NHS Reorganisation

Debate between John Baron and Kate Green

Wednesday 17th November 2010 Commons Chamber

[Mr Baron]

The answer to the hon. Lady’s question was supplied by my right hon. Friend the Secretary of State in answer to my question earlier. The one and five-year cancer survival rate figures will be published and presented, although how that will happen is in the melting pot. I very much welcome the work of the Office for National Statistics, the National Cancer Intelligence Network and the London School of Hygiene and Tropical Medicine. Whatever form the figures take, they will be in a performance table, not a league table, to ensure that all PCTs and then GP consortiums are tasked with improving performance, irrespective of how they compare with others. That will obviously include PCTs in deprived areas across the country.

I suggest to my right hon. Friend the Secretary of State that the focus on outcomes must include patient experience measures and longer-term quality of life measures, such as whether patients are able to return to work. That, too, is very important from the point of view of cancer patients.

As an aside, I suggest that there is a question mark about process-based targets such as waiting times in general. To return to the point made by the hon. Member for West Ham (Lyn Brown), the real problem when it comes to late diagnosis is not whether it takes one, two or four weeks for a patient to see a cancer specialist. It is how long it takes for the suspicion to be raised that cancer exists in that patient in the first place. Perhaps we should incentivise GPs to detect cancer earlier.

[Kate Green]

I absolutely appreciate the expertise that the hon. Gentleman brings to the debate, but I should like to ask his views on the issue of anxiety while waiting for an appointment. Whatever the physical outcomes of early treatment, there is a peace of mind issue for patients who are anxious to see their doctor as quickly as possible.

[Mr Baron]

I accept what the hon. Lady says, and I hope that the focus on outcomes will include matters such as patient experience surveys, which will incorporate that very point. It is an integral part of a patient’s experience, and it should be picked up when we start focusing on outcomes.

I return to GPs being incentivised to detect cancers earlier. In that vein, I very much support Cancer Research UK’s campaign to encourage greater access for GPs to diagnostic testing. That will be terribly important when it comes to detecting cancers earlier.

Moving on to GP commissioning of cancer services, there is no doubt in my mind that there is room for improvement in this area, and it would be naïve of Members to believe otherwise. There is often frequent confusion between the roles of strategic health authorities, cancer networks, PCTs and hospital trusts. The priorities of the cancer reform strategy are often not aligned with those of the PCTs.

I should like to play devil’s advocate and suggest to the Secretary of State that we need to tread carefully in dealing with the challenges ahead. The Secretary of State will be aware that GPs see only about eight new cancer cases a year, and that cancer is a set of 200-plus diseases with often complex care pathways. The GPs are often involved in the early and late stages of that care pathway, but the complex bit in the middle is often conducted by clinicians in hospitals.

Challenges lie ahead. We need to ensure that the responsibilities of the NHS commissioning board, the PCTs and the GP consortiums are clearly defined to avoid fragmentation of treatment across the cancer pathway. The reforms must help and not hinder the close working relationship between primary and secondary care doctors. The role of cancer networks in supporting GP consortiums needs to be clarified before those networks are broken up and their expertise is lost.

Furthermore, we must consider whether we need to redistribute the financial incentives to encourage more focus on the earlier and late stages of the care pathway. In other words, we must ensure that reward matches responsibility. Should a qualities and outcomes framework be realigned so that early diagnosis, survival and people dying in their place of choice are included?

In the last minute left to me I shall mention the cancer drugs fund. I have raised the issue with the Secretary of State before. There appears to be early evidence of disparity of access. When it comes to the cancer drugs fund, access should always be clinician-led. In some regions, approaches can be made to the PCT, and in others they are made to the cancer network, which, in turn, has access to the fund. Elsewhere, GPs are forming panels. May I suggest that best practice from the interim drugs fund is applied uniformly before the main drugs fund kicks off next spring? We do not want to add to cancer inequalities when it comes to access to treatment and drugs.

In the past, rarer cancers have had a very raw deal. I know that the Secretary of State is conscious of that and will ensure that those who suffer from rarer cancers will be treated much more fairly than in the past.

There is not time for the Secretary of State to answer all my questions now, but I hope that he will address them when he speaks at the Britain Against Cancer conference on 14 December, and I look forward to hearing what he has to say.

In short, the refocusing on outcomes is the greatest innovation and benefit to patients since the NHS began. However, that must not be undermined by the problems with GP commissioning.