Pancreatic Cancer

John Baron Excerpts

Monday 8th September 2014 Westminster Hall

[Mr Jackson]

Or frequently, in my case, as my hon. Friend says.

A good friend of mine—a non-political friend in my constituency—was utterly shocked at the premature death of the husband of a very good friend of hers. He was, I think, 48, and the father of two young children. He had visited his general practitioner several times and was told over again that he was suffering from a very bad case of back pain. By the time he had his scan it was too late; the tumour was inoperable and was wrapped round other vital organs. It was not possible to operate and the poor gentleman died, leaving a young family, a matter of weeks later. That account prompted me to think and research more. Of course, I read the moving article that my hon. Friend the Member for Lancaster and Fleetwood wrote for The Daily Telegraph about his experience and the tragic death of his partner such a short time after diagnosis, and that, too, prompted my interest.

Figures have already been given about the comparative spending on different cancers. The current figure of 1% of research spending, representing £5.2 million, is pitiful for a cancer that is so prevalent. If 8,800 people were being knocked down on the roads every year or killed on level crossings or through any other possibly preventable cause, we would demand immediate action; but it seems we are prepared to countenance little if anything being done by central Government on pancreatic cancer. That is not a party political view, obviously. The comparative data show that the USA has a 6% survival rate after five years and Australia has a rate of 5%; but in the UK it is only 3.3%. We must address that. My hon. Friend the Member for Stevenage (Stephen McPartland) made the point that it is shocking that people attend accident and emergency jaundiced and clearly seriously ill before it dawns on anyone that they are in the advanced stages of pancreatic cancer. I just feel that something more can be done, not least because, according to the briefing we have received, one in six people attend a general practitioner or other health care facility more than seven times, yet they do not receive the treatment they need.

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

I congratulate my hon. Friend on his powerful speech. I think we all accept that earlier diagnosis is cancer’s magic key. The problem is that one in four cancers are first diagnosed late in A and E and the figure for pancreatic cancer is double that—nearly half of all pancreatic cancer patients are diagnosed there. In fairness to the Government, and I will speak about this when I make my speech, does my hon. Friend agree that the focus on survival rates as a means of driving forward initiatives for earlier diagnosis at local level, whether better awareness, better screening, better diagnostics or better care pathways, is the secret to unlocking this dreadful disease?

[Mr Jackson]

I thank my hon. Friend for his excellent work as chairman of the all-party group on cancer in raising the issue of cancer generally. He is right in saying that there is no magic bullet and that a multi-faceted strategy is needed to deal with the issue. I will elucidate on that in a few moments without taking up too much further time.

The hon. Member for Worsley and Eccles South is right about public perception. We must remember that 25% of men and women who are diagnosed with this condition are not old, but younger men and women. The public should understand and embrace that fact, and I know from my experience of a much younger man who was diagnosed with the disease and died very quickly. It affects everyone throughout the country irrespective of gender, age, ethnicity, region and so on.

Over and above academic research, we should focus on GP education. This is not an opportunity to have a go at general practitioners, who do a fantastic job and work hard, but reference has been made in the nicest possible way to the ping-pong effect, as was mentioned in the all-party group’s report. We must stop that and make a decision to have clear strategies with a clinical pathway that people can get on to if they exhibit certain symptoms.

There are several reasons for the poor rate of diagnosis, which are not strictly speaking the “fault” of the general practitioner. As I have already said, there are no definitive biomarkers or tests and there is no way to get round that. It may be ameliorated or overcome following future research, but at the moment GPs are unable to decide definitively that someone is suffering from pancreatic cancer. That is clearly linked to more funding over and above the current 1%, to which I will refer later.

Low awareness of symptoms among the general public needs a multi-media approach to try to persuade people that they are not wasting a general practitioner’s time by alerting them to their symptoms, even if they are under 65. There is a lack of obvious referral pathways into secondary care for patients without obvious symptoms. The hon. Member for Worsley and Eccles South gave an excellent anecdote about the way people are pushed around between different clinicians. That is completely different from the treatment of breast cancer where there are prescribed and definitive treatment pathways.

What are the priorities? It is vital to develop local screening tests. People should not have to travel 40 or 50 miles, and there should be such a testing facility locally in an acute district hospital or in primary care facilities. There should be collaboration between clinical commissioning groups, for example, as well as GP training, referral guidelines and diagnostic support.

I am realistic and I understand that not every GP will be an expert on pancreatic cancer, but there should be a general practitioner in the local area who can offer expert advice, training and assistance. GPs should also have direct access to CT scans. The all-party group on pancreatic cancer made all those recommendations. There should be one-stop shops where patients with vague symptoms can have a battery of different diagnostic tests. That would not remove the risk that someone has pancreatic cancer, but it would reduce the risk that they remain undiagnosed. There should be a rapid access clinic for jaundiced patients. It may be too late for some people, but some may be saved.

We need research into the biology of tumours and we must look again at the cancer drugs fund, as my hon. Friend the Member for Lancaster and Fleetwood said. We must move to a personalised-medicine approach. It is wrong that pancreatic cancer is struggling to receive even £10 million a year for research. The Department should aspire to higher funding than the current £700,000. It should aspire to £25 million by 2022. We need a new strategy along the lines of the Recalcitrant Cancer Research Act passed by the US House of Representatives for cancers of unmet need. We must ring-fence grants for such recalcitrant cancers by means of clinical trials.

This has been an excellent debate. I am convinced that the issue will rise up the political agenda and I thank everyone who has made that possible. I have had dealings with the Minister and I know that she is compassionate and diligent. I believe that she and her Department are listening and that we are well on the way to beating pancreatic cancer.

--- Later in debate ---

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

I congratulate the hon. Member for Scunthorpe (Nic Dakin) and my hon. Friend the Member for Lancaster and Fleetwood (Eric Ollerenshaw) on securing this important debate, as well as other Members on their powerful contributions so far.

May I, as chairman of the all-party group on cancer, focus my remarks briefly on the importance of earlier diagnosis? That has been touched on by everybody who has spoken, but sometimes when we consider the figures that are available, they bring into stark relief the need to drive forward local initiatives to encourage earlier diagnosis.

Recent statistics have clearly shown that if we could match the average one-year survival rates in Europe, we would save something like 5,000 lives a year. The recently published OECD report said that if we could match the average international one-year and five-year survival rates, we could save up to 10,000 lives a year. Those are the sorts of numbers we are talking about. They run very easily off the tongue, but those are individual lives and it is individual grief when it comes to family and friends. It is shameful in this country that something like one in four cancers are first diagnosed as late as A and E. That cannot be right and when it comes to pancreatic cancer, as I think everybody in this room knows, the figures are much worse. They double: something like half of all pancreatic cancer sufferers are not first diagnosed until they reach A and E, when often the condition is so well advanced that it makes survival far less likely, which the figures bear out.

Many years ago, the all-party group on cancer produced a report on cancer inequalities. We found that we in this country stand as much chance as anybody else of getting patients from the one-year point to the five-year point, but compared with others, we fail to get patients to the one-year point. What that suggests, and this was substantiated by the good and great of the cancer world at the time—that report was now five years ago, which suggests that I have been chairman for far too long—is that the NHS is as good as anybody else, and maybe even better, at treating cancer once it has been diagnosed, but it is very poor at diagnosing cancer in the first place. Once we fall behind that one-year point, it is very difficult to make up the lost ground. We lose those 5,000 or 10,000 lives—depending on what we are comparing—at that one-year point, and it is exceptionally difficult to catch up, no matter how good the treatment is within the NHS.

We therefore came up with a very simple measure to try to drive forward earlier diagnosis. It was very straightforward, because we believe that early diagnosis is cancer’s magic key—if we can catch the cancer earlier, we stand a so much better chance of improving all cancers, including pancreatic. Instead of bombarding the NHS with a load of targets, we decided to come up with one measure: to get the local NHS—then the primary care trust, now the clinical commissioning group—to focus on one-year cancer survival rates. The logic is very simple: if there is late diagnosis, we get poor one-year figures. Therefore, by getting the local NHS to focus on one-year survival rates, we get the local NHS, through the CCGs, to focus on introducing initiatives to drive forward earlier diagnosis. It is that simple.

What could those initiatives be? It is up to the local CCG managements—the local NHS managements—to decide what initiatives to introduce that best suit their local populations. They could be, for example, better screening uptake or better diagnostics at primary care. They could be better referral pathways to, for example, CT scans, or better awareness campaigns. It could be any or all of those coming together to drive forward local initiatives to encourage earlier diagnosis.

This is where I would like to congratulate the Government. That may come as a bit of a surprise on my side, but I think the Government have done what is required in this respect, because as of the end of—let me get this right—June, we now have, in the local DNA of the NHS, one-year survival rates. That is very much to be welcomed, because broken down by CCG, it is now going to encourage managements—or it should encourage them—to focus on their one-year figures, and where they are behind, where they are towards the bottom of the table, it will encourage them to act. All of us will be coming together—the cancer community, cancer charities, MPs and local politicians—and putting the spotlight on the underperforming CCGs. If it works as it should—and provided the levers of change and accountability are there—that should encourage underperforming CCGs to raise their game and introduce local initiatives to encourage earlier diagnosis, and over time, improve their one-year survival rates.

The tools are in the toolbox for us all to use to encourage earlier diagnosis. I congratulate the Government on actually listening, because we have been campaigning on this issue for five years now and we now have those tools in the toolbox. However, things are never quite what they seem, and I wanted to speak in this debate to bend the Minister’s ear on a particular issue. We all have our wish list of things that we would like to see introduced by way of initiatives, and I know that the Minister will respond in the fullness of time, if not in this debate, but one thing that I would like to get across to her is what we have learned since succeeding in getting the one-year figures into the local DNA. CCG chief executives have been contacting us and others in the cancer community, making the point that CCG chief executives are more focused on the delivery dashboard, as part of the assurance framework, than on the outcomes indicator set, which is where the one-year cancer survival rates are placed.

We had been aiming to get the one-year figures in the local DNA, which is great. We have succeeded, but lo and behold, another layer of accountability has been shunted in, which has knocked down the OIS, and CCG chief executives are now more focused on the delivery dashboard than on the OIS. There is actually no health outcome in the delivery dashboard, and I think that that is wrong, because in the health reforms introduced by the Government, there were two big ideas. There was the restructuring, which some of us did not agree with, but there was also the focus on outcomes, which was a brilliant concept and, I think, will be far more transformative for the NHS than any restructuring. The restructuring is now history, but the focus on outcomes as a way to deliver improvements or focus on improvements is a real plus. However, if we then put that focus on outcomes in a structure that gets knocked down when it comes to accountability and CCG chief executives are instead focusing on the delivery dashboard, introduced by NHS England and the Department of Health, that risks dissipating the potential benefits that we could see by focusing on outcomes.

I therefore ask the Minister this, and she does not have to reply in this debate. I do not want to put her on the spot, but she knows that I have raised this issue before. Could we focus on putting health outcomes into the delivery dashboard? I am focusing on cancer. I think that the one-year figures in the delivery dashboard would be transformative. We have the figures. They are broken down by CCG. There is no reason why they could not be put into the dashboard. I am speaking with high-ranking officials—I will not name names, but the Minister will know who they are, because she knows whom I am meeting—in NHS England, and they cannot see any reason why that should not happen either, so we need to push on this. If we are serious about saving by 2014-15 or 2015-16 those extra 5,000 cancer lives—that was described to me as above the already improving trend line—we have to ensure that health outcomes are in the DNA of the NHS and that CCG chief executives are focused on them and know that if they do not deliver and they underperform, there are levers of accountability that will really put the spotlight on them. That is how we will improve outcomes in the NHS and how we have to drive forward improvements in the NHS.

Even if we just meet the average in Europe, that will be 5,000 lives saved, which is a phenomenal number, and that is just the average. The average survival rate in this country is about 68% or perhaps 69%; in Sweden, it is over 80%. That is what we are talking about; that is the potential, but we have to get those outcomes into the DNA of the CCGs, and we are being told and are advocating that the best way to do that is by getting it into the delivery dashboard. I shall leave that point with the Minister. I do not want to thrash it too much. She knows where we are coming from, and we will be raising the issue in December at our Britain Against Cancer conference, which will be attended by 500 or 600 people. The great and the good of the cancer community, including the charities, will come together, and we will focus on that.

May I also ask the Minister this, please? She has had our report from last year, “Cancer across the Domains”. We still have not had a response; there has been no official response from the Department of Health to that report. I spoke with her before the recess. I encourage her, please, to let us have that response, because time is now on the wing, given that we have Britain Against Cancer. If the Minister thinks that she has sent it, I would love to know, because we have not received it. If the fault is at our end, I will be the first to apologise, but we have not received it yet—neither the secretariat nor my office.

In conclusion, Mr Speaker—Mr Chope, my apologies. [Laughter.] I do not know whether you will be standing, Mr Chope, but there is plenty of potential, I am sure. I congratulate the Government. We have the focus on outcomes. We have the one-year measure. We have the tools in the toolbox. However, I suggest that unless we put those one-year figures in the delivery dashboard, we will not be using those tools, and many cancer patients will suffer as a result.

[Several hon. Members]

rose—