Health and Care Bill

Lord Sandhurst Excerpts

2nd reading
Tuesday 7th December 2021 Lords Chamber

[Lord Sandhurst (Con)]

My Lords, I add my congratulations to the noble Lord, Lord Stevens of Birmingham, on his very uplifting maiden speech.

I shall direct my remarks to Clause 4. This inserts a new provision into Section 13A of the National Health Service Act:

“The objectives that the Secretary of State considers NHS England should seek to achieve which are specified in subsection (2)(a) must include objectives for cancer treatment defined by outcomes for patients with cancer, and those objectives are to be treated by NHS England as having priority over any other objectives relating to cancer”.


This is a very specific and important mandate. Henceforth, successful management will be judged by “outcomes for patients”: how many survive and for how long.

Let me explain why this is important. For the first time, cancer survival rates from the date of diagnosis will be given priority over other objectives in the treatment and management of cancer. Hitherto in respect of cancer this country has focused for too long on targets, such as the two-week wait to see a specialist after a referral and the 62-day wait from referral to first definitive treatment. Those targets are not irrelevant or unimportant, but they are only part of the picture and have distorted the way we have managed cancer. They have had too much priority as measures for achieving funding support. They have not resulted in better results.

Over the last 20 years, there has been only limited evidence of cancer survival rates catching up with international averages in other prosperous countries. Professor Sir Alex Markham, the founding chief executive of Cancer Research UK, has observed that

“comparable health services abroad continue to outperform the NHS in terms of cancer survival. They all remain focused on cancer outcomes and the UK would be foolish not to do likewise”.

This clause should put that right.

When it comes to treatment after diagnosis, I understand that the NHS largely performs as well as other comparable health services. However—this is the important thing—it is not as good at catching cancers in their crucial earlier stages. If the new commissioning bodies under the Bill have to focus on outcomes, they will monitor survival from date of diagnosis. They will have to collect that data, identify dates of diagnosis and match outcomes. This will show which places are doing better than others. Researchers can then establish what the more successful places do and how they differ from the less successful ones. That way, routes to success may be identified. Improvements can and should follow. That is true evidence-based medicine.

Hitherto, data collection and data transparency have not been a strength. As Bowel Cancer UK told the APPG on Cancer, the priority should be to

“improve the quality and use of data”

produced. Indeed. Another point is that data on the less common cancers are not used consistently throughout the NHS. The focus to date has been on the so-called big four: breast cancer, prostate cancer, bowel cancer and lung cancer. Yet it is a fact that the other less common cancers, taken as a whole, constitute more than 50% of cancer cases in England at any one time.

The new statutory obligation addressing outcomes for all cancer treatment would ensure that such data are collected across the range of different cancers. This new provision will provide the springboard for long-overdue improvement in cancer detection and cure. I commend it to the House.