NHS: Cancer Treatments

Lord O'Shaughnessy Excerpts

Thursday 25th January 2018 Lords Chamber

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord O'Shaughnessy) (Con)]

My Lords, I begin by joining all Members of this House in paying fulsome tribute to the noble Baroness, not just for securing this debate today but for the extraordinary character she is showing by leading it. It has been a rich and moving discussion and, as the noble Lord, Lord Blunkett, said, it is extremely daunting to follow her and try to do justice to the requests and speech she has made, but it is also a privilege to be able to do that on behalf of the Government.

I also praise the noble Baroness for the determination that she has shown in raising the profile of issues around cancer treatment during the course of her illness. I think it is fair to say that she has inspired us all, and many cancer sufferers too, but I suppose we should expect nothing less from the woman who brought us the most wonderful Olympic and Paralympic Games in 2012.

I am also very grateful to the noble Baroness for sharing her speech, via the noble Baroness, Lady Thornton, and I have done everything I can to address in my response today the questions that she has asked. She will forgive me if there are any stones left unturned; perhaps we can pick them up afterwards.

As we have heard, every story about cancer is a personal one, but behind those stories lie some very stark numbers. As our population ages, the prevalence of cancer rises. One in two of us will get cancer at some stage in our life. The question is not so much how we stop that happening, but how we can diagnose and treat it more quickly and effectively, so that it moves from being a life-threatening disease to one that can be managed throughout a normal and happy lifetime.

We must be honest in saying we are not yet there. Historically, we have lagged behind the best performing countries in Europe, and catching up with those standards has been a focus for successive Governments, including this one.

There is good news. Things are getting better. In the past eight years, various actions, including the establishment of the cancer drugs fund, mean that there are about 7,000 people alive who would not have been otherwise, but, as we have heard, the benefits of these actions are spread unevenly. Survival rates for certain cancers are stubbornly low. Testicular cancer has been transformed into a nearly totally curable disease, but for other cancers—we have heard about oesophageal, stomach, pancreatic, lung, liver and, unfortunately, brain cancers—very little progress has been made. There is much still to do and we need to do better.

The first step towards achieving the world-class cancer outcomes we all want and which NHS patients rightly expect is to have a plan backed by the cancer community. As noble Lords will know, that plan was provided three years ago by the Independent Cancer Taskforce, which provided a cancer strategy aimed at saving 30,000 lives a year by 2020. It was truly a landmark moment. As any Government would have, the Government accepted the recommendations of the strategy and have backed it with funding.

It starts, of course, with prevention, and we have heard about the vigour with which the noble Baroness pursued public health and prevention when she was a Health Minister. Smoking and obesity remain the biggest preventable risk factors for cancer. That is why last year the Government introduced a childhood obesity strategy and a tobacco control plan for England. The truth is that we are making progress on smoking, and rates are coming down for almost every age group. However, we have a long way to go to tackle the obesity epidemic which we have not yet done. More courage is needed, I fear.

As the noble Baroness also said, early diagnosis is critical, and there are new early diagnosis standards, including a new 28-day faster-diagnosis standard. However, we all know that it is not just about targets but about bringing the best diagnostic tools and therapies into the NHS more quickly. There are also incredibly exciting discoveries in diagnostic science happening as we speak. I am sure that noble Lords will have heard about the successful trial of a blood test for cancers by a team at Johns Hopkins University, and we want our NHS to be able to bring on these kinds of innovations as quickly as possible. I am hopeful that our new accelerated access pathway, whose team meets for the first time next week and which becomes operative in April, will be looking at these kinds of technologies and will provide opportunities for them to come into the health service for NHS patients up to four years quicker than is currently the case.

At the centre of every cancer experience is a human being, their family and friends, with all the emotional and physical needs that attend. So it is right to expect that every patient is treated with compassion and dignity. The National Cancer Patient Experience Survey shows that more cancer patients are experiencing positive care overall, which is extremely welcome. I want to use this opportunity to pay tribute not only to the amazing NHS and care staff who deliver that care for cancer patients, but to our extraordinary range of charities and voluntary organisations. It is invidious to name some, but Macmillan Cancer Support, Cancer Research UK, The Brain Tumour Charity, and others provide outstanding support to people with, and recovering from, cancer.

Of course, their illness is not what defines cancer patients; life goes on, with its usual joys—if I heard the radio correctly, I think that for the noble Baroness that includes dancing—as well as its challenges. Making sure that life can go on as normal, or as close to normal as possible, is essential. At the moment, standards of care are high but there is local variation, and that is why there is a plan to create a national recovery package that is there for every cancer patient from the moment they are diagnosed. Inevitably, where the Government can make the most difference is in providing the necessary investment. I would like to highlight three examples of that investment, and shall attempt to avoid the list that Ministers often slip in to these kind of speeches. There are two areas where investment is really making an impact for cancer patients.

Elsewhere, the noble Baroness, Lady Jowell, has spoken about the surgery required to treat her cancer, which can be highly invasive and debilitating. There is major investment, I am pleased to say, in the modernisation of radiotherapy equipment taking place across England, including two new proton beam therapy centres. Combined with new approaches to surgery, it is hoped that that will bring benefits to around 6,000 brain tumour patients a year who will get access to less invasive surgeries. The noble Baroness specifically asked about the availability of a key florescent dye, and I can tell her it is called 5-ALA. It helps surgeons to see malignant tissue, so helps to ensure a more accurate surgical margin during surgery. We have spoken to NHS England in advance of this debate, which has committed to working with the cancer alliances and the brain cancer surgery centres to drive national uptake of its usage.

I also want to highlight another innovation or change, which is a big investment in the health infrastructure through 20 biomedical research centres in England. I had the opportunity to visit one of these last year at University College London Hospital, where I met some wonderful and very brave cancer patients who were among some of the very first people in the world to trial immuno and combined therapies, and they absolutely understand the importance of giving patients a choice about the ability to take risks when the prize is extra months of life with the people they love. These centres and their clinical research networks are now recruiting or have set up around 700 trials. I am just sorry that the noble Baroness was unable to find one in this country that she could access for her particular form of cancer. I can promise her that our determination, like hers, is that British cancer patients should not have to travel abroad to be part of trials or to access the kind of treatments that they need for their cancer.

Before closing, I want to address a number of the other issues raised by the noble Baroness during her speech. I absolutely agree with her that more investment is needed in cancer research for brain cancer. Making that happen is a specific objective of the departmental working group that has been operating under our Chief Scientific Adviser, Professor Chris Whitty. I can confirm that this group will deliver its final report to me next Wednesday, and I can also say today that one action stemming from that will be a highlight notice from the National Institute for Health Research to encourage researchers to submit applications for funding in the specific area of brain cancer research. I hope that some of the interesting ideas and research projects going on today will look at that opportunity so that we get more funding into this important area.

The noble Baroness also talked about the importance of adaptive trials. I am again pleased to report that they form a growing proportion of the clinical research network’s portfolio and are mainly in cancer trials. We undoubtedly need to be more radical in this, and the noble Baroness has provided a specific suggestion. I would be delighted to meet the director of the ECI, and I am thrilled that he is here today to hear the debate.

There has been, as the noble Baroness pointed out, a lack of new brain cancer drugs. Again, we have been in touch with the National Institute for Health and Care Excellence—I did not know that she had a role in its founding—about this. I am informed that there are a number of drugs in development specifically for glioblastoma and NICE has committed to publishing draft guidance on these drugs before they receive a licence. Drugs recommended in the draft guidance will be funded from the point of licensing, which brings forward the opportunity to use them by many months.

The noble Baroness also talked about the importance of data and having access to data. I could not agree more. As we know, one of the wonderful things about the NHS is that it is here for all of us, all the time. One quirk of the way that it was set up—I am not sure that Nye Bevan intended it, but it is certainly a benefit—is that it has an unrivalled dataset on patients’ medical experiences and journeys, which is invaluable to the research community. We all know that we have not always got policy right in this area or brought the public with us about the benefits of sharing data, but there are some key decisions coming up in the next few months to help us to access and create that dataset for research purposes. I warmly welcome the opportunity to engage with the noble Baroness and other noble Lords to make sure that we can win the argument with the public about sharing data for the benefit of not just ourselves but one another.

There have been many questions from noble Lords, and I hope that they will forgive me for not trying to answer all of them in the interests of time. I will of course write to any noble Lords whom I have not answered specifically. I just want to highlight three other things. First, genomic medicine and its potential in combination with artificial intelligence and machine learning have been mentioned. We have a set of 5,000 whole cancer genome sequences—believe it or not, that is the biggest set in the world. But, thinking about the number of people getting cancer every year, we need to do much better on this. There are big ambitions here, and I hope to use the opportunity of the NHS’s 70th birthday to make real progress in something ambitious in this area.

Several noble Lords asked about the Lords’ sustainability report. The department is perhaps not shown in its best light in how late the response has been. It will be published very soon, I can promise that. The issue of taxation has also been raised. I hope that noble Lords will forgive me if I say that is above my pay grade. They may also have noticed, however, that the Secretary of State for Health and Social Care has been here throughout the whole debate and listening intently. So I am looking to him, as I know that he will be making a case across government.

Finally, I have been a Minister for long enough to know that you cannot have a debate without talking about Brexit—so let us make it quick and positive. Clinical trials have been mentioned, but we should also mention medicine regulation. The Government’s intention, going into that negotiation, is to have a new way to create the same kind of partnership that we have now, not just for the good of patients in this country but for those across the EU as well. That is our intention and we think that is the right thing to do.

To close, I would like to talk about a word on which the noble Baroness focused towards the end of her speech, and that word is “Hope”—it also happens to be the name of my youngest daughter. The NHS symbolises many noble ideas—reassurance, compassion and service to others—but more than anything it provides people with hope: hope of a better life and more years enjoyed, not just for themselves but for those they hold dear: hope for a better today and for a better tomorrow.

What the noble Baroness has done today is to offer hope. With her courage in calling and leading this debate, and with her ever-fertile mind making suggestions for how we can improve cancer care, she raises our sights and demands that, collectively, we work harder to offer hope to people affected by the terrible disease she suffers with such dignity. It is the right challenge, and one I am prepared to accept on behalf of the Government. In doing so, I promise her that our efforts will not waver until the scourge of cancer no longer robs us of the ones we love.