New Cancer Strategy

David Tredinnick Excerpts

Thursday 19th November 2015 Commons Chamber

[David Tredinnick (Bosworth) (Con)]

I must start by offering my congratulations to my hon. Friend the Member for Basildon and Billericay (Mr Baron)—who is smiling next to me—who I have watched over the years toiling in this Chamber in the cause of cancer patients. He has done so, if I may say so, very effectively, and not just on cancer outcomes—he focused today on one-year outcomes—but on the provision of specialist drugs for patients. He has maintained a relentless pressure on the Government and it has been a joy to serve with him as a junior vice-chairman on the all-party group on cancer.

I hope today to bring to bear some of my experience in the House, which on Tuesday Mr Speaker generously described as 28 years of experience. He might have said 28 years of pursuing an holistic, patient-centred agenda that broadens choice in the health service. If we look at the cancer outcomes report, “Achieving World-Class Cancer Outcomes: A Strategy for England 2015-2020”, we find that the key themes are integrated pathways, holistic support for patients and a patient-centred service—“Patients should feel empowered”.

The agenda we find in that report is not a new one in the House. I have referred to my long involvement in this side of parliamentary life—I have been chair of the all-party group on integrated healthcare since it was formed and before that I was chair of the all-party parliamentary group for alternative and complementary medicine, so it covers pretty much the whole of my time in the House. If we look back at the meetings of that group, we see that they offer some instruction. The first message to get across to the House is that there is no need to recreate the wheel. If we look back, as I did, at the meetings of the all-party group on integrated healthcare—I discovered that I chaired more than 100 of them over the best part of the last 30 years—we find that there has always been a strong base of holistic and personalised care, which has been developed in certain hospitals and care institutions in this country.

I looked up the information about the 2001 exhibition that we put on in the Upper Waiting Hall for providers of complementary medicine. It was to highlight particularly good practice in the integrated healthcare awards of 1999. The winner was Charing Cross cancer services for offering a multidisciplinary approach to specialist cancer and palliative care services, which integrates complementary therapies, massage, aromatherapy, reflexology and art therapy for patients receiving treatment for cancer.

If we go forward two years, in March 2003, Caroline Hoffman, a nurse consultant in cancer care rehabilitation at the Royal Marsden and editor of Complementary Therapies in Nursing and Midwifery, spoke about her experiences at the Marsden hospital. Chris Perrin, a registered general nurse who uses complementary therapies in his work, also spoke. In May that year, the then Member representing Salford, Hazel Blears, launched new national guidelines for the use of complementary therapies for long-term or chronic illness. She was then the parliamentary Under-Secretary of State, and these were new national guidelines for use in hospitals, hospices, primary care, cancer support centres and self-help groups. The document was called “National Guidelines for Complementary Therapies in Supportive and Palliative Care”.

If I blow the dust off this document, I see that it could well have been integrated into the cancer proposals that we have before us now. It looked very closely at the possible options to expand patient choice in holistic care—the very things that the new report calls on. It is worth quoting—I see my hon. Friend the Member for Basildon and Billericay is looking at me intently—Professor Mike Richards, who was the National Cancer Director at the time. He said:

“A substantial number of cancer patients choose to receive complementary therapies alongside their mainstream cancer treatment. Individual patients frequently report that the use of a complementary therapy has helped them.”

He went on to say that there was

“broad agreement, however, that patients should have ready access to reliable information about complementary therapies and complementary therapy services”,

and finished by saying:

“The guidelines will usefully complement the forthcoming NICE guidelines on supportive and palliative care.”

Would that those NICE guidelines had been implemented then—all those years ago! I live in hope, particularly under the guidance of my hon. Friend the Member for Basildon and Billericay and the Under-Secretary of State for Health, my hon. Friend the Member for Ipswich (Ben Gummer), that we will make more progress. In March 2011, Professor Karol Sikora, the medical director of Cancer Partnership UK and Sosie Kassab, director of cancer services at the Royal London Hospital for Integrated Medicine came to give evidence to us.

The message is that a lot of the work that this report calls for has already been done. A lot of effort has already been put in. It is instructive in going through the Macmillan contribution to the 2015 to 2020 proposals to note that it points out:

“More than one in three of cancer patients use complementary therapies and many report finding them helpful.”

Macmillan’s own “Cancer and Complementary Therapies” booklet says it would

“like to see more high-quality research into complementary therapies”.

We have been calling for that for many years. Some evidence is very good; some is not so good—but there is a lot of evidence that patients are content with these services.

Having sat through so many Budget debates, I am not normally a great one for statistics, which I know can send colleagues to sleep, but my second statistic, apart from the one that a third of all cancer patients use complementary therapies, is that one third of the incremental annual cost of cancer care—this can be seen in the small print on page 76 of this lengthy report—is for living “with and beyond cancer”. Once patients have had chemotherapy and radiotherapy, it is often to the holistic and alternative world that they turn. It is there that we find a Gruyère cheese landscape. Many of these services are not available throughout the country, and we must address that.

A number of contributions are worth quoting, but I will quote one about acupuncture. “We are Macmillan Cancer Support” says:

“Some studies show acupuncture has helped reduce sickness in people who have had surgery or chemotherapy… acupuncture may help in treating other problems such as breathlessness and a dry mouth.”

In the last Parliament I served as vice-chairman of the herbal working group, under Professor David Walker. We reported on the last day of the Parliament. The Prime Minister generously wrote me a letter, which I received this morning, saying that the Government would respond before the House rose for Christmas. Herbal medicine is part of the two-pronged Chinese approach to treatment. I hope that my hon. Friend the Minister will respond positively by recommending either statutory regulation—for which many have asked—or voluntary regulation.

As I have said, the landscape of treatment available in this country is very patchy. Let us now look elsewhere in the world. The Prime Minister said that he had been to a football match at Wembley with the Indian Prime Minister, Mr Modi, and I believe that that was also mentioned by the right hon. Member for Leicester East (Keith Vaz), my Leicestershire colleague. Prime Minister Modi is quite a supporter of complementary medicine, and India now has a Department of Ayurveda, Yoga and Naturopathy, Meditation and Homeopathy. It has a Ministry—it used to be a Department—that draws all those complementary services together. In February 2012, when Prime Minister Modi was Chief Minister, he said that

“homeopathic medicines are affordable and free from side effects”,

and that

“homeopaths should create awareness...among the people”

of an easy method of treatment. He added:

“There should not be a question of conflict between allopathy, Ayurveda and homeopathy”.

All three systems of treatment had some very good things in them, he said.

It was therefore with some surprise that I saw a headline in—I think—The Daily Telegraph last week: “Prescribing homeopathy on the NHS may be banned”. Given its widespread use in the various complementary centres in the country, I wondered what on earth Ministers were thinking of. The doctors who practise homeopathy have been regulated by Act of Parliament since 1950. Ministers have been encouraging complementary therapists to become accredited by the Professional Standards Authority, and 2,000 members of the Society of Homeopaths have just achieved that accreditation.

What could be behind what I see as a kind of madness? The answer is that a tiny lobby group is trying to stop the use of £100,000 of Government money for homeopathic prescriptions every year. When we look into who those people are, we find that they are closely aligned with the medical establishment, and have been using legal challenges to try to stop health authorities and clinical commissioning groups using these treatments. I think that that is quite wrong. During Health questions this week, I pointed out that, according to Clinical Evidence, a review published by The BMJ,

“only 11% of the 3,000 treatments looked at in clinical trials”

in the UK

“proved to be beneficial, with 50% being of unknown effectiveness.”—[Official Report, 17 November 2015; Vol. 602, c. 507.]

If The BMJ says that, why are the Government considering picking on the homeopaths? I suggest to the Minister that these people are at best foolish and at worst wicked, because they know that they are trying to remove a very valid medical system from the health service.

In support of what I am saying, in 2001 Professor Edzard Ernst, in a published overview of exemplary studies and available systematic reviews of complementary therapies in palliative care, which is included in the 2003 report “National Guidelines” I mentioned earlier, says:

“Several clinical trials suggested that homeopathy also may benefit patients suffering from cancer. For instance, a recent double-blind RCT included 66 women undergoing radiotherapy after breast cancer surgery. In addition to conventional treatment, they received either a homeopathic mixture (belladonna 7CH, X-ray 15CH, i.e. two homeopathic remedies in high dilutions) or a placebo daily for 8 weeks. The results suggested that the homeopathic mixture was superior to placebo in minimizing the dermatologic adverse effects of radiotherapy.”

If we look at the hospitals where these support therapies are offered, we see that one not far from here offers aromatherapy, homeopathy, massage, reflexology and shiatsu. This is not some tiny clinic buried in a remote part of the capital. This is Barts Health, which is the largest NHS trust in the country. It has 15,000 employees and a £1.25 billion budget.

One of the issues that my hon. Friend the Minister is going to have to address is how we get more properly regulated practitioners into the health service. If we are going to provide the cancer support that this report argues for—the holistic support, the patient-centred support—and if we are going to listen to what patients want, we need to get a greater number of professionals deployed in the health service. He and his colleagues need to look at the Professional Standards Authority, a Government organisation that has 63,000 practitioners on 17 accredited registers covering 25 occupations. The Society of Homeopaths is one of its most recent additions: it now oversees the society’s regulation. However, there are many other groups there. It is important that we do not ignore that valuable resource. One third of the costs of the whole cancer budget is going on care after treatment. We can reduce that bill by using these people. I know the field of homeopathy very well. With acute conditions, if conventional medicine and homeopathic medicine are used, one reduces the acute drugs bill and with chronic conditions one tends to increase patient satisfaction, so it is a win-win situation.

I am not going to speak for much longer as I know other colleagues wish to contribute, but I want to raise the Cancer Act 1939 with the Minister. When his colleague appeared in a Committee Room not long ago, I got the distinct impression that that was not something the Department had looked at very recently. It says—this is important when it comes to trying to get patient-centred health care and broadening the scope of treatments for cancer care:

“No person shall take any part in the publication of any advertisement—

(a) containing an offer to treat any person for cancer, or to prescribe any remedy therefor, or to give any advice in connection with the treatment thereof.”

That means that it is illegal to advertise or promote any medicine, diets, therapies or treatments as cures for cancer. Well, most of the treatments that I have discussed and referred to today are not claiming to cure. They are claiming to help and to increase the quality of life of those who have the disease. The Advertising Standards Authority and other bodies have been very sharp with anyone who is suggesting that they can assist patients in the provision of therapies that will improve their quality of life.

There are many examples of good support services across the country. I am not going to mention them all, but I do want to mention Coping with Cancer in Leicestershire and Rutland, an independent local charity that provides practical and emotional support to anyone affected by cancer. It offers counselling, complementary therapies, befriending and drop-in centres.

We heard today on the news that in China there is now a superbug that defeats all antibiotics. The last resort antibiotic has no power, and I suggest to my hon. Friend the Minister that we have to go back to the future. I served on the Science and Technology Committee for most of the last Parliament when we looked at antimicrobial resistance, and I was on the Health Committee for the whole of the last Parliament when we looked at this issue. If we have not got the antibiotics and nothing is coming through the pipeline despite the efforts of those the Front Bench, we will have to go back to the future, as medicine is going back to the dark ages, as a commentator said this morning on Radio 4. That means we will have to look more at natural remedies. We will have to listen to people who have used acupuncture for thousands of years and know their way around herbal medicine.

I will end on the following note. I have served with many Secretaries of State in this House. One of them once called me the hon. Member for Holland and Barrett which I took as a great compliment as its headquarters are in my constituency. I am sure it helped me in the 1997 general election, which was not the easiest for Conservative Members. I would like to quote the former right hon. Member for Holborn and St Pancras, Frank Dobson. He said when he was Health Secretary:

“I believe that what works is what counts and what counts is what works. With so many threats to our health we can’t afford to ignore anything that works and is safe.”

I agree. Where patients are gaining benefits, those services should be available.

--- Later in debate ---

[Ben Gummer]

We should indeed. I found the hon. Gentleman’s remarks extremely interesting; I learned a lot from them.

I want to answer hon. Members’ questions as well as I can, although I am conscious that I am answering them on behalf of the public health Minister, who has responsibility for cancer and has considerable expertise in this area. She is sorry she cannot be here. My hon. Friend the Member for Basildon and Billericay (Mr Baron) asked some salient questions. The first was: when will the taskforce conclusions be implemented? He will know that the new national director for cancer has just been appointed, and I met her yesterday. As he knows, she is an immensely impressive women, having run one of the foremost cancer institutes in the world, and she is aware that one of her initial tasks is rapidly to set out an implementation plan. In doing that, I know she will want to speak to the all-party group on cancer as soon as she develops her plans in order to keep its members abreast of developments and to hear their views about the pace of implementation. I will ensure that officials write to Members with any further details about implementation.

My hon. Friend asked about the CCG scorecards. I understand the nervousness—I detected it in his voice—about the complex measurements and the dashboard being translated into apparently simple measurements in the scorecard. I want to give him some reassurance. The scorecards used for hospitals are immensely complex and have behind them a huge amount of data that are then distilled into simple scorings, the point of which is to provide clear accountability and transparency to patients and people living in CCG areas, who, at the moment, have no grip, because we do not give them any, on how well a CCG is performing. The expert panel looking at the operation of the scorecards will be out for consultation next month and will report back before the scorecards are put in place in April. I know it will listen carefully to his comments about one-year survival rates and the detail of how the scorecards are put together, but I am clear that the oncological experts on the panel will not want to undermine the work done on the various metrics and the dashboard.

My hon. Friend spoke with eloquence about genomics. It is of course true that the reason we are able to make increasingly rapid progress is that cancer is a genetic disease, and genetics and genomics are the great new frontier in medical innovation. In a sense, therefore, dealing with cancer and drugs for cancer will be the tip of the spear when it comes to developing all new drugs in the decades ahead. It is very exciting, but presents massive challenges to funded healthcare systems around the world. It is in trying to find a way of affording the new drugs that are coming online, but also releasing the unique possibilities that the NHS offers, that we think we are in such a strong position to offer opportunities both to those wanting to research cancer from an academic point of view and to those businesses and companies doing so in order to develop drugs.

The point of saying that is that the cancer drugs fund, which many Members referred to in their speeches, will necessarily have to change in response to the significant changes of the last few years. To the shadow Minister’s point about the cancer drugs fund, I would gently say that it was an innovation personally promoted by the Prime Minister in 2010. He has made a personal commitment to it, so all Members should take solace from the fact that he will be watching carefully how the fund develops. It has risen from a few hundred million pounds to over £1.2 billion. That demonstrates a commitment that was not present before the cancer drugs fund was invented. Its size is such that it now makes up a considerable part of the overall drugs spending of the NHS.

I hope hon. Members will take comfort from the fact that the consultation announced today by NHS England aims to build on the success of the cancer drugs fund, to incorporate the new structures that need to come about as a result of the significant changes in genomic research over the last five years and to align the general research, licensing and funding of drugs through NICE with the principles of the cancer drugs fund, so that we have a far more integrated system in future. I would encourage all hon. Members present to contribute to the consultation on the cancer drugs fund and thereby help to inform the second stage of its existence, when that comes about—I imagine at some point next year.

[David Tredinnick]

I may be pre-empting what my hon. Friend is about to say, but on the point about widening the scope of drugs, which he has alluded to, will he take note of the remarks about broadening the scope of patient choice and the range of therapies available, and perhaps using Professional Standards Authority-regulated professionals rather more?

[Ben Gummer]

I will, and I was about to move on to my hon. Friend’s remarks. He made a similar point—that great progress had been made but there was still much to be done. He spoke with eloquence and detail about complementary treatments, in which I have absolutely no expertise—I shall have to disappoint him on that. I know that he has written to me about the regulation of herbal medicines. I have today spoken to the Minister for Life Sciences, and I know that my hon. Friend will be receiving a full response about the various issues he has raised.

In response to my hon. Friend’s points about complementary treatments, I would say that it is very important when spending taxpayers’ money on cancer treatments that there is a solid evidence base for what we do. However, his point is well made—that the entire person needs to be taken into account when considering treatment. That can also involve people living with cancer, not just the treatment of it.

It was very nice to hear the hon. Member for Alyn and Deeside (Mark Tami) speak. It was also good to hear him speak from a personal point of view—it was good of him to share his sorrow regarding his son. On the stem cell transplantation issue that he raised, I can tell him that the recovery package as part of the taskforce’s recommendations that the Government have already moved on will apply to blood cancer patients who have undergone stem cell transplantation. The Government are very supportive of the work by the Anthony Nolan trust and other charities, but I will make sure that the hon. Gentleman gets a fuller response on the specific issues that he raised, so he can be satisfied that we have taken into account the particular difficulties and challenges facing those who have undergone stem cell transplantation.

It was a great pleasure to hear from the hon. Member for Scunthorpe (Nic Dakin). I have a particular affection for him, not only because he helped me on the way through King’s Cross the other day, but because he spoke just before me in my maiden speech—we made ours at the same time. This is a good point at which to reflect that the Member who spoke after me was the former right hon. Member for Oldham West and Royton, who is much missed in this place.

The hon. Member for Scunthorpe brought to our attention the issue of rare cancers—specifically pancreatic and blood cancers. I would like to reassure him about research. He will know that Cancer Research UK has looked specifically at the rare cancers and has prioritised work in the areas where it feels additional research funding and effort need to go, which include blood and pancreatic cancers—and, indeed, brain cancers, which my hon. Friend the Member for Castle Point (Rebecca Harris) mentioned. The hon. Member for Scunthorpe also raised the issue of GP imaging capacity, and I would like to reassure him that, as part of the ACE programme—Accelerate, Co-ordinate, Evaluate—by NHS England, imaging will be expanded within primary care. I hope that I will be able to write to him with further details.

I thank my hon. Friend the Member for Castle Point for her fascinating speech and for bringing to our attention the very sad story of her constituent Danny Green. Her point about a national register for off-label drugs was well made, and I know it is an issue that the Under-Secretary of State for Life Sciences, my hon. Friend the Member for Mid Norfolk (George Freeman), is looking at actively. My hon. Friend the Member for Castle Point made a point about research,. She will be aware that it is always difficult to try to divvy up research funding, but I will make sure that her point is reflected back to my hon. Friend the Under-Secretary.

My hon. Friend the Member for Bury St Edmunds (Jo Churchill) made some very good points about joined-up care. It is certainly the case that we need to see such care across the NHS.

The hon. Member for Foyle (Mark Durkan) spoke about the cancer drugs fund, and made an interesting point about a UK-wide set of arrangements. I shall certainly pass on his comments to the Minister responsible for cancer. He also spoke about molecular diagnostics, and I would like to reassure him that, in England at least, we will significantly roll out molecular diagnostics as a result of our acceptance of the principles of the taskforce recommendations.

Finally, the hon. Member for Ellesmere Port and Neston (Justin Madders), the shadow Minister, rightly made some points about public health strategy. It is, of course, difficult to make sure that we balance the books, while keeping to our manifesto pledges. His points about tobacco and obesity were well made, and I know that the Government will be coming forward with obesity plans in short order.

With no more time available to me, I would like to thank Members for their full, excellent and expert contributions to this fascinating debate. I hope that the Government have shown the kind of progress and commitment to this important area that they are so keen to see.