Health and Care Bill

Baroness Morgan of Drefelin Excerpts

Lords Hansard - Part 2 & Committee stage
Monday 31st January 2022 Lords Chamber

[Lord Moylan (Con)]

My Lords, I greatly welcome the amendments proposed by my noble friend. In fact, I put my name to the equivalent amendments earlier, proposed by my noble friend Lady Morgan of Cotes. I rise to speak to my Amendment 294, the purpose of which is to draw attention to the dire state of the services and treatment offered to people suffering from cancer of the pancreas—although I could also say that there are other, equally forgotten and equally deadly cancers, such as bile duct cancer, that deserve a debate as well. I am grateful to my noble friend Lord Vaizey of Didcot and to the noble Lords, Lord Patel and Lord Aberdare, for their support of the amendment.

Many of us have seen family members and friends fall prey to this disease. Pancreatic cancer is the deadliest common cancer. It affects 10,000 people a year across the UK, and more than half will die within three months. Three in four will die within a year. Vague symptoms, lack of a simple early test, and low symptom awareness among both the public and primary care professionals result in three in five people with pancreatic cancer being diagnosed at a late stage, when curative treatment and life-saving surgery are no longer possible.

Research into pancreatic cancer has been underfunded for decades: it receives only 3% of the UK cancer research budget, despite being the deadliest common cancer. The result is that pancreatic cancer has the lowest survival rate of all common cancers, with five-year survival rates less than 7%. Five-year survival in the UK lags behind the rest of the world, with the UK ranking 29th out of 33 countries with comparable data. These survival statistics have barely improved in decades.

In addition, there is an unacceptable variability of services for pancreatic cancer sufferers, depending in part on geography, with those living near the few specialist centres able to access some services barely available elsewhere.

I wrote last year to my noble friend Lord Bethell with a particular suggestion being promoted by the small but excellent charity Pancreatic Cancer UK. In due course, on 1 December, I received a reply from my honourable friend Maria Caulfield, who said that NHS England and NHS Improvement had launched an audit of pancreatic cancer services with a view to reducing variations in treatment and improving outcomes. That is wholly welcome. The information we have nationally on pancreatic cancer treatment in the NHS is woefully poor. An audit is a good place to start. But she went on to say that the first data were expected in 2023—not the report, not the action plan that we need, and not the funding allocation, merely the first data.

My amendment seeks to impose certain reporting obligations on the Secretary of State, but its real purpose, and the real purpose of this debate, is to inject some urgency into the Government and the NHS. We cannot afford to wait years just to begin to understand the state of pancreatic cancer treatment and care, let alone to take action to improve outcomes. Pursuing the audit with urgency and dispatch should be a top government priority.

There is one thing the Government could do right away that would at least alleviate the suffering of pancreatic cancer patients—and this indeed is the subject I wrote to my noble friend Lord Bethell about at the urging of Pancreatic Cancer UK. The symptoms caused by pancreatic cancer have a very distressing impact. In particular, people are often unable to digest their food, ultimately starving the body of nutrients and calories, leading to rapid weight loss, malnutrition and loss of muscle mass.

The solution to these symptoms is pancreatic enzyme replacement therapy—PERT. PERT comes in tablet form; you take it with your food. It replaces the digestive enzymes that many people with pancreatic cancer can no longer produce. Taking the tablet helps food to be digested and absorbed by the body, and can vastly improve people’s quality of life. It can also, crucially, help them to gain the strength needed to undergo treatment. If people have lost weight and are too weak, they are sometimes not able to have surgery for that reason. NICE guidelines clearly recommend PERT for people with pancreatic cancer, whether the cancer is operable or inoperable, and there is widespread clinical consensus on its effectiveness. It is widely available and is cost-effective: it costs the NHS just £7 per day per patient.

However, a recent study has shown that only half the people with pancreatic cancer across the UK are prescribed PERT. The May 2021 RICOCHET study, undertaken by the West Midlands Research Collaborative, found that 50% of pancreatic cancer patients were not being prescribed the tablet they needed to digest food. The key reason people are not being prescribed PERT currently is a lack of dissemination of specialist knowledge about pancreatic cancer and the benefits of PERT to general healthcare settings. PERT is more likely to be prescribed in specialist surgical centres than in general hospitals, meaning that people whose cancer is operable are more likely to be prescribed PERT than those whose cancer is inoperable, because people whose cancer is operable are more likely to be moved to a specialist setting.

However, three in five people with pancreatic cancer are not diagnosed until their cancer is at an advanced stage and no longer operable, so they will tend to be treated with palliative care in a non-specialist setting. This means they will be far less likely to be prescribed PERT than if they had been diagnosed early.

What I would hope to hear my noble friend the Minister say this evening is that without waiting for the results of the audit, he will immediately set a national priority that PERT should be routinely prescribed as a feature of pancreatic cancer care. Without setting this focus and without corresponding leadership from national and local health bodies, knowledge and expertise will continue to spread far too slowly for the people with the quickest-killing cancer.

[Baroness Morgan of Drefelin (CB)]

My Lords, I am delighted to rise in support of the Minister’s amendments to Clause 4, and I would like to declare my interest as chief executive of Breast Cancer Now. I am also absolutely delighted to pay tribute to the honourable member John Baron, from the other place, for his incredible leadership as chair of the All-Party Group on Cancer, his tireless campaigning for the interests of cancer patients and his relentless demands around prioritising improvement in cancer outcomes—hence the origin of this new clause.

For me and for those listening to this debate, it is extremely important that the Minister has been able to clarify that the wide range of outcomes covered by this new clause will include, for example, early diagnosis, objectives around end-of-life care, the importance of measuring quality of life as an outcome, and timeliness of care, as well as survival, because we know that all those factors lead to improved quality of life but also improved survival. We do not have the time to wait five or 10 years to see whether improvements in survival are occurring—we need to see them today, next month. We need to see, for example, that PERT is getting through to all patients with pancreatic cancer, rather than waiting for the longer-term survival results.

I am very pleased that these amendments have been tabled and that the Minister has confirmed that a wide range of metrics will be used to ensure a tight grip on keeping track of the system’s performance, identifying emerging problems and backlogs as they arise, because we do not have the time to wait to find out if the system is off-track. I am very pleased that we have some clarity around what is included in these objectives. I will read the Minister’s remarks properly—when it is not quarter to 10 at night—and reflect. I am very grateful for them.

Also, what a tremendous amendment we have on pancreatic cancer, which is, as we have heard, such a pernicious disease. The audit will be very powerful when it really gets to work on what is going on locally to unearth thoughtful ideas about how the system can be improved. So much good work goes on in these audits, not just on pancreatic cancer but other diseases too. Making sure that those improvements are put into practice as quickly as possible has got to be a really good thing that this House will care about very much.

Breast Screening

Baroness Morgan of Drefelin Excerpts

Tuesday 14th December 2021 Lords Chamber

Tabled by

[Baroness Morgan of Drefelin]

To ask Her Majesty’s Government what plans they have to ensure screening of the estimated 1.2 million women in England who missed breast screening during the COVID-19 pandemic; and what assessment they have made of the extent to which health disparities may have been exacerbated due to the reduction in screening attendance.

[Baroness Meacher (CB)]

My Lords, I beg leave to ask the Question standing in the name of my noble friend Lady Morgan on the Order Paper.

Cancer Drugs: Licensing and Approval

Baroness Morgan of Drefelin Excerpts

Monday 8th November 2021 Lords Chamber

Asked by

[Baroness Morgan of Drefelin]

To ask Her Majesty’s Government what steps they are taking to align the timelines between cancer drugs being licensed and being approved by the National Institute for Health and Care Excellence.

[Baroness Morgan of Drefelin (CB)]

My Lords, I beg leave to ask the Question standing in my name on the Order Paper and declare an interest as chief executive of the charity Breast Cancer Now.

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Kamall) (Con)]

NICE is committed to publishing draft guidance on cancer drugs around the time of licensing, with final guidance published within three months of licensing wherever possible. The MHRA and NICE work closely together to ensure that licensing procedures and health technology assessments are as streamlined as possible. For cancer drugs, the NHS in England provides funding from the point of draft positive NICE guidance, delivering faster access to promising new cancer treatments.

[Baroness Morgan of Drefelin (CB)]

My Lords, the delay between licensing and NICE technology appraisal has been dealt with in the case of two out of the three drugs approved under Project Orbis, through agreements between NHS England and the drug company concerned. Unfortunately for women with secondary incurable breast cancer, for which there are very few treatment options, no agreement has been made with the drug company Gilead, and this creates a new treatment lottery. Are interim access agreements meant to be the permanent solution, and if not, what can be done to address this lottery and close the gap between Orbis licensing and NICE appraisal?

[Lord Kamall (Con)]

I thank the noble Baroness for her Question. Clearly, there is distress and concern at the delay between MHRA approval and NICE licensing. The drug Trodelvy was licensed by the MHRA for both unresectable locally advanced and metastatic triple-negative breast cancer through Project Orbis. On NICE’s appraisal of Trodelvy to determine its clinical and cost-effectiveness for use in the NHS, NICE hopes to have guidance next year but, in the meantime, NHS England, NHS Improvement and NICE continue to work with the manufacturer to explore options for interim access to Trodelvy.

Medicines and Medical Devices Bill

Baroness Morgan of Drefelin Excerpts

2nd reading & 2nd reading (Hansard) & 2nd reading (Hansard): House of Lords
Wednesday 2nd September 2020 Lords Chamber

[Baroness Morgan of Drefelin (CB) [V]]

My Lords, I declare an interest as chief executive of the research and care charity Breast Cancer Now and as chair of the National Cancer Research Institute.

I would like to start by congratulating the noble Baroness, Lady Cumberlege, and her colleagues on her committee, for her report and her compelling contribution today; it was incredibly moving. I, too, will be supporting steps to see this Bill serve as a vehicle for the implementation of her recommendations, most notably, as so many Peers have commented today, the establishment of a patient safety commissioner.

This Bill covers two areas of particular concern to cancer patients that I wish to emphasise today, which others have touched on, too. These are access to clinical trials and speed of access to newly licensed medicines. For the estimated 35,000 women living with incurable secondary breast cancer in the UK, clinical trials can provide early access to potential new treatments which might extend the time before their disease progresses, which might extend their lives and which can improve quality of life. These women often have few treatment options available to them, and clinical trials really do offer people with incurable secondary breast cancer and other cancers hope for the future. I do not want us to underestimate the value of that in these debates.

Research is, as we have heard, underpinned by pan-European and international collaboration. As an example, over 4,800 EU clinical trials involved the UK between 2004 and 2016. That is a significant number of important trials. The new EU clinical trials regulation, which we have already heard about today, will improve patient safety and streamline the process for setting up new trials, and this is vital. The Government made an extremely welcome commitment in 2018 to align as closely as possible with the new regulation, and it is essential that this commitment is restated and honoured. Today is an opportunity for that. However, without access to the infrastructure that clinical trials require, such as the portal and the database to support the regulation system, it will become much more difficult to run clinical trials across borders; that has already been talked about today.

Where trials show that medicines are safe and effective, it is vital that they are licensed and made available to patients as quickly as possible. We have heard today that the EMEA area represents 25% of global pharmaceutical sales and the UK just 3%. These are important numbers to bear in mind. If the pharmaceutical companies have to make a separate application to the MHRA, and incur additional costs, to license their medicines, delays are likely in those medicines becoming available in the UK. This is a threat to timely access for patients to new medicines, and its importance should not be underestimated.

We are also particularly concerned about access to medicines developed by small pharmaceutical companies. Can the Minister give some reassurance to patients with secondary breast cancer and other incurable cancers that access to clinical trials and newly licensed medicines will not be adversely impacted by the effects of this Bill? I look forward to hearing from the Minister.

[The Deputy Speaker (Baroness Garden of Frognal) (LD)]

The noble Lord, Lord Darzi, has withdrawn, so I now call the noble Lord, Lord Freyberg.

NHS: Cancer Treatments

Baroness Morgan of Drefelin Excerpts

Thursday 25th January 2018 Lords Chamber

[Baroness Morgan of Drefelin (CB)]

My Lords, I have joined this debate to pay tribute to the noble Baroness, Lady Jowell, for speaking out so bravely and powerfully on behalf of patients to promote faster access to innovative treatments for cancer patients, which is so desperately needed. I start by declaring my interests as the chief executive of the medical research charity Breast Cancer Now and as chair of the National Cancer Research Institute.

We know that research has led to huge improvements in cancer outcomes, particularly in breast cancer, the area I know best. We know too that, sadly, progress has not been uniform, and it has been woefully slow for some cancer types. This needs to change. As we have heard, it is time to do the really difficult stuff. Brain tumour research must be of enormous concern for the whole cancer research community, not least because, in addition to many patients with primary brain tumours, thousands of patients with breast, lung, skin and bowel cancer will develop metastatic brain tumours, reducing their life expectancy to single figures too.

Time is short and speed is of the essence. However, because we want patient safety and fair access for all, the system takes its time to assess the clinical evidence for, and cost effectiveness of, new treatments, then to negotiate deals with drug companies and then to work through the budget impact hurdles that treatments have to overcome. But patients need access to life-saving treatments now, and we are being left behind other similarly wealthy economies. Therefore, the system needs to change.

I believe that adaptive trials offer real flexibility that can benefit both patients and research, but there are challenges involved. This type of trial and other new approaches are becoming more accepted by funders and, crucially, by the regulators, who drive the methodology in these situations. This needs to be further encouraged, and there are other innovative ways of speeding up trials that can help too.

Innovative clinical trials are the key to faster access, but joining up data is vital too. On a very practical level, the NCRI is bringing together multidisciplinary teams of researchers who are expert in clinical trials. They represent a unique resource for UK science. I am delighted that the latest new collaboration is to bring UK researchers in lung, breast and skin cancer together with brain tumour researchers to look at new opportunities. This would be a great chance to take forward the noble Baroness’s ideas.

Finally, innovation does not have to be expensive. For example, you would think that repurpose drugs could get to patients quickly but it is not so easy. I know that the Minister knows all about that and I look forward to hearing from him. Again, I congratulate the noble Baroness on speaking hope for patients.

Health and Social Care Act

Baroness Morgan of Drefelin Excerpts

Tuesday 5th March 2013 Lords Chamber

[Earl Howe]

I think that everybody was agreed during the passage of the Health and Social Care Bill that we wish to encourage integration in the way that services are commissioned. Integration in this context should be taken as a term that reflects the experience of the patient. The patient has to feel that he or she is on a seamless pathway of care. That care may be provided by a number of agencies, if necessary, whether in the NHS or social care, but the patient’s experience should not be disjointed. Therefore, as my noble friend will remember, numerous provisions were inserted into what is now the Act to ensure that commissioning should be on that basis. Nothing in these regulations interferes with that, but it is very much in our minds to make it crystal clear that integration of services is one of the main factors which commissioners should take into account.

[Baroness Morgan of Drefelin]

My Lords, can the Minister reassure the House that the new draft regulations are consulted on before they are tabled—very swiftly, I am sure—to safeguard against misinterpretation again by lay audiences? Perhaps a very swift consultation programme could be developed with stakeholder organisations, royal colleges, patient groups, and so on, so that we can avoid the misunderstanding to which the noble Earl refers.

[Earl Howe]

I intend to meet some of the royal colleges, and I have met one already. I do not feel that a full-scale consultation is appropriate because the Government’s policy has not changed. It is the wording of the regulations that has given rise to anxiety. I therefore think that, having taken on board, as I hope I have, all the concerns that have been raised, a clarification of the regulations is all that is necessary and there is no need to consult on the policy yet again.

Health: Medical Innovation

Baroness Morgan of Drefelin Excerpts

Wednesday 16th January 2013 Lords Chamber

[Baroness Morgan of Drefelin]

My Lords, I congratulate the noble Lord, Lord Saatchi, on securing this debate. I, too, found his introduction moving, so I thank him for that.

I declare an interest as chief executive of the medical research charity Breast Cancer Campaign and, perhaps more importantly for this debate, honorary president of Cancer52, an alliance of more than 60 organisations—many of which are very small and unstaffed—working to address the issues faced by those with less common cancers who make up 52% of UK cancer deaths, including ovarian cancer.

The promotion of a vibrant research environment is absolutely essential for the development, evaluation and take-up of new medical innovations in our NHS. Research and innovation are vital if we are to ensure better outcomes for cancer patients, which is why I am so proud that we in this House worked hard and successfully to ensure that duties to promote research and innovation were included in the Health and Social Care Act 2012. It is now equally essential to make sure that these duties are embraced by the new NHS structures as they take up their responsibilities in the coming months. I know that there is much debate about how that will happen.

I turn to an issue that is of concern to many patients: the use of drugs which are off-patent and not licensed for a particular indication, but which could be helpful in new and innovative ways. This is a little related to concerns that the noble Lord, Lord Saatchi, has raised through his Private Member’s Bill. Many noble Lords will have seen the news yesterday about proposals from the National Institute for Health and Clinical Excellence to recommend the use of the drugs tamoxifen and raloxifene for the prevention of breast cancer in high-risk patients. The barrier to using tamoxifen for chemoprevention in the UK arises from the fact that the drug is now off-patent and its original licence does not cover the use of tamoxifen for chemopreventive purposes, despite the drug being licensed for this indication in the United States for a number of years. Because existing UK legislation only allows the original owner of the drug to seek to change the indication—even when a drug is off-patent and there is therefore no incentive for the drug company to seek a change at this stage—this means that medical professionals who may wish to prescribe the drug for their patients must do so outside the existing licensing agreement. This is a significant disincentive and we could argue that it is stifling innovation.

Indeed, the draft guidelines issued by NICE yesterday are clear. They state that the prescriber of these drugs should follow the General Medical Council’s good practice in prescribing medicines and take full responsibility for their decision. This means that medical professionals must clearly document that the patient, or whoever has the authority to give consent on the patient’s behalf, has provided informed consent to receive the drugs for chemopreventive purposes.

Although the NICE guidelines are designed to circumvent this problem and make health professionals more comfortable with prescribing these particular drugs for chemoprevention, the best way to eliminate any remaining doubts for prescribers would be for a new avenue to obtain licences for new indications for drugs where there is a clear evidence base of clinical benefit and when they are off-patent. Therefore, would the Minister tell us what avenues the Government are exploring for closing this existing shortfall in the current legislation? Have the Government perhaps explored any possibilities for public bodies such as NICE to seek new licences for off-patent drugs where the manufacturer has no incentive to do so? He might want to write to me on this, but it would be very interesting to hear how this kind of innovation—which is looking at existing medicines and discovering how they might be used in different ways in different conditions —could be made a more nimble, innovative process.

Health: Cancer

Baroness Morgan of Drefelin Excerpts

Wednesday 7th November 2012 Lords Chamber

[Earl Howe]

My Lords, I agree that clinical networks are a success story in the NHS. They have raised standards, supported easier and faster access to services and encouraged the spread of best practice. We very much want to see that continue. The final number of strategic clinical networks and the number of clinical staff who support them have not been finalised yet. Those numbers will be determined locally so it is too early to speak with any certainty about final staff numbers. We do not anticipate many compulsory redundancies at all. A number of staff have been deployed to other posts already. The aim of all this is to achieve not only a more effective series of networks but a more efficient system as well. We believe that that will be delivered.

[Baroness Morgan of Drefelin]

My Lords, I, too, declare an interest, as chief executive of the Breast Cancer Campaign. Does the Minister agree with the charities Cancer Research UK, Macmillan, and Cancer 52—which represents the rare cancer charities—that this is a real issue of concern? The uncertainty is causing a real haemorrhaging of expertise out of the networks that have been such a success in driving up standards in cancer services.

[Earl Howe]

My Lords, I accept that the uncertainty has been unfortunate and, in some cases, damaging. The noble Baroness is right in her broad observations. However, the intent to maintain networks was signalled very early on this summer by the Commissioning Board. The standard operating framework, which will apply to all clinical networks, will be published very shortly. I think that that will provide helpful additional clarity. However, I repeat to the noble Baroness that the aim here is to maintain networks and to ensure that the good work continues and that the expertise which we still have in networks is translated across into the new system.

Health: Cancer

Baroness Morgan of Drefelin Excerpts

Tuesday 9th October 2012 Grand Committee

[Baroness Morgan of Drefelin]

My Lords, I congratulate the noble Baroness, Lady Gardner of Parkes, on securing this important debate and thank her for her very informative and helpful introduction. As we move towards the new health system, it is vital that people with rarer cancers are fully recognised and receive the specialist care that they need so that outcomes can be improved in the less common as well as the more common cancers. I declare an interest as chief executive of Breast Cancer Campaign, which is a research charity.

As noble Lords know, the Government published their strategy for cancer in January 2011, stating their ambition to save an additional 5,000 lives from cancer every year by 2014-15, to improve the experiences of cancer patients in England and to narrow the gap in cancer outcomes between different groups in society. In turn, the All-Party Parliamentary Group on Cancer, of which I am a vice-chair, published a report in 2011, Effective Cancer Commissioning in the New NHS, which set out recommendations that would support the NHS in achieving the Government’s aims.

The all-party group has spent this year campaigning for implementation of our recommendations, focusing particularly on the new accountability structures, the NHS outcomes framework and the commissioning outcomes framework. We have raised the issue of improved outcomes in less common cancers, including the head and neck cancers that we have heard about today.

Key to improving outcomes and to achieving the Government’s ambition of saving an additional 5,000 lives from cancer each year is earlier diagnosis, as we have heard so eloquently put by the noble Baroness, Lady Gardner. The earlier a cancer is diagnosed, the greater the chance a patient has of surviving it. That is why the all-party group has long campaigned for the NHS to be measured against one-year cancer survival rates as well as five-year survival rates for all cancers and all ages—not just the common cancers.

That is because in the new health system the NHS outcomes framework will be used by the Secretary of State to hold the NHS Commissioning Board to account for its performance. As such, it sets the overall direction and priorities for the NHS. We were pleased that the Government included one-year and five-year cancer survival rates for breast, lung and colorectal cancer for people aged between 15 and 99 in the NHS outcomes framework. However, as we know, cancer is one of the biggest premature killers in this country and we do not believe that the current version of the framework goes far enough.

We know that 53% of people who die from cancer in the UK have a rarer cancer, such as head and neck. There is a significant gap in survival rates between people with a rarer cancer, such as head and neck cancers, and those with a more common cancer. For example, the five-year survival rate for brain cancer is less than 20% compared with more than 80% for breast cancer. We must take steps to ensure that survival rates for rarer cancers improve and catch up with those for the more common cancers such as breast cancer. Across the board, there is a lot more to do and we need to do more. The APPGC is calling for one-year and five-year survival rate indicators in the NHS outcomes framework to be extended to all cancer types.

We are pleased that the Government are listening to our concerns and know that, as a result, they are considering developing a composite survival rate indicator which would include rarer cancers. While we recognise the efforts being made to address the current absence of focus on rarer cancers, we believe that a composite indicator should be in addition to, rather than a replacement for, existing indicators. There is a very important reason why that should be so. It is vital that any new indicator provides additional insight into performance relating to rarer cancers. A composite indicator covering all cancers could mask poorer performance by the NHS in relation to rarer cancers through improvements in relation to the more common cancers. We should be concerned about that. Can the Minister say what progress has been made towards developing a composite indicator? Would it apply to those cancers not currently covered in the framework, such as head and neck cancer?

From Answers that I have seen to parliamentary Questions it appears that there will be a separate publication route for the composite indicator. Will the Minister be able to explain that a bit more? Could he reassure the Committee that any composite indicator will be in addition to existing indicators that are already planned and will not serve as a mask for poorer performance in the less common cancers?

While it is vital that the NHS Commissioning Board is held to account, it will be the clinical commissioning groups which will play a key role at the local level in achieving that additional 5,000 lives saved. The commissioning outcomes framework will be used by the NHS Commissioning Board to hold CCGs to account. In August this year, the Commissioning Outcomes Framework Advisory Committee published recommendations for indicators to be included in the framework. The APPG on Cancer was shocked that only one cancer-specific indicator was included in this recommendation—that of under-75 mortality. It may be that we have not understood it properly, so I look forward to being corrected on that.

However, the APPG on Cancer believes that the omission of one-year and five-year cancer survival rate indicators at this level is a serious oversight and a missed opportunity to ensure that every CCG prioritises not only the earlier diagnosis of cancer but the commissioning of high-quality services. We cannot understand the reasons for the omission. I have been assured that, once the boundaries for CCGs have been defined, survival data will be available at the CCG level, so it should be workable. Given all this, can the Minister support the inclusion of one-year and five-year cancer survival rates in the outcomes framework for CCGs?

We are also calling for proxy indicators for cancer survival, which are particularly important for less common cancers. They are: stage of cancer at diagnosis, which we have already heard about, and cancers diagnosed as an emergency admission. We want these to be included in the commissioning outcomes framework as quickly as possible because this is about gearing up the services in real time to improve as we go forward. These measures will provide a more immediate picture of where improvements are needed in the early detection of cancer. By assessing the performance of CCGs on these through the COF, local commissioners will be encouraged to contract services that improve early diagnosis.

I support the remarks made by the noble Baroness, Lady Jolly, regarding cancer networks. I do not want to repeat the detailed points that she made, but I, too, believe strongly that cancer networks have a vital role to play in continuing to drive up standards and achieving the Government’s vision to save additional lives. I was concerned to be advised that, with the NHS Commissioning Board undertaking specialist commissioning and CCGs commissioning other aspects of patients’ care, patients with head and neck cancers could find their care pathway being commissioned by two entirely different levels of NHS commissioning. That is just one example of the role that cancer networks can play in improving quality, outcomes and the patient experience.

Can the Minister reassure us that there will be sufficient staff, including experienced directors? Will they be retained in each individual cancer network so that they can deliver their functions effectively? Can he reassure us also that the cancer-specific expertise that currently exists in networks will not be lost through this restructuring and that cancer networks will be tasked with driving improvements across the whole cancer journey? As the noble Baroness, Lady Jolly, has stressed, it is not just about early diagnosis; cancer networks have a vital role to play throughout the patient journey.

Once again, I congratulate the noble Baroness, Lady Gardner of Parkes, on securing this important debate. It is essential that we use opportunities such as this to raise awareness of the less common cancers, as she has most ably done.

Health: Pancreatic Cancer

Baroness Morgan of Drefelin Excerpts

Monday 23rd April 2012 Grand Committee

[Baroness Morgan of Drefelin]

My Lords, I congratulate my noble friend on securing this important debate and I declare my interest as CEO of a cancer research charity. I am also proud to be a patron of Pancreatic Cancer UK, and I am particularly proud of its work in its Campaign for Hope, which is a very important initiative. As a vice-chair of the All-Party Parliamentary Group on Cancer, I wanted to try to put together some of those interests and to talk about the work that the all-party group is doing that is important to patients with pancreatic cancer.

As we have heard, people with rare cancers are often diagnosed later and suffer poorer outcomes than those with more common cancers. I should like to thank the Government for listening to the all-party group and others for including one-year cancer survival rates alongside five-year rates for breast, lung and colorectal cancer in the NHS outcomes framework.

We believe this focus on the NHS implementing interventions that improve early diagnosis—which is key to better survival—is important. However, we must not forget that 53 per cent of people who die from cancer in the UK have a less common cancer such as pancreatic cancer. We have to ensure that improvements are made across the board and that the gap in survival between patients with less and more common cancers does not widen but starts to narrow. This is why the All-Party Parliamentary Group on Cancer has called for the one-year and five-year indicators in the NHS outcomes framework to be expanded to cover all types of cancer. I would be grateful if the Minister could provide an update on what consideration his department has given to broadening out these indicators to include less common cancers and pancreatic cancer in particular.

I would like to make a couple of points on patient experience. We know that the experience of cancer patients must improve, particularly for those with pancreatic cancer. The 2010 National Cancer Patient Experience Survey revealed that patients with rarer cancers had less positive views of their treatment than those with more common cancers. Pancreatic Cancer UK has today illustrated this further through its briefing for this debate. If we are to encourage commissioners to take action to improve this situation, the National Cancer Patient Experience Survey must be conducted annually and be included as an indicator in both the NHS outcomes framework and the commissioning outcomes framework. It would be helpful to know what progress has been made towards this.

As we all know, cancer networks have been extremely important in driving up standards in the last few years. Once the reforms are implemented, CCGs will be responsible for non-specialised cancer services while the NHS Commissioning Board will undertake specialised commissioning. For patients with rarer conditions, such as pancreatic cancer, this means that some parts of their care pathway will be commissioned locally while others will be commissioned nationally. Cancer networks play an important role in overseeing commissioning plans and ensuring that seamless care pathways for patients are delivered. Could the Minister update us on the Government’s plans for cancer networks?

I thank my noble friend Lord Aberdare once again for securing this important debate and Pancreatic Cancer UK for its vital work.