Health: Cancer

Earl Howe Excerpts

Wednesday 9th July 2014 Lords Chamber

[Baroness Gardner of Parkes]

To ask Her Majesty’s Government why the number of National Health Service patients treated for cancer by stereotactic ablative radiotherapy has fallen since April last year.

[The Parliamentary Under-Secretary of State, Department of Health (Earl Howe) (Con)]

My Lords, before NHS England began commissioning specialised services in April 2013, many local arrangements that were in place were outside recommendations issued by the National Radiotherapy Implementation Group, the NRIG. Since April 2013 a consistent national policy has been in place, backed by robust clinical evidence. In line with this evidence, the number of SABR indications commissioned has reduced. It is important to ensure that treatments commissioned are supported by robust evidence of their benefit to patients.

[Baroness Gardner of Parkes (Con)]

I thank the Minister but, as recently as February this year, I asked him a question on another form of very specifically targeted radiotherapy. He replied that access would be guaranteed to innovative radiotherapy. My Question today relates to another innovative form, one that targets the particular cancer without damaging the surrounding tissues. Can the Minister explain why the figures have fallen and whether these machines, which are very valuable, are being left unused? If they are, is it because of the lack of people being trained to use them? Do we have enough skilled staff to allow patients to benefit from what is greatly improved radiotherapy?

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[Earl Howe]

My Lords, there is no shortage of investment in radiotherapy and no barrier, indeed, to clinically appropriate access to radiotherapy. A lack of trained staff to operate the machines is not the reason that the use of SABR has fallen. The reason is that the clinical and commissioning decisions have been taken to reflect the evidence of what is clinically effective for certain cancers. That is why clinicians are no longer commissioning this form of radiotherapy for cancers which do not respond adequately to that form of treatment.

[Baroness Finlay of Llandaff (CB)]

Do the Government recognise, though, that there are times when commissioning has to invest to save and has to support evaluation while a treatment is ongoing, and that the new forms of stereotactic radiotherapy have very good local control rates? For example, in lung cancer the rates have improved from 20% to 30%, with 15 to 20 treatments, to about 70%-plus with only three to five treatments. For patients to be treated nearer home, the costs saved to other parts of the care system need to be considered in the commissioning decisions, where you have better local control and lower knock-on healthcare effects.

[Earl Howe]

Yes, my Lords. Radiotherapy, particularly of this kind, is highly cost effective when it is clinically indicated. In fact, SABR is available in eight radiotherapy centres in England. The number of centres providing this treatment is increasing, with over a quarter having equipment capable of delivering the treatment. Current evidence supports treating only a small number of patients with this treatment: that is, in early-stage lung cancers for patients who are unsuitable for surgery. That is about only 1,000 patients a year.

[Lord Hunt of Kings Heath (Lab)]

My Lords, the noble Earl will be aware of a pledge made by the Prime Minister last October that this kind of treatment would be available to cancer patients who needed it. He will also be aware of a statement by Mr Lawrence Dallaglio, who was asked by the Government to help in this. He described it as a “national disgrace” that NHS England reneged on a deal to fund these cancer treatments. Is the noble Earl absolutely certain that the reason the number of treatments has fallen is due entirely to clinical reasons?

[Earl Howe]

Yes, my Lords: that is the advice I received. It goes hand in hand with other advice around other forms of radiotherapy treatment that are increasing very dramatically. For example, intensity-modulated radiotherapy is a similar form of radiotherapy for different types of cancer—head and neck cancers, principally. The use of that radiotherapy has grown very considerably, partly as a result of considerable investment by the current Government.

[Baroness Barker (LD)]

My Lords, this treatment works for patients caught very early in the stages of their disease. Is NHS England working with GPs to increase the number of people who they suspect have cases that will respond to this treatment getting into these centres in the first place?

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[Earl Howe]

Yes, my Lords. One of the measures we took some months ago was to enable GPs to refer patients directly to diagnostic centres when cancer was suspected, thereby accelerating the pathway towards effective treatment if cancer is diagnosed. The signs and symptoms campaign is specifically directed at not only patients but also clinicians, including GPs.

[Baroness Hooper (Con)]

My Lords, is my noble friend aware of the important research carried out over the past 30 years at Southampton University’s centre for immunology to create a treatment based on stimulating the immune system? I appreciate that that is not on all fours with the Question, but it has the same parallel advantage of not causing the debilitating side-effects that traditional chemotherapy and radiotherapy treatments can.

[Earl Howe]

My noble friend draws attention to yet another area of research which may well prove very beneficial to cancer patients. I am not aware of the particular study she mentioned but I shall gladly look into that.