Improving Cancer Outcomes

Grahame Morris Excerpts

Thursday 5th February 2015 Commons Chamber

[Grahame M. Morris (Easington) (Lab)]

I place on record my thanks to the Backbench Business Committee for allocating time for this timely debate on cancer services. I also thank the hon. Member for Basildon and Billericay (Mr Baron) and the various co-sponsors who made the case for this debate. I pay tribute to the various all-party groups covering the issues. Many Members are dedicated to particular groups and play an important role in compiling research, getting information to Ministers and raising specific issues in Adjournment debates. We should pay tribute to all of those people for all the work they do, irrespective of which party they represent.

I wish to raise two specific issues; one that, I hope, is not terribly controversial but another—an issue I have raised previously—that I suspect might be. The hon. Member for Castle Point (Rebecca Harris) touched on it as well. I echo the comments of the hon. Member for Basildon and Billericay that we have made excellent progress within the NHS on tackling cancer and bringing forward new treatments and on promoting early diagnosis. But there is still an awful lot we need to do. I get angry when I see reports indicating how badly we are doing in this country at treating cancer patients when looking at international comparators. I know it is difficult because like has to be compared with like and there are issues about centres of excellence. I understand all that, but I think the NHS should be the best in the world. We argue about resources, but the funding should be there to deliver an excellent service.

The most recent Concord report on the use of advanced therapeutic radiotherapy puts the UK behind in Europe for certain cancers, but also behind Malaysia, Indonesia and Puerto Rico. It says there are a range of reasons why we are falling behind, and one of them is the lack of access to advanced radiotherapy.

Today, cancer treatment in England is an area of health care where the most money is spent on the least efficient method of treatment. I do not want this to become an argument between the cancer drugs fund and alternative cancer treatments, because they are, in essence, complementary. My concern is that we have taken our collective eye off the ball and have not made sufficient investment in what could, as the hon. Member for Castle Point mentioned, save many thousands or tens of thousands of lives, particularly outside the regions where there is limited access.

According to the Department of Health commissioning guidelines, radiotherapy cures 16% of all cancers on its own. When combined with surgery, that figure becomes over 40%. I know that my hon. Friend the Member for Denton and Reddish (Andrew Gwynne), on the Opposition Front Bench, has heard all these figures from the Society of Radiographers before, but they are important statistics. In comparison, cancer drugs, which are incredibly expensive—there is a huge outcry if the National Institute for Health and Care Excellence does not approve a cancer drug or if resources are not put into the cancer drugs fund—are statistically very different. If we look at the statistics in a cold and objective way, we find that cancer drugs by themselves cure only 2% of all cancers. The drugs are effective only in combination with other therapies such as surgery and radiotherapy.

Modern technology has made radiotherapy more effective and much safer for cancer patients. Yet the cancer drugs budget consumes a far larger proportion of the NHS budget in comparison with the radiotherapy budget, which I believe is in the order of £400 million. The disparity is huge because of the requirement to invest in the infrastructure, staff, training, evaluation of techniques and so forth. I personally do not understand how we can make a moral or economic case for not putting greater emphasis on advanced radiotherapy.

There is, in my view, no better example of unbalanced spending than in this country’s appalling record in delivering SABR—stereotactic ablative body radiotherapy—to cancer patients. This is one of the most precise ways of delivering radiotherapy. It is so accurate that it allows tumours to be targeted in a way that was almost impossible 10 years ago, and it can do so without causing harm to healthy tissues.

I went to see one of these machines in operation. I managed to get one of my constituents referred to a unit in St Bartholomew’s hospital. I saw that the machine focuses a beam—in fact, 200 beams—of intense radiation precisely on to the tumour. This is an incredible development in medical technology. It has the added benefit, because of its accuracy, of reducing the number of radiation doses a cancer patient needs from 30 to five. I recall undergoing two courses of radiotherapy like that myself some years ago. That was the standard procedure then; now it is potentially condensed through this advanced form of treatment to five doses. That will be invaluable for older patients. Members have talked about inequalities and how patients over 75 are often unable to access surgery. Perhaps the medical opinion is that they might not stand up to surgery or that conventional radiotherapy might not be an option for them.

SABR is now used to treat 18 different cancers in the United States. Closer to home, in Europe, it is used routinely in countries such as Italy, Belgium and Switzerland. Its use in France is so well developed that in one centre in Lille the SABR machine is treating 500 patients a year, whereas an identical machine in our country treats fewer than 100. It is all to do with the number of staff who are trained to deal with extended operations. I met a member of the Lille team at a conference in London, and he explained to me how they were able to achieve such a tremendous throughput.

A recent international survey of more than 1,000 clinicians in 43 countries revealed that 83% of them were using SABR. Only 34% of our radiotherapy centres in the United Kingdom—and it should be borne in mind that we have 28 cancer networks—have the capability to deliver SABR, and nearly all of them use it only for treating lung cancer.

Five years ago the National Radiotherapy Implementation Group, which consists of some of the best cancer doctors in our country, produced a plan which received extensive support, and which I have raised—not with this Minister, but with her predecessors—during Health questions and Adjournment debates. The plan would allow a wider range of cancer patients in England to be treated with SABR. More importantly, the group recommended that patients should be treated closer to their homes, in centres of excellence. My region, in the north-east, has two cancer centres. Why should your constituents, Madam Deputy Speaker, have to travel from Bristol to London in order to have access to advanced radiotherapy?

Sadly, that report was ignored—before the present Minister took office, I should add. However, the hon. Member for Wells (Tessa Munt), to whom I pay tribute, has been tenacious in raising the issue since I entered the House in 2010, and, following a campaign by the former England rugby captain Lawrence Dallaglio, which lasted for about two years, NHS England was finally persuaded to start putting it right. The “Dallaglio agreement” will allow our country to start treating cancer patients with SABR and to increase the number of cancers that are treated. It will facilitate the development of centres of excellence in the English regions. I certainly hope that we shall have some in the north-east. Those of us who represent constituencies outside London should pay attention to the agreement. We need to ensure that those centres of excellence are created, because they will be able to treat hundreds of cancer patients each year closer to their homes and families, and will have the right technology and staff who are trained to use it.

However, the Dallaglio agreement is just the beginning. We have a long way to go before we can catch up with our European neighbours. In particular, we need to adapt more skilfully to new technologies as they become available. Quicker adaptation does not mean cutting corners with patient safety; other countries appear to be able to use new technology safely, and to be adapting to it much faster than we are. New technology does not have all the answers, but it cannot be a coincidence that countries that adapt speedily to technological advances seem to have much higher cancer survival rates than we do.

This week, Cancer Research UK said that half of us living today will get cancer. The NHS needs to work out how to deal with that. Cancer is one of the biggest health challenges we face in the 21st century and we need to know that in tackling it we are utilising our valuable resources most effectively. The Government should conduct a full and independent review into the matter, particularly if they are going to spend many billions of pounds on cancer drugs as the best way forward, at the expense of adopting rapid advances in technology, especially robotic technology that is making radiotherapy safer, more efficient and better for patients.

I would like to address another important matter: end-of-life care and the need to make improvements for people with cancer. Seventy-three per cent. of cancer patients want to die at home but less than a third are able to do so. The palliative care funding review has pointed to the fact that providing free social care is key to supporting people to die at home. Evidence from Macmillan suggests that savings of £345 million could be made. The right hon. Member for Sutton and Cheam (Paul Burstow) will remember the debates that we had. I think we won the argument, although we lost the vote. I sensed that there was a lot of support for free end-of-life care across all parties. I press the Minister to consider that. The Government previously stated that they saw much merit in such a policy. Does the Minister still see merit in the principle of free social care for people at the end of their lives?

Two further policies are fundamental to improving end-of-life care. The first is the provision of 24/7 community care to ensure that, regardless of what time of day it is, if someone is at the end of their life, they do not have to contact the emergency services to be admitted to A and E. Secondly, there should be better recording of patient preferences at the end of life and better sharing of information between all the services that come into contact with that patient. I support the motion.