Health: Cancer

Lord Hunt of Kings Heath Excerpts

Tuesday 9th October 2012 Grand Committee

[Lord Hunt of Kings Heath]

My Lords, I, too, welcome this debate and thank the noble Baroness for instituting it and for the very important points that she made. I refer the Committee to my declaration of interests, which includes a number of health interests. I also echo the noble Baroness’s remarks about the role of dentists in this area. She and I have a long-standing interest in this profession, and it is important that when we consider what action needs to be taken we look at the contribution that dentists can make.

At the start of the debate, the noble Baroness said it was important to draw attention to the increase in the incidence of several head and neck cancers between 1990 and 2006. My understanding from work helpfully produced by the Library is that we have seen the incidence of oral cavity cancers increase by more than 30%, salivary gland cancers by around 37% and palate cancer by 66%, while that of thyroid cancer has doubled.

Incidence rates for all types of cancer vary significantly between those strategic health authorities and cancer networks with the lowest and highest incidence, and the geographical pattern of distribution varies from cancer to cancer. This may well reflect the distribution of different risk factors, including those that predominantly affect certain ethnic groups. We have to bear that in mind when deciding what action needs to be taken.

It is important to have accurate and up to date information available. I was interested to read the National Head and Neck Cancer Audit 2011 and the remarks made by Sir Mike Richards, the National Cancer Director. He pointed out that there have been further improvements in the completeness of the data submitted, but that more needs to be done. He urged cancer network directors, medical directors and head and neck cancer site-specific groups to reflect on this. Bearing in mind the remarks of the noble Baroness at the beginning of our debate, the more accurate information we have, the more we will be able to see the scale of the issue we face and decide what action needs to be taken. I hope that the noble Earl, Lord Howe, will be able to say something about how he thinks we might improve data collection in the future. The noble Baroness, Lady Morgan, made some important points about indicators, outcome measurements and requirements. Again, I hope that the noble Earl will be able to give some comfort to her with regard to looking at an extension of those requirements in the future.

I want to reflect on the points raised by all noble Lords who have taken part in the debate on the importance of improving public recognition, early diagnosis and treatment. I hope that the noble Earl will be able to say something about how this might be done, and perhaps how the work of GPs and dentists might be recognised and what we can do to encourage those professions to identify symptoms and advise their patients so as to make sure that where there is a suspicion, patients are encouraged to seek diagnosis and treatment.

Obviously, the backdrop to this debate will be the implementation of the Health and Social Care Act 2012. The noble Baroness, Lady Jolly, said that the reforms would allow for a refocus on these issues. I am not quite sure that I agree with her. Her speech was a very good description of why it would have been better if we had not had the reforms in the first place, and I think that there are a number of questions one has to ask about the architecture. We are looking for some further information about reports that the Government are going to reduce the number of cancer networks, along with their resources. The noble Baronesses, Lady Jolly and Lady Morgan, both spoke about that. It is important to note that the cancer networks have been universally regarded as a good thing that has led to a much more co-ordinated response. Given that we are now moving towards a much less integrated healthcare system, there is a real risk in reducing the effectiveness of these networks.

I would remind the noble Earl of the success of his department in relation to stroke services in London and the benefit of a strongly co-ordinated approach by reducing the number of centres for hyper-acute services. That is now being rolled out across the rest of the country. Surely we need that kind of co-ordinated leadership in relation to cancer services. I am not confident that simply leaving it to a smaller number with fewer resources working with clinical commissioning groups will do what is required. I hope that the noble Earl will be able to say something more about that.

I particularly noted the comment made by the noble Baroness, Lady Jolly, about the role of cancer networks in helping to select which hospitals should provide specialist services. I very much support that. It will be important, in thinking through the future provision of cancer services, not to forget the role of hospitals. There is a great danger in the current mantra that everything is decided through the commissioning network and the role of hospitals is simply to do what commissioners tell them to do. Obviously, chairing a foundation trust, I am somewhat biased, but I have to say that most innovation and most ideas come from those hospitals where professionals work—the reality is that mostly they are the people who know what needs to be done. That is the importance of the cancer networks. The market mantra is that commissioners decide what should be done and then the providers do what they are told, but what we need in future is much more of a partnership. That applies to all cancer services.

Does the noble Earl think that clinical senates might play a role in this? I think that we are all signed up to the idea of clinical senates, but none of us quite knows what they are going to do. It occurred to me that, given the expertise that the senates will have in their membership, they might be able to give advice to clinical commissioning groups on the effective services that need to be provided in relation to cancer services.

Let me come on to health campaigns. The noble Baroness, Lady Jolly, referred to the need for local authorities and Public Health England to work together. I echo her question about how the department will ensure that that happens in the future.

Finally, I pick up the point raised by the noble Baroness, Lady Morgan. It will clearly be important that we ensure that enough money is invested in research in these areas—identification, early diagnosis and early treatment. I wonder if the noble Earl could say a little bit more about how he thinks research should be invested in in the future. This is a very important debate and I am sure that we are all grateful to the noble Baroness for instituting it. We look forward to the noble Earl’s response.