Health: Cancer

Baroness Walmsley Excerpts

Wednesday 20th January 2016 Lords Chamber

Asked by

[Baroness Walmsley]

To ask Her Majesty’s Government what assessment they have made of the factors contributing to cancer survival rates in the United Kingdom.

[Baroness Walmsley (LD)]

My Lords, my reason for asking for this debate is to highlight the fact that, despite much good work, cancer patients in the UK have poorer survival chances than those in comparable countries. We rank 20th out of 24 developed countries for cancer survival in breast, cervical and colorectal cancers. For a Government that seek a world-class health service, this is not good enough. I want to look at the reasons and ask what the Government plan to do about it, in particular the implementation of the five-year cancer strategy.

Anyone who has had a diagnosis of cancer will know the naked fear that the news generates. At that moment, it is hard to remember the great strides we have made in cancer survival, with half of all cancer patients now surviving for 10 years or more compared with a quarter 40 years ago. Some cancers such as breast cancer have seen remarkable improvements in survival rates, particularly because of the excellent screening programme, for which I am most grateful. But others such as pancreatic cancer have seen very little improvement. Some cancers related to lifestyle or environmental factors, such as skin cancers or the various bowel cancers, have become more common. But many more people are living with cancer for a long time and we need to consider how we look after their needs.

So what needs to change? We need to invest in prevention through information and help for people to reduce their risk and earlier, more accurate diagnosis. We need better training and resources to enable GPs to refer quickly and a realistic approach to consultant utilisation and shortages, along with that of specialist nurses. We need better data collection and transparency and earlier access to innovative treatments. To show public support, I hope that all noble Lords will celebrate World Cancer Day on 4 February by sporting a unity band to celebrate survival, show solidarity with those in treatment and remember loved ones.

Let us look at some figures. According to Public Health England, four in 10 cancers are preventable. Cancer cases are increasing, partly it is believed because we are living longer and partly due to lifestyle, so more people are living with cancer. One in two people will develop cancer at some point in their lives. But according to Eurocare-5, the UK’s survival performance rates are below the European average. According to the Lancet in 2011, Norway, Canada, Sweden and Australia do a lot better than us, while recent studies have shown that the gap is not being closed. As we do better, other countries are doing even better. That is why we need excellent data and accountability. Experts tell us that the one-year survival rate is a very good indicator of success or failure, so it is important that this information is collected efficiently and made available transparently.

This week, we have had some very worrying headlines. Cancer services have missed key targets. The six-week target for diagnostic tests to be done was missed and it is now two years since it was last met. One of the key cancer targets, the 62-day target for treatment to start from urgent GP referral, was missed. Those missed targets mean that nearly 2,000 people—not targets—had to wait longer than they should have. Wales was the worst, with only 71.9% of patients starting treatment within that time in Swansea and 62.9% in Cardiff and Vale. In Wales overall, the target has not been met since 2008. In England, just under 8,000 people with suspected cancer did not see a consultant within two weeks of an urgent referral by their GP and 536 patients had to wait more than a month to have their first treatment for cancer. We need to be cautious about targets. There is no point in setting higher and tighter targets for tests if hospitals do not have enough consultants to deal with the patients diagnosed as positive.

What is the Government’s answer? The independent cancer strategy, which reported last July, made six key recommendations: a radical upgrade in prevention and public health, including national plans on reducing smoking and obesity; earlier diagnosis with 95% of patients referred by a GP being diagnosed or given the all-clear within four weeks; patient experience on a par with clinical effectiveness and safety through access to test results and a clinical nurse specialist or other key worker; transformation in support for people living with and beyond cancer, and appropriate end-of-life care; investment to deliver a modern high-quality service, including upgrading radiotherapy machines, reviewing the Cancer Drugs Fund and better molecular diagnostics for more personal treatment; and a big effort to address the shortage in the cancer workforce. It also called for overhauled processes for commissioning, accountability and provision with a regional network of care alliances and a national cancer team to oversee delivery of the strategy.

The Government have accepted the recommendations and the latest NHS five-year mandate asks for: early diagnosis to be a priority; more work to tackle smoking, alcohol and physical inactivity; reduced impact of ill-health and disability; and support for research and innovation to enable new treatments to reach patients more quickly. So there was a recognition of the role of speedy diagnosis in improving cancer survival rates, but nothing about better training or diagnostic tools for GPs. Molecular diagnostics have made enormous strides in recent years for monitoring the effectiveness of treatments as well as diagnosing the disease and enabling more effective personalised treatments. The strategy asks for a national commissioning framework for this. Will the Minister ensure that that happens? It is vital for equal access for patients, particularly for rare cancers.

The mandate recognised the need for prevention, but then we had cuts in public health budgets. When will the Government accept the common sense and economic benefit of prevention and put their money where their mouth is, and save money and lives at the same time? The mandate mentions support for research and innovative new treatments, but many in the service are not convinced that appropriate pathways exist. The mere existence of the accelerated access review recognises that the UK is very poor at getting innovative new treatments to patients, and that needs to change.

In the first year, among other things, the Government are reviewing the operating model of the Cancer Drugs Fund within its existing budget. This is currently being consulted on, but patients, clinicians and pharma companies have serious concerns that the outcome will not achieve what it should. Does the Minister agree that any new methodology should guarantee increased access to innovative medicines, as proposed in the cancer strategy? We do not want the UK to become a “late-launch market”, meaning that UK patients would have poor access to innovative drugs compared to others worldwide.

Nothing should be done to deter pharma companies from doing R&D and clinical trials in the UK, since this both adds to total UK life sciences and covers the costs of treating patients which would otherwise be borne by the NHS. Indeed, we need an about-turn in relation to research. Every patient, every doctor and every health worker could be involved in medical research, but there are currently threats to the collection of data. I would encourage all patients, with suitable assurances, to allow their anonymised data to be used for medical research to save future lives. Without complete data, the researchers are working blindfold and we cannot hold CCGs, hospitals and the Government to account.

NICE must look again at its methodology for evaluating cancer drugs, especially those focused on rare cancers. But there are no proposals for NICE to change the criteria or thresholds and no recognition of unmet need, such as for cancers with very poor prognoses, such as pancreatic cancer.

It is instructive to look at some specific cancers to see where the problems lie. Despite being the 10th most common cancer, pancreatic cancer is the fifth biggest killer. Yet it only gets a tiny research spend. Survival rates are shockingly low. Only 4% survive five years from diagnosis and this has not improved in 40 years, indicating a desperate need for earlier diagnosis and more research. Around four in five patients are diagnosed at a very advanced stage and may have made up to seven visits to their GP with symptoms. All that suggests a need for better GP training and better access to diagnostic tools so that patients can have surgery before it is no longer an option. Other specialties such as skin cancer have a shortage of consultants and the ones there are spend far too much of their time seeing patients whose GP could have diagnosed the lesion as benign if they had had better training. This is another area where public awareness of symptoms needs to improve.

I have not been able to cover all the ground in 10 minutes, but I hope that other speakers will. I thank all those who are about to take part in this debate and hope that the Minister can answer the many questions that will be raised.