NHS Reorganisation
John Baron Excerpts(13 years, 9 months ago)
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Mr Lansley
Yes, that is one possibility. Another is that Labour Members are paid for by the trade unions.
Our changes are driving real improvement. Our investment means that more than 1,300 patients are now getting the life-extending cancer drugs they need; that is investment in cancer drugs that the Labour party opposed.
Mr John Baron (Basildon and Billericay) (Con)
My right hon. Friend is absolutely right to make no apology about the need for reform when cancer outcomes in this country remain well below the European average. The all-party group on cancer and, most recently, the Public Accounts Committee have made the case for recording staging data, which provide an insight into early diagnosis. Will he assure the House that, under these reforms, the importance of this issue will be pursued by the Government?
Mr Lansley
Yes. I am grateful to my hon. Friend and pay tribute to his work in this area, which is much respected. He is absolutely right—we will be doing that. Indeed, we can see the benefit already. A few weeks ago, I launched the bowel cancer awareness campaign in the east of England. The reason we were able to start that awareness campaign in that region is that we had good staging data arising out of the cancer networks in the area, which means that we will be able to make valid comparisons between the past and the future in terms of the stage at which patients are presenting for diagnosis of cancer.
Health and Social Care Bill
John Baron Excerpts(13 years, 10 months ago)
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Mr Lansley
Let me complete this point, then I will give way to my hon. Friend the Member for Basildon and Billericay (Mr Baron). On the point of allowing the independent sector to be a provider to the NHS, I should say that it was the right hon. Member for Leigh (Andy Burnham), the shadow Secretary of State’s predecessor, who said that
“the private sector puts its capacity into the NHS for the benefit of NHS patients, which I think most people in this country would celebrate.”—[Official Report, 15 May 2007; Vol. 460, c. 250WH.]
Well, Labour Members are not celebrating it now; they have reverted to type.
Mr Baron
The Government’s increased focus on improving outcomes is long overdue and very welcome, but will the Secretary of State address the issue of cancer networks and the concern that some of the expertise may be lost because of the funding gap between the end of funding for the cancer networks themselves and GP commissioning fully taking effect? Can the Government do anything to bridge that gap so that we allow GP consortia to be better informed in making decisions about what services to commission?
Mr Lansley
My hon. Friend rightly takes a close interest in these matters. When I was with him and other colleagues at the Britain against cancer conference, I made it clear—and he made it equally clear—that the cancer networks funding is guaranteed during the course of 2011-12. There is not a gap, because from April 2012 onwards the NHS commissioning board will take up its responsibilities. There will then be decisions by the commissioning board about how it will structure that.
Let me come back to what the last Labour Government did. They introduced the concept of payment by results. Unfortunately, however, payment tended to be by activity and not by results. We will now make it payment by results and really make that happen.
To complete the picture, I should say that throughout the Bill there are elements of policy that we are taking forward, such as foundation trusts. The Bill follows the brainchild of Alan Milburn and Tony Blair back in 2002. In 2005, the Labour Government said that every NHS trust should become a foundation trust by December 2008. That just did not happen. Again, it will be our task to make modernisation in the NHS consistent and comprehensive.
John Healey
I want to make a bit of progress before I give way again.
The public are being told that this reorganisation is patient-centred, but most patients’ GPs will not, in practice, be doing what the Government claim they will be doing. GPs spend an average of only about eight minutes with each patient. If they continue as family doctors, the commissioning will not be done by them; it will be done in their name by the managers in the primary care trust who carry out that function now, or by private health companies that are already hard-selling their services to GP consortia. Those consortia are being sold a false promise as well. Because expanded open-ended choice of treatment means funding unused capacity in the system, it is highly unlikely to happen at a time when NHS finances are under pressure.
Despite the boast about putting patients at the heart of everything that the NHS does, there is no place for patients on the bodies that will make the most important decisions on the NHS. There is no place for them on GP consortia, no place for them on the national commissioning board, and no place for them on the regulator, Monitor.
John Healey
The hon. Gentleman has already heard some of my hon. Friends mention the analysis of Dr John Appleby, published in the British Medical Journal online last week. He took to task those who had made the sweeping assertion that somehow Britain’s health service lags behind those of the rest of Europe. It is an argument that the Prime Minister advances. It is an argument for change, he says, because we are still a long way from European standards of care.
Let me read something to the House. We have been told that
“if you have heart surgery in England, you now have a greater chance of survival than almost any other European country – over the last five years, death rates have halved and are now 25 per cent lower than the European average.”
Those are not my words, or even those of Dr John Appleby. They are the words of the Health Secretary, published on ConservativeHome last week.
The Prime Minister argues that this is somehow an evolution and not a revolution. The Bill, however, is more than three times as long as the legislation that set up the NHS in 1948. The NHS chief executive told the Select Committee on Health:
“The scale of change is enormous—beyond anything that anybody from the public or private sector has witnessed”.
The Health Secretary argues that the Bill is somehow an extension of Labour policies. That is wrong, and it disguises again the fundamental changes to the NHS in the Government’s plan. Make no mistake, Mr Deputy Speaker: this is a revolution, not an evolution.
Mr John Baron (Basildon and Billericay) (Con)
I rise to support the Bill, because I support the two big ideas behind it. The first of those is the increased focus on outcomes, which is long overdue and very welcome. For those who suggest that there is no need to improve the NHS or to worry about the issue of outcomes, I shall just highlight this country’s relatively poor cancer survival rates—as some hon. Members will know, I have a particular interest in cancer. Improvements have been made over the years, but those improvements go back over 30-odd years and other countries have improved, too. This country still flounders in the lower divisions of the international cancer league tables, and that situation has to be wrong.
The all-party group on cancer focused on that issue in 2009, finding that patients who reached the one-year survival mark in this country stand as much chance of getting to the five-year survival point as patients in other countries, but that our one-year survival rates are very poor indeed compared with those of other countries. That tends to suggest that the NHS is as good as others, if not better, at treating cancer once it is detected, but very poor at detecting cancer in the first place.
Part of the problem is in the area of early diagnosis, which is why we recommended focusing on one-year survival rates. We suggested introducing an outcomes benchmark that focuses the NHS on the one-year survival rate, because late diagnosis makes for poor one-year survival figures. If we can get the NHS focused on that, many patients will benefit. Therefore, we are delighted to see that both one-year and five-year benchmarks have been introduced in the outcomes framework for 2011-12. We very much welcome that, but I believe I am right in saying that the 2011-12 outcomes framework covers only colorectal, lung and breast cancer. We have lots of data for other cancers, such as prostate cancer, and I urge the Government to think seriously about extending the cancer types covered in the 2012-13 outcomes framework. The risk is that if we do not do so and we include just a narrow range at a national level, that will make for a lack of priority at the GP level.
As for GP commissioning, bringing commissioning decisions closer to the patient has to be a good idea; patients have got to benefit from that. Some people say, “GPs see only about eight new patients a year. What could they possibly know about commissioning cancer services?” I would turn that around by asking how many cancer patients the chief executives of primary care trusts see. They are commissioning cancer services at the moment. That point needs to be discussed.
Owen Smith (Pontypridd) (Lab)
Given the hon. Gentleman’s interest in cancer, I am sure that he will know that the point is that the cancer networks often aid commissioners at all levels in providing this care and they are dissolving before our eyes right now as a result of these changes. GPs will not have the experience to commission care in respect of rare tumour types.
Mr Baron
I agree with the general gist of what the hon. Gentleman is saying, but I would not say that the cancer networks are dissolving. I have raised this important point many times in the House—perhaps he was not in the House when I intervened on the Secretary of State—and what I would again ask my Front-Bench team about is the funding gap. I understand that the funding for the cancer networks ends in 2012 and there is a gap until the GP commissioning takes full effect. The answer given to me from the Dispatch Box today was that the national commissioning board will be up and running by 2012. The problem with that answer is that the national commissioning board will give guidance but the arrangements for the people who will actually make the commissioning decisions, the GPs at the front line, will not be truly effective until 2013 at the earliest—that will probably happen in 2014.
The worry is that in that gap a lot of expertise could be lost to the cancer community as a lot of expertise within those cancer networks decides to walk out of the door. I again ask the Government whether there is any way in which we could bridge that gap in order to ensure that GPs are better able to make informed decisions about the commissioning of cancer networks, because those networks contain an awful lot of expertise that we would not wish to lose.
I am fated to ask that question of the Minister of State, Department of Health, my hon. Friend the Member for Chelmsford (Mr Burns) again, as we are fated to discuss the issue. I appreciate that cancer is not his specialty, but I would like to get an answer on that point. There is a difference between the national commissioning board taking responsibility for guidance and the GP consortia actually taking responsibility for the commissioning. That point has to be addressed carefully, because various cancer charities have already reported that some 50% of the staff of cancer networks are thinking of leaving or have been told that they will be leaving within the next 12 to 18 months as part of a cost-cutting exercise. We need to address the point sooner rather than later.
In the remaining minute allowed me, may I quickly discuss eye health? I am wearing my hat as co-chair of the all-party group on eye health and visual impairment. I welcome the clauses that place primary ophthalmic services with the national commissioning board, which is likely to devolve enhanced optometry services to GP commissioners. That is the right decision and those working within the medical profession welcome it. However, I suggest two areas where we need to establish a national system. The first relates to glaucoma referrals under the NICE guidelines and the second relates to community-based acute services—in other words, those managing red eye and minor eye problems. The Secretary of State visited the school of optometry in Cardiff and, apparently, he liked what he saw. Can we ensure that those national guidelines are in touch, because otherwise we get a fragmented service and patients may suffer as a result?
In conclusion, I welcome this Bill, which could be transformational, particularly with its focus on outcomes. The Government will therefore have my support in the Chamber tonight.
Oral Answers to Questions
John Baron Excerpts(13 years, 10 months ago)
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Mr Burns
I think that the right hon. Gentleman either did not hear my earlier remarks or had penned his question prior to hearing them. What I said was that waiting times are important to patients—and if he looks at the record tomorrow, he will see that. May I also explain to him that the average median time for the latest month available—November—shows patients completing a referral to treatment pathway in about 8.3 weeks? The right hon. Gentleman’s comments on A and E are just factually wrong and somewhat cheap.
Mr John Baron (Basildon and Billericay) (Con)
There are concerns that some of the expertise of cancer networks might be lost because of the funding gap between the end of the Government’s funding for the networks and the transition to full GP commissioning. Will the Government consider bridging this gap, at least until GP consortia are fully up and running—and therefore better able to make informed decisions about the commissioning of cancer network services?
Mr Burns
I am grateful to my hon. Friend in view of the considerable interest he takes and work he does in this field of health care. Let me reassure him that we have guaranteed the funding for next year, so it can work itself out to a successful conclusion thereafter through the cancer networks in the commissioning plans.
Oral Answers to Questions
John Baron Excerpts(14 years ago)
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Mr Burns
The right hon. Gentleman is absolutely right. We have to supply all patients, including those suffering from diabetes as well as other conditions, with as much information that they can understand as possible, so that they can make the choices about the health care they need. They also need to be backed up with advice from their GPs, community pharmacists and others in the health sector, because that will empower them to take decisions in their best interests to manage their medical condition.
Mr John Baron (Basildon and Billericay) (Con)
The Government have rightly announced, in the consultation document on patient choice, that all patients with long-term conditions will be offered a care plan. May I urge the Minister to ensure that that will apply also to cancer patients?
NHS Reorganisation
John Baron Excerpts(14 years, 1 month ago)
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John Healey
My right hon. Friend the shadow Chancellor said in response to the Chancellor’s spending review:
“We support moves to ring-fence the”
NHS
“budget”.—[Official Report, 20 October 2010; Vol. 516, c. 968.]
People saw Labour’s big investment in the NHS bring big improvements—50,000 extra doctors, 98,000 more nurses, deaths from cancer and heart disease at an all-time recorded low, the number of patients waiting more than six months for operations in hospital down from more than 250,000 in 1997 to just 28 in February this year, and more than nine in 10 patients rating their experience of hospital care as good, very good or excellent.
Mr John Baron (Basildon and Billericay) (Con)
How does the right hon. Gentleman account for the fact that the UK is still floundering in the lower divisions of the international cancer league on survival rates?
John Healey
We still have a lot further to go. There have been big improvements in international comparisons, but we must go further. It beggars belief that the Government have decided not to press ahead with plans to give patients a guarantee of, for example, receiving test results within one week, especially as hon. Members on both sides of the House recognise the importance of early diagnosis for cancer, and the cancer specialist, Mike Richards, said that this contribution to early diagnosis could save 10,000 lives a year.
Instead of building on those great gains, I fear that the NHS will again go backwards under this Tory-led Government. It is already showing signs of strain. The number of patients waiting more than 13 weeks for diagnostic tests has trebled since last year, 27,000 front-line staff jobs are being cut, and two thirds of maternity wards are so short-staffed that the Royal College of Midwives says that mothers and babies cannot be properly cared for.
This is not what people expected when they heard the Prime Minister say that he would protect NHS funding. In fairness, a proper, long-term perspective is needed on NHS financing. Year-on-year funding just below or even 0.1% above inflation is way short of the 4% average increase that the NHS has had over its 60 years. During the last Labour decade, it averaged 7% in real terms.
There are, and have been for many years, built-in pressures on the NHS: the cost of staff, drugs and equipment rises by about 1.5% above general inflation, and the demands of our growing and ageing population adds £1 billion to the bill each year just to deliver the same services.
Mr Lansley
No, I will not do those things, because what I said was accurate. The specialist children’s hospitals and ourselves are engaged in a constructive process of discussion about the future of the tariff for those hospitals and the top-up. Until a proposal is made there is no purpose in informing the House. We will inform the House as soon as we are in a position to say what the tariff for next year looks like.
Mr Baron
I totally commend the Government for their focus on cancer reform and improving outcomes. I accept that this is in the melting pot at the moment, but does my right hon. Friend agree that it is important that the one-year and five-year cancer survival rate figures are presented not as a league table but as a performance table, to ensure that all primary care trusts and GP consortiums are tasked with improving performance, irrespective of how they compare with others?
Mr Lansley
Yes, my hon. Friend makes a good point. What we are looking for is not a league table at all, as health care should not be regarded in that way; we are looking for proper benchmarking to take place. We are going to benchmark this country’s performance against that of the best health care systems around the world—the Labour party never did that—and we are going to ensure that there is a culture of continuous improvement in the NHS in respect of both the one-year and the five-year cancer survival rates, which my hon. Friend rightly mentioned.
The reforms that I was talking about are not a radical departure from the past. The principles of the White Paper should be what the NHS has always been about, but it has been distracted too often by the bureaucratic processes that the Labour party was always supporting. Let me make it clear that many of the things that we are doing were championed by former Labour Ministers. When John Reid was Health Secretary he championed patient choice, and we know why. His view was, rightly, that in the NHS, in a bureaucratic system, the articulate middle classes get access to the best health care, and it is only through institutionalising and embedding patient choice—shared decision making for every patient—that we will ensure that the most disadvantaged in society get the right access to health care.
As for GP-led commissioning, the Labour party was supposed to have introduced practice-based commissioning.
Mr John Baron (Basildon and Billericay) (Con)
The Government’s refresh of the cancer strategy, announced within two months of their taking office, and their commitment to the cancer drugs fund, clearly illustrate their commitment to improving cancer services in this country. As chairman of the all-party group on cancer, I very much welcome that.
May I suggest that the Government’s focus on outcomes is long overdue? Cancer survival rates in this country have been improving steadily for the past 30 years, but it remains scandalous that the UK is still floundering in the lower divisions of the international cancer league. Part of the problem is that for too long, the NHS has been focused on process-based targets. We need greater focus on outcomes to put the spotlight on just how well the NHS treats patients, not just on how quickly they are seen. That focus will be very important to patients, and particularly to cancer patients.
Last year, our all-party group set up an inquiry, which reported at the end of the year, on cancer inequalities. The evidence clearly showed that patients who survive one year stand as much chance of reaching the five-year point as cancer patients in other countries. However, where this country lets itself down is that our figures are poor compared with other countries when it comes to the one-year survival rates. That suggests that the NHS is as good as, if not better than, any other health service when it comes to treating cancer once it is detected, but falls down badly in detecting the cancer in the first place. That was why the all-party group’s report recommended the introduction of a one-year cancer survival rate measure, to encourage earlier diagnosis. Late diagnosis makes for poor one-year figures, hence our recommendations. I was therefore delighted that the Government picked up on that point and introduced one-year cancer survival rates as well as five-year survival rates in the White Paper.
Lyn Brown
I am following the hon. Gentleman’s excellent speech with care, and I totally agree with what he has said so far, especially about early diagnosis. In poorer areas, early diagnosis does not occur so often, for myriad reasons. In his view, what is set out in the reorganisation White Paper that will make early detection of cancer easier in areas such as mine?
Mr Baron
The answer to the hon. Lady’s question was supplied by my right hon. Friend the Secretary of State in answer to my question earlier. The one and five-year cancer survival rate figures will be published and presented, although how that will happen is in the melting pot. I very much welcome the work of the Office for National Statistics, the National Cancer Intelligence Network and the London School of Hygiene and Tropical Medicine. Whatever form the figures take, they will be in a performance table, not a league table, to ensure that all PCTs and then GP consortiums are tasked with improving performance, irrespective of how they compare with others. That will obviously include PCTs in deprived areas across the country.
I suggest to my right hon. Friend the Secretary of State that the focus on outcomes must include patient experience measures and longer-term quality of life measures, such as whether patients are able to return to work. That, too, is very important from the point of view of cancer patients.
As an aside, I suggest that there is a question mark about process-based targets such as waiting times in general. To return to the point made by the hon. Member for West Ham (Lyn Brown), the real problem when it comes to late diagnosis is not whether it takes one, two or four weeks for a patient to see a cancer specialist. It is how long it takes for the suspicion to be raised that cancer exists in that patient in the first place. Perhaps we should incentivise GPs to detect cancer earlier.
Kate Green
I absolutely appreciate the expertise that the hon. Gentleman brings to the debate, but I should like to ask his views on the issue of anxiety while waiting for an appointment. Whatever the physical outcomes of early treatment, there is a peace of mind issue for patients who are anxious to see their doctor as quickly as possible.
Mr Baron
I accept what the hon. Lady says, and I hope that the focus on outcomes will include matters such as patient experience surveys, which will incorporate that very point. It is an integral part of a patient’s experience, and it should be picked up when we start focusing on outcomes.
I return to GPs being incentivised to detect cancers earlier. In that vein, I very much support Cancer Research UK’s campaign to encourage greater access for GPs to diagnostic testing. That will be terribly important when it comes to detecting cancers earlier.
Moving on to GP commissioning of cancer services, there is no doubt in my mind that there is room for improvement in this area, and it would be naïve of Members to believe otherwise. There is often frequent confusion between the roles of strategic health authorities, cancer networks, PCTs and hospital trusts. The priorities of the cancer reform strategy are often not aligned with those of the PCTs.
I should like to play devil’s advocate and suggest to the Secretary of State that we need to tread carefully in dealing with the challenges ahead. The Secretary of State will be aware that GPs see only about eight new cancer cases a year, and that cancer is a set of 200-plus diseases with often complex care pathways. The GPs are often involved in the early and late stages of that care pathway, but the complex bit in the middle is often conducted by clinicians in hospitals.
Challenges lie ahead. We need to ensure that the responsibilities of the NHS commissioning board, the PCTs and the GP consortiums are clearly defined to avoid fragmentation of treatment across the cancer pathway. The reforms must help and not hinder the close working relationship between primary and secondary care doctors. The role of cancer networks in supporting GP consortiums needs to be clarified before those networks are broken up and their expertise is lost.
Furthermore, we must consider whether we need to redistribute the financial incentives to encourage more focus on the earlier and late stages of the care pathway. In other words, we must ensure that reward matches responsibility. Should a qualities and outcomes framework be realigned so that early diagnosis, survival and people dying in their place of choice are included?
In the last minute left to me I shall mention the cancer drugs fund. I have raised the issue with the Secretary of State before. There appears to be early evidence of disparity of access. When it comes to the cancer drugs fund, access should always be clinician-led. In some regions, approaches can be made to the PCT, and in others they are made to the cancer network, which, in turn, has access to the fund. Elsewhere, GPs are forming panels. May I suggest that best practice from the interim drugs fund is applied uniformly before the main drugs fund kicks off next spring? We do not want to add to cancer inequalities when it comes to access to treatment and drugs.
In the past, rarer cancers have had a very raw deal. I know that the Secretary of State is conscious of that and will ensure that those who suffer from rarer cancers will be treated much more fairly than in the past.
There is not time for the Secretary of State to answer all my questions now, but I hope that he will address them when he speaks at the Britain Against Cancer conference on 14 December, and I look forward to hearing what he has to say.
In short, the refocusing on outcomes is the greatest innovation and benefit to patients since the NHS began. However, that must not be undermined by the problems with GP commissioning.
Ms Diane Abbott (Hackney North and Stoke Newington) (Lab)
This is a period of great challenge for the national health service, and it would be whoever was in government. However, Government Members accused us of not having a care for staff and patients. In fact, it is precisely because we are concerned about staff and patients that we are using this debate to point to all that is problematic—and potentially even disastrous—about the Secretary of State’s proposed NHS reorganisation.
In exploring the gap between what those in government said while in opposition and what they are saying now, we can do no better than refer to a speech that the present Prime Minister gave to the King’s Fund in 2006, in which he set out the five key components of his approach to the NHS—components that, to my knowledge, he has not altered. His first component was that he wanted to guarantee the NHS the money that it needs. Who believes that now? Certainly not the Institute for Fiscal Studies, which has noted that not since the 1950s—from April 1951 to March 1956, to be precise—has there been such a small increase in NHS funding; and not the chief executive of the Royal College of Nursing, who said:
“A huge range of services and jobs are earmarked for cuts against this urban myth that the NHS is being protected. The evidence is quite clear…this is simply not the case”.
Hon. Members, who, as the weeks turn to months, will see the cuts in their own constituencies, will not believe it either.
My hon. Friend the Member for Sheffield Central (Paul Blomfield) talked about what is happening to children’s hospitals. What has not been factored in is the cost of reorganisation, which experts have said will be £3 billion. Ministers have said that their estimate is £1.7 billion, but when asked about the number of redundancies they cannot answer. We know that the cost—
Ms Abbott
No, I must get on.
The cost of redundancies, when they are factored in, will be hundreds of thousands of pounds. We believe that the figure of £1.7 billion will be overshot, and bring greater financial pressure on the NHS.
The second point that the Prime Minister made in 2006 was that he wanted to end the damage caused by pointless and disruptive reorganisation of the NHS. He said:
“We will not mess around with existing local and regional structures”.
So the Secretary of State’s big idea for the NHS was a pointless and disruptive reorganisation.
What do the people who work in the NHS think about that? The Royal College of General Practitioners says:
“our members are not convinced that the scale of the changes proposed is justifiable, especially in the context of cost reductions”.
The British Medical Association
“questions whether a less disruptive, more cost-effective process could have achieved the aims of reducing bureaucracy”.
The Royal College of Midwives says that it is
“very disappointed that despite pre-election promises to end…top-down reorganisation…the White Paper focuses far more on structures than it does on care delivery.”
The reorganisation is high-cost, high-risk and contrary to everything that was said by those who are now Ministers in the run-up to the election. They have accused us of being confused and incoherent, but it is their reorganisation that is confused and incoherent. Every professional body echoes that thought.
The Prime Minister said that he wanted to
“work with the grain of the Government’s reforms…So we will go further in increasing the power and independence of GPs and PCTs”.
He has gone so far that he has left GPs behind, and only one in four believe that the reorganisation will improve patient care. As for PCTs, contrary to the Government’s promises when in Opposition, they have abolished them.
What was the Prime Minister’s fourth point about his main driving aims for the NHS? He said that he wanted to
“take the politics out of the management of the NHS”.
There could not be a more political reorganisation. It is driven by ideology and a belief in free market ideology. As the chair of the BMA, Hamish Meldrum, said:
“If the Government is truly committed to reducing waste and inefficiency, their proposals for NHS reform should focus less on competition and more on a co-operative approach on delivering health care.”
Finally in his 2006 speech the Prime Minister said that his main commitment on the NHS was
“fair funding to the NHS…We will end political meddling…removing the scope for fiddling”.
We will see how much the scope for fiddling is removed when money is moved from the NHS budget to local authorities for social care.
My hon. Friends the Members for West Lancashire (Rosie Cooper), for Kingston upon Hull North (Diana Johnson) and for Bolton South East (Yasmin Qureshi) all expanded on what is problematic about the reorganisation. The Secretary of State began by posing as the friend of patients and those who work in the NHS. I will not take lectures from him on that. My mother came to this country as a pupil nurse from Jamaica in the 1950s. She was part of that generation of West Indian women who helped to build the national health service. Government Members cannot talk to us about the people who work in the NHS. As for patients, are Ministers listening to the patient groups—people who represent children, people who represent the elderly, and people who represent those with mental health problems—about their concern about what the reorganisation will mean for them?
This reorganisation is ill thought out and, at a time of tremendous financial stress in the national health service, ill timed. We believe that Government Members have been lulled into a false sense of security about what is to come. They believe that although students might be marching and the Church might be in uproar, the NHS is safe. I put it to them that, as the weeks turn to months and we move through the winter, and as we begin to see winter bed pressures, the consequences of this ill-thought-out, unnecessary, top-down reorganisation will reverberate not only in this Chamber but in the surgeries of Government Members and of all Members of this House. I am proud to support the motion.
Oral Answers to Questions
John Baron Excerpts(14 years, 1 month ago)
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Mr Burns
I say in the politest way possible to the hon. Lady that we cannot abandon a target that has never been imposed in the first place. May I remind her that, as a sop to the Labour party conference more than a year ago, the former Prime Minister merely announced an aspiration? He never provided any funding or said where the funding should go, and he never provided any clinical evidence for the viability of the proposal. Saying that the Government have abandoned a target when it never existed is sheer poppycock.
Mr John Baron (Basildon and Billericay) (Con)
The all-party cancer group’s report last year found that those with rarer cancers got a bit of a raw deal from the NHS when it came to access to treatment and drugs. How will the new cancer fund put right that wrong?
Mr Burns
I am sure that my hon. Friend, through the tremendous work done by him and his colleagues on the all-party group, will appreciate that my right hon. Friend the Secretary of State’s initiative—providing £50 million for the rest of this year and £200 million from next year for the cancer fund—is an important step forward in helping those who suffer from cancer. I am sure that my hon. Friend will also welcome the fact that work is ongoing on refining, following the review, the cancer reform strategy, and we are looking at the scope for improving survival rates by the increased use of diagnostic tests and at improving care across the board, so that we raise our standards to the highest in Europe rather than being the poor relation.
Oral Answers to Questions
John Baron Excerpts(14 years, 3 months ago)
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Mr Burns
May I reassure the right hon. Gentleman that we will shortly consult on the cancer drugs fund. On the question of Afinitor, in which I know he has a particular interest, I appreciate that there has been some concern expressed by families and patients about the issuing of the interim guidance. I would like to emphasise that the guidance is only interim, that the appraisal is ongoing and that we await the final guidance from NICE. I hope that he will be reassured that, since the publication of the draft guidance, the manufacturer of Afinitor has proposed a revised patient access scheme for the drug, which is now being considered as part of the NICE appraisal. In the light of that, we will have to await the announcement of the final decision.
Mr John Baron (Basildon and Billericay) (Con)
13. What recent representations he has received on the proposed one-year cancer survival measure.
The Minister of State, Department of Health (Mr Paul Burstow)
I have received many helpful representations on the proposed one-year survival measure, including his own when I met him along with a number of leading cancer charities in July. We have launched a full public consultation to shape the first ever outcomes framework for the NHS, and I urge all interested parties to contribute. The consultation document has put forward a range of possible outcome measures, including a one-year cancer survival rate that could be included in the framework. A full response to the consultation will be provided when it closes on 11 October.
Mr Baron
The one-year cancer survival measure is welcome, because it will encourage earlier diagnosis. As the Minister will know, however, under-treatment of the elderly in the NHS remains a pressing problem, which was highlighted in a recent report on cancer inequalities by the all-party parliamentary group on cancer. Can he assure us that the over-75s will not be excluded from the one-year or the five-year cancer survival measures once they are constructed?
Mr Burstow
The hon. Gentleman makes an important point. It is essential for us to ensure that the NHS delivers treatments that are both based on evidence and age-appropriate, which means ensuring that older people receive treatments that will enable them to survive cancers. His representations will need to be taken fully into account as we consider the results of the consultation on the outcomes framework.
Mr John Baron (Basildon and Billericay) (Con)
T8. Is any flexibility available to allow the interim cancer drug fund to review earlier and more speedily adverse National Institute for Health and Clinical Excellence decisions—because in certain cases, as we know with Avastin for late-stage bowel cancer, a few months, or even a few weeks, can make a big difference to patients.
Mr Lansley
My hon. Friend will be aware that we have proceeded as rapidly as we possibly can in finding savings this year, so that from 1 October the regional panels of expert clinicians can look at individual cases. It is not a matter of their reviewing NICE decisions; it is a matter of their looking at individual cases that cannot be funded under existing guidance or local decisions, but being able to apply clinical criteria to individual cases using an additional fund.
NHS White Paper
John Baron Excerpts(14 years, 5 months ago)
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Mr Lansley
I do not recognise the hon. Lady’s latter point. Some 7% of the population in London are not registered with a GP, which is one reason why commissioning consortiums of GPs will take responsibility for their locality, not just their registered patient population.
In relation to hospitals such as the Royal Free, one reason why the hon. Lady, I and other Members were campaigning against her Government before the election was that we recognised that we cannot shut down accident and emergency departments when patients are coming in the door by the tens of thousands because there is no alternative provision. The best way to design services in the community that better meet the needs of patients is through general practitioners designing them around the needs of their patients.
Mr John Baron (Basildon and Billericay) (Con)
I very much welcome the White Paper’s increased focus on improving outcomes, and particularly my right hon. Friend’s comments about the introduction of one-year and five-year cancer survival rates, for which the all-party group on cancer has been pushing. How does he envisage GP commissioning of cancer services improving with the White Paper, given that part of the problem is that a typical GP will see only eight new cancer presentations a year?
Mr Lansley
I pay tribute to my hon. Friend’s work. He will have noted that I deliberately said both one-year and five-year cancer survival rates—he made an important point about that. Clearly, there are many specialist commissioning services, which will become the NHS commissioning board’s responsibility. To that extent, GPs should not be expected to commission specialised services—they have little experience of that. However, GPs as commissioning consortiums, like primary care trusts at the moment, are capable of having a relationship with their cancer networks to establish the services that they need for their patients. Indeed, that applies more to GPs because many of the patients and those who work in cancer services to whom I speak are critical of the lack of awareness on the part of PCT commissioners of the available services. Those who work in cancer services do not believe that PCT commissioners understand the service that they provide. Not every GP understands every aspect of cancer care, but they are much better placed to work with cancer specialists to design the services.
Oral Answers to Questions
John Baron Excerpts(14 years, 5 months ago)
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Mr Lansley
I am grateful to the hon. Lady for that question, and I have had the privilege of twice visiting the national bowel cancer screening programme at St Cross hospital in Rugby—it looks after people in parts of the midlands and the north-west—and indeed, I have visited the Preston royal infirmary, which deals with bowel cancer screening follow-up. As I said in my first reply, one of the things we aim to do is to increase awareness of the signs and symptoms of cancer. It is unfortunate that, as a recent study established, only 30% of the public had real awareness of what the symptoms of cancer would be, beyond a lump or a swelling. We have very high rates of bowel cancer, so it will be part of our future cancer strategy to increase awareness of those symptoms and to encourage men in particular to follow up on them.
Mr John Baron (Basildon and Billericay) (Con)
The recent inquiry of the all-party parliamentary cancer group into cancer and equalities heard expert evidence to suggest that if people can survive the first year of cancer, their chances of surviving for five years are almost identical to the chances in the rest of Europe. Does the Secretary of State therefore believe that a one-year survival indicator is a good idea both for encouraging early diagnosis and for matching the survival rates of the best in Europe?
Mr Lansley
My hon. Friend makes an extremely good point. When we set out proposals for an outcomes framework, I hope that he and others will respond, because that is one of the ways in which we can best identify how late detection of cancer is leading to very poor levels of survival to one year. I hope that we can think about that as one of the quality indicators that we shall establish.