Cancer Targets

John Baron Excerpts

Tuesday 1st May 2018 Westminster Hall

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

I beg to move,

That this House has considered NHS cancer targets.

I thank Mr Speaker for granting this important debate, and I thank you, Mr Streeter, for chairing it and the Minister for taking time out of his busy schedule to address it.

The matters I will raise today, as briefly as possible, are matters I have raised throughout my nine years at the helm of the all-party parliamentary group on cancer. As I near the end of my chairmanship, I thank all those parliamentarians, and the wider cancer community, who have supported and continue to support the group. They have been great stalwarts; the group has achieved much and has much to achieve. I look forward to remaining involved, but at the same time I look forward to handing over the reins.

Despite the fact that, when in government, both main parties have highlighted improving survival rates and supported process targets as a means of driving change, it remains an inconvenient truth that cancer survival rates in England and, indeed, the rest of the United Kingdom continue to lag well behind the international average. What is more, there is only limited evidence that we are catching up. In 2009, the Department of Health estimated that we could save an extra 10,000 lives a year if we matched European average survival rates. In 2013, the OECD confirmed that our survival rates rank near the bottom compared with other major economies, and for some cancer types only Poland and Ireland fare worse.

Of course, Health Ministers are right to point out that cancer survival rates continue to improve. That is welcome news, but it is not the full story. As our survival rates have improved, so have those of other countries, and there is very little evidence of our closing the gap with international averages, despite the considerable increases in health spending in recent decades. The major inquiry by the APPG on cancer in 2009 uncovered the main reason our survival rates are so far behind international averages. It is not that the NHS is worse at treating cancer—once cancer is detected, NHS treatment generally bears up as strongly as that of other healthcare systems—but that it is not as good at catching cancers in the early stages when treatment has the best chances of success. Late diagnosis, therefore, lies behind our comparatively poor survival rates, and addressing that is the key to improving our cancer performance. Early diagnosis is cancer’s magic key.

So how can we best achieve it? Since the publication of our 2009 report, we as an all-party group and the wider cancer community have come together and successfully campaigned for a one-year cancer survival rate indicator to be built into the DNA of the NHS, especially at a local level. Clinical commissioning groups are now held accountable for their local survival rates through both the delivery dashboard and the Ofsted-style scores.

[Jim Shannon (Strangford) (DUP)]

I congratulate the hon. Gentleman: we all know the hard work he does through the APPG and his personal passion for the subject. It is important to put that on the record, because we know why he is here. I have apologised to him, and I apologise to you, Mr Streeter, because I cannot stay. I have a meeting with a Minister at 3 o’clock, so unfortunately I cannot make the contribution that I would have liked to have made. I am sure that the Minister is disappointed, but none the less he will hear from me again in the near future.

Is the hon. Member for Basildon and Billericay (Mr Baron) aware that the target for 95% of patients with an urgent referral to wait no longer than 62 days for first treatment has not been met at all in the past year and, further, that the target for 98% of patients to receive first treatment within 31 days of a cancer diagnosis has also not been met in any of the last four quarters? Does he share my concern and, I am sure, that of the Minister?

[Mr Baron]

I thank the hon. Gentleman for his kind words. I am aware of those statistics, and I will come to the 62-day target specifically later in my address. He is right to say that many CCGs and cancer alliances are not close to achieving many of those targets. That is obviously a problem when treating cancer, but it highlights a bigger issue: we should be focusing on outcome indicators rather than process targets as a means of encouraging earlier diagnosis. I will address his point specifically in a moment.

We tried very hard to get the one-year survival rates into the DNA of the NHS. The Government listened, and we now have CCGs being held accountable for their one-year survival rates, which is good news. The logic is simple: earlier diagnosis makes for better survival rates, so by holding CCGs to account for their one-year figures and, in particular, the actual outcomes, we encourage the NHS to promote earlier diagnosis and therefore improve detection.

A key advantage of focusing on outcome measures is that it gives the local NHS the flexibility to design initiatives tailored to their own populations to improve outcomes. CCGs can therefore choose whether to widen screening programmes, promote better awareness of symptoms, establish better diagnostic capabilities in primary care, embrace better technology or perhaps improve GP referral routes—any or all of those, in combination—to try to promote earlier diagnosis, which in turn will improve the one-year cancer survival rate figures.

Rather than the centre imposing a one-size-fits-all policy, the local NHS has been given the freedom to respond to and focus on local priorities, whether that be lung cancer in the case of former mining communities or persuading reticent populations to attend screening appointments. As an all-party group we try to do our bit. Each summer, the group hosts a parliamentary reception to celebrate with the 20 or so CCGs that have most improved their one-year survival rates. Successive cancer Ministers have supported that in the past, including the incumbent.

There is strong evidence, however, that that outcome indicator is being sidelined by hard-pressed CCG managements, who are focused on those process targets that are connected to funding. If the process targets are missed, there is a cost; if the one-year figures are missed, there is not. In recent decades, the NHS has been beset by numerous process targets that, instead of measuring the success of treatment, measure the performance against process benchmarks, such as A&E waiting times.

[Mr Jim Cunningham (Coventry South) (Lab)]

I pay tribute to the hon. Gentleman, because I know he has a strong interest in this issue for a number of reasons—as we all have, because cancer in one form or another touches nearly every family in Britain. I agree with him that it is the outcomes that matter, not the input. I wonder whether the targets are in the wrong place; I may be wrong, and the hon. Gentleman knows more about it than I do, but I think he has made an important point. The problem seems to be how to get the NHS to implement that.

[Mr Baron]

I completely agree. The problem as I understand it is that, according to the House of Commons Library, there are something like nine process targets focused on cancer alone. Briefly, it is an inconvenient truth that, if we look back over the past 20 or 30 years, we will see that the NHS has been beset by process targets from both sides and for the best of reasons. The bottom line is that we have not caught up with international averages in any meaningful way over those 20 to 30 years, so we must start to question the efficacy of those process targets when what we are trying to do is to improve survival rates. If we get the NHS focused on one-year survival rates, it should look at the journey as a whole, not just a small part of it, in trying to promote initiatives to encourage earlier diagnosis, which at the end of the day is what we all have to do if we are to improve survival rates.

[Karen Lee (Lincoln) (Lab)]

I am the mother of somebody who died of breast cancer and I would argue that this is about the lived experience. It is not just about survival; it is also about the journey—getting there. If care is not adequate or good enough along the way, whether somebody survives or not—well, it is better to survive, of course, but I would argue that this is absolutely about the journey. Targets are meaningless if they are not about people and their lived experience.

[Mr Baron]

I completely agree. My worry about targets is that they focus on a very small, specific part of the journey when we should be talking about the journey as a whole. What I have not mentioned so far is that it was not just the one-year figures but the five-year figures that we were arguing for. We have to take a longer view of the journey in order to ensure that we take into account all aspects of it, including the support, the surround sound—the way of living—and so on. We have to ensure that those who survive receive enough support, but my central point is that if we really are intent on encouraging earlier diagnosis, the process targets have been too blunt a weapon. We all love them. Politicians love them. Both sides love them, and the Opposition can hit the Government with them if they are missed. It is a short-term approach. In reality, they have not improved survival rates to the point where we are catching up with international averages, and that is the key problem.

[Dr Philippa Whitford (Central Ayrshire) (SNP)]

I echo the hon. Gentleman’s concern about process targets being just waiting times, particularly when we know that the wait for a patient to get up the courage even to go to see their GP will often be much longer than the wait on the pathway. Does he share my concern about not having a focus on the clinical evidence of what treatment should be? My concern about leaving everything to CCGs to decide is that we are not then sharing what we know to be the best way to treat any particular cancer. We need clinical standards that are also measured.

[Mr Baron]

I have a lot of sympathy for what the hon. Lady says, and that is why I think that cancer alliances have a decent role to play. They can take more of an overview and more responsibility for ensuring that best practice spreads and is learned from, but they can also take more of a role when it comes to clinical evidence in relation to treating cancer. My suggestion to the hon. Lady is this: if we get the NHS properly focused on improving its one-year figures and, therefore, its five-year figures, it will come closer to embracing the journey as a whole and coming up with initiatives, particularly at primary care level, that are designed to encourage earlier diagnosis. I fully accept that that is not the only answer—it is about supporting people and so on—but at the end of the day we are using blunt weapons to try to improve cancer survival rates, and the evidence clearly shows that we are not succeeding.

I will make some progress, but I will be happy to take more interventions later. In recent decades, the NHS has been beset by numerous process targets, as we have just discussed. Those have a role to play. It would be too revolutionary for me to stand here and say that we should discard them all and just bring in the one-year figures. I think that that would be too much for the NHS to grasp, but I do believe that process targets are too blunt a weapon. They offer information without context and, in my view, can hinder rather than help access to good treatment, especially when financial flows are linked to process targets, which has been the hallmark of our NHS since 1997. What is more, those targets, being very ambitious, have a tendency not to be met—a point made by the hon. Member for Strangford (Jim Shannon)—except in the very best of circumstances. They can easily become, as I have suggested, a political football between parties eager to score short-term points when in reality a longer-term approach is required. All sides are guilty of that.

Cancer has been no stranger to process targets. As I have mentioned, the House of Commons Library suggests that no fewer than nine process targets currently apply to cancer, most notably the two-week wait to see a specialist after a referral and the 62-day wait from urgent referral to first definitive treatment. Process targets, as I have suggested, can pose a particular problem when the NHS’s performance against them is used as a metric to control financial flows, which tends to skew medical priorities. Such targets are only part of the journey when trying to improve one-year survival rates, yet CCGs, although held accountable for outcome measures, in practice follow process targets, because they are the key to unlocking extra funds. That is one of the key issues that we need to explore further in the months and years ahead. I am talking about the fact that process targets account for only part of the journey when we need a longer-term view.

I also suggest that process targets are not the best means of helping when it comes to rarer and less survivable cancers, which for too long have been the poor cousins in the cancer community. Rarer and less survivable cancers often fall between the cracks of process targets. Data on those cancers is not used routinely in much of the NHS. That encourages the NHS to go for the low-hanging fruit of the major cancers. That has to change. Given that rarer cancers account for more than half of cancer cases, serious improvements in cancer survival will not be possible unless rarer and less survivable cancers are included. Outcome measures have the advantage of encouraging their inclusion when seeking to catch up with average international survival rates.

The all-party group’s most recent report, launched at the Britain Against Cancer conference in December, highlighted an example of how process targets can act against patients. In 2016, as I think all hon. Members in the Chamber will be aware, NHS England announced £200 million of transformation funding, intended to help the newly formed cancer alliances to achieve the standards set out in the five-year cancer strategy to 2020, and bids were invited. This should be straightforward. An extra £200 million is coming in and is being handed over by the Government to NHS England. The money should be going where it is most needed—to help cancer services at the front-line to deliver on the cancer strategy.

However, after the bidding process closed, a requirement for good performance against the 62-day target was introduced retrospectively. That was after the deadline—by some weeks, if not months. It resulted in multiple alliances whose performance was not deemed good enough not receiving their expected funding allocation. Oral and written evidence was taken by and submitted to the all-party group last autumn. I see members of the group in the Chamber. For those who arrived late, I point out that I have thanked the members for their help and stalwart support over the years. The oral and written evidence given to the group when we were conducting our inquiry suggested that the retrospective application of the 62-day condition was causing real problems at the frontline. We heard in effect a cry for help from those at the frontline of our cancer services. Our December report, as the Minister will be fully aware, called for a breaking of the link between the 62-day target and access to the transformation funds. Let us break that link and get the transformation funding down to the frontline, where it is needed to help to implement the cancer strategy.

It is an iniquitous situation, as the conditionality on process targets prior to funding release means that high-performing alliances receive even more money, while those that are struggling and could therefore most benefit from the extra investment do not receive the extra support. That is against the whole spirit of transformation funding.

[Dr Dan Poulter (Central Suffolk and North Ipswich) (Con)]

I congratulate my hon. Friend on securing the debate and thank him for all that he has done to raise these important issues consistently during his time in the House. I, too, must leave a little before the end of the debate, so please accept my apologies, Mr Streeter. With regard to funding, notwithstanding the fund that my hon. Friend has mentioned, NHS core funding often tends to be diverted to prop up the acute sector during winter crises; that happens year after year. We are now missing cancer targets, whatever we think of them—they have ceased to be meaningful to many trusts at local level. Does he therefore agree that, if we are to make a difference, we must ensure that more of the money from the core NHS budget goes to community services and cancer services?

[Mr Baron]

I broadly agree. Although a system as big as the NHS must always be able to respond to short-term emergencies, such as the winter crisis, longer-term thinking is needed to address key issues such as cancer survival. At the moment we have an absence of long-term thinking, let alone long-term funding, which is harming patients to the extent that we are not focusing on outcomes. In 2009 the then Department of Health’s own figures showed that 10,000 lives were needlessly lost because we were not meeting European averages for survival rates. I agree that we need longer-term thinking, and that is where outcome indicators, such as one-year and five-year cancer survival rates, would encourage not just long-term thinking, but long-term funding.

[Karen Lee]

That is a problem right across the NHS. We need to take the NHS out of the political arena. The absolute bottom line is that we need a proper, long-term strategy.

[Mr Baron]

I thank the hon. Lady for her support. I have been non-partisan on this matter, as I have been as chairman of the all-party group. Both sides have been guilty of trying to score political points on the back of process targets, because no Government have met them all in their entirety; we play this short-term political game when in reality what we need to do is, as best as possible, take the NHS out of politics and encourage long-term thinking. The best approach, at least with regard to cancer, would be to get the NHS to focus on those one-year and five-year survival rates. We could then stand back and say, “You are the medical experts and we are the politicians. We will hold you accountable, but use your expertise now to come up with the best plans to improve your one-year and five-year figures.” That would certainly encourage longer-term thinking and funding.

I am conscious that other hon. Members want to contribute, so I will not bore everyone with the ins and outs of the all-party group’s efforts to encourage the Government to break the link between the 62 days and the transformation funding, because discussions are still ongoing. However, I will share with the House the fact that I raised the issue at Prime Minister’s questions back in December. During a positive subsequent meeting in March, the Prime Minister agreed that all transformation funding should be released immediately, provided that relevant cancer alliances promised to produce a 62-day plan—the promise is the important thing; they did not have to produce them.

I am now in discussions with officials from No. 10 and the DHSC, because the system has been slow in following through what was agreed at that meeting. Following my further question at Prime Minister’s questions last Wednesday, the Prime Minister has agreed to meet me again, should we continue to make insufficient progress. Negotiations are now in train and I hope that we can get the funding released as quickly as possible, without waiting for the alliances to actually hit the 62-day target. The Prime Minister clearly said that she wants the transformation funding released on the promise that they will produce a plan to hit the 62-day target.

In the long term, the NHS needs to rebalance its focus away from process targets in favour of outcome indicators, such as the one-year cancer survival rates, that best help patients. If outcome measures are good and being hit, it follows that the processes will also be good; one cannot have good outcomes if there are not good processes. Patients will be seen and diagnosed in a timely fashion appropriate to their illness. These outcome measures will also have the benefit of allowing the NHS to design services and pathways flexibly, and without the straitjacket imposed by blunt process targets. That is the key issue here: focusing on the outcomes encourages the NHS at the frontline to devise ways of encouraging earlier diagnosis, including better awareness campaigns, wider screening uptake, better GP referral routes and better diagnostics. The NHS is encouraged to make those decisions at the frontline in order to drive forward earlier diagnosis.

[Mr Gregory Campbell (East Londonderry) (DUP)]

I congratulate the hon. Gentleman on securing the debate and on the excellent work that he has done, not only with the all-party parliamentary group, but on a wide range of events over recent years. On the transformative nature of events, does he agree that we need to see international best practice, which he alluded to earlier, employed in the United Kingdom to ensure that cancer sufferers here, and their friends and families, can see the benefits?

[Mr Baron]

I completely agree. Our inquiry into cancer inequalities in 2009 found that the NHS is as good as any other healthcare system internationally, if not better, at treating cancer once it is detected; the problem is that we do not detect it early enough and we never catch up. The line of international averages compared with UK averages shows that we are always behind, and there is little evidence that we are catching up. We get behind at that early one-year point, because we are not diagnosing as early as other healthcare systems, and no matter how good our treatment, we do not catch up. That is how we are losing those tens of thousands of lives, because we are not matching the European averages for survival rates.

[Paul Girvan (South Antrim) (DUP)]

Having been through treatment in the past, I appreciate that early diagnosis can, if dealt with correctly, save an absolute fortune. Everyone has heard the saying, “A stitch in time saves nine.” Unfortunately, leaving it too late, rather than intervening early, and having to treat the symptoms as they progress costs the health system a lot more money.

[Mr Baron]

I completely agree. I have not mentioned that aspect, because I have been focusing on patients, but the hon. Gentleman is absolutely right. If we were to diagnose earlier, the NHS could save a lot of money. We all know that, by and large, the more invasive the treatment, the more costly. Given how large the NHS is, too few health economists are trying to quantify this. When I ask my local CCG or cancer alliance, they do not know the cost savings associated with earlier diagnosis. That is a great shame.

[Dr Poulter]

My hon. Friend makes a good point. When we talk about quality-adjusted life years—there are other measures of the cost-benefits and cost-efficiency of treatments—it seems extraordinary that a more holistic view is not taken, particularly looking at quality-of-life indicators in cancer treatment. I am sure that he will want to press the Minister on that.

[Mr Baron]

I am sure that the Minister has taken that on board and I look forward to his comments. It goes without saying that the earlier we diagnose, the more money we save, which could then be ploughed back into frontline cancer services. We need to try to quantify that, and we are nowhere close to doing that at the moment.

That is why, in conclusion, I come back to the point that we need to take a longer-term view on our plans for cancer care—longer-term funding and thinking. Process targets actually act against that, because the focus is on specific issues, which can skew priorities, particularly when they are associated with funding. In the end, that has proven not to be in the best interests of patients, given our failure to catch up with international averages. Outcome measures retain the focus on accountability, which quite rightly governs our health service. They provide the best of both worlds: they encourage long-term thinking and long-term funding, while at the same time we as politicians rightly have to hold the NHS accountable. We are talking about £115 billion to £120 billion of taxpayers’ money. We have to ensure that there is the element of accountability in the system, but that is where outcome indicators could be very helpful.

One cannot cover everything in a debate such as this. I am glad that the HPV issue will be given a proper airing in tomorrow’s debate. I think that the vaccine should be extended to boys. I also think that the big issue of prevention is important. Healthier lifestyles make for lower cancer risks, but this specific debate is about targets. It has been a helpful debate and I thank everyone for their interventions. I look forward to other contributions and to the Minister’s comments at the conclusion.

[Karen Lee (Lincoln) (Lab)]

I do not want to repeat a lot of what the hon. Member for Basildon and Billericay (Mr Baron) has said because he has already said some of what I was going to say. I am here because when I was elected I was asked by Breast Cancer Now to be an ambassador and I readily agreed. I will highlight a few things on its behalf.

Breast Cancer Now says that although some CCGs meet diagnosis and detection targets, there are national geographical inequalities in the provision of care, and diagnosis and detection are taking priority over treatment for secondary breast cancer, which is an issue. Transformation funding has been mentioned, and Breast Cancer Now feels that such funding must be decoupled from waiting time targets immediately.

My CCG is failing to hit the targets, which means it does not get the funding. If it is failing to meet the targets, how will withholding the money make things any better? I want the Government to tell us how that makes things any better. I understand about targets and measures, but how does not giving CCGs money to treat people properly make things any better?

NHS cancer targets have tended to focus on early detection and diagnosis, which means there is less focus and resource allocated to supporting people after they have finished treatment and are living with secondary cancers. One in four people find that the end of their treatment is the hardest part and they do not always have access to a clinical nurse specialist. My daughter did not. Things moved fast for my daughter. She was diagnosed and died within 13 months. She was just 35 and she left a husband and three children behind. To get her back into hospital was an absolute nightmare. I knew all the right things to say to get her into hospital and I finally managed it, but the support was not there. People try and do their best, but the support was not right and it was not good enough. The treatment for secondary breast cancer is not good enough and that really needs to be looked at.

Every cancer patient coming to the end of their treatment should have a recovery package. A clearer picture of progress on the availability of health and wellbeing events for people living with and beyond breast cancer across England is urgently needed. The Government, as the agency that ultimately decides how our NHS is run, must deliver on that and answer for that.

I was asked to mention the collection of data and access to clinical nurse specialists, because there has been no progress. Breast Cancer Care’s 2015 research showed that only a third of NHS trusts were collecting full data on secondary breast cancer, and three quarters of NHS trusts and health boards say there is not enough specialist nursing care available. People with secondary breast cancer feel they are second rate. Lynsey used to say that. She said, “It was all right, Mum, when I was having chemo and radiotherapy and everybody was buzzing round me, but now there is nothing. There is no support at all.”

I spoke on Breast Cancer Now’s 2050 vision in Parliament a couple of months ago. If we all act now, by 2050 everybody who develops breast cancer will live, and I really hope that that happens.

[Mr Baron]

The first point that the hon. Lady made about the iniquitous position that many CCGs now find themselves in is a strong one. The Government have given transformation funding of £200 million to NHS England, but a lot of it is sitting there when it is desperately needed, particularly by those that need to do a lot of catching up. It was not meant to be withheld in such a fashion. It is iniquitous also that the 62 days was retrospectively applied.

[Mr Gary Streeter (in the Chair)]

The hon. Lady spoke most powerfully.

--- Later in debate ---

[Dr Philippa Whitford (Central Ayrshire) (SNP)]

I declare an interest; I was for 30 years a breast cancer surgeon, and I am co-chair of the all-party parliamentary group on breast cancer. Cancer affects one in three people in the United Kingdom at this point, but that is expected to rise to one in two for the population born after 1960. Part of the reason for that is that we live longer, and unfortunately still have not improved our lifestyles to a significant degree. In particular, we all know about smoking and cancer, but we should also be aware that obesity is the second most common driver of cancer, and is increasing.

The hon. Member for Basildon and Billericay (Mr Baron) spoke about process targets—particularly on waiting times. I remember when the cancer-specific waiting times came in, in Scotland, and I welcomed them. Before that, there was only the standard waiting time of 18 weeks. If a manager was told, “We are struggling to keep up with breast cancer,” but the 18 weeks had not been exceeded, there was no interest. That is the problem with any target; once a target is set, anything that is not subject to a target starts to be neglected. We welcomed targets at first. As the hon. Gentleman mentioned, the 31-day target is either being met, or is close to being met, because once people are diagnosed, all four NHSs switch into high gear and manage to treat people within the 31 days.

The problem is that that is only a little bit of the journey. The 62 days are meant to cover the time from seeing the GP to the referral to the clinic, from the clinic to the diagnosis, from the diagnosis to discussion and planning and a multidisciplinary team meeting, and from that point to the first treatment. If we look into it, the delay is often between being seen in the clinic and the diagnosis. With breast cancer we luckily tend to meet the 62-day target at around 95%, because our clinics are largely one stop. The patient usually gets all the tests on one day. However, in England the 62-day figure is below 83%, even though the 31-day figure is over 97%, and we can see how big the fall is, in trying to get people diagnosed. There is a huge workforce challenge in radiology, and in breast cancer a cliff edge is coming, because the generation who were appointed when screening started in 1991 are all retiring right now, and that is a real issue.

As I said earlier, in an intervention, it is not just a question of the time on the pathway; the biggest delay is getting people to go to see their GP. We need to get rid of the fear, embarrassment and stigma, particularly when a more embarrassing part of the body is involved.

We all run projects such as, in Scotland, Detect Cancer Early, and in England, Be Clear on Cancer, but it is important that such campaigns bubble along, rather than become intense. People need to see those adverts when it is in the back of their head that, yes, perhaps their bowel habits have changed, there is blood in their urine, or they find a lump. If that happened six months ago, it is no use. When we ran our first Detect Cancer Early campaign in Scotland with the comedian Elaine C. Smith, it was very humorous and well picked up. We got a 50% increase in people referred to breast clinics, but there was no significant difference in the diagnosis of cancer. It meant that the clinics were completely overwhelmed. We were doing clinics at night and at weekends to try to catch up, but the people who had cancer actually ended up waiting longer for their diagnosis. It is important that we generate not fear but education, and that first experience was taken into account in future campaigns.

Early detection has been mentioned, and screening is the best way of doing that if the cancer is screenable. Such screening will result in an increased incidence of cancer. People often do not think about the fact that if screening is introduced or expanded, or the technique is improved, more cancers will be diagnosed. The system must be ready to deal with that, and we need not to see it as a negative.

Since bowel screening was introduced in Scotland, there has been an 18% drop in colon cancer in men. Bowel screening, which was debated in this Chamber this morning, is not just a screening technique; it is actually preventive. When we test for blood in the stool, we can also diagnose polyps, which can then be treated to avoid them developing into cancer. That is a drop of almost one fifth over 10 years in our incidence of colon cancer. Bowel screening in Scotland starts from the age of 50 and runs to 75. Those over the age of 75 can request a kit, but they will not be sent it automatically. We have now moved to the faecal immunochemical test, which requires only one sample. It is also more sensitive, and there seems to be an almost 10% increase in uptake. Again, that will mean more colonoscopies and more diagnoses, and people must be prepared for that.

Process and outcome targets have been mentioned, but an important group of targets in between is those on quality of treatment. It is not good enough just to leave things to clinical commissioning groups or cancer alliances to work out the best way to treat various types of cancer. The data are international and national, and we need a group of experts to pool them together and come up with something that no one will quibble about, and that everyone agrees is what we should be aiming to achieve for various cancers, in people’s surgeries, after their diagnoses, and with their radiation or chemo.

In 2000, what is now called Healthcare Improvement Scotland developed clinical cancer standards for the four common cancers. I had the honour to lead on the development of breast cancer standards, and I led that project until 2011. We are now on the fifth iteration of our standards, and they have been slimmed down. We have moved from looking at four cancers in 2002, to 11 cancers in 2012, and now 18 cancers have detailed clinical targets for which they are audited, and for which peer review takes place. We do not set league tables, but we set standards that every unit can aim to pass. There is no point in being told, “The best unit is 500 miles away”; people want their local unit to be good.

The first two standards in our quality performance indicators state that every patient with breast cancer must be discussed at a multidisciplinary team meeting, and that patients must be diagnosed non-operatively by needle biopsy. When I started in my unit in the mid-1990s, our pre-op diagnosis rate was about 40%; it is now about 98%. If those two standards had been in place in England, the rogue surgeon Ian Paterson might have been picked up earlier. We now know that he tended to make his own treatment decisions, and he operated on women without proof of cancer. Obviously, the standards cover all sorts of things, including surgery, diagnosis, chemo and radiotherapy. Data are collected at the MDT meeting with a member of audit staff present. That means that they can capture evidence of recurrence and patients who develop metastatic disease, and everyone on the team is aware that that has happened.

To respond to the point raised by the hon. Member for Lincoln (Karen Lee), my unit discussed whether we would have separate cancer nurse specialists for those with recurrent or secondary disease, or whether it would be better if the original nurse followed the patient through, and that is what we went for—our nurses work between the surgical clinic and oncology, so that people see a face they already know. Having done it for years, I know that breaking bad news a second time is infinitely worse than breaking it the first time.

In England there are screening data from breast cancer and guidelines from the National Institute for Health and Care Excellence. There are, however, no audit data that are peer-reviewed and compared. We get no financial reward for improvement in our targets. Money is not part of it; it is simple clinical pride, and a wee touch of competitiveness. In Scotland we meet every year in the breast cancer service, and our data are put up. That is open and public; people can look for any of our reports on the internet, and they will see all the details about the numbers of patients treated and what has been achieved. Peer review and peer pressure is a great way to drive up quality.

The hon. Member for Basildon and Billericay mentioned early diagnosis and the need for one-year outcome figures, but spending all the money to gain another couple of per cent in a waiting time is not necessarily the best way to go. A comparison was made between breast cancer treatment in the UK and in Denmark, and because of screening—the UK was one of the earliest nations to pick up breast screening as a population screening—we have a higher percentage of patients diagnosed at stage 1 than Denmark. We do not, however, have a better survival rate because we have very slow access to new drugs. It takes new, expensive cancer drugs three or five years to get into common use. Yes, if someone is diagnosed early they might not need those drugs, but if they are unlucky enough to have a really nasty, aggressive cancer, they may end up fighting to get them.

[Mr Baron]

For a whole host of reasons mentioned by the hon. Lady, one area that perhaps shows promise in improving early diagnosis is breast cancer. In general, however, we fall behind international averages at that one-year point. The whole point of focusing the NHS on one-year survival rates, and encouraging it to improve those rates, is to send a message down the line and encourage early diagnosis across the whole panoply of primary care services, including improving screening rates and participation.

[Dr Whitford]

I totally agree. People who have died before one year—that is, in essence, what is being measured by our one-year survival rate—are largely those who presented with an advanced or incredibly aggressive disease. We are measuring people for whom we did not have a treatment, rather than just early diagnosis, and we will see that much more in the five-year figures. I am not saying that we should not have those measurements, but if a clinician is just being told, “You have to get better one-year figures,” should they take a bigger margin? Do they use this chemo or that one? They need guidance on what evidence shows will provide better one-year figures.

On prevention, there has been a drop of more than 17% in men with lung cancer, because of the fall in smoking in men. Unfortunately, there has been a rise in lung cancer in women. There has also been a rise in malignant melanoma in men, because they are catching up with women in the use of sunbeds and overseas holidays. We still have a long way to go simply to try to prevent cancer, because the gold standard is not getting it in the first place. As I have said, obesity is the second most common cause of cancer. We do not need strategies that are just for cancer. We need health in all policies to try to make people healthier, and that way we will reduce the number of people who are suffering from cancer.

--- Later in debate ---

[Steve Brine]

I will not give way. I remember Mr Streeter’s ruling.

There are eight cancer waiting time standards and, since one in two of us born since 1960 will be diagnosed with cancer in our lifetime, they are an important indicator—to patients, clinicians and politicians and the public—of the quality of cancer diagnosis, treatment and care that NHS organisations provide to millions of our constituents every year. They are a component of the success we have had with survival rates, so it is good that we are discussing them here today. I use the word “target” cautiously, because I have always been clear that standards should not necessarily be targets. If someone has a suspected cancer, 28 days is 28 lifetimes too long—I will talk about the urgent diagnostic centres in a moment. Sometimes we are not trying to get to the maximum, so “target” can be a misleading term.

As has been said, we are currently meeting six of the eight standards. One of those we are not meeting is the 62 days from urgent GP referral for suspected cancer to first treatment, which is important because we want to ensure that patients receive the right treatment quickly, without any unnecessary delays. The standards contribute to cancers being diagnosed earlier—only “contribute to”—and that is crucial to improving our survival rates. However, our rates have historically lagged behind those of some of the best-performing countries in Europe and around the world. That is why we have the cancer strategy; we want to do better. The primary reason for those rates is late diagnosis. Early diagnosis is, indeed, the magic key. My hon. Friend the Member for Basildon and Billericay has used that term many times—I have heard him use it at the Britain Against Cancer conference—and he is absolutely spot on.

Going back to the 62-day standard and the recovery thereof, my hon. Friend the Member for Basildon and Billericay will know that due to factors such as an ageing population and the increase in obesity, which we have touched on, the incidence of cancer is increasing. The NHS is treating more patients for cancer than ever before. It is testament to the hard work of NHS staff across all four nations of our United Kingdom that we are treating more people, and do so with the care and compassion for which we know the NHS is world-renowned. However, those numbers are making the achievement of the 62-day standard challenging. To be perfectly honest, the standard has not been met since December 2015 and, although we do not yet have the figures for March 2018, it is unlikely to have been met in 2017-18 either. However, we remain committed to the standard and want to see it recovered. That is why, through this year’s mandate from the Secretary of State to NHS England, we have agreed that the standard will be achieved in 2018-19, while we maintain performance against other waiting time standards.

[Mr Baron]

Will the Minister give way?

[Steve Brine]

I will very quickly. I know that my hon. Friend wants me to come on to the funding.

[Mr Baron]

The Minister will be aware that about a quarter of all cancers are first detected as late as at an emergency procedure. What I would like him to do in the few minutes he has left is to focus on the need to break the 62-day target link with the transformation funding because it is unfair, penalising as it does those cancer services that need help most. Will he consider that?

[Steve Brine]

That is exactly what I was coming on to. I know that my hon. Friend has expressed concern, to put it mildly, about the methods used to allocate funding for the alliances in 2017-18, and in last December’s report by the all-party parliamentary group on cancer it was clear that the alliances should not be linked to achieving the 62-day target. I am aware that my hon. Friend has met with the Prime Minister to discuss the issue and I will reiterate what I am sure she will have told him. Achievement of the 62-day standard is not a prerequisite for funding. Instead, it provides a basis on which NHS England and NHS Improvement, along with senior clinical advice, can assess an alliance’s readiness to transform services.

The alliances are an important mechanism for us in improving performance on the 62-day standard from urgent referral to treatment. They bring together clinicians from primary and secondary care, ensuring collective responsibility for the multidisciplinary teams and the services that they provide, and enabling the leadership that is crucial to the transformation of services. But the bottom line is that it is taxpayers’ money that is being allocated, and it is right and proper that alliances can demonstrate their preparedness for the funding. In 2018-19, NHS England has modified how it will fund alliances, and I can confirm that all alliances will receive transformation funding to support earlier diagnosis and better quality of life for patients.

The national support fund is a genuinely new approach to distributing funding that we have introduced in 2018-19, within the £200 million over two years funding envelope announced in 2017-18. That was in no small part in response to advocacy by my hon. Friend the Member for Basildon and Billericay, and I pay great credit to him and to others for their work on the link—but not the pre-requisite—that was introduced in 2017-18 between transformation funding and 62-day performance.

The fund has a number of purposes. NHS England uses it to help iron out significant variations between alliances in the amount of funding for which they originally bid. The money will be used to support alliance activity to improve 62-day performance, as well as to enable all alliances to deliver priorities, such as accelerated pathways for lung, colorectal and prostate cancer, and other innovations, such as those we heard from the hon. Member for Scunthorpe, which are included in the 2018-19 CCG planning guidance. The Secretary of State, NHS England’s national cancer director, Cally Palmer, and I all agree that the link to the 62-day standard is the right approach and the right thing for patients. I hope that that clears the matter up, even if it does not go all the way towards satisfying Members.

Although I accept that there is anxiety in some quarters about the link between the performance and the funding, I and the Government are of the view that retaining the link is in the very best interests of patients. Ultimately, they must be our primary focus, and this is public money. We will keep the matter under review. I thank my hon. Friend for his advocacy on the subject.

By the end of the cancer programme, we want to have improved survival and provided equity of access to the highest standards of modern care across all our constituencies in England. As the cancer Minister, I seldom sleep and when I am not sleeping I think very little about anything else, because we are focused on meeting the recommendations in the cancer strategy and doing better for all our constituents—those who are here, those who will live with cancer, those who are living with it now, and those who have passed, who we all know. We are on our way to realising the transformation in services that we all want to see, to make our NHS the world leader in the treatment of cancer that I know it can be.

[Mr Baron]

I thank everyone who has participated in the debate, and the Minister for his response. No one doubts his genuine care and concern about cancer patients and the need to improve treatment. I will look closely at his words. The national support fund may not be quite as new as he thinks, but putting that to one side, all I urge him to do is to look at the pleas for help from the cancer frontline services. As far as they are concerned, there is a strong link between the 62-day target and the release of the cancer transformation funding. That is iniquitous, because the services that need it most are being denied it. I ask the Minister to go away and have another look at that, because many frontline services say that the link exists and because of it they are not getting the transformation funding they require to deliver on the cancer strategy. I will continue to pursue that matter until the transformation funding is released.

In the 15 seconds that are left to me, all I say is that a quarter of all cancers are first diagnosed during an emergency procedure. That is far too late; we all accept that. We also accept that we are failing to catch up with international averages when it comes to survival rates, despite all the talk about improving them. We have to focus on outcomes.

Motion lapsed (Standing Order No. 10(6)).

Oral Answers to Questions

John Baron Excerpts

Tuesday 21st March 2017 Commons Chamber

[Nicola Blackwood]

We are working extremely hard on increasing staff. We are not only introducing our new mental health workforce strategy, which we will publish shortly, but increasing the number of people who are seeing these services. Four million extra people have seen psychiatry services—talking therapies—and 90% of those patients are being seen within six weeks, which is exceeding our waiting time target.

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

9. What assessment he has made of the potential effect of the EU general data protection regulation on the availability of data for research in the health sector.

[The Parliamentary Under-Secretary of State for Health (Nicola Blackwood)]

We have engaged fully with the health and research community to ensure a positive and beneficial application of the GDPR in the UK. My hon. Friend is right that data are vital to the delivery of safe and high-quality care, but we need to ensure that there is a trusted system in place, and that people understand that their information is secure and have confidence in its use.

[Mr Baron]

I thank the Minister for that answer, but I have to tell her that when the EU’s general data protection regulation becomes enforceable next year, it will be more difficult to share data. Cancer charities, including Cancer Research UK, are concerned because the progress of life-saving research, especially into rare and children’s cancers, would not have been possible were it not for data-sharing. Will she do what she can to shield the UK from this harmful regulation, given that it disproportionately affects us because of the wealth of our data?

[Nicola Blackwood]

We have been clear that we are going to introduce the data regulation. We are working on exactly how we will do that in a balanced way that encourages data-sharing for the purposes of research in a sustainable NHS. We have set up a sub-group to examine the impact of the GDPR on research. It is hosted by the Wellcome Trust and includes members of the Health Research Authority’s confidentiality advisory group, the NHS Confederation, the Medical Research Council, the Department of Health, and the PHG Foundation. We will ensure that this works in an effective way to address the concerns that my hon. Friend has raised.

Oral Answers to Questions

John Baron Excerpts

Tuesday 7th February 2017 Commons Chamber

[Mr Hunt]

Let us look at the reality, instead of the hon. Gentleman’s rhetoric. In his own local trust in Leicester, there are 246 more nurses than in 2010 and 313 more doctors. Some 185 more patients are being seen in A&E every day and next year a new £43 million emergency floor will open at the Leicester Royal Infirmary. That is because we are backing the NHS instead of wanting to cut its budget.

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

T2. The recently introduced one-year cancer survival rate indicator is a beacon of light in a system still too focused on process targets. What more can the Government do to hold underperforming clinical commissioning groups to account for that outcome indicator, given that we are still failing to catch up with international averages when it comes to our survival rates?

[The Parliamentary Under-Secretary of State for Health (David Mowat)]

My hon. Friend is right to say that we now publish one-year survival rates for every CCG in the country, and I agree that that is a beacon of light and a transformative step. It also shows differences of more than 10% between the best and the worst, which is unacceptable. The transparency itself will bring improvement, but we have also recently established 16 cancer alliances, whose sole job is to roll out best practice and investigate and bear down on poor performance.

Earlier Cancer Diagnosis: NHS Finances

John Baron Excerpts

Tuesday 18th October 2016 Westminster Hall

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

I beg to move,

That this House has considered earlier cancer diagnosis and NHS finances.

I thank Mr Speaker for allowing this debate and you, Mr Nuttall, for presiding over it. I also take this opportunity to welcome the Minister to his new post. He has been in it a while now, but this might be his first Westminster Hall debate. We look forward to working with him—he comes highly recommended—and I thank him for accepting the invitation, on behalf of the Secretary of State for Health, who was unable to make the appointment, to speak at our Britain Against Cancer conference in December.

Early diagnosis has been a key theme of the all-party group on cancer for some time. We call it the “magic key” to cancer. If we can drive forward on our rates of early diagnosis, the stage at which we first detect cancer, we can improve survival rates significantly.

I should perhaps briefly explain to the Minister that there is a little history to this involvement. Back in 2009, the all-party group published the report of an inquiry it had conducted into cancer inequalities. We found that patients in the NHS at the one-year point since their cancers were detected stand as much chance of surviving to the five-year point as they would in any other healthcare system. Where we let ourselves down, however, is getting patients to the one-year point. That suggests that the NHS is as good as any other healthcare provider in treating cancers once detected, but poor at detecting them in the first place.

In this country, our survival rates have been ticking up, with the rate of improvement broadly similar to that in other countries, but our survival rates still stand well below those of many other countries. For example, in this country the overall one-year survival rate is about 70% or 71%, but in Sweden it is 82%. That might not sound like a big difference, but overlay that differential with regard to the population of the UK as a whole and it tells us that tens of thousands of lives a year are needlessly being lost because we are diagnosing too late.

We need to focus on early diagnosis, and the Minister is in a unique position to be able to make a real difference to a large number of people if we can get it right. Yes, cancer survival rates are improving, but they are improving around the world and we are still well behind international averages. We welcome the improvements, but we have still not yet seen that kick-up that will allow us to catch up with those international averages.

Our 2009 report came up with, in essence, one recommendation. Reports can always come up with myriad recommendations, but we believe in short reports and, having consulted with the wider cancer community, the good and the great of the cancer world, the charities, patients and so forth, we came up with one recommendation: to ensure that we focus the local NHS, the clinical commissioning groups— primary care trusts then, CCGs now—on their one-year survival rates.

The logic is simple: the earlier we diagnose, the better our one-year survival rates. They are therefore a good measure of how successful we are in diagnosing early. Late diagnosis makes for poor one-year figures, so we get the CCGs to focus on the one-year figure and, if there is a line of accountability there, they will be encouraged to focus on how to improve earlier diagnosis and introduce initiatives promoting earlier diagnosis.

[David Tredinnick (Bosworth) (Con)]

Has my hon. Friend seen the results of the Barts Health NHS Foundation Trust’s 2013 study at Whipps Cross hospital? It showed the effectiveness of complementary therapies in improving symptom control following diagnosis. The three-year study revealed that 90% of people noticed that side-effects of chemotherapy and radiotherapy decreased following such treatment, and patients said that their pain, sleep and emotional health improved. Should we make greater use of those supportive therapies as part of the scheme of things?

[Mr Baron]

We certainly have to be inclusive with regards to how we look at treatment generally. As my hon. Friend knows, the all-party group and, indeed, the wider cancer community are looking at such things. He comes to our meetings, and we listen carefully. Questions certainly need to be answered on that front, so he is pushing at an open door. We have an open mind, and we are listening.

Together with the wider cancer community—at the end of the day it has been a team approach—we have been successful in ensuring that CCGs are now held accountable. The one-year survival rates have been included in the delivery dashboard of the assurance framework, and that is very good news. Figures have only been published for the past one or two years, so we are still seeing what is happening with regards to improvements and how CCGs are performing, but at least we have made a start and there is an element of accountability.

[Sir Paul Beresford (Mole Valley) (Con)]

I must of course declare that I am a dentist and so have considerable professional interest in the subject, although it is rare that I am in the surgery. I am also chair of the all-party group on skin, and one might think that diagnosing skin cancer is fairly obvious, in particular given that skin problems are a major concern of GPs. However, one of the things we soon discovered was that undergraduate tuition time on skin conditions is extremely short—often a week or two weeks, which are frequently used by undergraduates, as I understand it, as an opportunity to go away, rather than to attend. If the education of GPs and doctors was better and reinforced by continuing professional development, we might get better results on skin cancer.

[Mr Baron]

I thank my hon. Friend for that intervention.

We have been successful in getting the one-year figures into the DNA of the NHS, but there is no point having the tools in the toolkit if we do not use them, and one thing we are looking carefully at is the lines of accountability. We acknowledge that we are pushing at an open door—the Government have kindly accepted the need for the one-year figures—but there is still a very long way to travel. The latest Ofsted-style ratings have maintained the focus on survival rates, and yet those ratings still found that eight out of 10 CCGs must improve. That shows the scale of the challenge and the extent to which we need to raise our game.

[Jim Shannon (Strangford) (DUP)]

If I could cast the hon. Gentleman’s mind back to the previous intervention, the Be Clear on Cancer campaign identified about 700 more patients with lung cancer, which led to about 300 more patients receiving life-saving surgery. That shows that publicity campaigns work. Does he agree that the Government need to encourage the NHS to have more publicity campaigns to identify the issues and save more lives?

[Mr Baron]

I agree completely. Briefly, the initiatives that could be introduced to promote earlier diagnosis are greater awareness campaigns, better diagnostics at primary care level, better uptake of screening in screening programmes, and better GP awareness—although this is not only about GPs. A whole host of initiatives could be introduced at the primary care level to improve survival rates and awareness generally. So yes, I completely and utterly agree.

Given the limited time available, I will make a little progress on the central point of this debate. We are pushing at an open door, which is fine; we are keeping a watching brief as a cancer community; and, as I have said, the Ofsted-style ratings have shown, among other things, that a big improvement is required. The all-party group on cancer will hold its annual parliamentary reception next summer—the Minister no doubt will be invited to that—at which we will focus on those CCGs that have most improved their one-year survival rates. The Britain Against Cancer conference, which we believe is the largest gathering of the cancer community in this country, will take place at the end of this year and will also focus on that issue.

We are therefore not walking away from the issue of survival rates, but we are saying as part of our watching brief that we wish to bring to the Government’s attention the fact that when it comes to cancer treatment, earlier diagnosis can not only help patients—diagnosing cancers earlier makes for better survival rates—but save a lot of money. The later cancer is diagnosed, the more aggressive the treatments and the higher the cost. That cost is quite significant, and the cost savings from earlier diagnosis could be ploughed back into treatment for patients. At a time when the NHS is under financial pressure, we suggest that too little attention is being paid to those potential cost savings. Too little work has been done by the NHS and too few health economists are looking at how reducing costs to such an extent would benefit both the taxpayer and, most importantly, patients.

Given the NHS’s lack of focus on that area, we have had to go to outside sources to give us some sort of measure of the potential cost savings. A September 2014 report by Incisive Health and Cancer Research UK showed quite a disparity between the cost of treating patients with early stage, or stage 1, cancer and those with late stage, or stages 3 and 4, cancer. For example, the cost per patient per year of treating colon cancer is £3,300 at stage 1 and £12,500 at stage 4—a near fourfold increase. Treating stage 1 rectal cancer costs £4,400; that goes up to nearly £12,000 if it is treated at a late stage. Treating ovarian cancer costs just over £5,000 per patient per year at an early stage, but £15,000 at a late stage. That report focused on four cancers: colon, rectal, lung and ovarian. They amount to only around a fifth of all cancers diagnosed, but if such cost savings were replicated across all cancers, we could be talking about savings of hundreds of millions of pounds, and that is before we even consider the number of patients who would benefit from earlier diagnosis, which Incisive Health cites as something like 52,000.

[Mark Durkan (Foyle) (SDLP)]

Will the hon. Gentleman give way?

[Mr Baron]

I ask for a bit of patience. Let me make a little progress, and if there is time, I will take further interventions.

That report also showed variation between the highest and lowest-performing CCGs in the proportion of patients diagnosed early. That is also important. In colorectal cancer the variation was threefold, in lung cancer it was fourfold and in ovarian cancer it was fivefold. It is clear that if we could ensure that all CCGs achieved the best rate of early diagnosis—the rate achieved by the top performing CCG—significant cost savings could be made.

Those are interesting figures. Many believe them to be conservative—with a small “c”—in the sense that we often forget the costs of treatment later on down the care pathway beyond diagnosis, but we are certainly talking about hundreds of millions of pounds. One could argue that that is a drop in the ocean when we are looking at the NHS budget, but patients—cancer patients in particular—could certainly benefit from a couple of hundred million pounds. In an age when it is all too easy for politicians to talk about spending more money, we are trying to focus on potential cost savings from encouraging earlier diagnosis. As prevalence rises—Macmillan Cancer Support believes there may be another half a million cancer patients in the next five years, in addition to the around 2.5 million we have at the moment—so will costs, so the need for such savings will grow in importance.

The most recent report of the all-party parliamentary group on cancer followed an oral evidence session with the then cancer Minister and key decision makers in NHS England, as well as written evidence from more than 30 cancer-related organisations. That report concluded that where the new initiatives outlined in the cancer strategy could save costs, those initiatives required more focus and attention. It is our opinion that there needs to be greater appreciation in NHS England and the Department of Health of the savings that earlier diagnosis offers. As I have said, there are too few health economists working in the NHS, and even fewer looking at this area.

As the Minister is well aware, when I raised that issue at Health questions last week, he correctly referred to some ongoing studies, including the three-year research project being undertaken by Macmillan Cancer Support in a related area. He also mentioned Public Health England, which is looking at cost-effective initiatives for colorectal cancers. Those studies are welcome, but I maintain that the approach is piecemeal. We need a root and branch approach to look more specifically at this area. We need to promote earlier diagnosis at CCG and health and wellbeing board level. We have the one-year figures. We must not allow this to become a tick-box exercise; the issue is far too important for that. There needs to be greater focus on how underperforming CCGs will be held to account for their rate of improvement.

The all-party parliamentary group on cancer will play its full part in that work. We are looking at other areas. We have achieved our goal of getting the one-year figures into the DNA of the NHS, and we certainly will not walk away. We are focused on several areas, including patient experience and rarer cancers. There cannot be a meaningful improvement in the one-year figures if rarer cancers are not included, as those account for more than half the cancers that are diagnosed. We will play our full part, which includes the annual reception and the Britain Against Cancer conference, but I would be interested to hear the Minister’s responses to the questions I have raised. What more does he believe the NHS can do to promote and focus on cost savings from earlier diagnosis? On behalf of the wider cancer community, and certainly the all-party parliamentary groups, including the cancer-specific groups represented by several hon. Members in the Chamber, may I request a meeting with the Minister to discuss this and other related cancer issues?

--- Later in debate ---

[David Mowat]

I thank the hon. Gentleman for his intervention and completely agree with the point he made. In this instance, there is no competition between saving money, saving lives and doing the right thing. In a sense, there is a secondary question as to just how much cost is saved, and the balance of cost saving versus doing more diagnostically, because in order to save lives, which is a highly cost-effective thing to do and the right thing to do, we need to do more on early diagnosis.

I have not yet got to the start of my remarks and I have a lot of pages to get through, so I will not be giving too much detail. It is worth acknowledging that cancer survival rates are increasing in the UK. In terms of improvement, between 2011 and 2015 we think something like 12,000 lives a year were saved. That exceeds the goals we set out in the cancer outcomes strategy in 2011.

Last year we saw a 91% increase in urgent GP referrals of patients with suspected cancer—that is another 822,000 patients. That shows a massive increase in NHS resources and all that goes with that, and we are beginning to see those early referrals, and the different guidelines GPs are using to refer, start to come through in the one-year survival statistics. However, as my hon. Friend the Member for Basildon and Billericay reminded us, that does not mean that we are the best in Europe. We need to continue the drive to improve.

The cancer strategy produced by the cancer taskforce is the backbone of what we are trying to achieve. The—I think it is fair to say—acclaimed strategy it produced, “Achieving World-Class Cancer Outcomes”, was published last year. It had 96 recommendations in it, and the Government accepted all 96. We are now putting in place an implementation taskforce. We believe that if we are able to make the progress we expect by 2020, a further 30,000 lives a year can be saved.

Recommendation 96 is the one we are talking about today. It essentially says that we need to do a lot more on early diagnosis because of the cost savings that will potentially arise from that. There are differing views in the Department of Health as to whether for all cancer types in all instances earlier diagnosis does save costs because of the increase in cost and effort associated with the diagnosis—the early screening and all that goes with that. That was not addressed overtly in Cancer Research UK’s “Saving lives, averting costs” report, which was mentioned by my hon. Friend. He quoted numbers of several millions of pounds, and there is no doubt that stage 4 cancer costs massively more to treat than stage 1 cancer, but whether or not there are clear cost savings in all instances and even if we dispute the detail of some of those numbers, we go back to the point made by the hon. Member for Foyle (Mark Durkan) that early diagnosis is the right thing to do. My hon. Friend also mentioned that there are not enough health economists in the NHS; the truth is there are not enough of lots of things in the NHS. Early diagnosis is certainly cost-effective in terms of lives saved, even if there may be some dispute as to whether it saves costs in all instances.

My hon. Friend mentioned the work being done by Macmillan, which I acknowledge. It is a three-year study, which we are looking forward to.

[Mr Baron]

I am conscious that I am eating into the few minutes the Minister has left, but the point about cost savings links to the point made earlier about initiatives and processes for earlier diagnosis. I urge him to think carefully about this, as I know he is doing. There has been no shortage of process targets in the NHS, but the one-year survival figures focus on outcomes, and that is the true measure of whether the processes are having an effect. By using outcome measures, we are leaving a large element of discretion to CCGs to introduce the initiatives they think best fit their local populations. That does not necessarily mean big cost increases to introduce such initiatives. Better awareness campaigns and better screening uptake figures do not necessarily cost a lot of money at a local level; they just take a bit of thought.

[David Mowat]

I agree completely with my hon. Friend that it is right that we use outcome measures. I come back to the point that the Government did a big thing in publishing the statistics for every CCG in the country. That allowed headlines to be out there in the press— we all saw them—that 80% of CCGs need to improve. We used a pretty rigorous test to assess the CCGs. If we reach those levels, we will be close to being the best in Europe as we make progress.

I am coming towards the end of my time. I want to finish by re-emphasising the Government’s commitment to early diagnosis. I have not had a chance to talk about our public health measures and all that goes with them, but I thank my hon. Friend again for getting us this debate. I emphasise my commitment to work with him and the APPG to make progress in this area.

Motion lapsed (Standing Order No. 10(6)).

Oral Answers to Questions

John Baron Excerpts

Tuesday 11th October 2016 Commons Chamber

[Mr Dunne]

Health Ministers have been very clear about reassuring all the 53,000 EU citizens working in our NHS that their roles are secure. Regarding clinicians, I remind the hon. Gentleman that, although we have some vacancy rates, which are acknowledged, we now have 7,800 more consultants employed in the NHS than in May 2010, 8,500 more doctors than in May 2010, and over 10,500 more nurses working on our wards. We have gone through a very consistent policy of recruiting more people to work in the NHS under this Government.

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

10. What steps his Department is taking to model the potential cost savings to the NHS budget of earlier diagnosis of cancers.

[The Parliamentary Under-Secretary of State for Health (David Mowat)]

The independent cancer taskforce highlighted the report “Saving lives, averting costs”, which identified cost savings resulting from earlier diagnosis, in particular for colon, rectal and ovary cancers. We have committed to a further £300 million for earlier diagnosis, one major product of which will be the 28-day diagnosis standard to which the Secretary of State referred earlier.

[Mr Baron]

In welcoming the Minister to his post, may I highlight evidence to show that early diagnosis, in addition to making for better survival rates, offers substantial cost savings? Colon cancer costs £3,000 per patient per year to treat at stage 1, compared with over £12,000 if it is diagnosed and treated at stage 4. We have a shortage of health economists in the NHS, so will the Minister go further and actually commission a study to look at this issue on behalf of the taxpayer, because it requires further detail?

[David Mowat]

We agree that early diagnosis saves lives and can lead to cost savings. Just as an example, we know that GP referrals are up by 91% since 2010—an additional 800,000 people are getting early diagnosis—and we are beginning to see the results of that coming through in the one-year survival figures. On my hon. Friend’s specific point about further study, Public Health England and Macmillan have commissioned recent studies on modelling, one part of which will be on the cost impact of earlier diagnosis, and we look forward to seeing the results of those studies.

Oral Answers to Questions

John Baron Excerpts

Tuesday 10th May 2016 Commons Chamber

[George Freeman]

The hon. Gentleman makes an important point. In both Northern Ireland and the Republic, I have seen some great leadership in this field, and as the UK Parliamentary Under-Secretary of State for Life Sciences, I would be delighted to pick this up through that council, and suggest that our nations, working together, can collaborate better, not least in implementing the accelerated access reforms that I am putting in place. Those reforms, aligned with the cancer drugs fund in its revised format, should see us able to accelerate the adoption of drugs for rarer cancers for patients’ benefit.

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

In part because they are the hidden majority, people with rarer cancers are often diagnosed later, often through an emergency presentation. That can make for more aggressive treatments, which can have a longer-term impact on health. Will the Minister update the House on tailored recovery packages, and the plan to roll those out that was outlined by the Government back in September last year—a Government who have, I must say, been a great friend to the cancer community?

[George Freeman]

I am very grateful for that acknowledgment. We have put £1 billion into the cancer drugs fund, and we are completely committed to increasing the pace at which we bring cancer drugs through. It is true that cancer outcomes have improved quickly since 2010; in 2014-15, over 645,000 more patients with suspected cancers were seen. That is an increase of 71%. Almost 40,000 more patients were treated for cancer—an increase of 17%. We have announced funding of up to £300 million a year by 2020 to increase diagnostic capacity, so that we can meet the new target, which is that patients will be given a definitive cancer diagnosis or the all-clear within 28 days of being referred by a GP.

Oral Answers to Questions

John Baron Excerpts

Tuesday 9th February 2016 Commons Chamber

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

The Minister will be aware that, despite great improvements in cancer care under this Government and the previous Government, one in five cancer patients—more than 20%—are first diagnosed as late as when they go to A&E. The Government rightly focus on one-year survival rates as a means of driving forward earlier diagnosis. Can he give me an assurance that that will remain a key focus?

[Alistair Burt]

My hon. Friend raises a serious issue. Pursuing the earliest diagnosis of cancer is very important to the Government; it is obviously also important to all patients. We are going to publish the statistics on early detection through the clinical commissioning groups to improve transparency still further, because as this Government have shown, transparency often drives improvement in performance.

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.

--- Later in debate ---

[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.

--- Later in debate ---

[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.

Oral Answers to Questions

John Baron Excerpts

Tuesday 17th November 2015 Commons Chamber

[George Freeman]

My hon. Friend makes an excellent point. We are completely committed to tackling anti-microbial resistance, and reducing the volume of antibiotics prescribing is vital to that. We are a world leader in this field in tackling AMR. We have an expert group looking at how to improve diagnostic services in relation to AMR, and it has already identified what diagnostics are currently in use and what new technologies are on the horizon, including C-reactive protein point-of-care testing. The group is currently formulating conclusions. The public health Minister, my hon. Friend the Member for Battersea (Jane Ellison), is looking forward to responding to my hon. Friend’s debate on Monday to set out more of the detail.

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

The Government have done a very good job in getting one-year cancer survival rates into the DNA of the NHS as a means of encouraging clinical commissioning groups to promote earlier diagnosis—cancer’s magic key. Does the Minister agree that we all need to ensure that we keep the CCGs’ feet close to the fire as regards these one-year figures so that we do not just improve diagnostic testing in primary care, but improve screening rates, GP referral rates and awareness campaigns as a means of ensuring that we save the thousands of lives that are needlessly lost through late diagnosis?

[George Freeman]

My hon. Friend is absolutely right. I pay tribute to his work on this through the independent cancer taskforce. The aim is to save 30,000 more lives a year by 2020. We are working with Harpal Kumar and Cancer Research UK on implementing its recommendations. NICE has set out new guidelines on clear ambitions and standards on how quickly patients should be referred for diagnostics. There is good news in that in 2014-15, compared with 2009-10, over 4.3 million more imaging and endoscopy tests were commonly used to diagnose cancers, but I agree that we have much more still to do.

Access to Medical Treatments (Innovation) Bill (Money)

John Baron Excerpts

Tuesday 3rd November 2015 Commons Chamber

[George Freeman]

The debate on Second Reading raised a large number of issues, which clearly need to be addressed and I have no doubt will be addressed in Committee. We cannot second-guess where that Committee will get to or the shape of any Bill that might subsequently return to the Floor of the House.

The costs associated with this Bill, were it to be implemented in its current shape, arise from the establishment and maintenance of a database by the Health and Social Care Information Centre. Early discussions on costing with the HSCIC, which is leading on the construction of a number of databases and data streams crucial to the operation of the NHS, have provided an indicative costing of between £5 million and £15 million for developing the database of innovative medicines that the Bill anticipates.

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

My hon. Friend has implied broad Government support for the Bill. Can he provide any evidence to suggest that litigation is preventing doctors from innovating in medical science and practice generally? That is the premise on which the Bill is based.

[George Freeman]

My hon. Friend makes a good point. That is the premise on which the Bill introduced by Lord Saatchi in the other place earlier in the year in the previous Parliament was predicated. My hon. Friend is right that it is a controversial proposition that fear of litigation for medical negligence is putting clinicians off innovating. The evidence that the Government received through the consultation was that some clinicians do feel that that is a problem, but very few saw it as the principal problem or the principal obstacle. A number of clinicians made the point that several factors have acted in recent decades to slow down the rate of innovative prescribing and other procedures in surgery and elsewhere, not least increasing central control of procurement from NHS England, which puts in place very tight procurement guidelines, as well as a general sense of an increasingly litigious society, which is just one of a number of factors cited in an extensive range of barriers to innovation.

--- Later in debate ---

[George Freeman]

Yes, indeed; I have listened. I acknowledged those concerns on Second Reading and said I was concerned about them. This is merely a debate about the Bill—there is no change in the law—and it is only this debate that is upsetting people at the moment. It is therefore very important that we carry it out in a way that makes it clear to them what this Bill does and does not achieve.

I am concerned that the passage of the Bill, the conduct of the debate, and any legislation that may survive the process of parliamentary scrutiny do not in any way undermine public or patient trust and confidence in clinical research or mainstream medicine. Were it to do so, I would be very concerned and the Government would be unable to support it. I have made it very clear to my hon. Friend the Member for Daventry that that is the No. 1 consideration, and as this is his private Member’s Bill, it is his task to get it to a point at which the Government would feel able to support it. Public trust and confidence in our NHS and in our clinical research infrastructure is crucial.

[Mr Baron]

May I add to the voice of my hon. Friend the Member for Totnes (Dr Wollaston) and suggest that not just the bodies she mentioned but many of the cancer bodies, charities and communities are very concerned about this Bill? Let me bring the Minister back to the issue of evidence. The pursuit of justice starts with evidence, and there is no evidence that litigation is deterring doctors from innovating. This Bill, in many respects, addresses a non-existent problem. If it is not necessary to legislate, it is necessary not to legislate.

[George Freeman]

As my hon. Friend knows, I have a lot of respect for his logic and his position, so let me be very clear again. As I tried to explain, I accept that if one were setting out a list of the biggest barriers to the uptake of innovation, fear of negligence would not be No. 1 on the list. However, it is equally true, as has been put to us during the consultation on this Bill, that it is a consideration. It is very important that the mechanism is proportionate to that obstacle. I think that that is the point he is really making, and I could not agree more. I signalled on Second Reading, and signal again now, that for the Government the most interesting part of this Bill is about access to information on innovative medicines and treatments for clinicians, who already have the freedom to innovate.

The second part of the Bill, as we understand it—we have taken substantial legal advice—does not in any way change the law on medical negligence; we would struggle if it did. Rather, it sets out a clear pathway for doctors seeking to enjoy the freedoms that are already in law to make it very clear what the procedure would be. People might say that these are fairly marginal improvements and ask whether they really merit the time of the House, but it is not for me to judge what is or is not an appropriate use of Parliament’s time. However, I do understand that my hon. Friend the Member for Daventry is trying to tackle, through a small measure, something that we all have an interest in, which is increasing access to innovative medicine.

The focus on provision of information that is reflected in the Bill’s new title and structure has the potential for an interesting mechanism. That is why we have looked at what the costs might be of putting such a database together. The figure that I have given is based on the understanding that further significant scoping work would be required were the Bill to become law, including consideration of the modification of existing coding systems to capture an innovation in medical notes, the data flow and the searching capability before the information centre—the HSCIC—was able to provide a robustly costed solution. Until proposed options and variables undergo additional policy refinement, including the development of a proper specification, it is not possible to offer a further estimate of supporting costs. The affordability of any specific proposal and future investment in technology more generally will also need to be considered in the light of the forthcoming spending review settlement, and the work of the National Information Board, which is putting in place a broader framework for the flow of information in the NHS.

Medical practitioners are already required to comply with the General Medical Council and BMA guidance on record keeping, and the recording of an innovation for front-line staff is therefore based on existing practice. Thus no additional costs are foreseen for medical practitioners or their own organisation. Officials in the Department of Health are currently drafting an impact assessment to examine the estimated impact of the Bill and to understand better the likely costs and benefits of the proposals.

The database proposed by the Bill—should it survive parliamentary scrutiny—may ultimately improve the flow of information to clinicians on the range of innovative treatments that are already available. Those treatments might include off-label uses of medicines, about which the House is interested in connection with another Bill. In our view, the biggest barrier to the flow of information through the system is the lack of incentives or proper reward for innovation. That is to do with how we reward patterns of activity, rather than the promotion of health and healthcare. The lack of availability of data and information is one of the biggest barriers. Subject to whatever scrutiny and changes the Bill may undergo in Committee, we think that there is a potential prize worth winning, but I appreciate that the Committee will need to go through the Bill in some detail.

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[Chris Heaton-Harris]

Yes, it does. I have talked to those organisations constantly from the conception of the idea of stealing these two ideas from the Saatchi Bill, and I will continue to talk to every organisation that wishes to talk to me about the Bill. If that was a bid to be on the Bill Committee to offer an alternative view and help me pick through the details of the legislation to ensure that it does what I intend it to do, I welcome my hon. Friend’s approach because a couple of people who would have added great value to the process and the Bill are not able to sit on the Committee.

I gave the example on Second Reading of a surgeon who had innovated and saved the life of his patient, but who was unable quickly to communicate that to his peers as there was no comprehensive means of doing so. The database has been called for by many of the medical colleges, as is acknowledged in the briefings that my hon. Friend will have read. The database is important in spreading the best innovations, because it will include not just the successes of any innovation, but its failures. That will allow best practice to spread quickly and for other registered medical practitioners to learn from any innovation. It will not be available for patients to access and will be held by the Health and Social Care Information Centre, as we have just heard, which is where the money resolution directs the money towards.

The database will not cover research and will not hamper recruitment to clinical trials. Nothing in the Bill will allow doctors to bypass any process or requirement that has been set by their trust in relation to undertaking innovative treatments in the NHS, including the requirement to ensure that commissioners will fund any treatment that is not provided by the NHS. As we all know, individual innovation is incredibly important, but it is not a suitable substitute for medical research, which usually tests the efficacy of treatments in a systematic way. I hope that successful innovations will lead to systematic research projects as the evidence builds around a particular specialty and that they will thereby encourage more clinical trials.

The second part of the Bill, which I fully acknowledge is much more controversial, will give registered medical practitioners a supplementary method of demonstrating that they have acted responsibly while innovating. It closely mirrors the existing legal test, the Bolam test, that is used when clinical negligence proceedings reach the court stage. It brings the test forward and enables doctors to use it to demonstrate that they have acted responsibly before they enter the courtroom. It does not change the common law.

[Mr Baron]

I fully respect the good intentions behind the Bill and those of my hon. Friend. I suggest to him that his last point perhaps misses the more fundamental point that it is the fear of litigation that may deter doctors and medical professionals generally from innovating, and thereby put patients at risk. Does he accept that that is at least a valid concern?

[Chris Heaton-Harris]

I am not convinced that that is the case because doctors and registered medical practitioners innovate daily across the national health service. Litigation might be a consideration in the back of their minds, but they are all responsible doctors doing the best for their patients. I do not quite see my hon. Friend’s point.

Doctors have to demonstrate that they have acted responsibly and that remains the case under my Bill. If they have not acted responsibly, they will be subject, as they are now, to the full force of medical negligence law and bodies such as the General Medical Council.

I would argue that my Bill provides extra safeguards to protect patients from medics who peddle treatments that are dangerous or misguided. First, any doctor must act responsibly and in the best interests of his or her patients. They must also be able to demonstrate that they have done so—as they do now—if it gets to a court of law. Secondly, when an innovation is listed on the database, its successes and failures have to be listed. If a rogue doctor’s peers are able quickly to see the exact results of their innovation, would that doctor not be almost exposing themselves and their quackery to their peers?

My Bill has massively evolved from Lord Saatchi’s Medical Innovation Bill from which many of the criticisms levelled against it come. I have been working with the Department of Health, and others, to ensure that the Bill achieves its central aim, and I know that I have a long road ahead should the Bill get through Committee and its other stages. I fully intend to work with everybody who wishes to make suggestions and help constructively so that we can get to a point where we have a database of innovation that can help spread best practice across our NHS.

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

I, too, wholly support the purpose of the Bill and the good intentions behind it, but I am opposed to the Bill itself. I declare an interest as chair of the all-party group on cancer.

Parliamentary scrutiny demands evidence. The Bill is based on the false premise that doctors are somehow deterred from innovating because of a fear of being sued for negligence. I am not aware of any evidence to support that. Doctors can and do innovate without the proposed law. The innovative response to the Ebola crisis was one example of that. Lord Woolf, a leading supporter of the Bill in the other place, wrote in The Daily Telegraph in April 2014:

“What I do know about, from sitting as a judge, are the cases where doctors are sued for negligence because they have innovated in the treatment they offer, rather than following generally accepted medical standards.”

A member of the public then questioned him and asked him to produce evidence of such cases, to which he replied:

“I am not prepared to be cross-examined further”.

Lord Woolf did not cite a single case to support his position. Surely the pursuit of justice starts with evidence. With respect, that sort of judicial paternalism has no place in the modern world. Nowadays, the public expect and deserve better. I am informed by the joint editors of the leading text “Clinical Negligence” that they are not aware of any such cases. Doctors are sued for poor practice, not for innovative practice.

The supporters of the Bill need to provide evidence that doctors are being sued for innovative practice. They need to identify the cases in which that is happening. There cannot be any informed debate until they provide that information. So far, they have not produced any shred of evidence to support their position. The Bill addresses a non-existent problem. If it is not necessary to legislate, then it is necessary not to legislate. Moreover, there is a duty not to pass bad law. This Bill, like the Medical Innovation Bill before it, proposes law that is not only unnecessary but would turn out to be bad.