Cancer Care (England and Wales)

Alun Cairns Excerpts

Tuesday 12th February 2013 Westminster Hall

[Alun Cairns (Vale of Glamorgan) (Con)]

Thank you, Mrs Riordan, for calling me to speak and for chairing this debate. It is a privilege to serve under your chairmanship.

The subject under discussion is cancer care in England and Wales. Naturally, I understand that the Minister who is here is only responsible for treatment and care in England, and that health is a devolved matter, with responsibility for it in Wales falling to the Welsh Government. However, the different approaches will allow each nation to share best practice and compare outcomes, with the objective of raising the standard of cancer care wherever we live.

I do not want this debate to be party political; this issue is far too important for that. I want to compare the facts and to recognise success, wherever that may be found. The starting point for the debate must be mortality rates or, to put it another way, the success of any medical intervention. Overall, life expectancy among men in Wales is 77.6 years, and in England it is 78.6 years. Among women, life expectancy is 81.8 years in Wales and 82.6 years in England. I am sorry to say that the figures for Scotland and Northern Ireland are worse than the figures for either England or Wales.

However, focusing purely on life expectancy is too broad an approach, and we need to consider the influences on life expectancy. There may be historical and social reasons for the differences in life expectancy, but it is fair to say that cancer survival rates are a significant factor, which brings me to my key points. The most commonly diagnosed cancers are breast cancer among women and prostate cancer among men.

[Lilian Greenwood (Nottingham South) (Lab)]

Is the hon. Gentleman aware of the “Hear me now” report by Rose Thompson, the chief executive of BME Cancer Communities, which was launched here in Parliament yesterday? It revealed that the death rate from prostate cancer is 30% higher among black men than among their white counterparts. Does he agree that such inequalities in cancer outcomes must be addressed?

[Alun Cairns]

I am grateful to the hon. Lady for making an extremely valid point. The collection of data is exceptionally important, to identify which groups are potentially more vulnerable or which groups are not seeking the right sorts of treatment. Comparison between the home nations is important, but so is comparison between groups within the home nations, in order to bring the data together. It is exceptionally important if we are to reach the right conclusions.

I will focus on breast cancer to begin with. As I have already said, the mortality rate from breast cancer in England is 24.3 per 100,000 people, and in Wales it is 25.8 per 100,000 people. Clearly, those are worrying data, and it is worth considering the different approaches to treatment in the two nations.

In England, a patient concerned about the possibility of breast cancer can expect to see a consultant within 10 working days of the GP referral. In Wales, there is a different approach, which means that a GP differentiates between urgent and non-urgent cases. In cases that are deemed urgent, 95% of patients should expect treatment to start within 62 days, and in cases deemed non-urgent, the patient should expect treatment to start within 26 weeks. I want to underline this situation: a woman in England who is concerned about the risk of breast cancer will be reassured, or have her case elevated to the next level, within 10 days. In Wales, however, a patient has no such guarantee of consultant expertise until much, much later in the process.

We need to recognise that these are different measures and approaches. Breakthrough Breast Cancer has a helpful quote. It says that waiting for a referral is like being “left in the dark”.

[Glyn Davies (Montgomeryshire) (Con)]

The issue of waiting time for treatment and diagnosis is important to me. Does my hon. Friend agree that there should be an absolute focus on awareness, particularly regarding colon and rectal cancer, from which the chance of recovery is far greater if diagnosed early? There has to be a focus on early diagnosis, because it greatly increases the chances of recovery.

[Alun Cairns]

My hon. Friend makes a valid point about screening and awareness. Today I want to focus on treatment, but awareness and screening are exceptionally important and no doubt warrant another debate.

[Simon Hart (Carmarthen West and South Pembrokeshire) (Con)]

My hon. Friend has in some respects taken the words out of my mouth. To what extent does he attribute some of the differences between England and Wales to a problem of education and diet, as well as to the problems of treatment and early diagnosis?

[Alun Cairns]

My hon. Friend raises an important point about diet. There are historical and social issues. Diets and issues like that are relevant and also need wider consideration, perhaps in another debate that my hon. Friend may choose to nominate.

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

Does the hon. Gentleman agree that however good the cancer care in hospitals is—it is excellent in many places—it often leaves a gap in psychological, emotional and social support? Excellent work is being done by Maggie’s centres in that respect. There is one in Swansea, and I believe one is due to open in Cardiff. There are also many centres in England and Scotland, including in my constituency. Will he endorse the value of their work?

[Alun Cairns]

I am grateful for the right hon. Gentleman’s valid point. I absolutely endorse the role that independent and charitable organisations can play; I quoted Breakthrough Breast Cancer. Emotional support is exceptionally important, and that relates to my point about delays in receiving treatment. A consultant can reassure people on many occasions, give a realistic assessment of the condition and provide the wider support available from some of the charitable organisations that have been mentioned.

[Mr Mark Williams (Ceredigion) (LD)]

Will my hon. Friend acknowledge the importance of care in the recovery of cancer patients? Statistics from Macmillan Cancer Support reveal that 19% of 18,000 newly diagnosed cancer patients in Wales were deemed to lack that kind of support, not just during diagnosis or treatment but, critically, in aftercare.

[Alun Cairns]

I am grateful to my hon. Friend for sharing those data. In interventions, hon. Members have talked not only about pre-screening, awareness, social issues and treatment, which I will focus on, but the aftercare that is needed, the emotional support that is provided, and the need for and responsibility and role of a whole host of agencies, including those in the charitable sector.

Returning to the point about treatment, I had been comparing the different approaches to breast cancer in England and Wales. The wait before seeing a consultant in England is 10 days. It is interesting to note that the Welsh Government removed 10-day monitoring in 2006. Although data are recorded locally, they are not published nationally. In the interests of transparency, it would be helpful if those data were published to allow fair and just comparisons. Waiting time targets improve survival outcomes, reduce emotional distress and improve the quality of life for people with cancer and those who turn out not to have cancer.

There are similarly alarming figures for prostate cancer. Five-year survival rates can be higher than 80%. There are no figures comparing the rates of the home nations, but the side-effects of the sort of treatment one receives for prostate cancer can be significant and can have a huge impact on future lifestyle. Again, there is a different approach to prostate cancer care in the two nations.

I want to draw attention to the availability of treatment. There was significant attention some years ago to access to brachytherapy. Even when it was finally approved by the Welsh authorities, after having been widely available in England, Scotland and Northern Ireland, the threshold for intervention was much higher in Wales. As far as I know, that remains the case.

Currently an identical debate is focused on robotic surgery. A constituent who suffers from prostate cancer, who is qualified medically and who consulted widely before making the decision with his clinicians on the most suitable form of treatment for himself, wrote to the Welsh Health Minister. He shared a copy of the letter with me, in which he said:

“I was both surprised and disappointed to find that this option is not available to Welsh men in Wales and that a significant number of Welsh men are opting to go to England, where this technology is established and available throughout the country.”

[Tessa Munt (Wells) (LD)]

Does my hon. Friend accept that if that kind of treatment—be it robotic or radio surgery—was available perhaps in a location such as Bristol, it would be accessible for patients in south Wales, along the M4 corridor and elsewhere, and those who go down the M5, right the way through to Cornwall?

[Alun Cairns]

My hon. Friend makes a valid point about the need for joint working and better co-ordination between the health services. Devolution can provide valid comparisons to establish the success of various treatments, but on many occasions there is a need for joint working where capital investment is needed, allowing patients to benefit from a different sort of intervention, but with shared responsibility between the two organisations.

I was talking about my constituent who had wanted robotic treatment for prostate cancer. He was later forced, in his stressful situation, to raise the £13,000 necessary to receive the form of treatment that he thought best suited him. I am pleased to report that the outcome of the treatment was positive.

The Wales Minister argued that if local heath boards do not provide treatment routinely, people could follow a process for individual patient funding requests. The panel meets monthly, which hardly reflects the urgency of some cases. I am not aware that any case of robotic treatment has been successfully applied for.

That leads me on to the cancer drugs fund, which is available in England but not in Wales. The fund allows clinicians and patients to prescribe and receive the latest drugs. Again, that is not available in Wales, where there is a cumbersome process to seek such a prescription.

The Rarer Cancers Foundation reported that 24 cancer treatments that are not routinely available in Wales may be available in England through the cancer drugs fund. It concludes that people in Wales are five times less likely than people in England to gain access to a cancer drug that is not routinely available. It also states that if the same approval rate occurred in Wales as it does in England, 159 cancer patients in Wales would gain access to life-extending treatment, instead of the 31 recorded. I raised the issue with the Welsh Health Minister, and she reported that establishing such a fund would reduce the money available for treating other serious conditions, as in England. I find that worrying, and I would be grateful if the Minister could address that point in her response.

That deficiency applies to other cancers, too. Selective internal radiation therapy is an innovative treatment for inoperable liver tumours. Although the University hospital of Wales in Cardiff is part of the UK-wide phase 3 clinical trial, not one patient from Wales has been funded for treatment. The patients under trial have been financed by the cancer drugs fund, yet the hospital is in Wales and demonstrates the expertise that exists in Wales in the field.

Survival rates for pancreatic cancer also differ significantly, and I could go on at length about those. When it comes to five-year survival rates for pancreatic cancer, Wales scores better than England. Unfortunately, that tends to be the exception rather than the rule. Those differences are worrying, and had I referred to Scotland and Northern Ireland selectively, I would have been able to paint a more alarming picture, but that is not the point; it is not about the politics of the issue, but about sharing best practice and getting the right treatment for the right people.

The motivation for the debate came from individual cases in my surgery. Having researched the data, I was forced to bring the matter to the House’s attention. I hope the Minister and Members present will be able to use their influence on colleagues here and elsewhere to raise standards, allay fears and improve survival rates for cancer patients.