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Mr James Clappison (Hertsmere) (Con)
Mr Owen, it is a pleasure to have you chairing the debate on a subject that is important to many families up and down the country. Some 2 million people in the UK are living with or beyond cancer, and that figure is set to rise to 4 million by 2030. Although it is a cause for celebration that more people than ever survive after a diagnosis of cancer, a significant challenge must arise in ensuring that their clinical and human needs are met and that patients have the best possible experience.
Before turning to the nature of the challenge and the points I wish to raise, I pay tribute to all those who work in and support the many charities and voluntary organisations that address the challenge posed by cancer. There are many such organisations, but, with utter respect to all those involved in the field, I shall mention just a few: Macmillan Cancer Support, Cancer Research UK, Breakthrough Breast Cancer, Marie Curie Cancer Care, Breast Cancer Care, Beating Bowel Cancer, the Roy Castle Lung Cancer Foundation and the Teenage Cancer Trust. There are many others. They all do fantastic work and much to improve patient experience and give hope to many of our constituents.
The Government have set great store by patient experience and all the issues that naturally interest cancer patients. I warmly welcome my right hon. Friend the Prime Minister’s ambition to give every cancer patient the opportunity to be a research patient if he or she so wishes; that must interest many people in that position.
The UK now leads the world in recruiting cancer patients to take part in research. One in five cancer patients in the UK takes part in some form of research, which compares with 3% of people in a similar position in the United States. I pay tribute to the research of Cancer Research UK in that regard. Last year, 36,000 patients took part in its trials in this country.
I welcome the fact that NHS England has said that it plans to continue the important national cancer patient experience survey. The results of the 2012-13 survey showed that there is room for improvement in some areas of care. I make that point not as a criticism of the NHS, but to highlight areas where there is room for improvement. Macmillan Cancer Support highlighted some such areas in particular, and has urged Ministers to take notice of and act on them. I urge Ministers to listen to the representations being made to them by Macmillan Cancer Support and others.
The national cancer patient experience survey highlighted several important issues, and I will mention three. The first is care planning and information. The most recent cancer patient experience survey reveals that before starting treatment, 45% of patients were not fully informed about the side effects that could affect them in future, that 78% were not offered a written assessment and care plan, and that 41% were not given enough support from health and social services after leaving hospital. As a result, not all patients felt that their families were given all the information needed to help care for them at home. That is clearly an area where there is room for improvement.
David Simpson (Upper Bann) (DUP)
I congratulate the hon. Gentleman on obtaining this important debate. He mentioned Macmillan, which says in the research paper on the survey:
“The lack of basic care, dignity and respect experienced by cancer patients in hospital is shocking.”
It also says that 15% of patients experienced humiliation. That should not happen to someone suffering from cancer.
Mr Clappison
The hon. Gentleman makes an excellent point, and some of the matters I will turn to in due course underline its strength. May I apologise to hon. Members? I mentioned NHS England, because that is what the survey covers, but I will turn to the situation in Northern Ireland, Wales and Scotland in due course. I am delighted that so many Members from Northern Ireland are here this morning.
The next issue is financial support. Cancer patients and their families obviously need financial support, just as everybody else does. Although significant progress has been made since the first cancer patient survey in 2010, almost half of patients who would have liked information about how to get financial help or benefits still do not receive it.
Mr Robin Walker (Worcester) (Con)
I congratulate my hon. Friend on securing this hugely important debate. He mentioned the importance of financial advice and support, but does he agree that service design is also important? I came across a case of one constituent, David Wilson, who, while undergoing chemotherapy, received 270 different pieces of paper from our city council in just one month—August this year. It is vital that we design services so that Her Majesty’s Revenue and Customs, local councils and the Department for Work and Pensions work together to make life for patients easier and simpler and to ensure that they understand the financial entitlements.
Mr Clappison
My hon. Friend makes an excellent point that I am sure the Minister will want to address. The last thing that somebody coping with the treatments and everything else wants is to be bombarded with different pieces of information and requests from central or local government bodies, which could do something much more coherent and easy to understand if they streamlined their services.
I would like to address relational care, which the hon. Member for Upper Bann (David Simpson) raised in his intervention. It covers matters such as communication, trust in nurses and being treated with respect, all of which are important for cancer patients. There is still room for improvement, according to the findings of the most recent survey. For example, 42% of respondents said that not all doctors and nurses asked what name patients preferred to be called by, which can be important to older people. It is a question of finding the right amount of kindness. Our clinicians—nurses and doctors—are marvellous, but that did emerge from the patient survey. Kindness can make a great difference to people in that situation.
Macmillan Cancer Support’s report showed that patient experience across the NHS is still not regarded as having equal importance as clinical effectiveness and patient safety. The Government’s decision to make patient experience one of the five domains against which the health service will be held to account should be warmly welcomed. It is clear, however, that a lot of effort needs to be put into the institutional framework to reinforce that priority.
The NHS mandate and outcomes framework needs a stronger focus on improving relational care. Hospital boards need to take a lead on prioritising patient care; a recent survey showed that its importance to different hospital boards varies considerably, which is clearly wrong, because all hospital boards should take it seriously. Commissioners of cancer services have a vital role to play, as does the chief inspector of hospitals. All such bodies need to reinforce the need for relational care and kindness in dealing with cancer patients.
Nic Dakin (Scunthorpe) (Lab)
I congratulate the hon. Gentleman on securing the debate, and I apologise for having to leave before the end. Does he think that it is also important that priority be given to communication skills between medical staff and patients? That is the core of what he has outlined.
Mr Clappison
I am grateful to the hon. Gentleman for that intervention. I agree that communication skills are important; the important factor is that kindness should be received by the patient.
I put a point to the Minister on behalf of Macmillan Cancer Support: I hope that the Government will deal with the matters we have discussed and put patient experience at the heart of the inspection process being put in place for our health service. One way of doing that is to use the results of the cancer patient experience survey to inform ratings at a cancer team and service level and to monitor and assess providers of care—for example, as part of the foundation trust assessment process.
In the light of all that, I have four specific questions for the Minister, on behalf of Macmillan Cancer Support and other charities. First, will the Government consider making relational care a priority area in the refreshed 2014-15 mandate to NHS England? Secondly, will the Government support the use of cancer patient experience data in the inspection regime of the Care Quality Commission, which is led by the chief inspector of hospitals?
Thirdly, will the Government work with commissioners and providers to ensure that the results of the national cancer experience survey continue to drive improvements in cancer care? Fourthly, and specifically on breast cancer, can the national cancer patient experience survey include a question asking whether the respondent has secondary breast cancer? The Breast Cancer Campaign specifically asks to have that included.
More generally, I welcome the Government’s ambitious plans to improve cancer care in the United Kingdom, including those they set out in January 2011 in “Improving Outcomes: A Strategy for Cancer”, which promised action on a number of important fronts, such as diagnosing symptomatic cancer earlier; helping people live healthier lives to reduce the incidence of preventable cancers; screening more people; introducing new screening programmes, as recommended by the National Screening Committee; and ensuring that all patients have access to the best possible treatment, care and support.
Those measures should save at least an additional 50,000 lives every year by 2014-15. Many of us will be aware of the efforts being put into those different fields, to encourage people to come forward for screening, to make screening available, to make members of the public more aware of symptoms and to encourage people to lead healthier lives. That has been much more evident than it had been hitherto. In the light of all that, it would be good to hear from the Minister what progress has been made on the ambitions that the Government set out in January 2011.
Furthermore, what progress has been made in tackling inappropriate regional variations in cancer outcomes? Many advances have been made in cancer treatment in the UK, of course, but historically there has been a disparity on cancer survival rates between the UK and other comparable western nations. That has been the case for many years, under Governments of all parties, but it was underlined most recently by a 2009 Eurocare study, which revealed a disparity between UK cancer survival rates and those achieved in countries with the best outcomes.
England rated 16th in the survey for both men and women. Wales was ranked just in front, and Scotland and Northern Ireland were just behind. Apart from Ireland, every other major western European nation performed better than the UK, and some of them much better. Sweden was the best performing country.
The 2009 analysis was a little old, because it was based on patients diagnosed between 1995 and 1999, although that had to be the case to detect survival rates. More recent surveys have also seen the same pattern, such as one comparing the USA with the United Kingdom. With older patients, there is an even more marked gap between the UK and other comparable nations and economies. I have seen figures from the British Journal of Cancer that show that for women over 70 with breast cancer, the three-year survival rate in the UK is 79%, but in Sweden, it is 91%.
Mr John Baron (Basildon and Billericay) (Con)
I congratulate my hon. Friend on securing the debate. Although comparisons are always dangerous, a further acknowledgement of how far we remain behind our European partners is that even if we met the Government’s laudable target of saving an extra 5,000 cancer lives over the next couple of years, that would still only bring us up to the European average on survival rates.
Mr Clappison
My hon. Friend makes an excellent point. I am sure he would agree that there is a lot of ground to make up. The important point is that we should not only take encouragement from the improvement of survival rates as a result of advances in medical science; we should judge ourselves by how well we use those advances compared with other countries. We should set ourselves the more ambitious target of not just improving survival rates, but improving them so much that we close the gap on other countries.
Members of the British public who fall ill with cancer and their families expect cancer treatment to be on a level with that of comparable countries, our neighbours and other western developed economies. Sadly, it is not at that level, although I hope the Minister will tell us that we have made some progress.
Yesterday, some encouraging statistics were released that showed a trend of increasing survival for patients diagnosed between 2007 and 2011. The Minister will agree that that is good news, but I look forward to hearing from her that the Government’s ambition is to close the performance gap between ourselves and other countries and that the gap is being closed.
In closing, I should like to pay the utmost respect to doctors, nurses and all clinicians working in the field. We owe them a great debt of gratitude and my comments are no reflection on them. We are all hugely indebted to their work and I am sure that many of our constituents would echo that sentiment. I am just drawing attention to how the system has operated in this country over a number of years, and the experience of the patients within it. I hope that the Minister can tell me that the Government have ambitious plans for improving the cancer patient experience and that there is evidence that those plans are on the road to fulfilment.
Jim Shannon (Strangford) (DUP)
I am grateful, Mr Owen, for being called to make a contribution to this debate. It is on cancer patient experience, but we will all have personal experience of the issues. I congratulate the hon. Member for Hertsmere (Mr Clappison) on tabling the subject for debate. In his introduction he rightly said that the debate refers to the NHS in the UK, and there are four Northern Ireland MPs here because each of us can contribute to the debate by relating our experiences. I hope that the Minister will consider a strategy that involves not just the mainland, but all four regions.
As I was saying to my hon. Friend the Member for Upper Bann (David Simpson) earlier today, when I first considered my contribution to the debate, I realised that I have never before known so many people in my age group, so many of my friends and so many of those just older than me who have had cancer, and I have never experienced so many people passing away as a result of it.
I have had a number of meetings with the Minister back in Northern Ireland, Edwin Poots, and I intend to have a public meeting in my constituency to review cancer care with the general public and the trust and look at how best we can do it. My frustration is compounded by discussions with the trust. I do not want to be critical, because that is not how I do things—I try to see how we can move forward and be more positive—but I am concerned about the magnitude of cancer cases in my area and across the United Kingdom. I suspect that other Members will confirm what I already know. A 10% increase in cancer cases in Northern Ireland is extremely worrying.
My father and sister suffered from cancer. Of the four staff employed in my Newtownards office, my parliamentary aide had two grandparents die from cancer and her father suffers from cancer, my secretary had her mother die from cancer and she recently buried one brother-in-law to cancer and has another undergoing chemotherapy. Only my office manager seems to have escaped cancer in their immediate family. Some 75% of my office staff have experienced cancer in their close family and individually.
If we look into the community, we can see that my examples provide an accurate reflection of the way that cancer affects entire communities. Someone in the United Kingdom is diagnosed with cancer every two minutes. More than one in three people in the UK will develop some form of cancer during their lifetime, which is a horrifying statistic. The risk of developing cancer before 50 is 1 in 35 for men and 1 in 20 for women, so the situation is more extreme for ladies.
As elected representatives, our constituents often come to our offices to ask how to find their way through the benefits system. They experience health pressures to start with, but financial pressures soon follow. Just yesterday, my hon. Friend the Member for East Londonderry (Mr Campbell) and I went to the Macmillan Cancer Support reception here in the Houses of Parliament and we had the important opportunity to speak to carers. I will highlight some of the issues raised as we go through this debate.
Mr Gregory Campbell (East Londonderry) (DUP)
Before my hon. Friend moves on to discuss carers, which is an important matter, does he agree that a big issue is people’s reluctance and sometimes failure, in particular among us males, to visit the GP when there may be a problem? We should encourage everybody, but males in particular. I do not understand the logic. If my television does not work, I get a TV repair man in. If the washing machine does not work, I get the washing machine repair man in. If people have a health problem, they go to their GP. Unfortunately, however, males seem reluctant to do that.
Jim Shannon
I thank my hon. Friend for that contribution. The males of the species do tend to wait just that wee bit longer. I will not relate my personal case to Westminster Hall, but we do sometimes leave things a little longer than we should, which is perhaps a failing on our part. The Health Minister and his Department in Northern Ireland have run several campaigns to highlight prostate cancer in particular. It may be that MPs know more people, but I have two close friends who were diagnosed with cancer. Thankfully, in both cases, they acknowledged early that something was wrong and went to their doctors and were then referred for health checks. I am happy to say that the treatment that they are now receiving will save their lives, but if the diagnoses had been made a couple of months later, I suspect that it may have been different. My hon. Friend is absolutely right. Entire families and communities are affected by this cancer pandemic. The House must deliver an effective strategy to help those experiencing the scourge of cancer.
I read with great interest the Macmillan report and the hon. Member for Hertsmere outlined the many cancer organisations and societies that do tremendous work. Macmillan’s document, “Improving care for people with cancer: Putting cancer patient experience at the heart of the NHS”, wants patient care at the core of the NHS and I heard yesterday from carers and people involved with Macmillan how important that is. The report references England and Wales only, but the overall message is mirrored throughout the UK, and the other Northern Irish Members and I are here today to provide the experience of Northern Ireland.
I recently met Edwin Poots, the Minister of Health, Social Services and Public Safety in Northern Ireland, regarding the provision of cancer carers in my area, as it is clear that changes that could really make a difference cannot be implemented due to a lack of funding, which is part of the problem, and the lack of a strategy for the increases in demand over the next 10, 20 or 30 years. Looking at the Ulster hospital in particular—I am not going to be critical of the staff, who are tremendous and can never be paid enough for what they do—I can see greater demand and that needs to be taken on board. I ask the Minister to consider holding discussions with those in the regions, in particular with the Northern Ireland Assembly and Edwin Poots, because we need a strategy that takes into account the whole of the United Kingdom and not just the mainland. We can work together. Experiences, interests, qualifications and knowledge may differ across the UK, but it is time that we exchanged some of that in order to help each other.
Getting back to the Macmillan report, it states what I am sure that everyone here believes:
“Every person diagnosed with cancer should have a positive care experience and be treated with dignity and respect throughout their cancer journey.”
My hon. Friend the Member for Upper Bann said in his intervention that people needed to be treated as human beings and not just as numbers.
David Simpson
Will my hon. Friend join me in praising young carers, who look after family members until Marie Curie or Macmillan move in? Their lives are detrimentally affected by the trauma. Young carers cannot be praised enough.
Jim Shannon
I thank my hon. Friend for that comment. In my constituency, we have a young carers organisation that also works with adults. I have met some young carers and am aware of young sons and daughters who look after mothers, fathers and other siblings. We could not do without them. We are ever mindful of their experiences. I know young carers, my hon. Friend knows them and I suspect that everyone in the House knows individual young carers.
Some people may ask how the cancer experience can ever be positive, but although going through cancer will always be horrific, the care that is given can and does impact upon how a patient feels. The Macmillan report states:
“Good patient experience is closely connected to improving other outcomes such as recovery from an illness. However, the sad reality is that many people still have a poor experience of care.”
We can hopefully try to address that problem today. Cancer is no respecter of persons, but that does not mean that cancer treatment precludes the sufferer receiving the utmost respect and dignity through treatments that may be undignified in their essence. We have all lost a little dignity while in the doctor’s surgery and the manner of the doctor or nurse often determines how embarrassed we become. If we are treated gently and with care rather than being pushed through the process as quickly as possible to get the next patient seen, we may feel better as a result. That does not always happen and I can certainly appreciate the pressure that doctors and nurses are under to do the procedures, tick the red-tape boxes and bring down waiting lists. However, the fact that we are not dealing with lists but with people must never be far from our minds.
Again, I stress that I am not placing the blame on the providers of care, but something must be done to address the fact that, on average, only 56% of cancer patients in England said that doctors and nurses asked them by what name they wanted to be called, which was an issue highlighted by the hon. Member for Hertsmere. A little bit of consideration and allowing the patient to maintain their dignity does not take a whole lot of effort. It may seem trivial, but this is a serious point: a girl called Betty works in my office and were I to call her “Beatrice”, she would get upset and would tell me. Similarly, should I refer to the other lady in my office as Mrs Cotter when she is actually Mrs Armstrong-Cotter, she would immediately put me in my place. I use those examples because it is important that a caring bond is formed with cancer patients. A wee bit of time, consideration, humility and dignity can really make a difference. The same can be said on a greater scale when people are doing intimate things to patients while always reminding them that patients do not know them. That is a small thing that the Macmillan report highlighted that could make a patient feel that much more comfortable and indeed that much more safe.
The carers at the Macmillan reception also described some things that they thought should be happening in hospitals. They outlined the need for someone to be available to hospitals across all regions. The six people we met yesterday were all from different parts of the United Kingdom and all had different stories to tell. It seems that some trusts are responding well, but others are not. We need a universal response that encompasses all areas. The Macmillan representatives also suggested that someone should also be available to provide advice on benefits and on care and just to give support.
Another point that came out of yesterday’s discussion was about respite care. Some of the ladies we met were single carers—in other words, a wife looking after a husband, with no sons, daughters or other family members close at hand. We also need to consider the issue of respite care and how we can help such carers get a wee bit of time for themselves.
Mark Durkan (Foyle) (SDLP)
The hon. Gentleman said that Macmillan Cancer Support has suggested that help with understanding social security and welfare advice is important. Is he aware that, in the Altnagelvin area hospital in my constituency, Macmillan and the Western Health and Social Care Trust run the independent Macmillan/North West advice service to do exactly that? It basically navigates people through the benefits system and all the other support mechanisms. It does not expect people to be experts on such arrangements in the public administration system, but takes away an awful lot of the worry and provides pathways to care and support that they would not otherwise know was available.
Jim Shannon
The hon. Gentleman is absolutely right. I have such a service in my area. I am pleased that Macmillan and others provide such a level of care and support at times of great concern and worry in the Ulster hospital in Dundonald. I must say a great thank you to the volunteers—a great many of them are volunteers —who provide that service.
It is nice to see the shadow Minister, the hon. Member for Leicester West (Liz Kendall), in her place, because she and I had a discussion the other day about the report on care that is coming to the House for consideration. I hope that some of the points made by the ladies to whom we spoke will be part of our next debate on the draft Care and Support Bill, and I am sure that no one will be found wanting in responding to that.
In my opinion, the ethos of a hospital is reflected in how patients are treated. The Macmillan survey, which highlighted the priority of patient experience, has painted a picture of how each different hospital board views the importance of the patient care experience. It found that boards raised patient experience as an agenda item in policy meetings, but that only 5% of such items led to further action: boards noted the patient experience, but did not deem it important enough to follow up.
When I wore my other hat as a councillor, for some years I chaired the council’s audit and risk management committee and read the absolutely endless reports on matters prioritised as categories 1, 2 or 3: something in category 1 needed immediate attention, something in category 2 needed attention in a reasonable time, and something in category 3 needed attention just at some stage. It is safe to say that many of the category 3 priority cases remained the same and did not change from year to year, because time never permitted for making those changes, as something more urgent was always pressing. In other words, there were always category 1 and 2 priorities and, unfortunately, category 3 priorities sometimes sat on the shelf. My belief is that patient experience should not be a category 3 priority, but should be considered as a category 1 priority; it should not have to wait until everything else is fixed before it receives attention.
To conclude as I began, cancer is a wretched illness, whose deadly or grimy fingers reach out to impact on wide family circles, as well as entire communities. The experience of going through cancer has an impact on not only the individual, but the people around them. I believe that it is time to make cancer a priority, with a UK strategy for the Government here and those in the regions of Scotland, Northern Ireland and Wales. That is why I wholeheartedly support the hon. Member for Hertsmere and, in doing so, I again ask that any decision taken by the Secretary of State will look at having a UK strategy as well as additional funding. I thank the hon. Gentleman for bringing forward this debate.
Mr John Baron (Basildon and Billericay) (Con)
I congratulate my hon. Friend the Member for Hertsmere (Mr Clappison) on securing this important debate. I apologise to him that I will have to leave slightly early to meet, coincidentally, the new cancer tsar, Mr Sean Duffy. That appointment has been in the diary for some time. I echo my hon. Friend’s warm words of praise for all those charities and individuals who work towards combating this disease. They do excellent work, which I know all of us across the House very much support and praise.
As chairman of the all-party group on cancer, I congratulate the Government on their excellent work on cancer in recent years. Focusing on outcomes as a driver of change within the NHS has been crucial in not only driving up outcomes, but ensuring that changes in the NHS take place for the benefit of patients.
I will not speak for long, because I am conscious that there will be other speakers after me, but to give a little bit of the history, the all-party group produced a report in 2009 on cancer inequalities across the UK. We tried to analyse why patients who reach the one-year point in this country stood as much chance of getting to the five-year point as in any other health system in Europe, while we fell down on getting patients to the one-year point. That result tends to suggest that the NHS is as good as, if not better, at treating patients once cancer has been diagnosed, but is very poor at diagnosing cancer in the first place.
We tried to come up with a solution for how to drive forward earlier diagnosis. I suggest that that is the magic key for cancer. There are very few magic keys in life that will unlock the door to a panoply of unexpected treasures, but one exists for cancer—earlier diagnosis. With the wider cancer community, the all-party group—it sees itself as representing that community in Parliament—proposed putting up in lights the one-year and five-year survival indicators.
Instead of bombarding local primary care trusts, as they then were, with lots of targets and bureaucracy, we decided to put up those indicators in lights, with the emphasis on the one-year point, as a driver of change. PCTs—now clinical commissioning groups—that were towards the bottom of the table would, if their managers were worth their salt and their large salaries, introduce local initiatives, peculiar to their population: for example, whether theirs was an ageing population, whether an adaptation was needed for an industrial illness, such as mesothelioma, or whether there were black and minority ethnic communities. Those local initiatives would drive up earlier diagnosis to combat those poor one-year survival figures, because we all know that late diagnosis makes for poor one-year survival figures and, in turn, poor five-year figures.
The Government listened not only to us, but to the cancer community that also came up with the idea, and to Members from both sides of the House who came in behind it. We campaigned together, and we are delighted that the Government have now put in place one-year and five-year survival figures both nationally and locally through the CCG outcomes indicator set—brilliant news.
There has to be a bit of tweaking, for the simple reason that we were previously dealing with PCT populations that were larger than those of CCGs, so the issue of statistical significance comes into play. I was not wholeheartedly behind—in fact, if anything, I was quite sceptical—about the structural changes to the NHS, but that is now history and we have to deal with the future. Given that the populations are smaller, we are now arguing for the introduction of proxy measures locally to supplement, although not to replace, the one-year figures. Measures focusing on accident and emergency and on staging would be two ways to supplement the one-year figure. That is an ongoing conversation, and the Government and NHS England are in constructive dialogue with us about it.
I mentioned the focus on outcomes because, to achieve improved cancer outcomes, it is essential to put up in lights the patient experience and to prioritise it nationally and locally. If I have one concern about the present direction of Government policy, it is that patient experience is built in at national level, through the outcomes framework, but as yet, it is not built in at the local or outcomes indicator set level. I am not alone in worrying that there will be a disconnect. Setting the bigger picture strategy is well intentioned and essential, but if we are really to improve patient experience, we need to ensure that that national policy is followed through locally. At the moment, that is not taking place, and if we do not put that right pretty quickly, we risk not meeting the Government’s laudable target of an extra 5,000 lives saved by 2015, which is something that we all very much want.
The Minister, to whom I wish the very best in her new post—I did not get the opportunity to say that in Health questions—will know from her civil servants that the cancer community and the APPG on cancer participated in the public consultation on the 2013-14 clinical commissioning group outcomes indicator set. Held by the National Institute for Health and Care Excellence, it listed patient experience of cancer services as a potential indicator for future development. The NICE CCG OIS advisory committee agreed that such experience would be useful, yet it is not included in the 2014-15 CCG outcomes indicator set. I ask the Minister in all earnestness to look at that again. We are talking about NHS England to a very large extent, but I would be very surprised if there were not conversations with it about such issues. Will the Minister use her influence and best offices to try to influence the debate?
There is no shortage of reasons why cancer patient experience is important and why it should be included locally. I will bombard the Minister with one or two facts. We know, for example, that there is vast variation of cancer care across the country. There are unacceptable geographical variations, and we need to iron them out. There have been some particularly bad examples recently in London, and we need to look at them.
Within cancer itself and the condition of cancer, there are huge variations. For example, people with rarer cancers report a worse experience. People in the most deprived areas report less favourably on their care. Those are reasons why the monitoring of cancer patient experience locally is important.
Furthermore, the cancer patient experience survey is effective at driving improvements locally, and that must not be overlooked. By contrast to the current CCG OIS indicators under domain 4, the cancer patient experience survey captures detailed service specific data about trusts’ performance across a range of aspects of cancer patient experience. For example, all London trusts put action plans in place, following the 2010 cancer patient experience survey, so we know that that is effective. We do not need to reinvent the wheel on that one; we have something within our possession that is effective in driving forward improvements. The idea of monitoring cancer patient experience locally is feasible.
As my hon. Friend the Member for Hertsmere mentioned, more than 2 million people are living with and beyond cancer. That will rise to 4 million by 2030. Cancer is a unique and complex medical condition, and as we well know, certain aspects of patient experience have a particular emphasis for people living with cancer.
The CPES has a high sample size and response rate. Data from the 2010, 2011 and 2012 surveys are already easily accessible for CCGs to analyse. They are useful and user friendly. Furthermore, the CPES is regarded as an example of best practice in measuring holistic patient experience of care—looking at the complete pathway—which is something that we do not talk enough about in the NHS. It is particularly important, as the Minister fully understands, when it comes to cancer patients.
In conclusion, lots of good work is being undertaken by the Government on cancer. The Minister will know that I am not afraid to come forward and say otherwise if I think that that is the case. None the less, I urge her to look again at what appears to be a disconnect between a national priority and implementation locally. The cancer patient experience survey is terribly useful, helpful and effective. We need to get it into the CCG OIS. I hope the Minister will respond to that point when she sums up, but I apologise that I will not be here to listen to her.
Mark Durkan (Foyle) (SDLP)
It is a pleasure, Mr Owen, to meet under your chairmanship this morning. I congratulate the hon. Member for Hertsmere (Mr Clappison) on introducing this important debate. I want to raise a few points on the cancer experience that arise from my constituency.
As other Members have said, it is important that, in providing and modelling our services, we should directly draw on the experience, both in qualitative and quantitative terms, of patients and focus on outcomes. We also need to harness fully the insights that patients can give us into how services can be improved, better managed, better modelled and, more importantly, better accessed and understood.
In my constituency, there has been a major campaign for a localised radiotherapy unit. It was meant to happen as part of the overall improved cancer strategy in Northern Ireland, but for various reasons it got held up. The campaign was led by the Pink Ladies, a group who have gone through the cancer journey. They have all experienced breast cancer, but they are in no way exclusive about their cancer as opposed to other types of cancer experience.
On Monday morning, I attended a Pink Ladies event, which focused on the new partnerships in which the group was involved. It has spread its involvement to include not just Macmillan Cancer Support and Action Cancer but local community partnerships. It discussed providing new services at a neighbourhood level, including counselling services, listening-ear services and complementary therapy services. All are supported by professionals in the Western Health and Social Care Trust.
The issue is about making the services more accessible, comfortable and compatible with local users, who will rely very much on those who have been through, and are going through, the cancer experience, because such people are best placed to give support to others who are new to the journey.
On the point made by the hon. Member for East Londonderry (Mr Campbell) about male sufferers, an offshoot of the Pink Ladies has been formed comprising males who have been through, or are on, the cancer journey. They, purely in derivative terms, call themselves the Pink Panthers, but they are addressing exactly the issues that the hon. Gentleman mentioned. Part of the role of the groups is to help to provide advice to other patients, and their families and carers, about some of the issues that might arise and to anticipate some of the questions that might be going through patients’ heads—questions that they are just not able to articulate or are not yet ready to vocalise.
Mr Robin Walker
I am grateful to the hon. Gentleman for giving way. I apologise for having to leave the debate before the summing up.
I want to pick up on the hon. Gentleman’s point about how cancer patients can contribute to the campaigns. I have had a radiotherapy campaign in my own constituency in which Paul Crawford, a former head and neck cancer patient, has played an important role. Does the hon. Gentleman agree that cancer patients can play an important role by getting on the boards of local health trusts and health bodies and providing knowledge and experience, as indeed my constituent has?
Mark Durkan
I fully accept the hon. Gentleman’s point. The point that I was about to make myself exactly “rhymes” with his observation. It is that these people are in a position to offer advice to others diagnosed with cancer; to offer advocacy to politicians, service providers and managers as to how things can be improved; and to offer real insight in administrative terms, by helping to future-manage such services and review them against the sort of yardsticks that other hon. Members have said they must be measured against.
I said that the radiotherapy unit now to be based at Altnagelvin, which will be funded on a cross-border basis in Ireland, is really a roll-out of part of the wider cancer strategy in Northern Ireland. A number of years ago, I served as Minister of Finance in Northern Ireland in the first Executive following the Good Friday agreement, and then as Deputy First Minister. One of the most important things I did was when we negotiated what was called a reinvestment and reform package, with new borrowing powers coming from Westminster but also a funding package that was to complement the infrastructure fund that we as the Executive had developed.
The first item that I was able to insist on with Tony Blair and then with the right hon. Member for Kirkcaldy and Cowdenbeath (Mr Brown)—the two former Prime Ministers—was that funding should go to the regional cancer centre. It was meant to be a key part of the cancer strategy in Northern Ireland that was being led and advocated by Professor Paddy Johnston. We were able to fund that scheme, which was not coming forward and which did not seem to be breaking through in the Department of Health’s plans or budget submissions to me or to anybody else. We had been on the point of losing Paddy Johnston, who was going to go back to the United States, where he was going to be funded to do all sorts of things and use his skills.
However, as I say, we were able to create that cancer centre without going to a private finance initiative or anything else. Great work is being done there, not only for the patients it serves in Northern Ireland but because of the calibre of people it can attract and the clinical trials it can run, which are all part of improving the picture of cancer services throughout the United Kingdom.
As other hon. Members have said, staff at that centre and others are helping to work miracles every day with people who are suffering from cancer, but they are very conscious and very clear that their task is still to keep narrowing the gap between what the services ought to be and what they actually are, which is why we constantly need to drive on performance and outcomes in these areas.
Regarding the cancer experience, I am also very conscious of a constituent of mine who wrote a book a number of years ago, based on her experience, which basically says, “I have cancer but it doesn’t have me.” She is a lady called Kate Dooher and her book sets out very clearly her experience of a cancer journey and the implications for her family, colleagues and friends. Again, policy makers can get real insight from that about what the issues mean in real and practical terms.
I am a member of a number of the all-party groups on cancer, including all-party groups on different cancers, here in Parliament. Those groups can provide a platform for those with real insights, those who are providing care, those who are leading a lot of the professional fight against cancer and those who are driving the research platform. We should not underestimate the importance of either research or the linkage between good care networks and research. That is why Cancer Research UK is one of the most prominent advocates for more radiotherapy provision, because it believes that such provision not only makes services more accessible but that it is important in qualitative terms and in the research benefits that can come from improving services and treatment models in the future.
Going back to what the hon. Member for Hertsmere said, that is why, when we are talking about the patient experience, we very much have to listen to the patients themselves and base things not on what we think is the “nice fit, reasonable fit, just about cost-effective patient experience” but think in real and wholehearted terms about the patient experience.
Patients know how they have been able to improve their own experience for themselves, and they know how services whose staff might think they work do not really work for them, and how those services can be improved and modified. We need to gain their insight and emancipate their understanding as part of lighting the way forward for ourselves.
Albert Owen (in the Chair)
In calling Eric Ollerenshaw to speak, I remind Members that I will be calling the Front-Bench spokespersons at 10.40 am at the latest.
Eric Ollerenshaw (Lancaster and Fleetwood) (Con)
I would like to think that I take the message, Mr Owen. It is a pleasure to serve under you.
It is also a pleasure to congratulate the new Minister, my hon. Friend the Member for Battersea (Jane Ellison), on her appointment. She has a reputation as a listening Minister and I am sure that, when she makes her closing remarks, she will prove to have listened to all of us here today.
I start off in a very partisan situation. As the hon. Member for Strangford (Jim Shannon) said, we are getting to the “cancer world”, as I call it; it is like a separate world that involves different people, often through personal experience. My experience of it is personal, but also through being secretary of the all-party group on pancreatic cancer. If I may, Mr Owen, I will give a little plug here—the all-party group is producing a report, which the Secretary of State for Health has agreed to take at a meeting on 25 November. All hon. Members will be invited to that meeting.
The report is about improving outcomes. I congratulate my hon. Friend the Member for Hertsmere (Mr Clappison) on securing this debate at this timely moment. What we in the all-party group are trying to see is a further improvement in outcomes, at a time when outcomes for cancer patients are improving. When I was growing up in the 1950s and 1960s, if somebody mentioned the word “cancer” it was almost as if a life sentence had been passed. We are in a different situation now.
Pancreatic cancer is seen as perhaps the most difficult cancer, and there are issues connected with that. I will cite some statistics to demonstrate the situation that pancreatic cancer patients often find themselves in. My hon. Friend the Member for Basildon and Billericay (Mr Baron) is far more experienced in this area than I am, and he put his finger on the issue by stressing the importance of early diagnosis.
I will give the figures from the national cancer patient experience survey: 40% of pancreatic cancer patients visited their GP three or more times before diagnosis; and 25% visited their GP five or more times before diagnosis. Those figures compare with 75% of all other cancer patients who are referred to hospital after one or two GP visits.
From the investigation that the all-party group made, I can cite the specific example of someone who came to us to give their own personal experience. They said:
“With regard to early diagnosis, the most important aspect for us was the fact that Gemma went to her GP on a total of 10 separate occasions between the middle of April 2009 and the end of August, when she was finally referred to a specialist”.
That is the experience of most people with pancreatic cancer. In my own case, I think that my partner went to the GP six or seven times before somebody then said, “Better go to a hospital.”
Then, when a patient gets to the hospital situation, quite often there is no access to a specialist in pancreatic cancer. If a clinical nurse specialist is not available, the patient is even more lost. I underline the importance that the all-party group attaches to the clinical nurse specialist in almost holding the hand of somebody with cancer as they go through the system.
Andrew Percy (Brigg and Goole) (Con)
I want to tell my hon. Friend about a meeting that I had with a radiotherapist in my constituency just a week or two ago. They told me that, all too often, patients who appear for treatment tell him that they visited their GP on numerous occasions and, sadly, often they were sent home. I know that it is incredibly difficult for GPs. We are expecting a lot of them, but there is still a lot more to be done in ensuring that GPs across the country are consistent in their approach to people who present with certain symptoms.
Eric Ollerenshaw
My hon. Friend is absolutely right and I totally agree with him. That is the kind of information that we, as an all-party group, have been receiving from right across the country.
As I said, there is a lack of specialism, even in a hospital situation sometimes. The issue with pancreatic cancer is that there is a repetition of non-specific symptoms. Again, I cite my own personal experience from the case of my partner—he just had a stomach ache that went on and on, without a particular issue. Other hon. Members have referred to what males tend to do, and they are absolutely right; we often put these things to one side and say, “It is a stomach upset”, despite the repetition of symptoms. What we are trying to get GPs to look at is this: if they are seeing somebody who has never been to them before, somebody who never really goes to a GP but keeps turning up, an alarm bell should be sounding.
I will cite some other figures, although I am aware of the time factor. Some 33% of pancreatic cancer patients feel that they have been given conflicting information, compared with 29% of all other cancer patients. Some 13% of pancreatic cancer patients did not get answers to important questions all or most of the time, compared with 9% of all other cancer patients. Some 36% of pancreatic cancer patients felt less likely to feel that their views were being taken into account by doctors and nurses when discussing treatment, compared with 30% of all other cancer patients.
As I said, I am being totally partisan. The all-party group’s experience and my experience personally is that, for some reason, this country is way down the line on pancreatic cancer—despite it being the fifth biggest cancer, in terms of the number of people who die from it—when it comes to international comparisons for improved outcomes. There are treatments, but far too often they are far too late, because of people’s constant appearances at GPs.
Other Members have talked about dignity and humiliation. I will be utterly personal about the issue, because, in one sense, that is what has driven me to get so involved. I remember my partner’s situation. It was a case of finally going to hospital, being told that people there would do some tests and then that they would carry out an operation because they thought it was cancer. “What does that mean?” We did not know.
I can remember being sat in the hospital and my partner coming back, straight from surgery, with things wrapped round. We said, “What is it?” The doctor turned round and said, “Oh, it’s terminal.” That is the kind of situation that happens. Where is the understanding? Where are the few minutes where they say, “Let’s just go through this. Let’s look at the options”?
I understand that people working in hospitals are under pressure, but there were repeated examples of such experiences at the all-party group. As other hon. Members, particularly those from Northern Ireland, have said, a person should not have to be brain of Britain or have gone on a training course to have a little more time and to treat people with a little more dignity.
I finish with two particular demands, or requests, for the Minister. The all-party group wants consideration to be given to an awareness campaign, particularly about pancreatic cancer. I add my praise for the involvement of Macmillan and Pancreatic Cancer UK, which is the charity that backs up the all-party group and continues to support us, in terms of the campaign on awareness.
Macmillan has been piloting decision tools to help GPs assess the risk of cancer, including pancreatic cancer, and make decisions about further referrals. We would like to see those properly evaluated with consideration given to a full roll-out of the pilots that Macmillan has been spearheading so fantastically.
We have also been trying to raise awareness that pancreatic cancer is not an old man’s disease, in crude terms. The risk increases with age, but 35% of all diagnoses of pancreatic cancer occur in people under the age of 65—that is about 3,000 of the 8,500 diagnosed each year. The split among men and women is reasonably even, with slightly more cases in women than in men. I am not sure that that is clear, so that would be part of what we would request in a campaign. It would lead to greater awareness and, hopefully, earlier referrals and better outcomes.
My final request relates to the national cancer patient experience data. Pancreatic Cancer UK paid for a separation of data for pancreatic cancer patients—in fact, the Department of Health paid for that to be done once. We would like pancreatic cancer patients to be routinely separated out from all upper-gastrointestinal cancer patients as part of the system of getting such statistics. I do not see why a charity or the Department should try to do that as an extra thing. It should be part and parcel of the routine, given the nature and impact of this dreadful, increasingly misunderstood cancer.
Liz Kendall (Leicester West) (Lab)
It is a pleasure to serve under your chairmanship, Mr Owen, and I really want to congratulate the hon. Member for Hertsmere (Mr Clappison) on securing this important debate.
I will start with why this issue is so important. At the risk of stating the obvious, first and foremost, it is crucial for patients and their families, and as the hon. Member for Strangford (Jim Shannon) said, many of us—not only people of his age—are affected. Today, the father of one of my dearest and oldest friends is going through yet another operation for cancer. I saw him on Saturday night. I shall spend today thinking about him and all his family, and I hope that it goes well.
We know that a good experience makes all patients feel as though they have been supported and respected as individuals, whereas a bad experience can make them feel, at best, as though their needs do not matter and, at worst, that their basic human dignity has been denied. Cancer patients whom I speak to, such as those at the local Macmillan Cancer Support group, which I recently joined in my constituency, constantly emphasise their experience of care and how they are treated by NHS staff as absolutely critical at such a frightening time in their lives. However, the importance of the patient experience goes far beyond the personal value to individuals.
There is now strong evidence that good patient experience is consistently and positively associated with better health outcomes and safer and more clinically effective care. A systematic review of 55 studies, which was published in the British Medical Journal last year, found that good experience is linked to better outcomes for individual patients—both the outcomes that patients themselves report and objectively measured outcomes. It was also found that patients who have a good experience are also more likely to stick to their recommended treatments and medicines and to use preventive services, such as screening, immunisation and healthy living programmes.
The third reason why patient experience is important is that there is increasing evidence—from the US, if not from the UK—that it is linked to getting better value for money. A good patient experience, in the US at least, is associated with a reduced length of stay in hospitals and fewer problems with patient safety—so-called adverse patient events. Hospitals that achieve good scores on patient experience also have higher staff retention rates, which also contribute to lower costs through lower staff turnover. Understanding the link between staff experience and patient experience is absolutely essential in this debate. That is actually common sense: when staff feel valued and respected, they are more likely to treat patients in the same way.
What makes for a good experience for cancer patients? Macmillan Cancer Support says that three issues are consistently highlighted. The first is meaningful involvement in their care, not only for individual cancer patients, but for their families, too. The second is excellent communication, so the patient’s diagnosis, treatment options, risks and follow-up care are clearly and simply explained. The third is properly co-ordinated care. When people are going through a desperately difficult time, the last thing that they want to face is a battle between all the different services. They want their hospital, primary and community services, social care and wider help—such as financial information and welfare and benefits advice—brought together in a seamless package that is built around their needs and not the individual institutions. That kind of whole person care is vital to all patients, not only those with cancer, but if we can get it right for cancer patients, I think that we can get it right for all patients, too.
The previous Government made huge strides in improving cancer care through the work of the national cancer plan and the cancer networks. There is still further to go, particularly with earlier diagnosis, but major progress was made in starting to bring NHS care for cancer patients up to the standards in other countries. The national cancer patient experience survey, which was started under the previous Government, was absolutely integral to that. The latest results, from August this year, found that about 80% of cancer patients rate their care as good or excellent. However, there are warning signs that problems are building in the system, which could harm that progress.
Waits for vital cancer tests are getting longer. The number of people waiting more than six weeks for diagnostic tests, including ultrasounds, colonoscopies and gastroscopies, has increased by 65% between July 2010 and July 2013. The cancer networks that were so important in improving the quality and co-ordination of care have been abolished, with their work subsumed into generic clinical networks, and many staff say that that risks losing their vital specialist and local expertise. We have seen a reduction of 5,000 nursing posts since 2010, including in vital specialist services, which is putting huge pressure on remaining staff.
Many hon. Members have talked about the persistent long-term variations in the experience of cancer patients. The national cancer survey has consistently shown worse outcomes for patients with rarer cancers, for younger patients—an issue highlighted by the Teenage Cancer Trust—and for patients from ethnic minority communities, which is an issue particularly close to my heart as an MP for the very diverse city of Leicester. There are also continuing problems with ensuring that patients get the financial information and benefits advice they need and with the crucial issue of end-of-life care.
I am sure hon. Members saw the excellent report published earlier this week by Macmillan Cancer Support, which found that 73% of people with cancer would prefer to die at home but that less than a third are able to do so. Therefore, some 36,000 cancer patients died in hospital when they would have preferred to die at home. That is not only terrible for cancer patients and their families at an awful and difficult time; it does not deliver best value for taxpayers’ money either. Research by the national end-of-life care programme suggests that there are potential net savings of some £950 for every person who dies in the community, rather than in a hospital, because of the reduced use of hospital beds.
The Minister, whom I welcome to her post, may not be aware of this because she was not in her post at the time, but in the cross-party talks on Andrew Dilnot’s recommendations for funding social care, the shadow Health Secretary and I proposed removing the means test for end-of-life social care to help make choice a reality at that difficult time. I hope that the Minister will be able to update us on the Government’s actions.
I will now focus on what we need to do to put cancer patient experience much more fundamentally at the heart of the NHS. I understand that the national cancer patient experience survey is currently under review. Will the Minister commit to that survey continuing to happen during each year of the coalition? Those data are vital, but we must use them effectively. A key point highlighted by the hon. Member for Basildon and Billericay (Mr Baron), who chairs the all-party group on cancer, is that we must ensure that each clinical commissioning group is properly held to account for improving patient experience, including for cancer patients.
Currently, there are generic indicators on patient experience of hospital care and the friends and family test for acute inpatient care and A and E, but is NHS England developing more specific patient experience indicators for individual hospital services, including cancer, and, across the whole patient pathway, for primary and community services, too?
As hon. Members will know, last week, the Care Quality Commission published results of its new hospital inspection scheme, which is based on 150 indicators. I welcome and pay tribute to the excellent work of the chief inspector of hospitals, Professor Sir Mike Richards, who is the former national clinical director for cancer, but only two of the 150 indicators in the CQC’s new methodology currently address patient experience. Again, those indicators are generic. What plans does the CQC have to ensure that patient experience of individual services, including cancer services, is assessed? Will the chief inspector of hospitals work with the chief inspectors of social care and GPs to ensure that we join up our thinking in that area?
I will conclude on an important point relating to what the hon. Member for Basildon and Billericay said. We must ensure that we address patient experience locally and on the ground, not just nationally. Although holding CCGs to account and the CQC’s monitoring of hospitals are important, they essentially happen after the event—after care has been delivered. We must ensure that patient experience is at the heart of what all parts of the NHS and all staff do day in, day out. I have two suggestions for how we can make that happen.
First, we have to transform the use of what I call real-time patient feedback—not annual surveys or annual monitoring, but day in, day out use of patient feedback. There are brilliant services such as Patient Opinion, which allows patients to tell their story, positive or negative, online, by phone or in writing. Hospitals, GPs and social care providers that register with Patient Opinion can see what people are saying about them on that same day. I know because I used the service when I had to make an unfortunate visit to an urgent care centre this time last year. Patient Opinion is a powerful tool for individual patients to tell their story, for members of the public to see what others are saying about their service and for staff to hear first-hand, immediately what they can do to improve the quality of care. What plans do the Government have to encourage greater use of such services across the NHS and social care?
Secondly, the education and training of NHS staff is important. Last week, I visited the university of Worcester, which is doing pioneering work. Patients and users help to interview student nurses who apply for the course to ensure that they have the right values and attitude. Patients and users help to develop the curriculum used to train student nurses and other health professionals to ensure that it covers the issues that really matter to patients. Patients and users are also an integral part of the course, and they help with the training process.
In Leicester, we also have a groundbreaking project between De Montfort university and Macmillan Cancer Support in which students training to be nurses, NHS managers or pharmacists volunteer for Macmillan. Those students get vital skills and experience of communicating with cancer patients. How will the Government ensure that such work to improve the skills, knowledge, experience and training of staff starts when they begin working for health services? What vital work is being done to hold CCGs to account and to monitor the quality of care in hospitals?
Albert Owen (in the Chair)
I also congratulate the Minister and welcome her to her new role.
The Parliamentary Under-Secretary of State for Health (Jane Ellison)
Thank you, Mr Owen. It is a pleasure to serve under your chairmanship.
I congratulate my hon. Friend the Member for Hertsmere (Mr Clappison) on securing this debate. I am conscious that I am still relatively new to my post—I am in my fourth week—so if I am unable to respond in total detail to some of the points raised, I will undertake to get back to the relevant hon. Members.
This has been a very good debate. Many extremely constructive points have been made, and there have been some thoughtful contributions. Members, some of whom have not been able to stay for the end, have brought great insight and experience to the topic.
Cancer patient experience is close to our hearts, and I echo the tributes paid to NHS staff and, particularly, to the charities that campaign in this area. We have all taken part in moonwalks and Macmillan Cancer Support fundraisers or gone round at the back of the race for life year after year talking to cancer survivors and people running or walking with the names of loved ones on their chests, and we know what amazing work those charities do, particularly on highlighting patient experience.
In England, each year more than 250,000 people receive a cancer diagnosis. As we have heard this morning, being diagnosed with cancer can be a traumatic experience. Like the shadow Minister, a dear friend of mine has just had that experience, so I am going on that journey with my friend to understand how she will be cared for and treated as she goes through what I hope will be a full recovery.
We know that receiving personal care that is responsive to people’s needs is vital. The Government have committed to making England a global leader in producing great cancer outcomes. We are making strides, but we know there is further to go. We are improving access to treatments, including investing £750 million during this Parliament, and we are strongly committed to saving an additional 5,000 lives by 2015.
The cancer outcomes strategy remains at the core of what we are doing and what we hold the NHS to account for in terms of delivering. However, if the NHS is to deliver high-quality care, patients’ voices and experiences are vital, and I could not agree more with what everyone has said about the end-to-end experience of care being important and a big part of recovery.
My hon. Friend rightly asked that the NHS give parity of esteem to the patient experience, alongside patient safety and clinical effectiveness. I agree, and through the mandate we have asked NHS England to deliver continued improvement in patients’ experience of care. Domain 4, which is one of the key areas of the NHS outcomes framework, is
“Ensuring that people have a positive experience of care”.
I reassure my hon. Friend that that is of equal importance to the other key areas.
Mr Clappison
I was remiss in not welcoming the Minister to her post. I welcome her most warmly, and I am sure she will do an excellent job. Will she take on board the fundamental plea made by Macmillan Cancer Support and echoed in the debate that the patient experience be put at the heart of the inspection process and of the assessment of different NHS organisations? Will she ensure that that is made a real priority?
Jane Ellison
Absolutely, and I will talk a little about some of the ways in which that will be done, but I would make the point that the Secretary of State has made this an absolute priority. He could not have been clearer recently about the priority that the Government and he personally put on the patient experience. We have never given such high-profile attention to talking about the patient experience and patient care. I hope that gives some reassurance, but I will talk later about some specifics.
In the same vein, let me pick up some of the shadow Minister’s interesting points. I was interested in some of the initiatives she mentioned. Again, they all feed into the idea of putting patient care and the patient experience absolutely at the heart of things. I certainly undertake to look at some of the specific local examples she highlighted.
To drive a good patient experience, we must listen to patients’ voices. In December 2010, the Government published the first national cancer patient experience survey report. The survey was the first cancer patient survey to take place for six years, the first to involve patients with all types of cancer and the first national survey explicitly to use the word “cancer”. The survey revealed that, while there had been substantial improvements in the patient experience since 2000, there are still unacceptable variations in the quality of care people receive, as hon. Members have highlighted.
To drive improvement locally, reports were produced for individual trusts. This is where the transparency agenda the Government set such store by is really important. The data are openly available and published, and all of us—not just people in the NHS, but hon. Members, local councillors and local government—can hold commissioners and providers to account, based on that openly published data at local trust level. Commissioners and providers can be directly challenged and incentivised to improve. Providers can benchmark their performance against each other’s. Quality Health, which provided the survey, also visits poor-performing trusts to discuss their results in detail. A number of those discussions have led to really quick improvements in local outcomes, but there is always more to do.
The cancer outcomes strategy, which we published in January 2011, built on those results. We have acted to improve the patient experience at national level by implementing the cancer information prescriptions programme and expanding the Connected national advanced communications skills programme, which is a bit of a mouthful, but which is essentially about supporting thousands of clinicians to work more effectively with patients, picking up the many issues highlighted by my hon. Friend, the hon. Member for Strangford (Jim Shannon) and others regarding how seemingly small issues and small aspects of communication actually matter an awful lot at an intensely difficult time for patients and their families.
Since 1 April this year, NHS England has been responsible for delivering improvements in the cancer patient experience. That is one reason why I cannot just stand here and make particular commitments. Such debates are, however, useful because they help NHS England to know parliamentarians’ priorities in terms of where it should focus some of its attention.
Building on the work of the 2010 and 2012 patient experience surveys, NHS England published its report on the 2013 survey at the end of August. It showed improvements in many areas and some very positive experiences of aspects of care, including on privacy, being treated with respect and being listened to. Overall, 88% of cancer patients reported their care had been excellent or good, and there were some real highlights. As my hon. Friend highlighted, some of the percentages in key areas were in the 80s and 90s, although we are obviously interested in the areas where we could do better.
It is clear that many trusts acted on the findings between 2010 and 2013, and they are to be congratulated on that. Many have reorganised their pathways and services, retrained staff and created further mechanisms for patients. Cancer charities have been involved in further analysing the data to understand particular aspects of care and particular groups of patients and to create new information for patients, where needed. Much of that has been touched on this morning.
We have also looked at some of the variations in care. The hon. Member for Strangford and others mentioned care plans. Over the past three years, more work has been done on them, but given that only 22% of patients were offered care plans, everyone would acknowledge considerable improvement is still needed.
NHS England has convened a cancer patient experience advisory group to get direct input on priorities for service improvement. The group includes clinicians, experts concerned with cancer care and, crucially, patients. The group’s first meeting has now taken place. It examined the results of the 2013 survey, and actions have been agreed. As a result, NHS Improving Quality will develop a rapid-response programme to visit trusts with poor scores to discuss results and suggest improvements. I hope that gives Members some assurance about the fact that the survey does not just sit there; it is very much being acted on.
NHS England also wants to highlight high-performing trusts and identify best practice. It will put that information into toolkits that other trusts can use to develop better service in response to poor scores. NHS England is also encouraging the use of the Macmillan values-based standard and other patient-led tools, which engage patients and staff in co-creating and measuring some of the things that matter so much with regard to dignity and respect. All organisations involved in delivering care are urged to look at the survey and take it extremely seriously.
Time is a little short, so I will try to answer some of the specific questions raised. First, we recognise that making relational care a priority is important. That includes communication, trusting nurses and all the other things that have been talked about today. Rather than include references in the mandate, we have included important pledges in the NHS constitution, setting out what patients have a right to expect. All NHS services have a duty under the constitution when carrying out their functions, and we have a range of indicators to capture how well the NHS is performing in delivering dignified and personal care.
On the CQC inspection regime, I can reassure my hon. Friend that the CQC has made a commitment to listen and to take the experiences of people using services very much to heart. The new inspection teams include trained members of the public called “experts by experience”. In addition to public listening events, that will be an important way of putting patient experience at the heart of inspections.
A specific question was asked about including secondary breast cancer in the survey. NHS England is trying to ensure the survey catches the needs of all patients and looks across all cancers, but my hon. Friend’s point will have been taken.
I was asked about the future of the survey, including by the shadow Minister. NHS England has confirmed it will be run in 2014. The organisation will then undertake a review of all the surveys it runs. The debate will have highlighted to it the value that so many people place on the survey and the important role it has played in driving improvement. I cannot say whether NHS England will continue it, but I will certainly vividly describe to NHS England how strongly Members feel and what role they think the survey has had in driving change.
My hon. Friend’s last question was about using the survey to improve cancer care, and I have alluded to the ways in which we are trying to do that. In particular, I give him the assurance that the patient experience, putting the patient first and championing their care is absolutely at the heart of what all of us at the Department of Health are doing, taking our lead from the Secretary of State.
I thank my hon. Friend for highlighting the issue, and I echo his words from the start of the debate. I, too, thank the NHS staff and charities that do such amazing work in this area, and I hope hon. Members will continue to debate this important topic.
Albert Owen (in the Chair)
I am grateful to the Minister, the sponsor of the debate and all the Members who took part.