New Cancer Strategy

Justin Madders Excerpts

Thursday 19th November 2015 Commons Chamber

[Justin Madders (Ellesmere Port and Neston) (Lab)]

I congratulate the hon. Member for Basildon and Billericay (Mr Baron) on securing this incredibly important debate along with the hon. Members for Bury St Edmunds (Jo Churchill) and for Bosworth (David Tredinnick). I welcome the considered way in which he set out the issues in his opening speech. He raised a series of important questions for the Minister on earlier diagnosis, the measurement of the performance of CCGs, patient experience metrics and the cancer drugs fund. Those are all important issues that are set out in the strategy. I echo his tribute to the various all-party parliamentary groups on cancer. They do an extremely good job of highlighting these issues in Parliament and we all welcome the contribution they make.

I thank my hon. Friend the Member for Alyn and Deeside (Mark Tami) for raising the important issue of blood cancer. His family experience highlights the lack of support, particularly for children, during the period beyond cancer. The strategy tries to begin to address that issue. I also thank my hon. Friend the Member for Scunthorpe (Nic Dakin) for his speech, as well as for his work as chair of the all-party group on pancreatic cancer. He quite rightly pointed out the very poor survival rates for pancreatic cancer and the difficulty of getting referrals for diagnosis from GPs.

I echo the comments made by the hon. Member for Castle Point (Rebecca Harris). She raised important issues regarding the repurposing of drugs, particularly for the treatment of brain tumours. The hon. Member for Foyle (Mark Durkan) also made valid points about how the various groups should not be seen as rivals. Indeed, they should be united behind this one strategy, the full force of which has been expressed today.

I also echo the comments made by the hon. Member for Bury St Edmunds. She pointed out that, with more than 200 different types of cancer, an overriding strategy is needed. She reminded us of the shocking statistic that about 20% of diagnoses take place in accident and emergency, which really highlights the challenge we face in making correct diagnoses. She also highlighted the policy gap in relation to off-patent drugs, which we recently discussed in the Chamber.

All Members speak on this matter from experience, which is sometimes of a very personal nature. It is the personal experience of many of those who have contributed to the strategy that we are debating that makes the document so powerful. We know that one in five people who are diagnosed with cancer feel they are treated as a set of symptoms, rather than recognised as a person. We clearly need to change that. The very moving speeches today help us to remember that behind every statistic there is a person with a family and friends.

The Opposition welcome the recommendations of the independent cancer taskforce, many of which build on proposals that the Labour party set out before the election. We hope that the strategy will be implemented in full. It has the potential to deliver improved outcomes for patients, while also delivering better value to the taxpayer. However, as several hon. Members have said, we will realise such benefits only if the recommendations are delivered in full, with front-loaded investment. I hope that the Minister will confirm that the funding required to deliver the strategy will be included in the comprehensive spending review next week. He may be under instructions not to pre-empt the Chancellor’s big day, in which case we hope that the mood of the House can be conveyed to the right hon. Gentleman.

There have been some positive developments on cancer drugs and screening in recent years, but our progress on cancer care has stalled to some extent. The target to treat at least 85% of cancer patients within 62 days of being urgently referred by their GP for suspected cancer has been missed in successive quarters across England for almost two years. Of the 21,629 patients who waited more than 62 days in 2014-15, 42% waited between two weeks and one month after the target date and about a quarter waited for even longer. As Cancer Research UK has pointed out, this is not just a missed target; patients are being failed when they have to wait too long for treatment.

Another concern is that, despite progress in improving some cancer survival rates over the past decade, we still lag behind the best-performing countries. As several hon. Members have mentioned, it has been estimated that up to 10,000 deaths each year in England can be attributed to lower survival rates compared with those in the best-performing countries. As hon. Members have repeatedly pointed out, diagnosis of cancer at a later stage is generally agreed to be the single most important reason for the lower survival rates in England, so it is vital that we do better not only on early diagnosis, but on prevention and awareness.

With a total of 95 recommendations, the strategy will need consistent political and financial support if it is to be implemented in full. We welcome the possibility of a national cancer advisory board, which, as the report states, would allow a mirror to be held up to the NHS on progress in implementing the strategy. No doubt the precise make-up of such a body would be a matter of detail, but we are keen to ensure that there is an independent chair, as has been mentioned, and that patients’ voices are heard on that body.

With so many individual recommendations in the report, it is impossible to do them all justice in the time available. For those unable to read the entire report, I suggest that the principles set out on page 16 are a very helpful overview of the core aims of the strategy. I do not propose to go through all 95 recommendations—we certainly do not have time to do so—but I want to talk about one or two areas.

I want to speak about the quality of life after treatment and about end-of-life care. One of the most compelling and difficult debates in which I have been involved during my short time in the House was that on the Assisted Dying (No. 2) Bill. One message that came through loud and clear in the debate was that there are massive differences in the quality of palliative care available. Evidence consistently shows that far more people diagnosed with a terminal illness would prefer to die in their own home than currently get the chance. That is not an easy conversation to have, but we must get better at it.

I was pleased that the report acknowledges the clear link between cancer and poor mental health. Around 10% of patients with cancer will develop serious depression, and around half of all patients have some unmet need six months after treatment has concluded. Proposals to improve detection of mental health issues and to integrate better the various treatments are to be welcomed, and will hopefully lead to better patient outcomes.

However, the strategy goes well beyond that and, as we have heard, it recognises that support for patients post-treatment in terms of lifestyle, finances and work must be hugely improved. Secondary cancer is also a huge problem, and we must ensure that care after cancer is just as good as treatment of it. I am glad that the Secretary of State has committed to the development of a quality of life metric. Improvements to the system must ensure that how well people are living is just as important as how long they live for.

Too many people are left to fend for themselves in a complicated, bureaucratic maze, while having to cope with unmet physical, emotional and financial needs—my hon. Friend the Member for Alyn and Deeside set out starkly some of the challenges that individual patients have to deal with. Nobody should have to go without help after suffering the hardship of cancer treatment, and we hope it will be possible to ensure that everybody with cancer has access to a recovery package by 2020.

In the short term, steps can be taken to make life easier. Macmillan Cancer Support has calculated that the financial impact of a cancer diagnosis makes someone on average £575 a month worse off. That is why proposals in the Welfare Reform and Work Bill to take away £30 a week in unemployment support allowance from those with cancer who are placed in the work-related activity group seem at odds with what is set out in the strategy. We need joined-up thinking not just across the health service, but across the Government and the whole of society. The report estimates that by 2030 the number of people in work who will be affected by cancer is set to increase by 1 million, and although there is statutory protection under the Equality Act 2010, in reality someone is 1.4 times more likely to be unemployed if they have cancer.

The greater role that wider society can play is set out clearly in the report, which calls for

“a radical upgrade in prevention and public health.”

If we are to make this strategy work, we must consider forming a new tobacco control strategy, and a national obesity strategy that goes beyond the responsibility deal, which is largely limited to reducing the prevalence of obesity in children. The strategy is right to include an ambition to reduce the prevalence of overall adult smoking to less than 13% by 2020. It is not difficult to imagine that current measures will do much to make that happen, and I am pleased that the report includes a recommendation that the NHS should work with the Government to deliver and implement a new tobacco control strategy within the next 12 months.

This is a matter of equality. We all know about the diverse life expectancy figures in different parts of the country, and about how a difference of just a few miles can mean huge gaps in life expectancy. There would be around 20,000 fewer deaths per year across all cancers if socioeconomically deprived groups had the same incidence rates as the least deprived. Smoking plays a large part in that, and more than half of the inequity in overall life expectancy between different social classes can be at least partially attributed to higher smoking rates among the less well-off.

My hon. Friend the Member for Liverpool, Wavertree (Luciana Berger) deserves praise for her marathon effort to ban smoking in cars with children, and such measures will further deter smoking and encourage people to give up. However, even before that strategy has found its feet, it has been undermined by another huge cut to the public health grant for local councils, which will almost certainly mean that smoking cessation services are slashed.

If we are to take the Government seriously on public health, and if this strategy is to work, it must be supported fully. In-year cuts to public health funds go wholly against the strategy, and are contrary to any strategy that seeks a sustainable health service moving forward. As many experts have said, these cuts will end up costing more than they save. They are a political choice, and we should send a strong message to the Chancellor that they should not go ahead.

The introduction of the cancer drugs fund has been a positive development, and it delivered important benefits to patients over the course of the last Parliament, which we welcome. However, 19 treatments were cut from the cancer drugs fund at the beginning of the year, and another 18 went this month. Charities estimate that more than 5,500 patients a year will now be denied access to these life-extending treatments. Will the Minister tell the House whether he supports the removal of those treatments, and, crucially, what support will now be given to the thousands of patients who will miss out on the drugs in the future? I appreciate that this is not an easy situation, but it seems particularly cruel to give people hope and then to take it away.

I want to mention the need for renewed focus on treatments other than drugs. Before the election, Labour promised to create a new cancer treatment fund to look at all treatments available. Surgery and radiotherapy are responsible for nine in 10 cases where cancer is cured. The taskforce concluded that in a number of areas access to treatments such as radiotherapy are not at the level they should be. About half of all radiotherapy machines are reaching the end of their useful lives. We need to upgrade them so we can deliver safer care. We should also enable the more widespread use of modern radiotherapy techniques. Some 38% of cancer patients in England currently have radiotherapy as part of their treatment, but evidence from abroad suggests that this should be closer to 50%. We need to understand why there is this difference and to work towards correcting it.

I have touched on only a few parts of the strategy, and I hope there is recognition that there are wider challenges beyond the strategy itself. Where the Government are clearly working towards the aims of the cancer strategy, they will have our support. I would therefore like to ask the Minister what steps the Department will be taking to ensure that comprehensive implementation plans are laid out for the strategy as a whole by 31 March 2016.

Many Members will have lost someone close to them as a result of cancer. We owe it to everyone affected by this terrible disease to implement and support in full the recommendations set out in the strategy, so we can take further steps towards finally beating cancer.