Oral Answers to Questions

Nicholas Dakin Excerpts

Tuesday 24th February 2015 Commons Chamber

[Dr Poulter]

The most important thing we have done is support our front-line staff with additional investment in the NHS, which Labour called irresponsible, and there is about £13 billion more going into the NHS during this Parliament. We have also increased transparency to make sure that where there are isolated pockets of poor care, the Care Quality Commission can intervene and make recommendations to improve the quality of care for patients in those hospitals.

[Nic Dakin (Scunthorpe) (Lab)]

20. Given the significant challenges facing the NHS and the fact that this top-down reorganisation has led to this hiring and firing and therefore a distraction of energy and attention at crucial times, do not the Government now regret their top-down reorganisation?

[Dr Poulter]

A reorganisation of NHS services that results in administration spending being reduced from 4.27% under the previous Government to 2.77% under this Government, meaning that there is £5 billion more money for front-line patient care, is a good thing. That is something the Opposition should support, because it means that patients are getting a better service.

Pancreatic Cancer

Nicholas Dakin Excerpts

Thursday 15th January 2015 Commons Chamber

[Nic Dakin (Scunthorpe) (Lab)]

There have been several parliamentary debates on pancreatic cancer over the past year, not least the one in Westminster Hall in September in response to the e-petition launched by my constituent, Maggie Watts, which gained more than 100,000 signatures. The petition called for more to be done to improve public awareness and early diagnosis of, and increased research into, pancreatic cancer. It was a positive, constructive debate, with many Members from across the House showing their passion and commitment to upping our game on tackling pancreatic cancer.

The Minister and hon. Members in the Chamber are well aware of the issues, but it is important to put on the record again the seriousness of this disease. Pancreatic cancer is the fifth largest cause of cancer deaths in the UK today, and is set to overtake breast cancer as the fourth biggest cancer killer by 2030. Some 8,800 people are diagnosed with the disease each year, and 8,700 people die from it each year. Five-year survival rates are less than 4%—the worst rate for any of the 21 most common cancers—and have barely changed during the past 40 years. While mortality rates have fallen for most forms of cancer, sadly, those for pancreatic cancer are rising. That is largely due to late diagnosis, with half of all diagnoses made via emergency admissions, which means that less than 20% of patients are diagnosed at a stage when curative surgery remains an option.

Thankfully, these days a majority of cancer patients survive for 10 years. Sadly, that is not the case for pancreatic cancer patients, of whom fewer than 1% survive 10 years. That is why future medical support for pancreatic cancer—greater awareness, early diagnosis, new treatments and faster access to treatments—is so important.

The debate this week is fortuitous as it follows Monday’s announcement that the cancer drugs fund has removed 25 drugs from its approved list. As the Minister will know, there was real anxiety about the pancreatic cancer drug Abraxane being removed. That drug has been shown to extend patients’ lives by an average of about two months, and in some cases by significantly more. It is routinely used around the world as a basic standard of care for pancreatic cancer patients. If it is removed from the CDF, there is a real danger that English patients will be hugely disadvantaged. It was positive news that Abraxane has not been removed from the CDF list.

However, from reading the small print of the CDF decision, it appears that the drug is still under threat of removal. The CDF panel has merely granted a stay of execution while more evidence on Abraxane is gathered. Do not get me wrong: the extra time is welcome—I hope, once more evidence has been provided, that the CDF panel will agree to keep Abraxane for the longer term—but at the moment we are in a state of limbo.

Will the Minister clarify just how much time will be allowed for the drug manufacturer to provide additional evidence to the CDF panel? What specifically needs to be provided for a positive decision? Importantly, will clinicians dealing with pancreatic cancer day to day and patient organisations be allowed to feed into the process and submit their observable evidence to the CDF? I hope that the Minister will agree that an appropriate period should be allowed for sufficient evidence to be collated, presented and analysed. Ideally, gathering evidence over a period from clinicians, using the drug at the coal face, would be the best way to trial commissioning through evaluation. Does the Minister support that approach?

The truth is that the CDF’s decision not immediately to delist Abraxane on Monday is more important than ever because over the Christmas break NICE announced that it would not fund Abraxane routinely on the NHS. Consequently, if Abraxane were no longer on the CDF list, patients in England would not be able to access the drug for free. Its place on the CDF list is now, literally, the last lifeline for some patients.

NICE rejected the drug on cost grounds, yet it costs only £8,000 per patient—much less than some other specialist drugs, which run to tens of thousands of pounds. The issue is the way that NICE calculates cost benefit through its system of quality adjusted life years, which in reality works against cancer drugs, especially for those cancers with poor prognoses such as pancreatic cancer. In this instance I understand that the drug was not even assessed or considered under NICE’s less prescriptive end-of-life criteria. That seems rather strange when the disease we are talking about has the worst survival rate of any common cancer, with the average survival time for metastatic pancreatic cancer patients just two to six months.

Questions have been raised about the effectiveness of the NICE drug appraisal system, with 60% of cancer drugs rejected by NICE in 2012—an increase on figures for 2010. Despite the excellent work that NICE and the CDF have done, there is a strong argument for reform, and I know that a number of models have been considered in the last few years. I urge the Minister to bring together NICE, the CDF, the NHS, charities, the industry, and others to thrash out as soon as possible a new, workable drug appraisal model that everybody has confidence in.

Important as they are in extending life, chemotherapy drugs are not the be-all and end-all. In fact, for pancreatic cancer survival rates to increase substantially we need earlier diagnosis of the disease, and new types of treatment made available to patients as a matter of priority. Will the Minister prioritise a public awareness campaign? Campaigners such as my constituent, Maggie Watts, and fantastic pancreatic cancer charities such as Pancreatic Cancer Action and Pancreatic Cancer UK would, I am sure, be keen to work with the Department, and others, to promote a public awareness campaign that leads to earlier diagnosis.

Some of the trial measures for early diagnosis announced by NHS England last weekend, including direct GP access to CT scans, direct patient referral to specialists, and multi-disciplinary diagnostic centres, are welcome. Measures that are designed to speed referral pathways and stop patients being “ping-ponged” backwards and forwards between GPs and different specialists were raised in the Westminster Hall e-petition debate.

Self-referral may end the tragic cases of patients who get so fed up with being ignored by their GP or hospital that they end up paying for a private scan to confirm one way or another whether they have cancer, and I am optimistic that progress can be made. Perhaps the Minister can provide us with more details about the trials, which I know are being implemented jointly with Cancer Research UK and Macmillan Cancer Support. How many trial areas will be selected? Where will they be? How can patients take part? Perhaps importantly for this debate, will access to tests for pancreatic cancer, such as CT scans, be included in the pilots?

One issue raised in the September debate was the need to prioritise promising new technologies for treating cancers of unmet need—such as pancreatic cancer—as soon as possible. It was welcome when the Minister said in response to that debate that a new NHS England and Cancer Research UK trial into stereotactic ablative radiotherapy—treatments such as CyberKnife—would include pancreatic cancer. That, and other treatments such as NanoKnife, can precisely target tumours, potentially making them very important in the fight against pancreatic cancer where the location of the tumour sometimes makes curative surgery impossible—for instance, when the tumour has grown very close to an artery. Those new technologies could therefore help to reduce the size of the tumour on so-called borderline resectable patients, subsequently making them eligible for full curative surgery. The confirmation over the weekend that NHS England will be carrying out the SABR trial is most welcome. Will the Minister confirm that the trial will include pancreatic cancer? Will she confirm how many patients will be recruited and which centres will carry out the trial? When will it start recruiting?

One of the ways we might gain more rapid data on the efficacy of technologies such as CyberKnife and NanoKnife and benefit patients at the same time is through the commissioning through evaluation programme. The Minister will be aware that the all-party group on pancreatic cancer produced a report in October that made a number of recommendations about how to boost research into pancreatic cancer. I am grateful to the Minister for copying me in to her response to the hon. Member for Lancaster and Fleetwood (Eric Ollerenshaw), who is in his place. He has done an outstanding job of chairing the all-party group and raising issues both in this House and outside relating to this difficult matter. One recommendation suggested including both NanoKnife and CyberKnife in the NHS England commissioning through evaluation programme as a matter of priority. Will the Minister update us on the current funding status for commissioning through evaluation? What consideration will be given to the all-party group’s recommendation to include those technologies in the scheme as a priority?

On a similar subject, and referring to another recommendation from the recent all-party group’s research report, the Minister will know that Genomics England is funding a huge project to sequence the genomes of people with rare diseases and cancer. As things stand, I believe only six types of cancer are included in that project and that pancreatic cancer is not one of them. I therefore ask the Minister to include pancreatic cancer as a priority area as part of that project. Failing that, will she confirm that, under their service specifications with Genomics England, individual centres have the flexibility to add to the types of disease from which they collect and sequence samples? If individual centres were agreeable, they could themselves decide to add pancreatic cancer to their work areas above and beyond the six cancer types agreed nationally.

I note that a new independent cancer taskforce has been established to produce a new national cancer strategy for the next five years. That is truly welcome news. I understand it will look at areas such as early diagnosis, access to treatment, improvements to care, and, vitally, research and innovation. As part of that development, will the Minister consider making sure that the new strategy has a particular focus on prioritising cancers of unmet need? If we are to make real inroads into improving overall cancer survival rates, we must prioritise building research and innovation to better tackle the most difficult-to-treat cancers—those with the lowest survival rates such as lung cancer, brain tumours, oesophageal cancer and, of course, pancreatic cancer.

In conclusion, hopefully in the coming months we will receive confirmation that Abraxane stays on the cancer drugs fund list for the longer term. This is a short-term, but important, step. I hope we will see new treatments, such as CyberKnife and NanoKnife, made quickly available to pancreatic cancer patients, perhaps through the commissioning through evaluation process. I hope clinical trials and research projects, such as the Genomics England project, will prioritise pancreatic cancer for research, and that a new national cancer strategy might prioritise research and innovation into tackling the cancers with the worst survival outcomes. Lastly, I hope the Government will work with all interested parties to introduce a public awareness campaign to maximise early presentation, followed by early diagnosis, leading to earlier action and transforming outcomes for patients with pancreatic cancer.

--- Later in debate ---

[Nic Dakin]

I thank the Minister for everything she has said to date. On the issue of a public awareness campaign on pancreatic cancer, is there a way in which those with pancreatic cancers could engage with that body to see if there is a way forward?

[Jane Ellison]

If I recall my diary correctly, I have a meeting with Sean Duffy coming up, and I would be happy to raise that issue with him, along with any other points arising from this debate. It will certainly be on my agenda for discussions with him. I have touched on the matter briefly with him before, but I will pick it up again.

The problems with late diagnosis have been explored before, and it is critical that we get people the most appropriate treatment early. We have discussed radiotherapy before. It can be a very helpful treatment for some patients. As part of its recent announcement, NHS England committed a further £15 million over three years to evaluate and treat patients with a modern, more precise type of radiotherapy— stereotactic ablative radiotherapy or SABR, as the hon. Gentleman mentioned. That evaluation programme will mean a significant increase in the number of cancer patients eligible to access this treatment by around 750 a year, and the programme will widen the number of cancers being treated by SABR, including cancer that has spread to another part of the body.

The new investment is in addition to NHS England’s pledge to provide up to £6 million over the next five years to cover NHS treatment costs of SABR clinical trials, most of which are being led by Cancer Research UK and one of which—as the hon. Gentleman knows from our debate last September—relates to pancreatic cancer. As for the hon. Gentleman’s suggestion regarding commissioning through evaluation, I shall raise it with NHS England. I am afraid that we do not yet know which centres or how many patients will take part in the trials to assess the effectiveness of SABR in comparison with conventional radiotherapy or surgery, but I understand that we are likely to have that information in the coming weeks. I will certainly make the decision-makers involved aware of the debate, and of the interest in the outcome of their deliberations.

NHS England’s chemotherapy clinical reference group has set out service specifications defining what NHS England expects to be in place to enable providers to offer evidence-based, safe and effective chemotherapy services. NICE has issued technology appraisal guidance which recommends Gemzar as an option for treating patients with advanced or metastatic adenocarcinoma of the pancreas who meet certain clinical criteria. NICE is also appraising a number of new drugs for pancreatic cancer. NHS commissioners are legally required to fund treatments recommended by NICE in its technology appraisal guidance.

Understandably, the cancer drugs fund has been mentioned this evening. The Government’s reasons for establishing the fund are well documented. At the end of August 2014 it received an additional £160 million, and I welcome the announcement on 12 January by NHS England, which is now responsible for the fund’s operational management, that it too would provide extra money. The CDF panel has decided that further consideration of Abraxane for the treatment of pancreatic cancer is needed, and it will remain on the national CDF list until that has been concluded. I am not yet sure about the timings, but I will undertake to update the all-party group, including the hon. Members for Scunthorpe and my hon. Friend the Member for Lancaster and Fleetwood, in due course.

Let me now say something about NICE appraisals. Representatives of the Department, NICE, 10 key cancer charities and the pharmaceutical industry met in December to discuss the future of cancer drugs commissioning. They committed themselves to establishing a working group to develop a robust process to support the sustainable, long-term commissioning of cancer drugs. The group will meet for the first time, opportunely, on Monday 19 January.

I am glad that the hon. Member for Scunthorpe found the letter about research useful. He and I, along with my hon. Friend the Member for Lancaster and Fleetwood, had a very good meeting with the chief medical officer, and we have followed that up with a response to the all-party group’s excellent report, which was published last October. At our meeting, the chief medical officer said that she would be happy to attend a meeting of the all-party group. I will remind her of that, but I suggest that the hon. Gentleman and my hon. Friend get in touch with her. We would respond positively to that.

The Government are investing a record £800 million over the five years to 2017 in a series of biomedical research centres and units, including £6.5 million of funding for the Liverpool pancreas biomedical research unit. The unit is working in partnership with industry and leading research institutions to develop new treatments and diagnostic strategies for pancreatic cancer. The National Cancer Research Institute brings together clinicians, scientists, statisticians and lay representatives. Its upper gastro-intestinal cancer clinical studies group has a pancreas sub-group, which plays a vital role in the development of trials.

Late in 2012, the Prime Minister launched the 100,000 genomes project, which will sequence 100,000 whole genomes from NHS patients by 2017. It focuses on patients with rare diseases and their families, as well as on patients with some types of cancer. We believe that the six cancers that will be covered will give us knowledge and understanding that can be applied to all cancers. Although pancreatic cancer is not one of the six, we expect the project to make a useful contribution in that regard.

I thank both Members who have spoken this evening, I thank the all-party group, and I thank all those who campaign tirelessly for progress on pancreatic cancer. We know that achieving improved outcomes for people with the disease is a huge challenge, but I believe that the change that we all desperately want to see will come. I welcome the new cancer taskforce, which will be leading the way, and I undertake to write to its independent chairman, drawing his attention to this evening’s important debate and the work of the all-party group.

Question put and agreed to.

National Health Service (Amended Duties and Powers) Bill

Nicholas Dakin Excerpts

Friday 21st November 2014 Commons Chamber

[Clive Efford]

I hope the hon. Gentleman does not mind, but I am going to make some progress.

Never before have we had market tendering of the health service as we have today, and it is breaking down our NHS. The Bill is not a solution to all the mistakes that this Government have made in their top-down restructuring of the NHS, but it is an important block on enforced privatisation. The argument can be simplified into two distinct sides. If people believe the NHS should be a pure market, open to competition regulations, where the interests of competition are put before those of patients, they belong on the side of the Government. If people believe the NHS is a public service that should be free of competition rules, where the interests of patients are put first, they should vote for the Bill today.

We know that No. 10 did not understand what was going on in 2012. The Chancellor was asleep at the wheel, and the Liberal Democrats, suffering from some form of terminal Stockholm syndrome, were led by the nose to turn the NHS from a public service into a free market. My Bill takes a scalpel to cut the heart out of the hated 2012 Act and put right the worst of the Government’s mistakes. It will remove the sections that require the tendering of NHS services for competition with the private sector, the result of which has been millions of pounds being diverted from patient care into the pockets of lawyers and accountants through the tendering process. NHS bodies are spending millions either bidding or managing bidding processes, and that is all money being diverted from patient care. That must stop, and this Bill will end it.

[Nic Dakin (Scunthorpe) (Lab)]

I congratulate my hon. Friend on securing the Bill’s progress today. Does he agree with my constituent Julian Corlett, who expresses real concern that further privatisation would mean the NHS may be reduced simply to a brand and nothing more?

Five Year Forward View

Nicholas Dakin Excerpts

Thursday 23rd October 2014 Commons Chamber

[Mr Hunt]

Exactly—that is precisely the point. This report has example after example of how the new structures—clinical commissioning groups—are integrating care. That is why it makes it so clear that it would be wrong to do what Labour wants to do, which is to repeal the Health and Social Care Act 2012 and to strip CCGs of their powers when they are providing precisely the integrated care that we all think is important.

[Nic Dakin (Scunthorpe) (Lab)]

Northern Lincolnshire and Goole Hospitals NHS Trust has made significant progress over the past two years, but it remains financially very challenged and in significant deficit. What, if anything, in these plans will help to remedy that challenging situation?

[Mr Hunt]

Two things. I have had a very interesting visit to Goole hospital. It was very impressive to see how it has responded to the special measures programme and how, as a result of the new inspection regime, which Labour Front Benchers tried to vote down, it has made real improvements in care on the front line for the hon. Gentleman’s constituents. Those at the hospital will be pleased to see that this report endorses the new transparent approach to dealing with variations in care. It also says that we need to continue with increases in real-terms funding for the NHS, which we only get with a strong economy.

Pancreatic Cancer

Nicholas Dakin Excerpts

Monday 8th September 2014 Westminster Hall

[Nic Dakin (Scunthorpe) (Lab)]

I beg to move,

That this House has considered the e-petition relating to research funding for and awareness of pancreatic cancer.

It is a pleasure to serve under your chairmanship, Mr Chope. I thank the Backbench Business Committee for granting this important debate. That citizens of the United Kingdom can, through their petitioning, move issues up the national agenda shows the strength of our democracy. Pancreatic cancer has not had the strong public spotlight of concern that some other diseases have had, so it is fantastic that the public’s voice has led directly to this debate, which I am proud to initiate. I thank every one of the 106,398 people who signed the petition by 8 April, and all those who have signed it since.

I pay particular tribute to my constituent, Maggie Watts, who started the petition with a determination to push pancreatic cancer further into the public’s conscience and higher up the political agenda. That we are here today in a packed Westminster Hall debate is tribute to her efforts and to those of everyone in the pancreatic cancer community—the charities, clinicians, patients, survivors and family members and friends of patients—who energised the nation to say through the petition that the time is right for us to up our collective game on pancreatic cancer.

It is worth pausing to consider the powerful testimony of the petition text, which asks the Government to:

“Provide more Funding & Awareness for Pancreatic Cancer to aid long overdue progress in earlier detection and, ultimately, improved survival rates”.

It reminds us that pancreatic cancer is the

“5th leading cause of UK cancer death with the worst survival rate of all cancers yet it receives only c1% of research spend. 5 year survival of 3% hasn’t improved in over 40 years, whilst survival rates for other cancers have… More funding/more public awareness is vital so that progress can be made in earlier detection and, ultimately, better survival rates. Often termed the “silent killer”, many of PC’s symptoms mirror other less critical illnesses. Sometimes GPs may not recognise these early enough, looking first at other possible causes resulting in lost time before diagnosis. By this time, in many cases, the prognosis is terminal.”

The petition calls for action:

“Another 40 years can’t pass without change. The requirement is for significantly increased research funding and inclusion in the National Awareness & Early Diagnosis Initiative (NAEDI) Public Symptoms Awareness Campaign”.

Pancreatic cancer is the fifth most common cause of cancer death in the UK. It has the worst five-year survival rate of the 21 most common cancers, and that has not changed in 40 years. Maggie Watts’s husband Kevin died of pancreatic cancer exactly 20 months from diagnosis, aged 48. His mum died 40 years earlier of the same disease, aged 27. Maggie said:

“What shocked me the most when I started to research pancreatic cancer is that, actually, Kevin stood no better chance of survival in 2009 than his mum did in 1969. Their deaths were 40 years apart yet there was no change in survival rates in all of that time. I found that hard to understand—there is not a lot in this world that hasn’t changed or improved over a 40 year period, including most other cancers but, for pancreatic cancer, survival rates are still shockingly low.”

She concluded that

“there must be a direct correlation between the lack of funding allocated to pancreatic cancer and the lack of progress in the disease.”

The lack of funding has meant that there has been no progress in 40 years. It has not been a public or political priority, and that has to change. As Dr Andrew Millar of London Cancer told the all-party group on pancreatic cancer last week, the very fact that people have only a one in 90 chance of getting this cancer, but a 95% chance of dying once it is diagnosed means that it is less likely to attract commercial funding than the more treatable forms of cancer. As he said, that is exactly when the Government need to step up to the mark and step in, yet site-specific funding for pancreatic cancer research is very low in real terms when compared to other forms of cancer. Only £5.2 million, or just 1% of the National Cancer Research Institute’s 2013 budget, was spent on pancreatic cancer research—that equates to just £625 per death per year on pancreatic cancer, compared with £3,426 per death per year on breast cancer—despite pancreatic cancer being responsible for 5.2% of all cancer deaths in the UK and deaths from pancreatic cancer increasing between 2002 and 2013, while deaths from most other cancers declined.

[John Hemming (Birmingham, Yardley) (LD)]

I congratulate the hon. Gentleman on taking up this issue in Parliament and the campaigners on raising the petition. Constituents have come to me to explain their concerns about pancreatic cancer. Does he agree that it is important that the campaign continues to do excellent work in raising awareness of the difficulties with pancreatic cancer?

[Nic Dakin]

The hon. Gentleman is absolutely right. The campaign must go on, beyond today and into the future. Campaigners are here today in strong heart and with a strong determination to ensure that that is the case.

Breaking down the NCRI spend into contributions from individual partner members is difficult, but we know from evidence given to the all-party group that in 2013, Cancer Research UK provided £2.3 million and the Medical Research Council provided £750,000. The contribution from the Department of Health was therefore just £700,000. In its 2012 policy briefing, “Study for Survival”, Pancreatic Cancer UK calculated that at least £10 million of investment is needed by 2015 and that £12 million is needed by 2017. The target is £25 million by 2022. The minimum figure of £10 million to £12 million has not been plucked out of the air; it comes from a high-level analysis of other cancers, such as prostate and bowel, which suggests that there is a point where funding starts to grow in a more rapid and, importantly, more sustainable manner. A critical mass is needed to generate a solid research infrastructure—for example, through the establishment of centres of research excellence. A critical mass of researchers generating competitive research proposals needs to accrue, and those investment targets are a key starting point for such progress.

Maggie told me that she considers herself in a way to be lucky. She said that she and Kevin had 20 months post-diagnosis and that he was an incredibly positive man, who refused to give in to the disease. Maggie said:

“When I say we were ‘lucky’ I mean because we got 20 months to do and say everything we wanted to. People that I have met whilst I’ve been working on the e-petition lost their loved ones weeks or even days from diagnosis. They were only just getting their heads around a terminal cancer diagnosis when they were having to deal with death. I’ve heard some incredibly sad stories around pancreatic cancer and I’ve heard lots of them.”

Stories of such shattering losses are not rare. One quick look at the tributes left online for victims is testament to that.

[Mr Andrew Smith (Oxford East) (Lab)]

I congratulate my hon. Friend and the others who have raised this debate, as well as those who have petitioned on this vital matter. Does he agree that, as well as the general need for more research funding, screening tools, which are not presently available, need to be developed to make early diagnosis possible? Such developments have been responsible for so much progress with other cancers.

[Nic Dakin]

My right hon. Friend is absolutely right that the nub of the issue is how to get early diagnosis—the difficult-to-achieve holy grail.

In evidence to the all-party group a week after celebrating six years of survival, pancreatic cancer survivor Ali Stunt said:

“We need to focus on early diagnosis… Those of us who are diagnosed in time for surgery, which is what we want to achieve, have a tenfold increase in the chance of surviving five years… I was lucky. I was told that surgery was an option and that my operation would be booked in for a week’s time. I was told I needed chemotherapy and a week later was in my consultant oncologist’s office. I told him that I wanted to live to see my boys graduate. Following combination chemotherapy for 6 months and then chemo-radiotherapy, my scans were clear. Regular check-ups followed with scans and blood tests—all of which revealed ‘no evidence of disease’. My oncologist finally ‘signed me off’ in April 2013.

This is a story not often heard when pancreatic cancer is involved. These past 4 years since I founded Pancreatic Cancer Action I have met and got to know some fabulous people who have bravely fought and helped me raise awareness of this cruel disease. Not many of them are still alive, but all will have a special place in my heart. It is and always will be my mission to get more people diagnosed sooner—so more can have the same outcome as me.”

I first became aware of pancreatic cancer many years ago when my friend and colleague Martin Newbould became ill with it. Martin was an inspirational individual, a wonderful family man and an outstanding head of maths. More recently, my witty local newsagent Mick Emerson retired only to be diagnosed with pancreatic cancer soon after and then pass away. My friend Sir John Mason passed away just before the summer after a dignified battle against the disease, leaving a massive legacy of good work in the community. Having been ill for some time with an undiagnosed condition, John’s pancreatic cancer was, I understand, finally diagnosed after an emergency admission at Scunthorpe hospital’s A and E.

Currently, a staggering 48% of pancreatic cancer diagnoses are made by emergency admission, which is more than twice the total for other forms of cancer. That is important, as presentation via emergency admission is normally when the disease is more advanced and associated with much poorer survival rates than other routes to diagnosis. For example, one-year survival for patients presenting via emergency admission is just 9%, as opposed to 26% for those diagnosed as a result of GP referral. Over 40% of pancreatic cancer patients visit their GPs three times or more before even being referred to hospital. Some 16% have to visit their GP or hospital seven times or more before the correct diagnosis is made. By comparison, figures show that 75% of all cancer patients combined are referred to hospital after only one or two visits to their GPs.

Such data are only recently known as a result of the National Cancer Intelligence Network’s impressive work. It shows the power of data in helping us to tackle this disease. Further improvements in the collection and application of real-time data have the potential to transform medical practice in this area. Evidence given to the all-party group last week suggests that establishing a tool to collect patient data online would not be difficult to achieve. Such a robust IT system would radically improve data collection. Patients support their data being used for analysis and expect their data to be used to improve care for everyone else. London Cancer’s Dr Millar recommended that patient data be made freely available for use, within the law, for research in return for the free health care received under the NHS. Linking more GP data with that already received through secondary care and the research lab will help to improve early diagnosis in terms of the amount of data that can be analysed.

One issue highlighted throughout the all-party group’s inquiry was the disconnect between primary and secondary specialist care in achieving timely, effective treatment. Pancreatic cancer patients are not transferred quickly enough from primary to secondary care when time is of the essence if better outcomes are to be achieved. Most European countries do not have the same GP gateway as the UK; patients can see a specialist more quickly and clinical outcomes are better. One consultant surgeon and surgical oncologist told us:

“The patient turns up and the chap says, ‘Well it’s not reflux and I’m a reflux doctor. Back to your GP.’ So he goes back to the GP—more delay is coming. The GP says, ‘Well it isn’t reflux. Maybe now he has some back pain or something. We’ll try the spine doctor.’ So he goes to the spine surgeon. The spine surgeon says, ‘Well, it’s not spine pain. Back to your GP.’ This is the common scenario. The patient becomes a tennis ball.”

To get around this investigative ping-pong, it is worth seriously considering whether to allow GPs direct, easier access to CT scans, which would be much more likely to rule cancer in or out at an earlier stage than other investigative measures. One experienced GP told us:

“I think it’s about getting the right test, for the right patient, at the right time. Presently a hospital doctor who has had—no disrespect to my colleagues—two years’ medical experience can request a CT scan for a patient in hospital where I can’t.”

There is recognition that allowing GPs to refer patients directly for CT scans could accelerate diagnosis, but there is understandable concern about how it might work in practice.

[Dr Phillip Lee (Bracknell) (Con)]

Mr and Mrs Stella, constituents of mine who tragically lost their son Robert aged just 26, are sitting in the Public Gallery. I am a working doctor and fully understand how difficult it is to diagnose pancreatic cancer early because of the non-specificity of the symptoms. However, the solution might be in research. GPs require a test and to be able press a button and diagnose something from within the primary care setting. As the hon. Gentleman rightly points out, obtaining tests from primary care is difficult. Does he agree that once we have found such tests, which will come with time, primary care is where funding should be placed, so that earlier diagnosis is more achievable? Pancreatic cancer can be beaten, but to beat it we must diagnose it early.

[Nic Dakin]

I absolutely agree that the need is to find the tests and to have the wherewithal to allow them to take place.

I want to ask the Minister a few specific questions that she may pick up on in her response. Will the Government put in place pilots across the UK to experiment with direct GP referrals for CT scans to see how that might work and what impact it has on what actually happens—the positives and the negatives—so that we can learn from the experience? What actions can she take to boost awareness of pancreatic cancer signs and symptoms among GPs, to which the hon. Member for Birmingham, Yardley (John Hemming) referred earlier? Will the Department of Health consider pump-priming research into more recalcitrant cancers, such as pancreatic cancer, with ring-fenced grants where sustainable research has yet to be reached? As pancreatic cancer survival rates remain stubbornly low, will the Minister consider running specific awareness campaigns for the public through appropriate media?

The petition and this debate will have helped to raise pancreatic cancer up everyone’s agenda. I pay tribute to how Julie Hesmondhalgh—Hayley Cropper in “Coronation Street”—has helped to raise awareness of pancreatic cancer. I understand that she has been nominated for the best soap actress award at the TV Choice awards tonight. We wish her luck with that, because it will move pancreatic cancer yet further up the agenda. It is good to have her here today as part of the campaign. Julie points out:

“What the Coronation Street storyline did for pancreatic cancer awareness is phenomenal, but much more attention and funding is required. I worked with Maggie, along with many motivated people affected by pancreatic cancer and the charities Pancreatic Cancer Action and Pancreatic Cancer UK, to push the petition to the 100,000 signature milestone. This cancer desperately needs to be in the spotlight.”

She is absolutely right. The spotlight shines on it today. We need to seize this opportunity, this moment, this petition, this debate to up our game. Another 40 years cannot pass by without change. We need to set our stall out to make the same progress that we have made in prostate, breast and bowel cancer in the past 40 years for pancreatic cancer in the next 40 years. Nothing less is satisfactory. It is, as our parliamentary inquiry says, time to change the story.

[Mr Christopher Chope (in the Chair)]

I call—[Applause.] Order. It is not customary for us to applaud. We keep quiet and listen. I am sure that the mere presence of so many people in the Public Gallery is an indication of the strength of feeling on this important issue. I call Eric Ollerenshaw.

--- Later in debate ---

[Nic Dakin]

It is a pleasure to see you in the Chair, Mr Davies. It is important that the House of Commons takes seriously issues that are of concern to the general public. As the Minister recognised, that an e-petition can get a subject on our agenda is a big plus for UK democracy and is something of which we should all be proud. Those who worked with Maggie Watts to get the e-petition over the 100,000 mark should be congratulated on helping to secure today’s quality debate and to shine a spotlight on pancreatic cancer.

What a debate we have had! Twenty-five Members of Parliament have been in the room during the sitting and the Public Gallery has been full throughout. As the hon. Member for Pudsey (Stuart Andrew) said, the debate has been varied. As the hon. Member for Peterborough (Mr Jackson) said, it has been Parliament at its best. We had a contribution from the hon. Member for Lancaster and Fleetwood (Eric Ollerenshaw), whom I congratulate on the leadership that he has shown on the issue over the past few years in this Parliament. It is my pleasure to have worked with him. We also heard contributions from my hon. Friends the Members for Worsley and Eccles South (Barbara Keeley), for Stalybridge and Hyde (Jonathan Reynolds) and for Easington (Grahame M. Morris), the hon. Members for Basildon and Billericay (Mr Baron) and for Milton Keynes South (Iain Stewart) and then the shadow Minister and the Minister. Each and every contribution was of the highest quality.

The issues that we constantly returned to were cracking the challenge of early diagnosis, getting faster referrals from primary care to specialist secondary care to improve outcomes, the nature of research and the amount of funding, GP training and awareness, GP access to CT scans and the use of international and intra-national comparisons to help drive our performance. The Minister’s response engaged with the points made in the debate and was full and positive. As she said, the issue is fundamentally hard, but we need to do better. Listening to her, I thought that she shares our determination to ensure that we do better and that, following 40 years of no change, the next 40 years will be transformational in how the disease is dealt with. I welcome her willingness to continue to meet the all-party group and campaigners from outside Parliament to help to improve our performance on pancreatic cancer.

The title of the all-party group’s report is worth repeating as we conclude the debate: “Time to Change the Story”. It is time for action. This is the beginning of the rest of the campaign.

Question put and agreed to.

Resolved

That this House has considered the e-petition relating to research funding for and awareness of pancreatic cancer.

Hospital Car Parking Charges

Nicholas Dakin Excerpts

Monday 1st September 2014 Commons Chamber

[Nic Dakin (Scunthorpe) (Lab)]

I rise to make a brief contribution to the debate. I congratulate the hon. Members who secured the debate. Already, we can see the value of it, not least from the way in which the last speaker drew attention to the sort of best practice that should be considered by trusts up and down the land.

In my patch, I have been very concerned about the rise in car park charges at Scunthorpe general hospital. I presented a petition to the House on behalf of local residents and patients in September 2013, which argued that the rises in car parking charges should not go ahead. At the time, the Secretary of State advised me that every trust has the autonomy to make decisions locally and that the provision of car parking for patients, visitors and staff should reflect the local situation. I am pleased that he has now gone further in the guidance that he has issued, which I hope will help people such as my constituents, who are taxed for being ill or for visiting the hospital. As the hon. Member for Eastbourne (Stephen Lloyd) pointed out, the impact on parking in the local area is also a problem for local residents. For those two strong reasons, it is important that the movement on this issue is welcomed and that it goes even further.

[David Wright (Telford) (Lab)]

I believe that hospital parking charges should be abolished. The car parks in Telford and Shrewsbury could easily be managed without charges. Some people have expressed the concern that people will overflow-park in hospital parking areas. Tickets could still be issued to ensure that parking spaces are controlled, but it could be made free. The House should push the Government and the Opposition to make a commitment to abolish parking charges at hospitals in the medium to long term.

[Nic Dakin]

I very much agree with my hon. Friend’s point. That has been the thrust of the contributions to the debate. I hope the Minister and the shadow Minister are listening to the voice of the House, which reflects the voice of our constituents as patients and residents who live close to hospitals. Hospital car parking charges should be got rid of in the interests of better, more open and fairer access to health care. The hon. Member for Thurrock (Jackie Doyle-Price) made the point well that increasing the number of visitors increases the speed of recovery. It should therefore be welcomed and facilitated as part of the healing process.

[Martin Vickers (Cleethorpes) (Con)]

As the hon. Gentleman knows, we share the same hospital trust. Patients are prepared to accept that more services are being shared between our two hospitals at Scunthorpe and Grimsby, but does he agree that patients face the double whammy of increased travelling costs and car parking charges at the other end?

[Nic Dakin]

The hon. Gentleman and I work well together on local issues such as health care. He makes the sound point that as we rationalise the way in which hospitals perform to maximise health outcomes, there will be more travelling by patients. Why should there be an added barrier to that travelling and to access? People should not have to focus on things like that, rather than on better health care, when there have to be discussions about where services will be delivered, as there have to be in north Lincolnshire. That is a sound and positive point that supports the point that was made by my hon. Friends the Members for Bolton South East (Yasmin Qureshi) and for Telford (David Wright), which is that the best way forward would be to have free car parking at every hospital as standard.

[David Wright]

My hon. Friend makes a sound point about rural areas, but it is often difficult for people in urban areas to use public transport as well. Sometimes, people have to change buses several times to get to a hospital. If people in Telford want to go to Shrewsbury, they have to change buses multiple times.

--- Later in debate ---

[Nic Dakin]

My hon. Friend makes a sound point. The hon. Member for Cleethorpes (Martin Vickers) and I represent rural areas as well, so the point is well made and well received.

[Rosie Cooper (West Lancashire) (Lab)]

Everybody in the House wants free car parking at hospitals now, but what does my hon. Friend think we can do in the interim to ensure that hospitals stop private car parking companies targeting the disabled and those who arrive in emergency situations? None of that will stop now without proper enforcement.

[Nic Dakin]

I very much agree with my hon. Friend. I am sure that the Minister and the shadow Minister will take that point on board and listen to the other points that have been made in the debate. That will put pressure on hospital trusts to respond positively to the point that she has made.

Special Measures Regime

Nicholas Dakin Excerpts

Wednesday 16th July 2014 Commons Chamber

[Mr Hunt]

That is certainly something we keep under constant review, because it is a particular issue in some trusts. I would like to pay tribute to the progress made in Sherwood Forest trust—and in Newark hospital, which I know my hon. Friend has campaigned for—and to mention that it has an excellent chief executive, who has done a very good job in challenging circumstances.

[Nic Dakin (Scunthorpe) (Lab)]

I would like to pay tribute to the staff team at Northern Lincolnshire and Goole Hospitals Trust for the progress they have made, which has resulted in the trust moving out of special measures, but there is still much more to do. How will the Secretary of State ensure that the funding challenges faced by the local health service do not get in the way of making the further progress that is necessary?

[Mr Hunt]

Good progress has indeed been there, including centralising stroke services in Scunthorpe. There are funding pressures everywhere. What I would say about funding is that I do not want to run away from the fact that money is tight throughout the NHS, but lots of places are delivering safe, compassionate care even with those funding constraints. In fact, when we look in detail, we see that less safe care is the most expensive, so what we are doing should help trusts such as the hon. Gentleman’s to deliver safer care.

Patient Safety

Nicholas Dakin Excerpts

Tuesday 24th June 2014 Commons Chamber

[Mr Hunt]

My hon. Friend speaks wisely, and I commend her for her work in championing whistleblowers. In her relatively brief time here, she has made a big difference on that issue. Personally, I do not like to use the term “naming and shaming” because I think identifying problems should always be the first step to sorting them out. What we are doing today by identifying trusts that do not have a proper open and honest reporting culture is also helping them to change that reporting culture while at the same time identifying trusts that have a good culture. It is all about changing the culture, so this is a positive move, and I think that NHS staff will really welcome it.

[Nic Dakin (Scunthorpe) (Lab)]

Does the Secretary of State agree that the best way to deal with concerns about patient safety, such as those raised last week about Scunthorpe general hospital, is to have a proper independent investigation that respects patient confidentiality and reports objectively, clearly and transparently so that appropriate action can be taken when all the facts are known?

[Mr Hunt]

There are definitely times when an independent investigation is needed, and a number of them are going on in the NHS at the moment. The first thing, however, is to talk to the trust and get it to deal with the particular issues being raised and to create a culture in which trusts are willing, enthusiastic and keen to do that. Today is an attempt to deal not only with what happens when things go wrong with whistleblowers, but with how to create the right culture in the first place.

Health

Nicholas Dakin Excerpts

Monday 9th June 2014 Commons Chamber

[Nic Dakin (Scunthorpe) (Lab)]

Thank you, Madam Deputy Speaker. It is a pleasure to speak in this debate.

There is unanimity across the House on the importance of the NHS in our lives and the lives of the people we serve. The vast majority of people working in the NHS do fantastic work day in, day out, often in difficult conditions, to deliver a health service that is the envy of most parts of the world. In our desire to make that even better, we sometimes forget the very good things that are there, but when the NHS fails us, it is important that we tackle those failures effectively.

One thing I have noticed when talking to health professionals at whatever level in my constituency in Scunthorpe is that they, to a man and a woman, feel that the reorganisation that was thrust upon them by this Government after promising no top-down reorganisation has distracted attention and added work load, when there is already a challenging work load to tackle without having to deal with that. There is a big enough challenge anyway.

“Healthy Lives, Healthy Futures” is the consultation that North Lincolnshire clinical commissioning group is undertaking to find out whether to take forward health provision locally. That is an important endeavour, but the growth in the number of people turning up at A and E and the ageing population create great challenges for everyone. It is interesting that the financial challenges that are faced compound that. The PCT legacy debts were provided for and CCGs had further money taken out of their budget for that. A further £2 million was taken out of the CCG budget locally, although its budget is about £100 million, to deal with the pressures in specialist commissioning. The challenges involved in specialist commissioning need to be tackled. That might have been included in the Queen’s Speech.

One of the oddities of the Queen’s Speech is how little there is in it about the things that are most important to us—nothing about standard cigarette packaging, despite the Minister saying that she would introduce regulations, nothing on smoking in cars, despite the Minister saying that she would introduce regulations, and nothing to make it easier for people to see their GP. In its consultation with local people, Healthwatch North Lincolnshire identified access to a GP as one of the big issues locally. I had hoped that something would be done on that. I am pleased that the shadow Health Secretary made it very clear that Labour will at the first opportunity repeal the Health and Social Care Act 2012 and by rolling back the costs of competition and marketisation will guarantee an appointment at the GP’s surgery within 48 hours. That is something to be proud of.

Another missed opportunity was to do something to end the abuse of older people. Why not respond to Age UK’s call to make it an offence to neglect a vulnerable adult and to ensure that directors of organisations that provide health or care services can be held accountable for neglect or abuse? Why not do something about that? There is so much that could be in this Queen’s Speech and is not but, as my hon. Friend the Member for Birmingham, Selly Oak (Steve McCabe) said, at least we have the 5p plastic bag Bill and we should be grateful for that.

Let me turn to another issue that could have been tackled in the Queen’s speech: the need to up the game on our work on antimicrobial resistance. Take for example tuberculosis, caused by bacterial infection through the air. If left untreated, it becomes deadly and BCG vaccinations are not as effective as they should be. Many people think that TB has been wiped out, yet London has the highest rate of TB of any capital in the western world. An increasing percentage of those cases are resistant to TB drugs and TB has always affected the poor. No new front-line drugs have been developed in 50 years, so why not tackle this disease, which is a real threat and is already here?

TB can be prevented by relatively low levels of investment in proactive diagnosis, outreach and good social and clinical care. It is a complex disease that can be made more complex by our health services, which often fail to diagnose it on first sight. Some doctors unfortunately prescribe antibiotics, which feed the AMR and do nothing to help patients with TB. We need to raise awareness of the disease and make sure that patients get the right support from health services that are properly staffed and equipped. We need comprehensive outreach for TB, with screening, diagnosis and treatment of people before their health deteriorates and before they can pass the disease on to others. In short, we need a preventive approach to TB and other infectious diseases like it.

We need to invest now to save later, and my point about TB is illustrative of the many other things on which we need action. Instead of that action, in this Queen’s Speech we have more of the same inaction and inertia. It is not good enough. I mark this Queen’s Speech low on its approach to health issues, and I look forward to hearing the responses from the shadow Minister and the Minister.

Cancer Treatment and Prevention

Nicholas Dakin Excerpts

Tuesday 11th March 2014 Westminster Hall

[Eric Ollerenshaw (Lancaster and Fleetwood) (Con)]

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

I apologise in advance because there will be some repetition as I had an Adjournment debate last week on pancreatic cancer and a new drug, which is fundamentally what I will speak about this morning. I think hon. Members will understand that there is a need for repetition, because we are right in the middle of the Cancer Drugs Fund’s making a decision about this drug, so anything extra we can add is useful. I am sure the Minister has heard this before, because she attended that Adjournment debate on Tuesday 4 March.

The Cancer Drugs Fund met on Thursday 6 March and I understand that the process is that it will take a week to consider, then it will inform the applicants and then, in two weeks’ time, its decision about Abraxane will be made public and we will know. Abraxane has been licensed for use in patients in the UK and Ireland with metastatic pancreatic cancer; it has been described as the biggest advance in pancreatic cancer treatment in almost two decades, for a disease where survival rates have barely changed in 40 years.

As Abraxane has not been approved by NICE, it is not yet available on the NHS as a standard treatment. Pancreatic Cancer UK, the biggest charity in this field, together with Pancreatic Cancer Action are both keen to ensure that patients are able to access Abraxane through the Cancer Drugs Fund. We should like to see the drug approved by the CDF then eventually by NICE, so that access to it is more readily available. We know that Abraxane is due to be reviewed by NICE soon, but this process takes a great deal of time, and time is something that most pancreatic cancer patients do not always have.

My comments relate to the treatment of cancer. As I have said, I hope that hon. Members will put up with some repetition, given the importance of these few weeks to the sufferers, survivors and friends and relatives connected to this cancer, because it is a highly charged moment.

[Nic Dakin (Scunthorpe) (Lab)]

I congratulate the hon. Member for Mid Derbyshire (Pauline Latham) on securing this debate. Does the hon. Gentleman agree with her that the key is early intervention and effective treatment? That is the key to getting it right with regard to melanoma, bowel cancer, pancreatic cancer and ovarian cancer, for example. The hon. Gentleman is making powerful points in this respect.

[Eric Ollerenshaw]

As per usual, I agree with the hon. Member for Scunthorpe (Nic Dakin). I pay tribute to his work on the all-party group on pancreatic cancer. He and my hon. Friend the Member for Mid Derbyshire hit the nail on the head. At the moment I am just talking about treatment, but early diagnosis is the key to all of this, particularly pancreatic cancer. More than 50% of people who are diagnosed with pancreatic cancer are diagnosed after emergency admission to hospital: it is that late and, too often, too late to be able to do much in terms of survival beyond a year. Only 4% of people diagnosed with pancreatic cancer survive for up to five years, so it is clear how dramatic an improvement in early diagnosis would be.

It is estimated, on average, that Abraxane will allow a further two months’ survival, which, in the great scheme of things, does not seem massive, but it could double the lifetime chances of the average pancreatic cancer sufferer. Pancreatic Cancer UK launched its campaign, “Two More Months”, to highlight that. I quoted examples in my other Adjournment debate, which hon. Members may read, of survivors describing what two more months could have done for them, in their situation. Survivors talk about the possibility of getting married, which was not available because the person died early. There are other heart-rending examples of what that time would have enabled them to do. To underline the point, in terms of pancreatic cancer, as I have said, two more months is a massive improvement on what is available, unfortunately, to far too many.

In my Adjournment debate, I expressed our fears—the all-party group’s, Pancreatic Cancer UK’s and Pancreatic Cancer Action’s—that the call for the drug to be made available would be dismissed by the Cancer Drugs Fund because it gives only two more months. It is interesting that there are no pancreatic specialists in the Cancer Drugs Fund. Our key concern last week was that the two months would not be considered sufficient, because in comparison with other cancers it does not seem a great deal of time. Yet more than 60 specialists treating patients with pancreatic cancer shared their names, via Dr Seb Cummins, supporting this submission and therefore hoping that they would be listened to.

Although I did not attend the meeting, apparently the panel did not acknowledge the unmet need in this disease area and did not allocate points to represent this, given its criteria. Individual panel members did not appear to accept, as we feared, the benefits of an additional two months, although I am told that there was some acceptance that, yes, the drug did prolong life. Obviously, the panel has to take into account—I am not a specialist in medicine, Mr Gray, as you well know—the quality of life in those two months.

I understand that the decision will have been made, but it will not be public until two weeks’ time. So where do we go from here? I have already expressed concern about the Cancer Drugs Fund, because, to my knowledge, last year not one new cancer drug was agreed, plus none, if I understand the system correctly—I admit that my understanding of it is a bit basic—has been passed down to standard NHS clinical use. Nothing has left its funding stream. I am told that it has overspent a certain amount of money, but again I do not know whether it is anecdotal or exactly correct; I hope that the Minister comments on that.

The Cancer Drugs Fund process has had enormous success, which I acknowledge. Thousands of people have benefited from this innovation. There is anecdotal evidence that, because this does not exist in Wales, people there are moving across into England to take advantage of it, and why would they not, if they or somebody in their family is in this situation? The hon. Member for Strangford (Jim Shannon), who is present, has commented previously on the situation in Northern Ireland. However, although I acknowledge its massive success, it seems to me, from the outside, that somehow we are stuck in respect of where we go with the Cancer Drugs Fund and its funding in future.

It almost appears as though the Cancer Drugs Fund has become a victim of its own success. We must not let that success become failure now, simply because we are going to get a blockage of applications for new drugs; I thought that dealing with those was the whole purpose of the Cancer Drugs Fund in the long run.

In terms of pancreatic cancer, too many hopes have been raised too many times and for too long it has remained the poor relation in all this. So when hope, such as this new drug, comes along, we want that hope tested, not against other cancers but against a past history of neglect. Pancreatic cancer already has the lowest survival rate of the 21 most common cancers. As I mentioned, five-year survival rates are less than 4%. This figure has barely changed in nearly 40 years. Pancreatic cancer five-year survival rates lag behind many other European Union countries and are almost half of what they are in the United States, Canada and Australia.

Hon. Members might now understand why we want the hope given by this new drug extended to the 7,900 of the soon-to-be diagnosed 8,500 patients this year, because these 7,900 will be diagnosed with cancer too late and will die within the year. They deserve that extra time that so many others were denied in the past because there was nothing like Abraxane available. They deserve some extra consideration, given our past neglect of this, the fifth biggest cancer killer in our country.