Pancreatic Cancer

Naomi Long Excerpts

Monday 8th September 2014 Westminster Hall

[Eric Ollerenshaw]

I thank the hon. Gentleman for underlining that critical point about survival rates and their impact on the ability of researchers to get that much-needed research.

The consensus we found was that more work is needed and that one of the reasons why survival rates for other cancers are increasing is that effective screening and markers have been developed to allow early diagnosis, thus giving more time for curative treatments to be given to patients. The other side of the argument, which we will go into, is that what we are looking for is support and treatment to allow survival rates after diagnosis to increase. In this day and age, having only six weeks left in which to make life-shattering decisions is unbelievably difficult for people.

[Naomi Long (Belfast East) (Alliance)]

I am glad that we are able to have this important debate. Does the hon. Gentleman agree that, in addition to the need for primary research, there is a disparity between the UK one-year survival rates and the best survival rates in Europe—it is often as much as 11%? Things are known about pancreatic cancer that we can perhaps learn from to treat and diagnose the condition.

[Eric Ollerenshaw]

The hon. Lady makes an extremely important point, which the all-party group was trying to weigh up. The hon. Member for Scunthorpe made an important point about CT scans and made the important suggestion that there should be pilots. Also, interestingly, he mentioned that the going backwards and forwards between the GP and the specialists delayed diagnosis. There are certainly things that we could learn from other countries.

One of the basic needs that came up from our research was the need for investment in the basic science and biology of tumours, as well as access to better infrastructure that would allow that, such as access to tissue samples. On the latter point, the Pancreatic Cancer Research Fund told the APPG that it was working in conjunction with Barts on creating a specific pancreatic cancer tissue bank, which would help. That is a massive investment for a small charity and it should be applauded.

As Members know, there is a massive shift throughout all cancer research towards personalised medicine. Pancreatic cancer patients could benefit particularly from such an approach, given the nature of the disease and the fact that so many different tumour types are involved. New treatments need to be developed to attack and destroy the cancer cells. That does not mean new drugs alone, but perfecting the use of advanced radiotherapy techniques, such as NanoKnife or CyberKnife, for the benefit of patients and to the satisfaction of the National Institute for Health and Care Excellence, so that they can be provided on the NHS.

All in all, a lot of research needs funding. A key statistic for this debate, as mentioned in Maggie’s e-petition, is that pancreatic cancer receives only 1% of the National Cancer Research Institute’s site-specific spend of £5.2 million a year. That is despite the fact that pancreatic cancer is the fifth biggest cancer killer in the UK, and predicted to become the fourth biggest by 2030. It is responsible for 5.2% of all cancer deaths in the UK. The National Cancer Research Institute itself acknowledges that research into pancreatic cancer and other cancers deemed to have unmet need, such as brain and oesophageal cancers—forgive me if I do not pronounce that correctly—remains “relatively low”.

By “relatively low”, however, the institute means “low”. I contend that £5.2 million a year from the NCRI partner funders is simply not enough to tackle the extreme intransigence of a disease as tough as pancreatic cancer, a disease that has seen—as has been mentioned before and should be mentioned again and again—little change in survival rates over the past 40 years or by comparison with other countries, as the hon. Member for Belfast East (Naomi Long) said.

Why does funding matter? Is money the be-all and end-all? No—other things need to be done as well if research into pancreatic cancer is to become more effective. However, if we look at other cancer types, we see that sharp increases in survival rates from breast, prostate and bowel cancer, for example, have mirrored sharp increases in research spending into those diseases. As Professor Peter O’Hare, chair of Pancreatic Cancer UK’s scientific advisory board—now there’s a powerful job—told the APPG inquiry:

“I think if you simply looked at the history of science, I don’t think you can, as a scientist, start to make guarantees about research. It’s not like a sausage grinder; you don’t put research in and it comes out and you solve the problem. It just doesn’t work that way”—

we totally understand and agree with that—

“there are convoluted pathways and you can’t make guarantees.

However, I think there is a guarantee you can make: if you don’t carry out research, you are not going to move; nothing is going to happen. That’s the guarantee that you could make.”

Some evidence suggests a critical mass, a level at which research needs to be funded, if advances are to start to gather pace. Pancreatic Cancer UK produced a report in 2012, “A Study for Survival”, which demonstrated a level—around £10 million to £12 million minimum—at which the amount of research starts to become sustainable and from which new research proposals and ideas are generated. Those new ideas in turn lead to more funding coming in, and we get a virtuous circle.

We are some way off that level of funding at the moment. National Cancer Research Institute funding partners contribute just £5.2 million at present. Incidentally, we learned during the all-party parliamentary group’s research inquiry that the Department of Health’s contribution to that sum is just £700,000 a year. Although they are growing, charities for pancreatic cancer are still small and supply probably less than £2 million a year between them for research. Where, then, can that extra funding come from? What needs to be done?

In its new research strategy, published in April this year, Cancer Research UK made a welcome move in the right direction, with a promise to increase funding into pancreatic and other cancers of unmet need—brain, lung and oesophageal—twofold or threefold over the next few years. That is great news.

Mid Staffordshire NHS Foundation Trust

Naomi Long Excerpts

Tuesday 26th March 2013 Commons Chamber

[Mr Hunt]

That is at the heart of what the reforms intend to achieve. An organisation as complex and as large as the NHS needs corporate objectives and targets—for example, we need to do a lot better on dementia—and we do set system-wide objectives. However, we have to ensure that those objectives, set by whichever party happens to be in power, never compromise the fundamental care and compassion that needs to be at the heart of what the NHS does. We are putting in the safeguards that ensure that that cannot happen.

[Naomi Long (Belfast East) (Alliance)]

Given the mobility of both the work force and students, what discussions has the Secretary of State had with the devolved Administrations regarding the proposed changes to funding nurse places and training?

[Mr Hunt]

We have not had those discussions yet, but we will be introducing them through pilot schemes to give the devolved Administrations plenty of time to talk to us about any knock-on impacts they may have in their areas.

Oral Answers to Questions

Naomi Long Excerpts

Tuesday 27th November 2012 Commons Chamber

[Anna Soubry]

At my ministerial surgery last night, which has been somewhat scorned by Opposition Members, I met my hon. Friend the Member for Bracknell (Dr Lee) and discussed his proposals at length. I do not agree with his proposals, but I welcome the debate. There is nothing wrong with a healthy debate. However, on this one, he and I disagree.

[Naomi Long (Belfast East) (Alliance)]

10. How much the Government have spent on (a) treatment, (b) diagnosis and (c) raising awareness of pancreatic cancer since May 2010.

[The Parliamentary Under-Secretary of State for Health (Anna Soubry)]

We cannot provide the absolute figures on how much we have spent on pancreatic cancer in particular, but some £200 million has been spent on cancers of that type. This month is pancreatic cancer awareness month and I welcome all the hon. Lady’s work towards that.

[Naomi Long]

I recently met some families in my constituency who have been directly affected by pancreatic cancer. One of their main concerns is late diagnosis, which contributes to this cancer having the worst survival rate of the 21 most common cancers in the UK. What assessment has the Department made of the recommendations in the early diagnosis report by Pancreatic Cancer UK, such as improved referral pathways and assessment tools, direct access for GPs to diagnostic tools, and the development of a National Institute for Health and Clinical Excellence quality standard for pancreatic cancer as a means of improving the speed of diagnosis and survival?

[Anna Soubry]

I am very grateful for the work of Pancreatic Cancer UK. We have put the proposals from its seminar last June into the guidance that we are issuing. I am meeting Pancreatic Cancer UK, other cancer charities and other people who are involved in cancer work this afternoon. I will be happy to raise the matter with them directly and to meet the hon. Lady and representatives of this very good cancer charity. She is right to expose the fact that this cancer is difficult to diagnose. We will be launching pilots in January and I hope that more people will take advantage of that campaign and come forward if they have any symptoms.

Induced Abortion

Naomi Long Excerpts

Wednesday 31st October 2012 Westminster Hall

[Anna Soubry]

Forgive me, but I want to make progress, because the clock is against me. I will give way when I have made some points. In the short time available, it is important that I make some of the main points in my speech.

It is right that abortion is a matter of conscience. It is important to respect the views of all individuals and accept that we have different views, whichever side of the political fence we sit on. My hon. Friend the Member for Southend West (Mr Amess) reminded us that certain Cabinet members have expressed their own views on the upper limit for legal abortions. They all made it clear that those are their own personally expressed views. I want to make it quite clear that, notwithstanding the fact that some Cabinet members may want a reduction in the upper limit, the Government have no plans to bring about a change to the time at which an abortion can be carried out. I want to stress that point again, so I repeat: we have no plans to review the Abortion Act 1967.

We are by no means complacent. When I was fortunate enough to be made a Minister, I made it clear that in the time I am in office I want a reduction in the number of abortions. We all want that, but there is a debate about how we best achieve it. I take the view that we best achieve it through better contraception and by empowering our young men and women to make the choices that they want to make, if they have a sexual relationship.

[Naomi Long (Belfast East) (Alliance)]

Will the Minister give way?

[Anna Soubry]

I will, but I want to make these points because they are important. I want better counselling services—

--- Later in debate ---

[Anna Soubry]

The committee has done some good work. I do not think that it would be right to take the matter any further. I am sorry if that disappoints people, but that is my view. I can see no purpose in a consultation, because we do not intend to change either the law or the guidelines.

As the committee identified, counselling services throughout the NHS are patchy. That is not acceptable. It also decided that it is of primary importance that there are no delays when a woman seeks a termination of her pregnancy. That is why it is important that if a woman is going to have a termination, she does it as quickly as possible. The group was in unanimous agreement on that, which I welcome. There is other work to be done on counselling, but I take the view that that is not the primary issue that we should address, which is why I made the decision I did.

[Naomi Long]

Everyone, whether pro-life, like me, or pro-choice, agrees that we would like a reduction in the number of abortions. Does the Minister have any concerns that the policy of limiting child-related benefits to two children could increase the financial pressure and stress on people who find themselves pregnant, thus driving up the number of abortions, rather than reducing it?

[Anna Soubry]

No is the simple answer, but I am happy to discuss it further with the hon. Lady.

In the short time I am allowed, I want to talk about viability, bearing in mind the points made by my hon. Friend the Member for Mid Bedfordshire and the helpful interventions of the hon. Member for Feltham and Heston. The current clinical evidence shows that although there have been medical advances in caring for premature babies, only a small number of babies born at under 24 weeks’ gestation can survive, and there may well be questions about their quality of life. Most have severe problems. The situation markedly improves at 24 to 25 weeks, which reaffirms why the limit of 24 weeks was chosen.

Results from the EPICure study, which looked at the chances of survival and later health status of children born at less than 26 weeks, show that survival to discharge was 0% at 21 weeks, 1% at 22 weeks, and 11% at 23 weeks. Of the two children in the study born at 22 weeks’ gestation who survived to discharge, one had severe disability and one had mild disability at 6 years of age.

The British Association of Perinatal Medicine stated, in evidence to the 2007 Select Committee on Science and Technology inquiry on abortion, that it was concerned that lowering the legal definition of viability would imply that quality of survival has improved for infants below the present limit of 24 weeks. The evidence for the UK population to date does not support that.

Even though some babies have survived at a very early stage, the threshold of viability cannot be continually pushed back, because there is a limit beyond which the lungs will simply be insufficiently developed to sustain life. Although embryonic lungs start to form as early as four weeks into a pregnancy, their maturation continues until the end of a normal pregnancy. Recent data published by the Office for National Statistics show that 0.1% of live births occurred at less than 24 weeks, and the mortality rate for those babies was 877.3 deaths per 1,000 live births.

We are right to ask why women have late abortions. Women who have such abortions do so in the most extreme situations. They work with their doctors, nurses and loved ones to make what must be the most difficult choice that any woman, or her partner, will ever face. We have heard why so many hon. Members feel that the current 24-week limit should be retained, and why others feel strongly that the limit should be reduced. I personally support the retention of the 24-week limit, but my priority is to reduce the number of women who turn up at a clinic or doctor’s surgery seeking a termination.

My hon. Friend the Member for Gainsborough (Mr Leigh) spoke about the pain and suffering of women who undergo termination of a pregnancy, but perhaps he forgets the pain, suffering and mental distress of women who found that the law did not allow them that choice. My priority is ensuring that women have informed choice, and that we have fewer abortions.

NHS Cancer Services

Naomi Long Excerpts

Friday 14th September 2012 Commons Chamber

[Mr John Baron (Basildon and Billericay) (Con)]

May I start this important debate by congratulating the Under-Secretary of State for Health, my hon. Friend the Member for Broxtowe (Anna Soubry), on her appointment to what many of us consider to be an important position in Government? May I also pay a warm tribute to her predecessor, the right hon. Member for Sutton and Cheam (Paul Burstow), who did an excellent job in understanding the issues and pushing the case for cancer care? We wish him well for the future. The all-party group on cancer, of which I am chair, looks forward to enjoying the same constructive relationship with this Minister. However, I secured today’s debate because we believe that after making excellent progress on cancer care the Government now risk making a gross error, which could be very costly indeed, when it comes to cancer treatment.

As the Minister is new in her post, I will, if I may, briefly provide some background information. Cancer survival rates have steadily improved over the past 40 years, but they still lag considerably behind those in Europe and in other countries. Comparisons are never easy, but although we compare with, say, France when it comes to the four or five cancer centres of excellence, it is generally accepted that we lag behind the rest of Europe. The Government have recognised and accepted that point. In January last year, they set themselves the target of saving an additional 5,000 lives by 2014-15, but that would bring us up only to the European average, not even the best.

Why do we in this country trail behind the rest of Europe when it comes to cancer survival rates? In 2009, the all-party group undertook a major inquiry into cancer inequalities that looked at that very issue. What we found was most revealing. We discovered that patients in this country who make it to the one-year survival point stand as much chance as anybody on the continent of making it to five years. Where we fall down badly is in getting patients to the one-year survival point. That led to the conclusion, which is backed up by lots of evidence from those working in the NHS, that the NHS is as good as any other health care system at treating cancer once it is detected, but very poor at detecting it in the first place. It is a national disgrace that nearly one quarter of all cancers in this country are detected only at A and E. That is far too late and it obviously affects survival rates.

The Minister will be fully aware that very rarely in life is there a golden key—an Act or policy through which one can find unbounded riches. However, when it comes to cancer, I would suggest to her that there is a golden key—earlier diagnosis. The earlier a cancer is detected, the greater the chance of survival and the better the survival rate.

Our key recommendation from the 2009 report was the introduction of a one-year survival outcome measure, in order to get the local NHS to raise its game. There is no point in the Department of Health trying to micro-manage primary care trusts; it is better to put up in lights the one-year and five-year outcome measures and to get the local NHS to introduce the various measures and initiatives needed to encourage earlier diagnosis. Those measures could involve greater awareness, earlier or better screening, better use of diagnostics or a combination of those. We should leave it to the local PCTs, while encouraging them to put up in lights the one-year and five-year outcome measures. Such initiatives at ground level would encourage earlier diagnosis, which would result in better one-year and five-year survival rates.

The all-party group campaigned hard on this issue. We raised it in Parliament and at our annual Britain Against Cancer conference—which is the largest of its kind and which is often addressed by Secretaries of State—and elsewhere. We had some success. We were pleased to see the inclusion of one-year and five-year cancer survival rates for breast, lung and colorectal cancer as indicators in the national outcomes framework, which, as the Minister knows, holds the NHS Commissioning Board to account.

Of the two big ideas in the Government’s NHS reforms—the focus on outcomes and the restructuring of the commissioning arrangements—we always thought that the focus on outcomes was by far the most important. We believed that the heat, rather than light, generated by the debate on commissioning structures was unfortunate, to say the least.

In many respects, the national picture has been taken care of. We have the one-year and five-year figures in the NHS outcomes framework, which holds the NHS Commissioning Board to account. Locally, however, it is the clinical commissioning groups—the CCGs—that will play a key role in delivering better cancer care. They are held to account by a different outcomes framework: the commissioning outcomes framework, known as the COF.

The COF will do much to set cancer priorities locally, and it is therefore vital that we get this right. Up until last month, we were led to believe that the five-year survival indicator was to be included in the COF, and the all-party group was lobbying hard to get the one-year indicator included as well. After all, both derive from the same data set. We fully participated in the National Institute for Health and Clinical Excellence consultation in February this year. We learned last month, however, that the NICE COF advisory committee had decided not to recommend the inclusion of either the one-year or the five-year survival rates in the first iteration of the COF. Instead, only the under-75 mortality rates were recommended for inclusion.

I suggest to the Minister that that is a major error. Given all the evidence on how the measure of the one-year and five-year survival rates encourages earlier diagnosis, the Government should not allow this major step backwards in cancer care. The NHS Commissioning Board is, at this very moment, deciding on the make-up of the COF, and the all-party group is calling on it and the Government to include the one-year and five-year cancer measures in this important outcomes framework.

NICE offered two reasons for the exclusion, but they simply do not stack up. First, it said that survival rates were dependent on the socio-economic status of an area. However, the all-party group has heard from a broad range of experts working in the NHS that the most effective way to incentivise early diagnosis is to measure the NHS against cancer survival rates, specifically at one year. The inclusion of cancer survival indicators in the COF is the best way of guaranteeing that CCGs prioritise early diagnosis.

NICE’s second objection related to the application of survival data at local level. However, my understanding, from conversations with the National Cancer Intelligence Network and others, is that cancer survival figures for CCGs can be produced—sliced up, if you like—once the boundaries are known. At the very least, CCGs could then be measured against one-year and five-year survival rates for breast, lung and colorectal cancer, and so be included in the 2013-14 COF, thereby bringing it in line with the NHS outcomes framework.

In our opinion, it is vital that survival indicators are included in the COF, but the all-party-group has also called for proxy measures such as staging and cancer-diagnosed A and E admissions to be included in the COF to complement the one and five-year figures. We have been calling for this because of the smaller population sizes of CCGs compared to what they are replacing—the PCTs. Proxy measures would help to provide a more complete picture of what is happening on the ground, and would help commissioners to identify the bottlenecks to early diagnosis. Will the Minister update us on the progress made on these proxy measures?

Before I conclude and while I have the Minister’s ear, let me quickly raise two further points. Although perhaps a little less urgently than in respect of our main concerns about the COF, the all-party group would like to see both the outcomes framework and the COF to include all cancers. In our view, if all cancer patients are to benefit from the Government’s correct focus on outcomes, it is vital that the rarer cancers be included, thereby narrowing the unacceptable survival gap between the rarer and more common cancers. After all, breast, lung and colorectal cancers account for only 40% of all new cancers. I add that we are somewhat concerned about Government talk about a composite cancer benchmark or indicator because we fear that such a composite would hide failings perhaps in respect of rarer cancers by focusing on improvements made in the more common cancers. We need to narrow that unacceptable survival gap between rarer and the more common cancers.

[Naomi Long (Belfast East) (Alliance)]

I join the hon. Gentleman in welcoming the Under-Secretary of State for Health, the hon. Member for Broxtowe (Anna Soubry) to her new role.

One way of treating more difficult cancers can be the use of very specialist radiotherapy techniques. I have spoken before about stereotactic body radiation therapy and other treatments, which have the potential to improve outcomes, but because they are novel treatments they are advised for use only in clinical trials. Many health trusts are afraid to refer patients because there is no clinical evidence that they are successful for particular cancers. There is a vicious circle here, which needs to be broken so that rarer and harder-to-treat cancers can be treated, at least at that test phase.

[Mr Baron]

The hon. Lady raises a very good point. I believe that cancer networks have a particularly important role when it comes to treatments that span CCGs such as radiotherapy. I know that local cancer networks would help to look into those treatments in order to address the concerns the hon. Lady has rightly raised.

Let me touch briefly on the second point, which is the importance of improving the patient experience. The all-party group recommends that the national cancer patient experience survey should be conducted annually and should be included as an indicator in domain 4 of both the NHS outcomes framework and the COF, as we believe that that would be a solid way of getting the NHS to focus on the importance of improving cancer patients’ experience at all levels.

In conclusion, important though those last two points are, let me return to the central concern of the all-party group and the point of this debate. We think it a very bad decision to exclude the one-year and five-year survival indicators from the COF, and we ask the Government to think again. It sends out the wrong message, defies all the evidence and risks different parts of the NHS focusing on different messages—the outcomes framework on the one hand and the COF on the other. If one thinks about it, there is no reason why the one and five-year measures cannot appear in the COF if they are in the outcomes framework; the numbers can be sliced once the boundaries are known.

Our message is clear: we risk a major traffic accident here, which really could set back cancer care and treatment in this country. We raised this issue with Ministers outside this place prior to the reshuffle, and we raise it again with the Minister in this Chamber now. We urge the Government to think again. A lot of cancer patients are watching this space very closely.

Stereotactic Body Radiotherapy

Naomi Long Excerpts

Wednesday 8th February 2012 Commons Chamber

[Tessa Munt (Wells) (LD)]

I asked for this debate because for nearly 12 months I have been questioning the Department of Health about why the latest radiotherapy techniques and equipment to treat cancer patients are not being used by our NHS. I have pressed hard on this subject because, like Cancer Care UK and many other respected organisations, I believe radiotherapy is underused in the front line for curing cancer.

This country has a history and a habit of resorting to pumping cancer patients full of pharmaceuticals. Do not get me wrong, I am not knocking cancer drugs—many are highly effective and a great help to patients, and many cancer patients are alive today thanks to them. However, a lot of those drugs also have some pretty horrific side effects, and patients are often reluctant to take them for that reason. So in reality, throughout the latter part of the last century, heavy doses of drugs or death were almost the only choices that cancer patients had.

Although there has been plentiful use of drugs throughout the last 60 years, the uptake of radiotherapy as a front-line treatment has been slow. Radiologists have told me that one reason for that is they have not been as successful at lobbying as the pharmaceutical companies, but that is a matter for another debate. The main reason why there was resistance to using radiotherapy in the past was its method of delivery—single large beams of radiation being fired into the body to ensure that the tumour at which they were aimed was radiated. Unfortunately, those large beams also radiated an awful lot of healthy tissue around a tumour, especially if the tumour was moving, and frequently caused more damage than good. Patients often complained that the side effects of radiotherapy were worse than the cancer.

During this century, there have been huge advances in the delivery and accuracy of radiotherapy treatment. Around the world, radiosurgery is being used increasingly to cure cancer as a front-line treatment. Stereotactic body radiotherapy treatment, or SBRT, uses multiple very fine beams of radiation locked directly on to just the tumour. With some new technologies the beams move as the tumour moves, ensuring that the surrounding healthy tissue is not harmed and only the tumour is radiated.

Unfortunately, in the UK we are failing to embrace the new technologies that allow for the effective use of SBRT to treat cancer patients. We are falling behind both Europe and the US. On 22 November last year, I asked the Secretary of State for Health in the Chamber how many radiotherapy centres in this country were providing SBRT to cancer patients. When he told me the figure was 25%, I must admit to having been surprised—not as surprised, I would add, as some of the medical professionals I know, who found the figure unbelievable, but that was what he said.

Within a few days, the cancer tsar repeated that same figure in a letter to The Times. Thus, 25% suddenly became received wisdom for the standard of provision of SBRT in England. I therefore asked the Secretary of State in a written question on what evidence he had based his statement. “Not really sure,” was the reply. The evidence was based on an “informal study” conducted by the National Cancer Action Team. NCAT also said it believed there were more than 20 machines in the country that could deliver SBRT.

I am not a fan of Government policy making based on “informal studies” and vague beliefs, so I conducted my own, very formal study on the availability of SBRT in the UK. Under the terms of the Freedom of Information Act, I wrote to every hospital in the country that provides radiotherapy and asked each a series of questions about its ability to deliver SBRT. I am pleased to say that 57 replied—all but the Royal Shrewsbury hospital—and very helpful they were too.

For the record, I shall share the data with the Minister, so he can pass them on to the Secretary of State. In 2011, only seven centres in England and one in Scotland treated cancer patients with SBRT. There were no centres in Wales or Northern Ireland. Only four of the centres conducted a large enough number of procedures to comply with national radiotherapy implementation group recommendations. Therefore, 14% offer SBRT and just 8% are compliant. The total number of patients treated in those centres was just 323. That figure is not surprising when we consider that, according to the hospitals, there are only seven machines in the country capable of delivering SBRT—a good deal fewer than the number NCAT believes there are.

The Minister will not be surprised that my questioning did not stop there. I had also asked what indications the centres treated with SBRT. The data became even more interesting. Those centres using the Elekta or Varian systems treated only lung cancer. Centres using the CyberKnife system treated lung cancer, but they also treated liver, prostate, spine, breast, myeloma, sarcoma, head and neck, and ovarian cancers.

I asked the centres what their estimates for SBRT treatment in 2012 were. Again, they were very helpful in providing that information, and I place on record my gratitude to them for it. The centres estimate that approximately 725 procedures will take place in hospitals planning SBRT programmes for this year: 48 using the Varian system; 195 using the Elekta system; and 385 using CyberKnife system. The remaining 97 procedures were claimed as “estimates” by centres that have not conducted any SBRT in the past, and which do not appear—from their responses—to have suitable equipment for conducting such procedures.

I must admit that I found that last statistic, and the fact that only four centres conducted the number of procedures necessary to comply with the NRIG recommendations, very alarming. I, for one, would not wish to be treated at a centre where the team carries out only half a dozen procedures each year. How can it possibly have any expertise in such a complex treatment process if the staff so rarely conduct the procedure? For the Minister to allow that to continue would be contrary to the aims of the new Health and Social Care Bill and all that the Secretary of State has said about concentrating resources in centres of excellence to improve patient outcomes.

A number of other things alarmed me when I read the returns from the centres. On numerous occasions, the Minister has assured me that work is in hand by NCAT to establish a national tariff, or price tag, for SBRT, and yet, while the centres tell me they would welcome a national tariff, they also tell me that no progress is being made towards it. In fact, the vast majority have not even been consulted about establishing one. One of the most well known and respected centres has gone further, and said that

“a national radiotherapy tariff without SBRT would be seriously flawed and its fitness for purpose questionable.”

Will the Minister comment on that?

[Naomi Long (Belfast East) (Alliance)]

The hon. Lady is aware of a case involving Brian Withers, my constituent. He has been able to access the treatment, but has had to self-fund to do so. One reason it was not included in his clinical pathway was that it was argued that there was no clinical trial evidence for it in his situation. Does she agree that part of the problem is that SBRT is treated as a novel treatment for cancer as opposed to the development of an existing one? Therefore, without the tariff, people from other regions will not be able to access it on a routine basis.

[Tessa Munt]

I could not agree more. As the hon. Lady and others are well aware, I have spoken with her constituent, Mr Withers, and it is clear that radiosurgery is a well-established and proven therapy—it is just that we have to wait to get it.

In an answer to a parliamentary question, I was told that a price tag would not be set up until 2014. NCAT must be the only organisation in the NHS that believes it should take three years from the point that an esteemed committee recommends a national tariff until one can be implemented. From what they tell me, the centres do not believe it, and I do not believe it, and I do not think that the Minister believes it. The question of establishing an SBRT tariff, as recommended in the report from NRIG last April, is not just a question of the administration involved in setting up some codes so that the NHS can cost it; this lack of tariff has a direct impact on cancer patients’ lives.

Let me tell the Minister about my friend Kerry Dunn, a 42-year-old mother from Somerset who was diagnosed with cancer. Last September, her clinicians in Bristol concluded that the only treatment available that could save her life was SBRT on CyberKnife. The CyberKnife experts in London agreed. Her clinicians applied for funding from North Somerset primary care trust, but it took them two months before it refused. It said no because, according to it, there was not enough evidence to suggest that CyberKnife would work.

It is important that the Minister fully understands the train of events in this case. Kerry Dunn’s clinician in Bristol, one of the leading oncologists in the country, believed that CyberKnife could treat her, and the clinicians in London, who routinely use CyberKnife to treat cancer, said that they could treat her, but the bean-counters on North Somerset PCT thought otherwise. Kerry Dunn told me what had happened at the beginning of December. She and her family were in absolute despair over this decision. Once I had contacted North Somerset PCT and after the local press had, separately, taken an interest in her case, the PCT allowed Kerry Dunn to appeal its decision. Three weeks after the first decision, the PCT changed its mind and agreed her funding for CyberKnife.

If Members were expecting a happy ending to this story, I am sorry to disappoint them. Kerry went straight back to the CyberKnife people in London, but her tumour had grown so much that they could no longer treat her. Kerry and her family now face an uncertain future. Three months earlier, there was considerable hope that she would beat her cancer.

The Minister will know as well as I do that if the NRIG report had been implemented last April and an SBRT tariff set at that time, North Somerset PCT would not have delayed approval for Kerry’s treatment and she would be a much healthier woman than she is today. Over the past 12 months, the Department of Health has painted a very different picture of the provision of SBRT in the NHS. I must say to the Minister that I am shocked by the disparities between what the Secretary of State has told me and what all the hospitals have told me in answer to my freedom of information requests. Knowing the Minister as well as I do, I trust that it has more to do with his officials keeping him in the dark than their misleading hon. Members.

In conclusion, I would like some answers from the Minister today. Will he instruct the National Cancer Action Team to conduct a full review of the SBRT facilities available in the NHS? That review should establish whether hospitals are using technology that is fit for purpose and can treat a wide range of tumours with SBRT, and whether hospitals are conducting the number of procedures needed to comply with the NRIG recommendations. Will he commit to speeding up the process of establishing an SBRT tariff in line with the NRIG recommendations, and will he start immediately by asking NCAT to establish a costing code? Finally, I would like a commitment from him to investigate why decisions to fund SBRT by PCTs can ignore clinical opinions of medical professionals when assessing the need for treatment for people such as Kerry Dunn.

HIV

Naomi Long Excerpts

Tuesday 29th November 2011 Westminster Hall

[Pamela Nash]

The all-party group has consistently campaigned for the Government to put more funding into another national 1980s-style campaign. I hope that today’s debate and the events taking place throughout the week will get the message across to the Government that it is necessary to have that style of campaign again.

An increasing proportion of adults—about 10% at the moment—incorrectly believe that HIV can be transmitted through impossible routes, such as kissing and spitting. That is not helped by scaremongering media reporting. There was recently a report in Edinburgh about a couple who, when being arrested by the police, had bitten a police officer. Both members of the couple were HIV-positive, and that was the primary headline in the Scottish media, much to my disappointment. Misinformation fuels stigma and discrimination, which are still a daily reality for many people living with HIV.

[Naomi Long (Belfast East) (Alliance)]

The hon. Lady has rightly referred to the importance of people being tested, but she has also referred to stigma. Does she agree that unless we overcome the stigma surrounding simply having been tested for HIV and for AIDS and not having the disease—the stigma that still exists in society about going for those tests—that will decrease the number of people who come forward to submit themselves for testing and take care of their health as they should?

[Pamela Nash]

Yes, that is a crucial point. I hope that any future public campaign would incorporate looking at the stigma about the virus. Unfortunately, in the meantime, it persists. That is why I would also push for the home testing kits to become available, but that is not the ultimate solution.

In a recent study in east London, one in three people living with HIV said that they had been victims of discrimination, but most alarmingly the study showed that half of all that discrimination was in the health care system. The Department of Health must take a lead on tackling stigma and develop training resources for its staff that are aimed at stopping such discrimination. Those resources must be used by all current and new NHS and professional bodies.