Earlier Cancer Diagnosis: NHS Finances

Mark Durkan Excerpts

Tuesday 18th October 2016 Westminster Hall

[Mr Baron]

I agree completely. Briefly, the initiatives that could be introduced to promote earlier diagnosis are greater awareness campaigns, better diagnostics at primary care level, better uptake of screening in screening programmes, and better GP awareness—although this is not only about GPs. A whole host of initiatives could be introduced at the primary care level to improve survival rates and awareness generally. So yes, I completely and utterly agree.

Given the limited time available, I will make a little progress on the central point of this debate. We are pushing at an open door, which is fine; we are keeping a watching brief as a cancer community; and, as I have said, the Ofsted-style ratings have shown, among other things, that a big improvement is required. The all-party group on cancer will hold its annual parliamentary reception next summer—the Minister no doubt will be invited to that—at which we will focus on those CCGs that have most improved their one-year survival rates. The Britain Against Cancer conference, which we believe is the largest gathering of the cancer community in this country, will take place at the end of this year and will also focus on that issue.

We are therefore not walking away from the issue of survival rates, but we are saying as part of our watching brief that we wish to bring to the Government’s attention the fact that when it comes to cancer treatment, earlier diagnosis can not only help patients—diagnosing cancers earlier makes for better survival rates—but save a lot of money. The later cancer is diagnosed, the more aggressive the treatments and the higher the cost. That cost is quite significant, and the cost savings from earlier diagnosis could be ploughed back into treatment for patients. At a time when the NHS is under financial pressure, we suggest that too little attention is being paid to those potential cost savings. Too little work has been done by the NHS and too few health economists are looking at how reducing costs to such an extent would benefit both the taxpayer and, most importantly, patients.

Given the NHS’s lack of focus on that area, we have had to go to outside sources to give us some sort of measure of the potential cost savings. A September 2014 report by Incisive Health and Cancer Research UK showed quite a disparity between the cost of treating patients with early stage, or stage 1, cancer and those with late stage, or stages 3 and 4, cancer. For example, the cost per patient per year of treating colon cancer is £3,300 at stage 1 and £12,500 at stage 4—a near fourfold increase. Treating stage 1 rectal cancer costs £4,400; that goes up to nearly £12,000 if it is treated at a late stage. Treating ovarian cancer costs just over £5,000 per patient per year at an early stage, but £15,000 at a late stage. That report focused on four cancers: colon, rectal, lung and ovarian. They amount to only around a fifth of all cancers diagnosed, but if such cost savings were replicated across all cancers, we could be talking about savings of hundreds of millions of pounds, and that is before we even consider the number of patients who would benefit from earlier diagnosis, which Incisive Health cites as something like 52,000.

[Mark Durkan (Foyle) (SDLP)]

Will the hon. Gentleman give way?

[Mr Baron]

I ask for a bit of patience. Let me make a little progress, and if there is time, I will take further interventions.

That report also showed variation between the highest and lowest-performing CCGs in the proportion of patients diagnosed early. That is also important. In colorectal cancer the variation was threefold, in lung cancer it was fourfold and in ovarian cancer it was fivefold. It is clear that if we could ensure that all CCGs achieved the best rate of early diagnosis—the rate achieved by the top performing CCG—significant cost savings could be made.

Those are interesting figures. Many believe them to be conservative—with a small “c”—in the sense that we often forget the costs of treatment later on down the care pathway beyond diagnosis, but we are certainly talking about hundreds of millions of pounds. One could argue that that is a drop in the ocean when we are looking at the NHS budget, but patients—cancer patients in particular—could certainly benefit from a couple of hundred million pounds. In an age when it is all too easy for politicians to talk about spending more money, we are trying to focus on potential cost savings from encouraging earlier diagnosis. As prevalence rises—Macmillan Cancer Support believes there may be another half a million cancer patients in the next five years, in addition to the around 2.5 million we have at the moment—so will costs, so the need for such savings will grow in importance.

The most recent report of the all-party parliamentary group on cancer followed an oral evidence session with the then cancer Minister and key decision makers in NHS England, as well as written evidence from more than 30 cancer-related organisations. That report concluded that where the new initiatives outlined in the cancer strategy could save costs, those initiatives required more focus and attention. It is our opinion that there needs to be greater appreciation in NHS England and the Department of Health of the savings that earlier diagnosis offers. As I have said, there are too few health economists working in the NHS, and even fewer looking at this area.

As the Minister is well aware, when I raised that issue at Health questions last week, he correctly referred to some ongoing studies, including the three-year research project being undertaken by Macmillan Cancer Support in a related area. He also mentioned Public Health England, which is looking at cost-effective initiatives for colorectal cancers. Those studies are welcome, but I maintain that the approach is piecemeal. We need a root and branch approach to look more specifically at this area. We need to promote earlier diagnosis at CCG and health and wellbeing board level. We have the one-year figures. We must not allow this to become a tick-box exercise; the issue is far too important for that. There needs to be greater focus on how underperforming CCGs will be held to account for their rate of improvement.

The all-party parliamentary group on cancer will play its full part in that work. We are looking at other areas. We have achieved our goal of getting the one-year figures into the DNA of the NHS, and we certainly will not walk away. We are focused on several areas, including patient experience and rarer cancers. There cannot be a meaningful improvement in the one-year figures if rarer cancers are not included, as those account for more than half the cancers that are diagnosed. We will play our full part, which includes the annual reception and the Britain Against Cancer conference, but I would be interested to hear the Minister’s responses to the questions I have raised. What more does he believe the NHS can do to promote and focus on cost savings from earlier diagnosis? On behalf of the wider cancer community, and certainly the all-party parliamentary groups, including the cancer-specific groups represented by several hon. Members in the Chamber, may I request a meeting with the Minister to discuss this and other related cancer issues?

--- Later in debate ---

[David Mowat]

I thank my hon. Friend for that and for reminding us that at the core of the debate is a point we all agree on: early diagnosis is the key, whether it is for cost-saving purposes—I will come on to some of the points my hon. Friend the Member for Basildon and Billericay made on that—or to be cost-effective. There is no question that early diagnosis saves lives and that it is the right thing to do. Whether we argue a bit about precisely how much money is saved is in a way a secondary issue; it saves lives and it is the right thing to do.

I also want to acknowledge the intervention of the hon. Member for Strangford (Jim Shannon), who reminded us about the need for public health and GP awareness. In England we have had a significant increase in the number of referrals and the National Institute for Health and Care Excellence—latterly in England—has changed its guidelines for referral, which, together with the awareness issue, has increased significantly the number of people diagnosed in stages 1 and 2. We need to continue to make progress on that.

[Mark Durkan]

I commend the hon. Member for Basildon and Billericay (Mr Baron) for leading the debate and for the leadership he has provided on one-year survival rates through the APPG. Does the Minister accept the basic premise that value of life and value for money are not in competition? They are perfectly compatible. We can have better use of money with better outcomes because of better-timed treatments, and that also means there is better evaluation and research, which will feed into better education in a virtuous circle, to meet the point made by the hon. Member for Mole Valley (Sir Paul Beresford).

[David Mowat]

I thank the hon. Gentleman for his intervention and completely agree with the point he made. In this instance, there is no competition between saving money, saving lives and doing the right thing. In a sense, there is a secondary question as to just how much cost is saved, and the balance of cost saving versus doing more diagnostically, because in order to save lives, which is a highly cost-effective thing to do and the right thing to do, we need to do more on early diagnosis.

I have not yet got to the start of my remarks and I have a lot of pages to get through, so I will not be giving too much detail. It is worth acknowledging that cancer survival rates are increasing in the UK. In terms of improvement, between 2011 and 2015 we think something like 12,000 lives a year were saved. That exceeds the goals we set out in the cancer outcomes strategy in 2011.

Last year we saw a 91% increase in urgent GP referrals of patients with suspected cancer—that is another 822,000 patients. That shows a massive increase in NHS resources and all that goes with that, and we are beginning to see those early referrals, and the different guidelines GPs are using to refer, start to come through in the one-year survival statistics. However, as my hon. Friend the Member for Basildon and Billericay reminded us, that does not mean that we are the best in Europe. We need to continue the drive to improve.

The cancer strategy produced by the cancer taskforce is the backbone of what we are trying to achieve. The—I think it is fair to say—acclaimed strategy it produced, “Achieving World-Class Cancer Outcomes”, was published last year. It had 96 recommendations in it, and the Government accepted all 96. We are now putting in place an implementation taskforce. We believe that if we are able to make the progress we expect by 2020, a further 30,000 lives a year can be saved.

Recommendation 96 is the one we are talking about today. It essentially says that we need to do a lot more on early diagnosis because of the cost savings that will potentially arise from that. There are differing views in the Department of Health as to whether for all cancer types in all instances earlier diagnosis does save costs because of the increase in cost and effort associated with the diagnosis—the early screening and all that goes with that. That was not addressed overtly in Cancer Research UK’s “Saving lives, averting costs” report, which was mentioned by my hon. Friend. He quoted numbers of several millions of pounds, and there is no doubt that stage 4 cancer costs massively more to treat than stage 1 cancer, but whether or not there are clear cost savings in all instances and even if we dispute the detail of some of those numbers, we go back to the point made by the hon. Member for Foyle (Mark Durkan) that early diagnosis is the right thing to do. My hon. Friend also mentioned that there are not enough health economists in the NHS; the truth is there are not enough of lots of things in the NHS. Early diagnosis is certainly cost-effective in terms of lives saved, even if there may be some dispute as to whether it saves costs in all instances.

My hon. Friend mentioned the work being done by Macmillan, which I acknowledge. It is a three-year study, which we are looking forward to.