Health: Cancer

Lord Aberdare Excerpts

Wednesday 20th January 2016 Lords Chamber

[Lord Aberdare (CB)]

My Lords, I congratulate the noble Baroness, Lady Walmsley, on securing this debate and on making a number of points in her excellent speech—as indeed did other noble Lords—of such merit that I plan to repeat them.

It is good news that cancer death rates have fallen steadily in the past 20 years and that half of adult cancer patients are now expected to survive for 10 years or more. As a cancer survivor myself, I hope to reinforce those figures. However, this is not a uniform picture, and I shall speak about one of the cancers with the worst survival rates of all. I declare my interest as a vice-chair of the All-Party Group on Pancreatic Cancer.

As we have heard, pancreatic cancer is the 10th most prevalent of the top 21 cancers but the fifth biggest killer, causing some 8,700 deaths a year. UK five-year survival rates are just over 5%. Shockingly, these have hardly changed in 40 years. Average survival after diagnosis is a mere two to six months; 80% of patients are diagnosed too late to be operated on; and 45% are diagnosed only as a result of emergency admission to hospital, with only a 9% chance of surviving for one year, as opposed to 26% for GP referrals. I could go on but I will end with just one more dismal fact: the UK is near the bottom of the European league table in its pancreatic cancer outcomes, with a one-year survival rate that is only half that of Belgium—21% versus 40%—and well below the average of 30%.

What are the factors contributing to pancreatic cancer survival rates—or, more accurately, non-survival rates—in the UK and what might be done to improve them? I will make five suggestions, based on the findings of two inquiries carried out by the all-party group in 2013 and 2014. If the Minister has not seen them, I would be glad to send him copies.

The first requirement is for more research. Pancreatic cancer accounts for 5.2% of UK cancer deaths but only 1.4% of research spending. Of course, the experience of other cancers shows a clear link between research and improved survival rates. The second is earlier diagnosis. The all-party group reports have highlighted ways to achieve this, including better training and diagnostic support tools for GP practices; new referral pathways, giving GPs direct access to CT scans; and multidisciplinary centres to avoid patients being shuttled back and forth between their GP and various investigative routes before a correct diagnosis is made.

Thirdly, a specific strategy is needed for tackling pancreatic cancer and other so-called cancers of unmet need whose outcomes are lagging behind. These are not adequately addressed in the current national strategy for England. Fourthly, as we have heard, the public should be made more aware of pancreatic cancer. A 2015 poll found that 71% of people in England could not name a single symptom of pancreatic cancer unprompted. An awareness campaign is needed, if not for pancreatic cancer on its own, then perhaps for the whole group of gastrointestinal cancers, including pancreatic.

Finally, it is deeply troubling that the only new treatment for pancreatic cancer in some 20 years, providing a real, albeit small, extension of life for patients, has been removed from the cancer drugs fund and rejected by NICE for use in the NHS, although it remains available in both Scotland and Wales. This only exacerbates the finding of the 2014 national Cancer Patient Experience Survey that pancreatic cancer patients report a lower standard of care than others; for example, in terms of the information provided, the availability of cancer nurse specialists with specific pancreatic cancer skills, and access to specialist dieticians.

I have outlined five ways in which the Minister could set about improving cancer survival rates, particularly for pancreatic cancer sufferers, for whom the need is so dire. Perhaps he might borrow from President Obama’s cancer “moonshot” idea in his recent State of the Union address and bring to the battle against cancer the sort of energy, innovation, commitment and resources that led to America putting a man on the moon—or at least enable us to catch up with other leading countries.

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[The Parliamentary Under-Secretary of State, Department of Health (Lord Prior of Brampton) (Con)]

My Lords, I join everybody else in thanking the noble Baroness, Lady Walmsley, for bringing this very important debate to the House. It really is a shame that we have only an hour. So much has been said that I cannot do it all justice. The noble Baroness kindly gave me a hint of what she might say this evening, so I hope that I will cover that in my main speech. I would like to come back to her on the two-week target. Maybe I could write to her on that.

My noble friend Lord Colwyn raised the importance of the dental profession, which again is all part of the common theme of early diagnosis. The importance of clinical trials was raised by the noble Lord, Lord Wood, particularly in relation to teenagers and children. They are clearly very important. I would like to come back to the noble Lord, Lord Sharkey, about his comment that CCGs were putting in incentives to GPs for not referring suspected cases of cancer. Perhaps I might investigate and come back to him on that important issue.

The noble Lord, Lord Freyberg, mentioned powerfully the power of transparency. The example he gave which stuck with me was that of prostate cancer and the differing rates of incontinence as a result of that. I think that it was in Hamburg that the results were particularly good. In answer to the noble Lord, Lord Hunt, I have already agreed to meet the noble Lord, Lord Freyberg. Transparency about survival rates will not solve all the issues but could be very powerful.

Both my noble friend Lady Hodgson and the noble Lord, Lord Hunt, raised the issue of screening for elderly people. I will write to them on that issue, as I cannot give them an answer this evening. The noble Baroness, Lady Masham, raised the issue of proton beam therapy. Again, I will write a progress report to her on that. As she knows, we are proceeding with two centres, one in Manchester and one at UCLH in London. I believe that both of them have started and are on target, but I will revert to her on that if I can.

My noble friend Lady Redfern asked whether we could look at increasing public awareness and referred to the Be Clear on Cancer campaign. That is important. The noble Lord, Lord Aberdare, raised the issue of pancreatic cancer. I was not aware that the survival rate after a year was 5%. That is terribly low, and I would like to research that more. The noble Lord, Lord Hunt, raised lots of important questions, but in answer to a particularly important one, NHS England has, as I understand it, accepted the recommendations of the Harpal Kumar report and will be implementing them over the next four years.

I hope that I will answer most of the questions in my speech. It is worth noting that we have made huge progress over the last 15 years, even though the kernel of the debate this evening is that we have got a lot further to go to catch up with our European neighbours. Activity has increased dramatically. In the last five years, 645,000 more patients with suspected cancers were seen, an increase of 71%. Almost 40,000 more patients were treated for cancer, an increase of 17%.

The proportion of cancers diagnosed as a result of emergency presentation—an issue raised by a number of noble Lords—has decreased significantly. At the same time, the proportion of cancers diagnosed through urgent GP referral following a suspicion of cancer has increased. In 2006, almost 25% of all cancers were diagnosed as an emergency. In 2013, this figure had fallen to 20%, or one in five. That is a considerable reduction, but there is still a long way to go. To help diagnose cancer earlier, we have invested over £22 million in our Be Clear on Cancer campaigns and we continue to expand and modernise our cancer screening programmes. Nationally, 37% of radiotherapy treatments are now being delivered with more precise intensity-modulated radiation therapy—IMRT—ahead of the 24% target.

Since October 2010, the Cancer Drugs Fund has helped more than 84,000 cancer patients in England, and £1 billion has now been made available to support that fund. We are committed to the fund, although we are out for consultation at the moment as to how we should progress it forward for next year. It is worth noting that in this current year some £340 million has been spent in that fund. Some of these new cancer drugs are extremely expensive.

We know that cancer survival in England has historically lagged behind the best-performing countries in Europe and the world, but none of these international comparisons of cancer include patients more recently diagnosed than 2009. As a result, we should be careful about using these comparisons as a measure of the current performance of the system, although they can be useful as a long-term benchmark. Although we will have improved considerably since that time, I suspect that other countries will also have improved, so the question is whether that gap has closed. Although our survival rates are at a record high and continue to improve, as shown by the new figures published by the ONS in November, we know that we must do better. The gap between England and the better-performing countries is narrowing for some cancers, but for others it remains.

That is why, in January last year, NHS England announced a new Independent Cancer Taskforce to develop a five-year strategy for cancer. A report was published in July 2015, which I think was well received by most interested parties. It recommends improvements across the cancer pathway with the aim of improving survival rates. I thank Sir Harpal Kumar and his colleagues for that report.

In terms of delivery, NHS England has recently appointed Cally Palmer, whom some of you will know, as she is also chief executive of the Royal Marsden, as the NHS National Cancer Director. She will lead on implementation, as well as new cancer vanguards to redesign care and patient experience. She is currently setting up a new Cancer Transformation Board to lead the rollout of the recommendations of the new strategy, and a Cancer Advisory Group, chaired by Sir Harpal Kumar, will oversee and scrutinise its work. I hope that that will go some way to addressing the concerns of the noble Lord, Lord Hunt, about the networks that used to be there. We hope that they will put in place something similar, if not the same.

Although this is a five-year strategy and an implementation plan is being developed, good progress has already been made on many of the key recommendations. The task force recognised the importance of early and faster diagnosis to improve outcomes and experience. It is essential that we make sure that cancer is diagnosed as early as possible, so we will adopt the task force’s ambitious new waiting times target for the NHS. From 2020, patients will be given a definitive cancer diagnosis or the all-clear within 28 days of being referred by a GP. This will mean that the period of uncertainty will be as short as possible.

We are backing this with an expected investment of up to £300 million a year by 2020, along with a national training programme for an additional 200 staff with the skills and expertise to carry out endoscopy tests by 2018. This is an area of shortage at the moment. We have also confirmed a commitment from NHS England to implement the Independent Cancer Taskforce’s recommendations on molecular diagnostics. This will mean that about 25,000 additional people a year will have their cancers genetically tested to identify the most effective treatments. I noted the comments of the noble Baroness, Lady Masham, about fairness in access to molecular diagnostic tests.

To monitor the impact of the new strategy, we are also introducing two new outcome metrics: the proportion of cancers diagnosed at stages 1 and 2 and the proportion of cancers diagnosed through an emergency route. These will be published quarterly at CCG level from May 2016. From April 2016, the new cancer dashboard will enable every CCG to see its data and benchmark itself against other CCGs and England as a whole. It will measure progress with a focus on incidence, survival rates, patient experience and quality of life for patients.

In conclusion, I congratulate your Lordships’ House on the quality of this debate. Some fascinating issues have been raised. The personal experience of many noble Lords has been particularly illuminating. I hope that I have been able to set out our commitment to delivering the Independent Cancer Taskforce’s new strategy, the good progress that has already been made, and NHS England’s robust plans to turn the recommendations into reality.

If the NHS is successful in implementing its initiatives and ambitions, an additional 30,000 patients a year will survive cancer for 10 years or more by 2020, 11,000 through early diagnosis. There will also be a closing of the gap in survival rates between England and the best countries in the world, which is something that we all want to see.

We have some progress to report. It is never enough. It will take time to build up both the diagnosis and treatment resources so that we can close that gap with other European countries completely, but with Sir Harpal Kumar’s task force report, we have a very clear way to do that.

[Lord Aberdare]

My Lords, before the noble Lord sits down, I hope that I did not misspeak, but the figure I cited of 5% for pancreatic survival was for five years, not one. I apologise if I misled the Minister.