Health: Cancer

Lord Wills Excerpts

Thursday 11th November 2010 Lords Chamber

[Lord Wills]

My Lords, I, too, congratulate the noble Baroness, Lady Finlay, on enabling the House to discuss a subject of such importance to so many people in this country, and on her most impressive and comprehensive speech. I cannot lay claim to her professional experience and wisdom but, in the short time available, I will make two points about early diagnosis, which is so crucial to outcomes for people with cancer, as the House has heard so often today in so many moving speeches.

First, I ask the Minister about the Government’s plans to scrap the Labour Government’s commitment to reduce waiting times for cancer tests to one week. There is a legitimate debate to be had about the place of targets in the NHS, but it must be rooted in fact. The Government’s July White Paper states:

“Success will be measured, not through bureaucratic process targets, but against results that really matter to patients—such as improving cancer and stroke survival rates”.

This is a caricature of the previous Government’s health policy. It misses the point that these so-called process targets have been focused on outcomes and have played a significant role in the improvements in clinical outcomes in recent years. Moreover, it is not clear exactly how the Government’s theological position on targets has determined them to scrap the one-week waiting time for tests while retaining the two-week target for seeing a specialist. I hope everyone accepts that reducing the time that patients and their families have to wait anxiously for results must, axiomatically, be welcome. I also assume that it is accepted that the prompter the test results, the sooner any necessary treatment can begin.

So I would be grateful if the Minister could explain exactly why the Government have kept the Labour Government’s two-week target to see a specialist but scrapped the one-week target for test results. All I have heard by way of justification are vague words about there not being enough clinical evidence to support it. Can the Minister provide the detailed reasoning for this assertion and for retaining the two-week target?

My second point is about prostate cancer. Here I associate myself with the powerful speech by my noble friend Lord Kinnock. Prostate cancer is the second largest cause of cancer death in men and has seen no significant improvement in mortality rates. As the House will know, there are specific problems with early diagnosis of this cancer. There is poor awareness of it. Many men, for whatever reason, have been squeamish about discussing possible symptoms with their doctors. There has been a particular problem with the reliability of diagnostic procedures. The PSA test is a blunt instrument. In addition to producing false negative results and a relatively high level of false positive results, it cannot accurately distinguish between aggressive and indolent forms of the disease. This has created doubt about its suitability as the basis for a screening programme. As we know, screening has proved very effective in the successful treatment of other cancers.

On the other hand, last year the European Study of Screening for Prostate Cancer, which surveyed 182,000 men aged 50 to 74 in seven European countries, suggested that PSA-based screening can reduce the rate of death from prostate cancer by 20 per cent, although it also suggested that it was associated with a high risk of overdiagnosis. The Minister will be aware that the Prostate Cancer Charity has been working to develop the concept of universal informed choice to overcome these difficulties. With universal informed choice, it would be not for the Government to make the decision on screening but for the individual, on the basis of properly informed choice. The Government’s role would be to create the circumstances and conditions in which everyone was enabled to make such an informed choice by ensuring that every man over 50 and younger men at higher risk would have access to balanced information about the PSA test.

The charity has suggested three models: one that is GP-led, one based on community walk-in clinics and one based on roadshow clinics. The Minister will I am sure be aware that these are not necessarily alternatives but could well be complementary. Whatever model is adopted, it would, as my noble friend Lord Kinnock pointed out so powerfully, have to be supported by regular public awareness campaigns and consciousness raising among healthcare professionals.

I should be grateful if the Minister could say whether he believes that this approach could play an important role in at last reducing mortality rates of this cancer. If he does not agree, I would be grateful if he would explain why. But if he does agree, can he say what steps he will take in the next year to implement this new approach? For example, will the revised cancer reform strategy endorse the need for universal informed choice in relation to prostate cancer screening?

I recognise that this debate has already been wide-ranging, so the Minister may not have the answers to hand or have time to address all these questions fully. In that case, I would be grateful if he could write to me with the answers.