Earlier Cancer Diagnosis: NHS Finances

Debate between Mark Durkan and John Baron

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?

New Cancer Strategy

Debate between Mark Durkan and John Baron

Thursday 19th November 2015 Commons Chamber

[Mark Durkan (Foyle) (SDLP)]

It is a pleasure to follow the hon. Member for Bury St Edmunds (Jo Churchill), particularly as she ended by referring to off-patent drugs. She spoke powerfully on Second Reading of the Off-patent Drugs Bill, which was promoted by the hon. Member for Torfaen (Nick Thomas-Symonds) only a couple of weeks ago. This debate draws on many points made in previous debates, including that Second Reading debate and Westminster Hall debates. There have been debates about the cancer drugs fund, specific cancers and, recently, secondary breast cancer.

I am an officer of a number of all-party groups, including that on cancer, which is so ably led by the hon. Member for Basildon and Billericay (Mr Baron), who secured this debate. We have also heard from colleagues who are members of other all-party groups, including the hon. Member for Scunthorpe (Nic Dakin), who is on the all-party group on pancreatic cancer, and the hon. Member for Castle Point (Rebecca Harris), who is doing so much to raise awareness and to promote action on and understanding of brain tumours.

I welcome the fact that the Backbench Business Committee has afforded us this opportunity to join up what might otherwise appear to be disparate work. The APPGs are not rivals—their efforts are entirely complementary. The cancer strategy is a benchmark document and this debate gives us an important opportunity to consider how we can marshal parliamentary effort and will behind it. We need Ministers in the Department of Health and elsewhere to know that we are not taking it for granted and that, just because we have had unmet need for a long time, that should not continue to be the case. I would like to hear a Minister tell us that their portfolio means that they see themselves as the Minister for meeting unmet need. If they set that target and seek to make that change and turnaround, they will have many backing vocalists from the different all-party groups.

Other hon. Members have said that there may be some issues with aspects of the cancer strategy, but it clearly lays down some important standards, not least on a recurring message that the APPGs get from the evidence we receive, namely the question of early diagnosis.

[Mr Baron]

The hon. Gentleman is a good friend of the all-party group on cancer. He will already know this, but it is worth putting it on the record that the separate all-party groups on cancer are endeavouring to get their act together and to speak with one voice where there is a common interest—and there are many when it comes to cancer.

[Mark Durkan]

I fully recognise that point. That was what I was trying to say when I said that the APPGs are not rivals. This debate allows us to bring together their work and their common message, and to acknowledge the work of the hon. Gentleman and the chairmen of the other APPGs. In that regard, I should also mention the hon. Member for Washington and Sunderland West (Mrs Hodgson). She cannot be here this afternoon, but she has done so much on the all-party groups on ovarian cancer and on breast cancer.

Early diagnosis is a common theme and the issue is not just about making sure that there is more access to diagnosis. The hon. Member for Bury St Edmunds has mentioned how many people end up being diagnosed in A&E, which is not what should happen. Although certain cancers raise more sensitive and technical questions than others, there needs to be more awareness among GPs, and diagnostic tools are also key. However, this is about not just ensuring earlier diagnosis with better use of diagnostic tools, but ensuring much clearer referral pathways. The cancer strategy sets a target of making sure that, by 2020, 90% of people are diagnosed within a month to see whether or not they have cancer. That is a very good working standard.

All the APPGs, particularly the all-party group on cancer, have strongly suggested that the indicator of one-year survival rates would be a very good test of our ambitions and efforts and of the actions of health authorities. That working standard needs to be adopted, because it would help us to monitor and manage our progress.

I am conscious of the fact that I speak as a Member from Northern Ireland, whereas the cancer strategy and much of this effort relate to England. However, as everybody knows, in a lot of these areas we are talking about predictive policy. When we set frameworks or national strategies on particular diseases or illnesses for the NHS in England, they can extend, through policy airspace principles, to the devolved areas. That is one reason why I have no hesitation in joining in the work of the APPGs here—it helps to advance understanding at home.

Of course, that was not the case with the cancer drugs fund. We do not have a Northern Ireland version of that, which has led to the frustration that was identified by the late Una Crudden, who suffered from ovarian cancer. Many of the drugs that were available in England under the cancer drugs fund had been the subject of clinical trials in the excellent centre in Belfast, yet they were not available to patients in Belfast.

The success of the cancer drugs fund has shown its limitations, which is confounding us in thinking about how to develop and replace it. When considering the future of the cancer drugs fund and what will succeed it, I ask him to think not just about doing something for England and then seeing whether the devolved Administrations can match it or do better, but about the possibility of a UK-wide funding pool for some of the newer drugs and for some innovations in research and diagnosis, such as molecular diagnostic testing, which comes under the cancer drugs fund. Perhaps this is a conversation that we need to have with the Chancellor in the context of his announcement next week and what will happen beyond that. I am saying not that it should all be funded by London, but that there could be a pool of money to which the devolved areas contribute, with common standards and bands. It might be that certain groups of patients would then be covered by further arrangements made at the devolved level.

The more commonality and consistency we can bring to funding, the better. It would make it so much better for the many good cancer charities and policy advocacy groups that work with cancer patients, which have to busk around the different Administrations to see who has what bit of money. That also creates a lot of confusion at the parliamentary level. It is hard for us to join up our efforts and marshal our arguments when we are dealing with different structures and systems. The more commonality we can create in funding, particularly in the area of innovation, the better.

Perhaps there should be a UK-wide effort, or perhaps it should go beyond the UK. The British-Irish Council includes all eight Administrations on these islands, including the south of Ireland. Perhaps there should be a common effort at that level, given some of the clinical networks that will be involved. When we consider the rarer cancers that will not be treated in some of the other places, perhaps a more united effort would help to take the thinking forward. A lot of the ingredients in the cancer strategy for England might best be brought forward as part of a combined strategic effort on cancer across these islands.