Oral Answers to Questions

Debate between John Baron and Jane Ellison

Tuesday 2nd June 2015 Commons Chamber

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

The all-party group on cancer has long campaigned on the importance of holding clinical commissioning groups accountable for their one-year cancer survival rates as a means of promoting earlier diagnosis. That will be part of the delivery dashboard from April onwards. What steps will the Government take to ensure that underperforming CCGs take corrective action?

[Jane Ellison]

My hon. Friend has long championed this issue and I look forward to debating it with him further. He is right to say that the CCG scorecard is currently being developed. Academic experts are looking at a range of indicators, including the one-year cancer survival data which he has brought to the House so often, for inclusion in the scorecard. It is likely to be published this summer. I will of course look carefully at the points he makes ahead of that.

Improving Cancer Outcomes

Debate between John Baron and Jane Ellison

Thursday 5th February 2015 Commons Chamber

[The Parliamentary Under-Secretary of State for Health (Jane Ellison)]

It is a pleasure and an honour to respond to an excellent debate in which we have heard distinguished contributions from both sides. This is the sixth debate in six months I have responded to on cancer, which demonstrates the House’s interest in this important subject. I congratulate the all-party groups on cancer, not only on securing this debate, but on everything they have achieved—I will touch on that at the end of my remarks. I sometimes think that with the expertise we have between us, and given the number of times some of us have met in these debates, were we not to be returned to this place, we could take our cancer awareness roadshow around Britain and do some good for the nation in another way.

I shall try to respond to as many points as possible, and in some areas, I can update the House. However, I want to rattle through as many of the detailed points as possible, and I am sure that the shadow Minister, who I like very much, will forgive me if I do not counter his reiteration of the Opposition’s policy position with a detailed exposition of the Government’s. I will say only three things. First, I shall respond mostly to the Back-Bench contributions. Secondly, I do not recognise his figures on reduced spend, although I understand where they are derived from. Thirdly, when the NHS is bringing together its own strategy on cancer, I would question why we would want to come forward with another strategy. As the hon. Gentleman and others have argued, there is a remarkable degree of consensus about what needs to be done, and that is the area we need to focus on.

Obviously, improving cancer outcomes is a major priority for the Government. As the annual report on our outcomes strategy showed in December, we estimate that we will save an extra 12,000 lives a year by 2015, more than double the ambition of 5,000. That figure of 12,000 lives is the best estimate based on a projection using the latest survival estimates and assuming incidence is constant, which I think responds to points made in the debate. I am sure that my hon. Friend the Member for Basildon and Billericay (Mr Baron) will be interested to see the detailed breakdown of how that figure is derived in the annexe to the fourth annual report on the cancer outcomes strategy.

Clearly that figure represents a great achievement by the NHS and it is good news for the thousands of people affected by cancer. Yesterday was world cancer day. A number of Members have referred to the one in two figure. I emphasise that, in the bylines to that headline, it made the point that that was only if lifestyle factors for many people were not adjusted. In fact, chances are considerably better if we could make some of those lifestyle changes. That was alluded to my right hon. Friend the Member for Sutton and Cheam (Paul Burstow), who as usual made a distinguished contribution. I know that he could not stay for the winding-up speeches.

My hon. Friend the Member for Salisbury (John Glen) made well a point about prevention. Were it not unparliamentary, I might have run up the green Benches to embrace him when I heard his argument in favour of tobacco control and standardised packaging. I could not agree with him more. It was absolutely excellent. The “Five Year Forward View”, which many Members have talked about, is the NHS’s vision of its future strategy. It was brilliant to see prevention right at the heart of that strategy; there is an entire chapter about it. Picking up the point made by my hon. Friend the Member for Salisbury, I have discussed this issue with all the major charities over the past six months and asked them to bring their considerable reach and influence to bear and to talk as much about prevention, given their authority on treatments and drugs. That is an ongoing conversation and we have seen some evidence of that. My hon. Friend is right to remind us that 80,000 people a year die in England as a result of tobacco. If only the women in the 1970s who started smoking knew what we know today; it is now two weeks since lung cancer took over from breast cancer as the biggest killer of women. We continue with our tobacco control measures with enthusiasm. We have a good record.

Of course we want to match the best in Europe, and there has been some discussion about that. We accept that cancer survival in England has historically lagged behind the best performing countries in Europe and the world. However, none of those international comparisons of cancer survival includes patients diagnosed after 2007. I delved into this matter in anticipation of the debate. We always cite the figures, but the reality is that because of the time lag, the five-year survival rates are essentially the gold standard—the benchmark against which the international comparisons are made. Therefore, because of the time lag in the five-year survival rates, we are not in a position to know exactly how we are doing compared with other nations.

However, I take the points made often and well by my hon. Friend the Member for Basildon and Billericay about the one-year survival data. It is inaccurate at the moment to use those figures based on patients diagnosed before 2007 as a measure of current performance in the system. The next best estimate of international benchmarks will be in 2017-18. Until then we will look at issues such as projection.

[Mr Baron]

May I seek clarity on that? Is my hon. Friend saying that the 2007 figures are pertinent to the five-year survival rate figures? What we have been focusing on is the one-year figure as a means of driving forward earlier diagnoses, because it is largely at the one-year point that we are losing thousands of lives.

[Jane Ellison]

I completely understand that point, which is well made. We will not have the next best international benchmark until 2017-18, but my hon. Friend is absolutely right that that does not mean that we are without proxy benchmarking and real benchmarking in the interim. He is right to draw attention to the one-year survival rates. I was trying to give a sense of the international picture and of comparisons.

On how further to improve cancer outcomes, I am sure all Members will be delighted that on 11 January, NHS England announced a new independent cancer taskforce to develop a five-year action plan for cancer services, to consider the vital survival rates and to improve them, saving thousands more lives. The taskforce has been set up to produce a new cross-system national cancer strategy, bringing all the strands together, as so many Members wanted. This is a strategy—by the NHS for the NHS—to take us through the next five years to 2020, building on NHS England’s own vision for improving cancer outcomes, as set out in the “Five Year Forward View”.

Picking up a point made by my hon. Friend the Member for Salisbury, many of the major charities involved in the taskforce have told me that much of it is about working smarter. It is not necessarily to be measured purely by spending more. I thought my hon. Friend made a very thoughtful contribution on that topic. The taskforce is an expression of our ambition for outcomes. It has been set up in partnership with the cancer community and other health system leaders, and it is chaired by Dr Harpal Kumar, chief executive of Cancer Research UK. It met for the first time on 27 January. The new strategy will set a clear direction covering the whole cancer pathway from prevention to end-of-life care; a statement of intent will be produced by March 2015; and the new strategy will then be published in the summer.

I have always been keen in responding to these debates to emphasise the need for the NHS and all others intending to improve cancer outcomes to come together and interact effectively with Parliament. That is vital. The expertise is here in the all-party group, so I am pleased that the cancer taskforce yesterday sent a call for evidence to the various all-party groups—on pancreatic cancer, brain tumours, breast cancer, ovarian cancer and cancer generally. I of course encourage colleagues to submit evidence to the taskforce. After the debate, I will speak to the chairman and of course draw his attention to the quality of the inputs into this debate.

Turning to deal with early diagnosis, I shall not reiterate all the points made about the importance of tackling late diagnosis. We have heard some important illustrations of just how crucial this can be. We have invested over £450 million to achieve earlier diagnosis. As part of the recent taskforce announcement, NHS England also launched a major early diagnosis programme, working jointly with Cancer Research UK and Macmillan Cancer Support, to test new approaches to identifying cancer more quickly.

The new approaches include offering patients the option to self-refer for diagnostic tests; lowering the threshold for GP referrals; creating a pathway for vague symptoms such as tiredness—a big issue for pancreatic cancer, so it is important to work on this; and setting up multi-disciplinary diagnostic centres so that patients can have several tests done at the same place on the same day. So many Members have spoken in today’s and other debates about the wearying journeys and the debilitating effects that multiple tests on multiple occasions can exert on their constituents—another important area to look at. NHS England’s aim is to evaluate these innovative initiatives across more than 60 centres around England to collect evidence on approaches that could be implemented from 2016-17.

Briefly, all Members will need to debate and bring more into the open in the coming years the inevitable tension between the concentration of expertise to carry out early diagnosis, particularly in rarer cancers and those with more difficult symptoms, and the understandable desire that Members and members of the public have to have facilities closer to people. There is a tension, and we will inevitably have to debate it. I think it was the hon. Member for Heywood and Middleton (Liz McInnes) who made the point about the number of rare cancers that GPs see. The issue has been teased out in these debates before, but in reality the number of common cancers seen by the average GP is very few, while the number of rare cancers they see is very few indeed.

[Jane Ellison]

I entirely agree; I think there is a balance to be struck. One of the issues that was discussed at about the time of the launch of the “Five Year Forward View”, by the NHS among others, was that of moving consultant expertise from secondary to primary settings. There are a number of ways of looking at that. I urge Members to feed the points that they have raised to the taskforce, because it is exactly that kind of new way of looking at things that we want to capture in its work.

Since 2010-11, the Department of Health has undertaken a series of local, regional and national Be Clear on Cancer campaigns to raise awareness of signs and symptoms of specific cancer types, and to encourage people with such symptoms to visit their GPs. Decisions on further Be Clear on Cancer activity will be made during 2015, and will be based on all the available evidence relating to the effectiveness of the campaigns. I will argue strongly for their continuation, because I think that the case for them has been conclusively made. Many have been very successful, and they are evidence-based, which I think is important. The Department will continue to work with Public Health England, NHS England and all the relevant experts and stakeholders to keep the campaigns under review.

Let me briefly update the House on the ovarian cancer campaign, which was mentioned by the hon. Member for Washington and Sunderland West (Mrs Hodgson), and for which she is a long-standing and doughty champion. I recently lost a dear friend to ovarian cancer, so the issue is very close to my heart. Public Health England ran an ovarian pilot campaign in the North West television region between February and March last year, which, as the hon. Lady said, focused particularly on awareness of bloating as a symptom of ovarian cancer. Public Health England is waiting for the full evaluation results of the campaign, but we expect the interim report to be shared with the charities later this month. Public Health England has also agreed to meet them. A decision on how to proceed will then be made, at a national level.

A draft policy proposal for BRCA gene testing is among those on which NHS England’s clinical priorities advisory group is awaiting consultation. That consultation will probably take place following a 90-day public consultation on the decision-making framework. I understand that NHS England will soon consult on the lowering of the threshold for BRCA1 and BRCA2 testing in line with guidance from the National Institute for Health and Care Excellence.

Let me now briefly touch on the point made by the hon. Member for Heywood and Middleton, from whose health expertise we benefited earlier in the week during another debate. In May last year, before the hon. Lady entered the House, we had a very good debate about cervical cancer and screening following a tragic case involving a young woman in Liverpool. She may find it interesting to read the report of that debate, in which Members described cases similar to that of the young woman to whom she referred.

If people have gynaecological symptoms that make them alarmed enough to visit their GPs, they should be referred for diagnostic tests. Smear tests are screening tests, not diagnostic tests. In fact, the best clinical guidance is that if there are gynaecological symptoms, a smear test will only delay possible diagnosis. I think it important to send young women the message that if they are worried about gynaecological symptoms, they should seek a diagnostic test rather than a smear test.

My hon. Friend the Member for Castle Point (Rebecca Harris) raised the important issue of brain tumours. I can update her on the work that has been done. Representatives of the Brain Tumour Charity recently met representatives of Public Health England, and the meeting went very well. The charity is to give a presentation to the school nursing partnership in March. It is also going to contact the NHS England’s national clinical director for cancer to see how it can contribute to work on early diagnosis. Other actions were agreed on, but I understand that that particular piece of work is proceeding well.

As we know, screening is an important way of detecting cancer early, and under this Government there has been a £170 million expansion and modernisation of cancer screening programmes. They are reviewed regularly, and I am always happy to tell Members how further information can be submitted to the UK National Screening Committee.

On cancer waiting times, the NHS is treating more cancer patients than ever and survival rates are improving. In the last 12 months, nearly 560,000 more patients were referred with suspected cancer than in 2009-10, an increase of 60%. In 2013-14, almost 35,000 more patients were treated for cancer than in 2009-10, an increase of 15%.

Most waiting times standards are being maintained despite the growing numbers, although we are aware of the dip in the 62-day pathway standard in the last three quarters. Of course it is vital that all patients fighting cancer should have high-quality, compassionate care and we expect every part of the NHS to deliver against those national standards. Therefore, the NHS is looking urgently at any dips in local performance to ensure that all patients can get access to cancer treatment as quickly as possible. It has a specific waiting times taskforce looking at that.

Radiotherapy has long been championed by the hon. Member for Easington (Grahame M. Morris). Radiotherapy can be a helpful treatment for some patients. His points about its success rate when used at the appropriate time were well made. As part of its recent announcement, NHS England also committed a further £15 million over three years to evaluate and treat patients with a modern, more precise type of radiotherapy, stereotactic ablative radiotherapy, or SABR, to which he referred. That new investment is in addition to NHS England’s pledge to fund up to £6 million over the next five years to cover the NHS treatment costs of SABR clinical trials, most of which are being led by Cancer Research UK. Those are for pancreatic cancer, lung cancer, biliary tract cancer and prostate cancer.

I can confirm that we are investing £250 million in two proton beam therapy centres. One is at UCLH—I saw the foundations being built when I visited the hospital recently; it was exciting to see that centre being built—and the other is at the Christie in Manchester, so that patients can be treated in the UK. As Members will be aware, patients are currently referred abroad

On the cancer patient experience and the cancer patient experience survey, nothing could more amply demonstrate the importance of putting cancer patients’ experience at the heart of treatment and of the NHS response than the speech by my hon. Friend the Member for Filton and Bradley Stoke (Jack Lopresti). It was impossible to remain unmoved by it. It could not have more aptly underlined the importance of taking patients’ experience into account. Therefore, I was pleased to see that the results of the 2014 cancer patient experience survey, published in September, show some improvement on many of the scores since the previous survey—89% of patients reported that their care was either excellent or very good.

Following the 2014 survey, NHS Improving Quality is launching a pioneering project that pairs highly rated cancer trusts with trusts that have potential to improve. That “buddying” programme will involve up to 12 trusts and will be directed at clinical and managerial staff so that we can continue to use that survey to drive improvements.

As to the future of the survey, on which there has been some discussion, my hon. Friend the Member for Basildon and Billericay mentioned the new tendering of the contract, which NHS England is taking forward. For those reasons, it is unlikely that there will be a survey report in 2015. I know that that will be a disappointment to him, but it is very much the intention to run a survey this year for publication next year. NHS England is working with a range of stakeholders, including cancer charities, to ensure that that survey is even more effective.

[Mr Baron]

I can probably accept that there may be good reasons for the delay, but perhaps even more importantly, will the Minister do what she can to ensure that the results of that survey, when it is eventually brought forward, are followed through for the benefit of patients? Too often, they are not and different CCGs are doing different things with the results.

[Jane Ellison]

Absolutely. That is the purpose of the buddying programme. There is now a more formalised process to ensure that those that are not doing so well are “buddied up” with those that are doing very well.

I want to make a few more points in response to hon. Members’ comments. My hon. Friend rightly brought up the issue of CCG accountability and how we hold CCGs to account. I congratulate the APPG and his personal campaign to make sure we get the one-year cancer survival rates added to NHS England’s delivery dashboard from April this year. Where the evidence from the delivery dashboard is that local providers are not meeting the standards, that will be challenged by NHS England. I think there is still work to do to understand how we can do that most effectively. I know the APPG will also be giving thought to that. I encourage all local authorities, health and wellbeing boards and Members to be part of that challenge process. I also refer them to the work of the chief inspector of general practice, Professor Steve Field, in that regard, because that is an important part of his work, too.

I can confirm that work is ongoing with regard to free social care at the end of life. The hon. Member for Easington asked about that. That work is ongoing, but the Minister with responsibility for care will be able to expand on that.

On health and inequalities, I could not agree more with all hon. Members who made the point that tackling health inequalities is inextricable from tackling cancer effectively. I visited the constituency of the hon. Member for Nottingham North (Mr Allen) recently. The figures for how many cancers are diagnosed through the emergency route have been put on the record in this debate—around 22%. He told me that in his constituency 40% of lung cancers are diagnosed in A and E, and they have very poor outcomes. That brought that point home to me extremely clearly.

Sean Duffy, the national clinical director, is passionate about the treatment and care of older people affected by cancer. That can play a very significant role in improving our overall outcomes. I know that is something he wants to focus on through his call to action, as well as looking at lower socio-economic groups and some black and minority ethnic groups. A recent Be Clear on Cancer campaign on prostate cancer took place in six London boroughs and focused on black men and their particular susceptibility to that cancer.

On rarer cancers, I have touched on some of the work that is going on, but I am pleased that Cancer Research UK’s new strategy launched last year set out how it would increase research in key areas such as early diagnosis, and again that work will feed into the taskforce.

On research, I will not go into detail, but I invite my hon. Friend the Member for Castle Point to contact me at the Department of Health with regard to research on brain cancer. I was recently able to supply some very detailed figures to the all-party group on pancreatic cancer from the chief medical officer, and I would be very happy to supply them in her area of interest.

Lastly, let me give some reassurance on access to data. Transparency is a key theme for this Government. We have rightly put huge amounts of data into the public domain. It is a frustration that the data availability issue to which my hon. Friend the Member for Basildon and Billericay referred has been hard to resolve. Last year some concerns were raised about the legitimacy of the release of patient data to a range of organisations. When these concerns were raised, Public Health England did absolutely the right thing and suspended the release of data while it conducted a full review. This review is now complete. Public Health England and the Health and Social Care Information Centre have also clarified the legal basis of data transfer between the organisations and a letter of authority has just been issued by the departmental sponsors to remove any ambiguity. Data should now begin flowing more quickly.

I would like to thank all those who have contributed to this debate and to so many other debates we have had in the House on this vital subject. I strongly believe there is a great deal of consensus about what needs to happen. We need to continue to challenge the system, and I am delighted that Parliament continues to challenge Ministers in this regard. The new NHS England independent cancer taskforce is leading the way in partnership working and will make a real difference.

If this is the last general debate we have on cancer in this Parliament, may I say thank you to the various APPGs and the people who speak for them, and give them the following assurance? I can tell them that, although it may not always seem like it, in the 18 months or so that I have been a Minister their work has made a difference, and I do know of things that have happened because APPGs and individual Members championed them in this place. If that does not give them the heart and encouragement to keep going and to come back in the new Parliament and champion these issues further, I do not know what will. I congratulate them on their efforts today, and on other days and throughout the year, on this highly important topic that matters so much to all our constituents.

Oral Answers to Questions

Debate between John Baron and Jane Ellison

Tuesday 10th June 2014 Commons Chamber

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

4. What assessment he has made of the role of the comprehensive delivery dashboard in holding clinical commissioning groups accountable for their one-year cancer survival rates.

[The Parliamentary Under-Secretary of State for Health (Jane Ellison)]

NHS England uses a range of data, as my hon. Friend will know, including data from the delivery dashboard, to assess the performance of CCGs. That includes the data from the composite cancer one-year survival indicators. NHS England will take action— it has quarterly assurance meetings between area teams and CCGs—if there are concerns about CCGs’ performance.

[Mr Baron]

May I suggest to the Minister that if the Government are to meet their target of saving an additional 5,000 lives a year and to promote diagnosis, we need to hold underperforming CCGs to account. Why is it, then, that the one-year survival rates, which are designed to promote earlier diagnosis, are not in the delivery dashboard, which, unlike the outcomes indicator set, has teeth, particularly given that CCG chief executives have said that they see no reason why the one-year figures could not be included in the dashboard?

[Jane Ellison]

We will certainly look at that, but I emphasise that all those things are important as part of the conversation between area teams and CCGs. I remind the House that the CCG outcome indicators set for 2014-15 include a range of important indicators for cancer, including one-year survival for all cancers, one-year survival for breast, lung and colorectal cancers combined, cancers diagnosed via emergency routes, and cancers diagnosed at an early stage—something I know my hon. Friend has, quite rightly, championed consistently in this House.

Cervical Cancer Screening

Debate between John Baron and Jane Ellison

Thursday 1st May 2014 Commons Chamber

[Mr Baron]

The hon. Lady makes an excellent point, which leads me neatly on to the report that the all-party group produced back in 2009 on reducing cancer inequalities—I should perhaps declare an interest as the chairman of the group. The report, which was extensive and took in much written and oral evidence, found that this country’s health care system stood as much chance as any other of getting patients from the one-year point to the five-year point after diagnosis. However, where we fell down was on getting them to the one-year point in the first place. That suggests that the NHS is as good as any other health care system at treating cancer once it is detected, but very poor at detecting it. That underperformance in diagnosing cancer means that we trail other health care systems. We never catch up from that original loss.

Comparisons are always dangerous. When we compare our system with that in France, for example, we are comparing it with centres of excellence, so we have to be careful in our comparisons. However, the figures of 5,000 lives a year that could be saved if we matched European averages and 10,000 that could be saved if we met international averages are generally accepted. They can largely be accounted for by the early phase, when we fail to pick up cancer early enough and so do not get enough people to the one-year point after diagnosis.

The all-party group therefore decided to ask how we could focus the NHS on earlier diagnosis. We have been laser-like and dogged in our campaign on that front.

[The Parliamentary Under-Secretary of State for Health (Jane Ellison)]

indicated assent.

[Mr Baron]

The Minister is nodding—kindly, I think. I thank her for that in one respect.

The solution that the all-party group came up with was to focus on outcomes. We could bombard the NHS with a lot of targets to try to encourage earlier diagnosis, but instead we decided to focus on one outcome measure—the one-year survival rate, broken down by CCG—as a driver towards earlier diagnosis.

--- Later in debate ---

[Jane Ellison]

Of course. I remember that I responded to the hon. Lady on the detail of that.

I have started to write routinely to the chairmen of health and wellbeing boards to make them aware of issues that are of interest to parliamentarians and changes in law or guidance. I undertake to mention this subject, particularly in the context of Sophie Jones’s case, in my next letter to health and wellbeing board chairmen, to draw it to their attention. There is a 1 million study under way by the National Institute for Health Research under its health technology assessment programme to look at the issues of effective interventions for younger women on the take-up of screening, so work is in progress.

[Mr Baron]

Will the Minister update the House briefly on whether there has been any progress on work regarding how we will hold underperforming CCGs to account, once the one-year cancer survival figures are published from June onwards?

[Jane Ellison]

I applaud my hon. Friend for taking a further opportunity to draw that to my attention—we met on Monday evening and discussed it. That will be part of the Department’s response to the all-party group’s report, and I undertake to update him further. I note, as he does, that he raised the matter with the Prime Minister recently and I will keenly pursue the points that he has made.

Finally, I thank all the staff involved in the national screening programme and those who deliver the important HPV vaccination programme for all their hard work. More power to the elbow of those who are looking for ways at local or national level to reach more young women, for all the reasons outlined by so many Members in so many excellent speeches. We can do so much more to achieve greater awareness and greater take-up, to get greater numbers of people screened and taking up the HPV vaccine. All that is work that we as Members of Parliament, I as a Minister and many people involved in our health services around the country can take part in. I recognise that for Sophie’s family, nothing we do can make up for her loss, but it can be part of her legacy. I thank Members for bringing this debate to the House.

Cancer Priorities

Debate between John Baron and Jane Ellison

Thursday 13th February 2014 Commons Chamber

[The Parliamentary Under-Secretary of State for Health (Jane Ellison)]

Before addressing only some—I fear—of the many points raised in this debate, I would like to thank the all-party group, which, as the shadow Minister and others have said, does astonishing work. It rightly, and regularly, holds Ministers’ feet to the flames—my feet regularly feel the heat—but that is a good thing, because this is about driving up standards and pushing us all to work harder and do the right thing in this important policy area.

I also pay tribute to my hon. Friend the Member for Basildon and Billericay (Mr Baron), who brought this debate, and to the Backbench Business Committee—it used to be more fun being on it than responding to its debates—and I also warmly welcome the contribution from, and the presence of, the hon. Member for Ashton-under-Lyne (David Heyes), whose personal testimony greatly enhanced the debate this afternoon. We should also pause to think of our colleague, my hon. Friend the Member for Filton and Bradley Stoke (Jack Lopresti), who is being treated for bowel cancer; our thoughts are with him.

I shall try to reply to some of the many points raised in this fascinating debate. I shall try to respond, to some extent, on the structure of the report and the different domains, and to pick up on some other points made, and I absolutely undertake to get back to colleagues where I cannot respond substantively. As my hon. Friend the Member for Basildon and Billericay said, this is part of an ongoing dialogue, and I am delighted that he will be meeting the national clinical director soon. Out of that dialogue, I think we can progress in some of these areas. Some of the issues are inevitably a work in progress. However, important points have been made and I shall try to respond to as many as I can while updating the House more generally on what the Government are doing.

Many of the report’s recommendations are for NHS England. As I said, I am pleased that the national clinical director is to meet the all-party group later this month. He will find the meeting a helpful opportunity to discuss the report in detail. As I prepared for this debate, I was particularly struck by the fact that NHS England is considering the report in great detail—indeed, it contributed during the consultation phase. I am really encouraged by that, as NHS England is absolutely critical in our new health structures. It is very aware of its responsibilities. Some of the challenge today has been about how we interact and how those new responsibilities settle.

I want to set out some of the actions under way that I hope will provide reassurance about the Government’s and NHS England’s commitment to delivering on our ambition, articulated by other Members, to make England among the best in Europe on this issue. My hon. Friend the Member for Hertsmere (Mr Clappison) said that we had major challenges and a long way to go in that regard, although the shadow Minister was right to say that we are beginning to make significant progress in some areas. However, we recognise that we have a long way to go.

I was first asked to respond formally to the report, and it would be improper if I did not respond to such a thoughtful and well put together piece of work. Obviously, I hope to respond to some degree today, but I will take the report away and certainly respond formally later. Some of that will be about the Government’s responsibilities in holding NHS England to account. I will think about how we can do that.

The first domain that the report addresses is preventing people from dying prematurely. It raises concerns about responsibilities and accountability in the new health system. It is right to challenge on such issues; we cannot pretend that, when there is such major change to a system, everything will immediately be settled and clear. I accept that there is a challenge. Our progress must be as speedy as possible in understanding who is responsible for what—particularly in understanding how we make accountability as transparent as possible and a driver of change and improvement.

We are responding to the new system and the inevitable tensions between devolving power on delivery in a way that empowers clinicians while also being accountable to Parliament. No one could pretend that that is not challenging. I certainly feel that challenge as a Minister; the responsibility for delivering most of that clinical care sits somewhere else, so the issue is about how we respond and account to Parliament for that.

I gently say that we should be careful not to suggest that, in such a large and complex health economy, all was perfectly clear and beautifully directed from the centre before. I respect the shadow Minister’s enormous knowledge of the NHS and I know that neither she nor anyone else is suggesting that. However, in highlighting concerns about where the new system is settling down, it is sometimes tempting to think that previously Ministers had a big lever under their desks that they could pull to make everything right. Even if that was the theory, it certainly was never the practice, as is evidenced by our persistent lagging in some of the key survival statistics discussed today.

The challenge is to respond to the new system and get clarity where there is none at the moment. A number of Members, including the shadow Minister, have mentioned how we hold people to account at the most local level. That issue emerges from this debate as the one on which we have the most work to do and to which we must give the most thought.

I want to discuss how the system is set out. I accept that the way in which we make it work in practice is not necessarily the same as that, but I will go through how we have set out the different frameworks and processes of accountability.

The indicators in the NHS outcomes framework provide the basis against which the performance of the NHS will be monitored. NHS England is responsible for delivering year-on-year improvement and is accountable to the Secretary of State. Those arrangements are set out in the Health and Social Care Act 2012, under which the Secretary of State set out the strategic priorities for NHS England through the mandate. The mandate makes it clear what is expected of NHS England with regard to contributing to the prevention of ill health through the better early diagnosis and treatment of conditions such as cancer.

The outcomes framework sets out different measures against which we hold people to account, and the Department has quarterly accountability meetings with NHS England, through which NHS England’s progress in delivering those improved outcomes is monitored. We will continue to monitor its progress in delivering against the mandate. The evidence showing how it has met the mandate is published, and forms the basis on which Ministers can ultimately judge the success or otherwise of NHS England’s performance.

I entirely accept the point that that is quite a macro way of looking at things, and that Members are also seeking a sense of what can be done on the ground. Perhaps I need to respond in more detail after the debate on the challenges relating to the role of the strategic clinical networks. Cancer has been made a priority for those networks. Making the new networks work is also a challenge for the national clinical directors and other colleagues in NHS England. Their role in relation to cancer is obviously to drive quality and innovation in prevention and screening, survivorship and end-of-life care. I know that NHS England is keen to see the links between the national clinical directors and those respective networks strengthened. There is clearly more to do, and I welcome the fact that the all-party group is in direct dialogue with the national clinical director. I will pick this up with the group and with him after their meeting.

With regard to clinical commissioning group accountability, NHS England is responsible for ensuring that the CCGs secure the excellent outcomes that we want, through commissioning. The assurance framework provides the basis for that assessment. It is an integral part of the agreement of improvements to be delivered locally. When CCGs are found to be at risk of failing to deliver improvements, NHS England will provide the necessary support. Statutory intervention powers exist, but they are to be used as a last resort only when CCGs are demonstrably lacking the capacity to make improvements.

Through “Everyone Counts”, the planning guidance for 2014-15, NHS England has asked CCGs to set a level of ambition for reducing premature mortality as part of their strategic and operational plans. They will be expected to demonstrate progress against those plans. The 2014-15 CCG outcomes indicator set is used as a tool by CCGs to understand trends in outcomes and to help them to identify potential priorities for improvement. It has a range of new cancer measures covering early detection, stage at diagnosis, and diagnosis via emergency routes. I pay tribute to the all-party group for championing the inclusion of those indicators, which have now been adopted, as the hon. Member for Basildon and Billericay said. The indicators will help to ensure that progress is being made on early diagnosis and, in turn, on survival rates.

With regard to the various bits of data, we will shortly have the one-year cancer survival information for patients diagnosed in 2012, which will tell us the stage at diagnosis. This will allow us to calculate stage-adjusted one-year survival, and that will probably represent the most accurate and timely cancer data that have ever been available in England. Using those data, we will be able to populate important indicators in order to drive up improvement, including the public health outcomes framework and the CCG outcomes indicator set, in relation to the proportion of cancers diagnosed at stages 1 and 2—the early stages.

On the five-year data, I am sorry that things have changed since the answer that I gave to my hon. Friend the Member for Basildon and Billericay at Health questions. That was the information that I was working on at the time. NHS England has been working with the London School of Hygiene and Tropical Medicine to establish whether the five-year indicator was statistically valid. When I answered my hon. Friend’s question, the data had not been fully gathered in. Having gathered them in, however, the conclusion was that because of the small number of survivors at five years, disaggregating the data down to individual CCGs would not leave the data statistically robust enough to draw conclusions. It would therefore be unsafe to do so. They are not therefore planning to publish at the CCG level, but they are considering how it can be published at a level that is not only meaningful and helpful, but statistically safe. I understand that this has been disappointing, but I think that the all-party group and Members will understand that the data set is so sensitive that if it was not felt to be safe and robust, it could not be published in that way. We will talk to NHS England about it.

[Mr Baron]

I very much welcome that explanation, which goes a long way towards explaining the reason for the change in such a short period. May I leave the Minister with the thought that there appeared to be almost a complete disregard of the need to consult? Although I accept that this is NHS England’s ultimate responsibility, the cancer community came together on this issue and it seemed to be completely ignored from the point of view of consultation. Perhaps the Minister will look at that.

[Jane Ellison]

That is a fair challenge, and I will certainly take it up and raise it. On what we can do with data and transparency at the local level, the Department is looking at a number of things. The Government have tried to use data transparency in lots of different ways to drive improvement and accountability, and we are currently looking at some other ideas which I hope will produce a far greater sense of what is happening on the ground and in someone’s local area. We are very open to suggestions, and some have been made during the debate. I am happy to look at those, but this is an area under active consideration.

There has been a lot of discussion in this excellent debate about awareness and early diagnosis, and we know that it is one of the keys to getting better survival rates. It is central to meeting our ambition of saving the additional 5,000 lives each year by 2014-15, and we have committed more than £450 million in funding to achieving that and doing more on early diagnosis. To date, we have run national campaigns on tackling bowel and lung cancers; we have the Blood in Pee campaign, which hon. Members will be aware of, to raise awareness of bladder and kidney cancers; and we are currently running a breast cancer campaign for women aged 70 and over. The early response to that campaign has been really encouraging.

The shadow Minister raised some of the core public health issues which I spend much of the day job discussing: obesity, alcohol and smoking. I am slightly surprised that we have had relatively little discussion of those in the context of early diagnosis and prevention. Public health has been devolved to local authorities. They have more than £5 billion of ring-fenced money over two years, and all the local authorities I speak to—I was at the Local Government Association public health conference two weeks ago—are excited by the possibilities that that holds for them. There is a fair challenge about where the responsibility sits, but if everyone is doing work on awareness and early diagnosis, that can only be a good thing. Many local authorities are taking seriously the challenge of raising their game locally, and that is in addition to the national campaigns.

As hon. Members will be aware, many of the indicators are very mixed; there is a variety of statistics and variation around the country. I pay tribute to my local Wandsworth authority, whose six-week “get to know cancer” pop-up shop closes this Sunday. A local shopping centre gave the authority an empty unit and it worked with NHS London, staffing the unit for six weeks during the same hours as the shopping centre. It was run on a walk-in basis, and hundreds of people in my local community have popped in to that non-threatening environment to talk to trained nurses and get advice about cancer and some of those important awareness issues. Such local initiatives can only help us in our ambition to do much better.

My hon. Friend the Member for South West Bedfordshire (Andrew Selous) has had to leave us for a constituency engagement, but he touched on the work of charities. I met people from the excellent HeadSmart charity recently and I undertook to write to health and wellbeing boards about its work, so I will give him that assurance when I next see him. I also pay tribute to the work that Cancer Research UK has been doing on pilots dealing with melanoma, which my hon. Friend the Member for Mid Derbyshire (Pauline Latham) mentioned.

NHS England works with Public Health England and the Department to determine the focus of campaigns and to manage the development of the Be Clear on Cancer campaign. Decisions on the 2014-15 campaign activity will be based on the evidence and learning from the evaluation campaigns of the past two years, and it will be subject to all the normal clearances in terms of delivering really good value for money.

To deliver access to the best treatment, we have committed more than £173 million to improve and expand radiotherapy services. That includes £23 million for the radiotherapy innovation fund, which has supported centres to deliver increased levels of intensity modulated radiotherapy—a more accurate form of treatment that can reduce side effects.

The cancer drugs fund featured heavily in the debate. More than 44,000 patients have benefited from the fund so far, and last September we announced a further £400 million to extend it to the end of March 2016. Going forward, we will consider what arrangements can be put in place to deliver access to drugs previously funded through the CDF at a cost that represents value to the NHS. I recognise the nervousness that exists among those who understand what the fund has done and the impact it has had on individual patients. My hon. Friend the Member for Mid Derbyshire highlighted that matter, but clearly it is something that NHS England will be taking forward, and it will be aware of the concerns that have been expressed in the House.

Regarding the all-party group’s specific concern about NHS England’s duty to promote research, NHS England recently carried out an open consultation on a draft research and development strategy to deliver its statutory responsibilities and the NHS mandate duties. Again, we will learn more about that when the meetings take place, and as NHS England delivers that project.

The all-party group rightly highlights the importance of supporting cancer survivors. Increasingly, cancer is viewed as a long-term condition—that was certainly not the case when many of us were younger—as more are living with and beyond the disease. In March 2013, the Department’s national cancer survivorship initiative published “Living with and beyond cancer: taking action to improve outcomes”. It set out key recommendations to improve survivorship care, which were drawn from two years of evidence gathering.

I understand that the national clinical director is working closely with Macmillan, which provides the secretariat so ably to the all-party group, to encourage implementation and spread of the recommendations, including around stratified care pathways. The all-party group will be pleased to learn that ensuring all survivors benefit from the survivorship recovery package is a priority work programme.

We want to support people to stay in and return to work. A specific concern of the all-party group is how NHS England intends to support people to do that, as set out in the mandate. I can confirm that NHS England has issued an invitation to tender for a piece of work to examine the factors that impact on the employment rate of people with long-term conditions and to identify the useful interventions that can be made. It will be looking to consider the next steps. I think it is expecting to report on that in 2015.

The all-party group has also said that it would like to see wider use of the patient reported outcomes measure—PROM—data. This month, we have already seen the publication of “Quality of life of cancer survivors in England—one year on”. That is a survivorship update commissioned by the Department, which provides important information on recovery, unmet needs and the consequences of treatment. NHS England has already begun work to extend the PROM programme. A new pilot PROM data collection has recently started looking at quality of life issues for survivors of womb, ovarian and cervical cancer. For men, NHS England is supporting Prostate Cancer UK on a nationwide PROM data collection.

The all-party group makes a number of recommendations on the national cancer patient experience survey, which was referred to by the shadow Minister. I think we all acknowledge that it has been an invaluable tool in driving improvement in cancer care. When I first heard about it and looked at it in response to an earlier debate in Westminster Hall, I was very impressed with the level of detail that it can drive down to individual trusts. It uses what the best are doing to drive performance among those that are not meeting the highest standards.

NHS England recognises the value of the survey and currently has no plans to halt the programme. NHS England is the lead, but I think the more often we in Parliament recognise how important the programme is, and show how much parliamentarians value it and regard it as central to understanding the cancer patient experience, the more NHS England will feel that it is the right decision to go forward with it. I know that NHS England intends to examine the potential for a survey-related indicator as part of the future development of the clinical commissioning group outcome indicator set. That is a good thing. The shadow Minister made some interesting points and constructive suggestions in that regard, which I will happily look at after the debate and draw to the attention of NHS England.

The all-party group was concerned that more could be done to understand the experience of those who are close to people affected by cancer, and its members might be interested to know that following the NHS’s commitment to carers event, held last December, a number of priorities for supporting carers were identified. An action plan is in development and although it focuses more on the experience of carers in general, NHS England will consider cancer care as part of that. The 2014 cancer patient experience survey will begin in March and report in late summer. I am sure that there will be parliamentary interest in that report.

In order to realise the Berwick report’s vision of the NHS as an organisation devoted to continual learning and improvement, NHS England and NHS Improving Quality will establish a new patient safety collaborative programme to spread best practice, build skills and capabilities in patient safety and improvement science, and focus on actions that can make the biggest difference to patients in every part of the country.

NHS England is undertaking work to improve the collection and analysis of patient safety data, including introducing “safety thermometers” for medication error, maternity care and mental health, and revising the NHS serious incident framework further to support best practice. It is working with the Care Quality Commission and others to provide consistent and clear information for all on what patient safety data are available.

Let me try to pick up on some of the points made by hon. Members. My hon. Friend the Member for Hertsmere expressed a concern about older people with cancer. I will respond to him in more detail after the debate, but we know that older people sometimes do not get the support they need and what happens during diagnosis is often the primary driver of poor outcomes. He might be interested to know that we have worked on a £1 million project with Macmillan Cancer Support and Age UK to improve uptake of treatment in older people. That has established some key principles for the delivery of age-friendly cancer services and, as I mentioned earlier, we are seeing encouraging take-up of the over-70 breast screening programme in response to the current campaign.

Finally—I apologise, Madam Deputy Speaker, but I had many points to respond to and although I have not reached all of them, I will draw my remarks to a close—I am advised that NHS England will engage with the vision for the management of complaints and concerns developed on the recommendations of the right hon. Member for Cynon Valley (Ann Clwyd) and Professor Tricia Hart. I think the whole House acknowledges the amazing work done by our parliamentary colleague in that regard. The plan is to establish an advisory group of patients and patient representatives to feed into the complaints improvement work.

My hon. Friend the Member for Salisbury (John Glen) talked about palliative care. Work is going on in that area and I shall write to him after the debate. He might also be interested to know that NHS England is considering the potential for an indicator based on death in a preferred place of care. I will get back to him with more detail on that.

My hon. Friend the Member for Harrow East (Bob Blackman) mentioned issues to do with work and pensions, which I shall refer to the Department for Work and Pensions. He also talked about procurement issues and smoking. I am afraid that at the risk of sounding a little boring after Monday I must put on the record the fact that the Government have not yet made a decision about standardised packaging. We have instead introduced regulation-making powers so that we can make a decision when we have received the Chantler review and considered the wider aspects of that policy while taking its findings into account. Ministers will make the final decision. I am sure that my hon. Friend understands why we must put that rather legalistic sounding statement on the record.

In conclusion, I apologise for the length of my response, but this was such a good debate and many interesting points were made. I will take away those that I have not been able to respond to in detail. Once the all-party group has met the national clinical director, that might be a good time for us to meet again, to reflect on the meeting and to consider what more we can do to take this important work forward. I thank everybody who has contributed to the debate, and the all-party group for its continued detailed work and the challenge it puts out to us all to do better in this area on behalf of all our constituents.

Tobacco Packaging

Debate between John Baron and Jane Ellison

Thursday 28th November 2013 Commons Chamber

[Jane Ellison]

The hon. Gentleman refers to another Bill, rather than the issue we are discussing now. I have heard none of those concerns from the charities he mentioned, which I understand have warmly welcomed today’s announcement.

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

I, for one, very much congratulate the Minister on this welcome news. As she well knows, the all-party group on cancer has been one of many that have argued for added urgency on this issue. The Government have listened and responded, which is a sign of strength, not weakness. To follow up a previous question, will the Minister give an assurance that the regulations will be in place before the end of this Parliament, because if the recommendations are in favour of introducing standardised packaging, they will need to be implemented quickly?

[Jane Ellison]

That is certainly the objective of the timetable that has been drafted, once the Government have received the review and made a decision. I see no reason why what my hon. Friend suggests could not be the case.

Oral Answers to Questions

Debate between John Baron and Jane Ellison

Tuesday 26th November 2013 Commons Chamber

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

T8. The Secretary of State is well aware that the all-party group on cancer has campaigned long and hard for the monitoring of one and five-year survival rates as a means of promoting earlier diagnosis, cancer’s magic key. Is he confident, though, that the mechanisms are sufficient to ensure that those clinical commissioning groups that are underperforming in relation to their one and five-year survival rates will face concrete action to improve earlier diagnosis, given the recent OECD report suggesting that 10,000 lives a year could be saved in this country if we matched European average survival rates?

[Jane Ellison]

My hon. Friend is right to champion early diagnosis and he has raised these issues in the House on many occasions and with me. Improving cancer survival is a key priority for this Government. We aim to save an additional 5,000 lives each year by 2014-15. Clinical commissioning groups have a duty on early diagnosis. It is part of their crucial outcomes indicators set, and they will be held to account for that because we cannot deliver those improvements in cancer outcomes without early diagnosis.

Tobacco Packaging

Debate between John Baron and Jane Ellison

Thursday 7th November 2013 Commons Chamber

[Jane Ellison]

We are aware of that, but smoking in this country has dipped below 20% for the first time ever. I am aware of the hon. Lady’s concerns and I shall talk a bit about some of the public health campaigns and the new opportunities, not just for the Government but for local government and individual Members, on tobacco control policy.

As our plan makes clear, effective tobacco control needs comprehensive action on many fronts. The Government are taking action nationally. We are committed to completing the implementation of legislation to end the display of tobacco in shops. Since 2012, supermarkets can no longer openly display tobacco. In 2015 all shops will need to take tobacco off view. Tobacco can no longer be sold from vending machines, which has stopped many young people under 18 accessing smoking.

I do not want to downplay the importance of this policy—we are conscious that it could make an important contribution—but we can do many other things. The reasons why children, in particular, take up smoking are very complex, and are to do with family and social circumstances. One policy alone will not address that. Local authorities have a vital role to play, which is why we have given local government responsibility for public health backed by large ring-fenced budgets—more than £5.4 billion in the next two years. I encourage all hon. Members who have participated in today’s debate to ask tough questions of people locally. I hope that they are talking to their public health directors, health and wellbeing boards and clinical commissioning groups about where tobacco control sits in the armoury of local government. That is why this power has been devolved. The local insight and innovation made possible by that policy will help us to tackle tobacco use at a local level as well as through policies that the Government can put in place.

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

I congratulate the Minister on her obvious grasp of the subject. She is right to say that this will be a continuing debate beyond the issue of standardised packaging. Does she agree, however, that an increasing welter of evidence suggests that standardised packaging would help in the fight against smoking, particularly among the young? Will she give an assurance that the Government will increase the urgency of their review of the situation, and especially of the growing evidence in favour of standardised packaging?

[Jane Ellison]

I can give my hon. Friend that commitment and I am giving this my urgent consideration. It is impossible to sit through a debate such as today’s, and hear the passion expressed by many hon. Members on both sides of the House, without going away, as the public health Minister, to give it one’s serious, urgent and active consideration.

I have laid out a little challenge to hon. Members to take this issue up at the local level. I appreciate that it is right that I should be held to account on this issue, but in the new world of devolved public health powers, I urge hon. Members to have those conversations with their health and wellbeing boards and with public health directors. In areas of the country where smoking prevalence among children is a difficult issue—some examples have been cited in the debate—our belief is that by devolving some of the power and, importantly, the ring-fenced budget to local authorities who know their communities best, they can begin to tackle the problem with great urgency and added innovation in a way that central Government cannot.

Public Health England has an important part to play. As a new, dedicated, professional public health service, it will be available to advise on local action to promote public health and encourage behaviour change to help people live healthier lives. It will put expert advice at the disposal of local authorities.

Oral Answers to Questions

Debate between John Baron and Jane Ellison

Tuesday 22nd October 2013 Commons Chamber

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

15. For what reasons the publication of data on one-year and five-year survival rates for all cancers within the Clinical Commissioning Group Outcomes Indicator Set has been deferred until March 2014.

[The Parliamentary Under-Secretary of State for Health (Jane Ellison)]

I am aware of delays in the availability of source data at a local level. For that reason, it is not possible to publish data on one-year and five-year survival rates for all cancers before March 2014. I know that my hon. Friend is frustrated by this and that he has done a lot of work on this issue as the chair of the all-party group, but I am sure he will agree that it is better to have accurate information to make these vital clinical judgments.

[Mr Baron]

The Minister will be aware that the all-party group on cancer has campaigned long and hard for the monitoring of the one-year and five-year survival rates as a driver for earlier diagnosis—cancer’s magic key. What assurances can she give that the March 2014 deadline will be met and that appropriate action will be taken against those CCGs that underperform?

[Jane Ellison]

We have spoken to NHS England, which has advised me that it is not aware of any reason to think that the March 2014 will not be met. As my hon. Friend knows, however, the day-to-day management of CCGs is a matter for NHS England, and I am sure he would not approve of Ministers trying to micro-manage CCGs from Whitehall. His strength of feeling is clear, and I am happy to have an ongoing dialogue with him and the all-party group on this matter.