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Cancer Targets — [Mr Gary Streeter in the Chair]

– in Westminster Hall at 11:35 am on 1st May 2018.

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[Mr Gary Streeter in the Chair]

Photo of John Baron John Baron Conservative, Basildon and Billericay 2:30 pm, 1st May 2018

I beg to move,

That this House
has considered NHS cancer targets.

I thank Mr Speaker for granting this important debate, and I thank you, Mr Streeter, for chairing it and the Minister for taking time out of his busy schedule to address it.

The matters I will raise today, as briefly as possible, are matters I have raised throughout my nine years at the helm of the all-party parliamentary group on cancer. As I near the end of my chairmanship, I thank all those parliamentarians, and the wider cancer community, who have supported and continue to support the group. They have been great stalwarts; the group has achieved much and has much to achieve. I look forward to remaining involved, but at the same time I look forward to handing over the reins.

Despite the fact that, when in government, both main parties have highlighted improving survival rates and supported process targets as a means of driving change, it remains an inconvenient truth that cancer survival rates in England and, indeed, the rest of the United Kingdom continue to lag well behind the international average. What is more, there is only limited evidence that we are catching up. In 2009, the Department of Health estimated that we could save an extra 10,000 lives a year if we matched European average survival rates. In 2013, the OECD confirmed that our survival rates rank near the bottom compared with other major economies, and for some cancer types only Poland and Ireland fare worse.

Of course, Health Ministers are right to point out that cancer survival rates continue to improve. That is welcome news, but it is not the full story. As our survival rates have improved, so have those of other countries, and there is very little evidence of our closing the gap with international averages, despite the considerable increases in health spending in recent decades. The major inquiry by the APPG on cancer in 2009 uncovered the main reason our survival rates are so far behind international averages. It is not that the NHS is worse at treating cancer—once cancer is detected, NHS treatment generally bears up as strongly as that of other healthcare systems—but that it is not as good at catching cancers in the early stages when treatment has the best chances of success. Late diagnosis, therefore, lies behind our comparatively poor survival rates, and addressing that is the key to improving our cancer performance. Early diagnosis is cancer’s magic key.

So how can we best achieve it? Since the publication of our 2009 report, we as an all-party group and the wider cancer community have come together and successfully campaigned for a one-year cancer survival rate indicator to be built into the DNA of the NHS, especially at a local level. Clinical commissioning groups are now held accountable for their local survival rates through both the delivery dashboard and the Ofsted-style scores.

Photo of Jim Shannon Jim Shannon Shadow DUP Spokesperson (Human Rights), Shadow DUP Spokesperson (Health)

I congratulate the hon. Gentleman: we all know the hard work he does through the APPG and his personal passion for the subject. It is important to put that on the record, because we know why he is here. I have apologised to him, and I apologise to you, Mr Streeter, because I cannot stay. I have a meeting with a Minister at 3 o’clock, so unfortunately I cannot make the contribution that I would have liked to have made. I am sure that the Minister is disappointed, but none the less he will hear from me again in the near future.

Is Mr Baron aware that the target for 95% of patients with an urgent referral to wait no longer than 62 days for first treatment has not been met at all in the past year and, further, that the target for 98% of patients to receive first treatment within 31 days of a cancer diagnosis has also not been met in any of the last four quarters? Does he share my concern and, I am sure, that of the Minister?

Photo of John Baron John Baron Conservative, Basildon and Billericay

I thank the hon. Gentleman for his kind words. I am aware of those statistics, and I will come to the 62-day target specifically later in my address. He is right to say that many CCGs and cancer alliances are not close to achieving many of those targets. That is obviously a problem when treating cancer, but it highlights a bigger issue: we should be focusing on outcome indicators rather than process targets as a means of encouraging earlier diagnosis. I will address his point specifically in a moment.

We tried very hard to get the one-year survival rates into the DNA of the NHS. The Government listened, and we now have CCGs being held accountable for their one-year survival rates, which is good news. The logic is simple: earlier diagnosis makes for better survival rates, so by holding CCGs to account for their one-year figures and, in particular, the actual outcomes, we encourage the NHS to promote earlier diagnosis and therefore improve detection.

A key advantage of focusing on outcome measures is that it gives the local NHS the flexibility to design initiatives tailored to their own populations to improve outcomes. CCGs can therefore choose whether to widen screening programmes, promote better awareness of symptoms, establish better diagnostic capabilities in primary care, embrace better technology or perhaps improve GP referral routes—any or all of those, in combination—to try to promote earlier diagnosis, which in turn will improve the one-year cancer survival rate figures.

Rather than the centre imposing a one-size-fits-all policy, the local NHS has been given the freedom to respond to and focus on local priorities, whether that be lung cancer in the case of former mining communities or persuading reticent populations to attend screening appointments. As an all-party group we try to do our bit. Each summer, the group hosts a parliamentary reception to celebrate with the 20 or so CCGs that have most improved their one-year survival rates. Successive cancer Ministers have supported that in the past, including the incumbent.

There is strong evidence, however, that that outcome indicator is being sidelined by hard-pressed CCG managements, who are focused on those process targets that are connected to funding. If the process targets are missed, there is a cost; if the one-year figures are missed, there is not. In recent decades, the NHS has been beset by numerous process targets that, instead of measuring the success of treatment, measure the performance against process benchmarks, such as A&E waiting times.

Photo of Jim Cunningham Jim Cunningham Labour, Coventry South

I pay tribute to the hon. Gentleman, because I know he has a strong interest in this issue for a number of reasons—as we all have, because cancer in one form or another touches nearly every family in Britain. I agree with him that it is the outcomes that matter, not the input. I wonder whether the targets are in the wrong place; I may be wrong, and the hon. Gentleman knows more about it than I do, but I think he has made an important point. The problem seems to be how to get the NHS to implement that.

Photo of John Baron John Baron Conservative, Basildon and Billericay

I completely agree. The problem as I understand it is that, according to the House of Commons Library, there are something like nine process targets focused on cancer alone. Briefly, it is an inconvenient truth that, if we look back over the past 20 or 30 years, we will see that the NHS has been beset by process targets from both sides and for the best of reasons. The bottom line is that we have not caught up with international averages in any meaningful way over those 20 to 30 years, so we must start to question the efficacy of those process targets when what we are trying to do is to improve survival rates. If we get the NHS focused on one-year survival rates, it should look at the journey as a whole, not just a small part of it, in trying to promote initiatives to encourage earlier diagnosis, which at the end of the day is what we all have to do if we are to improve survival rates.

Photo of Karen Lee Karen Lee Shadow Minister (Home Office) (Fire)

I am the mother of somebody who died of breast cancer and I would argue that this is about the lived experience. It is not just about survival; it is also about the journey—getting there. If care is not adequate or good enough along the way, whether somebody survives or not—well, it is better to survive, of course, but I would argue that this is absolutely about the journey. Targets are meaningless if they are not about people and their lived experience.

Photo of John Baron John Baron Conservative, Basildon and Billericay

I completely agree. My worry about targets is that they focus on a very small, specific part of the journey when we should be talking about the journey as a whole. What I have not mentioned so far is that it was not just the one-year figures but the five-year figures that we were arguing for. We have to take a longer view of the journey in order to ensure that we take into account all aspects of it, including the support, the surround sound—the way of living—and so on. We have to ensure that those who survive receive enough supported, but my central point is that if we really are intent on encouraging earlier diagnosis, the process targets have been too blunt a weapon. We all love them. Politicians love them. Both sides love them, and the Opposition can hit the Government with them if they are missed. It is a short-term approach. In reality, they have not improved survival rates to the point where we are catching up with international averages, and that is the key problem.

Photo of Philippa Whitford Philippa Whitford Shadow SNP Spokesperson (Health and Social Care)

I echo the hon. Gentleman’s concern about process targets being just waiting times, particularly when we know that the wait for a patient to get up the courage even to go to see their GP will often be much longer than the wait on the pathway. Does he share my concern about not having a focus on the clinical evidence of what treatment should be? My concern about leaving everything to CCGs to decide is that we are not then sharing what we know to be the best way to treat any particular cancer. We need clinical standards that are also measured.

Photo of John Baron John Baron Conservative, Basildon and Billericay

I have a lot of sympathy for what the hon. Lady says, and that is why I think that cancer alliances have a decent role to play. They can take more of an overview and more responsibility for ensuring that best practice spreads and is learned from, but they can also take more of a role when it comes to clinical evidence in relation to treating cancer. My suggestion to the hon. Lady is this: if we get the NHS properly focused on improving its one-year figures and, therefore, its five-year figures, it will come closer to embracing the journey as a whole and coming up with initiatives, particularly at primary care level, that are designed to encourage earlier diagnosis. I fully accept that that is not the only answer—it is about supporting people and so on—but at the end of the day we are using blunt weapons to try to improve cancer survival rates, and the evidence clearly shows that we are not succeeding.

I will make some progress, but I will be happy to take more interventions later. In recent decades, the NHS has been beset by numerous process targets, as we have just discussed. Those have a role to play. It would be too revolutionary for me to stand here and say that we should discard them all and just bring in the one-year figures. I think that that would be too much for the NHS to grasp, but I do believe that process targets are too blunt a weapon. They offer information without context and, in my view, can hinder rather than help access to good treatment, especially when financial flows are linked to process targets, which has been the hallmark of our NHS since 1997. What is more, those targets, being very ambitious, have a tendency not to be met—a point made by Jim Shannon—except in the very best of circumstances. They can easily become, as I have suggested, a political football between parties eager to score short-term points when in reality a longer-term approach is required. All sides are guilty of that.

Cancer has been no stranger to process targets. As I have mentioned, the House of Commons Library suggests that no fewer than nine process targets currently apply to cancer, most notably the two-week wait to see a specialist after a referral and the 62-day wait from urgent referral to first definitive treatment. Process targets, as I have suggested, can pose a particular problem when the NHS’s performance against them is used as a metric to control financial flows, which tends to skew medical priorities. Such targets are only part of the journey when trying to improve one-year survival rates, yet CCGs, although held accountable for outcome measures, in practice follow process targets, because they are the key to unlocking extra funds. That is one of the key issues that we need to explore further in the months and years ahead. I am talking about the fact that process targets account for only part of the journey when we need a longer term view.

I also suggest that process targets are not the best means of helping when it comes to rarer and less survivable cancers, which for too long have been the poor cousins in the cancer community. Rarer and less survivable cancers often fall between the cracks of process targets. Data on those cancers is not used routinely in much of the NHS. That encourages the NHS to go for the low-hanging fruit of the major cancers. That has to change. Given that rarer cancers account for more than half of cancer cases, serious improvements in cancer survival will not be possible unless rarer and less survivable cancers are included. Outcome measures have the advantage of encouraging their inclusion when seeking to catch up with average international survival rates.

The all-party group’s most recent report, launched at the Britain Against Cancer conference in December, highlighted an example of how process targets can act against patients. In 2016, as I think all hon. Members in the Chamber will be aware, NHS England announced £200 million of transformation funding, intended to help the newly formed cancer alliances to achieve the standards set out in the five-year cancer strategy to 2020, and bids were invited. This should be straightforward. An extra £200 million is coming in and is being handed over by the Government to NHS England. The money should be going where it is most needed—to help cancer services at the front line to deliver on the cancer strategy.

However, after the bidding process closed, a requirement for good performance against the 62-day target was introduced retrospectively. That was after the deadline—by some weeks, if not months. It resulted in multiple alliances whose performance was not deemed good enough not receiving their expected funding allocation. Oral and written evidence was taken by and submitted to the all-party group last autumn. I see members of the group in the Chamber. For those who arrived late, I point out that I have thanked the members for their help and stalwart support over the years. The oral and written evidence given to the group when we were conducting our inquiry suggested that the retrospective application of the 62-day condition was causing real problems at the frontline. We heard in effect a cry for help from those at the frontline of our cancer services. Our December report, as the Minister will be fully aware, called for a breaking of the link between the 62-day target and access to the transformation funds. Let us break that link and get the transformation funding down to the frontline, where it is needed to help to implement the cancer strategy.

It is an iniquitous situation, as the conditionality on process targets prior to funding release means that high-performing alliances receive even more money, while those that are struggling and could therefore most benefit from the extra investment do not receive the extra support. That is against the whole spirit of transformation funding.

Photo of Daniel Poulter Daniel Poulter Conservative, Central Suffolk and North Ipswich

I congratulate my hon. Friend on securing the debate and thank him for all that he has done to raise these important issues consistently during his time in the House. I, too, must leave a little before the end of the debate, so please accept my apologies, Mr Streeter. With regard to funding, notwithstanding the fund that my hon. Friend has mentioned, NHS core funding often tends to be diverted to prop up the acute sector during winter crises; that happens year after year. We are now missing cancer targets, whatever we think of them—they have ceased to be meaningful to many trusts at local level. Does he therefore agree that, if we are to make a difference, we must ensure that more of the money from the core NHS budget goes to community services and cancer services?

Photo of John Baron John Baron Conservative, Basildon and Billericay

I broadly agree. Although a system as big as the NHS must always be able to respond to short-term emergencies, such as the winter crisis, longer term thinking is needed to address key issues such as cancer survival. At the moment we have an absence of long-term thinking, let alone long-term funding, which is harming patients to the extent that we are not focusing on outcomes. In 2009 the then Department of Health’s own figures showed that 10,000 lives were needlessly lost because we were not meeting European averages for survival rates. I agree that we need longer term thinking, and that is where outcome indicators, such as one-year and five-year cancer survival rates, would encourage not just long-term thinking, but long-term funding.

Photo of Karen Lee Karen Lee Shadow Minister (Home Office) (Fire)

That is a problem right across the NHS. We need to take the NHS out of the political arena. The absolute bottom line is that we need a proper, long-term strategy.

Photo of John Baron John Baron Conservative, Basildon and Billericay

I thank the hon. Lady for her support. I have been non-partisan on this matter, as I have been as chairman of the all-party group. Both sides have been guilty of trying to score political points on the back of process targets, because no Government have met them all in their entirety; we play this short-term political game when in reality what we need to do is, as best as possible, take the NHS out of politics and encourage long-term thinking. The best approach, at least with regard to cancer, would be to get the NHS to focus on those one-year and five-year survival rates. We could then stand back and say, “You are the medical experts and we are the politicians. We will hold you accountable, but use your expertise now to come up with the best plans to improve your one-year and five-year figures.” That would certainly encourage longer term thinking and funding.

I am conscious that other hon. Members want to contribute, so I will not bore everyone with the ins and outs of the all-party group’s efforts to encourage the Government to break the link between the 62 days and the transformation funding, because discussions are still ongoing. However, I will share with the House the fact that I raised the issue at Prime Minister’s questions back in December. During a positive, subsequent meeting in March, the Prime Minister agreed that all transformation funding should be released immediately, provided that relevant cancer alliances promised to produce a 62-day plan—the promise is the important thing; they did not have to produce them.

I am now in discussions with officials from No. 10 and the DHSC, because the system has been slow in following through what was agreed at that meeting. Following my further question at Prime Minister’s questions last Wednesday, the Prime Minister has agreed to meet me again, should we continue to make insufficient progress. Negotiations are now in train and I hope that we can get the funding released as quickly as possible, without waiting for the alliances to actually hit the 62-day target. The Prime Minister clearly said that she wants the transformation funding released on the promise that they will produce a plan to hit the 62-day target.

In the long term, the NHS needs to rebalance its focus away from process targets in favour of outcome indicators, such as the one-year cancer survival rates, that best help patients. If outcome measures are good and being hit, it follows that the processes will also be good; one cannot have good outcomes if there are not good processes. Patients will be seen and diagnosed in a timely fashion appropriate to their illness. These outcome measures will also have the benefit of allowing the NHS to design services and pathways flexibly, and without the straitjacket imposed by blunt process targets. That is the key issue here: focusing on the outcomes encourages the NHS at the frontline to devise ways of encouraging earlier diagnosis, including better awareness campaigns, wider screening uptake, better GP referral routes and better diagnostics. The NHS is encouraged to make those decisions at the frontline in order to drive forward earlier diagnosis.

Photo of Gregory Campbell Gregory Campbell Shadow DUP Spokesperson (International Development), Shadow DUP Spokesperson (Cabinet Office)

I congratulate the hon. Gentleman on securing the debate and on the excellent work that he has done, not only with the all-party parliamentary group, but on a wide range of events over recent years. On the transformative nature of events, does he agree that we need to see international best practice, which he alluded to earlier, employed in the United Kingdom to ensure that cancer sufferers here, and their friends and families, can see the benefits?

Photo of John Baron John Baron Conservative, Basildon and Billericay

I completely agree. Our inquiry into cancer inequalities in 2009 found that the NHS is as good as any other healthcare system internationally, if not better, at treating cancer once it is detected; the problem is that we do not detect it early enough and we never catch up. The line of international averages compared with UK averages shows that we are always behind, and there is little evidence that we are catching up. We get behind at that early one-year point, because we are not diagnosing as early as other healthcare systems, and not matter how good our treatment, we do not catch up. That is how we are losing those tens of thousands of lives, because we are not matching the European averages for survival rates.

Photo of Paul Girvan Paul Girvan Shadow DUP Spokesperson (Education), Liberal Democrat Lords Spokesperson (Transport), Shadow DUP Spokesperson (Transport)

Having been through treatment in the past, I appreciate that early diagnosis can, if dealt with correctly, save an absolute fortune. Everyone has heard the saying, “A stitch in time saves nine.” Unfortunately, leaving it too late, rather than intervening early, and having to treat the symptoms as they progress costs the health system a lot more money.

Photo of John Baron John Baron Conservative, Basildon and Billericay

I completely agree. I have not mentioned that aspect, because I have been focusing on patients, but the hon. Gentleman is absolutely right. If we were to diagnose earlier, the NHS could save a lot of money. We all know that, by and large, the more invasive the treatment, the more costly. Given how large the NHS is, too few health economists are trying to quantify this. When I ask my local CCG or cancer alliance, they do not know the cost savings associated with earlier diagnosis. That is a great shame.

Photo of Daniel Poulter Daniel Poulter Conservative, Central Suffolk and North Ipswich

My hon. Friend makes a good point. When we talk about quality-adjusted life years—there are other measures of the cost-benefits and cost-efficiency of treatments—it seems extraordinary that a more holistic view is not taken, particularly looking at quality-of-life indicators in cancer treatment. I am sure that he will want to press the Minister on that.

Photo of John Baron John Baron Conservative, Basildon and Billericay

I am sure that the Minister has taken that on board and I look forward to his comments. It goes without saying that the earlier we diagnose, the more money we save, which could then be ploughed back into frontline cancer services. We need to try to quantify that, and we are nowhere close to doing that at the moment.

That is why, in conclusion, I come back to the point that we need to take a longer term view on our plans for cancer care—longer term funding and thinking. Process targets actually act against that, because the focus is on specific issues, which can skew priorities, particularly when they are associated with funding. In the end, that has proven not to be in the best interests of patients, given our failure to catch up with international averages. Outcome measures retain the focus on accountability, which quite rightly governs our health service. They provide the best of both worlds: they encourage long-term thinking and long-term funding, while at the same time we as politicians rightly have to hold the NHS accountable. We are talking about £115 billion to £120 billion of taxpayers’ money. We have to ensure that there is the element of accountability in the system, but that is where outcome indicators could be very helpful.

One cannot cover everything in a debate such as this. I am glad that the HPV issue will be given a proper airing in tomorrow’s debate. I think that the vaccine should be extended to boys. I also think that the big issue of prevention is important. Healthier lifestyles make for lower cancer risks, but this specific debate is about targets. It has been a helpful debate and I thank everyone for their interventions. I look forward to other contributions and to the Minister’s comments at the conclusion.

Photo of Karen Lee Karen Lee Shadow Minister (Home Office) (Fire) 3:00 pm, 1st May 2018

I do not want to repeat a lot of what Mr Baron has said because he has already said some of what I was going to say. I am here because when I was elected I was asked by Breast Cancer Now to be an ambassador and I readily agreed. I will highlight a few things on its behalf.

Breast Cancer Now says that, although some CCGs meet diagnosis and detection targets, there are national geographical inequalities in the provision of care, and diagnosis and detection are taking priority over treatment for secondary breast cancer, which is an issue. Transformation funding has been mentioned, and Breast Cancer Now feels that such funding must be decoupled from waiting time targets immediately.

My CCG is failing to hit the targets, which means it does not get the funding. If it is failing to meet the targets, how will withholding the money make things any better? I want the Government to tell us how that makes things any better. I understand about targets and measures, but how does not giving CCGs money to treat people properly make things any better?

NHS cancer targets have tended to focus on early detection and diagnosis, which means there is less focus and resource allocated to supporting people after they have finished treatment and are living with secondary cancers. One in four people find that the end of their treatment is the hardest part and they do not always have access to a clinical nurse specialist. My daughter did not. Things moved fast for my daughter. She was diagnosed and died within 13 months. She was just 35 and she left a husband and three children behind. To get her back into hospital was an absolute nightmare. I knew all the right things to say to get her into hospital and I finally managed it, but the support was not there. People try and do their best, but the support was not right and it was not good enough. The treatment for secondary breast cancer is not good enough and that really needs to be looked at.

Every cancer patient coming to the end of their treatment should have a recovery package. A clearer picture of progress on the availability of health and wellbeing events for people living with and beyond breast cancer across England is urgently needed. The Government, as the agency that ultimately decides how our NHS is run, must deliver on that and answer for that.

I was asked to mention the collection of data and access to clinical nurse specialists, because there has been no progress. Breast Cancer Care’s 2015 research showed that only a third of NHS trusts were collecting full data on secondary breast cancer, and three quarters of NHS trusts and health boards say there is not enough specialist nursing care available. People with secondary breast cancer feel they are second rate. Lynsey used to say that. She said, “It was all right, Mum, when I was having chemo and radiotherapy and everybody was buzzing round me, but now there is nothing. There is no support at all.”

I spoke on Breast Cancer Now’s 2050 vision in Parliament a couple of months ago. If we all act now, by 2050 everybody who develops breast cancer will live, and I really hope that that happens.

Photo of John Baron John Baron Conservative, Basildon and Billericay

The first point that the hon. Lady made about the iniquitous position that many CCGs now find themselves in is a strong one. The Government have given transformation funding of £200 million to NHS England, but a lot of it is sitting there when it is desperately needed, particularly by those that need to do a lot of catching up. It was not meant to be withheld in such a fashion. It is iniquitous also that the 62 days was retrospectively applied.

Photo of Gary Streeter Gary Streeter Conservative, South West Devon

The hon. Lady spoke most powerfully.

Photo of Nicholas Dakin Nicholas Dakin Opposition Whip (Commons) 3:04 pm, 1st May 2018

It is a real pleasure to serve under your chairmanship, Mr Streeter. I congratulate Mr Baron on securing this debate. It is a good opportunity for us in this House to recognise the excellent work and service that he has given in leading the all-party group over nine years. I am pleased that he is still in post. I suspect he will continue to serve the cancer community for ever, so we are grateful for that. I pay tribute to the courageous personal testament of my hon. Friend Karen Lee and her role as a breast cancer champion, particularly in highlighting the need to do better on secondary breast cancer, which everybody wants us to deal with much better.

For all but one month since April 2014, the 62-day target for patients to have received their first treatment since initial referral has been missed, and 81 trusts failed to meet the 85% target last year. When we do not meet targets, we let patients down in one way or another. As has been said, the target is not perfect. It does, however, set our sights on what we are trying to achieve: securing treatments, reducing waiting lists and improving outcomes. The target is important because it helps to measure the patient pathway. It gives us a better understanding of what patients are going through and offers the opportunity to prevent unnecessarily long waits.

Waiting can be a very anxious time. While treatment is on hold, life carries on. Bills still need to be paid, the kids still need picking up from school and jobs still need to be done. Life does not stop, and cancer does not stop, so it is important that we have the 62-day target. It performs a function, but it is not everything. As the hon. Member for Basildon and Billericay has said, we need to move to outcome measures such as the one-year survival rate, or indeed the five-year survival rate. He spoke most eloquently about how that has the potential to change behaviours in a positive way. However, unless we have targets, we do not know how they impact on behaviours; they are always imperfect, but they are useful measures.

As the all-party group’s December report said, we need to break the link between the 62-day performance target and access to transformation funds. As the exchange between my hon. Friend the Member for Lincoln and the hon. Member for Basildon and Billericay demonstrates, unfortunately that can have iniquitous consequences and the areas that most need support get least support. Of course, the support needs to go where it can be most effective. I think we all have confidence in the Minister. Like many other people who work to help tackle cancer up and down the land and for whom we can have only the greatest admiration, he is fighting every day to try to make things better for cancer patients, cancer survivors and their families.

As the hon. Member for Basildon and Billericay has said, early diagnosis is the key. It is the magic wand, the holy grail, the silver button, but if it was easy to achieve it would have been achieved by now. Rarer cancers make up more than 50% of cancer cases, so we need to provide transformation funding for cancer alliances so that it can help drive early diagnosis and achieve NHS targets. It is crucial that the less survivable cancers benefit from allocation of transformation funding. The funding must continue to be used to tackle hard-to-treat cancers such as pancreatic cancer. I speak as chair of the all-party group on pancreatic cancer. It has the lowest survival rates of the 20 most common cancers. Its one-year survival rate is sadly still 24%, far behind the 75% one-year survival target set in the cancer strategy. So there is still a long way to go and we know that it is a massive challenge. Things are moving in the right direction, and we are right to be impatient, but we need to use our impatience to help us to work with the Government to bring about the positive changes we all want.

As an example of what is being done to tackle pancreatic cancer, and the need to get the transformation funding in the right place, Mr Keith Roberts and his team in Birmingham have created a faster pathway to surgery for pancreatic cancer patients by redesigning services. With the fast-track pathway, a patient receives surgery for a tumour quickly, avoiding the need for a separate procedure for jaundice. A patient not on the fast-track pathway would have a procedure for jaundice followed by a separate surgery, which could take two months on average. Going straight to resection cuts out the delay. At present, surgery is the only treatment that can save lives, yet fewer than one in 10 people with pancreatic cancer have access to it. The pathway is achieved in part through the use of a dedicated clinical nurse specialist, who is appointed to support and prepare patients to receive surgery within 16 days of referral. The results of the fast-track surgery pathway have been quite compelling. It has increased the number of patients whose surgery was successful by 22%, and patients received surgery within 16 days as opposed to two months from referral. It has saved the NHS an average of £3,200 per patient, and we would expect those savings to have reached £100,000 within a year.

The initial fast-track findings were so successful that the NICE guidelines on pancreatic cancer, which were published in February, now recommend the fast-track pathway, unless the person is taking part in a clinical trial requiring other treatment. However, despite all those benefits, the savings to the NHS and the fact that the pathway is recommended by NICE, Mr. Roberts’ team is still struggling to secure funding for a full-time clinical nurse specialist, which means it has one fewer than a year ago. That does not make logical sense, but sometimes in the real world things that make no logical sense happen because of the other pressures on people. The fast-track pathway and its patients are being challenged. That situation is a good example of the need to get transformation funding to the right places, and is probably one of many around the country. It is not because people do not want them that the things in question do not happen; it is because the system does not work as everyone wants it to. One of our jobs is to use our voice here to help to unlock the barriers, so that the things we want can happen, and so that patients are seen faster and have the transformational treatments that are needed.

The all-party parliamentary group on cancer has called on the NHS to ensure that the cancer alliances are given the necessary transformation funding and support, and it is crucial that the NHS delivers that. Cancer alliances everywhere need to be able to use their funding to implement the NICE guidelines, including those on pancreatic cancer. Fast-track surgery is recommended for certain patients with jaundice. Yet it will not be available to most patients because the pathway is not in their area. We need to make sure that it is accessible. Cancer alliances must prioritise innovations for less survivable cancers and ensure that opportunities are provided, because, as the hon. Member for Basildon and Billericay reminded us, 50% of cancers are rarer ones that are more difficult to address.

I have one or two other points to make. The cancer dashboard has been helpful in driving improvements in cancer treatment. It might be worth looking at whether blood cancer could be included, as I think it would be of assistance. I very much support what the hon. Member for Basildon and Billericay, the chair of the all-party group, said about the HPV vaccine. It seems like an opportunity for prevention, which is always better than cure, particularly if it is reasonably cost-effective, as I believe that vaccine is. There are opportunities to raise awareness, such as the “Be Clear on Cancer” campaign on difficult abdominal pains, which was piloted in the west midlands. Such things help to increase patient and GP awareness, and the chance that people will go to their GP at the right time and get an assessment. That can drive them into early diagnosis, so that things can be moved forward. Such things, which I know the Minister is keen on, are opportunities that can help, and are to be applauded and encouraged.

It is estimated that by 2020 2.4 million people in England will have had a cancer diagnosis at some point in their lives. We cannot let them down. Our job is to do the best by them. We need to do the best with the 62-day target, but also to continue the debate on whether process targets take us where we need to be or whether we should look more carefully at outcome targets. We must use whatever means we can to improve early diagnosis, and do all we can to support patients from the day they receive the news no one wants to hear to the day they receive the all clear. If we achieve those things, not only will we improve the NHS but we will save hundreds of lives every day of the year.

Photo of Philippa Whitford Philippa Whitford Shadow SNP Spokesperson (Health and Social Care) 3:16 pm, 1st May 2018

I declare an interest; I was for 30 years a breast cancer surgeon, and I am co-chair of the all-party parliamentary group on breast cancer. Cancer affects one in three people in the United Kingdom at this point, but that is expected to rise to one in two for the population born after 1960. Part of the reason for that is that we live longer, and unfortunately still have not improved our lifestyles to a significant degree. In particular, we all know about smoking and cancer, but we should also be aware that obesity is the second most common driver of cancer, and is increasing.

Mr Baron spoke about process targets—particularly on waiting times. I remember when the cancer-specific waiting times came in, in Scotland, and I welcomed them. Before that, there was only the standard waiting time of 18 weeks. If a manager was told, “We are struggling to keep up with breast cancer”, but the 18 weeks had not been exceeded, there was no interest. That is the problem with any target; once a target is set, anything that is not subject to a target starts to be neglected. We welcomed targets at first. As the hon. Gentleman mentioned, the 31-day target is either being met, or is close to being met, because once people are diagnosed, all four NHSs switch into high gear and manage to treat people within the 31 days.

The problem is that that is only a little bit of the journey. The 62 days are meant to cover the time from seeing the GP to the referral to the clinic, from the clinic to the diagnosis, from the diagnosis to discussion and planning and a multidisciplinary team meeting, and from that point to the first treatment. If we look into it, the delay is often between being seen in the clinic and the diagnosis. With breast cancer we luckily tend to meet the 62-day target at around 95%, because our clinics are largely one stop. The patient usually gets all the tests on one day. However, in England the 62-day figure is below 83%, even though the 31-day figure is over 97%, and we can see how big the fall is, in trying to get people diagnosed. There is a huge workforce challenge in radiology, and in breast cancer a cliff edge is coming, because the generation who were appointed when screening started in 1991 are all retiring right now, and that is a real issue.

As I said earlier, in an intervention, it is not just a question of the time on the pathway; the biggest delay is getting people to go to see their GP. We need to get rid of the fear, embarrassment and stigma, particularly when a more embarrassing part of the body is involved.

We all run projects such as, in Scotland, Detect Cancer Early, and in England, Be Clear on Cancer, but it is important that such campaigns bubble along, rather than become intense. People need to see those adverts when it is in the back of their head that, yes, perhaps their bowel habits have changed, there is blood in their urine, or they find a lump. If that happened six months ago, it is no use. When we ran our first Detect Cancer Early campaign in Scotland with the comedian Elaine C. Smith, it was very humorous and well picked up. We got a 50% increase in people referred to breast clinics, but there was no significant difference in the diagnosis of cancer. It meant that the clinics were completely overwhelmed. We were doing clinics at night and at weekends to try to catch up, but the people who had cancer actually ended up waiting longer for their diagnosis. It is important that we generate not fear but education, and that first experience was taken into account in future campaigns.

Early detection has been mentioned, and screening is the best way of doing that if the cancer is screenable. Such screening will result in an increased incidence of cancer. People often do not think about the fact that if screening is introduced or expanded, or the technique is improved, more cancers will be diagnosed. The system must be ready to deal with that, and we need not to see it as a negative.

Since bowel screening was introduced in Scotland, there has been an 18% drop in colon cancer in men. Bowel screening, which was debated in this Chamber this morning, is not just a screening technique; it is actually preventive. When we test for blood in the stool, we can also diagnose polyps, which can then be treated to avoid them developing into cancer. That is a drop of almost one fifth over 10 years in our incidence of colon cancer. Bowel screening in Scotland starts from the age of 50 and runs to 75. Those over the age of 75 can request a kit, but they will not be sent it automatically. We have now moved to the faecal immunochemical test, which requires only one sample. It is also more sensitive, and there seems to be an almost 10% increase in uptake. Again, that will mean more colonoscopies and more diagnoses, and people must be prepared for that.

Process and outcome targets have been mentioned, but an important group of targets in between is those on quality of treatment. It is not good enough just to leave things to clinical commissioning groups or cancer alliances to work out the best way to treat various types of cancer. The data are international and national, and we need a group of experts to pool them together and come up with something that no one will quibble about, and that everyone agrees is what we should be aiming to achieve for various cancers, in people’s surgeries, after their diagnoses, and with their radiation or chemo.

In 2000, what is now called Healthcare Improvement Scotland developed clinical cancer standards for the four common cancers. I had the honour to lead on the development of breast cancer standards, and I led that project until 2011. We are now on the fifth iteration of our standards, and they have been slimmed down. We have moved from looking at four cancers in 2002, to 11 cancers in 2012, and now 18 cancers have detailed clinical targets for which they are audited, and for which peer review takes place. We do not set league tables, but we set standards that every unit can aim to pass. There is no point in being told, “The best unit is 500 miles away”; people want their local unit to be good.

The first two standards in our quality performance indicators state that every patient with breast cancer must be discussed at a multidisciplinary team meeting, and that patients must be diagnosed non-operatively by needle biopsy. When I started in my unit in the mid-1990s, our pre-op diagnosis rate was about 40%; it is now about 98%. If those two standards had been in place in England, the rogue surgeon Ian Paterson might have been picked up earlier. We now know that he tended to make his own treatment decisions, and he operated on women without proof of cancer. Obviously, the standards cover all sorts of things, including surgery, diagnosis, chemo and radiotherapy. Data are collected at the MDT meeting with a member of audit staff present. That means that they can capture evidence of recurrence and patients who develop metastatic disease, and everyone on the team is aware that that has happened.

To respond to the point raised by Karen Lee, my unit discussed whether we would have separate cancer nurse specialists for those with recurrent or secondary disease, or whether it would be better if the original nurse followed the patient through, and that is what we went for—our nurses work between the surgical clinic and oncology, so that people see a face they already know. Having done it for years, I know that breaking bad news a second time is infinitely worse than breaking it the first time.

In England there are screening data from breast cancer and guidelines from the National Institute for Health and Care Excellence. There are, however, no audit data that are peer reviewed and compared. We get no financial reward for improvement in our targets. Money is not part of it; it is simple, clinical pride, and a wee touch of competitiveness. In Scotland we meet every year in the breast cancer service, and our data are put up. That is open and public; people can look for any of our reports on the internet, and they will see all the details about the numbers of patients treated and what has been achieved. Peer review and peer pressure is a great way to drive up quality.

The hon. Member for Basildon and Billericay mentioned early diagnosis and the need for one-year outcome figures, but spending all the money to gain another couple of per cent in a waiting time is not necessarily the best way to go. A comparison was made between breast cancer treatment in the UK and in Denmark, and because of screening—the UK was one of the earliest nations to pick up breast screening as a population screening—we have a higher percentage of patients diagnosed at stage 1 than Denmark. We do not, however, have a better survival rate because we have very slow access to new drugs. It takes new, expensive cancer drugs three or five years to get into common use. Yes, if someone is diagnosed early they might not need those drugs, but if they are unlucky enough to have a really nasty, aggressive cancer, they may end up fighting to get them.

Photo of John Baron John Baron Conservative, Basildon and Billericay

For a whole host of reasons mentioned by the hon. Lady, one area that perhaps shows promise in improving early diagnosis is breast cancer. In general, however, we fall behind international averages at that one-year point. The whole point of focusing the NHS on one-year survival rates, and encouraging it to improve those rates, is to send a message down the line and encourage early diagnosis across the whole panoply of primary care services, including improving screening rates and participation.

Photo of Philippa Whitford Philippa Whitford Shadow SNP Spokesperson (Health and Social Care)

I totally agree. People who have died before one year—that is, in essence, what is being measured by our one-year survival rate—are largely those who presented with an advanced or incredibly aggressive disease. We are measuring people for whom we did not have a treatment, rather than just early diagnosis, and we will see that much more in the five-year figures. I am not saying that we should not have those measurements, but if a clinician is just being told, “You have to get better one-year figures”, should they take a bigger margin? Do they use this chemo or that one? They need guidance on what evidence shows will provide better one-year figures.

On prevention, there has been a drop of more than 17% in men with lung cancer, because of the fall in smoking in men. Unfortunately, there has been a rise in lung cancer in women. There has also been a rise in malignant melanoma in men, because they are catching up with women in the use of sun beds and overseas holidays. We still have a long way to go simply to try to prevent cancer, because the gold standard is not getting it in the first place. As I have said, obesity is the second most common cause of cancer. We do not need strategies that are just for cancer. We need health in all policies to try to make people healthier, and that way we will reduce the number of people who are suffering from cancer.

Photo of Justin Madders Justin Madders Shadow Minister (Health and Social Care) 3:29 pm, 1st May 2018

It is a pleasure to serve under your chairmanship, Mr Streeter. I congratulate Mr Baron on securing the debate and on his considered and balanced speech. As chair of the all-party parliamentary group on cancer, he commands a great deal of respect on both sides of the House for his commitment to improving the way we deal with cancer, as has been reflected in the tributes paid to him by hon. Members.

I also pay tribute to my hon. Friend Mrs Hodgson, the shadow Public Health Minister. She contributes a huge amount through her work as co-chair of the APPG on breast cancer and as chair of the APPG on ovarian cancer, and through her involvement with countless other organisations. Were it not for a long-standing, important commitment, she would be responding to the debate.

We have heard several contributions. My hon. Friend Karen Lee spoke movingly from personal experience about the difficulty of getting the right care for her daughter. She described feeling a lack of support when the condition moved away from traditional treatments. I hope that her time in the House and her experiences will enable an improvement in the treatment experience of patients, particularly those suffering from secondary breast cancer. She made an important point about the geographical inequalities in treatment for secondary breast cancer. She also said that the transformation funding should be decoupled from the targets, as did most other hon. Members. The hon. Member for Basildon and Billericay talked about retrospective conditionality, which neatly highlights the absurdity of the situation.

I pay tribute to my hon. Friend Nic Dakin for his work on the APPG on pancreatic cancer. He spoke in defence of the 62-day target and set out very well why it is important, not just for measuring some elements of performance, but because the wait between first being suspected of a condition and receiving treatment is probably the most anxious time for a patient. He also said that the link between the 62-day target and access to the transformation fund should be broken, and that funding should be available for conditions that are harder to treat, such as pancreatic cancer. He spoke in some detail about the fast-track surgery pathway. I am pleased to hear that the NICE guidelines have been amended to reflect the success of that initiative, but it was disappointing to hear about the funding difficulties and the fact that it has not yet been rolled out to other areas of the country.

As all hon. Members have said, cancer is a difficult subject to talk about. It touches all our lives in some way. One in two people will be affected by cancer at some point in their lifetime. Every two minutes, someone in this country is diagnosed with cancer. It is right that the tone of the debate has been about trying to do the best we can to improve outcomes for people touched by cancer.

As has been said, there has been a steady and welcome improvement in cancer survival rates in this country, which can partly be attributed to considerable improvements in early diagnosis, but the sad and inconvenient truth is that we still lag far behind our European counterparts, as the hon. Member for Basildon and Billericay said. Five-year survival rates in the UK are far behind European averages in nine out of 10 cancers. Of the five largest EU countries, we have the highest mortality rates and the lowest survival rates. It is estimated that up to 10,000 deaths a year in England could be attributed to lower survival rates compared with those in the best performing countries. The OECD has said that our survival rates for certain types of cancer are near the bottom of the table. Several hon. Members made the point that although we have improved, other countries have progressed at a similar rate, so our relative performance is still a considerable challenge.

There is an international element, but there is also a local one within England. If all clinical commissioning groups were able to achieve the level of early diagnosis in lung cancer that the best CCGs manage, 52,000 people would be diagnosed earlier, which could save lives. The introduction of the CCG dashboard has helped to raise the visibility of such issues and, as the hon. Member for Basildon and Billericay said, the flexibility afforded to CCGs has enabled them to adjust their approach and take account of local priorities.

The hon. Gentleman was right to express the concern that process targets can have funding consequences, which sometimes have a distorting effect on priorities. My hon. Friend the Member for Scunthorpe raised an important issue about the applicability of blood cancers to the CCG dashboard.

We all agree that the most important element of any cancer treatment is time; as hon. Members have said, it is key to a successful outcome. It is generally agreed to be the single most important reason for lower survival rates in England, so it is vital that we do better not only on early diagnosis, but on prevention and awareness. Dr Whitford spoke well about the challenge we face in encouraging people to go and see their GP as soon as symptoms present.

That is why it is vital that early diagnosis continues to be a priority. As the hon. Member for Basildon and Billericay said, we should take a wider view about longer term survival rates. We know that 35% of lung cancer patients are diagnosed only after presenting as an emergency, and one in 20 are not diagnosed until after they have died. The Roy Castle Lung Cancer Foundation found that if a person is treated early, their chance of surviving for five years or more is up to 73%, but the current five-year survival rate is only 10%. For ovarian cancer, the National Cancer Registration and Analysis Service found that more than 25% of women are diagnosed through an emergency presentation. Of those, just 45% will go on to live for a year or more, compared with more than 80% of women who survive beyond a year if they are diagnosed following a referral from their GP.

We also know that once patients have been diagnosed, they have an agonising wait for treatment, as my hon. Friend the Member for Scunthorpe said. The 62-day target has now been met only once in the last four years since January 2014, and more than 100,000 people have had to wait longer than two months for their treatment to start. Although we are talking about some of the merits of those targets, it is important to ask the Minister if he can update us about the steps that are being taken to meet them in future.

One of the key elements in meeting those targets is having an adequately staffed workforce. From our experiences of visiting hospitals, we all know how reliant we are on the members of staff who go above and beyond the call of duty each day. Without them, the staff shortages that we are experiencing would have a much more significant impact on the services that are offered. Across the workforce, we have immediate challenges and demographic issues that are likely to have a significant impact in the near future, and that is before we consider the implications of Brexit.

Cancer Research UK has observed that the vacancy level across diagnostic radiographers, radiologists, gastroenterologists and histopathologists is at least 10%. In the cancer patient experience survey, 7% of cancer patients said that there were rarely or never enough nurses to care for them properly. The most recent report by the APPG on cancer highlights that 28% of radiographers are forecast to leave the profession by 2021. There are also reports that visa restrictions are hampering trusts’ recruitment plans.

Photo of Karen Lee Karen Lee Shadow Minister (Home Office) (Fire)

This is not meant to be a political point, but if we want people to train as medical staff, we need to look at the funding for that, such as the nursing bursary, which has now gone. It has been noted that the number of people applying for training has fallen since the bursaries were withdrawn.

Photo of Justin Madders Justin Madders Shadow Minister (Health and Social Care)

I thank my hon. Friend for that intervention. We have touched on the impact of the nursing bursary on a number of occasions, and Labour has a commitment to restore it. There are also implications for the ongoing training and continuing professional development for nurses and other health professionals who wish to specialise. The budgets available for those kinds of initiatives are being continually squeezed.

Turning back to the issue of overseas recruitment, it is worrying to hear that there is a block on recruiting trained and “ready to go” staff from other parts of the world, because it is evident from the numbers we have talked about today, and not only in this area but in other areas across the NHS, that there is a funding crisis and a recruitment crisis. Actually, staff in some of the disciplines that we have talked about do the essential behind-the-scenes work that helps us to reach patients that bit quicker and makes the targets easier to meet.

Only yesterday, Macmillan Cancer Support released research showing that hospitals in England have more than 400 specialist vacancies for cancer nurses, chemotherapy nurses, palliative care nurses and cancer support workers. Macmillan said that cancer patients were losing out, with delays in their receiving chemotherapy, and that cancer nurses were being “run ragged”, as they were forced to take on heavier workloads because of rota gaps. It also reported that vacancy rates for some specialist nurses are as high as 15% in some areas. Clearly, those kinds of gaps will have an impact on our efforts to achieve the outcomes that we all want to deliver.

There is little doubt that we would enjoy much more success in meeting some of our aims, particularly in the cancer strategy, if the workforce had the resources they need. We welcomed the publication of the cancer workforce plan in December, although we would have liked to have seen it much earlier. I would be grateful if the Minister could update us on the progress of that plan, if he has time to do so when he responds to the debate.

More generally, the “two years on” progress report on the cancer strategy was published last October, and it set out some of the progress that has been made, but we are now six months on from that. Again, if the Minister has an opportunity, I would be grateful if he could provide us with an update. If he is unable to do so today, could he indicate when the next formal update will be available?

In conclusion, it is wholly unacceptable that we continue to lag behind many of our neighbours with regard to outcomes, but I believe that, with the right funding, the right strategy and support from the Government, the situation can change. I hope that the Minister, when he responds to the debate, will confirm that there are plans to put in place the world-class services that our patients truly deserve.

Photo of Gary Streeter Gary Streeter Conservative, South West Devon

I call the Minister. If he could leave two minutes at the end for Mr Baron to respond, that would be most helpful.

Photo of Steve Brine Steve Brine The Parliamentary Under-Secretary for Health and Social Care 3:42 pm, 1st May 2018

Thank you very much, Mr Streeter, and it is a pleasure to see you in the Chair. As always, it was a pleasure to hear the debate.

I, too, congratulate my hon. Friend Mr Baron on securing yet another debate on cancer in this place. I do not know how he does it; he must have a special line to Mr Speaker.

My hon. Friend and I worked very closely together in my previous iterations on the Back Benches. I am hugely appreciative of all his work as chair of the all-party parliamentary group on cancer. I did not know until today that he is coming towards the end of his tenure, but my goodness—he has certainly done his bit. He will be a hard act to follow, and I do not know who will succeed him. Who knows? Maybe that next person is with us today, Mr Streeter; you never know.

We have had some excellent contributions today. I do not know why Nic Dakin is looking at me that way; he is welcome to intervene on me.

May I just say that Dr Whitford made a speech that was, as always, very sensible, balanced and packed with experience, which most of us can only hope to get near to. It is very welcome and very important in these debates that she speaks about her long time working in the breast unit in Edinburgh—

Photo of Steve Brine Steve Brine The Parliamentary Under-Secretary for Health and Social Care

In Ayrshire—sorry. The hon. Lady is one of my successors as the chair of the all-party parliamentary group on breast cancer and she was so right in what she said about prevention; she was right in a lot of things she said, but she was so right about prevention. As we meet here in Westminster Hall, a certain well-known TV chef is giving evidence to the Health Committee upstairs; I am sure that can be seen on all good news channels this evening. One of the things the Committee is considering as part of its inquiry is child obesity, and one of the first things that I did in this job was to publish the tobacco control plan. I am passionate about that and I am also passionate about our alcohol challenge.

Plenty of people in this country—the majority—have a very healthy relationship with alcohol, but there are some people for whom that is not the case. As the hon. Lady knows, alcohol is also a big cancer risk factor. She was spot on in saying that this debate is not just about a cancer plan; it is about a health plan. I see the obesity challenge, the smoking challenge and the alcohol challenge as a holy trinity, if you like, in the task of tackling cancer.

Photo of Philippa Whitford Philippa Whitford Shadow SNP Spokesperson (Health and Social Care)

I would just like to mark the fact that Scotland starts its minimum unit pricing on alcohol today. That will not be a panacea, but we hope that it will at least help to make the dirt-cheap white ciders no longer dirt cheap and keep them away from our teenagers.

The obesity strategy introduced by the previous Prime Minister appeared to be quite comprehensive, yet the final version published by the current Government—or the Government before; it is always hard to keep track—was only about a third of the original strategy. Is a much more ambitious plan likely to be issued and will it include attempts to tackle things such as advertising, which make our living space so obesogenic?

Photo of Steve Brine Steve Brine The Parliamentary Under-Secretary for Health and Social Care

Nice try. We always said that addressing child obesity was chapter 1 and therefore the start of a conversation. There are a lot of things within that plan that we are still to do, or in the middle of doing. For instance, Public Health England will shortly publish the initial results of the sugar tax on soft drinks—the industry levy—and we said that we would watch that tax very closely, to see whether we needed to continue the conversation. The hon. Lady will also know that there have been lots of discussions in this Chamber and in the main Chamber about advertising, “buy one, get one free”, labelling and reformulation. As she knows, I am very interested in said agenda and I watch these things like the proverbial hawk. So I thank her for raising that issue.

I always enjoy listening to the hon. Member for Scunthorpe; he speaks so well and I see him at so many different events in this House. He mentioned the cancer dashboard and blood—or non-solid—cancers. He knows that I agree with him; it is something that I am looking at very closely with officials and with NHS England. I also pay tribute to the work that he does on pancreatic cancer. I met one of the pancreatic cancer charities with my right hon. Friend the Secretary of State for Health last week—or was it the week before last? Time flies.

The hon. Gentleman talked about the survival figures for pancreatic cancer, and they are terrible in comparison with those for other cancers. However, sometimes we have to recognise that there is an enormous challenge with pancreatic cancer, in that it is very hard to diagnose because often it is not symptomatic until its latter stages. That is one of the reasons why I was very interested in the 16-day referral to surgery pathway that he talked about and the challenge that he identified within his cancer alliance. My officials will have heard what he said, and I will take it away and consider it, because it is a really important point.

Justin Madders, who is the shadow Minister, asked about the cancer strategy and the next update to it. It is not a “three year on” update, but the next update will be in the autumn of this year. I was glad to hear his welcome for the first ever cancer workforce plan, which Health Education England published in December. It sets out how we will expand the workforce numbers. Just last week, I was with Harpal Kumar of Cancer Research UK before he steps down, and we were talking about the critical importance of that plan. I, too, would have liked to have seen it sooner, but we are committed to training 746 more cancer consultants and 1,890 more diagnostic and therapeutic radiographers by 2021.

I was at the Royal College of Radiographers annual dinner last week in London, and its members did not miss an opportunity to make the case to me about the workforce. The cancer workforce plan is a really positive innovation, and I look forward to working with HEE and my colleagues as we take it forward.

I said in this place this morning that cancer is a huge priority for this Government, and I think that everyone in here knows it is a priority for me. Yes, survival rates have never been higher. Our latest figures showed an estimated 7,000 more people surviving cancer after successful NHS treatment compared to three years earlier, and our aim is to save 30,000 more lives by 2020. However, we know that there is a huge amount still to do, and that is why we accepted the 96 recommendations in the cancer strategy and have backed that up with the £600 million of additional funding up to 2021.

Two years into the implementation of the strategy, we are making progress, as I said in the Backbench Business debate that my hon. Friend the Member for Basildon and Billericay secured in February. I hear what he says about standards and targets, and in some part I agree, but they are only part of the story. The alliances are not targets; they are about pathways and best practice—not just learning best practice but implementing it. The NHS is very good at sharing best practice, but perhaps not always brilliant at implementing it. The example given by the hon. Member for Scunthorpe about the pancreatic pathway—

Photo of Steve Brine Steve Brine The Parliamentary Under-Secretary for Health and Social Care

I will not give way. I remember Mr Streeter’s ruling.

There are eight cancer waiting time standards and, since one in two of us born since 1960 will be diagnosed with cancer in our lifetime, they are an important indicator—to patients, clinicians and politicians and the public—of the quality of cancer diagnosis, treatment and care that NHS organisations provide to millions of our constituents every year. They are a component of the success we have had with survival rates, so it is good that we are discussing them here today. I use the word “target” cautiously, because I have always been clear that standards should not necessarily be targets. If someone has a suspected cancer, 28 days is 28 lifetimes too long—I will talk about the urgent diagnostic centres in a moment. Sometimes we are not trying to get to the maximum, so “target” can be a misleading term.

As has been said, we are currently meeting six of the eight standards. One of those we are not meeting is the 62 days from urgent GP referral for suspected cancer to first treatment, which is important because we want to ensure that patients receive the right treatment quickly, without any unnecessary delays. The standards contribute to cancers being diagnosed earlier—only “contribute to”—and that is crucial to improving our survival rates. However, our rates have historically lagged behind those of some of the best-performing countries in Europe and around the world. That is why we have the cancer strategy; we want to do better. The primary reason for those rates is late diagnosis. Early diagnosis is, indeed, the magic key. My hon. Friend the Member for Basildon and Billericay has used that term many times—I have heard him use it at the Britain Against Cancer conference—and he is absolutely spot on.

Going back to the 62-day standard and the recovery thereof, my hon. Friend the Member for Basildon and Billericay will know that due to factors such as an ageing population and the increase in obesity, which we have touched on, the incidence of cancer is increasing. The NHS is treating more patients for cancer than ever before. It is testament to the hard work of NHS staff across all four nations of our United Kingdom that we are treating more people, and do so with the care and compassion for which we know the NHS is world-renowned. However, those numbers are making the achievement of the 62-day standard challenging. To be perfectly honest, the standard has not been met since December 2015 and, although we do not yet have the figures for March 2018, it is unlikely to have been met in 2017-18 either. However, we remain committed to the standard and want to see it recovered. That is why, through this year’s mandate from the Secretary of State to NHS England, we have agreed that the standard will be achieved in 2018-19, while we maintain performance against other waiting time standards.

Photo of Steve Brine Steve Brine The Parliamentary Under-Secretary for Health and Social Care

I will very quickly. I know that my hon. Friend wants me to come on to the funding.

Photo of John Baron John Baron Conservative, Basildon and Billericay

The Minister will be aware that about a quarter of all cancers are first detected as late as at an emergency procedure. What I would like him to do in the few minutes he has left is to focus on the need to break the 62-day target link with the transformation funding because it is unfair, penalising as it does those cancer services that need help most. Will he consider that?

Photo of Steve Brine Steve Brine The Parliamentary Under-Secretary for Health and Social Care

That is exactly what I was coming on to. I know that my hon. Friend has expressed concern, to put it mildly, about the methods used to allocate funding for the alliances in 2017-18, and in last December’s report by the all-party parliamentary group on cancer it was clear that the alliances should not be linked to achieving the 62-day target. I am aware that my hon. Friend has met with the Prime Minister to discuss the issue and I will reiterate what I am sure she will have told him. Achievement of the 62-day standard is not a pre-requisite for funding. Instead, it provides a basis on which NHS England and NHS Improvement, along with senior clinical advice, can assess an alliance’s readiness to transform services.

The alliances are an important mechanism for us in improving performance on the 62-day standard from urgent referral to treatment. They bring together clinicians from primary and secondary care, ensuring collective responsibility for the multidisciplinary teams and the services that they provide, and enabling the leadership that is crucial to the transformation of services. But the bottom line is that it is taxpayers’ money that is being allocated, and it is right and proper that alliances can demonstrate their preparedness for the funding. In 2018-19, NHS England has modified how it will fund alliances, and I can confirm that all alliances will receive transformation funding to support earlier diagnosis and better quality of life for patients.

The national support fund is a genuinely new approach to distributing funding that we have introduced in 2018-19, within the £200 million over two years funding envelope announced in 2017-18. That was in no small part in response to advocacy by my hon. Friend the Member for Basildon and Billericay, and I pay great credit to him and to others for their work on the link—but not the pre-requisite—that was introduced in 2017-18 between transformation funding and 62-day performance.

The fund has a number of purposes. NHS England uses it to help iron out significant variations between alliances in the amount of funding for which they originally bid. The money will be used to support alliance activity to improve 62-day performance, as well as to enable all alliances to deliver priorities, such as accelerated pathways for lung, colorectal and prostate cancer, and other innovations, such as those we heard from the hon. Member for Scunthorpe, which are included in the 2018-19 CCG planning guidance. The Secretary of State, NHS England’s national cancer director, Cally Palmer, and I all agree that the link to the 62-day standard is the right approach and the right thing for patients. I hope that that clears the matter up, even if it does not go all the way towards satisfying Members.

Although I accept that there is anxiety in some quarters about the link between the performance and the funding, I and the Government are of the view that retaining the link is in the very best interests of patients. Ultimately, they must be our primary focus, and this is public money. We will keep the matter under review. I thank my hon. Friend for his advocacy on the subject.

By the end of the cancer programme, we want to have improved survival and provided equity of access to the highest standards of modern care across all our constituencies in England. As the cancer Minister, I seldom sleep and when I am not sleeping I think very little about anything else, because we are focused on meeting the recommendations in the cancer strategy and doing better for all our constituents—those who are here, those who will live with cancer, those who are living with it now, and those who have passed, who we all know. We are on our way to realising the transformation in services that we all want to see, to make our NHS the world leader in the treatment of cancer that I know it can be.

Photo of John Baron John Baron Conservative, Basildon and Billericay 3:58 pm, 1st May 2018

I thank everyone who has participated in the debate, and the Minister for his response. No one doubts his genuine care and concern about cancer patients and the need to improve treatment. I will look closely at his words. The national support fund may not be quite as new as he thinks, but putting that to one side, all I urge him to do is to look at the pleas for help from the cancer frontline services. As far as they are concerned, there is a strong link between the 62-day target and the release of the cancer transformation funding. That is iniquitous, because the services that need it most are being denied it. I ask the Minister to go away and have another look at that, because many frontline services say that the link exists and because of it they are not getting the transformation funding they require to deliver on the cancer strategy. I will continue to pursue that matter until the transformation funding is released.

In the 15 seconds that are left to me, all I say is that a quarter of all cancers are first diagnosed during an emergency procedure. That is far too late; we all accept that. We also accept that we are failing to catch up with international averages when it comes to survival rates, despite all the talk about improving them. We have to focus on outcomes.

Motion lapsed (Standing Order No. 10(6)).