Cancer Priorities

John Glen Excerpts

Thursday 13th February 2014 Commons Chamber

[John Glen (Salisbury) (Con)]

It is a pleasure to speak in this important debate. I congratulate the all-party group on its work and, especially, my hon. Friend the Member for Basildon and Billericay (Mr Baron) who, since I came to the House four years ago, has been a determined advocate on all matters relating to cancer, such as funding and NHS treatment. He has set a good example to us all of how to campaign forensically on such matters.

There is little need for me to repeat what other hon. Members have said: cancer is a devastating disease. It is obviously right that the Government do all they can to put the best support in place and to set up appropriate frameworks to prioritise finite resources. I welcome the all-party group’s report and its recommendations on improving survival rates and supporting patients through recovery. A third of a million people are now diagnosed with cancer each year, and despite the considerable advances in research, about half those cases will sadly still be fatal.

I shall focus my remarks on end-of-life care. There is a considerable gap between what people want and what they receive. We know that 63% of all patients would prefer to die at home, while a further 29% would choose a hospice. Just 3% of patients would choose to die in hospital, yet more than 53% ended up dying there last year. Among cancer patients, nearly three quarters—73%—want to die at home, but only 29% are able to do so, which means that 36,400 cancer patients died in hospital last year although they wanted to be at home, surrounded by their loved ones. That causes great distress to family members, and many hon. Members will have met constituents who have expressed a lot of frustration about what happens at such a difficult time in their families’ lives.

The national end-of-life-care strategy has rightly called for that to change as a priority, and it has support from across the House. However, practical barriers need to be overcome to make it a reality. This is rooted in reprioritisation of resources, which, if done properly, will not mean increased costs. That is the challenge with so much that happens in the NHS. If small changes are made in certain procedures—the way that things work and research is conducted, and the way that referral processes take place—money can be saved.

There are three challenges. First, high quality 24-hour community support needs to be available. Secondly, patients need to be able to see how their services perform in helping people to die at home. Thirdly, the NHS needs to use innovative tools more effectively so that hospital professionals know what a patient has told their general practitioner. Nearly half of all primary care trusts in 2010 did not provide 24/7 community services, despite groups such as Macmillan Cancer Support and Marie Curie Cancer Care emphasising its importance and despite the clear economic case for doing so. A day of community care costs around £145, compared with £425 for a hospital bed. Improving community care is one of the most effective ways to free up much-needed bed space and prevent emergency admissions, and, of course, give a better quality of life experience for the patients involved.

In Wiltshire, we have a dedicated community nursing team, and Sarum clinical commissioning group in my constituency has chosen to focus on improving end-of-life care. It has a clear target to ensure that there is not just 24-hour community care, but specialist support and advice, which is particularly important in the context of cancer. In addition, it has chosen to set an outcomes indicator on the number of patients who are supported to die in their place of choice.

I wanted specifically to highlight this as the APPG cancer report recommends that the national indicators set by the National Institute for Health and Clinical Excellence should include it. I agree. It is important that patients can see how their local health services are respecting their wishes, or, in some cases sadly, not. It is important that where they fail to do so they can be held to account and a local dialogue can take place. This can only happen with clear and transparent data. If this measure were adopted nationally, it would mean that pressure could be exerted when patient preferences were not being respected.

Patient choice and accountability are at the heart of many of the NHS reforms in recent months and years. Those principles need to apply to end-of-life care. In some London boroughs, I understand that as many as 70% of all patients die in hospitals, yet fewer than half of Wiltshire patients end their days in the same way. It is unacceptable that one area can support 49% of cancer patients at home, while another can reach only 16% of patients. It is important that patients can readily see these numbers, and clinical commissioning groups can account for progress towards meeting their goals and targets.

In 2013, NICE recommended that death in the preferred place of care should be taken forward as an outcome indicator. I urge the Minister to make progress on this issue and ensure that the data will be available as soon as possible in a form that can be understood and digested by our constituents. But it is not just about data for patients; it is also about data for professionals. Innovation allows us to ensure that this is used more effectively, and electronic palliative care co-ordination systems are a real step forward in that area. The proportion of patients on EPaCCS who have died in their preferred place is 76%, and just 8% died in hospital. Not only is that a substantial relief for the families who have benefited, but it delivers, on average, a saving of £270,000 to a clinical commissioning group.

Salisbury district hospital, the outstanding hospital at Odstock that serves my constituency, has taken that concept further. Through greater integration with GPs in the area, emergency department doctors can now access medical records that include an end-of-life care plan. They have trialled an innovative rapid discharge pathway for patients in the last 72 hours of life, and 20 patients were successfully supported at home last year. As a result, the scheme is being rolled out across the hospital and will bring great benefit to patients in the last few days of their life.

Obviously, cancer will continue to present a significant challenge for the NHS, but I hope that the progress that has been made on palliative care can be built upon so that the NHS can support patients during an extremely difficult time. I would like to finish by once again reiterating my support for the work of the APPG and the considerable efforts being undertaken to challenge the Government, in a constructive way, to come forward with measures that will make such significant improvements in the quality of the experience for our constituents and to the functioning of the NHS.