Cancer Priorities

Debate between James Clappison and Liz Kendall

Thursday 13th February 2014 Commons Chamber

[Liz Kendall (Leicester West) (Lab)]

Like other hon. Members, I thank the Backbench Business Committee for providing time on the Floor of the House for us to debate this excellent report by the all-party parliamentary group on cancer.

I commend the hon. Member for Basildon and Billericay (Mr Baron) for his tireless work on this issue. Like the hon. Member for Salisbury (John Glen), I have been in this place for four years and have been amazed at the work that the hon. Member for Basildon and Billericay has done and at his forensic attention to detail. He never gives up and I am sure that he never will. I am grateful to him for that. I also pay tribute to the work of my hon. Friend the Member for Easington (Grahame M. Morris) and the noble Baroness Morgan of Drefelin, who are officers of the group.

The hon. Member for Harrow East (Bob Blackman) was right to say that hearing the words “You have cancer” is one of the most frightening things that can happen to somebody. It is frightening not only for the person who is given the diagnosis, but for their family. He was also right that more and more of us will hear those words in the future. As we live for longer, the prevalence of cancer increases. Just last week, the World Health Organisation warned that the world faces a “tidal wave” of cancer, with the number of cases globally set to reach 24 million a year by 2035. We often think of cancer and heart disease as issues of the western, developed world. In fact, long-term conditions are becoming the primary health conditions in developing countries as well. We have made big strides in tackling conditions such as malaria and HIV, but long-term conditions such as cancer are big issues in developing countries.

In the UK, 330,000 people are diagnosed with cancer each year. That figure has gone up by 50,000 in a decade. The primary reason for that is the ageing population. Cancer Research UK has highlighted a number of other risk factors: alcohol and the increase in obesity are two of the biggest drivers of that change.

Cancer Research UK produced a report in December, which showed that cancer deaths have dropped by 20% over the past 20 years. I am proud of the Labour Government’s contribution to that record. We launched the first ever national cancer plan in 2000 and made cancer a top priority. That work was led by Professor Sir Mike Richards who, as Members will know, is now the chief inspector of hospitals. The plan was backed by increased funding and, crucially, by reforms to drive improvements in cancer care, including better diagnosis, reduced waiting times for treatment and better standards of care. As a result, survival rates have improved steadily and cancer deaths have fallen by 50,000 a year.

Many hon. Members have rightly highlighted the need to ensure that patients with cancer have the best outcomes and survival rates, and that we narrow the gap with other countries. Many figures have been cited, but in some areas we have seen the gap narrow. An article by John Appleby from the King’s Fund in the British Medical Journal in January 2011 reminded us that death rates for lung cancer in men peaked in the late 1970s, but they have steadily come down and are now lower than those for French men. There has been a similar trend in breast cancer mortality for which we have virtually closed the gap with France. As the all-party group on cancer report rightly said, however, we need to do much more to prevent, treat and cure cancer, which means raising awareness of the symptoms of cancer among members of the public and GPs.

[Mr Clappison]

I am grateful to the hon. Lady for expanding my point because, as I made clear in my speech, I am not out to make any political point about this. According to Eurocare statistics, which I have been supplied with by the House of Commons Library and which refer to December last year—more recent than the article the hon. Lady mentioned—the survival rate for lung cancer in Frenchmen is 4% better than for people in this country. For lung cancer we lag behind nearly every other country in Europe, certainly western Europe.

[Liz Kendall]

I am not a statistician; I am reporting something from the British Medical Journal. There are different ways of cutting the statistics and different reports, but I absolutely agree that we need to do more to catch up with other European countries. There are a variety of statistics on that, and in some areas—but not enough—we have made big improvements in recent years.

We must raise awareness of the symptoms of cancer among members of the public and GPs, to ensure that everyone gets the earliest possible diagnosis. We must tackle variations in treatment so that everyone gets the best possible care, and we must provide better support to cancer patients and their families as they go through treatment, not just in terms of physical care, but emotional and social support such as help with finances, benefits and work. The hon. Member for Harrow East made an important point about how when they go through such a terrible time, many patients have a problem with their finances and benefits. I visited a brilliant multidisciplinary cancer team at Leicester Royal Infirmary, where Macmillan Cancer Support had a brilliant network of people providing financial information and support, as well as emotional support. That joined-up care is exactly what we need.

We must also ensure that people who have recovered from cancer can cope with life after cancer. People’s experience of the condition, as many hon. Members will know, does not end—hopefully—with the all-clear, because there are all sorts of emotional problems after that. As the hon. Member for Salisbury said, we must ensure that patients who cannot be cured, and their families, have real choice and control over the last days of their life, including where they die. The hon. Gentleman has probably not been reading the Hansard reports of the Care Bill Committee, but there is cross-party support for moving more quickly on that issue. In that Committee, the Minister of State, Department of Health, the hon. Member for North Norfolk (Norman Lamb), said that he was personally committed to getting that up and running and sorted out quickly.

As the hon. Member for Salisbury said, we should help people to stay at home with the right social care and support, including support for family members. It can be quite frightening to think that one’s loved one may be dying at home, and people can feel panicked about that. If we can provide the right social care support, and Macmillan specialist nurses to sit with people through the night, it can be better for those families and also provide better value for money. I hope that when the Care Bill reaches Report, we will get some clearer commitments.

The overarching question that the all-party group focuses on is how we can make such things happen on the ground. It takes the new structure within the NHS and asks, “How are we going to make this work?” The Health and Social Care Act 2012 reform was not perfect, and it was clear that cancer networks took the lead in driving changes and improvements in cancer services. As my hon. Friend the Member for Ashton-under-Lyne (David Heyes) has said, we had 27 cancer networks that brought together the commissioners of services and the providers of cancer care to plan high-quality services in their areas. They were staffed by people with specific expertise in cancer care and local knowledge of the different hospitals and services. They worked across primary and secondary care and on a wide range of issues such as increasing the uptake of screening, improving training for staff on the best possible treatments, spotting early symptoms and signs, and championing a focus on the patient experience and the patient’s pathway through the system.

As the all-party group’s report states, there is concern, including among organisations such as Macmillan, that the good work and vital expertise of those networks are being lost. I was first alerted to the problem by Dr Mike Peake, a lung cancer specialist at Glenfield hospital. He is also the national clinical lead for cancer and responsible for the national cancer intelligence network. The worry is that the Government’s reorganisation means that the dedicated cancer networks have been abolished and subsumed into 12 generic strategic clinical networks, which cover a larger geographical region and have fewer dedicated staff. The fundamental concern is that moving from a specialist to a generic focus will reduce the ability, which we desperately need, to drive improvements in cancer care.

Members on both sides of the House, and clinicians and staff, are saying that in every other part of the health system we need to concentrate specialist services like cancer services to improve outcomes, rather than having them delivered through every district general hospital. It does not make sense to people: we say that we want clinical advice to drive clinical improvements and change, but then we go the opposite way—from specialist to generic. That is a cause for concern.

There is also confusion about how the strategic clinical networks will work with all the other parts of the new system—the 10 specialist commissioning hubs, the 19 commissioning support groups, the 211 clinical commissioning groups, the 27 local area teams, the 152 health and wellbeing boards, NHS England, Public Health England and Health Education England. The new system is very confusing. People have to work together, so clear lines of responsibility and accountability are important.

We urgently need clarity on two points. First, will the Minister update Members on what is happening in the strategic clinical networks, and, specifically, how is the cancer expertise being protected? Secondly, will she outline precisely how the strategic clinical networks will work with other parts of the system?

The all-party parliamentary group report makes many excellent recommendations and raises many issues. I cannot go into all of them in detail, but will focus on the two that I believe are the most important for patients. The first, as most hon. Members have said, is early diagnosis. The second is improving the patient experience, which we have not discussed in detail.

Getting early diagnosis right is the key to improving survival rates. Several things would make a difference, but I shall describe the most important ones, the first of which is raising public awareness of symptoms. If the Government want to meet their target of saving an additional 5,000 lives by 2014-15, we must arm people with knowledge of the warning signs and symptoms. Once again, the Government’s reorganisation means that the responsibilities for public health are split between lots of different bodies and we are not clear how they will work together. The APPG report says that the responsibilities for increasing public awareness must be more clearly spelt out for NHS England, the Department of Health and Public Health England, and for local authorities and health and wellbeing boards. I hope the Minister will set out exactly who will be responsible for running public awareness and other campaigns.

Secondly, we have to improve the ability of GPs to spot signs and refer people to specialists for early diagnosis. As the report states, more than a quarter of people diagnosed with cancer see their GP three times or more before they are referred to a specialist. Under the old system, before the Health and Social Care Act 2012 and the reorganisation, cancer networks absolutely led improvements in training for GPs and other health professionals, but it is not really clear who is going to do that now. How will NHS England work with Health Education England, the royal colleges and other education providers to ensure that training programmes for health professionals are really there on the ground?

Thirdly—this is probably the most important point in the report, one which the hon. Member for Basildon and Billericay emphasised—how are we going to hold clinical commissioning groups to account for the one and five-year survival rates? The report states:

“NHS England has not provided any guidance on how the one- and five-year survival rates will be used to drive improvements in CCGs.”

The data may be available, but what will happen to them? Will NHS England identify poor performers? Will it make practical support and guidance available to CCGs? How will we know whether actions and steps have been taken? How can we hold them to account? As a local MP, I would certainly want to know how my CCG rates, what the problems are, what it has not been doing, what its action plan is and when it is going to report back. We do not know any of that. The survival rate targets are excellent, but we have to make sure we can deliver. At the moment, we simply do not have the mechanisms to do that.

The other point I want to focus on is improving the patient experience. This is not only absolutely central for patients, but a key driver of improvements in the quality of care and better value for money. As such, it should be a much higher priority in the NHS. We all know, whether from personal experience, the experience of those we love or those in our constituencies, that a good experience makes patients feel as though they have been supported and respected as an individual. A bad experience makes them feel at best that their needs do not matter, and at worst that their basic human dignity has been denied. Cancer patients I have spoken to, for example those at the Macmillan Cancer Support group in my constituency, constantly emphasise their experience of care and how they are treated by NHS staff. That would be important at any point, but for someone going through such a frightening time, it is even more important.

The importance of patient experience goes far beyond the personal value to individuals. There is now strong evidence that good patient experience is consistently and positively associated with better health outcomes, and safer and more clinically effective care. The British Medical Journal published a systematic review of 55 studies last year, which provided very clear evidence. Patients who have a good experience are more likely to stick to their recommended treatments and medicines, and more likely to use preventive services such as screening and healthy living programmes.

There is also increasing evidence, although I would say that it is from the US and not the UK at this stage, that a good patient experience is linked to getting better value for money. It is associated with reduced length of stay in hospitals and fewer problems with patient safety—the so-called “adverse incidents”. A good patient experience is also associated with higher staff retention rates and, in turn, lower staff turnover. That is common sense: when staff feel valued and respected they are more likely to treat patients in that way.

For all the reasons I have outlined, the patient experience in cancer care should be given an even higher priority. The cancer patient experience survey introduced by the previous Government has made a big difference in trying to drive improvements. I welcome the assurances given to the all-party group on cancer that the survey will continue, but for how many more years? We must ensure that we use that information to drive changes on the ground, and I will make some concrete proposals on how to do that. First, commissioners should be held to account through the inclusion of a cancer patient experience indicator in the CCG OIS. If that is how we hold them to account, we have to include patient experience. Secondly, patient experience should be much more central to the hospital inspection process led by the chief inspector of hospitals. Currently, out of 150 CQC indicators, only two concern patient experience. We need more patient experience indicators in the work of the CQC, including one specifically for cancer teams or services.

Thirdly, we need to look at how we improve professionals’ training in patient experience. I want to highlight a brilliant example from my own constituency that I hope the Minister will look into. Under a joint Macmillan and De Montfort university partnership project, people training to be nurses, pharmacists and NHS managers get training from Macmillan in patient experience and how to talk to and support patients. In return, those students volunteer for Macmillan in the community in order to increase awareness about cancer, particularly among black and minority ethnic groups—Leicester is a very diverse city. That is something to think about. Has the Minister spoken to Health Education England and the royal colleges about how to improve training in patient experience for professionals, and will she speak to Ministers in the Department for Business, Innovation and Skills to see what other universities could do to learn from the fantastic work at De Montfort?

To conclude, Members on both sides of the House want to see big improvements in cancer care. The new system in the NHS is confusing. Both as MPs and as people with families and friends, we want the right people held to account so that they take the right action, but it is not yet clear how that accountability will work. For me, that was at the heart of the all-party group’s report. The Minister might not be able to respond to all the many questions she has been asked in this debate, but if she cannot, I hope she will write to me about the specific issues I have raised. This is about improving patient experience and early diagnosis and ensuring that CCGs are held to account. We as MPs must hold them to account on behalf of our constituents.