Improving Cancer Outcomes

Jane Ellison Excerpts

Thursday 5th February 2015 Commons Chamber

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

It is a pleasure and an honour to respond to an excellent debate in which we have heard distinguished contributions from both sides. This is the sixth debate in six months I have responded to on cancer, which demonstrates the House’s interest in this important subject. I congratulate the all-party groups on cancer, not only on securing this debate, but on everything they have achieved—I will touch on that at the end of my remarks. I sometimes think that with the expertise we have between us, and given the number of times some of us have met in these debates, were we not to be returned to this place, we could take our cancer awareness roadshow around Britain and do some good for the nation in another way.

I shall try to respond to as many points as possible, and in some areas, I can update the House. However, I want to rattle through as many of the detailed points as possible, and I am sure that the shadow Minister, who I like very much, will forgive me if I do not counter his reiteration of the Opposition’s policy position with a detailed exposition of the Government’s. I will say only three things. First, I shall respond mostly to the Back-Bench contributions. Secondly, I do not recognise his figures on reduced spend, although I understand where they are derived from. Thirdly, when the NHS is bringing together its own strategy on cancer, I would question why we would want to come forward with another strategy. As the hon. Gentleman and others have argued, there is a remarkable degree of consensus about what needs to be done, and that is the area we need to focus on.

Obviously, improving cancer outcomes is a major priority for the Government. As the annual report on our outcomes strategy showed in December, we estimate that we will save an extra 12,000 lives a year by 2015, more than double the ambition of 5,000. That figure of 12,000 lives is the best estimate based on a projection using the latest survival estimates and assuming incidence is constant, which I think responds to points made in the debate. I am sure that my hon. Friend the Member for Basildon and Billericay (Mr Baron) will be interested to see the detailed breakdown of how that figure is derived in the annexe to the fourth annual report on the cancer outcomes strategy.

Clearly that figure represents a great achievement by the NHS and it is good news for the thousands of people affected by cancer. Yesterday was world cancer day. A number of Members have referred to the one in two figure. I emphasise that, in the bylines to that headline, it made the point that that was only if lifestyle factors for many people were not adjusted. In fact, chances are considerably better if we could make some of those lifestyle changes. That was alluded to my right hon. Friend the Member for Sutton and Cheam (Paul Burstow), who as usual made a distinguished contribution. I know that he could not stay for the winding-up speeches.

My hon. Friend the Member for Salisbury (John Glen) made well a point about prevention. Were it not unparliamentary, I might have run up the green Benches to embrace him when I heard his argument in favour of tobacco control and standardised packaging. I could not agree with him more. It was absolutely excellent. The “Five Year Forward View”, which many Members have talked about, is the NHS’s vision of its future strategy. It was brilliant to see prevention right at the heart of that strategy; there is an entire chapter about it. Picking up the point made by my hon. Friend the Member for Salisbury, I have discussed this issue with all the major charities over the past six months and asked them to bring their considerable reach and influence to bear and to talk as much about prevention, given their authority on treatments and drugs. That is an ongoing conversation and we have seen some evidence of that. My hon. Friend is right to remind us that 80,000 people a year die in England as a result of tobacco. If only the women in the 1970s who started smoking knew what we know today; it is now two weeks since lung cancer took over from breast cancer as the biggest killer of women. We continue with our tobacco control measures with enthusiasm. We have a good record.

Of course we want to match the best in Europe, and there has been some discussion about that. We accept that cancer survival in England has historically lagged behind the best performing countries in Europe and the world. However, none of those international comparisons of cancer survival includes patients diagnosed after 2007. I delved into this matter in anticipation of the debate. We always cite the figures, but the reality is that because of the time lag, the five-year survival rates are essentially the gold standard—the benchmark against which the international comparisons are made. Therefore, because of the time lag in the five-year survival rates, we are not in a position to know exactly how we are doing compared with other nations.

However, I take the points made often and well by my hon. Friend the Member for Basildon and Billericay about the one-year survival data. It is inaccurate at the moment to use those figures based on patients diagnosed before 2007 as a measure of current performance in the system. The next best estimate of international benchmarks will be in 2017-18. Until then we will look at issues such as projection.

[Mr Baron]

May I seek clarity on that? Is my hon. Friend saying that the 2007 figures are pertinent to the five-year survival rate figures? What we have been focusing on is the one-year figure as a means of driving forward earlier diagnoses, because it is largely at the one-year point that we are losing thousands of lives.

[Jane Ellison]

I completely understand that point, which is well made. We will not have the next best international benchmark until 2017-18, but my hon. Friend is absolutely right that that does not mean that we are without proxy benchmarking and real benchmarking in the interim. He is right to draw attention to the one-year survival rates. I was trying to give a sense of the international picture and of comparisons.

On how further to improve cancer outcomes, I am sure all Members will be delighted that on 11 January, NHS England announced a new independent cancer taskforce to develop a five-year action plan for cancer services, to consider the vital survival rates and to improve them, saving thousands more lives. The taskforce has been set up to produce a new cross-system national cancer strategy, bringing all the strands together, as so many Members wanted. This is a strategy—by the NHS for the NHS—to take us through the next five years to 2020, building on NHS England’s own vision for improving cancer outcomes, as set out in the “Five Year Forward View”.

Picking up a point made by my hon. Friend the Member for Salisbury, many of the major charities involved in the taskforce have told me that much of it is about working smarter. It is not necessarily to be measured purely by spending more. I thought my hon. Friend made a very thoughtful contribution on that topic. The taskforce is an expression of our ambition for outcomes. It has been set up in partnership with the cancer community and other health system leaders, and it is chaired by Dr Harpal Kumar, chief executive of Cancer Research UK. It met for the first time on 27 January. The new strategy will set a clear direction covering the whole cancer pathway from prevention to end-of-life care; a statement of intent will be produced by March 2015; and the new strategy will then be published in the summer.

I have always been keen in responding to these debates to emphasise the need for the NHS and all others intending to improve cancer outcomes to come together and interact effectively with Parliament. That is vital. The expertise is here in the all-party group, so I am pleased that the cancer taskforce yesterday sent a call for evidence to the various all-party groups—on pancreatic cancer, brain tumours, breast cancer, ovarian cancer and cancer generally. I of course encourage colleagues to submit evidence to the taskforce. After the debate, I will speak to the chairman and of course draw his attention to the quality of the inputs into this debate.

Turning to deal with early diagnosis, I shall not reiterate all the points made about the importance of tackling late diagnosis. We have heard some important illustrations of just how crucial this can be. We have invested over £450 million to achieve earlier diagnosis. As part of the recent taskforce announcement, NHS England also launched a major early diagnosis programme, working jointly with Cancer Research UK and Macmillan Cancer Support, to test new approaches to identifying cancer more quickly.

The new approaches include offering patients the option to self-refer for diagnostic tests; lowering the threshold for GP referrals; creating a pathway for vague symptoms such as tiredness—a big issue for pancreatic cancer, so it is important to work on this; and setting up multi-disciplinary diagnostic centres so that patients can have several tests done at the same place on the same day. So many Members have spoken in today’s and other debates about the wearying journeys and the debilitating effects that multiple tests on multiple occasions can exert on their constituents—another important area to look at. NHS England’s aim is to evaluate these innovative initiatives across more than 60 centres around England to collect evidence on approaches that could be implemented from 2016-17.

Briefly, all Members will need to debate and bring more into the open in the coming years the inevitable tension between the concentration of expertise to carry out early diagnosis, particularly in rarer cancers and those with more difficult symptoms, and the understandable desire that Members and members of the public have to have facilities closer to people. There is a tension, and we will inevitably have to debate it. I think it was the hon. Member for Heywood and Middleton (Liz McInnes) who made the point about the number of rare cancers that GPs see. The issue has been teased out in these debates before, but in reality the number of common cancers seen by the average GP is very few, while the number of rare cancers they see is very few indeed.

[John Glen]

Does the Minister acknowledge that there is a difference between urban and rural in this context? While those who represent rural constituencies understand the need to aggregate services to get the specialism, we are also concerned about access. Is this not a careful judgment to be made?

[Jane Ellison]

I entirely agree; I think there is a balance to be struck. One of the issues that was discussed at about the time of the launch of the “Five Year Forward View”, by the NHS among others, was that of moving consultant expertise from secondary to primary settings. There are a number of ways of looking at that. I urge Members to feed the points that they have raised to the taskforce, because it is exactly that kind of new way of looking at things that we want to capture in its work.

Since 2010-11, the Department of Health has undertaken a series of local, regional and national Be Clear on Cancer campaigns to raise awareness of signs and symptoms of specific cancer types, and to encourage people with such symptoms to visit their GPs. Decisions on further Be Clear on Cancer activity will be made during 2015, and will be based on all the available evidence relating to the effectiveness of the campaigns. I will argue strongly for their continuation, because I think that the case for them has been conclusively made. Many have been very successful, and they are evidence-based, which I think is important. The Department will continue to work with Public Health England, NHS England and all the relevant experts and stakeholders to keep the campaigns under review.

Let me briefly update the House on the ovarian cancer campaign, which was mentioned by the hon. Member for Washington and Sunderland West (Mrs Hodgson), and for which she is a long-standing and doughty champion. I recently lost a dear friend to ovarian cancer, so the issue is very close to my heart. Public Health England ran an ovarian pilot campaign in the North West television region between February and March last year, which, as the hon. Lady said, focused particularly on awareness of bloating as a symptom of ovarian cancer. Public Health England is waiting for the full evaluation results of the campaign, but we expect the interim report to be shared with the charities later this month. Public Health England has also agreed to meet them. A decision on how to proceed will then be made, at a national level.

A draft policy proposal for BRCA gene testing is among those on which NHS England’s clinical priorities advisory group is awaiting consultation. That consultation will probably take place following a 90-day public consultation on the decision-making framework. I understand that NHS England will soon consult on the lowering of the threshold for BRCA1 and BRCA2 testing in line with guidance from the National Institute for Health and Care Excellence.

Let me now briefly touch on the point made by the hon. Member for Heywood and Middleton, from whose health expertise we benefited earlier in the week during another debate. In May last year, before the hon. Lady entered the House, we had a very good debate about cervical cancer and screening following a tragic case involving a young woman in Liverpool. She may find it interesting to read the report of that debate, in which Members described cases similar to that of the young woman to whom she referred.

If people have gynaecological symptoms that make them alarmed enough to visit their GPs, they should be referred for diagnostic tests. Smear tests are screening tests, not diagnostic tests. In fact, the best clinical guidance is that if there are gynaecological symptoms, a smear test will only delay possible diagnosis. I think it important to send young women the message that if they are worried about gynaecological symptoms, they should seek a diagnostic test rather than a smear test.

My hon. Friend the Member for Castle Point (Rebecca Harris) raised the important issue of brain tumours. I can update her on the work that has been done. Representatives of the Brain Tumour Charity recently met representatives of Public Health England, and the meeting went very well. The charity is to give a presentation to the school nursing partnership in March. It is also going to contact the NHS England’s national clinical director for cancer to see how it can contribute to work on early diagnosis. Other actions were agreed on, but I understand that that particular piece of work is proceeding well.

As we know, screening is an important way of detecting cancer early, and under this Government there has been a £170 million expansion and modernisation of cancer screening programmes. They are reviewed regularly, and I am always happy to tell Members how further information can be submitted to the UK National Screening Committee.

On cancer waiting times, the NHS is treating more cancer patients than ever and survival rates are improving. In the last 12 months, nearly 560,000 more patients were referred with suspected cancer than in 2009-10, an increase of 60%. In 2013-14, almost 35,000 more patients were treated for cancer than in 2009-10, an increase of 15%.

Most waiting times standards are being maintained despite the growing numbers, although we are aware of the dip in the 62-day pathway standard in the last three quarters. Of course it is vital that all patients fighting cancer should have high-quality, compassionate care and we expect every part of the NHS to deliver against those national standards. Therefore, the NHS is looking urgently at any dips in local performance to ensure that all patients can get access to cancer treatment as quickly as possible. It has a specific waiting times taskforce looking at that.

Radiotherapy has long been championed by the hon. Member for Easington (Grahame M. Morris). Radiotherapy can be a helpful treatment for some patients. His points about its success rate when used at the appropriate time were well made. As part of its recent announcement, NHS England also committed a further £15 million over three years to evaluate and treat patients with a modern, more precise type of radiotherapy, stereotactic ablative radiotherapy, or SABR, to which he referred. That new investment is in addition to NHS England’s pledge to fund up to £6 million over the next five years to cover the NHS treatment costs of SABR clinical trials, most of which are being led by Cancer Research UK. Those are for pancreatic cancer, lung cancer, biliary tract cancer and prostate cancer.

I can confirm that we are investing £250 million in two proton beam therapy centres. One is at UCLH—I saw the foundations being built when I visited the hospital recently; it was exciting to see that centre being built—and the other is at the Christie in Manchester, so that patients can be treated in the UK. As Members will be aware, patients are currently referred abroad

On the cancer patient experience and the cancer patient experience survey, nothing could more amply demonstrate the importance of putting cancer patients’ experience at the heart of treatment and of the NHS response than the speech by my hon. Friend the Member for Filton and Bradley Stoke (Jack Lopresti). It was impossible to remain unmoved by it. It could not have more aptly underlined the importance of taking patients’ experience into account. Therefore, I was pleased to see that the results of the 2014 cancer patient experience survey, published in September, show some improvement on many of the scores since the previous survey—89% of patients reported that their care was either excellent or very good.

Following the 2014 survey, NHS Improving Quality is launching a pioneering project that pairs highly rated cancer trusts with trusts that have potential to improve. That “buddying” programme will involve up to 12 trusts and will be directed at clinical and managerial staff so that we can continue to use that survey to drive improvements.

As to the future of the survey, on which there has been some discussion, my hon. Friend the Member for Basildon and Billericay mentioned the new tendering of the contract, which NHS England is taking forward. For those reasons, it is unlikely that there will be a survey report in 2015. I know that that will be a disappointment to him, but it is very much the intention to run a survey this year for publication next year. NHS England is working with a range of stakeholders, including cancer charities, to ensure that that survey is even more effective.

[Mr Baron]

I can probably accept that there may be good reasons for the delay, but perhaps even more importantly, will the Minister do what she can to ensure that the results of that survey, when it is eventually brought forward, are followed through for the benefit of patients? Too often, they are not and different CCGs are doing different things with the results.

[Jane Ellison]

Absolutely. That is the purpose of the buddying programme. There is now a more formalised process to ensure that those that are not doing so well are “buddied up” with those that are doing very well.

I want to make a few more points in response to hon. Members’ comments. My hon. Friend rightly brought up the issue of CCG accountability and how we hold CCGs to account. I congratulate the APPG and his personal campaign to make sure we get the one-year cancer survival rates added to NHS England’s delivery dashboard from April this year. Where the evidence from the delivery dashboard is that local providers are not meeting the standards, that will be challenged by NHS England. I think there is still work to do to understand how we can do that most effectively. I know the APPG will also be giving thought to that. I encourage all local authorities, health and wellbeing boards and Members to be part of that challenge process. I also refer them to the work of the chief inspector of general practice, Professor Steve Field, in that regard, because that is an important part of his work, too.

I can confirm that work is ongoing with regard to free social care at the end of life. The hon. Member for Easington asked about that. That work is ongoing, but the Minister with responsibility for care will be able to expand on that.

On health and inequalities, I could not agree more with all hon. Members who made the point that tackling health inequalities is inextricable from tackling cancer effectively. I visited the constituency of the hon. Member for Nottingham North (Mr Allen) recently. The figures for how many cancers are diagnosed through the emergency route have been put on the record in this debate—around 22%. He told me that in his constituency 40% of lung cancers are diagnosed in A and E, and they have very poor outcomes. That brought that point home to me extremely clearly.

Sean Duffy, the national clinical director, is passionate about the treatment and care of older people affected by cancer. That can play a very significant role in improving our overall outcomes. I know that is something he wants to focus on through his call to action, as well as looking at lower socio-economic groups and some black and minority ethnic groups. A recent Be Clear on Cancer campaign on prostate cancer took place in six London boroughs and focused on black men and their particular susceptibility to that cancer.

On rarer cancers, I have touched on some of the work that is going on, but I am pleased that Cancer Research UK’s new strategy launched last year set out how it would increase research in key areas such as early diagnosis, and again that work will feed into the taskforce.

On research, I will not go into detail, but I invite my hon. Friend the Member for Castle Point to contact me at the Department of Health with regard to research on brain cancer. I was recently able to supply some very detailed figures to the all-party group on pancreatic cancer from the chief medical officer, and I would be very happy to supply them in her area of interest.

Lastly, let me give some reassurance on access to data. Transparency is a key theme for this Government. We have rightly put huge amounts of data into the public domain. It is a frustration that the data availability issue to which my hon. Friend the Member for Basildon and Billericay referred has been hard to resolve. Last year some concerns were raised about the legitimacy of the release of patient data to a range of organisations. When these concerns were raised, Public Health England did absolutely the right thing and suspended the release of data while it conducted a full review. This review is now complete. Public Health England and the Health and Social Care Information Centre have also clarified the legal basis of data transfer between the organisations and a letter of authority has just been issued by the departmental sponsors to remove any ambiguity. Data should now begin flowing more quickly.

I would like to thank all those who have contributed to this debate and to so many other debates we have had in the House on this vital subject. I strongly believe there is a great deal of consensus about what needs to happen. We need to continue to challenge the system, and I am delighted that Parliament continues to challenge Ministers in this regard. The new NHS England independent cancer taskforce is leading the way in partnership working and will make a real difference.

If this is the last general debate we have on cancer in this Parliament, may I say thank you to the various APPGs and the people who speak for them, and give them the following assurance? I can tell them that, although it may not always seem like it, in the 18 months or so that I have been a Minister their work has made a difference, and I do know of things that have happened because APPGs and individual Members championed them in this place. If that does not give them the heart and encouragement to keep going and to come back in the new Parliament and champion these issues further, I do not know what will. I congratulate them on their efforts today, and on other days and throughout the year, on this highly important topic that matters so much to all our constituents.