Improving Cancer Outcomes

Edward Leigh Excerpts

Thursday 5th February 2015 Commons Chamber

[Mr John Baron (Basildon and Billericay) (Con)]

I beg to move,

That this House has considered improving cancer outcomes.

Recent analysis from Macmillan Cancer Support shows that there are now an estimated 2.5 million people living with cancer in this country—an increase of almost half a million over the past five years. May I therefore begin by thanking the Backbench Business Committee for granting this timely debate on an issue that is becoming ever more urgent: improving cancer outcomes?

I would also like to thank my fellow officers of the all-party group on cancer for all their hard work, and the officers of the other cancer-specific all-party groups. It speaks volumes about the importance of the issue that we have come together to secure this timely and important debate. I would like to give the all-party group on cancer a plug. The group is recognised as the wider cancer community’s voice in Parliament. It has a proud campaigning track record. It runs what is now the largest one-day conference on cancer in the UK—Britain against cancer—each December. In the Minister’s own words, it rightly holds the Government’s feet to the flames.

The timing of this debate is crucial. With only a matter of weeks of parliamentary time before the general election, and at a time when NHS England is embarking on a new cancer strategy, this is likely to be the last opportunity for this Parliament to speak up on behalf of the cancer community and feed into that strategy.

The challenge has never been greater. Macmillan Cancer Support estimates that 3 million people will be living with cancer in this country by the end of the next Parliament. By the end of next year, 1,000 people a day are expected to be diagnosed with cancer. Hospital admissions for cancer in England have increased by around 100,000 a year, compared with five years ago. The NHS has missed the target of cancer patients receiving their first treatment within 62 days of an urgent referral for three quarters.

There is also good news, though, in that we have certainly made improvements in cancer outcomes over the past few decades. The latest figures published in December show that the one-year cancer survival rates in the UK now average 68.5% to 69%—up by a full 10 percentage points since 1997. These are figures on a page, but we are talking about thousands of lives saved every single year because we are driving up cancer survival rates, particularly in the one-year figures.

However, those improvements have been gradual and incremental, and they have not been enough to catch up with our European counterparts. Research has shown that our one-year survival rates still significantly lag behind European averages. Whereas we have 68.5% to 69% in this country, the best in Europe is 81% to 82% in Sweden. That is a significant difference that accounts, very roughly, for some 10,000 lives a year. There is always a danger in making comparisons. For example, if we look at the French figures, we are making comparisons with France’s centres of excellence. None the less, the established evidence suggests that we are down by some 5,000 lives a year on European averages, and perhaps by as many as 10,000 when compared with the best in Europe.

[Sir Edward Leigh (Gainsborough) (Con)]

That is why we want an open debate about the future of the NHS. We need to recognise that the social insurance systems in France and Germany produce better outcomes for people than our own national health service.

[Mr Baron]

That is a debate for another day. I accept that dramatic improvements could be made within the existing structures of the NHS, and I want to focus on that in this debate.

The Government have estimated that from 2011 to 2015 an additional 12,000 patients will survive for more than five years after diagnosis compared with the previous five-year period. That figure tells us nothing about how we are doing relative to our European counterparts, who will no doubt also have made improvements. Are those 12,000 lives just a continuation of a fairly stable and steady trend line that has been in evidence for the past 25 to 30 years, or a kick-up, as it were, above the trend line that suggests that we are catching up with our European neighbours? I would appreciate it if the Minister provided clarity on how the figure of 12,000 additional lives saved has been calculated and what action the Government are taking to ensure that we continue to strive towards matching the best outcomes in Europe.

I am conscious that a good number of other Members will speak in the debate, so, without being exhaustive, I will focus my remarks on four key areas: earlier diagnosis and survival rates; inequalities and older people; patient experience; and, last but certainly not least, the problem that some charities are having with data access.

Earlier diagnosis has long been an issue that the all-party group has campaigned on: we describe it as cancer’s magic key. All the statistics suggest that the NHS is as good as any other health care system at treating cancers once they are detected, but poor at detecting them in the first place. That suggests that we need to raise our game as regards earlier diagnosis. Most of these 5,000 or 10,000 lives are being lost at the one-year point, and the NHS is not catching up. We therefore need to drive forward initiatives at the coalface that encourage earlier diagnosis. It is almost a national disgrace that one in five cancers are first diagnosed at A and E when those patients are, on average, twice as likely to die within a year than those diagnosed via an urgent GP referral. That shows the importance of earlier diagnosis.

With this knowledge, we have spent the past two years working with the Government and NHS England to ensure that the right accountability levers are in place to encourage earlier diagnosis. We have been successful, together with the wider cancer community—because ultimately this is about teamwork—in getting one-year and five-year cancer survival rates into the NHS outcomes framework and one-year cancer survival rates into the commissioning outcomes indicator set. That is good news. We were also delighted when Simon Stevens agreed to our recommendations on including one-year survival rates in the delivery dashboard of the clinical commissioning group assurance framework from April this year.

I have used a lot of terminology, but there is a basic logic in putting the one-year figures up in lights and breaking them down by CCG. One of the best ways, if not the best way, of driving up one-year survival rates is to better introduce initiatives that encourage earlier diagnosis at the coalface. Those could be, for example, better awareness campaigns at a local level; encouraging better screening uptake figures, some of which are pretty poor; better diagnostics at primary care; better GP referral rates; or an A and E system which, when it detects these one-in-five cancers, instead of pushing patients back down the system, refers them up, potentially saving crucial time. All or any of those could be introduced by CCGs that are trying to get their one-year figures up. Putting the one-year figures up in lights will put pressure on those CCGs to raise their game on earlier diagnosis.