Cancer Patient Experience

Debate between Jane Ellison and James Clappison

Wednesday 30th October 2013 Westminster Hall

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

Thank you, Mr Owen. It is a pleasure to serve under your chairmanship.

I congratulate my hon. Friend the Member for Hertsmere (Mr Clappison) on securing this debate. I am conscious that I am still relatively new to my post—I am in my fourth week—so if I am unable to respond in total detail to some of the points raised, I will undertake to get back to the relevant hon. Members.

This has been a very good debate. Many extremely constructive points have been made, and there have been some thoughtful contributions. Members, some of whom have not been able to stay for the end, have brought great insight and experience to the topic.

Cancer patient experience is close to our hearts, and I echo the tributes paid to NHS staff and, particularly, to the charities that campaign in this area. We have all taken part in moonwalks and Macmillan Cancer Support fundraisers or gone round at the back of the race for life year after year talking to cancer survivors and people running or walking with the names of loved ones on their chests, and we know what amazing work those charities do, particularly on highlighting patient experience.

In England, each year more than 250,000 people receive a cancer diagnosis. As we have heard this morning, being diagnosed with cancer can be a traumatic experience. Like the shadow Minister, a dear friend of mine has just had that experience, so I am going on that journey with my friend to understand how she will be cared for and treated as she goes through what I hope will be a full recovery.

We know that receiving personal care that is responsive to people’s needs is vital. The Government have committed to making England a global leader in producing great cancer outcomes. We are making strides, but we know there is further to go. We are improving access to treatments, including investing £750 million during this Parliament, and we are strongly committed to saving an additional 5,000 lives by 2015.

The cancer outcomes strategy remains at the core of what we are doing and what we hold the NHS to account for in terms of delivering. However, if the NHS is to deliver high-quality care, patients’ voices and experiences are vital, and I could not agree more with what everyone has said about the end-to-end experience of care being important and a big part of recovery.

My hon. Friend rightly asked that the NHS give parity of esteem to the patient experience, alongside patient safety and clinical effectiveness. I agree, and through the mandate we have asked NHS England to deliver continued improvement in patients’ experience of care. Domain 4, which is one of the key areas of the NHS outcomes framework, is

“Ensuring that people have a positive experience of care”.

I reassure my hon. Friend that that is of equal importance to the other key areas.

[Mr Clappison]

I was remiss in not welcoming the Minister to her post. I welcome her most warmly, and I am sure she will do an excellent job. Will she take on board the fundamental plea made by Macmillan Cancer Support and echoed in the debate that the patient experience be put at the heart of the inspection process and of the assessment of different NHS organisations? Will she ensure that that is made a real priority?

[Jane Ellison]

Absolutely, and I will talk a little about some of the ways in which that will be done, but I would make the point that the Secretary of State has made this an absolute priority. He could not have been clearer recently about the priority that the Government and he personally put on the patient experience. We have never given such high-profile attention to talking about the patient experience and patient care. I hope that gives some reassurance, but I will talk later about some specifics.

In the same vein, let me pick up some of the shadow Minister’s interesting points. I was interested in some of the initiatives she mentioned. Again, they all feed into the idea of putting patient care and the patient experience absolutely at the heart of things. I certainly undertake to look at some of the specific local examples she highlighted.

To drive a good patient experience, we must listen to patients’ voices. In December 2010, the Government published the first national cancer patient experience survey report. The survey was the first cancer patient survey to take place for six years, the first to involve patients with all types of cancer and the first national survey explicitly to use the word “cancer”. The survey revealed that, while there had been substantial improvements in the patient experience since 2000, there are still unacceptable variations in the quality of care people receive, as hon. Members have highlighted.

To drive improvement locally, reports were produced for individual trusts. This is where the transparency agenda the Government set such store by is really important. The data are openly available and published, and all of us—not just people in the NHS, but hon. Members, local councillors and local government—can hold commissioners and providers to account, based on that openly published data at local trust level. Commissioners and providers can be directly challenged and incentivised to improve. Providers can benchmark their performance against each other’s. Quality Health, which provided the survey, also visits poor-performing trusts to discuss their results in detail. A number of those discussions have led to really quick improvements in local outcomes, but there is always more to do.

The cancer outcomes strategy, which we published in January 2011, built on those results. We have acted to improve the patient experience at national level by implementing the cancer information prescriptions programme and expanding the Connected national advanced communications skills programme, which is a bit of a mouthful, but which is essentially about supporting thousands of clinicians to work more effectively with patients, picking up the many issues highlighted by my hon. Friend, the hon. Member for Strangford (Jim Shannon) and others regarding how seemingly small issues and small aspects of communication actually matter an awful lot at an intensely difficult time for patients and their families.

Since 1 April this year, NHS England has been responsible for delivering improvements in the cancer patient experience. That is one reason why I cannot just stand here and make particular commitments. Such debates are, however, useful because they help NHS England to know parliamentarians’ priorities in terms of where it should focus some of its attention.

Building on the work of the 2010 and 2012 patient experience surveys, NHS England published its report on the 2013 survey at the end of August. It showed improvements in many areas and some very positive experiences of aspects of care, including on privacy, being treated with respect and being listened to. Overall, 88% of cancer patients reported their care had been excellent or good, and there were some real highlights. As my hon. Friend highlighted, some of the percentages in key areas were in the 80s and 90s, although we are obviously interested in the areas where we could do better.

It is clear that many trusts acted on the findings between 2010 and 2013, and they are to be congratulated on that. Many have reorganised their pathways and services, retrained staff and created further mechanisms for patients. Cancer charities have been involved in further analysing the data to understand particular aspects of care and particular groups of patients and to create new information for patients, where needed. Much of that has been touched on this morning.

We have also looked at some of the variations in care. The hon. Member for Strangford and others mentioned care plans. Over the past three years, more work has been done on them, but given that only 22% of patients were offered care plans, everyone would acknowledge considerable improvement is still needed.

NHS England has convened a cancer patient experience advisory group to get direct input on priorities for service improvement. The group includes clinicians, experts concerned with cancer care and, crucially, patients. The group’s first meeting has now taken place. It examined the results of the 2013 survey, and actions have been agreed. As a result, NHS Improving Quality will develop a rapid-response programme to visit trusts with poor scores to discuss results and suggest improvements. I hope that gives Members some assurance about the fact that the survey does not just sit there; it is very much being acted on.

NHS England also wants to highlight high-performing trusts and identify best practice. It will put that information into toolkits that other trusts can use to develop better service in response to poor scores. NHS England is also encouraging the use of the Macmillan values-based standard and other patient-led tools, which engage patients and staff in co-creating and measuring some of the things that matter so much with regard to dignity and respect. All organisations involved in delivering care are urged to look at the survey and take it extremely seriously.

Time is a little short, so I will try to answer some of the specific questions raised. First, we recognise that making relational care a priority is important. That includes communication, trusting nurses and all the other things that have been talked about today. Rather than include references in the mandate, we have included important pledges in the NHS constitution, setting out what patients have a right to expect. All NHS services have a duty under the constitution when carrying out their functions, and we have a range of indicators to capture how well the NHS is performing in delivering dignified and personal care.

On the CQC inspection regime, I can reassure my hon. Friend that the CQC has made a commitment to listen and to take the experiences of people using services very much to heart. The new inspection teams include trained members of the public called “experts by experience”. In addition to public listening events, that will be an important way of putting patient experience at the heart of inspections.

A specific question was asked about including secondary breast cancer in the survey. NHS England is trying to ensure the survey catches the needs of all patients and looks across all cancers, but my hon. Friend’s point will have been taken.

I was asked about the future of the survey, including by the shadow Minister. NHS England has confirmed it will be run in 2014. The organisation will then undertake a review of all the surveys it runs. The debate will have highlighted to it the value that so many people place on the survey and the important role it has played in driving improvement. I cannot say whether NHS England will continue it, but I will certainly vividly describe to NHS England how strongly Members feel and what role they think the survey has had in driving change.

My hon. Friend’s last question was about using the survey to improve cancer care, and I have alluded to the ways in which we are trying to do that. In particular, I give him the assurance that the patient experience, putting the patient first and championing their care is absolutely at the heart of what all of us at the Department of Health are doing, taking our lead from the Secretary of State.

I thank my hon. Friend for highlighting the issue, and I echo his words from the start of the debate. I, too, thank the NHS staff and charities that do such amazing work in this area, and I hope hon. Members will continue to debate this important topic.