Blood Safety (Variant Creutzfeldt-Jakob Disease)

Debate between Jane Ellison and Paul Beresford

Thursday 29th January 2015 Westminster Hall

[Jane Ellison]

I will say a few words about some aspects of the Collinge work later, but I want to focus on giving an update on some of the work on the assays.

[Sir Paul Beresford]

In the early days of research, a number of different tests were brought forward. To my knowledge, all have fallen by the wayside bar one. Have any of the 18 research projects come up with tests that look fruitful?

[Jane Ellison]

I will come on to talk about the assay in some detail.

[Jane Ellison]

I will update the Select Committee further. We have already committed to submit an additional piece of work before the end of the Session.

I will say a few words about the work undertaken so far. The chief medical officer and I gave evidence to the Committee last April. The report was published in the summer and the Government response in October. In that response, the Government committed to responding with a further update report to the Committee. I subsequently received a letter from the Committee with more than 20 further questions, to which I responded in November. The Select Committee then held a legacy hearing on 3 December at which Professor David Walker, the deputy chief medical officer, and I gave further evidence.

I am extremely grateful to all members of the Committee who have put the issue on Parliament’s agenda and maintained a close interest in it, something that has been clear to me in the relatively short time I have been in post. I will write to members of the Committee, as we have undertaken to do, before the end of March with further updates on some work. That will include an update on the CQC issues that have been raised, which I will not give an update on today.

Let me focus on the potential use of the vCJD blood test. In the response, we made a commitment on that, so I can focus largely on it today. There is the potential to use a prototype variant CJD blood assay, developed by Professor Collinge and his team. He leads the relevant unit, and as hon. Members might know, the MRC is concluding its latest quinquennial review of that unit.

I am pleased to report that—along with two of my Public Health England officials, Professor Noel Gill and Dr Katy Sinka—Professor Marc Turner and Dr Lorna Williamson, the medical directors of, respectively, the Scottish and the English national blood services, met Professor Collinge and his team in October 2014 to discuss the potential use of the prototype assay. At the meeting on 13 November 2014 of the transmissible spongiform encephalopathy sub-group of the Advisory Committee on Dangerous Pathogens, Professors Turner and Gill presented a paper on the possibility of using the assay to carry out an anonymised blood prevalence survey for asymptomatic vCJD, as recommended by the Select Committee.

Members might recall that the ACDP is the independent scientific advisory committee that provides the Government with authoritative advice on all forms of TSE, including all forms of CJD. During the presentation to the sub-group, the professors asked three specific questions. I will update Members on those questions and the ACDP’s responses.

First, with a view to the ability of the assay to detect sub-clinical vCJD infection in otherwise healthy individuals, the ACDP was asked if it had confidence in three qualities of the assay. The first was sensitivity, which is the ability of the assay to give true positive results; in this case, that is the true number of asymptomatic cases that the test could identify in any population. The second was specificity, which is the ability of the assay to give true negative results; in this case, that is the true number of unaffected individuals that the test would identify in any population. The third was reproducibility, which is the ability of the assay to be reliably and repeatedly reproduced outside the centre in which it was developed.

Basically, that process would be to find out whether the assay could be used to identify people with asymptomatic infection, and those who showed no clinical signs of vCJD but who would be presumed at some stage to be potentially infective and/or go on to develop clinical symptoms. My hon. Friend the Member for Mole Valley (Sir Paul Beresford) said that symptoms could develop over a very long period.

The ACDP’s sub-group discussed the issue and agreed that the answer to the first question had to be no, because it has seen no published data on the assay when used in any human or animal samples from individuals without clinically diagnosed disease. Members might recall the February 2011 paper in The Lancet that first gave detailed information on this assay. That paper provided evidence that the assay can give, in seven out of 10 cases, a positive result in blood samples taken from patients with known and clinically diagnosed vCJD. Unfortunately, however, that is not what we need if we are looking for evidence of vCJD in those with no clinical signs. There is no published evidence that provides assurance that the assay, if used in the general population, would give true positive results in those who might be carrying the infection but are asymptomatic.

If a test for this very rare disease—it has been noted that we have had only 14 new cases in the UK since 2005, and only one was after 2010—is used in presumed healthy individuals, it is essential that it is accurate. We have no evidence that the MRC assay can identify vCJD infection in an asymptomatic individual. Those in Westminster Hall with a keen interest in science will understand that undertaking a test of large numbers of individuals when we do not know what a test result means—either for those individuals or, as in this case, for the development of effective public health measures—is not the best use of limited resources.

The second question that the ACDP was asked—

[Sir Paul Beresford]

Of course, the results would be anonymised, so the effect on individuals would not be apparent.

[Jane Ellison]

Let me move through the second question; I will be very happy to pick up on any further things in my additional response to the Committee.

The second question that the ACDP was asked was whether it would replace its current UK prevalence estimate of 1:2,000, which is based on data generated by a blood study using the MRC Prion Unit assay. In response to that second question, the ACDP also agreed that the answer to the question—whether to replace the current prevalence estimate—was no. It gave that answer because it is uncertain as to what the blood assay would measure in a general population. Even in the event that a prevalence result lower than the current 1:2,000 figure were found, the precautionary principle, which the Select Committee rightly emphasised in its report, would still apply and the 1:2,000 figure would continue to be used.

Thirdly, given its negative answers to the first two questions, the ACDP was asked what further data it would need to develop confidence in the outcome of any study using the assay. In summary, it suggested that in the first instance the assay developers work with the National Institute for Biological Standards and Control, and with others, to show that the assay can be used to identify asymptomatic infection, and with the blood services to develop the throughput of the assay. If that work progresses successfully, the ACDP will, of course, look again at the issue and we will take its advice on any potential use of the assay.

I turn briefly to the RelyOn issue, as it has been raised. RelyOn is the protein removal soak developed by DuPont, which Members have discussed. Members will recall that this technology has been fully considered by the Rapid Review Panel, which assesses new products that may be of value to the NHS in improving infection control, on two occasions.

Although the RRP raised specific points on the application of the product in practice—my hon. Friend the Member for Mole Valley well described the challenges around it being a soak—it considered that it would be a

“useful addition to available decontamination products”

if it could be correctly formulated. Obviously, it is for the developers to make a commercial decision to market the product, although I have noted what has been said about where DuPont is with that. It is not within the remit of the RRP to influence procurement and the uptake of products in the NHS, but we would always be willing to discuss with manufacturers the potential for adoption of all effective technologies.

The Minister for life sciences, my hon. Friend the Member for Mid Norfolk (George Freeman), takes seriously the ensuring of rapid access to innovative therapies. It is a large part of his portfolio, and that is why he launched the major review of the pathways for the development, assessment and adoption of innovative medicines and medical technology. That very much goes to the point made on whether the process can be speeded up to make it more easily usable.

The review will consider how to speed up access for NHS patients to cost-effective new diagnostics, medicines and devices. It will set out short and long-term options for action by the Government and relevant bodies, including the National Institute for Health and Care Excellence, the Medicines and Healthcare products Regulatory Agency and NHS England. That will make a major contribution to the policy debate and may well answer some of the points made on this piece of technology.

[Sir Paul Beresford]

I thank the Minister and apologise for being persistent. DuPont undertook the work because it thought there was a market. When the Department backed away from the market and it became apparent that, if developed, the product was not going to be put through as a requirement, perhaps through the Care Quality Commission, DuPont stopped. There was no market and no interest, so it stopped the project.

[Jane Ellison]

I understand the point. We have debated it before, and it was explored in the meeting with him and Professor Collinge. As I said, the Department was happy to discuss the potential for adoption with manufacturers, but the hurdle was the Rapid Review Panel’s rating. That work is ongoing and has moved on in the past year or so. The new Minister for life sciences acknowledged that there are sometimes challenges around the adoption and the speed with which large organisations can adopt these things, and I am happy to keep Members updated on that work.

There is a well established process whereby the Rapid Review Panel assesses potentially useful products. Those achieving a level 1 rating are suggested as suitable for NHS use. It was acknowledged by the DuPont representative on 5 March that RelyOn had reached only the level 2 rating and more work was needed. It would be unfair on the manufacturers of other level 2-rated products to change unilaterally the RRP processes for one product. As it stands, it is not formulated in a way that could be used in standard NHS decontamination processes.

In my remarks, I have offered a potential route forward and an assurance that the area is being carefully looked at by my colleague the Minister for life sciences. He is looking not only at soaks, but devices, other diagnostics and other medicines. I am happy to draw to his attention the view of the Committee and other Members that this product might be an example of where adoption has been delayed or held up.

We have undertaken to give the Committee a detailed update before the end of March on the other points that have been raised. I thank the Committee again for bringing this subject for debate. I am glad I have had another chance to put before Members some of the recent and ongoing developments and to commit to continuing to use our extensive research strategies. I stress, particularly to the Chair of the Committee, how seriously this Government and successive Governments have taken the subject. It was interesting to hear some of the history from the right hon. Member for Holborn and St Pancras. We will update Members shortly.

Thank you, Sir David, for giving me the opportunity and reminding me that I had time available to respond in a little more detail than I thought I could. I thank you, the Committee and Members who have attended the debate.

Head and Neck Cancer

Debate between Jane Ellison and Paul Beresford

Tuesday 1st July 2014 Commons Chamber

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

I congratulate my hon. Friend the Member for Mole Valley (Sir Paul Beresford) on securing this debate on this important issue and on continuing to champion it. It shows Parliament at its best when Members bring to bear here the expertise and insight they have acquired outside this place, and that is certainly what my hon. Friend is doing and I commend him on it.

Let me set the scene before dealing with some of my hon. Friend’s specific concerns. As he said, we have debated this issue before and I am anxious to try to keep him up to date with any developments as well as to make sure the House has a general picture of what we are doing in this area.

The Government want England to lead the world in tackling cancer. That is why our 2011 cancer outcomes strategy set the ambition to save a further 5,000 lives a year from cancer by 2014-15, including head and neck cancer. As my hon. Friend rightly said, the incidence of head and neck cancer has been increasing since the 1970s, with over 6,500 people in England diagnosed with oral cancer alone in 2012. That is due to the prevalence of the major risk factors for oral cancer, such as heavy alcohol consumption and smoking. Chewing betel quid, which is more common among south-east Asian communities, is also a risk factor for oral cancer and that may have contributed to the trend. As the House knows, we have major programmes of work in place to tackle smoking and excessive alcohol consumption —and it is heartening that, although there is a long way to go yet, we did see smoking prevalence rates dip below 20% for the first time in England in the most recent figures.

There is now growing evidence that HPV, already linked to the development of nearly all cervical cancer in women, is also a major risk factor for oral cancer. That is not disputed. The types of HPV that are found in the mouth are almost entirely sexually transmitted, and they have been associated with about a quarter of head and neck cancers. So if we can reduce the incidence of HPV in females through a high uptake of the national vaccination programme, a reduction of other HPV-associated cancers in females and males is likely to follow. I note, however, that my hon. Friend feels that that herd immunity is not going far enough and there is further to go. It is worth restating that the aim of the current HPV vaccination programme is to prevent cervical cancer related to HPV infection—that is where it started. When introducing the vaccine in 2008 the Joint Committee on Vaccination and Immunisation, which advises the Government on all immunisation matters, did not recommend HPV vaccination for boys because the reasoning was that once 80% coverage among girls had been achieved there would be little benefit in vaccinating boys to prevent cervical cancer in girls.

Judged by any standard, the HPV immunisation programme has been very successful. More than 7.8 million doses have been given so far in the UK since 2008, and we have among the highest rates of HPV vaccine coverage achieved in the world. I encourage hon. Members to look at their own local statistics, because although we achieve a very high average vaccination rate, there is some local variation. That matter is worth pursuing, particularly with schools, as this vaccine is delivered in schools almost universally. Some 86% of girls who are eligible for routine vaccination in England in the 2012-13 academic year have completed the three-dose course and 90% have received at least two doses, but in some schools the rates are lower and we want to get those up.

There is an increasing evidence base on the association between the HPV infection and oral, throat, anal and penile cancers, and on the impact of HPV vaccination on those infections. As a result, the JCVI issued a call for evidence in August 2012 to inform a review of HPV vaccination. The JCVI is very much aware of the issues concerning HPV vaccination for men who have sex with men, and at its October 2013 meeting recognised that the current immunisation programme may be of little benefit to those men and agreed to create an HPV sub-committee to consider the evidence for extending that vaccination programme. The sub-committee will aim to identify and evaluate the full range of options.

[Sir Paul Beresford]

The Minister has just talked about extending the programme, but to what or to whom?

[Jane Ellison]

On to my next paragraph. The sub-committee will look to identify and evaluate the full range of options for extending the protection from HPV infection to men who have sex with men, including by vaccinating them, and the potential extension of the programme to include adolescent boys. That deals with the point my hon. Friend was making. The JCVI HPV sub-committee—I apologise for all the acronyms but they are inevitable in a health debate—met for the first time on 20 January 2014 to review the available evidence on the impact and cost-effectiveness of potential extensions to the HPV programme. Any recommendation by the JCVI must be based on cost-effectiveness; there is a particular formula it uses to look at that within our health economy. The sub-committee will report its findings to the JCVI following consideration of a yet to be completed study by Public Health England into the cost-effectiveness of extending the HPV vaccination in both those directions. I hope I can give my hon. Friend some reassurance by confirming that the study will consider the impact of vaccination against penile, anal and oropharyngeal—head and neck—cancers and genital warts. Those things definitely form part of the studies that will be made and of the calculation about cost-effectiveness. There is no evidence to suggest that the current HPV vaccines will offer protection against skin cancer—I do not know whether he wishes to develop things further in that area, but we are aware of no evidence that makes that link.

The decision on the vaccination of adolescent boys requires the development of complex models to determine whether or not it would be cost-effective. Obviously, this would mean extending an already big programme to a much larger group. These models may identify a need to generate additional evidence, and therefore a decision on vaccination of adolescent males is not likely before 2015 at the earliest.

[Sir Paul Beresford]

One difficulty with models is that they take absolutely no account of the unpleasantness of the disease and the damage it does. Head and neck cancer is one of the most frightful conditions to deal with and to live with.

[Jane Ellison]

My hon. Friend makes a good point, but I will have to come back to him on it. I will not speculate at the Dispatch Box. Many factors go into these calculations, but I will make inquiries with regard to other JCVI decisions. I think that the severity of effect is taken into account and is part of the calculation, but I will clarify that and come back to the hon. Gentleman. None the less, he is right to remind the House of that matter.

The evidence to support a decision on a selective programme to target men who have sex with men may become available at the end of this year, which is earlier than expected. Obviously, the Department will consider carefully the advice from JCVI once the Committee has completed its assessment. As that is all in the future, it is worth talking about some of the things that we have at our disposal now in terms of early diagnosis. In addition to taking steps to tackle unhealthy lifestyle factors and the virus linked to head and neck cancer, we have also set out, through the mandate to NHS England, a clear ambition for the NHS to improve outcomes for all people with cancer.

One of the most common symptoms of oral cancer is a persistent sore or lump on the lip or in the mouth, so there is an opportunity for both doctors and dentists to play a role in supporting earlier diagnosis.

Since 2005, the referral guidelines for suspected cancer, published by the National Institute for Health and Care Excellence, has supported GPs to identify symptoms of oral cancer and urgently refer patients. The National Institute for Health and Care Excellence is currently updating that guidance to ensure that it reflects the latest available evidence.

[Sir Paul Beresford]

With great respect, on the question of the sore or the ulcer, the problem with cancer is that it is not sore until it is too late.

[Jane Ellison]

I will reflect on that point. I do not pretend to have the hon. Gentleman’s professional expertise. He has corrected the record, if he feels that it needs correcting. I hope that he will not disagree with me when I say that dentists have a key role to play in the early detection of oral cancer.

[Sir Paul Beresford]

indicated assent.

[Jane Ellison]

All dentists are trained as undergraduates to look for such signs during routine check-ups and to pay close attention to patients’ self-reported history of smoking and drinking—both key risk factors. A new patient pathway, currently being piloted in 94 practices, includes an oral health assessment, which requires dentists to examine the soft tissue of the mouth; assess a patient’s risk in relation to oral cancer; and offer advice on lifestyle changes.

I am also pleased to say that the General Dental Council has confirmed that improving early detection of oral cancer is to be included as a recommended topic in its continuing professional development scheme.

The hon. Gentleman will also be aware that the Department has run a series of “Be Clear on Cancer” campaigns, and we keep all forms of cancer under review to see whether they might be considered within that campaign. As he made the case that oral cancers and head and neck cancer are becoming more common, they too will be kept under review.

As I have mentioned in previous debates, the NICE improving outcomes guidance in head and neck cancer, which was published in 2004, provides advice on the organisation of health care for adults with those cancers. Head and neck cancer has also been referred to NICE as a topic for quality standard development.

The NICE guidance has informed the development of NHS England's service specification for head and neck cancer, which was published last summer. This clearly sets out what NHS England expects to be in place for providers to offer evidence-based, safe and effective services.

Of particular relevance to patients with oral cancer is the £23 million radiotherapy innovation fund, which supports the radiotherapy centres across England to deliver increased levels of intensity-modulated radiotherapy. That is a more precise form of radiotherapy, which reduces the risk of patients with oral cancers suffering from a permanent dryness of the mouth as a result of treatment.

Tobacco Products (Standardised Packaging)

Debate between Jane Ellison and Paul Beresford

Thursday 3rd April 2014 Commons Chamber

[Sir Paul Beresford]

I am ignoring the interruptions. I am particularly pleased by what the Minister has said and I thank her for it. I encourage her to move this nation ahead first, as I hope she will, rather than to wait for the Australians.

[Jane Ellison]

I thank my hon. Friend for his comments and support. He speaks from a position of knowledge, which is always a good position from which to speak. Sir Cyril and his team visited Australia, and hon. Members can find reflections on the Australian experience to date in the report. We are proceeding on our own timetable, not waiting for the end of Australian litigation on this subject.

Hospices (Children and Young People)

Debate between Jane Ellison and Paul Beresford

Wednesday 18th December 2013 Westminster Hall

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

I congratulate hon. Members on an excellent debate. I congratulate my hon. Friend the Member for Pudsey (Stuart Andrew) on securing it, and on speaking, not for the first time, with great passion and knowledge on this subject. The debate rather gives the lie to the lazy cliché that MPs bring no real-life experience to the House. It has been enormously informed by the life experience of a number of Members, and I congratulate everyone who has taken part. I will do my best to respond to the various questions put to me, but if by chance time defeats me, I undertake to write to colleagues. The Minister of State, Department of Health, my hon. Friend the Member for North Norfolk (Norman Lamb), is sorry that he cannot respond to this debate. As Members will have observed a few minutes ago on the Annunciator, he is otherwise engaged in the main Chamber.

Hospice care and palliative care for children and young people is an important and sensitive subject. From what the shadow Minister said, I can see that there is a good degree of cross-party consensus on the need to take the subject seriously and to sustain the way we serve the sector. The coalition placed great emphasis on palliative care in the coalition agreement, which included several specific commitments, such as a commitment to placing hospice funding on a more transparent and sustainable footing—that has been the subject of many comments today—and to introducing a new per-patient funding system for all hospices and providers of palliative care, so that the most gravely ill children and adults can receive care in the setting of their choice.

We have committed £10 million a year to support children’s hospices, as well as an additional £7 million in this financial year to support capital projects. In 2012, that allocation increased by over £700,000 to support new providers entering the sector, and we are keen to continue that substantial level of support now that responsibility has transferred to NHS England. We recognise the need for change in how children’s hospices are commissioned and funded. While a new funding system will be introduced in 2015, and while we have provided money to support hospices until then, we know that more needs to be done to support effective local commissioning. That, rightly, has been the focus of many of the speeches today.

Many hospices do not have as effective a relationship with their local commissioners as they might like, and funding from health commissioners is a relatively low proportion of the incomes of most children’s hospices and hospice-at-home providers. That is not universal, however. There are examples of local good practice where primary care trusts, formerly, and clinical commissioning groups, currently, have entered into funding arrangements with their local children’s hospice. My hon. Friend the Member for Salisbury (John Glen) has not returned from the main Chamber, but he spoke about the arrangements in his area for Naomi House, which has a per patient, per night tariff that has been arranged with the local CCG in Wiltshire.

We want the principle of CCGs supporting children’s hospices to be embraced widely across England. Monitor and NHS England are looking to include the arrangement between Wiltshire CCG and Naomi House in the national tariff document as a case study of good commissioning arrangements. Obviously, it is important that any nationally mandated or recommended tariff is based on a robust body of national evidence and provides clarity for commissioners on the services provided. I know that the working group has discussed the Naomi House example.

The charitable sector and the excellent fundraising work it does will always have a role. It has made an absolutely magnificent achievement over many years in all parts of the country; we have heard about that today. We are keen to see more effective and sustainable commissioning for hospices. We want commissioners to assume a more active role with their local providers, and we are keen to engage with the sector to see how we can support that. A lot of work is going on to develop that new model.

As has been referred to, the independent palliative care funding review, which reported in 2011, found that the absence of a clear funding model, or even a proper understanding of the costs of palliative care, was a major impediment to developing that care. The right hon. Member for Rother Valley (Mr Barron) mentioned the “stunning” absence of good data on the costs of palliative care, and the first step in developing a new funding system had to be improving the evidence base. We established eight pilots to collect a range of data and to test the review’s recommendations. The pilots—seven for adult palliative care, and one for children’s palliative care—are running for two years, and will provide the evidence to underpin decisions on how best to transfer to a fair and transparent funding system, which we intend to introduce in the 2015-16 financial year.

Hon. Members challenged us on the implementation plan and its timings. As part of the development of the tariff, there will be a plan for testing and implementation. Once we have clarity on the funding model, we will continue to ensure that the stakeholders are involved. Many of the hospices and their umbrella groups are closely involved in that work, and they will continue to engage in it.

I have heard the mood of the House on consultation. Although this is an NHS England lead, and I cannot commit it to carrying out a consultation, I can strongly encourage it and relay the mood of the House. The details of the tariff are still being worked on, but given that the new system will come into effect in 2015-16 and the sector needs to be able to plan ahead, we hope that that will happen in autumn 2014. That should be feasible, but I cannot commit to it. The sector is closely involved in that work and will be closely involved in the timing arrangements as well. It is key to say that we will not let this issue drift. The hospices are involved in the data collection and the discussion, and are key to the NHS England working group. The Government have made a commitment on that; we are conscious of that, and Members are right to push us on it.

NHS England is leading the work, and more than 80 organisations are involved. Barbara Gelb, the chief executive of Together for Short Lives, is a member of the Secretary of State’s children and young people’s health outcomes forum, so there is good read-across there. I emphasise how closely the sector is involved in the work, and how important it is to ensure that it supports the new funding model, which will be simple and non-bureaucratic—all the things that Members have alluded to today.

Having that clear, quality-assured information on the real costs of providing complex, costly care to a relatively small number of children will make a significant difference to commissioners. That has been emphasised by a number of Members. Concerns have been focused on that transitional period and the commissioning guidelines. The Department will consider in the coming months how we might further support that local understanding and preparedness among not only CCGs, but local authorities, as commissioners of social care.

[Sir Paul Beresford]

rose—

[Jane Ellison]

I will struggle to respond to the points made in the debate if I give way. I hope my hon. Friend will forgive me, but I am happy to pick up points after the debate.

We realise that health and wellbeing boards need to be involved, and that sits firmly in my area of public health. I will think about how we can take that forward and publicise that more.

The transitional period and the challenge for older children and young adults was referred to a great many times, and has given much food for thought. The Department of Health has given section 64 funding to Together for Short Lives to support development and research around appropriate pathways and the transition to adulthood. The National Institute for Health and Care Excellence has been commissioned by the Department to develop guidelines around that transition. A number of areas of Government policy come back to that same challenge of how we deal with transition, and stop there being a cliff edge when a child becomes an adult. We all recognise that in real life that is not a cliff edge. In other policy areas, in other Departments, people are looking closely to see where we can get that right.

The Government have made short breaks a priority, and have put money, albeit not ring-fenced, into local authorities. We have introduced the short breaks duty, which requires all local authorities to provide a range of short break services for disabled children, young people and their families. A statement has to be developed in consultation with families and published. That is one thing that local authorities can be judged against. My hon. Friend the Member for Mid Dorset and North Poole (Annette Brooke)spoke about Julia’s House, which is an interesting case in that regard. We will ensure that that is brought to the attention of the national clinical director. I will bring all the points that have been made in this debate to their attention.

In the final few seconds that I have left, I wish to put on record my thanks to all the volunteers and staff who work in this sector. I know that in the coming weeks, which will be a difficult time of year for families with a loved one who is ill, they will bring both comfort and joy to the people they care for, and for that we thank them very deeply.

Dermatology Funding

Debate between Jane Ellison and Paul Beresford

Wednesday 4th December 2013 Westminster Hall

[Jane Ellison]

I am very happy to give a commitment to take that point away and I will certainly bear it in mind in other discussions that I have.

I am glad that some hon. Members have taken the opportunity offered by the debate to highlight the growing issue of malignant melanoma. It is absolutely right to say that we need to make more people aware of the dangers of skin cancer. I was struck by the point made by my hon. Friend the Member for Romsey and Southampton North about the regional variation and the fact that in her area it is a particular problem.

The Department has funded Cancer Research UK to continue to test approaches to encourage, in particular, men over the age of 50 to visit their GP if they have signs of skin cancer. I have to say that, if anyone can come up with a magic way of making men over 50 approach their GP about anything, that would be very welcome and they would be rewarded by all parts of the NHS.

[Sir Paul Beresford]

There is a largish American community in Surrey, just outside my constituency. They are very aware of skin protection, to such a degree that there is a slight recurrence of rickets.

[Jane Ellison]

That is perhaps a debate for another time, but I note the concern. There is a happy medium to be struck.

Hon. Members might be interested to know that in autumn 2013 Cancer Research ran a campaign in south Devon, utilising text message communications, phone consultations with specialist nurses and volunteer community outreach to try to address some of the barriers to getting harder-to-reach groups to seek advice about skin concerns. Between 2003 and 2011, Cancer Research also collected data via the Office for National Statistics monthly omnibus survey to measure awareness, attitudes and reported behaviour of adults in relation to sun protection. The Department is funding a repeat of that survey in 2013, so that Cancer Research can track changes over time. I think that the results will be very interesting.

Public Health England, in partnership with the Department, NHS England and other stakeholders, proposes to run a local “Be Clear on Cancer” pilot campaign in early 2014 to encourage the early detection of malignant melanoma. The South West Strategic Clinical Network will host that pilot. It will build on evidence from the work in this area that I have just described.

This is a sizeable challenge. We can only, as individual Members of Parliament, take every opportunity that we can to encourage people to seek help from their GP and not to put that off, because for some cancers, the only thing that explains different outcomes for men and women is the fact that men refer themselves later and therefore do not benefit from early diagnosis.

With regard to the point made by the shadow Minister, the hon. Member for Copeland (Mr Reed), on sunbeds, I can respond to him separately on some of the specific things that he asked. I will make the point that the figures that I have seen for the problems associated with sunbeds are highly regionalised and that is one reason why public health is now devolved to local government. Some local government areas are giving the issue real attention and making it a priority. It is perhaps better suited for that sort of local and regional priority than it is for a national campaign, but I take the point that he makes.

A range of support is in place to help GPs to identify malignant melanoma. There is NICE guidance, “Improving Outcomes for People with Skin Tumours including Melanoma”, and there are the “Referral guidelines for suspected cancer”. We cannot highlight them too often.

I would like to take this opportunity to recognise the hugely important role that patient support organisations play. As has been said, they sometimes operate on a shoestring. They make an enormous contribution in helping patients to understand and cope with their conditions. Sometimes, knowing someone who can stand alongside us and say, “I know how you feel and this is how we have learned to cope with it,” is very important as a supplement to clinical guidance.

I again congratulate my hon. Friend the Member for Gainsborough on securing the debate and raising the profile of what is an important issue. As I said at the outset of my speech, I have learned a lot in researching my response to the debate, and I will now have these important issues firmly in my mind in my meetings and visits, where I can raise them. I pay tribute to the work that my hon. Friend is doing and to the all-party group. I assure the House that I will make NHS England and all the relevant bodies that I have mentioned today aware of the issues raised in the debate and the depth of feeling expressed about them.