Cancer Targets

Nic Dakin Excerpts

Tuesday 1st May 2018 Westminster Hall

[Nic Dakin (Scunthorpe) (Lab)]

It is a real pleasure to serve under your chairmanship, Mr Streeter. I congratulate the hon. Member for Basildon and Billericay (Mr Baron) on securing this debate. It is a good opportunity for us in this House to recognise the excellent work and service that he has given in leading the all-party group over nine years. I am pleased that he is still in post. I suspect he will continue to serve the cancer community for ever, so we are grateful for that. I pay tribute to the courageous personal testament of my hon. Friend the Member for Lincoln (Karen Lee) and her role as a breast cancer champion, particularly in highlighting the need to do better on secondary breast cancer, which everybody wants us to deal with much better.

For all but one month since April 2014, the 62-day target for patients to have received their first treatment since initial referral has been missed, and 81 trusts failed to meet the 85% target last year. When we do not meet targets, we let patients down in one way or another. As has been said, the target is not perfect. It does, however, set our sights on what we are trying to achieve: securing treatments, reducing waiting lists and improving outcomes. The target is important because it helps to measure the patient pathway. It gives us a better understanding of what patients are going through and offers the opportunity to prevent unnecessarily long waits.

Waiting can be a very anxious time. While treatment is on hold, life carries on. Bills still need to be paid, the kids still need picking up from school and jobs still need to be done. Life does not stop, and cancer does not stop, so it is important that we have the 62-day target. It performs a function, but it is not everything. As the hon. Member for Basildon and Billericay has said, we need to move to outcome measures such as the one-year survival rate, or indeed the five-year survival rate. He spoke most eloquently about how that has the potential to change behaviours in a positive way. However, unless we have targets, we do not know how they impact on behaviours; they are always imperfect, but they are useful measures.

As the all-party group’s December report said, we need to break the link between the 62-day performance target and access to transformation funds. As the exchange between my hon. Friend the Member for Lincoln and the hon. Member for Basildon and Billericay demonstrates, unfortunately that can have iniquitous consequences and the areas that most need support get least support. Of course, the support needs to go where it can be most effective. I think we all have confidence in the Minister. Like many other people who work to help tackle cancer up and down the land and for whom we can have only the greatest admiration, he is fighting every day to try to make things better for cancer patients, cancer survivors and their families.

As the hon. Member for Basildon and Billericay has said, early diagnosis is the key. It is the magic wand, the holy grail, the silver button, but if it was easy to achieve it would have been achieved by now. Rarer cancers make up more than 50% of cancer cases, so we need to provide transformation funding for cancer alliances so that it can help drive early diagnosis and achieve NHS targets. It is crucial that the less survivable cancers benefit from allocation of transformation funding. The funding must continue to be used to tackle hard-to-treat cancers such as pancreatic cancer. I speak as chair of the all-party group on pancreatic cancer. It has the lowest survival rates of the 20 most common cancers. Its one-year survival rate is sadly still 24%, far behind the 75% one-year survival target set in the cancer strategy. So there is still a long way to go and we know that it is a massive challenge. Things are moving in the right direction, and we are right to be impatient, but we need to use our impatience to help us to work with the Government to bring about the positive changes we all want.

As an example of what is being done to tackle pancreatic cancer, and the need to get the transformation funding in the right place, Mr Keith Roberts and his team in Birmingham have created a faster pathway to surgery for pancreatic cancer patients by redesigning services. With the fast-track pathway, a patient receives surgery for a tumour quickly, avoiding the need for a separate procedure for jaundice. A patient not on the fast-track pathway would have a procedure for jaundice followed by a separate surgery, which could take two months on average. Going straight to resection cuts out the delay. At present, surgery is the only treatment that can save lives, yet fewer than one in 10 people with pancreatic cancer have access to it. The pathway is achieved in part through the use of a dedicated clinical nurse specialist, who is appointed to support and prepare patients to receive surgery within 16 days of referral. The results of the fast-track surgery pathway have been quite compelling. It has increased the number of patients whose surgery was successful by 22%, and patients received surgery within 16 days as opposed to two months from referral. It has saved the NHS an average of £3,200 per patient, and we would expect those savings to have reached £100,000 within a year.

The initial fast-track findings were so successful that the NICE guidelines on pancreatic cancer, which were published in February, now recommend the fast-track pathway, unless the person is taking part in a clinical trial requiring other treatment. However, despite all those benefits, the savings to the NHS and the fact that the pathway is recommended by NICE, Mr. Roberts’ team is still struggling to secure funding for a full-time clinical nurse specialist, which means it has one fewer than a year ago. That does not make logical sense, but sometimes in the real world things that make no logical sense happen because of the other pressures on people. The fast-track pathway and its patients are being challenged. That situation is a good example of the need to get transformation funding to the right places, and is probably one of many around the country. It is not because people do not want them that the things in question do not happen; it is because the system does not work as everyone wants it to. One of our jobs is to use our voice here to help to unlock the barriers, so that the things we want can happen, and so that patients are seen faster and have the transformational treatments that are needed.

The all-party parliamentary group on cancer has called on the NHS to ensure that the cancer alliances are given the necessary transformation funding and support, and it is crucial that the NHS delivers that. Cancer alliances everywhere need to be able to use their funding to implement the NICE guidelines, including those on pancreatic cancer. Fast-track surgery is recommended for certain patients with jaundice. Yet it will not be available to most patients because the pathway is not in their area. We need to make sure that it is accessible. Cancer alliances must prioritise innovations for less survivable cancers and ensure that opportunities are provided, because, as the hon. Member for Basildon and Billericay reminded us, 50% of cancers are rarer ones that are more difficult to address.

I have one or two other points to make. The cancer dashboard has been helpful in driving improvements in cancer treatment. It might be worth looking at whether blood cancer could be included, as I think it would be of assistance. I very much support what the hon. Member for Basildon and Billericay, the chair of the all-party group, said about the HPV vaccine. It seems like an opportunity for prevention, which is always better than cure, particularly if it is reasonably cost-effective, as I believe that vaccine is. There are opportunities to raise awareness, such as the Be Clear on Cancer campaign on difficult abdominal pains, which was piloted in the west midlands. Such things help to increase patient and GP awareness, and the chance that people will go to their GP at the right time and get an assessment. That can drive them into early diagnosis, so that things can be moved forward. Such things, which I know the Minister is keen on, are opportunities that can help, and are to be applauded and encouraged.

It is estimated that by 2020 2.4 million people in England will have had a cancer diagnosis at some point in their lives. We cannot let them down. Our job is to do the best by them. We need to do the best with the 62-day target, but also to continue the debate on whether process targets take us where we need to be or whether we should look more carefully at outcome targets. We must use whatever means we can to improve early diagnosis, and do all we can to support patients from the day they receive the news no one wants to hear to the day they receive the all clear. If we achieve those things, not only will we improve the NHS but we will save hundreds of lives every day of the year.