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The Minister of State, Department of Health (Paul Burstow)
Thank you very much, Mr Rosindell, for calling me to speak.
I assure the hon. Member for Hackney North and Stoke Newington (Ms Abbott) that I have not found my last 12 months “humdrum” at all and I agree entirely with the comment by the hon. Member for Cardiff West (Kevin Brennan) that being a Minister is a privilege, and a privilege that one should use fully to serve the common good and the purposes that our constituents send us here for.
I want to try to do justice to the debate, and if I do not cover any issues that have been raised, that will purely be because of time and I will write to hon. Members about those issues. However, I will try to cover as much ground as I can.
I congratulate the hon. Member for Pudsey (Stuart Andrew) on securing the debate and congratulate all those who have taken part. I particularly congratulate the all-party group on ovarian cancer, which has done an excellent job in mobilising colleagues to be here in Westminster Hall today and to be persistent and persuasive in their arguments on the issue.
As others have rightly said, the speech by the hon. Member for Slough (Fiona Mactaggart) was typically powerful and typically persuasive. I think that I have served in the House as long as the hon. Lady, and during the time that she fought her cancer I certainly admired the way that she did so, while continuing to provide the service that she gives to her constituents and the House. She made a very powerful set of points today.
I think that everyone who has spoken in the debate has been touched by ovarian cancer. I had not planned to refer to my own experience, but, given that others have talked about their experiences, I will say that my aunt died of ovarian cancer some years ago. Having fought the disease for some time, she sadly died at the Royal Marsden hospital, despite receiving excellent treatment there. Ovarian cancer touches many of us.
I thank Target Ovarian Cancer, Ovarian Cancer Action, Ovacome and the Eve Appeal, which have all done an excellent job in raising MPs’ awareness of ovarian cancer, in the ways that the hon. Member for Pudsey and others have described today. That work has done a lot, not only to initiate debates in this place, but to assist us as MPs to play our part in our communities to help to raise awareness of those issues.
I could rehearse the statistics again, but will not do so because they have already been well rehearsed and powerfully illustrated with personal stories. I certainly recognise the urgency that we need to attach to our fight against cancers and I particularly note the points that have been made today about ovarian cancer. That is why we urgently came forward with the strategy that we published in January and why we have been fast in trialling and rolling out awareness campaigns. I will say more about those awareness campaigns shortly.
As has been pointed out, late diagnosis is one of the main reasons for the relatively poor cancer survival rates in England. I must crave the forgiveness of those colleagues who have spoken today from the perspective of Northern Ireland, Scotland and Wales. They all made important points and they need to continue, as I know they will, to raise them with their colleagues in the devolved Administrations who have responsibility for health.
Research by the National Cancer Intelligence Network showed that nearly a quarter of all cancers are diagnosed through an emergency route, as my hon. Friend the Member for Westmorland and Lonsdale (Tim Farron) said. That is at a stage when the cancer is very advanced. The research also showed that one in five patients did not visit their GP before being diagnosed with cancer. Diagnosis of ovarian cancer often comes late because the symptoms in the early stages—they have been powerfully set out—are often ignored or thought to be something else.
The hon. Member for Slough talked about volunteers, and about the volunteer who did the manicure on that day when her head was in another place. I have visited hospitals where Macmillan Cancer Support and other voluntary organisations play a part. Such volunteers bring back the key human dimension, which the hon. Lady was absolutely right to underline. We will ensure that the role of volunteers in the NHS is valued by including that point in the Department of Health’s message to the NHS in its soon-to-be-published updated volunteer strategy.
Reference has been made to the £450 million for early diagnosis work that the Government have put in as part of the spending review. The funds will support campaigns to raise public awareness of the symptoms of cancers, encouraging people to present with persistent symptoms. They will also support GPs in more effectively assessing people with possible cancer symptoms and improve access to diagnostic tests. In 2010-11, we ran local cancer awareness campaigns and a regional pilot campaign for bowel cancer, and in 2011-12 we are running a national campaign on bowel cancer, a regional campaign on lung cancer and 18 local campaigns to raise awareness of breast cancer among women over 70 and of the symptoms of some less common cancers.
A question that has been rightly put is, why, so far, have we not addressed ourselves to ovarian cancer? Understandably, Members want answers, not least because of the evidence that if we were performing at, I believe, just the average of our European neighbours—certainly if we were matching the best of them—500 additional lives would be saved every year. We are considering whether there is scope for piloting ovarian cancer awareness campaigns, drawing on the experience of our more generic campaigns on blood in urine, which can be a marker for bladder and kidney cancers, and on the evaluations of awareness campaigns on specific disease sites. That will inform us how we can most effectively roll out further campaigns. I give that undertaking, and I am more than happy to meet with members of the all-party group.
The hon. Member for Romsey and Southampton North (Caroline Nokes) spoke very persuasively about the scope for using existing screening programmes to deliver awareness-raising messages about other cancers, and ovarian cancer in particular, and we will consider how we might implement such a practical solution. Nevertheless, I hope that hon. Members appreciate that awareness raising is just one of a range of actions and that we need to look at the other aspects of the strategy that we set out earlier this year. We are working on other fronts to try to drive up earlier diagnosis and treatment.
A key focus of the cancer outcome strategy is primary care, which is why we are investing in providing GPs with practical tools for assessing patients who might have cancer. In addition, some of the cancer networks are reviewing referral pathways to help to shorten the time taken for patients to access diagnostic tests. I welcome the contribution of the cancer charities that have been working with primary care professionals to promote early diagnosis of cancer, and I specifically pay tribute to Target Ovarian Cancer, which, in partnership with BMJ Learning, has produced an online GP learning tool that covers the signs and symptoms of ovarian cancer, and diagnostic tests based on the latest evidence.
Paul Burstow
I want to try to do justice to the debate and ensure that I get to answer a couple more of the questions posed, but I will give way in a moment if I can.
If a GP suspects cancer, it is vital that they can refer people urgently for further tests, using the two-week referral pathway. For women who do not meet the criteria for that pathway for suspected cancer but have symptoms that require investigation, we are providing additional funds over the next four years to support the diagnosis of ovarian cancer by giving GPs direct access to four key diagnostic tests, including non-obstetric ultrasound. Questions have been asked about what data are collected. We plan routinely to collect data on GP usage of the four tests and to publish them alongside data on GP usage of the two-week referral pathway, so that we can benchmark performance and expose areas that are not performing as well as others.
Several hon. Members asked about the CA 125 test and suggested that there are restrictions. I can assure Members that if there were restrictions we would challenge them. Just last month, Bruce Keogh, NHS medical director, wrote to strategic health authorities to raise questions about general access to diagnostics, and David Flory, deputy NHS chief executive, reiterated in the September edition of The Quarter that there must be no “arbitrary restrictions on access”. That would apply to the CA 125 test, not least because it is clearly covered in NICE guidance.
Hon. Members referred to the two ongoing trials, which are evidence of the research taking place. The UK collaborative trial of ovarian cancer screening offers real prospects for a screening tool, but on screening the Government of the day take the advice of the UK National Screening Committee, which considers the evidence from trials of the sort going on at the moment. A randomised control trial of 200,000 post-menopausal women aged between 50 and 74 is studying the use of annual CA 125 blood tests as a way to identify—along with annual trans-vaginal ultrasound—which women are most at risk of ovarian cancer. The results of the study will be available in 2015, and the Government will then respond to the recommendations that the UK National Screening Committee makes on the basis of the evidence. I hope that there will be a positive recommendation that enables us to roll out such a screening programme.
Familial ovarian cancer screening was referred to early in the debate, and a study has shown that up to 10% of ovarian cancers can be attributed to an inherited genetic predisposition. It was mentioned that the results of that research would be available in 2012, but we understand that the study will close in 2013. We would want to act on the evidence from that study.
Research, therefore, is taking place in those two fields. High-quality applications are the key to getting research funding; we do not fund solely on the basis of something being a priority. The hon. Member for Hackney North and Stoke Newington asked about Ovarian Cancer Action’s nine recommendations, and I will respond to her in writing, with copies to colleagues.
National measurement was mentioned. The NHS operating framework for England for 2011-12 requires that cancer registries record the stage of cancer, which is a key proxy for predicting outcomes, and publish one-year, as well as five-year, survival rates. We are benchmarking, providing a useful way to see who is performing well and who is not, and, as the hon. Lady mentioned, we are in the international benchmarking partnership with other nations. Would she like to make her intervention in the remaining time?
Paul Burstow
In conclusion, I hope that I have responded positively to the debate. We must make progress on a broad front in this area to improve early diagnosis and get the treatment that people need, so that we can cut the death toll in this country from all cancers. Ovarian cancer is, and will continue to be, a priority for this Government.