There have been 5 exchanges between John Baron and Department of Health and Social Care
|Mon 16th March 2020||Covid-19||3 interactions (106 words)|
|Tue 29th October 2019||Oral Answers to Questions||3 interactions (65 words)|
|Mon 1st July 2019||NHS Long-Term Plan: Implementation||3 interactions (180 words)|
|Tue 24th July 2018||Oral Answers to Questions||7 interactions (124 words)|
|Tue 1st May 2018||Cancer Targets (Westminster Hall)||33 interactions (3,880 words)|
My hon. Friend makes an incredibly important point. One reason why we have held off from taking measures like this for as long as we have is because they have significant downsides, many of which have been discussed in the Chamber today. I of course urge people to follow the advice that my hon. Friend gave, and I urge communities to come together as much as possible to help each other through.
I agree with the hon. Lady on this. The Richards review and working through the recommendations will enable us to put more screening in places where people can access it. The Eve Appeal, specifically directed at cervical cancer, is looking to put screening in workplaces and so on, but anybody who is worried must get tested.
I thank my hon. Friend for all his work leading the all-party parliamentary group on cancer. We are putting more money into diagnostic tests, which means that there will be more than 7.9 million more tests. Making sure that we have the correct data on survivability, in which the one-year test is an important metric, is part of that programme.
Well, it is great that by the end of his questions the hon. Gentleman finally got to the future of the NHS, which is what we are here to discuss. However, what I did not hear—unless I missed it—was a welcome for the extra £33.9 billion that we are putting into the NHS. I did not hear him welcome the fact that life expectancies are rising, or our plan to drive up healthy life expectancy still further. I did not hear him say whether the Labour party supports our efforts to ensure that the NHS is properly funded and supported not only now but into the future, because that is what this Government are delivering.
I will go through some of the questions that the hon. Gentleman did raise. He asked about the prevention Green Paper. Indeed, he will know that preventing people getting ill in the first place is a central objective of mine, and it will be forthcoming shortly. He mentioned the better care fund. I was very precise in what I said about the better care fund, because its funding is rising in line with NHS revenue growth. In fact, the overall funding available to deliver social care in this country has risen by 11% over the past three years. Of course there is more to do to ensure that we have a social care system that is properly funded and structured to ensure that everybody can have the dignity of the care they need in older age, and that people of working age get the social care they need, but the Labour party ought to welcome the increase in funding, as well as the aim of ensuring that we get the best possible value for every pound.
The hon. Gentleman mentioned the clinical review of standards, which he welcomed when it was announced recently. The pilots that he mentioned started just four weeks ago, and of course we will be assessing the results and ensuring that we get the right structures in place in future. I am glad that he welcomed it, but in relation to publishing data, after just four weeks it is unsurprising that we are still in the early stages.
The hon. Gentleman asked me to ensure that the increase in funding for mental health will happen and that CCGs will be required to see that increase flowing through to make sure that patients get better service. I can confirm that NHS England is already intervening. The £2.3 billion increase that we have set out in the long-term plan will be required to flow through to the frontline. This implementation framework is part of the system that we are putting in place to make sure that that happens.
I pay tribute to the work that the APPG, so ably led, has done in putting the measurement of improvements of cancer at the forefront of the debate. I particularly acknowledge the point about early diagnosis. Here in the UK, we are one of the best countries in the world at treating cancer once it is diagnosed, but we are behind the curve on early diagnosis. Putting a one-year cancer diagnosis metric at the heart of the implementation of the long-term plan is a critical step in making that happen. What is going to happen now is that each of the local systems will feed into the framework in terms of how they will be putting this into action. The full implementation plan, which will be published shortly after the spending review, will take that into account, as well as all the budgets that need to be settled in the spending review. I would recommend to my right hon. Friend—my hon. Friend—[Interruption.] Just for now. I recommend that he keep up this campaign, because we have made significant progress in the implementation framework but there is still more to do.
I call Bim Afolami. Not here. This is a rum state of affairs. I hope the fellow is all right. He was here earlier, but he has beetled out of the Chamber at a most inopportune moment. Well, there is nothing to be done, and the grouping breaks down, but I hope Bim’s okay. Reports would be welcome.
I, too, hope my hon. Friend the Member for Hitchin and Harpenden (Bim Afolami) is okay.
Saying that gave me a crucial few seconds. [Interruption.]
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We are very clear that achieving the 62-day standard is not a prerequisite for transformation funding, but the better the performance against the standard, the more funding alliances will receive. Most have now received 75% to 100% of the funding requested. This is taxpayers’ money, so we must ensure alliances are operationally strong and ready to achieve transformation.
I thank my hon. Friend for his work chairing the all-party group on cancer over many years, as I know he is about to step down. He has two answers in one here. Yes is the answer. Improving cancer patient outcomes will be the seam that runs through the centre of the NHS’s long-term plan, like the proverbial stick of rock.
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?
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.
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.
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.
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?
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?
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.
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.
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.
Break in Debate
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.
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.
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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.
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.