Defibrillators

Lord Aberdare Excerpts

Tuesday 24th June 2014 Grand Committee

[Lord Aberdare (CB)]

My Lords, I warmly congratulate the noble Lord, Lord Storey, on tabling this debate. It is a subject that is not only close to my heart, if your Lordships will forgive a feeble pun, but quite literally a matter of life and death for a significant number of our fellow citizens in the UK. Having listened to the three excellent speeches so far, I could probably cut my own contribution to little more than the words, “Hear, hear!”, but I hope that I will be allowed to reinforce some of the arguments and will be forgiven for inevitably covering a considerable amount of the same ground. No doubt that is due in part to my having received the same helpful briefings from the bodies mentioned by the noble Lord, Lord Storey, and indeed from the House of Lords Library. I have to say that my heart sank as one after another of my points was made by the previous speakers. I do not think that my heart has actually stopped yet but, if it does, there is a defibrillator in the Peers’ Lobby.

As we have heard, some 60,000 out-of-hospital cardiac arrests occur each year in the UK. Somewhere between 20% and 40% of them are estimated to occur in public places, with nearly half of them being witnessed by bystanders. The remainder take place at home. Any assistance that is provided at the scene by those bystanders before the emergency services arrive can help to save life. In such cases, every minute that passes without intervention reduces the chances of survival by around 10%. So what are the chances of survival from shockable cardiac arrest? In Oregon, they are as high as 56%, while in Norway they are 52%. In the UK, the average comparable survival rate is only 20%. What accounts for the difference is, quite simply, the number of people who have been trained in first aid. In Germany and the Scandinavian countries, where first aid training in schools is mandatory, the proportion of people with first aid skills is estimated to be as high as 80%. It seems to me a matter of national embarrassment, to put it mildly, that only one in 13 people in the UK feels confident that they could carry out emergency first aid.

Automatic external defibrillators can and do save lives. They are a key part of the so-called chain of survival as defined by the British Heart Foundation and the Resuscitation Council (UK). That includes four elements: early recognition of a cardiac arrest, cardiopulmonary resuscitation, early defibrillation and post-resuscitation care. In order to improve survival rates, that whole chain needs to be in place. AEDs themselves will be effective only, first, if there are enough of them; secondly, if they are in appropriate and visible places; thirdly, if they are accessible and not locked away with the key nowhere to be found, about which I have heard stories from time to time; and, finally, if people know how to use them and are willing to do so. I therefore welcome the policy of encouraging the wider installation of AEDs. Research by St John Ambulance indicates that the majority of people, some 79%, think that it should be compulsory to have AEDs in places such as NHS buildings, 74% that they should be in care homes, as the noble Lord told us, 73% that they should be in large event venues such as concert halls, 67% that they should be in sports centres and gyms, 55% that they should be in workplaces, 53% that they should be in hotels and 50% that they should be in supermarkets.

As important as having defibrillators in place is, of course, knowing where that place is. I was going to suggest that this would be a perfect opportunity for an app, only to hear from the noble Baroness that the app already exists. That is another good point gone. Moreover, as the noble Lord, Lord Storey, mentioned, there are 16 defibrillators on the Parliamentary Estate and a significant number of trained first-aiders who know where they are and how to use them, including, I believe, most or all of the House of Lords attendants. Some noble Lords may not be aware that the best number to call on the Parliamentary Estate in the event of my having an emergency during my speech is not 999 but extension 3333. That is the first point that I alone have made.

All the AEDs that have been or are about to be installed, however numerous, well located and easily accessible, will be effective only if people know how to use them and are willing to do so. Current research shows that only one person in 10 knows what an AED is and, of those who do, just half know how to use it. Again, training is needed. The only way to increase, over time, the proportion of the population who have basic emergency life-saving and first aid skills is to teach those skills in schools, not just to teachers but to students as well. In that way, we can ultimately create a nation of lifesavers, to quote a phrase whose source I have mislaid.

Many voluntary organisations, such as St John Ambulance, the British Red Cross, the British Heart Foundation, the Resuscitation Council (UK) and SADS—Sudden Arrhythmic Death Syndrome—UK, do a good job of providing both information and training. I declare an interest as a trustee of St John Cymru Wales. I have now been trained in first aid three times: by St John Cymru Wales, by St John Ambulance under the auspices of the All-Party Parliamentary Group on First Aid, of which I am a vice-chair, and by the parliamentary Safety, Health and Wellbeing Service, which also covered the use of defibrillators. At least 14 parliamentarians have completed the training offered via the first aid all-party group.

The Government have committed to enabling schools to acquire defibrillators at discounted prices, which I welcome. However, they also believe that schools should decide for themselves whether to include first aid training in their curriculum. That is just not working. The combined efforts of all the groups that I have mentioned reach only a relatively small proportion of students in schools—I believe about one in seven, or 14%. This is nowhere near enough to address what should surely be a significant national priority. Leaders of all five of these bodies signed a letter to the Times last month, expressing their disappointment that, at the same time as encouraging schools to buy defibrillators,

“the government did not go further and insist on first aid education for all pupils and staff”.

I apologise if I am overrunning. I am very much encouraged by the fact that I seem to have spoken for no time at all, but that is presumably not the case.

At the very least, government should surely look at providing much more in the way of incentives and encouragement to schools. Subsidised AEDs, at least for schools in England, are a welcome start, but what about subsidised training in how to use them? What about awards and recognition for schools that achieve the best results in numbers of students trained or in levels of proficiency attained? Incidentally, I welcome the Social Action, Responsibility and Heroism Bill, which should help to overcome any concerns that people may have about the possibility of being sued after trying to resuscitate someone.

Children aged 10 and above can learn the full range of emergency life support skills, including CPR. From the age of 14 they can be, and are, trained in using defibrillators. A significant number have had to use the skills that they have learnt to save the life of a family member or fellow student. Of the children on a British Heart Foundation Heartstart programme in Northern Ireland, 98% enjoyed the training and 67% shared what they learnt with family and friends. Separate BHF research found that 86% of teachers thought that emergency life support should be part of the national curriculum, 78% of children wanted to be taught how to save someone’s life in an emergency and 70% of parents thought that children should be taught emergency life support at school.

First aid and defibrillator training is straightforward; it is quick, requiring as little as two to three hours; it is cheap; it promotes self-esteem and citizenship; it is fun; and it can save lives. Without it, the Government’s laudable initiative to enable more schools to acquire defibrillators may not—will not—be as effective as it could be. So why on earth should such training not be made mandatory in all schools? I look forward to the Minister’s response to that question.

NHS: NICE-appraised Medicines

Lord Aberdare Excerpts

Thursday 27th February 2014 Lords Chamber

[Earl Howe]

Mesothelioma is a devastating disease, and I certainly undertake to look at the material that the noble Lord has sent me.

[Lord Aberdare (CB)]

My Lords, is the noble Earl aware that a new treatment has recently been licensed for advanced pancreatic cancer, offering the greatest improvement in survival of any such treatment in 17 years? Does he share my concern that it needs to be made available to sufferers from the disease as urgently as possible via the Cancer Drugs Fund while awaiting NICE approval?

[Earl Howe]

My Lords, drugs which have not yet been assessed or approved by NICE are eligible for use under the Cancer Drugs Fund. I am pleased to say that the Government have made a total of £1 billion available under that fund and 44,000 patients have been treated under it. I appreciate the noble Lord bringing that particular drug to my attention and I undertake to look at it.

Care Bill [HL]

Lord Aberdare Excerpts

Monday 21st October 2013 Lords Chamber

[Lord Aberdare (CB)]

My Lords, I shall speak to Amendment 160A, which is sandwiched in the middle of this group of government amendments. My amendment seeks to add an additional matter to which Health Education England must have regard when publishing its objectives and priorities—namely,

“the needs of patients to have their conditions diagnosed promptly”.

This is intended to promote the interests of patients suffering from diseases that are hard to diagnose but where early diagnosis can be critical. There are, of course, a number of such conditions, but the Minister may not be surprised to learn that the particular condition on which I shall focus is pancreatic cancer, for which early diagnosis is often literally a matter of life and death. This amendment is based on my work with the charity Pancreatic Cancer UK. I am also a member of the All-Party Parliamentary Group on Pancreatic Cancer, chaired by my noble friend Lord Patel, which has been conducting an inquiry into how survival rates can be improved. Speed of diagnosis is critical and depends largely on the level of awareness of pancreatic cancer and its symptoms in primary care.

The 2010 National Cancer Patient Experience Survey found that 40% of pancreatic cancer patients visit their GP three times or more before being referred to hospital for investigation. The National Cancer Intelligence Network has found that half of all pancreatic cancer patients are diagnosed only as a result of an emergency admission to hospital. Patients diagnosed via this route have far lower one-year survival rates—only 9%, compared to 26% for patients diagnosed as a result of GP referral. A 2012 survey of GPs found that half said that they were not confident that they could identify the signs and symptoms of possible pancreatic cancer in a patient. Education and training are needed to give them enhanced skills and tools in order to improve their ability to recognise and diagnose the symptoms of conditions such as pancreatic cancer, and to help prevent the sort of shuttling between GPs and a range of different secondary care providers that some patients undergo before a firm diagnosis is made. That needs to be a clear part of Health Education England’s brief.

The aim of this amendment, therefore, is simply to ensure that such a responsibility is formally included among matters to which Health Education England must have regard. It would require it specifically to recognise that time is of the essence in diseases such as pancreatic cancer, and encourage HEE to identify, share and promote best practice in achieving earlier diagnosis. It might, for example, lead to initiatives such as conducting case reviews with experts from the Royal College of General Practitioners to determine why cases identified through emergency admission could not have been diagnosed earlier. I hope that such initiatives would help to close the gap between the UK and other leading countries that do significantly better in terms of survival rates and other outcomes.

My amendment may not be the best way to achieve these goals but it is important that they should be achieved, and I look forward to hearing the Minister’s response as to how this can and will be done.

NHS: Association of Medical Research Charities Report

Lord Aberdare Excerpts

Thursday 27th June 2013 Grand Committee

[Lord Aberdare]

My Lords, I should like to focus on only one area of NHS research—namely, research relating to pancreatic cancer, which is probably not to the great surprise of the Minister. In doing so, I thank the charity Pancreatic Cancer UK for its briefing, James Tobin at the House of Lords Library for his typically helpful briefing pack and I congratulate the noble Lord, Lord Turnberg, on obtaining this debate.

Pancreatic cancer accounts for 5% of cancer deaths in the UK but it currently attracts only 1% of research spending. So perhaps it is little wonder that outcomes in survival rates, for example, have shown little if any improvement in 40 years, yet evidence from other cancers, such as breast cancer, shows that increased research effort can lead to significantly better outcomes.

For research to be effective in this way, a number of essential infrastructure elements need to be in place, several of which are rightly identified in the AMRC report. There need to be recognised centres of research excellence covering areas such as pancreatic cancer; an adequate body of appropriately qualified and skilled researchers; an ability to attract new young researchers into the specific field; and a strong pipeline of good research proposals. Beyond that, research needs a critical mass, estimated to be at least £10 million to £12 million a year, as opposed to the current spending level of £5 million for pancreatic cancer research.

The first part of the AMRC report focuses on patient involvement in research and sets out three aims: every patient should be able to take part in research; research should be patient-centred; and research should be embedded in patient care. I ask the Minister: what can he and the Government do to ensure that these three aims are achieved for pancreatic cancer patients?

Specifically, pancreatic cancer patients are often unable to access clinical trials. Lower levels of investment in pancreatic cancer research mean that there are fewer clinical trials available. One study found 91 breast cancer clinical trials taking place against only 15 for pancreatic cancer. Less than 10% of pancreatic cancer patients say that they have been involved in any discussion about clinical trials, and less than 12% are enrolled in such trials, against about one in six cancer patients overall. In any case, many pancreatic cancer patients are diagnosed too late to be fit enough to participate in trials. So how can the Government help to ensure that more pancreatic cancer patients can access clinical trials? I hope the Minister will have some ideas.

The third part of the report relates to conducting high quality research and adopting new treatments. Apparently, much pancreatic cancer research tends to be researcher-led—there is little in the way of strategic direction from funders—unlike some other countries, such as Australia, which have clearly defined research priorities and achieve more impressive results. How can the Minister help to ensure that government engages with relevant research bodies in a collaborative effort to develop a strategic research agenda for pancreatic cancer?

I ask the Minister to look at a number of other measures, such as encouraging existing cancer research centres to increase their focus on pancreatic cancer; providing support to develop more skilled researchers, specifically in pancreatic cancer, and to ensure that this field of research is seen as offering a good career path, which is clearly one of the challenges at the moment; helping to raise the profile of pancreatic cancer within the research community, perhaps by the appointment of a UK pancreatic cancer research champion; and ensuring that the UK learns from experience in other countries and that research findings are freely shared internationally.

Pancreatic Cancer UK is doing its bit, for example with its own research innovation fund and future research leaders fund. I hope the Minister can tell us how government will add weight to efforts such as these so that we can put in place an effective research programme which will finally start to turn the tide of dismal pancreatic cancer outcomes and bring some real hope to sufferers from this dreadful disease and to their loved ones.

Health: Cancer

Lord Aberdare Excerpts

Monday 14th January 2013 Lords Chamber

Asked By

[Lord Aberdare]

To ask Her Majesty’s Government what steps they are taking to ensure that the Department of Health 2013 generic cancer symptoms awareness campaign will help improve early diagnosis of pancreatic cancer.

[The Parliamentary Under-Secretary of State, Department of Health (Earl Howe)]

My Lords, from today, we are piloting a general cancer symptoms campaign to raise awareness and encourage people with relevant symptoms to visit their GP. The campaign will run in five cancer network areas until mid-March and will be relevant to a range of cancers, including pancreatic cancer. Data, including GP attendance, urgent referrals for suspected cancer and diagnostic test activity, will be collected and analysed to assess the impact of the campaign.

[Lord Aberdare]

My Lords, pancreatic cancer is the fifth most deadly cancer in the UK, accounting for some 7,900 deaths a year. UK survival rates are significantly worse than in some other countries, as are the numbers of patients being referred for operations, the only effective cure. Since earlier diagnosis is essential to improve these outcomes, what plans does the Minister have to ensure that the proposed campaign includes new tools to help GPs detect pancreatic cancer and better pathways for them to refer suspected cases for further testing and support?

[Earl Howe]

The noble Lord is absolutely right about the importance of earlier diagnosis. I can give two examples of work running this year to assist GPs in the assessment and earlier diagnosis of cancer patients, including those with pancreatic cancer. Rolling out from March, Macmillan Cancer Support, with funding from the department, will be piloting an electronic cancer decision support tool for GPs to use as part of their routine practice in order to help identify and assess more effectively patients with possible cancer. The initial pilot will cover a number of cancers, including pancreatic cancer. Further, the National Action Cancer Team is supporting the distribution of further desk-based versions of risk assessment tools for use in general practice, and these include a pancreatic cancer risk assessment tool.

Health: Pancreatic Cancer

Lord Aberdare Excerpts

Monday 23rd April 2012 Grand Committee

Asked By

[Lord Aberdare]

To ask Her Majesty’s Government what steps they will take to improve both the quality of care and the overall survival rates for pancreatic cancer in the United Kingdom.

[Lord Aberdare]

My Lords, pancreatic cancer is in some respects the poor relation of major cancers. It is the fifth most deadly cancer in the UK after breast, lung, bowel and prostate cancer. However, its survival rate, unlike those of the other cancers, has hardly improved in the past 40 years. In addition, there is evidence that pancreatic cancer patients often do not receive an adequate standard of care. Pancreatic cancer is all too often seen as a death sentence, leaving little or nothing to hope for. I sought this debate to try to focus on ways in which the Government, working with others concerned, might help to bring some hope—something more to live for—to sufferers from pancreatic cancer and their friends and families.

My concern about the issue is purely that of a layman without medical or specialist expertise. Two friends of mine died from pancreatic cancer in recent years. One was a business acquaintance who battled with it for several years, the other a friend who died within weeks of diagnosis. At least three others lost parents at a relatively early age, while another currently has the disease and is doing his utmost to beat the odds. He has been lucky enough to be treated privately at the Royal Marsden Hospital. Through the efforts of his medical team he was given a drug called Folfirinox, which is not approved for this purpose by NICE but which shrank his tumour to the point where it could be operated on. He is convinced that without that operation he would have died.

As I prepared for this debate, I was struck by the number of people who have had direct experience of friends or relatives falling victim to pancreatic cancer. When I looked at the statistics relating to it, I found them shocking. There are more than 8,000 diagnoses of pancreatic cancer in the UK each year, which represents less than 3 per cent of total cancer diagnoses. However, it accounts for nearly 5 per cent of deaths, and the length of time between diagnosis and death is typically less than six months. More than 80 per cent of patients will die within a year of diagnosis. Three-year survival rates in the UK range from 3.6 per cent to 11.9 per cent, and five-year rates from 0 per cent to 10.4 per cent. Only 3 per cent of patients survive for five years. The figures have hardly improved since the 1970s, yet countries such as the USA, Canada and Australia achieve five-year survival rates that are twice as high, and a number of European countries also do better than the UK. Furthermore, there are significant variations in outcomes between different UK regions. London and the south-east have better results than the north of England, Scotland, Wales and Northern Ireland.

Of equal concern is that the 2010 NHS National Cancer Patient Experience Survey showed that pancreatic cancer patients had a poorer NHS experience than most other cancer sufferers, for example in the information they received, in the management of their pain, and in the confidence they had in their medical teams. One aspect of this is the support available from clinical nurse specialists. Although most pancreatic cancer patients surveyed said that they had access to a clinical nurse specialist, research by Pancreatic Cancer UK found that those specialist nurses were concerned that they were not receiving the support and resources they needed to do their job well. Moreover, although it is estimated that some 20 per cent of pancreatic cancer patients may be suitable candidates for surgery, which is recognised as the only effective way of tackling the disease, only about 10 per cent receive it. Noble Lords may share my view that these figures are deeply disappointing and raise serious questions about whether we in the UK cannot and should not do considerably better for those unlucky enough to contract this dreadful disease.

There are three issues I should like to highlight as needing to be tackled. The first is to increase research into the many aspects of the disease which are not yet adequately understood. Despite accounting for 5 per cent of cancer deaths, pancreatic cancer attracts only 1 per cent of cancer research funding. Any prospect of improving survival rates must start from better data about what causes or contributes to the disease and what sorts of treatment are effective in tackling it. Experience, for example with breast cancer, has clearly shown that research does lead to improved survival rates.

The second issue is to find ways of diagnosing pancreatic cancer earlier. There are no straightforward ways of recognising the disease, and many weeks or months often pass before a firm diagnosis is reached, with almost 30 per cent of patients visiting their GPs five times or more. However, the prospects for successful treatment—or even for high-quality palliative care—depend largely on how soon the disease is identified. In addition, many patients do not have the chance to participate in clinical trials for new treatments because their condition is already too far advanced by the time they are diagnosed.

The third issue I want to raise is the quality of care for all pancreatic cancer patients, which needs to be improved, for example through better information for patients and their carers, better co-ordination between those involved in treatment, better support from clinical nurse specialists and a more consistent service across the UK.

I know that the Government share my concern about the need to improve the experience of pancreatic cancer sufferers. Paul Burstow, a Minister in the Department of Health, has met Pancreatic Cancer UK and indicated his support for its Campaign for Hope, and I welcome the fact that two pancreatic cancer-related research studies are to be conducted under the aegis of the National Cancer Intelligence Network.

I very much look forward to the Minister's response to this debate, as well as to the contributions and suggestions of other noble Lords who have much greater experience and knowledge of this issue than I do, but who none the less get three minutes as opposed to my 10. I am sure they will do much better with it. Government, of course, cannot provide all the answers; but in partnership with other organisations and interested parties—the medical profession, research bodies, funders, charities, carers, and of course patients themselves and their families and friends—they can offer encouragement, support and resources.

In particular, I ask the Minister to answer four questions. First, will he look into conducting a full audit of current pancreatic cancer services, to assess why different regions currently achieve different results, and what structures and systems work best to provide pancreatic cancer patients with an optimum quality of care?

Secondly, will he ensure that pancreatic cancer is firmly included in the national awareness and early diagnosis initiative to assess what can be done to shorten the time to diagnosis?

Thirdly, what steps will he take to increase the amount of funding going to pancreatic cancer, both for research and care, in line with its significance among major cancers in the UK? Finally, how will he seek to improve the experience of care for pancreatic cancer patients?

Progress on other major cancers has shown how much improvement can be achieved through focused efforts to raise awareness and improve diagnosis and treatment. Surely we can also improve the outlook for pancreatic cancer sufferers and give them some real hope for longer lives, better care and greater fulfilment in the time that remains to them.