Health: Cancer

Baroness Thornton Excerpts

Thursday 11th November 2010 Lords Chamber

[Baroness Thornton]

My Lords, I join other noble Lords in congratulating the noble Baroness, Lady Finlay, on initiating this important debate. We have had a debate of exceptional quality, but that is only to be expected in your Lordships’ House on this subject. I also join others in congratulating the noble Lord, Lord Howard, on his maiden speech. I am sure that it is the first of many sparkling contributions to your Lordships' House.

I shall start by echoing the remarks of the noble Baroness, Lady Finlay, on tobacco regulation. This seems to be a question that I ask every week. What exactly is happening to the implementation of vending machine bans and point-of-sale tobacco regulation?

The timing of this debate is most appropriate. It is a snapshot of where we are after the previous Government’s work and investment, which have so improved the prospects for cancer patients, and of what still needs to be done. It is also an acknowledgement that change is coming, and poses questions to the Government about what that will mean for cancer patients and their families. It has also provided some suggestions for inclusion in the refreshed, new Cancer Plan.

I was moved by many of the speeches, not least that of my noble friend Lord Beecham, who I am delighted to have as a member of our small but perfectly formed opposition health team. My noble friends Lady Pitkeathley, Lord Kinnock and Lady Morgan made contributions that were enhanced by personal experiences, and my noble friend Lord Wills brought to the House’s attention his forensic ability, which I am sure we shall benefit from as we move forward.

We know that the most effective way of improving cancer survival rates is through prevention and early detection. That is why as a Government we invested in improved cancer prevention and diagnostic services. Breast screening for women, for example, means that 14,166 cases were diagnosed in women aged 45 and over—a figure which is similar to the one the previous year and nearly double that of 10 years previously. The Labour Government also rolled out the NHS bowel screening programme, the first screening programme targeted at both men and women. As a result of cancer screening and the two-week requirement for a specialist to see the patient, survival rates for breast cancer, as for bowel cancer, are improving for those getting this early screening and diagnostic.

The premature mortality rate for cancer is the lowest ever recorded, saving nearly 9,000 lives in 2006 compared with 10 years previously. A recent study by the International Agency for Research on Cancer found that breast cancer mortality rates in the UK were reduced by 30 per cent during the period 1989 to 2006, more than in any other European country. We are on the right trajectory, and it is important to keep moving in the direction in which we have started.

I should like to make a related point to the Minister. It is important to stop allowing this issue to be used as a political football. Andrew Lansley’s continued suggestions that the previous Government somehow failed cancer sufferers is not appropriate. I would be the first to admit that this was work in progress and that there was much more to do, but Mr Lansley does not need to attack the previous Labour Government to justify keeping cancer high on the healthcare agenda.

The Government have, for example, recently used data from EUROCARE that compare UK survival rates of patients diagnosed between 1995 and 1999 and between 2000 and 2002. The data show that the UK has lower survival rates for the most common cancers—lung, breast, prostate and bowel—than other countries with a similar health experience. However, there are two problems with this comparison. Few other European countries have the fully comprehensive cancer registry—referred to by the noble Baroness, Lady Finlay—that England has. Cancer data in Germany, for example, relate to only 1 per cent of the population. This information comes from the King’s Fund. It is also worth keeping in mind that there is a five-year time lag associated with five-year survival rates and that, at the end of this Government, EUROCARE will be measuring the experience of patients diagnosed during the early part of Labour’s Cancer Plan 2000. We know that five-year survival rates for the 21 most common cancers improved for both sexes between 2003 and 2007, compared with the period between 2001 and 2006.

The noble Baroness, Lady Finlay, raised some important questions about the cancer fund. I am still unclear about how the decisions to use this fund will be made and about what will happen if it runs out of money, as it surely will. There are various estimates about the inadequacy of the fund to meet the need. The British Oncology Pharmacy Association has estimated that the real cost of funding treatments will be £85 million this year and £120 million in a full year. We have to ask questions about the fund, which are linked to questions about NICE.

Can the Minister tell us which is likely to save more lives—investing in early diagnosis, or in cancer drugs not approved by NICE? Linked to this is the Government’s intention to downgrade NICE’s work in this area. It is extraordinary that the Government are removing NICE’s authority. It is the one outfit designed to prevent the Secretary of State having to take responsibility for unbearable rationing decisions. As the Guardian reported recently, and as the Minister said, NICE will become “somewhat redundant”. That week we saw the Daily Mail crowing about victory for its campaign. Under the headline “‘Penny-pinching’ NICE stripped of power”, the article stated:

“The scandal of patients being denied drugs just because the NHS rationing body decides they are too expensive will end”.

There is a serious problem here because, regardless of whether the NHS budget is increasing, it is vital to preserve NICE’s integrity and to ensure that the use of all drugs and treatments on the NHS is approved on an equal and fair basis while ensuring that they are cost-effective to the taxpayer. I do not understand why NICE cannot be the body that undertakes the new value-based system which the Government have been outlining. At the end of the day, if the changes go through, how will the Government help those GP commissioners who will be targeted in local campaigns by newspapers and patient groups to prescribe expensive drugs for rare conditions?

I shall return to the issue of waiting lists which I raised in an Oral Question to the noble Earl in the past couple of weeks. I asked about the lengthening of waiting lists for diagnostic tests and its impact on the diagnosis of cancer. Waiting lists for diagnostic tests have almost doubled since Andrew Lansley got rid of the 18-week target. Those are the Government’s statistics, not mine. I clearly did not put my supplementary question to the noble Earl correctly because he told me that I was completely misinformed and wrong. I was pointing out that if diagnostic tests are being delayed, it seems likely that cancer patients will be in that cohort, and that the two-week target—which I am not disputing; I am glad that the Government are keeping it in place—therefore begs the question: how will the Government monitor the consequences of increasing waiting lists for cancer patients and other conditions? Is it acceptable for waiting lists to be lengthening in this manner? How will GP commissioning deal with this issue, and how will the two-week target be maintained under the new regime?

I shall conclude with two questions, one of which picks up on the remarks of the noble Baroness, Lady Hussein-Ece, about people with cancer in the workplace. I am also grateful to Macmillan Cancer Care for sending me a briefing which calls for a set of initiatives to deal with people who want to work and who have, or are recovering from, cancer. Will such initiatives be included in the new Cancer Plan? Macmillan is calling for every patient who wants to work after cancer to be given back-to-work information; explicit outcomes on cancer patients remaining in and returning to work to be included in domain 3 of the NHS outcomes framework; vocational rehabilitation services to be included in cancer quality standards and the NHS Commissioning Board's guidance; and the Department for Work and Pensions to promote employers' awareness of the employment provisions of the Equality Act and their impact on disabled people, in particular those affected by cancer.

Finally, I return to an issue that I have raised before with the noble Lord, namely, the impact of excessive hospital parking charges for those with cancer and other conditions. The average cancer patient pays £325 in travel costs and hospital car parking charges while travelling 53 times to hospital in the course of their treatment. We know that the department's guidance is not working because it is not enforced. Around 60 per cent of cancer patients still have to pay the full price for parking during their treatment, even though DH guidance recommends that hospitals offer free or concessionary rates. Excessive car parking charges are too often the final straw that breaks the camel's back during a highly stressful, emotional and financially challenging time for the patient and their loved ones. We have had a full and fascinating debate and I look forward to the Minister's response.