Improving Cancer Outcomes

John Baron Excerpts

Thursday 5th February 2015 Commons Chamber

[Mr John Baron (Basildon and Billericay) (Con)]

I beg to move,

That this House has considered improving cancer outcomes.

Recent analysis from Macmillan Cancer Support shows that there are now an estimated 2.5 million people living with cancer in this country—an increase of almost half a million over the past five years. May I therefore begin by thanking the Backbench Business Committee for granting this timely debate on an issue that is becoming ever more urgent: improving cancer outcomes?

I would also like to thank my fellow officers of the all-party group on cancer for all their hard work, and the officers of the other cancer-specific all-party groups. It speaks volumes about the importance of the issue that we have come together to secure this timely and important debate. I would like to give the all-party group on cancer a plug. The group is recognised as the wider cancer community’s voice in Parliament. It has a proud campaigning track record. It runs what is now the largest one-day conference on cancer in the UK—Britain against cancer—each December. In the Minister’s own words, it rightly holds the Government’s feet to the flames.

The timing of this debate is crucial. With only a matter of weeks of parliamentary time before the general election, and at a time when NHS England is embarking on a new cancer strategy, this is likely to be the last opportunity for this Parliament to speak up on behalf of the cancer community and feed into that strategy.

The challenge has never been greater. Macmillan Cancer Support estimates that 3 million people will be living with cancer in this country by the end of the next Parliament. By the end of next year, 1,000 people a day are expected to be diagnosed with cancer. Hospital admissions for cancer in England have increased by around 100,000 a year, compared with five years ago. The NHS has missed the target of cancer patients receiving their first treatment within 62 days of an urgent referral for three quarters.

There is also good news, though, in that we have certainly made improvements in cancer outcomes over the past few decades. The latest figures published in December show that the one-year cancer survival rates in the UK now average 68.5% to 69%—up by a full 10 percentage points since 1997. These are figures on a page, but we are talking about thousands of lives saved every single year because we are driving up cancer survival rates, particularly in the one-year figures.

However, those improvements have been gradual and incremental, and they have not been enough to catch up with our European counterparts. Research has shown that our one-year survival rates still significantly lag behind European averages. Whereas we have 68.5% to 69% in this country, the best in Europe is 81% to 82% in Sweden. That is a significant difference that accounts, very roughly, for some 10,000 lives a year. There is always a danger in making comparisons. For example, if we look at the French figures, we are making comparisons with France’s centres of excellence. None the less, the established evidence suggests that we are down by some 5,000 lives a year on European averages, and perhaps by as many as 10,000 when compared with the best in Europe.

[Sir Edward Leigh (Gainsborough) (Con)]

That is why we want an open debate about the future of the NHS. We need to recognise that the social insurance systems in France and Germany produce better outcomes for people than our own national health service.

[Mr Baron]

That is a debate for another day. I accept that dramatic improvements could be made within the existing structures of the NHS, and I want to focus on that in this debate.

The Government have estimated that from 2011 to 2015 an additional 12,000 patients will survive for more than five years after diagnosis compared with the previous five-year period. That figure tells us nothing about how we are doing relative to our European counterparts, who will no doubt also have made improvements. Are those 12,000 lives just a continuation of a fairly stable and steady trend line that has been in evidence for the past 25 to 30 years, or a kick-up, as it were, above the trend line that suggests that we are catching up with our European neighbours? I would appreciate it if the Minister provided clarity on how the figure of 12,000 additional lives saved has been calculated and what action the Government are taking to ensure that we continue to strive towards matching the best outcomes in Europe.

I am conscious that a good number of other Members will speak in the debate, so, without being exhaustive, I will focus my remarks on four key areas: earlier diagnosis and survival rates; inequalities and older people; patient experience; and, last but certainly not least, the problem that some charities are having with data access.

Earlier diagnosis has long been an issue that the all-party group has campaigned on: we describe it as cancer’s magic key. All the statistics suggest that the NHS is as good as any other health care system at treating cancers once they are detected, but poor at detecting them in the first place. That suggests that we need to raise our game as regards earlier diagnosis. Most of these 5,000 or 10,000 lives are being lost at the one-year point, and the NHS is not catching up. We therefore need to drive forward initiatives at the coalface that encourage earlier diagnosis. It is almost a national disgrace that one in five cancers are first diagnosed at A and E when those patients are, on average, twice as likely to die within a year than those diagnosed via an urgent GP referral. That shows the importance of earlier diagnosis.

With this knowledge, we have spent the past two years working with the Government and NHS England to ensure that the right accountability levers are in place to encourage earlier diagnosis. We have been successful, together with the wider cancer community—because ultimately this is about teamwork—in getting one-year and five-year cancer survival rates into the NHS outcomes framework and one-year cancer survival rates into the commissioning outcomes indicator set. That is good news. We were also delighted when Simon Stevens agreed to our recommendations on including one-year survival rates in the delivery dashboard of the clinical commissioning group assurance framework from April this year.

I have used a lot of terminology, but there is a basic logic in putting the one-year figures up in lights and breaking them down by CCG. One of the best ways, if not the best way, of driving up one-year survival rates is to better introduce initiatives that encourage earlier diagnosis at the coalface. Those could be, for example, better awareness campaigns at a local level; encouraging better screening uptake figures, some of which are pretty poor; better diagnostics at primary care; better GP referral rates; or an A and E system which, when it detects these one-in-five cancers, instead of pushing patients back down the system, refers them up, potentially saving crucial time. All or any of those could be introduced by CCGs that are trying to get their one-year figures up. Putting the one-year figures up in lights will put pressure on those CCGs to raise their game on earlier diagnosis.

[Liz McInnes (Heywood and Middleton) (Lab)]

Does the hon. Gentleman agree that we need to look at the age range for cervical cancer screening? Only this morning, I heard of a 21-year-old who was found to be suffering from this disease, and who had begged the GP to give her a screening test but was unable to get it until it was too late. We also have a problem at the older end of the spectrum above the age of 64.

[Mr Baron]

Obviously, I cannot comment on the specific case, but I repeat that putting the one-year figures up in lights will put pressure—the best kind of pressure—on CCGs to look at all the initiatives at their command.

I do not think that the Department of Health or NHS England should be too prescriptive about this. We have CCG managements earning six-figure salaries who should, frankly, be able to make these sorts of decisions by introducing initiatives that best suit their populations. Where there is, say, a black and minority ethnic population, an elderly population, or a mining community population, initiatives have to be skewed accordingly, and that is what CCG managements should be doing. We have to leave an element of local initiative. One cannot just sign a cheque to the NHS for £120 billion and not expect accountability. By putting CCGs’ one-year figures up in lights, we can, over a period of time—there is no quick fix—monitor how they are doing. In the case that the hon. Lady mentioned, I would hope that the CCG would have a look at local initiatives that could perhaps change the situation for the better.

[Rebecca Harris (Castle Point) (Con)]

I, too, welcome the one-year survival rates being put up in lights. Does my hon. Friend agree that there may be a risk of missing rarer cancers such as brain tumours in a drive to catch what might be seen as the low-hanging fruit through screening processes?

[Mr Baron]

That is a very good point, and I will touch on it briefly later; I know that my hon. Friend will do so as well. I agree that there is a danger of that. We need to raise our one-year figures significantly—not by just a few percentage points; if we want to be among the best in Europe, then it has to be by 10 percentage points—and that means that we cannot exclude a lot of the rarer cancers, because there is only so much low-hanging fruit. I hope that this sends out a general message that there must be initiatives across the whole spectrum of all 200 cancers. The rarer cancers are the poor cousin at the moment, and we need to address that specifically. I look forward to hearing what my hon. Friend says later.

Let me explain why it was important to get the one-year figures into the delivery dashboard. We were told that it was all very well to get them into the outcomes indicator set, but they also needed to get into the top tier of NHS accountability—namely, the delivery dashboard. Chief executives of CCGs have told us that they felt they were monitored on that delivery dashboard, or—shall I put it this way—that that was their first port of call.

It is great to be able to inform the House that cancer is now the only disease-specific outcome indicator on the delivery dashboard. I say “great” in the sense that I am delighted that cancer is included, although I wish the delivery dashboard had more outcome indicators, not just process indicators. Processes are fine, but they do not necessarily lead to better outcomes. In my view, if we are serious about improving outcomes, the more outcome indicators we can get on to the delivery dashboard across a range of diseases, the better.

Getting the one-year figures on to the delivery dashboard will be transformational only if we use the tools in the toolbox and ensure that CCGs are held to account effectively. That means not only addressing poor performance, but encouraging those with the highest survival rates in the UK to continue to strive for improvement. There is no point having such figures if we do not use them. Will the Minister clarify how CCGs are being made aware of the upcoming changes to accountability? More importantly, what measures will NHS England take to address underperformance in one-year cancer survival rates by CCGs?

On survival rates, I want to touch on another issue that the all-party group has campaigned on—inequalities. Our recent report, “Cancer across the Domains: A vision for 2020”, particularly highlighted the poorer outcomes for older people. We are not the only ones to have drawn attention to the issue. A recent report from the National Cancer Intelligence Network noted that

“over half of all cancer deaths occur in people aged 75 and over”.

A National Audit Office report on cancer services, published last month, found that

“cancer patients aged 55-64 are 20% more likely to survive for at least 1 year after diagnosis than those aged 75-99.”

Such variation is completely unacceptable. Evidence suggests that the under-treatment of older people happens because some clinicians base their prescriptions on chronological age, not necessarily on their fitness to receive treatment. There is general recognition that older people suffer worse outcomes. The NAO report accepted that

“survival rates for older people are expected to be lower”,

but stated that

“this is unlikely to explain fully the significant variation between age groups.”

I suggest that we need to look at that issue. The all-party group on cancer welcomes the increased focus on it. However, we must ensure that such focus results in action and, as with early diagnosis, that the right accountability levers are in place to deliver real change.

Our recent report highlights our concerns about the fact that all the cancer mortality indicators in the NHS outcomes framework are for under-75s. It is almost as though the NHS has made a decision that the lives of those over 75 are worth just a little bit less than those under 75. That impression has been created in certain quarters, and we need to address that perception. We believe that it sends the wrong message about the importance of older people with cancer. Will the Minister outline what steps the Department is taking to tackle the inequalities faced by older people with cancer?

To move on to patient experience, we tend to think of outcomes simply as survival rates, but it is essential for the NHS to deliver good outcomes for patients at every stage of the cancer pathway. Members will be aware that tomorrow marks two years since the report of the Francis inquiry into the Mid Staffordshire scandal. It therefore feels like an appropriate moment to highlight the importance of the patient experience not as an add-on or a facility that is nice to have, but as an integral part of how we deliver cancer care.

The cancer patient experience survey has given us valuable insight into the experience of cancer patients in the UK. The findings continue to reveal widespread variation in the experience of care that people receive. For example, people with rarer cancers, which were mentioned by my hon. Friend the Member for Castle Point (Rebecca Harris), continue to report poorer experiences than those with more common cancers. The same is true of people with long-term conditions, younger patients, older patients, some ethnic minority patients and patients treated in London hospitals. That widespread variation is unacceptable.

Such an insight is worth very little if we do not ensure that it is used to drive real change. I suggest to the Minister that the mechanisms for doing so simply do not exist at the moment, or if they do, they are disparate and unco-ordinated. The all-party group has real concerns. We know that some trusts develop action plans based on CPES results, but there is no requirement for them to do so. NHS England does not require trusts to report on results. CCGs and NHS England do not seem actively to measure NHS trusts’ progress against their action plans to improve their scores. All that leads to a gap in accountability on the cancer patient experience. There are still concerns about the accessibility of the data from trusts and other local bodies for patients. For example, trust-level reports do not seem to be available on official NHS websites.

The all-party group was pleased that the Minister, in her response to “Cancer across the Domains”, confirmed there were no plans to discontinue the CPES. However, we were concerned to hear that, due to procurement issues, the CPES may not report in 2015. Will she provide an update on whether it will report results in 2015? Perhaps more importantly, will she clarify how NHS England will ensure that the CPES is used to drive improvements in the cancer patient experience, and to hold trusts and CCGs to account?

[Jack Lopresti (Filton and Bradley Stoke) (Con)]

Aside from my hon. Friend’s points about the strategic level of decision making and accountability, does he agree that at an individual level it is crucial to have complete clarity, understanding and credibility from the point of view of the consultant and the patient, and that there should not be any room for ambiguity or confusion?

[Mr Baron]

My hon. Friend makes an excellent point. Good communication and indeed consultation is terribly important, and it is one of the key issues that the cancer patient experience survey addresses in trying to gauge patients’ experiences. The NHS can sometimes forget that patients with cancer, like those with long-term conditions generally, are often very knowledgeable about their condition. They need to be consulted, and there must be better communication. That is why we should formulate the cancer patient experience survey better, and ensure we draw out the lessons to be learned so that we can take action to improve experience. I completely agree with my hon. Friend, and I look forward to hearing his speech.

Finally, may I touch briefly on data access? The effective use of data is the foundation for improving cancer outcomes. Good data are at the epicentre of how we are going to improve outcomes. However, I suggest to the Minister that there are problems. Health charities play a crucial role in driving improvements in the health service, including in cancer services. For example, Macmillan’s research has provided invaluable new insight into patient clinical outcomes and the accuracy of GP cancer referrals, which has helped to improve services. However, charities and others are finding it increasingly difficult to access routinely collected data, leaving vital projects stranded for months. In some cases, they do not get the data at all.

There are a number of reasons for that. First, information governance rules are being applied inconsistently. Changes to the legal status of bodies under the NHS reforms have led to confusion about who data can be shared with and, in some cases, have reduced the capacity for analysis. Secondly, different parts of the system are failing to work together. Both nationally and locally, organisations are adopting an increasingly fragmented approach. Furthermore, organisations that are responsible for releasing data do not appear to have the capacity to do so. In a recent Public Accounts Committee hearing, Cancer Research UK indicated that the research group had been waiting 16 months to access data on cancer waiting times.

As the Minister will know, the recent National Audit Office report on cancer services made recommendations on that issue. First, it recommended that the Health and Social Care Information Centre should be

“held to account for how effectively it is discharging its responsibility to disseminate data to help drive improvements”.

Secondly, it recommended:

“As a minimum, it should seek, and publish the results of, regular feedback from NHS data users.”

The cancer community was concerned to hear Sean Duffy call for greater pressure to release and use data at our Britain against cancer conference. To me, that sent a clear signal that further leadership from the Government was needed on this issue. When she responds, will the Minister outline what plans the Department has to clarify the data access rules and to ensure that they are applied consistently, so that we can plan and make proper use of them? That is the essential point.

In conclusion, I thank the Minister for being here and for being prepared to respond to the debate. I have not had a chance to cover a great number of areas, including inequalities more generally, cancer commissioning and survivorship to name a few. However, I hope and expect that other Members will touch on those important issues. I will end where I began: by focusing not only on the scale of the challenge facing us, with the news that 3 million people will be living with cancer by the end of the next Parliament, but on the opportunity. Because of many of our campaigns over the past few years, the NHS now has the tools that it needs to accelerate the improvements in cancer survival rates. The challenge that I set for the Minister today is to ensure that NHS England uses those tools to full effect to deliver the best outcomes in Europe and, quite literally, to save tens of thousands of lives.

--- Later in debate ---

[Rebecca Harris (Castle Point) (Con)]

As one of the co-sponsors of the debate and as chair of the all-party group on brain tumours, I thank the Backbench Business Committee for scheduling the debate and the Minister for her presence in the Chamber. This is a timely debate: yesterday was world cancer day. It is also timely for me for another reason, which I will come on to later. I think we all agree on the importance of raising awareness of early diagnosis and I will come on to talk about that, but world cancer day has done an enormous amount of work with the many cancer charities to raise awareness of the risk of cancer. We are much more likely to spot the initial signs of the disease, but I think the consensus is that there is still a way to go.

I would first like to share the story of the Green family in my constituency. Their son Danny, who was a happy, sporty, energetic 10-year-old, suffered a dizzy spell after playing football. After a few days of being unwell his parents, Chris and Lisa, were very concerned about this health and took him to hospital. They were turned away and told that he had a migraine. After trying hard to persuade doctors that this was not how their son was normally and that it was not just a migraine, the family took him back to hospital and asked for a scan, only to be told that a scan could take months to schedule. Only when he collapsed in hospital, was he rushed to have a CAT and MRI scan.

Danny was taken straight to Great Ormond Street hospital, where he received incredibly good care. His brain tumour was removed and he stayed in hospital for many months fighting a little-known unfortunate side effect of brain tumour surgery—something called posterior fossa syndrome—that left him badly disabled and unable to speak. Unfortunately, the cancer came back. After a heavy course of chemotherapy it started to shrink again, but tragically, Danny lost his life after contracting pneumonia and another virus in Great Ormond Street in July 2012.

Like many people, the Greens had taken someone to hospital with balance problems and headaches that were dismissed as a migraine. Far too many people finally get treatment only after having had the symptoms for a long time. Mercifully, brain tumours are rare, but that is the problem, because rare cancers are not sufficiently picked up. The Greens would like to see patients displaying possible symptoms of brain tumours given scans much earlier, and greater awareness of the possibility of brain tumours among clinicians.

From this unbearable tragedy, however, sprang a determination by Chris and Lisa Green and Danny’s sister, Holly, to support families going through a similar ordeal and to tackle the lack of awareness about brain tumours. For that reason, they set up a charity, the Danny Green Fund, of which I am glad to be a patron. It has gone from strength to strength in supporting families of those suffering from brain tumours, and in particular the debilitating condition of posterior fossa syndrome. It has raised an enormous amount of money for research—in the past two years alone, this tiny charity on Canvey Island has raised more than £160,000.

Although awareness of more mainstream cancers, such as breast and prostate cancer, has dramatically increased over recent years, and with it funding for research into cures and treatment to improve patient outcomes, it appears that the same level of awareness of, and funding for, brain tumours is not forthcoming. In fact, brain tumours receive just 1% of the entire national spend on cancer research. I find that shocking, considering that brain tumours are the biggest cancer killer of children and adults under 40. Outcomes remain relatively poor, with patients diagnosed with brain tumours having a five-year survival rate of just 18.8%, compared with cancer as a whole, where 50% of patients can expect to survive for at least 10 years.

Between 1970 and 2010, while cancer survival rates doubled, brain tumour survival rates increased by a mere 7.7%. Rare or not, how can we improve these outcomes for the 16,000 people diagnosed every year with a brain tumour? With more than 120 different types, brain tumours are notoriously difficult to diagnose, and our understanding of other cancers does not readily translate to them. I therefore appreciate that improving outcomes will not be easy, but that does not mean that brain tumours should remain an overlooked cancer.

Having worked with two excellent cancer charities, Brain Tumour Research and the Brain Tumour Charity, along with two charities in my constituency, the Danny Green Fund and the Indee Rose Trust, I know that the charities are doing an exceptional job in raising awareness about brain tumours and increasing the funding and research to improve treatments. However, I believe I speak for all these charities and those affected by brain tumours in saying that we need to focus on at least four key issues if we are to improve outcomes.

The first and most obvious area is funding. Brain Tumour Research estimates that to bring research and treatment of brain tumours into line with other cancers and improve patient outcomes, research funding would need to increase to £35 million a year for a decade. We urgently need earlier diagnosis. About 58% of brain cancers are diagnosed in A and E, which is considerably higher than the figure for cancer overall. We need a far better understanding among GPs of symptoms, and better pathways to secure early treatment. Early diagnosis is essential for starting early treatment. As the cancer proceeds, the brain tumours grow, becoming far harder to treat and manage, and for brain tumours, even benign tumour growth, this is potentially fatal.

New NICE guidelines need to improve the early diagnosis of brain tumours so that more patients are diagnosed by a GP and receive early treatment. We also need a national register of all site-specific cancer research to track the research work, the grants and their results. That is vital, as currently there is not a great deal of transparency in the research field and no clear idea of what research is being funded and results achieved. This leads to confusion, duplication of work and a system that prioritises research into more common cancers, rather than those disease areas of most need, such as brain tumours. A national register would make research more transparent, reduce duplication and allow greater variation in type and scope of research.

Finally, we need better and easier access to available treatments. Research into new treatments and early diagnosis is essential to beating brain cancer, but more can be done with existing treatments through the NHS. One such example that has been in the news in the last year is proton beam therapy. It is similar to traditional radiotherapy, destroying cancerous cells with beams of high-energy radiation, but it is far better suited to the brain as it only affects the cancerous cells. More widespread centres using this technology could be set up and the therapy given to as many brain tumour patients as possible.

I hope that some of the issues that I and others will cover in the debate will raise awareness of how outcomes could improve for all cancer patients, particularly brain tumour patients, and put the spotlight on just how deadly brain cancer is in comparison with other cancers.

[Mr Baron]

Before my hon. Friend moves too far from the subject of proton beam therapy—something I would have raised had time allowed it—may I suggest that she is absolutely right to raise it? A new generation of technology is coming out of CERN and going to British companies, and we must do our best to at least explore the feasibility of embracing that within the NHS. Not only is it cheaper and better technology, it is smaller, which means that we could have more sites around the country. I know the Minister is aware of this, as we have raised it before, but I hope that it will be addressed in the debate.

[Rebecca Harris]

This sort of therapy gives great hope to many sufferers of brain tumours in particular.

The debate is timely for another reason; tomorrow is Danny’s birthday. He should have turned 14, and his family, in his memory, have funded a further day of research with the money they have raised. Mercifully, brain tumours are very rare but, as Lisa Green—Danny’s mum—pointed out, “They are not rare enough when it is your child.” I very much hope that the spotlight can be put on the urgency of improving care.

--- Later in debate ---

[Jack Lopresti (Filton and Bradley Stoke) (Con)]

I was not entirely sure whether it was a good idea to apply to speak in the debate. It is the first time I have properly put anything on the record about my own experience. I am a cancer survivor. A year ago virtually to the day, I finished about 30 sessions of daily radiotherapy, with oral chemotherapy. It is like awakening from a bad dream. I wanted to get on with my life and not look back. Looking back and putting it all together has been quite difficult this week, but the thing that convinced me that I should say a few words was that, apart from support from family, friends and colleagues once I had my initial diagnosis, the most valuable thing for me in getting through the whole thing, keeping my spirits up and being positive was reading, as an inspiration, about people who had been through the journey.

I ordered tonnes of books from Amazon. I read Bob Champion’s story and re-read the chapter in Rudy Giuliani’s memoirs on beating cancer to give myself as much information as I could about happy endings and going through the process. So I will tell my story, with the message that anyone who is facing the journey, which is very daunting and can be a lonely process, despite the best efforts of friends and family, will get through it. All things end and I am pleased to say that, after I finished my treatment, I was back here within a week or two.

Within a few months of listening to my friends telling me not to overdo it, I managed to run the Bristol half-marathon and the Stroud half-marathon before Christmas. [Hon. Members: “Hear, hear.”] Thank you. I have just applied to run the first Bristol to Bath marathon in October. That points to a surprising thing. I was always incredibly fit and healthy. I had run my first full marathon nearly a year before my diagnosis. So this can come out of left-field. That is not an excuse for not looking after ourselves, however, because the fact that I had looked after myself and was fit and healthy meant I coped with my treatment better and got through it more easily than I might have done.

Two years ago in January I had what I thought was the normal annual virus or bug. I thought perhaps I had overdone it a bit at Christmas, so I carried on with the usual paracetamol and got on with things, but eventually, after a couple of weeks, I succumbed and went to see my GP. She was very good and very calm and said, “We’re not quite sure what it is,” but she did refer me quite quickly to my local hospital as an out-patient.

The staff there said they were worried about me and the fact that I kept flinching when they pressed on my appendix area. They did not let me go home even to get some books and my pyjamas, but my family helped me out. I stayed in for a few days, and the prognosis when the consultant let me go on the Monday morning was that they were pretty certain it was appendicitis but I had an abscess and it could well have hit a cancer. That was the first time I had heard that word. He quickly reassured me that I was far too healthy-looking and it was not very likely, but it was a possibility. They gave me intravenous antibiotics while I was there and sent me home to recover saying, “We don’t normally like to operate on appendixes straight away these days because it is a tricky operation and can be treated with antibiotics.”

To cut a long story short, this went on for two or three months. I kept finishing the antibiotics, and within about 10 days I would start to feel really ill again. My hon. Friend the Member for Basildon and Billericay (Mr Baron) said to me, “For goodness sake, go back to your constituency and get whatever’s in your body removed because you’re obviously very ill.” I even went to the nurse here at Parliament who said almost the same thing: “I’m very worried. I’m not happy. Get back and get it removed.” But the hospital said, “Oh, it’s a grumbling appendix” and kept me in for another week on intravenous antibiotics. Within a week or two of that not working three months had passed, so the initial stages of quick referral and reasonable expectation of what it could be had dragged on for a long time.

I again recovered quite quickly after the operation, but within a week was due to go back for a referral. I had a phone call in the morning: “You’re coming in to see the consultant tonight?” “Yes, I am. Is that still okay?” “Yes, it’s fine. Bring somebody with you.” That was the first indication that things perhaps were not going to work out. I took my mother, and they gave me the good news. I was being very cheerful because my mother was with me and I said, “The only thing I really want to know is can you sort it?” “Yes,” was the answer, so I was fine. “And can we get on with it?” I asked right away, and they did, in fairness. I started six cycles of chemotherapy over three months, which I got through relatively easily because of my health and my natural optimism.

I remember doing gardening for the first time in my life and planting a fig tree in my garden, and thought things were progressing quite well. Colleagues sent me books. My hon. Friend the Member for Bristol North West (Charlotte Leslie) sent me some poetry which was really nice of her and I will always be grateful. So that period passed well, and I had cracked it in my own mind: I was in that place, and I was moving forward.

Then, on 17 September, after a sort of debriefing appointment to ask me how I felt and how I was getting on with things, I had a letter which said: “I saw Mr Lopresti today in clinic. He has chosen to stop his chemotherapy after three months and so has completed treatment.” I thought to myself, “That conversation never took place,” and started to question myself and wonder whether I had heard correctly. Fortunately, I then had a consultation with the oncologist who said, “You will have six rounds of treatment over three months.” For the first time in my life I did not question instructions: I did as I was told. Actually, I am very impatient, and I just wanted to get on with it and get on with the next stage of my life, but I had started to question whether I had heard that correctly.

I thought about what had happened and spoke to my mother and my wife who had been there. They said, “Yes, they said, ‘It hasn’t spread, we’re going to cure it, and we’re going to give you six rounds.’” So I made a complaint. I said, “This has knocked me back probably almost as much as the original diagnosis,” because it shatters confidence in getting straightforward, reasonable, objective analysis and projections of treatment. I also thought, “What would have happened if I was an older person on my own and feeling quite vulnerable?” The apology I received explained that it was because a randomised control was being carried out and they were trying to work out whether giving somebody six rounds in three months was as good as 12 lots in six months. That is fine, and as it turned out my next scan was clear—as have been all my scans, so I am in good order. If they had told me, “You are relatively young and fit. You don’t need 12 lots because it can damage the nerves and there are long-term consequences”, I would have been okay with that, but in fact a conversation that did not take place was recorded and they wrote to me about it. I started to think, “If they can make a mistake on this, what else have I discovered?”

So I had the apology, and I went back to see my consultant. He said to me, “I have really good news. Your scan is clear. You are fine. We can just keep an eye on you or you can have some radiotherapy.” I said, “Look, given what has gone on, I want everything you’ve got. Whatever you’ve got, let’s do it once, get it done. I do not care if you have to carry me out of here, let’s try to get it first time.” In fairness, they did that. I had daily radiotherapy, which surprisingly was more debilitating and took more of my energy than my long course of chemotherapy. I think that was because it was daily and because of the way radiation reacts on the body.

As hon. Members have said, early intervention is, obviously, key. The referral to the hospital was done quickly in my case and was great. The problem was that three-month delay, when a tumour about the size of a fist was in my body. Fortunately, the cancer had not gone anywhere else, but I had a very lucky escape. It could have moved and gone elsewhere, and we could be having a different conversation. I agree that early intervention is key and people should get off to the hospitals quickly, but if there is any suspicion that something is cancer, people have an obligation to get on with dealing with it as quickly as possible, for all the obvious reasons.

I received great medical support and care from the nurses—the people at the sharp end, the people in the wards, the people who did my PICC line—but I felt slightly detached from the consultants. As I say, the experience of a letter completely misrepresenting an interview that took place was shattering and it shredded my nerves for quite a time. I am pleased that the Government have been working to achieve earlier diagnosis of cancer and to set up a strategy to save 5,000 lives by 2015. The latest projections are that, as a result, the NHS is on track to save an extra 12,000 lives each year. That is all fantastic.

What I wish to say in conclusion—I apologise for my emotion—is that when someone gets the diagnosis, they have to stay focused and stay as positive as they can. There are lots of help groups, such as Macmillan.

[Mr Baron]

I commend my hon. Friend for the bravery he has shown, not just in how he dealt with his complaint, but in sharing his journey with the House, because nothing is more powerful than hearing personal testimony. He illustrates better than anybody in the Chamber will do today the importance of good communication and consultation between patients and the NHS and the consultants. For me, at least, that is the key message he is portraying. It is terribly important, and I hope all of us and, in particular, the NHS learn from it.

[Jack Lopresti]

I thank my hon. Friend for his kind remarks, which I shall not dwell on. You do become, if not an expert, certainly quite knowledgeable, and are introduced to the cancer world. There is a lot of information out there. I was told by some consultants not to spend too much time on the internet, as you can go down different avenues and worry yourself to death, but there are lots of good books. I would recommend talking to Macmillan and other cancer groups, reading others’ stories, being inspired and being motivated. You should never lose heart.

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[Paul Burstow (Sutton and Cheam) (LD)]

Thank you, Madam Deputy Speaker. I wish to echo that very point. Some of the best debates that we have in this House, and certainly some of the best Back-Bench business debates, are ones in which people bring their own personal experience and their own stories. My hon. Friend the Member for Filton and Bradley Stoke (Jack Lopresti) talked about the stories that gave him inspiration and hope. I hope that people listening to this debate will gain inspiration and hope from what he has said today. I hope, too, that those who are responsible for planning and commissioning our services and for training our medical professions gain insight from it.

We talk a lot about the concept of shared decision making, and my hon. Friend has demonstrated where that can work well and where it can fall apart. When it falls apart, the impact on the person concerned is immeasurable. I am really grateful to my hon. Friend for his unique and important contribution.

I also thank my hon. Friend the Member for Basildon and Billericay (Mr Baron) for tenaciously pursuing not just the opportunity to have this debate but this whole issue. It is undoubtedly the case that, when it comes to cancer, he has been there championing the cause. When I was a Minister, I had plenty of occasions to feel the effects of his championing. I always appreciated the way in which he pursued the matter, and I am sure that the Under-Secretary of State for Health, my hon. Friend the Member for Battersea (Jane Ellison), has experienced that as well. He is always civil, always polite, but relentless in pursuing what he wants to achieve.

In this particular week, when we have marked world cancer day and had the news from Cancer Research UK that one in two of us are likely to experience cancer in our lifetime, it is absolutely right that we should be debating what more we need to do to go beyond the ambition of this coalition Government to save lives and to achieve the ambition that we set for the NHS in the next Parliament.

Part of the news that sits behind that one in two figure is the fact that we are living longer. I want to caution against the notion that, in some way, living longer is some sort of curse—all too often it is portrayed in that way—and that we should be worried about it. The other thing behind that research is that those cancers that may occur in later life are not inevitable. There are things that we all can do if we make choices about the lifestyles that we lead—whether that is quitting smoking or losing weight. When one considers that there are still 100,000 deaths a year due to smoking and that two thirds of people who are addicted to smoking become addicted before the age of 18, it is clear that we need to focus quite rightly and relentlessly on issues around prevention as well. That is why we should celebrate the news that, just yesterday, the Minister successfully took the regulations through this House that will result in a ban on smoking in cars where children are present, which will make a difference. We have an assurance from the Minister and the Government that, before the end of this Parliament, there will be a vote to have standardised packaging, which will be a real step forward in dealing with the impact of smoking.

We must do more to tackle smoking, especially in the context of mental health and mental health services, where the prevalence of smoking is so much higher. There are examples of good mental health services that have found ways to reduce smoking. None the less, there is a significant difference in life expectancy between people with severe and enduring mental health problems and people who do not have such problems.

Some reference has already been made to the health inequalities with regard to ageing, and I will come back to that. We need to recognise that there is a broader issue around the social gradient. If someone is poorer, they are more likely to be at risk from cancer, especially when lifestyle is a factor. The strategy that is being drawn up by the taskforce needs to address the whole range of health inequalities to deliver on the challenge that was rightly set and the duty that was imposed on the NHS to tackle health inequalities under the Health and Social Care Act 2012.

Sean Duffy, the national clinical director for cancer, has said that our cancer survival rates are at an all-time high, and my hon. Friend the Member for Basildon and Billericay set out the statistics that show why we should celebrate the progress that has been made over a number of years. Clearly, if half of us will get cancer during our lifetimes, we must keep looking afresh at what more we can do. That is why the announcement of the taskforce in January to look at what the next five years should hold for cancer work is absolutely right. We cannot rest on our laurels.

Again, I pay tribute to the hon. Member for Easington (Grahame M. Morris) for tenaciously pursuing the case for radiography, just as my hon. Friend the Member for Wells (Tessa Munt) has done, and I give him due respect for doing so. The strategy that is being developed must answer the concerns that he and other hon. Members have been raising for a number of years. The ability to combine different innovations—whether pharmacological or technological—is absolutely key to how we catch up and then stay ahead in terms of cancer survival rates, and it is why we need this ambition of going beyond just achieving the average cancer survival rates in Europe to strive to become the best in Europe. Better prevention, swifter diagnosis, better treatment and aftercare are all part of that.

On early diagnosis, we have heard that a quarter of diagnoses or thereabouts take place at an emergency stage—far too late—and the outcomes are bad as a result. Therefore, we need a clear commitment to fund the Be Clear on Cancer campaign throughout the life of the next Government, because awareness raising and the identification of signs and symptoms make a difference. For example, in the areas where the lung cancer signs and symptoms campaign was tried initially, 700 extra patients were diagnosed—700 people had an opportunity to live their lives longer as a consequence.

The hon. Member for Washington and Sunderland West (Mrs Hodgson), who, again, is a tenacious pursuer of ovarian cancer issues, is absolutely right to ask why, on the basis of the pilot evidence from 2013, we are not pursuing ovarian cancer in the Be Clear on Cancer campaign. I hope that the Minister will answer that and perhaps give us the prospect of good news. The hon. Lady certainly persuaded me when we took the decision to hold the pilots, and I would want to know why we should not pursue it. Certainly, the pilots that she referred to suggest that there is good cause to do just that.

I was struck in preparing for the debate by the research published by Cancer Research UK looking at what could be achieved with earlier diagnosis if we strove to eliminate inexplicable variations in England. In other words, if we had diagnosis rates at the best level just in England everywhere—for colon, rectal, ovarian and lung cancer—it would benefit 11,000 patients and save the NHS £44 million. If we could do that for all 200 cancers, it would help 52,000 people. It is within our grasp to do massively more if we learn just from the best in our own country, let alone striving to be the best in Europe, which we would become if we did that. I very much welcome the work that CRUK and Macmillan are doing with NHS England to deliver that.

My hon. Friend the Member for Basildon and Billericay talked about the unacceptable cancer death toll among older people and the over-reliance on chronological rather than biological age in making judgments. As the then Minister who took the decision that there should be no exemptions from the equality duty with regard to age discrimination for the NHS, I think that that is not acceptable. Chronological age should not be used; the person and their individual circumstances should be considered in judging which treatments should be available.

It is therefore also vital that we recognise that in later life, because of complex comorbidity and frailty, there are additional needs, sometimes social needs, that are not properly taken into account. While I was the Minister with responsibility for cancer, I was pleased to help launch the work that Age UK and Macmillan were doing to pilot new ways of ensuring that more older people would gain access to cancer treatments. It would be useful if the Minister could say where that has gone and whether it will be continued. I hope the work will be looked at when the taskforce draws up its strategy.

[Mr Baron]

As a Minister, the right hon. Gentleman was always a great champion of cancer. One accepts the complexity arising from comorbidity, but does he believe that the under-75s cancer mortality rate indicator should be looked at again as a means of helping to redress the issue?

[Paul Burstow]

Personally, I think that at some point there must be a legal challenge as to whether that places ageist assumptions at the heart of the NHS. The fastest growing part of our population are the over-85s. How on earth can it be that we do not have statistics that allow us to know how well that older part of our population is being treated for cancer, let alone anything else? When one considers that when the NHS celebrates its 100th birthday, there will be over 100,000 centenarians in this country, it is clear that we need to start catching up in the way in which we use data to ensure that we are not discriminating inappropriately on the basis of the person’s date of birth. I agree that the indicator needs to be looked at.

The hon. Member for Easington also mentioned the cancer drugs fund. After the election there should be a thorough evaluation of the impact of the cancer drugs fund over the past five years. It was a good initiative; it plugged a gap, but unfortunately the gap that it was plugging is now not being filled because there has not been a change in the way we pay for drugs. It could play a part in underpinning combinatorial innovation of the sort that the “Five Year Forward View” mentions.

On the hon. Gentleman’s reference to free end-of-life social care, I have not changed my view. When I wrote the care and support White Paper, we made it clear that we saw much merit in free end-of-life social care. Because of the reports that have been published since, I believe that the evidence has grown even more compelling that this is not a cost to the NHS. It would be a benefit to the NHS. I know that my right hon. Friend the Minister of State who has responsibility for care and support has taken that view as well, and I hope we can see progress on that too.

As the Member of Parliament for Sutton and Cheam, it is a source of great pride to me that I live in a constituency which has a hidden gem—the Institute of Cancer Research. As I am sure hon. Members in all parts of the House know, that is a world-beating research facility, taking research and discovery from the lab to the bedside in collaboration with the Royal Marsden hospital, which is on the same site—a phenomenal site which is looking to expand further. It does fantastic work, including genetic testing, which is an area that I want to raise with the Minister.

The institute has been a pioneer in mainstreaming genetic testing, particularly around BRCA1 and 2. It has developed a good practice model that can mainstream genetic testing into existing oncology appointments. The potential of that is amazing—four times the volume of activity can be delivered through this new pathway at twice the speed and half the cost. In other words, we can gain the benefits of genetic testing without apparently having to spend more money, but delivering much more targeted and insightful diagnosis and onward treatment as a result. That pathway exists. It has been developed, refined and tested, but it has not yet been widely adopted, despite the fact that it is freely available. I wonder what more could be done to make sure that it is more freely adopted. Perhaps the Minister could say how the strategy might help take that forward.

This debate needs to be set in a broader context. If we are to achieve an ambition of matching the best in Europe over the life of the next Parliament, we must address the funding pressures that are acknowledged in the “Five Year Forward View”. This Government have started to acknowledge that with what Simon Stevens described as the “down payment” of the £2 billion announced in the autumn statement, which will come in from this April, but we know that we need to give the NHS certainty about funding for the life of the next Parliament.

All of us who are responsible for articulating different party points of view on health policy need to be clear with the NHS and with the public about what we would do with regard to funding. I am therefore pleased that the Deputy Prime Minister and the care and support Minister have set out how the Liberal Democrats would provide the £8 billion requested in the “Five Year Forward View”. I look forward to the debates we will have over the coming weeks on how others would achieve the same thing, which we need. This debate, however, is an important way of shining a light on the progress that has been made and the opportunities to make further progress.

I thank the hon. Member for Basildon and Billericay for securing the debate and the Backbench Business Committee for allowing it. This is what it makes clear: yes, there has been progress, but there is still much more to come.

--- Later in debate ---

[John Glen]

Absolutely, and I was going to come on to that. My fundamental point is that we must change the appetite of the nation for the NHS. Yes, we want it to be there when random events take place, but we must also recognise that if we are to promote better health, everyone in this country has a responsibility as individual citizens to reduce the demands on it. Unless we do that, every five-year forward view will imply further and further increases. We need to be realistic about the fact that, unless we make real changes, we as a country will be presented with profound challenges.

[Mr Baron]

My hon. Friend is making a thoughtful and powerful point, but may I push back very gently? For me, the most transformational improvement we could make would be to put the one-year figures up in lights, as I said earlier. That will not cost money; it is about our sense of priorities, as he is fully aware. When we consider that we spend almost as much money per head of population on our health care system as many continental countries, but are still 5,000 lives behind the average—let alone 10,000 lives behind the best—there are still vast improvements to be made within existing resources, and those improvements would save money.

[John Glen]

I absolutely take that point, but I am challenging the fact that it is extremely demanding to deliver structural changes to how we provide the volume of services in a national system. For 18 months, I went through the experience of dealing with Naomi House, which provides palliative care for children and serves Hampshire, Berkshire and Wiltshire. I met four Ministers and the Prime Minister, but we still did not get a concession on bringing forward guidance on the use of tariffs by local authorities supporting palliative care for children. It was a case of being told that there would be a review, which would happen this year, next year or whenever. Because of my great frustration that delivering this change demands such effort, I doubt that continuing with the NHS as it is now will ever satisfy people. We must be more nimble in dealing with such challenges.

The other outstanding issue relates to the use of data. My hon. Friend the Member for Basildon and Billericay (Mr Baron) rightly pointed to the need for more awareness of data transparency so that we can target resources more effectively. I hope that he is right about the sufficiency of the resources that every party in the House will no doubt pledge in the run-up to the general election. However, when we have a lot of data, we need to be able to process and deal with it, and ensure that we use it to guide resource allocation decisions. I resist strongly all the voices saying that we need to be extremely cautious about using data. Unless we can aggregate data on health outcomes in different dimensions, and use them to drive the reallocation and refocusing of resources, we will not deal with inequalities.

I have probably said enough, but I want to thank my hon. Friend who has given us all something to aim for by championing cancer issues. I once again commend the recruitment event pushed by my local paper in Salisbury, the Salisbury Journal, to make us the place with the highest number of people on the register of Delete Blood Cancer UK. Will the Minister reflect on the key point about the sufficiency of resources and the challenges that the NHS faces and give us an honest answer, as I know she will? It is really important that people outside Parliament know that Members understand the challenges involved in the vital area of how to tackle cancer.

[Andrew Gwynne (Denton and Reddish) (Lab)]

I congratulate the hon. Member for Basildon and Billericay (Mr Baron) on securing this incredibly important debate and on the considered way in which he set out the issues in his opening speech.

I thank my hon. Friends the Members for Washington and Sunderland West (Mrs Hodgson) and for Easington (Grahame M. Morris), the hon. Member for Castle Point (Rebecca Harris), the right hon. Member for Sutton and Cheam (Paul Burstow) and the hon. Member for Salisbury (John Glen). I have not left out the hon. Member for Filton and Bradley Stoke (Jack Lopresti), but have left him to the end. I pay special tribute to him for the moving way in which he shared his personal experience. His message will have offered hope and inspiration to people who are listening to this debate. I thank him especially for that.

I extend my thanks to the Backbench Business Committee for ensuring that this debate could go ahead. It is crucial that when we mark important events such as world cancer day, the message goes out from this House of Commons that, whatever our political differences on whole areas of public policy, including the national health service, when it comes to matters such as our commitment to tackling cancer, we speak with one voice.

It is a particular privilege to take part in this debate on behalf of Her Majesty’s Opposition. From the outset, I want to echo the proposer of the motion in paying my own tribute to the various cancer all-party parliamentary groups, which do such good work to highlight these issues in Parliament. Cancer care and prevention is one of the most important policy areas for politicians to consider.

When I was a teenager, my mother was diagnosed with ovarian cancer. I would like to say a personal thank you to my hon. Friend the Member for Washington and Sunderland West for the work that she does on ovarian cancer. Despite my mother paying numerous visits to her GP in the months before she was diagnosed, the cancer was not picked up until a later stage. As my hon. Friend described, although the symptoms were there, they were put down to other factors such as heavy lifting at work. By the time the cancer was diagnosed, it was too late for treatment to be effective and my mother passed away in hospital when I was 19. Not a day goes by that I do not miss her. Not only was I robbed of my mother; my three children missed out on a pretty fantastic grandmother. I therefore understand the very personal hurt that a loss from cancer can cause.

I do not blame the GP for not spotting my mother’s cancer. As my hon. Friend the Member for Washington and Sunderland West set out, patients with ovarian cancer often present with symptoms that are not easily recognisable. However, it did make me question what more could have been done. That was in 1994. In the 20 years since, we have made huge progress in improving cancer services. In the last decade, five-year survival rates improved for nearly all types of cancer. However, as we heard in the opening contribution of the hon. Member for Basildon and Billericay and in the speeches of other hon. Members, we still lag behind other countries.

There is worrying evidence from the past five years that the progress that we have made on cancer care has stalled to some extent. People are waiting longer for vital tests and the national cancer target has been missed in the past three quarters. Over the past four years, cancer spending has been reduced by £800 million in real terms. It is worth saying that in government, Labour created 28 cancer networks to drive change and improvement in cancer services. Those networks brought together the providers and commissioners of cancer care to plan and deliver high-quality cancer services in their areas. They helped to oversee and drive up the quality of services that were delivered to cancer patients. By significantly changing their structure and reducing their budgets by millions, as well as by scrapping the highly regarded national cancer action team, I would argue that the Government have disrupted those networks.

Cancer Research UK published an analysis late last year that suggests that cancer services have been weakened by the shake-up of the NHS. It also suggested they lack the money to cope with the fast growing number of people getting the disease. The charity found that real-terms spending on cancer reached a record high of £5.9 billion in 2009-10, but since then it has declined to £5.7 billion in 2012-13. So not only has the money been reduced, but the delivery mechanisms, which helped share expertise and best practice, have been dismantled.

Our hard-working clinicians and staff are trying their best within the system, and despite the challenges, continue to deliver quality care, and we should all recognise and pay tribute to the work that they do across the NHS. Let me come on to what we would do were we in government. We have made a commitment that within the first six months of the election, the next Labour Government will publish a cancer strategy with the goal of being the best in Europe on cancer survival. That would include increasing the rate of cancers diagnosed early, which—as we have heard in this debate—drastically increases the chances of survival. At the moment, just over half of cancers are diagnosed at an early stage, but over the next 10 years, we want to see that increase to at least two in every three cancers. If the benchmark of today’s best performing areas—60% of all cancers being detected early—were met across the country, it would mean 33,000 more cancers diagnosed early each year by 2020.

We also plan to make leaps forward on screening and diagnostic tests. We have announced that we will put an extra £750 million of investment into testing over the next Parliament. That will enable us to guarantee a maximum one-week wait for tests and a one-week wait for results by 2020. That will be the first step towards achieving one-week access to key tests for all urgent diagnostics by 2025. That will be made possible by new investment, paid for through a levy on the tobacco industry, because it is only right that those who make soaring profits on the back of ill health should be forced to make a greater contribution in that area.

We will also ensure that the new bowel scope screening programme is rolled out by 2016, which I know will please the hon. Member for Basildon and Billericay. Research has found that patients who are able to see their GPs within 48 hours are less likely to have their initial cancer diagnosis via an emergency hospital admission.

[Mr Baron]

The whole cancer community has been behind the all-party group on cancer and the cancer-specific all-party groups in pushing for the one-year survival rates to be broken down by CCG and put on the delivery dashboard. The shadow Secretary of State welcomed that development when he spoke at the Britain against cancer conference in December. I do not intend to make predictions about who will win the general election during this debate, but may I press the hon. Gentleman—I am pressing my own side—to ensure that if Labour wins it will attach as much importance to the one-year figures and pursue those CCGs that are underperforming, in order to drive forward initiatives at a local level that encourage earlier diagnosis, as I know my party will do, once returned.

[Andrew Gwynne]

I absolutely agree with the hon. Gentleman. In fact, my right hon. Friend the Member for Leigh (Andy Burnham) has given that commitment as shadow Secretary of State. We need to make sure that if CCGs are not performing as well as they could be in this area, Ministers and NHS England take every action they can so that we bring standards up and everyone can expect the same level of treatment, irrespective of which part of England they live in.

The right hon. Member for Sutton and Cheam is not able to be here for the winding-up speeches but, as a courtesy, he let both Front Benchers and the proposer of the debate know that he would not be able to be here. He was right to raise the issue of long-term funding for the NHS. I do not think it is appropriate to talk in a knockabout fashion in this debate about who is going to raise what or when, but Labour has committed to the new time to care fund, which will enable us to have 8,000 more GPs by 2020. That, undoubtedly, will help to improve access and ensure that doctors get more time with their patients.

At the moment, fragmented primary care makes it more difficult for patients, particularly the elderly, to see one doctor who can develop a long-term view of long-term complex conditions. That is why, alongside our commitment to guaranteed GP appointments within 48 hours, we have made an equally important pledge to ensure that patients can book ahead with a GP of their choice.

Hon. Members may also have heard that Labour wants to work with the Teenage Cancer Trust to expand its cancer awareness programmes across all schools in England. Too many young people leave school without knowing the warning signs of cancer. Every young person should have the opportunity to learn more and know where to go if they are worried about their health. We in this place, on both sides of the House, owe it to our young people to teach them the signs of cancer and it is just as important to build their confidence so they can seek help. Early diagnosis, as we have heard, is critical to improving cancer survival, because treatment is more likely to be successful at an earlier stage. I commend the hon. Member for Castle Point for her powerful contribution today, and for the work she is doing in her constituency along these lines to make sure, working with those charities, that young people are more aware of the symptoms of cancer and where they should go if they exhibit signs of ill health.

When doctors catch bowel cancer at the earliest stage, more than nine in 10 people survive for at least five years. At the moment, however, fewer than one in 10 people with bowel cancer are diagnosed at the earliest stage. Many Members will be aware of the appalling statistic that a quarter of cancer cases in England are currently diagnosed through an emergency route. Naturally, far too many of these cases are in the advanced stages, meaning the prognosis is poor compared with cancer diagnosed through other routes.

Late diagnosis is not just worse for health outcomes; as we have heard, it can cost more too. The average cost of treating stage 1 colon cancer is about £3,400, compared to £12,500 at stage 4. Analysis by Incisive Health found that if all CCGs were able to achieve the level of early diagnosis of the best CCGs—our long-term target—then across all cancers we would be making annual savings in treatment costs of about £210 million. That touches on the points made by the hon. Member for Basildon and Billericay, as well as by the hon. Member for Salisbury and the right hon. Member for Sutton and Cheam.

The hon. Member for Salisbury also touched on the postcode lottery for diagnostics and treatments. He is absolutely right. With the leave of the House, I would like to talk about a case from my early time as a Member of Parliament, back in 2005. I have the privilege of representing a cross-borough constituency, so I have two of everything. I have two local authorities and two police divisions and so on. Back then, there were two primary care trusts. My constituent came to my surgery having been diagnosed with breast cancer. Her doctor had decided that the best treatment for her was Herceptin. If she had lived in the other part of my constituency, the primary care trust responsible would have provided Herceptin treatment for her, but because she lived on the other side of a road, with an invisible line down the middle, she was not able to access that treatment. It was one of those moments where it was appropriate for the MP to throw all his toys out the pram, and thankfully the PCT changed its decision. One of my nicest moments as an MP was about two years ago when the lady, whom I did not recognise, came back to my surgery with a completely different case. At the end, she said, “Mr Gwynne, you don’t recognise me, do you?” I looked blank, and panic-stricken, because we deal with so many constituents, and she said, “I’m that lady you got Herceptin for. I’m still here.” It was one of the proudest moments of my time so far as an MP.

That brings me to our plans for treatment. We have pledged that a Labour Government would continue to work with the cancer drugs fund, but we also recognise that the fund unreasonably excludes other advanced treatments. This takes up the point made by the hon. Member for Castle Point and the firmly and long-held views of my hon. Friend the Member for Easington. For that reason, we would expand the cancer drugs fund to include other treatment options, such as radiotherapy and surgery—the two treatments that together are responsible for nine in 10 cases where cancer is cured. That point has been powerfully made by my hon. Friend on so many occasions—it is still ringing in my ears.

The nature of cancer is changing. Just as with AIDS, rapid advances in technology mean that cancer is no longer the death sentence it once was, and this welcome change means that cancer is increasingly considered a long-term condition, which brings its own requirements, in terms of long-term care and support. A report from the King’s Fund suggested that as cancer survival rates improved, health care services needed to improve the quality of life of the growing number of people with cancer. The needs of cancer patients often span every tier of care in our system, yet it often proves incredibly difficult to navigate the various systems. We therefore plan to give everyone with the greatest need a single point of contact. This person will be their co-ordinator and advocate in the system, identifying their needs and ensuring they are met. No cancer patient should end up lost in our vast health system, unable to find the treatment they are entitled to.

Cancer survivors have to be properly supported once their treatment stops to help their recovery and minimise the impact of their illness on their overall health. The current formulaic approaches are not meeting the needs of cancer patients, and the current hospital-based follow-up service will not cope with the growing cancer population. We owe it to families battling cancer to continue to have high ambitions. In that spirit, Labour has set out its plans for improving early diagnosis and expanding access to new innovative cancer treatments. I thank all Members for their contributions. Despite our many political differences, we have the same ambition for cancer—to bring forward the day when this terrible disease is beaten.

[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.

[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.

[Mr Baron]

I am heartened that the Minister says we should keep going, and I assure her we will. Let me thank all hon. Members for their contributions. We have had some heartfelt ones, particularly from my hon. Friend the Member for Filton and Bradley Stoke (Jack Lopresti). His contribution was very brave, and we have all said so. Other hon. Members have made heartfelt contributions about their own personal stories, including the hon. Member for Denton and Reddish (Andrew Gwynne). Let me also thank, as I did at the beginning, the cancer-specific all-party groups. The all-party group on cancer may consider itself the wider cancer community’s voice in Parliament, but we are all doing essential work that adds value to the debate, and I thank all concerned. We work together well and we are making a valuable contribution, as the Minister has kindly said.

I thank the Minister and her team, as ever, for her constructive response. I asked one or two detailed questions in my opening speech that she has not had time to address, given the pressure of time, and I look forward to receiving a response in writing from her on those. May I leave one thought with her about improving outcomes, which is the subject of today’s debate? No one single measure will drive forward on the objective of improving outcomes. Science has its role to play. With my cancer hat on, courtesy of Cancer Research UK, I went to visit the Francis Crick building, the enormous building being constructed next to Euston station. It is inspiring to see that being built, and I was not the only one to feel that it will be a great source of hope in the future. Government initiatives will also take their place in improving cancer outcomes. My hon. Friend the Member for Salisbury (John Glen) made the point about standardised packaging, and, as the Minister well knows, I have made my support for that clear, as it is a step forward.

However, there is one important measure—this is the thought I leave with the Minister—and one initiative that could be transformational in driving forward and improving cancer outcomes. I am talking about the one-year figures broken down by CCG, and the cancer community has come together in getting the Government successfully, together with NHS England, to put them in the top tier of NHS accountability. The Minister has admitted that there is a bit of vague ground on the levers of accountability and how NHS England will ensure that CCGs which underperform over a period of time will be brought to book. I suggest to her that if there is one measure that we will look back on in decades to come and say, “That, more than anything else, encouraged earlier diagnosis at a local level,” it is those one-year figures broken down by CCG. I encourage the Minister and the Department of Health, with NHS England, to do all they can to make sure that those levers of accountability are properly in place, so that we can save those extra thousands of lives, which is what we all wish for.

Question put and agreed to.

Resolved,

That this House has considered improving cancer outcomes.