Oral Answers to Questions

John Baron Excerpts

Tuesday 24th February 2015 Commons Chamber

[Mr Hunt]

We are putting more resources into Halton. In fact, we are putting more resources into the NHS across the country. We are carrying out 21,000 more diagnostic tests, including cancer tests, every year compared with four years ago, and I hope that that is something the hon. Gentleman will welcome.

[Mr John Baron (Basildon and Billericay) (Con)]

The all-party group on cancer and the wider cancer community have commended the Government on introducing the one-year survival rates for cancer into the delivery dashboard from April of this year as a means of driving forward earlier diagnosis. But what can the Secretary of State tell us about the work that is being undertaken to ensure that the levers of accountability are in place to push under-performing clinical commissioning groups into raising their standards on behalf of patients?

[Mr Hunt]

I congratulate my hon. Friend on his understanding of the importance of transparency. He will welcome the fact that we are now saving 1,000 more lives a month as a result of focusing on the five-year survival rates. But that transparency must apply to CCGs as well, and discussions are ongoing with NHS England as to the best way to do that for lots of things, including cancer.

GP Services

John Baron Excerpts

Thursday 5th February 2015 Commons Chamber

[Dr Poulter]

It is easy for the hon. Gentleman to take quotes out of context. It is undoubtedly the case that A and E admissions rose dramatically and the pressure on A and E increased dramatically because people could not access their GP out of hours. Of course that is the case. The facts and the statistics bear that out. Also, many people work, so having access to their GP service in the evenings is increasingly important to working people, so that they can see their GP at a time that is convenient to them. We have a chronic disease burden, which all hon. Members are concerned about, so why should primary and community care services be unavailable at weekends? That is not a well structured GP contract or arrangement. It is important that we do our very best to put that right.

Mike O’Brien, who was a Health Minister in the previous Labour Government, is on the record as having criticised that GP contract and the damage it did to patient care. We want to support GPs to provide a seven-days-a-week service again, which is why we have put in place the Prime Minister’s fund. I hope that the hon. Member for Copeland, putting aside party political differences, will recognise that GP services need to be properly available to patients seven days a week.

[Mr John Baron (Basildon and Billericay) (Con)]

Will my hon. Friend give way?

[Dr Poulter]

I am encroaching on the House’s time and have been generous in giving way, so I will bring my remarks to a conclusion.

As the Prime Minister has said, a strong NHS needs a strong economy. As a result of this Government’s prudent economic policies and long-term economic plan, we have been able to proceed with several major investments in general practice and primary care more broadly. Between 2012-13 and 2013-14, the total spend on general practice increased in cash terms by £229 million. Many hon. Members, and the hon. Member for Walthamstow (Stella Creasy) in particular, raised concerns about the quality of GP premises. On top of the increased funding, therefore, we recently announced a £1 billion investment in primary and community care infrastructure over the next four years. It aims to improve premises, help practices to harness technology, give them the space they need to offer more appointments and lay the foundations for more integrated care to be delivered in community settings.

Improving Cancer Outcomes

John Baron Excerpts

Thursday 5th February 2015 Commons Chamber

[Mr John Baron (Basildon and Billericay) (Con)]

I beg to move,

That this House has considered improving cancer outcomes.

Recent analysis from Macmillan Cancer Support shows that there are now an estimated 2.5 million people living with cancer in this country—an increase of almost half a million over the past five years. May I therefore begin by thanking the Backbench Business Committee for granting this timely debate on an issue that is becoming ever more urgent: improving cancer outcomes?

I would also like to thank my fellow officers of the all-party group on cancer for all their hard work, and the officers of the other cancer-specific all-party groups. It speaks volumes about the importance of the issue that we have come together to secure this timely and important debate. I would like to give the all-party group on cancer a plug. The group is recognised as the wider cancer community’s voice in Parliament. It has a proud campaigning track record. It runs what is now the largest one-day conference on cancer in the UK—Britain against cancer—each December. In the Minister’s own words, it rightly holds the Government’s feet to the flames.

The timing of this debate is crucial. With only a matter of weeks of parliamentary time before the general election, and at a time when NHS England is embarking on a new cancer strategy, this is likely to be the last opportunity for this Parliament to speak up on behalf of the cancer community and feed into that strategy.

The challenge has never been greater. Macmillan Cancer Support estimates that 3 million people will be living with cancer in this country by the end of the next Parliament. By the end of next year, 1,000 people a day are expected to be diagnosed with cancer. Hospital admissions for cancer in England have increased by around 100,000 a year, compared with five years ago. The NHS has missed the target of cancer patients receiving their first treatment within 62 days of an urgent referral for three quarters.

There is also good news, though, in that we have certainly made improvements in cancer outcomes over the past few decades. The latest figures published in December show that the one-year cancer survival rates in the UK now average 68.5% to 69%—up by a full 10 percentage points since 1997. These are figures on a page, but we are talking about thousands of lives saved every single year because we are driving up cancer survival rates, particularly in the one-year figures.

However, those improvements have been gradual and incremental, and they have not been enough to catch up with our European counterparts. Research has shown that our one-year survival rates still significantly lag behind European averages. Whereas we have 68.5% to 69% in this country, the best in Europe is 81% to 82% in Sweden. That is a significant difference that accounts, very roughly, for some 10,000 lives a year. There is always a danger in making comparisons. For example, if we look at the French figures, we are making comparisons with France’s centres of excellence. None the less, the established evidence suggests that we are down by some 5,000 lives a year on European averages, and perhaps by as many as 10,000 when compared with the best in Europe.

[Sir Edward Leigh (Gainsborough) (Con)]

That is why we want an open debate about the future of the NHS. We need to recognise that the social insurance systems in France and Germany produce better outcomes for people than our own national health service.

[Mr Baron]

That is a debate for another day. I accept that dramatic improvements could be made within the existing structures of the NHS, and I want to focus on that in this debate.

The Government have estimated that from 2011 to 2015 an additional 12,000 patients will survive for more than five years after diagnosis compared with the previous five-year period. That figure tells us nothing about how we are doing relative to our European counterparts, who will no doubt also have made improvements. Are those 12,000 lives just a continuation of a fairly stable and steady trend line that has been in evidence for the past 25 to 30 years, or a kick-up, as it were, above the trend line that suggests that we are catching up with our European neighbours? I would appreciate it if the Minister provided clarity on how the figure of 12,000 additional lives saved has been calculated and what action the Government are taking to ensure that we continue to strive towards matching the best outcomes in Europe.

I am conscious that a good number of other Members will speak in the debate, so, without being exhaustive, I will focus my remarks on four key areas: earlier diagnosis and survival rates; inequalities and older people; patient experience; and, last but certainly not least, the problem that some charities are having with data access.

Earlier diagnosis has long been an issue that the all-party group has campaigned on: we describe it as cancer’s magic key. All the statistics suggest that the NHS is as good as any other health care system at treating cancers once they are detected, but poor at detecting them in the first place. That suggests that we need to raise our game as regards earlier diagnosis. Most of these 5,000 or 10,000 lives are being lost at the one-year point, and the NHS is not catching up. We therefore need to drive forward initiatives at the coalface that encourage earlier diagnosis. It is almost a national disgrace that one in five cancers are first diagnosed at A and E when those patients are, on average, twice as likely to die within a year than those diagnosed via an urgent GP referral. That shows the importance of earlier diagnosis.

With this knowledge, we have spent the past two years working with the Government and NHS England to ensure that the right accountability levers are in place to encourage earlier diagnosis. We have been successful, together with the wider cancer community—because ultimately this is about teamwork—in getting one-year and five-year cancer survival rates into the NHS outcomes framework and one-year cancer survival rates into the commissioning outcomes indicator set. That is good news. We were also delighted when Simon Stevens agreed to our recommendations on including one-year survival rates in the delivery dashboard of the clinical commissioning group assurance framework from April this year.

I have used a lot of terminology, but there is a basic logic in putting the one-year figures up in lights and breaking them down by CCG. One of the best ways, if not the best way, of driving up one-year survival rates is to better introduce initiatives that encourage earlier diagnosis at the coalface. Those could be, for example, better awareness campaigns at a local level; encouraging better screening uptake figures, some of which are pretty poor; better diagnostics at primary care; better GP referral rates; or an A and E system which, when it detects these one-in-five cancers, instead of pushing patients back down the system, refers them up, potentially saving crucial time. All or any of those could be introduced by CCGs that are trying to get their one-year figures up. Putting the one-year figures up in lights will put pressure on those CCGs to raise their game on earlier diagnosis.

[Liz McInnes (Heywood and Middleton) (Lab)]

Does the hon. Gentleman agree that we need to look at the age range for cervical cancer screening? Only this morning, I heard of a 21-year-old who was found to be suffering from this disease, and who had begged the GP to give her a screening test but was unable to get it until it was too late. We also have a problem at the older end of the spectrum above the age of 64.

[Mr Baron]

Obviously, I cannot comment on the specific case, but I repeat that putting the one-year figures up in lights will put pressure—the best kind of pressure—on CCGs to look at all the initiatives at their command.

I do not think that the Department of Health or NHS England should be too prescriptive about this. We have CCG managements earning six-figure salaries who should, frankly, be able to make these sorts of decisions by introducing initiatives that best suit their populations. Where there is, say, a black and minority ethnic population, an elderly population, or a mining community population, initiatives have to be skewed accordingly, and that is what CCG managements should be doing. We have to leave an element of local initiative. One cannot just sign a cheque to the NHS for £120 billion and not expect accountability. By putting CCGs’ one-year figures up in lights, we can, over a period of time—there is no quick fix—monitor how they are doing. In the case that the hon. Lady mentioned, I would hope that the CCG would have a look at local initiatives that could perhaps change the situation for the better.

[Rebecca Harris (Castle Point) (Con)]

I, too, welcome the one-year survival rates being put up in lights. Does my hon. Friend agree that there may be a risk of missing rarer cancers such as brain tumours in a drive to catch what might be seen as the low-hanging fruit through screening processes?

[Mr Baron]

That is a very good point, and I will touch on it briefly later; I know that my hon. Friend will do so as well. I agree that there is a danger of that. We need to raise our one-year figures significantly—not by just a few percentage points; if we want to be among the best in Europe, then it has to be by 10 percentage points—and that means that we cannot exclude a lot of the rarer cancers, because there is only so much low-hanging fruit. I hope that this sends out a general message that there must be initiatives across the whole spectrum of all 200 cancers. The rarer cancers are the poor cousin at the moment, and we need to address that specifically. I look forward to hearing what my hon. Friend says later.

Let me explain why it was important to get the one-year figures into the delivery dashboard. We were told that it was all very well to get them into the outcomes indicator set, but they also needed to get into the top tier of NHS accountability—namely, the delivery dashboard. Chief executives of CCGs have told us that they felt they were monitored on that delivery dashboard, or—shall I put it this way—that that was their first port of call.

It is great to be able to inform the House that cancer is now the only disease-specific outcome indicator on the delivery dashboard. I say “great” in the sense that I am delighted that cancer is included, although I wish the delivery dashboard had more outcome indicators, not just process indicators. Processes are fine, but they do not necessarily lead to better outcomes. In my view, if we are serious about improving outcomes, the more outcome indicators we can get on to the delivery dashboard across a range of diseases, the better.

Getting the one-year figures on to the delivery dashboard will be transformational only if we use the tools in the toolbox and ensure that CCGs are held to account effectively. That means not only addressing poor performance, but encouraging those with the highest survival rates in the UK to continue to strive for improvement. There is no point having such figures if we do not use them. Will the Minister clarify how CCGs are being made aware of the upcoming changes to accountability? More importantly, what measures will NHS England take to address underperformance in one-year cancer survival rates by CCGs?

On survival rates, I want to touch on another issue that the all-party group has campaigned on—inequalities. Our recent report, “Cancer across the Domains: A vision for 2020”, particularly highlighted the poorer outcomes for older people. We are not the only ones to have drawn attention to the issue. A recent report from the National Cancer Intelligence Network noted that

“over half of all cancer deaths occur in people aged 75 and over”.

A National Audit Office report on cancer services, published last month, found that

“cancer patients aged 55-64 are 20% more likely to survive for at least 1 year after diagnosis than those aged 75-99.”

Such variation is completely unacceptable. Evidence suggests that the under-treatment of older people happens because some clinicians base their prescriptions on chronological age, not necessarily on their fitness to receive treatment. There is general recognition that older people suffer worse outcomes. The NAO report accepted that

“survival rates for older people are expected to be lower”,

but stated that

“this is unlikely to explain fully the significant variation between age groups.”

I suggest that we need to look at that issue. The all-party group on cancer welcomes the increased focus on it. However, we must ensure that such focus results in action and, as with early diagnosis, that the right accountability levers are in place to deliver real change.

Our recent report highlights our concerns about the fact that all the cancer mortality indicators in the NHS outcomes framework are for under-75s. It is almost as though the NHS has made a decision that the lives of those over 75 are worth just a little bit less than those under 75. That impression has been created in certain quarters, and we need to address that perception. We believe that it sends the wrong message about the importance of older people with cancer. Will the Minister outline what steps the Department is taking to tackle the inequalities faced by older people with cancer?

To move on to patient experience, we tend to think of outcomes simply as survival rates, but it is essential for the NHS to deliver good outcomes for patients at every stage of the cancer pathway. Members will be aware that tomorrow marks two years since the report of the Francis inquiry into the Mid Staffordshire scandal. It therefore feels like an appropriate moment to highlight the importance of the patient experience not as an add-on or a facility that is nice to have, but as an integral part of how we deliver cancer care.

The cancer patient experience survey has given us valuable insight into the experience of cancer patients in the UK. The findings continue to reveal widespread variation in the experience of care that people receive. For example, people with rarer cancers, which were mentioned by my hon. Friend the Member for Castle Point (Rebecca Harris), continue to report poorer experiences than those with more common cancers. The same is true of people with long-term conditions, younger patients, older patients, some ethnic minority patients and patients treated in London hospitals. That widespread variation is unacceptable.

Such an insight is worth very little if we do not ensure that it is used to drive real change. I suggest to the Minister that the mechanisms for doing so simply do not exist at the moment, or if they do, they are disparate and unco-ordinated. The all-party group has real concerns. We know that some trusts develop action plans based on CPES results, but there is no requirement for them to do so. NHS England does not require trusts to report on results. CCGs and NHS England do not seem actively to measure NHS trusts’ progress against their action plans to improve their scores. All that leads to a gap in accountability on the cancer patient experience. There are still concerns about the accessibility of the data from trusts and other local bodies for patients. For example, trust-level reports do not seem to be available on official NHS websites.

The all-party group was pleased that the Minister, in her response to “Cancer across the Domains”, confirmed there were no plans to discontinue the CPES. However, we were concerned to hear that, due to procurement issues, the CPES may not report in 2015. Will she provide an update on whether it will report results in 2015? Perhaps more importantly, will she clarify how NHS England will ensure that the CPES is used to drive improvements in the cancer patient experience, and to hold trusts and CCGs to account?

[Jack Lopresti (Filton and Bradley Stoke) (Con)]

Aside from my hon. Friend’s points about the strategic level of decision making and accountability, does he agree that at an individual level it is crucial to have complete clarity, understanding and credibility from the point of view of the consultant and the patient, and that there should not be any room for ambiguity or confusion?

[Mr Baron]

My hon. Friend makes an excellent point. Good communication and indeed consultation is terribly important, and it is one of the key issues that the cancer patient experience survey addresses in trying to gauge patients’ experiences. The NHS can sometimes forget that patients with cancer, like those with long-term conditions generally, are often very knowledgeable about their condition. They need to be consulted, and there must be better communication. That is why we should formulate the cancer patient experience survey better, and ensure we draw out the lessons to be learned so that we can take action to improve experience. I completely agree with my hon. Friend, and I look forward to hearing his speech.

Finally, may I touch briefly on data access? The effective use of data is the foundation for improving cancer outcomes. Good data are at the epicentre of how we are going to improve outcomes. However, I suggest to the Minister that there are problems. Health charities play a crucial role in driving improvements in the health service, including in cancer services. For example, Macmillan’s research has provided invaluable new insight into patient clinical outcomes and the accuracy of GP cancer referrals, which has helped to improve services. However, charities and others are finding it increasingly difficult to access routinely collected data, leaving vital projects stranded for months. In some cases, they do not get the data at all.

There are a number of reasons for that. First, information governance rules are being applied inconsistently. Changes to the legal status of bodies under the NHS reforms have led to confusion about who data can be shared with and, in some cases, have reduced the capacity for analysis. Secondly, different parts of the system are failing to work together. Both nationally and locally, organisations are adopting an increasingly fragmented approach. Furthermore, organisations that are responsible for releasing data do not appear to have the capacity to do so. In a recent Public Accounts Committee hearing, Cancer Research UK indicated that the research group had been waiting 16 months to access data on cancer waiting times.

As the Minister will know, the recent National Audit Office report on cancer services made recommendations on that issue. First, it recommended that the Health and Social Care Information Centre should be

“held to account for how effectively it is discharging its responsibility to disseminate data to help drive improvements”.

Secondly, it recommended:

“As a minimum, it should seek, and publish the results of, regular feedback from NHS data users.”

The cancer community was concerned to hear Sean Duffy call for greater pressure to release and use data at our Britain against cancer conference. To me, that sent a clear signal that further leadership from the Government was needed on this issue. When she responds, will the Minister outline what plans the Department has to clarify the data access rules and to ensure that they are applied consistently, so that we can plan and make proper use of them? That is the essential point.

In conclusion, I thank the Minister for being here and for being prepared to respond to the debate. I have not had a chance to cover a great number of areas, including inequalities more generally, cancer commissioning and survivorship to name a few. However, I hope and expect that other Members will touch on those important issues. I will end where I began: by focusing not only on the scale of the challenge facing us, with the news that 3 million people will be living with cancer by the end of the next Parliament, but on the opportunity. Because of many of our campaigns over the past few years, the NHS now has the tools that it needs to accelerate the improvements in cancer survival rates. The challenge that I set for the Minister today is to ensure that NHS England uses those tools to full effect to deliver the best outcomes in Europe and, quite literally, to save tens of thousands of lives.

--- Later in debate ---

[Rebecca Harris (Castle Point) (Con)]

As one of the co-sponsors of the debate and as chair of the all-party group on brain tumours, I thank the Backbench Business Committee for scheduling the debate and the Minister for her presence in the Chamber. This is a timely debate: yesterday was world cancer day. It is also timely for me for another reason, which I will come on to later. I think we all agree on the importance of raising awareness of early diagnosis and I will come on to talk about that, but world cancer day has done an enormous amount of work with the many cancer charities to raise awareness of the risk of cancer. We are much more likely to spot the initial signs of the disease, but I think the consensus is that there is still a way to go.

I would first like to share the story of the Green family in my constituency. Their son Danny, who was a happy, sporty, energetic 10-year-old, suffered a dizzy spell after playing football. After a few days of being unwell his parents, Chris and Lisa, were very concerned about this health and took him to hospital. They were turned away and told that he had a migraine. After trying hard to persuade doctors that this was not how their son was normally and that it was not just a migraine, the family took him back to hospital and asked for a scan, only to be told that a scan could take months to schedule. Only when he collapsed in hospital, was he rushed to have a CAT and MRI scan.

Danny was taken straight to Great Ormond Street hospital, where he received incredibly good care. His brain tumour was removed and he stayed in hospital for many months fighting a little-known unfortunate side effect of brain tumour surgery—something called posterior fossa syndrome—that left him badly disabled and unable to speak. Unfortunately, the cancer came back. After a heavy course of chemotherapy it started to shrink again, but tragically, Danny lost his life after contracting pneumonia and another virus in Great Ormond Street in July 2012.

Like many people, the Greens had taken someone to hospital with balance problems and headaches that were dismissed as a migraine. Far too many people finally get treatment only after having had the symptoms for a long time. Mercifully, brain tumours are rare, but that is the problem, because rare cancers are not sufficiently picked up. The Greens would like to see patients displaying possible symptoms of brain tumours given scans much earlier, and greater awareness of the possibility of brain tumours among clinicians.

From this unbearable tragedy, however, sprang a determination by Chris and Lisa Green and Danny’s sister, Holly, to support families going through a similar ordeal and to tackle the lack of awareness about brain tumours. For that reason, they set up a charity, the Danny Green Fund, of which I am glad to be a patron. It has gone from strength to strength in supporting families of those suffering from brain tumours, and in particular the debilitating condition of posterior fossa syndrome. It has raised an enormous amount of money for research—in the past two years alone, this tiny charity on Canvey Island has raised more than £160,000.

Although awareness of more mainstream cancers, such as breast and prostate cancer, has dramatically increased over recent years, and with it funding for research into cures and treatment to improve patient outcomes, it appears that the same level of awareness of, and funding for, brain tumours is not forthcoming. In fact, brain tumours receive just 1% of the entire national spend on cancer research. I find that shocking, considering that brain tumours are the biggest cancer killer of children and adults under 40. Outcomes remain relatively poor, with patients diagnosed with brain tumours having a five-year survival rate of just 18.8%, compared with cancer as a whole, where 50% of patients can expect to survive for at least 10 years.

Between 1970 and 2010, while cancer survival rates doubled, brain tumour survival rates increased by a mere 7.7%. Rare or not, how can we improve these outcomes for the 16,000 people diagnosed every year with a brain tumour? With more than 120 different types, brain tumours are notoriously difficult to diagnose, and our understanding of other cancers does not readily translate to them. I therefore appreciate that improving outcomes will not be easy, but that does not mean that brain tumours should remain an overlooked cancer.

Having worked with two excellent cancer charities, Brain Tumour Research and the Brain Tumour Charity, along with two charities in my constituency, the Danny Green Fund and the Indee Rose Trust, I know that the charities are doing an exceptional job in raising awareness about brain tumours and increasing the funding and research to improve treatments. However, I believe I speak for all these charities and those affected by brain tumours in saying that we need to focus on at least four key issues if we are to improve outcomes.

The first and most obvious area is funding. Brain Tumour Research estimates that to bring research and treatment of brain tumours into line with other cancers and improve patient outcomes, research funding would need to increase to £35 million a year for a decade. We urgently need earlier diagnosis. About 58% of brain cancers are diagnosed in A and E, which is considerably higher than the figure for cancer overall. We need a far better understanding among GPs of symptoms, and better pathways to secure early treatment. Early diagnosis is essential for starting early treatment. As the cancer proceeds, the brain tumours grow, becoming far harder to treat and manage, and for brain tumours, even benign tumour growth, this is potentially fatal.

New NICE guidelines need to improve the early diagnosis of brain tumours so that more patients are diagnosed by a GP and receive early treatment. We also need a national register of all site-specific cancer research to track the research work, the grants and their results. That is vital, as currently there is not a great deal of transparency in the research field and no clear idea of what research is being funded and results achieved. This leads to confusion, duplication of work and a system that prioritises research into more common cancers, rather than those disease areas of most need, such as brain tumours. A national register would make research more transparent, reduce duplication and allow greater variation in type and scope of research.

Finally, we need better and easier access to available treatments. Research into new treatments and early diagnosis is essential to beating brain cancer, but more can be done with existing treatments through the NHS. One such example that has been in the news in the last year is proton beam therapy. It is similar to traditional radiotherapy, destroying cancerous cells with beams of high-energy radiation, but it is far better suited to the brain as it only affects the cancerous cells. More widespread centres using this technology could be set up and the therapy given to as many brain tumour patients as possible.

I hope that some of the issues that I and others will cover in the debate will raise awareness of how outcomes could improve for all cancer patients, particularly brain tumour patients, and put the spotlight on just how deadly brain cancer is in comparison with other cancers.

[Mr Baron]

Before my hon. Friend moves too far from the subject of proton beam therapy—something I would have raised had time allowed it—may I suggest that she is absolutely right to raise it? A new generation of technology is coming out of CERN and going to British companies, and we must do our best to at least explore the feasibility of embracing that within the NHS. Not only is it cheaper and better technology, it is smaller, which means that we could have more sites around the country. I know the Minister is aware of this, as we have raised it before, but I hope that it will be addressed in the debate.

[Rebecca Harris]

This sort of therapy gives great hope to many sufferers of brain tumours in particular.

The debate is timely for another reason; tomorrow is Danny’s birthday. He should have turned 14, and his family, in his memory, have funded a further day of research with the money they have raised. Mercifully, brain tumours are very rare but, as Lisa Green—Danny’s mum—pointed out, “They are not rare enough when it is your child.” I very much hope that the spotlight can be put on the urgency of improving care.

--- Later in debate ---

[Jack Lopresti (Filton and Bradley Stoke) (Con)]

I was not entirely sure whether it was a good idea to apply to speak in the debate. It is the first time I have properly put anything on the record about my own experience. I am a cancer survivor. A year ago virtually to the day, I finished about 30 sessions of daily radiotherapy, with oral chemotherapy. It is like awakening from a bad dream. I wanted to get on with my life and not look back. Looking back and putting it all together has been quite difficult this week, but the thing that convinced me that I should say a few words was that, apart from support from family, friends and colleagues once I had my initial diagnosis, the most valuable thing for me in getting through the whole thing, keeping my spirits up and being positive was reading, as an inspiration, about people who had been through the journey.

I ordered tonnes of books from Amazon. I read Bob Champion’s story and re-read the chapter in Rudy Giuliani’s memoirs on beating cancer to give myself as much information as I could about happy endings and going through the process. So I will tell my story, with the message that anyone who is facing the journey, which is very daunting and can be a lonely process, despite the best efforts of friends and family, will get through it. All things end and I am pleased to say that, after I finished my treatment, I was back here within a week or two.

Within a few months of listening to my friends telling me not to overdo it, I managed to run the Bristol half-marathon and the Stroud half-marathon before Christmas. [Hon. Members: “Hear, hear.”] Thank you. I have just applied to run the first Bristol to Bath marathon in October. That points to a surprising thing. I was always incredibly fit and healthy. I had run my first full marathon nearly a year before my diagnosis. So this can come out of left-field. That is not an excuse for not looking after ourselves, however, because the fact that I had looked after myself and was fit and healthy meant I coped with my treatment better and got through it more easily than I might have done.

Two years ago in January I had what I thought was the normal annual virus or bug. I thought perhaps I had overdone it a bit at Christmas, so I carried on with the usual paracetamol and got on with things, but eventually, after a couple of weeks, I succumbed and went to see my GP. She was very good and very calm and said, “We’re not quite sure what it is,” but she did refer me quite quickly to my local hospital as an out-patient.

The staff there said they were worried about me and the fact that I kept flinching when they pressed on my appendix area. They did not let me go home even to get some books and my pyjamas, but my family helped me out. I stayed in for a few days, and the prognosis when the consultant let me go on the Monday morning was that they were pretty certain it was appendicitis but I had an abscess and it could well have hit a cancer. That was the first time I had heard that word. He quickly reassured me that I was far too healthy-looking and it was not very likely, but it was a possibility. They gave me intravenous antibiotics while I was there and sent me home to recover saying, “We don’t normally like to operate on appendixes straight away these days because it is a tricky operation and can be treated with antibiotics.”

To cut a long story short, this went on for two or three months. I kept finishing the antibiotics, and within about 10 days I would start to feel really ill again. My hon. Friend the Member for Basildon and Billericay (Mr Baron) said to me, “For goodness sake, go back to your constituency and get whatever’s in your body removed because you’re obviously very ill.” I even went to the nurse here at Parliament who said almost the same thing: “I’m very worried. I’m not happy. Get back and get it removed.” But the hospital said, “Oh, it’s a grumbling appendix” and kept me in for another week on intravenous antibiotics. Within a week or two of that not working three months had passed, so the initial stages of quick referral and reasonable expectation of what it could be had dragged on for a long time.

I again recovered quite quickly after the operation, but within a week was due to go back for a referral. I had a phone call in the morning: “You’re coming in to see the consultant tonight?” “Yes, I am. Is that still okay?” “Yes, it’s fine. Bring somebody with you.” That was the first indication that things perhaps were not going to work out. I took my mother, and they gave me the good news. I was being very cheerful because my mother was with me and I said, “The only thing I really want to know is can you sort it?” “Yes,” was the answer, so I was fine. “And can we get on with it?” I asked right away, and they did, in fairness. I started six cycles of chemotherapy over three months, which I got through relatively easily because of my health and my natural optimism.

I remember doing gardening for the first time in my life and planting a fig tree in my garden, and thought things were progressing quite well. Colleagues sent me books. My hon. Friend the Member for Bristol North West (Charlotte Leslie) sent me some poetry which was really nice of her and I will always be grateful. So that period passed well, and I had cracked it in my own mind: I was in that place, and I was moving forward.

Then, on 17 September, after a sort of debriefing appointment to ask me how I felt and how I was getting on with things, I had a letter which said: “I saw Mr Lopresti today in clinic. He has chosen to stop his chemotherapy after three months and so has completed treatment.” I thought to myself, “That conversation never took place,” and started to question myself and wonder whether I had heard correctly. Fortunately, I then had a consultation with the oncologist who said, “You will have six rounds of treatment over three months.” For the first time in my life I did not question instructions: I did as I was told. Actually, I am very impatient, and I just wanted to get on with it and get on with the next stage of my life, but I had started to question whether I had heard that correctly.

I thought about what had happened and spoke to my mother and my wife who had been there. They said, “Yes, they said, ‘It hasn’t spread, we’re going to cure it, and we’re going to give you six rounds.’” So I made a complaint. I said, “This has knocked me back probably almost as much as the original diagnosis,” because it shatters confidence in getting straightforward, reasonable, objective analysis and projections of treatment. I also thought, “What would have happened if I was an older person on my own and feeling quite vulnerable?” The apology I received explained that it was because a randomised control was being carried out and they were trying to work out whether giving somebody six rounds in three months was as good as 12 lots in six months. That is fine, and as it turned out my next scan was clear—as have been all my scans, so I am in good order. If they had told me, “You are relatively young and fit. You don’t need 12 lots because it can damage the nerves and there are long-term consequences”, I would have been okay with that, but in fact a conversation that did not take place was recorded and they wrote to me about it. I started to think, “If they can make a mistake on this, what else have I discovered?”

So I had the apology, and I went back to see my consultant. He said to me, “I have really good news. Your scan is clear. You are fine. We can just keep an eye on you or you can have some radiotherapy.” I said, “Look, given what has gone on, I want everything you’ve got. Whatever you’ve got, let’s do it once, get it done. I do not care if you have to carry me out of here, let’s try to get it first time.” In fairness, they did that. I had daily radiotherapy, which surprisingly was more debilitating and took more of my energy than my long course of chemotherapy. I think that was because it was daily and because of the way radiation reacts on the body.

As hon. Members have said, early intervention is, obviously, key. The referral to the hospital was done quickly in my case and was great. The problem was that three-month delay, when a tumour about the size of a fist was in my body. Fortunately, the cancer had not gone anywhere else, but I had a very lucky escape. It could have moved and gone elsewhere, and we could be having a different conversation. I agree that early intervention is key and people should get off to the hospitals quickly, but if there is any suspicion that something is cancer, people have an obligation to get on with dealing with it as quickly as possible, for all the obvious reasons.

I received great medical support and care from the nurses—the people at the sharp end, the people in the wards, the people who did my PICC line—but I felt slightly detached from the consultants. As I say, the experience of a letter completely misrepresenting an interview that took place was shattering and it shredded my nerves for quite a time. I am pleased that the Government have been working to achieve earlier diagnosis of cancer and to set up a strategy to save 5,000 lives by 2015. The latest projections are that, as a result, the NHS is on track to save an extra 12,000 lives each year. That is all fantastic.

What I wish to say in conclusion—I apologise for my emotion—is that when someone gets the diagnosis, they have to stay focused and stay as positive as they can. There are lots of help groups, such as Macmillan.

[Mr Baron]

I commend my hon. Friend for the bravery he has shown, not just in how he dealt with his complaint, but in sharing his journey with the House, because nothing is more powerful than hearing personal testimony. He illustrates better than anybody in the Chamber will do today the importance of good communication and consultation between patients and the NHS and the consultants. For me, at least, that is the key message he is portraying. It is terribly important, and I hope all of us and, in particular, the NHS learn from it.

[Jack Lopresti]

I thank my hon. Friend for his kind remarks, which I shall not dwell on. You do become, if not an expert, certainly quite knowledgeable, and are introduced to the cancer world. There is a lot of information out there. I was told by some consultants not to spend too much time on the internet, as you can go down different avenues and worry yourself to death, but there are lots of good books. I would recommend talking to Macmillan and other cancer groups, reading others’ stories, being inspired and being motivated. You should never lose heart.

--- Later in debate ---

[Paul Burstow (Sutton and Cheam) (LD)]

Thank you, Madam Deputy Speaker. I wish to echo that very point. Some of the best debates that we have in this House, and certainly some of the best Back-Bench business debates, are ones in which people bring their own personal experience and their own stories. My hon. Friend the Member for Filton and Bradley Stoke (Jack Lopresti) talked about the stories that gave him inspiration and hope. I hope that people listening to this debate will gain inspiration and hope from what he has said today. I hope, too, that those who are responsible for planning and commissioning our services and for training our medical professions gain insight from it.

We talk a lot about the concept of shared decision making, and my hon. Friend has demonstrated where that can work well and where it can fall apart. When it falls apart, the impact on the person concerned is immeasurable. I am really grateful to my hon. Friend for his unique and important contribution.

I also thank my hon. Friend the Member for Basildon and Billericay (Mr Baron) for tenaciously pursuing not just the opportunity to have this debate but this whole issue. It is undoubtedly the case that, when it comes to cancer, he has been there championing the cause. When I was a Minister, I had plenty of occasions to feel the effects of his championing. I always appreciated the way in which he pursued the matter, and I am sure that the Under-Secretary of State for Health, my hon. Friend the Member for Battersea (Jane Ellison), has experienced that as well. He is always civil, always polite, but relentless in pursuing what he wants to achieve.

In this particular week, when we have marked world cancer day and had the news from Cancer Research UK that one in two of us are likely to experience cancer in our lifetime, it is absolutely right that we should be debating what more we need to do to go beyond the ambition of this coalition Government to save lives and to achieve the ambition that we set for the NHS in the next Parliament.

Part of the news that sits behind that one in two figure is the fact that we are living longer. I want to caution against the notion that, in some way, living longer is some sort of curse—all too often it is portrayed in that way—and that we should be worried about it. The other thing behind that research is that those cancers that may occur in later life are not inevitable. There are things that we all can do if we make choices about the lifestyles that we lead—whether that is quitting smoking or losing weight. When one considers that there are still 100,000 deaths a year due to smoking and that two thirds of people who are addicted to smoking become addicted before the age of 18, it is clear that we need to focus quite rightly and relentlessly on issues around prevention as well. That is why we should celebrate the news that, just yesterday, the Minister successfully took the regulations through this House that will result in a ban on smoking in cars where children are present, which will make a difference. We have an assurance from the Minister and the Government that, before the end of this Parliament, there will be a vote to have standardised packaging, which will be a real step forward in dealing with the impact of smoking.

We must do more to tackle smoking, especially in the context of mental health and mental health services, where the prevalence of smoking is so much higher. There are examples of good mental health services that have found ways to reduce smoking. None the less, there is a significant difference in life expectancy between people with severe and enduring mental health problems and people who do not have such problems.

Some reference has already been made to the health inequalities with regard to ageing, and I will come back to that. We need to recognise that there is a broader issue around the social gradient. If someone is poorer, they are more likely to be at risk from cancer, especially when lifestyle is a factor. The strategy that is being drawn up by the taskforce needs to address the whole range of health inequalities to deliver on the challenge that was rightly set and the duty that was imposed on the NHS to tackle health inequalities under the Health and Social Care Act 2012.

Sean Duffy, the national clinical director for cancer, has said that our cancer survival rates are at an all-time high, and my hon. Friend the Member for Basildon and Billericay set out the statistics that show why we should celebrate the progress that has been made over a number of years. Clearly, if half of us will get cancer during our lifetimes, we must keep looking afresh at what more we can do. That is why the announcement of the taskforce in January to look at what the next five years should hold for cancer work is absolutely right. We cannot rest on our laurels.

Again, I pay tribute to the hon. Member for Easington (Grahame M. Morris) for tenaciously pursuing the case for radiography, just as my hon. Friend the Member for Wells (Tessa Munt) has done, and I give him due respect for doing so. The strategy that is being developed must answer the concerns that he and other hon. Members have been raising for a number of years. The ability to combine different innovations—whether pharmacological or technological—is absolutely key to how we catch up and then stay ahead in terms of cancer survival rates, and it is why we need this ambition of going beyond just achieving the average cancer survival rates in Europe to strive to become the best in Europe. Better prevention, swifter diagnosis, better treatment and aftercare are all part of that.

On early diagnosis, we have heard that a quarter of diagnoses or thereabouts take place at an emergency stage—far too late—and the outcomes are bad as a result. Therefore, we need a clear commitment to fund the Be Clear on Cancer campaign throughout the life of the next Government, because awareness raising and the identification of signs and symptoms make a difference. For example, in the areas where the lung cancer signs and symptoms campaign was tried initially, 700 extra patients were diagnosed—700 people had an opportunity to live their lives longer as a consequence.

The hon. Member for Washington and Sunderland West (Mrs Hodgson), who, again, is a tenacious pursuer of ovarian cancer issues, is absolutely right to ask why, on the basis of the pilot evidence from 2013, we are not pursuing ovarian cancer in the Be Clear on Cancer campaign. I hope that the Minister will answer that and perhaps give us the prospect of good news. The hon. Lady certainly persuaded me when we took the decision to hold the pilots, and I would want to know why we should not pursue it. Certainly, the pilots that she referred to suggest that there is good cause to do just that.

I was struck in preparing for the debate by the research published by Cancer Research UK looking at what could be achieved with earlier diagnosis if we strove to eliminate inexplicable variations in England. In other words, if we had diagnosis rates at the best level just in England everywhere—for colon, rectal, ovarian and lung cancer—it would benefit 11,000 patients and save the NHS £44 million. If we could do that for all 200 cancers, it would help 52,000 people. It is within our grasp to do massively more if we learn just from the best in our own country, let alone striving to be the best in Europe, which we would become if we did that. I very much welcome the work that CRUK and Macmillan are doing with NHS England to deliver that.

My hon. Friend the Member for Basildon and Billericay talked about the unacceptable cancer death toll among older people and the over-reliance on chronological rather than biological age in making judgments. As the then Minister who took the decision that there should be no exemptions from the equality duty with regard to age discrimination for the NHS, I think that that is not acceptable. Chronological age should not be used; the person and their individual circumstances should be considered in judging which treatments should be available.

It is therefore also vital that we recognise that in later life, because of complex comorbidity and frailty, there are additional needs, sometimes social needs, that are not properly taken into account. While I was the Minister with responsibility for cancer, I was pleased to help launch the work that Age UK and Macmillan were doing to pilot new ways of ensuring that more older people would gain access to cancer treatments. It would be useful if the Minister could say where that has gone and whether it will be continued. I hope the work will be looked at when the taskforce draws up its strategy.

[Mr Baron]

As a Minister, the right hon. Gentleman was always a great champion of cancer. One accepts the complexity arising from comorbidity, but does he believe that the under-75s cancer mortality rate indicator should be looked at again as a means of helping to redress the issue?

[Paul Burstow]

Personally, I think that at some point there must be a legal challenge as to whether that places ageist assumptions at the heart of the NHS. The fastest growing part of our population are the over-85s. How on earth can it be that we do not have statistics that allow us to know how well that older part of our population is being treated for cancer, let alone anything else? When one considers that when the NHS celebrates its 100th birthday, there will be over 100,000 centenarians in this country, it is clear that we need to start catching up in the way in which we use data to ensure that we are not discriminating inappropriately on the basis of the person’s date of birth. I agree that the indicator needs to be looked at.

The hon. Member for Easington also mentioned the cancer drugs fund. After the election there should be a thorough evaluation of the impact of the cancer drugs fund over the past five years. It was a good initiative; it plugged a gap, but unfortunately the gap that it was plugging is now not being filled because there has not been a change in the way we pay for drugs. It could play a part in underpinning combinatorial innovation of the sort that the “Five Year Forward View” mentions.

On the hon. Gentleman’s reference to free end-of-life social care, I have not changed my view. When I wrote the care and support White Paper, we made it clear that we saw much merit in free end-of-life social care. Because of the reports that have been published since, I believe that the evidence has grown even more compelling that this is not a cost to the NHS. It would be a benefit to the NHS. I know that my right hon. Friend the Minister of State who has responsibility for care and support has taken that view as well, and I hope we can see progress on that too.

As the Member of Parliament for Sutton and Cheam, it is a source of great pride to me that I live in a constituency which has a hidden gem—the Institute of Cancer Research. As I am sure hon. Members in all parts of the House know, that is a world-beating research facility, taking research and discovery from the lab to the bedside in collaboration with the Royal Marsden hospital, which is on the same site—a phenomenal site which is looking to expand further. It does fantastic work, including genetic testing, which is an area that I want to raise with the Minister.

The institute has been a pioneer in mainstreaming genetic testing, particularly around BRCA1 and 2. It has developed a good practice model that can mainstream genetic testing into existing oncology appointments. The potential of that is amazing—four times the volume of activity can be delivered through this new pathway at twice the speed and half the cost. In other words, we can gain the benefits of genetic testing without apparently having to spend more money, but delivering much more targeted and insightful diagnosis and onward treatment as a result. That pathway exists. It has been developed, refined and tested, but it has not yet been widely adopted, despite the fact that it is freely available. I wonder what more could be done to make sure that it is more freely adopted. Perhaps the Minister could say how the strategy might help take that forward.

This debate needs to be set in a broader context. If we are to achieve an ambition of matching the best in Europe over the life of the next Parliament, we must address the funding pressures that are acknowledged in the “Five Year Forward View”. This Government have started to acknowledge that with what Simon Stevens described as the “down payment” of the £2 billion announced in the autumn statement, which will come in from this April, but we know that we need to give the NHS certainty about funding for the life of the next Parliament.

All of us who are responsible for articulating different party points of view on health policy need to be clear with the NHS and with the public about what we would do with regard to funding. I am therefore pleased that the Deputy Prime Minister and the care and support Minister have set out how the Liberal Democrats would provide the £8 billion requested in the “Five Year Forward View”. I look forward to the debates we will have over the coming weeks on how others would achieve the same thing, which we need. This debate, however, is an important way of shining a light on the progress that has been made and the opportunities to make further progress.

I thank the hon. Member for Basildon and Billericay for securing the debate and the Backbench Business Committee for allowing it. This is what it makes clear: yes, there has been progress, but there is still much more to come.

--- Later in debate ---

[John Glen]

Absolutely, and I was going to come on to that. My fundamental point is that we must change the appetite of the nation for the NHS. Yes, we want it to be there when random events take place, but we must also recognise that if we are to promote better health, everyone in this country has a responsibility as individual citizens to reduce the demands on it. Unless we do that, every five-year forward view will imply further and further increases. We need to be realistic about the fact that, unless we make real changes, we as a country will be presented with profound challenges.

[Mr Baron]

My hon. Friend is making a thoughtful and powerful point, but may I push back very gently? For me, the most transformational improvement we could make would be to put the one-year figures up in lights, as I said earlier. That will not cost money; it is about our sense of priorities, as he is fully aware. When we consider that we spend almost as much money per head of population on our health care system as many continental countries, but are still 5,000 lives behind the average—let alone 10,000 lives behind the best—there are still vast improvements to be made within existing resources, and those improvements would save money.

[John Glen]

I absolutely take that point, but I am challenging the fact that it is extremely demanding to deliver structural changes to how we provide the volume of services in a national system. For 18 months, I went through the experience of dealing with Naomi House, which provides palliative care for children and serves Hampshire, Berkshire and Wiltshire. I met four Ministers and the Prime Minister, but we still did not get a concession on bringing forward guidance on the use of tariffs by local authorities supporting palliative care for children. It was a case of being told that there would be a review, which would happen this year, next year or whenever. Because of my great frustration that delivering this change demands such effort, I doubt that continuing with the NHS as it is now will ever satisfy people. We must be more nimble in dealing with such challenges.

The other outstanding issue relates to the use of data. My hon. Friend the Member for Basildon and Billericay (Mr Baron) rightly pointed to the need for more awareness of data transparency so that we can target resources more effectively. I hope that he is right about the sufficiency of the resources that every party in the House will no doubt pledge in the run-up to the general election. However, when we have a lot of data, we need to be able to process and deal with it, and ensure that we use it to guide resource allocation decisions. I resist strongly all the voices saying that we need to be extremely cautious about using data. Unless we can aggregate data on health outcomes in different dimensions, and use them to drive the reallocation and refocusing of resources, we will not deal with inequalities.

I have probably said enough, but I want to thank my hon. Friend who has given us all something to aim for by championing cancer issues. I once again commend the recruitment event pushed by my local paper in Salisbury, the Salisbury Journal, to make us the place with the highest number of people on the register of Delete Blood Cancer UK. Will the Minister reflect on the key point about the sufficiency of resources and the challenges that the NHS faces and give us an honest answer, as I know she will? It is really important that people outside Parliament know that Members understand the challenges involved in the vital area of how to tackle cancer.

[Andrew Gwynne (Denton and Reddish) (Lab)]

I congratulate the hon. Member for Basildon and Billericay (Mr Baron) on securing this incredibly important debate and on the considered way in which he set out the issues in his opening speech.

I thank my hon. Friends the Members for Washington and Sunderland West (Mrs Hodgson) and for Easington (Grahame M. Morris), the hon. Member for Castle Point (Rebecca Harris), the right hon. Member for Sutton and Cheam (Paul Burstow) and the hon. Member for Salisbury (John Glen). I have not left out the hon. Member for Filton and Bradley Stoke (Jack Lopresti), but have left him to the end. I pay special tribute to him for the moving way in which he shared his personal experience. His message will have offered hope and inspiration to people who are listening to this debate. I thank him especially for that.

I extend my thanks to the Backbench Business Committee for ensuring that this debate could go ahead. It is crucial that when we mark important events such as world cancer day, the message goes out from this House of Commons that, whatever our political differences on whole areas of public policy, including the national health service, when it comes to matters such as our commitment to tackling cancer, we speak with one voice.

It is a particular privilege to take part in this debate on behalf of Her Majesty’s Opposition. From the outset, I want to echo the proposer of the motion in paying my own tribute to the various cancer all-party parliamentary groups, which do such good work to highlight these issues in Parliament. Cancer care and prevention is one of the most important policy areas for politicians to consider.

When I was a teenager, my mother was diagnosed with ovarian cancer. I would like to say a personal thank you to my hon. Friend the Member for Washington and Sunderland West for the work that she does on ovarian cancer. Despite my mother paying numerous visits to her GP in the months before she was diagnosed, the cancer was not picked up until a later stage. As my hon. Friend described, although the symptoms were there, they were put down to other factors such as heavy lifting at work. By the time the cancer was diagnosed, it was too late for treatment to be effective and my mother passed away in hospital when I was 19. Not a day goes by that I do not miss her. Not only was I robbed of my mother; my three children missed out on a pretty fantastic grandmother. I therefore understand the very personal hurt that a loss from cancer can cause.

I do not blame the GP for not spotting my mother’s cancer. As my hon. Friend the Member for Washington and Sunderland West set out, patients with ovarian cancer often present with symptoms that are not easily recognisable. However, it did make me question what more could have been done. That was in 1994. In the 20 years since, we have made huge progress in improving cancer services. In the last decade, five-year survival rates improved for nearly all types of cancer. However, as we heard in the opening contribution of the hon. Member for Basildon and Billericay and in the speeches of other hon. Members, we still lag behind other countries.

There is worrying evidence from the past five years that the progress that we have made on cancer care has stalled to some extent. People are waiting longer for vital tests and the national cancer target has been missed in the past three quarters. Over the past four years, cancer spending has been reduced by £800 million in real terms. It is worth saying that in government, Labour created 28 cancer networks to drive change and improvement in cancer services. Those networks brought together the providers and commissioners of cancer care to plan and deliver high-quality cancer services in their areas. They helped to oversee and drive up the quality of services that were delivered to cancer patients. By significantly changing their structure and reducing their budgets by millions, as well as by scrapping the highly regarded national cancer action team, I would argue that the Government have disrupted those networks.

Cancer Research UK published an analysis late last year that suggests that cancer services have been weakened by the shake-up of the NHS. It also suggested they lack the money to cope with the fast growing number of people getting the disease. The charity found that real-terms spending on cancer reached a record high of £5.9 billion in 2009-10, but since then it has declined to £5.7 billion in 2012-13. So not only has the money been reduced, but the delivery mechanisms, which helped share expertise and best practice, have been dismantled.

Our hard-working clinicians and staff are trying their best within the system, and despite the challenges, continue to deliver quality care, and we should all recognise and pay tribute to the work that they do across the NHS. Let me come on to what we would do were we in government. We have made a commitment that within the first six months of the election, the next Labour Government will publish a cancer strategy with the goal of being the best in Europe on cancer survival. That would include increasing the rate of cancers diagnosed early, which—as we have heard in this debate—drastically increases the chances of survival. At the moment, just over half of cancers are diagnosed at an early stage, but over the next 10 years, we want to see that increase to at least two in every three cancers. If the benchmark of today’s best performing areas—60% of all cancers being detected early—were met across the country, it would mean 33,000 more cancers diagnosed early each year by 2020.

We also plan to make leaps forward on screening and diagnostic tests. We have announced that we will put an extra £750 million of investment into testing over the next Parliament. That will enable us to guarantee a maximum one-week wait for tests and a one-week wait for results by 2020. That will be the first step towards achieving one-week access to key tests for all urgent diagnostics by 2025. That will be made possible by new investment, paid for through a levy on the tobacco industry, because it is only right that those who make soaring profits on the back of ill health should be forced to make a greater contribution in that area.

We will also ensure that the new bowel scope screening programme is rolled out by 2016, which I know will please the hon. Member for Basildon and Billericay. Research has found that patients who are able to see their GPs within 48 hours are less likely to have their initial cancer diagnosis via an emergency hospital admission.

[Mr Baron]

The whole cancer community has been behind the all-party group on cancer and the cancer-specific all-party groups in pushing for the one-year survival rates to be broken down by CCG and put on the delivery dashboard. The shadow Secretary of State welcomed that development when he spoke at the Britain against cancer conference in December. I do not intend to make predictions about who will win the general election during this debate, but may I press the hon. Gentleman—I am pressing my own side—to ensure that if Labour wins it will attach as much importance to the one-year figures and pursue those CCGs that are underperforming, in order to drive forward initiatives at a local level that encourage earlier diagnosis, as I know my party will do, once returned.

[Andrew Gwynne]

I absolutely agree with the hon. Gentleman. In fact, my right hon. Friend the Member for Leigh (Andy Burnham) has given that commitment as shadow Secretary of State. We need to make sure that if CCGs are not performing as well as they could be in this area, Ministers and NHS England take every action they can so that we bring standards up and everyone can expect the same level of treatment, irrespective of which part of England they live in.

The right hon. Member for Sutton and Cheam is not able to be here for the winding-up speeches but, as a courtesy, he let both Front Benchers and the proposer of the debate know that he would not be able to be here. He was right to raise the issue of long-term funding for the NHS. I do not think it is appropriate to talk in a knockabout fashion in this debate about who is going to raise what or when, but Labour has committed to the new time to care fund, which will enable us to have 8,000 more GPs by 2020. That, undoubtedly, will help to improve access and ensure that doctors get more time with their patients.

At the moment, fragmented primary care makes it more difficult for patients, particularly the elderly, to see one doctor who can develop a long-term view of long-term complex conditions. That is why, alongside our commitment to guaranteed GP appointments within 48 hours, we have made an equally important pledge to ensure that patients can book ahead with a GP of their choice.

Hon. Members may also have heard that Labour wants to work with the Teenage Cancer Trust to expand its cancer awareness programmes across all schools in England. Too many young people leave school without knowing the warning signs of cancer. Every young person should have the opportunity to learn more and know where to go if they are worried about their health. We in this place, on both sides of the House, owe it to our young people to teach them the signs of cancer and it is just as important to build their confidence so they can seek help. Early diagnosis, as we have heard, is critical to improving cancer survival, because treatment is more likely to be successful at an earlier stage. I commend the hon. Member for Castle Point for her powerful contribution today, and for the work she is doing in her constituency along these lines to make sure, working with those charities, that young people are more aware of the symptoms of cancer and where they should go if they exhibit signs of ill health.

When doctors catch bowel cancer at the earliest stage, more than nine in 10 people survive for at least five years. At the moment, however, fewer than one in 10 people with bowel cancer are diagnosed at the earliest stage. Many Members will be aware of the appalling statistic that a quarter of cancer cases in England are currently diagnosed through an emergency route. Naturally, far too many of these cases are in the advanced stages, meaning the prognosis is poor compared with cancer diagnosed through other routes.

Late diagnosis is not just worse for health outcomes; as we have heard, it can cost more too. The average cost of treating stage 1 colon cancer is about £3,400, compared to £12,500 at stage 4. Analysis by Incisive Health found that if all CCGs were able to achieve the level of early diagnosis of the best CCGs—our long-term target—then across all cancers we would be making annual savings in treatment costs of about £210 million. That touches on the points made by the hon. Member for Basildon and Billericay, as well as by the hon. Member for Salisbury and the right hon. Member for Sutton and Cheam.

The hon. Member for Salisbury also touched on the postcode lottery for diagnostics and treatments. He is absolutely right. With the leave of the House, I would like to talk about a case from my early time as a Member of Parliament, back in 2005. I have the privilege of representing a cross-borough constituency, so I have two of everything. I have two local authorities and two police divisions and so on. Back then, there were two primary care trusts. My constituent came to my surgery having been diagnosed with breast cancer. Her doctor had decided that the best treatment for her was Herceptin. If she had lived in the other part of my constituency, the primary care trust responsible would have provided Herceptin treatment for her, but because she lived on the other side of a road, with an invisible line down the middle, she was not able to access that treatment. It was one of those moments where it was appropriate for the MP to throw all his toys out the pram, and thankfully the PCT changed its decision. One of my nicest moments as an MP was about two years ago when the lady, whom I did not recognise, came back to my surgery with a completely different case. At the end, she said, “Mr Gwynne, you don’t recognise me, do you?” I looked blank, and panic-stricken, because we deal with so many constituents, and she said, “I’m that lady you got Herceptin for. I’m still here.” It was one of the proudest moments of my time so far as an MP.

That brings me to our plans for treatment. We have pledged that a Labour Government would continue to work with the cancer drugs fund, but we also recognise that the fund unreasonably excludes other advanced treatments. This takes up the point made by the hon. Member for Castle Point and the firmly and long-held views of my hon. Friend the Member for Easington. For that reason, we would expand the cancer drugs fund to include other treatment options, such as radiotherapy and surgery—the two treatments that together are responsible for nine in 10 cases where cancer is cured. That point has been powerfully made by my hon. Friend on so many occasions—it is still ringing in my ears.

The nature of cancer is changing. Just as with AIDS, rapid advances in technology mean that cancer is no longer the death sentence it once was, and this welcome change means that cancer is increasingly considered a long-term condition, which brings its own requirements, in terms of long-term care and support. A report from the King’s Fund suggested that as cancer survival rates improved, health care services needed to improve the quality of life of the growing number of people with cancer. The needs of cancer patients often span every tier of care in our system, yet it often proves incredibly difficult to navigate the various systems. We therefore plan to give everyone with the greatest need a single point of contact. This person will be their co-ordinator and advocate in the system, identifying their needs and ensuring they are met. No cancer patient should end up lost in our vast health system, unable to find the treatment they are entitled to.

Cancer survivors have to be properly supported once their treatment stops to help their recovery and minimise the impact of their illness on their overall health. The current formulaic approaches are not meeting the needs of cancer patients, and the current hospital-based follow-up service will not cope with the growing cancer population. We owe it to families battling cancer to continue to have high ambitions. In that spirit, Labour has set out its plans for improving early diagnosis and expanding access to new innovative cancer treatments. I thank all Members for their contributions. Despite our many political differences, we have the same ambition for cancer—to bring forward the day when this terrible disease is beaten.

[The Parliamentary Under-Secretary of State for Health (Jane Ellison)]

It is a pleasure and an honour to respond to an excellent debate in which we have heard distinguished contributions from both sides. This is the sixth debate in six months I have responded to on cancer, which demonstrates the House’s interest in this important subject. I congratulate the all-party groups on cancer, not only on securing this debate, but on everything they have achieved—I will touch on that at the end of my remarks. I sometimes think that with the expertise we have between us, and given the number of times some of us have met in these debates, were we not to be returned to this place, we could take our cancer awareness roadshow around Britain and do some good for the nation in another way.

I shall try to respond to as many points as possible, and in some areas, I can update the House. However, I want to rattle through as many of the detailed points as possible, and I am sure that the shadow Minister, who I like very much, will forgive me if I do not counter his reiteration of the Opposition’s policy position with a detailed exposition of the Government’s. I will say only three things. First, I shall respond mostly to the Back-Bench contributions. Secondly, I do not recognise his figures on reduced spend, although I understand where they are derived from. Thirdly, when the NHS is bringing together its own strategy on cancer, I would question why we would want to come forward with another strategy. As the hon. Gentleman and others have argued, there is a remarkable degree of consensus about what needs to be done, and that is the area we need to focus on.

Obviously, improving cancer outcomes is a major priority for the Government. As the annual report on our outcomes strategy showed in December, we estimate that we will save an extra 12,000 lives a year by 2015, more than double the ambition of 5,000. That figure of 12,000 lives is the best estimate based on a projection using the latest survival estimates and assuming incidence is constant, which I think responds to points made in the debate. I am sure that my hon. Friend the Member for Basildon and Billericay (Mr Baron) will be interested to see the detailed breakdown of how that figure is derived in the annexe to the fourth annual report on the cancer outcomes strategy.

Clearly that figure represents a great achievement by the NHS and it is good news for the thousands of people affected by cancer. Yesterday was world cancer day. A number of Members have referred to the one in two figure. I emphasise that, in the bylines to that headline, it made the point that that was only if lifestyle factors for many people were not adjusted. In fact, chances are considerably better if we could make some of those lifestyle changes. That was alluded to my right hon. Friend the Member for Sutton and Cheam (Paul Burstow), who as usual made a distinguished contribution. I know that he could not stay for the winding-up speeches.

My hon. Friend the Member for Salisbury (John Glen) made well a point about prevention. Were it not unparliamentary, I might have run up the green Benches to embrace him when I heard his argument in favour of tobacco control and standardised packaging. I could not agree with him more. It was absolutely excellent. The “Five Year Forward View”, which many Members have talked about, is the NHS’s vision of its future strategy. It was brilliant to see prevention right at the heart of that strategy; there is an entire chapter about it. Picking up the point made by my hon. Friend the Member for Salisbury, I have discussed this issue with all the major charities over the past six months and asked them to bring their considerable reach and influence to bear and to talk as much about prevention, given their authority on treatments and drugs. That is an ongoing conversation and we have seen some evidence of that. My hon. Friend is right to remind us that 80,000 people a year die in England as a result of tobacco. If only the women in the 1970s who started smoking knew what we know today; it is now two weeks since lung cancer took over from breast cancer as the biggest killer of women. We continue with our tobacco control measures with enthusiasm. We have a good record.

Of course we want to match the best in Europe, and there has been some discussion about that. We accept that cancer survival in England has historically lagged behind the best performing countries in Europe and the world. However, none of those international comparisons of cancer survival includes patients diagnosed after 2007. I delved into this matter in anticipation of the debate. We always cite the figures, but the reality is that because of the time lag, the five-year survival rates are essentially the gold standard—the benchmark against which the international comparisons are made. Therefore, because of the time lag in the five-year survival rates, we are not in a position to know exactly how we are doing compared with other nations.

However, I take the points made often and well by my hon. Friend the Member for Basildon and Billericay about the one-year survival data. It is inaccurate at the moment to use those figures based on patients diagnosed before 2007 as a measure of current performance in the system. The next best estimate of international benchmarks will be in 2017-18. Until then we will look at issues such as projection.

[Mr Baron]

May I seek clarity on that? Is my hon. Friend saying that the 2007 figures are pertinent to the five-year survival rate figures? What we have been focusing on is the one-year figure as a means of driving forward earlier diagnoses, because it is largely at the one-year point that we are losing thousands of lives.

[Jane Ellison]

I completely understand that point, which is well made. We will not have the next best international benchmark until 2017-18, but my hon. Friend is absolutely right that that does not mean that we are without proxy benchmarking and real benchmarking in the interim. He is right to draw attention to the one-year survival rates. I was trying to give a sense of the international picture and of comparisons.

On how further to improve cancer outcomes, I am sure all Members will be delighted that on 11 January, NHS England announced a new independent cancer taskforce to develop a five-year action plan for cancer services, to consider the vital survival rates and to improve them, saving thousands more lives. The taskforce has been set up to produce a new cross-system national cancer strategy, bringing all the strands together, as so many Members wanted. This is a strategy—by the NHS for the NHS—to take us through the next five years to 2020, building on NHS England’s own vision for improving cancer outcomes, as set out in the “Five Year Forward View”.

Picking up a point made by my hon. Friend the Member for Salisbury, many of the major charities involved in the taskforce have told me that much of it is about working smarter. It is not necessarily to be measured purely by spending more. I thought my hon. Friend made a very thoughtful contribution on that topic. The taskforce is an expression of our ambition for outcomes. It has been set up in partnership with the cancer community and other health system leaders, and it is chaired by Dr Harpal Kumar, chief executive of Cancer Research UK. It met for the first time on 27 January. The new strategy will set a clear direction covering the whole cancer pathway from prevention to end-of-life care; a statement of intent will be produced by March 2015; and the new strategy will then be published in the summer.

I have always been keen in responding to these debates to emphasise the need for the NHS and all others intending to improve cancer outcomes to come together and interact effectively with Parliament. That is vital. The expertise is here in the all-party group, so I am pleased that the cancer taskforce yesterday sent a call for evidence to the various all-party groups—on pancreatic cancer, brain tumours, breast cancer, ovarian cancer and cancer generally. I of course encourage colleagues to submit evidence to the taskforce. After the debate, I will speak to the chairman and of course draw his attention to the quality of the inputs into this debate.

Turning to deal with early diagnosis, I shall not reiterate all the points made about the importance of tackling late diagnosis. We have heard some important illustrations of just how crucial this can be. We have invested over £450 million to achieve earlier diagnosis. As part of the recent taskforce announcement, NHS England also launched a major early diagnosis programme, working jointly with Cancer Research UK and Macmillan Cancer Support, to test new approaches to identifying cancer more quickly.

The new approaches include offering patients the option to self-refer for diagnostic tests; lowering the threshold for GP referrals; creating a pathway for vague symptoms such as tiredness—a big issue for pancreatic cancer, so it is important to work on this; and setting up multi-disciplinary diagnostic centres so that patients can have several tests done at the same place on the same day. So many Members have spoken in today’s and other debates about the wearying journeys and the debilitating effects that multiple tests on multiple occasions can exert on their constituents—another important area to look at. NHS England’s aim is to evaluate these innovative initiatives across more than 60 centres around England to collect evidence on approaches that could be implemented from 2016-17.

Briefly, all Members will need to debate and bring more into the open in the coming years the inevitable tension between the concentration of expertise to carry out early diagnosis, particularly in rarer cancers and those with more difficult symptoms, and the understandable desire that Members and members of the public have to have facilities closer to people. There is a tension, and we will inevitably have to debate it. I think it was the hon. Member for Heywood and Middleton (Liz McInnes) who made the point about the number of rare cancers that GPs see. The issue has been teased out in these debates before, but in reality the number of common cancers seen by the average GP is very few, while the number of rare cancers they see is very few indeed.

[Jane Ellison]

I entirely agree; I think there is a balance to be struck. One of the issues that was discussed at about the time of the launch of the “Five Year Forward View”, by the NHS among others, was that of moving consultant expertise from secondary to primary settings. There are a number of ways of looking at that. I urge Members to feed the points that they have raised to the taskforce, because it is exactly that kind of new way of looking at things that we want to capture in its work.

Since 2010-11, the Department of Health has undertaken a series of local, regional and national Be Clear on Cancer campaigns to raise awareness of signs and symptoms of specific cancer types, and to encourage people with such symptoms to visit their GPs. Decisions on further Be Clear on Cancer activity will be made during 2015, and will be based on all the available evidence relating to the effectiveness of the campaigns. I will argue strongly for their continuation, because I think that the case for them has been conclusively made. Many have been very successful, and they are evidence-based, which I think is important. The Department will continue to work with Public Health England, NHS England and all the relevant experts and stakeholders to keep the campaigns under review.

Let me briefly update the House on the ovarian cancer campaign, which was mentioned by the hon. Member for Washington and Sunderland West (Mrs Hodgson), and for which she is a long-standing and doughty champion. I recently lost a dear friend to ovarian cancer, so the issue is very close to my heart. Public Health England ran an ovarian pilot campaign in the North West television region between February and March last year, which, as the hon. Lady said, focused particularly on awareness of bloating as a symptom of ovarian cancer. Public Health England is waiting for the full evaluation results of the campaign, but we expect the interim report to be shared with the charities later this month. Public Health England has also agreed to meet them. A decision on how to proceed will then be made, at a national level.

A draft policy proposal for BRCA gene testing is among those on which NHS England’s clinical priorities advisory group is awaiting consultation. That consultation will probably take place following a 90-day public consultation on the decision-making framework. I understand that NHS England will soon consult on the lowering of the threshold for BRCA1 and BRCA2 testing in line with guidance from the National Institute for Health and Care Excellence.

Let me now briefly touch on the point made by the hon. Member for Heywood and Middleton, from whose health expertise we benefited earlier in the week during another debate. In May last year, before the hon. Lady entered the House, we had a very good debate about cervical cancer and screening following a tragic case involving a young woman in Liverpool. She may find it interesting to read the report of that debate, in which Members described cases similar to that of the young woman to whom she referred.

If people have gynaecological symptoms that make them alarmed enough to visit their GPs, they should be referred for diagnostic tests. Smear tests are screening tests, not diagnostic tests. In fact, the best clinical guidance is that if there are gynaecological symptoms, a smear test will only delay possible diagnosis. I think it important to send young women the message that if they are worried about gynaecological symptoms, they should seek a diagnostic test rather than a smear test.

My hon. Friend the Member for Castle Point (Rebecca Harris) raised the important issue of brain tumours. I can update her on the work that has been done. Representatives of the Brain Tumour Charity recently met representatives of Public Health England, and the meeting went very well. The charity is to give a presentation to the school nursing partnership in March. It is also going to contact the NHS England’s national clinical director for cancer to see how it can contribute to work on early diagnosis. Other actions were agreed on, but I understand that that particular piece of work is proceeding well.

As we know, screening is an important way of detecting cancer early, and under this Government there has been a £170 million expansion and modernisation of cancer screening programmes. They are reviewed regularly, and I am always happy to tell Members how further information can be submitted to the UK National Screening Committee.

On cancer waiting times, the NHS is treating more cancer patients than ever and survival rates are improving. In the last 12 months, nearly 560,000 more patients were referred with suspected cancer than in 2009-10, an increase of 60%. In 2013-14, almost 35,000 more patients were treated for cancer than in 2009-10, an increase of 15%.

Most waiting times standards are being maintained despite the growing numbers, although we are aware of the dip in the 62-day pathway standard in the last three quarters. Of course it is vital that all patients fighting cancer should have high-quality, compassionate care and we expect every part of the NHS to deliver against those national standards. Therefore, the NHS is looking urgently at any dips in local performance to ensure that all patients can get access to cancer treatment as quickly as possible. It has a specific waiting times taskforce looking at that.

Radiotherapy has long been championed by the hon. Member for Easington (Grahame M. Morris). Radiotherapy can be a helpful treatment for some patients. His points about its success rate when used at the appropriate time were well made. As part of its recent announcement, NHS England also committed a further £15 million over three years to evaluate and treat patients with a modern, more precise type of radiotherapy, stereotactic ablative radiotherapy, or SABR, to which he referred. That new investment is in addition to NHS England’s pledge to fund up to £6 million over the next five years to cover the NHS treatment costs of SABR clinical trials, most of which are being led by Cancer Research UK. Those are for pancreatic cancer, lung cancer, biliary tract cancer and prostate cancer.

I can confirm that we are investing £250 million in two proton beam therapy centres. One is at UCLH—I saw the foundations being built when I visited the hospital recently; it was exciting to see that centre being built—and the other is at the Christie in Manchester, so that patients can be treated in the UK. As Members will be aware, patients are currently referred abroad

On the cancer patient experience and the cancer patient experience survey, nothing could more amply demonstrate the importance of putting cancer patients’ experience at the heart of treatment and of the NHS response than the speech by my hon. Friend the Member for Filton and Bradley Stoke (Jack Lopresti). It was impossible to remain unmoved by it. It could not have more aptly underlined the importance of taking patients’ experience into account. Therefore, I was pleased to see that the results of the 2014 cancer patient experience survey, published in September, show some improvement on many of the scores since the previous survey—89% of patients reported that their care was either excellent or very good.

Following the 2014 survey, NHS Improving Quality is launching a pioneering project that pairs highly rated cancer trusts with trusts that have potential to improve. That “buddying” programme will involve up to 12 trusts and will be directed at clinical and managerial staff so that we can continue to use that survey to drive improvements.

As to the future of the survey, on which there has been some discussion, my hon. Friend the Member for Basildon and Billericay mentioned the new tendering of the contract, which NHS England is taking forward. For those reasons, it is unlikely that there will be a survey report in 2015. I know that that will be a disappointment to him, but it is very much the intention to run a survey this year for publication next year. NHS England is working with a range of stakeholders, including cancer charities, to ensure that that survey is even more effective.

[Mr Baron]

I can probably accept that there may be good reasons for the delay, but perhaps even more importantly, will the Minister do what she can to ensure that the results of that survey, when it is eventually brought forward, are followed through for the benefit of patients? Too often, they are not and different CCGs are doing different things with the results.

[Jane Ellison]

Absolutely. That is the purpose of the buddying programme. There is now a more formalised process to ensure that those that are not doing so well are “buddied up” with those that are doing very well.

I want to make a few more points in response to hon. Members’ comments. My hon. Friend rightly brought up the issue of CCG accountability and how we hold CCGs to account. I congratulate the APPG and his personal campaign to make sure we get the one-year cancer survival rates added to NHS England’s delivery dashboard from April this year. Where the evidence from the delivery dashboard is that local providers are not meeting the standards, that will be challenged by NHS England. I think there is still work to do to understand how we can do that most effectively. I know the APPG will also be giving thought to that. I encourage all local authorities, health and wellbeing boards and Members to be part of that challenge process. I also refer them to the work of the chief inspector of general practice, Professor Steve Field, in that regard, because that is an important part of his work, too.

I can confirm that work is ongoing with regard to free social care at the end of life. The hon. Member for Easington asked about that. That work is ongoing, but the Minister with responsibility for care will be able to expand on that.

On health and inequalities, I could not agree more with all hon. Members who made the point that tackling health inequalities is inextricable from tackling cancer effectively. I visited the constituency of the hon. Member for Nottingham North (Mr Allen) recently. The figures for how many cancers are diagnosed through the emergency route have been put on the record in this debate—around 22%. He told me that in his constituency 40% of lung cancers are diagnosed in A and E, and they have very poor outcomes. That brought that point home to me extremely clearly.

Sean Duffy, the national clinical director, is passionate about the treatment and care of older people affected by cancer. That can play a very significant role in improving our overall outcomes. I know that is something he wants to focus on through his call to action, as well as looking at lower socio-economic groups and some black and minority ethnic groups. A recent Be Clear on Cancer campaign on prostate cancer took place in six London boroughs and focused on black men and their particular susceptibility to that cancer.

On rarer cancers, I have touched on some of the work that is going on, but I am pleased that Cancer Research UK’s new strategy launched last year set out how it would increase research in key areas such as early diagnosis, and again that work will feed into the taskforce.

On research, I will not go into detail, but I invite my hon. Friend the Member for Castle Point to contact me at the Department of Health with regard to research on brain cancer. I was recently able to supply some very detailed figures to the all-party group on pancreatic cancer from the chief medical officer, and I would be very happy to supply them in her area of interest.

Lastly, let me give some reassurance on access to data. Transparency is a key theme for this Government. We have rightly put huge amounts of data into the public domain. It is a frustration that the data availability issue to which my hon. Friend the Member for Basildon and Billericay referred has been hard to resolve. Last year some concerns were raised about the legitimacy of the release of patient data to a range of organisations. When these concerns were raised, Public Health England did absolutely the right thing and suspended the release of data while it conducted a full review. This review is now complete. Public Health England and the Health and Social Care Information Centre have also clarified the legal basis of data transfer between the organisations and a letter of authority has just been issued by the departmental sponsors to remove any ambiguity. Data should now begin flowing more quickly.

I would like to thank all those who have contributed to this debate and to so many other debates we have had in the House on this vital subject. I strongly believe there is a great deal of consensus about what needs to happen. We need to continue to challenge the system, and I am delighted that Parliament continues to challenge Ministers in this regard. The new NHS England independent cancer taskforce is leading the way in partnership working and will make a real difference.

If this is the last general debate we have on cancer in this Parliament, may I say thank you to the various APPGs and the people who speak for them, and give them the following assurance? I can tell them that, although it may not always seem like it, in the 18 months or so that I have been a Minister their work has made a difference, and I do know of things that have happened because APPGs and individual Members championed them in this place. If that does not give them the heart and encouragement to keep going and to come back in the new Parliament and champion these issues further, I do not know what will. I congratulate them on their efforts today, and on other days and throughout the year, on this highly important topic that matters so much to all our constituents.

[Mr Baron]

I am heartened that the Minister says we should keep going, and I assure her we will. Let me thank all hon. Members for their contributions. We have had some heartfelt ones, particularly from my hon. Friend the Member for Filton and Bradley Stoke (Jack Lopresti). His contribution was very brave, and we have all said so. Other hon. Members have made heartfelt contributions about their own personal stories, including the hon. Member for Denton and Reddish (Andrew Gwynne). Let me also thank, as I did at the beginning, the cancer-specific all-party groups. The all-party group on cancer may consider itself the wider cancer community’s voice in Parliament, but we are all doing essential work that adds value to the debate, and I thank all concerned. We work together well and we are making a valuable contribution, as the Minister has kindly said.

I thank the Minister and her team, as ever, for her constructive response. I asked one or two detailed questions in my opening speech that she has not had time to address, given the pressure of time, and I look forward to receiving a response in writing from her on those. May I leave one thought with her about improving outcomes, which is the subject of today’s debate? No one single measure will drive forward on the objective of improving outcomes. Science has its role to play. With my cancer hat on, courtesy of Cancer Research UK, I went to visit the Francis Crick building, the enormous building being constructed next to Euston station. It is inspiring to see that being built, and I was not the only one to feel that it will be a great source of hope in the future. Government initiatives will also take their place in improving cancer outcomes. My hon. Friend the Member for Salisbury (John Glen) made the point about standardised packaging, and, as the Minister well knows, I have made my support for that clear, as it is a step forward.

However, there is one important measure—this is the thought I leave with the Minister—and one initiative that could be transformational in driving forward and improving cancer outcomes. I am talking about the one-year figures broken down by CCG, and the cancer community has come together in getting the Government successfully, together with NHS England, to put them in the top tier of NHS accountability. The Minister has admitted that there is a bit of vague ground on the levers of accountability and how NHS England will ensure that CCGs which underperform over a period of time will be brought to book. I suggest to her that if there is one measure that we will look back on in decades to come and say, “That, more than anything else, encouraged earlier diagnosis at a local level,” it is those one-year figures broken down by CCG. I encourage the Minister and the Department of Health, with NHS England, to do all they can to make sure that those levers of accountability are properly in place, so that we can save those extra thousands of lives, which is what we all wish for.

Question put and agreed to.

Resolved,

That this House has considered improving cancer outcomes.

Pancreatic Cancer

John Baron Excerpts

Monday 8th September 2014 Westminster Hall

[Mr Jackson]

Or frequently, in my case, as my hon. Friend says.

A good friend of mine—a non-political friend in my constituency—was utterly shocked at the premature death of the husband of a very good friend of hers. He was, I think, 48, and the father of two young children. He had visited his general practitioner several times and was told over again that he was suffering from a very bad case of back pain. By the time he had his scan it was too late; the tumour was inoperable and was wrapped round other vital organs. It was not possible to operate and the poor gentleman died, leaving a young family, a matter of weeks later. That account prompted me to think and research more. Of course, I read the moving article that my hon. Friend the Member for Lancaster and Fleetwood wrote for The Daily Telegraph about his experience and the tragic death of his partner such a short time after diagnosis, and that, too, prompted my interest.

Figures have already been given about the comparative spending on different cancers. The current figure of 1% of research spending, representing £5.2 million, is pitiful for a cancer that is so prevalent. If 8,800 people were being knocked down on the roads every year or killed on level crossings or through any other possibly preventable cause, we would demand immediate action; but it seems we are prepared to countenance little if anything being done by central Government on pancreatic cancer. That is not a party political view, obviously. The comparative data show that the USA has a 6% survival rate after five years and Australia has a rate of 5%; but in the UK it is only 3.3%. We must address that. My hon. Friend the Member for Stevenage (Stephen McPartland) made the point that it is shocking that people attend accident and emergency jaundiced and clearly seriously ill before it dawns on anyone that they are in the advanced stages of pancreatic cancer. I just feel that something more can be done, not least because, according to the briefing we have received, one in six people attend a general practitioner or other health care facility more than seven times, yet they do not receive the treatment they need.

[Mr John Baron (Basildon and Billericay) (Con)]

I congratulate my hon. Friend on his powerful speech. I think we all accept that earlier diagnosis is cancer’s magic key. The problem is that one in four cancers are first diagnosed late in A and E and the figure for pancreatic cancer is double that—nearly half of all pancreatic cancer patients are diagnosed there. In fairness to the Government, and I will speak about this when I make my speech, does my hon. Friend agree that the focus on survival rates as a means of driving forward initiatives for earlier diagnosis at local level, whether better awareness, better screening, better diagnostics or better care pathways, is the secret to unlocking this dreadful disease?

[Mr Jackson]

I thank my hon. Friend for his excellent work as chairman of the all-party group on cancer in raising the issue of cancer generally. He is right in saying that there is no magic bullet and that a multi-faceted strategy is needed to deal with the issue. I will elucidate on that in a few moments without taking up too much further time.

The hon. Member for Worsley and Eccles South is right about public perception. We must remember that 25% of men and women who are diagnosed with this condition are not old, but younger men and women. The public should understand and embrace that fact, and I know from my experience of a much younger man who was diagnosed with the disease and died very quickly. It affects everyone throughout the country irrespective of gender, age, ethnicity, region and so on.

Over and above academic research, we should focus on GP education. This is not an opportunity to have a go at general practitioners, who do a fantastic job and work hard, but reference has been made in the nicest possible way to the ping-pong effect, as was mentioned in the all-party group’s report. We must stop that and make a decision to have clear strategies with a clinical pathway that people can get on to if they exhibit certain symptoms.

There are several reasons for the poor rate of diagnosis, which are not strictly speaking the “fault” of the general practitioner. As I have already said, there are no definitive biomarkers or tests and there is no way to get round that. It may be ameliorated or overcome following future research, but at the moment GPs are unable to decide definitively that someone is suffering from pancreatic cancer. That is clearly linked to more funding over and above the current 1%, to which I will refer later.

Low awareness of symptoms among the general public needs a multi-media approach to try to persuade people that they are not wasting a general practitioner’s time by alerting them to their symptoms, even if they are under 65. There is a lack of obvious referral pathways into secondary care for patients without obvious symptoms. The hon. Member for Worsley and Eccles South gave an excellent anecdote about the way people are pushed around between different clinicians. That is completely different from the treatment of breast cancer where there are prescribed and definitive treatment pathways.

What are the priorities? It is vital to develop local screening tests. People should not have to travel 40 or 50 miles, and there should be such a testing facility locally in an acute district hospital or in primary care facilities. There should be collaboration between clinical commissioning groups, for example, as well as GP training, referral guidelines and diagnostic support.

I am realistic and I understand that not every GP will be an expert on pancreatic cancer, but there should be a general practitioner in the local area who can offer expert advice, training and assistance. GPs should also have direct access to CT scans. The all-party group on pancreatic cancer made all those recommendations. There should be one-stop shops where patients with vague symptoms can have a battery of different diagnostic tests. That would not remove the risk that someone has pancreatic cancer, but it would reduce the risk that they remain undiagnosed. There should be a rapid access clinic for jaundiced patients. It may be too late for some people, but some may be saved.

We need research into the biology of tumours and we must look again at the cancer drugs fund, as my hon. Friend the Member for Lancaster and Fleetwood said. We must move to a personalised-medicine approach. It is wrong that pancreatic cancer is struggling to receive even £10 million a year for research. The Department should aspire to higher funding than the current £700,000. It should aspire to £25 million by 2022. We need a new strategy along the lines of the Recalcitrant Cancer Research Act passed by the US House of Representatives for cancers of unmet need. We must ring-fence grants for such recalcitrant cancers by means of clinical trials.

This has been an excellent debate. I am convinced that the issue will rise up the political agenda and I thank everyone who has made that possible. I have had dealings with the Minister and I know that she is compassionate and diligent. I believe that she and her Department are listening and that we are well on the way to beating pancreatic cancer.

--- Later in debate ---

[Mr John Baron (Basildon and Billericay) (Con)]

I congratulate the hon. Member for Scunthorpe (Nic Dakin) and my hon. Friend the Member for Lancaster and Fleetwood (Eric Ollerenshaw) on securing this important debate, as well as other Members on their powerful contributions so far.

May I, as chairman of the all-party group on cancer, focus my remarks briefly on the importance of earlier diagnosis? That has been touched on by everybody who has spoken, but sometimes when we consider the figures that are available, they bring into stark relief the need to drive forward local initiatives to encourage earlier diagnosis.

Recent statistics have clearly shown that if we could match the average one-year survival rates in Europe, we would save something like 5,000 lives a year. The recently published OECD report said that if we could match the average international one-year and five-year survival rates, we could save up to 10,000 lives a year. Those are the sorts of numbers we are talking about. They run very easily off the tongue, but those are individual lives and it is individual grief when it comes to family and friends. It is shameful in this country that something like one in four cancers are first diagnosed as late as A and E. That cannot be right and when it comes to pancreatic cancer, as I think everybody in this room knows, the figures are much worse. They double: something like half of all pancreatic cancer sufferers are not first diagnosed until they reach A and E, when often the condition is so well advanced that it makes survival far less likely, which the figures bear out.

Many years ago, the all-party group on cancer produced a report on cancer inequalities. We found that we in this country stand as much chance as anybody else of getting patients from the one-year point to the five-year point, but compared with others, we fail to get patients to the one-year point. What that suggests, and this was substantiated by the good and great of the cancer world at the time—that report was now five years ago, which suggests that I have been chairman for far too long—is that the NHS is as good as anybody else, and maybe even better, at treating cancer once it has been diagnosed, but it is very poor at diagnosing cancer in the first place. Once we fall behind that one-year point, it is very difficult to make up the lost ground. We lose those 5,000 or 10,000 lives—depending on what we are comparing—at that one-year point, and it is exceptionally difficult to catch up, no matter how good the treatment is within the NHS.

We therefore came up with a very simple measure to try to drive forward earlier diagnosis. It was very straightforward, because we believe that early diagnosis is cancer’s magic key—if we can catch the cancer earlier, we stand a so much better chance of improving all cancers, including pancreatic. Instead of bombarding the NHS with a load of targets, we decided to come up with one measure: to get the local NHS—then the primary care trust, now the clinical commissioning group—to focus on one-year cancer survival rates. The logic is very simple: if there is late diagnosis, we get poor one-year figures. Therefore, by getting the local NHS to focus on one-year survival rates, we get the local NHS, through the CCGs, to focus on introducing initiatives to drive forward earlier diagnosis. It is that simple.

What could those initiatives be? It is up to the local CCG managements—the local NHS managements—to decide what initiatives to introduce that best suit their local populations. They could be, for example, better screening uptake or better diagnostics at primary care. They could be better referral pathways to, for example, CT scans, or better awareness campaigns. It could be any or all of those coming together to drive forward local initiatives to encourage earlier diagnosis.

This is where I would like to congratulate the Government. That may come as a bit of a surprise on my side, but I think the Government have done what is required in this respect, because as of the end of—let me get this right—June, we now have, in the local DNA of the NHS, one-year survival rates. That is very much to be welcomed, because broken down by CCG, it is now going to encourage managements—or it should encourage them—to focus on their one-year figures, and where they are behind, where they are towards the bottom of the table, it will encourage them to act. All of us will be coming together—the cancer community, cancer charities, MPs and local politicians—and putting the spotlight on the underperforming CCGs. If it works as it should—and provided the levers of change and accountability are there—that should encourage underperforming CCGs to raise their game and introduce local initiatives to encourage earlier diagnosis, and over time, improve their one-year survival rates.

The tools are in the toolbox for us all to use to encourage earlier diagnosis. I congratulate the Government on actually listening, because we have been campaigning on this issue for five years now and we now have those tools in the toolbox. However, things are never quite what they seem, and I wanted to speak in this debate to bend the Minister’s ear on a particular issue. We all have our wish list of things that we would like to see introduced by way of initiatives, and I know that the Minister will respond in the fullness of time, if not in this debate, but one thing that I would like to get across to her is what we have learned since succeeding in getting the one-year figures into the local DNA. CCG chief executives have been contacting us and others in the cancer community, making the point that CCG chief executives are more focused on the delivery dashboard, as part of the assurance framework, than on the outcomes indicator set, which is where the one-year cancer survival rates are placed.

We had been aiming to get the one-year figures in the local DNA, which is great. We have succeeded, but lo and behold, another layer of accountability has been shunted in, which has knocked down the OIS, and CCG chief executives are now more focused on the delivery dashboard than on the OIS. There is actually no health outcome in the delivery dashboard, and I think that that is wrong, because in the health reforms introduced by the Government, there were two big ideas. There was the restructuring, which some of us did not agree with, but there was also the focus on outcomes, which was a brilliant concept and, I think, will be far more transformative for the NHS than any restructuring. The restructuring is now history, but the focus on outcomes as a way to deliver improvements or focus on improvements is a real plus. However, if we then put that focus on outcomes in a structure that gets knocked down when it comes to accountability and CCG chief executives are instead focusing on the delivery dashboard, introduced by NHS England and the Department of Health, that risks dissipating the potential benefits that we could see by focusing on outcomes.

I therefore ask the Minister this, and she does not have to reply in this debate. I do not want to put her on the spot, but she knows that I have raised this issue before. Could we focus on putting health outcomes into the delivery dashboard? I am focusing on cancer. I think that the one-year figures in the delivery dashboard would be transformative. We have the figures. They are broken down by CCG. There is no reason why they could not be put into the dashboard. I am speaking with high-ranking officials—I will not name names, but the Minister will know who they are, because she knows whom I am meeting—in NHS England, and they cannot see any reason why that should not happen either, so we need to push on this. If we are serious about saving by 2014-15 or 2015-16 those extra 5,000 cancer lives—that was described to me as above the already improving trend line—we have to ensure that health outcomes are in the DNA of the NHS and that CCG chief executives are focused on them and know that if they do not deliver and they underperform, there are levers of accountability that will really put the spotlight on them. That is how we will improve outcomes in the NHS and how we have to drive forward improvements in the NHS.

Even if we just meet the average in Europe, that will be 5,000 lives saved, which is a phenomenal number, and that is just the average. The average survival rate in this country is about 68% or perhaps 69%; in Sweden, it is over 80%. That is what we are talking about; that is the potential, but we have to get those outcomes into the DNA of the CCGs, and we are being told and are advocating that the best way to do that is by getting it into the delivery dashboard. I shall leave that point with the Minister. I do not want to thrash it too much. She knows where we are coming from, and we will be raising the issue in December at our Britain Against Cancer conference, which will be attended by 500 or 600 people. The great and the good of the cancer community, including the charities, will come together, and we will focus on that.

May I also ask the Minister this, please? She has had our report from last year, “Cancer across the Domains”. We still have not had a response; there has been no official response from the Department of Health to that report. I spoke with her before the recess. I encourage her, please, to let us have that response, because time is now on the wing, given that we have Britain Against Cancer. If the Minister thinks that she has sent it, I would love to know, because we have not received it. If the fault is at our end, I will be the first to apologise, but we have not received it yet—neither the secretariat nor my office.

In conclusion, Mr Speaker—Mr Chope, my apologies. [Laughter.] I do not know whether you will be standing, Mr Chope, but there is plenty of potential, I am sure. I congratulate the Government. We have the focus on outcomes. We have the one-year measure. We have the tools in the toolbox. However, I suggest that unless we put those one-year figures in the delivery dashboard, we will not be using those tools, and many cancer patients will suffer as a result.

[Several hon. Members]

rose—

Oral Answers to Questions

John Baron Excerpts

Tuesday 10th June 2014 Commons Chamber

[Norman Lamb]

I pay tribute to the right hon. Gentleman for his tireless campaigning on diabetes. He has played an essential role in ensuring that it is brought to public attention. It is critical that people who require care for diabetes get access to the care they need, whether they are living in a care home or in their own home.

[Mr John Baron (Basildon and Billericay) (Con)]

4. What assessment he has made of the role of the comprehensive delivery dashboard in holding clinical commissioning groups accountable for their one-year cancer survival rates.

[The Parliamentary Under-Secretary of State for Health (Jane Ellison)]

NHS England uses a range of data, as my hon. Friend will know, including data from the delivery dashboard, to assess the performance of CCGs. That includes the data from the composite cancer one-year survival indicators. NHS England will take action— it has quarterly assurance meetings between area teams and CCGs—if there are concerns about CCGs’ performance.

[Mr Baron]

May I suggest to the Minister that if the Government are to meet their target of saving an additional 5,000 lives a year and to promote diagnosis, we need to hold underperforming CCGs to account. Why is it, then, that the one-year survival rates, which are designed to promote earlier diagnosis, are not in the delivery dashboard, which, unlike the outcomes indicator set, has teeth, particularly given that CCG chief executives have said that they see no reason why the one-year figures could not be included in the dashboard?

[Jane Ellison]

We will certainly look at that, but I emphasise that all those things are important as part of the conversation between area teams and CCGs. I remind the House that the CCG outcome indicators set for 2014-15 include a range of important indicators for cancer, including one-year survival for all cancers, one-year survival for breast, lung and colorectal cancers combined, cancers diagnosed via emergency routes, and cancers diagnosed at an early stage—something I know my hon. Friend has, quite rightly, championed consistently in this House.

--- Later in debate ---

[Norman Lamb]

Absolutely, and we are doing it. One of the problems we are having to confront is that when the Labour Government introduced the 18-week waiting standard, unbelievably they left out mental health. When mental health is left out from a standard of that sort, that determines where the money goes, and ever since then mental health has lost out. We are committed to changing that.

[Mr John Baron (Basildon and Billericay) (Con)]

T1. If he will make a statement on his departmental responsibilities.

[The Secretary of State for Health (Mr Jeremy Hunt)]

Almost a year ago, following the Keogh report, we put 11 NHS trusts into special measures, the first time such a large number of trusts have been put into special measures. Yesterday I was pleased to report to the House that the first trust, Basildon, has come out of special measures. I am pleased to tell the House today that across all the trusts in special measures, an additional 1,202 nurses and an additional 118 doctors have been recruited. The programme is making good progress, and the whole House will want to commend the efforts of all the staff in those hospitals on the tremendous efforts they are making.

[Mr Baron]

I join the Secretary of State in commending the management and all the staff of Basildon hospital for their excellent work and a great team effort. The hospital is now no doubt on an upward trajectory. I should like to raise with him the matter of the human papilloma virus vaccination programme for young women. It has been a success, and there is mounting evidence that is should be extended to young men. Will the Government now look into the feasibility of doing that?

[Mr Hunt]

My hon. Friend is right, and I am grateful to him for mentioning how proud we are of the HPV vaccination programme for girls and women. It is one of the best in the world, and we are getting an 86% take-up rate among eligible 12 to 13-year-old girls. He is also right to say that we now need to look at whether the programme should be extended to men and boys. A decision was taken at the time that it did not need to be, but we are now reviewing that decision. We will shortly be getting advice from the Joint Committee on Vaccination and Immunisation—which, as he will know, gives us independent advice on these matters—and we will take its advice seriously.

Cervical Cancer Screening

John Baron Excerpts

Thursday 1st May 2014 Commons Chamber

[Mr John Baron (Basildon and Billericay) (Con)]

First, I congratulate the hon. Member for Liverpool, Walton (Steve Rotheram) on securing the debate. Needless to say, all our thoughts go out to Sophie’s family and friends at this time of loss.

The hon. Gentleman rightly focused on the importance of early diagnosis, which is crucial with not just cervical cancer but cancer in general. I hope, in a relatively brief speech, to remind the House of the importance of the figures that the Government are due to publish soon—one-year cancer survival rates broken down by clinical commissioning group. I and fellow Members of the all-party group on cancer believe that those figures could have a transformative effect in encouraging earlier diagnosis, thereby saving literally thousands of lives.

The recent period has been interesting, because we have had both good news and bad news on cancer. The good news is that, as Cancer Research UK announced only a few days ago, 50% of those diagnosed with cancer now are likely to make it to 10 years following diagnosis, which is twice the survival rate that existed back in the 1970s. That is extremely positive. The bad news is that in this country, shamefully, one in four cancers are still first diagnosed as late as when somebody goes to A and E. It is of further shame that figures suggest that if we were to match European averages for cancer survival rates—just the averages—we could save an additional 5,000 lives a year. If we believe the OECD’s figures, if we were to match international averages—again, just the averages—we could save up to 10,000 lives a year. That shows clearly that we have a long way to go and that early diagnosis is crucial. The all-party group describes it as cancer’s magic key. There are very few magic keys in life, with which we can open the door and find that there is suddenly a plethora of riches in front of us, but a magic key does exist for cancer, and it is early diagnosis.

[Katy Clark (North Ayrshire and Arran) (Lab)]

Does the hon. Gentleman agree that there is huge regional variation in cancer survival rates? In areas such as the one that I represent, where we have high levels of poverty and deprivation, survival rates are a lot worse than elsewhere, so we have massive challenges before us.

[Mr Baron]

The hon. Lady makes an excellent point, which leads me neatly on to the report that the all-party group produced back in 2009 on reducing cancer inequalities—I should perhaps declare an interest as the chairman of the group. The report, which was extensive and took in much written and oral evidence, found that this country’s health care system stood as much chance as any other of getting patients from the one-year point to the five-year point after diagnosis. However, where we fell down was on getting them to the one-year point in the first place. That suggests that the NHS is as good as any other health care system at treating cancer once it is detected, but very poor at detecting it. That underperformance in diagnosing cancer means that we trail other health care systems. We never catch up from that original loss.

Comparisons are always dangerous. When we compare our system with that in France, for example, we are comparing it with centres of excellence, so we have to be careful in our comparisons. However, the figures of 5,000 lives a year that could be saved if we matched European averages and 10,000 that could be saved if we met international averages are generally accepted. They can largely be accounted for by the early phase, when we fail to pick up cancer early enough and so do not get enough people to the one-year point after diagnosis.

The all-party group therefore decided to ask how we could focus the NHS on earlier diagnosis. We have been laser-like and dogged in our campaign on that front.

[The Parliamentary Under-Secretary of State for Health (Jane Ellison)]

indicated assent.

[Mr Baron]

The Minister is nodding—kindly, I think. I thank her for that in one respect.

The solution that the all-party group came up with was to focus on outcomes. We could bombard the NHS with a lot of targets to try to encourage earlier diagnosis, but instead we decided to focus on one outcome measure—the one-year survival rate, broken down by CCG—as a driver towards earlier diagnosis.

[Alison McGovern]

Given some of the specific details that we have heard, does the hon. Gentleman agree that the all-party group’s approach of not setting a lot of targets but instead focusing on outcomes might enable groups of GPs to make themselves more aware of symptoms that have been missed in the case that we have discussed and in similar cases?

[Mr Baron]

That is absolutely right. When it comes to cervical cancer, all the figures suggest that if it is caught early, 95% to 98% of patients can reach the one-year point. That figure falls away significantly if it is not caught early enough. The hon. Lady is right that the idea behind one-year survival rates, broken down by CCG, is to encourage earlier diagnosis. It is intended to encourage CCGs to introduce local initiatives to address the points that the hon. Member for Liverpool, Walton made about late diagnosis. We all know that late diagnosis makes for poor one-year figures, so putting the one-year figures up in lights, broken down by CCG, means that we can see clearly which CCGs are underperforming. The cancer community and politicians can therefore come together and put pressure on those CCGs to raise their game.

As the hon. Member for Wirral South suggests, there could be a range of initiatives, such as better awareness campaigns, whether on cervical or other cancers, better diagnostics in primary care or better GP training—the hon. Member for Liverpool, Walton made the point that the GP in the case in question missed the diagnosis. There could be a range of local measures, and to answer the point that the hon. Member for Wirral South made, it would be up to the CCG to tailor-make those initiatives to address the needs of its individual area. That is what those figures are about and, for the first time, we will have the opportunity to hold underperforming CCGs to account when it comes to late diagnosis. Late diagnosis makes for poor one-year figures, and when those figures are broken down by CCG, we will know which ones are failing to do more to raise their game on early diagnosis.

In conclusion, I have one or two questions for the Minister. First, I managed to secure from the Prime Minister at Prime Minister’s Questions an assurance that the one-year figures will be published in June. I asked that question because those figures were due out in January but then postponed to the spring, I think, and then postponed again. Will the Minister assure the House that we are still on course for their publication in June this year?

Secondly—the Minister knows what is coming— can we throw any more light on how we can hold underperforming CCGs to account? There is no point in having one-year cancer survival figures broken down by CCG if there are no systems in place to ensure that CCGs that underperform are held accountable and encouraged to raise their game. There is no point having the tools in the toolbox if we do nothing with them. Will the Minister enlighten the House about whether there has been any further thought on that issue since we last raised it in this place back in February?

I know that the all-party group’s report, “Cancer Across the Domains”, is on the Minister’s desk at the moment, and I hope she will say a few words about how quickly we will get a response—we look forward to that. In direct relevance to the point made by the hon. Member for Liverpool, Walton about GPs and the challenges of improving earlier diagnosis, will the Minister say whether there are any other initiatives by the Department of Health or NHS England to look at earlier diagnosis, apart from the one-year figures? For example, GPs are recompensed through the quality and outcomes framework system, and I think I am right in suggesting that the QOF system deals with everything when it comes to cancer post-diagnosis, but there is nothing to encourage earlier diagnosis.

Finally, I mention briefly the all-party group’s reception on 8 July, which will highlight the importance of those one-year figures. In summary, for the first time we will have the tools in the toolbox to hold underperforming CCGs accountable when it comes to earlier diagnosis. We must make use of those tools, and the cancer community, politicians, and everyone else must be aware of their importance—I am confident that they will be. If we embrace the concept fully and focus on outcomes and the one-year figures, we have the potential to save, quite literally, thousands of lives a year in this country.

--- Later in debate ---

[Alison McGovern]

In my slightly cack-handed way, that is what I was trying to say. Women are incredibly good at putting off things that concern our own health, which is why it is important that our brothers, fathers, husbands and friends encourage us to be concerned about our health and to look after ourselves. It is also important that we make the point today about the importance of smear tests. People should have a choice and be able to talk to their GP about having a test if they need one, and if invited to be screened, they should take up the invitation.

[Mr Baron]

The hon. Lady correctly makes the point that we can do more about the disparity in late diagnosis. By focusing on the one-year cancer survival figures by CCG, we can also come together—whether as cancer charities, the cancer community or as politicians—to focus on the under-performing CCGs and ask why that is happening, in the hope that they will themselves introduce initiatives at the local level to drive forward earlier diagnosis. I hope she recognises that that will be an important element of our battle against late diagnosis.

[Alison McGovern]

I agree with the hon. Gentleman. As I said, Merseyside has a particular issue with cancer, and I feel sure that some of that is to do with late diagnosis that arises from aspects of people’s daily lives. We need to think how we can engage with people in a way that does not depend on their having already some amazing knowledge about the possible symptoms. Many people in my family have had cancer, so we would know, but many people do not know. It can be incredibly stressful to take the first step of going to the GP and saying, “I am really worried. What tests can I have?” We need to encourage CCGs to look at the local conditions and figure out how to get through to the public in their area. The all-party group on cancer has led on that, and I fully support that work.

Another important aspect is broader cultural change. We need a culture change in the NHS in two respects, and Sophie’s case has caused me to reflect on how the NHS works. First, it is important that we talk about women’s health. Women are very good at putting themselves last and putting off the visit to the GP or the smear test that they need. We have seen the great success of breast cancer and other awareness campaigns, and we need to do the same with some of the less well-known cancers, whose symptoms are less well-known. We need a real focus on women’s cancers to try to improve everybody’s knowledge of them. I realise that it is not always easy to talk about periods and so on. Women are very good at hiding such issues and just coping with them, but we need to talk about symptoms. It is also crucial that GPs are aware of possible symptoms. I have learnt from Sophie’s family and friends, and others in Wirral, that the big barrier is ensuring that GPs understand better what they should be looking for and what advice they should be giving to people who come to them with worries or concerns. I know that some excellent GPs are wrestling with that question. People should not be made overly concerned, but if we had more of a culture of giving people information and helping them to make their own decisions, it would help them to feel more empowered.

The second culture change that I would like to see in the NHS is the NHS listening to young women, who are often dismissed in our society. Colleagues have done great work on women’s representation in the media, and I think we have a cultural issue with the place and value of young women that sometimes presents itself in our health service. Too often in the NHS—this is, I am afraid, something I know from my own experience—young women are given advice and told, or at worst instructed, what to do about their health, which is totally disempowering. There are lots of forces in society that are set up to undermine young women, so please let us not have the NHS be one of them. Let us rethink how we identify symptoms early and get people the tests they need. Rather than trying to instruct people, we need to listen to them, respect them, provide them with information and help them to find their own way to the right treatment. In serious cases such as Sophie’s, there are clear worries. More broadly, there is no future for a health service that thinks it can tell people; it has to empower people to make their own decisions.

In conclusion, Sophie’s family and friends started the petition and all signed it, which has brought us to this debate. They have shown tremendous courage at what must be a difficult time. They want to see the change outlined by my hon. Friend the Member for Liverpool, Walton. The public across the country have signed the e-petition—this has been a national campaign—and have brought the issue to the top of the agenda. That shows how important it is and how much cancer affects family life. We are asking for women to be given more choice over their own health, no matter what their age, and for them to feel more empowered. This was a tragic event. We feel the loss of Sophie in our community. It sparked an outpouring of grief and we must do better to make sure it is less likely to happen again.

This is Sophie’s debate and we remember and honour her. In her name, I ask that we resolve to make whatever changes are necessary to make this less likely to happen to anyone else. Cancer is a terrible disease, but we are now more able to diagnose, control and contain it than we have ever been. We can win this fight against cancer, so let us all recommit ourselves to do more, to help others and to make sure that we take care of everybody in our society.

--- Later in debate ---

[Jane Ellison]

Of course. I remember that I responded to the hon. Lady on the detail of that.

I have started to write routinely to the chairmen of health and wellbeing boards to make them aware of issues that are of interest to parliamentarians and changes in law or guidance. I undertake to mention this subject, particularly in the context of Sophie Jones’s case, in my next letter to health and wellbeing board chairmen, to draw it to their attention. There is a 1 million study under way by the National Institute for Health Research under its health technology assessment programme to look at the issues of effective interventions for younger women on the take-up of screening, so work is in progress.

[Mr Baron]

Will the Minister update the House briefly on whether there has been any progress on work regarding how we will hold underperforming CCGs to account, once the one-year cancer survival figures are published from June onwards?

[Jane Ellison]

I applaud my hon. Friend for taking a further opportunity to draw that to my attention—we met on Monday evening and discussed it. That will be part of the Department’s response to the all-party group’s report, and I undertake to update him further. I note, as he does, that he raised the matter with the Prime Minister recently and I will keenly pursue the points that he has made.

Finally, I thank all the staff involved in the national screening programme and those who deliver the important HPV vaccination programme for all their hard work. More power to the elbow of those who are looking for ways at local or national level to reach more young women, for all the reasons outlined by so many Members in so many excellent speeches. We can do so much more to achieve greater awareness and greater take-up, to get greater numbers of people screened and taking up the HPV vaccine. All that is work that we as Members of Parliament, I as a Minister and many people involved in our health services around the country can take part in. I recognise that for Sophie’s family, nothing we do can make up for her loss, but it can be part of her legacy. I thank Members for bringing this debate to the House.

Cancer Treatment and Prevention

John Baron Excerpts

Tuesday 11th March 2014 Westminster Hall

[Mr John Baron (Basildon and Billericay) (Con)]

I, too, congratulate my hon. Friend the Member for Mid Derbyshire (Pauline Latham) on securing this important debate.

I will focus my remarks on the importance of early diagnosis, but in many respects we have already won that debate. In recent years, there has been a general awareness of that issue’s importance, so I will also focus on the importance of accountability within the NHS in ensuring that the measures introduced to encourage early diagnosis are followed through by NHS England. I speak as chairman of the all-party group on cancer, which has long recognised the importance of early diagnosis—we call it cancer’s magic key. There are very few magic keys in life that open doors to untold riches, but that key exists for cancer with early diagnosis.

Initially, we may need to be reminded of the scale of the problem. Members have already alluded to some of the statistics. The Government’s figures and many independent studies suggest that if we matched European averages on survival rates, we could save 5,000 lives a year in this country. Only a month ago, the OECD published a further study, which showed that we could save up to 10,000 lives a year if we matched international averages. That is the scale of the issue.

My hon. Friend the Member for Strangford (Jim Shannon) rightly suggested that the figures, which I think are from Macmillan Cancer Support, show that within 10 years, one in two people will be diagnosed with cancer during their lifetime. Another shocking statistic that illustrates the scale of the problem is that one in four cancers in this country is first diagnosed as late as at A and E, when it is, in far too many cases, far too late to treat. Rarely can we define the scale of a problem as precisely as that. We are only talking about averages here, but thousands of lives depend on our ability to come together—not just Parliament, but the cancer community as a whole and the NHS—to drive forward initiatives to promote earlier diagnosis and thereby raise survival rates.

One or two colleagues will remember that the all-party group first looked at the issue back in 2009, when we produced a report looking into cancer inequalities. We found that the NHS stood as much chance as any other health care system of getting patients who made it to the one-year point to the five-year point. Where the system failed, however, was in getting them to the one-year point. That suggested that the NHS was as good at treating cancer patients as anyone else, but was poor at detecting and diagnosing cancer in the first instance, and that accounted for why we were behind on cancer survival rates and averages.

All the evidence clearly showed that the NHS treated patients as well as any other system after the one-year point, but we fell down in getting them to it, and we never made up that gap. There are always dangers and pitfalls with comparisons—in France, for example, we are comparing with four or five cancer centres of excellence—but by and large the figures are robust in suggesting that we have a major problem with our survival rates.

What is the remedy? It could have been to bombard the NHS with even more targets on this, that and the other, such as better training for GPs or other initiatives, but we thought that there were enough targets in the system. We came up with the idea of putting one-year and five-year survival rates up in lights, broken down by clinical commissioning group—or primary care trust, as they were then. That is important, because we all know that late diagnosis makes for poor survival. Showing those survival rates at a local level would clearly show which CCGs were failing on early diagnosis. As the report and all the evidence shows, early diagnosis makes for better survival rates, particularly at the one- year level.

We have campaigned long and hard on the issue, and I am pleased to say that the Government have listened. There have been two big reforms of the health care system. One was the reorganisation, which I will not go into, because not all of us were as supportive of that as some might have liked. The second was the focus on outcomes, which will have the longer lasting effect, to the benefit of patients. That focus put the one and five-year survival rates in the NHS outcomes framework, which sets the parameters at a national level.

The one-year survival rates are in at the local level in the CCG outcomes indicator set. That is good news, because if the managements of CCGs at the bottom of that list are worth their salt—their salaries run into six figures—they will introduce a range of initiatives to boost their one-year figures. That can mean everything from better uptake of screening, to better prevention and awareness, to more diagnostics and primary care, to better GP training. It can be a whole host of initiatives—not in isolation, but taken together.

The bottom line is that it is incumbent on the management of a CCG with one-year figures at the bottom of the pile to get their act together and to introduce initiatives to encourage early diagnosis. If those initiatives are right and that early diagnosis is pushed forward, the one-year figures will rise. The mathematicians in the room will appreciate that if the low-hanging fruit on averages—the low figures at the bottom of the table—is picked off and those managements raise their game, that will have a disproportionate effect when it comes to averages for the group as a whole.

If we as a country are seriously going to set ourselves the target of saving an extra 5,000 lives by 2015, which would bring us only up to the average, and of perhaps exceeding that thereafter, we have to focus on how we can drive forward early diagnosis at a local level. One hopes that it all then becomes self-fulfilling, in that once the poorer CCGs start raising their game, others will do likewise, because no one will want to be at the bottom of the pack. That is why we as an all-party group have been delighted with the Government’s putting the one and five-year survival rates in at the national level, and the one-year survival rates in at the local level.

I will not muddy the waters by reminding everyone that because the population sizes of CCGs are smaller than those of PCTs, we have had to introduce some proxy measures, such as staging and emergency presentations, to complement the one-year figure and add to the overall picture. The bottom line is that we are focusing on early diagnosis through those figures, particularly the one-year figure going in at the local level.

I want to ask the Minister one question about something that she knows we have focused on in the past. The all-party group, the wider cancer community and other all-party groups have worked together as a team and should be congratulated, but despite the one-year figures in the CCG outcomes indicator set, the lines of accountability are still unclear. Who will actually ensure that CCGs will be held accountable for the figures? We have the tools, but if we do not use them, there is no point in having them.

Will the Minister provide clarity on what will happen if CCGs are at the bottom of the table year after year? There is no point in having one-year figures that show poor one-year survival rates, and therefore late diagnoses, if nothing happens as a result. Where are the levers of change? Where are the mechanisms to ensure that local managers are brought to account for their poor performance? We need to focus on that. Early diagnosis is important not only because it raises survival rates, but because it, along with the figures, will reduce disparities between CCGs when it comes to cancer. Poorly performing CCGs will have to raise their game, which will also serve to reduce inequalities across the system. It is unfortunately still a fact, at least to a certain extent, that cancer care in this country comes down to a postcode lottery.

Will the Minister please address the central issue of the levers of change—if not in this debate, then subsequently? I appreciate that many such functions are now the responsibility of NHS England and that the Department of Health has taken a step back, but the Government still have a responsibility to the taxpayer to ask questions and to ensure that improvements are followed through. The Minister has been gracious in that she will be formally responding to the all-party group’s report, “Cancer across the Domains”, and a meeting will follow, but we cannot leave such a great opportunity as this debate without raising the issue. I hope she will forgive me for pursuing the matter again, but it helps to keep the focus on the issue in hand.

Mental Health Services (South-East Essex)

John Baron Excerpts

Wednesday 5th March 2014 Westminster Hall

[Norman Lamb]

I hope that my hon. Friend recognises that I have sought to address his concerns directly, rather than reading from a pre-prepared speech. I share his concern about levels of pay in the upper echelons of the NHS, and I believe that that must be addressed.

On a more positive note, in the short time that I have available let me mention some of the positive things that we are doing. In January, we launched a document called “Closing the gap”, which directly addresses the fact that mental health services always fall behind physical health services. We have stated publicly, and we have put into legislation, that there should be parity of esteem and equality between mental and physical health services. The document identifies 25 areas in mental health services in which essential change is needed. One example is the widespread use of face-down restraint. Such restraint is not acceptable or necessary in a modern mental health service, and many areas have demonstrated how to create positive regimes without the use of such a barbaric approach.

[Mr John Baron (Basildon and Billericay) (Con)]

I congratulate my hon. Friend the Member for Southend West (Mr Amess) on securing this important debate. There are various shades of mental health problems, and care in the community is an important aspect of looking after those who suffer from such problems. However, day centres up and down the country, including Mundy House in my constituency, are under threat. Will the Minister look at what more can be done to support day centres as a means of caring for not only mental health patients but other patients and community members generally?

[Norman Lamb]

I am conscious that I am close to running out of time, but community services often do enormously good work in their local areas. The focus on mental health must shift towards a prevention approach. We must intervene early rather than allowing a problem to deteriorate and acting only after something has happened. We must also focus much more on recovery. So often, we seek to contain people’s ill health rather than helping them to recover in a meaningful sense.

Finally, I would like to mention our crisis care concordat, which will set high standards of crisis care in mental health that have never existed before. We expect every area to implement that concordat to ensure that people, wherever they are in the country, get access to the right standards of care.

Cancer Priorities

John Baron Excerpts

Thursday 13th February 2014 Commons Chamber

[Mr John Baron (Basildon and Billericay) (Con)]

I beg to move,

That this House has considered the All-Party Parliamentary Group on Cancer report on cancer priorities in the NHS.

The motion stands in my name and those of other hon. Members.

It is not an exaggeration to say that thousands of lives, if not tens of thousands, depend on our getting the cancer strategy right. That is the scale of things. I therefore thank the Backbench Business Committee for granting the debate and allowing the all-party group on cancer to debate its recent report, “Cancer across the Domains”. I thank fellow officers, Macmillan and the secretariat to the all-party group, particularly Tim Nicholls and his team, for their support and hard work.

The all-party group on cancer is recognised as the wider cancer community’s voice in Parliament and has a proud campaigning track record. It was an early advocate of the need to focus on survival rates as a means of promoting earlier diagnosis. It has campaigned on a range of other issues, including cancer networks and the cancer drugs fund. As hon. Members will know, the group hosts the annual Britain Against Cancer conference, at which the cancer community comes together. Last December, it attracted about 500 delegates and heard excellent speeches from the Secretary of State for Health, the shadow Secretary of State and other experts.

[Mr James Clappison (Hertsmere) (Con)]

I warmly congratulate my hon. Friend on his sterling work in this field. He mentions cancer survival rates. The most recent European study, published in December last year, showed that UK survival rates are still lagging behind those of comparable western nations in most, if not all, cancers. Does he therefore agree that the need to focus on cancer survival rates is as great as ever?

[Mr Baron]

My hon. Friend makes an excellent point. The fact remains that, although there have been good increases in survival rates and there has been progress when it comes to cancer care generally, we still lag behind European and international average survival rates. That alone means they are costing this country thousands of lives. Thousands of families are suffering as a result of our not being able to match international averages on cancer care. That is not to say that cancer care has not improved over recent decades—it has. Survival rates have improved, but they have done so in line with survival rates across the world. That is good, but it somewhat masks the fact that we remain well behind international averages.

Despite all the additional funding, we still have not managed to catch up with other health care systems and thousands of lives are being lost as a result. My hon. Friend alluded to the fact that if we matched European averages on survival rates we could save an additional 5,000 lives a year. The OECD recently ranked Britain towards the very bottom of the 35 countries whose survival rates it measured, and it suggests that up to 10,000 lives could be saved if we matched international survival averages. Indeed, the Secretary of State for Health himself, speaking at the Britain Against Cancer conference in December, described survival rates as disappointing.

Reliable predictions suggest cancer incidence is on the rise. The World Health Organisation suggests its incidence will increase by 70% in the coming decades. Macmillan Cancer Support estimates that by 2020 almost one in two people will receive a cancer diagnosis—a phenomenal increase. The challenge for the NHS is to ensure that the significant structural change it has seen in recent years is not allowed to obstruct the much-needed improvement in cancer services and survival rates that are necessary if we are to catch up with our neighbours and save those thousands of extra lives.

The report by the all-party group on cancer should be seen in this context. We now have an NHS based around five domains, each with a responsibility for delivering improved outcomes. The report makes recommendations across each of those domains, and is the product of an extensive consultation with the cancer community, from NHS England right through to cancer patients, carers and charities. The recommendations of this year-long project can therefore truly be said to reflect the views of the whole cancer community. I should take a brief moment to thank all those who are involved in the production of the report, from those who responded to the consultation to the charities that devoted significant time and expertise to crafting it, including Macmillan Cancer Support, Cancer Research UK, Prostate Cancer UK, Teenage Cancer Trust and Breakthrough Breast Cancer.

“Cancer across the Domains” makes 18 recommendations and believes that the Government have an important role to play. Although the recommendations are specifically aimed at NHS England—the body that now has responsibility for commissioning services—it is the Health Secretary who retains overall responsibility for health services. The support of his Department is invaluable in achieving these goals, so my first question for the Minister is: will she formally respond to the recommendations set out in the report, or commit her Department to do so?

Other hon. Members will address other parts of the report, but I want to focus on the importance of earlier diagnosis and accountability. There are very few magic keys— where someone can open a door and suddenly untold opportunities lie before them. In cancer, such a magic key does exist: earlier diagnosis, the importance of which cannot be overestimated. When the all-party group on cancer produced its 2009 report, “Tackling Cancer Inequalities”, we found that patients in this country who reached the one year point stood as much chance of making it to five years as most other health care systems. Where we fall down is in getting patients to the one year point. We came to the conclusion, which expert witnesses confirmed at the time, that this clearly showed that the NHS was as good, if not better, at treating cancer when it was detected, but very poor at detecting it in the first place, and that is why we fell so far behind on survival rates.

We sat down with the cancer community and asked: what is the remedy? Do we bombard the NHS with more targets and regulation to try to encourage earlier diagnosis? Should we adopt a much simpler approach—and this is what we concluded—and put up in lights one and five-year cancer survival rates, broken down at a local NHS level, then primary care trusts, now clinical commissioning groups, to encourage earlier diagnosis? We all know that late diagnosis makes for poor survival rates. Therefore, putting the survival rates up in lights and broken down by the local NHS should encourage underperforming CCG management to promote initiatives, at primary care level, aimed at promoting earlier diagnosis. It would be up to them to choose which initiatives suit their local populations: better prevention and awareness campaigns, better uptake of screening programmes, better diagnostics at a primary care level or better education or information for GPs. There could be a host of initiatives in isolation or in combination, but the bottom line is that it would be up to local CCGs to introduce them. Those at the bottom of the table would be particularly encouraged to do so. That was the logic behind the idea of one and five-year figures. We are happy to say that, with the rest of the cancer community, we now have one and five-year figures as outcome measures in the DNA of the NHS. This is to be welcomed. It is in the NHS outcomes framework and it is in the CCG outcomes indicator set governing CCGs at a local level. I will come back to the five-year outcome measure at the outcomes indicator set level a little later, but that is all encouraging.

I will not complicate issues by going on about the importance of introducing other proxy measures at a local level, such as staging and emergency admissions. We have recommended those initiatives, and they have been taken up as complementing the one and five-year figures at a local level because of the smaller population sizes of CCGs compared with PCTs. The campaign has been a success, but it is a success only in that we have managed to get these measures included. Actions speak louder than words and the true success will be judged on what effect these measures are having on survival rates. On that measure, the jury is still out.

That brings me on to my next point: accountability. There is no point in having these wonderful initiatives on one and five-year figures, staging and emergency admissions to try to promote earlier diagnosis if it is not followed through and there are no teeth in the system or levers of change to ensure that underperforming CCGs raise their game on behalf of their local patients. Key questions therefore remain on accountability.

How accountable is NHS England to Parliament? NHS England’s annual report is laid before Parliament, but it is the Secretary of State who must assess performance. The extent of ministerial accountability remains unclear. Parliament seems to have a very limited role in this process. So does the Minister agree that there appears to be limited scope for Members to scrutinise NHS England’s performance? Furthermore, how will the Department of Health monitor NHS England’s performance on cancer care against the NHS outcomes framework and address areas that need improvement?

If that is one concern, a greater concern I have is the accountability of CCGs themselves. While some cancer services, as hon. Members will be aware, remain the responsibility of NHS England, owing to their specialised nature, many vital services are CCG-commissioned, hence the importance of the CCG outcomes indicator set as a means of monitoring performance. What remains unclear is the extent to which NHS England will hold underperforming CCGs accountable. For example, what happens if a CCG is continually at the bottom of the one-year survival rate figures? Where are the levers of change to correct that? The mathematicians in the House will understand that if we raise the game of those at the bottom of the table, it will have a disproportionate effect on averages in general, and that is what we are talking about: catching up with European and international averages on survival rates.

We need clarity, therefore, about what action will be taken should CCGs continue to languish in poor performance. What support would NHS England give to a CCG to improve survival rates, and, should CCGs continue to languish, what powers will be used, what levers of change will be implemented, to ensure that improvements are made at a local level? There is no point having the CCG OIS if failure is not addressed and there are no teeth to the correction regime. We need clarity, both to ensure that corrective action is taken, if needed, and because CCGs need to know that the regime is in place.

Other questions remain, which our report addresses, about the differences between the last two CCG OIS iterations, and perhaps a little clarity from the Minister would be helpful to the wider cancer community. In the 2013-14 OIS, our call for indicators for one and five-year survival rates for all cancers was accepted, and in the 2014-15 OIS, our call, in the “Cancer Across the Domains” report, for indicators on staging and emergency presentations was also accepted—all very good news—but the indicators for the five-year survival rates were dropped from the 2014-15 OIS.

NICE argued there were potential problems with the five-year indicator, as the numbers were small, but those arguments had been made before, when we campaigned for one and five-year survival rate inclusion. Will the Minister help the House and the wider cancer community by explaining what changed in the data between 2013-14 and 2014-15? That would be helpful. We now have an NHS outcomes framework that retains one and five-year indicators, but a local CCG OIS that does not have the five-year indicator. This suggests a disconnect. It is important that the NHS speaks with one voice, yet it has measures nationally different from those at a local level. How will her Department work with NHS England to address this apparent disconnect?

While earlier diagnosis increases survival rates, without data on longer-term survival rates, it will be harder for NHS England to ensure that early diagnosis is being improved by CCGs. Will the Minister re-examine the case for five-year survival rates in the next iteration of the CCG OIS, or at least communicate to the cancer community the logic behind the move and carry the community with the Department so that it is clear for everyone to understand. It remains to be answered, however, why there was a difference between the 2013-14 and the 2014-15 iterations.

The removal of the five-year survival rate indicator raises questions about the process. The development of the CCG OIS is complex; suffice it to say that the system provides for newly suggested indicators, but does not appear to recommend indicators for removal. In the development of the 2014-15 OIS, while emergency diagnosis and stage of diagnosis were flagged for inclusion, five-year survival rates were not flagged for exclusion, meaning that the removal does not appear to have been consulted on. I find this particularly alarming.

The cancer community campaigned hard for the inclusion of one and five-year survival rates, both nationally and locally, to promote earlier diagnosis, but then, at the last minute and without any consultation, was made aware, practically on the last day before Parliament rose before Christmas, that the five-year figures were being removed. There was a lack of communication, and certainly the process itself raises questions. Will the Minister comment on this process? Why does she think it delivers appropriate transparency? It was not clear to the wider cancer community that the five-year indicators would be removed until the final document was published.

On 17 December, the hon. Member for Scunthorpe (Nic Dakin) asked the Minister whether five-year survival rates would be included, and he received an unequivocal answer:

“NHS England will be publishing the 2014-15 CCG OIS next year…which will set out measures aimed at supporting improvements in the five-year cancer survival.”—[Official Report, 17 December 2013; Vol. 572, c. 594W.]

However, the OIS released three days later, on 20 December, excluded the five-year figures, and it would help to know why the position apparently changed completely in those three days.

I thank the Minister for responding to this debate. I appreciate that she has drawn the short straw, given that this is the last debate before the half-term recess, but the all-party group would welcome a detailed response to all our recommendations, if not in this debate, certainly subsequently. She has a great responsibility. She is well aware that few ministerial posts can literally save thousands of lives if policy is got right, and she brings to her post a dedication and professionalism that are welcomed across the cancer community, but I remind her, on behalf of that community, that the Government’s goal to save an additional 5,000 lives every year by 2015 will not be achieved unless the NHS raises its game, particularly on earlier diagnosis. With that thought in mind, I look forward to her response to our recommendations.

--- Later in debate ---

[The Parliamentary Under-Secretary of State for Health (Jane Ellison)]

Before addressing only some—I fear—of the many points raised in this debate, I would like to thank the all-party group, which, as the shadow Minister and others have said, does astonishing work. It rightly, and regularly, holds Ministers’ feet to the flames—my feet regularly feel the heat—but that is a good thing, because this is about driving up standards and pushing us all to work harder and do the right thing in this important policy area.

I also pay tribute to my hon. Friend the Member for Basildon and Billericay (Mr Baron), who brought this debate, and to the Backbench Business Committee—it used to be more fun being on it than responding to its debates—and I also warmly welcome the contribution from, and the presence of, the hon. Member for Ashton-under-Lyne (David Heyes), whose personal testimony greatly enhanced the debate this afternoon. We should also pause to think of our colleague, my hon. Friend the Member for Filton and Bradley Stoke (Jack Lopresti), who is being treated for bowel cancer; our thoughts are with him.

I shall try to reply to some of the many points raised in this fascinating debate. I shall try to respond, to some extent, on the structure of the report and the different domains, and to pick up on some other points made, and I absolutely undertake to get back to colleagues where I cannot respond substantively. As my hon. Friend the Member for Basildon and Billericay said, this is part of an ongoing dialogue, and I am delighted that he will be meeting the national clinical director soon. Out of that dialogue, I think we can progress in some of these areas. Some of the issues are inevitably a work in progress. However, important points have been made and I shall try to respond to as many as I can while updating the House more generally on what the Government are doing.

Many of the report’s recommendations are for NHS England. As I said, I am pleased that the national clinical director is to meet the all-party group later this month. He will find the meeting a helpful opportunity to discuss the report in detail. As I prepared for this debate, I was particularly struck by the fact that NHS England is considering the report in great detail—indeed, it contributed during the consultation phase. I am really encouraged by that, as NHS England is absolutely critical in our new health structures. It is very aware of its responsibilities. Some of the challenge today has been about how we interact and how those new responsibilities settle.

I want to set out some of the actions under way that I hope will provide reassurance about the Government’s and NHS England’s commitment to delivering on our ambition, articulated by other Members, to make England among the best in Europe on this issue. My hon. Friend the Member for Hertsmere (Mr Clappison) said that we had major challenges and a long way to go in that regard, although the shadow Minister was right to say that we are beginning to make significant progress in some areas. However, we recognise that we have a long way to go.

I was first asked to respond formally to the report, and it would be improper if I did not respond to such a thoughtful and well put together piece of work. Obviously, I hope to respond to some degree today, but I will take the report away and certainly respond formally later. Some of that will be about the Government’s responsibilities in holding NHS England to account. I will think about how we can do that.

The first domain that the report addresses is preventing people from dying prematurely. It raises concerns about responsibilities and accountability in the new health system. It is right to challenge on such issues; we cannot pretend that, when there is such major change to a system, everything will immediately be settled and clear. I accept that there is a challenge. Our progress must be as speedy as possible in understanding who is responsible for what—particularly in understanding how we make accountability as transparent as possible and a driver of change and improvement.

We are responding to the new system and the inevitable tensions between devolving power on delivery in a way that empowers clinicians while also being accountable to Parliament. No one could pretend that that is not challenging. I certainly feel that challenge as a Minister; the responsibility for delivering most of that clinical care sits somewhere else, so the issue is about how we respond and account to Parliament for that.

I gently say that we should be careful not to suggest that, in such a large and complex health economy, all was perfectly clear and beautifully directed from the centre before. I respect the shadow Minister’s enormous knowledge of the NHS and I know that neither she nor anyone else is suggesting that. However, in highlighting concerns about where the new system is settling down, it is sometimes tempting to think that previously Ministers had a big lever under their desks that they could pull to make everything right. Even if that was the theory, it certainly was never the practice, as is evidenced by our persistent lagging in some of the key survival statistics discussed today.

The challenge is to respond to the new system and get clarity where there is none at the moment. A number of Members, including the shadow Minister, have mentioned how we hold people to account at the most local level. That issue emerges from this debate as the one on which we have the most work to do and to which we must give the most thought.

I want to discuss how the system is set out. I accept that the way in which we make it work in practice is not necessarily the same as that, but I will go through how we have set out the different frameworks and processes of accountability.

The indicators in the NHS outcomes framework provide the basis against which the performance of the NHS will be monitored. NHS England is responsible for delivering year-on-year improvement and is accountable to the Secretary of State. Those arrangements are set out in the Health and Social Care Act 2012, under which the Secretary of State set out the strategic priorities for NHS England through the mandate. The mandate makes it clear what is expected of NHS England with regard to contributing to the prevention of ill health through the better early diagnosis and treatment of conditions such as cancer.

The outcomes framework sets out different measures against which we hold people to account, and the Department has quarterly accountability meetings with NHS England, through which NHS England’s progress in delivering those improved outcomes is monitored. We will continue to monitor its progress in delivering against the mandate. The evidence showing how it has met the mandate is published, and forms the basis on which Ministers can ultimately judge the success or otherwise of NHS England’s performance.

I entirely accept the point that that is quite a macro way of looking at things, and that Members are also seeking a sense of what can be done on the ground. Perhaps I need to respond in more detail after the debate on the challenges relating to the role of the strategic clinical networks. Cancer has been made a priority for those networks. Making the new networks work is also a challenge for the national clinical directors and other colleagues in NHS England. Their role in relation to cancer is obviously to drive quality and innovation in prevention and screening, survivorship and end-of-life care. I know that NHS England is keen to see the links between the national clinical directors and those respective networks strengthened. There is clearly more to do, and I welcome the fact that the all-party group is in direct dialogue with the national clinical director. I will pick this up with the group and with him after their meeting.

With regard to clinical commissioning group accountability, NHS England is responsible for ensuring that the CCGs secure the excellent outcomes that we want, through commissioning. The assurance framework provides the basis for that assessment. It is an integral part of the agreement of improvements to be delivered locally. When CCGs are found to be at risk of failing to deliver improvements, NHS England will provide the necessary support. Statutory intervention powers exist, but they are to be used as a last resort only when CCGs are demonstrably lacking the capacity to make improvements.

Through “Everyone Counts”, the planning guidance for 2014-15, NHS England has asked CCGs to set a level of ambition for reducing premature mortality as part of their strategic and operational plans. They will be expected to demonstrate progress against those plans. The 2014-15 CCG outcomes indicator set is used as a tool by CCGs to understand trends in outcomes and to help them to identify potential priorities for improvement. It has a range of new cancer measures covering early detection, stage at diagnosis, and diagnosis via emergency routes. I pay tribute to the all-party group for championing the inclusion of those indicators, which have now been adopted, as the hon. Member for Basildon and Billericay said. The indicators will help to ensure that progress is being made on early diagnosis and, in turn, on survival rates.

With regard to the various bits of data, we will shortly have the one-year cancer survival information for patients diagnosed in 2012, which will tell us the stage at diagnosis. This will allow us to calculate stage-adjusted one-year survival, and that will probably represent the most accurate and timely cancer data that have ever been available in England. Using those data, we will be able to populate important indicators in order to drive up improvement, including the public health outcomes framework and the CCG outcomes indicator set, in relation to the proportion of cancers diagnosed at stages 1 and 2—the early stages.

On the five-year data, I am sorry that things have changed since the answer that I gave to my hon. Friend the Member for Basildon and Billericay at Health questions. That was the information that I was working on at the time. NHS England has been working with the London School of Hygiene and Tropical Medicine to establish whether the five-year indicator was statistically valid. When I answered my hon. Friend’s question, the data had not been fully gathered in. Having gathered them in, however, the conclusion was that because of the small number of survivors at five years, disaggregating the data down to individual CCGs would not leave the data statistically robust enough to draw conclusions. It would therefore be unsafe to do so. They are not therefore planning to publish at the CCG level, but they are considering how it can be published at a level that is not only meaningful and helpful, but statistically safe. I understand that this has been disappointing, but I think that the all-party group and Members will understand that the data set is so sensitive that if it was not felt to be safe and robust, it could not be published in that way. We will talk to NHS England about it.

[Mr Baron]

I very much welcome that explanation, which goes a long way towards explaining the reason for the change in such a short period. May I leave the Minister with the thought that there appeared to be almost a complete disregard of the need to consult? Although I accept that this is NHS England’s ultimate responsibility, the cancer community came together on this issue and it seemed to be completely ignored from the point of view of consultation. Perhaps the Minister will look at that.

[Jane Ellison]

That is a fair challenge, and I will certainly take it up and raise it. On what we can do with data and transparency at the local level, the Department is looking at a number of things. The Government have tried to use data transparency in lots of different ways to drive improvement and accountability, and we are currently looking at some other ideas which I hope will produce a far greater sense of what is happening on the ground and in someone’s local area. We are very open to suggestions, and some have been made during the debate. I am happy to look at those, but this is an area under active consideration.

There has been a lot of discussion in this excellent debate about awareness and early diagnosis, and we know that it is one of the keys to getting better survival rates. It is central to meeting our ambition of saving the additional 5,000 lives each year by 2014-15, and we have committed more than £450 million in funding to achieving that and doing more on early diagnosis. To date, we have run national campaigns on tackling bowel and lung cancers; we have the Blood in Pee campaign, which hon. Members will be aware of, to raise awareness of bladder and kidney cancers; and we are currently running a breast cancer campaign for women aged 70 and over. The early response to that campaign has been really encouraging.

The shadow Minister raised some of the core public health issues which I spend much of the day job discussing: obesity, alcohol and smoking. I am slightly surprised that we have had relatively little discussion of those in the context of early diagnosis and prevention. Public health has been devolved to local authorities. They have more than £5 billion of ring-fenced money over two years, and all the local authorities I speak to—I was at the Local Government Association public health conference two weeks ago—are excited by the possibilities that that holds for them. There is a fair challenge about where the responsibility sits, but if everyone is doing work on awareness and early diagnosis, that can only be a good thing. Many local authorities are taking seriously the challenge of raising their game locally, and that is in addition to the national campaigns.

As hon. Members will be aware, many of the indicators are very mixed; there is a variety of statistics and variation around the country. I pay tribute to my local Wandsworth authority, whose six-week “get to know cancer” pop-up shop closes this Sunday. A local shopping centre gave the authority an empty unit and it worked with NHS London, staffing the unit for six weeks during the same hours as the shopping centre. It was run on a walk-in basis, and hundreds of people in my local community have popped in to that non-threatening environment to talk to trained nurses and get advice about cancer and some of those important awareness issues. Such local initiatives can only help us in our ambition to do much better.

My hon. Friend the Member for South West Bedfordshire (Andrew Selous) has had to leave us for a constituency engagement, but he touched on the work of charities. I met people from the excellent HeadSmart charity recently and I undertook to write to health and wellbeing boards about its work, so I will give him that assurance when I next see him. I also pay tribute to the work that Cancer Research UK has been doing on pilots dealing with melanoma, which my hon. Friend the Member for Mid Derbyshire (Pauline Latham) mentioned.

NHS England works with Public Health England and the Department to determine the focus of campaigns and to manage the development of the Be Clear on Cancer campaign. Decisions on the 2014-15 campaign activity will be based on the evidence and learning from the evaluation campaigns of the past two years, and it will be subject to all the normal clearances in terms of delivering really good value for money.

To deliver access to the best treatment, we have committed more than £173 million to improve and expand radiotherapy services. That includes £23 million for the radiotherapy innovation fund, which has supported centres to deliver increased levels of intensity modulated radiotherapy—a more accurate form of treatment that can reduce side effects.

The cancer drugs fund featured heavily in the debate. More than 44,000 patients have benefited from the fund so far, and last September we announced a further £400 million to extend it to the end of March 2016. Going forward, we will consider what arrangements can be put in place to deliver access to drugs previously funded through the CDF at a cost that represents value to the NHS. I recognise the nervousness that exists among those who understand what the fund has done and the impact it has had on individual patients. My hon. Friend the Member for Mid Derbyshire highlighted that matter, but clearly it is something that NHS England will be taking forward, and it will be aware of the concerns that have been expressed in the House.

Regarding the all-party group’s specific concern about NHS England’s duty to promote research, NHS England recently carried out an open consultation on a draft research and development strategy to deliver its statutory responsibilities and the NHS mandate duties. Again, we will learn more about that when the meetings take place, and as NHS England delivers that project.

The all-party group rightly highlights the importance of supporting cancer survivors. Increasingly, cancer is viewed as a long-term condition—that was certainly not the case when many of us were younger—as more are living with and beyond the disease. In March 2013, the Department’s national cancer survivorship initiative published “Living with and beyond cancer: taking action to improve outcomes”. It set out key recommendations to improve survivorship care, which were drawn from two years of evidence gathering.

I understand that the national clinical director is working closely with Macmillan, which provides the secretariat so ably to the all-party group, to encourage implementation and spread of the recommendations, including around stratified care pathways. The all-party group will be pleased to learn that ensuring all survivors benefit from the survivorship recovery package is a priority work programme.

We want to support people to stay in and return to work. A specific concern of the all-party group is how NHS England intends to support people to do that, as set out in the mandate. I can confirm that NHS England has issued an invitation to tender for a piece of work to examine the factors that impact on the employment rate of people with long-term conditions and to identify the useful interventions that can be made. It will be looking to consider the next steps. I think it is expecting to report on that in 2015.

The all-party group has also said that it would like to see wider use of the patient reported outcomes measure—PROM—data. This month, we have already seen the publication of “Quality of life of cancer survivors in England—one year on”. That is a survivorship update commissioned by the Department, which provides important information on recovery, unmet needs and the consequences of treatment. NHS England has already begun work to extend the PROM programme. A new pilot PROM data collection has recently started looking at quality of life issues for survivors of womb, ovarian and cervical cancer. For men, NHS England is supporting Prostate Cancer UK on a nationwide PROM data collection.

The all-party group makes a number of recommendations on the national cancer patient experience survey, which was referred to by the shadow Minister. I think we all acknowledge that it has been an invaluable tool in driving improvement in cancer care. When I first heard about it and looked at it in response to an earlier debate in Westminster Hall, I was very impressed with the level of detail that it can drive down to individual trusts. It uses what the best are doing to drive performance among those that are not meeting the highest standards.

NHS England recognises the value of the survey and currently has no plans to halt the programme. NHS England is the lead, but I think the more often we in Parliament recognise how important the programme is, and show how much parliamentarians value it and regard it as central to understanding the cancer patient experience, the more NHS England will feel that it is the right decision to go forward with it. I know that NHS England intends to examine the potential for a survey-related indicator as part of the future development of the clinical commissioning group outcome indicator set. That is a good thing. The shadow Minister made some interesting points and constructive suggestions in that regard, which I will happily look at after the debate and draw to the attention of NHS England.

The all-party group was concerned that more could be done to understand the experience of those who are close to people affected by cancer, and its members might be interested to know that following the NHS’s commitment to carers event, held last December, a number of priorities for supporting carers were identified. An action plan is in development and although it focuses more on the experience of carers in general, NHS England will consider cancer care as part of that. The 2014 cancer patient experience survey will begin in March and report in late summer. I am sure that there will be parliamentary interest in that report.

In order to realise the Berwick report’s vision of the NHS as an organisation devoted to continual learning and improvement, NHS England and NHS Improving Quality will establish a new patient safety collaborative programme to spread best practice, build skills and capabilities in patient safety and improvement science, and focus on actions that can make the biggest difference to patients in every part of the country.

NHS England is undertaking work to improve the collection and analysis of patient safety data, including introducing “safety thermometers” for medication error, maternity care and mental health, and revising the NHS serious incident framework further to support best practice. It is working with the Care Quality Commission and others to provide consistent and clear information for all on what patient safety data are available.

Let me try to pick up on some of the points made by hon. Members. My hon. Friend the Member for Hertsmere expressed a concern about older people with cancer. I will respond to him in more detail after the debate, but we know that older people sometimes do not get the support they need and what happens during diagnosis is often the primary driver of poor outcomes. He might be interested to know that we have worked on a £1 million project with Macmillan Cancer Support and Age UK to improve uptake of treatment in older people. That has established some key principles for the delivery of age-friendly cancer services and, as I mentioned earlier, we are seeing encouraging take-up of the over-70 breast screening programme in response to the current campaign.

Finally—I apologise, Madam Deputy Speaker, but I had many points to respond to and although I have not reached all of them, I will draw my remarks to a close—I am advised that NHS England will engage with the vision for the management of complaints and concerns developed on the recommendations of the right hon. Member for Cynon Valley (Ann Clwyd) and Professor Tricia Hart. I think the whole House acknowledges the amazing work done by our parliamentary colleague in that regard. The plan is to establish an advisory group of patients and patient representatives to feed into the complaints improvement work.

My hon. Friend the Member for Salisbury (John Glen) talked about palliative care. Work is going on in that area and I shall write to him after the debate. He might also be interested to know that NHS England is considering the potential for an indicator based on death in a preferred place of care. I will get back to him with more detail on that.

My hon. Friend the Member for Harrow East (Bob Blackman) mentioned issues to do with work and pensions, which I shall refer to the Department for Work and Pensions. He also talked about procurement issues and smoking. I am afraid that at the risk of sounding a little boring after Monday I must put on the record the fact that the Government have not yet made a decision about standardised packaging. We have instead introduced regulation-making powers so that we can make a decision when we have received the Chantler review and considered the wider aspects of that policy while taking its findings into account. Ministers will make the final decision. I am sure that my hon. Friend understands why we must put that rather legalistic sounding statement on the record.

In conclusion, I apologise for the length of my response, but this was such a good debate and many interesting points were made. I will take away those that I have not been able to respond to in detail. Once the all-party group has met the national clinical director, that might be a good time for us to meet again, to reflect on the meeting and to consider what more we can do to take this important work forward. I thank everybody who has contributed to the debate, and the all-party group for its continued detailed work and the challenge it puts out to us all to do better in this area on behalf of all our constituents.

[Mr Baron]

I thank the Minister for her response and especially welcome her offer of a meeting, which we will be more than happy to take up.

This was always going to be a difficult slot to fill. Many Members who would have wished to speak are not here, and that is fully understandable, given the transport disruption caused by the floods. However, in that vein, I thank those Members who did make a contribution. We heard excellent speeches, and I thank those who courageously shared their personal experiences, whether as patients themselves or family members. Our thoughts are with those Members who are battling cancer, including my hon. Friend the Member for Filton and Bradley Stoke (Jack Lopresti).

If there is one message that I would like to relay to the Minister, it is: please, please focus on clinical commissioning group accountability. There is no point having the tools in the toolbox if they are not going to be used. We have the measures in place and we know that we are monitoring survival rates as a means of promoting earlier diagnosis, but we need to be sure that there is follow-through so that underperforming CCGs are brought up to the mark. If we fail to do that, we are failing thousands of NHS patients throughout the country, given that our survival rates are woefully behind the average on the continent and internationally. It is a national disgrace that a quarter—one in four—of all cancers are first diagnosed at A and E, when it is often too late. That is the challenge before us, so the NHS needs to raise its game, as thousands of lives depend on it doing so. I look forward to the Minister responding to our report in full in due course.

Question put and agreed to.

Resolved,

That this House has considered the All-Party Parliamentary Group on Cancer report on cancer priorities in the NHS.

Tobacco Packaging

John Baron Excerpts

Thursday 28th November 2013 Commons Chamber

[Jane Ellison]

The hon. Gentleman refers to another Bill, rather than the issue we are discussing now. I have heard none of those concerns from the charities he mentioned, which I understand have warmly welcomed today’s announcement.

[Mr John Baron (Basildon and Billericay) (Con)]

I, for one, very much congratulate the Minister on this welcome news. As she well knows, the all-party group on cancer has been one of many that have argued for added urgency on this issue. The Government have listened and responded, which is a sign of strength, not weakness. To follow up a previous question, will the Minister give an assurance that the regulations will be in place before the end of this Parliament, because if the recommendations are in favour of introducing standardised packaging, they will need to be implemented quickly?

[Jane Ellison]

That is certainly the objective of the timetable that has been drafted, once the Government have received the review and made a decision. I see no reason why what my hon. Friend suggests could not be the case.