New Cancer Strategy

Debate between Henry Smith and John Baron

Thursday 19th November 2015 Commons Chamber

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

I beg to move,

That this House notes the findings of the independent cancer taskforce published in July 2015; and calls on the Government to publish an action plan on implementing the new cancer strategy.

I want to begin by thanking the Backbench Business Committee for granting this timely debate. I also thank fellow officers of the all-party group on cancer, some of whom are going to participate in this debate, and the officers of the other cancer-specific all-party groups, who joined me in applying for this debate. This therefore represents a coming together of all the cancer-related APPGs. Although we want to raise specific issues, we are all agreed on the importance of debating the new cancer strategy delivered by the cancer taskforce.

I hope you will not mind, Mr Deputy Speaker, if I mention the fact that on 8 December the all-party group on cancer will hold our annual Britain Against Cancer conference in Central hall. It is the largest gathering in the country of the cancer community, and I warmly invite all Members to join us on the day. My thanks would not be complete if I did not also thank the Under-Secretary of State for Health, my hon. Friend the Member for Ipswich (Ben Gummer), who is sitting on the Front Bench, having stepped into the shoes of the Under-Secretary of State for Health, my hon. Friend the Member for Battersea (Jane Ellison), who has responsibility for cancer. Unfortunately, she cannot be with us today, but she is a good friend of the cancer community. To help my hon. Friend on the Front Bench, I sent him an advance copy of my speech. He may not be able to answer all of my questions from the Dispatch Box, but I look forward to receiving his written responses to those that he cannot answer today.

Perhaps we need to remind ourselves of the challenge. There are currently 2.5 million people living with cancer in the UK, and by the end of next year it is expected that 1,000 people will be diagnosed with cancer every day. Macmillan Cancer Support has suggested that in a few years’ time, one in two people will have been affected by cancer.

The challenge of delivering world-class cancer outcomes for all patients is growing ever greater. Hospital admissions for cancer in England have gone up by 100,000 a year compared with five years ago. For 17 months, the NHS has missed the target for cancer patients to receive their first treatment within 62 days of an urgent referral. Our outcomes continue to lag behind our European counterparts. Research has shown that the one-year cancer survival rate in the UK is about 13 percentage points behind the best in Europe, which is about 81%. That may not sound like a big figure, but it means that in the region of 10,000 lives a year are lost needlessly, in large part because the cancer was diagnosed too late.

That is the backdrop against which the cancer taskforce delivered its recommendations for a new five-year cancer strategy in July—something that the whole cancer community welcomed. Like others who are campaigning for improvements in cancer services, I was disappointed that the cancer taskforce report ended up being a report to the NHS and its arm’s length bodies, rather than a report of the NHS and its arm’s length bodies. That was not the original intention. However, that should not detract from the excellent work that went into it. Our congratulations should go to Mr Harpal Kumar for his efforts and hard work in preparing the strategy.

The recommendations of the strategy are based on evidence and advice from organisations across the cancer community, including the all-party parliamentary group on cancer. It covers the whole cancer pathway from early diagnosis to care after treatment and at the end of life. It aims to deliver a radical improvement in cancer outcomes by 2020.

Since its publication, the strategy has been welcomed by the Government, the health sector, the charities and the cancer-related all-party groups in this place. Attention must now turn to the implementation of the taskforce’s report. I congratulate Ministers on pre-empting the spending review in at least two ways by committing the Government to two of the key recommendations in the strategy. First, there is a commitment to ensure that all patients receive a definitive diagnosis within four weeks of their referral from a GP. Secondly, there is a commitment to ensure that all patients are offered a recovery package by 2020 and to develop a new metric on quality of life.

However, the taskforce has been clear that the recommendations set out in the strategy will deliver a step change in outcomes only if implemented as a whole. It is therefore important that there is urgency in implementing the remainder of the strategy. If he can, will the Minister outline today when he expects to publish the implementation plan and what degree of consultation he envisages before its publication? What assurances can he give that Ministers will ensure that the implementation plan contains clear deadlines and earmarked resources for implementing the strategy’s recommendations?

May I touch briefly on the importance of earlier diagnosis, which is one of the key priorities identified in the strategy? That point is of particular interest to the all-party parliamentary group on cancer and the other cancer-related all-party groups. As some Members will be aware, the all-party parliamentary group on cancer campaigned tirelessly on improving early diagnosis—what we call “cancer’s magic key”. The logic behind our campaign is exceedingly simple: the evidence shows that people who are diagnosed earlier are more likely to survive for over one year and, therefore, to survive cancer generally.

[Henry Smith (Crawley) (Con)]

I warmly congratulate my hon. Friend and all the cancer APPGs on securing this important debate. Early diagnosis is absolutely key, as he rightly points out. Regrettably, my mother died of acute myeloid leukaemia in 2012. She was diagnosed on the day before her death. We really do need to bear down on this issue. Will my hon. Friend pay tribute to charities such as Bloodwise that do such important work in highlighting this area of cancer?

[Mr Baron]

I will do so by all means. Let me express my heartfelt sympathies to my hon. Friend as regards his mother. He is absolutely right that charities such as Bloodwise, as well as many others across the charitable sector, realise the importance of earlier diagnosis. I will give him one statistic that directly answers his question. I spoke at an event about bowel cancer yesterday. The statistics quite clearly show that 90% of people diagnosed in the early stages of bowel cancer survive for more than 10 years, but that figure drops to just 5% if they are diagnosed at a later stage. That is the difference that earlier diagnosis can make.

The logic behind focusing on earlier diagnosis is very simple. We have found over a number of years that the NHS is as good as any other healthcare system at getting patients from the one-year point after diagnosis to the five-year point, but is poor at getting them to the one-year point in the first place. That suggests that it is not good at detecting cancer. We lose the vast majority of those 10,000 lives in the early phase—up to one year—and then it is simply not possible to catch up. We therefore need to do more on earlier diagnosis.

Getting the NHS to focus on the one-year figures will encourage initiatives on the frontline to promote earlier diagnosis. By putting the one-year figures up in lights, we can ensure that the local NHS realises that it is being monitored. It will therefore be up to the local NHS to introduce and adapt a range of initiatives that suit the local population best, whether they are elderly people, black and minority ethnic populations or whatever. The initiatives range from everything from encouraging better screening uptakes to encouraging better awareness campaigns when it comes to education, better diagnostics in primary care and better GP referral rates, all or any of which could be approved locally to drive up earlier diagnosis.

I suggest that earlier diagnosis, as well as being better for patients, can also save the NHS money. Incisive Health and Cancer Research UK published a report last year that set out the cost savings of diagnosing a patient early. One example is in colon cancer. Stage 1 treatment costs about £3,300, while stage 4 treatment costs £12,500, which is a notable difference. If we look at the range of cancers and the number of cancer patients involved, we can see that we could save hundreds of millions of pounds if we raised our game and diagnosed cancer early.

The all-party group on cancer and the wider cancer community, including the Cancer Campaigning Group, have worked collaboratively with the Government and NHS England—I congratulate the Government most heartily on listening to our concerns—and have campaigned together to get the one-year figures into the DNA of the NHS. We have managed to get them into the NHS outcomes framework and the commissioning outcomes framework.

Last year, our efforts culminated in a successful campaign to ensure that a one-year cancer survival rate indicator is included in the delivery dashboard of the clinical commissioning group assurance framework from this April. For the moment, that is the primary mechanism by which CCGs are held to account. Many CCGs have told us that it is the primary tool they use for determining priorities at local level. With the one-year figures now up in lights in the top tier of NHS accountability, commissioners will be encouraged to take action in their local area to improve earlier diagnosis and ultimately to improve cancer survival rates.

Many people may think, “Job done. We’ve managed to get the one-year rate into the DNA of the NHS. We’ve managed to get it on the radar screen of CCGs. Is there anything else we should be doing except following through on those initiatives?” However, many of us are concerned that the recently proposed changes to the accountability system in place for CCGs may undermine this work. A few weeks ago, the Secretary of State announced a new scorecard for measuring the performance of CCGs, which will involve each CCG being awarded an Ofsted-style rating with effect from next April. Although the all-party group on cancer approves in principle the improvement of accountability, we strongly advocate, on behalf of the cancer community as a whole, that the use of the one-year figures to drive earlier diagnosis at local level is not lost throughout this process. Will the Minister outline in further detail the Government’s plan to implement a CCG scorecard and the process by which the metrics relating to cancer will be determined? Will he confirm that the focus on one-year survival rates will not be diluted?

Let me mention the reforms suggested in the cancer strategy for the patient pathway. With a growing number of people surviving cancer, it is particularly important that we make improvements throughout the whole cancer pathway, and there are two key parts to that. First, all too often patients report being treated as a set of symptoms rather than as a person, and certain groups of patients—namely older people, ethnic minorities and those with rarer cancers—report a poor patient experience. Secondly, many cancer patients lack the necessary support to get on with their lives once treatment has ended.

The all-party group on cancer welcomes the increased focus on patient experience across the NHS, but we must do more to ensure that we have the right data to drive improvement at local level. Although the cancer patient experience survey is a useful tool, too often the data are difficult to access and not widely used. The cancer strategy recommends the creation of a new metric to measure the patient experience across the whole pathway. Will the Minister set out how the Government plan to implement the strategy’s recommendation on a new patient experience metric, and say how they will ensure that data are used effectively to drive improvement at local level? Will he confirm that there will be sufficient resources for the new metric and the cancer patient experience survey?

We welcome the Government’s commitment to ensuring that all patients have access to a recovery package following their treatment, but if we are fully to address that challenge it is vital that the NHS understands where it is working well and where improvements are needed. As such, it is vital that the strategy for the development of a new quality of life metric is taken forward as a priority. Will the Minister ensure that the Government’s commitment to take forward that recommendation for the cancer strategy to develop a quality of life metric is backed up with clear plans for funding and implementation?

In the few minutes that remain, let me address a couple of key issues including rarer cancers and the cancer drugs fund. It is an interesting fact that the combined number of rarer cancers—those less common than breast, lung, prostate and bowel cancer—outnumber the sum total of those more common cancers. Services for people with rarer cancers are no less important, and we must ensure that people with rarer cancers get access to the right level of specialist expertise, irrespective of where they live. The taskforce recommendation for the creation of highly specialised multi-disciplinary teams for rarer cancers is particularly welcome. Will the Minister assure the House that that will happen, and that MDTs will be supported by technology so that they can deliver specialist care without inconveniencing patients?

Research efforts into rarer cancers must be redoubled. The Government are leading the world in their investment in genomics, most notably through their 100,000 genomes project, which is sequencing the genomes of those with cancer and rare diseases in general. It is good that the project has so far fully sequenced the genomes of 5,000 patients, but will the Minister update the House on progress with cancer patients? May I suggest that, once complete, Genomics England should independently carry that research forward for the benefit of the NHS and patients, given its excellent track record?