Earlier Cancer Diagnosis: NHS Finances

Paul Beresford Excerpts

Tuesday 18th October 2016 Westminster Hall

[Mr Baron]

We certainly have to be inclusive with regards to how we look at treatment generally. As my hon. Friend knows, the all-party group and, indeed, the wider cancer community are looking at such things. He comes to our meetings, and we listen carefully. Questions certainly need to be answered on that front, so he is pushing at an open door. We have an open mind, and we are listening.

Together with the wider cancer community—at the end of the day it has been a team approach—we have been successful in ensuring that CCGs are now held accountable. The one-year survival rates have been included in the delivery dashboard of the assurance framework, and that is very good news. Figures have only been published for the past one or two years, so we are still seeing what is happening with regards to improvements and how CCGs are performing, but at least we have made a start and there is an element of accountability.

[Sir Paul Beresford (Mole Valley) (Con)]

I must of course declare that I am a dentist and so have considerable professional interest in the subject, although it is rare that I am in the surgery. I am also chair of the all-party group on skin, and one might think that diagnosing skin cancer is fairly obvious, in particular given that skin problems are a major concern of GPs. However, one of the things we soon discovered was that undergraduate tuition time on skin conditions is extremely short—often a week or two weeks, which are frequently used by undergraduates, as I understand it, as an opportunity to go away, rather than to attend. If the education of GPs and doctors was better and reinforced by continuing professional development, we might get better results on skin cancer.

[Mr Baron]

I thank my hon. Friend for that intervention.

We have been successful in getting the one-year figures into the DNA of the NHS, but there is no point having the tools in the toolkit if we do not use them, and one thing we are looking carefully at is the lines of accountability. We acknowledge that we are pushing at an open door—the Government have kindly accepted the need for the one-year figures—but there is still a very long way to travel. The latest Ofsted-style ratings have maintained the focus on survival rates, and yet those ratings still found that eight out of 10 CCGs must improve. That shows the scale of the challenge and the extent to which we need to raise our game.

--- Later in debate ---

[The Parliamentary Under-Secretary of State for Health (David Mowat)]

It is a pleasure to serve under your chairmanship, Mr Nuttall, in my second Westminster Hall debate since I became a Minister. I start by congratulating my hon. Friend the Member for Basildon and Billericay (Mr Baron) on securing this debate and raising the valid points that he did and on his stewardship of the APPG on cancer, which is highly effective and has provided a large part of the briefings that I have received since becoming a Minister. I very much hope that he will carry on that work, and I am sure that he will.

My hon. Friend mentioned several times the phrase “pushing at an open door,” and I reassure him that the door is open. We have discussed this issue twice in fairly formal circumstances, and I am keen to take him up on his offer of meeting him and colleagues to discuss it further and make progress over and above what we can do in Westminster Hall debates and oral questions. I also look forward to speaking at the event in December.

I will talk, as Ministers do, about the progress that we are making in this area across England, but my hon. Friend reminded us that we are not best in class or among the best in Europe, and he is absolutely right. He gave us the statistics for Sweden, where the one-year survival rate is 82% versus our 71%. That is a target; it is where we need to get to. As we have made progress, we have got to where the best in Europe were several years ago. We need to keep progressing in that respect.

My hon. Friend rightly talked about CCG accountability, and I will talk a little about that. I want to emphasise the power of what was done last month, when we published the four indicators for every CCG in the country. That is a massive commitment to transparency. We were quite open that many CCGs needed to improve. My hon. Friend mentioned the figure of, I think, 80%, which we agree with. It is worth analysing the data and spending a bit of time looking at that, because small differences in percentages against the indicators, one of which is one-year survival, make a big difference to how a CCG is perceived. Accountability comes from transparency, and we have made big steps in that regard, last month in particular.

I want to thank the Members who intervened in the debate. As ever, my hon. Friend the Member for Bosworth (David Tredinnick) reminded us of the role that complementary remedies can play as part of an overall solution. There is no impediment to that in the NHS—CCGs can commission what they wish to commission. He mentioned the Barts study. My view is that it needs to be clear that commissioning is science driven, repeatable and all that goes with that, but there is no impediment if CCGs wish to commission complementary therapies.

My hon. Friend the Member for Mole Valley (Sir Paul Beresford), in his capacity as chair of the all-party group on skin, told us how weak some of the training in that area may be at undergraduate level. I was not aware of that, so I will take it up and come back to him. It does not sound acceptable if the skin cancer diagnosis part of the syllabus is the bit that people leave.

[Sir Paul Beresford]

If I could emphasise that a little more, we have a distinct shortage of consultant dermatologists. They are backed up by GPs with a special interest, but a large number of referrals to dermatologists are made due to fear on the part of both the patient and the doctor that they will miss a melanoma or a squamous cell carcinoma when the doctor should be able to diagnose them. Many are dealt with in the early stage with cryosurgery, which is a very effective, quick treatment that I know, having been on the wrong end of it quite often, can be undertaken by a GP who has had the right education.

[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.