Radiotherapy Services (North East Hertfordshire)

Jane Ellison Excerpts

Wednesday 4th February 2015 Westminster Hall

[The Parliamentary Under-Secretary of State for Health (Jane Ellison)]

I congratulate my hon. and learned Friend the Member for North East Hertfordshire (Sir Oliver Heald) on securing this debate on, as he pointed out, a very apt day: world cancer day. I am still getting used to the idea of the MPs’ road trip that he appears to be planning for himself, my right hon. Friend the Member for North East Bedfordshire (Alistair Burt) and my hon. Friend the Member for Stevenage (Stephen McPartland). I will come on to address the issue of access, but that certainly sounds like an offer that no one could refuse.

[Stephen McPartland]

NHS England has refused us on several occasions. We keep pushing, so we would be grateful if the Minister could persuade it to accept the offer to embark on our road trip.

[Jane Ellison]

I will certainly draw NHS England’s attention to the force with which the invitation was put in this debate.

Let me say a few words about the bigger picture on cancer before we go into the detail in the contribution by my hon. and learned Friend the Member for North East Hertfordshire. The Government are committed to improving cancer outcomes and matching the best in Europe. As Members are aware, we do not match the best in Europe; we were certainly lagging behind some important countries when the Government came to office in 2010.

The 2011 strategy, which was backed by £750 million, set the ambition of saving an additional 5,000 lives a year. We believe that we are on track to save an additional 12,000 lives a year, far exceeding that ambition. Much of the focus has been on early diagnosis and awareness. Given the clear interest in cancer that Members have expressed by being here, I hope that they will join me in welcoming the announcement of NHS England’s cancer taskforce, which is charged with designing a new cancer strategy for the NHS to take us through to 2020.

I thought Members might be interested in the statistics for East and North Hertfordshire NHS Trust over the last 12 months. Some 2,881 more patients with suspected cancers were seen than in 2010—a 49% increase. In addition, 239 more patients were treated for cancer than in 2009-10—an 11% increase. Local NHS staff, to whom I pay tribute, are therefore doing a good job of seeing more people.

[Sir Oliver Heald]

I am grateful to the Minister for giving way on that important point. About half of the patients require radiotherapy, so the numbers on that journey are getting higher and higher, and there surely comes a point when we can have our satellite.

[Jane Ellison]

Indeed, and I will address some of the issues my hon. and learned Friend raised, but let me say a quick word on radiotherapy more generally. The Government have set about improving these services. NHS England will be investing an additional £15 million in stereotactic ablative radiotherapy on top of the £6 million already committed. That will benefit about 750 patients a year. There is also a £23 million radiotherapy innovation fund, which has resulted in the doubling of intensity-modulated radiotherapy activity. In addition, we are investing £250 million in building two new proton beam therapy centres. A lot of investment is therefore being made in some very up-to-date and important technology.

Let me turn to local health matters. First, I congratulate my hon. and learned Friend the Member for North East Hertfordshire, my right hon. Friend the Member for North East Bedfordshire and my hon. Friend the Member for Stevenage, who are all known as doughty champions of their local health services. It is particularly good to see the latter, who champions health matters with great vigour in this place.

I am aware of the issues that have been raised. Regardless of the part of the country we live in, we would all expect patients to have ready access to radiotherapy services as part of patient care. Obviously, radiotherapy is a specialised service. It is commissioned directly by NHS England. Fortunately, it is not needed by the majority of NHS patients, but it is vital to those who do need it. The smaller number of patients involved means that the health service needs to think carefully about access—locating units to provide the maximum benefit closest to the highest possible number of people. I will go on to talk about the implications for expertise.

Such decisions are made locally, and are best made locally, by clinical leaders who have the full benefit of local knowledge. However, it is right, of course, to bring concerns to Parliament and to give Ministers a chance to understand what is happening in the local health economy, so that we are aware of the issues and can discuss them, where necessary. Decisions on where to locate specialist services need careful consideration. The issue is of particular note to those who represent more rural constituencies. Patients who live some distance from treatment centres—not only those providing radiotherapy—can, unfortunately, face repeated, long and tiring journeys. I realise that the seats of my hon. Friend the Member for Stevenage and my hon. and learned Friend the Member for North East Hertfordshire are not necessarily rural, but those are factors in parts of our country. My hon. and learned Friend gave us examples of the anxieties that long, tiring journeys bring, alongside the already stressful situation of being treated for cancer.

Interest in where radiotherapy services are located is understandably heightened by the NHS England review of stereotactic radiotherapy and stereotactic radio surgery services, which is being undertaken at a national level. For the benefit of Members, let me explain that those services involve a type of external beam radiotherapy treatment currently commissioned by NHS England for the treatment of patients with a wide range of cranial cancers. That consultation closed recently, on 26 January, and as part of the review, NHS England found

“an unmet need in the provision of treatment, with services distributed unevenly across the country.”

The proposed changes to the way in which stereotactic radio surgery and radiotherapy services are commissioned in England was looked at in the public consultation. Proposals include consideration of the location of services provided in the interests of ensuring equity of access, and the results are being reviewed by NHS England.

My hon. and learned Friend will be aware that NHS England has also carried out a separate, high-level exercise to assess capacity and demand for external beam radiotherapy more generally at a national level to give it a sense of the national picture. A further phase of work is proposed to take place locally, as there will be some specific local issues of which commissioners and providers will need to take account. That process is due to begin in late March.

Accessibility is characterised by an assurance that all patients are offered the most appropriate and effective treatment for their cancer. The latest research suggests that about 40% of all cancer patients should receive radiotherapy, complementing earlier recommendations made by the National Radiotherapy Advisory Group that aim to boost cancer survival through increasing access to that therapy, delivered as part of a treatment with curative intent. The England average access rate was 33% in 2007, and 38.8% in the most recent figures, which demonstrates real progress. I know, however, that there is further to go, as my hon. and learned Friend made clear in his speech.

NHS England has told me that the radiotherapy clinical reference group, which supports it in commissioning radiotherapy, is of the view that all patients should be offered equitable access to specialist radiotherapy care and treatment. The clinical reference group plans to build on the assessment of radiotherapy demand and capacity for England by considering aspects such as innovative treatments, the stock of equipment and how needs differ across areas. That national overview will enable commissioners to ensure that the right services are in the right places to meet future demand, including innovative forms of radiotherapy. Such improvements might well mean that, in future, patients need fewer episodes of treatment, so the problem of repeated tiring journeys would at least be reduced. I think we would all welcome that.

Access to radiotherapy treatment locally is a matter for NHS England to lead on. The decisions on the introduction of satellite radiotherapy centres will need to involve the local providers—in this case, East and North Hertfordshire NHS Trust—and NHS England as commissioners. As my hon. and learned Friend said, his closest radiotherapy services are the excellent services at the Mount Vernon hospital, and there are also services at Addenbrooke’s hospital in Cambridge. NHS England will continue to review the need for additional radiotherapy facilities outside those centres, if such facilities would benefit sufficient numbers of patients, be economically viable and enhance the existing care pathways.

It is possible that, as a result of those discussions, it will be found that more radiotherapy services are needed, but the optimum location will be determined by a number of criteria, including the impact on nearby trusts and existing cancer pathways—in other words, in trying to balance out one lack of access, we would not want to cause a problem elsewhere. Such decisions need to be looked at in the round in the local health economy. However, my hon. and learned Friend made good points about access, and I will ensure that those are underlined.

I understand that in 2009-10 there was a capacity review of radiotherapy provision for the Mount Vernon cancer network. That concluded that although the capacity to meet future demand up to 2016 could be met by the current providers, increasing access to the north of the network was an objective that needed looking at. My hon. and learned Friend underlined that point.

[Sir Oliver Heald]

It is remarkable that the county of Hertfordshire, which has 1.2 million people, does not have radiotherapy facilities at all. Does my hon. Friend agree that the urgency of the matter is changed by the fact that the whole county—or at least most of it—has to go all the way down to London? That is a rather old-fashioned approach. I do not know whether she is prepared to ensure that my remarks, and the support of my right hon. Friend the Member for North East Bedfordshire (Alistair Burt) and my hon. Friend the Member for Stevenage (Stephen McPartland), are relayed to NHS England.

[Jane Ellison]

I will certainly do that. I make a point of drawing the attention of the relevant clinical leaders to our debates, and to the strength of feeling expressed by Members on behalf of their constituents. I am of course happy to do that.

The siting of a satellite unit at either the Luton and Dunstable hospital or the Lister hospital in Stevenage was considered in the previous review, but given that the system already had sufficient capacity to meet future requirements, the report acknowledged that any satellite development would need to be planned as part of existing capacity, not additional capacity. In other words, services would have to transfer.

Any review should include an assessment of the best fit, to ensure that if a radiotherapy satellite service is a preferred solution, it is located in the right place. I understand all the points made about location and the county not having such a facility, but equally, looking purely at the geography and the county boundaries might not always lead one to completely the right conclusion. That point was, however, important and has been well underlined today. The unit has to be located in the right place, so that there is capacity, and so that the preferred location offers cost-effective treatment to a sufficiently large number of patients. That is the important point: the number of patients.

I understand, too, that my hon. and learned Friend is not talking about using old equipment, but looking at the location of new equipment. Furthermore, sometimes there is concern about involving what might be called the “penny packet” approach, scattering specialist services thinly to achieve better access. One of the challenges with that approach, however, is that while it can often make sense to people on the face of things—“Of course we want those services there”—there is always the caution about staff not getting the benefit of mutual support, and expertise in particular can become diluted. That approach might also make it sometimes more difficult to manage demand, as one unit might become overwhelmed while others are underworked.

Those factors need to be taken into account, and I underline the expertise one in particular. We all want our constituents to be seen by people who treat sufficient specialist health problems to be really expert in them. We want those experts to see enough patients to know what they are doing when they see something. Concentration of expertise is important in many areas of health and has been much focused on.

[Sir Oliver Heald]

I am suggesting a Mount Vernon operation—that it provides the service in the Lister. Mount Vernon would have two fewer machines, which we would have in the Lister. In that way, we hope that the expertise would be as good as it always has been, but people would not have to do the long journeys.

[Jane Ellison]

I completely understand that point. I expect local clinical leadership to understand the expertise and staffing available. All those factors will be taken in the round and looked at, because the work is specialist. I would expect the NHS to look at things such as his suggestion about the new machines at Mount Vernon. I will of course write, drawing attention to the particular concerns of my hon. and learned Friend and of my hon. Friend the Member for Stevenage about access and the travel distances. They, however, would in turn expect the local NHS to look at issues such as the distribution of expertise to ensure that the continuity of expertise was available.

[Stephen McPartland]

I am grateful to the Minister, who is being generous in giving way. The local Lister hospital in Stevenage is part of the same trust as Mount Vernon. The chief executive and the cancer surgeons of the local hospital support the concept of a satellite radiotherapy unit, so the local NHS supports having such a unit in Stevenage, or nearby in Hertfordshire. The issue we have is with NHS England getting on and commissioning it. The problem is that we cannot understand how the NHS is getting travel times of 45 minutes.

[Jane Ellison]

I have certainly picked up from the debate the importance of the issue of travel times. I will make a particular point of drawing that to NHS England’s attention.

It is always heartening to hear that colleagues are so engaged with their local health leaders as to be working together on such things. I am sure that that will all be fed into the process of making a decision. That will have to look at the implications for the whole cancer pathway, and all the other patients who receive services as part of the cancer network.

My hon. and learned Friend the Member for North East Hertfordshire, my right hon. Friend the Member for North East Bedfordshire and my hon. Friend the Member for Stevenage are hoping to meet the local NHS, as they detailed. Again, it sounds as if all the right people will be at that meeting. I strongly encourage colleagues to continue such meetings. Such a high level of engagement with local clinical leaders can only be to the benefit of their constituents. They will want to get the best and safest services for their constituents.

I congratulate my hon. and learned Friend the Member for North East Hertfordshire, who was supported by other right hon. and hon. Friends, on the debate and on their interest in the issue, which they are championing on behalf of their constituents. It is great to hear that they have the local newspaper, The Comet, involved, because it is always good for local newspapers to be involved in health campaigns, drawing attention to and explaining the issues to their readership. It sounds like a real commitment to fighting cancer in their part of the country. I commend them. I will draw the debate to the attention of those who will be interested, including NHS England. I am happy to continue to liaise with Members, and to hear how they get on with their discussions and the eventual outcome of the local review.

Question put and agreed to.