap on better-performing nations but beginning to lead the way.

Photo of Henry Smith Henry Smith Conservative, Crawley 3:04 pm, 8th December 2016

Thank you, Mr Deputy Speaker, for calling me early in this debate. May I express my sincere thanks to Nic Dakin, and to my hon. Friend Mr Baron? Of course, I join the whole House in sending our best wishes to my hon. Friend’s wife at a very difficult time. I also pay tribute to the Backbench Business Committee for allowing time for this vital debate about the cancer strategy now that it is almost 18 months since it was published in July last year.

I am going to confine my remarks to the issue of blood cancers, and hope to be concise. There are 137 different types of blood cancer, although many of them are not well understood by the general public, and awareness is relatively low. In fact, blood cancers are the fifth most common type of cancer that people are diagnosed with in this country, and, sadly, the third biggest killer. It therefore deserves much greater awareness and understanding, and further efforts by the Department of Health and the national health service to ensure that patients who are diagnosed and their families are properly supported. I thank the hon. Member for Scunthorpe for raising that issue.

I was initially very unaware of the issue of blood cancer; my knowledge was relatively vague. That was until midway through 2012, when after only a few weeks of being ill with flu-like symptoms, my mother was diagnosed with acute myeloid leukaemia, and within 24 hours of diagnosis unfortunately passed away. Sadly, this experience has been revisited in my office. One of my employees, Tom, who also works for my hon. Friend Jeremy Quin, found out only weeks ago that his mother has unfortunately been diagnosed with leukaemia. I know that the House will join me in sending our best wishes to her and to her family.

The issue of blood cancers often comes thundering into people’s lives unexpectedly, because it does not, perhaps, have the same profile as solid tumour cancers. Indeed, I mentioned my mother’s experience of being ill for a short time and being diagnosed very late. Unfortunately, the national cancer patient experience survey has shown that a third of those who are diagnosed with blood cancers have gone to see their GP twice before they finally get that diagnosis, again because of the lack of awareness.

In relation to our efforts here in Parliament, I am pleased that just before the summer recess I was able, with the help of other right hon. and hon. Members, to establish the all-party parliamentary group on blood cancer. I am delighted to see Jim Shannon in his place—he is a very key member of that group—as we seek to raise awareness of this issue. I would like to put on the record my sincere thanks to the Speaker for allowing Bloodwise, the cancer charity that is the secretariat to the all-party group, to hold an awareness event in his apartments in September.

The Minister is very diligent and works very hard, and in the short time he has held his well-deserved position he has been very kind and generous to me when responding to health concerns. I would be grateful if the issue of blood cancers was specifically addressed, so that the patient pathway and patient experience can be improved with regard to general awareness, diagnosis and the treatment and care provided by our national health service.

Photo of Jim Fitzpatrick Jim Fitzpatrick Labour, Poplar and Limehouse 3:10 pm, 8th December 2016

It is a pleasure to follow Henry Smith, who has made a very strong case on blood cancers. I am sure that the Minister was listening and I suspect that he will respond positively.

I congratulate my hon. Friend Nic Dakin on opening the debate. I also congratulate him and his colleague on the all-party parliamentary group on cancer, Mr Baron, on securing it. I echo the hon. Member for Crawley in wishing the hon. Gentleman’s wife and family well in the treatment that they are undertaking.

I had not intended to speak in this debate, but I have received briefings from Action on Smoking and Health and from Cancer Research UK, as well as a copy of the British Lung Foundation’s expert working group report on lung cancer, and I thought that it would be appropriate to reinforce some of the points that they make. I checked that there was no massive pressure on time and that I would be able to make those points were I to catch your eye, Mr Deputy Speaker, so I am grateful to you for calling me.

I thank Deborah Arnott from ASH and Lucy Absolom for their briefings, which I found very helpful. I should point out that I have had four basal cell carcinomas removed from my face. Fortunately, the biopsy on all of them found that they were benign, but my consultant dermatologist has recommended that I wear a hat to protect my Scottish features from the southern sun and the ultraviolet rays, which are even more worrying. Being married to a doctor, I always take very careful notice of any clinical advice that I am given, to avoid the risk of being criticised for not listening to those who are more intelligent and better qualified than me. I thank the good doctors at the Aberfeldy health centre and the dermatology department of the Royal London hospital for their assistance in protecting me.

I will start with the bad news, because all three of the briefings that I have received have many positive things to say about the Government’s cancer strategy. I also think that, on the whole, my hon. Friend the Member for Scunthorpe was positive in his opening remarks. There are clearly some questions to be asked, and I will do so, but the briefings are more supportive than critical of what the Government and the clinicians of NHS England are trying to achieve.

The ASH briefing begins:

The UK’s Cancer Strategy…for England 2015-2020 recommends the publication of a new Tobacco Control Plan within 12 months as a key element of its first strategic priority, a radical upgrade in prevention and public health. If this target had been met a new Plan would have been published in July 2016. However six months on, and a year since the last Tobacco Control Plan expired, there is still no new Plan.”

That is a major criticism in the briefings. ASH goes on to say:

“The previous Tobacco Control Plan achieved its ambitions to reduce smoking rates: adults fell from 21.2% to below 18.5%, 15 year olds from 15% to below 12% and among pregnant women from 14% to 11% or less. The Government must publish a new plan to build on this progress.”

I apologise to the Minister if the plan has been published, but my hon. Friend clearly suggested that it has not, so when will it be published? We would be grateful if the Minister gave us any encouragement that it is due sometime soon. The data show how successful the previous plan was at cutting the number of smokers and, consequently, reducing the exposure of non-smokers, especially children, to second-hand smoke.

I should own up to being an ex-smoker. I started in my early teens, and I gave up at 21.35 hours on 4 November 1980. The fact that I remember the minute does not indicate that I miss it at all. I remember it because it was during a “Panorama” programme that highlighted the legs of a chap who was, it became apparent later, in a wheelchair. The poor gentleman had suffered thrombosis in both legs and had had amputations on both legs. The camera eventually got to his face, and we could see that he was still smoking cigarettes. My then wife was pregnant at the time, and giving up smoking seemed a very sensible thing to do. I had tried to do so 18 months previously, when I gave up for six months. However, I burned my hand badly in a fire, and the first thing I asked as I was being taken to hospital—after six months off cigarettes—was, “Will somebody give me a cigarette?” It took me 18 months to get back off them, but I managed to quit.

When I joined the London fire brigade, two thirds of firemen—as it was in those days—smoked. This is only anecdotal, but 23 years later, two thirds of fire fighters did not smoke. That demonstrates the change in attitudes to health and fitness within the service, and it reflects a similar change in attitudes in society towards smoking. All the positive policies that have been introduced, such as no smoking in public buildings, demonstrate that we live in a society that is completely different from 30 or 40 years ago.

On a new plan for tobacco control, which we hope will be published shortly, I would be grateful if the Minister shared his thoughts ahead of publication on what targets we might expect from 2020 onwards for reducing adult smoking numbers, what budget might be set aside for mass media campaigns and what support might be available for stop-smoking services. Those services reduce health inequalities, because most of the people who access them are from more deprived communities. That will help many of my constituents, appropriately. The last plan clearly worked, and we need a new one.

Cancer Research UK’s briefing states:

“If the strategy is implemented in full then it is estimated that 30,000 more lives could be saved per year by 2020. 11,000 of those lives will be saved through improvements to early diagnosis.”

That is one of the strong points that my hon. Friend the Member for Scunthorpe made. Cancer Research UK stated that it had not seen the progress needed on the plan. On prevention, it states:

“4 in 10 cancers are preventable. We need a radical upgrade in prevention to ensure the future sustainability of the NHS and reduce cancer incidence.”

Cancer Research UK wants the Government to publish the tobacco control strategy without further delay, as does ASH, and it wants the Government to extend existing junk food TV marketing restrictions to the 9 pm watershed to reduce children’s exposure to marketing by more than half. The briefing states that

“urgent action needs to be taken to ensure the NHS cancer workforce is adequately equipped to deal with rising demand and improving care…We welcome the commitment to increase the spend on diagnostics by up to an additional £300 million by 2020, but need clarity over how this is being allocated and used in local areas to improve earlier diagnosis. In addition, the national Diagnostic Capacity Funding must also be continued.”

Those points were also raised by my hon. Friend. The briefing states:

“Cancer waiting times targets are being consistently missed…suggesting there are still thousands of people not having the tests they need on time.”

As I have said, Cancer Research UK has also made a lot of positive comments. On governance and the progress made on implementation so far, the charity states:

“We welcome the appointment of Cally Palmer as National Cancer Director and Chris Harrison as National Clinical Director for Cancer…We welcome the establishment of the Cancer Alliances across the country…We welcome the priority that has been given to earlier diagnosis in the first year and the commitment to invest more.”

Cancer Research UK welcomes NHS England’s proposed investment of £130 million for over 100 replacements or upgrades of radiotherapy machines over the next two years in hospitals in England. It says:

“Replacing the machines will mean that more patients can access the innovative radiotherapy which plays a vital role in curing cancer, slowing the growth of tumours and improving quality of life for cancer patients.”

Its final question is about the Government’s commitment of £300 million by 2020 to improve diagnostic capacity, which was also raised by my hon. Friend. It asks for

“clarification on how this money is being allocated and used in local areas and how its impact is being evaluated.”

As I said at the beginning, not only are not all the comments from respected organisations critical of the Government’s policy, but they are actually complimentary about their policy and approach, apart from for the absence of a tobacco control plan. That key absence has been highlighted by all the charities and research organisations concerned. I want to reinforce to the Minister that there have been lots of positive comments, because this is not just the Opposition being critical of the Government. There are lots of great and positive stories, but there is that one absence.

As my hon. Friend said, and as I have said on behalf of Cancer Research UK and ASH, we want the Minister to answer a number of questions. If he is not in a position to do so today, it would be very welcome if he asked his officials to write to those of us involved in this debate in due course with additional information. I look forward to hearing the comments of the shadow Minister, my hon. Friend Mrs Hodgson, and of the Minister in response to this debate.

Photo of David Tredinnick David Tredinnick Conservative, Bosworth 3:21 pm, 8th December 2016

I am most grateful to you, Mr Deputy Speaker, for calling me to speak in this important debate.

I listened with great interest to Jim Fitzpatrick talking about his experiences of smoking. I gave up smoking before a flight with a parliamentary delegation coming back from Bahrain nearly 15 years ago, and I have never looked back. One of the drivers that made me give up smoking was a conversation with the then Member for Manchester, Withington—I would call him an hon. Friend, but he was an Opposition Member—who is now Lord Bradley. Like the hon. Member for Poplar and Limehouse, I remember smoking in the House. I remember lighting up in a Standing Committee and being reprimanded, but we could smoke in the Library Room C then. I offered the then Member for Manchester, Withington a cigarette in the Tea Room—we could smoke anywhere then, as well as in the Smoking Room—and he said, “David, no thanks. I’ve got an emphysema hospital in my constituency.” That really hit home.

Nic Dakin is nodding. May I pay tribute to him? He was at the Britain against Cancer conference on Tuesday, which I attended as an officer of the all-party group on cancer. He has served on that group for much longer than I have, and he chaired the meeting in the absence of my hon. Friend Mr Baron. Other hon. Members have paid tribute to my hon. Friend, and of course to his wife, who is undergoing treatment at the moment. I want to say what a great job my hon. Friend has done to drive this agenda on the Conservative Benches. It just shows that if you follow something you believe in in this House, you can get dramatic results.

As a politician, I often think that we should be able to sum up something, such as a very wordy report, in just a phrase or a sentence. That may be because of my background in advertising many years ago. Those dramatic results were clearly illustrated by Simons Stevens, when he said that in 1999, 60% of cancer patients survived, but in 2014, the figure was 70%. We went over some of those figures, which I thought were truly remarkable and really very encouraging.

I want to focus on something else that Simon Stevens said, which the hon. Member for Scunthorpe has mentioned. He announced £200 million of funding at the conference:

“The £200m fund has been set up to encourage local areas to find new and innovative ways to diagnose cancer earlier, improve the care for those living with cancer and ensure each cancer patient gets the right care for them.”

That includes aftercare treatment. What do we do when a patient has had chemotherapy and then there is nothing else—they have not been given any other options, so they feel depressed and unhappy?

That is where my main experience in this House comes in, as I have worked on integrated healthcare—holistic medicine, I suppose—with the all-party parliamentary group on integrated healthcare for nearly 30 years. I have been an officer of the group for nearly 25 years, and have chaired it for quite a while. It feels almost as if our time has come. It has now been clearly recognised that part of the cancer package should be a wide range of support. We can see that all over the country. I was at LOROS last week, which is where very ill people in Leicestershire go for their last few days. A range of different therapies were being offered there. That is happening not just in my constituency but in many others.

I return to the conference mentioned by the hon. Member for Scunthorpe—[Interruption.] I see he has now been promoted to the Front Bench. That is the great thing about the Opposition—the Front-Bench team changes so quickly that we can never be sure where any hon. Members are. I remember that when I was a young Member the advice I was given was always to sit in the same place in the House so that the Speaker knew where you were. In that case, it is a wonder that any Opposition Members get called at all, because they are always moving around the Benches. The hon. Member for Scunthorpe has clearly been promoted this afternoon, so congratulations.

One battle I have had over the years has been with the medical establishment about what should be included in treatments on the health service. It has been an ongoing battle against vested interests in the medical establishment who do not want to see money leaking from their own particular silos. That is down to scarce resources. One of the most interesting stalls at the Britain against Cancer conference on Tuesday was about cancer detection dogs. Even I gasped when I saw it—my hon. Friend Jo Churchill, who has also had experience of cancer and has contributed so much in her short time in this House to addressing cancer problems, is nodding and smiling. Just as we have dogs in this House—I will not say when or where they go—to detect things that may have been placed here by people who do not particularly agree with what we do, so it is possible to use dogs to detect cancer. If that is possible, I suspect that the authorities have not run double-blind placebo-controlled trials to establish whether it works. It works on the basis of experience, because the dogs are trained to detect by smell when people have developed cancer.

On the great battleground with the orthodox proponents of orthodox medicine the battle line has in recent years been drawn on something called evidence-based medicine. We are told that in the health service medicine should always be evidence-based, and nothing should be used unless it meets that criterion. I had a look at that, and got the Library to look the papers up. It goes back to 1992 and a statement by Professor Sackett that various other academics then ran with—there was a Professor Guyatt also. But when saying how important evidence-based medicine was, Professor Sackett also said:

“Good doctors use both individual clinical expertise and the best available external evidence, and neither alone is enough. Without clinical expertise, practice risks becoming tyrannized by external evidence, for even excellent external evidence may be inapplicable to or inappropriate for an individual patient. Without current best external evidence, practice risks becoming rapidly out of date, to the detriment of patients.”

It is hardly a secret that we were discussing Brexit in the House yesterday and that we have been very much involved in the whole debate since the summer—and for many of us, a long time before that. One problem in healthcare in relation to the EU has been the imposition of directives on the UK that have negatively impacted support services in healthcare. The traditional herbal medicines directive requires Chinese medical practitioners to show 30 years’ usage of a particular medicine in the UK, or 15 years under other circumstances, and bans a whole range of complex preparations freely available, and produced to very high standards in modern factories, in the People’s Republic of China.

Before I came to the Chamber this afternoon, I was at a Chinese medical clinic. I practise what I preach and have acupuncture once a month. I take Chinese herbal medicine and I think it has kept me away from antibiotics, steroids and other drugs for a good few years. I talked to practitioners about what they are able to do for cancer patients. There is a very long list of types of cancer that can be treated using traditional Chinese herbal medicine: cervical cancer, Non-Hodgkin lymphoma, HIV, colon cancer, head and neck cancer, breast cancer and prostate cancer. The list goes on.

I believe that several of my constituents are alive today because they have used Chinese medicine. It strengthens one’s immune system and is very effective after cancer treatment. It deals with particular symptoms. I asked the practitioner this afternoon what conditions she would expect to be able to alleviate using Chinese herbal medicine and acupuncture. She said: tiredness, lack of energy, fevers, headaches, hypertension, dry skin, seizures and involuntary muscular twitching.

We have to broaden the scope of services available on the health service to help to meet patient demand. I hope the £200 million fund will mean a further widening of the scope of services available. My hon. Friend the Minister, who is new to his post, could do a lot worse than contact the head of the Professional Standards Authority, Harry Cayton. Harry Cayton’s organisation oversees the regulation of 23 different health organisations, including about 20,000 providers. If we go to the trouble of regulating different therapies, or having oversight of that regulation, why on earth do we not use it? What is the point of having a statutory regulator that checks the oversight when we do not actually use its services? That is a great mistake.

My hon. Friend the Minister could do a lot worse than go around the country and look at some of the practices that help cancer patients in remission. One of the best is the award-winning Velindre cancer centre in south Wales. Each year, it sees over 5,000 new referrals and about 50,000 new out-patient appointments. It employs over 670 staff and has an annual budget of over £49 million. The money for that service, which is widely used by doctors, comes not from the Department but from charitable donations. At that centre, they use reflexology, reiki healing, which I have studied over the years, aromatherapy, and breathing and relaxation techniques, and they have spectacular results.

Another wonderful clinic that my hon. Friend would do well to visit—it is a few stops on the District line from here, in Fulham—is the Breast Cancer Haven. It offers a range of therapies to combat stress, and I have attended its sessions. It is wonderful to see people suffering from breast and other cancers being given hope that chemotherapy is not the end of the road and that there is something out there to support them.

Another wonderful organisation of which my hon. Friend should be aware, and which was at the cancer conference on Tuesday, is Penny Brohn UK, the living well with cancer organisation. It has worked hard to produce a report on the long-term impact of its living well course, and the results from the five-year follow-up show a high approval rating among patients. The figures are staggering: 97% of patients reported making positive lifestyle changes after the course; 75% said they had maintained the positive changes for four to five years or were still maintaining them; and 85% said the living well course had enabled them to self-manage their health more effectively.

My hon. Friend, being well aware of Government policy, will know that patient choice is, according to the Health Secretary in the last Parliament, at the heart of the health service. If we are to give patients choice, we have to give them the provision to choose from. I was a member of the Health Committee for the whole of the last Parliament—I chaired it for a while when Stephen Dorrell stood down, before my hon. Friend Dr Wollaston took over—as well as a member of the Science and Technology Committee, both of which looked at the complex problems of polypharmacy and polymorbidity, which is jargon for too many people taking too many drugs and nobody really knowing what those drugs do. We need to reduce that.

There is a crisis in this country with antimicrobial and antibiotic resistance—we are not getting new antibiotics into the pipeline—and part of the problem is that we are trying to create new drugs while also trying to reduce antibiotic use. There is a range of other therapies that can help patients stay away from antibiotics. I will not get called to order, Madam Deputy Speaker; I know that this is a cancer debate, but a lot of alternative therapies—I will get to the H word, homeopathy, in a minute—offer options at a time when mainstream medicine is running out of solutions.

I have always championed the cause of homeopathy in this House, and I want to relate that strictly to cancer this afternoon. Homeopaths do not claim to cure cancer, but my goodness they can assist people who have had cancer and who are in remission by helping them to adjust their moods and to deal with anxiety and sleeplessness. It is a great tragedy that a tiny number of people, whom I regard at best as foolish and at worst as wicked, are trying to erase the tiny sum of money—£500 million—spent on homeopathy in the health service. Without looking at the benefits, they argue that it is a waste of money.

We have seen the pressure on institutions at Liverpool and elsewhere. What could be more stupid than to attack a medical system that is widely used in France, that voters went for in Switzerland, and that is used across the world, including in India and Brazil? What is the problem here?

I was in Toulouse to look at British Aerospace work recently, and I found a homeopathic chemist right in the middle of the main square there. Some 90% of pregnant women in France use homeopathy. The Minister must not be bludgeoned by the tiny number of people who use legal threats and resist it. Simon Stevens is now coming up with new money for aftercare for cancer, so we need to look out of the box and consider new possibilities. We are not even looking at some possibilities that are orthodox.

As I said, I am an officer of the cancer group, and I chaired a meeting the other day to hear anxious and anguished professors of medicine from this country talking about a new mainstream treatment called Target for breast cancer. Target is about putting a small device the size of a tangerine on the end of a cricket stump into an incision in the chest. The chemotherapy treats the tumour and not all the other organs in the chest. The professors saw this as a great breakthrough. It was invented in Britain, and it is widely available in Europe. How come NICE has only given it draft clearance? What is going on? Professors of medicine are saying that this is hugely important, yet we are not actually dealing with it.

Photo of Jo Churchill Jo Churchill Conservative, Bury St Edmunds

On that particular point about targeted interoperable radiotherapy, I too have spoken to these professors, and I understand where they are in the clearance process. I find it a little bit concerning when there is a lack of money in the system. Is my hon. Friend aware that there are half a dozen machines around the country that could deliver that targeted therapy? Perhaps we need to look at what we should do first—whether it is purchasing the machines or giving the clearance in full.

Photo of David Tredinnick David Tredinnick Conservative, Bosworth

My hon. Friend makes her point very well. In his excellent presentation, Simon Stevens talked about bringing new equipment onstream for radiography, I believe. [Interruption.] Yes, my hon. Friend was there, and she confirms this. I certainly agree with what she said, and we need to wake up to what is being invented in Britain and used across the world.

I shall conclude shortly, in case anyone else is hoping to catch your eye, Madam Deputy Speaker. I want to finish with a couple of other points. There are other treatments out there, to which people turn in desperation when they reach the end of their conventional treatments. One of them is called oxygen therapy, and broadly speaking it means getting more oxygen than is normally received, from a container. It is not a very expensive treatment, and the information I am getting is that it produces spectacular results when it comes to energising people and improving their sense of self-worth and wellbeing.

My final point is one that I find amazing. In the great cancer hospitals and clinics of this country, diet is seen as a sideline. In some of these institutions, the diet is, frankly, appalling, but I am not going to name of any of them this afternoon. Like most colleagues, I have a big enough postbag already and I do not want to hear the defence. Anyone attending a big clinic in America, such as the Mayo Clinic, can say goodbye to dairy and sugar, and hello to more juices. The Haven in Fulham certainly uses a lot of raw juices and raw vegetables. Diet is absolutely fundamental. When I worked in the computer industry, we used to say “Garbage in; garbage out”—and the same applies to humans. Our outputs as a being—[Interruption.] Nic Dakin does me the honour of laughing, but it is true. Diet is such a soft ball to hit, is it not? We are spending millions of pounds on all these expensive treatments, but what about telling people to cut back on sugar? Well, there we are.

I have tried to address some of the issues following the landmark speech at a landmark conference on Tuesday. For the first time, we have seen a lot of money set aside for developing aftercare for patients and improving services around mainstream medicine.

My hon. Friend the Minister has a great opportunity to make his mark in the House. His Department is, I believe, the fourth largest employer in the world. I think the Red Army comes top and McDonald’s second; I expect another burger provider comes third; and my hon. Friend is presiding over part of an organisation that comes fourth. His brief gives him enormous opportunities to improve the quality of life of cancer patients in this country, and by the time he has finished, there should not be just an increase in the cancer survival rate from 60% to70%—his target should be 80%.

Madam Deputy Speaker, I rest my case.

Photo of Jim Shannon Jim Shannon Shadow DUP Spokesperson (Health), Shadow DUP Spokesperson (Transport), Shadow DUP Spokesperson (Equality) 3:45 pm, 8th December 2016

It is always a pleasure to debate these issues. I commend Nic Dakin for his presentation and for setting the scene so well, and, in his absence, I commend Mr Baron. I hope and pray that his wife is keeping much better. I know that if he were here, he would be making a valuable contribution. He may be watching the debate from afar, but, in any event, we hope that everything goes well for him.

I thank the Backbench Business Committee for giving us an opportunity to take part in this debate on a Thursday afternoon. I also thank Henry Smith, who is the chair of the all-party parliamentary group on blood cancer, and who chairs it very well. He was instrumental in setting up the group, and we thank him for that. We are all very pleased to work alongside him, and to join in his endeavours.

As we know, the latest figures provided by Macmillan Cancer Support indicate that by the end of the current Parliament, one in two people will suffer from a form of cancer during their lifetimes. It is a sobering thought that, technically speaking, 50% of the 12 or so Members who are present in the Chamber now could be in that position in the next few years.

It is clear that improvements in diagnosis and treatment of the disease mean that more people are surviving it, or living for longer with it, and, as a consequence, 2.5 million people are living with or beyond it in the UK today. My father was a cancer survivor on three occasions. David Tredinnick mentioned diet, and it is true that diet cannot be ignored as an element that we can use. As I have said, my dad—who passed away last year—survived cancer three times, and he lived for some 38 years after he was first diagnosed. He was very careful about his diet, and I believe that that was a factor in his survival. The doctors told him to be careful with his diet. However, he survived for main three reasons: the skill of the surgeons, the care of the nurses, and the fact that he was a man of great faith: the Prayer for God’s People was very important to him.

Nevertheless, the sheer scale of the problem of cancer demands a co-ordinated and proactive strategy. The Minister knows that I hold him in the utmost respect, as does every one of us in the House, but I must say to him that we need a strategy that will cover the whole of that problem. I am going to make some constructive comments, and I am convinced that his response will be the one that we hope to hear.

There is more that can and, indeed, must be done. It would be remiss of us not to mention the charities with which we are all involved, or of which we all know. There is Marie Curie, which does wonderful work, there is Action on Cancer, and there is Macmillan Cancer Support, and I am only mentioning those that I have direct contact with. There are also church groups. Elim church in Newtownards, in my constituency, has a cancer group that meets every Friday. There are different groups that go to different places. I think that faith is very important when it comes to this issue.

I raised this issue during the debate on NHS funding, because cancer funding is an essential component of that. Macmillan has said that about one in four people living with or beyond cancer face disability or poor health following their treatment, and that that can remain the case for many years after treatment has ended. We should sometimes consider the care needs of cancer survivors who must face disabilities and a different lifestyle with which their families must also come to terms. It is vital that they are able to access the best care that is right for them when they need it, and to ensure that the NHS is set up to meet the changing needs of cancer patients. We have to have an NHS that responds to patients’ needs. Not only would this increase the quality and experience of survival, but it would ensure that resources put into tackling the disease are invested in the most efficient way. We must closely co-operate with cancer charities and patients to ensure that the NHS can respond in the best way possible.

This efficient use of money is key for the “Five Year Forward View” projections, indicating that expenditure on cancer services will need to grow by about 9% a year, reaching £13 billion by 2020-21. However, £13 billion of spending in 2020-21 and increased investment through the “Five Year Forward View” is what is required just to stand still. So while the figures look good, the needs indicate that we will have to look at the figures and the available funding again. This level of spending is likely to yield outcomes that continue to be below average when compared with similar international healthcare systems.

The hon. Member for Scunthorpe referred in his opening speech to international care and the need for us to be batting above our position on the international stage, and I agree. Now is therefore the time to ensure that money is spent as effectively as possible to give England and the United Kingdom of Great Britain and Northern Ireland a better chance to achieve world-class cancer outcomes and deliver on the Government’s manifesto commitment. It is clear that we need greater funding of research, and while charities do a wonderful job, and we appreciate them very much, there is most certainly a Government role that can be better fulfilled.

All Members have received the “Together for short lives” briefing, and it prompts me to highlight to the Minister the fact that there are barriers to research into children’s palliative care, which is a subject close to all our hearts when we have children of our own, and grandchildren as many of us now have. Despite improving survival rates, cancer is the leading cause of death in children, teenagers and young adults. The survival rate is significantly lower for teenagers and young adults than for children for several cancer types, including bone tumours and soft tissue sarcomas.

About 250 children aged zero to 14 lose their lives to cancer every year in the UK. In children aged 1 to 14, this is around one fifth of deaths. For teenagers and young adults, cancer accounts for around 310 deaths per year in the UK. I make a plea for children’s palliative care. I am sure that the civil servants will be looking for some notes to pass to the Minister to let him know what has been done, but I want to know what will be in done in future as well.

The cancer strategy recommended that by September 2016 a proposal should be developed to ensure that all children, teenagers and young adults diagnosed with cancer are asked at diagnosis for consent for their data and a tissue sample to be collected for use in future research studies. Data collection is important so that we can look to the future by studying the information and responding in such a way to give better help down the road. The strategy also states that NHS England should work with research funders to make best use of these resources in the future. What action can the Minister take to make sure that NHS England works to remove barriers to including children and young people with cancer in research?

Smoking has been mentioned, which reminds me of my first cigarette. I think I was five. My grandfather smoked Gallahers; there was no filter in them, and they were the strongest cigarettes in the world. Wee boys look up to their grandfathers, and I thought, “My Grandad is a great fella and he smokes away at those cigarettes. I wonder what it’s like.” I pestered my grandfather to let me try one, and he said, “Take a deep breath.” I did, and it would not be untrue to say that I was the colour of these Green Benches, and was violently sick. I never had any wish ever again to smoke a cigarette; if that is how to learn the lesson, I certainly learned it.

The Minister will know that I have a deep interest in Queen’s University Belfast and in the great research work that it does. It is world renowned for its medical research and especially for the research it carries out in the field of cancer. It is innovative, and it is looking into new drugs and medications to address cancers. Yes, we have survival rates of 50% or more, but we are still looking for the one drug that will cure all cancers, and to do that, we need research. I know that this is not the Minister’s direct responsibility, but I know that he has as deep an interest in this matter as I do.

The evidence-enabled outcomes research to inform precision oncology innovation adoption by health systems that is pioneered by Queen’s highlights how Northern Ireland punches above its weight in this rapidly evolving area, which is providing us with new approaches to prevent and treat this killer disease and preserve and improve the lives of cancer survivors. This success can and must be replicated by making greater funding available for research facilities and grants designated to changing the way in which cancer is approached and dealt with.

We have only to think of just how far the diagnosis of cancer has come in 50 years. The hon. Member for Scunthorpe spoke earlier of the achievements in this field, and also mentioned how far we still have to go. Queen’s University has partnerships with local businesses, and many foreign students come there to do their degrees and contribute to the research. There are also partnerships between Queen’s and universities here on the mainland, involving a wonderful group of universities and people making these things happen. They are making a difference through their research into cancer and the drugs that we need.

If we are to treat cancer successfully, we can do so only by adopting a continually updated approach. We have the initiative and desire to do this, but we need to ensure that the funding is in place as well. Governments need to take a positive interest in providing financial resources to ensure that everything is done to find the ultimate cure for cancer. Any strategy must make that clear, and the Minister must ensure that the necessary funding is available and enhanced when we negotiate Brexit. Brexit is mentioned in every debate we have now, but it is a fact of life. We have moved on, but we need assurances in this regard. I think we are having a debate on 19 December on the effect of Brexit on our universities.

We also need to address the postcode lottery in relation to the availability of cancer drugs. Again, this is not a criticism of the Minister—I do not do that—but it is a fact that cancer drugs are much more readily available in some parts of the UK than in others. In the past, central Government have supported the regional and devolved Administrations with funding for drugs. Is that anywhere in the equation at the moment? What discussions does he have with the regional and devolved Administrations—the Scottish Parliament, the Welsh Assembly and the Northern Ireland Assembly—on agreeing cancer strategies and bids for resources?

A cancer strategy is a difficult one to negotiate, and it seems as though there can never be enough investment. We have to ask ourselves certain questions. Are we investing in the right things and producing the best outcomes? Are we sowing seeds for the future, and are we doing the best we can with what we have? It is up to each of us to raise these questions, and, for my part, I feel we must set aside more, do more and achieve more for the one in two people who will be effected by cancer.

Photo of Rebecca Harris Rebecca Harris Conservative, Castle Point 3:58 pm, 8th December 2016

I should like to add my words of thanks to my hon. Friend Mr Baron for securing the debate. I very much regret the circumstances that mean he cannot be here today. It is unusual to be having a debate on cancer without him, as he works diligently on these matters. I send him my best wishes.

As chair of the all-party parliamentary group on brain tumours, I very much welcomed the new cancer strategy that was announced in the Chamber just over a year ago, and I am delighted that we have this opportunity to scrutinise it again now. I congratulate the Government on their focus and their direction of travel, and on the fact that survival times are constantly going up. We are absolutely going in the right direction, but like all hon. Members, I want to push the Government to go further, particularly in relation to brain tumours.

We heard earlier from my hon. Friend Henry Smith about the difficulty of early diagnosis of blood cancers and from Nic Dakin about pancreatic cancers. Early diagnosis, about which we hear time and again, is also a problem with brain tumours. People are often turned away by doctors and the cancer is found at the last moment. Jim Fitzpatrick spoke about prevention, but unfortunately we think that only 1% of brain tumours may be preventable, so it is not really an area of exploration for us.

For patients with brain tumours, the only hope of a cure is through research and innovation into the many types of tumour. While such tumours represent just slightly under 3% of all cancers, they are the biggest killer among cancers of children and people under the age of 40. As for years of life lost, it is a devastating disease. Surprisingly, just 1% of the national cancer spend has gone into research into this area of cancer since 2002, which is clearly an injustice for those suffering from brain tumours and is why survival times have not been improving. Brain tumour research remains perennially underfunded, which was highlighted by the excellent Petitions Committee report—its first ever—into brain tumour research funding and the fine Westminster Hall debate. As a result, the Government set up a “task and finish” working group, for which I am extremely grateful. I look forward to the work that that brings forward, but we are not there yet and more must be done.

From reading the NHS’s “One year on” progress report, it appears that there has been much focus on meeting the clinical service recommendations set out in the original strategy. That should be welcomed, but there has been rather less focus on the research and innovation recommendations. While I recognise the importance of clinical services and their potential to improve outcomes in the diagnosis, treatment and care of people affected by brain tumours, we need equal, if not more, focus on research and innovation into potential cures. To that end, I have a few observations to make about several of the research points in the progress report and how realistic they are for patients with brain tumours and about research into the disease.

The report mentions a focus on modernising radiotherapy services and embedding research in the latest investment. Given the location, brain tumour radiotherapy comes with complex side effects, including increases in cranial pressure for some patients, alongside the more common side effects. More precise stereotactic radiotherapy is welcome, but it still does not represent a cure for many brain tumour patients, only an extension of life. The report states that a key 2020-21 metric is an

“Increase in five and ten year survival, with 57% surviving ten years or more”.

However, Brain Tumour Research’s latest report on national research funding, released in October, shows that five-year survival for brain tumour patients is a mere 19.7% in England, lagging far behind other cancers. With a one year survival rate of 46.5%, which is well below the NHS’s 2020 target of 75%, the NHS looks set not to meet its own key measure on brain tumours. In doing so, it is letting down brain tumour patients.

A key paragraph from the NHS progress report states:

“Although a commitment has been made, NHS England has yet to publish its 2016/17 research plan, leaving the NHS without an up-to-date strategy for research. Now that the Accelerated Access Review has been published, we hope that the NHS England research plan is also delivered without delay.”

That appears to be an admission of prioritising other objectives over research. Clinical services are important in the here and now but without proper planning and investment into medical research, ongoing improvements in health outcomes of many diseases will not be realised, and brain tumour patient outcomes will continue to stagnate when compared with other cancers. I welcome many aspects of the progress report, including the launch of a new integrated cancer dashboard to ensure greater analysis of patient outcomes in local areas. I would be grateful to know whether phase 2 of the dashboard will include data on brain tumours, as they do not appear to have been collected in phase 1.

The launch of the national “Be Clear on Cancer” campaign will also hopefully lead to faster diagnosis of cancer for all patients. However, Brain Tumour Research’s latest report shows that, according to the National Cancer Research Institute, the Government spend on brain tumour research represents just 0.52% of its total spend on cancer. It is clear that brain tumour research continues to be drastically underfunded, even with the cancer strategy in place. Therefore, although the strategy is a major step in the right direction, it will need to be made to work for all types of cancer, including the rarer ones and, in particular, brain tumours. Every week, a family loses a child to brain tumour and, as with many cancers, the incidence of brain tumour is rising. I very much hope that that will be taken on board by the new Minister, and he will hear more from me in future about the need to increase brain tumour research.

Photo of Bob Blackman Bob Blackman Conservative, Harrow East 4:05 pm, 8th December 2016

Thank you for calling me in this debate, Madam Deputy Speaker. It is always a pleasure to follow my hon. Friend Rebecca Harris, and one benefit of this type of debate is that we learn something that we did not know before. I, too, congratulate Nic Dakin, who introduced the debate. I know that he has been a doughty campaigner, particularly on behalf of pancreatic cancer sufferers, for as long as we have both been elected, and the way he introduced the debate was fitting and appropriate. I also pass on my best wishes to my hon. Friend Mr Baron and his family at this difficult time. It is a surprise not to see him in this Chamber for a debate such as this, but we understand the circumstances.

I want to start by paying tribute to Greg Lake, the rock star who, sadly, died yesterday after a long battle with cancer. To me, he was one of the icons. He founded King Crimson, and one of the first albums I bought was “In the Court of the Crimson King”. He then went on to form the supergroup Emerson, Lake and Palmer, and he also produced the iconic hit “I believe in Father Christmas”, which we hear at this time of year. I want to put that on the record because it is appropriate that we remember that people are suffering and dying as a result of cancer literally every day.

I declare my interest as chair of the all-party group on smoking and health, and I note that Jim Fitzpatrick raised a number of the issues set out in the briefing that has been circulated quite widely. I want, however, to build on some of the things that have taken place. One of the key recommendations of the UK cancer strategy, which was founded not a year ago, as the title of this debate suggests, but 18 months ago, was that the replacement tobacco control plan should be published within a year. The last tobacco control plan expired a year ago, and we were promised a replacement in the summer. I know that “the summer” can stretch, but stretching it to Christmas is a bit of a long stretch. We recently had an excellent debate in Westminster Hall, where we briefed the new Minister, the Under-Secretary of State for Health, my hon. Friend Nicola Blackwood, on all the key issues relating to tobacco control. She promised that the new plan would be published soon, and she did so again when I raised it with her at Health questions. It will not surprise today’s Minister to learn that the one thing I have to ask is to be given a date for the new plan—he should not tell me, “Soon”.

I now come to a significant fact. The Prime Minister said in her first major speech, on the steps of Downing Street, that she would be

“fighting against the burning injustice that, if you’re born poor, you will die on average nine years earlier than others.”

Smoking is responsible for half the difference in life expectancy between rich and poor in this country, so if we can cut smoking rates, we will help deliver the Prime Minister’s ambition. I ask the Minister to make sure that we get this tobacco control plan as quickly as possible.

We know that smoking is the greatest preventable cause of cancer worldwide. It accounts for more than one in four cancer deaths in the UK and for a fifth of all cancer cases. Smoking increases the risk of getting 14 other cancers and is responsible for more than 80% of cases of lung cancer—the cancer that is the biggest killer in this country. It also has the worst five-year survival rate. Therefore, from that perspective, if we can cut smoking, we will cut the causes of cancer.

I wish to declare an interest in this matter. As I have said in this place on more than one occasion, both of my parents died, in 1979, of smoking-related diseases. They both died of cancer because they smoked virtually every day of their lives. I heard the hon. Member for Poplar and Limehouse say that he gave up in 1980. I still remember those terrible days when my parents died, and I want us to get to a position where no one has to suffer what my family and I had to suffer.

Photo of Rebecca Harris Rebecca Harris Conservative, Castle Point

Does my hon. Friend agree that those Members who said that we should not bring in a ban on smoking in cars with children because it was unpoliceable may now regret that? Children are policing that measure very well indeed.

Photo of Bob Blackman Bob Blackman Conservative, Harrow East

When the change in law came through, a number of people objected to it, saying that it would not be enforceable. I remember back to my childhood when both of my parents were smoking in the car in front of me. It was difficult then as a child to say, “Please, will you not smoke, because I do not like it?” It was just easier to open the window. I do not want children to go through that. It is right and important that we changed the law in that way, as we know that second-hand smoke is a key killer of young lungs. It was a significant development—and a development that people did not think would happen. People did not think that we could introduce this change and get it through both Chambers, but I am delighted to say that we did it and that it was the right thing to do.

Photo of Jo Churchill Jo Churchill Conservative, Bury St Edmunds

I thank my hon. Friend for providing such a powerful case. I could not agree with him more. To my way of thinking, banning smoking would do me, but we probably cannot go that far. Does he agree that the broader point of health economics is also important? Lung cancer is not the only issue. There is also emphysema, pulmonary disease and so on. If we sort out the tobacco issue, we could make much broader savings across the health service.

Photo of Bob Blackman Bob Blackman Conservative, Harrow East

There are aspects of that with which I agree. The reality is that tobacco is the only product in the world, which, if used in the way that was intended, will kill us. Therefore, controlling it is vital.

We know as well that those with complex medical needs have the highest smoking rates. I am talking about people who are unemployed, who have mental health conditions, and who are in prison. I am also talking about the people whom I am championing at the moment—the homeless. All of them are much more likely to smoke than others, and they are also more likely to have the most health problems as a direct result. It is quite clear that the most disadvantaged members of society are more likely to smoke and therefore suffer cancer and other health-related problems as a result. Clearly, we need to take action. Quitting smoking reduces the likelihood of having cancer. It is also key that lungs can recover if one gives up smoking. We must encourage people to give up smoking and, more importantly, to try to prevent young people from ever starting. Jim Shannon told us what happened to him as a five-year-old. I would not advocate that as a shock treatment. None the less, it is quite clear that stopping people from starting to smoke is the best way forward, rather than trying to get them to give up later in life.

The recent report “Smoking Still Kills”, which was endorsed by no fewer than 129 organisations, recommended that, as a target, we should reduce adult smoking to less than 13% by 2020 and to 5% by 2035. I take the point made by my hon. Friend Jo Churchill: that is not ambitious enough. We should be going for a smoke-free Britain, or, rather, a smoke-free United Kingdom. I must get my phraseology correct.

To achieve that target, we need mass media campaigns, which the Department of Health has ceased. We need stop-smoking services to be encouraged, promoted and funded across the UK, and local authorities should enforce the necessary activities and to do their job. We know that mass media campaigns are extremely effective and cost- effective in prompting people to stop smoking and in discouraging young people from starting. In 2009 we had funding of just under £25 million for anti-smoking campaigns, but by 2015—last year—that had been reduced to £5.3 million. That is a false economy.

If we had much better funding for mass media campaigns, I am sure we could reduce the incidence of smoking far more. Equally, we know that stop-smoking services across the UK have been highly effective in reducing smoking rates. Smokers are up to four times more likely to quit if they have support from specialist groups and smoking services, compared to quitting cold. The hon. Member for Poplar and Limehouse referred to when he gave up smoking, and he can remember the time and the date when he did so. Most people who have smoked in their adult lives have difficulty giving up and they need help and support. We should ensure that that is available.

The sad fact is that right across the UK smoking cessation services are either having their funding reduced or being closed altogether. That is extremely regrettable. I suggested to the Chancellor that by putting just 5p on a packet of 20 cigarettes and using that money to fund smoking cessation services we could provide all the money that is needed to continue smoking cessation services across the United Kingdom. That, to me, would be a very sensible investment indeed.

Funding for trading standards has fallen from £213 million in 2010 to £124 million now; the teams have been cut to the bone and the number of staff working in trading standards has been reduced radically. That means fewer local controls to target illicit tobacco in the way we should, to prevent some very nasty products from being used by people across the United Kingdom. That is a retrograde step. We need to invest in those services to make sure that we deliver better health outcomes.

We desperately need a new tobacco control plan and programme so that we can see the radical targets that are needed and the investment required across the United Kingdom. We should be setting out our stall—we want a smoke-free United Kingdom not by 2035 or beyond, but by 2020 or 2025. We can achieve it with the right programme. The key point is that if we deliver this plan, we will cut the rate of cancer deaths and the number of people suffering from cancer, which will reduce the burden on the national health service and allow us to take that money from the health service to use on the more difficult cancers that colleagues have mentioned. Those cancers are difficult to spot, difficult to treat and need specialist drugs and specialist treatments.

Photo of Henry Smith Henry Smith Conservative, Crawley

My hon. Friend is making the powerful point that if we reduce preventable cancers, we can redirect resources to the difficult cancers. It is a fact that more than 230,000 people in the United Kingdom suffer from blood cancers. As in the case of pancreatic cancer, which Nic Dakin mentioned, if we could better treat those difficult cancers with those resources, we could go so much further.

Photo of Bob Blackman Bob Blackman Conservative, Harrow East

Clearly, the priority has to be to eliminate what we can eliminate. If people smoke, they put themselves at risk of cancer—as I said, 14 different cancers are affected by smoking. If people stop smoking, it eliminates that risk. Equally, through diet, people can eliminate some of the risks. However, there are cancers that are not affected by smoking or diet. Therefore, if we can reuse resources and concentrate on the detection or treatment of the more difficult cancers, the health of the nation must be improved.

I bring my remarks to a close by saying that I hope we will get an answer in a few minutes to the question we are all asking: may we please have a date—with a day, a month and a year—when we will get the tobacco control plan?

Photo of Jo Churchill Jo Churchill Conservative, Bury St Edmunds 4:20 pm, 8th December 2016

I, too, thank the Backbench Business Committee for allowing this debate. I also thank Nic Dakin for the way he introduced it, which has allowed us to conduct it in the tone that we have.

I came to this place after a journey with this disease, but I have been amazed since I have been here. Thangam Debbonaire has fought the disease and now sits back in her place, and very welcome that is. The news about Mr Campbell, too, is welcome. I have heard my hon. Friend Michael Fabricant talk about his journey with the disease. My best wishes go to my hon. Friend Nick Boles, who is on the journey at the moment. It is unusual not to see my hon. Friend Mr Baron in the Chamber, and my thoughts and prayers go out to him and his wife at this time.

Cancer is interesting: you don’t pick it, it picks you. We have heard from many Members that some cancers are preventable, but there are over 200 cancers. The debate often gets channelled towards rare diseases or prolific diseases such as breast cancer, prostate cancer or lung cancer—one of the big four. However, the debate we have had today is very broad, and I welcome that.

My hon. Friend David Tredinnick said we are doing better, which we are, but we could do even better, and I would like to return to the issue of research, which was brought up by my hon. Friend Rebecca Harris, to see how we might do better there.

I welcome the commitment to the strategy. Implemented, it could be transformational, which is why I hope we will hear about better implementation. The “Five Year Forward View” shows that funding for cancer services will go up by 9%, reaching £13 billion by 2020-21.

As we have heard, one in two of us will suffer from cancer by the end of this Parliament, and 2.5 million people in this country are living with the disease. A question the strategy does not necessarily address properly is how we will care for those people. How will we deal with the survivors affected by it—625,000 people will be, as was mentioned earlier—who will carry forward some form of disability or hardship from having the disease? How will we deal with palliative care? Have the sustainability and transformation plans looked into palliative care and into how we can address the needs of people who are looking towards the end of their lives?

I would also like to highlight teenage cancers, although it is usually breast cancer that I talk about in this place. I have a young friend for whom a year on means something different. She wrote to me on Sunday, after I said I was talking in this debate. I thought of her because, on 11 December last year, young Emily was diagnosed with cancer.

She said:

“Last year in December I was diagnosed with ALL Leukaemia. It was a very scary time for me and my family. But something that makes going to hospital that little bit nicer is how lovely the nurses are.

However, there were a lot of horrid bits during the start of treatment, such as hair loss and sickness.

Although, I still have two years to go of treatment to go on treatment, it is a lot less intense now I am in maintenance. The majority of chemo is in tablet form at home, one hospital visit a month and the HORRID, HORRID steroids, also once a month for five days!

I know that the steroids work as one of the main chemo therapy treatment - but they make me put on weight, feel emotional for no reason and sometimes cross and angry at my mum, who is my absolute rock and is always there for me, so that makes me feel very sad!

If I could change anything about the chemo it would definitely be;
to not feel sick and not take steroids!”

Emily is a year on in her journey. I am sure I can speak for everybody in wishing her lots of success for a great journey.

One of the best things we can do for young people is to educate them. Education is a theme that has come out of this debate. I will not go over the comments by my hon. Friend Bob Blackman and Jim Fitzpatrick about smoking, which they discussed so well, but merely say that education in that regard is important. Nor will I go over education around food and nutrition, which, as we have heard, is worked on by the Penny Brohn institute and The Haven.

Jim Shannon mentioned diet. Every oncologist I have ever had through all three of my journeys has spoken about the need to look after oneself through a good diet, keeping fit and exercise. We do our young people a disservice if we do not help them to lead better and healthier lives. I want to understand how the Minister is looking across Departments to make sure that this is addressed in the policies of the Department for Communities and Local Government and the Department for Transport through cycle paths, trim trails, and right across the piece so that we can all lead healthier lives.

I am pleased that the industry is responding by reducing adverts for children and so on, and I would like this to go further, but parents have a huge part to play in their children’s lives. We have a huge part to play in our own lives with regard to what we eat and how we make choices about whether we smoke or have that extra beer or extra pie. There is some self-responsibility involved. If the Minister will do his bit by helping to educate people a little more through public health information, I am sure that we will step up to the mark and do our bit as well.

I welcome the setting up of cancer alliances and the appointment of Cally Palmer, the excellent head of the cancer taskforce. Early diagnosis is fundamental, as the hon. Member for Scunthorpe pointed out, because it gives us better outcomes, but the Government must set out, with NHS England, how funding will be strategically allocated. For example, will we be able to use mobile diagnostics and molecular diagnostics? I note my interest as chair of the all-party parliamentary group on personalised medicine, and vice-chair of the cancer APPG and the breast cancer APPG. If we could see who would benefit from the use of drugs, we would stop waste. For example, only 20% of women with breast cancer would benefit from Herceptin. Will the Minister address the point about the use of innovative technologies raised by my hon. Friend the Member for Castle Point?

How can we utilise the workforce in a more strategic approach? Macmillan, Cancer Research UK and 20 other organisations have developed eight principles on this. We need a workforce that is fit for the future, with people who understand the changing landscape that we are dealing with. I welcome the £130 million put into radiotherapy machines, but I would like to know that we have the radiographers who can work those machines and optimise their use.

More of us survive living with and beyond cancer, but metastatic cancer, in particular, is a type that we need to learn more about. That brings me on to the use of data. The Teenage Cancer Trust would welcome clinical trials with young people. There is a lack of data on metastatic breast cancer.

Photo of Rebecca Harris Rebecca Harris Conservative, Castle Point

My mother-in-law passed away from secondary metastatic breast cancer after opportunities to diagnose her were missed. It has been brought to my attention that we do not keep very good records or data on metastasized breast cancer. The cancer pathway does not provide a specialist nurse for those with breast cancer, and we do not seem to provide a specialist nurse for those with metastasized breast cancer, either.

Photo of Jo Churchill Jo Churchill Conservative, Bury St Edmunds

I agree with my hon. Friend. People who are diagnosed with metastatic cancers—not only of the breast, but across the piece—feel like they are dropping through the cracks. They do not necessarily get a clinical nurse specialist, so that is another area for the specialist workforce to address. We need to make sure that we catch people on the journey, because it may be iterative. People may feel fit and well, but then find that they have to use the services again, so our approach needs to be flexible.

My hon. Friend has mentioned the importance of the ecosystem of research, hospitals and patients. My hon. Friend the Member for Crawley works hard with the Bloodwise charity, which is truly emblematic of an empowering organisation that works with the patient, clinician and researcher to help drive understanding. That is one way of giving UK plc a huge advantage. The hon. Member for Strangford has said that we need to look at the ecosystem, which is not just about cancer treatment at the end, but about researchers, universities, those brilliant students and staff whom we welcome from Europe and everyone in the pharmaceutical industry and charities working collaboratively to get the best outcome possible. That is how we will start to rise up the table and be as good as Sweden and other countries whose patients have truly fantastic outcomes.

Timely interventions can help recovery. I want to understand how recovery packages are being rolled out, because the issue of the workforce is critical.

David Tredinnick has mentioned alternative therapies, which can be useful, but this is a space in which charities can help people. Only this week, the Countryside Alliance Foundation took women who have received treatment fly-fishing. They find that the experience of being outside, doing something physical and enjoying nature gives them a huge sense of wellbeing. Personally, I do not think that it is a question of either/or; it is a question of joining them together.

Finally, I know that this is not the Minister’s area, but I would like him to take it back with him. I welcome the cancer drugs fund, but I am worried about those who benefit from combined treatments. Melanoma Focus has said that people on combined treatments may be disadvantaged, because not all of them will have access to the cancer drugs fund. I hope that the fund will be flexible and that the matter will be addressed.

Photo of Sharon Hodgson Sharon Hodgson Shadow Minister (Public Health) 4:33 pm, 8th December 2016

Like all other hon. Members who have spoken, I welcome this very important debate, which was secured by Mr Baron and others. Although he is, uncharacteristically, not in his place, for very important reasons—we all send him and his wife our very best wishes—I want to place on the record that this House and, indeed, the whole country owe him a huge debt of gratitude for all that he does on the issue and for his sterling leadership as chair of the all-party parliamentary group on cancer in aiding our work in fighting this terrible disease.

I thank my hon. Friend Nic Dakin, who opened the debate. Like me and several others, he is a chair of an all-party group on cancer; his group is on pancreatic cancer. He works tirelessly on this issue, and he chaired the “Britain against cancer” conference with aplomb this week. He set the scene today so well, and his knowledge and passion shone through.

I thank all hon. Members who have spoken in the debate: Henry Smith, my hon. Friend Jim Fitzpatrick, the hon. Members for Bosworth (David Tredinnick), for Strangford (Jim Shannon) and for Castle Point (Rebecca Harris)—the hon. Lady is also the chair of a cancer all-party group—Bob Blackman and my very good friend Jo Churchill, who is also vice-chair of the all-party group on breast cancer, of which I am a co-chair. They all made excellent contributions, and each and every one has made some important points about where we need to go next with the cancer strategy.

Much of the debate has focused on the report published by the all-party group on cancer, which looked at the progress made in implementing the cancer strategy one year on from its publication. The report makes many valid points and recommendations, and I look forward to hearing from the Minister on the specifics mentioned in it. The strategy can go a long way towards helping some of the estimated 2.5 million people living with cancer and the people who are diagnosed each year with cancer. The strategy, if implemented in full, could save 30,000 more lives per year by 2020.

That should be paired with the deeply worrying news that broke at the beginning of November that more than 130,000 patients a year have not been receiving cancer treatment on time, because cancer patients did not see a cancer specialist within the required 14 days. In some areas, the problem was so severe that more than 6,000 patients were forced to wait 104 days or more. In addition, our findings show that the Government met their 62-day target only once in the last 20 months. That should drive the Government to do more, and it is clear that we are seeing issues around the transformations already. That should not be knocked, and I am certainly not knocking it, but we must all continue to hold the Government to account where we can.

That is why in my contribution I want to touch on two areas: improvement in preventive measures that can help to reduce the occurrence of cancer, and the significant concerns that have recently been raised regarding the cancer workforce. We can all agree that prevention is key to addressing many health conditions, illnesses and diseases, and cancer is no different. As we have heard from several hon. Members in this debate, four in 10 cancers are preventable, and we should be doing much more to prevent cancers from developing, especially those that could have been prevented by lifestyle changes. Prevention was a central pillar of the cancer strategy, along with the five-year forward view.

The Minister is surely prepared for what I am going to say next, because I have said it to him often enough in my short time as the shadow Minister with responsibility for public health. It remains true, sadly. The false economy of cutting public health funding with no assessment of the ramifications of doing so on various aspects of our lives, or on other parts of the NHS and the wider health service, is seriously worrying. According to data collected by the Association of Directors of Public Health, smoking cessation services are expected to be reduced by 61% in 2016-17, with 5% of services completely decommissioned. For weight management support there will be a 52% reduction, with 12% being decommissioned. That is damning information when smoking and obesity are, as we have heard, two of the biggest preventable causes of cancer. We know that 100,000 people are dying each year from smoking-related diseases, including cancer.

It is right that the cancer strategy strongly recommended the introduction of a new tobacco control plan post haste and an ambitious plan for a smoke-free society by 2035, as has been outlined. We still have not seen the plan, despite being promised repeatedly over the last year that we would. I am sure that the Minister will give us further information on that in his response, and we all look forward to it. I hope that we see that plan sooner rather than later, and that hope has been echoed by several hon. Members from both sides of the House.

A continued delay will never be beneficial for our shared vision of a smoke-free society or for preventing cancer from happening. Another plan we have finally seen, although it has been considerably watered down, is the one for childhood obesity. After smoking, it is understood that obesity is the next biggest preventable cause of cancer. If we allow current trends to continue, there could be more than 670,000 additional cases of cancer by 2035. This completely goes against the vision set out in the cancer strategy. We saw some of the detail of the sugary drinks levy earlier this week, and it will be interesting to see how this develops in the months ahead, but I hope the Minister can outline a little bit more about what else he and his colleagues plan to do on obesity and its links to cancer.

As part of the cancer strategy, a review of the current workforce was called for so that we could fully understand the shortfalls—the areas of investment needed and the gaps in the training of new and existing NHS staff—and meet the ambitious and noble goals set out in the strategy. In my capacity as chair of the all-party group on ovarian cancer and co-chair of the all-party group on breast cancer, I along with colleagues from both sides of the House—some of them are in the Chamber, notably the hon. Member for Bury St Edmunds, who is a vice-chair of the all-party group on breast cancer—raised this at the beginning of the year with Health Education England, which is conducting the review. In our letter, we raised the need for immediate solutions to fill the specialist gaps in our cancer workforce, but also the need for a strategic, longer-term solution to be put in place.

The issue of the cancer workforce is an incredibly important one, especially given that Cancer Research UK warned over two weeks ago that pathology services in the UK were at a tipping point, and that the Royal College of Radiologists warned earlier in the year that 25% of NHS breast screening programmes were understaffed, with 13% of consultant breast radiologist posts left vacant, a figure that has doubled since 2010. That should spur on the Department to push ahead on the workforce issues that have been raised so often with Ministers.

Only this July, organisations such as Macmillan and Cancer Research UK joined with other organisations to call for a set of principles to be taken up by the Government, including a review of the current and future workforce. The Minister should also heed the words of Dr Harpal Kumar, who during an oral evidence session for the inquiry by the all-party group on cancer into progress on the implementation of the review, said that workforce issues remained “significant and severe”.

The ageing population, which means that more and more people could be diagnosed with cancer, and the much welcomed push to improve earlier diagnosis of cancer mean that pressures on the workforce will rise if the right support is not found, especially given the projection that 500,000 Britons will be diagnosed with cancer by 2035. That should remain at the forefront of the Minister’s mind, and in the minds of his officials and those who deal with workforce capacity.

It is clear that investment is failing to keep up with demand. That was raised in the cancer strategy, which called on NHS England to invest to unlock the extra capacity we need to meet the higher levels of cancer testing. The Opposition support the calls made only a few short months ago by the national cancer advisory group for NHS England’s cancer transformation board to prioritise a focus on the cancer workforce in the coming months. I hope the Minister will ensure that that happens, and that when we come back from the Christmas recess, we will start to see the much needed progress that has been called for.

In conclusion, the work that has started on the transformative programme is to be welcomed. It is a large task to undertake, yet the Government will not be allowed to sit back; I know that they and the Minister will not do so. It is up to all of us in this House, along with many people outside this place, to continue to do all we can to hold the Minister and the Government to account on what are such important and personal matters for all of us who have been affected by cancer, be it personally or through family and friends. We must all be critical friends in this drive to fight off cancer once and for all. We all agree that cancer should be at the top of our list of health priorities. It is so destructive, and, very sadly, it will affect us all in some way. We must ensure that we get this right, because we cannot afford to get it wrong.

Photo of David Mowat David Mowat The Parliamentary Under-Secretary of State for Health 4:45 pm, 8th December 2016

It is a pleasure to respond to this really important debate. I, too, would like to start by paying tribute to my hon. Friend Mr Baron. I wish him and his wife the best in the journey they are on. I have been in this job a few months now and he has been extremely diligent in coming to see me and talking to me to ensure that cancer is, as it should be, right at the top of my radar screen. He also organised, with Nic Dakin, an excellent Britain Against Cancer event on Tuesday, which was attended by 400 people.

What has happened to my hon. Friend and his family reinforces what we all know: cancer affects us all. One person is diagnosed with cancer every two minutes. During the course of this debate, 100 people will have received a cancer diagnosis in England. That shows how important the issue is and how we need to make progress. There are a lot of chairs of all-party groups in the Chamber and all Members have spoken from a lot of personal knowledge and experience. I will not have time to respond in detail to every point raised.

I will start by making a generic point that this debate and others like it remind us that our health service is not principally about bricks and mortar. Survival rates are far more important. The hon. Member for Scunthorpe gave a very fair and reasonable introduction to the debate in terms of what the priorities ought to be. On a typical day, when I walk across the Chamber and the Lobby about two Members will talk to me about their concerns in relation to some aspect of hospital reconfiguration or A&E downgrades and so on. Those are fair concerns, which we all need to be concerned about in our own patches. However, I am not accosted by Members saying they are concerned that their clinical commissioning group has lower than average survival rates. Over time, we need to learn to think about them, too. We have not talked about this in any detail, but the Government have published four indicators that rank every clinical commissioning group in the country. The news was not brilliant when it came out, but that transparency is very powerful. We all ought to get used to this being as important to our constituents—arguably more so—than some of the bricks and mortar concerns that we tend to spend our time on.

As I said, the hon. Member for Scunthorpe was fair. I think the phrase he used was that a lot has been done, but that more needs to happen. I think all Members would probably agree with that. A lot of good things are being done. Our one-year, five-year and 10-year survival rates are all improving for all cancer types. What we have learnt in this debate is that we talk about aggregate cancer survival rates, but there are very large variabilities. My hon. Friend Rebecca Harris made a very good point with regard to brain tumours having a 19% five-year survival rate, against a target for all cancer types of 70%. That is absolutely true. One of the themes of the debate has been that we are making less progress on some rarer cancer types and we need to do better.

We are making progress on early diagnosis. There are eight cancer targets and we are now meeting seven of them. As Members have pointed out, however, not least Mrs Hodgson who speaks for the Opposition, one very important cancer target is not being met: the 62-day target. The strategy needs to drive and develop that and we need to work harder.

We have been reminded that, in spite of the progress made, we are not, by any means, the best in the world at this. We are not even the best in Europe. Indeed, there is evidence that we are below the average in Europe for most cancer types. It is fair to say that we are catching up in many cases but not in all. In particular, we are not closing the gap with the rest of Europe on lung cancer, which several hon. Members have talked about. We need to be aware of that and focus on it.

As I said on Tuesday at the conference, when I started this role I was struck by the discovery that we had had five cancer strategies in the last 20 years. We can deduce two things from that: first, this is a cross-party issue—all Governments do cancer strategies—and secondly, and more importantly, we do not need another strategy. We do not need more ideas about what we need to do; instead, we need to deliver, with a strong focus, the 96 points set out in the cancer strategy and drive them through over its final four years. We need to make that happen.

The hon. Member for Washington and Sunderland West used a very good phrase when she said we must be “critical friends” in this process, and so we must. Every Member, despite their having different perspectives, needs to support Cally and her team in driving this strategy through. My role is to ensure clear accountability around what is being done, by when and by whom, and to ensure that we have milestones, targets and deliverables. Frankly, though, we have some way to go before we get that as clear as it needs to be. My hon. Friend the Member for Basildon and Billericay has pointed out to me several times that we need to focus on output measures, not on process and input measures, and that, too, is true. It is something we could make work better.

In the strategy, there are six programmes of work, including on prevention, early diagnoses, commissioning, high-quality modern services and, importantly, patient experience and living well beyond cancer. My hon. Friend David Tredinnick made some very good points about the overall approach. This is not just a technical matter; we need to get better on patient experience and living beyond cancer. I spoke at an event organised by the all-party group on ovarian cancer. At that event, I met a lady who had been given a prognosis of six months to live, and she told me that she had no support in terms of an ongoing dialogue with a clinical nurse—that clearly is a failure and completely inadequate. My hon. Friend Jo Churchill talked about clinical nurses. Our response, through the strategy, is to put in place cancer recovery packages for everyone with a diagnosis. That is important, although the point was well made about the staffing implications. We need to address that as well, and we will.

A point was made about rarer cancers, particularly brain and blood cancers. We need to make more progress more quickly on research, as we do not have as many answers on those cancers as on others. I am talking not just about research by the Government, but about Cancer Research UK and the other charities. As several colleagues said, the voluntary sector is extremely important, and of course it is. Macmillan, Marie Curie, Cancer Research UK, plus the hundreds of small charities in our constituencies, make a big difference.

We also know that the workforce matters. This is a consistent stream in the strategy and something that it needs to get right.

I was asked by the hon. Member for Scunthorpe in his opening comments how we are holding Health Education England to account on the workforce requirements. I meet Professor Cummings regularly, as does my right hon. Friend the Secretary of State, not just on this aspect of the workforce but on other related responsibilities, such as increasing the number of GPs working in primary practice.

We need to make progress quickly on certain issues. We know that we do not have enough radiographers, for example. The point was made that there is no point in having linear accelerators if we do not have people to work them. That is right, but let us at least be grateful for, and pleased about, the fact that we are now rolling out the linear accelerators that Simon Stevens announced this week at 15 locations in all parts of our country. Endoscopy has been a real area of shortage, and it has been called out as a specific work stream within the 96 aspects of the cancer strategy. We will have 200 extra endoscopists trained by 2020, 40 of whom are already in place, and we will continue to build on that. Workforce generally is of massive importance.

I have not answered all the questions and points raised in the debate. I have not so far talked about the tobacco control plan. Several Members mentioned this issue. All I can say now, I am afraid, is that it will happen soon. That is the answer. The relevant Minister has informed me that she is determined to get this right, and I guess we can all agree that getting it right is indeed important. I am probably as disappointed as some Members that the process of the strategy is not as developed as we would like, but let me say that we are doing a lot on smoking by placing explicit images on packages and that type of thing. We are doing more than many other countries on that, and we should not forget it. It is not all about strategy.

I am about to finish, but I will say that we need to come back to this debate in a year’s time. I hope that the Backbench Business Committee and the chairmen of all the cancer all-party groups will make sure that we have a debate in this place every year about the cancer strategy, so that the Government can be held to account by critical friends. We all need to make sure that we focus on getting this strategy delivered. We absolutely do not need another strategy until 2020, and we will have made massive potential steps forward if we achieve what we have set out.

Photo of David Tredinnick David Tredinnick Conservative, Bosworth

My hon. Friend tempts me by saying that he is about to sit down with three minutes to go. May I come to see him to discuss the announcement of the £200 million for support services?

Photo of David Mowat David Mowat The Parliamentary Under-Secretary of State for Health

I would be happy to speak to my hon. Friend about that. He made the point that there was no investment in a number of areas. I was briefed that we are putting in £5 million to the two Haven centres that are being put together. I would be happy to speak to my hon. Friend about the £200 million, although I did not agree with every point he made. At this point, I will sit down.

Photo of Nicholas Dakin Nicholas Dakin Opposition Whip (Commons) 4:58 pm, 8th December 2016

I thank the Minister for his response to what he was right to say has been a very good debate among critical friends, to steal the excellent point made by my hon. Friend Mrs Hodgson. My hon. Friend Jim Fitzpatrick and the hon. Members for Bosworth (David Tredinnick) and for Harrow East (Bob Blackman) all highlighted the importance of public health measures, and particularly smoking cessation campaigns, in preventing cancer. We are reassured that we will have the plan “soon”.

Henry Smith, who is the chair of the all-party group on blood cancer, spoke movingly from personal experience about how blood cancers thunder into people’s lives unexpectedly. Rebecca Harris, who is chair of the all-party group on brain tumours, echoed that in much that she said about the need to do something about these cancers that are stuck. She reminded us that brain cancer is the biggest killer of young people, and she was right to say that although the cancer strategy is a strong step in the right direction, we need to do more. Jim Shannon echoed the point that we need to do even better. As the hon. Member for Bosworth said, if we have moved from 60% to 70%, why not to 80%? Jo Churchill, a cancer survivor herself, posed a series of very challenging questions—exactly the sort of questions that should drive better performance as we move forward.

We are at a pivotal moment for the cancer services. I know that many people will be heartened by the Minister’s comments both today and on Tuesday, at the Britain Against Cancer event. He was right to say that it is easy to write strategies, but now is the time to deliver.

Question put and agreed to.


That this House
has considered the Cancer Strategy one year on.