New Cancer Strategy

John Baron Excerpts

Thursday 19th November 2015 Commons Chamber

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

I beg to move,

That this House notes the findings of the independent cancer taskforce published in July 2015; and calls on the Government to publish an action plan on implementing the new cancer strategy.

I want to begin by thanking the Backbench Business Committee for granting this timely debate. I also thank fellow officers of the all-party group on cancer, some of whom are going to participate in this debate, and the officers of the other cancer-specific all-party groups, who joined me in applying for this debate. This therefore represents a coming together of all the cancer-related APPGs. Although we want to raise specific issues, we are all agreed on the importance of debating the new cancer strategy delivered by the cancer taskforce.

I hope you will not mind, Mr Deputy Speaker, if I mention the fact that on 8 December the all-party group on cancer will hold our annual Britain Against Cancer conference in Central hall. It is the largest gathering in the country of the cancer community, and I warmly invite all Members to join us on the day. My thanks would not be complete if I did not also thank the Under-Secretary of State for Health, my hon. Friend the Member for Ipswich (Ben Gummer), who is sitting on the Front Bench, having stepped into the shoes of the Under-Secretary of State for Health, my hon. Friend the Member for Battersea (Jane Ellison), who has responsibility for cancer. Unfortunately, she cannot be with us today, but she is a good friend of the cancer community. To help my hon. Friend on the Front Bench, I sent him an advance copy of my speech. He may not be able to answer all of my questions from the Dispatch Box, but I look forward to receiving his written responses to those that he cannot answer today.

Perhaps we need to remind ourselves of the challenge. There are currently 2.5 million people living with cancer in the UK, and by the end of next year it is expected that 1,000 people will be diagnosed with cancer every day. Macmillan Cancer Support has suggested that in a few years’ time, one in two people will have been affected by cancer.

The challenge of delivering world-class cancer outcomes for all patients is growing ever greater. Hospital admissions for cancer in England have gone up by 100,000 a year compared with five years ago. For 17 months, the NHS has missed the target for cancer patients to receive their first treatment within 62 days of an urgent referral. Our outcomes continue to lag behind our European counterparts. Research has shown that the one-year cancer survival rate in the UK is about 13 percentage points behind the best in Europe, which is about 81%. That may not sound like a big figure, but it means that in the region of 10,000 lives a year are lost needlessly, in large part because the cancer was diagnosed too late.

That is the backdrop against which the cancer taskforce delivered its recommendations for a new five-year cancer strategy in July—something that the whole cancer community welcomed. Like others who are campaigning for improvements in cancer services, I was disappointed that the cancer taskforce report ended up being a report to the NHS and its arm’s length bodies, rather than a report of the NHS and its arm’s length bodies. That was not the original intention. However, that should not detract from the excellent work that went into it. Our congratulations should go to Mr Harpal Kumar for his efforts and hard work in preparing the strategy.

The recommendations of the strategy are based on evidence and advice from organisations across the cancer community, including the all-party parliamentary group on cancer. It covers the whole cancer pathway from early diagnosis to care after treatment and at the end of life. It aims to deliver a radical improvement in cancer outcomes by 2020.

Since its publication, the strategy has been welcomed by the Government, the health sector, the charities and the cancer-related all-party groups in this place. Attention must now turn to the implementation of the taskforce’s report. I congratulate Ministers on pre-empting the spending review in at least two ways by committing the Government to two of the key recommendations in the strategy. First, there is a commitment to ensure that all patients receive a definitive diagnosis within four weeks of their referral from a GP. Secondly, there is a commitment to ensure that all patients are offered a recovery package by 2020 and to develop a new metric on quality of life.

However, the taskforce has been clear that the recommendations set out in the strategy will deliver a step change in outcomes only if implemented as a whole. It is therefore important that there is urgency in implementing the remainder of the strategy. If he can, will the Minister outline today when he expects to publish the implementation plan and what degree of consultation he envisages before its publication? What assurances can he give that Ministers will ensure that the implementation plan contains clear deadlines and earmarked resources for implementing the strategy’s recommendations?

May I touch briefly on the importance of earlier diagnosis, which is one of the key priorities identified in the strategy? That point is of particular interest to the all-party parliamentary group on cancer and the other cancer-related all-party groups. As some Members will be aware, the all-party parliamentary group on cancer campaigned tirelessly on improving early diagnosis—what we call “cancer’s magic key”. The logic behind our campaign is exceedingly simple: the evidence shows that people who are diagnosed earlier are more likely to survive for over one year and, therefore, to survive cancer generally.

[Henry Smith (Crawley) (Con)]

I warmly congratulate my hon. Friend and all the cancer APPGs on securing this important debate. Early diagnosis is absolutely key, as he rightly points out. Regrettably, my mother died of acute myeloid leukaemia in 2012. She was diagnosed on the day before her death. We really do need to bear down on this issue. Will my hon. Friend pay tribute to charities such as Bloodwise that do such important work in highlighting this area of cancer?

[Mr Baron]

I will do so by all means. Let me express my heartfelt sympathies to my hon. Friend as regards his mother. He is absolutely right that charities such as Bloodwise, as well as many others across the charitable sector, realise the importance of earlier diagnosis. I will give him one statistic that directly answers his question. I spoke at an event about bowel cancer yesterday. The statistics quite clearly show that 90% of people diagnosed in the early stages of bowel cancer survive for more than 10 years, but that figure drops to just 5% if they are diagnosed at a later stage. That is the difference that earlier diagnosis can make.

The logic behind focusing on earlier diagnosis is very simple. We have found over a number of years that the NHS is as good as any other healthcare system at getting patients from the one-year point after diagnosis to the five-year point, but is poor at getting them to the one-year point in the first place. That suggests that it is not good at detecting cancer. We lose the vast majority of those 10,000 lives in the early phase—up to one year—and then it is simply not possible to catch up. We therefore need to do more on earlier diagnosis.

Getting the NHS to focus on the one-year figures will encourage initiatives on the frontline to promote earlier diagnosis. By putting the one-year figures up in lights, we can ensure that the local NHS realises that it is being monitored. It will therefore be up to the local NHS to introduce and adapt a range of initiatives that suit the local population best, whether they are elderly people, black and minority ethnic populations or whatever. The initiatives range from everything from encouraging better screening uptakes to encouraging better awareness campaigns when it comes to education, better diagnostics in primary care and better GP referral rates, all or any of which could be approved locally to drive up earlier diagnosis.

I suggest that earlier diagnosis, as well as being better for patients, can also save the NHS money. Incisive Health and Cancer Research UK published a report last year that set out the cost savings of diagnosing a patient early. One example is in colon cancer. Stage 1 treatment costs about £3,300, while stage 4 treatment costs £12,500, which is a notable difference. If we look at the range of cancers and the number of cancer patients involved, we can see that we could save hundreds of millions of pounds if we raised our game and diagnosed cancer early.

The all-party group on cancer and the wider cancer community, including the Cancer Campaigning Group, have worked collaboratively with the Government and NHS England—I congratulate the Government most heartily on listening to our concerns—and have campaigned together to get the one-year figures into the DNA of the NHS. We have managed to get them into the NHS outcomes framework and the commissioning outcomes framework.

Last year, our efforts culminated in a successful campaign to ensure that a one-year cancer survival rate indicator is included in the delivery dashboard of the clinical commissioning group assurance framework from this April. For the moment, that is the primary mechanism by which CCGs are held to account. Many CCGs have told us that it is the primary tool they use for determining priorities at local level. With the one-year figures now up in lights in the top tier of NHS accountability, commissioners will be encouraged to take action in their local area to improve earlier diagnosis and ultimately to improve cancer survival rates.

Many people may think, “Job done. We’ve managed to get the one-year rate into the DNA of the NHS. We’ve managed to get it on the radar screen of CCGs. Is there anything else we should be doing except following through on those initiatives?” However, many of us are concerned that the recently proposed changes to the accountability system in place for CCGs may undermine this work. A few weeks ago, the Secretary of State announced a new scorecard for measuring the performance of CCGs, which will involve each CCG being awarded an Ofsted-style rating with effect from next April. Although the all-party group on cancer approves in principle the improvement of accountability, we strongly advocate, on behalf of the cancer community as a whole, that the use of the one-year figures to drive earlier diagnosis at local level is not lost throughout this process. Will the Minister outline in further detail the Government’s plan to implement a CCG scorecard and the process by which the metrics relating to cancer will be determined? Will he confirm that the focus on one-year survival rates will not be diluted?

Let me mention the reforms suggested in the cancer strategy for the patient pathway. With a growing number of people surviving cancer, it is particularly important that we make improvements throughout the whole cancer pathway, and there are two key parts to that. First, all too often patients report being treated as a set of symptoms rather than as a person, and certain groups of patients—namely older people, ethnic minorities and those with rarer cancers—report a poor patient experience. Secondly, many cancer patients lack the necessary support to get on with their lives once treatment has ended.

The all-party group on cancer welcomes the increased focus on patient experience across the NHS, but we must do more to ensure that we have the right data to drive improvement at local level. Although the cancer patient experience survey is a useful tool, too often the data are difficult to access and not widely used. The cancer strategy recommends the creation of a new metric to measure the patient experience across the whole pathway. Will the Minister set out how the Government plan to implement the strategy’s recommendation on a new patient experience metric, and say how they will ensure that data are used effectively to drive improvement at local level? Will he confirm that there will be sufficient resources for the new metric and the cancer patient experience survey?

We welcome the Government’s commitment to ensuring that all patients have access to a recovery package following their treatment, but if we are fully to address that challenge it is vital that the NHS understands where it is working well and where improvements are needed. As such, it is vital that the strategy for the development of a new quality of life metric is taken forward as a priority. Will the Minister ensure that the Government’s commitment to take forward that recommendation for the cancer strategy to develop a quality of life metric is backed up with clear plans for funding and implementation?

In the few minutes that remain, let me address a couple of key issues including rarer cancers and the cancer drugs fund. It is an interesting fact that the combined number of rarer cancers—those less common than breast, lung, prostate and bowel cancer—outnumber the sum total of those more common cancers. Services for people with rarer cancers are no less important, and we must ensure that people with rarer cancers get access to the right level of specialist expertise, irrespective of where they live. The taskforce recommendation for the creation of highly specialised multi-disciplinary teams for rarer cancers is particularly welcome. Will the Minister assure the House that that will happen, and that MDTs will be supported by technology so that they can deliver specialist care without inconveniencing patients?

Research efforts into rarer cancers must be redoubled. The Government are leading the world in their investment in genomics, most notably through their 100,000 genomes project, which is sequencing the genomes of those with cancer and rare diseases in general. It is good that the project has so far fully sequenced the genomes of 5,000 patients, but will the Minister update the House on progress with cancer patients? May I suggest that, once complete, Genomics England should independently carry that research forward for the benefit of the NHS and patients, given its excellent track record?

[Mark Tami (Alyn and Deeside) (Lab)]

Is the hon. Gentleman as worried as I am that companies that are investing in finding drugs for rarer cancers are, because of their nature, small in number, and they should not be put off investing in research to find cures for those cancers because they feel that the Government—whatever party is in power—will perhaps pull the plug or concentrate only on the more common cancers?

[Mr Baron]

The hon. Gentleman makes an excellent point, and one hopes that there is proper dialogue with all the parties concerned to ensure that what he describes does not happen. The approach to science must be collaborative. Nobody has a monopoly on good ideas, but I suggest that the Government should be congratulated on their ground-breaking 100,000 genomes project, as long as it does not freeze out research in the private sector. I hope that there is dialogue to ensure that that will not happen. If there is not, that issue needs to be raised with the relevant bodies in this place.

On the cancer drugs fund, people living with cancer need the best treatment available. We can all agree to that. Approximately 72,000 cancer patients have benefited from the fund. That testifies to the Government’s commitment. We recognise, however, that reform is needed over the longer term. We need a longer term solution to the cancer drugs fund. The Government apparently also believe that reform is essential. Recent NHS England board papers indicated a continuing overspend on the cancer drugs fund, underlining the fact that a long-term solution is needed now.

When reforms are introduced, it will be important that the spirit of the CDF—that patients are able to gain access to the treatments their doctors recommend—is maintained at a cost that is affordable to the NHS. There have been reports about NHS England refusing to discuss some offers of cost reduction with drug companies due to the rules under which the CDF operates. That needs to be addressed urgently if the overspend is to be tackled. I very much welcome—I am sure everybody else in the House does, too—the news that the CDF consultation opened today, at, I think, 1 o’clock this afternoon. I recommend, as I am sure others do, that all relevant parties participate in this very important consultation. Will the Minister provide assurances that the NHS will be supported in demanding the best possible deal from the drug companies, because that will be an important element of the process?

I want to finish by speaking about the importance of leadership and accountability, both at national and local level. The all-party group on cancer strongly welcomes both the strategy’s recommendation to introduce cancer alliances to drive improvement at a local level, and for the National Cancer Advisory Board to provide accountability at a national level. The National Cancer Advisory Board, in particular, will be important in ensuring accountability for the strategy, and that momentum and focus is retained. It is vital that this body is set up as a priority, so we can monitor progress and implementation from the beginning and set up the right structures to ensure strong accountability. Will the Minister set out how the Government plan to monitor the delivery of the cancer strategy recommendations and to measure their success?

I thank the Minister once again for responding to the debate. I know this is not his usual brief and I would be very happy for him to write to me after the debate if he does not have the answers to all the questions at his fingertips. As ever, there are a number of areas I have not had the chance to cover. Time simply has not allowed it, but I hope they will be covered by other colleagues speaking in this afternoon’s debate.

I want to finish by emphasising the opportunity presented by the new cancer strategy. By implementing its recommendations in full, and by retaining the focus on the one-year survival rates as a means of driving forward and promoting earlier diagnosis, we have the potential to deliver world class outcomes across the entire cancer pathway: to dramatically improve our cancer survival rates, to deliver care tailored to the patient and to ensure that patients are supported. But action must be taken now. Doing nothing is not an option. The challenge, as I highlighted at the beginning, is huge, but in the cancer strategy we have a clear plan for how to make it work. I urge the Government to take action now, to fulfil our manifesto commitment to implement the strategy in full, and to deliver the care, treatment and world class outcomes cancer patients deserve.

--- Later in debate ---

[Mark Durkan (Foyle) (SDLP)]

It is a pleasure to follow the hon. Member for Bury St Edmunds (Jo Churchill), particularly as she ended by referring to off-patent drugs. She spoke powerfully on Second Reading of the Off-patent Drugs Bill, which was promoted by the hon. Member for Torfaen (Nick Thomas-Symonds) only a couple of weeks ago. This debate draws on many points made in previous debates, including that Second Reading debate and Westminster Hall debates. There have been debates about the cancer drugs fund, specific cancers and, recently, secondary breast cancer.

I am an officer of a number of all-party groups, including that on cancer, which is so ably led by the hon. Member for Basildon and Billericay (Mr Baron), who secured this debate. We have also heard from colleagues who are members of other all-party groups, including the hon. Member for Scunthorpe (Nic Dakin), who is on the all-party group on pancreatic cancer, and the hon. Member for Castle Point (Rebecca Harris), who is doing so much to raise awareness and to promote action on and understanding of brain tumours.

I welcome the fact that the Backbench Business Committee has afforded us this opportunity to join up what might otherwise appear to be disparate work. The APPGs are not rivals—their efforts are entirely complementary. The cancer strategy is a benchmark document and this debate gives us an important opportunity to consider how we can marshal parliamentary effort and will behind it. We need Ministers in the Department of Health and elsewhere to know that we are not taking it for granted and that, just because we have had unmet need for a long time, that should not continue to be the case. I would like to hear a Minister tell us that their portfolio means that they see themselves as the Minister for meeting unmet need. If they set that target and seek to make that change and turnaround, they will have many backing vocalists from the different all-party groups.

Other hon. Members have said that there may be some issues with aspects of the cancer strategy, but it clearly lays down some important standards, not least on a recurring message that the APPGs get from the evidence we receive, namely the question of early diagnosis.

[Mr Baron]

The hon. Gentleman is a good friend of the all-party group on cancer. He will already know this, but it is worth putting it on the record that the separate all-party groups on cancer are endeavouring to get their act together and to speak with one voice where there is a common interest—and there are many when it comes to cancer.

[Mark Durkan]

I fully recognise that point. That was what I was trying to say when I said that the APPGs are not rivals. This debate allows us to bring together their work and their common message, and to acknowledge the work of the hon. Gentleman and the chairmen of the other APPGs. In that regard, I should also mention the hon. Member for Washington and Sunderland West (Mrs Hodgson). She cannot be here this afternoon, but she has done so much on the all-party groups on ovarian cancer and on breast cancer.

Early diagnosis is a common theme and the issue is not just about making sure that there is more access to diagnosis. The hon. Member for Bury St Edmunds has mentioned how many people end up being diagnosed in A&E, which is not what should happen. Although certain cancers raise more sensitive and technical questions than others, there needs to be more awareness among GPs, and diagnostic tools are also key. However, this is about not just ensuring earlier diagnosis with better use of diagnostic tools, but ensuring much clearer referral pathways. The cancer strategy sets a target of making sure that, by 2020, 90% of people are diagnosed within a month to see whether or not they have cancer. That is a very good working standard.

All the APPGs, particularly the all-party group on cancer, have strongly suggested that the indicator of one-year survival rates would be a very good test of our ambitions and efforts and of the actions of health authorities. That working standard needs to be adopted, because it would help us to monitor and manage our progress.

I am conscious of the fact that I speak as a Member from Northern Ireland, whereas the cancer strategy and much of this effort relate to England. However, as everybody knows, in a lot of these areas we are talking about predictive policy. When we set frameworks or national strategies on particular diseases or illnesses for the NHS in England, they can extend, through policy airspace principles, to the devolved areas. That is one reason why I have no hesitation in joining in the work of the APPGs here—it helps to advance understanding at home.

Of course, that was not the case with the cancer drugs fund. We do not have a Northern Ireland version of that, which has led to the frustration that was identified by the late Una Crudden, who suffered from ovarian cancer. Many of the drugs that were available in England under the cancer drugs fund had been the subject of clinical trials in the excellent centre in Belfast, yet they were not available to patients in Belfast.

The success of the cancer drugs fund has shown its limitations, which is confounding us in thinking about how to develop and replace it. When considering the future of the cancer drugs fund and what will succeed it, I ask him to think not just about doing something for England and then seeing whether the devolved Administrations can match it or do better, but about the possibility of a UK-wide funding pool for some of the newer drugs and for some innovations in research and diagnosis, such as molecular diagnostic testing, which comes under the cancer drugs fund. Perhaps this is a conversation that we need to have with the Chancellor in the context of his announcement next week and what will happen beyond that. I am saying not that it should all be funded by London, but that there could be a pool of money to which the devolved areas contribute, with common standards and bands. It might be that certain groups of patients would then be covered by further arrangements made at the devolved level.

The more commonality and consistency we can bring to funding, the better. It would make it so much better for the many good cancer charities and policy advocacy groups that work with cancer patients, which have to busk around the different Administrations to see who has what bit of money. That also creates a lot of confusion at the parliamentary level. It is hard for us to join up our efforts and marshal our arguments when we are dealing with different structures and systems. The more commonality we can create in funding, particularly in the area of innovation, the better.

Perhaps there should be a UK-wide effort, or perhaps it should go beyond the UK. The British-Irish Council includes all eight Administrations on these islands, including the south of Ireland. Perhaps there should be a common effort at that level, given some of the clinical networks that will be involved. When we consider the rarer cancers that will not be treated in some of the other places, perhaps a more united effort would help to take the thinking forward. A lot of the ingredients in the cancer strategy for England might best be brought forward as part of a combined strategic effort on cancer across these islands.

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[The Parliamentary Under-Secretary of State for Health (Ben Gummer)]

It is a great pleasure to respond to the excellent speeches that have formed this interesting and remarkably well-informed debate. I echo the thanks given by the shadow Minister and others to my hon. Friends the Members for Basildon and Billericay (Mr Baron), for Bury St Edmunds (Jo Churchill) and for Bosworth (David Tredinnick) for securing the debate in such a timely manner. I do not think that even they would have anticipated it coinciding with today’s launch of the consultation.

The debate touches on the lives not only of everyone in this House but of everyone in the country. The frustrating regularity of cancer diagnosis—in the past week, two of my friends have had a cancer diagnosis confirmed—is shared by Members and by people watching this debate across the country. That is why this is such an important and salient issue for all our constituents. I am therefore very grateful to hon. Members for both speaking on this matter and for bringing it to the attention of the House.

At the start of my speech, it is worth reflecting that we are able to speak about this issue from a position of celebrating the success of the past few years. There have been quantum leaps in the treatment, diagnosis and survival rates of cancer. More than half of people receiving a cancer diagnosis now live 10 years or more, a remarkable statistic that would scarcely have been believed 20 or 30 years ago. The fact that we are able to speak frankly about this at all, with the very personal speeches hon. Members have given today, marks the end of the dangerous taboo surrounding talking about cancer. Happily, we are now able to replicate that fight in relation to mental health and end-of-life care. The work done by cancer charities over many years, to talk about cancer and to make it a live issue in the public imagination, is now reflected in other important areas of care.

[Mr Baron]

The Minister is absolutely right to say that we have made great strides, and the Government are to be congratulated on playing their full part in that, but may I gently remind him that as we have made great strides, other countries have also made great strides? The debate is largely about the fact that we are still well behind European averages on survival rates. The first year survival rate in this country is 69%, whereas in Sweden it is 81%. That apparently small difference accounts for about 10,000 lives a year in this country being needlessly lost because we diagnose too late. I am sure the Minister will agree that there is still a lot to improve on.

[Ben Gummer]

I could not agree more with my hon. Friend. I was not trying to offer mere bromides. Indeed, I was about to say that although we perform well in many clinical areas, we perform badly on cancer compared with other countries. We have made significant progress over the past few years, but we are still not where we should be: at the top of the pack. There are many reasons for that, some of which we understand and some of which we do not, but it behoves us all to do something about it, which is why the taskforce was set up. In that regard, I add my thanks to Harpal Kumar and the many people who contributed to the taskforce’s conclusions.

I am speaking to an expert audience here—I am conscious that almost everyone who has spoken has considerably greater expertise in this area than I do—so I will not rehearse the history of the taskforce or its recommendations. Importantly, there is now a consensus about what needs to happen. Various things have to happen if we are to deliver on the aims of the taskforce.

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[Mr Baron]

That is very kind and generous, Madam Deputy Speaker.

I would like to thank all who contributed today—it proves how much expertise has been brought to bear in such a well-informed debate from all sides. I would like to thank the Minister once again for stepping into the cancer Minister’s shoes and for answering our questions. I am sure he will want to answer some further questions in writing. I would like to thank him, too, for taking on board the importance that the whole cancer community attaches to the one-year cancer survival rates as a means of promoting earlier diagnosis. I thank him for that.

I leave the Minister and the House with just one thought. There are not many areas of Government policy that could save 10,000 lives a year if we raised our game on earlier diagnosis. We need a policy that will match the best internationally. We have that capability in our hands: let us hope that we seize the opportunity.

Question put and agreed to.

Resolved,

That this House notes the findings of the independent cancer taskforce published in July 2015; and calls on the Government to publish an action plan on implementing the new cancer strategy.