Health: Cancer

Baroness Morgan of Drefelin Excerpts

Tuesday 9th October 2012 Grand Committee

[Baroness Morgan of Drefelin]

My Lords, I congratulate the noble Baroness, Lady Gardner of Parkes, on securing this important debate and thank her for her very informative and helpful introduction. As we move towards the new health system, it is vital that people with rarer cancers are fully recognised and receive the specialist care that they need so that outcomes can be improved in the less common as well as the more common cancers. I declare an interest as chief executive of Breast Cancer Campaign, which is a research charity.

As noble Lords know, the Government published their strategy for cancer in January 2011, stating their ambition to save an additional 5,000 lives from cancer every year by 2014-15, to improve the experiences of cancer patients in England and to narrow the gap in cancer outcomes between different groups in society. In turn, the All-Party Parliamentary Group on Cancer, of which I am a vice-chair, published a report in 2011, Effective Cancer Commissioning in the New NHS, which set out recommendations that would support the NHS in achieving the Government’s aims.

The all-party group has spent this year campaigning for implementation of our recommendations, focusing particularly on the new accountability structures, the NHS outcomes framework and the commissioning outcomes framework. We have raised the issue of improved outcomes in less common cancers, including the head and neck cancers that we have heard about today.

Key to improving outcomes and to achieving the Government’s ambition of saving an additional 5,000 lives from cancer each year is earlier diagnosis, as we have heard so eloquently put by the noble Baroness, Lady Gardner. The earlier a cancer is diagnosed, the greater the chance a patient has of surviving it. That is why the all-party group has long campaigned for the NHS to be measured against one-year cancer survival rates as well as five-year survival rates for all cancers and all ages—not just the common cancers.

That is because in the new health system the NHS outcomes framework will be used by the Secretary of State to hold the NHS Commissioning Board to account for its performance. As such, it sets the overall direction and priorities for the NHS. We were pleased that the Government included one-year and five-year cancer survival rates for breast, lung and colorectal cancer for people aged between 15 and 99 in the NHS outcomes framework. However, as we know, cancer is one of the biggest premature killers in this country and we do not believe that the current version of the framework goes far enough.

We know that 53% of people who die from cancer in the UK have a rarer cancer, such as head and neck. There is a significant gap in survival rates between people with a rarer cancer, such as head and neck cancers, and those with a more common cancer. For example, the five-year survival rate for brain cancer is less than 20% compared with more than 80% for breast cancer. We must take steps to ensure that survival rates for rarer cancers improve and catch up with those for the more common cancers such as breast cancer. Across the board, there is a lot more to do and we need to do more. The APPGC is calling for one-year and five-year survival rate indicators in the NHS outcomes framework to be extended to all cancer types.

We are pleased that the Government are listening to our concerns and know that, as a result, they are considering developing a composite survival rate indicator which would include rarer cancers. While we recognise the efforts being made to address the current absence of focus on rarer cancers, we believe that a composite indicator should be in addition to, rather than a replacement for, existing indicators. There is a very important reason why that should be so. It is vital that any new indicator provides additional insight into performance relating to rarer cancers. A composite indicator covering all cancers could mask poorer performance by the NHS in relation to rarer cancers through improvements in relation to the more common cancers. We should be concerned about that. Can the Minister say what progress has been made towards developing a composite indicator? Would it apply to those cancers not currently covered in the framework, such as head and neck cancer?

From Answers that I have seen to parliamentary Questions it appears that there will be a separate publication route for the composite indicator. Will the Minister be able to explain that a bit more? Could he reassure the Committee that any composite indicator will be in addition to existing indicators that are already planned and will not serve as a mask for poorer performance in the less common cancers?

While it is vital that the NHS Commissioning Board is held to account, it will be the clinical commissioning groups which will play a key role at the local level in achieving that additional 5,000 lives saved. The commissioning outcomes framework will be used by the NHS Commissioning Board to hold CCGs to account. In August this year, the Commissioning Outcomes Framework Advisory Committee published recommendations for indicators to be included in the framework. The APPG on Cancer was shocked that only one cancer-specific indicator was included in this recommendation—that of under-75 mortality. It may be that we have not understood it properly, so I look forward to being corrected on that.

However, the APPG on Cancer believes that the omission of one-year and five-year cancer survival rate indicators at this level is a serious oversight and a missed opportunity to ensure that every CCG prioritises not only the earlier diagnosis of cancer but the commissioning of high-quality services. We cannot understand the reasons for the omission. I have been assured that, once the boundaries for CCGs have been defined, survival data will be available at the CCG level, so it should be workable. Given all this, can the Minister support the inclusion of one-year and five-year cancer survival rates in the outcomes framework for CCGs?

We are also calling for proxy indicators for cancer survival, which are particularly important for less common cancers. They are: stage of cancer at diagnosis, which we have already heard about, and cancers diagnosed as an emergency admission. We want these to be included in the commissioning outcomes framework as quickly as possible because this is about gearing up the services in real time to improve as we go forward. These measures will provide a more immediate picture of where improvements are needed in the early detection of cancer. By assessing the performance of CCGs on these through the COF, local commissioners will be encouraged to contract services that improve early diagnosis.

I support the remarks made by the noble Baroness, Lady Jolly, regarding cancer networks. I do not want to repeat the detailed points that she made, but I, too, believe strongly that cancer networks have a vital role to play in continuing to drive up standards and achieving the Government’s vision to save additional lives. I was concerned to be advised that, with the NHS Commissioning Board undertaking specialist commissioning and CCGs commissioning other aspects of patients’ care, patients with head and neck cancers could find their care pathway being commissioned by two entirely different levels of NHS commissioning. That is just one example of the role that cancer networks can play in improving quality, outcomes and the patient experience.

Can the Minister reassure us that there will be sufficient staff, including experienced directors? Will they be retained in each individual cancer network so that they can deliver their functions effectively? Can he reassure us also that the cancer-specific expertise that currently exists in networks will not be lost through this restructuring and that cancer networks will be tasked with driving improvements across the whole cancer journey? As the noble Baroness, Lady Jolly, has stressed, it is not just about early diagnosis; cancer networks have a vital role to play throughout the patient journey.

Once again, I congratulate the noble Baroness, Lady Gardner of Parkes, on securing this important debate. It is essential that we use opportunities such as this to raise awareness of the less common cancers, as she has most ably done.