Cancer Strategy

Debate between Nicholas Dakin and Fiona Mactaggart

Thursday 8th December 2016 Commons Chamber

[Nic Dakin (Scunthorpe) (Lab)]

I beg to move,

That this House has considered the Cancer Strategy one year on.

In moving this motion, which stands in my name and that of the hon. Member for Basildon and Billericay (Mr Baron), I wish to recognise all those in the cancer community for all their work, day in, day out, fighting this disease, and the huge number of Members of this House who, through a wide range of cancer-related all-party groups, carry out work in this very important area.

The hon. Member for Basildon and Billericay, who is chairman of the all-party group on cancer, is unable to be here today, but he wanted me to say how much he appreciates the Backbench Business Committee’s granting this debate. As Members may know, the hon. Gentleman’s wife is undergoing treatment, and I am sure that everyone in the House would want to send their best wishes to him and his family at this difficult time.

It is estimated that there are more than 2.4 million people living with cancer in the UK, and that number continues to grow. Cancer is becoming more complex, with many more treatments available. Many patients are living with co-morbidities and with the consequences of a cancer diagnosis many years after treatment has finished.

The all-party group on cancer has a proud record of successfully campaigning on a number of issues. Just two days ago, we held our annual Britain against Cancer conference in Central Hall—it is one of the largest cancer conferences in the UK. On behalf of the group, I wish to pass on thanks to all the contributors, including the Under-Secretary of State for Health, the hon. Member for Warrington South (David Mowat), and the shadow Secretary of State for Health, my hon. Friend the Member for Leicester South (Jonathan Ashworth), for their contributions. Delegates very much appreciated everybody’s input.

The last two years have seen significant developments in cancer policy. In July 2015, the independent cancer taskforce published the England cancer strategy. Since we last debated this issue in November last year, NHS England has published its England cancer strategy implementation plan, setting out how it will roll out the 96 recommendations.

More recently, we have seen the publication of the National Cancer Transformation Board’s progress report, outlining what steps NHS England has taken over the past year in implementing these recommendations across the country. Only last Friday, the Office for National Statistics published the latest one-year cancer survival rate figures for those patients diagnosed in 2014 and followed up to 2015. As NHS England chief executive Simon Stevens pointed out at the Britain against Cancer conference, that showed the dramatic improvement in patient outcomes that has been achieved over the past 20 years. That is something to be celebrated, but there is still much more to do.

The all-party group has been active in monitoring progress on the England cancer strategy, holding a short inquiry early in the year to assess progress. We concluded that positive progress is being made, but that there is still much more to do to realise the ambition of the England cancer strategy. Having taken evidence from a wide range of people, we made a number of recommendations, which I will use to highlight some of the key themes that emerged from the inquiry.

The first key recommendation focused on the need for greater clarity on funding for all the 96 recommendations of the England cancer strategy. It was positive, therefore, to see more detail in the National Cancer Transformation Board’s progress report, which set out the funding available per year for the next four years. I very much welcome the announcement by Simon Stevens at our Britain against Cancer conference that Cancer Alliances will be able to bid for £200 million of funding to invest in early diagnosis, care for people living with cancer, and cancer after treatment. That is very good news, and I look forward to getting further clarity on how the full funding package, set out in the progress report, will be allocated across the cancer strategy’s recommendations. This is particularly important given the lack of clarity around cancer funding to date. The estimates for the total amount spent on cancer care in the NHS per newly diagnosed patient have not been published beyond 2012-13, which has been described as a significant data gap when it comes to evaluating the cost and efficiency of cancer care. Will the Minister today commit to publish an update on those figures in the House of Commons Library at the earliest opportunity?

Alongside funding, another recommendation and concern that was raised by stakeholders in our inquiry was around the need for further transparency on how the cancer strategy is being delivered, what the priorities are, and who is responsible for delivering key recommendations. Again, the progress report from the National Cancer Transformation Board went some way to address that concern. However, further detail around how the strategy is being delivered, particularly the membership and terms of reference for the six oversight groups tasked with overseeing delivery, is vital to ensure that the wider cancer community is properly engaged.

We also heard from many organisations that were unclear on how the delivery of recommendations will be monitored at a local level.

[Fiona Mactaggart (Slough) (Lab)]

One of the things that shocked me in a debate on ovarian cancer was to find that there are parts of the country where CA125 is not routinely available to women who are suspected of having ovarian cancer. I have also had letters from a number of constituents who say that they are unable to get access to bisphosphonates, a drug that helps to prevent breast cancer. Did the all-party group come up with recommendations to try to ensure that wherever people live, they get the best possible cancer prevention and care? At present there clearly is not universal provision of these important diagnostic tests and drugs.

[Nic Dakin]

My right hon. Friend makes an important point about equal access across the country. We are all concerned about that and focused on it.

It is positive news that the 16 cancer alliances have been established and that NHS England will publish further guidance for alliances to help them develop their plans to deliver the cancer strategy locally, but if they are to monitor the delivery of the strategy, it is vital that they are given the right resource to do so effectively.

A particular issue which was raised in relation to both transparency and accountability was workforce. Most people, I believe, will agree with me when I say that our NHS workforce is under great strain. The cancer workforce is experiencing significant gaps in key areas, including radiography and clinical nurse specialists. For example, Anthony Nolan highlights the fact that access to post-transplant clinical nurse specialists is inconsistent across the country. At the same time, demand is growing, and cancer is becoming more complex, as patients often have multiple co-morbidities. Unless they are addressed, these workforce pressures will undoubtedly have a severe effect on cancer services.

Another area of growing need for cancer patients is access to timely and appropriate mental health support which, if achieved, can reduce pressures on other parts of the health service.

The all-party group welcomes the recommendation in the strategy that Health Education England would deliver a strategic review of the cancer workforce by March 2017, and we were grateful to Professor Ian Cumming for meeting us earlier this year. However, we have strong concerns about progress on this crucial piece of work. Although we are aware that a baseline report of the current cancer workforce has been produced, it has not been published, and there is currently little detail on how Health Education England is planning to conduct the strategic review. We are not aware of any plans from HEE to engage with the sector on the strategic review, and we continue to be concerned by the lack of transparency and involvement of the wider sector. We were pleased to see a reference to the strategic review of workforce in the Department of Health’s mandate to HEE. Will the Minister outline how he is holding HEE to account on that recommendation?

Diagnosing cancer earlier improves survival rates, and the all-party group believes that focusing on outcome indicators such as the one-year survival rate is crucial to driving progress in this area. The inclusion of the one-year cancer survival indicator in the clinical commissioning group improvement and assessment framework—formerly the delivery dashboard—is very much welcomed by the all-party group, which has long campaigned for that. Since then, the all-party group has continued to champion this cause, and earlier this year at our annual summer reception we were the first to congratulate and recognise clinical commissioning groups that had improved their one-year cancer survival figures.

So it was music to our ears to hear Simon Stevens at this week’s Britain against Cancer conference further commit NHS England to increasing its efforts on diagnosing cancer early. Last week the latest one-year cancer survival rates were published, and we were pleased to see an improvement, with the average one-year cancer survival rate in England standing at 70.4%. However, incremental improvements are not enough to match our neighbours in Europe and across the world, as our figures are below the standard set in countries such as Sweden, which has a one-year survival rate of 82%.

As chair of the all-party parliamentary group on pancreatic cancer, I am acutely aware of the difficulty of diagnosing some cancers early. My constituent Maggie Watts lost her husband to pancreatic cancer. Kevin’s mother had died from pancreatic cancer 40 years earlier. Difficulty in early diagnosis is one of the reasons why the outcomes for pancreatic cancer had not improved over those 40 years. Some 74% of patients across the UK cannot name a single symptom of pancreatic cancer, so there is a need for further cancer awareness campaigns to improve the outcomes for these “stuck” cancers, as well as further research into better diagnostic tools in these areas.

Be Clear on Cancer campaigns have been very effective but, as Bloodwise points out, we need further thought on how the NHS can work closely with cancer charities and patient organisations to increase awareness of cancers with non-specific symptoms, such as blood cancers.

I recently met representatives of the Roy Castle Lung Cancer Foundation, who were clear that early diagnosis of lung cancer dramatically improves patient outcomes for this, the biggest cancer killer. In some countries, screening for lung cancer is being introduced, with positive outcomes. Should we actively consider that here?

It is worth pausing to recognise the excellent work that public health campaigns have played in fighting cancer. Since the smoking ban was introduced nearly 10 years ago, the number of adult smokers in the UK has dropped by 1 million. Smoking cessation is still the most effective cancer preventive strategy, and all of us need to ensure that, when local government budgets are under pressure, that does not lead to reductions in public health budgets for short-term fiscal gain, with long-term negative health consequences and associated costs. As Cancer Research has made clear, the Government must publish the tobacco control strategy without delay.

The final recommendation I want to highlight from our inquiry is on a similar theme: the involvement of patients and organisations in the cancer community in the implementation of the cancer strategy across England. This recommendation has been supported by other groups, such as the Cancer Campaigning Group, which noted in its recent report that the National Cancer Transformation Board and the Independent National Cancer Advisory Group should collaborate with organisations with an expertise in cancer and involve patients in delivery.

The issue is particularly pertinent to people with rarer or less common cancers, many of which are childhood and teenage cancers. The all-party group was concerned when the cancer transformation board’s implementation plan did not highlight rarer cancers specifically. Rarer cancers—particularly those with vague symptoms—tend to be diagnosed later than most common cancers, with many diagnosed through emergency presentation. That not only impacts on survival but leads to poor patient experience. In addition, many patients with rarer cancers, and particularly those with blood cancers, can live with their conditions for many years, and it is vital that provision to support people living with and beyond cancer, such as the Recovery Package, consider the needs of these patients. While many of the recommendations in the cancer strategy will go some way to address that issue, it is vital that NHS England retain a strong focus on this group. What discussions has the Minister had with NHS England about how it is ensuring that organisations across the cancer community are involved in the delivery of the cancer strategy?

Currently, cancer medicines, including those for rare cancers, are appraised by the National Institute for Health and Care Excellence on a timetable designed to ensure that a recommendation can be issued at the time of licence. However, there is growing recognition in the cancer community that current NICE methodology and process are not suitable for assessing treatments for rarer cancers, and that the one-size-fits-all model adopted by NICE could result in patients with rarer cancers losing out on access to treatments that patients in other developed countries are able to access.

There is an ongoing joint consultation by NICE and NHS England, which incorporates changes to highly specialised technology appraisal thresholds, introduces an affordability assessment and creates a fast-track route for highly cost-effective drugs. However, the consultation does not address or acknowledge any specific recommendations for the assessment of treatments for rarer cancers. Concern has been raised by the cancer community that this makes these available treatments vulnerable to always falling through the net. What is the plan to ensure that the NICE process and methodology applied to rarer cancers incorporate the limited patient numbers and data collection, rather than applying the same process irrespective of the rarity of the cancer? What additional flexibility will be applied to NICE criteria when assessing rare cancers, to account for inevitable uncertainties in clinical data?

In summary, it is important to recognise the progress that is being made in implementing the cancer strategy one year on, but there is much more to do. Together, properly supported by Government, those in the cancer community are willing and eager to deliver the better outcomes that would mean we were not just closing the gap on better-performing nations but beginning to lead the way.