Health: Cancer

Lord Aberdare Excerpts

Thursday 29th November 2018 Lords Chamber

[Lord O'Shaughnessy]

I absolutely recognise that it is a problem. As I said, we have increased the numbers of doctors in a range of specialties. Pathology has been a challenge, it must be said. There are two answers: the first is to continue to recruit more people, either domestically or internationally. The second refers to the point that the noble Baroness, Lady Finlay, made: we are determined to utterly transform this service through technology while also delivering better results.

[Lord Aberdare (CB)]

My Lords, pancreatic cancer is one of the deadliest cancers. One in four sufferers survives for less than a month after diagnosis, and only 7% survive for five years. What is more, the outcomes have hardly improved in the last 40 years. Will the Minister join me in welcoming the Demand Faster Treatment campaign led by Pancreatic Cancer UK, whose ambition is that by 2024 people with pancreatic cancer will be treated within 20 days of diagnosis? Will he assure the House that the Government will play a leading part in helping to achieve that goal? I declare my interest as an officer of the Pancreatic Cancer All-Party Group.

[Lord O'Shaughnessy]

The noble Lord is quite right. We have seen incredible improvements in outcomes for some cancers, whereas others, pancreatic cancer among them just, have not seen improved survival rates. We need to do a lot more, and part of that is early diagnosis. I understand that while pancreatic cancer becomes symptomatic in the last six months of a person’s life, it can be in the body for up to 14 years, so making that early diagnosis and using new technology such as liquid biopsies will help us achieve that noble goal.

Queen’s Speech

Lord Aberdare Excerpts

Thursday 29th June 2017 Lords Chamber

[Lord Aberdare (CB)]

My Lords, it is pleasure to follow the noble Baroness, Lady Benjamin, especially as, unlike some of her colleagues, she has not pre-empted many of my own remarks.

I shall focus on skills and the creative industries. The success of Brexit will depend on the competitiveness of UK business in global markets, which in turn requires access to talent and skills and capitalising on our world-class strengths in sectors such as the creative industries.

I welcome the Government’s commitment to creating a world-class technical education system, building on the generally admirable Technical and Further Education Act passed in the last Session. It is high time for the disparity of esteem between academic and technical education to be finally laid to rest, so that teachers, parents and young people themselves recognise that technical education routes offer opportunities at least as rewarding and valuable as academic ones. That might also help to address the education divide, so thoughtfully described earlier by the noble Baroness, Lady Stowell.

The gracious Speech makes little mention of apprenticeships, but I was reassured by the Minister’s confirmation that the commitment to deliver 3 million new high-quality apprenticeship starts in England by 2020 has not changed, despite the rather surprising appointment of a new Skills Minister, Anne Milton MP, to replace Robert Halfon. I wish her success in progressing the new system for funding and managing apprenticeships, based on the apprenticeship levy, which was introduced in April, and the new Institute for Apprenticeships, and in ensuring that this actually delivers the enhanced skills that we need in terms of quality as well as quantity. I am particularly concerned that the vital role of independent training providers in delivering apprenticeships—over half of the total, I believe—should be properly recognised and supported.

The gracious Speech includes proposals for a new digital charter, aimed at making the UK the best place to start and run a digital business and the safest place in the world to be online. I hope that the first of these aims will include sufficient emphasis on enhancing digital skills. The Digital Skills Committee, on which I served, described this as a make or break issue for the UK and increasingly vital not just for digital businesses but in almost every field of activity. The noble Lord, Lord Baker of Dorking, pointed out in a letter to the Times on Tuesday that the number of students taking GCSE computer science this year is still only 68,000, while a Commons report forecasts a shortfall of 750,000 digital technicians. I remain to be convinced that the scale of this challenge is adequately reflected in the measures outlined in the gracious Speech and supporting documents. I strongly endorse the call made by my noble friend Lord Kinnoull for improving the effectiveness of careers education.

One of the areas in which the UK has the potential to continue to excel is in the creative industries, which represent £87 billion of gross value added. It is one of the UK’s fastest growing sectors and accounts for almost 10% of our service exports. I share the view expressed by a number of noble Lords, including the noble Baronesses, Lady McIntosh and Lady Bonham-Carter, and the noble Lord, Lord Clement-Jones, that the exclusion of creative subjects from the Government’s plans for the EBacc is perverse. The noble Lord, Lord Storey, mentioned the declining take-up of arts and creative subjects in schools, yet these subjects are included as a matter of course in the most successful schools, particularly in the independent sector, and businesses are crying out for skills in just these areas. There seems to be a real risk of pupils in disadvantaged areas missing out on arts and creative subjects, thereby reinforcing the concerns about the potential educational divide mentioned by the noble Lord, Lord Whitty, and others.

The creative sector, as we have heard, acts as a hub for global talent and depends significantly on overseas workers, not just to plug major skills gaps in the domestic workforce but to bring market insight into different territories where it competes. Twenty per cent of orchestral musicians in this country come from overseas. To support the continued success of the sector, a new immigration system should take account of issues such as the high proportion of freelancers in the creative industries workforce, the relatively low pay levels of many workers—below the current thresholds for entering and remaining in the UK—and the importance of touring for many arts organisations, such as orchestras.

For some creative sectors, such as broadcasting, market access is specifically dependent on membership of the EU single market, which enables it to offer services across the whole EU on the basis of just one licence from Ofcom. Some members of the EU Internal Market Committee went on a visit to Discovery Networks, which runs well over 100 broadcast channels from Chiswick, which may need to consider relocation from the UK, if it no longer has access to the market. It is not surprising that 96% of members of the Creative Industries Federation said that they wish to remain in the EU.

I hope the Government will succeed in retaining some degree of access to the EU single market, perhaps through membership of the EEA and/or EFTA, at least during a period of transition. Let me note also that it will be more important than ever after we leave the EU as a member to foster mutual understanding and partnerships with our closest neighbours through continuing to participate in EU programmes such as Creative Europe, Horizon 2020 and Erasmus+. Those issues are key to the Brexit aim of taking British values around the world and need to be at the forefront of the Government’s programme in this session, even during the ongoing process of negotiating Brexit.

Health: Cancer

Lord Aberdare Excerpts

Wednesday 20th January 2016 Lords Chamber

[Lord Aberdare (CB)]

My Lords, I congratulate the noble Baroness, Lady Walmsley, on securing this debate and on making a number of points in her excellent speech—as indeed did other noble Lords—of such merit that I plan to repeat them.

It is good news that cancer death rates have fallen steadily in the past 20 years and that half of adult cancer patients are now expected to survive for 10 years or more. As a cancer survivor myself, I hope to reinforce those figures. However, this is not a uniform picture, and I shall speak about one of the cancers with the worst survival rates of all. I declare my interest as a vice-chair of the All-Party Group on Pancreatic Cancer.

As we have heard, pancreatic cancer is the 10th most prevalent of the top 21 cancers but the fifth biggest killer, causing some 8,700 deaths a year. UK five-year survival rates are just over 5%. Shockingly, these have hardly changed in 40 years. Average survival after diagnosis is a mere two to six months; 80% of patients are diagnosed too late to be operated on; and 45% are diagnosed only as a result of emergency admission to hospital, with only a 9% chance of surviving for one year, as opposed to 26% for GP referrals. I could go on but I will end with just one more dismal fact: the UK is near the bottom of the European league table in its pancreatic cancer outcomes, with a one-year survival rate that is only half that of Belgium—21% versus 40%—and well below the average of 30%.

What are the factors contributing to pancreatic cancer survival rates—or, more accurately, non-survival rates—in the UK and what might be done to improve them? I will make five suggestions, based on the findings of two inquiries carried out by the all-party group in 2013 and 2014. If the Minister has not seen them, I would be glad to send him copies.

The first requirement is for more research. Pancreatic cancer accounts for 5.2% of UK cancer deaths but only 1.4% of research spending. Of course, the experience of other cancers shows a clear link between research and improved survival rates. The second is earlier diagnosis. The all-party group reports have highlighted ways to achieve this, including better training and diagnostic support tools for GP practices; new referral pathways, giving GPs direct access to CT scans; and multidisciplinary centres to avoid patients being shuttled back and forth between their GP and various investigative routes before a correct diagnosis is made.

Thirdly, a specific strategy is needed for tackling pancreatic cancer and other so-called cancers of unmet need whose outcomes are lagging behind. These are not adequately addressed in the current national strategy for England. Fourthly, as we have heard, the public should be made more aware of pancreatic cancer. A 2015 poll found that 71% of people in England could not name a single symptom of pancreatic cancer unprompted. An awareness campaign is needed, if not for pancreatic cancer on its own, then perhaps for the whole group of gastrointestinal cancers, including pancreatic.

Finally, it is deeply troubling that the only new treatment for pancreatic cancer in some 20 years, providing a real, albeit small, extension of life for patients, has been removed from the cancer drugs fund and rejected by NICE for use in the NHS, although it remains available in both Scotland and Wales. This only exacerbates the finding of the 2014 national Cancer Patient Experience Survey that pancreatic cancer patients report a lower standard of care than others; for example, in terms of the information provided, the availability of cancer nurse specialists with specific pancreatic cancer skills, and access to specialist dieticians.

I have outlined five ways in which the Minister could set about improving cancer survival rates, particularly for pancreatic cancer sufferers, for whom the need is so dire. Perhaps he might borrow from President Obama’s cancer “moonshot” idea in his recent State of the Union address and bring to the battle against cancer the sort of energy, innovation, commitment and resources that led to America putting a man on the moon—or at least enable us to catch up with other leading countries.

--- Later in debate ---

[The Parliamentary Under-Secretary of State, Department of Health (Lord Prior of Brampton) (Con)]

My Lords, I join everybody else in thanking the noble Baroness, Lady Walmsley, for bringing this very important debate to the House. It really is a shame that we have only an hour. So much has been said that I cannot do it all justice. The noble Baroness kindly gave me a hint of what she might say this evening, so I hope that I will cover that in my main speech. I would like to come back to her on the two-week target. Maybe I could write to her on that.

My noble friend Lord Colwyn raised the importance of the dental profession, which again is all part of the common theme of early diagnosis. The importance of clinical trials was raised by the noble Lord, Lord Wood, particularly in relation to teenagers and children. They are clearly very important. I would like to come back to the noble Lord, Lord Sharkey, about his comment that CCGs were putting in incentives to GPs for not referring suspected cases of cancer. Perhaps I might investigate and come back to him on that important issue.

The noble Lord, Lord Freyberg, mentioned powerfully the power of transparency. The example he gave which stuck with me was that of prostate cancer and the differing rates of incontinence as a result of that. I think that it was in Hamburg that the results were particularly good. In answer to the noble Lord, Lord Hunt, I have already agreed to meet the noble Lord, Lord Freyberg. Transparency about survival rates will not solve all the issues but could be very powerful.

Both my noble friend Lady Hodgson and the noble Lord, Lord Hunt, raised the issue of screening for elderly people. I will write to them on that issue, as I cannot give them an answer this evening. The noble Baroness, Lady Masham, raised the issue of proton beam therapy. Again, I will write a progress report to her on that. As she knows, we are proceeding with two centres, one in Manchester and one at UCLH in London. I believe that both of them have started and are on target, but I will revert to her on that if I can.

My noble friend Lady Redfern asked whether we could look at increasing public awareness and referred to the Be Clear on Cancer campaign. That is important. The noble Lord, Lord Aberdare, raised the issue of pancreatic cancer. I was not aware that the survival rate after a year was 5%. That is terribly low, and I would like to research that more. The noble Lord, Lord Hunt, raised lots of important questions, but in answer to a particularly important one, NHS England has, as I understand it, accepted the recommendations of the Harpal Kumar report and will be implementing them over the next four years.

I hope that I will answer most of the questions in my speech. It is worth noting that we have made huge progress over the last 15 years, even though the kernel of the debate this evening is that we have got a lot further to go to catch up with our European neighbours. Activity has increased dramatically. In the last five years, 645,000 more patients with suspected cancers were seen, an increase of 71%. Almost 40,000 more patients were treated for cancer, an increase of 17%.

The proportion of cancers diagnosed as a result of emergency presentation—an issue raised by a number of noble Lords—has decreased significantly. At the same time, the proportion of cancers diagnosed through urgent GP referral following a suspicion of cancer has increased. In 2006, almost 25% of all cancers were diagnosed as an emergency. In 2013, this figure had fallen to 20%, or one in five. That is a considerable reduction, but there is still a long way to go. To help diagnose cancer earlier, we have invested over £22 million in our Be Clear on Cancer campaigns and we continue to expand and modernise our cancer screening programmes. Nationally, 37% of radiotherapy treatments are now being delivered with more precise intensity-modulated radiation therapy—IMRT—ahead of the 24% target.

Since October 2010, the Cancer Drugs Fund has helped more than 84,000 cancer patients in England, and £1 billion has now been made available to support that fund. We are committed to the fund, although we are out for consultation at the moment as to how we should progress it forward for next year. It is worth noting that in this current year some £340 million has been spent in that fund. Some of these new cancer drugs are extremely expensive.

We know that cancer survival in England has historically lagged behind the best-performing countries in Europe and the world, but none of these international comparisons of cancer include patients more recently diagnosed than 2009. As a result, we should be careful about using these comparisons as a measure of the current performance of the system, although they can be useful as a long-term benchmark. Although we will have improved considerably since that time, I suspect that other countries will also have improved, so the question is whether that gap has closed. Although our survival rates are at a record high and continue to improve, as shown by the new figures published by the ONS in November, we know that we must do better. The gap between England and the better-performing countries is narrowing for some cancers, but for others it remains.

That is why, in January last year, NHS England announced a new Independent Cancer Taskforce to develop a five-year strategy for cancer. A report was published in July 2015, which I think was well received by most interested parties. It recommends improvements across the cancer pathway with the aim of improving survival rates. I thank Sir Harpal Kumar and his colleagues for that report.

In terms of delivery, NHS England has recently appointed Cally Palmer, whom some of you will know, as she is also chief executive of the Royal Marsden, as the NHS National Cancer Director. She will lead on implementation, as well as new cancer vanguards to redesign care and patient experience. She is currently setting up a new Cancer Transformation Board to lead the rollout of the recommendations of the new strategy, and a Cancer Advisory Group, chaired by Sir Harpal Kumar, will oversee and scrutinise its work. I hope that that will go some way to addressing the concerns of the noble Lord, Lord Hunt, about the networks that used to be there. We hope that they will put in place something similar, if not the same.

Although this is a five-year strategy and an implementation plan is being developed, good progress has already been made on many of the key recommendations. The task force recognised the importance of early and faster diagnosis to improve outcomes and experience. It is essential that we make sure that cancer is diagnosed as early as possible, so we will adopt the task force’s ambitious new waiting times target for the NHS. From 2020, patients will be given a definitive cancer diagnosis or the all-clear within 28 days of being referred by a GP. This will mean that the period of uncertainty will be as short as possible.

We are backing this with an expected investment of up to £300 million a year by 2020, along with a national training programme for an additional 200 staff with the skills and expertise to carry out endoscopy tests by 2018. This is an area of shortage at the moment. We have also confirmed a commitment from NHS England to implement the Independent Cancer Taskforce’s recommendations on molecular diagnostics. This will mean that about 25,000 additional people a year will have their cancers genetically tested to identify the most effective treatments. I noted the comments of the noble Baroness, Lady Masham, about fairness in access to molecular diagnostic tests.

To monitor the impact of the new strategy, we are also introducing two new outcome metrics: the proportion of cancers diagnosed at stages 1 and 2 and the proportion of cancers diagnosed through an emergency route. These will be published quarterly at CCG level from May 2016. From April 2016, the new cancer dashboard will enable every CCG to see its data and benchmark itself against other CCGs and England as a whole. It will measure progress with a focus on incidence, survival rates, patient experience and quality of life for patients.

In conclusion, I congratulate your Lordships’ House on the quality of this debate. Some fascinating issues have been raised. The personal experience of many noble Lords has been particularly illuminating. I hope that I have been able to set out our commitment to delivering the Independent Cancer Taskforce’s new strategy, the good progress that has already been made, and NHS England’s robust plans to turn the recommendations into reality.

If the NHS is successful in implementing its initiatives and ambitions, an additional 30,000 patients a year will survive cancer for 10 years or more by 2020, 11,000 through early diagnosis. There will also be a closing of the gap in survival rates between England and the best countries in the world, which is something that we all want to see.

We have some progress to report. It is never enough. It will take time to build up both the diagnosis and treatment resources so that we can close that gap with other European countries completely, but with Sir Harpal Kumar’s task force report, we have a very clear way to do that.

[Lord Aberdare]

My Lords, before the noble Lord sits down, I hope that I did not misspeak, but the figure I cited of 5% for pancreatic survival was for five years, not one. I apologise if I misled the Minister.

Defibrillators

Lord Aberdare Excerpts

Tuesday 24th June 2014 Grand Committee

[Lord Aberdare (CB)]

My Lords, I warmly congratulate the noble Lord, Lord Storey, on tabling this debate. It is a subject that is not only close to my heart, if your Lordships will forgive a feeble pun, but quite literally a matter of life and death for a significant number of our fellow citizens in the UK. Having listened to the three excellent speeches so far, I could probably cut my own contribution to little more than the words, “Hear, hear!”, but I hope that I will be allowed to reinforce some of the arguments and will be forgiven for inevitably covering a considerable amount of the same ground. No doubt that is due in part to my having received the same helpful briefings from the bodies mentioned by the noble Lord, Lord Storey, and indeed from the House of Lords Library. I have to say that my heart sank as one after another of my points was made by the previous speakers. I do not think that my heart has actually stopped yet but, if it does, there is a defibrillator in the Peers’ Lobby.

As we have heard, some 60,000 out-of-hospital cardiac arrests occur each year in the UK. Somewhere between 20% and 40% of them are estimated to occur in public places, with nearly half of them being witnessed by bystanders. The remainder take place at home. Any assistance that is provided at the scene by those bystanders before the emergency services arrive can help to save life. In such cases, every minute that passes without intervention reduces the chances of survival by around 10%. So what are the chances of survival from shockable cardiac arrest? In Oregon, they are as high as 56%, while in Norway they are 52%. In the UK, the average comparable survival rate is only 20%. What accounts for the difference is, quite simply, the number of people who have been trained in first aid. In Germany and the Scandinavian countries, where first aid training in schools is mandatory, the proportion of people with first aid skills is estimated to be as high as 80%. It seems to me a matter of national embarrassment, to put it mildly, that only one in 13 people in the UK feels confident that they could carry out emergency first aid.

Automatic external defibrillators can and do save lives. They are a key part of the so-called chain of survival as defined by the British Heart Foundation and the Resuscitation Council (UK). That includes four elements: early recognition of a cardiac arrest, cardiopulmonary resuscitation, early defibrillation and post-resuscitation care. In order to improve survival rates, that whole chain needs to be in place. AEDs themselves will be effective only, first, if there are enough of them; secondly, if they are in appropriate and visible places; thirdly, if they are accessible and not locked away with the key nowhere to be found, about which I have heard stories from time to time; and, finally, if people know how to use them and are willing to do so. I therefore welcome the policy of encouraging the wider installation of AEDs. Research by St John Ambulance indicates that the majority of people, some 79%, think that it should be compulsory to have AEDs in places such as NHS buildings, 74% that they should be in care homes, as the noble Lord told us, 73% that they should be in large event venues such as concert halls, 67% that they should be in sports centres and gyms, 55% that they should be in workplaces, 53% that they should be in hotels and 50% that they should be in supermarkets.

As important as having defibrillators in place is, of course, knowing where that place is. I was going to suggest that this would be a perfect opportunity for an app, only to hear from the noble Baroness that the app already exists. That is another good point gone. Moreover, as the noble Lord, Lord Storey, mentioned, there are 16 defibrillators on the Parliamentary Estate and a significant number of trained first-aiders who know where they are and how to use them, including, I believe, most or all of the House of Lords attendants. Some noble Lords may not be aware that the best number to call on the Parliamentary Estate in the event of my having an emergency during my speech is not 999 but extension 3333. That is the first point that I alone have made.

All the AEDs that have been or are about to be installed, however numerous, well located and easily accessible, will be effective only if people know how to use them and are willing to do so. Current research shows that only one person in 10 knows what an AED is and, of those who do, just half know how to use it. Again, training is needed. The only way to increase, over time, the proportion of the population who have basic emergency life-saving and first aid skills is to teach those skills in schools, not just to teachers but to students as well. In that way, we can ultimately create a nation of lifesavers, to quote a phrase whose source I have mislaid.

Many voluntary organisations, such as St John Ambulance, the British Red Cross, the British Heart Foundation, the Resuscitation Council (UK) and SADS—Sudden Arrhythmic Death Syndrome—UK, do a good job of providing both information and training. I declare an interest as a trustee of St John Cymru Wales. I have now been trained in first aid three times: by St John Cymru Wales, by St John Ambulance under the auspices of the All-Party Parliamentary Group on First Aid, of which I am a vice-chair, and by the parliamentary Safety, Health and Wellbeing Service, which also covered the use of defibrillators. At least 14 parliamentarians have completed the training offered via the first aid all-party group.

The Government have committed to enabling schools to acquire defibrillators at discounted prices, which I welcome. However, they also believe that schools should decide for themselves whether to include first aid training in their curriculum. That is just not working. The combined efforts of all the groups that I have mentioned reach only a relatively small proportion of students in schools—I believe about one in seven, or 14%. This is nowhere near enough to address what should surely be a significant national priority. Leaders of all five of these bodies signed a letter to the Times last month, expressing their disappointment that, at the same time as encouraging schools to buy defibrillators,

“the government did not go further and insist on first aid education for all pupils and staff”.

I apologise if I am overrunning. I am very much encouraged by the fact that I seem to have spoken for no time at all, but that is presumably not the case.

At the very least, government should surely look at providing much more in the way of incentives and encouragement to schools. Subsidised AEDs, at least for schools in England, are a welcome start, but what about subsidised training in how to use them? What about awards and recognition for schools that achieve the best results in numbers of students trained or in levels of proficiency attained? Incidentally, I welcome the Social Action, Responsibility and Heroism Bill, which should help to overcome any concerns that people may have about the possibility of being sued after trying to resuscitate someone.

Children aged 10 and above can learn the full range of emergency life support skills, including CPR. From the age of 14 they can be, and are, trained in using defibrillators. A significant number have had to use the skills that they have learnt to save the life of a family member or fellow student. Of the children on a British Heart Foundation Heartstart programme in Northern Ireland, 98% enjoyed the training and 67% shared what they learnt with family and friends. Separate BHF research found that 86% of teachers thought that emergency life support should be part of the national curriculum, 78% of children wanted to be taught how to save someone’s life in an emergency and 70% of parents thought that children should be taught emergency life support at school.

First aid and defibrillator training is straightforward; it is quick, requiring as little as two to three hours; it is cheap; it promotes self-esteem and citizenship; it is fun; and it can save lives. Without it, the Government’s laudable initiative to enable more schools to acquire defibrillators may not—will not—be as effective as it could be. So why on earth should such training not be made mandatory in all schools? I look forward to the Minister’s response to that question.

NHS: NICE-appraised Medicines

Lord Aberdare Excerpts

Thursday 27th February 2014 Lords Chamber

[Earl Howe]

Mesothelioma is a devastating disease, and I certainly undertake to look at the material that the noble Lord has sent me.

[Lord Aberdare (CB)]

My Lords, is the noble Earl aware that a new treatment has recently been licensed for advanced pancreatic cancer, offering the greatest improvement in survival of any such treatment in 17 years? Does he share my concern that it needs to be made available to sufferers from the disease as urgently as possible via the Cancer Drugs Fund while awaiting NICE approval?

[Earl Howe]

My Lords, drugs which have not yet been assessed or approved by NICE are eligible for use under the Cancer Drugs Fund. I am pleased to say that the Government have made a total of £1 billion available under that fund and 44,000 patients have been treated under it. I appreciate the noble Lord bringing that particular drug to my attention and I undertake to look at it.

Care Bill [HL]

Lord Aberdare Excerpts

Monday 21st October 2013 Lords Chamber

[Lord Aberdare (CB)]

My Lords, I shall speak to Amendment 160A, which is sandwiched in the middle of this group of government amendments. My amendment seeks to add an additional matter to which Health Education England must have regard when publishing its objectives and priorities—namely,

“the needs of patients to have their conditions diagnosed promptly”.

This is intended to promote the interests of patients suffering from diseases that are hard to diagnose but where early diagnosis can be critical. There are, of course, a number of such conditions, but the Minister may not be surprised to learn that the particular condition on which I shall focus is pancreatic cancer, for which early diagnosis is often literally a matter of life and death. This amendment is based on my work with the charity Pancreatic Cancer UK. I am also a member of the All-Party Parliamentary Group on Pancreatic Cancer, chaired by my noble friend Lord Patel, which has been conducting an inquiry into how survival rates can be improved. Speed of diagnosis is critical and depends largely on the level of awareness of pancreatic cancer and its symptoms in primary care.

The 2010 National Cancer Patient Experience Survey found that 40% of pancreatic cancer patients visit their GP three times or more before being referred to hospital for investigation. The National Cancer Intelligence Network has found that half of all pancreatic cancer patients are diagnosed only as a result of an emergency admission to hospital. Patients diagnosed via this route have far lower one-year survival rates—only 9%, compared to 26% for patients diagnosed as a result of GP referral. A 2012 survey of GPs found that half said that they were not confident that they could identify the signs and symptoms of possible pancreatic cancer in a patient. Education and training are needed to give them enhanced skills and tools in order to improve their ability to recognise and diagnose the symptoms of conditions such as pancreatic cancer, and to help prevent the sort of shuttling between GPs and a range of different secondary care providers that some patients undergo before a firm diagnosis is made. That needs to be a clear part of Health Education England’s brief.

The aim of this amendment, therefore, is simply to ensure that such a responsibility is formally included among matters to which Health Education England must have regard. It would require it specifically to recognise that time is of the essence in diseases such as pancreatic cancer, and encourage HEE to identify, share and promote best practice in achieving earlier diagnosis. It might, for example, lead to initiatives such as conducting case reviews with experts from the Royal College of General Practitioners to determine why cases identified through emergency admission could not have been diagnosed earlier. I hope that such initiatives would help to close the gap between the UK and other leading countries that do significantly better in terms of survival rates and other outcomes.

My amendment may not be the best way to achieve these goals but it is important that they should be achieved, and I look forward to hearing the Minister’s response as to how this can and will be done.

NHS: Association of Medical Research Charities Report

Lord Aberdare Excerpts

Thursday 27th June 2013 Grand Committee

[Lord Aberdare]

My Lords, I should like to focus on only one area of NHS research—namely, research relating to pancreatic cancer, which is probably not to the great surprise of the Minister. In doing so, I thank the charity Pancreatic Cancer UK for its briefing, James Tobin at the House of Lords Library for his typically helpful briefing pack and I congratulate the noble Lord, Lord Turnberg, on obtaining this debate.

Pancreatic cancer accounts for 5% of cancer deaths in the UK but it currently attracts only 1% of research spending. So perhaps it is little wonder that outcomes in survival rates, for example, have shown little if any improvement in 40 years, yet evidence from other cancers, such as breast cancer, shows that increased research effort can lead to significantly better outcomes.

For research to be effective in this way, a number of essential infrastructure elements need to be in place, several of which are rightly identified in the AMRC report. There need to be recognised centres of research excellence covering areas such as pancreatic cancer; an adequate body of appropriately qualified and skilled researchers; an ability to attract new young researchers into the specific field; and a strong pipeline of good research proposals. Beyond that, research needs a critical mass, estimated to be at least £10 million to £12 million a year, as opposed to the current spending level of £5 million for pancreatic cancer research.

The first part of the AMRC report focuses on patient involvement in research and sets out three aims: every patient should be able to take part in research; research should be patient-centred; and research should be embedded in patient care. I ask the Minister: what can he and the Government do to ensure that these three aims are achieved for pancreatic cancer patients?

Specifically, pancreatic cancer patients are often unable to access clinical trials. Lower levels of investment in pancreatic cancer research mean that there are fewer clinical trials available. One study found 91 breast cancer clinical trials taking place against only 15 for pancreatic cancer. Less than 10% of pancreatic cancer patients say that they have been involved in any discussion about clinical trials, and less than 12% are enrolled in such trials, against about one in six cancer patients overall. In any case, many pancreatic cancer patients are diagnosed too late to be fit enough to participate in trials. So how can the Government help to ensure that more pancreatic cancer patients can access clinical trials? I hope the Minister will have some ideas.

The third part of the report relates to conducting high quality research and adopting new treatments. Apparently, much pancreatic cancer research tends to be researcher-led—there is little in the way of strategic direction from funders—unlike some other countries, such as Australia, which have clearly defined research priorities and achieve more impressive results. How can the Minister help to ensure that government engages with relevant research bodies in a collaborative effort to develop a strategic research agenda for pancreatic cancer?

I ask the Minister to look at a number of other measures, such as encouraging existing cancer research centres to increase their focus on pancreatic cancer; providing support to develop more skilled researchers, specifically in pancreatic cancer, and to ensure that this field of research is seen as offering a good career path, which is clearly one of the challenges at the moment; helping to raise the profile of pancreatic cancer within the research community, perhaps by the appointment of a UK pancreatic cancer research champion; and ensuring that the UK learns from experience in other countries and that research findings are freely shared internationally.

Pancreatic Cancer UK is doing its bit, for example with its own research innovation fund and future research leaders fund. I hope the Minister can tell us how government will add weight to efforts such as these so that we can put in place an effective research programme which will finally start to turn the tide of dismal pancreatic cancer outcomes and bring some real hope to sufferers from this dreadful disease and to their loved ones.

Health: Cancer

Lord Aberdare Excerpts

Monday 14th January 2013 Lords Chamber

Asked By

[Lord Aberdare]

To ask Her Majesty’s Government what steps they are taking to ensure that the Department of Health 2013 generic cancer symptoms awareness campaign will help improve early diagnosis of pancreatic cancer.

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

My Lords, from today, we are piloting a general cancer symptoms campaign to raise awareness and encourage people with relevant symptoms to visit their GP. The campaign will run in five cancer network areas until mid-March and will be relevant to a range of cancers, including pancreatic cancer. Data, including GP attendance, urgent referrals for suspected cancer and diagnostic test activity, will be collected and analysed to assess the impact of the campaign.

[Lord Aberdare]

My Lords, pancreatic cancer is the fifth most deadly cancer in the UK, accounting for some 7,900 deaths a year. UK survival rates are significantly worse than in some other countries, as are the numbers of patients being referred for operations, the only effective cure. Since earlier diagnosis is essential to improve these outcomes, what plans does the Minister have to ensure that the proposed campaign includes new tools to help GPs detect pancreatic cancer and better pathways for them to refer suspected cases for further testing and support?

[Earl Howe]

The noble Lord is absolutely right about the importance of earlier diagnosis. I can give two examples of work running this year to assist GPs in the assessment and earlier diagnosis of cancer patients, including those with pancreatic cancer. Rolling out from March, Macmillan Cancer Support, with funding from the department, will be piloting an electronic cancer decision support tool for GPs to use as part of their routine practice in order to help identify and assess more effectively patients with possible cancer. The initial pilot will cover a number of cancers, including pancreatic cancer. Further, the National Action Cancer Team is supporting the distribution of further desk-based versions of risk assessment tools for use in general practice, and these include a pancreatic cancer risk assessment tool.

Health: Pancreatic Cancer

Lord Aberdare Excerpts

Monday 23rd April 2012 Grand Committee

Asked By

[Lord Aberdare]

To ask Her Majesty’s Government what steps they will take to improve both the quality of care and the overall survival rates for pancreatic cancer in the United Kingdom.

[Lord Aberdare]

My Lords, pancreatic cancer is in some respects the poor relation of major cancers. It is the fifth most deadly cancer in the UK after breast, lung, bowel and prostate cancer. However, its survival rate, unlike those of the other cancers, has hardly improved in the past 40 years. In addition, there is evidence that pancreatic cancer patients often do not receive an adequate standard of care. Pancreatic cancer is all too often seen as a death sentence, leaving little or nothing to hope for. I sought this debate to try to focus on ways in which the Government, working with others concerned, might help to bring some hope—something more to live for—to sufferers from pancreatic cancer and their friends and families.

My concern about the issue is purely that of a layman without medical or specialist expertise. Two friends of mine died from pancreatic cancer in recent years. One was a business acquaintance who battled with it for several years, the other a friend who died within weeks of diagnosis. At least three others lost parents at a relatively early age, while another currently has the disease and is doing his utmost to beat the odds. He has been lucky enough to be treated privately at the Royal Marsden Hospital. Through the efforts of his medical team he was given a drug called Folfirinox, which is not approved for this purpose by NICE but which shrank his tumour to the point where it could be operated on. He is convinced that without that operation he would have died.

As I prepared for this debate, I was struck by the number of people who have had direct experience of friends or relatives falling victim to pancreatic cancer. When I looked at the statistics relating to it, I found them shocking. There are more than 8,000 diagnoses of pancreatic cancer in the UK each year, which represents less than 3 per cent of total cancer diagnoses. However, it accounts for nearly 5 per cent of deaths, and the length of time between diagnosis and death is typically less than six months. More than 80 per cent of patients will die within a year of diagnosis. Three-year survival rates in the UK range from 3.6 per cent to 11.9 per cent, and five-year rates from 0 per cent to 10.4 per cent. Only 3 per cent of patients survive for five years. The figures have hardly improved since the 1970s, yet countries such as the USA, Canada and Australia achieve five-year survival rates that are twice as high, and a number of European countries also do better than the UK. Furthermore, there are significant variations in outcomes between different UK regions. London and the south-east have better results than the north of England, Scotland, Wales and Northern Ireland.

Of equal concern is that the 2010 NHS National Cancer Patient Experience Survey showed that pancreatic cancer patients had a poorer NHS experience than most other cancer sufferers, for example in the information they received, in the management of their pain, and in the confidence they had in their medical teams. One aspect of this is the support available from clinical nurse specialists. Although most pancreatic cancer patients surveyed said that they had access to a clinical nurse specialist, research by Pancreatic Cancer UK found that those specialist nurses were concerned that they were not receiving the support and resources they needed to do their job well. Moreover, although it is estimated that some 20 per cent of pancreatic cancer patients may be suitable candidates for surgery, which is recognised as the only effective way of tackling the disease, only about 10 per cent receive it. Noble Lords may share my view that these figures are deeply disappointing and raise serious questions about whether we in the UK cannot and should not do considerably better for those unlucky enough to contract this dreadful disease.

There are three issues I should like to highlight as needing to be tackled. The first is to increase research into the many aspects of the disease which are not yet adequately understood. Despite accounting for 5 per cent of cancer deaths, pancreatic cancer attracts only 1 per cent of cancer research funding. Any prospect of improving survival rates must start from better data about what causes or contributes to the disease and what sorts of treatment are effective in tackling it. Experience, for example with breast cancer, has clearly shown that research does lead to improved survival rates.

The second issue is to find ways of diagnosing pancreatic cancer earlier. There are no straightforward ways of recognising the disease, and many weeks or months often pass before a firm diagnosis is reached, with almost 30 per cent of patients visiting their GPs five times or more. However, the prospects for successful treatment—or even for high-quality palliative care—depend largely on how soon the disease is identified. In addition, many patients do not have the chance to participate in clinical trials for new treatments because their condition is already too far advanced by the time they are diagnosed.

The third issue I want to raise is the quality of care for all pancreatic cancer patients, which needs to be improved, for example through better information for patients and their carers, better co-ordination between those involved in treatment, better support from clinical nurse specialists and a more consistent service across the UK.

I know that the Government share my concern about the need to improve the experience of pancreatic cancer sufferers. Paul Burstow, a Minister in the Department of Health, has met Pancreatic Cancer UK and indicated his support for its Campaign for Hope, and I welcome the fact that two pancreatic cancer-related research studies are to be conducted under the aegis of the National Cancer Intelligence Network.

I very much look forward to the Minister's response to this debate, as well as to the contributions and suggestions of other noble Lords who have much greater experience and knowledge of this issue than I do, but who none the less get three minutes as opposed to my 10. I am sure they will do much better with it. Government, of course, cannot provide all the answers; but in partnership with other organisations and interested parties—the medical profession, research bodies, funders, charities, carers, and of course patients themselves and their families and friends—they can offer encouragement, support and resources.

In particular, I ask the Minister to answer four questions. First, will he look into conducting a full audit of current pancreatic cancer services, to assess why different regions currently achieve different results, and what structures and systems work best to provide pancreatic cancer patients with an optimum quality of care?

Secondly, will he ensure that pancreatic cancer is firmly included in the national awareness and early diagnosis initiative to assess what can be done to shorten the time to diagnosis?

Thirdly, what steps will he take to increase the amount of funding going to pancreatic cancer, both for research and care, in line with its significance among major cancers in the UK? Finally, how will he seek to improve the experience of care for pancreatic cancer patients?

Progress on other major cancers has shown how much improvement can be achieved through focused efforts to raise awareness and improve diagnosis and treatment. Surely we can also improve the outlook for pancreatic cancer sufferers and give them some real hope for longer lives, better care and greater fulfilment in the time that remains to them.