(8 years, 9 months ago)
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Baroness Walmsley
To ask Her Majesty’s Government what assessment they have made of the factors contributing to cancer survival rates in the United Kingdom.
Baroness Walmsley (LD)
My Lords, my reason for asking for this debate is to highlight the fact that, despite much good work, cancer patients in the UK have poorer survival chances than those in comparable countries. We rank 20th out of 24 developed countries for cancer survival in breast, cervical and colorectal cancers. For a Government that seek a world-class health service, this is not good enough. I want to look at the reasons and ask what the Government plan to do about it, in particular the implementation of the five-year cancer strategy.
Anyone who has had a diagnosis of cancer will know the naked fear that the news generates. At that moment, it is hard to remember the great strides we have made in cancer survival, with half of all cancer patients now surviving for 10 years or more compared with a quarter 40 years ago. Some cancers such as breast cancer have seen remarkable improvements in survival rates, particularly because of the excellent screening programme, for which I am most grateful. But others such as pancreatic cancer have seen very little improvement. Some cancers related to lifestyle or environmental factors, such as skin cancers or the various bowel cancers, have become more common. But many more people are living with cancer for a long time and we need to consider how we look after their needs.
So what needs to change? We need to invest in prevention through information and help for people to reduce their risk and earlier, more accurate diagnosis. We need better training and resources to enable GPs to refer quickly and a realistic approach to consultant utilisation and shortages, along with that of specialist nurses. We need better data collection and transparency and earlier access to innovative treatments. To show public support, I hope that all noble Lords will celebrate World Cancer Day on 4 February by sporting a unity band to celebrate survival, show solidarity with those in treatment and remember loved ones.
Let us look at some figures. According to Public Health England, four in 10 cancers are preventable. Cancer cases are increasing, partly it is believed because we are living longer and partly due to lifestyle, so more people are living with cancer. One in two people will develop cancer at some point in their lives. But according to Eurocare-5, the UK’s survival performance rates are below the European average. According to the Lancet in 2011, Norway, Canada, Sweden and Australia do a lot better than us, while recent studies have shown that the gap is not being closed. As we do better, other countries are doing even better. That is why we need excellent data and accountability. Experts tell us that the one-year survival rate is a very good indicator of success or failure, so it is important that this information is collected efficiently and made available transparently.
This week, we have had some very worrying headlines. Cancer services have missed key targets. The six-week target for diagnostic tests to be done was missed and it is now two years since it was last met. One of the key cancer targets, the 62-day target for treatment to start from urgent GP referral, was missed. Those missed targets mean that nearly 2,000 people—not targets—had to wait longer than they should have. Wales was the worst, with only 71.9% of patients starting treatment within that time in Swansea and 62.9% in Cardiff and Vale. In Wales overall, the target has not been met since 2008. In England, just under 8,000 people with suspected cancer did not see a consultant within two weeks of an urgent referral by their GP and 536 patients had to wait more than a month to have their first treatment for cancer. We need to be cautious about targets. There is no point in setting higher and tighter targets for tests if hospitals do not have enough consultants to deal with the patients diagnosed as positive.
What is the Government’s answer? The independent cancer strategy, which reported last July, made six key recommendations: a radical upgrade in prevention and public health, including national plans on reducing smoking and obesity; earlier diagnosis with 95% of patients referred by a GP being diagnosed or given the all-clear within four weeks; patient experience on a par with clinical effectiveness and safety through access to test results and a clinical nurse specialist or other key worker; transformation in support for people living with and beyond cancer, and appropriate end-of-life care; investment to deliver a modern high-quality service, including upgrading radiotherapy machines, reviewing the Cancer Drugs Fund and better molecular diagnostics for more personal treatment; and a big effort to address the shortage in the cancer workforce. It also called for overhauled processes for commissioning, accountability and provision with a regional network of care alliances and a national cancer team to oversee delivery of the strategy.
The Government have accepted the recommendations and the latest NHS five-year mandate asks for: early diagnosis to be a priority; more work to tackle smoking, alcohol and physical inactivity; reduced impact of ill-health and disability; and support for research and innovation to enable new treatments to reach patients more quickly. So there was a recognition of the role of speedy diagnosis in improving cancer survival rates, but nothing about better training or diagnostic tools for GPs. Molecular diagnostics have made enormous strides in recent years for monitoring the effectiveness of treatments as well as diagnosing the disease and enabling more effective personalised treatments. The strategy asks for a national commissioning framework for this. Will the Minister ensure that that happens? It is vital for equal access for patients, particularly for rare cancers.
The mandate recognised the need for prevention, but then we had cuts in public health budgets. When will the Government accept the common sense and economic benefit of prevention and put their money where their mouth is, and save money and lives at the same time? The mandate mentions support for research and innovative new treatments, but many in the service are not convinced that appropriate pathways exist. The mere existence of the accelerated access review recognises that the UK is very poor at getting innovative new treatments to patients, and that needs to change.
In the first year, among other things, the Government are reviewing the operating model of the Cancer Drugs Fund within its existing budget. This is currently being consulted on, but patients, clinicians and pharma companies have serious concerns that the outcome will not achieve what it should. Does the Minister agree that any new methodology should guarantee increased access to innovative medicines, as proposed in the cancer strategy? We do not want the UK to become a “late-launch market”, meaning that UK patients would have poor access to innovative drugs compared to others worldwide.
Nothing should be done to deter pharma companies from doing R&D and clinical trials in the UK, since this both adds to total UK life sciences and covers the costs of treating patients which would otherwise be borne by the NHS. Indeed, we need an about-turn in relation to research. Every patient, every doctor and every health worker could be involved in medical research, but there are currently threats to the collection of data. I would encourage all patients, with suitable assurances, to allow their anonymised data to be used for medical research to save future lives. Without complete data, the researchers are working blindfold and we cannot hold CCGs, hospitals and the Government to account.
NICE must look again at its methodology for evaluating cancer drugs, especially those focused on rare cancers. But there are no proposals for NICE to change the criteria or thresholds and no recognition of unmet need, such as for cancers with very poor prognoses, such as pancreatic cancer.
It is instructive to look at some specific cancers to see where the problems lie. Despite being the 10th most common cancer, pancreatic cancer is the fifth biggest killer. Yet it only gets a tiny research spend. Survival rates are shockingly low. Only 4% survive five years from diagnosis and this has not improved in 40 years, indicating a desperate need for earlier diagnosis and more research. Around four in five patients are diagnosed at a very advanced stage and may have made up to seven visits to their GP with symptoms. All that suggests a need for better GP training and better access to diagnostic tools so that patients can have surgery before it is no longer an option. Other specialties such as skin cancer have a shortage of consultants and the ones there are spend far too much of their time seeing patients whose GP could have diagnosed the lesion as benign if they had had better training. This is another area where public awareness of symptoms needs to improve.
I have not been able to cover all the ground in 10 minutes, but I hope that other speakers will. I thank all those who are about to take part in this debate and hope that the Minister can answer the many questions that will be raised.
Lord Colwyn (Con)
My Lords, I congratulate the noble Baroness, Lady Walmsley, on securing time for this debate. Her excellent speech enables me to bring the dental profession to your Lordships’ attention—again. A speaking slot of four minutes is always very restrictive but I am pleased to be able to make reference to dental professionals, most of whom play an important role in the detection, diagnosis and treatment of many forms of oral cancer.
As we all know well, cancer remains one of the biggest killers and burdens on our health service. In turn, tobacco is by far the biggest preventable cause of cancer, with more than one-quarter of all cancer deaths in the UK being linked to it. Cancers of the head and neck are among the ones most directly linked to smoking, second only to lung cancer. Two-thirds of all cases are as a direct result of tobacco use and as many as nine in 10 cases could be prevented. Oral cancer is also one of the fastest-increasing types of cancer, with cases up by almost 40% in the last decade alone. With almost 7,000 patients diagnosed every year, it now kills more people in the UK than cervical and testicular cancers combined.
With tobacco cessation and early diagnosis being the keys to reducing the incidence and improving the survival rates of this particular kind of cancer, we cannot overlook the important contribution dentists can make in the fight against this terrible disease. Dental professionals are on the front line in the fight against mouth cancer. Dentists are uniquely placed to diagnose oral cancers very early, before the patient notices any symptoms and seeks help. This is crucial, as mouth cancer patients have a 90% chance of survival if the condition is detected early, but this plummets to just 50% if their diagnosis is delayed. The British Dental Association and Cancer Research UK have recently jointly launched a very useful new scheme called the Oral Cancer Toolkit, which improves dentists’ knowledge of how to prevent and detect oral cancer. This is something that could and should be built on.
Being the only health professionals who regularly see healthy patients, members of the dental team are also in an ideal position to help prevent future cases of oral and other cancers by becoming involved in tobacco cessation. They update the patient’s medical history form, which includes questions on tobacco, during every visit and can often see visual evidence of smoking or chewing tobacco during a check-up or treatment. Trials have revealed that dentists with the right support and access to information on tobacco counselling can contribute significantly to tobacco control measures in the community. It is important that the dental profession is involved in the development and delivery of the new tobacco control strategy, as it is a potential resource we truly cannot afford not to harness in the fight against cancer.
Lord Wood of Anfield (Lab)
My Lords, I, too, thank the noble Baroness, Lady Walmsley, for securing this debate. I shall focus on childhood cancers, which present challenges that are often distinct from more common adult cancers. I declare an interest as a father of a boy who has been treated for brain cancer and take this opportunity to declare my thanks for the extraordinary joined-up care he continues to receive.
Childhood cancer is the most common cause of death in children aged one to 14 and the most common medical cause of death for 15 to 25 year-olds. Death from cancer at any age is, of course, tragic and traumatic for those left behind, but childhood deaths from cancer are especially so, and the years of life lost are considerably higher.
Paediatric cancers are rare and histologically diverse, which provides challenges for both diagnosis and attracting research funding. For many cancers, such as non-Hodgkin lymphoma and bone tumours, survival rates for 15 to 25 year-olds are worse than for adults, and childhood cancer treatments have particular hazards because they take place while bodies are still in the early stages of development and often involve lifelong consequences for those affected. But there is good news: survival rates have steadily increased for more than 20 years, from under 70% in 1990 to more than 80% in 2010. We are in the top third of high-income countries for childhood cancer survival rates, which is encouraging—but we know what more needs to be done to improve further, as the noble Baroness, Lady Walmsley, talked about.
There are four challenges in particular. The first is diagnosis. Nearly a third of teenage and young adult cancers are diagnosed through emergency presentation at A&E—much higher than the average for all other cancers in the adult population. About a third of this young age group have to visit the GP three times with symptoms before getting a referral—delays that make it more likely that a cancer will advance and that make the treatment much more complex. I know a number of parents of child cancer sufferers who very sadly feel that their GP acted as though rationing entry into the diagnostic system. I am keen to hear what more the Minister thinks can be done to raise awareness among GPs of warning symptoms.
The second challenge is education. Surveys show that teenagers have less understanding of cancer than older age groups, yet we know that many of the major risk factors for developing cancer in adulthood are initiated in adolescence. The Independent Cancer Taskforce recommended that a cancer education programme should be instituted for all secondary schools to raise awareness of healthy lifestyles and cancer symptoms. Will the Minister say whether the Government plan to endorse this proposal?
Thirdly, there is the issue of clinical trials. Half of young children with cancer enter trials for common cancer types. Among 15 to 19 year-olds just under a third do, and for 20 to 24 year-olds the figure is only 14%. That is why the Teenage Cancer Trust is calling for NHS England to set an expectation that at least half of teenagers and young adults with cancer be recruited to cancer trials over the next decade. Will the Minister comment on that ambition and say whether the Government intend to support it?
Lastly, perhaps the most important issue is funding for research. From 2010 to 2012, paediatric cancer research funding fell by 25%. What is as worrying as this dramatic fall is that it is wholly due to a reduction in government-funded research, which fell from nearly 40% of all research spend in 2011 to just 12% in 2014—so in 2014 the Government spent on paediatric cancer research one-third of what was being spent by the Government in 2009. We live in straitened times that force us to focus on priorities—we all know that—but I suggest that public funding of research into childhood cancer has to be, as for any generation, one of those priorities.
Lord Sharkey (LD)
My Lords, I declare an interest as chair of the Association of Medical Research Charities, via whose members the British public contribute £1.3 billion annually to medical research, the largest part of which is spent on cancer research.
My noble friend Lady Walmsley noted that our cancer survival rates are significantly worse than in many comparable countries. People in the UK are dying of cancer quite unnecessarily. I know that the Government are acutely aware of that and that they recognise the need for urgent progress. The very impressive report of the Independent Cancer Taskforce, led by Sir Harpal Kumar of Cancer Research UK, shows us how to make that progress, and I am glad that the NHS has endorsed its recommendations.
Not surprisingly, a key recommendation of the report is an improvement in early diagnosis. I am myself a beneficiary of a very early diagnosis five years ago of lung cancer. Without that early diagnosis, I would not now be alive. To improve early diagnosis we need better training of GPs, better symptom awareness among patients, and better and quicker access to scanning. In this context, I am very disturbed to read reports of CCGs offering financial incentives to GP surgeries not to refer patients for further tests or specialist advice. Will the Minister tell us how widespread this practice is and what is being done to stop it?
The UK has a world-class record in medical research—a vital tool in improving cancer survival rates—and the mandate for NHS England requires publication of a plan for research. But we do not have that plan for 2016-17; in fact, we never got it for 2015-16. I know that some charities have had sight of a draft plan and that Cancer Research UK, for example, considers it to be limited in its vision of the NHS as research-active. Will the Minister say when we can all see the plan?
To date, the NHS has been slow to engage with the research community and to act on its recommendations. More effort is needed from NHS England to ensure that research funders can help them effectively meet their ambition to support and promote research. For example, as things stand, despite the pledge in the NHS constitution and the wishes of the Prime Minister, only 31% of cancer patients said that taking part in research had been discussed with them. This is despite the fact, too, that there is very good evidence that research-active trusts deliver better health outcomes.
Then there is the issue of money. The Government deserve congratulations for the science funding settlement in the spending review, but there are some important outstanding issues. The plan for a national fund to be held by NHS England for payment of excess treatment costs for cancer radiotherapy trials—a recommendation of the independent task force endorsed by NHS England—has not yet been published. Will the Minister say when we will see this?
Then there is the issue of excess treatment costs in general. We now have the guidance on this, but no published timetable for implementation. Delay in implementation prevents the full benefits of the HRA’s new single-approval system being fully realised, which is critical to the much-needed streamlining of research approvals. Will the Minister say when we might see the excess treatment costs implementation plan?
Finally, there is the question of the Charity Research Support Fund. The Minister will know that this fund is critical to universities seeking charitable funds for basic research, the largest part of which is on cancer. He will know how successful this fund has been: in 2013, the Government’s £198 million leveraged £883 million in charitable investment. We need this fund to continue. We need to protect it in real terms and to increase it in line with charitable investment.
Lord Freyberg (CB)
My Lords, I begin my speech with a startling fact: rare cancers accounted for 43% of cases in 2010, but 59% of cancer deaths. Let me repeat that: these less common cancers affect roughly four in 10 of new patients, but make up six in 10 of deaths. If we want to improve survival overall we have to improve our performance in these cancers, and our performance in caring for them is poor relative to international peers. Broadly speaking, in every case there is a 5% to 15% gap in the UK’s one year performance. In stark numbers, we kill one patient more for every 10 we treat. This cannot go on.
So what can we do to improve care in these cancers? First, we should publish risk-adjusted hospital survival by cancer so that patients have informed choice. These do not need to be put into the NHS dashboard if that will delay things. Patient advocacy groups can pick up the data and take them to their constituents.
Secondly, we should measure other important care quality outcomes, such as incontinence in prostate cancer. To give noble Lords a sense of the power of measurement, Germany recently introduced metrics in incontinence and impotence after prostatectomy. On average, about 50% of German patients are left incontinent, except in Hamburg, where the Martini-Klinik has been tracking its outcomes to drive internal performance improvements. Its rates are 6.5%—in other words, a national average of one in two men in diapers for the rest of their lives, versus one in 20.
Thirdly, we should streamline diagnosis and better connect primary and secondary care. The Government should be commended for putting one-year survival rates and emergency presentation data into the CCG dashboards, and these will drive local behaviours in this area.
Fourthly, we should centralise more services, especially specialist surgery. As an example, my sister’s cancer was in the chest cavity. Getting access for such thoracic surgery is highly complex and risky. General surgeons doing these sorts of procedures get worse outcomes than those who do them more often. It is like playing the piano; the more you practise, the better you get, yet we run shy of the necessary service reconfigurations to achieve this; and, without the data on hospital performance, one can see why. Patients can judge only convenience.
Fifthly, we should introduce national molecular testing for those cancers where there is no service incumbency, such as cancers of the upper digestive system or of the female reproductive system. We should use that patient volume to catalyse precision medicine trials in these diseases. They share the same genetic mutations as common cancer, and so, if pharma can recruit to trial, they will prove whether their drugs for common cancers work for these less common ones.
Sixthly, we must continue to collect rich clinical data on all patients with cancer out of routine care. This is essential in the emerging era of personalised molecular medicine. England has at the moment the largest and best cancer registration data collection service anywhere in the world. It is this rich clinical data linked to the molecular and genomic analysis that will allow us to understand both rare and common types of cancer. However, if we allow large numbers of individuals to opt out of the registries, then our hopes for improving care quality and finding treatments and cures for rare cancers will be lost for ever.
While some of these measures will cost money, some are cost-free. Public Health England, in the form of the National Cancer Intelligence Network, has hospital survival data, but we just do not publish them on. The Government have made a commitment to open data. This is an area where data can save lives. We must unlock Public Health England’s vaults and give the information to patients and doctors.
Baroness Hodgson of Abinger (Con)
My Lords, I thank the noble Baroness, Lady Walmsley, for bringing forward this important debate. Most of us have had someone close who has been diagnosed with cancer, so this subject is personal to me, as it is no doubt to many other noble Lords here this evening.
Every two minutes, someone in the UK is diagnosed with cancer. It is now estimated that one in every two people born after 1960 will be diagnosed with some form of cancer during their lifetime. Cancer can be both physically and psychologically distressing given its unpredictable nature, the potential for spreading, and the often intensive and damaging treatment required to treat it. Then there is the uncertainty about whether the disease has truly gone, and the lurking fear about whether it will return.
In the wider and longer-term context, results are improving. Awareness and understanding, through to diagnosis, treatment and, ultimately, survival, have improved enormously in recent decades. Overall, rates of cancer survival have doubled in the last 40 years. However, these rates still remain around 10% lower than the European average. As we have already heard, as with all health matters, prevention is key. While cancer is indiscriminate, we are able to influence our likelihood of falling prey to it. Alongside medical advances, we must examine what we as individuals can do to lessen our risk. We also need to focus very heavily on the most prevalent cancers, as, between them, lung, prostate, breast and bowel cancer account for more than half of all cases. Public awareness campaigns play an important role in educating people about the risks they face should they make certain lifestyle choices.
Early diagnosis is critical. Regular tests and screening for cancers is where government support and personal responsibility can go hand in hand. However, given that cancer is most common in older people, with a third of cases being diagnosed in people aged 75 and over, I am slightly concerned that this is not reflected in the age brackets where regular screening is standard. For example, women over the age of 70 cease receiving invitations for breast screening, and instead must self-refer. However, the fact is that around one in three women diagnosed with breast cancer, and more than half of those who die from it, are over 70. Given that we know early diagnosis is the best way of stopping cancer in its tracks, and with an ageing population, surely we should allocate proper resources to ensure comprehensive awareness and monitoring among this older age group.
Cervical cancer is most common in women aged 30 to 45, and after this time screening invitations are sent only once every five years, and cease to be sent once a woman reaches the age of 65. However, an academic study last year found that one in five new cases of cervical cancer are in fact diagnosed in women 65 and over. Half of cervical cancer deaths are now also in this older age group. The charity, Jo’s Cervical Cancer Trust, has called for further research into a self-administered urine test, which women can carry out at home to check for signs of cervical cancer. I suggest that this is exactly the sort of measure that we should be looking into.
I also encourage greater uptake of the PSA blood test for prostate cancer, and to consider introducing the CA125 blood test for ovarian cancer, as this is often discovered all too late. Once cancer has been diagnosed, follow-up appointments and treatment need to happen speedily.
Government must ensure that their policies are shaped by science and statistics, using resources where they are needed the most. In turn, we must all be proactive in taking responsibility for our health and choosing to live healthier lifestyles. This will ultimately save public money and, more importantly, lives.
Baroness Masham of Ilton (CB)
My Lords, I thank the noble Baroness, Lady Walmsley, for securing this short but very important debate. I declare an interest as a member of the All-Party Group on Cancer. On many occasions, I have been to presentations of cancer survival rates in Europe and it is alarming to see the UK near the bottom. I ask the Minister, why is this? Whatever happens, we must get better. Early diagnostics are vital.
On Monday evening, I attended a reception for the Lymphoma Association. I met a young scientist who told me the story of her brother. He was aged 26 and had just taken his exam for a pilot’s licence. He had swellings, excessive night sweats, weight loss and tiredness. He went to his GP three times but was told that he was suffering from stress from taking his pilot’s exam. Family members then took him to a private doctor and insisted that he had blood tests. The results came back and he was sent directly to St Thomas’ Hospital and told that he had cancer. Because it was a late diagnosis he had to have strong chemotherapy, which gave him many problems including depression. His career was in ruins and he is now a stay-at-home father.
Lymphoma is cancer of the lymphatic system, which is part of the body’s immune system. It is the fifth most commonly diagnosed form of cancer. Without consistent and reliable data, further opportunities to improve the diagnosis, treatment and aftercare for lymphoma will be missed.
The Minister knows my concern about the patchy provision of vital healthcare across the country. The vision of the British In Vitro Diagnostics Association is to have robust, fair and sustainable access to and provision of molecular diagnostics across England. Rapid advances in medical science and technology are transforming the way health problems are identified, prevented and treated. However, in the area of molecular diagnostics, further reform is needed to ensure that patients can realise the benefits of these tests and have equity across the country. I hope that NHS England will take note.
Proton beam therapy came to the public’s notice when the parents of a young boy with a brain tumour went to the Czech Republic for treatment. This showed that the UK was lagging behind other countries in targeted methods of treatment. The treatment allows high-energy protons to be targeted directly at the tumour, reducing the dose to surrounding tissues and organs. Can the Minister give us a progress report on the availability of this treatment in the UK? If London and Manchester are to be the chosen centres for this treatment, patients from all over England should be able to use it and should have help with travelling and accommodation.
Baroness Redfern (Con)
My Lords, I, too, thank the noble Baroness, Lady Walmsley, for introducing this debate this evening. Unfortunately and as we all know, cancer touches us all. Every year, more than 250,000 people in England are diagnosed with cancer and, sadly, around 130,000 of these die as a result of the disease.
However, more people are now surviving cancer and I take this opportunity to pay tribute to all those healthcare professionals and volunteers—and dentists—who dedicate their lives to finding cures and caring for patients. The sad fact remains though, that our survival rates are still worse than those for other countries that are as wealthy as us. If we want the best for cancer patients, we have to invest in treatment but our priority also needs to be prevention through early diagnosis, as we have heard from earlier speakers.
I welcomed the Government’s strategy on cancer in 2011 and efforts to raise awareness of symptoms, with £750 million allocated to support this. If we take bowel cancer, for example, which is the fourth most common cancer in the UK and where survival rates are closely associated with the stage at diagnosis, it is estimated that up to nine in 10 people could survive if they were diagnosed in the earliest stages of that cancer. There is a huge variation in survival between cancer types and we have the staggering statistic that one in five cancers is not spotted until A&E.
This Government made a manifesto commitment to continue to support tackling cancer through campaigns such as Be Clear on Cancer. Many noble Lords will be familiar with radio and television advertising that encourages people with possible symptoms or concerns to visit their GP and get them checked out. I, for one, would welcome increased media attention, with a possible monthly “focus on cancer” to promote awareness of the symptoms of a different cancer each time and what to look for.
Alongside diagnosis, access to appointments is vital. In May last year, the Prime Minister reiterated a commitment to seven-day general practice and hospital services by 2020. One initiative that I think has been particularly effective is the free NHS “midlife MOTs” for those aged 40 to 74 who do not have a pre-existing condition, which we have delivered in north Lincolnshire with GP support. These health checks mean that residents will be better prepared for the future and able to take steps to maintain or improve their health. However, we still have a stigma attached to seeking advice on health, particularly with older residents and especially men. I would welcome the Minister considering this point and explaining what further assistance may be available to local authorities to increase contact with these target groups to improve survival rates. We also need to look at lifestyles to reduce the risk of cancer, with around a third of cancers being linked to smoking, diet, alcohol and obesity. By running screening programmes, we have the chance to get an earlier diagnosis so that treatment is more likely to work.
We face a massive challenge ahead to do the best we can against the seemingly endless toll that cancer has on people’s lives. I am positive that more can be done to support those with cancer and identify the risks sooner, but at the same time I acknowledge the huge strides that have already been made.
Lord Aberdare (CB)
My Lords, I congratulate the noble Baroness, Lady Walmsley, on securing this debate and on making a number of points in her excellent speech—as indeed did other noble Lords—of such merit that I plan to repeat them.
It is good news that cancer death rates have fallen steadily in the past 20 years and that half of adult cancer patients are now expected to survive for 10 years or more. As a cancer survivor myself, I hope to reinforce those figures. However, this is not a uniform picture, and I shall speak about one of the cancers with the worst survival rates of all. I declare my interest as a vice-chair of the All-Party Group on Pancreatic Cancer.
As we have heard, pancreatic cancer is the 10th most prevalent of the top 21 cancers but the fifth biggest killer, causing some 8,700 deaths a year. UK five-year survival rates are just over 5%. Shockingly, these have hardly changed in 40 years. Average survival after diagnosis is a mere two to six months; 80% of patients are diagnosed too late to be operated on; and 45% are diagnosed only as a result of emergency admission to hospital, with only a 9% chance of surviving for one year, as opposed to 26% for GP referrals. I could go on but I will end with just one more dismal fact: the UK is near the bottom of the European league table in its pancreatic cancer outcomes, with a one-year survival rate that is only half that of Belgium—21% versus 40%—and well below the average of 30%.
What are the factors contributing to pancreatic cancer survival rates—or, more accurately, non-survival rates—in the UK and what might be done to improve them? I will make five suggestions, based on the findings of two inquiries carried out by the all-party group in 2013 and 2014. If the Minister has not seen them, I would be glad to send him copies.
The first requirement is for more research. Pancreatic cancer accounts for 5.2% of UK cancer deaths but only 1.4% of research spending. Of course, the experience of other cancers shows a clear link between research and improved survival rates. The second is earlier diagnosis. The all-party group reports have highlighted ways to achieve this, including better training and diagnostic support tools for GP practices; new referral pathways, giving GPs direct access to CT scans; and multidisciplinary centres to avoid patients being shuttled back and forth between their GP and various investigative routes before a correct diagnosis is made.
Thirdly, a specific strategy is needed for tackling pancreatic cancer and other so-called cancers of unmet need whose outcomes are lagging behind. These are not adequately addressed in the current national strategy for England. Fourthly, as we have heard, the public should be made more aware of pancreatic cancer. A 2015 poll found that 71% of people in England could not name a single symptom of pancreatic cancer unprompted. An awareness campaign is needed, if not for pancreatic cancer on its own, then perhaps for the whole group of gastrointestinal cancers, including pancreatic.
Finally, it is deeply troubling that the only new treatment for pancreatic cancer in some 20 years, providing a real, albeit small, extension of life for patients, has been removed from the cancer drugs fund and rejected by NICE for use in the NHS, although it remains available in both Scotland and Wales. This only exacerbates the finding of the 2014 national Cancer Patient Experience Survey that pancreatic cancer patients report a lower standard of care than others; for example, in terms of the information provided, the availability of cancer nurse specialists with specific pancreatic cancer skills, and access to specialist dieticians.
I have outlined five ways in which the Minister could set about improving cancer survival rates, particularly for pancreatic cancer sufferers, for whom the need is so dire. Perhaps he might borrow from President Obama’s cancer “moonshot” idea in his recent State of the Union address and bring to the battle against cancer the sort of energy, innovation, commitment and resources that led to America putting a man on the moon—or at least enable us to catch up with other leading countries.
Lord Hunt of Kings Heath (Lab)
My Lords, I, too, thank the noble Baroness, Lady Walmsley, for instituting this debate. Clearly, we have made progress over the past 10 to 15 years but much more needs to be done. International comparisons show that to be the case. I also acknowledge briefings from many different organisations for this debate, including Macmillan Cancer Support, Cancer Research UK and the Teenage Cancer Trust. Of course, my noble friend Lord Wood has already spoken very eloquently about the devastating impact of cancer on young people.
I have a number of questions for the Minister. First, can he clear up the status of the Cancer Taskforce report? A number of noble Lords referred to this being accepted. I would like to know what that means. Does it mean that, in essence, NHS England is committed to implementing all its recommendations or is it a broad-brush acceptance of the philosophy behind the report? I believe that there is some confusion here.
Secondly, I move on to early diagnosis. A number of noble Lords mentioned GPs. There are any number of conditions where issues are raised about GPs and diagnosis. I am not one who rushes to blame GPs but there is now a general issue about how you get the benefits of general practice, which are many, and then ensure that diagnosis is better than before. It is a very difficult question. At the very least, are the Government working with the profession on this?
Thirdly, there was the question about screening and the age limits. Why, for instance, is the screening for bowel cancer stopped at the age of 74? I have tabled Written Questions about this and I am not convinced that there is an answer. I am not at all sure whether the National Screening Committee is keeping up to date with the demographics in this country. Also on screening, there is the recommendation from the NSC about making changes to both bowel and cervical cancer screening programmes to make them more effective. What has happened to those recommendations? One of the tests is called FIT; the other is for HPV in relation to cytology tests. I would be grateful if the Minister could at least write to me on that.
A lot of charities have expressed concerns that we do not have enough diagnostic capacity. I know from the latest OECD survey that, in the UK, we have less access to new equipment than in many other countries. What is going to happen in relation to that?
I would like to ask the Minister about drugs. A number of noble Lords, in particular the noble Baroness, Lady Walmsley, mentioned the fact that we have an appalling record in getting innovative new drugs to our patients. We have an accelerated access review. The question that I keep asking the Minister is: where is NHS England’s commitment to this? I sense that there is no commitment and that it sees drugs as a burden and a cost, rather than a huge advance for patients. It is essential that the philosophy of the NHS is changed in terms of the accelerated access review.
The noble Lord, Lord Freyberg, raised very important points. The Minister is very generous with his time, but I wonder whether he would be prepared to meet him to discuss the points that he raised about data and huge variations. The noble Lord referred to Germany but he could of course have referred to the UK in those terms.
Finally, the noble Lord, Lord Aberdare, raised a lack of co-ordination. Will the Minister agree to bring back cancer networks locally? They were brilliant and it was a pity that they were dissolved. They should be brought back.
The Parliamentary Under-Secretary of State, Department of Health (Lord Prior of Brampton) (Con)
My Lords, I join everybody else in thanking the noble Baroness, Lady Walmsley, for bringing this very important debate to the House. It really is a shame that we have only an hour. So much has been said that I cannot do it all justice. The noble Baroness kindly gave me a hint of what she might say this evening, so I hope that I will cover that in my main speech. I would like to come back to her on the two-week target. Maybe I could write to her on that.
My noble friend Lord Colwyn raised the importance of the dental profession, which again is all part of the common theme of early diagnosis. The importance of clinical trials was raised by the noble Lord, Lord Wood, particularly in relation to teenagers and children. They are clearly very important. I would like to come back to the noble Lord, Lord Sharkey, about his comment that CCGs were putting in incentives to GPs for not referring suspected cases of cancer. Perhaps I might investigate and come back to him on that important issue.
The noble Lord, Lord Freyberg, mentioned powerfully the power of transparency. The example he gave which stuck with me was that of prostate cancer and the differing rates of incontinence as a result of that. I think that it was in Hamburg that the results were particularly good. In answer to the noble Lord, Lord Hunt, I have already agreed to meet the noble Lord, Lord Freyberg. Transparency about survival rates will not solve all the issues but could be very powerful.
Both my noble friend Lady Hodgson and the noble Lord, Lord Hunt, raised the issue of screening for elderly people. I will write to them on that issue, as I cannot give them an answer this evening. The noble Baroness, Lady Masham, raised the issue of proton beam therapy. Again, I will write a progress report to her on that. As she knows, we are proceeding with two centres, one in Manchester and one at UCLH in London. I believe that both of them have started and are on target, but I will revert to her on that if I can.
My noble friend Lady Redfern asked whether we could look at increasing public awareness and referred to the Be Clear on Cancer campaign. That is important. The noble Lord, Lord Aberdare, raised the issue of pancreatic cancer. I was not aware that the survival rate after a year was 5%. That is terribly low, and I would like to research that more. The noble Lord, Lord Hunt, raised lots of important questions, but in answer to a particularly important one, NHS England has, as I understand it, accepted the recommendations of the Harpal Kumar report and will be implementing them over the next four years.
I hope that I will answer most of the questions in my speech. It is worth noting that we have made huge progress over the last 15 years, even though the kernel of the debate this evening is that we have got a lot further to go to catch up with our European neighbours. Activity has increased dramatically. In the last five years, 645,000 more patients with suspected cancers were seen, an increase of 71%. Almost 40,000 more patients were treated for cancer, an increase of 17%.
The proportion of cancers diagnosed as a result of emergency presentation—an issue raised by a number of noble Lords—has decreased significantly. At the same time, the proportion of cancers diagnosed through urgent GP referral following a suspicion of cancer has increased. In 2006, almost 25% of all cancers were diagnosed as an emergency. In 2013, this figure had fallen to 20%, or one in five. That is a considerable reduction, but there is still a long way to go. To help diagnose cancer earlier, we have invested over £22 million in our Be Clear on Cancer campaigns and we continue to expand and modernise our cancer screening programmes. Nationally, 37% of radiotherapy treatments are now being delivered with more precise intensity-modulated radiation therapy—IMRT—ahead of the 24% target.
Since October 2010, the Cancer Drugs Fund has helped more than 84,000 cancer patients in England, and £1 billion has now been made available to support that fund. We are committed to the fund, although we are out for consultation at the moment as to how we should progress it forward for next year. It is worth noting that in this current year some £340 million has been spent in that fund. Some of these new cancer drugs are extremely expensive.
We know that cancer survival in England has historically lagged behind the best-performing countries in Europe and the world, but none of these international comparisons of cancer include patients more recently diagnosed than 2009. As a result, we should be careful about using these comparisons as a measure of the current performance of the system, although they can be useful as a long-term benchmark. Although we will have improved considerably since that time, I suspect that other countries will also have improved, so the question is whether that gap has closed. Although our survival rates are at a record high and continue to improve, as shown by the new figures published by the ONS in November, we know that we must do better. The gap between England and the better-performing countries is narrowing for some cancers, but for others it remains.
That is why, in January last year, NHS England announced a new Independent Cancer Taskforce to develop a five-year strategy for cancer. A report was published in July 2015, which I think was well received by most interested parties. It recommends improvements across the cancer pathway with the aim of improving survival rates. I thank Sir Harpal Kumar and his colleagues for that report.
In terms of delivery, NHS England has recently appointed Cally Palmer, whom some of you will know, as she is also chief executive of the Royal Marsden, as the NHS National Cancer Director. She will lead on implementation, as well as new cancer vanguards to redesign care and patient experience. She is currently setting up a new Cancer Transformation Board to lead the rollout of the recommendations of the new strategy, and a Cancer Advisory Group, chaired by Sir Harpal Kumar, will oversee and scrutinise its work. I hope that that will go some way to addressing the concerns of the noble Lord, Lord Hunt, about the networks that used to be there. We hope that they will put in place something similar, if not the same.
Although this is a five-year strategy and an implementation plan is being developed, good progress has already been made on many of the key recommendations. The task force recognised the importance of early and faster diagnosis to improve outcomes and experience. It is essential that we make sure that cancer is diagnosed as early as possible, so we will adopt the task force’s ambitious new waiting times target for the NHS. From 2020, patients will be given a definitive cancer diagnosis or the all-clear within 28 days of being referred by a GP. This will mean that the period of uncertainty will be as short as possible.
We are backing this with an expected investment of up to £300 million a year by 2020, along with a national training programme for an additional 200 staff with the skills and expertise to carry out endoscopy tests by 2018. This is an area of shortage at the moment. We have also confirmed a commitment from NHS England to implement the Independent Cancer Taskforce’s recommendations on molecular diagnostics. This will mean that about 25,000 additional people a year will have their cancers genetically tested to identify the most effective treatments. I noted the comments of the noble Baroness, Lady Masham, about fairness in access to molecular diagnostic tests.
To monitor the impact of the new strategy, we are also introducing two new outcome metrics: the proportion of cancers diagnosed at stages 1 and 2 and the proportion of cancers diagnosed through an emergency route. These will be published quarterly at CCG level from May 2016. From April 2016, the new cancer dashboard will enable every CCG to see its data and benchmark itself against other CCGs and England as a whole. It will measure progress with a focus on incidence, survival rates, patient experience and quality of life for patients.
In conclusion, I congratulate your Lordships’ House on the quality of this debate. Some fascinating issues have been raised. The personal experience of many noble Lords has been particularly illuminating. I hope that I have been able to set out our commitment to delivering the Independent Cancer Taskforce’s new strategy, the good progress that has already been made, and NHS England’s robust plans to turn the recommendations into reality.
If the NHS is successful in implementing its initiatives and ambitions, an additional 30,000 patients a year will survive cancer for 10 years or more by 2020, 11,000 through early diagnosis. There will also be a closing of the gap in survival rates between England and the best countries in the world, which is something that we all want to see.
We have some progress to report. It is never enough. It will take time to build up both the diagnosis and treatment resources so that we can close that gap with other European countries completely, but with Sir Harpal Kumar’s task force report, we have a very clear way to do that.
Lord Aberdare
My Lords, before the noble Lord sits down, I hope that I did not misspeak, but the figure I cited of 5% for pancreatic survival was for five years, not one. I apologise if I misled the Minister.