Cancer Treatments

Liz Kendall Excerpts

Tuesday 19th June 2012 Westminster Hall

[Liz Kendall (Leicester West) (Lab)]

I thank all hon. Members who have taken part in this important debate. I congratulate the hon. Member for Southport (John Pugh), hard-working as always, on focusing on the issue.

Several hon. Members talked about the context of the debate and the improvements made over recent years. Several mentioned the research—published, I think, in the British Journal of Cancer—that showed that, over the past 20 or so years, the NHS in England and Wales has achieved the biggest drop in overall cancer deaths among 10 leading countries worldwide. There have also been significant improvements with individual cancers. For example, death rates for breast cancer have fallen by 40% since 1989, virtually closing the gap with other countries such as France. Furthermore, the NHS has done so despite having a smaller budget, which led the British Journal of Cancer to conclude that the NHS had achieved more with proportionately less than in other major developed countries.

It is clear, however, that far more can and must be done to bring cancer outcomes for all cancers and all patients up to the very best standards achieved in other countries. Hon. Members have rightly said that our overall survival rates are still not as good as those in countries such as Canada, Australia, Sweden and Norway and that, although survival rates are good for breast and skin cancer, for example, they are low for lung and pancreatic cancer. I am also particularly concerned about differences in outcomes for people from different minority ethnic groups or from different social and economic backgrounds. As the shadow Minister with responsibility for older people, I am concerned about the worse outcomes for older people in the UK compared with those in other countries, even after we have taken social and economic factors into account—I shall say a bit more about that in a moment.

Hon. Members welcomed the focus in the NHS outcomes framework on one and five-year survival rates but rightly questioned why the three cancers mentioned account for 40% of new cancer diagnoses and asked about the other cancers that could be included. Although survival rates are absolutely vital, other issues need to be addressed to improve the patient experience and the quality of care—in particular, for those who will not survive cancer, at the end of life.

[Mr Edward Leigh in the Chair]

I want to focus my comments on three key areas of care in which we need to improve services: first, early diagnosis and intervention; secondly, tackling treatment variations; and thirdly, ensuring that the patient experience is at the heart of all aspects of cancer care. There is a very important issue about how we prevent cancer from happening in the first place, but I will not focus on that in this debate.

The hon. Member for Basildon and Billericay (Mr Baron) —I pay tribute to the all-party parliamentary group—hit the nail on the head when he said that the survival rates at one year are crucial, and the differences between our survival rates and those in other countries are largest around that first year. We have to ensure either that patients present to their doctors earlier or that we identify them through effective screening. We then have to ensure that GPs properly examine, diagnose and quickly refer patients to appropriate specialist and other services.

International comparisons generally indicate that England has high-quality cancer screening programmes, although there is considerable regional variation in uptake. The key to improving uptake of screening programmes and ensuring that patients present early is to improve public awareness. I am worried about who will be responsible for promoting public awareness of cancer and running cancer awareness campaigns.

In April 2013, local authorities will take over responsibility for public health. The main focus will be on strategic needs assessment for their local population and developing joint strategic health and well-being strategies, but they will also be responsible for commissioning specific public health services, and they will be free to set their own priorities.

[Mr Baron]

The hon. Lady is absolutely right in saying that cancer survival rates have been improving for 30 to 40 years, but we still lag behind the European average, although I accept that we must be careful when comparing statistics. Will she confirm that, although we heard a lot about the Opposition’s concerns about changes to the commissioning structures, we did not hear much about the other key element of the NHS reforms: the importance of focusing on outcomes, particularly in cancer, as a way to drive forward earlier diagnosis? The spotlight should be on the local NHS and areas with poor outcomes, which should introduce initiatives to drive forward earlier diagnosis, including awareness of cancer screening programmes and so on, but we did not hear a lot about that from Opposition Members.

[Liz Kendall]

I thank the hon. Gentleman for his intervention. He was lucky enough not to experience the 16 weeks of the two Public Bill Committees that considered the Health and Social Care Bill, when I regularly raised the key concerns, such as how to improve outcomes for cancer and heart disease and how services, not structures, needed to be reformed to do that. If he has a spare moment and reads the report of those debates, I am sure that he would become aware that I was very concerned about how to improve patients’ lives, their experience and the quality of care, which is always the issue for me. My concern was always about whether the reforms would do that.

I return to the point that I was making about local authorities’ role and the concern that, under the mandated public health services that local authorities will have to commission, public awareness campaigns, including those for cancer, are not included. There is a real worry among public health professionals and those working for and with cancer patients about whether public health awareness campaigns, such as the bowel cancer awareness campaign, which certainly attracted my attention, will continue.

A second issue is how to improve GPs’ skills and their awareness of cancer. Many GPs see cancer patients relatively infrequently, particularly those with rare cancers. Will the Minister explain what national or local action may be taken to ensure that skills and awareness improve?

We want to ensure that, when people are referred by a GP, they have swift access to diagnostic tests. That is about not just good outcomes, but the quality of their experience. Anyone who has had the misfortune of themselves or a family member waiting for cancer diagnostic tests knows that it is a frightening experience and that it should be done as quickly as possible. There were big improvements under the previous Government in speeding up diagnostic tests, but there is evidence that the service is going backwards. Some 78% more patients now wait more than six weeks for diagnostic tests compared with May 2010, and there are even bigger increases in the number waiting for vital tests to diagnose cancer. Some 230% more patients now wait more than six weeks for endoscopic diagnostic tests, and that includes a 242% increase in the number waiting more than six weeks for colonoscopy and a 140% increase in the number waiting more than six weeks for MRI scans. What action could and should be taken to reduce those diagnostic waits, which is vital to improve one-year survival rates?

Turning to the important issue of treatment variation, I want to put on the record the excellent briefing from the King’s Fund, “How to improve cancer survival”, which goes through the issues in detail, with the best clinical evidence and the implications for services on the ground. Treatment factors can be divided into four main groups: surgery, radiotherapy, cancer drugs and the overall co-ordination of care. On surgery, there is a lot of evidence that the outcomes for many types of cancer might be better in centralised, specialist centres, particularly for complex surgery, because their use can lead to better training for surgeons. If they have a higher case load, doctors develop greater expertise and experience. More specialist support is available, such as nursing and intensive care, as well as superior equipment. One concern that we raised when discussing the Health and Social Care Bill and reorganisation was who will lead the strategic configuration that is needed to centralise some services, such as cancer, into specialist centres.

Radiotherapy has a significant although modest overall impact on five-year mortality rates. Obviously, the optimum proportion of patients with cancer who should receive radiotherapy varies by tumour type and stage, but it is thought that overall around 50% of patients with cancer would benefit from radiotherapy. However, in 2005, the radiotherapy access rate in England was 38%. That was one reason why the former Government introduced a new strategy, “Radiotherapy: developing a world class service for England”, in 2007. Can the Minister update me on any progress on that?

I am sure that the Minister will talk about the cancer drugs fund and the Government’s aim of improving access to such drugs. He will know that concern remains that the fund has not removed variations from the system. There have been underspends in some parts of the country, and some regional cancer drug funds approve drugs that others do not. The King’s Fund raises a bigger question in its document. It says that it is more important to improve access to surgery and radiotherapy overall. It is worried that there has been almost too much attention on the cancer drugs fund and not enough on the variations in radiotherapy and surgery.

I am really concerned about older people and the variation in their care. Will the Minister say whether the Government will look into that specifically? Older people are under-treated, and their outcomes for cancer are worse as a result, even when account is taken of the different types of tumour and the presence of other diseases or co-morbidity. Older people are less likely to receive intensive treatment and more likely to be admitted as an emergency.

Crucially, major international studies show that differences in survival rates between the UK and other countries are greater for older people. We are not sure of the reasons for that based on the evidence, but the King’s Fund suggests that there may be three key issues: even later presentation; co-morbidity with older people having two, three or more other long-term chronic conditions, which may lead to cancer then being misdiagnosed or not diagnosed; and age discrimination and the feeling that, because someone is getting older, their health is perhaps not so important. I am pleased that the Minister will implement the ban on age discrimination in public services that the former Labour Government introduced. I am very keen that the Government look more into that issue as part of their work on cancer.

I wish to say something about co-ordination of care, which, as we know, is important for patients and the patient experience. During debates on the Health and Social Care Bill, we asked whether cancer networks would continue in the NHS and, if so, how they would be funded. In May last year, the Secretary of State for Health said that the Government would fund and support cancer networks in 2012 and that, after that, the NHS Commissioning Board would continue to support and strengthen them. Over a year later, however, the future of cancer networks is still unclear.

The NHS Commissioning Board has recently published early proposals for clinical networks, which include the new strategic clinical networks prescribed by the NHS Commissioning Board. The proposals also mention 14 to 15 overarching networks in England that will cover a specific geographical area and review the work of the prescribed strategic clinical networks every six months. I think, however, that people are still quite confused about how that will work, and the Government’s proposals do not refer specifically to the 28 cancer networks. I therefore ask the Minister whether all 28 current cancer networks will become prescribed strategic clinical networks, or will their number be reduced? How will they fit into the umbrella networks?

Funding is crucial. In response to a parliamentary question on 21 May this year, the Minister stated that strategic health authorities will be given £18.5 million to fund cancer networks in 2012-13, just as in the previous two years. Page 6 of the recent document from the Department of Health, “Progress Update on the Design of the NHSCB” states:

“Around £10 million of the costs of supporting Networks and Senates are expected to count against running costs.”

That seems to imply that the £10 million is to run not only cancer networks but all clinical networks and senates and that would be a cut of £8.5 million to the cancer networks. Will the Minister say whether the £10 million referred to in the document about the future functioning of the NHS Commissioning Board covers all networks, or cancer networks alone? That is a real concern for people who work in cancer networks and are already worried about the future.

I will conclude by mentioning the patient experience. Several hon. Members have rightly mentioned the need for the patient’s experience of a service to be placed at the heart of what the NHS is trying to achieve. I agree with the call from Macmillan Cancer Support and Breakthrough Breast Cancer for the NHS cancer patient experience survey to be included as part of the fourth domain of the NHS outcomes framework, which is about ensuring that people have a positive experience of care.

The cancer patient experience survey shows that the NHS does well on issues such as waiting times, pain control and patients who feel that they have been treated with dignity and respect. It does not, however, do as well as it could on issues such as patients receiving written information about their condition, financial help, clinicians who work well in a hospital and the community and whether there is enough nurse support. Those are important matters for patients.

[Mr Virendra Sharma]

Does my hon. Friend agree with expectations that the system will work more closely in partnership with the third sector, so that when patients come into the community they get support from that as well? We need a partnership that works together to improve the condition of patients once they are released from hospital.

[Liz Kendall]

I absolutely agree. Last year, I visited the oncology and radiotherapy wards at Leicester royal infirmary, and I saw the work done by Macmillan Cancer Support to help patients with cancer and their families. It had a multi-disciplinary team that worked around the needs of the individual patient and their family and involved not only doctors, nurses and radiographers in the hospital, but GPs, physiotherapists, occupational therapists, dieticians and pharmacists in the community. Macmillan Cancer Support does excellent work to improve the information and advice that is given to patients and their families, and it deals sensitively with issues such as when patients might want information, how it is provided and what is wanted by different family members. I am very supportive of that.

[Mr Edward Leigh (in the Chair)]

Order. I know that the hon. Lady will wish to leave time for the Minister to reply. The debate must finish at 12.30 pm.

[Liz Kendall]

I am about to sit down, Mr Leigh. The Minister will know that the Opposition have put forward proposals for social care to be free at the end of life, to avoid the awful situation in which families have to fill out means-test forms and might struggle to get the care package that they need at that crucial time—the end of their loved one’s life. There is evidence that such a proposal would be cost-neutral, as it would reduce the number of more expensive bed days spent in hospital. Survival rates are absolutely critical, but we must not forget other issues, such as the quality of the patient experience and end-of-life care.